Search

In order to discriminate between stress-induced leukocytosis and an infection/inflammation-related one, we have used a modified leukocyte adhesiveness/aggregation test (LAAT) to examine the adhesive properties of white blood cells towards glass surfaces. A highly significant p

The expressions of both the CD11b/CD18 and CD62L (L-selectin) antigens as well as the absolute number of white blood cells in the peripheral circulating pool of blood in 116 patients with various inflammatory conditions were determined. A highly significant (P

Objective. To evaluate whether the difference in aggregation of cerebrospinal fluid cells from patients with bacterial, viral, aseptic and partially treated meningitis can be used for diagnostic purposes. Methods. Cerebrospinal fluid samples of 100 patients with meningitis (15 bacterial, 13 partially treated, 10 viral and 62 aseptic) were compared on the basis of the predefined leukocyte aggregation score (LAS). Results. Mean LAS was 56% in the bacterial meningitis group (range, 15 to 90%), 5.8% in the partially treated meningitis group (range, 0 to 27%), 2% in the proven viral meningitis group (range, 0 to 5%) and 2% in the aseptic meningitis group (range, 0 to 15%). All patients with bacterial meningitis had a LAS of >15%, whereas all those with viral or aseptic meningitis had a score of

Stress is associated with an increment in the concentration of cortisol, a leukocytotic response and increased state of leukocyte adhesiveness/aggregation (LAA) in the peripheral blood. We investigated the interrelationship between these three parameters in individuals under various conditions of stress. These included 123 emergency room patients with chest pain who were also classified in regard to the presence or absence of heart failure; 15 men in the fertility clinic donating semen and 16 women in the operating room before induction of anaesthesia for dilatation and curettage. A low (r=0.35) but significant (p

Red blood cell distribution width (RDW), which is routinely reported in complete blood counts, is a measure of the variability in size of circulating erythrocytes. RDW is a novel, independent predictor of prognosis in patients with cardiovascular diseases. The aim of the present study was to evaluate the significance of this biomarker in a relatively large cohort of patients, and to assess its association with a more severe underlying cardiovascular disease. A cohort of 3,222 consecutive patients undergoing coronary angiography was divided according RDW median. The association between RDW and 3-year outcome in the context of other predictors was assessed using Cox’s proportional hazards analysis. Patients with elevated RDWs were older, had higher body mass indices, and had more cardiovascular risk factors and more cardiovascular diseases. The total rate of mortality, MI and stroke (MACE) was 7.7 % (120 events) in the lower RDW group, and 18.2 % (303 events) in the higher RDW group, p < 0.001. Following adjustment for multiple background risk factors, medications, and laboratory results, the RDW value was independently associated with worse outcome (HR = 1.12, 95 % CI 1.07–1.18, p < 0.001, for each 1 % increase in RDW). Elevated RDW values are independently associated with adverse 3-year outcome in patients undergoing coronary angiography.

Background: MicroRNA-132 (miR-132) targets acetylcholinesterase (AChE) and potentiates the cholinergic blockade of inflammatory reactions in cultured cells and experimental mice, but the implications of this interaction to human inflammatory disease remained unexplored. This study aimed to test whether miR-132 is causally involved in anti-inflammatory reactions of patients with inflammatory bowel disease (IBD) and modulates vagal tone and consequently inflammation in patients with IBD. Methods: We prospectively measured inflammation readouts and the cholinergic status (total capacity for hydrolyzing acetylcholine in one’s circulation), and AChE activity in 2 independent cohorts of patients with IBD and quantified miR-132 levels in intestinal tissue biopsies removed at colonoscopy from inflamed and apparently quiescent tissues of tested volunteers. Results: MiR-132 levels are higher in inflamed compared with apparently quiescent intestinal biopsies from patients with IBD. Correspondingly, the cholinergic status and AChE activity was significantly lower in patients with IBD suffering from moderate–severe disease as compared with healthy controls or patient with IBD presenting low disease severity. Patients with IBD (n ¼ 16) presented lower AChE activity compared with healthy controls (n ¼ 33; 289 6 128 AU versus 391 6 102 AU, P ¼ 0.001), and a negative correlation between AChE activity and C-reactive protein levels (r ¼ 20.47, P ¼ 0.01). Corroborating these observations in an additional cohort of participants, C-reactive protein and AChE activity were negatively correlated in patients with moderate–severe disease (n ¼ 16; r ¼ 20.6, P ¼ 0.04) and positively correlated in healthy controls (n ¼ 74, r ¼ 0.24, P ¼ 0.046). Conclusions: Taken together, these findings support an inflammation-dependent homeostatic role for the regulation by miR-132 of AChE in IBD, opening new venues for therapeutic interference. (Inflamm Bowel Dis 2013;0:1–8)

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most common cause of elevated alanine aminotransferase (ALT). NAFLD is associated with insulin resistance and hepatic inflammation. Similarly, patients with depression exhibit insulin resistance and increased inflammatory markers. However, no study has shown a clear association between elevated ALT and the development of depression. The aim of the study was to test whether elevated ALT, a surrogate marker for NAFLD, predicts the development of depression.MethodThe present prospective cohort study investigated 12 180 employed adults referred for health examinations that included fasting blood tests and anthropometric measurements between 2003 and 2010. Exclusion criteria were: baseline minor/major depression, excessive alcohol consumption and other causes for ALT elevation. Depression was evaluated by the eight-item Patient Health Questionnaire (PHQ-8) score.ResultsThe final cohort included 5984 subjects [69.4% men, aged 45.0 (s.d. = 10.24) years]. The incidence rate of minor and major depression was 3.8% and 1.4%, respectively. Elevated ALT was a significant independent predictor for the occurrence of minor [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.40–2.92] and major (OR 3.132, 95% CI 1.81–5.40) depression after adjusting for age, gender, body mass index, education level, serum levels of lipids, glucose, smoking and physical activity. Adding subjective health and affective state parameters (sleep disturbances, self-rated health, anxiety and burnout) as potential mediators only slightly ameliorated the association. Persistently elevated ALT was associated with the greatest risk for minor or major depression as compared with elevation only at baseline or follow-up (p for trend ConclusionsElevated ALT was associated with developing depressive symptoms, thus suggesting that NAFLD may represent an independent modifiable risk factor for depression.

