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Biomedical subjects

M May

Publications and source records attributed to M May.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Impact of immunochemotherapy on survival of patients with metastatic renal cell carcinoma. A retrospective study comparing interferon-alpha-2a/vinblastine versus interferon-alpha-2a/interleukin-2/5-fluorouracil].

The prognosis for patients with metastatic renal cell carcinoma (RCC) remains unsatisfactory to date. Combined immunochemotherapy (ICT) strives for a synergistic effect avoiding a substantial increase of therapy-related adverse events. The combination therapy regimes consisting of either interferon-alpha-2a/vinblastine (IFN-alpha2a/VBL) or interferon-alpha-2a/interleukin-2/5-fluorouracil (IFN-alpha2a/IL-2/5-FU) demonstrated objective remission rates, surpassing the results obtained with the administration of single immunotherapeutic agents. Despite the data from a recently published study, the role of these two therapy combinations did not seem clearly defined. Therefore, we compared the impact of IFN-alpha2a/VBL and IFN-alpha2a/IL-2/5-FU on remission and survival as well as the safety profile in a retrospective study in patients with metastatic RCC. In a retrospective single-center study, 105 patients with metastatic RCC having received treatment between 1992 and 2002 with either s.c. IFN-alpha2a/ i.v. VBL ( n=70, group 1) or s.c. IFN-alpha2a/ s.c. IL-2/ i.v. 5-FU ( n=35, group 2) were evaluated. At a median follow-up of 17 months, remission and survival rates as well as the toxicity profiles of the respective groups were documented and compared. The median age throughout the entire patient population was 61 years. Patients in the IFN-alpha2a/VBL group reached a median overall survival of 20 months compared to 17 months for the patients in the IFN-alpha2a/IL-2/5-FU population ( p=0.850). The objective response rate in the first patient group reached 25.7%, whereas the tumor remission rate of group 2 amounted to 22.9% ( p=0.680). Patients showing an objective response reached a significantly higher survival rate than patients without response reaction (median survival was 36 vs 10 months, p=0.0001). The incidence of each therapy-induced adverse event was higher throughout the second treatment group. These differences were significant with respect to flu-like symptoms (85.7 vs 57.1%, p=0.003), grade 3/4 elevations of liver enzymes (14.3 vs 1.4%, p=0.007), nausea/vomiting (74.3 vs 50%, p=0.017), the severity of erythemas (74.3 vs 10%, p<0.001), and patients with lung edema (17.1 vs 2.9%, p=0.009). Eight patients discontinued the ICT, two of whom died of a myocardial infarction.Despite an overall limited prognosis, patients showing a tumor remission seem to benefit from ICT in terms of overall survival. While both treatment options offer comparable remission and survival rates, the IFN-alpha2a/VBL regimen induces fewer adverse events than the treatment with IFN-alpha2a/IL-2/5-FU.

Adult↗
PubMed2004

[Liposarcoma of the spermatic cord--report of one new case and review of the literature].

Liposarcoma of the spermatic cord is a rare entity. Although most liposarcomas of the spermatic cord are well-differentiated, the propensity for local recurrence is high. Preferential treatment of spermatic cord liposarcoma is radical orchiectomy with high ligation of the cord. Radiation therapy is recommended in addition to surgery in cases with evidence of more aggressive tumour behavior (i.e., high-grade tumour, lymphatic invasion, inadequate margin, or recurrence). A 39-year-old-male presented with a 4-year history of a mass in the left scrotum. Radical orchiectomy was performed. Pathological analysis demonstrated a well-differentiated liposarcoma with tumour detection in the surgical margin. In view of the incomplete surgical removal of the tumour a retroperitoneal reoperation of the testicular vessels and vas deferent with R0-resection was conducted. Without any postoperative adjuvant therapy in evidence of recurrence or metastasis was noted during the 12-month follow-up period. The current literature on management of malignant tumours of the spermatic cord is reviewed. Paratesticular liposarcomas are most commonly well-differentiated and lipoma-like and have a prolonged clinical course. Radical orchiectomy with wide local excision of the mass is the recommended therapy, while adjuvant radiotherapy may be considered in high-grade tumours and in recurrent liposarcomas. Retroperitoneal lymphadenectomy does not offer any additional therapeutic benefit, and the role of chemotherapy is not well defined. Regardless of initial therapy, the risk of local recurrence always necessitates long-term followup.

