Case Subjects Research Articles

High expression of CD9 and Epidermal Growth Factor Receptor promotes the development of tongue cancer.

Tongue cancer is distinguished by aggressive behavior, a high risk of recurrence, lymph, and distant metastases. Hypoxia-Induced Factor 1 α functions as a CD9 transcription factor. CD9 is a transmembrane protein that may be found on the cell membrane. It can modulate the expression of the Epidermal Growth Factor Receptor (EGFR) pathway. ELISA was used to measure serum CD9, p-EGFR, and p-Akt levels in 70 tongue cancer patients and 35 healthy controls. RT-PCR was used to analyze the gene expression of the related genes. The gene as well as protein expression of CD9, EGFR/p-EGFR, and Akt/p-Akt was significantly higher in case subjects when compared with the controls. The expression of CD9 was higher in case subjects who were smokers/alcoholics when to control subjects who were smokers/alcoholics. Overexpression of CD9 due to hypoxic conditions leads to the activation of EGFR-signaling pathway resulting in cancer progression, resistance to chemotherapy. Hence, CD9 could be a potential target to suppress cancer progression.

Relationship between Iron Saturation Indices and Psychiatric Disorders among Persons Seeking Care at Selected Psychiatry Health Facilities in Ghana

Aim: This study investigated the relationship between iron metabolism and psychiatric disorder and whether iron saturation indices could predict disease severity.
 Study Design: The study was a case-control study.
 Place and Duration of Study: The study was conducted between December 2020 to March 2022 in some selected psychiatric facilities in Ghana.
 Methodology: Venous blood was collected and serum iron, TIBC, ferritin, transferrin and full blood count were quantified to calculate intraindividual variation and to assess the relationships of these iron saturation indices to severity of psychiatric disorders.
 Results: Serum iron (38.98±14.55 µmol/L), ferritin (100.23±84.98 ng/mL) and transferrin saturation (44.35±14.6%) were significantly (p<0.05) higher in group with psychiatric disorders compared with the controls (29.25±8.0 µmol/L; 75.25±42.71 ng/mL and 28.66±7.1%). However, total iron binding capacity (TIBC) (102.47±15.01 µmol/L), UIBC (73.22±13.12 µmol/L) and transferrin (4.08±0.6 g/L) concentrations were considerably greater in control group than in the case subjects (88.95±19.73 µmol/L; 49.97±18.32 µmol/L and 3.54±0.79 g/L). One unit increase in BMI is associated with 1.27 (aOR=1.27, p<0.001) times risk of psychiatric disorders and males are 6 (aOR=5.87, p<0.005) times at risk of disorders. At a cut off of ≤65.79 µmol/L, UIBC can distinguish psychiatric disorders from controls.
 Conclusion: Serum iron and transferrin saturation appears to be good prognostic markers of diseases severity but serum iron at cut off of >35.23 µmol/L better classified individuals of severe form of psychiatric disorder.

The Effects of Prolonged Use of Caffeine on Thyroid and Adrenal Glands: A Retrospective Cohort Study

Abstract Background: Caffeine consumption has skyrocketed in recent decades as we try to match the pace with the machines. Studies have been conducted on animals and a few on humans, mainly on the acute effects of high-dose caffeine intake. Almost none have been conducted on the chronic effects of caffeine consumption. This study involved medical professionals as case subjects, who consumed caffeine daily. Methods: This study, for 3 months, involved 96 volunteers (chosen randomly w.r.t. gender and field in the medical fraternity), including people who drank >500 mg of caffeine a day and people who consumed none. People with any comorbidities at all were excluded straight away. Two sets of blood samples were drawn and assessed. Three groups were created: group 1 (>200 mg caffeine/day), group 2 (15–200 mg caffeine/day) and group 3 (<200 mg caffeine/day). Results: The result of the study found that exposure to caffeine at doses >200 mg/day for more than 6 months leads to a significant difference in circulating free T3 ((-0.96 pmol/L ± 0.07) = (-18.5%), 95% confidence interval (CI), P = .000024) and cortisol ((-123 nmol/L ± 9.8) = (-46.8%), 95% CI, P = .00029) hormones but shows an insignificant effect on circulating thyroid-stimulating hormone (TSH) (0.4 mIU/L, 95% CI, P = .37) and adrenocorticotrophic hormone (ACTH) ((-3.2 pg/ml ± 0.3), 95% CI, P = .53) hormones, which stay within normal physiological ranges, irrespective of the daily dose of consumption. Results also highlight that women are more susceptible to a decrement in fT3 than men (relative risk = 1.58, analysis of variance (ANOVA) F-static = 7.15, P = 0.0105). Conclusions: Caffeine consumption in excess of 200 mg/day, for more than or equal to 6 months, causes significant derangement in basal fT3 and cortisol hormone levels, without affecting the TSH and ACTH (regulatory) hormone levels, indicating disturbance of action at the peripheral and/or cellular levels, possibly via the paraventricular nucleus (PVN)–leptin–CAR–adenosine interactions. Women are more susceptible to a decrement in fT3 levels than men (at the same dose of caffeine).