We examined the effects of burnout and vigor on the incidence of hyperlipidemia. Based on the bivariate theoretical approach to negative and positive affects and on past studies on the prediction of blood lipids by burnout and vigor, we expected increases from Time 1 (T1) to Time 2 (T2) in burnout levels to be associated with an increase in the risk for hyperlipidemia and T1-T2 increases in vigor levels to be associated with a decrease in the risk of hyperlipidemia. Our sample consisted of 3,337 healthy employees (2,214 men and 1,123 women) who were followed up for about 27 months on average. Burnout and vigor were assessed by well-validated multiple-item instruments. We used logistic regressions and controlled for variables associated with blood lipids as well as with vigor and burnout. We cross-validated all self-reported hyperlipidemia by their T2 lipids levels. As expected, we found that T1-T2 increases in vigor levels were associated with a decreased risk of hyperlipidemia. However, the T1-T2 change in burnout levels was marginally significant (p = .06) in predicting hyperlipidemia. We consider our finding that vigor and burnout are independently associated with the risk of hyperlipidemia as providing support for the bivariate approach to affective states. In addition, our major finding suggests a possible mechanism via which vigor influences physical health outcomes.

Background and Purpose— Inflammation may contribute to cognitive impairment after stroke. Inflammatory markers are associated with hippocampal atrophy. We tested whether markers of inflammation, erythrocyte sedimentation rate (ESR), and serum levels of C-reactive protein are associated with reduced hippocampal volume and poor cognitive performance among stroke survivors. Methods— We analyzed 368 consecutive cases from our prospective study of first-ever mild–moderate stroke patients. MRI, cognitive tests, and inflammatory markers were determined. Patients were reevaluated 6 and 12 months after the event. Results— ESR remained unchanged in follow-up examinations, suggesting a chronic inflammation background in some patients. Higher levels of C-reactive protein and ESR were associated with worse performance in cognitive tests, particularly memory scores. This association was maintained for ESR (but not C-reactive protein) after adjustment for confounders ( P =0.002). Patients with smaller hippocampi had inferior cognitive results. Moreover, in a multivariate regression model, higher ESR values (but not C-reactive protein) were related to reduced hippocampal volume ( P =0.049). Conclusions— This report shows a strong relationship between ESR and hippocampal volume, as well as with cognitive performance among poststroke patients. This could plausibly relate to incipient cognitive decline via hippocampal pathways.

A large body of research deals with the effect of life events (LE) on stress and health. Since the findings were controversial, attempts were made to circumscribe the kind or aspect of LEs affecting stress. Our purpose was to show that it is not the LE per se but the problem to which it is related (problem-ladenness) or personal problems which are stress related. Subjects were 68 healthy men and women, 29 to 53 years old. They were examined on physiological stress measures (erythrocyte sedimentation rate [ESR], white blood cell count and aggregated white blood cells in peripheral blood), and were administered the Life Experiences Survey, the Personal Problems (PP) scale, Eysenck's neuroticism scale, Tellegen's stress reaction, emotional scales (The Profile of Mood States and the Positive Emotions Check List) and the Strelau Temperament Inventory. The findings showed that problem-ladenness was a distinct aspect of LEs, related only lowly to the number of LEs, regardless of their appraisal, but correlated highly with number of PPs. The number of LEs and the number of negative LEs were each related to only one stress index. The number of positive LEs was related to counter-stress indices, mainly increased positive emotions. LEs high on problem-ladenness were related to many stress indices (e.g., neuroticism, tension-anxiety, depression). The number of PPs was related to these, to increased ESR, anger, and to decreased excitation and vigor. The conclusions are that problem-ladenness is the stress-effective element in LEs and that the number of PPs provides a preferable, direct, simple and fast measure of a major stress determinant for both genders.

Objective Previous reports on the association between statin use and venous thromboembolism (VTE) did not examine patient adherence to medications, thus their applicability in a real life setting is questionable. Our objective was to investigate the association between the use of statins and incidence of first ever idiopathic VTE. Design A retrospective cohort study. Settings A large healthcare maintenance organisation. Patients Included were statin initiators aged 30 years or older since 2003 who did not have a statin prescription for at least 4 years before that and had at least 18 months follow-up. Excluded were patients with known risk factors for VTE. End of follow-up was defined as the first of the following: leaving Maccabi Healthcare Services, death, VTE or October 27, 2010. Interventions Prescription drug purchase data was analysed in order to evaluate the association between statin use and adherence and between VTE prevention. Main outcome measures VTE diagnosis during follow-up. Results The study population included 127 822 subjects (53 618 females). The follow-up period was comprised of 594 190 patient years, and included 1375 VTE cases and 5-year cumulative incidence rate of 1.15%. Cox regression analysis demonstrated a significantly lower VTE risk of 19% and 22% in the more adherent patient groups, compared to the risk for the lowest adherence group. The simvastatin dose, the most frequently prescribed statin, was negatively associated with the risk of VTE. Conclusions In a real life healthcare maintenance organisation setting, better adherence to statins is associated with a reduced risk of first ever idiopathic VTE events.

Burnout is a negative affective state consisting of emotional exhaustion, physical fatigue, and cognitive weariness symptoms. This study was designed to evaluate prospectively the association between burnout and coronary heart disease (CHD) incidence and to test the possibility that this association is nonlinear.Participants were 8838 apparently healthy employed men and women, aged 19 to 67 years, who came for routine health examinations at the Tel Aviv Sourasky Medical Center. They were followed up for 3.4 years on average. Burnout was measured by the Shirom-Melamed Burnout Measure. CHD incidence was defined as a composite of acute myocardial infarction, diagnosed ischemic heart disease, and diagnosed angina pectoris.During follow-up, we identified 93 new cases of CHD. Baseline levels of burnout were associated with an increased risk of CHD, after adjustment for various risk factors (hazard ratio = 1.41; 95% confidence interval = 1.08-1.85). In addition, we observed a significant threshold effect of burnout on CHD incidence. Participants who scored high on burnout (scores in the upper quintile of the Shirom-Melamed Burnout Measure scores distribution) had a higher risk (hazard ratio = 1.79; 95% confidence interval = 1.05-3.04) of developing CHD on follow-up compared with others.Burnout is an independent risk factor for future incidence of CHD. Individuals with high levels of burnout (upper quintile) have a significantly higher risk of developing CHD compared with those with low levels of burnout.

Background Estimated glomerular filtration rate (eGFR) predicts major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD), though the effect of eGFR on MACE and vascular disease extent among individuals with normal or mildly impaired renal function requires definition. Our aim was to examine the prognostic implications of eGFR and its effect on atherosclerosis burden in individuals without CKD undergoing vascular imaging studies. Methods The study enrolled 2746 consecutive patients undergoing clinically-driven coronary angiography who had an eGFR > 60 mL/min/1.73 m 2 and no history of CKD. Same-day carotid duplex results were available for 317 patients. Patients were followed for up to 3 years for the occurrence of all-cause mortality, myocardial infarction, and stroke. Results After adjustment for potential clinical and biochemical confounders, eGFR was found to be independently associated with coronary artery disease extent in the entire study population and among patients with normal renal function (n = 1170; eGFR > 90 mL/min/1.73 m 2 ): odds ratio (OR) = 1.16 (95% confidence interval [CI], 1.09-1.24) and OR = 1.25 (95% CI, 1.11-1.4) per 10 mL/min decrements in eGFR, respectively. Similarly, eGFR was independently associated with carotid artery stenosis in the entire cohort (OR, 1.86 [95% CI, 1.12-3.1]). By Cox regression analysis, eGFR was an independent predictor of the composite MACE end point (hazard ratio, 1.16 [95% CI, 1.04-1.28]), and all-cause mortality (hazard ratio, 1.38 [95% CI, 1.19-1.60]). Conclusions eGFR is an independent predictor of atherosclerotic vascular disease extent and MACE rates in patients with normal or mildly impaired renal function.

