Journal of Investigative Medicine

The total burden of subclinical coronary artery disease (CAD) is significant among young adults. Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality because of cardiovascular disease. The objective of the study was to evaluate the relationship between subclinical CAD and serum FGF-23 and fetuin-A concentrations among a population of young adults.

A total of 241 subjects younger than 45 years who had undergone coronary computed tomographic angiography (CCTA) were included in the study. In 117 patients, the CCTA detected subclinical CAD; the rest of the patients had no CAD detected on CCTA.

Serum FGF-23 and fetuin-A levels were significantly increased in the CAD patients as compared with the non-CAD patients (26.7 [interquartile range, 22.4-31.9] vs 15.7 [interquartile range, 13.2-18.1] pg/mL and 904.7 [interquartile range, 695.5-1021.6] vs 469.6 [331.4-660.5] mg/L, respectively; P < 0.001 for both). Furthermore, a positive correlation was identified between FGF-23 and fetuin-A levels and the total number of plaques (r = 0.21 and r = 0.28, respectively; P < 0.001 for both). In multivariate logistic regression analysis, age, smoking status, uric acid, FGF-23, and fetuin-A levels were found to be independently associated with the presence of CAD.

The presence of subclinical CAD is independently associated with FGF-23 and fetuin-A and could be used as novel risk markers of cardiovascular disease in the asymptomatic young adult population.

The aim of this study was to evaluate the effect of ivabradine treatment on aortic stiffness by measuring aortic elastic parameters in patients with heart failure (HF) receiving ivabradine treatment.

The study included clinical patients who were diagnosed with HF (ejection fraction, <35%), had sinus rhythm and persistent symptoms despite full medical treatment. The study group consisted of patients with a heart rate greater than 70 beats per minute and the control group consisted of patients with a heart rate less than 70 beats per minute. Echocardiographic measurements were conducted and aortic strain, aortic distensibility, and aortic stiffness index were calculated.

By the end of the twelfth month, a decrease was observed in the left ventricular end-diastolic and end-systolic volumes, whereas ejection fraction was increased (P < 0.001). When aortic elastic parameters were evaluated between the 2 groups, there was no significant difference regarding aortic strain, aortic distensibility, and aortic stiffness index at the time of enrollment and during the visit at 3 months. At the twelfth month visit, aortic strain (P < 0.001) and distensibility (P < 0.001) were significantly increased, whereas there was a significant decrease in the aortic stiffness index (P < 0.001).

During the follow-up at 12 months, significant improvements were observed in the left ventricular functions and aortic elastic parameters along with decreased heart rate in patients with HF receiving ivabradine treatment. This outcome may indicate that ivabradine treatment may correct aortic stiffness and may reduce aortic stiffness after 1 year of follow-up.

Elevated serum and synovial fluid (SF) fractalkine (CX3CL1) levels have been detected in patients with knee osteoarthritis (OA). The current study was carried out to investigate the association between serum and SF fractalkine levels with symptomatic severity in patients with knee OA.

One hundred ninety-three patients with OA and 182 healthy controls were enrolled in this study. The symptomatic severity was assessed by the Western Ontario McMaster University Osteoarthritis scores.

Fractalkine levels in SF and serum were both positively associated with self-reported greater pain and physical disability.

Fractalkine in SF and serum may serve as a biomarker for reflecting symptomatic severity. Therapeutic interventions that target fractalkine signaling pathways to delay OA-related symptoms deserve further study.

We sought to assess whether serum salusin-β levels are correlated with the presence and severity of coronary artery disease (CAD).

We measured serum salusin-β levels in 278 consecutive patients undergoing coronary angiography (CAG) for the evaluation of CAD and in 126 healthy controls. Serum salusin-β levels were measured by enzyme-linked immunosorbent assay. The severity of CAD was assessed by angiographic coronary atherosclerosis index score system.

Serum salusin-β levels were significantly higher in patients undergoing CAG (n = 278) than those in healthy controls (n = 126) (3.81 ± 0.99 vs 4.34 ± 1.40 nmol/L, P < 0.01). In patients undergoing CAG, patients with CAD (n = 160) had significantly higher serum salusin-β levels compared to patients without CAD (n = 118) (4.65 ± 1.44 vs 3.94 ± 1.23 nmol/L, P < 0.01). Multivariate logistic regression analysis revealed that serum salusin-β levels were independently associated with the presence of CAD (odds ratio, 1.439; 95% confidence interval, 1.176–1.760; P < 0.01). Serum salusin-β levels were positively correlated with the coronary atherosclerosis index score (r = 0.316, P < 0.001).

Serum salusin-β levels were associated with the presence and severity of CAD. Salusin-β in serum might serve as a potential biomarker for reflecting the development and progression of CAD. Therapeutic treatment by inhibiting salusin-β interaction to prevent CAD warrants further investigation.

Myeloproliferative disorders are characterized by proliferation of 1 or more lineage of hematologic cells. Rapid proliferation of cells may lead to depletion of vitamin B₁₂, which may be falsely elevated by conventional assays in these disorders. We evaluated vitamin B₁₂ status with conventional vitamin B₁₂ assay and levels of serum methylmalonic acid (MMA), serum holotranscobalamin (holoTC), and plasma homocysteine in myeloproliferative disorders.