Percutaneous management of Lutembacher’s syndrome: A case report

The definitive percutaneous management of Lutembacher’s syndrome (LS) is a recognized alternative to surgery in selected cases. This intervention involves balloon mitral valvuloplasty (BMV) followed by device closure of the atrial septal defect (ASD). However, despite its recognition, certain challenges inherent to the procedure have not been highlighted in the majority of earlier case reports. The subject of the present case is a 30-year-old male diagnosed with LS who underwent definitive percutaneous treatment. The coexisting ASD required improvisation to facilitate balloon insertion across the mitral valve using the modified Inoue technique. Furthermore, the ASD device was deliberately oversized to prevent device embolization. This case highlights that percutaneous management of LS is not merely a combination of BMV and device closure procedures. Instead, the unique anatomic and hemodynamic features of LS should be considered when formulating treatment strategies for these patients.

Efficacy and Safety of Glucagon-Like Peptide 1 Agonists in a Retrospective Study of Patients With Familial Partial Lipodystrophy.

Glucagon-like peptide 1 receptor agonists (GLP-1RA) are widely used for the management of diabetes mellitus (DM), but their efficacy in familial partial lipodystrophy (FPLD) is unknown. In this retrospective study, we evaluated the effect of GLP-1RA in patients with FPLD. We analyzed data, reported with SDs, from 14 patients with FPLD (aged 58 ± 12 years; 76.47% female) and 14 patients with type 2 DM (aged 58 ± 13 years; 71% female) before and 6 months after starting GLP-1RA. We observed reduction in weight (95 ± 23 to 91 ± 22 kg; P = 0.002), BMI (33 ± 6 to 31 ± 6 kg/m2; P = 0.001), HbA1c (8.2% ± 1.4% to 7.7% ± 1.4%; P = 0.02), and fasting glucose (186 ± 64 to 166 ± 53 mg/dL; P = 0.04) in patients with FPLD. The change in triglycerides after treatment was greater in the FPLD group compared with the DM group (P = 0.02). We noted acute pancreatitis in two case subjects with FPLD with longer therapy. Our study demonstrates the relative safety and effectiveness of GLP-1RA in patients with FPLD.

Screening of the Combined Risk of Genetics and Epidemiology on Infertility Among Indian Men: Synergistic Effect of AZFc Partial Deletions and Habits of Smokeless Chewing Tobacco.

The AZFc partial deletions of Y chromosome and lifestyle/epidemiological factors such as the use of smokeless chewing tobacco (SCT) exhibit intriguing variations in their association with male infertility across the population, ethnicity, and genetic background. Here, a pioneering attempt has been made to elucidate the interactions of such deletions with the habits of SCT consumption among the participating individuals, using their large epidemiological data. This screening program was conducted among Bengali-speaking men in West Bengal, India. We screened the prevalence and association of distinct partial deletions (gr/gr, b1/b3, and b2/b3) of the AZFc region using locus-specific sequence-tagged site (STS) markers among 728 case subjects and compared them with 264 ethnicity- and age-matched proven-fertile control men. The recorded epidemiological data of the study group and the outcome of partial deletion analysis were compiled to frame the plausible Gene × Epidemiological factor (G × E) interactions. The gr/gr deletion was reported to be significantly associated with azoospermic (p = .0015, odds ratio [OR] = 3.413) and oligozoospermic (p = .0382, OR = 3.012) case subgroups, and b1/b3 deletions were also detected among the infertile persons only. The G × E model revealed that men who carried microdeletions as well as were SCT users had an elevated risk of infertility (p = .002, OR = 6.38). The study highlights the fact that AZFc partial deletions and SCT, when co-occurred, synergistically increase the risk of infertility among men. This work helps to get more insight into the etiology of male infertility in the light of gene-environmental interaction.

