Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux

Objectives. To determine the prevalence and distribution of primary venous re truncal saphenous reflux.Design. Prospective cohort study.Patients and methods. One thousand and seven hundred and twelve patients with suspected venous disease were examined by duplex ultrasonography. Seven hundred and thirty-five patients had primary varicose veins with competent saphenous trunks. Limbs With truncal saphenous reflux, deep vein reflux or obstruction, previous injection sclerotherapy or vein surgery, arterial disease and inflammation of non-venous origin were excluded from further consideration. the CEAP classification system was used for clinical staging. Systematic duplex ultrasound examination was undertaken to assess the distribution a incompetent saphenous tributaries.Results. the prevalence of primary reflux with competent saphenous trunks was 43%. Reflux of GSV calf tributaries was the most common. the majority of the limbs (96%) belonged to chronic venous disease classes C1 and C2 of the CEAP classification.Conclusions. Superficial venous reflux causing varicose veins in the presence competent saphenous trunks is very prevalent in this series in contrast to other studies, presumably reflecting differing patient populations. Our data clearly show that varicose veins may occur in any vein and do not depend on truncal saphenous incompetence. Careful duplex ultrasound evaluation allows the pattern of venous reflux to be established in this group of patient ensuring appropriate management of varices.Maringa State Univ, BR-87050610 Maringa, Parana, BrazilUniversidade Federal de São Paulo, Vasc Div, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biostat, São Paulo, BrazilSanto Amaro Univ, São Paulo, BrazilMaringa Reg Hosp, Maringa, Parana, BrazilUniversidade Federal de São Paulo, Vasc Div, Dept Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biostat, São Paulo, BrazilWeb of Scienc

A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease

<p>Abstract</p> <p>Background</p> <p>Weight loss in patients with Alzheimer's disease (AD) is a common clinical manifestation that may have clinical significance.</p> <p>Objectives</p> <p>To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD.</p> <p>Methods</p> <p>A randomized, prospective 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups: Control Group (CG) [n = 27], Education Group (EG) [n = 25], which participated in an education program and Supplementation Group (SG) [n = 26], which received two daily servings of oral nutritional supplementation. Subjects were assessed for anthropometric data (weight, height, BMI, TSF, AC and AMC), biochemical data (total protein, albumin, and total lymphocyte count), CDR (Clinical Dementia Rating), MMSE (Mini-mental state examination), as well as dependence during meals.</p> <p>Results</p> <p>The SG showed a significant improvement in the following anthropometric measurements: weight (H calc = 22.12, p =< 0.001), BMI (H calc = 22.12, p =< 0.001), AC (H calc = 12.99, p =< 0.002), and AMC (H calc = 8.67, p =< 0.013) compared to the CG and EG. BMI of the EG was significantly greater compared to the CG. There were significant changes in total protein (H calc = 6.17, p =< 0.046), and total lymphocyte count in the SG compared to the other groups (H cal = 7.94, p = 0.019).</p> <p>Conclusion</p> <p>Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status.</p

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Hepatic stellate cells:central modulators of hepatic carcinogenesis

Hepatocellular carcinoma (HCC) represents the second most common cause of cancer-related death worldwide, and is increasing in incidence. Currently, our therapeutic repertoire for the treatment of HCC is severely limited, and therefore effective new therapies are urgently required. Recently, there has been increasing interest focusing on the cellular and molecular interactions between cancer cells and their microenvironment. HCC represents a unique opportunity to study the relationship between a diseased stroma and promotion of carcinogenesis, as 90 % of HCCs arise in a cirrhotic liver. Hepatic stellate cells (HSC) are the major source of extracellular proteins during fibrogenesis, and may directly, or via secreted products, contribute to tumour initiation and progression. In this review we explore the complex cellular and molecular interplay between HSC biology and hepatocarcinogenesis. We focus on the molecular mechanisms by which HSC modulate HCC growth, immune cell evasion and angiogenesis. This is followed by a discussion of recent progress in the field in understanding the mechanistic crosstalk between HSC and HCC, and the pathways that are potentially amenable to therapeutic intervention. Furthermore, we summarise the exciting recent developments in strategies to target HSC specifically, and novel techniques to deliver pharmaceutical agents directly to HSC, potentially allowing tailored, cell-specific therapy for HCC

