Corrigendum to "review on recycling energy resources and sustainability"

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15107.].

Review on recycling energy resources and sustainability

Shifting the production and disposal of renewable energy as well as energy storage systems toward recycling is vital for the future of society and the environment. The materials that make up the systems have an adverse effect on the environment. If no changes are made, the CO2 emissions will continue to increase while also impacting vital resources such as contaminating water sources and wildlife, manifesting in rising sea levels, and air pollution. The development of renewable energy storage systems (RESS) based on recycling utility and energy storage have been an important step in making renewable energy more readily available and more reliable. The emergence of RESS has revolutionized the way energy is obtained and stored for future uses. RESS such as those based on recycling utility and energy storage, provide a reliable and efficient means to harvest, store and provide energy from renewable sources on a large scale. The potential to reduce our dependence on fossil fuels, increase energy security, and help protect the environment makes RESS an important tool in the fight against climate change. As the technology evolves, such systems will continue to play a vital role in the green energy revolution, providing access to a reliable, efficient, and cost-effective power source. This paper provides an overview of the current research on recycling utility based renewable energy storage systems, including their components, power sources, benefits, and challenges. Finally, it assesses potential methods to overcome the challenges and improve the efficiency and reliability of the recycling utility based renewable energy storage systems.

[Is it possible to extract intracranial pressure information based on the EEG activity?]

INTRODUCTION

The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics.

AIM

To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit.

PATIENTS AND METHODS

Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed.

RESULTS

In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics.

CONCLUSIONS

The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.

Cerebral hemodynamics is altered in patients with sleep apnea/hypopnea syndrome

According to recent epidemiologic studies, patients with sleep apnea/hypopnea syndrome (SAHS) are at increased risk of cardiovascular diseases, including stroke. However, the mechanisms are not well defined. Nocturnal apneas can trigger acute cerebral ischemia in predisposed patients and impaired vasodilatation is present in SAHS, but few studies have explored vascular cerebral dysfunction and often gave inconclusive results. The aims of our study were to assess whether patients with SAHS have impairment of cerebral hemodynamics with respect to controls, and to investigate a possible relationship with clinical data. We studied two groups, one of 76 SAHS patients and another one of 76 non-SAHS subjects matched for age, sex and main cardiovascular risk factors. All participants underwent a daytime transcranial Doppler study of right middle cerebral artery to record cerebral blood flow velocity and cerebrovascular reactivity by means of breath-holding test (BHT). SAHS patients have a reduction in mean cerebral blood flow velocity (MFV) (52 ± 9 vs 60 ± 12 cms/s, p < 0.001) and BHT (31 ± 12 vs 36 ± 11 %, p = 0.005) when compared to non-SAHS controls. Moreover, MFV correlated negatively with the presence of coronary disease, and BHT with female sex and arterial pressure. On the other hand, in the SAHS group, MFV correlated negatively with oxygen desaturation severity. Patients with SAHS have impaired MFV and cerebrovascular reactivity when compared to controls. Interestingly, poorly controlled or unknown hypertension and severe nocturnal hypoxemia caused additional cerebral hemodynamic disturbances to these patients.

Osteocalcin, under-carboxylated osteocalcin and osteopontin are not associated with gestational diabetes mellitus but are inversely associated with leptin in non-diabetic women

OBJECTIVE

To measure serum osteocalcin (OC), under-carboxylated osteocalcin (ucOC), osteopontin (OPN), and leptin in pregnant women with gestational diabetes mellitus (GDM) and in healthy pregnant women during pregnancy and after birth and relate these markers to glucose metabolism.

METHODS

This was a prospective study including 60 women with GDM and 60 subjects with normal gestation who were evaluated at gestational week 30 and 6 weeks postpartum. Serum OC, ucOC, OPN, leptin, insulin and insulin resistance were evaluated during the study.

