Associations of plasma fibrinogen assays, C-reactive protein and interleukin-6 with previous myocardial infarction

Background: The association of plasma fibrinogen with myocardial infarction (MI) may (like that of C-reactive protein, CRP) be a marker of subclinical inflammation, mediated by cytokines such as interleukin-6 (IL-6). There are well- recognized discrepancies between commonly performed fibrinogen assays. Increased ratio of clottable fibrinogen to intact fibrinogen (measured by a recently developed immunoassay) has been proposed as a measure of hyperfunctional fibrinogen, and is elevated in acute MI.<br/> Objective: To compare the associations of intact fibrinogen and four routine fibrinogen assays (two von Clauss assays; one prothrombin-time derived; and one immunonephelometric) in a case-control study of previous MI. Patients/methods: Cases (n = 399) were recruited 3-9 months after their event; 413 controls were age- and sex-matched from the case-control study local population. Intact fibrinogen was measured in 50% of subjects. Results: All routine fibrinogen assays showed high intercorrelations (r = 0.82-0.93) and significant (P lt 0.0001) increased mean levels in cases vs. controls. These four routine assays correlated only moderately with intact fibrinogen (r = 0.45-0.62), while intact fibrinogen showed only a small, nonsignificant increase in cases vs. controls. Consequently, the ratio of each of the four routine assays to the intact fibrinogen assay was significantly higher (P lt 0.0003) in cases vs. controls. Each fibrinogen assay correlated with plasma levels of CRP and IL-6 (which were also elevated in cases vs. controls). Each routine fibrinogen assay remained significantly elevated in cases vs. controls after further adjustment for C-reactive protein and interleukin-6. Conclusions: These data provide evidence for acquired, increased hyperfunctional plasma fibrinogen in MI survivors, which is not associated with markers of inflammatory reactions. The causes and significance of these results remain to be established in prospective studies

Circulating endothelial cells in patients with heart failure and left ventricular dysfunction 1

Abstract. Introduction and Aims: Acute and chronic heart failure may manifest different degrees of endothelial damage and angiogenesis. Circulating endothelial cells (CEC) have been identified as marker of vascular damage. The aim of our study was to evaluate the evolution of the CEC at different stages of patients with heart failure. We also investigated a potential correlation between CEC and markers of vascular damage and angiogenesis. Methods: We studied 32 heart failure patients at hospital admission (acute phase) and at revision after 3 months (stable phase) and 32 controls. Circulating markers of endothelial damage (CEC; von Willebrand factor, vWF and soluble E-selectin, sEsel) and angiogenesis (vascular endothelial growth factor, VEGF and thrombospondin-1) were quantified. Results: Levels of CEC, vWF, sEsel and VEGF are significantly higher in heart failure patients than in controls. Levels of CEC (36.9 ± 15.3 vs. 21.5 ± 10.0 cells/ml; p < 0.001), vWF (325 ± 101 vs. 231 ± 82%; p < 0.001) and VEGF (26.3 ± 15.2 vs. 21.9 ± 11.9 ng/ml; p < 0.001) are significantly higher in the acute phase than in the stable phase of heart failure. CEC levels correlate with vWF and VEGF. Results show than 100% of patients in acute phase and 37.5% in stable phase have levels of CEC higher than the 99th percentile of the distribution of controls (16 cells/ml). Therefore, increases in CEC represent a relative risk of 9.5 for heart failure patients suffering from acute phase. Conclusions: CEC, in addition to being elevated in heart failure, correlate with vWF levels, providing further support for CEC as markers of endothelial damage. Levels of CEC are associated with the acute phase of heart failure and could be used as a marker of the worsening in heart failure

Are there differences in acute phase inflammation markers regarding the type of heart failure?

