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Both sagittal abdominal diameter (SAD) and waist circumference (WC) highly correlate with visceral adipose tissue (VAT) being linked to an atherogenic lipoprotein profile. However, it is uncertain whether SAD is a better correlate of atherogenic lipoprotein subfractions than WC. We examined relative associations of SAD vs WC with lipoprotein subfractions for US white and Japanese men, concurrently examining the associations of VAT vs subcutaneous adipose tissue with lipoprotein subfractions. A population-based sample of 260 white and 282 Japanese men aged 40 to 49 years was examined for VAT and subcutaneous adipose tissue by computed tomography; SAD and WC by a portable sliding-beam caliper and a measuring tape, respectively; and lipoprotein subfractions by nuclear magnetic resonance spectroscopy. Both SAD and WC were significantly and positively associated with large very low-density lipoprotein and total and small low-density lipoprotein particle concentrations, and inversely associated with large high-density lipoprotein particle concentration for both white and Japanese men. In body mass index-adjusted regression models, the significant associations of SAD remained for both white and Japanese men, whereas those of WC became nonsignificant for white men. When SAD and WC were simultaneously included into the body mass index-adjusted models, the associations of SAD remained significant and statistically stronger than those of WC for both white and Japanese men. Furthermore, the pattern of the associations of SAD with those lipoprotein subfractions was comparable to that of the associations of VAT. Sagittal abdominal diameter was comparable to VAT and stronger than WC in the associations with atherogenic lipoprotein subfractions for middle-aged, nondiabetic, white and Japanese men.

Background.Certain emerging infections, such as severe acute respiratory syndrome and avian influenza, represent a great risk to healthcare workers (HCWs). There are few data about the epidemiology of H1N1 influenza among HCWs.Methods.We conducted a prospective surveillance study for all HCWs at King Abdulaziz Medical City (Riyadh, Saudi Arabia) who were confirmed positive for H1N1 influenza by polymerase chain reaction (PCR) from June 1 through November 30, 2009.Results.During 6 months of surveillance, 526 HCWs were confirmed positive for H1N1 influenza. The distribution of these cases showed 2 clear outbreaks: an initial outbreak (peak at early August) and a shorter second wave (peak at end of October). Among all PCR-confirmed cases, the attack rate was significantly higher in clinical HCWs than in nonclinical HCWs (6.0% vs 4.3%; P < .001 ) and in HCWs in emergency departments than in HCWs in other hospital locations (17.4% vs 5.0%, P < .001). The percentage of HCWs who received regular influenza vaccination was greater for clinical HCWs than for nonclinical HCWs (46.2% vs 24.6%; P < .001). The majority of HCWs with confirmed H1N1 influenza were young (mean age ± standard deviation, 34.5 ± 9.5 years), not Saudi (58.4%), female (55.1%), and nurses (36.1%). Approximately 4% of women who were less than 50 years old were pregnant. Reported exposures included contact with a case (41.0%), contact with a sick household member (23.8%), and recent travel history (13.3%). Respiratory symptoms (98.0%), including cough (90.1%), were the most frequently reported symptoms, followed by muscle aches (66.2%), fever (62.5%), headache (57.9%), diarrhea (16.5%), and vomiting (9.8%). None of these HCWs died, and all recovered fully without hospital admission.Conclusions.The results confirm the vulnerability of HCWs, whether clinical or nonclinical, to emerging H1N1 influenza.

SummaryBackgroundThe epidemiology of invasive pneumococcal disease (IPD) in children aged ≤5 years in Saudi Arabia has not been described. We conducted a retrospective surveillance study to describe the epidemiology of IPD in the population of children aged ≤5 years served by the National Guard Health Affairs hospitals in central and western regions of Saudi Arabia.MethodsWe reviewed the medical records of children ≤5 years old admitted to the King Abdulaziz Medical City hospitals in Riyadh and Jeddah with pneumococcal infections for the period January 1999 through December 2003. Only microbiologically confirmed IPD cases (meningitis or bacteremia) were included in the analysis.ResultsA total of 82 IPD cases, 19 (23.2%) meningitis and 63 (76.8%) bacteremia, were diagnosed during the five-year period. Of these, 12.2% (10/82) died, with a case-fatality slightly but insignificantly higher in cases of meningitis (15.8%) than bacteremia (11.1%). The average annual IPD incidence was 17.4 per 100 000 (4.0 for meningitis and 13.4 for bacteremia). The incidence was roughly similar in males and females (18.3 and 16.6, respectively; p=0.663) and was almost 4-fold higher in the first year of life compared to the next four years (40.6 and 11.5, respectively; p

This study examines the differences in circulating levels of cytokines among Japanese in Japan (JJ), Japanese Americans (JA), and whites and their associations with obesity and marine n-3 fatty acids (FA) in a cross-sectional population-based study of 297 men aged 40-49 (100 JJ, 99 whites, and 98 JA). Experimental studies show that cytokines are associated with obesity positively and marine n-3 FA inversely. Serum interleukin-1alpha (IL-1alpha), IL-1 receptor agonist (IL-1ra), IL-4, IL-8, IL-10, inducible protein-10 (IP-10), tumor necrosis factor-alpha (TNF-alpha), monocyte chemoattractant protein-1 (MCP-1), and marine n-3 FA were determined. Body mass index (BMI), waist circumference, and computed tomography-measured visceral and subcutaneous adipose tissues were determined. The JJ had significantly lower levels of IL-1alpha, IL-4, IL-8, MCP-1, and TNF-alpha than whites and JA. Whites and JA had similar levels of IL-1alpha, IL-4, and IL-8 whereas whites had significantly higher levels of MCP-1 and TNF-alpha than JA. The JJ were least obese (BMI (kg/m(2)), mean +/- standard deviation) 23.6 +/- 2.8, 27.9 +/- 4.6, and 27.9 +/- 4.5 for JJ, whites, and JA, respectively. The JJ had marine n-3 FA about 100% higher than whites and JA (serum marine n-3 FA (%), median (interquartile range) 8.79 (7.41, 11.16), 3.47 (2.63, 4.83), and 4.44 (3.33, 6.01) for JJ, whites, and JA, respectively). Generally cytokines had weak and nonsignificant associations with indices of obesity and nonsignificant associations with marine n-3 FA. BMI had significant inverse associations with IL-1alpha, IL-4, and IL-8 in JA (P0.05). Marine n-3 FA had marginally significant inverse associations with IL-8 in JJ (P = 0.055) and TNF-alpha in whites (P = 0.076). The JJ had lower levels of many cytokines than whites and JA. Generally cytokines had weak and nonsignificant associations with indices of obesity and marine n-3 FA. Further investigation is needed to determine why JJ had lower circulating levels of cytokines.