RESULTS

Bone biomarkers and leptin were similar between GDM and normal pregnancy. After delivery, OC, ucOC and OPN increased in both groups, while leptin decreased only in healthy controls. Bone markers did not correlate with insulin and insulin resistance in the two groups, but leptin was positively correlated with insulin and insulin resistance and negatively correlated with bone biomarkers only in healthy women. Furthermore, the women who developed diabetes postpartum had lower levels of OC than women with normal glucose tolerance.

CONCLUSION

GDM is not associated with OC, ucOC, OPN, and leptin and does not correlate with insulin resistance. At postpartum, women who develop diabetes have lower osteocalcin concentrations. Leptin correlates with insulin resistance and bone biomarkers in non-diabetic women.

Polymorphisms of the farnesyl diphosphate synthase gene modulate bone changes in response to atorvastatin

Although their primary therapeutic indications are different, aminobisphosphonates and statins target enzymes in the mevalonate pathway, which is critical for bone homeostasis. Previous studies have shown that some polymorphisms of the gene encoding farnesyl diphosphate synthase (FDPS), the main target of aminobisphosphonates, modulate the response to these drugs. In this study, we explored whether those single nucleotide polymorphisms (SNPs) also influence the changes in bone mineral density (BMD) following therapy with statins. Sixty-six patients with coronary heart disease were studied at baseline and after 1-year therapy with atorvastatin. BMD was measured by DXA. Three SNPs of the FDPS gene (rs2297480, rs11264359 and rs17367421) were analyzed by using Taqman assays. The results showed that there was no association between the SNPs and basal BMD. However, rs2297480 and rs11264359 alleles, which are in linkage disequilibrium, were associated with changes in hip BMD following atorvastatin therapy. Thus, patients with AA genotype at the rs2297480 locus had a 0.8 ± 0.8 % increase in BMD at the femoral neck, whereas in patients with AC/CC genotypes, BMD showed a 2.3 ± 0.8 % decrease (p = 0.02). Similar results were obtained regarding changes of BMD at the femoral trochanter and when alleles at the rs11264359 locus were analyzed. However, there was no association between BMD and rs17367421 alleles. In conclusion, these results suggest that polymorphisms of the FDPS gene may influence the bone response to various drugs targeting the mevalonate pathway, including not only aminobisphosphonates but also statins.

Vitamin d levels and lipid response to atorvastatin

Adequate vitamin D levels are necessary for good vascular health. 1,25-dihydroxycholecalciferol activates CYP3A4, an enzyme of the cytochrome P450 system, which metabolizes atorvastatin to its main metabolites. The objective of this study was to evaluate the response of cholesterol and triglycerides to atorvastatin according to vitamin D levels. Sixty-three patients with acute myocardial infarction treated with low and high doses of atorvastatin were included. Levels of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol were measured at baseline and at 12 months of follow-up. Baseline levels of 25-hydroxyvitamin D (25-OHD) were classified as deficient (<30 nmol/L), insufficient (30-50 nmol/L), and normal (>50 nmol/L). In patients with 25-OHD <30 nmol/L, there were no significant changes in levels of total cholesterol (173 +/- 47 mg/dL versus 164 +/- 51 mg/dL), triglycerides (151 +/- 49 mg/dL versus 177 +/- 94 mg/dL), and LDL cholesterol (111 +/- 48 mg/dL versus 92 45 +/- mg/dL); whereas patients with insufficient (30-50 nmol/L) and normal vitamin D (>50 nmol/L) had a good response to atorvastatin. We suggest that vitamin D concentrations >30 nmol/L may be required for atorvastatin to reduce lipid levels in patients with acute myocardial infarction.