Prevalence, associated factors, and gene polymorphisms of obesity in Tibetan adults in Qinghai, China

ObjectivesTo explore the prevalence and associated factors of obesity in Tibetan adults in Qinghai, China, and to determine the association between the FTO (rs1121980 and rs17817449) and MC4R gene (rs17782313 and rs12970134) polymorphisms with obesity.MethodsA cross-sectional survey was conducted in 2015 in Qinghai to selected Tibetan adults aged 20 to 80 years. Prevalence of obesity (BMI ≥ 28 kg/m2) and overweight (BMI 24 ~ 27.9 kg/m2) were evaluated. Multivariable logistic models were used to determine the associated factors. Pair-matched subjects of obesity cases and normal-weight controls were selected for the gene polymorphism analyses. Conditional logistic models were used to assess the association between gene polymorphisms with obesity. Additive and multiplicative gene-environment interactions were tested.ResultsA total of 1741 Tibetan adults were enrolled. The age- and sex- standardized prevalence of obesity and overweight was 18.09% and 31.71%, respectively. Male sex, older age, heavy level of leisure-time exercise, current smoke, and heavy level of occupational physical activity were associated with both obesity and overweight. MC4R gene polymorphisms were associated with obesity in Tibetan adults. No significant gene-environment interaction was detected.ConclusionThe prevalence of obesity and overweight in Tibetan adults was high. Both environmental and genetic factors contributed to the obesity prevalent.

Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis.

There are limited data characterizing eating habits among pediatric patients with eosinophilic esophagitis (EoE). We compared eating behaviors in pediatric patients with EoE with healthy controls and assessed the degree of correlation with symptomatology, endoscopic and histologic findings, and esophageal distensibility. We conducted a prospective, observational study where subjects consumed 4 food textures (puree, soft solid, chewable, and hard solid) and were scored for eating behaviors including number of chews per bite, sips of fluid per food, and consumption time. Symptomatic, endoscopic, histologic, and esophageal distensibility data were collected for case subjects. Twenty-seven case subjects and 25 healthy controls were enrolled in our study (mean age 11.0 years, 63.5% male). Compared with healthy controls, pediatric patients with EoE demonstrated more chews per bite with soft solid (13.6 vs 9.1, P = 0.031), chewable (14.7 vs 10.7, P = 0.047), and hard solid foods (19.0 vs 12.8, P = 0.037). Patients with EoE also demonstrated increased consumption time with soft solid (94.7 vs 58.3 seconds, P = 0.002), chewable (90.0 vs 65.1 seconds, P = 0.005), and hard solid foods (114.1 vs 76.4 seconds, P = 0.034) when compared with healthy controls. Subgroup analysis based on disease status showed no statistically significant differences in eating behaviors between active and inactive EoE. Total endoscopic reference score positively correlated with consumption time ( r = 0.53, P = 0.008) and number of chews ( r = 0.45, P = 0.027) for chewable foods and with number of chews ( r = 0.44, P = 0.043) for hard solid foods. Increased consumption time correlated with increased eosinophil count ( r = 0.42, P = 0.050) and decreased esophageal distensibility ( r = -0.82, P < 0.0001). Altered eating behaviors including increased chewing and increased consumption time can be seen in pediatric patients with EoE, can persist despite histologic remission, and may be driven by changes in esophageal distensibility.

The oral and systemic health impact profile for periodontal disease (OSHIP-Perio)-Part 2: Responsiveness and minimal important difference.

