Biomedical subjects
Publications and source records attributed to D Wood.
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AIMS: To determine whether the Joint European Societies' recommendations that first degree blood relatives of patients with premature coronary heart disease (CHD) should be screened for coronary risk factors is being followed and, if so, how effectively these relatives are being managed. METHODS AND RESULTS: Using a postal questionnaire, 3322 relatives (siblings and children >/=18 years of age) of 1289 index patients in the EUROASPIRE II survey who had suffered from premature CHD (men under 55 years and women under 65 years) were asked whether screening for coronary risk factors had occurred and, if so, how they were being managed in terms of lifestyle advice and drug therapies. Overall, screening for coronary risk factors because of CHD in the family was only performed in 11.1% of siblings and 5.6% of children. However, prevalences of different cardiac risk factors were high both in relatives and offspring and a clear familial clustering could be documented. Less than 50% of siblings and 25% of children were given some general lifestyle advice regarding cardiac risk factors. Moreover, active interventions such as starting antihypertensive or lipid lowering drugs were rarely carried out, particularly in children of patients with premature CHD. CONCLUSIONS: European physicians rarely screen family members of patients with premature CHD for cardiac risk factors. General lifestyle style advice or active treatment for these risk factors are also rarely given. However, since these family members have a high prevalence and familial clustering of cardiac risk factors, they form an ideal target population for primary prevention of CHD in high-risk patients.
Sex chromosome abnormalities are common in mammals and humans and are often associated with subfertility. In this study a boar with normal sperm parameters was indicated to have reduced prolificacy from figures obtained for return rate, farrowing rate and total number of piglets born. G-banded cytogenetic analysis of peripheral blood identified an abnormal mosaic sex chromosome constitution 39,XYY[74]/38,XY[23]/37,X[3]. Cytogenetic analysis of fibroblasts confirmed this mosaic karyotype with similar percentages of cell lines observed 39,XYY[76]/38,XY[19]/37,X[5]. External genitalia revealed a poorly developed scrotum with the right testicle being smaller than the left. To the best of our knowledge this is the first time that this chromosome constitution has been reported in the pig. It is of particular interest that this karyotype is associated with reduced boar fertility, which could lead to potential economic losses if such a boar were selected for breeding purposes.
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Neuromodulation provides considerable flexibility to the output of neural networks. In spite of the extensive literature documenting the presence of modulatory peptide co-transmitters in many neurons, considerably less is known about the specific roles of co-transmission in circuit function. This review describes some of the potential consequences of peptide co-transmission in functional circuits, using specific examples from recent work on the actions of identified peptidergic projection neurons acting on the multifunctional neural network within the crustacean stomatogastric ganglion. This system reveals that co-transmission provides projection neurons with a rich assortment of strategies for eliciting multiple outputs from a multifunctional network.
The Joint European Societies--European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension--1998 recommendations on prevention of coronary heart disease (CHD) in clinical practice set priorities and goals. The top priority is patients with established CHD, or other atherosclerotic disease, because they are already under the care of cardiologists and are at high risk of further morbidity and mortality. The lifestyle goals are to stop smoking, make healthy food choices and be active physically. The risk factor goals are a BP < 140/90 mmHg, total cholesterol < 5.0 mmol/l (190 mg/dl) and LDL-cholesterol < 3.0 mmol/l (115 mg/dl). The appropriate use of prophylactic drug therapies--aspirin, beta-blockers, ACE inhibitors, lipid modification therapies and anticoagulants--is also a recommended goal. The final goal is to screen relatives of patients with premature CHD (men < 55 years and women < 65 years). Surveys of clinical practice such as EUROASPIRE (European Action on Secondary Prevention) have shown risk can be further reduced in patients with established CHD because many are not achieving these lifestyle and risk factor goals. So there is considerable potential to raise the standard of preventive care for coronary patients through more effective lifestyle intervention and the use of drug therapies with proven efficacy. For the patient, this will mean a longer life with better quality.
The nucleation and crystallization behavior of a series of glasses based on 4.5SiO2-3Al2O3-YP2O5-3CaO-1.51CaF2 was studied. The parameter Y was varied to give calcium to phosphate ratios between one and two. All of the glasses studied crystallized firstly to fluorapatite (Ca5PO4)3F). The glass with a calcium to phosphate ratio of 1.67, corresponding to apatite, bulk nucleated to give fluorapatite (FAP). The glasses with calcium : phosphate ratios either less than that of apatite, or greater than that of apatite all exhibited surface nucleation of FAP. However, following a nucleation hold of one hour at approximately 50 K above the glass transition temperature these glasses exhibited bulk nucleation of FAP.
