Serum nesfatin-1 levels are decreased in pregnant women newly diagnosed with gestational diabetes

ABSTRACT Objective To investigate serum nesfatin-1 levels at 24-28 weeks of pregnancy in women newly diagnosed with gestational diabetes and determine the association of nesfatin-1 with several metabolic parameters. Subjects and methods Forty women newly diagnosed with gestational diabetes at 24-28 weeks of pregnancy and 30 healthy pregnant women matched in age and gestational week were included in this cross-sectional study. Serum nesfatin-1 levels were analyzed using ELISA, and the relationship between nesfatin-1 and several metabolic parameters were assessed. Results Serum nesfatin-1 levels were found to be lower in women with gestational diabetes compared to the pregnant women in the control sample (p = 0.020). Multiple linear regression analysis revealed that nesfatin-1 was lower in participants with gestational diabetes independently from gestational age, BMI, HOMA-IR, fasting plasma glucose, and age. In correlation analysis, the only variable that was found to have a statistically significant correlation with nesfatin-1 was gestational age (p = 0.015, r = 0.30). Conclusion Lower nesfatin-1 levels in women with gestational diabetes compared to the control group at 24-28 weeks of gestation draws attention to nesfatin-1 levels in gestational diabetes and motivates further research in this area.

Scale and scope economies in Mexican private medical units / Economías de escala y alcance en unidades médicas privadas en México

Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)" questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

Objetivo. Evaluar la eficiencia técnica y la presencia de potenciales economías de escala y alcance en unidades médicas privadas (UMP) mexicanas, de forma que sea posible establecer planes para la mejora de su gestión. Material y métodos. Se utilizó el método de Análisis Envolvente de Datos con información de insumos y productos para 2 105 UMP del año 2010 publicada por el Instituto Nacional de Estadística y Geografía a través del cuestionario denominado "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)". Resultados. La aplicación de los modelos encuentra una presencia marginal de economías de escala y alcance en las UMP mexicanas. Conclusiones. La operación de las UMP en México debe enfocarse a prestar servicios bajo un modelo diversificado para alcanzar mejores niveles de eficiencia técnica.

Markers of neural degeneration and regeneration in Down syndrome patients

On the trisomy Down syndrome Critical Region [DSCR1] is located the APP gene, which accelerates amyloid peptide protein [APP] expression leading to cerebral accumulation of APP-derived amyloid-beta peptides [Abeta] and age-dependent cognitive sequelae. Also DSCR1 attenuates endothelial cell proliferation and angiogenesis required for tissue repair. The aim of the present work is to determine markers of neural degeneration and regeneration in the blood of young and adolescent Down syndrome [DS] patients as well as controls. Markers of regeneration were measured in terms of circulating mononuclear cells expressing Nestin and CD34, while markers of degeneration were measured in terms of plasma Abeta[42] and advanced glycation end products receptors [RAGES]. Results showed a significant increase in plasma Ap[42] [20 +/- 5.1 vs. 11.9 +/- 3.4] and RAGES leucocytes mRNA relative expression [1.9 +/- 0.2 vs. 1.1 +/- 0.6] in adolescent DS patients compared to young DS. Both parameters were also significantly increased in DS compared to controls: Abeta[42] [15.4 +/- 5.9 vs. 12. 3 +/- 4.5]; RAGES [1.4 +/- 0.5 vs. 0.7 +/- 0.2]. Nestin [5.2 +/- 1.4 vs. 6.3 +/- 0.6] and CD34 [52 +/- 2.5 vs. 53 +/- 4.7] were non-significantly lower in adolescent DS patients compared to young DS, but significantly lower in DS patients compared to controls: Nestin [6.3 +/- 1.5 vs. 9 +/- 4.4]; CD34 [54 +/- 3.4 vs. 60 +/- 4.8]. The significant decrease in the number of mononuclear cells bearing Nestin and CD34 markers accompanied by a significant increase in Abeta[42] and RAGES indicate that degeneration in DS is an ongoing process, which is not counterbalanced by the regenerative mechanism

Vitamin D Levels and Their Relationship with Cardiac Biomarkers in Chronic Hemodialysis Patients

Vitamin D insufficiency may be associated with cardiovascular (CV) mortality in HD patients. To test this hypothesis, we cross-sectionally measured 25-hydroxyvitamin D (25D), 1,25-dihydroxyvitamin D (1,25D), cardiac troponin T (cTnT), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in chronic HD patients. Sixty-five patients (M:F=31:34, age 52.2+/-13.2 yr, DM 41.5%) were selected. Along with the expected low levels of 1,25D, 59 (90.8%) patients had 25D insufficiency (<30 ng/mL) among whom 15 (23.1%) were 25D deficient (<10 ng/mL). The 25D levels showed a negative correlation with cTnT levels (Spearman's rho=-0.44, p<0.01) but not with NT-pro-BNP levels (Spearman's rho=-0.17, p=0.17). The 1,25D levels, however, did not show any relationship with either cTnT or NT-pro-BNP. In multivariate analysis, being male and having low levels of 25D were independent risk factors associated with cTnT elevation (beta=0.44, p<0.01 and beta=-0.48, p<0.01, respectively). In conclusion, not only 1,25D but also 25D are commonly decreased in HD patients. Lower 25D levels appear to be associated with cTnT elevation, predicting worse CV outcome, and are possible to involve cardiac hypertrophy or coronary artery disease.