Infection might be associated with increased risk of venous thromboembolism (VTE) and arterial thrombosis. Specific hypotheses have been raised regarding the procoagulant response induced by acute cytomegalovirus (CMV) infection. Accordingly, we investigated the 6-month incidence of VTE and/or arterial thrombosis in patients that had been tested positive for CMV-IgM antibodies in a large health maintenance organization. Logistic regression analysis was used to identify independent risk factors for VTE and arterial thrombosis. Among 90,515 patients eligible for the VTE analysis and 90,805 patients eligible for the arterial thrombosis analysis, 6,205 (6.9 %) and 6,222 (6.9 %) patients were tested positive for CMV-IgM antibodies, respectively. During 6 months of follow-up from index date, the incidence rates per 1,000 capita of VTE among CMV-IgM seropositive and CMV-IgM seronegative patients were 3.06 (19 patients) and 1.36 (115 patients), respectively (odds ratio (OR) 2.25; 95 % confidence intervals (95 % CI) 1.38–3.66; p = 0.003). CMV-IgM seropositivity was independently associated with VTE appearance (OR 2.49; 95 % CI 1.53–4.06; p

SummaryAssisted reproductive technology (ART) is extensively used as a tool for pregnancy achievement in subfertile couples. Congenital and acquired thrombophilias have been suggested by some investigators to play a role in abnormal embryo implantation and placentation. The objective of this study was to assess the role of common thrombophilias in women with unexplained infertility undergoing in vitrofertilisation (IVF). We retrospectively analysed 594 women from a large healthcare maintenance organisation going through IVF and who had a thrombophilia workup, and compared them for prevalence of thrombophilia to two reference groups consisting of 637 fertile women from previous work and 17,337 women members of the same healthcare organisation with no history of venous thromboembolism. The mean age of the women at the first cycle of IVF was 30.9 years (SD: 4.1).The mean number of IVF cycles was 7.3 (SD: 5.0), and the mean fertility success rate per woman was 14.6% (SD: 19.0%). None of the common thrombophilias tested was found to be significantly associated with the number of IVF cycles or with lower fertility success rate. Rather, women who had APCR and /or factor V Leiden and lupus anticoagulant had significantly higher live birth rates (12.3% and 12.6%, respectively) in comparison to women who were tested negative (9.0% and 9.7%, respectively). Thus, hypercoagulability is not associated with failure to achieve pregnancy. These data suggest that neither screening for thrombophilia nor anticoagulant treatment is indicated in cases with unexplained reproductive failure.

Background One out of 5 patients undergoing coronary angiography has angiographically normal coronary arteries (ANCA). Some of them have abnormally slow coronary flow (SCF). The prevalence and causes of SCF in these patients are not clear. Methods We studied 114 consecutive patients with ANCA. Each angiogram was independently evaluated by 2 physicians unaware of all other clinical features of the case. Coronary flow (CF) was graded using the corrected TIMI Frame Count (cTFC) and Coronary Clearance Frame Count (CCFC) methodologies. SCF was defined as a cTFC exceeding the reported normal (mean cTFC + 2 SD) in each of the three major coronary arteries. The association between SCF and various clinical, inflammatory, and metabolic variables was tested using a multivariable analysis model. Results Thirty-nine (34%) patients had SCF. Inter-individual CF varied substantially among them (range 10-143 frames/sec, mean: 37 ± 22 frames/sec). The intra-individual CF did not vary: CF correlated well in the three major epicardial coronary arteries of a given individual (r = 0.7, p = 0.0001). Multivariable analysis revealed that current smoking was the most significant variable related to SCF (odds ratio = 4.7, p = 0.006, CI 95% 1.6-13.3). The SCF group included significantly more smokers (41% versus 15%, p = 0.002). Conclusions SCF is a common finding (34%) among patients with angiographically normal coronary arteries. In these patients, slow flow is a systemic phenomenon that involves all three coronary arteries rather than a local event and is associated with current smoking.

To investigate whether treatment initiated with an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) for patients with ischemic heart disease, hypertension, or diabetes causes a reduction in hemoglobin (Hb) levels.This was a retrospective cohort analysis using the computerized database of a large health maintenance organization. Included were all adults with a first purchase of an ACE-I, an ARB, or a calcium channel blocker (CCB) between January 1, 2004, and December 31, 2009, defined as the index date. Measures of Hb levels before and 1 year after the index date were reviewed, and the change was calculated. All the analyses were stratified by pharmaceutical class. The main exposure variables were the proportion of days covered (PDC) by these drugs and the mean enalapril dosage (for enalapril users only).Levels of Hb before and after treatment were available for 14,754 patients taking ACE-Is, 751 taking ARBs, and 3087 taking CCBs. A high PDC was significantly associated with greater yearly reductions in Hb levels compared with a low PDC for CCB use, but was more pronounced for ACE-I and ARB use. A high PDC was also associated with a higher odds of developing anemia in ACE-I users (odds ratio [OR], 1.59; P.001) and ARB users (OR, 2.21; P=.05). In nonanemic enalapril users, every 10-mg increment in daily dose was associated with an OR of 1.45 for the development of anemia (P.001). The association remained after excluding nonadherent patients.Levels of Hb are reduced during the first year of use of ACE-Is and to a lesser extent with use of ARBs. This association is dose dependent and is not explained by patient adherence.

article Background: Anemia on admission and during hospitalization is associated with poor short and long term prog- nosis among patients with acute coronary syndrome (ACS). Our objective was to examine the prognostic impli- cations of longitudinal hemoglobin (Hb) levels following a first acute myocardial infarction (AMI). Methods: We utilized data obtained from the computerized database of a large community based health care maintenance organization to identify patients who survived for at least 6 months following a first AMI, during the years 2003-2010. Hazard ratios were calculated using Cox proportional regression models with various Hb measurements as dependent variables, and net reclassification improvement (NRI) was applied to evaluate the prognostic usefulness of these Hb measurements. Results: Last Hb measurement during a 6-24month follow-up period was found to have the highest prognostic power. In males, Hb levels below 13 g/dL were gradually associated with a higher risk of events, reaching a HR of 4.13 at Hb levels b11g/dL. In females, only Hb levels lower than 11g/dL were significantly associated with a higher event rate (HR = 2.42, p = 0.003). Hb decrease was significantly associated with an increased risk in both genders, even among non-anemic patients at baseline. Conclusions: Anemia and Hb decrement following a first AMI are associated with worse prognosis and elevated risk of combined all cause mortality and recurrent cardiac events.