Adult↗
PubMed2004

[An unusual complication of extracorporeal shock wave lithotripsy: rupture of the kidney with consecutive nephrectomy].

INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) plays a major role in the treatment of urolithiasis. It has a high success rate, and spectrum and incidence of treatment-related morbidity are low. CASE REPORT: A 66-year-old male patient underwent ESWL treatment for an 8 mm medium-sized stone in the left kidney. During the subsequent post-interventional phase he experienced persistent flank pain, macrohematuria and protracted hemodynamic instability. An acute CT scan displayed a massive kidney rupture. Emergency lumbar exploration of the left kidney revealed multiple lacerations in the renal parenchyma and a nephrectomy was carried out. CONCLUSION: This is the second internationally reported case study in which nephrectomy was necessitated after ESWL treatment due to multiple ruptures of the kidney. In view of the increasing use of ESWL in outpatient care, it is important that this potential complication is recognized and its clinical aspects appropriately assessed. The conclusion of the report comprises a concise review of the most severe complications in the immediate period after ESWL.

Aged↗
PubMed2004

Significance of the time period between diagnosis of muscle invasion and radical cystectomy with regard to the prognosis of transitional cell carcinoma of the urothelium in the bladder.

OBJECTIVE: Standard treatment of muscle-infiltrated transitional cell carcinoma (TCC) of the urothelium consists of radical cystectomy. In some cases there is a delay between the initial diagnosis and a definitive treatment being administered. The objective of this study was to determine the effect of the time window between evidence of muscle invasion and radical cystectomy on the pathological stage and progression-free survival. MATERIAL AND METHODS: Between February 1992 and August 2002, 239 radical cystectomies were carried out as a result of TCC of the bladder. In a total of 189 patients (79%), cystectomy was carried out due to muscle-infiltrated TCC with no evidence of distant metastases (>/=T2, M0). The time between the diagnosis of muscle invasion and cystectomy was determined for all of these patients, who were then divided into two groups on the basis of a 3-month cut-off period. Univariate and multivariate analyses were used to determine the effect of the time period on clinical factors and progression-free survival. RESULTS: The average age of the patients was 63 (range 35-80) years. A median follow-up of 40 months showed a progression-free survival rate of 49% after 5 years. The average time between the diagnosis of muscle invasion and cystectomy was 1.8 (0.3-12.1) months. For a time window of >3 months, 30/42 patients (72%) showed signs of extravesical tumor growth and/or tumor-positive lymph nodes, compared to 89/147 patients (60%) (p = 0.198) for a time window of </=3 months. In terms of the distribution of tumor stages according to the time groups, there were significantly more pT4 stage tumors in patients with delayed cystectomy (p = 0.009). Patients with a time interval of </=3 months between diagnosis of muscle invasion and cystectomy had a significantly better progression-free survival rate (55%) than those with a longer time window (34%) (p = 0.04). In contrast to lymph node status, clinical stage, pathological tumor stage and differentiation level, the prognostic relevance of the time window fell just short of the significance level in Cox's multivariate regression analysis (p = 0.057). Lymph node status (p < 0.001) and pathological tumor stage (p = 0.05) were the only independent prognostic parameters which could be used to predict progression-free survival. CONCLUSION: Patients with a time window of >3 months between diagnosis of muscle invasion and radical cystectomy were associated with an advanced pathological stage and a poorer progression-free survival. These results underline the need for early cystectomy within the 3-month period between diagnosis of muscle invasion and cystectomy.

Adult↗
PubMed2004

Apoptosis and proliferation in lungs of human fetuses exposed to chorioamnionitis.