Levels of DKK1 in patients with acute myocardial infarction and response to atorvastatin

The Wnt-LPR5 signalling pathway plays an important role in skeletal homeostasis, especially in regulating osteoblastic activity. Activation of this pathway is regulated by various inhibitors, including DKK1. The objective of this study was to evaluate DKK1 levels in patients with ischemic heart disease, the response to atorvastatin and the relationship with bone mass. Twenty-one patients with acute myocardial infarction and twenty-three controls with a mean age of 61 ± 9 years with acute coronary syndrome were included. Patients were allocated to low (10-20mg) and high doses (40-80 mg) of atorvastatin according to baseline levels of cholesterol and triglycerides and the index of vascular risk. Patients were studied at hospital admission (baseline) and at 12 months of follow up. DKK1 was determined in all patients at baseline and at 12 months of follow up. Densitometric studies were conducted in the lumbar spine (L2-L4) and the femoral neck and trochanter using an X-ray densitometer. Patients had higher levels of DKK1 than controls, (111 ± 41 nmol/l versus 84 ± 27 nmol/l, p=0.014). Osteoporotic patients had higher levels of DKK1 (137.5 ± 33 nmol/l versus 95.4 ± 36 nmol/l, p=0.021). Analysis of the response to atorvastatin showed reduced DKK1 levels. In conclusion, in patients with acute coronary syndrome, atorvastatin decreases DKK1 levels. This may be a previously unreported mechanism of action of atorvastatin on bone, stimulating the Wnt signalling pathway and increasing bone mass.

Atorvastatin and BMD in coronary syndrome. Role of Lys656Asn polymorphism of leptin receptor gene

OBJECTIVES

To evaluate the effect of atorvastatin on bone mass and markers of bone remodeling in patients with acute coronary syndrome according to the Lys656Asn leptin receptor gene polymorphism.

METHODS

Sixty-two patients with acute coronary syndrome were included. Patients were allocated to low and high doses of atorvastatin according to baseline levels of cholesterol and triglycerides and the index of vascular risk and were studied at hospital admission and at 12 months. Cholesterol, triglycerides, total calcium, phosphorus, magnesium, osteocalcin and urinary deoxypyridinoline were determined in all patients at baseline and at 12 months of follow up. Densitometric studies were conducted in the lumbar spine and hip. Patients with a T-score<-2.5 were considered osteoporotic. The Lys656Asn leptin receptor gene polymorphism was determined by PCR.

RESULTS

Forty-two patients were Lys/Lys homozygotic and 20 Lys/Asn heterozygotic. The prevalence of osteoporosis was 31% for the Lys/Lys genotype and 27% for the Lys/Asn genotype with no significant differences between groups. There was a significant increase in bone mineral density in the lumbar spine (1.117 +/- 0.24 versus 1.135 +/- 0.24, P = 0.008) in patients with the Lys/Lys genotype.

CONCLUSION

Atorvastatin increases lumbar spine bone mineral density only in patients with the Lys/Lys genotype of the Lys656Asn polymorphism.

Bone mineral density, bone remodeling and osteoprotegerin in patients with acute coronary syndrome

The objective of this study was to evaluate the relationship between coronary disease and osteoporosis and determine the effect of osteoprotegerin (OPG) on bone remodeling and bone mineral density (BMD) in a group of patients with acute coronary syndrome. Eighty-three patients (52 males and 31 women) with acute coronary syndrome (75 patients with acute myocardial infarction and 8 with unstable angina) with an average age of 61+/-10 years were studied. Levels of osteocalcin, urinarydeoxypyridinoline, OPG and the receptor activator of nuclear factor-kappaB ligand (RANKL) were determined during the hospital stay. Femoral neck, trochanter and lumbar spine densitometry was carried out using a DXA densitometer. Thirty percent of patients presented osteoporosis (39% of females and 26% of males). Osteoporotic patients were older and had a lower weight and height and elevated serum levels of osteocalcin (3.6+/-2.25 2.63 versus +/-1.55, p=0.05). Levels of OPG and RANKL were similar in both groups and showed no relationship with BMD. In conclusion, no relationship was observed between the OPG/RANKL system and BMD in these patients.

Effect of atorvastatin on bone mineral density in patients with acute coronary syndrome

OBJECTIVE

The aim of this paper is to evaluate the effect of atorvastatin on bone mineral density in patients with acute ischemic heart disease.

