Lipoprotein (a): perspectives from a lipid-referral program.

Background: Lipoprotein (a) [Lp(a)] has a strong association with coronary disease (CHD). We evaluated the implications of implementing a niacin strategy in persons above low risk by the Framingham risk score (FRS).

Methods: Patients referred to a university lipid management program from January 2004 to June 2010 had an Lp(a) level measured at initial evaluation.

Histone deacetylase inhibition increases levels of choline kinase α and phosphocholine facilitating noninvasive imaging in human cancers.

Histone deacetylase (HDAC) inhibitors are currently approved for cutaneous T-cell lymphoma and are in mid-late stage trials for other cancers. The HDAC inhibitors LAQ824 and SAHA increase phosphocholine (PC) levels in human colon cancer cells and tumor xenografts as observed by magnetic resonance spectroscopy (MRS). In this study, we show that belinostat, an HDAC inhibitor with an alternative chemical scaffold, also caused a rise in cellular PC content that was detectable by (1)H and (31)P MRS in prostate and colon carcinoma cells.

Comparison of standard, prone and cine MRI in the evaluation of tethered cord.

Background: Tethered cord syndrome (TCS) is defined by abnormal traction on the spinal cord that confines its movement. Surgical cord release usually stops neurological deterioration; therefore, early and accurate neuroradiological diagnosis is important. Supine MRI is the imaging modality of choice, but prone MRI and cine MRI can demonstrate cord movement.

Effect of use of combination evidence-based medical therapy after acute coronary syndromes on long-term outcomes.

Several medications have individually been shown to reduce mortality in patients with acute coronary syndromes (ACS), but data on long-term outcomes related to the use of combinations of these medications are limited. For 2,684 consecutive patients admitted with ACS from January 1999 and January 2007, a composite score was calculated correlating with the use upon discharge of indicated evidence-based medications (EBMs): aspirin, β blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents. Multivariate models were used to examine the impact of EBM score on 2-year events with adjustment for components of the Global Registry of Acute Coronary Events (GRACE) risk score, thienopyridine use, and year of discharge.

Role of cigarette smoking and gender in acute coronary syndrome events.

Cigarette smoking has been associated with lower mortality after an acute coronary event. We hypothesized that the improved survival in smokers is related to demographic differences and sought to further evaluate the gender disparities in smokers after an acute coronary event. A prospective cohort of 3,588 patients hospitalized at a single center from 1999 to 2006 was identified.

Constipation and risk of cardiovascular disease among postmenopausal women.

Background: Constipation is common in Western societies, accounting for 2.5 million physician visits/year in the US. Because many factors predisposing to constipation also are risk factors for cardiovascular disease, we hypothesized that constipation may be associated with increased risk of cardiovascular events.

Potential effects on clinical management of treatment algorithms on the basis of apolipoprotein-B/A-1 and total/high-density lipoprotein-cholesterol ratios.

Background: Apolipoprotein-B/A-1 (apoB/A-R) and total/high-density lipoprotein-cholesterol ratios (TC/HDL-R) outperform non-high-density lipoprotein-cholesterol (non-HDL-C) suggested by Adult Treatment Panel (ATP) III guidelines for predicting cardiovascular (CV) outcomes.

Objective: To evaluate the potential effects that implementing our proposed apoB/A-R and TC/HDL-R treatment algorithms would have on clinical management.

Methods: We performed a chart review of all patients referred to the University of Michigan Lipid Clinic from January 2004 to June 2010.

A brief questionnaire for assessing patient healthcare experiences in low-income settings.

Objective: The aim of this study was to develop and to assess the validity and reliability of two brief questionnaires for assessing patient experiences with hospital and outpatient care in a low-income setting.

Design: Using literature review and data from focus groups (n = 14), we developed questionnaires to assess patient experiences with inpatient (I-PAHC) and with outpatient (O-PAHC) care in a low-income setting. Questionnaires were administered in person by trained interviewers.

Patient awareness of the risks for heart disease posed by air pollution.

Background: The purpose of this study was to assess patient awareness of the coronary heart disease (CHD) risks posed by air pollution.

Methods: We distributed a questionnaire to 500 patients at a University of Michigan cardiology clinic.

Results: More than half of patients (n = 264, 53%) did not believe that air pollution was "proven" or "likely" to cause CHD, whereas a similar percentage (n = 284, 57%) were not previously aware of its association with CHD.

Perceived quality of care and lifestyle counseling among patients with heart disease.

Background: To examine patients' perceived quality of care and reported receipt of information on diet and exercise related to cardiovascular disease prevention.

Methods: Patients admitted with acute coronary syndromes or elective cardiac catheterization were eligible for enrollment. Baseline medical information was collected through medical-record review.

The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).

Background: historically, women with ST elevation myocardial infarction (STEMI) have had a higher mortality compared with men. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI) with focus on early reperfusion.

Methods: we assessed the impact of sex on the outcome of 8,771 patients with acute STEMI who underwent primary PCI from 2003 to 2008 at 32 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry.

