Established cardiovascular disease and CVD risk factors in a primary care population of middle-aged Irish men and women

Contemporary Irish data on the prevalence of major cardiovascular disease (CVD) risk factors are sparse. The primary aims of this study were (1) to estimate the prevalence of major cardiovascular disease risk factors, including Type 2 Diabetes Mellitus, in the general population of men and women between the ages of 50 and 69 years; and (2) to estimate the proportion of individuals in this age group at high absolute risk of cardiovascular disease events on the basis of pre-existing cardiovascular disease or as defined by the Framingham equation. Participants were drawn from the practice lists of 17 general practices in Cork and Kerry using stratified random sampling. A total of 1018 people attended for screening (490 men, 48%) from 1473 who were invited, a response rate of 69.1%. Cardiovascular disease risk factors and glucose intolerance are common in the population of men and women aged between 50 and 69 years. Almost half the participants were overweight and a further quarter met current international criteria for obesity, one of the highest recorded prevalence rates for obesity in a European population sample. Forty per cent of the population reported minimal levels of physical activity and 19% were current cigarette smokers. Approximately half the sample had blood pressure readings consistent with international criteria for the diagnosis of hypertension, but only 38% of these individuals were known to be hypertensive. Eighty per cent of the population sample had a cholesterol concentration in excess of 5 mmol/l. Almost 4% of the population had Type 2 Diabetes Mellitus, of whom 30% were previously undiagnosed. A total of 137 participants (13.5%) had a history or ECG findings consistent with established cardiovascular disease. Of the remaining 881 individuals in the primary prevention population, a total of 20 high-risk individuals (19 male) had a risk of a coronary heart disease event 30% over ten years according to the Framingham risk equation, giving an overall population prevalence of 2.0% (95% CI 1.3 - 3.0). At a risk level 20% over ten years, an additional 91 individuals (8.9%) were identified. Thus a total of 24.4% of the population were at risk either through pre-existing CVD (13.5%) or an estimated 10-year risk exceeding 20% according to the Framingham risk equation (10.9%). Thus a substantial proportion of middle-aged men are at high risk of CVD. The findings emphasise the scale of the CVD epidemic in Ireland and the need for ongoing monitoring of risk factors at the population level and the need to develop preventive strategies at both the clinical and societal level.

Alterations in cardiac adrenergic signaling and calcium cycling differentially affect the progression of cardiomyopathy.

The medical treatment of chronic heart failure has undergone a dramatic transition in the past decade. Short-term approaches for altering hemodynamics have given way to long-term, reparative strategies, including beta-adrenergic receptor (betaAR) blockade. This was once viewed as counterintuitive, because acute administration causes myocardial depression. Cardiac myocytes from failing hearts show changes in betaAR signaling and excitation-contraction coupling that can impair cardiac contractility, but the role of these abnormalities in the progression of heart failure is controversial. We therefore tested the impact of different manipulations that increase contractility on the progression of cardiac dysfunction in a mouse model of hypertrophic cardiomyopathy. High-level overexpression of the beta(2)AR caused rapidly progressive cardiac failure in this model. In contrast, phospholamban ablation prevented systolic dysfunction and exercise intolerance, but not hypertrophy, in hypertrophic cardiomyopathy mice. Cardiac expression of a peptide inhibitor of the betaAR kinase 1 not only prevented systolic dysfunction and exercise intolerance but also decreased cardiac remodeling and hypertrophic gene expression. These three manipulations of cardiac contractility had distinct effects on disease progression, suggesting that selective modulation of particular aspects of betaAR signaling or excitation-contraction coupling can provide therapeutic benefit.

The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations.

The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in fruits, vegetables, low-fat dairy products with reduced total and saturated fat, cholesterol, and sugar-sweetened products effectively lowers blood pressure in individuals with prehypertension and stage I hypertension. Limited evidence is available on the safety and efficacy of the DASH eating pattern in special patient populations that were excluded from the trial. Caution should be exercised before initiating the DASH diet in patients with chronic kidney disease, chronic liver disease, and those who are prescribed renin-angiotensin-aldosterone system antagonist, but these conditions are not strict contraindications to DASH. Modifications to the DASH diet may be necessary to facilitate its use in patients with chronic heart failure, uncontrolled diabetes mellitus type II, lactose intolerance, and celiac disease. In general, the DASH diet can be adopted by most patient populations and initiated simultaneously with medication therapy and other lifestyle interventions.

