Curve In Men Research Articles

Postprandial glycemic response to isocaloric carbohydrate load in men with different types of obesity

BACKGROUND: Carbohydrates exert major impact on postprandial blood glucose levels. Diet therapy for obesity and diabetes mellitus usually implies dietary restrictions on the amount, type and daily distribution of carbohydrates, wherein the timing of meals and its composition play a significant role. However currently there is insufficient evidence-based data to guide how carbohydrates consumption should be distributed during a day in obese men.AIM: To investigate postprandial glucose levels in response to an isocaloric carbohydrate load at main meals (breakfast, lunch, dinner) in individuals with different types of obesity.MATERIALS AND METHODS: The study enrolled men aged 25 to 65 years. The total number of study participants was 43 men. Group 1 (n=17) consisted of obese men with subcutaneous type of fat distribution (SFD) while group 2 (n=16) was represented by obese men with abdominal type of fat distribution (AFD). Group 3 (comparators) consisted of 10 men with normal body weight (NBW). The duration of continuous glucose monitoring was 5–6 days. Observation period included 3 days of usual physical and work activity regimens. Glycemic response on carbohydrate isocaloric load was assessed on different days and mealtime. During first and fifth days men were instructed to eat as usual without any restrictions. Standard carbohydrate breakfast was introduced during the second day while standard carbohydrate lunch and dinner were performed at the third and fourth days respectively.RESULTS: Results of isocaloric carbohydrate load representing different standard meals (breakfast, lunch, dinner) showed that in NBW men the most intense utilization of glucose occurs in the morning during breakfast. Glucose tolerance was significantly lower at all meals in AFD men group comparing to men with NBW and SFD. In men with SFD glucose tolerance was relatively lower than in NBW men only during standard breakfast. At lunch and dinner time disposition of the glycemic curve in men with SFD and NBW didn’t significantly differ.CONCLUSION: Dividing men according to obesity phenotypes allows to identify features of regulation of carbohydrate metabolism and as a result to reveal different risk levels of type 2 diabetes and its’ complications. The combination of continuous glucose monitoring with dietary control can significantly increase the effectiveness of therapeutic interventions for obesity and offers a pathogenetic approach to personalized diet therapy

High-density lipoprotein cholesterol levels is negatively associated with intertrochanter bone mineral density in adults aged 50 years and older.

High-density lipoprotein cholesterol (HDL-C) has long been viewed as a protective factor for cardiovascular health. Yet, higher HDL-C was not necessarily beneficial. The purpose of this study was to investigate the relationship between HDL-C levels and intertrochanter bone mineral density. The study collected the most recent data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Weighted multiple regression analysis was used to evaluate the relationship between HDL-C and intertrochanter BMD, and further subgroup analysis and threshold effect analysis were conducted. Finally, the relationship between HDL-C and intertrochanter BMD was analyzed by fitting smooth curves. The study included 3,345 people ranging in age from 50 to 80. HDL-C was discovered to be negatively correlated with intertrochanter BMD (β = -0.03, 95%CI: -0.04, -0.01, P = 0.0002). In subgroup analysis, the negative correlation was found among 60-70-year-olds (β = -0.04, 95%CI: -0.06, -0.02, P = 0.0010), additionally, non-Hispanic whites (β = -0.03, 95%CI: -0.05, -0.01, P = 0.0140), and obese individuals (β = -0.03, 95%CI: -0.05, -0.01, P = 0.0146). The negative correlation, on the other hand, remained significant and consistent across genders, menstruation status, hormone usage, and long-term use of steroids. The relationship between HDL-C and intertrochanter BMD was an inverted U-shaped curve in men and hormone users, with inflection points of 1.01 mmol/L and 1.71 mmol/L, and an U-shaped curve in other Hispanic and premenopausal individuals, with inflection points of 0.96 mmol/L and 1.89 mmol/L. HDL-C was negatively associated with intertrochanter BMD in people over 50 years of age, non-Hispanic whites, and obesity.