Third heart sound revisited: a correlation with N-terminal pro brain natriuretic peptide and echocardiography to detect left ventricular dysfunction.

BACKGROUND: Auscultation of the third heart sound is an age-old sign for predicting ventricular dysfunction. New technology and biomarkers like two-dimensional echocardiography and N-terminal pro brain natriuretic peptide, respectively, have sidelined the utility of this sign, which does not involve any cost and is readily accessible. We sought to find the predictive accuracy of third heart sound and its correlation with N-terminal pro brain natriuretic peptide and ejection fraction using two-dimensional echocardiography to detect left ventricular dysfunction in patients of acute coronary syndrome. METHODS AND RESULTS: One hundred and ten patients presenting with acute coronary syndrome [acute ST elevation myocardial infarction (n=74) and non-ST elevation myocardial infarction (n=36)] were prospectively studied. A senior cardiologist, blinded to N-terminal pro brain natriuretic peptide and ejection fraction results auscultated for a left ventricular third heart sound in each patient. Ejection fraction was measured using modified Simpson's technique on two-dimensional echocardiography and N-terminal pro brain natriuretic peptide was measured using electrochemiluminiscence assay. Median levels of N-terminal pro brain natriuretic peptide were used to provide a dichotomous approach for analysis of the data. Third heart sound was present in 40 patients (acute ST elevation myocardial infarction: n=27, non-ST elevation myocardial infarction: n=13) and absent in 70 patients (acute ST elevation myocardial infarction: n=47, non-ST elevation myocardial infarction: n=23). The sensitivity and specificity of third heart sound for predicting N-terminal pro brain natriuretic peptide above median was 65.5% and 92.7%, respectively. The positive and negative predictive value was 90% and 73%, respectively. The N-terminal pro brain natriuretic peptide of those having third heart sound was 4081 +/- 2705 pg/ml compared to 1239.3 +/- 1169 pg/ml in those without third heart sound (p < 0.001). The sensitivity of third heart sound to detect ejection fraction <45% was 67.9% while the specificity was 74.4%. The positive and the negative predictive values were 47.5% and 87.1%, respectively. The ejection fraction of patients having third heart sound was 47.5 +/- 11.3% compared to 56 +/- 10.4% without third heart sound (p < 0.001). CONCLUSIONS: Auscultation of third heart sound has a good specificity and predictive value for predicting elevated N-terminal pro brain natriuretic peptide and left ventricular dysfunction. Thus age-old clinical cardiology still holds its forte in this new era of technology-driven cardiology.

Correlation Between Levels of N-terminal Pro-B-Type Natriuretic Peptide and Degrees of Heart Failure

BACKGROUND: The N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized in the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between the NT-pro BNP levels and the New York Heart Association function class (NYHA Fc) of dyspnea and echocardiographic findings for the patients who visited our cardiology departments. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients who visited the Samsung Medical Center and the Jong Koo Lee Heart Clinic. RESULTS: The NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p< 0.001 by ANOVA), the increase in the systolic left ventricular internal dimension (p< 0.05), and the decrease in the ejection fraction (p< 0.01). For the NYHA Fc I patients, the NT-pro BNP levels were positively correlated with age (p< 0.001) and left atrial size (p< 0.001). For the patients with ischemic heart disease, the NT-pro BNP levels were also positively correlated with the NYHA Fc (p< 0.001 by ANOVA). The NT-pro BNP levels were increased with the increase in the systolic (p< 0.001) and diastolic pressure (p=0.017), the left ventricular internal dimension as well as the decrease in the ejection fraction (p< 0.001). The area under the receiver operating characteristic (ROC) curve for the NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level for the NT-pro BNP was 293.6 pg/mL. CONCLUSION: The NT-pro BNP levels were positively correlated with the NYHA Fc of dyspnea and the systolic dysfunction for the patients who visited our cardiology departments. A 300 pg/mL value for the NT-pro BNP cut-off point appears to be a sensitive level to differentiate dyspnea originating from an ailing heart or not for the patients who visited our cardiology departments.