Assessment of the potential impacts of coasteering on rocky intertidal habitats in Wales

The relatively new recreational pursuit of coasteering, which has developed in the St David's area of Pembrokeshire, appears to be expanding rapidly. The majority of local commercial recreation providers (outdoor pursuit centers etc.) now appear to offer this pursuit. The majority of the rocky coastlines where it takes place lie within Pembrokeshire Marine Special Area of Conservation (SAC), and are also Sites of Special Scientific Interest (SSSI). No assessment has yet been undertaken of coasteering's potential impact on the intertidal habitats. Therefore the Countryside Council for Wales (CCW) commissioned the Marine Life Information Network (MarLIN) to undertake a desk study of the likely environmental effects of coasteering on rocky intertidal habitats within the Pembrokeshire marine SAC. The desk study was based on a review of the available literature, and in particular the effects of trampling on rocky intertidal communities. Communities (as biotopes) within the Pembrokeshire marine SAC likely to be exposed to coasteering activities were identified from Phase I biotope data for the area, provided by CCW. Where possible, existing research by MarLIN into the intolerance, recoverability and sensitivity of the biotopes identified, was used to identify their potential vulnerability to trampling. The literature review revealed that: - foliose canopy forming algae (e.g. fucoids) were particularly intolerant and sensitive to trampling impacts; - trampling damaged erect coralline turfs, barnacles, and resulted in an increase in bare space; in some cases paths across the shore were visible; - on brown algae dominated shores, understorey algae could suffer due to increased desiccation but algal turf species, opportunists and gastropod grazers (e.g. limpets) could increase in abundance as an indirect effect of trampling, and that - trampling impacts resulted from physical contact and wear and were dependant on the intensity, duration, and frequency of trampling, and even the type of footwear used. A total of 19 intolerant rocky intertidal biotopes were identified as potentially vulnerable to trampling and hence coasteering within the Pembrokeshire marine SAC, of which six are of Welsh importance and eight are nationally rare or scarce. Trampling is a highly localized impact and it was not possible to identify biotopes, and hence communities, actually impacted by coasteering activities in the Pembrokeshire marine SAC. In addition, the majority of the literature addresses the impacts of trampling on wave sheltered or moderately exposed brown algal dominated shores, while coasteering occurs on more wave exposed, steeply inclined shores. Therefore, direct survey of the routes used by coasteering groups within the Pembrokeshire marine SAC is required to identify the intensity, duration and frequency of trampling impact, together with the communities impacted. Given the paucity of data concerning trampling effects in the rocky intertidal in the UK, a survey of the impacts of coasteering would provide an opportunity to examine the effects of trampling and visitor use in steep rocky, wave exposed shores. The report recognizes the potential to engage coasteerers in contributing to the development of strategies for minimizing adverse impacts, recording impacts and collecting information of use in identifying climate change and the occurrence of non-native species.

A method to assess the sensitivity of sedimentary communities to fishing activities.

1.Methods of sensitivity assessment to identify species and habitats in need of management or protection have been available since the 1970s. 2.The approach to sensitivity assessment adopted by the Marine Life Information Network (MarLIN) assumes that the sensitivity of a community or biotope is dependent on the species within it. However, the application of this approach to sedimentary communities, especially offshore, is complex because of a lack of knowledge of the structural or functional role of many sedimentary species. 3.This paper describes a method to assess the overall sensitivity of sedimentary communities, based on the intolerance and recoverability of component species to physical disturbance. A range of methods were applied to identify the best combinations of abundant, dominant or high biomass species for the assessment of sensitivity in the sedimentary communities examined. 4.Results showed that reporting the most frequent species' sensitivity assessment, irrespective of the four methods used to select species, consistently underestimated the total sensitivity of the community. In contrast, reporting the most sensitive assessment from those species selected resulted in a range of biotope sensitivities from very low to very high, that was better able to discriminate between the sensitivities of the communities examined. 5.The assumptions behind the methodology, its limitations and potential application are discussed.