AIMS: To determine whether chorioamnionitis has an impact on the extent of apoptosis and proliferation in fetal lungs. Fetuses exposed to chorioamnionitis have an increased risk of aquiring lung tissue damage in utero. METHODS AND RESULTS: Lung tissue sections from 35 stillborn fetuses were used in this study. Chorioamnionitis-exposed fetuses were subdivided depending on whether pneumonia was diagnosed (n = 13) or not (n = 10); 12 unaffected fetuses served as controls. Apoptotic and proliferating cells were determined by in-situ terminal deoxytransferase-mediated dUTP nick end labelling (TUNEL) assay and by anti-Ki67 immunohistochemistry, and quantified. The median apoptotic index in lungs of chorioamnionitis-exposed fetuses increased 2.4-fold compared with chorioamnionitis-negative stillborn controls (P = 0.043) and rose 21.6-fold when chorioamnionitis-exposed fetuses additionally developed pneumonia (P < 0.001). Compared with the proliferation index of the control group (PI = 2.3), the median percentage of proliferating cells in the lungs of chorioamnionitis-exposed fetuses decreased (PI = 1.4) (P = 0.036), but increased 1.8-fold (P = 0.036) in fetal lungs of the chorioamnionitis/pneumonia group. By double labellings combining the TUNEL assay or the Ki67 antigen with cell marker proteins, we identified distal airway epithelial cells as the cell type undergoing apoptosis in chorioamnionitis-exposed fetal lungs, while epithelial, endothelial and smooth muscle cells proliferated. Immunolabellings of cleaved caspases -8 and -9 revealed that apoptosis is mediated via initiator caspase-8. CONCLUSION: Chorioamnionitis induces apoptosis of distal airway epithelial cells via the caspase-8 pathway and interferes with the normal proliferative activity of epithelial, endothelial, and smooth muscle cells in fetal lungs. Thus, apoptosis and proliferation are an important feature of chorioamnionitis-associated lung injury in utero.

Antigens, CD34↗
PubMed2004

Neural correlates of first-person perspective as one constituent of human self-consciousness.

Taking the first-person perspective (1PP) centered upon one's own body as opposed to the third-person perspective (3PP), which enables us to take the viewpoint of someone else, is constitutive for human self-consciousness. At the underlying representational or cognitive level, these operations are processed in an egocentric reference frame, where locations are represented centered around another person's (3PP) or one's own perspective (1PP). To study 3PP and 1PP, both operating in egocentric frames, a virtual scene with an avatar and red balls in a room was presented from different camera viewpoints to normal volunteers (n = 11) in a functional magnetic resonance imaging experiment. The task for the subjects was to count the objects as seen either from the avatar's perspective (3PP) or one's own perspective (1PP). The scene was presented either from a ground view (GV ) or an aerial view (AV ) to investigate the effect of view on perspective taking. The factors perspective (3PP vs. 1PP) and view (GV vs. AV ) were arranged in a two-factorial way. Reaction times were increased and percent correctness scores were decreased in 3PP as opposed to 1PP. To detect the neural mechanisms associated with perspective taking, functional magnetic resonance imaging was employed. Data were analyzed using SPM'99 in each subject and non-parametric statistics on the group level. Activations common to 3PP and 1PP (relative to baseline) were observed in a network of occipital, parietal, and prefrontal areas. Deactivations common to 3PP and 1PP (relative to baseline) were observed predominantly in mesial (i.e., parasagittal) cortical and lateral superior temporal areas bilaterally. Differential increases of neural activity were found in mesial superior parietal and right premotor cortex during 3PP (relative to 1PP), whereas differential increases during 1PP (relative to 3PP) were found in mesial prefrontal cortex, posterior cingulate cortex, and superior temporal cortex bilaterally. The data suggest that in addition to joint neural mechanisms, for example, due to visuospatial processing and decision making, 3PP and 1PP rely on differential neural processes. Mesial cortical areas are involved in decisional processes when the spatial task is solved from one's own viewpoint, whereas egocentric operations from another person's perspective differentially draw upon cortical areas known to be involved in spatial cognition.

Adult↗
PubMed2004

Apoptosis and proliferation in lungs of ventilated and oxygen-treated preterm infants.

Apoptosis and proliferation and the effect of exogenous surfactant on these processes were investigated in the lungs of mechanically ventilated/oxygen-treated preterm infants with respiratory distress syndrome and stillborn foetuses. Apoptotic and proliferation indices were determined in lung tissue sections from 27 ventilated/oxygen-treated preterm infants and 29 stillborn foetuses. The effect of exogenous surfactant on apoptosis and proliferation was studied in 16 ventilated preterm infants; 11 untreated infants served as control. Apoptotic and proliferating cells were identified by double labelling combining terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate nick end-labelling or Ki-67 with cell marker proteins. Pathways to cell death were explored by immunolabelling of cleaved caspases-3, -8 and -9. In the lungs of ventilated/oxygen-treated preterm infants, the numbers of apoptotic and proliferating cells increased significantly compared to the respective numbers in the lungs of stillborn foetuses. Apoptosis was detected in alveolar epithelial cells, whereas epithelial, endothelial and smooth muscle cells proliferated. Surfactant treatment reduced apoptosis induced by ventilation/oxygen-treatment; however, the decrease was not significant. Caspases-8 and -9 do not contribute to ventilation-induced apoptosis, whereas caspase-3 is involved. In conclusion, ventilation/oxygen-treatment induces epithelial cell apoptosis and proliferation of epithelial, endothelial and smooth muscle cells in the lungs of preterm infants.