Breast cancer is the most common cancer in Egyptian women. However, the mean tumor size at diagnosis is 4.5 cm, and the median age is approximately 46 years. Both of these factors decrease the utility and cost-effectiveness of a mammography-based screening program typically designed for developed countries. We report the first clinical breast assessment-based screening project in an entirely rural Egyptian community. Targeted population: Women aged 25–65 years in three municipal regions of Dakahlia province, Egypt. The estimated targeted population was 57,500 and participation was voluntary. First stage was performed at primary health care points. Surgeons performed systematic clinical breast examination. All data were collected at Mansoura University. Abnormal findings in the primary examination led to an invitation to the Oncology Center—Mansoura University—where the second stage of the study took place. It comprised repeat examination, ultrasonography, and/or mammography. Therapeutic interventions were performed at the governmentally funded Mansoura Oncology Center. Voluntary participation reached 10.2% of the target group and abnormal clinical examination represented 3.2% (191/5,900). The screen-detected cancers were (18/5,900) of examined population, and thus the cancer detection rate of clinical breast assessment-based screening was 30.5 per 100,000 of participating women during 2 years. The tumor size was 1.5 cm (median) and 1.3 cm (mean). The cost of screening per cancer case detected was approximately 415 US$, and the overall cost of treating a screen-detected cancer was 1,015–1,215 US$. Clinical breast assessment-based screening with selective mammography is an effective modality, which improves the results of breast cancer management in Egypt.

Background: The associations of serum omega-6 (n−6) fatty acids with lipoprotein subclasses at the population level are uncertain. Objective: We aimed to examine associations between major n−6 fatty acids [ie, linoleic acid (LA, 18:2n−6) and arachidonic acid (AA, 20:4n−6)] and the lipoprotein subclasses VLDL, LDL, and HDL. Design: We conducted a cross-sectional study in 1098 participants using population-based data from US white, Japanese American, Japanese, and Korean men aged 40–49 y. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Lipoprotein subclasses were measured by nuclear magnetic resonance spectroscopy. Multiple linear regression models as a function of each fatty acid were used after adjustment for age, population, body mass index, pack-years of smoking, alcohol consumption, diabetes, hypertension, and omega-3 (n−3) and trans fatty acids. Results: Serum LA was inversely associated with large VLDL (β = −0.62, P < 0.001), total LDL (β = −22.08, P < 0.001), and small LDL (β = −31.89, P < 0.001) particle concentrations and VLDL size (β = −0.72, P < 0.001). Serum LA was positively associated with large HDL particle concentration (β = 0.21, P < 0.001) and HDL size (β = 0.03, P < 0.001). The patterns of association of AA with large VLDL and large HDL particle concentrations were comparable with those of LA. Conclusions: At the population level, higher serum concentrations of LA were significantly associated with lower concentrations of total LDL particles. Higher serum concentrations of LA and AA were significantly associated with a lower concentration of large VLDL particles and a higher concentration of large HDL particles. These associations were consistent across the population groups. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00069797","term_id":"NCT00069797"}}NCT00069797.

Background Brain natriuretic peptide (BNP) level has emerged as a predictor of death and hospital readmission in patients with heart failure (HF). The value of baseline BNP assessment in advanced HF patients receiving cardiac resynchronization defibrillator therapy (CRT-D) has not been firmly established. Hypothesis We hypothesized that a baseline BNP level would predict all cause mortality and HF hospitalization in HF patients receiving cardiac resynchronization therapy. Methods A retrospective chart review of all patients having BNP assessment prior to implantation of a CRT-D for standard indications during 2004 and 2005 was conducted at the Veterans Affairs Pittsburgh Healthcare System. The primary endpoint was all-cause mortality and the secondary endpoint was HF-related hospitalization. We used findings from the receiver operating characteristic (ROC) curve to define low (

Among Asians, including Japanese, obesity is related to dyslipidemia and insulin resistance at a lower level of body mass index (BMI) compared with non-Hispanic whites (NHW). We hypothesize that this ethnic difference in the relationship between BMI and metabolic risks is partly associated with the ethnic difference in fat distribution, namely, liver fat as well as visceral adipose tissue. To compare liver fat content among Japanese vs NHW men, regional computed tomographic images were taken to measure liver computed tomographic density in population-based samples of 313 Japanese and 288 NHW men aged 40 to 49 years, along with the assessment of metabolic parameters. Liver fat content was higher in Japanese than NHW men (liver to spleen attenuation ratio [lower value means higher liver fat content]: 1.01 +/- 0.16 vs 1.07 +/- 0.15, respectively; P < .01), despite a lower mean BMI in Japanese men (BMI: 23.6 +/- 2.9 vs 27.8 +/- 4.2 kg/m(2), P < .01). Moreover, Japanese men had a greater disposition for fatty liver with a small increase in BMI than NHW (P < .01), whereas both groups had a similar relationship between visceral adipose tissue and BMI. In both groups, liver fat content correlated with triglycerides, homeostasis model assessment of insulin resistance, and C-reactive protein. Liver fat content is higher among Japanese than NHW; and this ethnic difference becomes more robust with a small increase in BMI, suggesting that fatty liver is a sensitive marker for the failure of the adipose tissue to expand to accommodate an increased energy influx, and is associated with similar metabolic risk in Japanese despite lower BMI compared with NHW men.

Background: The association of serum polyunsaturated fatty acids (PUFAs) with lipids in different populations is not known. Objective: Our aim was to examine the association of serum n−6 (omega-6) or n−3 (omega-3) PUFAs with triglycerides or HDL-cholesterol concentrations in 261 white, 285 Japanese, and 212 Japanese American men aged 40–49 y. Design: We used a population-based cross-sectional study. Of the original sample (n = 926), those taking lipid-lowering medications or who had diabetes (n = 168) were excluded. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Multiple regression models as a function of tertile groups of each PUFA were used. Results: Serum n−6 PUFAs were significantly inversely associated with triglycerides across populations after adjustment for age, body mass index, pack-years of smoking, and ethanol consumption [β = −0.39 (P < 0.001), −0.38 (P < 0.001), and −0.33 (P < 0.001) in whites, Japanese, and Japanese Americans, respectively]. Marine n−3 PUFAs were significantly inversely associated with triglycerides across populations [β = −0.15 (P < 0.001), −0.22 (P < 0.001), and −0.13 (P < 0.001) in whites, Japanese, and Japanese Americans, respectively]. n−6 PUFAs were significantly positively associated with HDL cholesterol in whites (β = 4.49, P < 0.001) and Japanese (β = 3.73, P < 0.01). Marine n−3 PUFAs were significantly positively associated with HDL cholesterol in Japanese (β = 2.15, P < 0.05), and eicosapentaenoic acid was significantly positively associated with HDL cholesterol in whites (β = 2.68, P < 0.01). Conclusion: Serum n−6 and n−3 PUFAs are inversely associated with triglycerides across populations.