Musical Indeterminacy as Critical and Affirmative play

Musical Indeterminacy as Critical and Affirmative play1 Kirsten L. Speyer Carithers (bio) "Dialed Music, or Whatever, Offers Stiff Test of Nerves," proclaimed a headline in the Buffalo Evening News in December 1966. The article's author, music critic JOHN DWYER, further argued that the evening's concert was more challenging for the audience than Russian roulette or "Dead Man's Curve at 120 in the rain."2 What was so demanding about this event? The recently formed Sonic Arts Union, visiting the University at Buffalo's Baird Hall as part of the Slee Music Lecture series, incorporated strange new techniques into their performance, disrupting norms and unsettling audience members. Musicians ROBERT ASHLEY, GORDON MUMMA, DAVID BEHRMAN, and ALVIN LUCIER presented new compositions that evening, many of which incorporated experimental technology. By that point, MUMMA and ASHLEY had developed the ONCE Festival (in Ann Arbor, Michigan) into an important site for new music, and they brought that [End Page 119] energy to the Buffalo concert, performing works that altered typical conventions of vocalization and instrumental performance. The Sonic Arts Union's work coincides temporally with the rise of the do-it-yourself (DIY) ethos within certain forms of popular music, which has been an important aspect of several musical subcultures, and experiments like Mumma and Ashley's suggest a similar fascination with sonic technology.3 As explained by Dwyer, Mumma "played a wired-up French horn, though used more as a modifying long-tube for the whispering or growling voice, and his colleagues made amplified vocal sounds through throat mikes."4 It seems likely that an early version of Mumma's composition Hornpipe was presented that evening in 1966. In the composer's own description, "Hornpipe is a live electronic work for French horn with cybersonic console," in reference to "a small metal box worn by the performer" that "contains electronic circuits of my own design which respond to the sounds of the Horn and to the acoustical resonances of the performance space" (Fig. 1).5 In other words, the artist modified his instrument—a practice that, as I will demonstrate, predicts similar actions in electronic and digital games. The group also presented Ashley's now-(in)famous piece The Wolfman (1964), which is "essentially a work about feedback—a microphone is positioned so close to the performer's mouth that changes in the size of the oral cavity bring about great changes in the feedback sound."6 While the performer must actually produce the sounds extremely quietly, the amplification and feedback are arranged in such a way that the resulting sound can be painfully loud for the audience. In fact, Renée Levine Packer, the longtime program coordinator in the School of Music at UB, recalls the Buffalo performance as "fierce amplified growls and yells emanating from the hall" near her office.7 Like so many of the events presented by the Center of the Creative and Performing Arts (CCPA, also known as the Creative Associates) at Buffalo, which was active from 1964 to 1980, the artists in this concert incorporated strange new techniques into their performance, disrupting norms and unsettling audience members. At a recital held in 1970, for example, Petr Kotík and his group effectively rewrote the conventions of classical concert attendance. By placing musicians in three separate rooms, the audience had to actively participate by moving through the space, or limit themselves to only one set (or, as suggested in the program, "take a break from listening and go to the basement for some [End Page 120] Click for larger view View full resolution Figure 1. Gordon Mumma performing Hornpipe with cybersonic console and horn at the Metropolitan Museum of Art, New York, February 19, 1972. Gordon Mumma, Cybersonic Arts: Adventures in American New Music ed. Michelle Fillion (Urbana: University of Illinois Press, 2015), 56. refreshment, to play ping-pong or "bowl").8 Performers in the 1972 concert called S.E.M. Gives a Lecture turned the lecture-recital on its ear by eating dinner onstage, then sharing dessert with their bemused audience before playing a little music, including Julius Eastman's Eine kleine Nachtmusik—almost certainly a riff on W. A. Mozart's well...

Acute Flaxseed Intake Reduces Postprandial Glycemia in Subjects with Type 2 Diabetes: A Randomized Crossover Clinical Trial.

Background: Postprandial glycemic excursions are associated with impairment control of diabetes mellitus. Long-term consumption of flaxseed can lower blood glucose levels; however, its effects on the postprandial glycemic response remain unknown. Therefore, this study aimed to evaluate the acute effects of raw flaxseed consumption on the 2 h postprandial glycemic curve in men with type 2 diabetes mellitus (T2DM). Methods: This was a randomized crossover clinical trial. Nineteen men with T2DM were randomly assigned a standardized breakfast without (control) or with a previous intake of 15 g of ground raw golden flaxseed (flax). Glycemia was measured at fasting and postprandial at 15, 30, 45, 60, 90, and 120 min. Palatability markers (visual appeal, smell, and pleasantness of taste) and taste intensity (sweetness, saltiness, bitterness, sourness, and creaminess) were evaluated. Results: The peak glucose rise and the 2 h AUC glycemic response reduced in the flax group by 17% (p = 0.001) and 24% (p < 0.001), respectively. The glucose peak time, palatability, and taste parameters did not differ between the two groups. Conclusions: Ingestion of 15 g of ground raw golden flaxseed before breakfast decreases the 2 h postprandial glycemic response in men with T2DM.