Past studies expected measures of obesity to be positively associated with positive affects. However, this hypothesis was not tested in reference to a specific positive affect. We tested the hypothesized unidirectional effects of measures of obesity on vigour, representing a positive affect, and of vigour on measures of obesity.We used a longitudinal design, separately for men and women. Participants were 1,876 and 931 healthy men and women, respectively, examined at Time 1 (T1) and Time 2 (T2), about 2 years apart.Measures of obesity included body mass index, waist circumference, and waist-to-hip ratio. Vigour was assessed by the Shirom-Melamed Vigour Measure. We used structural equation modelling to test our hypotheses.We found that for both genders, T1 measures of obesity did not predict either T1 or T2 vigour. Among both genders, we found support for the effects of T1 vigour on T1 but not on T2 measures of obesity.To the extent that the 'Jolly fat hypothesis' refers to the effects of measures of obesity on positive affects, we failed to support it for vigour as a positive affect. Vigour has contemporaneous but not longitudinal effects on body weight.

Most psychoimmunological studies have focused on the effects of short-term situation-bound stress. This study was designed to explore the effects of different short-and long-term psychological factors on immunity, as reflected in the state of leukocyte adhesiveness/aggregation (LAA) in the peripheral blood, the white blood cell count (WBCC) and the erythrocyte sedimentation rate (ESR). The subjects were 91 healthy men and women, aged 18–69 years. They were administered the tests for LAA, WBCC and ESR, the Life Experiences Survey (Sarason et al.), the Questionnaire of Personal Problems (Kreitler and Kreitler), three measures of emotions, scales of neuroticism (Eysenck), stress susceptibility (Tellegen), strength of excitation, inhibition and mobility of nervous processes (Strelau), and the cognitive orientation (CO) of health. The results showed that the state of LAA in the peripheral blood correlated with 21.3 per cent of the psychological variables and that in a regression analysis these accounted for 38.2 per cent of the variance in LAA, the major predictors being specific personal problems and a constituent of the CO of health. The former alone accounted for 22.8 per cent of the variance and the latter for 26.6 per cent. The major predictor in men was personal problems and in women CO of health. WBCC and ESR were related to psychological factors to a lesser degree and to other predictors, mainly emotional. The conclusions emphasize the relatedness of LAA to specific sources of stress of short (viz problems) and long (viz deficient means of reducing stress) duration.

Retinal artery occlusion is rare in young adults, and may be associated with hereditary thrombophilia. We present a 19-year-old male who was evaluated for central retinal artery occlusion and found to be homozygous for the factor V Leiden mutation and heterozygous for the prothrombin G20210A mutation. Anterior chamber paracenthesis resulted in dramatic improvement, but recurring loss of vision necessitated repeated paracenthesis and the addition of aspirin to standard anticoagulation treatment. The literature concerning hereditary thrombophilia and retinal artery occlusion is reviewed, and the synergistic effect of multiple risk factors is emphasized. Screening for hereditary thrombophilia should be considered for young people presenting with unexplained retinal artery occlusion.

To the Editor: In the May issue of Stroke , we read with great interest the recent article by Sykora et al regarding the association of decreased baroreflex sensitivity with infections after intracerebral hemorrhage.1 The authors demonstrated decreased baroreflex sensitivity and an invasive procedure as independent predictors for postintracerebral hemorrhage infection, supporting the concept of autonomic shift toward sympathetic predominance as an independent risk of higher occurrence of infection in intracerebral hemorrhage. Although not discussed by the authors, their findings further confirm a critical role for the cholinergic–anti-inflammatory effect in patients with stroke, as was also shown in several …

article i nfo Vena cava filters (VCFs) are used to prevent pulmonary embolism when anticoagulation is contraindicated or in the event of progression of thrombosis despite adequate anticoagulation. Retrievable VCFs provide a po- tential advantage over permanent VCFs, but the appropriateness of their use and the frequency with which they are removed is not well established. Objectives: Document the indications for insertion of retrievable VCFs, filter removal in hospital practice. Methods: Observational study conducted in three academic medical centers. Consecutive patients undergoing retrievable VCF insertion were identified. Clinical data was extracted from the patients' charts and follow up data were obtained from treating physicians after discharge. Results: 300 patients were studied. The indication for filter insertion was acute bleeding (46.1%) or surgery (24.2%) in patients with acute thrombosis, prevention of venous thromboembolism in trauma (13.3%), potential bleeding in patients with deep vein thrombosis (9.1%) thromboembolism while on adequate anticoagulation (5.7%) and other (1.3%). 21 (7%) filters were removed. An unsuccessful attempt at retrieval was undertaken in a further 9 (3%) patients. Conclusions: The use of retrievable VCFs was appropriate, with the possible exception of their prophylactic use in major trauma. The majority of VCFs were not removed, for reasons that are not apparent.

Reflux of contrast medium into the inferior vena cava (IVC) is often detected on computerized tomographic pulmonary angiogram. The potential clinical implications and associated diagnoses of this finding have not been established. We investigated the prevalence and significance of reflux of contrast medium into the IVC in a large cohort of patients evaluated for possible pulmonary embolism (PE) by computerized tomographic pulmonary angiography. We retrospectively reviewed 1,065 consecutive computerized tomographic pulmonary angiographic examinations performed from January 1, 2007 through January 7, 2008 for the presence of reflux. Degree of reflux into the IVC and hepatic veins was graded from 1 (none) to 6 (severe). Patients' charts were reviewed for diagnoses during the index hospitalization and for background diseases. These clinical data were correlated with the reflux grade. The final study included 967 computerized tomographic pulmonary angiographic scans of 367 men and 600 women (mean age 62 ± 20 years, range 17 to 103). Almost 1/2 (480, 49.6%) had grade 1, 310 (32.1%) had grades 2 to 3, and 177 (18.3%) had grades 4 to 6. Multivariate logistic regression found that pulmonary hypertension, history of congestive heart failure, chronic atrial fibrillation, and acute PE were associated with extensive reflux (grades 4 to 6) with odds ratios (95% confidence intervals) of 5.4 (3.0 to 9.9, p

This article further explores the effects of stress on leukocyte adhesiveness. The concentration of plasma catecholamines as well as the LAA values were examined in 16 volunteers during a cold pressor test and in 15 volunteers following physical activity. A significant correlation between LAA values and plasma norepinephrine, dopamine and epinephrine was noted. In addition, experimental studies of anaesthetized dogs infused with dopamine and norepinephrine showed increased LAA values, and an insulin-induced hypoglycaemic animal model for adrenergic stress indicated an inverse correlation between serum glucose concentrations and LAA values. Finally, in the presence of an MAO inhibitor, norepinephrine significantly increased the state of LAA in vitro. Thus, there exists an association between adrenergic stress and the appearance of sticky leukocytes in the circulating pool. We assume that, at least in part, this stickiness results from a direct effect of the catecholamines on the adhesive properties of the cells. Other factors might be related to the decreased endothelial adhesiveness towards the white blood cells as well as the concomitant effect of other mediators released during stress. This study also supports our notion that the state of LAA in the peripheral blood can serve as a useful stress marker.