Background: The recently published Ventricular Arrhythmia Suppression Trial (VAST) found no effect of rate-smoothing (RS) algorithm on frequency of ventricular tachycardia (VT) episodes in patients with implantable defibrillator. A similar recent trial reported an opposite result. In order to determine possible reasons for the discrepancy between the trials and achieve better understanding of events preceding VT onset, we analyzed stored device electrograms preceding 162 VT episodes from 50 VAST trial patients with dual-chamber devices. Results: In this analysis, short-long sequences were more common prior to polymorphic VTs than before monomorphic VTs. The proportion of VT episodes preceded by short-long sequences was lower during randomization to RS ON (5.3% vs 31.3%, P < 0.001). For patients with multiple episodes of monomorphic VT, there was higher interpatient than intrapatient variability in preceding RR intervals. When adjusting for this similarity of RR interval sequences preceding VT onset in individual patients, the difference in proportion short-long sequences between RS ON and RS OFF programming was no longer significant. Conclusion: Episodes of VT were preceded by stereotypic, patient-specific sequences of RR intervals in several VAST trial patients. RS reduced the percentage of VTs preceded by short-long sequences, but did not change overall VT incidence.

Objectives We sought to examine whether marine-derived n-3 fatty acids are associated with less atherosclerosis in Japanese versus white populations in the U.S. Background Marine-derived n-3 fatty acids at low levels are cardioprotective through their antiarrhythmic effect. Methods A population-based cross-sectional study in 281 Japanese (defined as born and living in Japan), 306 white (defined as white men born and living in the U.S.), and 281 Japanese-American men (defined as Japanese men born and living in the U.S.) ages 40 to 49 years was conducted to assess intima-media thickness (IMT) of the carotid artery, coronary artery calcification (CAC), and serum fatty acids. Results Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar levels. Japanese had 2-fold higher levels of marine-derived n-3 fatty acids than whites and Japanese Americans in the U.S. Japanese had significant and nonsignificant inverse associations of marine-derived n-3 fatty acids with IMT and CAC prevalence, respectively. The significant inverse association with IMT remained after adjusting for traditional cardiovascular risk factors. Neither whites nor Japanese Americans had such associations. Significant differences between Japanese and whites in multivariable-adjusted IMT (mean difference 39 μm, 95% confidence interval [CI]: 21 to 57μm, p Conclusions Very high levels of marine-derived n-3 fatty acids have antiatherogenic properties that are independent of traditional cardiovascular risk factors and may contribute to lower the burden of atherosclerosis in Japanese, a lower burden that is unlikely the result of genetic factors.

In men in the post-World War II birth cohort, that is, men aged 40 to 49 years, whites in the United States had significantly higher levels of intima-media thickness of the carotid arteries (IMT) than the Japanese in Japan (Electron-Beam Tomography and Risk Assessment Among Japanese and US Men in the Post World War II Birth Cohort [ERA JUMP] study). The difference remained after adjusting for traditional risk factors. Primary genetic effects are unlikely, given the degree to which IMT is increased in the Japanese who migrated to the United States. We investigated whether the differences in the distributions of lipoprotein subclasses explain the difference in IMT between the 2 populations. We examined population-based samples of 466 randomly selected men aged 40 to 49 years (215 whites from Allegheny County, Pennsylvania, and 241 Japanese from Kusatsu, Shiga, Japan). Lipoprotein subclasses were determined by nuclear magnetic resonance (NMR) spectroscopy. The whites had significantly higher levels of large very low-density lipoprotein particles and significantly lower levels of large high-density lipoprotein particles than the Japanese, whereas the 2 populations had similar levels of small low-density lipoprotein particles. The 2 populations had similar associations of IMT with NMR lipoproteins. Adjusting for NMR lipoproteins did not attenuate the significant difference in IMT between the 2 populations (0.671 +/- 0.006 mm for the whites and 0.618 +/- 0.006 mm for the Japanese, P = .01, mean +/- SE). Differences in the distributions of NMR lipoproteins between the 2 populations did not explain the higher IMT in the whites.

Race-specific data for the association between coronary artery calcification (CAC) and carotid intimal medial thickness (IMT) are limited. We sought to compare black-white specific associations of these two measures.We conducted a population-based study of 379 randomly selected men aged 40-49 years (84 black and 295 white) from Allegheny County, US (2004-2006). Agatston CAC score was evaluated by electron-beam tomography and carotid IMT was evaluated by ultrasonography.Compared to white men, black men had similar prevalence of CAC (p=0.56) and higher total carotid IMT (p0.001). In black and white men, CAC score had significant positive correlations with total carotid IMT (r=0.47 and r=0.24, respectively, p0.001 for both) as well as the IMT for the common carotid artery (CCA), internal carotid artery and carotid bulb. The associations of CAC with total and CCA IMT were significantly stronger in black (beta=0.07 and beta=0.05, respectively) than white men (beta=0.03 and beta=0.01, respectively) after adjustment for traditional coronary risk factors (p=0.046 and p=0.036, respectively).In black and white middle aged men, CAC score had significant positive correlations with total and segmental carotid IMT. CAC was more predictive of total and CCA IMT in black than white men independent of coronary risk factors.

Endoscopic techniques have been introduced in most of surgical disciplines including surgery for breast cancer. However, there is shortage of evidence-based guidelines and oncological outcome data. We present a controlled trial of endoscopic axillary surgery for breast cancer with mid-term oncologic results. Fifty cases of axilloscopy for sentinel node biopsy, axillary sampling or full axillary dissection were included. Sentinel node biopsy was accomplished with the blue dye technique. Full axillary dissection was performed with a three-port approach with gas insufflation without liposuction. Endoscopic axillary dissection significantly lowered duration of drainage and operative blood loss. Lymph node harvest with endoscopic approach was significantly lower than with open procedure. One case developed axillary recurrence. Endoscopic sentinel node biopsy yielded identification rate of 80%. Current data do not justify the oncological safety of resectional endoscopic procedures. Endoscopically assisted axillary cancer surgery is technically feasible. The technique is valuable to maximize utility of blue dye method for sentinel lymphadenectomy in areas with no access to radio-guided surgery.

Explanations for the low prevalence of atherosclerosis in Japan versus the United States are often confounded with genetic variation. To help remove such confounding, the authors compared coronary artery calcification (CAC), a marker of subclinical atherosclerosis, between Japanese men in Japan and Japanese men in Hawaii. Findings were based on risk factors and CAC measured from 2001 to 2005 in 311 men in Japan and 300 men in Hawaii. Men were aged 40-50 years and without cardiovascular disease. After age adjustment, there was a threefold excess in the odds of prevalent CAC scores ofor = 10 in Hawaii versus Japan (relative odds = 3.2, 95% confidence interval: 2.1, 4.9). Whereas men in Hawaii had a generally poorer risk factor profile, men in Japan were four times more likely to smoke cigarettes (49.5% vs. 12.7%, p0.001). In spite of marked risk factor differences between the samples, none of the risk factors explained the low amounts of CAC in Japan. After risk factor adjustment, the relative odds of CAC scores ofor = 10 in Hawaii versus Japan was 4.0 (95% confidence interval: 2.2, 7.4). Further studies are needed to identify factors that protect against atherosclerosis in Japanese men in Japan.

