Evidence-based emergency medicine. The use of low-molecular-weight heparins in acute coronary syndromes.
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Comment↗
Biomedical subjects
Michael D Brown
Publications and source records attributed to Michael D Brown.
Differential inhibition of invasion and proliferation by bisphosphonates: anti-metastatic potential of Zoledronic acid in prostate cancer.
OBJECTIVES: To determine the mode of action of Zoledronic acid in the inhibition of metastasis in prostate cancer and the reduction of prostate cancer bone metastases. METHODS: Benign and malignant primary prostatic epithelial cells (PEC) and the PC-3 prostate cancer cell line were studied in co-culture using human bone marrow stroma in the presence of escalating doses of EDTA, Clodronate, Pamidronate and Zoledronic acid. PEC binding and colony growth in bone marrow stroma was measured using standardised quantitative techniques. PEC cellular invasion through Matrigel and an endothelial monolayer was measured either in invasion chambers or by the measurement of endothelial monolayer permeability to fluorescent dextran. Co-culture supernatants were assayed for specific cytokine levels. Bone marrow cellular toxicity was assessed using a standard Mix assay. RESULTS: Treatment of PEC with up to 100 microM bisphosphonate did not affect their ability to bind to bone marrow endothelium or stroma. Bone marrow endothelial permeability was reduced by 100 microM Zoledronic acid by 3.8% (p = 0.03856). Both Pamidronate (40% at 100 microM, p < or = 0.05) and Zoledronic acid inhibited PEC invasion, with Zoledronic acid being the most potent (40% at 10 microM, p < or = 0.05 rising to 91% at 100 microM, p < or = 0.001). Zoledronic acid inhibits malignant PEC proliferation in bone marrow stroma co-culture (26.5% at 10 microM rising to 66.5% at 40 microM). This was accompanied by changes within the cytokine milieu with a >800% rise in TIMP-2. CONCLUSION: Zoledronic acid is a potent inhibitor of PEC invasion across bone marrow endothelium and colony formation with the bone marrow stroma, affecting the MMP: TIMP-2 balance to favour MMP inhibition.
Antineoplastic Agents↗
Plasma nitrate/nitrite response to an oral glucose load and the effect of endurance training.
To assess the role of circulating nitric oxide (NO) production in glucose homeostasis, plasma nitrate/nitrite (NO(x)) was assessed during oral glucose tolerance tests (OGTTs) on 64 sedentary subjects and in a subset 40 subjects before and after 6 months of endurance exercise training. NO(x) decreased with the oral glucose load (P </=.001 for linear and quadratic effects). OGTT NO(x) response indices (NO(x) response area (NO(x) AREA), change in NO(x) from baseline to the minimum (DeltaNO(x)), and NO(x) time-to-minimum) were not associated with OGTT insulin or glucose areas under the curve (AUCs) or with insulin sensitivity index (ISI). Training did not alter NO(x) AREA, or DeltaNO(x), however, NO(x) time-to-minimum occurred later after training (P =.038). Training-induced insulin AUC and ISI changes were not associated with OGTT NO(x) index changes; however, glucose total AUC changes were associated with changes in NO(x) AREA (r =.42, P =.007) and DeltaNO(x) (r =.37, P =.019). In conclusion, these data suggest that circulating NO production is not involved in glycemic control after an oral glucose load in sedentary adults. In response to endurance training, however, it appears that the time required to reach minimum NO(x) levels after a glucose load is greater after training. Furthermore, although the magnitude of NO(x) response (as indicated by NO(x) AREA and DeltaNO(x)) to an oral glucose load does not appear to change with training for all individuals, individual training-induced changes in the NO(x) response magnitude are partly explained by training-induced changes in OGTT glucose responses.
Administration, Oral↗
The molecular staging of prostate cancer.
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Biopsy↗
Beta2- and beta3-adrenergic receptor polymorphisms and exercise hemodynamics in postmenopausal women.