In 58 patients who had myeloproliferative disorders and normal serum creatinine levels, we measured levels of vitamin B₁₂, MMA, holoTC, and homocysteine. Correlations were evaluated between these tests, with MMA as the reference standard for vitamin B₁₂ deficiency.

Prevalence of vitamin B₁₂ deficiency was 69%, despite high serum vitamin B₁₂ levels. Levels of holoTC of 40.6 pmol/L or less and homocysteine of greater than 14 mol/L were the best cutoff levels with sensitivity values of 75% and 70%, specificity values of 80% and 68%, and positive predictive values of 88% and 80%. Logistic regression showed that cutoff values of holoTC of 40.6 pmol/L or less and homocysteine of greater than 14 mol/L resulted in odds ratio 15.5 for low versus high holoTC, and odds ratio 5.4 for high versus low homocysteine, to confirm vitamin B₁₂ deficiency.

Patients who had myeloproliferative disorders had a high prevalence of vitamin B₁₂ deficiency, despite high serum vitamin B₁₂ levels. Therefore, vitamin B₁₂ status should be evaluated in patients with myeloproliferative disorders. Holotranscobalamin level may be the best initial test and may replace vitamin B₁₂ assay to accompany MMA and homocysteine levels.

Preeclampsia is a cardiovascular (CV) disease risk factor, and lifestyle modifications are recommended. It was suggested that preeclampsia may increase the prevalence of various CV disease risk factors such as metabolic syndrome, hypertension, insulin resistance, microalbuminuria, and endothelial dysfunction, among others. Here, we investigate the role of serum uric acid in preeclampsia in the development of CV complications.

This was an observational case-control study that compared women with history of preeclampsia (n = 25) with age-matched controls with uncomplicated pregnancies (n = 20) who were followed for at least 5 years. Measurements included clinical and ambulatory blood pressure monitoring, ultrasound-measured flow-mediated dilatation (FMD), microalbuminuria, carotid intima-media thickness (CIMT) and serum uric acid, as well as clinical and demographic features. Cardiovascular disease risk factors were compared in women with and without previous preeclampsia.

At the time of index gestation, preeclamptic women had higher serum uric acid values (4.36 ± 0.61 vs 2.27 ± 0.38 mg/dL, P < 0.001). Five years after pregnancy, the patients who had preeclampsia were more likely to have hypertension and had higher serum uric acid levels, higher microalbuminuria and CIMT levels, and lower FMD values than did the patients who did not have preeclampsia. The 2 groups were similar with regard to various ambulatory blood pressure parameters. Univariate associates of FMD were history of preeclampsia and the current hypertension status. Microalbuminuria correlated with gestational uric acid levels (coefficient of correlation of 0.40, P = 0.01 for FMD and coefficient of correlation of 0.37, P = 0.01 for CIMT, respectively).

Preeclampsia might be a risk factor for the development of cardiovascular risk factors at least 5 years after index pregnancy. Serum uric acid and microalbuminuria may be mechanistic mediators of heightened risk, along with impaired endothelial function in preeclampsia.

The objective of this study was to describe the epidemiology and trends in pediatric acute pancreatitis (AP)–associated emergency department (ED) visits in the United States.

Estimates of AP–associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample.

From 2006 to 2011, there were an estimated total of 78,787 ED visits associated with the diagnosis of AP. The greatest number of ED visits occurred in children 15 to 19 years of age (67.0%). A majority of patients were subsequently admitted to the hospital for further care (74.1%). Risk factors independently associated with an increased rate of hospital admission included 3 or more comorbid conditions (adjusted odds ratio [aOR] 12.81; 95% confidence interval [CI], 11.29–14.56), children younger than 5 years (aOR, 1.73; 95% CI, 1.58–1.89), presentation to a teaching hospital (aOR, 1.68; 95% CI, 1.62–1.74) or a hospital in the Western region of the United States (aOR, 1.48; 95% 1.42–1.54), and health coverage with Medicaid (aOR, 1.23; 95% CI, 1.17–1.29). Acute pancreatitis–associated ED visits increased from 14.5 per 100,000 children in 2006 to 16.1 per 100,000 children in 2011 (11.42% increase; P < 0.01).

There has been an increasing incidence of AP-associated ED visits in children from 2006 to 2011.

High weight status is associated with increased forearm fracture risk but its relationship to severity of fracture has not been evaluated. We compared the epidemiology of children's forearm fractures treated with fracture reduction to those not treated with reduction, hypothesizing that high weight status would be significantly associated with need for reduction.

This is a case-control study including Washington, DC children, ages 2 to 17 years, treated for isolated forearm fractures in an urban, tertiary care pediatric emergency department from 2003 to 2006. Descriptive statistics and logistic regression were conducted to compare patients with forearm fracture reductions to nonintervention controls.

Of 888 forearm fractures, 330 (37.2%) required reduction (cases) whereas 558 (64.8%) did not (controls). Cases were more likely than controls to be male [adjusted odds ratio, 1.67 (95% confidence interval, 1.11–2.50)] and to have experienced a more severe mechanism of trauma [adjusted odds ratio, 2.11 (95% confidence interval, 1.14–3.90)]. The groups did not differ in weight status, age, or race/ethnicity.

The need for reduction among children with forearm fractures is significantly associated with male sex and major mechanisms of trauma but not with high weight status. Strategies to reduce severe forearm fractures should focus on preventing major mechanisms of trauma.