BACKGROUND: We have previously reported that the prevalence of coronary artery calcification (CAC) was substantially lower among Japanese than American men despite a less favorable profile of many traditional risk factors in Japanese men. To determine whether lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are related to the difference in the prevalence of CAC between the two populations.METHODS: A total of 200 men aged 40-49 years were examined: 100 residents in Allegheny County, Pennsylvania, United States, and 100 residents in Kusatsu City, Shiga, Japan. Coronary calcium score (CCS) was evaluated by electron-beam tomography, Lp-PLA2 levels, nuclear magnetic resonance (NMR) lipoprotein subclasses, and other factors were assessed in 2001-2002.RESULTS: Lp-PLA2 levels were higher among American than Japanese men (Mean ± standard deviation 301.7 ± 82.6 versus 275.9 ± 104.7 ng/mL, respectively, p=0.06). Among all Japanese men and those with low density lipoprotein (LDL) cholesterol ≥130 mg/dL, there was an inverse association of the prevalence of CCS>0 with the tertile groups of Lp-PLA2 levels (p=0.08 and p=0.03, respectively). American men did not have any association between CCS>0 with the tertile groups of Lp-PLA2 (p=0.62). Although Lp-PLA2 among both populations correlated positively with LDL and total cholesterol, American and Japanese men had different correlations with NMR lipoprotein subclasses. Reported high odds ratio for CCS>0 among American compared to Japanese men was not reduced after adjusting for Lp-PLA2 levels.CONCLUSION: Lp-PLA2 may have different mechanisms of action among American and Japanese men. Lp-PLA2 levels can not explain the observed CAC differences between the two populations.J Epidemiol 2007; 17: 179-185.

Background Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are very limited. The aim of this study was to estimate VAP rates in GCC hospitals and to compare rates with published reports of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC). Methods VAP rates and ventilator utilization between 2008 and 2013 were calculated from aggregate VAP surveillance data using NHSN methodology pooled from 6 hospitals in 3 GCC countries: Saudi Arabia, Oman, and Bahrain. The standardized infection ratios of VAP in GCC hospitals were compared with published reports of the NHSN and INICC. Results A total of 368 VAP events were diagnosed during a 6-year period covering 76,749 ventilator days and 134,994 patient days. The overall VAP rate was 4.8 per 1,000 ventilator days (95% confidence interval, 4.3-5.3), with an overall ventilator utilization of 0.57. The VAP rates showed a wide variability between different types of intensive care units (ICUs) and were decreasing over time. After adjusting for the differences in ICU type, the risk of VAP in GCC hospitals was 217% higher than NHSN hospitals and 69% lower than INICC hospitals. Conclusions The risk of VAP in ICU patients in GCC countries is higher than pooled U.S. VAP rates but lower than pooled rates from developing countries participating in the INICC.

Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are either limited in some countries or completely lacking in other countries.

Background C-reactive protein (CRP) and many fatty acids (FAs) have been linked to cardiovascular disease. Associations of serum CRP with FAs in different populations have not been established.

low BP was associated with favorable risk of recurrent stroke, although high and low poststroke BP levels were associated with greater mortality. Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering BP in this population. J Am Geriatr Soc 54:1309–1316, 2006.

Background and Purpose— Stroke is a leading cause of death and disability in the US. There is limited data on geographic variations in stroke incidence among older US populations who experience the majority of stroke burden. The purpose of this study was to compare stroke incidence and mortality rates in 4 US communities. Methods— Participants in the Cardiovascular Health Study (CHS) who had no history of stroke at baseline (n=5639) were followed for 10 or 7 years in predominantly white (n=5002) and black (n=637) participants, respectively. Incident stroke was validated by a stroke adjudication committee after ascertainment at annual visits, interim telephone contacts, and review of Medicare hospitalization data. Results— The 2000 US population age and sex standardized total stroke incidence rate for all CHS participants was 17.7 per 1000 person-years (95% CI: 15.9, 19.5). The rate was significantly lower in Allegheny County, Pennsylvania 9.6/1000 person-years (95% CI: 7.7, 11.5) than Forsyth County, North Carolina 19.2/1000 person-years (95% CI: 15.6, 22.8), Sacramento County, California 20.7/1000 person-years (95% CI: 16.9, 24.5), and Washington County, Maryland 19.8/1000 person-years (95% CI: 16.1, 23.5). The lower stroke incidence rate in Allegheny County was consistent in gender, race, and age groups. Though not statistically significant, stroke mortality was also lower in Allegheny County than other 3 sites. The 1-month case fatality rate was similar in the 4 sites for all strokes, and by stroke types. Conclusions— Understanding geographic variations in stroke incidence may be an important step in improving preventive practices of stroke.

The authors studied mortality, vascular events, and preventive therapies following ischemic stroke among adults agedor =65 years.The authors identified 546 subjects with first ischemic stroke during 1989 to 2001 among Cardiovascular Health Study participants. Deaths, recurrent strokes, and coronary heart disease (CHD) events were identified over 3.2 years (median) follow-up.During the first year of follow-up, rates were 105.4/1,000 for recurrent stroke and 59.3/1,000 for CHD. After the first year, the stroke rate was 52.0/1,000 and the CHD rate was 46.5/1,000. Cardioembolic strokes had the highest mortality (185.4/1,000) and recurrence rates (86.6/1,000). Lacunar strokes had the lowest mortality (119.3/1,000) and recurrence rates (43.0/1,000). Age and male sex predicted death and CHD, but not recurrence. Outcomes did not differ by race. Following stroke, 47.8% used aspirin and 13.5% used other antiplatelet agents; 52.6% of patients with atrial fibrillation used warfarin; 31.3% of hyperlipidemic subjects, 57.0% of diabetic patients, and 81.5% of hypertensive patients were drug-treated; and 40.0% of hypertensive patients had blood pressure (BP)140/90 mm Hg. Older subjects were less likely to use lipid-lowering therapy, women were less likely to have BP140/90 mm Hg, and low-income subjects were less likely to use diabetes medications.Recurrent strokes were nearly twice as frequent as coronary heart disease (CHD) events during the first year after initial stroke, but stroke and CHD rates were similar after the first year. Preventive drug therapies were underused, which may reflect clinical uncertainty due to the lack of clinical trials among the elderly. Utilization was lower among the oldest patients, women, and low-income individuals.

Both indices of obesity and lipoprotein subfractions contribute to coronary heart disease risk. However, associations between indices of obesity and lipoprotein subfractions remain undetermined across different ethnic groups. This study aims to examine the associations of indices of obesity in Japanese Americans (JA), African Americans (AA) and Koreans with lipoprotein subfractions.A population-based sample of 230 JA, 91 AA, and 291 Korean men aged 40-49 was examined for indices of obesity, i.e., visceral and subcutaneous adipose tissue (VAT and SAT, respectively), waist circumference (WC), and body-mass index (BMI), and for lipoprotein subfractions by nuclear-magnetic-resonance spectroscopy. Multiple regression analyses were performed in each of the three ethnic groups to examine the associations of each index of obesity with lipoprotein.VAT had significant positive associations with total and small low-density lipoprotein (LDL) and a significant negative association with large high-density lipoprotein (HDL) in all three ethnicities (p0.01). SAT, WC, and BMI had significant positive associations with total and small LDL in only JA and Koreans, while these indices had significant inverse associations with large HDL in all ethnic groups (p0.01). Compared to SAT, VAT had largerVAT is significantly associated with total and small LDL and large HDL in all three ethnic groups. The associations of SAT, WC, and BMI with lipoprotein subfractions are weaker compared to VAT in all three ethnic groups.