MATERIAL AND METHODS

Eighty-three patients (52 male and 31 female) with acute coronary syndrome were studied. They received treatment with atorvastatin using low doses (20 mg) and high doses (40 mg-80 mg). Initial and final cholesterol, triglyceride, calcium, phosphorus, 25-hydroxyvitamin D were obtained from every patient. Spine and hip bone mineral density were performed at the beginning and one year later.

RESULTS

Atorvastatin treatment increases vitamin D (33%, p = 0.007) and decreases the individuals with vitamin D insufficiency. Bone mineral density increased in the spine (1.31%, p = 0.02), but it was significant only in male and patients presenting vitamin D levels higher than 30 nmol/l.

CONCLUSION

Atorvastatin has a beneficial effect on bone metabolism in patients with acute ischemic heart disease (mainly males) by incrementing bone mineral density in which vitamin D levels are required to be higher than 30 nmol/l for the drug to be effective.

Effects of Atorvastatin on vitamin D levels in patients with acute ischemic heart disease

Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome, and ischemic heart disease. Cholesterol and vitamin D share the 7-dehydrocholesterol metabolic pathway. This study evaluated the possible effect of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Eighty-three patients (52 men and 31 women) with an acute coronary syndrome (75 with acute myocardial infarction and 8 with unstable angina) were included. After diagnosis, patients received atorvastatin as secondary prevention. Serum vitamin D was measured by high-performance liquid chromatography at baseline and at 12 months. Atorvastatin treatment produced a statistically significant decrease in cholesterol and triglyceride levels and an increase in vitamin D levels (41+/-19 vs 47+/-19 nmol/L, p=0.003). Vitamin D deficiency was decreased by 75% to 57% at 12 months. In conclusion, atorvastatin increases vitamin D levels. This increase could explain some of the beneficial effects of atorvastatin at the cardiovascular level that are unrelated to cholesterol levels.

Effect of beta-blockers on bone mass and biomechanical parameters of the femoral neck in males with acute myocardial infarction

OBJECTIVES

Evaluate the effect of cardioselective beta-blockers on bone mass and biomechanical properties of the femoral neck in males with acute myocardial infarction.

METHODS

Forty males with acute myocardial infarction were studied during one year. Seventy-five percent of the patients (30 patients) were treated with cardioselective beta-blockers and 10 were not similarly treated. A hip densitometry was performed upon release and one year later. The BMD was measured in the femoral neck and in biomechanical elements obtained by DXA.

RESULTS

Both groups had similar clinical conditions at the beginning of the study and after a one-year follow-up. No differences in the BMD (0.934+/-0.12 vs. 0.921+/-0.14) were observed in the group without beta-blockers or in the group with beta-blockers (0.980+/-0.12 vs. 0.977+/-0.12). No differences were observed in the measured structural parameters.

CONCLUSION

The cardioselective beta-blockers do not modify bone mass or the structural bone parameters in males with acute myocardial infarction.

[Myocardial infarction. Population case-fatality in seven Spanish autonomous communities: the IBERICA Study]

BACKGROUND AND OBJECTIVE

The magnitude of the problem of myocardial infarction (MI) is better understood by assessing the population case-fatality than by analyzing only the number of patients attending hospitals.

PATIENTS AND METHOD

Our data come from the IBERICA Study (Investigation, Specific Search and Registry of Acute Myocardial Ischemic Syndrome). Twenty eight-day MI population case-fatality is described in the population aged 25 to 74 years during 1997 and 1998 in the following Spanish autonomous communities: Castilla-La Mancha (Toledo and Albacete), Catalonia (Girona), Valencia Community (Valencia), Balearic Islands (Majorca), Murcia, Navarra and Basque Country. The relationship between case-fatality and other variables such as sex, age and geographic area is also analyzed.