Chemical ablation of gastric inhibitory polypeptide receptor action by daily (Pro3) GIP administration improves glucose tolerance and ameliorates insulin resistance and abnormalities of islet structure in obesity-diabetes.

Glucose-dependent insulinotropic polypeptide (gastric inhibitory polypeptide [GIP]) is an important incretin hormone secreted by endocrine K-cells in response to nutrient ingestion. In this study, we investigated the effects of chemical ablation of GIP receptor (GIP-R) action on aspects of obesity-related diabetes using a stable and specific GIP-R antagonist, (Pro3)GIP. Young adult ob/ob mice received once-daily intraperitoneal injections of saline vehicle or (Pro3)GIP over an 11-day period. Nonfasting plasma glucose levels and the overall glycemic excursion (area under the curve) to a glucose load were significantly reduced (1.6-fold; P <0.05) in (Pro3)GIP-treated mice compared with controls. GIP-R ablation also significantly lowered overall plasma glucose (1.4-fold; P <0.05) and insulin (1.5-fold; P <0.05) responses to feeding. These changes were associated with significantly enhanced (1.6-fold; P <0.05) insulin sensitivity in the (Pro3)GIP-treated group. Daily injection of (Pro3)GIP reduced pancreatic insulin content (1.3-fold; P <0.05) and partially corrected the obesity-related islet hypertrophy and ß-cell hyperplasia of ob/ob mice. These comprehensive beneficial effects of (Pro3)GIP were reversed 9 days after cessation of treatment and were independent of food intake and body weight, which were unchanged. These studies highlight a role for GIP in obesity-related glucose intolerance and emphasize the potential of specific GIP-R antagonists as a new class of drugs for the alleviation of insulin resistance and treatment of type 2 diabetes.

Beneficial effects of sub-chronic activation of glucagon-like peptide-1 (GLP-1) receptors on deterioration of glucose homeostasis and insulin secretion in aging mice

Aging is associated with an increased incidence of glucose intolerance and type 2 diabetes. Glucagon-like peptide-1 (GLP-1) is an important insulinotropic peptide secreted from the gastrointestinal tract in response to nutrient absorption. The present study was designed to assess the sub-chronic glucose regulatory effects of the potent long-acting GLP-1 receptor agonist, (Val(8))GLP-1, in aging 45-49 week old mice. Daily injection of (Val$)GLP-1 (25 nmol/kg body weight) for 12 days had no significant effect on food intake, body weight, non-fasting plasma glucose and insulin concentrations. However, after 12 days, the glycaemic response to intraperitoneal glucose was improved (P <0.05) in (Val(8))GLP-1 treated mice. In keeping with this, glucose-mediated insulin secretion was enhanced (P <0.05) and insulin sensitivity improved (P <0.05) compared to controls. These data indicate that sub-chronic activation of the GLP-1 receptor by daily treatment with (Val(8))GLP-1 counters aspects of the age-related impairment of pancreatic beta-cell function and insulin sensitivity. 2006 Elsevier Inc. All rights reserved.

Reflexiones y representaciones del exilio: de El canto del peregrino (1999) a "El sefardí romántico" (2005)