Health status and behavior among middle-school children in a midwest community: what are the underpinnings of childhood obesity?

Background: Childhood obesity is one of the nation's foremost health challenges. How much of this is due to lifestyle choices? The objective of the study was to determine health behaviors that contribute to obesity in sixth-grade children.

Methods: To assess which health habits contribute to childhood obesity, we studied body mass index, blood pressure, lipid profile, glucose, and heart rate recovery after a 3-minute step test among sixth-grade children enrolled in a school-based intervention study from 2004 to 2009, comparing health behaviors and physiologic markers in obese versus nonobese children.

Psychological distress in cardiac rehabilitation participants.

Purpose: Limited data are available on the psychosocial characteristics of patients entering cardiac rehabilitation (CR). We characterized the psychological and clinical profiles of men and women entering CR to determine which, if any, characteristic identifies persons at high risk for psychological distress.

Methods: The records of 417 patients enrolled in phase II CR between January 2001 and December 2004 were analyzed.

Modulation of melanoma cell phospholipid metabolism in response to heat shock protein 90 inhibition.

Molecular chaperone heat shock protein 90 (Hsp90) inhibitors are promising targeted cancer therapeutic drugs, with the advantage that they deplete multiple oncogenic client proteins and modulate all the classical hallmarks of cancer. They are now in clinical trial and show potential for activity in melanoma and other malignancies. Here we explore the metabolic response to Hsp90 inhibition in human melanoma cells using magnetic resonance spectroscopy.

Patient-related diet and exercise counseling: do providers' own lifestyle habits matter?

The goal of this research was to evaluate the personal health behaviors of physicians in training and attending physicians in association with patient-related lifestyle counseling. Physicians at a major teaching hospital were surveyed regarding their personal lifestyle behavior, perceived confidence, and frequency of counseling patients regarding lifestyle behaviors. One hundred eighty-three total responses were received.

Progression of renal insufficiency in children and adolescents with neuropathic bladder is not accelerated by lower urinary tract reconstruction.

Purpose: Children with chronic renal insufficiency and neuropathic bladder resistant to medical management may require lower urinary tract reconstruction before renal transplantation. A low pressure urinary reservoir optimizes the chance of graft survival and may slow native kidney death. We evaluated whether the renal deterioration rate is affected by augmentation cystoplasty.

Nanoporous membranes derived from block copolymers: from drug delivery to water filtration.

With nanoscale pores, high porosity, narrow pore size distributions, and tunable chemical and mechanical properties, block copolymers hold tremendous potential as robust, efficient, and highly selective separation membranes. Recent work by Yang et al. illustrates how block copolymers can be employed in the preparation of membranes for use in controlled, long-term, protein-delivery devices.

The phosphoinositide 3-kinase inhibitor PI-103 downregulates choline kinase alpha leading to phosphocholine and total choline decrease detected by magnetic resonance spectroscopy.

The phosphoinositide 3-kinase (PI3K) pathway is a major target for cancer drug development. PI-103 is an isoform-selective class I PI3K and mammalian target of rapamycin inhibitor. The aims of this work were as follows: first, to use magnetic resonance spectroscopy (MRS) to identify and develop a robust pharmacodynamic (PD) biomarker for target inhibition and potentially tumor response following PI3K inhibition; second, to evaluate mechanisms underlying the MRS-detected changes.

Evidence of disparity in the application of quality improvement efforts for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice Initiative in Michigan.

Background: Racial disparities exist in the management of patients with cardiovascular disease in the United States. The aim of the study was to evaluate if a structured initiative for improving care of patients with acute myocardial infarction (Guidelines Applied in Practice [GAP]) led to comparable care of white and nonwhite patients admitted to GAP hospitals in Michigan.

Methods: Medicare patients comprised 2 cohorts: (1) those admitted before GAP implementation (n = 1,368) and (2) those admitted after GAP implementation (n = 1,489).

The risk of recurrent urolithiasis in children is dependent on urinary calcium and citrate.

Objectives: To determine which risk factors help predict recurrent stone formation. Urinary stone disease is relatively rare in children. At our institution, a full urinary metabolic evaluation is initiated after the first stone episode.

Receipt of cardiac medications upon discharge among men and women with acute coronary syndrome and nonobstructive coronary artery disease.

Background: Management of acute coronary syndrome (ACS) patients with nonobstructive epicardial coronary artery disease (CAD) remains poorly understood.

Hypothesis: Acute coronary syndrome patients with nonobstructive CAD are less likely to receive effective cardiac medications upon discharge from the hospital.

Methods: We identified patients hospitalized with ACS that underwent coronary angiography and had a 6-month follow-up.

Physical functioning related to C-reactive protein and fibrinogen levels in mid-life women.

We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP) and fibrinogen are related to measures of physical functioning in mid-life women. Our sample included 543 participants in the Michigan site of Study of Women's Health Across the Nation (SWAN). Predictors included CRP from serum and fibrinogen from plasma.