Summary. Background: Early identification by computed tomography pulmonary angiography (CTPA) of patients with acute pulmonary embolism (PE) who have signs associated with a high embolic burden would be highly desirable. Objectives: To investigate whether an increased obstruction of the pulmonary vasculature is associated with reduced left atrial (LA) and increased right atrial (RA) areas. Methods: We retrospectively analyzed a consecutive series of CTPA studies of 137 patients with acute PE and 38 controls without PE between October 2004 and March 2006. Left and right atrial areas and longitudinal and short axis diameters were measured and correlated with the pulmonary arterial obstruction index (PAOI) divided into tertiles (obstruction of < 12.5%, 12.5%–42.5% and ‡ 42.5%). Results: There was a significant negative age- and gender-adjusted correlation between the PAOI and LA measurements, particularly the LA area (r = )0.259) and the LA short axis diameter (r = )0.331). All RA measurements had positive correlations (RA area, r = 0.279; RA short axis diameter, r = 0.313). The LA/RA area ratio correlated negatively with the PAOI (r = )0.447). All above-mentioned correlations had P < 0.002. All the LA measurements were the largest in the controls and gradually decreased with higher PAOIs. A receiver operating characteristic curve analysis demonstrated that the RV/LV diameter, LA/RA area and LA/RA short axis diameter ratios had comparable discriminative ability for higher PAOI tertiles. Conclusions: The higher the clot load in the pulmonary arteries, the smaller the LA area and the larger the RA area. Atrial area measurements by CTPA may serve as a real-time parameter in assessing the severity of PE upon diagnosis.

Background Data for predicting which patients with pandemic influenza A (H1N1) infection are likely to run a complicated course are sparse. We retrospectively studied whether the admission serum C-reactive protein (CRP) levels can serve as a predictor of illness severity. Methods Included were all consecutive adult patients who presented to the emergency department (ED) between May-December, 2009 with a flu-like illness, a confirmed diagnosis of pandemic influenza A (H1N1) infection and a serum CRP level measured within 24 hours of presentation. Patients with a proven additional concurrent acute illness (e.g., bacteremia) were excluded. We used the ROC curve analysis, Kaplan-Meier curves and the Cox proportional hazard model to evaluate the predictive ability of CRP as a prognostic factor. Results Seventeen (9%) of the 191 enrolled patients were admitted to the intensive care unit (ICU), of whom eight (4%) required mechanical ventilation and three (2%) died. The median admission serum CRP levels were significantly higher among patients who required subsequent ICU care and mechanical ventilation than among patients who did not (123 mg/L and 112 mg/L vs. 40 mg/L, p < .001 and 43 mg/L, p = .017, respectively). A Cox proportional hazard model identified admission serum CRP levels and auscultatory findings over the lungs as independent prognostic factors for ICU admission. Admission serum CRP levels were the only independent prognostic factor for mechanical ventilation. Thirty days after presenting to the ED, none of the patients with admission serum CRP level p < .001 for ICU and p < .024 for mechanical ventilation). Conclusions In our study group, serum CRP levels obtained in the early ED admission stage from patients presenting with pandemic H1N1 influenza A infection were found to serve as a useful gauge for predicting disease course and assisting in patient management.

Background Metabolic syndrome (MetS) is frequently characterized by elevated liver enzymes, including gamma-glutamyl transferase (GGT) and alanine aminotransferase (ALT). Our objective was to evaluate the range of prevalence of MetS in apparently healthy individuals whose liver enzyme concentrations were all within-normal-range. Methods We have performed a cross sectional analysis on participants of the Tel-Aviv medical center inflammation survey (TAMCIS) recruited between the years 2003-2009. Analyzed were a cohort of 6,561 men and 3,389 women. Results The prevalence of MetS increased significantly from the first quintile to the fifth for both GGT and ALT, all the five quintiles being in the normal range. Logistic regression analysis for the presence of MetS showed crude odds ratios of 2.7 and 2.4 between the first and fourth quintiles and 3.6 and 3.2 for the fifth quintile in men and women respectively for ALT. For GGT the respective odds being 3.6 and 3.2 for the fourth quintile and 3.9 and 3.4 for the fifth quintile in men and women, respectively. Conclusions A relatively high prevalence of MetS was noted in a cohort of apparently healthy individuals with liver enzyme concentrations within-normal-limits. Practical consequences include the need to follow up these enzyme concentrations as continuous variables and to take into consideration that even relatively small elevations within the normal range might reflect the presence of dysmetabolism.

Background : There is insufficient data regarding the differential diagnosis and the prognostic value of significantly elevated serum levels of C-reactive protein (CRP) in hospitalized medical patients. Design and methods: A retrospective review of medical charts of patients admitted to a tertiary hospital's Internal Medicine ward during a period of 1 year who had at least one CRP serum level measurement of 200 mg/L or more. Results : Overall, 341 patients with a mean age of 69.8 ± 1.0 years were included in the study. Acute infection was the most prevalent diagnosis ( n = 293; 85.9%) with community-acquired pneumonia being the most common acute infection ( n = 115; 33.7%). Non-infectious conditions accounted for 9.1% ( n = 31) of the diagnoses and included mainly malignant metastatic diseases ( n = 19; 5.6%). Overall, 70 (20.5%) patients died within 30 days of admission. Age and active malignancy, with metastasis or without metastasis, were independently associated with 30-day mortality. Conclusion: Significantly elevated CRP serum levels are associated with bacterial infections, malignant diseases, and very high rates of 30-day mortality in hospitalized medical patients.