Apoptosis↗
PubMed2004

Anatomically adapted, HA coated SBG stem--ten years of successful implantation.

For stable implantation of anatomically conforming femur prostheses, modifications that accommodate curving and torsion are necessary. In accordance to this concept, the anatomically shaped SBG stem has been developed. The first consecutive implantations were evaluated. 194 primary arthroplasties with uncemented anatomical, HA coated SBG stems were performed. Mean patient age was 61 years. 143 patients with 151 (78%) SBG stems were followed-up clinically and radiologically after an average of 10 (9-11) years. So far, only one implant had to be revised. Survivorship with revision of the femoral component is 99.5% at ten years. The mean postoperative Harris Hip Score was 92. Patients over 75 years had a score of 89; younger patients under 40 years scored 94. Sclerotic lines were seen in zone I or VII in 8%. Minor femoral remodeling (Type 1) occurred proximally in 75%. Minor thickening of the femur at the level of the tip of the prosthesis could be observed in 27% of the cases. There is no correlation between compacta thickening and clinical symptoms (p=0.15). The anatomical shape, the oval diameter and the longitudinal grooves secure stable primary fixation. Together with the HA coating, which enhances osseointegration, the SBG stem has a high success rate in the medium and long term.

Adolescent↗
PubMed2003

Prognostic importance of initial response in HIV-1 infected patients starting potent antiretroviral therapy: analysis of prospective studies.

BACKGROUND: We examined whether the initial virological and immunological response to highly active antiretroviral treatment (HAART) is prognostic in patients with HIV-1 who start HAART. METHODS: We analysed 13 cohort studies from Europe and North America including 9323 adult treatment-naive patients who were starting HAART with a combination of at least three drugs. We modelled clinical progression from month 6 after starting HAART, taking into account CD4 count and HIV-1 RNA measured at baseline and 6 months. FINDINGS: During 13408 years of follow-up 152 patients died and 874 developed AIDS or died. Compared with patients who had a 6-month CD4 count of fewer than 25 cells/microL, adjusted hazard ratios for AIDS or death were 0.55 (95%CI 0.32-0.96) for 25-49 cells/microL, 0.62 (0.40-0.96) for 50-99 cells/microL, 0.42 (0.28-0.64) for 100-199 cells/microL, 0.25 (0.16-0.38) for 200-349 cells/microL, and 0.18 (0.11-0.29) for 350 or more cells/microL at 6 months. Compared with patients who had a 6-month HIV-1 RNA of 100000 copies/mL or greater, adjusted hazard ratios for AIDS or death were 0.59 (0.41-0.86) for 10000-99999 copies/mL, 0.42 (0.29-0.61) for 500-9999 copies/mL, and 0.29 (0.21-0.39) for 6-month HIV-1 RNA of 500 copies/mL or fewer. Baseline CD4 and HIV-1 RNA were not associated with progression after controlling for 6-month concentrations. The probability of progression at 3 years ranged from 2.4% in the patients in the lowest-risk stratum to 83% in patients in the highest-risk stratum. INTERPRETATION: At 6 months after starting HAART, the current CD4 cell count and viral load, but not values at baseline, are strongly associated with subsequent disease progression. Our findings should inform guidelines on when to modify HAART.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Laboratory simulation of charge exchange-produced X-ray emission from comets.

In laboratory experiments using the engineering spare microcalorimeter detector from the ASTRO-E satellite mission, we recorded the x-ray emission of highly charged ions of carbon, nitrogen, and oxygen, which simulates charge exchange reactions between heavy ions in the solar wind and neutral gases in cometary comae. The spectra are complex and do not readily match predictions. We developed a charge exchange emission model that successfully reproduces the soft x-ray spectrum of comet Linear C/1999 S4, observed with the Chandra X-ray Observatory.

