Evaluation of cardiovascular risk factors, events, and costs across four BMI categories.

OBJECTIVE: The purpose of this study was to analyze the 1-year cost of cardiovascular (CV) events by body mass index (BMI) subgroups from a US employer health plan perspective. DESIGN AND METHODS: Patients aged 20-64 years from the GE Centricity Electronic Medical Record, National Health and Nutrition Examination Survey, and MarketScan databases were used to determine prevalence of risk factors (RFs) and CV events and 1-year costs. Risk factors included hypertension (HTN), diabetes, and hyperlipidemia (HLD) and CV events included myocardial infarction, angina, heart failure, and stroke. CV event costs were determined from claims by ICD-9 code in patients with overweight/obesity. RESULTS: Of 220,136 patients identified in GE, BMI was 25-26.9 in 19.4%, 27-29.9 in 30.4%, 30-34.9 in 27.9%, and ≥35 in 22.3%. Patients with diabetes, HTN, and HLD increased with BMI from 1.8% (25-26.9) to 11.4% (≥35) in males and 1.1% to 6.8% in females. Prevalence of CV events increased from 0.1% with no RFs up to 10.2% with multiple RFs. The average 1-year cost per patient increased from $1122 to $2383 as BMI increased. CONCLUSIONS: Patients with higher BMI values had an increased prevalence of RFs and CV events, which lead to higher average 1-year costs.

Role of nitric oxide in regulating secreted phospholipase A2 release from astrocytes.

Inflammatory stimuli such as lipopolysaccharide increase nitric oxide and secreted phospholipase A2 release from glial cells. However, the signaling mechanism(s) regulating secreted phospholipase A2 in glial cells is not known. Here, rat brain astrocytes treated with lipopolysaccharide generated nitrite and released secreted phospholipase A2, while microglia generated nitrite without releasing secreted phospholipase A2. Unexpectedly, attenuation of nitrite production by pretreatment with the nitric oxide synthase inhibitor N-Omega-nitro-L-arginine methyl ester greatly enhanced lipopolysaccharide-stimulated secreted phospholipase A2 release from astrocytes; postreatment with N-Omega-nitro-L-arginine methyl ester did not potentiate secreted phospholipase A2 release, and addition of an nitric oxide donor attenuated the secreted phospholipase A2 release. The regulation of secreted phospholipase A2 may act via the transcription factor nuclear factor-kappaB, as a nuclear factor-kappaB inhibitor attenuated lipopolysaccharide-stimulated secreted phospholipase A2 release. These results demonstrate the role of basal nitric oxide levels as a regulator of inflammatory secreted phospholipase A2 release from glial cells of the brain.

Ganciclovir-mediated in vivo elimination of myeloid leukemic cells expressing the HSVtk gene induces HSVtk loss variants.

The in vivo elimination of suicide gene-expressing tumor cells with prodrug treatment can induce protective immunity against wild-type tumors. In this study, we determined the efficacy and safety of the in vivo elimination of HSVtk expressing cells with ganciclovir treatment of a bystander cell killing-insensitive leukemic cell line. The retroviral construct pLTk+NeoDeltaMo, containing the HSVtk gene and the NeoR gene in a bicistronic unit, was introduced into rat leukemic LT12 cells. LT12/Tk+N cells showed a 1000- to 10 000-fold increased sensitivity to ganciclovir in vitro. In vitro mixing experiments demonstrated that LT12 cells were not susceptible to bystander cell lysis by LT12/Tk+N-2 cells exposed to ganciclovir. Rats injected s.c. with cloned LT12/Tk+N-2 cells developed tumors reaching a diameter of 3-4 cm after 40 days. Rats treated with gan- ciclovir twice daily for 5 consecutive days starting at day 7 did not develop s.c. tumors. Large established s.c. LT12/Tk+N-2 tumors completely regressed after ganciclovir treatment. However, recurrences of s.c. tumors were observed that were no longer sensitive to ganciclovir treatment. In vitro analysis of aspirates from the recurrent tumors demonstrated loss of HSVtk expression. In vitro culture of LT12/Tk+N-2 cells in soft agar in the presence of ganciclovir indicated that the frequency with which HSVtk-loss variants occurred is approximately one per 104 cells. The in vivo occurrence of HSVtk-loss variants escaping ganciclovir-induced elimination may have important implications for vaccination protocols using HSVtk gene expressing tumor cells that are not susceptible to bystander cell killing.

