Race and gender differences in C-reactive protein levels

OBJECTIVES: This study sought to determine whether there are race and gender differences in the distribution of C-reactive protein (CRP) levels. BACKGROUND: Few data are available comparing CRP distributions in different race and gender groups. Recent clinical practice recommendations for CRP testing for cardiovascular risk assessment suggest a uniform threshold to define high relative risk (>3 mg/l). METHODS: We measured CRP in 2,749 white and black subjects ages 30 to 65 participating in the Dallas Heart Study, a multiethnic, population-based, probability sample, and compared levels of CRP between different race and gender groups. RESULTS: Black subjects had higher CRP levels than white subjects (median, 3.0 vs. 2.3 mg/l; p < 0.001) and women had higher CRP levels than men (median, 3.3 vs. 1.8 mg/l; p < 0.001). The sample-weight adjusted proportion of subjects with CRP levels >3 mg/l was 31%, 40%, 51%, and 58% in white men, black men, white women, and black women, respectively (p < 0.05 for each group vs. white men). After adjustment for traditional cardiovascular risk factors, estrogen and statin use, and body mass index, a CRP level >3 mg/l remained more common in white women (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1 to 2.5) and black women (OR 1.7; 95% CI 1.2 to 2.6) but not in black men (OR, 1.3; 95% CI, 0.8 to 1.9) when compared with white men. CONCLUSIONS: Significant race and gender differences exist in the population distribution of CRP. Further research is needed to determine whether race and gender differences in CRP levels contribute to differences in cardiovascular outcomes, and whether thresholds for cardiovascular risk assessment should be adjusted for different race and gender groups.     

Introduction, availability and role of simulation in surgical education and training: Review of current evidence and recommendations from the Association of Surgeons in Training

The utility of simulation in surgical training is now well-established, with proven validity and demonstrable transfer of skills to the clinical setting. Through a reduction in the technical learning curve, simulation can prepare surgeons for actual practice and in doing so it has the potential to improve both patient safety and service efficiency. More broadly, multi-disciplinary simulation of the theatre environment can aid development of non-technical skills and assist in preparing theatre teams for infrequently encountered scenarios such as surgical emergencies. The role of simulation in the formal training curriculum is less well-established, and availability of facilities for this is currently unknown. This paper reviews the contemporary evidence supporting simulation in surgical training and reports trainee access to such capabilities. Our national surgical trainee survey with 1130 complete responses indicated only 41.2% had access to skills simulator facilities. Of those with access, 16.3% had availability out-of-hours and only 54.0% had local access (i.e. current work place). These results highlight the paucity in current provision of surgical skills simulator facilities, and availability (or awareness of availability) varies widely between region, grade and specialty. Based on these findings and current best-evidence, the Association of Surgeons in Training propose 22 action-points for the introduction, availability and role of simulation in surgical training. Adoption of these should guide trainers, trainees and training bodies alike to ensure equitable provision of appropriate equipment, time and resources to allow the full integration of simulation into the surgical curriculum.     

Subcutaneous implantable testosterone pellets overcome noncompliance in adolescents with Klinefelter syndrome

For adolescents with hypogonadism, failure to comply with a testosterone replacement therapy (TRT) regimen can be a barrier to obtaining adequate and consistent serum testosterone (T) levels. We evaluated 4 young men with hypogonadism secondary to Klinefelter syndrome to determine if implantable pellets represented a viable treatment option for such patients. Four patients (aged 14-20 years) had previously received TRT but were not compliant. Patients initially received 4 to 10 subcutaneous T pellets with subsequent doses implanted at 3- to 4-month intervals. In all 4 patients, total and free T levels were improved at follow-up, although fluctuations between levels were inconsistent. All patients reported improvement in their energy and concentration, and parents noted improved stability of mood. The mean baseline total T level of 108.3 ng/dL increased in all patients at the time of second pellet implantation. Average total T levels were 325 to 587 ng/dL over the course of therapy. There was significant variability of serum T levels while patients were on therapy. All patients eventually received an increased number of pellets at some point in their care. Subcutaneous implantation of T pellets is a viable option for TRT in young men with Klinefelter syndrome in whom compliance is an issue. However, the requirement for repeat implantation every 3 months, increased cost of therapy and monitoring, dramatic shifts in serum total and free T concentrations, and seemingly unpredictable response requires close monitoring and careful follow up and suggests this modality of therapy may not be appropriate for a substantial number of hypogonadal patients, but this strategy warrants consideration in noncompliant patients.     

Transglutaminase levels and immunologic functions of BCG-elicited mouse peritoneal macrophages isolated by centrifugal elutriation

BCG-elicited mouse peritoneal macrophages were separated into three subpopulations by counterflow centrifugal elutriation. The three subpopulations were characterized on the basis of the level of a protein cross-linking enzyme, tissue transglutaminase. Subpopulation-3 consisted of large cells (greater than 95% esterase positive and greater than 90% viable) and had at least a fivefold higher transglutaminase activity (35 +/- 6 nmol/hr/mg) as compared to macrophages in subpopulation-1 (6 +/- 2 nmol/hr/mg) and at least a threefold higher enzyme activity as compared to subpopulation-2 (11 +/- 2 nmol/hr/mg). Subpopulation-3 also showed sevenfold higher phagocytosis of IgG-coated sheep red blood cells. The three subpopulations showed no difference in their ability to kill Listeria monocytogenes as determined by [3H]-thymidine release. Subpopulations-2 and -3 caused 90% inhibition of murine adenocarcinoma (EMT-6) tumor cell growth in the presence or absence of lipopolysaccharide. Subpopulation-1 had a poor ability to inhibit EMT-6 cell growth (29 +/- 12%). However, in the presence of lipopolysaccharide, this activity increased by at least threefold (92 +/- 7%). The three subpopulations showed no significant difference in their cytolytic activity against murine mastocytoma (P815) target cells in the presence or absence of lipopolysaccharide. These results suggest that tissue transglutaminase may have no significant role in bactericidal, tumoricidal, or tumoristatic function of macrophages; however, it might have some role in promoting the Fc-receptor-mediated phagocytic function of the macrophages.     

Assessment of computer game as a psychological stressor

To simulate the effects of acute psychological stress, the effects of stressful computer game in young adult subjects were assessed by various physiological, psychological and biochemical parameters. The results showed a significant increase in the physiological and psychological markers of stress. It is concluded from these results that computer game can be used as an acute laboratory psychological stressor for future studies on physiological effects of stress.     

Dimethadione-induced fetotoxicity in rats

The fetotoxic potential of dimethadione was studied in rats given single daily oral dosages of 0, 54, 433 or 541 mg/kg on days 1--21 or 6--15 of gestation. No maternal toxicity was observed following treatment on days 6--15. When administered from days 1 to 21 only the highest dose (541 mg/kg) produced a significant reduction in maternal body weight gain. Dimethadione caused a dose-related decrease in fetal weight and an increased incidence of umbilical hernia, ecchymoses and subcutaneous edema. There were also increased incidences of non-specific skeleton defects which consisted of unilateral or bilateral wavy ribs, additional ribs (14th rib, uni- and bilateral), retarded ossification of calvaria and a wide variety of sternal defects. Specific defects were bent radius and ulna, and bent tibia and fibula which increased with increasing dosages of dimethadione. Fetal mortality and incidence of skeletal anomalies were higher when the treatment was given on days 1--21 of gestation than on days 6--15 of pregnancy.