Microstates in complex and dynamical environments: Unraveling situational awareness in critical helicopter landing maneuvers.

Understanding decision‐making in complex and dynamic environments is relevant for designing strategies targeting safety improvements and error rate reductions. However, studies evaluating brain dynamics in realistic situations are scarce in the literature. Given the evidence that specific microstates may be associated with perception and attention, in this work we explored for the first time the application of the microstate model in an ecological, dynamic and complex scenario. More specifically, we evaluated elite helicopter pilots during engine‐failure missions in the vicinity of the so called “dead man's curve,” which establishes the operational limits for a safe landing after the execution of a recovery maneuver (autorotation). Pilots from the Brazilian Air Force flew a AS‐350 helicopter in a certified aerodrome and physiological sensor data were synchronized with the aircraft's flight test instrumentation. We assessed these neural correlates during maneuver execution, by comparing their modulations and source reconstructed activity with baseline epochs before and after flights. We show that the topographies of our microstate templates with 4, 5, and 6 classes resemble the literature, and that a distinct modulation characterizes decision‐making intervals. Moreover, the source reconstruction result points to a differential activity in the medial prefrontal cortex, which is associated to emotional regulation circuits in the brain. Our results suggest that microstates are promising neural correlates to evaluate realistic situations, even in a challenging and intrinsically noisy environment. Furthermore, it strengthens their usage and expands their application for studying cognition under more realistic conditions.

Dietary Nonheme, Heme, and Total Iron Intake and the Risk of Diabetes in Adults: Results From the China Health and Nutrition Survey.

Excessive iron intake has been linked to diabetes risk. However, the evidence is inconsistent. This study examined the association between dietary heme and nonheme iron intake and diabetes risk in the Chinese population. We included 17,026 adults (8,346 men and 8,680 women) who were part of the China Health and Nutrition Survey (1991-2015) prospective cohort. Dietary intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. Diabetes cases were identified through a questionnaire. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. A total of 547 men and 577 women developed diabetes during 202,138 person-years of follow-up. For men, the adjusted HRs (95% CIs) for quintiles of nonheme iron intake were 1.00, 0.77 (0.58-1.02), 0.72 (0.54-0.97), 0.63 (0.46-0.85), and 0.87 (0.64-1.19) (P-nonlinearity = 0.0015). The corresponding HRs (95% CIs) for women were 1.00, 0.63 (0.48-0.84), 0.57 (0.43-0.76), 0.58 (0.43-0.77), and 0.67 (0.49-0.91) (P-nonlinearity < 0.0001). The dose-response curves for the association between nonheme iron and total iron intake and diabetes followed a reverse J shape in men and an L shape in women. No significant associations were observed between heme iron intake and diabetes risk. Total iron and nonheme iron intake was associated with diabetes risk, following a reverse J-shaped curve in men and an L-shaped curve in women. Sufficient intake of nonheme or total iron might be protective against diabetes, while excessive iron intake might increase the risk of diabetes among men.

Generation and gender factors of the structure of value orientations

A great interest in the study of the value orientations of a person is explained by their decisive role in explaining human behavior. Previous studies have shown that demographic factors influence people's value system. Over the past 20 years, several mass surveys have been conducted with wide geography. Their results showed that in the world there are processes of transformation in the structure of cultural values of different communities of people. The aim of this study was to examine the effects of generation and gender factors on value orientations. The study was based on Schwartz's theoretical model of cultural values. The survey was attended by 384 residents of Chelyabinsk and the Chelyabinsk region (Russia). To collect empirical data, Schwartz's questionnaire in Russian was used. The study found that representatives of the Soviet generation are more oriented towards conservative values, and representatives of the post-Soviet generation more adhere to values reflecting their openness to experience. In this study, men differed from women in a greater commitment to the values of autonomy and power. Considering the values of generations in the context of the gender of respondents, it is found that hedonistic values and the desire for stimulation and power are represented by a U-shaped curve in men and an inverted U-shaped curve in women. This allows us to conclude that in Russia, conditions of economic stabilization lead to increased openness to experience and dominance among men. For women, these conditions make the desire for dominance and high social status less significant.