El exilio es un tema recurrente en la obra de Angelina Muñiz-Huberman, miembro del llamado grupo hispanomexicano. La visión del exilio en su obra incluye no solo el exilio republicano sino también el del pueblo judío. Por eso, diferentes Diásporas históricas se superponen enriqueciendo el significado de la experiencia. En su ensayo El canto del peregrino: hacia una poética del exilio (1999) desarrolla sus pensamientos sobre el exilio y analiza numerosos trabajos de autores exiliados (judíos y republicanos españoles) centrándose en como cada uno reflejó la vivencia del exilio en su trabajo.En mi opinión, las ideas desarrolladas en el ensayo se pueden encontrar en su novela El sefardí romántico: la azarosa vida de Mateo Alemán II (2005). El título de la novela establece una conexión directa con la novela picaresca y la vida judía aludiendo al autor converso de Guzmán de Alfarache (1599-1604). Siguiendo el patrón establecido por la novela picaresca clásica, el protagonista de Muñiz-Huberman viaja por España y Europa denunciando la intolerancia que llevó a la Guerra Civil española y a la II Guerra Mundial. Las circunstancias lo llevan al exilio en México, como en el caso de Mateo Alemán. Según la teoría de Ulrich Wicks, pícaros y exiliados tienen mucho en común en su búsqueda continua de libertad, libertad que el exiliado puede encontrar solo en el idioma, como expone Muñiz-Huberman en su ensayo.

Quality of food consumed by over wintering pale-bellied Brent geese Branta bernicla hrota and wigeon Anas penelope

The seasonal selection of food by pale-bellied Brent geese and wigeon on Strangford Lough was analysed with respect to nutritive quality. Both species selected food plants to maximise nutrition. In wigeon, food selection may also have been affected by the intolerance of this species to disturbance, forcing many individuals to feed in secondary habitats. Minerals do not seem to affect food selection, with most plant species in the diet providing a sufficiently balanced complement of nutrients. It is concluded that interspecific differences in food selection and reaction to human disturbance may have contributed to the decline in numbers of wigeon in Strangford Lough while numbers of Brent geese have been maintained. Some implications are discussed and recommendations for management are proposed.

Successful colonoscopy; completion rates and reasons for incompletion

Factors such as poor bowel preparation or obstructing colonic disease may confound the reporting of colonoscopy completion rates, as these factors are outside of the control of the endoscopist performing the procedure. By adjusting for these factors when calculating a colonoscopy completion rate, it may be possible to make a more accurate assessment of a unit's or individuals' competence. Details of two thousand two hundred and sixteen colonoscopies performed by four consultants and their trainees between 1993-2000 were analysed retrospectively from a prospective endoscopy database. Crude (all cases) and adjusted (excluding poor bowel preparation and disease as causes of incompletion) rates were recorded for each sex, and by age according to cause. Overall crude and adjusted completion rates were 77.9% and 85.0% respectively. There was a significant difference between male and female completion rates due to a difference in the incidence of excess looping and intolerance of the procedure (adjusted rate 88.9% in males vs. 81.6% in females, p

Treatment of intestinal Behçet's syndrome with chimeric tumour necrosis factor alpha antibody

Few patients with Behçet's syndrome have gastrointestinal ulceration. Such patients are difficult to treat and have a higher mortality. Faced with refractory symptoms in two patients with intestinal Behçet's, we used the tumour necrosis factor alpha (TNF-alpha) monoclonal antibody infliximab to induce remission. Both women (one aged 27 years, the other 30 years) presented with orogenital ulceration, pustular rash, abdominal pain, bloody diarrhoea due to colonic ulceration, weight loss, and synovitis. One had thrombophlebitis, digital vasculitis, perianal fistula, and paracolic abscess; the other had conjunctivitis and an ulcer in the natal cleft. Treatment with prednisolone, methyl prednisolone, and thalidomide in one and prednisolone, colchicine, and cyclosporin in the other was ineffective. After full discussion, infliximab (3 mg/kg, dose reduced because of recent sepsis in one, and 5 mg/kg in the other) was administered. Within 10 days the ulcers healed, with resolution of bloody diarrhoea and all extraintestinal manifestations. A second infusion of infliximab was necessary eight weeks later in one case, followed by sustained (>15 months) remission on low dose thalidomide. Remission was initially sustained for 12 months in the other but thalidomide had to be stopped due to intolerance, and a good response to retreatment lasted only 12 weeks without immunosuppression, before a third infusion. The cause of Behçet's syndrome is unknown but peripheral blood CD45 gammadelta T cells in Behçet's produce >50-fold more TNF-alpha than controls when stimulated with phorbol myristate acetate and anti-CD3. Infliximab could have a role for inducing remission in Behçet's syndrome.