RESULTS

A total of 10,660 MI cases were registered, 4,106 of whom died within the period of 28 days following the onset of symptoms (38.5%; CI 95%, 37.6-39.4%). The overall case-fatality was 37.0% (CI 95%, 35.9-38.0%) in men and 44.3% (CI 95%, 42.3-46.4%) in women. Death occurred out of hospitals in 2,869 (69.9%) cases. An increased case-fatality in women was associated with a higher in-hospital case-fatality (45% higher than men). The proportion of patients who died before reaching a hospital was similar in both genders. Classical symptoms of MI were more common among men than women (82.7% vs. 77.6%, p < 0,001). The interval between symptoms' onset and hospitalization was 30 minute longer among hospitalized women as compared with men (p < 0,001).

CONCLUSIONS

Population MI case-fatality is high in the seven Spanish autonomous communities studied. Approximately 2 out of 3 deaths occur without patients being able to reach a hospital. These results emphasize the importance of primary and secondary prevention measures and the necessity to design ready-access systems to defibrillation and resuscitation manoeuvres for patients with cardiopulmonary arrest.

HIV-exposed infants with acute respiratory failure secondary to acute lower respiratory infections managed with and without mechanical ventilation

OBJECTIVES

The decision to provide mechanical ventilation (intermittent positive pressure ventilation (IPPV)) to HIV-exposed infants in resource-poor settings has remained difficult owing to problems in confirming HIV infection and the lack of data on outcome. We evaluated the predictive value of the HIV antibody test in confirming infection in infants requiring mechanical ventilation for acute lower respiratory infections (ALRIs), and compared the outcome for children denied access with the outcome for similar subjects who were ventilated.

SETTING AND DESIGN

This investigative study was conducted over a 12-month period at the paediatric intensive care unit (PICU) at King Edward VIII Hospital (KEH) in Durban, and at Ngwelezana Hospital in northern KwaZulu-Natal.

SUBJECTS

HIV-exposed patients with acute respiratory failure (ARF) secondary to ALRI entering the PICU at KEH were enrolled into the IPPV arm, while similar children who were refused such care at Ngwelezana Hospital were admitted into the non-IPPV arm. Standardised protocols for entry and management of enrolled subjects were utilised.

OUTCOME MEASURES

HIV DNA polymerase chain reaction (PCR) testing was performed to establish HIV status. Clinical and laboratory parameters were correlated with HIV status to determine predictors of infection and outcome (survival to discharge).

RESULTS

One hundred and sixteen HIV-exposed infants were enrolled, 49 into the IPPV arm and 67 into the non-IPPV arm. The median age of both groups was 3.0 months (0.5-11 months), and the male/female ratio and proportion of infants under 3 months of age were similar in both groups. The predictive values of the HIV antibody test in determining HIV infection in the IPPV and non-IPPV arms were 87.8% and 85.0% respectively. Splenomegaly and a serum globulin of > 35 g/l increased the likelihood of being HIV PCR-positive (p = 0.006 and p = 0.04 respectively). Survival to discharge rates for HIV-infected children in the IPPV and non-IPPV arms were 41.9% and 24.6% respectively (p = 0.08). Age less than 3 months (p = 0.04) and very severe pneumonia (p = 0.007) were the only indicators of poor outcome.

CONCLUSION

Mechanical ventilation provided little benefit in HIV-infected children with ARF from ALRI. An HIV antibody test in infants with ALRI and ARF is highly suggestive of HIV infection. Splenomegaly and a serum globulin of greater than 35 g/l were the only useful markers in identifying HIV infection.