D-Dimer concentrations increase following the thrombotic event and decrease thereafter. Timing of D-Dimer evaluation in relation to the onset of the disease might have a diagnostic impact. We have presently performed a retrospective analysis of diagnostic procedures performed in individuals who presented to the Emergency department and evaluated for acute venous thromboembolism (VTE) following a single quantitative D-Dimer testing. Individuals who had a negative objective test served as controls to those who had a positive one (Doppler ultrasonography, high probability lung scan or a CT angiography). Seven hundred thirty-four individuals presented to the Emergency department, performed a single D-Dimer test as well as an objective test during their evaluation for an eventual event of acute VTE. One hundred ninety-seven patients had a positive objective test for either deep vein thrombosis (DVT) or pulmonary embolus. They were divided into seven tiles of times from symptoms onset. Highly significant differences between patients and controls regarding D-Dimer concentrations were noted mainly during the early days from symptom onset and turned less significant thereafter. Taking into consideration the time from symptoms onset in patients with acute VTE might have an effect on the diagnostic yield of quantitative D-Dimer in the Emergency department. We suggest not to exclude the eventual presence of acute VTE if quantitative D-Dimer is obtained later than 1 week following the onset of symptoms.

Anemia is associated with an unfavorable outcome in acute myocardial infarction (AMI). An acute phase response could contribute to the development of anemia in AMI patients.We have performed a cross-sectional analysis on prospectively collected data at a tertiary hospital catheterization laboratory. Multi-adjusted linear regression models were fitted for hemoglobin as the dependent variable. ANOVA tests were used to determine interactions between time cutoffs of the respective hemoglobin and the concentrations of two inflammatory proteins, namely C-reactive protein and fibrinogen. Anemia indices were analyzed in a subgroup of 138 male AMI patients for whom frozen serum samples were available.Enrolled were 1017 patients (340 with unstable angina pectoris [UAP] and 677 with AMI). Correlates of hemoglobin in the AMI group included age, male gender, the inflammatory proteins, as well as time from symptom onset to angiography (r(2)=0.47; p0.001). A significant decrease in the concentration of hemoglobin with a parallel increase in the inflammatory proteins was observed between the time cutoff from symptom onset to angiography only in the AMI group for males and females, respectively. A pattern suggestive of anemia of inflammation including higher ferritin, lower transferring, lower transferrin saturation, and lower serum iron concentrations has been observed in anemic AMI patients ( all p0.05).Inflammation-sensitive proteins are associated with lower hemoglobin concentrations in AMI patients. We therefore suggest the possibility that at least part of the hemoglobin drop in AMI prior to angiography is related to the anemia of inflammation.

Bleeding following dental extraction is frequently the first manifestation of severe factor XI deficiency. Safe oral surgery has previously been performed in such patients by using plasma replacement therapy with or without concomitant administration of antifibrinolytic agents. The aim of this study was to determine whether such patients can undergo safe dental extractions using only an antifibrinolytic agent. The study group consisted of 19 patients with severe factor XI deficiency (factor XI:C level less than 14 U/dl) who had previously bled following dental extractions (14 patients) or other trauma (five patients). Tranexamic acid, 1 g q.i.d., was given from 12 h before surgery, until 7 days afterwards. No excessive bleeding was observed following dental extractions. One patient had slight oozing after 3 days which ceased spontaneously. Thus, plasma replacement no longer appears necessary for patients with severe factor XI deficiency requiring dental extractions.

We determined the state of the leukocyte adhesiveness/aggregation in the peripheral blood by using a simple slide test and found it to be more sensitive than the white blood cell count for the detection of acute mental stress. Included were 71 controls, 64 young athletes examined just before their exercise, 14 volunteers who were examined 10-20 min before engagement in rappelling while an additional group of 20 were examined just before the act as they were facing an abyss from the top of a cliff. The state of leukocyte adhesiveness/aggregation correlated significantly (p less than 0.0005) only with the increasing strain assumed to occur from the first to the fourth group. The state of leukocyte adhesiveness/aggregation was 3.3 x more sensitive than white blood cell count in both rappelling groups and 5 x more sensitive than white blood cell count when evaluated in those examined at the last minute. We concluded that the state of leukocyte adhesiveness/aggregation is a reliable marker of acute mental stress.

The authors investigated the direct and interactive effects of the job demand– control–support(JDC-S) model’s components on subsequent changes in high-density lipoprotein cholesterol,low-density lipoprotein cholesterol, and triglycerides (TRI) separately for male and femaleemployees. In contrast to all 14 past studies on these relationships, the authors used a longitudinaldesign. Study participants ( N 1,137, 66% men) were all apparently healthy employees whounderwent a routine health check at 2 points in time (Time 1 and Time 2) about 22 months apart.In these analyses, the authors controlled for the Time 1 level of each criterion and for otherconfounders. Most of the direct and moderating effects found did not support the predictions ofthe JDC-S model; this nding is in agreement with the majority of past cross-sectional studies.The authors did not nd any evidence supporting the existence of a reverse causation for eitherof the components of the JDC-S model. The authors suggest that serum lipids may not be aphysiological mechanism mediating the effects of the JDC-S model on atherosclerotic diseases.Keywords: job demand–control–support model, social support at home, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol

Background Recent exposure to air pollution has a decremental effect on pulmonary function. This short-term effect has only been studied for up to a few days postexposure. Our objective was to analyze the effect of air pollution on spirometric parameters in varying lag times of up to 1 week from the time of exposure. Methods Healthy subjects, never smokers, who were participants in the Tel Aviv Sourasky Medical Center Inflammation Survey held between 2002 and 2007, were included if residing within an 11-km range to the nearest air pollution monitoring station. Linear regression models were applied to each lung function variable [first second of exhalation (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC] against air pollutant variables (particulate matter under 10 μ in diameter, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone) for increasing lag periods of up to 7 days, and they were adjusted for possible confounders that affect air pollution and spirometric measurements. Results The study population comprised 2380 individuals. We found a statistically significant negative correlation between air pollutants, mainly SO 2 , and between FEV 1 and FVC. This effect was significant from days 3 to 6, with a maximal effect noted for the fifth day and for the 7-day average before pulmonary function measurement. No significant change was found for FEV 1 /FVC ratio. Conclusions Air pollution has a decremental effect on lung function parameters for up to 6 days after exposure in healthy adults. SO 2 emerged as the most significant air pollutant affecting short-term lung function parameters.

The white blood cell count and its differential are established inflammation-sensitive biomarkers with a proven prognostic value in the field of atherothrombosis. However, the WBCC count range and determinants havenot been explored in the absence of a significant inflammatory response.To analyze the WBCC range and determinants in a large Israeli sample of individuals, excluding patients with a significant inflammatory response.WBCC and differential count reference ranges were determined in a large sample of apparently heal participants with high sensitivity C-reactive protein concentrations below 10 mg/L. Linear regression models were used to identify the determinants of the WBCC. The central 95% areas under the distribution curves were established for each gender.The study population comprised 8247 individuals (5391 males and 2856 females). The main laboratory and clinical variables found to affect the WBCC were gender, hemoglobin level, smoking status, triglycerides, and body mass index (all P0.001). Similar results were obtained for the differential count. The reference ranges for men and women were 3.6-9.9 and 3.4-10.0 x10(3) microl, respectively.The reference ranges for currently smoking men and women were 3.6-11.5 and 3.6-11.2 x10(3) microl, respectively, and were significantly higher compared with those of the never smokers and past smokers.We have demonstrated new limits of normal values for the WBCC in apparently healthy individuals who lack a significant "background" acute-phase response in a large Israeli sample. Our data might be useful for the risk stratification of apparently healthy individuals in the field of atherothrombosis.