At the same level of BMI, white people have less visceral adipose tissue (VAT) and are less susceptible to developing type 2 diabetes than Japanese people. No previous population-based studies have compared insulin resistance and insulin secretion between these two races in a standardised manner that accounts for VAT. We compared HOMA-IR, HOMA of beta cell function (HOMA-β%) and disposition index (DI) in US white men and Japanese men in Japan.We conducted a population-based, cross-sectional study, comprising 298 white men and 294 Japanese men aged 40-49 years without diabetes. Insulin, glucose, VAT and other measurements were performed at the University of Pittsburgh. We used ANCOVA to compare geometric means of HOMA-IR, HOMA-β% and DI, adjusting for VAT and other covariates.White men had higher HOMA-IR, HOMA-β% and DI than Japanese men, and the difference remained significant (p0.01) after adjusting for VAT (geometric mean [95% CI]): 3.1 (2.9, 3.2) vs 2.5 (2.4, 2.6), 130.8 (124.6, 137.3) vs 86.7 (82.5, 91.0), and 42.4 (41.0, 44.0) vs 34.8 (33.6, 36.0), respectively. Moreover, HOMA-IR, HOMA-β% and DI were significantly higher in white men even after further adjustment for BMI, impaired fasting glucose and other risk factors.The higher VAT-adjusted DI in white men than Japanese men may partly explain lower susceptibility of white people than Japanese people to developing type 2 diabetes. The results, however, should be interpreted with caution because the assessment of insulin indices was made using fasting samples and adjustment was not made for baseline glucose tolerance. Further studies using formal methods to evaluate insulin indices are warranted.

In a prospective surveillance study, we examine the risk of device-associated bloodstream infection (BSI) in a neonatal intensive care unit at Riyadh, Saudi Arabia, during 2006 and 2007. The incidence per 1000 device-days was 8.2 for central line-associated BSI and 10.5 for umbilical catheter-associated BSI. Both rates were higher with more umbilical catheter and less central line utilization ratios compared with those reported by the American National Healthcare Safety Network hospitals. Concurrent with implementation of more strict infection control practices, BSI rates declined over the course of the study. Prolonged device duration was an independent risk factor for device-associated BSI.

Since the first diagnosis of Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country (1). During June-August, 2015, a large MERS outbreak occurred at King Abulaziz Medical City, a 1,200-bed tertiary-care hospital that includes a 150-bed emergency department that registers 250,000 visits per year.

Objectives: Soy isoflavones may have beneficial roles as antioxidants and phytoestrogens. Dietary intake varies widely across populations: very high in Japan but low in North America. We measured the concentrations of daidzein and genistein in the serum of Japanese men and women and evaluated their associations with metabolic markers. Methods: Serum samples were obtained from a population based sample of 94 Japanese men (mean age 45.3), and 142 Japanese women (mean age 66.6; 97% were post-menopausal). Isoflavones were analyzed after extraction and derivatization using GC-MS. Concentrations of daidzein and genistein were summed to obtain total isoflavone concentrations. Results: Isoflavone concentrations were very high among the Japanese. Median values (nM) for men: 558, 452 and 86 and for women 660, 494 and 150 (total isoflavones, genistein and daidzein, respectively). Spearman correlation coefficients for the isoflavones with multiple outcomes among Japanese men and women are shown in the table. No significant (p Discussion: The concentrations of isoflavones are high in the Japanese, approximately 50 times greater than those of N. Americans. Associations between the isoflavones and various outcomes were very weak for the Japanese men. This possibly reflects a plateau of isoflavone concentration has been reached that precludes observing any associations. Although, many correlations were calculated the positive associations of total isoflavones and daidzein with HDLc among women may be real. HDLc concentrations are high in Japanese women which may reflect the estrogenic actions of isoflavones.

IntroductionBreast cancer is the most common cancer among Egyptian women. The disease is often advanced at diagnosis. Since molecular profiling is not feasible in routine practice, we sought to examine the association of age distribution with hormone receptor profile, disease stage and outcome among Egyptian women.Patients and MethodsWe conducted a retrospective review of breast cancer patients treated at Mansoura University Cancer Center in the Nile Delta from 2006 through 2011. Age groups were examined in relation to hormone receptors status and tumor clinicopathological criteria. Additionally, the effect of receptor status on disease relapse and disease-free survival was examined with logistic regression and Kaplan–Meier analysis.ResultsA total of 263 patients were included in the current analysis. About 66.9% (n = 176) of patients were hormone receptor positive, 14.1% (n = 37) were Her2/neu positive, and 19.0% (n = 50) were triple negative. Median age of the patients was 52 years and was equal across all receptor status types. Triple negative status correlated with increased risk of disease relapse (odds ratio = 1.8, P = 0.03) and with shortened disease-free survival (hazards ratio = 2.6, P < 0.01).ConclusionThe age distribution and receptor status pattern in the Nile Delta region does not explain the aggressive behavior of the disease. The age of the patients at diagnosis is older than patients in earlier studies from Egypt emphasizing the importance of implementing mammographic screening programs.

SummaryBackgroundThe guidelines for initial empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) are highly dependent on the type of causative pathogen and the time of diagnosis. The objective of this study was to examine the microbial causes of VAP and describe any variability by the timing of VAP onset and over time.MethodsA prospective surveillance study was conducted in the adult general intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Microbial isolates obtained from blood and different respiratory specimens of patients diagnosed with VAP (using the US Centers for Disease Control and Prevention definition) between August 2003 and June 2009 were included.ResultsA total of 457 pathogens were identified during the study; 380 (83.2%) were associated with primary VAP and 77 (16.8%) were associated with recurrent VAP. Of primary VAP pathogens, 159 (41.8%) were associated with early-onset (

Objectives: To compare incidence of coronary artery calcification (CAC) between men in Japan and the US and to examine whether marine n-3 fatty acids contribute to the difference in the incidence. Methods: The ERA JUMP Study is a population-based longitudinal study which has examined the progression of subclinical atherosclerosis in Japanese, Japanese American and white men aged 40-49 at baseline in 2002-2007. Incident cases of CAC were defined as those with CAC score=zero at baseline (n=278: 167 Japanese and 111 whites) and CAC score ≥10 at follow-up. Mean follow-up years were 6.2 for Japanese and 4.6 for whites. Stepwise robust logistic regression was used to determine baseline predictors of CAC incidence in each group. Generalized linear model was used to examine whether the difference in risk factors and marine n-3 fatty acids at baseline between Japanese and whites contributed to the difference in incidence rates. Results: Baseline characteristics show that levels of risk factors were similar between the two groups including LDL-C and BP. Exceptions were higher rates of smoking in Japanese (49 vs. 7%) and higher levels of HDL-C in Japanese (54 vs. 49 mg/dL). Levels of marine n-3 fatty acids were 100+% higher in Japanese. Incidence rate was significantly lower in Japanese than in whites (0.9 for Japanese vs. 2.9 for whites (per 100 person years) pTable ) Conclusions: CAC incidence is significantly lower in Japanese than in white men. The data suggest that high levels of EPA contribute to the lower CAC incidence in Japanese. Table. Incidence rate ratio of coronary artery calcification between Japanese men and white men (n=278) Incidence rate ratio between two groups (95% CI) (Japanese vs. whites) p -value Model I 0.606 (0.427, 0.861) Model II 0.571 (0.392, 0.830) Model III 0.669 (0.431, 1.038) 0.07 Model I: Adjusted for age, follow-up time, BMI, BP sys, HDL-C pack-years of smoking and LDL-C Model II: Further adjusted for triglycerides, glucose, hypertension medication, lipid medication, CRP and alcohol Model III: Further adjusted for EPA (eicosapentaenoic acid)