Sex and age interact to determine clinicopathologic differences in Alzheimer\u2019s disease

Women reportedly make up two-thirds of Alzheimer’s disease (AD) dementia sufferers. Many estimates regarding AD, however, are based on clinical series lacking autopsy confirmation. The Florida Autopsied Multi-Ethnic (FLAME) cohort was queried for AD cases with a total of 1625 identified ranging in age from 53 to 102 years at death. Standard neuropathologic procedures were employed and clinical information was retrospectively collected. Clinicopathologic and genetic data (MAPT and APOE) were stratified by sex. Within the neuropathologically diagnosed AD cohort, the overall number of women and men did not differ. Men were younger at onset of cognitive symptoms, had a shorter disease duration, and more often had atypical (non-amnestic) clinical presentations. The frequency of autopsy-confirmed AD among women and men stratified by age at death revealed an inverse U-shaped curve in men and a U-shaped curve in women, with both curves having inflections at approximately 70 years of age. Regional counts of neurofibrillary tangles differed in women and men, especially when examined by age intervals. Women had overall greater severity of neurofibrillary tangle counts compared to men, especially in the hippocampus. Men were more often classified as hippocampal sparing AD, whereas limbic predominant AD was more common in women. Men and women did not differ in frequency of MAPT haplotype or APOE genotype. Atypical clinical presentations, younger age at onset and shorter disease duration were more frequent in men, suggesting that the lower reported frequency of AD in men may be due to more frequent atypical clinical presentations not recognized as AD. Our data suggest that neuropathologically diagnosed AD cases have the same frequency of women and men, but their clinical presentations and ages at onset tend to differ.

La Recaída En Fumadores Que Dejan De Fumar Con Un Tratamiento Psicológico: ¿Una Cuestión De Sexo? [Relapse in Smokers Who Quit with a Psychological Treatment: A Gender Issue?

Although we have effective treatments for tobacco dependence, relapse is a frequent phenomenon in those who quit. The aim of this study was to analyze whether there were differences by gender in the relapse curve in men and women who participated in a cognitive-behavioral smoking cessation treatment. The sample was composed of 266 individuals (59.8 % women) who were abstinent at the end of treatment. The results indicate that as time after the intervention increases, the percentage of abstinent participants decreases. However, no significant differences between men and women in the relapse curve were found, which could be explained by the inclusion of effective psychological tools to cope with some of the main causes of relapse (e.g., negative affect) in the treatment. Given the importance of relapse in the smoking cessation process, it is necessary to deepen in its triggers.

The cytokinesis-blocked micronucleus assay: dose-response calibration curve, background frequency in the population and dose estimation.

An in vitro study of the dose responses of human peripheral blood lymphocytes was conducted with the aim of creating calibrated dose-response curves for biodosimetry measuring up to 4 Gy (0.25-4 Gy) of gamma radiation. The cytokinesis-blocked micronucleus (CBMN) assay was employed to obtain the frequencies of micronuclei (MN) per binucleated cell in blood samples from 16 healthy donors (eight males and eight females) in two age ranges of 20-34 and 35-50 years. The data were used to construct the calibration curves for men and women in two age groups, separately. An increase in micronuclei yield with the dose in a linear-quadratic way was observed in all groups. To verify the applicability of the constructed calibration curve, MN yields were measured in peripheral blood lymphocytes of two real overexposed subjects and three irradiated samples with unknown dose, and the results were compared with dose values obtained from measuring dicentric chromosomes. The comparison of the results obtained by the two techniques indicated a good agreement between dose estimates. The average baseline frequency of MN for the 130 healthy non-exposed donors (77 men and 55 women, 20-60 years old divided into four age groups) ranged from 6 to 21 micronuclei per 1000 binucleated cells. Baseline MN frequencies were higher for women and for the older age group. The results presented in this study point out that the CBMN assay is a reliable, easier and valuable alternative method for biological dosimetry.

