Exploring mechanisms of increased cardiovascular disease risk with antipsychotic medications: Risperidone alters the cardiac proteomic signature in mice

Atypical antipsychotic (AA) medications including risperidone (RIS) and olanzapine (OLAN) are FDA approved for the treatment of psychiatric disorders including schizophrenia, bipolar disorder and depression. Clinical side effects of AA medications include obesity, insulin resistance, dyslipidemia, hypertension and increased cardiovascular disease risk. Despite the known pharmacology of these AA medications, the mechanisms contributing to adverse metabolic side-effects are not well understood. To evaluate drug-associated effects on the heart, we assessed changes in the cardiac proteomic signature in mice administered for 4 weeks with clinically relevant exposure of RIS or OLAN. Using proteomic and gene enrichment analysis, we identified differentially expressed (DE) proteins in both RIS- and OLAN-treated mouse hearts (p < 0.05), including proteins comprising mitochondrial respiratory complex I and pathways involved in mitochondrial function and oxidative phosphorylation. A subset of DE proteins identified were further validated by both western blotting and quantitative real-time PCR. Histological evaluation of hearts indicated that AA-associated aberrant cardiac gene expression occurs prior to the onset of gross pathomorphological changes. Additionally, RIS treatment altered cardiac mitochondrial oxygen consumption and whole body energy expenditure. Our study provides insight into the mechanisms underlying increased patient risk for adverse cardiac outcomes with chronic treatment of AA medications.

[Accuracy of pleural fluid cytology in malignant effusions]

OBJECTIVE

To assess the usefulness of repeat cytological examination of pleural fluid (PF) for diagnosing malignancy as well as the influence of time length between analyses, effusion's size and pleural fluid biochemistries on the diagnostic yield of cytology.

METHODS

Retrospective analysis of 1,427 patients with pleural effusion (PE), including 466 patients with malignant PE. In this latter group, the time length between cytological analysis, the size of the PE, and the biochemical characteristics of PF were recorded.

RESULTS

The first cytological analysis had a sensitivity of 48.5%. If this was negative, a second PF specimen was diagnostic in 28.6% of cases, whereas submission of a third PF specimen allowed 10.3% of additional diagnosis. The incidence of positive results depended on the primary tumor (e.g. 66.5% in adenocarcinomas, 30.8% in mesotheliomas), but neither on the time length between cytological analyses nor on the effusion's size. A multivariate analysis showed that a PF to serum glucose ratio </= 0.75 was associated with a higher diagnostic yield of cytology (74 vs. 47%, p < 0.001).

CONCLUSION

At least a second PF specimen should be submitted immediately for cytologic analyis in all PE of unknown cause, when the first analysis is not contributory. To delay this second analysis does not increase diagnostic yield. The percentage of cases in which cytologic study of the PF established the diagnosis of malignant PE depends on the tumor type and on certain PF biochemical characteristics such as the PF to serum glucose ratio.

Comparison of Lynch predictive models for identification of MLH1/MSH2 mutation carriers in a Spanish multicentre clinic- based cohort

e22077

Background: Different predictive models for Lynch syndrome have recently been developed and their comparative performance in a clinic-based cohort has not been assessed. We aimed to analyze the accuracy of the MMRpro, Barnetson, and PREMM1,2 models to predict MLH1/MSH2 mutation carrier status in 564 unrelated probands with clinical suspicion of hereditary colorectal cancer and compare it with Wijnen model and clinical criteria. Methods: Overall, 538 individuals (95%) underwent mismatch repair (MMR) deficiency screening before germline genetic testing (sequencing with or without large rearrangement analysis) and 26 (5%) performed direct genetic testing. Prediction scores for all individuals were calculated by each model. Sensitivity, specificity, positive predictive value (PPV), and the areas under the receiver operating characteristics curves (AUC) for all models were calculated and compared with the Revised Bethesda Guidelines (RBG). Results: 114 individuals (20%) were mutation carriers (63 MLH1, 51 MSH2). The AUC was 0.95 (95% CI: 0.93–0.97) for MMRpro, 0.87 (95% CI 0.83–0.91) for the Barnetson model, 0.87 (95% CI 0.83–0.91) for PREMM1,2, and 0.75 (95% CI 0.69–0.80) for the Wijnen model (p<0.001). Testing thresholds and specificity at 100% and 90% sensitivity for each model were: 0.001/17% and 0.33/89% for MMRpro, 0.01/9% and 0.07/59% for Barnetson, 0.05/5% and 0.11/58% for PREMM1,2. Sensitivity and specificity of RBG were 86% and 14%, respectively. Calibration was 0.92, 1.05, 0.50, and 1.25 for PREMM1,2,Barnetson, Wijnen, and MMRpro, respectively. Conclusions: In a population of individuals at risk of Lynch syndrome, the MMRpro model has the largest AUC, although the Barnetson and PREMM1,2 model also show adequate discrimination. Any of the models perform better than the RBG and provide quantitative risk estimation of finding a MLH1/MSH2 mutation useful in genetic counselling.