Journal Article↗
PubMed2003

[Outlet of a megaureter with aplastic kidney into a seminal vesicle cyst. Case report of laparoscopic intervention].

Unilateral cyst of the seminal vesicle, ipsilateral ectopic ureter, and ipsilateral renal aplasia are the components of a rare congenital abnormality affecting the male urogenital tract. The clinical picture is characterized by a retrovesical cystic tumor, which may cause nonspecific symptoms. Differential diagnosis includes cysts of the müllerian duct, the urogenital sinus/ejaculatory duct, and the prostate. We report a case of a left seminal vesicle cyst associated with aplasia of the left kidney in a 14-year-old boy. Preoperatively, an ipsilateral renal agenesis was suspected, but a renal aplasia with an ectopic urinary megaureter into the seminal vesicle was found intraoperatively. An 8-cm cystic left seminal vesicle and an ipsilateral renal aplasia was successfully removed by operative laparoscopy. The advantages of the laparoscopic approach over open surgery include excellent exposure of the deep pelvic structures, a short hospitalization, and a rapid recovery for the patient. We searched the literature to review the clinical presentation, diagnostic procedures, differential diagnosis, and therapeutic treatment options for this anomaly.

Adolescent↗
PubMed2003

[Angiomyolipoma of the kidneys as a rare cause of retroperitoneal hemorrhage. Two case reports with tuberous sclerosis Bourneville-Pringle].

Tuberous sclerosis (Bourneville-Pringle-disease, TSC) is an autosomal dominant disorder characterized by seizures, mental retardation and hamartomatous tumours in multiple organs, including subependymal giant cell astrocytomas, cardiac rhabdomyomas and renal angiomyolipomas. Recent population-based studies suggest a prevalence of 1 case per 25,000 individuals. Renal angiomyolipomas, which may be found sporadically or associated with TSC, become evident as an acute retroperitoneal haemorrhage or by symptoms of a flank mass. Ultrasound and computed tomography provide clear evidence of lipomatous formation while, in rare instances, angiography can demonstrate the existence of multiple vascular tumour compartments. In view of two cases which were admitted with the clinical picture of an acute abdomen on the basis of retroperitoneal haemorrhage, the therapeutic strategies for TSC patients with renal angiomyolipomas are discussed, paying regard to the literature in this field.

Abdomen, Acute↗
PubMed2003

[Solitary renal cell carcinoma metastasis to the thyroid gland--a paradigm of metastasectomy?].

We investigated the usefulness of thyroidectomy for solitary metastases from renal cell carcinomas in ten patients. In the absence of postoperative morbidity and mortality, a mean survival time of 3.4 years was observed. Subsequently, four patients developed intracerebral metastases. Swelling of the neck and the discovery of a nodule in the thyroid of patients who have undergone nephrectomy for renal cell carcinoma should raise suspicion of a metastasis, possibly after a long latency period. With the aid of modern immunohistochemical methods, renal cell carcinoma metastasis can now be identified unequivocally, with differentiation from a primary follicular carcinoma of the thyroid rendered possible by a combination of TTF-1, thyroglobulin, and CD 10. In the event of a solitary lesion with no extrathyroidal tumour manifestation, an R0 resection of the metastasis should always be attempted. If tumour dissemination has occurred, palliative measures and endoscopic intervention (e.g. placement of an endotracheal stent) with the aim of improving quality of life by preventing obstruction of the airways are justified.

Adenocarcinoma, Follicular↗
PubMed2003

[Superior vena cava syndrome with bilateral jugular and subclavian vein thrombosis. Paraneoplastic manifestion of renal cell carcinoma].

At present thrombosis of the superior vena cava is an uncommon event that is now more frequently associated with diagnostic or therapeutic catheterization. If an apparent spontaneous thrombosis occurs, malignancy should be considered in the differential diagnosis. One case of clinically symptomatic thrombosis of the internal jugular, subclavian, and superior vena cava is presented. We detected an asymptomatic left renal cell carcinoma in a 54-year-old patient and nephrectomy was performed. Increased blood coagulability as part of a paraneoplastic syndrome was considered to be the possible etiology. In patients with otherwise unexplained superior vena cava thrombosis, examination not only of the head and neck but also of the abdomen, retroperitoneum, and pelvis should be pursued. A review of the literature pertinent to this rare case is provided.

Carcinoma, Renal Cell↗
PubMed2003

[Bilateral testicular masses in the scope of adrenogenital syndrome].