Objectives: We have previously reported that brachial-ankle PWV (baPWV) is more strongly related to lipoprotein subclasses than carotid-femoral PWV (cfPWV) among middle-aged white men. The current study examined the associations of baPWV, cfPWV and femoral ankle PWV (faPWV) with lipoprotein subclasses in Japanese Americans, Koreans, and Whites. Methods: The ERA JUMP Study is an international population-based study of subclinical atherosclerosis in men aged 40-49 without clinical CVD in the US, Korea, Hawaii and Japan. Participants for the current study were 310 whites, 303 Japanese Americans and 302 Koreans. PWV was assessed using an automated waveform analyzer (VP2000, Omron, Japan). Lipoprotein subclasses were assessed by NMR lipoproteins. Multiple linear regressions were performed to analyze the association of each PWV with NMR lipoprotein distributions after adjusting for age, body mass index, systolic blood pressure, and other potential confounders. Results: Both baPWV and faPWV had significant association with total, large, and small LDL-P after adjusting for race and other confounders, and across three racial groups except for faPWV in whites ( Table ). cfPWV had also significant associations with total and small LDL-P after adjusting for race and other confounders but these associations were weaker than those with baPWV and faPWV. Similarly, both baPWV and faPWV had significant associations with VLDL-P (total, large and small VLDL-P) and HDL-P (total, large, medium, and small HDL-P) but the associations of cfPWV with these lipoproteins were weaker and mostly non-significant. Conclusions: As compared to cfPWV, both baPWV and faPWV had stronger associations with lipoprotein distributions across three racial groups with very different lifestyle. Our results suggest that baPWV and faPWV are more related to atherosclerosis than cfPWV whereas cfPWV may represent arteriosclerosis. Table 1. Association between LDL subclasses(LDL-P) and carotid-femoral, brachial-ankle and femoral-ankle pulse wave velocities among young men in Korea, Hawaii and North America: Multiple linear regression derived beta (β) values (SE) @ Large LDL Small LDL Total LDL Particles cfPWV All participants $ −0.074 (.050) 0.405 (.204) * 0.152 (.072) * Whites −0.045 (.081) 0.442 (.309) 0.197 (.094) * Koreans −0.179 (.084) * 1.143 (.375) ** 0.337 (.140) * Japanese Americans 0.060 (.98) 0.064 (.361) 0.016 (.151) faPWV All participants $ −0.252 (.067) *** 1.201 (.264) *** 0.331 (.099) *** Whites 0.007 (.100) 0.368 (.389) 0.165 (.122) Koreans −0.252 (.113) * 1.609 (.502) ** 0.472 (.189) * Japanese Americans −0.501 (.152) ** 2.266 (.552) *** 0.698 (.225) ** baPWV All participants $ −0.310 (.053) *** 1.334 (.210) *** 0.404 (.075) *** Whites −0.212 (.108) * 1.220 (.415) ** 0.425 (.131) ** Koreans −0.245 (.079) ** 1.398 (.351) *** 0.493 (.126) *** Japanese Americans −0.194 (.098) * 1.132 (.357) ** 0.392 (.143) ** * p ** p *** p @ Adjusted for age, systolic blood pressure, body mass index, fasting glucose, pack-years smoking, alcohol intake and LDL cholesterol. $ Additionally adjusting for race.

Mood disorders (MD) have been demonstrated to influence outcome in cardiac disease in general and specifically in chronic heart failure (HF). Little is known about their possible effect on response to cardiac resynchronization therapy (CRT).To evaluate the influence of MD on CRT response.We conducted a retrospective chart review of all cardiac CRT-D (CRT defibrillator) recipients (N = 153) at the Veterans Affairs Pittsburgh Healthcare System from beginning of 2004 through end of 2006. All-cause death and HF-related hospitalizations (HFH), individually and combined, were sought through 2009.During a mean follow-up time of 31.4 ± 14.7 months, there were 48 (31.4%) deaths and 55 (35.9%) HFHs in HF patients having New York Heart Association class of 2.9 ± 0.3, left ventricular ejection fraction (LVEF) of 25.8 ± 9.1%, left ventricular end-diastolic diameter (LVEDD) of 61.6 ± 11.6 mm, and QRS of 152 ± 30.5 ms . A total of 65 (42.5%) patients had MD (depression, anxiety, or posttraumatic stress disorder). Compared to others, patients in the MD group were at a significantly higher risk of HFH alone (47.7% vs 27.3%, P = 0.009) or when combined with death (58.5% vs 39.8%, P = 0.022) but not death alone (35.4% vs 28.4%, P = 0.36). The significant predictive effect of MD on HFH alone and when combined with death shown in univariate analysis was not attenuated after adjustment for age, ejection fraction, etiology of cardiomyopathy, cumulative number of any shocks, smoking, and evidence of postimplantation echocardiographic improvement.MD in patients with advanced but stable HF receiving CRT-D therapy was a predictor of HFH alone or when combined with death but not mortality alone.

Epidemiological studies suggested thatn-6 fatty acids, especially linoleic acid (LA), have beneficial effects on CHD, whereas somein vitrostudies have suggested thatn-6 fatty acids, specifically arachidonic acid (AA), may have harmful effects. We examined the association of serumn-6 fatty acids with plasminogen activator inhibitor-1 (PAI-1). A population-based cross-sectional study recruited 926 randomly selected men aged 40–49 years without CVD during 2002–2006 (310 Caucasian, 313 Japanese and 303 Japanese-American men). Plasma PAI-1 was analysed in free form, both active and latent. Serum fatty acids were measured with gas-capillary liquid chromatography. To examine the association between totaln-6 fatty acids (including LA and AA) and PAI-1, multivariate regression models were used. After adjusting for confounders, totaln-6 fatty acids, LA and AA, were inversely and significantly associated with PAI-1 levels. These associations were consistent across three populations. Among 915 middle-aged men, serumn-6 fatty acids had significant inverse associations with PAI-1.