We sought to determine whether common genetic variations at the beta2 (beta2-AR, Gln27Glu) and beta3 (beta3-AR, Trp64Arg) adrenergic receptor gene loci were associated with cardiovascular (CV) hemodynamics during maximal and submaximal exercise. CV hemodynamics were assessed in 62 healthy postmenopausal women (20 sedentary, 22 physically active, and 20 endurance athletes) during treadmill exercise at 40, 60, 80, and 100% maximal O2 uptake using acetylene rebreathing to quantify cardiac output. The beta2-AR genotype and habitual physical activity (PA) levels interacted to significantly associate with arteriovenous O2 difference (a-vDO2) during submaximal exercise (P = 0.05), with the highest submaximal exercise a-vDO2 in sedentary women homozygous for the beta2-AR Gln allele and no genotype-dependent differences in submaximal exercise a-vDO2 in physically active and athletic women. The beta2-AR genotype also was independently associated with a-vDO2 during submaximal (P = 0.004) and approximately 100% maximal O2 uptake exercise (P = 0.006), with a 1.2-2 ml/100 ml greater a-vDO2 in the Gln/Gln than in the Glu/Glu genotype women. The beta3-AR genotype, independently or interacting with habitual PA levels, was not significantly associated with any CV hemodynamic variables during submaximal or maximal exercise. Thus it appears that the beta2-AR genotype, both independently and interacting with habitual PA levels, is significantly associated with a-vDO2 during exercise in postmenopausal women, whereas the beta3-AR genotype does not appear to be associated with any maximal or submaximal exercise CV hemodynamic responses in postmenopausal women.
Aged↗
Laboratory evaluation of the predation efficacy of native Australian fish on Culex annulirostris (Diptera: Culicidae).
The introduction and establishment of fish populations can provide long-term, cost-effective mosquito control in habitats such as constructed wetlands and ornamental lakes. The predation efficacy of 7 native Brisbane freshwater fish on 1st and 4th instars of the freshwater arbovirus vector Culex annulirostris was evaluated in a series of 24-h laboratory trials. The trials were conducted in 30-liter plastic carboys at 25+/-1 degrees C under a light:dark cycle of 14:10 h. The predation efficacy of native crimson-spotted rainbowfish Melanotaenia duboulayi (Melanotaeniidae), Australian smelt Retropinna semoni (Retropinnadae), Pacific blue-eye Pseudomugil signifer (Atherinidae), fly-specked hardyhead Craterocephalus stercusmuscarum (Atherinidae), firetail gudgeon Hypseleotris galii (Eleotridae), empire gudgeon Hypseleotris compressa (Eleotridae), and estuary perchlet Ambassis marianus (Ambassidae) was compared with the exotic eastern mosquitofish Gambusia holbrooki (Poeciliidae). This environmentally damaging exotic has been disseminated worldwide and has been declared noxious in Queensland. Melanotaenia duboulayi was found to consume the greatest numbers of both 1st and 4th instars of Cx. annulirostris. The predation efficacy of the remaining Australian native species was comparable with that of the exotic G. holbrooki. With the exception of A. marianus, the maximum predation rates of these native species were not statistically different whether tested individually or in a school of 6. Based on these data, M. duboulayi, H. compressa, and A. marianus warrant further investigation as biological control agents in pilot field trials.
Animals↗
Sequence variation in hypoxia-inducible factor 1alpha (HIF1A): association with maximal oxygen consumption.
Hypoxia-inducible factor 1 (HIF1) is a DNA transcription factor composed of two subunits, one of which is regulated by hypoxia (HIF1alpha, encoded by HIF1A). Genes regulated by HIF1 are involved in the processes of angiogenesis, erythropoiesis, and metabolism, making HIF1A a candidate gene in establishing maximal oxygen consumption (VO2 max) before and after aerobic exercise training. The purpose of the present study was to screen HIF1A for sequence variation and determine whether such variation is associated with VO2 max before and after aerobic exercise training. A total of 233 Caucasian and African-American subjects were available for screening of HIF1A and determination of allele frequencies, with 155 of those subjects used to study VO2 max in relation to identified variants. We measured VO2 max before and after 24 wk of aerobic exercise training. Screening revealed several rare and common polymorphisms in HIF1A with race-specific allele frequencies. African Americans with AT or TT genotype at the A-2500T locus exhibited significantly lower baseline VO2 max compared with those of AA genotype (21.9 +/- 0.99 vs. 25.1 +/- 1.0, P = 0.03). An age by P582S (C/T) genotype interaction was observed in Caucasian subjects, such that those of CT or TT genotype exhibited significantly lower change in VO2 max after training than those of CC genotype when compared at ages 65 and 60 yr, but not at age 55 yr. No other significant differences were noted among genotype groups at the A-2500T, P582S, or T+140C sites. Based on these findings, we conclude that HIF1A sequence variation is associated with VO2 max before and after aerobic exercise training in older humans.
Aging↗
Structuring a buy-in that works.
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Contracts↗
Novel method for the isolation and characterisation of the putative prostatic stem cell.