The Oral and Systemic Health Impact Profile for Periodontal Disease (OSHIP-Perio) was developed to measure health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL). This study aimed to determine the responsiveness and minimal importance difference (MID) of the OSHIP-Perio. Subjects with periodontal disease completed the OSHIP-Perio at baseline and six to ten weeks after non-surgical periodontal therapy. Comparisons of the clinical variables and the OSHIP-Perio scores before and after treatment were analysed using the Wilcoxon signed-rank test, together with the Oral Health Impact Profile (OHIP-49, OHIP-14 and OHIP-5) scores. The MIDs for all the instruments were calculated using distribution-based methods. Fifty-one case subjects who completed periodontal treatment and the OSHIP-Perio instrument were included for analysis. Significant improvement in all clinical variables after treatment (p < 0.001) was observed. The OSHIP-Perio total score as well as its four-dimensional scores (periodontal, oral function, orofacial pain and psychosocial impact) were significantly reduced after treatment (p < 0.001), indicating better OHRQoL. Findings were consistent with the other OHIP instruments. In determining the MID, the percentage point change of the OSHIP-Perio was found to be lower than the shorter OHIP-5 instrument when using both effect sizes (ES) (10.71% vs. 15.0% at 0.5SD) and standard error of measurement (SEM) (5.36% vs. 10.0% at 1SEM; 8.93% vs. 20.0% at 2SEM) calculations. The OSHIP-Perio demonstrated good responsiveness which was comparable to the OHIP-49 and its short-form derivatives. Its required percentage point change in determining its MID is smaller than the OHIP-5.

The oral and systemic health impact profile for periodontal disease (OSHIP-Perio)-Part 1: development and validation.

This study aimed to develop and validate the Oral and Systemic Health Impact Profile for Periodontal Disease (OSHIP-Perio), a disease-specific instrument for assessing the impact of periodontal disease on both general and oral health-related quality of life. A pool of 58 items, developed from the Oral Health Impact Profile (OHIP-49) and data generated through semi-structured patient interviews, was tested on 80 case subjects with periodontal disease and 80 control subjects. The dimensionality of the preliminary measure was evaluated using exploratory factor analysis (EFA). Rasch analysis was then performed on the primary dimension using the Winsteps software (Version 5.1.4.0) to render the final items for the OSHIP-Perio. The reliability and validity of the final OSHIP-Perio were subsequently determined. Using an EFA factor loading >0.50, the primary dimension comprised 18 items. Using Rasch analysis, four items were subsequently excluded. The final OSHIP-Perio with 14 items showed excellent test-retest reliability (overall intraclass correlation coefficient index = 0.99) and internal consistency (overall Cronbach's alpha coefficient = 0.96). It also exhibited good discriminant validity when case and control groups were compared (p < 0.001). It showed very strong correlations (rho coefficients >0.90) with the OHIP-5, OHIP-14 and OHIP-49, exhibiting good concurrent validity. It demonstrated a moderate correlation (rho coefficient = 0.60) with the global health rating, exhibiting a moderate convergent validity. The 14-item OSHIP-Perio exhibited good psychometric properties comparable to the OHIP-5, OHIP-14 and OHIP-49 for evaluating the impact of periodontal disease on quality of life.

Hypermethylation and down-regulation of vitamin D receptor (VDR) as contributing factors for polycystic ovary syndrome (PCOS): a case-control study from Kashmir, North India.

Polycystic ovarian syndrome (PCOS) is a prevailing endocrinopathy affecting a significant population of women of reproductive age across the globe. A myriad set of complex intertwined factors ranging from etiological, genetic, and epigenetic reasons cause this disorder. Out of the different factors, vitamin D shows an imperative aspect in health and fertility of women with polycystic ovary syndrome (PCOS). The importance of vitamin D is facilitated by vitamin D receptor (VDR), a ligand-dependent transcription factor in the steroid/ thyroid hormone receptor superfamily that controls the pleiotropic biological properties of vitamin D. The purpose of this study was to evaluate the role of promoter methylation of the VDR gene, a transcription factor with numerous biological utilities, with its relative expression and clinico-pathological findings and outcomes. A total of 200 blood samples were collected, 100 from PCOS case subjects, and 100 from the normal healthy controls respectively, which were assessed by qRT-PCR for determining the expression summary. MS-PCR technique was used for analyzing the promoter methylation status of the VDR gene. Blood samples were withdrawn, respectively, for each case and the control study separately experimented for different stages for the given study, of which estimation of vitamin D was also a part. In this test-versus-control study, first, the promoter methylation status of VDR gene was identified which was found more prominent i.e., hyper-methylation of the VDR gene was identified in 84 cases (84%), and in the normal healthy controls, it was found (62%). The promoter methylation status of the VDR gene has remarkably shown the results with a significant difference (p value < 0.0001*). Second, the expression analysis of VDR gene was found to be strongly downregulated in majority (64%) of PCOS case samples analyzed by means fold change of 0.8743 (± 0.06466) (p value 0.0054**). This result is, therefore, indicative of VDR gene role in PCOS pathogenesis as the said gene is downregulated. Moreover, compared to the vitamin D parameter, hyper-methylation and expression analysis of the VDR promoter gene were found to correspond to some associations with PCOS. Certain case-and-control study analyses showed that patients with normal vitamin D levels showed less indicative effects of PCOS and vice versa. Our study, being exclusive from Kashmir, one of the foremost specified that VDR confirms anomalous methylation configuration in PCOS with subsequent downregulation in the gene expression i.e., there is an inverse correlation among VDR gene expression (downregulated) and methylation status (hyper-methylated) from the conclusion of our PCOS case-versus-control study.