Dispositional Mindfulness Moderates the Effect of a Brief Mindfulness Induction on Physiological Stress Responses

This study investigated the effects of a brief mindfulness intervention on romantic partners’ physiological responses to conflict stress moderated by trait mindfulness. Young adult couples (n = 101 dyads) completed the Five Facet Mindfulness Questionnaire (FFMQ) to assess trait mindfulness approximately 1 week prior to a laboratory session involving a conflict discussion task. One third of partners were randomly assigned to a mindfulness induction condition before the conflict (remaining participants were assigned to a perspective taking or control condition). All participants gave five saliva samples over the course of the session to measure autonomic (salivary alpha-amylase, sAA) and neuroendocrine (cortisol) stress responses. There were no main effects of participation in the mindfulness condition, but analyses revealed differing intervention impacts for partners with high vs. low dispositional mindfulness. According to region of significance testing, partners with high FFMQ scores (top 23 % of men, 12 % of women) showed better stress regulation in the mindfulness condition, i.e., more dynamic sAA reactivity/recovery curves for men and quicker post-stress cortisol recovery for women, whereas those with low FFMQ scores (bottom 5 % of men, 11 % of women) showed poorer regulation, i.e., flatter sAA responses. Implications for using mindfulness to foster stress regulation are discussed.

Prevalence of anemia and associated factors in older adults: evidence from the SABE Study

OBJECTIVE To assess the prevalence of anemia and associated factors in older adults.METHODS The prevalence and factors associated with anemia in older adults were studied on the basis of the results of the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Welfare and Aging) study. A group of 1,256 individuals were interviewed during the third wave of the SABE study performed in Sao Paulo, SP, in 2010. The study included 60.4% females; the mean age of the participants was 70.4 years, and their average education was 5.3 years. The dependent variable was the presence of anemia (hemoglobin levels: 12 g/dL in women and 13 g/dL in men). Descriptive analysis and hierarchical logistic regression were performed. The independent variables were as follows: a) demographics: gender, age, and education and b) clinical characteristics: self-reported chronic diseases, presence of cognitive decline and depression symptoms, and body mass index.RESULTS The prevalence of anemia was 7.7% and was found to be higher in oldest adults. There was no difference between genders, although the hemoglobin distribution curve in women showed a displacement toward lower values in comparison with the distribution curve in men. Advanced age (OR = 1.07; 95%CI 0.57;1.64; p < 0.001), presence of diabetes (OR = 2.30; 95%CI 1.33;4.00; p = 0.003), cancer (OR = 2.72; 95%CI 1.2;6.11; p = 0.016), and presence of depression symptoms (OR = 1.75; 95%CI 1.06;2.88; p = 0.028) remained significant even after multiple analyses.CONCLUSIONS The prevalence of anemia in older adults was 7.7% and was mainly associated with advanced age and presence of chronic diseases. Thus, anemia can be an important marker in the investigation of health in older adults because it can be easily diagnosed and markedly affects the quality of life of older adults.

Risk of type 2 diabetes according to traditional and emerging anthropometric indices in Spain, a Mediterranean country with high prevalence of obesity: results from a large-scale prospective cohort study

BackgroundObesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric characterisation of T2DM risk is essential for disease prevention and clinical risk assessement.MethodsLongitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to calculate hazard ratios of T2DM by levels of anthropometric variables.ResultsOverall and central obesity were independently associated with T2DM risk. BMI showed the strongest association with T2DM in men whereas waist-related indices were stronger independent predictors in women. Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at 0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity was 17% in men and 31% in women.ConclusionsDiabetes risk was associated with higher overall and central obesity indices even at normal BMI and WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the evaluation of future T2DM risk in women.

Validation of liver fibrosis biomarker (FibroTest) for assessing liver fibrosis progression: Proof of concept and first application in a large population