BACKGROUND: Prostate stem cells, responsible for the development, maturation, and function of the prostate, have been implicated in the aetiology of both benign prostate hyperplasia (BPH) and prostate cancer (CaP). However, research has been hampered by the lack of a definitive stem cell marker. We have adapted the protocol for differential Hoechst 33342 uptake by hemopoietic stem cells to enable isolation of putative stem cells from the prostate. METHODS: Prostate epithelial cells isolated from prostate tissue obtained from patients with BPH after transurethral resection of the prostate were stained with Hoechst 33342. The Hoechst 33342 Red/Blue flow cytometry profile was then determined. Hoechst 33342 and Pyronin Y staining was used to determined the cell cycle status. RESULTS: A verapamil-sensitive side population (SP) can be isolated from primary prostate tissue accounting for 1.38% +/- 0.07% of prostate epithelial cells. Cell cycle analysis of this SP population revealed that the majority of SP cells are in either G0 (12.38 +/- 0.31%) or G1 (63.19 +/- 2.13%). CONCLUSIONS: The Hoechst 33342 dye efflux protocol can be adapted for the isolation of a SP from primary prostate tissue.
Benzimidazoles↗
Evidence-based emergency medicine/skills for evidence-based emergency care. Interval likelihood ratios: another advantage for the evidence-based diagnostician.
Emergency physicians are often confronted with making diagnostic decisions on the basis of a test result represented on a continuous scale. When the results of continuous data are expressed as binary outcomes using a single cutoff, loss of information and distortion may occur. In this setting, interval likelihood ratios provide a distinct advantage in interpretation over those based on a dichotomized sensitivity and specificity. Dividing the data into intervals uses more of the information contained in the data and allows the clinician to more appropriately interpret the test results and to make valid clinical decisions. This article illustrates the advantages of interval likelihood ratios with examples and demonstrates how to calculate them on the basis of different data formats. Authors and journals need to be encouraged to report the results of studies of performance of diagnostic tests using interval ranges rather than simple dichotomization when the tests involve continuous variables.
Confidence Intervals↗
Efficacy of VectoBac (Bacillus thuringiensis variety israelensis) formulations for mosquito control in Australia.
Laboratory bioassays were conducted on the efficacy of a water-dispersible granule (WG) formulation of Bacillus thuringiensis variety israelensis (VectoBac WG; active ingredient [AI]: 3,000 Bti international toxic units [ITU]/mg) against third instars of six common Australian mosquito species, Aedes aegypti (L.), Ochlerotatus vigilax (Skuse), Ochlerotatus notoscriptus (Skuse), Culex sitiens Wiedemann, Culex annulirostris Skuse, and Culex quinquefasciatus Say. The normal model for log-linear mortality data was used to determine laboratory 48-h LC50 and LC95 values. The target mosquito species tested were extremely sensitive to the VectoBac WG formulation, with the most sensitive species (Cx. annulirostris and Cx. quinquefasciatus, LC95 value of 0.019 ppm) being twice as susceptible as the most tolerant (Oc. notoscriptus, LC95 value of 0.037 ppm). Cx. annulirostris was selected as a target species for a small-plot evaluation of VectoBac WG and VectoBac 12 aqueous solution (AS) ([AI]: 1,200 Bti ITU/mg) efficacy over time, in freshwater in southeastern Queensland, Australia. Replicated cohorts of caged third instars were exposed weekly to six concentrations of WG formulation (0.004-0.13 ppm) and three concentrations of the 12AS formulation (0.04-0.13 ppm). In water with high organic content, treatment concentrations of 0.008 ppm WG and 0.04 ppm 12AS and above produced significant larval control (> or = 96%) at 48 h posttreatment, with no residual control at week 1. Water quality was not affected by treatment with either formulation.
Aedes↗
eNOS T-786C genotype, physical activity, and peak forearm blood flow in females.