LA “CONDOTTA LIBERA” DELL’ILLECITO SPORTIVO DE IURE CONDENDO NELLA GIUSTIZIA SPORTIVA DELLA F.I.G.C.

The paper aims to offer a functional contribution, and in certain respects operational, to the experts on sports law who engage in the sector’s procedural dynamics, other than a scientific in-depth analysis of substantial and procedural subjects of the present case of match-fixing, with particular reference to the F.I.G.C. sports justice system. After a brief overview of the reference regulatory framework, the article issues a view of the concrete cases which has enriched de iure condendo the set of substantial and procedural rules applicable specifically to alterations of the course or the result of a match in the football world. From the notorious “Calciopoli” trial to the recent ‘capital gains case’, which has affected the European competitions’ rankings and the top divisions in Italian football and which, although it cannot relate to a combine on the field, being a managerial and economic offense, has profoundly altered the juridical understanding of the principles of loyalty and fair play, where the economic and financial behaviors of football clubs decisively invalidate the regularity of the championships.

Healthcare Utilization, Physical and Psychiatric Comorbidities Before Self-Injurious Behavior in Patients with Asthma: A Nested Case-Control Study.

Patients with asthma experience more physical, psychological, and financial burdens; a link between asthma and suicidality has been reported in research. This study analyzed the medical utilization and comorbidity before their self-injurious behavior in patients with asthma. We enrolled 186,862 patients newly diagnosed with asthma between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 500 case subjects had ever conducted self-injurious behaviors during the study period. Based on a nested case-control study, each case was matched with 10 controls derived from the asthma cohort to analyze differences between them and their medical use models. The results indicated that, compared to the control group, the cases presented higher frequencies of outpatient visits and hospitalizations. Regarding comorbidity, the cases had more cardiovascular diseases (adjusted odds ratio [aOR]=1.58; p<0.001), bipolar disorder (aOR=2.97; p<0.001), depression (aOR=4.44; p<0.001), and sleep disorder (aOR=1.83; p<0.001) than the controls. The evidence-based information serves as a reference for medical staff to reduce the occurrence of self-injurious behavior in patients with asthma.

Non-Participant Observations in Experience-Based Codesign: An example using a Case Study Research approach to explore Emergency Department Care

Previous reviews of experience-based codesign (EBCD) projects have shown non-participant observations (NPOs) are omitted or unreported in the majority of studies, despite academics’ insistence of their value. We undertook Stage 1 of an EBCD project using a Case Study Research approach to organise the inquiry. NPOs were used as the first object (frame of analysis) of the case subject, exploring and understanding the experience of users and providers of ED care. 162 hours of NPOs were conducted by six research team members across three hospital Emergency Departments (EDs), representing a local nested case. The four principles of EBCD were used to guide the inquiry, providing rich understanding and description of the context, and valuable insights into critical issues. Summarised NPO narratives allowed the research team to familiarise themselves with the different physical environments, workflows, and processes, as well as think more deeply about work and interactions. Conducted within complex healthcare settings, this example demonstrates the value of observing Work-As-Done and has advanced knowledge of institutional logic that will be critical in considering realistic and sustainable change initiatives. Commitment to intentional design and well-reported research methods for exploring and understanding lived experience can satisfy academic audiences of the study integrity and provide comprehensive information for those undertaking accelerated EBCD.