Time-dependent statistics have been used to assess liver fibrosis progression (LFP) in liver diseases from birth to first biopsy, in a limited number of patients. Non-invasive biomarkers such as FibroTest (FT) should allow the estimation of LFP on larger populations. We aimed at validating this concept by comparing LFP using FT vs. biopsy (P1) and then at applying the non-invasive method to a large population (P2). In P1, LFP was assessed using biopsy and FT in 2472 untreated patients: 770 with chronic hepatitis C, 723 with hepatitis B, 761 with non-alcoholic fatty liver disease (NAFLD), and 218 with alcoholic fatty liver disease (ALD). In P2, 342,346 interpretable FT prospectively measured were used. LFP was estimated using transition rates (cumulative hazard rate) to cirrhosis (F4) or to minimal fibrosis (>F0). In P1, there was a significant concordance between FT and biopsy estimates of hazards with intraclass correlation (ICC)=0.961 (95% CI 0.948-0.970) and 0.899 (95% CI 0.135-0.969) for F4 and >F0, respectively. This concordance persisted according to the disease and the gender. The more rapid LFP to F4 (biopsy/FT) was observed for men with ALD (1.44/1.62), and the slower for women with NAFLD (0.09/0.02). In P2, the LFP started to increase for men at the age of 30 years. The cumulative fibrosis progression rate to minimal fibrosis in women crossed the "man curve" around the age of 80 years. The following factors were associated with LFP to F4 (all p<0.0001): male gender (Relative Risk=3.29), HIV co-infection (2.33), and residency in Middle East (2.67) or Eastern Europe (2.15). Validated biomarkers such as FibroTest should allow powerful analysis of fibrosis progression in chronic liver diseases and better identification of risk factors.

Cut off values for abdominal obesity as a criterion of metabolic syndrome in an ethnic Kyrgyz population (Central Asian region)

BackgroundPeople of different racial and ethnic backgrounds have a distinct pattern of central fat deposition, thus making it necessary to devise a race based approach for the diagnosis and evaluation of abdominal obesity (AO). This is the first study to determine the optimal waist circumference (WC) cutoff values for definition of AO in an ethnic Kyrgyz population.Methods323 persons of Kyrgyz ethnicity (183 women and 140 men), with a mean age of 51.8 ± 9.5 years old were included in the study. Measurement of blood pressure (BP), anthropometric data (including body mass index calculation and WC measurement), fasting blood sugar, serum lipid parameters and insulin were performed in all examined individuals. Insulin resistance (IR) was considered as HOMA index (insulin × fasting glucose/22.5) ≥ 2.77. Sensitivity and specificity for the presence of IR or two other criteria of MS (according to the international classification, 2009) were calculated by using receiver operating characteristic (ROC) curves for men and women separately.ResultsThe optimal sensitivity and specificity obtained from the ROC curves for IR were 88 cm in women (sensitivity of 0.85, 95%CI (0.72-0.93), specificity of 0.58, 95%CI (0.49-0.66)) and 94 cm for men (sensitivity of 0.8, 95% CI (0.65-0.91), specificity of 0.61, 95% CI (0.51-0.71)). The data from the ROC curve for any two other MS criteria confirmed the results and the WC 88 cm in women (sensitivity of 0.82, 95% CI (0.72-0.9), specificity of 0.72, 95% CI (0.62-0.8)) and 94 cm in men (sensitivity of 0.74, 95% CI (0.62-0.84), specificity of 0.73, 95% CI (0.61-0.83)) were corresponded to the optimal sensitivity and specificity.ConclusionWC ≥ 88 cm and ≥ 94 cm should be used as a criterion for the diagnosis of AO for Kyrgyz women and men respectively based on these results.

Abdominal circumference should not be a required criterion for the diagnosis of metabolic syndrome

Metabolic syndrome (MetS) is an established concept. However, it is characterized by a number of different definitions as well as different cut-off points (COPs) for waist circumference (WC) and different modes for incorporating WC into the diagnostic criteria. Abdominal ultrasonography was performed in 2,333 subjects who also underwent comprehensive medical examinations between April and July 2006. The odds ratios for the number of MetS components were calculated by taking central obesity status into account and considering concurrent fatty liver as an independent variable. We compared the areas under the receiver operating characteristic (ROC) curves for fatty liver and MetS using several MetS criteria. Regardless of the WC criterion selected, we observed a strong linear trend for an association (trend P<0.0001) between MetS and the number of components. The odds ratio (OR) of subjects without central obesity but with all three MetS components was 9.69 (95% confidence interval 3.11-30.2) in men and 55.3 (6.34-483) in women. The COP for the largest area under the curve in men and women was ≥82cm (OR 0.701) and ≥77cm (OR 0.699), respectively, when WC was considered as a component. When WC distribution is taken into consideration, practical and appropriate COPs should be ≥85cm for men and ≥80cm for women. We suggest that a WC of ≥85cm for men and ≥80cm for women would be optimal COPs for the central obesity criteria in the Japanese population. In addition, central obesity should be incorporated as a component of MetS rather than an essential requirement for the diagnosis of MetS.