Previous studies have demonstrated the presence of increased erythrocyte aggregation (EA) in patients with acute coronary syndromes (ACS). We have presently explored the correlation between the time from symptom onset to the appearance of an inflammatory response and aggregated erythrocytes in the peripheral blood of ACS patients. Consecutive individuals undergoing coronary catheterization at the Tel-Aviv Souraski medical center were enrolled. Matched controls were fitted for each case in order to compare the EA and inflammatory response in each time quartile from symptom onset. Linear regression models were fitted for wide-range C-reactive protein (wr-CRP), fibrinogen and for the Vacuum R a measure of EA, as the dependant variables and adjusted to multiple cardiovascular risk factors, relevant medications as well as to time from symptom onset to angiography. The study population comprised 428 male patients, 223 with unstable angina and 205 with acute myocardial infarction (AMI). A significant time-dependant increase in the concentrations of inflammation-sensitive biomarkers as well as EA has been noted only in the AMI group. Time from onset of pain to angiography entered as a significant predictor of fibrinogen, wr-CRP, and VR (r 2 = 0.24, p

Introduction C-reactive protein (CRP) is an inflammatory protein that may play a role in the pathogenesis of atherosclerosis. CRP gene single nucleotide polymorphisms (SNPs) have been shown to be associated with CRP concentration; however, their independent effect on atherosclerosis has not been yet established. We aimed to determine whether the 5′-flanking -757T>C CRP gene polymorphism is associated with CRP concentration and carotid atherosclerosis. Methods We genotyped the -757T>C CRP gene SNP and determined the concentration of serum CRP, the intima-media thickness (IMT) of the common carotid artery and the existence of plaque/s in 612 apparently healthy men and women aged 66 ± 10 years. Results Carriers of the CRP -757C allele presented with higher IMT and higher CRP concentrations (p = 0.002, p = 0.042, respectively). After adjustment for vascular risk factors, linear regression analysis showed an independent effect of CRP -757C allele on carotid IMT, beyond serum CRP concentrations. This SNP was also associated with carotid plaque occurrence (O.R. 1.74, 95% CI 1.1-2.77, p = 0.002). Conclusions The present study provides evidence that a genetic variant of CRP gene is associated with carotid atherosclerosis, independently of traditional vascular risk factors. Further large-scale genomic studies are required, which may identify the genetic vulnerable subjects to develop atherosclerosis.

Background: Increased strength of red blood cell (RBC) aggregates are present during the acute inflammatory response and contribute to erythrocyte aggregation and may lead to microvascular dysfunction. Inflammatory bowel diseases (IBDs) are characterized by damage to the bowel wall. This damage may be at least partially attributed to microvascular ischemia caused by enhanced erythrocyte aggregation. The aim of this study was to evaluate the strength of RBC aggregates in the blood of patients with IBD. Methods: The strengths of RBC aggregates were characterized by integrative RBC aggregation parameters, determined by measuring of RBC aggregation as a function of shear stress. The results are represented as the area under the curve (AUC) of aggregate size plotted against shear stress. For each patient, dynamic aggregation and disaggregation of RBC were recorded and analyzed according to the RBC aggregate size distribution at the different shear stresses. Aggregation indices were correlated with disease activity and inflammatory biomarkers. Results: We examined 53 IBD patients and 63 controls. IBD patients had significantly elevated concentrations of inflammation-sensitive proteins and aggregation parameters. The strength of large aggregates, represented by AUC for large fraction aggregates, among patients (15.2 ± 18.6) was double that of controls (7 ± 10.9) (P = 0.006). The strength of large aggregates correlated with disease activity (r = 0.340; P < 0.001) with concentration of fibrinogen (r = 0.575; P < 0.001) and with concentration of high sensitivity C-reactive protein (r = 0.386; P < 0.001). Conclusions: The strength of RBC aggregates is increased in patients with IBD and correlates with the intensity of the acute phase response. This could contribute to bowel damage in these diseases. (Inflamm Bowel Dis 2009)

The inflammatory response during thermal injury increases the adhesiveness of white blood cells. A direct slide test was used to compare the state of leucocyte adhesiveness/aggregation (LAA) in the peripheral blood of mice subjected to a thermal injury with the findings in control animals. The state of LAA in the peripheral blood increased from baseline values of 1.1 +/- 1.1 per cent to 6.5 +/- 1.3 per cent within 1 h and to 11.0 +/- 1.2 per cent and 14.8 +/- 4 per cent after 3 and 6 h respectively following thermal injury. The respective leucocyte counts were 3075 +/- 277/mm3 (baseline), 3871 +/- 359, 3840 +/- 687 and 6395 +/- 1152 cells/mm3. The LAA values had subsided by 5 days following burning and correlated with the degree of pulmonary leukostasis. Our study suggests that the LAA is an early and sensitive marker of inflammation and that it can be used as a marker for the presence of pulmonary leukostasis during thermal injury.

A direct slide test was used to detect the presence of aggregated white blood cells in the peripheral blood. By this means the state of leucocyte adhesiveness/aggregation (LAA) during acute mental stress was determined in 22 healthy volunteers and compared to the white blood cell count (WBCC). The LAA test proved to be more sensitive (73 per cent) as compared to the WBCC (40 per cent). This increased sensitivity is a result of a greater deviation of the LAA from normal values (obtained in 22 healthy controls) than the one obtained in the absolute cell number in the circulating pool. It is assumed that factors released during stress induce a state of increased LAA. Hence the determination of the adhesive state together with the absolute WBCC may yield a rapid, cheap and efficient laboratory criterion for the detection of mental stress.

Recent studies have documented the utility of using heparin, and especially low molecular heparin, for the prevention of venous thromboembolism (VTE) in surgical patients. However, this approach might not be essential in individuals at low VTE risk and following minor surgical interventions. Arthroscopic surgery might be considered minor surgery but at times is performed in individuals with established risk factors for VTE. Furthermore, some arthroscopic procedures include tissue damage that is not necessarily trivial, and in addition, documented cases of VTE events, some of them even fatal, appeared in the literature. By now, most researchers agree that it is essential to adopt an individualized risk stratification to single out individuals who might benefit from a prophylactic approach that might include early mobilization, and mechanical devices, as well as heparins. Thus, despite the clearly low prevalence of documented VTE following arthroscopic surgery, one might not accept potential life threatening events following these relatively low risk procedures. Therefore, patients might benefit from a personalized risk-benefit equation before each particular intervention.