Heart transplant rejection is characterized pathologically by myocyte necrosis and apoptosis associated with interstitial mononuclear cell infiltration. Any one of these components can be targeted for noninvasive detection of transplant rejection. During apoptotic cell death, phosphatidylserine, a phospholipid that is normally confined to the inner leaflet of cell membrane bilayer, gets exteriorized. Technetium-99m-labeled annexin-V, an endogenous protein that has high affinity for binding to phosphatidylserine, has been administered intravenously for noninvasive identification of apoptotic cell death. In the present study of 18 cardiac allograft recipients, 13 patients had negative and five had positive myocardial uptake of annexin. These latter five demonstrated at least moderate transplant rejection and caspase-3 staining, suggesting apoptosis in their biopsy specimens. This study reveals the clinical feasibility and safety of annexin-V imaging for noninvasive detection of transplant rejection by targeting cell membrane phospholipid alterations that are commonly associated with the process of apoptosis.
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BACKGROUND: In the context of a comprehensive population strategy to reduce tobacco use, encourage healthy food choices, and increase physical activity for the whole population, the medical priority is to focus on those who have developed symptoms of coronary heart disease (CHD) or other major atherosclerotic disease, and those who are at high risk of developing such diseases in the future. To give cardiologists the best possible advice to facilitate their work in the prevention of CHD, the Joint European Societies (European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension) Task Force developed a set of recommendations on coronary disease prevention. METHODS: Published studies were reviewed, and a consensus document on risk factors and their management in cardiovascular disease prevention was developed with input from members of the Task Force representing several European and international societies devoted to the study of heart disease, family medicine and behavioral medicine. RESULTS: For patients with established CHD and individuals at high multifactorial risk of developing CHD, the same lifestyle and risk factor goals have been set (blood pressure <140/90 mm Hg, total cholesterol <190 mg/dL, LDL cholesterol <115 mg/dL), and the appropriate use of prophylactic drug therapies is recommended. The role of emerging risk factors-thrombogenic factors, homocysteine, markers of inflammation, infection and genetic factors-in risk prediction and management remains to be established. The scientific evidence for established risk factors is sufficiently strong to justify preventive action at a societal and medical level. CONCLUSIONS: Physicians have considerable opportunities to take preventive action, based on the present scientific evidence, to prevent CHD or other atherosclerotic diseases. However, the control of risk factors remains inadequate in many patients. Physicians are in an excellent position to motivate patients to make lifestyle changes and comply with drug therapies, to advocate better risk management in the hospital and the community, and to call for increased resources for preventive cardiology.
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The report of the World Health Organization Expert Committee on Prevention of Coronary Heart Disease considered that a comprehensive action for coronary heart disease (CHD) prevention has to include three components: A population strategy--for altering, in the entire population, those life-style and environmental factors, and their social and economic determinants, that are the underlying causes of the mass occurrence of coronary heart disease. A high risk strategy--identification of high risk individuals, and action to reduce their risk factor levels. Prevention of recurrent coronary heart disease events and progression of the disease in patients with clinically established coronary heart disease. Prevention targeted at patients with established coronary disease and the high risk strategy targeted at healthy individuals at high risk are an integral part of clinical practice. The clinical approaches and the population approaches for coronary heart disease prevention are complimentary, but the population strategy is fundamental to reducing the burden of cardiovascular disease.
To assess the immunogenicity of pneumococcal vaccine in recipients of heart transplants, we immunized 35 long-term transplantation survivors with pneumococcal vaccine and measured the pre- and postvaccination IgG antibody titers to 5 representative vaccine capsular polysaccharides. Responses of heart transplant recipients to pneumococcal vaccine antigens were generally suppressed.
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We have examined the potential for cholesterol lowering in secondary prevention of coronary heart disease based on data from the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) study carried out in 1995-1996 in nine European centres (Czech Republic, Finland, France, Germany, Hungary, Italy, The Netherlands, Slovenia and Spain). Consecutive patients aged < or = 70 years in four diagnostic categories--coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, and acute myocardial ischaemia without infarction--were identified from hospital records and invited for an interview and risk factor assessment at least 6 months after hospital admission. Plasma lipid measurements were carried out in a central laboratory. Combining patients from all centres and diagnostic categories (n = 2749) the medians (interquartile ranges) for plasma lipids were: total cholesterol 5.36 (4.76-6.03) mmol/l, high density lipoprotein (HDL) cholesterol 1.19 (1.01-1.42) mmol/l, triglycerides 1.55 (1.15-2.24) mmol/l, and low density lipoprotein (LDL) cholesterol 3.32 (2.76-3.91) mmol/l. Only 33% of the patients received lipid-lowering drugs. If the therapeutic goal given in the 1998 European recommendations, total cholesterol < 5.0 mmol/l, were applied, 67% of these patients would have needed an intensified cholesterol-lowering action, and with an even stricter goal, total cholesterol < 4.5 mmol/l, this proportion would have been as high as 84%.
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