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Background Low levels of the soluble receptor for advanced glycation endproducts (sRAGE) have been implicated in a number of chronic diseases. Previous studies indicate that sRAGE levels are ~ 30% lower in Blacks compared to Whites. However, the reasons for these differences are unclear. Purpose We aimed to identify predictors of circulating sRAGE biomarkers among Black and White adults at high cardiac risk. Methods Serum levels of total sRAGE, endogenous secretory RAGE (esRAGE), carboxymethyl-lysine (CML, a major RAGE ligand), and their ratios were measured in 99 Blacks and 454 Whites. Results Blacks had a more adverse cardiovascular risk profile, as well as lower median levels of total sRAGE (972 vs. 1564 pg/ml) and esRAGE (474 vs. 710 pg/ml) compared to Whites (p < 0.0001). In addition, the proportion of esRAGE was higher in Blacks (47% vs. 44%, p = 0.02), as were the CML/total sRAGE (0.89 vs. 0.56 ng/pg) and CML/esRAGE (1.72 vs. 1.20 ng/pg) ratios (p < 0.0001). Racial differences persisted after adjustment for key covariates including age, gender, tobacco use, comorbidities, BMI, blood pressure, glucose, insulin, triglycerides, C-reactive protein, and renal function (p < 0.05). Race alone accounted for nearly half of the variability in total sRAGE levels (10.6%; model explained 23.9%). In stratified analyses, gender and heart rate were independently associated with total sRAGE and esRAGE in Whites, while CML and C-reactive protein were associated with total sRAGE in Blacks. Conclusions We identified several independent predictors of sRAGE biomarkers. Notably, Black race was associated with an adverse AGE/RAGE profile, including lower sRAGE and higher CML/sRAGE ratios. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study is to evaluate a percent change model of postoperative parathyroid hormone level in thyroidectomy patients as a predictor of hypocalcemia. Materials and methods: Chart review was completed on patients who had undergone total or completion thyroidectomy over a 22-month period in our department. Only those patients with a preoperative ionized calcium and parathyroid hormone (PTH) level and at least 1 postoperative result were included. Ionized calcium levels served as an internal control. The Student t test was used to compare PTH level between the normocalcemic and hypocalcemic groups at each time point. Logistic regression analysis was used to predict hypocalcemia based on the diagnostic criteria. Receiver operator curves were used to maximize sensitivity. Results: Fifty-two patients met the inclusion criteria during the study period. A total of 22 patients (42%) experienced hypocalcemia. We were unable to maximize both sensitivity and specificity at the same time point. When comparing preoperative to 6-hour postoperative PTH percent change, patients with a greater than 44% decrease are likely to have hypocalcemia, with a sensitivity of 100%. Likewise, in those patients without a greater than 44% decrease at 6 hours, early discharge can be considered safe, given the negative predictive value of 100%. Conclusion: In our series, patients with a greater than 44% PTH decrease from preoperative to 6-hour postoperative are very likely to develop hypocalcemia. We would propose that these patients need further inpatient monitoring to progress to safe discharge. Likewise, patients with a less than 44% decrease at the 6-hour time point are unlikely to develop hypocalcemia and may be considered safe for discharge. [Copyright &y& Elsevier]

Summary: Objectives/Hypothesis: Maximum phonation time (MPT), a clinical measurement of the longest time one can phonate a vowel, typically /a/, is a frequently used measure of vocal function, but normative data are lacking for MPT in healthy older adults. The aim of this study was to provide data on MPT in healthy older adults and to determine the effect of advanced age, gender, and repeated measures on MPT. Study Design: Prospective. Methods: Sixty-nine healthy older adult volunteers participated (ie, 15, 26, and 28 in the seventh, eighth, and ninth decades of life, respectively). The effects of age, gender, and repeated measures (three trials in a single session) on MPT were assessed. Mean, standard deviation, compound symmetry covariance, analysis of variance, and analysis of covariance were used for statistical analysis. Results: Neither age group, gender, trial, nor their interactions was statistically significant (P >0.05). Adults in the seventh, eighth, and ninth decades of life had mean MPTs of 22.27 (standard error [SE]=1.56), 22.97 (SE=1.11), and 21.14 (SE=0.97) seconds, respectively. Females and males had mean MPTs of 20.96 (SE=0.92) and 23.23 (SE=0.96) seconds, respectively. Finally, MPTs for trials 1, 2, and 3 were 21.77 (SE=1.09), 21.67 (SE=1.12), and 22.80 (SE=1.27), respectively. Conclusions: MPTs were longer in this group of older adults than previously reported and did not vary significantly with age or gender. Additionally, across a single short sampling session, measurements were relatively stable across three trials of MPTs. [Copyright &y& Elsevier]