This study aimed to determine if there are differences in inflammatory markers in the acute phase between systolic heart failure and heart failure with preserved systolic function. One hundred and thirty-one patients with acute heart failure were recruited consecutively. At admission, plasma fibrinogen, C-reactive protein, sialic acid, von Willebrand factor, vascular endothelial growth factor, interleukin-6 and NTproBNP were all evaluated. If the ejection fraction was 45% or over patients were included in the HF-PSF group; the remaining patients were included in the SHF group. The HF-PSF patients were older (72±10 vs 63±12 years, P<0.001), presented a higher rate of atrial fibrillation (56.1 vs 21.3%, P<0.001), and had a lower rate of hemoglobin (12.2±2 vs 13.3±2.1 g/dL, P<0.01). No significant differences were observed in the inflammation markers analyzed among SHF and HF-PSF groups. In the acute phase of heart failure there is a marked elevation of inflammatory markers but there are no differences in the inflammatory markers analyzed between the two different types of heart failure

Assessing market competition in the Philippine cigarette industry

Background The recent passage of the Philippine Competition Act has caused many to rethink the market structure of Philippine industries. Foremost is the cigarette industry, whose structure bear important implications on the health of Filipinos. A competitive cigarette industry may mean price wars and intensified advertising, disproportionately harming the young and the poor. On the other hand, a concentrated industry may mean a dominant player with ability to engage in predatory pricing. The latter will also likely possess power to lobby against tobacco control policies. In this study, we assess the market competition in the Philippine cigarette industry, and its correlation with cigarette affordability in recent years. Methods Using retail volume data from Euromonitor International and financial reports from the Securities and Exchange Commission, we calculate for various measures of market concentration such as the Top 4 Concentration Ratio (C4), the Herfindahl-Hirschmann Index (HHI), and the Dominance Index (DI) over the period 2007 to 2016. We then compare these measures against cigarette affordability trends. Results Across all measures, we find a highly concentrated cigarette industry. C4 ratios ranged from 97%-99%, HHI from 4754-8848, and DI from 7479-9973. In 2010 when Philip Morris acquired Fortune Tobacco, industry concentration peaked (HHI rose by 72% and DI by 33%). In 2012 when the Sin Tax Law was passed, competition slightly intensified with Mighty Corporation taking advantage of the transitionary dual tax structure. Most significantly, fluctuations in market concentration did not affect cigarette affordability. A pack of cigarettes costed 7.4%-8.4% of the daily minimum wage between 2006-2012. Conclusions Assessing the market structure of the cigarette industry better informs the formulation of effective tobacco control regulations. For a concentrated cigarette industry such as in the Philippines, an effective tax policy must temper the power of companies to absorb taxes so that these are passed onto consumers to discourage smoking

Anesthesia for pediatric gastroscopy: a study comparing the ProSeal laryngeal mask airway with nasal cannulae

Background: We tested the hypothesis that pediatric gastroscopy is more successful using the ProSeal laryngeal mask airway with the drain tube as a conduit to the stomach (ProSeal LMA group) than using nasal cannulae with conventional oral access to the stomach (NC group).\ud \ud Methods: Sixty children were consecutively and randomly allocated into each group. Patients breathed spontaneously and were given sevoflurane/air/oxygen mixture with propofol 1 mg·kg−1 boluses, as required. Anesthesia was provided by experienced users of both techniques. The following data were collected by an unblinded observer: operation and anesthesia times; cardiorespiratory data; adverse events; and recovery scores. In addition, the surgeon scored the ease of performing the procedure.\ud \ud Results: The mean (range) age and weight was 74 (24–144) months and 26 (10–61) kg. Operation (15 min vs 24 min, P < 0.0001) and anesthesia (22 min vs 37 min, P < 0.0001) times were shorter in the ProSeal LMA group, but propofol bolus requirements per unit time were similar. Oxygen saturation was higher in the ProSeal LMA group (100% vs 94%, P < 0.0006), but other cardiorespiratory variables were similar. There were no differences in the ease of performing the procedure. Hypoxia occurred more frequently in the NC group (20% vs 0%). Recovery scores were similar.\ud \ud Conclusions: We conclude that pediatric gastroscopy is quicker and has fewer airway complications when performed through the ProSeal LMA than using nasal cannulae and a conventional approach by experienced users