The purpose of this investigation was to describe the first documented carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak in a tertiary care facility in Saudi Arabia. We initiated a prospective study to follow all cases of CRKP as well as the active surveillance of patients in areas where cases were identified. We also conducted a retrospective review of the microbiology database for any missed cases of CRKP. Pulsed field gel electrophoresis (PFGE) was conducted for the available CRKP isolates. During March 2010, a cluster of eight CRKPs was detected primarily in the adult intensive care unit (ICU). Patients with CRKPs were put under strict contact isolation, along with appropriate infection control measures. A retrospective review of K. pneumoniae isolates over the previous 6 months revealed two more CRKPs. The PFGE results during the outbreak period showed that the majority of strains were genetically indistinguishable or closely related. The majority of patients had prolonged hospital stay (91%), indwelling devices (81%), surgical procedures (74%), carbapenem use (62%), and colonization/infection with other multiple drug-resistant organisms (MDROs) (57%). Two-fifths of patients with CRKP had clinical infection and 38% died during the current hospitalization. Contact isolation, hand hygiene, environmental cleaning, and staff education may control CRKP outbreak in the acute care setting, but did not prevent endemicity.

Comparison of Saudi patients with chronic hemodialysis to an international benchmark was not performed before. We conducted a prospective surveillance study for all end-stage kidney disease patients served by the hemodialysis unit at King Abdulaziz Medical City (KAMC) in Riyadh, SA, between May 2008 and December 2009. US National Healthcare Safety Network (NHSN) definitions were used for comparison. Among 227 patients with adverse events, 55% were women and their age was 60.2 ± 20.2 years. Events recorded included 339 all-cause hospitalizations, 302 outpatient start of intravenous antimicrobials, and 174 access-associated bacteremias. In comparison with NHSN, hospitalization rate per 100 patient-months was lower (8.6 vs. 10.7, p0.001), rates of both antimicrobial start (7.6 vs. 3.5, p0.001) and access-associated bacteremia (4.4 vs. 1.3, p0.001) were higher, and blood cultures were more likely to grow gram-negative rods (47.9% vs. 21.3%, p0.001). Similar to NHSN, permanent catheter was associated with highest, while arterio-venous fistula was associated with lowest event rates, irrespective of event type. KAMC had 2-4 times higher rates of access-associated bacteremia and antimicrobial start as well as a higher catheter prevalence (42% vs. 31%). The lower hospitalization may indicate good control of comorbidities at outpatient level or underutilization of inpatient services.

Background Ventilator-associated pneumonia (VAP) prevention is an important patient safety initiative. We describe the impact of a multidisciplinary surveillance program on VAP rates in a tertiary medical-surgical-trauma intensive care unit (ICU). Methods An epidemiologic surveillance program was established in 2003 as a joint project between ICU and Infection Prevention and Control Department to regularly report VAP rates to guide evidence-based VAP preventive strategies. VAP cases were diagnosed according to predefined criteria and prospectively recorded by a research physician. VAP microbiology, risk factors, and outcomes were noted. Results Of 2,812 ventilated patients, 433 (15.4%) developed VAP corresponding to 15.9 episodes per 1,000 ventilator-days. The rate decreased from 19.1 in 2003 to 6.3 per 1,000 ventilator-days in 2009. On multivariate analysis, VAP was associated with accidental extubation (hazard ratio [HR], 4.11; 95% confidence interval [CI]: 1.93-8.73), trauma versus medical diagnosis (HR, 2.59; 95% CI: 2.07-3.23), chronic obstructive pulmonary disease (HR, 1.55; 95% CI: 1.08-2.22), and neuromuscular blockade (HR, 1.39; 95% CI: 1.07-1.81). The most common isolated pathogens were Gram-negative organisms. VAP patients had longer mechanical ventilation duration, ICU and hospital length of stay, but similar ICU and hospital mortality compared with non-VAP patients. Conclusion The study showed a reduction in VAP rates with active surveillance, reporting and evidence-based preventive strategies and identified several modifiable risk factors, which should be the focus of additional interventions.

Background and Purpose— Recent studies reported the differential effect of docosahexaenoic (DHA) and eicosapentaenoic acids (EPA). We examined the differential association of DHA and EPA with carotid intima-media thickness (IMT) in Japanese individuals in Japan and in U.S. white individuals and explored whether DHA or EPA contributes to the difference in IMT between the two groups. Methods— A population-based cross-sectional study in 608 Japanese and U.S. white men aged 40 to 49 was conducted to assess IMT, serum DHA, EPA, and other cardiovascular risk factors. Results— Japanese compared to U.S. whites had significantly lower IMT (mean±SD, 618±81 and 672±94 μm for Japanese and whites, respectively; P 2-fold higher levels of DHA and EPA. DHA, but not EPA, had an inverse association with IMT in both Japanese and U.S. whites. The inverse association remained only in Japanese men after adjusting for risk and other factors. The significant difference in multivariable-adjusted IMT became nonsignificant after further adjusting for DHA (mean difference, 17 μm; 95% CI, −8 to 43; P =0.177) but not EPA. In this multivariable-adjusted model, DHA but not EPA was a significant predictor of IMT ( P =−0.032 versus 0.863, respectively). Conclusions— These data suggest that DHA may have a more potent antiatherogenic effect than EPA, especially in levels observed in the Japanese, independent of risk factors.

We recently reported that Japanese had higher liver fat at a lower level of BMI compared with non-Hispanic whites (NHW).We hypothesize that ethnic difference in fat storage capacity contributes to this ethnic difference in liver fat.To examine this, we assessed liver fat among 244 Japanese-American aged 40-49, using regional computed-tomography images, along with metabolic variables.Despite the similar BMI between Japanese-Americans and NHW men, Japanese-Americans had more liver fat (liver to spleen attenuation ratio: 1.03 ± 0.22 for Japanese-Americans, and 1.07 ± 0.15 for NHW men; p0.05) and tended to have a greater disposition for fatty liver with an increase in BMI than NHW, indicating a clear difference between the two groups. In addition, liver fat is less in Japanese-Americans compared with Japanese men (1.03 ± 0.22 vs. 1.01 ± 0.16; p0.05), despite of a much higher BMI. These ethnic differences support the hypothesis that higher fat storage capacity indeed seems to be associated with less liver fat. In all the groups, liver fat content strongly correlated with triglycerides, homeostasis model assessment-insulin resistance, and C-reactive protein (CRP). Nevertheless, these metabolic variables were worse in Japanese-Americans, despite of less liver fat, compared with Japanese. Moreover, CRP levels were least among Japanese with highest liver fat, and highest among NHW men with least liver fat, despite of a strong positive association between CRP and fatty liver within each population.Fat content in the liver is intermediate for Japanese-Americans compared with Japanese and NHW men, which supports the hypothesis of less fat storage capacity among Japanese, closely linked to ethnic difference in predisposition to fatty liver.

We set to monitor adverse events among hemodialysis patientsfollowing re-enforcement of infection control measures.