BACKGROUND: The purpose of the present study was to determine interactive and main effects of the eNOS T-786C gene polymorphism and habitual physical activity level on forearm vascular resistance (FVR) and forearm blood flow (FBF) at rest and during 3 min of reactive hyperemia. METHODS: We studied healthy, Caucasian (age 25 +/- 1 yr), sedentary (maximal oxygen consumption, [OV0312]O2max: 33.8 +/- 1 mL x kg(-1)x min(-1)), and endurance-trained ([OV0312]O2max: 45.3 +/- 1 mL x kg(-1)x min(-1)) women. FBF was measured using venous occlusion plethysmography before (resting) and after 5 min of arm arterial occlusion at 1 (peak vasodilation), 2, and 3 min of reactive hyperemia. [OV0312]O2max was measured using a standard treadmill protocol, and skinfolds were measured to estimate body composition. RESULTS: There was a significant interaction between eNOS genotype and physical activity level on resting FVR (P = 0.0003). Sedentary subjects with the TT genotype had the lowest resting FVR, but among the endurance-trained group, the TC+CC genotype group had the lowest resting FVR. This interaction was reflected in the resting FBF values (P = 0.03). After accounting for important covariates, there was a main effect of eNOS genotype on peak FBF (TT, 7.0 +/- 0.3 vs TC+CC, 5.9 +/- 0.4 mL x 100 mL(-1) FAV x min(-1), P = 0.03) and the percent decrease in FVR (TT, -62 +/- 2 vs TC+CC, -51 +/- 4%, P = 0.04) at minute 1. CONCLUSIONS: These results of the interactive effects suggest that young females possessing a C allele may reduce their resting FVR by improving their cardiovascular fitness level, but TT homozygotes, who may have normal eNOS gene function, may not improve their resting FVR with improvements in cardiovascular fitness. Furthermore, regardless of physical activity level, the TT genotype showed a favorable hemodynamic response during reactive hyperemia compared with the C allele carriers.
Adolescent↗
Turbidimetric D-dimer test in the diagnosis of pulmonary embolism: a metaanalysis.
BACKGROUND: Clinicians in outpatient clinics and emergency departments desire an accurate quantitative D-dimer assay. The study objective was to evaluate the diagnostic performance characteristics of the latex turbidimetric D-dimer test in the diagnosis of pulmonary embolism (PE) in the emergency department population. METHODS: We conducted a search of MEDLINE, EMBASE, and bibliographies of previous systematic reviews with no language restriction. Experts in the field of PE research were contacted to identify unpublished studies. Prospective investigations involving predominately outpatient populations with suspected PE that used a turbidimetric D-dimer test were included. Two authors extracted data independently and assessed study quality based on the composition of the patient spectrum and the reference standard used. Consensus was reached by conference. The analysis was based on a summary ROC curve and combining sensitivity and specificity independently across studies using a random-effects model. RESULTS: The search yielded 264 publications and 2 unpublished studies. Nine studies met the inclusion criteria and provided a sample of 1901 individuals. Eight of the nine studies were homogeneous in terms of both sensitivity and specificity. One study had similar sensitivity but higher specificity. Combining the studies yielded an overall sensitivity of 0.93 (95% confidence interval, 0.89-0.96) and an overall specificity of 0.51 (95% confidence interval, 0.42-0.59). CONCLUSIONS: The turbidimetric D-dimer test is sensitive but nonspecific for the detection of PE in the emergency department setting. D-Dimer tests using latex turbidimetric methods appear to have test characteristics comparable to those for ELISA methods.
Ambulatory Care↗
Natural selection shaped regional mtDNA variation in humans.
Human mtDNA shows striking regional variation, traditionally attributed to genetic drift. However, it is not easy to account for the fact that only two mtDNA lineages (M and N) left Africa to colonize Eurasia and that lineages A, C, D, and G show a 5-fold enrichment from central Asia to Siberia. As an alternative to drift, natural selection might have enriched for certain mtDNA lineages as people migrated north into colder climates. To test this hypothesis we analyzed 104 complete mtDNA sequences from all global regions and lineages. African mtDNA variation did not significantly deviate from the standard neutral model, but European, Asian, and Siberian plus Native American variations did. Analysis of amino acid substitution mutations (nonsynonymous, Ka) versus neutral mutations (synonymous, Ks) (kaks) for all 13 mtDNA protein-coding genes revealed that the ATP6 gene had the highest amino acid sequence variation of any human mtDNA gene, even though ATP6 is one of the more conserved mtDNA proteins. Comparison of the kaks ratios for each mtDNA gene from the tropical, temperate, and arctic zones revealed that ATP6 was highly variable in the mtDNAs from the arctic zone, cytochrome b was particularly variable in the temperate zone, and cytochrome oxidase I was notably more variable in the tropics. Moreover, multiple amino acid changes found in ATP6, cytochrome b, and cytochrome oxidase I appeared to be functionally significant. From these analyses we conclude that selection may have played a role in shaping human regional mtDNA variation and that one of the selective influences was climate.
Africa↗
Tame the accounts receivable beast.
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Accounts Payable and Receivable↗
Exercise-induced changes in insulin action are associated with ACE gene polymorphisms in older adults.