Characterization and functional significance of glucocorticoid receptors in patients with major depression: modulation by antidepressant treatment

Hyperactivity of the hypothalamic pituitary adrenal (HPA) axis in patients with major depression is one of the most consistent findings in biological psychiatry. Experimental data support the idea that glucocorticoid-mediated feedback via glucocorticoid receptors (GR) is impaired in major depression. The aim of the present work was to assess the putative changes in GR density of peripheral blood mononuclear cells (PBMCs) in a group of patients with major depression and to determine modulation of these GR sites by antidepressant treatment. In addition, susceptibility of PBMCs to glucocorticoid effects was also studied using a functional end-point analysis in vitro, such as cortisol inhibition of mitogen-induced lymphocyte proliferation. Cortisol levels were also measured before and after dexamethasone suppression test (DST). The results showed a decrease in GR density in depressed patients compared with healthy subjects, mainly in those patients that showed basal cortisol levels in the upper normal range and were refractory to DST. Regarding the functional significance of this variation, two representative groups emerged from our study: a) free-medication patients with GR function comparable to healthy controls, and b) patients showing diminished GR activity. These results suggest a lack of relationship between GR density and cortisol-induced inhibition of lymphocyte proliferation. Patients treated with different antidepressant drugs showed a marked increase in the number of GR sites per cell compared to non-treated. Interestingly, this increase was even higher than in normal subjects. Hence, restoration of GR density after an efficient antidepressant treatment could be an index of an effective modulatory action of drugs on GR expression and highlights the possibility that GR levels might be used as markers of a successful treatment.

[Variability in the in-hospital management of acute myocardial infarction in Spain. IBERICA Study (Investigación, Búsqueda Específica y Registro de Isquemia Coronaria Aguda)]

Introduction and objective. Although some in-hospital studies have described the management of acute myocardial infarction (MI) patients in Spain, none has been able to guarantee the exhaustiveness of patient registry. This study sought to determine the clinical characteristics and in-hospital management of patients with MI in eight Spanish population registries.Methods. The IBERICA study is a population-based MI registry carried out in the 25 to 74 year-old population, in eight Spanish regions in 1997. A standardized methodology was used to register and investigate all MI arriving alive to a hospital. Clinical characteristics, cardiovascular risk factors prevalence, pharmacological treatment, invasive and non-invasive procedures performed and complications at 28 days of evolution were recorded. A descriptive analysis was performed and the variation coefficient (VC) was calculated.Results. In 1997, 4,041 MI patients were registered, 79.9% were men with a mean age of 61.1 years. Although 10.9% (95% CI: 9.9-11.9%) were not admitted to the coronary care unit, a large variability existed among different areas (VC = 53%). There was a high variability in the utilization and performance of non-invasive and invasive procedures among regions, as well as in the use of pharmacological treatment. Only the use of antiaggregants (91.5%) and thrombolytic therapy (41.8%) showed a low variability (VC < 10%). Twenty-eight day mortality was 16.2% (95% CI: 15.1-17.4%) with a high variability being observed among the different regions (VC = 20.6%).Conclusion. Patient characteristics vary among the different Spanish regions. The differences in management and prognosis suggest a lack of equality in the health care provided to MI patients in the different regions in Spain.

Apolipoprotein E epsilon 4, other risk factors, and course of Alzheimer's disease

BACKGROUND

The epsilon 4 allele of apolipoprotein E (apoE epsilon 4) is associated with late-onset Alzheimer's disease (AD), but its relationship to various aspects of AD has become increasingly unclear. We studied the relationship of apoE genotype in AD to educational attainment, history of heart disease or head injury, age of onset, gender, severity of illness, depression, psychotic symptoms, rate of dementia progression, and time from initial evaluation to nursing home placement.

METHODS

ApoE epsilon 4 genotype was determined for 97 clinically diagnosed AD patients and 61 neuropathologically confirmed cases of AD.

RESULTS

Presence of one or more epsilon 4 alleles occurred in 66% of AD cases as compared with 27% in control subjects (allele frequency was .40 for AD, .15 for control subjects). Among AD subjects there was no significant relationship between epsilon 4 alleles and educational attainment, history of heart disease, head injury, age of onset, severity of illness, depression, history of depression, rate of dementia progression, or time to nursing home placement. Marginal correlations emerged between number of epsilon 4 alleles, and delusions (p = .05) and hallucinations (p = .05). There was a trend toward increased epsilon 4 homozygosity in patients with onset between ages 65 and 70 years.