D-dimer and von Willebrand factor (vWF) are associated with atherosclerosis. We recently reported that in a post-World War II birth cohort, Japanese men in Japan had lower levels of atherosclerosis than white men in the United States (U.S.). We examined whether the differences in D-dimer and vWF levels are associated with differences in atherosclerosis between the two populations.Population-based samples of 99 Japanese and 100 white American men aged 40-49 years were examined for coronary artery calcification (CAC), carotid intima-media thickness (IMT), D-dimer, vWF, and other factors using a standardized protocol. When compared to white American men,Japanese had similar levels of D-dimer (0.22 +/- 0.28 vs. 0.19 +/- 0.24 microg/L, respectively, P = 0.39) but significantly higher levels of vWF (124.1 +/- 36.6 vs. 91.3 +/- 48.8%, respectively, P0.01). Japanese as compared to white American men had significantly lower prevalence of CAC (13.1 vs. 28.0%, P0.01, respectively) and significantly lower IMT (0.61 +/- 0.07 vs. 0.66 +/- 0.08 mm, P0.01, respectively). Japanese men had a significant positive association of D-dimer with the prevalence of CAC and a negative association of vWF with IMT, whereas white American men did not have any significant associations.In men aged 40-49 years, Japanese as compared to white Americans had similar levels of D-dimer and higher levels of vWF although Japanese had a significantly lower prevalence of CAC and IMT. These haemostatic factors are unlikely to explain the difference in atherosclerosis in these populations.

We carried out a surveillance study to calculate 2007 rates of surgical site infection (SSI) for herniorrhaphies and cholecystectomies performed at King Abdulaziz Medical City (KAMC) in Riyadh, to compare these rates to previous KAMC rates conducted in 1999-2001 and to benchmark these rates to those reported by American National Nosocomial Infections Surveillance (NNIS) hospitals in 2004. We reviewed the charts of patients who underwent herniorrhaphy (N=113) or cholecystectomy (N=208) from January to June 2007 using the Centers for Disease Control (CDC) criteria for SSI diagnosis. The rates were calculated and stratified by the modified risk index categories, based on American Society of Anesthesiology score, wound class, procedure duration and laparoscopy use. KAMC SSI rates per 100 operations in 2007 were 0.88 for herniorrhaphy and 0.48 for cholecystectomy. After adjusting to the different risk index categories between the KAMC and NNIS, standardized infection ratios (SIR) were comparable to NNIS at 97% for herniorrhaphy (p=0.553) and 90% for cholecystectomy (p>0.90). KAMC SSI rates per 100 operations in 1999-2001 were significantly higher than the NNIS rates at 4.34 for herniorrhaphy (p

The relation between cholesteryl ester transfer protein (CETP) levels and atherosclerosis is controversial. We examined whether the serum CETP levels were associated with subclinical atherosclerosis, independent of its most common gene variant, in a sample of Japanese men. A population-based cross-sectional study of 250 Japanese men aged 40 to 49 years was conducted to assess the intima-media thickness of the carotid artery, coronary artery calcium, serum CETP levels, and the CETP D442G gene variant. Compared with the lowest CETP quartile, the multivariate adjusted odds ratio for coronary artery calcium was 0.77 (95% confidence interval 0.18 to 3.36), 0.96 (95% confidence interval 0.27 to 3.40), and 3.49 (95% confidence interval 1.05 to 11.6) with increasing CETP quartiles. The serum CETP quartiles were also positively associated with the intima-media thickness of the carotid artery (adjusted mean 602, 616, 615, and 646 mum for the lowest to top quartile, respectively). The findings remained unchanged after additional adjustment for the CETP D442G gene variant. No significant difference was found in the prevalence of coronary artery calcium or in the mean intima-media thickness of the carotid artery between participants with and without the CETP D442G gene variant.

Koreans are recently at higher risk for coronary heart disease than are the Japanese. We aimed to evaluate levels of carotid intima-media thickness (IMT) and coronary risk factors in Korean and Japanese men in the post-World War II birth cohort.We conducted a population-based study of 352 randomly selected healthy men 40 to 49 years of age: 102 Koreans in Ansan City, Gyeonggi-do, Korea and 250 Japanese in Kusatsu City, Shiga, Japan. Imaging carotid IMT by ultrasonography and other procedures were standardized. Analyzing blood samples and reading carotid IMT were performed at the University of Pittsburgh.Despite more favorable or similar features in coronary risk factors as compared to Japanese men, the Korean men had a higher crude IMT level than the Japanese men (mean +/- standard error, 0.655+/-0.008 mm vs 0.616+/-0.005 mm, respectively, p0.0001). The difference in the levels of carotid IMT significantly remained after adjusting for metabolic and conventional risk factors (0.654+/-0.008 mm vs. 0.616+/-0.005 mm, respectively; p0.0001).Among men 40 to 49 years of age, Koreans had significantly higher levels of carotid IMT than the Japanese. Factors that underlie the different susceptibility to subclinical atherosclerosis need to be explored.

Secondary pulmonary hypertension is a marker of advanced heart failure (HF) that confers a poor prognosis. Consecutive patients from 2004 through 2005 who underwent echocardiographic assessments of systolic pulmonary arterial pressure (SPAP) before the implantation of cardiac resynchronization therapy defibrillators were included. Patients were divided into tertiles according to baseline SPAP. Patients in the lowest (group I, 20 to 29 mm Hg) and highest (group III, 45 to 88 mm Hg) tertiles were compared for the end points or death or transplantation and for HF hospital admission. Two hundred seventy patients were evaluated, of whom 95% were Caucasians and 91% men. The mean age was 66.5 +/- 11.6 years, the mean QRS duration was 155 +/- 30 ms, the mean left ventricular ejection fraction was 22.6 +/- 9.7%, and the mean New York Heart Association functional class was 3.0 +/- 0.4. In a multivariate model, death or transplantation was significantly more likely in group III (hazard ratio 2.62, 95% confidence interval 1.1 to 6.4, p = 0.036), as was HF admission (hazard ratio 6.35, 95% confidence interval 2.6 to 15.8, p

Coronary heart disease incidence and mortality remain very low in Japan despite major dietary changes and increases in risk factors that should have resulted in a substantial increase in coronary heart disease rates (Japanese paradox). Primary genetic effects are unlikely, given the substantial increase in coronary heart disease in Japanese migrating to the United States. For men aged 40-49 years, levels of total cholesterol and blood pressure have been similar in Japan and the United States throughout their lifetimes. The authors tested the hypothesis that levels of subclinical atherosclerosis, coronary artery calcification, and intima-media thickness of the carotid artery in men aged 40-49 years are similar in Japan and the United States. They conducted a population-based study of 493 randomly selected men: 250 in Kusatsu City, Shiga, Japan, and 243 White men in Allegheny County, Pennsylvania, in 2002-2005. Compared with the Whites, the Japanese had a less favorable profile regarding many risk factors. The prevalence ratio for the presence of a coronary calcium score ofor =10 for the Japanese compared with the Whites was 0.52 (95% confidence interval: 0.35, 0.76). Mean intima-media thickness was significantly lower in the Japanese (0.616 mm (standard error, 0.005) vs. 0.672 (standard error, 0.005) mm, p0.01). Both associations remained significant after adjusting for risk factors. The findings warrant further investigations.