We evaluated the association between insulin resistance and the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) gene polymorphism in a group of older hypertensive subjects (63 +/- 1 yr, n = 35) before and after a 6-mo aerobic exercise program (AEX). Insulin sensitivity index (S(I)), assessed by the frequently sampled intravenous glucose tolerance test, was significantly (P = 0.0001) increased following AEX. In addition, there was a significant (P = 0.001) interaction between AEX and ACE genotype. S(I) increased significantly (P < 0.05) more in those with the II (2.5 +/- 0.8 microU x 10(-4) x min(-1) x ml(-1)) ACE genotype compared with both the DD and ID (0.7 +/- 0.1 and 0.7 +/- 0.2 microU x 10(-4) x min(-1) x ml(-1), respectively) ACE genotypes. Similarly, there was a significant (P = 0.036) decrease in the acute insulin response to glucose (AIR(G)) and a significant (P = 0.05) interaction between AEX and ACE genotype. AIR(G) decreased significantly (P < 0.05) more in those with the II (-17.6 +/- 5.6 mU/ml) ACE genotype compared with both the DD and ID (-1.4 +/- 6.2 and -3.6 +/- 2.5 mU/ml) ACE genotypes. In conclusion, we demonstrated that those older hypertensives with the ACE II genotype have the greatest improvement in insulin action following AEX.
Blood Pressure↗
Fatty acid binding protein-2 gene variants and insulin resistance: gene and gene-environment interaction effects.
The intestinal fatty acid binding protein (FABP2) gene is proposed as a candidate gene for diabetes because the protein it codes is involved in fatty acid (FA) absorption and metabolism and may, therefore, affect insulin sensitivity and glucose metabolism. Numerous studies have assessed FABP2 gene variants and their association with insulin resistance and type 2 diabetes. Some weak evidence indicates that the silent variants and those in the noncoding regions of the gene (codon 118, 3' noncoding region, intron 2 trinucleotide repeat) might be associated with insulin resistance/type 2 diabetes. The most extensively studied variant is the missense Ala54Thr variation, which is common in diverse populations and results in increased FA absorption in vivo. Some evidence indicates that this variant may be associated with insulin sensitivity/type 2 diabetes. However, the large majority of studies assessing the potential association between the Ala54Thr FABP2 variant and insulin resistance/type 2 diabetes did not account for the independent and substantial effects of body composition, habitual physical activity (PA) levels, and diet on insulin resistance. We recently reported that there was an association between Ala54Thr FABP2 genotypes and insulin sensitivity after accounting for the independent effects of body composition and habitual PA levels on insulin sensitivity. Furthermore, others have demonstrated that Ala54Thr FABP2 may associate with insulin sensitivity, but only if individuals are consuming a high-fat diet. These results highlight the importance of including behavioral and environmental factors in the design of studies seeking to assess the impact of genes on physiological and clinical outcome phenotypes.
Amino Acid Substitution↗
Angiotensinogen M235T polymorphism associates with exercise hemodynamics in postmenopausal women.
We sought to determine whether the M235T angiotensinogen (AGT) polymorphism, either interacting with habitual physical activity (PA) levels or independently, was associated with cardiovascular (CV) hemodynamics during maximal and submaximal exercise. Sixty-one healthy postmenopausal women (16 sedentary, 21 physically active, and 24 endurance athletes) had heart rate (HR), blood pressure (BP), cardiac output, stroke volume (SV), total peripheral resistance (TPR), and arteriovenous O2 difference (a-vDO2) assessed during 40, 60, 80, and approximately 100% of VO2 max treadmill exercise. VO2 max did not differ among AGT genotype groups; however, maximal HR was 14 beats/min higher in AGT TT than MM genotype women (P < 0.05). AGT TT genotype women also had 19 beats/min higher HR during approximately 100% VO2 max exercise than AGT MM genotype women (P = 0.008). AGT genotype also interacted with habitual PA levels to associate with systolic BP and a-vDO2 during approximately 100% VO2 max exercise (both P < 0.01). AGT TT genotype women had 11 beats/min higher HR during submaximal exercise than MM genotype women (P < 0.05). AGT genotype interacted with habitual PA levels to associate with systolic BP during submaximal exercise (P = 0.009). AGT genotype, independently or interacting with habitual PA levels, did not associate significantly with diastolic BP, cardiac output, SV, or TPR during maximal or submaximal exercise. Thus this common genetic variant in the renin-angiotensin system appears to associate, both interactively with habitual PA levels and independently, with HR, systolic BP, and a-vDO2 responses to maximal and submaximal exercise in postmenopausal women.
Angiotensinogen↗