Abstract: Adjustment for covariates is a time-honored tool in statistical analysis and is often implemented by including the covariates that one intends to adjust as additional predictors in a model. This adjustment often does not work well when the underlying model is misspecified. We consider here the situation where we compare a response between two groups. This response may depend on a covariate for which the distribution differs between the two groups one intends to compare. This creates the potential that observed differences are due to differences in covariate levels rather than “genuine” population differences that cannot be explained by covariate differences. We propose a bootstrap-based adjustment method. Bootstrap weights are constructed with the aim of aligning bootstrap–weighted empirical distributions of the covariate between the two groups. Generally, the proposed weighted-bootstrap algorithm can be used to align or match the values of an explanatory variable as closely as desired to those of a given target distribution. We illustrate the proposed bootstrap adjustment method in simulations and in the analysis of data on the fecundity of historical cohorts of French-Canadian women. [Copyright &y& Elsevier]

Abstract: Background: Sepsis in premature infants is associated with adverse neurodevelopmental outcomes. No previous studies have assessed acute changes in brain function during sepsis that might precede these adverse outcomes. Methods: We performed amplitude-integrated electroencephalography (aEEG) monthly, from 28weeks until 36weeks of postmenstrual age, on 108 premature infants born before 28weeks of gestation. Additional aEEG recordings were performed during infants'' first episode of sepsis. Two independent readers who were blinded to the infant''s gestational age at birth and chronologic age, as well as to whether the infant had sepsis, evaluated aEEG recordings for the presence of burst suppression and assigned a maturation score. Results: Burst supression was found in 22% of aEEG recordings from infants without sepsis and 57% of recordings from infants with sepsis at the time of the recording (odds ratio=4.2; 95% confidence limits=2.4, 7.2; p<0.001). After adjustment for postmenstrual age at the time of the recording, the association between sepsis and burst suppression persisted (odds ratio=2.4; 95% confidence limits=1.2, 4.8; p=0.01). No statistically significant difference was found in the rate of increase in aEEG maturation score between infants with sepsis and those without. Conclusion: Sepsis is associated with acute electroencephalographic changes, as indicated by burst supression, but not with a decreased rate of brain wave maturation. [Copyright &y& Elsevier]

Abstract: We previously constructed two Pseudomonas exotoxin (PE)-based immunotoxins, IL15-PEΔ293 (IT1) and IL15M-PEΔ293 (IT2), for eliminating interleukin-15 receptor (IL-15R)-overexpressing cells. These two immunotoxins were generated by fusing either wild-type human IL-15 or an antagonist mutant IL-15 (IL-15M) to a modified form of PE. In this study the anti-arthritic effect of IT1 and IT2 was investigated using the rat model of adjuvant arthritis (AA). We found that both IT1 and IT2 could specifically target IL-15R-positive cells and induce apoptosis. After AA induction, treatment with either IT1 or IT2 resulted in profound improvement of the disease, with reductions in levels of synovial mononuclear leukocytes and certain inflammatory factors. Clinical and histological comparisons, together with the analyses of mRNA expression and the signal transducer and activator of transcription-3 (STAT-3) phosphorylation, revealed that the two immunotoxins decreased joint inflammation in AA rats to a similar extent. These data suggest that eliminating IL-15R-bearing cells via immunotoxins may be a promising approach for RA treatment. In addition, wild-type IL-15-based immunotoxins can be as effective as antagonist mutant IL-15-based immunotoxins in preventing joint inflammation associated with rheumatoid arthritis. [Copyright &y& Elsevier]

Abstract: The 2005 Dietary Guidelines for Americans publication placed increased emphasis on the importance of consuming a wide range of healthful foods and further reducing the consumption of less healthful ones. These recommendations are challenging for rural elders whose functional limitations, fewer resources, and limited access to foods negatively affect the quality of their diets. The purpose of this study was to characterize the diet quality of a multiethnic population-based sample of older adults (N=635) in the southern United States. Data were collected via home visit; dietary intakes were assessed using a food frequency questionnaire and converted into Healthy Eating Index-2005 (HEI-2005) scores used to monitor adherence to dietary guidelines. The mean total HEI-2005 score was 61.9/100 with fewer than 2% meeting the recommended score of 80/100. After controlling for age, sex, marital status, poverty status, and education, African Americans (n=136) had higher total HEI-2005 scores compared to American Indians (n=195) and non-Hispanic whites (n=304) (64.5 vs 60.1 and 61.1 respectively, P=0.001). Certain HEI-2005 foods were consumed in greater amounts by particular groups, such as total fruit and meat and beans (African Americans), whole fruit and grains (African Americans and American Indians), milk (non-Hispanic whites), and energy from solid fat, alcohol, and added sugars (American Indians). The overall diet quality of these rural elders was not adequate as determined by the HEI-2005; however, intakes of dark green and orange vegetables were adequate, and many participants were in compliance with the added fat and sugar guidelines. Determination of factors that promote or prevent the consumption of healthful foods among rural elders may help tailor nutrition education programs for these vulnerable communities. [Copyright &y& Elsevier]