Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions.

Purpose: Benign prostatic hyperplasia is a highly prevalent disease in older men with substantial adverse effects on public health. Classic etiological paradigms for benign prostatic hyperplasia focus on nonmodifiable risk factors. However, obesity also potentially promotes benign prostatic hyperplasia.

The appropriate use of biomarkers in heart failure.

Natriuretic peptides and troponins have been extensively studied and used in heart failure, and their value has been extensively discussed. Renal markers, such as cystasin-C, NGAL, and KIM-1, have shown growing utility in heart failure. The activation of compensatory pathways and ongoing hemodynamic changes result in the release of biomarkers that can be monitored to chart disease progression and possibly target for therapy.

Biomarkers in acute heart failure--state of the art.

The role of biomarkers in the management of patients with acute heart failure (HF) has evolved rapidly in the past several years. Representing a major burden on health systems, acute HF has increased the need for earlier diagnosis, better risk stratification, and cost-effective treatment to reduce rates of hospitalization. Biomarker-guided diagnosis and treatment have become essential, especially in the acute setting to which the majority of the patients with acute HF initially present.

Finasteride reduces the risk of incident clinical benign prostatic hyperplasia.

Background: Despite the high prevalence of clinical benign prostatic hyperplasia (BPH) among older men, there remains a notable absence of studies focused on BPH prevention.

Objective: To determine if finasteride prevents incident clinical BPH in healthy older men.

Design, Setting, And Participants: Data for this study are from the Prostate Cancer Prevention Trial.

Hospital costs and length of stay related to robot-assisted versus open radical and partial nephrectomy for kidney cancer in the USA.

There are scant national outcomes data for robot-assisted laparoscopic surgery. We assessed costs and length of stay (LOS) related to robot-assisted radical and partial nephrectomy in a nationally representative population database. We performed a cohort analysis of the US Nationwide Inpatient Sample database.

Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial.

Aims: Neutrophil gelatinase-associated lipocalin (NGAL) is a measure of acute kidney injury. Renal dysfunction portends significant risk after discharge from acute heart failure (AHF). Thus, a sensitive marker of renal injury might also help to risk stratify HF patients.

Evolving use of biomarkers for kidney injury in acute care settings.

Purpose Of Review: Acute kidney injury is increasingly recognized in acute care settings in more recent years. Proper diagnosis and risk stratification for acute kidney injury is necessary for carrying out appropriate and cost-effective treatments in patients with acute kidney injury. Kidney markers serve as diagnostic and prognostic tools to give physicians a more complete perspective of renal insult.

Gout. Novel therapies for treatment of gout and hyperuricemia.

In the past few decades, gout has increased not only in prevalence, but also in clinical complexity, the latter accentuated in part by a dearth of novel advances in treatments for hyperuricemia and gouty arthritis. Fortunately, recent research reviewed here, much of it founded on elegant translational studies of the past decade, highlights how gout can be better managed with cost-effective, well-established therapies. In addition, the advent of both new urate-lowering and anti-inflammatory drugs, also reviewed here, promises for improved management of refractory gout, including in subjects with co-morbidities such as chronic kidney disease.

Perceptions of disease and health-related quality of life among patients with gout.

Objective: To assess the impact of gout on health-related quality of life (HRQoL) among patients in three large US cities.

Methods: Gout patients completed the Short Form-36 (SF-36) and a series of questions regarding their gout, comorbidities and demographics. Their physicians confirmed the gout diagnosis and evaluated the severity of patient's gout.

Circulating natriuretic peptide levels in acute heart failure.

Natriuretic peptide (NPs) levels have achieved worldwide acceptance. They are excellent rule-in and rule-out biomarkers for patients presenting with dyspnea. In the hospital, NP levels may represent altered forms of B-type natriuretic peptide (BNP), including the inactive precursor molecule, pro-BNP.

Prevention of recurrent esophageal variceal hemorrhage: review and current recommendations.

Variceal rebleeding is a very frequent and severe complication in cirrhotic patients; therefore, its prevention should be mandatory. Lately several studies demonstrated that the rate of rebleeding was decreased by 40% and overall survival is improved by 20% with beta-blockers. However, this treatment presents some problems, such as the number of nonresponders and contraindications for its use.

The role of self-monitoring of blood glucose during the treatment of type 2 diabetes with medications targeting postprandial hyperglycemia.

Intensive treatment has been shown to improve glycemic control and reduce the risk of diabetic complications in controlled clinical trials; however, glycemic control has substantial room for improvement in the diabetic population. Management strategies have traditionally focused on achieving A1c targets, with fasting glucose levels serving as the primary measure of day-to-day glycemic control. Considerable evidence indicates that postchallenge plasma glucose, a surrogate for postprandial hyperglycemia, is an independent cardiovascular risk factor, highlighting the fact that optimal glycemic control requires management of both fasting and postprandial glucose levels.