OBJECTIVE: The recently introduced Bayer wide-range C-reactive protein (wr-CRP) assay might be relevant for the real-time low-cost and online determination of inflammatory bowel disease (IBD) activity. Our aim was to examine whether wr-CRP can substitute for the Dade Behring high sensitivity C-reactive protein (hs-CRP) assay in IBD patients. METHODS: A total of 71 patients with IBD, of whom 48 had Crohn’s disease CD and 23 had ulcerative colitis (UC) with various intensities of disease activity participated in the study. The CRP of patients who were under treatment at the Department of Gastroenterology and Liver Diseases were measured using both wr-CRP and the hs-CRP. RESULTS: A significant (r = 0.995; P < 0.001) correlation was noted between the hs-CRP and wr-CRP measurements for the whole sample as well as for the two diseases, CD (r = 0.994; P < 0.001) and UC (r = 0.997; P < 0.001), which were analyzed separately. CONCLUSION: The Bayer wr-CRP assay might be a useful low-cost and real-time inflammation-sensitive biomarker in patients with IBD.

Objective: We prospectively studied the hypothesized beneficial effects of feeling vigorous and of objective physical fitness (gauged based on functional capacity) on subsequently assessed self-rated health (SRH), controlling for possible confounders known to be precursors of SRH and of our predictors. We also investigated the reverse-causation hypothesis that SRH predicts subsequent vigor and functional capacity. Design: Participants were apparently healthy employees (N 779) who underwent a routine health check at two points of time, Time 1 (T1) and Time 2 (T2), about 18 months apart. We used regression analysis, predicting T2 SRH by T1 SRH, the control variables, and T1vigor and functional capacity. Main Outcome Measures: Vigor was assessed using the Shirom-Melamed Vigor Measure; objective physical fitness was indicated by functional capacity following a treadmill exercise, and self-rated health was measured by a single item. Results: As hypothesized, we found that the change in T2 SRH was positively predicted by T1 vigor, functional capacity, and their interactive term. Testing the reverse causation paths, we found that T1 SRH did not predict subsequent functional capacity and was a relatively weak predictor of subsequent vigor. Conclusion: The affective state of vigor and objectively assessed functional capacity interact to predict subsequent changes in self-rated health.

Summary. Objective: To investigate whether fast grading of reflux of contrast to the inferior vena cava (IVC) on computerized tomographic pulmonary angiography (CTPA) is a potential biomarker for real-time risk stratification. Methods: We retrospectively identified 343 patients investigated for possible pulmonary embolism (PE) by CTPA at our medical center between September 2004 and March 2006. A total of 145 consecutive patients with PE (age 67 ± 19 years) and 168 consecutive ones with negative CTPAs (age 64 ± 20 years) fulfilled entry criteria. CTPAs were evaluated for retrograde reflux of contrast to the IVC by fast visual grading from 1 to 6 using the original axial images. Pulmonary obstruction index, the diameters of right and left ventricles and pulmonary artery, and patient survival data were recorded as well. Results: Twenty-nine (20.0%) patients with positive CTs and 23 (13.7%) patients with negative CTs had substantial degrees (≥4) of reflux of contrast to the IVC (P = 0.14). The Kaplan–Meier 30-day survival curves demonstrated significant reduction in survival in individuals with PE and grade ≥4 reflux of contrast to the IVC compared with lower grades (P = 0.008), but not in patients with grade ≥4 and no PE on CTPA (P = 0.26). The other cardiovascular parameters showed no significant correlation with survival in patients with and without PE. Conclusion: Substantial grades of reflux of contrast to the IVC during CTPA could predict early mortality in patients with acute PE. Rapid grading of reflux of contrast from the original axial CTPA images can be used for real-time risk stratification in patients with acute PE.

Objective To explore the possibility that mild inflammatory changes exist in asymptomatic adults during bouts of acute respiratory tract infections in the general population, and may mediate atherothrombotic events. Methods An epidemiological study that enrolled 5315 males and 2795 females attending a routine screening health program between the years 2003 and 2007. We correlated the concentrations of high sensitivity C-reactive protein (hs-CRP) and quantitative fibrinogen in completely asymptomatic and non-inflamed adults to the weekly epidemiological data for the incidence of acute respiratory tract infections in the community. Results Significant seasonal variations in the inflammatory variables were found for both genders. The population's weekly rates of acute respiratory tract infection had a significant epidemiological influence on the inflammatory biomarkers in the asymptomatic cohort. The magnitude of this influence could reach as much as 12% (3–22%) in hs-CRP concentrations in women and 0.30 μmol/L (0.20–0.41) in fibrinogen concentrations in men, for the change between the mean August and the mean January population's respiratory illness burden. Conclusion Increase in the concentrations of two inflammation-sensitive biomarkers can occur in completely asymptomatic adults at times of increased burden of acute respiratory tract infection in the general population. The possibility exists that these inflammatory changes represent occult and asymptomatic infections that could by themselves trigger acute atherothrombotic events.

The purpose of this study was to explore the possibility that the recently described "hypertriglyceridemic waist" (HTGW) phenotype, a risk for future coronary artery disease, is associated with the presence of low-grade inflammation. This is a cross-sectional study in a cohort of apparently healthy nondiabetic employed individuals in whom the presence of low-grade inflammation was determined by using the Dade Behring high-sensitivity C-reactive protein (hs-CRP) assay. We have presently analyzed the results obtained in 9842 apparently healthy individuals, at a mean (SD) age of 44 (11) years. We identified 1249 individuals (70.0% men) with HTGW phenotype according to the cutoff points of waist girth of at least 90 cm for men and at least 85 cm for women and triglycerides levels of at least 177 mg/dL for men and at least 133 mg/dL for women. In addition, we identified 1164 individuals (69.3% men) with the metabolic syndrome (MetS) according to the updated Adult Treatment Panel III criteria. The mean (SD) of hs-CRP was 1.3 (2.9) mg/L for the 8055 individuals who had neither the HTGW phenotype nor the MetS, 2.1 (2.7) mg/L for those who had the HTGW phenotype and no MetS, and 2.5 (2.7) for 538 individuals with the MetS and no HTGW phenotype, whereas those who had both atherogenic disorders presented an hs-CRP concentration of 2.9 (2.3) mg/L. In this cohort of apparently healthy nondiabetic employed individuals, the HTGW phenotype had a similar prevalence as the MetS and was associated with the presence of low-grade inflammation. This inflammation could be a pathophysiologic link between this dysmetabolism and atherothrombosis. In addition, the HTGW phenotype is relatively prevalent and could be a simple and inexpensive way to single out individuals at risk for future coronary artery disease.