Hemoglobin Levels and Athletic Performance in Elite Speed Skaters During the Olympic Season 2006

To test the hypotheses that the hemoglobin (Hb) distribution curve in elite male and female long track speed skaters is not normally distributed and that there is a positive relationship between competitive success and Hb concentration. A venous blood sample was taken before the events from all skaters. The Hb concentration distribution curves of all ranked from 1 to 30 were tested for normality. In addition, individual Hb concentrations were plotted against ranking in the matching events. 2006 major championships and Olympic winter games. All elite male and female speed skaters (217 men and 200 women) competing in major international championships in 2006 and in the Olympic winter games 2006. Hb concentration and individual ranking in the matching event. The mean Hb levels in men and women were 15.7 +/- 0.8 g/dL and 14.0 +/- 0.7 g/dL, respectively. The distribution curve in men would meet the criteria for normal distribution when 4 values from 2 skaters with naturally high Hb levels were neglected. In the women, the distribution curve did not meet the criteria for normality because of low frequency in the right side of the distribution curve and a high frequency at the left side. The curve failed to have a steep drop off at the right side. When plotting Hb concentration against ranking, there is no correlation and relationship between Hb concentration and competitive success. The Hb concentrations are within the normal range for endurance athletes, and there is no indication that the values are titrated toward the upper allowed limit. In addition, there is no relationship between Hb concentration and competitive success in elite speed skaters.

LETTER TO THE EDITOR

I read with interest the editorial by John LaRosa, MD, concerning the newest NCEP guidelines.1 I concur that the guidelines have gotten more complex, and said so in a letter to the editor of JAMA.2 I have published a (global) risk-factor graph that accurately predicts the population at risk for atherothrombotic disease (ATD) (Figure). The lipid predictor balances the proatherogenic lipids (mainly low-density lipoprotein [LDL]) and antiatherogenic lipids (mainly high-density lipoprotein [HDL]) in the form of a fraction, the cholesterol retention fraction (CRF, or [LDL - HDL]/LDL), which is placed on the ordinate of the graph. The systolic blood pressure (SBP) in mm Hg is placed on the abscissa. A threshold line has been drawn, with loci at CRF-SBP plots (0.74, 100) and (0.49, 140). In the Bowling Green Study (BGS) database, 85% of all ATD patients will have CRF-SBP plots above the threshold line. Of the 15% of ATD patients who develop ATD despite a CRF-SBP plot below the threshold line, most are cigarette smokers. This leaves only 6% of all ATD patients in the BGS database that could not be predicted by a CRF-SBP plot above the threshold line and/or cigarette smoking status.3 The Bowling Green Study graph. CRF=cholesterol retention fraction ([low-density lipoprotein {LDL} - high-density lipoprotein]/LDL). Reproduced with permission from J Cardiovasc Risk. 2000;7:415–423. In a meta-analysis of eight published angiographic regression trials (over 2000 angiograms), involving all the usual treatments for dyslipidemia, any therapy that brought the patient's CRF-SBP plot below the threshold line resulted in angiographic stabilization or reversal of coronary plaque in a minimum average of 75% of cases. (Had the Program on Surgical Control of Hyperlipidemia [POSCH] been structured to control blood pressure, many more patients' CRF-SBP plots would have come below the threshold line and the average rate of plaque stabilization or regression would have approached 95%.3) I have shown a graph that plots the percentage of people's CRF-SBP plots per age group that transgress the threshold line vs. the percentage of people per age group, in that same population, who develop some form of clinical ATD. The curves, both for men and women, more or less run parallel, with a 40-year gap between the curves for men and a 20-year gap between the curves for women.4 Hence, the graph also tells the physician when the clock starts to tick. The people who develop ATD despite a CRF-SBP plot below the threshold line, in the absence of any history of cigarette smoking, are quite old when that ATD event occurs—at an average age of 78 years for men and 75 years for women. Moreover, the men don't die until an average age of 94 years, and the women don't die until an average age of 84 years.4 A CRF-SBP plot position below the threshold line, in the absence of any history of cigarette smoking, implies virtual invulnerability to ATD, and hence should be the goal of ATD treatment. I should like to note that HDL is unable to compensate for unlimited LDL. In our regional lab, the breakpoint of LDL above which HDL begins to lose its compensatory ability is 170 mg/dL (or 4.4 mmol/L). The more that LDL exceeds this breakpoint, the less that HDL can compensate. At LDL levels of 250 mg/dL (6.5 mmol/L), HDL is virtually unable to compensate. Even so, the lower the CRF, the older the person will be when the ATD event occurs. This scenario is much more likely to occur in women than in men. Hence, I also treat any LDL level ≥170 mg/dL to bring it below this level, regardless of CRF value. The BGS graph was initially presented to the medical community at the 1983 Annual Scientific Assembly of the American Academy of Family Physicians, was modified in 1988 to include an initial threshold line for primary prevention, and finally modified (threshold line lowered) to include secondary prevention in 2000. The BGS graph is simple to use and utilizes a global risk factor approach. It provides support for early screening for ATD risk factors, and gives the physician and patient an easy means of guiding therapy to maximally stabilize or reverse coronary (and by extension, cerebral, and peripheral vascular) plaque. The author does not intend to further modify the BGS graph.