CONCLUSIONS

We did not find that individuals with one or two apoE epsilon 4 alleles differed significantly in clinical course of AD from those without epsilon 4 except for a trend toward increased psychotic symptoms in the group as a whole and an increase in epsilon 4 homozygosity in patients with reported symptom onset in the late 60s.

Remnant-like particle cholesterol levels in patients with dysbetalipoproteinemia or coronary artery disease

PURPOSE

Several studies have provided support for a proatherogenic role for remnant lipoproteins. Thus, the aim of this study was to compare remnant-like particle (RLP) cholesterol levels in patients with coronary artery disease who were normolipidemic with those in controls of similar age and gender. We also assessed the usefulness of measuring RLP-cholesterol levels in patients with type III dyslipidemia.

SUBJECTS AND METHODS

Remnant-like particle cholesterol levels were measured in 63 normolipidemic men with coronary artery disease and 23 male controls of similar age as well as in 15 patients with type III dyslipidemia and 103 controls, using an immunoaffinity method.

RESULTS

Remnant-like particle cholesterol levels were significantly increased in men with coronary artery disease compared with controls (7.6 +/- 3.8 mg/dL versus 5.7 +/- 1.9 mg/dL, P < 0.01). In patients with coronary artery disease, RLP-cholesterol levels were correlated with total triglyceride and nonhigh-density-lipoprotein (HDL) cholesterol levels, but not with HDL-cholesterol levels. RLP-cholesterol levels were significantly elevated in patients with type III dyslipidemia (median 119, range 31 to 240 mg/dL) compared with controls (median 5.6, range 2.2 to 10.5 mg/dL, P < 0.001).

CONCLUSION

Normolipidemic men with coronary artery disease have increased levels of RLP-cholesterol that is not detected with conventional lipid screening. The RLP-cholesterol assay is a simple method for detecting high concentrations of remnant lipoproteins in patients with type III dyslipidemia.

Early vs conventional extubation after cardiac surgery with cardiopulmonary bypass

OBJECTIVES

Sedation and ventilation overnight after cardiac surgery is common practice. However, early extubation may be feasible with no increase in postoperative complications. This study examines (1) if early extubation is possible in a significant number of patients, (2) if it reduces ICU stay, and (3) if this practice increases postoperative complications.

DESIGN

Prospective, controlled, randomized clinical trial.

PATIENTS AND METHODS

We randomized 404 consecutive patients to early extubation (7 to 11 h postoperatively) (group A, 201 patients) or conventional extubation (between 8 and 12 AM the following day) (group B, 203 patients). Variables included type and severity of the disease, surgical risk, type of operation, operative incidences, postoperative complications, duration of mechanical ventilation, intubation and ICU stay, bleeding, reoperation, vasoactive drugs, and mortality.

RESULTS

Groups were comparable. Extubation within the preestablished time was successful in 60.2% of patients in group A and 74.4% in group B. Median ICU stay was 27 h in group A and 44 h in group B (p=0.008). Discharge from ICU within the first 24 h postoperatively was 44.3% in group A and 30.5% in group B (p=0.006). There was no significant difference in complications between groups. Successfully extubated patients in group A had more reintubation and prolonged ventilation than in group B.

CONCLUSIONS

(1) Sixty percent of our patients were extubated within 11 h of operation. (2) As a result, the length of stay in ICU was reduced and the percentage of patients discharged within 24 h was increased. (3) There was no increase in clinically important postoperative complications.