Management strategies to meet the core heart failure measures for acute decompensated heart failure: a nursing perspective.

Despite enormous advances in the medical management of heart disease, heart failure (HF) persists as a leading cause of hospitalization in our elderly. In 2001, the American Heart Association and the American College of Cardiology published Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease. The guidelines proactively responded to a growing body of evidence confirming that comprehensive risk factor management and risk reduction improve quality of life and survival, while reducing recurrent cardiovascular events.

Informatics in radiology: use of the MIRC DICOM service for clinical trials to automatically create teaching file cases from PACS.

The Medical Imaging Resource Center (MIRC) software of the Radiological Society of North America is used to share teaching files and clinical trial data. By using the MIRC service for clinical trials, teaching file cases can be automatically generated directly from picture archiving and communication systems (PACS). The advantage of using the clinical trials service over the authoring service is the need for minimal user intervention, because data already present in the Digital Imaging and Communications in Medicine (DICOM) header can be automatically inserted into teaching file cases.

Pramlintide in the treatment of diabetes.

Diabetes treatment has traditionally focused on correcting insulin deficiency with exogenous insulin and oral agents designed to enhance insulin secretion or insulin sensitivity in peripheral tissues. The more recent view of diabetes as a disease that affects multiple hormones in addition to insulin has led to the development of new therapies more broadly aimed at restoring glucose homeostasis by correcting abnormalities in additional glucoregulatory hormones. Pramlintide, a synthetic analogue of the beta-cell hormone amylin, regulates the appearance of glucose in the circulation following meals through several mechanisms of action: slowing gastric emptying, preventing inappropriate postprandial secretion of glucagon and increasing satiety.

Causes of hypercalcemia in a population of military veterans in the United States.

Objective: To determine the various causes of hypercalcemia in a population of US veterans at the San Diego Veterans Affairs Medical Center.

Methods: A retrospective analysis of medical records was performed on 212 US veterans encountered between 1998 and 2002 with serum calcium measurements between 10.5 and 10.

Synchrony between circular and longitudinal muscle contractions during peristalsis in normal subjects.

The current understanding is that longitudinal muscle contraction begins before and outlasts circular muscle contraction during esophageal peristalsis in normal subjects. The goal of our study was to reassess the relationship between the contractility of two muscle layers using novel ways to look at the muscle contraction. We studied normal subjects using synchronized high-frequency ultrasound imaging and manometry.

Intravenous immunoglobulin-associated acute renal failure: case series and literature review.

Intravenous immunoglobulin (IVIg) is widely used in the treatment of immunodeficient and autoimmune hematologic, neurologic, rheumatologic, and cutaneous disorders. The major adverse effects of IVIg infusions are pain (chest, hip, joint, and back), fever, chills, and fatigue. These effects are related to the rate of the infusion and may be attenuated by slowing the rate.

Strategies for insulin therapy in type 2 diabetes.

Chronic hyperglycemia in type 2 diabetes is responsible for an array of microvascular and macrovascular complications that can lead to significant morbidity and mortality. Several well-conducted large clinical studies have shown that normalizing blood glucose levels can help prevent the onset and slow the progression of complications from diabetes. As many as 25% of patients treated with oral hypoglycemic agents require the addition of insulin therapy to compensate for the progression of beta-cell failure and an inability to maintain glycemic control.

Inorganic pyrophosphate (PPI) in pathologic calcification of articular cartilage.

Physiologic levels of extracellular PPi, which suppresses hydroxyapatite crystal growth, must be maintained by articular chondrocytes and resident cells in many othee tissues in order to prevent pathologic calcification. However, extracellular PPi rises in articular cartilage in direct association with aging. Matrix supersaturation with PPi stimulates chondrocalcinosis manifesting as calcium pyrophosphate dihydrate (CPPD) crystal deposition.

The extracellular matrix differentially regulates the expression of PTHrP and the PTH/PTHrP receptor in FG pancreatic cancer cells.

Objectives: Previous studies by our laboratory have demonstrated that parathyroid hormone-related protein (PTHrP) and its receptor (PTH/PTHrP receptor) are commonly expressed in pancreatic cancer and suggest their participation in the progression of this devastating disease. It has also been demonstrated that one of the major hallmarks of pancreatic adenocarcinoma is an increased production of the extracellular matrix (ECM), a critical regulator of diverse cellular processes such as differentiation, proliferation, and angiogenesis. The present study focused on the relationship between the PTHrP and ECM axes in the pathobiology of pancreatic cancer.