A Comparative Study of Serum Butyric Acid in Subjects with Tongue Cancer

Abstract Aim: The aim of the study was to study the level of butyric acid in tongue cancer subjects. Materials and Methods: Thirty controls and 30 tongue cancer subjects were recruited for the study. Serum butyric acid levels were estimated using ELISA kits. Statistical analyses were done using SPSS vs 22. The Mann–Whitney U and Kruskal–Wallis tests were used. P ≤ 0.05 was considered statistically significant. Results: Butyric acid levels were significantly higher in control subjects when compared to case subjects. Conclusion: Butyric acid could be used as a potential anticancer agent in tongue cancer treatment.

The Relationship Between Homocysteine and Autoimmune Subclinical Hypothyroidism

Objectives: The present study was to correlate the association of homocysteine level with various profile of autoimmune subclinical hypothyroidism patients. Methods: A 40 subclinical hypothyroidism patients and 40 healthy control subjects were enrolled. The relevant laboratory parameters of patients who had been diagnosed with subclinical hypothyroidism due to Hashimoto’s thyroiditis in the clinic and were in follow-up, and whose homocysteine level had been tested in addition to assessment of thyroid function, thyroid autoantibodies, lipid parameters, thyroid ultrasonography, and hs-CRP were recorded. Patients with a thyroid-stimulating hormone (TSH) level above the normal range but with a free thyroxin (fT4) level within the normal range were considered to have subclinical hypothyroidism. Results: Mean TSH level of case and control group subjects were 6.71±1.23 and 2.11±o.34 µIU/mL respectively. Which is extremely significant (p&lt;0.0001). Mean FT4 (ng/dL) level of case and control group subjects were 1.3±0.38 and 1.4±0.43 ng/dL respectively. Which is not significant differences(p=0.273). Anti-Tg level of case and control group subjects were 221.6±06.65 and 12.2±04.24 IU/mL) respectively. Which is extremely significant (p&lt;0.0001). There was significant higher anti-Tg level in subclinical hypothyroidism patients as compared to control subjects. Similarly, anti-TPO level of subclinical hypothyroidism (165.8±05.17) patients were extremely significant (p &lt;0.0001) as compared to control (6.7±02.65) subjects. Homocysteine was significantly associated with TSH level (p=0.028), FT4 level (p=0.017), anti-TPO level (p=0.000), anti-Tg (p=0.024) and Hs-CRP level (p=0.011) in subclinical hypothyroidism patients. Conclusions: Increased level of homocysteine is an independent factors for the diagnosis of autoimmune subclinical hypothyroidism. Key words: Autoimmune Subclinical Hypothyroidism, Homocysteine, TSH level.

Characteristics of body mass index and sodium intake of adults with hypertension family history in Yogyakarta

Hypertension is a progression of prehypertension due to the accumulation of several non-genetic risk factors (environmental factors) that occur together (common underlying risk factors) or genetic factors or the interaction between the two. Risk factors for hypertension that can be controlled include high sodium intake, lack of physical activity, obesity, smoking, and alcohol consumption, while risk factors that cannot be controlled include increasing age, gender, and a family or genetic history of hypertension. This study aimed to determine the characteristics of Body Mass Index (BMI) and sodium intake in adults with a family history of hypertension in Yogyakarta. This study used a case-control design. Subjects studied were healthy individuals with a family history of hypertension as case subjects (n = 42), and control subjects were individuals without a family history of hypertension (n = 41). Body mass index (BMI) was measured with anthropometry, and sodium intake was measured using a quantitative food frequency questionnaire. Independent Sample T-test and Chi-Square test analyzed the data with a significance level of p &lt; 0.05. The average BMI and sodium intake are higher in the case group than in the control group. There was no significant association between BMI and sodium intake and risk factors of hypertension (p&gt;0.05). Body mass index and sodium intake in the case and control group were not significant differences (p&gt;0.05). The BMI values and sodium intake levels were higher in the group of individuals with a family history of hypertension compared to those without a family history of hypertension, but not statistically significant.

Association Between HDL2-C and HDL3-C with Cardiovascular Disease: A Nested Case-Control Study in an Iranian Population.