Cyclic beta-(1,2)-glucan synthesis in Rhizobiaceae: roles of the 319-kilodalton protein intermediate

Cyclic beta-(1,2)-glucans are synthesized by members of the Rhizobiaceae family through protein-linked oligosaccharides as intermediates. The protein moiety is a large inner membrane molecule of about 319 kDa. In Agrobacterium tumefaciens and in Rhizobium meliloti the protein is termed ChvB and NdvB, respectively. Inner membranes of R. meliloti 102F34 and A. tumefaciens A348 were first incubated with UDP-[14C]Glc and then solubilized with Triton X-100 and analyzed by polyacrylamide gel electrophoresis under native conditions. A radioactive band corresponding to the 319-kDa protein was detected in both bacteria. Triton-solubilized inner membranes of A. tumefaciens were submitted to native electrophoresis and then assayed for oligosaccharide-protein intermediate formation in situ by incubating the gel with UDP-[14C]Glc. A [14C]glucose-labeled protein with an electrophoretic mobility identical to that corresponding to the 319-kDa [14C]glucan protein intermediate was detected. In addition, protein-linked radioactivity was partially chased when the gel was incubated with unlabeled UDP-Glc. A heterogeneous family of cyclic beta-(1,2)-glucans was formed upon incubation of the gel portion containing the 319-kDa protein intermediate with UDP-[14C]Glc. A protein with an electrophoretic behavior similar to the 319-kDa protein intermediate was "in gel" labeled by using Triton-solubilized inner membranes of an A. tumefaciens exoC mutant, which contains a protein intermediate without nascent glucan. These results indicate that initiation (protein glucosylation), elongation, and cyclization were catalyzed in situ. Therefore, the three enzymatic activities detected in situ reside in a unique protein component (i.e., cyclic beta-(1,2)-glucan synthase). It is suggested that the protein component is the 319-kDa protein intermediate, which might catalyze the overall cyclic beta-(1,2)-glucan synthesis.

Modification of low density lipoprotein by advanced glycation end products contributes to the dyslipidemia of diabetes and renal insufficiency

Atherosclerosis develops rapidly in patients with diabetes or renal insufficiency. Plasma lipoprotein profiles are frequently abnormal in these conditions and reflect an elevation in the level of the apoprotein B (ApoB)-containing components very low density lipoprotein (VLDL) and low density lipoprotein (LDL). High levels of circulating advanced glycation end products (AGEs) also occur in diabetes and end-stage renal disease (ESRD). These products arise from glucose-derived Amadori products and include AGE-modified peptides (AGE-peptides) which result from the catabolism of AGE-modified tissue proteins. AGE-peptides have been shown to crosslink protein amino groups and to accumulate in plasma as a consequence of renal insufficiency. To address potential mechanisms for the dyslipidemia of diabetes and ESRD, we investigated the possibility that circulating AGEs react directly with plasma lipoproteins to prevent their recognition by tissue LDL receptors. AGE-specific ELISA showed a significantly increased level of AGE-modified LDL in the plasma of diabetic or ESRD patients compared with normal controls. AGE-LDL formed readily in vitro when native LDL was incubated with either synthetic AGE-peptides or AGE-peptides isolated directly from patient plasma. LDL which had been modified by AGE-peptides in vitro to the same level of modification as that present in the plasma of diabetics with renal insufficiency exhibited markedly impaired clearance kinetics when injected into transgenic mice expressing the human LDL receptor. These data indicate that AGE modification significantly impairs LDL-receptor-mediated clearance mechanisms and may contribute to elevated LDL levels in patients with diabetes or renal insufficiency. This hypothesis was further supported by the observation that the administration of the advanced glycation inhibitor aminoguanidine to diabetic patients decreased circulating LDL levels by 28%.

Schizophrenia and religious affiliation in Northern Ireland

First admissions for schizophrenia in Northern Ireland are significantly higher for the Roman Catholics than for the rest of the population, although not as high as in the Irish Republic. The excess of Catholic cases affects only the never-married, and derives much more from the rural west of the territory than from the industrial east. It does not appear to be accounted for by geography per se, by the differential use of services, diagnostic bias, social class distribution, or mean age at marriage. There are indications that some conflict around sex and marriage and, more doubtfully, a sense of relative deprivation may be contributing factors.