Testicular masses in male individuals with the adrenogenital syndrome (AGS) are a clinical and pathological diagnostic dilemma. The major differential diagnosis of gonadal nodules in this setting includes interstitial Leydig cell tumors and secondary benign tumors possibly of adrenal origin. We report a case of adrenogenital syndrome occurring in a 14-year-old boy. Examinations to clarify the cause of his dwarfism and bilateral testicular masses revealed 21-hydroxylase deficiency. The testes were not tender and were firm and nodular on palpation. The serum levels of adrenocorticotrophic hormone (ACTH), 17 alpha-hydroxyprogesterone (17-alpha-OHP), testosterone, and aldosterone were found to be elevated. Under corticosteroid therapy the serum marker abnormalities were corrected and there was gradual regression of the tumor lesions in both testes. Testicular tumors with adrenogenital syndrome are typically bilateral and develop in untreated or inadequately treated males with AGS.

Adolescent↗
PubMed2002

Hypernuclear fine structure in (9)(lambda)Be.

With a germanium detector array (Hyperball), we observed two gamma-ray peaks corresponding to the two transitions (5/2(+)-->1/2(+) and 3/2(+)-->1/2(+)) in the (9)(Lambda)Be hypernucleus which was produced by the 9Be(K-,pi(-)) reaction. The energies of the gamma rays are 3029 +/- 2 +/- 1 keV and 3060 +/- 2 +/- 1 keV. The energy difference was measured to be 31.4(+2.5)(-3.6) keV, which indicates a very small Lambda-spin-dependent spin-orbit force between a Lambda and a nucleon. This is the smallest level splitting by far ever measured in a hypernucleus.

Journal Article↗
PubMed2002

Concentrations of proinsulin like molecules predict coronary heart disease risk independently of insulin: prospective data from the Caerphilly Study.

AIMS/HYPOTHESIS: Higher concentrations of insulin correlate with several coronary heart disease (CHD) risk factors and have been shown to predict incident CHD in several studies, leading to hypotheses concerning the proatherogenic properties of insulin. However, in cross-sectional studies, relationships of concentrations of the insulin precursor molecules, proinsulin and des 31, 32 proinsulin, relate as strongly, or more strongly, to levels of risk factors and to (prevalent) CHD. METHODS: We investigated the relationship between concentrations of insulin, measured with a specific assay, and of proinsulin-like molecules, and risk factors in 1181 non-diabetic men 50-64 years old during Phase II of the Caerphilly Study. We also related concentrations of these molecules to incident CHD during the 10-14 years follow-up. RESULTS: The relationship between concentrations of insulin, of proinsulin and of des 31, 32 proinsulin and BMI ( r = 0.36-0.45), triglyceride (r = 0.25-0.31), high density lipoprotein- (HDL-) cholesterol (r = -0.17 to -0.21), systolic ( r = 0.05-0.11) and diastolic blood pressure ( r = 0.11-0.15) were similarly close, those with risk factors being somewhat and similarly reduced after adjustment for BMI. The correlation between insulin and of proinsulin-like molecules and those plasminogen activator inhibitor-1 (PAI-1) antigen was also similar (r = 0.28-0.29). There was a negative correlation between concentrations of proinsulin-like molecules - but not insulin - and birth weight. Insulin concentrations correlated positively with height ( r = 0.12). In logistic regression models, concentrations of proinsulin-like molecules, but not insulin, predicted incident of CHD over a follow-up of 10-14 years (insulin - standardised odds ratio (SOR) 1.30 (95 %-CI) 0.91, 1.85), p = 0.15; des 31, 32 proinsulin - SOR 1.38 (95 %-CI 1.02, 1.85), p = 0.034; sum of proinsulin-like molecules - SOR 1.54 (95 %-CI 1.07, 2.20), p = 0.019 after adjusting for age and BMI. The predictive ability of these molecules was reduced by around one third after adjustment for standard risk factors and concentrations of tryglyceride and HDL-cholesterol, and by about half after further adjustment for PAI-1 concentrations. CONCLUSION/INTERPRETATION: We conclude that concentrations of proinsulin-like molecules provide a better way to predict the incidence of CHD than those of insulin. However, the lack of biological evidence for a causative relationship suggests an association through a common antecedent, and this antecedent is not likely to be intrauterine growth retardation.

Biomarkers↗