Sperm maturity and treatment choice of in vitro fertilization (IVF) or intracytoplasmic sperm injection: diminished sperm HspA2 chaperone levels predict IVF failure

Objective: To reexamine whether low sperm HspA2 ratios (formerly sperm CK-M ratio) are predictive for failure to cause pregnancies by in vitro fertilization (IVF) and to explore whether there are other male or female factors that may be predictive for IVF pregnancy outcome. Design: Retrospective, cohort study. Setting: University-based IVF program. Patient(s): In 119 IVF cycles, three patient groups were studied: 25 men had a <10% sperm HspA2 ratio and a lack of pregnancies (HS <10% group), 50 men had a >10% sperm HspA2 ratio and no pregnancies (HS >10%NP group), and another 44 couples had a >10% sperm HspA2 ratio but did achieve pregnancies (HS >10%P group). Intervention(s): Sperm HspA2 ratio determinations within 1 year of the IVF cycles and analysis of male and female IVF cycle parameters. Main Outcome Measure(s): Sperm HspA2 ratio determinations within 1 year of the IVF cycles and analysis of male and female IVF cycle parameters. Result(s): In the three groups, male and female ages, number and maturation level of oocytes, and morphology of embryos were similar. In the HS < 10% group, mean sperm concentration and motility were close to normal, the fertilization and cleavage rates were lower, and cycles without any oocyte fertilization were higher. These parameters were similar in the two HS > 10% groups. The receiver operating characteristic curve in men with sperm HspA2 ratios of <17% (diminished and borderline sperm maturity) provided a cutoff value of 10.84% HspA2 ratio with a 100% positive predictive value for failure to achieve pregnancy, whether the men were oligospermic or normospermic. Conclusion(s): HspA2 ratios of <10% in the diminished sperm maturity range predict the failure to cause pregnancies by IVF. Thus, IVF should be bypassed in favor of ICSI. The occurrence of pregnancy with ICSI depends on the maturity of sperm selected, and it may not be as likely as in other indications for ICSI.

Dose-Response Curve and Time-Course of Effect of Vecuronium in Male and Female Patients

To determine the differences between men and women in the dose-response curve and the time-course of effect of vecuronium, we studied 60 adult patients (30 male and 30 female), ASA I, age 18-51 yr, undergoing elective plastic surgery. Anaesthesia was maintained with nitrous oxide 60% in oxygen; thiopentone and incremental doses of fentanyl were given as required. Neuromuscular function was assessed mechanomyographically using the train-of-four (TOF) stimulation at the wrist every 12 s. The percentage depression of T1 was used as the study variable. The dose-response relationship of vecuronium was determined by a cumulative dose-response technique. The dose-response curve in men was shifted in a parallel fashion to the right, indicating a decrease in the sensitivity to vecuronium-induced neuromuscular block, compared with women. The ED50, ED90 and ED95 of vecuronium were 23.9 (4.7), 45.4 (11.2) and 55.7 (14.3) micrograms kg-1 in men and 18.4 (3.7), 33.5 (7.8) and 39.8 (9.6) micrograms kg-1 in women respectively. There were statistically significant differences in these values between the two groups (P