Infertility services and managed care.

The birth of the McCaughey septuplets in Iowa in November 1997 brought issues of fertility assistance and their potential outcomes to worldwide attention. This Pergonal-stimulated multiple pregnancy ended successfully, but not without health hurdles and economic consequences for the new siblings and their family. This article reviews the general situation surrounding infertility services and, within the current debate of epidemiological, economic, legal and social issues, posits that managed care may be able to make greater strides than the present fee-for-service system in providing more accessible and comprehensive care to the 5.3 million US citizens at risk for infertility. Our conclusions suggest that managed care plans for infertility can aid in assuring quality and decreasing unnecessary costs. Managed care organizations should take the lead in providing infertile couples with an organized, humanistic approach that is mindful of the attending social issues. On May 5, 1997, a US District court in Chicago ruled that infertility fits the definition of a disability, and thus is subject to the antidiscrimination enforcement under the Americans with Disabilities Act.

Bacterial contamination of pneumoperitoneum gas in peritonitis and controls: a prospective laparoscopic study.

There is a theoretical risk that the pneumoperitoneum gas could carry bacteria in aerosol form and spread infection throughout the peritoneal cavity during laparoscopy for infective conditions such as appendicitis. The aim of this study was to attempt to culture bacteria from the pneumoperitoneum gas during laparoscopy for potentially infected cases and a group of controls. A total of 53 consecutive laparoscopies were studied, of which 21 were potentially infected and 32 served as controls. A lavage of the operative site was positive for pathogenic bacteria in almost 30% of the potentially infected group and only 3% of the control group. The pneumoperitoneum gas was bubbled through blood culture medium at the beginning and the end of the procedure, but only one of the 106 bottles grew any bacteria, and the specimen was a likely contaminant. In conclusion, we were unable to grow any significant bacteria from any of our cases despite using a sensitive method and demonstrating pathogenic bacteria in the peritoneal lavages. The pneumoperitoneum itself is unlikely to disperse bacteria.

[Does laparoscopic surgery affect immunity?]. / La coelio-chirurgie influence-t-elle l'immunité?

In a prospective study including 20 laparoscopic cholecystectomies, markers of the humoral (immunoglobuline) and cell mediated (lymphocytes and sub population T4/T8) have been assessed on 1st, 3nd and 8th post-operative days. There is no significant variation (except total lymphocyte count) within the limits of normality. This study suggests that laparoscopic surgery dont affect immunity. Laparoscopy seems to be preferable for immunodepressed patients (AIDS, cancer).

[Medical mission of Louis-André Gosse during his trip to Greece (1827-1829)]. / La mission médicale de Louis-André Gosse pendant son séjour en Grèce (1827-1829).

Louis-André Gosse (1791-1873), a liberal-minded Geneva physician, went to Greece in 1827 in order to work, for a couple of years, for the Greek State, which had won its independence just a few years ago. When, in 1828, an Egyptian army brought plague back to Greece, Gosse took an active part in the fight against the epidemic. The present author gives a detailed account of Gosse's relation of his experience including treatment and preventive measures.

Low interrater agreement on the semantic base of textual material.

The present paper describes three experiments which were conducted to determine whether independent raters could agree upon the semantic base of textual materials. These experiments were occasioned by an earlier experiment in which the investigators reported success in increasing the ability of students to extract the semantic base from textual materials. The present paper reports our unsuccessful attempts to obtain an acceptable level of agreement among independent raters about what constituted the semantic base of a number of texts. The paper concludes by raising some doubts about the strategy of extending behavior-analytic research to verbal behavior by combining behavior-change procedures with cognitive constructs.