Oxaliplatin/capecitabine versus oxaliplatin/infusional 5-FU in advanced colorectal cancer: The MRC COIN Trial.

Background:

COIN compared first-line continuous chemotherapy with the same chemotherapy given intermittently or with cetuximab in advanced colorectal cancer (aCRC).


Methods:

Choice between oxaliplatin/capecitabine (OxCap) and oxaliplatin/leucovorin (LV)/infusional 5-FU (OxFU) was by physician and patient choice and switching regimen was allowed. We compared OxCap with OxFU and OxCap+cetuximab with OxFU+cetuximab retrospectively in patients and examined efficacy, toxicity profiles and the effect of mild renal impairment.


Results:

In total, 64% of 2397 patients received OxCap(±cetuximab). Overall survival, progression free survival and overall response rate were similar between OxCap and OxFU but rate of radical surgeries was higher for OxFU. Progression free survival was longer for OxFU+cetuximab compared with OxCap+cetuximab but other efficacy measures were similar. Oxaliplatin/LV/infusional 5-FU (±cetuximab) was associated with more mucositis and infection whereas OxCap(±cetuximab) caused more gastrointestinal toxicities and palmar-plantar erythema. In total, 118 patients switched regimen, mainly due to toxicity; only 16% came off their second regimen due to intolerance. Patients with creatinine clearance (CrCl) 50–80?ml?min-1 on OxCap(±cetuximab) or OxFU+cetuximab had more dose modifications than those with better renal function.


Conclusions:

Overall, OxFU and OxCap are equally effective in treating aCRC. However, the toxicity profiles differ and switching from one regimen to the other for poor tolerance is a reasonable option. Patients with CrCl 50–80?ml?min-1 on both regimens require close toxicity monitoring.

Survey of arsenic and its speciation in rice products such as breakfast cereals, rice crackers and Japanese rice condiments

Rice has been demonstrated to be one of the major contributors to arsenic (As) in human diets in addition to drinking water, but little is known about rice products as an additional source of As exposure. Rice products were analyzed for total As and a subset of samples were measured for arsenic speciation using high performance liquid chromatography interfaced with inductively coupled plasma-mass spectrometry (HPLC-ICP-MS). A wide range of rice products had total and inorganic arsenic levels that typified those found in rice grain including, crisped rice, puffed rice, rice crackers, rice noodles and a range of Japanese rice condiments as well as rice products targeted at the macrobiotic, vegan, lactose intolerant and gluten intolerance food market. Most As in rice products are inorganic As (75.2-90.1%). This study provides a wider appreciation of how inorganic arsenic derived from rice products enters the human diet. (C) 2008 Elsevier Ltd. All rights reserved.

Mifepristone, a glucocorticoid receptor antagonist, produces clinical and metabolic benefits in patients with Cushing's syndrome

Cushing's syndrome (CS) is a disorder associated with significant morbidity and mortality due to prolonged exposure to high cortisol concentrations.

Channel Time Allocation PSO for Gigabit Multimedia Wireless Networks

This article introduces a resource allocation solution capable of handling mixed media applications within the constraints of a 60 GHz wireless network. The challenges of multimedia wireless transmission include high bandwidth requirements, delay intolerance and wireless channel availability. A new Channel Time Allocation Particle Swarm Optimization (CTA-PSO) is proposed to solve the network utility maximization (NUM) resource allocation problem. CTA-PSO optimizes the time allocated to each device in the network in order to maximize the Quality of Service (QoS) experienced by each user. CTA-PSO introduces network-linked swarm size, an increased diversity function and a learning method based on the personal best, Pbest, results of the swarm. These additional developments to the PSO produce improved convergence speed with respect to Adaptive PSO while maintaining the QoS improvement of the NUM. Specifically, CTA-PSO supports applications described by both convex and non-convex utility functions. The multimedia resource allocation solution presented in this article provides a practical solution for real-time wireless networks.