No significant financial relationships to disclose.

Influence of mineral metabolism parameters on pulse pressure in healthy subjects

BACKGROUND

The role of mineral metabolism in cardiovascular pathologies has been studied almost exclusively in chronic kidney disease patients. There are no studies that relate mineral metabolism to pulse pressure in healthy populations.

METHODS

692 subjects were initially selected. After applying clinical exclusion criteria, 659 subjects were recruited. Creatinine clearance was then calculated to detect subjects with occult chronic kidney disease. Statistical analysis was applied to the remaining population after excluding subjects with occult chronic kidney disease (n = 466). Pulse pressure, creatinine clearance, calcium, phosphorus, intact parathormone, 25-hydroxivitamin D3 and Bsm I genotype of the vitamin D receptor were determined. Means and frequencies were compared by ANOVA and Chi-square, respectively. Multivariate analysis was applied to the whole population and then to Caucasians, Sub-Saharans, Caucasian men and Caucasian women separately. Pulse pressure (PP) was the dependent variable, and adjustments were made for clinical and laboratory data.

RESULTS

The prevalence of occult chronic kidney disease was 32%. In subjects without kidney disease, phosphorus and vitamin D were independent predictors of elevated PP in Caucasian males whereas Bsm I genotype of the vitamin D was an independent predictor of elevated PP in the Caucasian population in both genders. No covariable showed relationship with PP in Sub-Saharan subjects.

CONCLUSION

Mineral metabolism influences pulse pressure in Caucasian men.

The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients

BACKGROUND

Evidence about the impact of routine feedback of patient-reported outcomes is contradictory, and there is limited information regarding its use in the routine management of cataract patients.

METHODS

The VF-14 Index was used to assess the visual function of 833 consecutive cataract patients, attending 19 ophthalmologists from public and private hospitals and primary care practices in Spain, in 1999-2000. In this before/after trial, the intervention included (1) an educational session, and (2) the provision of the VF-14 scores of all subsequent patients to the ophthalmologist. Mixed effects linear and logistic models were constructed to assess the effect on the process (correlation between patients' and physicians' assessments of visual function, appropriateness of surgery recommendation) and the outcome of care (satisfaction).

RESULTS

The adjusted regression coefficient for the VF-14 score significantly increased after the intervention as a predictor of the ophthalmologist's assessment of visual function (beta coefficient: control 0.10 vs. intervention 0.35, p < 0.05). The intervention did not increase the probability of an appropriate medical decision (OR = 0.90; 95% CI: 0.42; 2,69) and it did not change patient satisfaction with care.

CONCLUSIONS

Routine provision of education and feedback on the patient's VF-14 Index score significantly increases agreement between patients' and physicians' assessments of functional capacity. The lack of a beneficial effect on management or outcome suggests the need for a more intense intervention to change medical practice.

Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group

BACKGROUND

Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices.

PATIENTS AND METHODS

A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented the guidelines in a group of lung or prostate cancer patients, or to 'physician discretion' (PD) sites, where customary treatment was continued. Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the Brief Pain Inventory, and for change in other symptoms or mood.

RESULTS

The protocol terminated early because of poor accrual. We compared groups using proportions of patients who had no or mild pain at follow-up. Although measures of protocol adherence did not suggest the occurrence of major practice change, the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites. There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites.

CONCLUSION

A protocol for cancer pain management can improve pain control. Diffusion of these benefits to other patients was not confirmed. Given the small sample size, these findings require confirmation in a larger trial.

Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994)

BACKGROUND

The objective of this study was to describe the evolution of social class inequalities in Barcelona (Spain) residents in perceived health status, health-related behaviors, and utilization of health services between 1983 and 1994.

METHODS

The information was obtained from the Health Interview Surveys conducted in 1983, 1986, 1992, and 1994 in Barcelona. In this study we included noninstitutionalized people ages >14 years. Social class was obtained from the Spanish adaptation of the British Registrar General classification. We studied health status, health-related behaviors, and health services utilization variables. Age-adjusted percentages and the relative index of inequality were obtained.