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent boys

Background: the effect of environmental conditions on development, including growth, maturation and the fulfillment of genetic potential, can be identified through the study of the variations found among different ethnic groups in the same population. the objectives of the present study were: (i) to compare the various anthropometric and body composition parameters based on ethnicity and maturation stage in 31 Japanese and 99 Caucasian prepubescent boys and 50 Japanese and 98 Caucasian post-pubescent boys; and (ii) to assess body mass index (BMI) and its relationship with other methods of body fat evaluation.Methods: the percentage of body fat was measured using bioelectrical impedance, near-infrared interactance and Slaughter cutaneous skinfold equations.Results: Weight and height were statistically lower for the Japanese than the Caucasian subjects. There were no differences in body fat between the ethnic groups, but the Japanese subjects had statistically lower levels of fat-free mass. the gain in fat-free mass and the loss in body fat when attaining maturation were greater in the Caucasian subjects. the agreement of BMI with other methods was good in all of the groups but lower for the Japanese than for the Caucasian subjects.Conclusion: Height and weight differences between the ethnic groups indicated distinct genetic potential ranges. the body fat mass did not differ between the ethnic groups, but the degree of changes when attaining maturation in the Caucasian subjects was greater. If this difference were to be maintained between the groups then years later there would be a greater accumulation of fat in the Japanese subjects.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Postgrad Course Nutr, Paulista Sch Med, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Postgrad Course Nutr, Paulista Sch Med, BR-04020060 São Paulo, BrazilWeb of Scienc

Qualidade de Sono em Estudantes de Medicina do Método de Aprendizado Baseado em Problemas

Distúrbios do sono são comuns entre adultos e entre estudantes de Medicina e podem ter impacto nas atividades diárias profissionais ou acadêmicas. Modelo do estudo: Transversal. Objetivo e Método: O presente trabalho buscou avaliar a qualidade de sono de 157 estudantes de Medicina da Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo, que se disponibilizaram após pedido nosso, sem maior filtragem. Para isso foram utilizados dois instrumentos, o Índice de Qualidade de Sono de Pittsburgh (PSQI) e a Escala de Sonolência de Epworth (ESE), ambos os questionários autoaplicáveis. Resultados: A média de duração de sono da amostra foi de 6,8 horas. Pobre qualidade de sono (PSQI &gt; 5) foi encontrada em 44,59% dos indivíduos. A sonolência diurna excessiva mostrou-se presente em 36,3% dos avaliados. Não se mostrou diferença significativa dos escores do PSQI entre sexos, anos acadêmicos e grupos etários. A sonolência diurna foi maior dentro do gênero feminino. O uso de drogas hipnóticas foi relatado por 6,9% da amostra. Conclusão: A prevalência de distúrbios do sono encontrada entre estudantes de Medicina foi alta, sem importante predileção por grupo etário ou sexo.Sleep disorders are common among adults and students of Medicine and can have an impact on daily activities, both academic and professional. Study Model: Cross-sectional. Objective and Method: This study intended to evaluate the quality of sleep of 157 students of Medicine from the Faculty of Medical and Health Sciences of the Catholic Pontificial University of São Paulo (Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo). Two main instruments were used to achieve that, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), both selfapplicable questionnaires. Results: The average of sleep duration in the sample was 6,8 hours. Poor sleep quality (characterized by PSQI &gt; 5) was found in 44.59% of individuals. Excessive daytime sleepiness was found in 36.3% of the evaluated subjects. There was no significant difference of the PSQI scores between sexes, academic year or age groups. Daytime sleepiness was higher among women. Hypnotic drug use was reported by 6.9% of the sample. Conclusion: The prevalence of sleep disorders found among medical students was high, without important predilection towards sex or age group