Policy recommendations on tacing and reducing program mismatch and perverse incentives present in earmarking sin tax to tobacco growing areas

Background Recognizing that the Philippine 1991 tobacco tax sharing law favoured the development of tobacco, the Sin Tax Law, a separate law on restructuring cigarette tax, expanded the use of such to also cover shifting farmers to viable alternative livelihood. Aside from health-driven supply reduction objectives, this is crucial as evidence shows that tobacco production is continuously declining starting decades ago, requiring to actively shift farmers. Methods Data on tobacco excise tax earmarking and utilization, farmers´ production and shifting behaviours, labor improvement and poverty alleviation indicators, and LGU capacity were analysed to determine potential program mismatches and perverse incentives. Supporting qualitative data were used to identify policy and structural gaps to address these. Results Financing livelihood projects becomes the least priority (only 6% average share i funds), as a result of LGU´s final allocation being determined by their share in total tobacco leaf production, which actually put pressure on their farmers to increase production volume. Meanwhile, infrastructure continue to get bulk of sin tax earmarking and are linked to its political benefits. Last, the provision of cooperative and agro-industrial projects in selected areas were shifting behaviour is heavy can still be improved. Conclusions As the two tobacco tax sharing laws fund both programs to develop tobacco and to shift tobacco farmers to other livelihood, a schizophrenic management exists. Key structural and policy ingredients have to be present to reverse this. First is the need to establish institutional support to manage alternative livelihood funds, in order to balance the powers of National Tobacco Administration over tobacco growing areas. Allocation should not be based on production volume but rather on a systemic or comprehensive welfare assessment of shifted farmers. As livelihood programs are most commonly coursed through civil society organizations and cooperatives, trainings on local budget engagement, tobacco interference, and enterpreneurial skills, have to be offered

One-Year Results of an Algorithmic Approach to Managing Failed Back Surgery Syndrome

BACKGROUND: Failed back surgery syndrome (FBSS) is a major clinical problem. Different etiologies with different incidence rates have been proposed. There are currently no standards regarding the management of these patients. Epiduroscopy is an endoscopic technique that may play a role in the management of FBSS

Atorvastatin neutralises the thrombin-induced tissue factor expresion in endothelial cells via geranylgeranyl pyrophosphate

Statins may have beneficial effects in atherogenesis given their antithrombotic properties involving non-lipid mechanisms that modify endothelial function of tissue factor induction by thrombin. In this study, we investigate the effect of atorvastatin on tissue factor (TF) activity in thrombin-stimulated endothelial cells and its regulation through mevalonate or its derivatives. First subculture of human umbilical endothelial cells was used for this study. Cells were treated with thrombin and atorvastatin for different time intervals and dosage. Tissue factor activity was measured as Factor Xa generation induced by Tissue Factor-Factor VIIa complex on confluent cells. Our results show that atorvastatin prevents the thrombin-induced up-regulation of tissue factor activity in a concentration-dependent manner. Mevalonate and geranylgeranyl pyrophosphate reversed this inhibitory effect of atorvastatin on tissue factor activity, while the presence of farnesyl pyrophosphate did not prevent the atorvastatin effect on thrombin-induced tissue factor activity. Rho-kinase inhibitor did not affect the thrombin stimulation of tissue factor activity. High amount of hydrophobic isoprenoid groups decreases the thrombin-induced TF activity and may promote endothelial cell anti-thrombotic action. Rho kinase pathways do not have a major role in the thrombin-mediated TF activity. The inhibitory effect of atorvastatin on thrombin-induced TF activity was partially reversed by MVA and GGPP but not FPP