RESULTS

Of the health status variables, having been confined to bed and acute restriction of activity in the 2 weeks prior to the interview showed an increase in inequalities by social class in 1994. The pattern of chronic conditions by social class in men did not change between 1983 and 1994. Women had a higher prevalence of chronic conditions and the inequalities among social classes had increased. In men there were no social class inequalities in smoking in 1983. In 1992 and 1994 smoking was more prevalent in men of social classes IV and V. In women, smoking was more prevalent in social classes I and II in 1983 than in social classes IV and V, something that had changed by 1994. Lack of usual physical activity in men was always more prevalent in social classes I and II, and this difference increased since more people of advantaged classes moved into inactivity. Health services utilization showed no inequalities in the years studied.

CONCLUSION

The changing pattern according to social class of smoking and physical activity practice needs to be taken into account by policy-makers and public health workers.

Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer

BACKGROUND

The aim of this study was to assess the factors that may cause failure of endoscopic injection in patients bleeding from a duodenal ulcer.

METHODS

One hundred twenty patients admitted for a bleeding duodenal ulcer with active arterial hemorrhage or a nonbleeding visible vessel were included.

RESULTS

Endoscopic injection was not feasible in 14 of 120 (11.6%) patients because of inaccessibility or massive hemorrhage. The remaining 106 patients underwent endoscopic therapy by injection of adrenaline and polidocanol. The efficacy (achievement of definitive hemostasis) of endoscopy therapy was 83% (88 of 106). Univariate analysis showed that failure of endoscopic injection was related to age, presence of shock, ulcer size greater than 2 cm, and hemoglobin level. Multivariate analysis showed that ulcer size greater than 2 cm (p = 0.005) and the presence of shock (p = 0.03) were factors predictive of endoscopic treatment failure. Failure to achieve hemostasis (p < 0.001) and poor physical status measured by American Society of Anesthesiology classification (p = 0.02) were significantly related to mortality.

CONCLUSIONS

Ulcer size and severity of hemorrhage are predictive of endoscopic injection failure in patients bleeding from high-risk duodenal ulcers. Survival is determined by clinical status and associated diseases.

Reuleaux triangle somatocharts

The three-numeral somatotype index to quantitatively represent human body type has gained general acceptance since being proposed in 1940. The two-dimensional Reuleaux triangle somatochart has been a customary format for graphically representing three-dimensional somatotype data. This paper presents the traditional, quick plot somatochart, the rationale for development of the Health-Carter 1980 somatochart with scaled axes and, based on that rationale, a proposal for a somatochart utilizing a traditional x, y-coordinate axis system. Two completed somatocharts are presented; one showing mean somatotypes of collegiate rugby, football and soccer players, and another depicting phenotypic changes in somatotype after diet and exercise.

[A descriptive epidemiological study of ulcerative colitis in a community hospital (1985-1989)]

BACKGROUND

The incidence of ulcerative colitis (UC) shows a marked geographical variation. It is high in Anglo-Saxon and Scandinavian countries, while in Mediterranean countries the available data on its epidemiological features are few. Spain is not an exception.

METHODS

The new cases of UC diagnosed during the period 1985-1989 in the Hospital de Sabadell (a reference center of an area with a markedly industrial population of 343924) were retrospectively evaluated. The definitive diagnosis of UC required a negative fecal microbiological study and findings in colonoscopy and biopsy consistent with UC.

RESULTS

During the study period 68 new cases of UC were diagnosed, representing a mean yearly incidence of 3.95/10(5) population, and 5.26/10(5) considering only the adult population (age greater than 14 years). No significant differences were found (p greater than 0.05) in the sex and age distributions, although the male/female ratio was 1.06. In 84% of cases UC was limited to the rectum and/or distal colon, with a low frequency of pancolonic forms (5%). In 70% of patients UC was classified as a low severity disease.

CONCLUSIONS

Although the estimation of incidence only from hospital cases underestimates the true incidence, and also considering the limitation of comparing results of studies from several time periods, the incidence of UC in our area is the highest one reported to the present time in Spain and Southern Europe. Nevertheless, it is lower than that in most Northern European countries.

Ecological association between hypertension and stroke in Catalonia (Spain): development and use of an ecological regression model

The objectives of this paper were to study the association between the prevalence of uncontrolled hypertension (PUHT) and stroke mortality at the ecological level, in nine geographical areas of Catalonia (Spain); to develop an ecological regression model and to assess its ability to predict crude stroke mortality rate (CMR) from the PUHT. The regression equation obtained for the population older than 25 yrs was CSMR x 10(3) = 0.67035 + 4.94752 PUTH x 10(-2). The ecological risk ratio was 8.38 and the ecological attributable proportion 71.1%. The CSMR estimation obtained by applying the model in a concrete case was close to that observed. The results support an ecological association between the studied variables. The ecological model can be useful in the assessment of observed changes in health problems and risk factor levels in the community. It could also be used in the evaluation of intervention programmes.