The contribution of high-density lipoprotein cholesterol (HDL-C) subclasses to incident cardiovascular disease (CVD) and coronary heart disease (CHD) remains a subject of debate. The objective of this study was to investigate these associations in a population with a high prevalence of dyslipidemia and CVD. In a nested case-control study, HDL-C and its subclasses (HDL2-C and HDL3-C) in 370 age and gender-matched case and control subjects were determined. This study employed multivariable-adjusted conditional logistic regression to calculate the odds ratios (ORs) for the associations between HDL-C, HDL2-C, HDL3-C, and HDL2-C/HDL3-C (both as continuous and categorical variables) with incident CVD and CHD. The present study models were adjusted for a comprehensive set of confounders, including body mass index, current smoking, hypertension, type 2 diabetes mellitus, use of lipid-lowering drugs, family history of premature CVD, non-HDL-C, and triglycerides. In multivariate analysis, when considering lipoprotein parameters as continuous variables, a 1-unit increase in HDL-C and HDL3-C was associated with a reduced risk of incident CVD and CHD. For CVD, the ORs (95% confidence intervals [CI]) were 0.95 (0.92 - 0.98) and 0.95 (0.93 - 0.98) for HDL-C and HDL3-C, respectively. The corresponding values for CHD were 0.94 (0.91 - 0.97) and 0.94 (0.91 - 0.97). In the categorical approach to lipoprotein parameters, higher quartiles of HDL-C and HDL3-C, compared to the first quartile, were significantly associated with a lower risk of incident CVD and CHD. The ORs (95% CI) for the fourth quartiles were 0.43 (0.25 - 0.74, P for trend = 0.003) and 0.46 (0.27 - 0.78, P for trend = 0.005) for HDL-C and HDL3-C regarding CVD and 0.32 (0.17 - 0.59) and 0.32 (0.18 - 0.59) (all P for trend = 0.001) regarding CHD, respectively. Paradoxically, across quartiles of HDL2-C/HDL3-C, this lipid ratio was associated with a higher risk of CHD (92% higher risk in the fourth quartile). The results showed that HDL3-C, but not HDL2-C, was primarily responsible for the protective effect of HDL-C against CVD, particularly CHD, in Iranian adults.

Потенциал использования судебной неустойки (астрента) в обеспечении исполнения обязанности по представлению истребуемых доказательств в цивилистическом процессе

The presentation of evidence in civil proceedings is a subjective right of the persons involved in the case, however, the court is entitled (in civil proceedings — should be entitled) to demand evidence under threat of penalties. The subjects of punitive liability are both the persons involved in the case and other subjects who own the required evidence. However, a court fine as a measure of responsibility for failure to provide evidence is not always effective, which gives rise to a rare application of this measure in judicial practice. Requests for evidence are often not executed by the persons to whom they are addressed. The author proposes to establish a judicial penalty (astrent) as a measure of responsibility for failure to provide evidence, which is currently established for the case of non-execution of only the final judicial act. It is proved that the penalty, which is increasingly increasing as the procedural obligation is not fulfilled, will serve as a more effective incentive for the presentation of evidence. The proposed measure performs three functions: when it is established in case of possible non–presentation of the requested evidence, it has a preventive function; when it is applied for the fact of non–presentation of evidence, it has a liability measure function and a security function.

Screening history and risk of death from prostate cancer: a nested case–control study within the screening arm of the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC)

PurposeWe assessed the risk of death from prostate cancer (PCa) in relation to men’s screening histories, i.e., screening attendance among men who were offered screening.MethodsMen in the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) screening arm were invited to up to three screening rounds with the serum prostate-specific antigen (PSA) test at 4-year intervals during 1996–2007.Case subjects (n = 330) were men who died from PCa. Each case was matched to five controls (n = 1544) among the men who were free of PCa.Screening history was defined as (1) never/ever attended screening prior to the case diagnosis; (2) attended at the first screening round; and (3) recency of screening, calculated as the time from last screening attendance to the date of case diagnosis.The association between screening history and the risk of death from PCa was estimated by odds ratios (OR) with 95% confidence intervals (CI) using conditional logistic regression.ResultsHaving ever attended screening versus never attended was associated with a reduced risk of PCa death (OR 0.60, 95% CI 0.45–0.81) and a similar association was found for those attended (versus not attended) the first screening round (OR 0.67, 95% CI 0.51–0.87).The effect by time since last screen for the risk of PCa death was significantly lower 2–7 years since last screen.ConclusionAmong men invited to screening, subjects who attended any PSA screening during the previous 19 years had a 40% reduction in PCa mortality compared to non-screened men.