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Objective An elevated total serum bilirubin level has been demonstrated to be protective against cardiovascular disease with the majority of evidence limited to males. We assessed the hypothesis th...

Physical therapists' perceptions of sexual boundaries in clinic settings in the United States have not been studied. Given the magnitude of potential consequences of sexual boundary violations, examination of this topic is imperative.The purpose of this study was to describe the perceptions of sexual boundaries among licensed physical therapists in the United States.Licensed physical therapists from Arkansas, Kansas, Maine, Ohio, and Oregon were contacted by email and asked to complete a sexual boundaries questionnaire via Survey Monkey™; 967 surveys (7.3%) were returned.While most physical therapists practice within the profession's Code of Ethics, there are practitioners who date current and former patients, and condone patients' sexual banter in the clinic. Almost half (42%) of the participants acknowledged feeling sexually attracted to a patient. While gender differences were seen throughout the analyses, generally, the demographic and professional variables did not account for meaningful variance. Results were similar to previous research on physiotherapists in other countries.Sexuality is part of the physical therapy practice environment and physical therapists' understanding of sexual boundaries is ambiguous. These data can inform professional conversation on sexual boundaries in physical therapy practice leading to greater understanding and decreased potential for violations.

Platelet-to-lymphocyte ratio (PLR) has recently been studied as a biomarker in patients with established coronary artery disease (CAD). The association between PLR and long-term all-cause mortality is unclear in patients at high risk of CAD who undergo coronary angiography for various indications. Follow-up was completed for 514 patients who underwent coronary angiography in a prospective study cohort. The primary end point was all-cause mortality. Patients were classified into tertiles based on preangiography PLR and also dichotomized based on the optimal cutoff at a PLR of 137, determined from the receiver operating characteristic curve analysis. The mean follow-up period was 5.0 ± 1.3 years, with 50 all-cause deaths. On the Kaplan-Meier analysis, patients in Tertile 3 (PLR > 145) had worse prognosis than patients in Tertiles 1 (PLR ≤ 106) and 2 (PLR 106.1 to 145) (p = 0.0075), and patients with PLR ≥ 137 had a significantly higher rate of all-cause mortality than those with PLR

Background Thrombocytosis and inflammation are vital elements in the pathogenesis of atherosclerosis. The platelet-to-lymphocyte ratio (PLR) is a novel biomarker that combines these parameters and has been shown to be associated with cardiovascular disease (CVD). This study aimed to determine whether PLR correlates with coronary artery disease (CAD) in high-risk patients, and if the relationship is affected by age. Methods Consecutive patients referred for coronary angiogram were evaluated (n = 822). with 608 patients demonstrating CAD, compared to 214 patients with normal coronary arteries. Patients were stratified into premature CAD (age < 55) and non-premature CAD (age ≥ 55). High and low PLR groups were defined as admission PLR in the highest (≥ 146.7) and lower two tertiles ( < 146.7) respectively. Multivariate logistic regression was undertaken to adjust for traditional cardiovascular risk factors. Results In univariate analysis, high PLR negatively correlated with premature CAD (OR 0.45, 95%CI 0.23–0.87, P = 0.017), while its association with CAD in older patients did not reach statistical significance (OR 1.32, 95%CI 0.89–1.97, P = 0.170). After adjustment for traditional risk factors, high PLR was significantly associated with increased CAD in older patients (OR 2.22, 95%CI 1.28–3.82, P = 0.004) but decreased premature CAD (OR 0.31, 95%CI 0.11–0.87, P = 0.026). Conclusions There is an age-related effect on the correlation between PLR and CAD. While high PLR was an independent marker of CAD in older high-risk patients, it was negatively correlated with premature CAD in younger patients. PLR is widely available and inexpensive, and could be used in highlighting patients at high risk for CAD.

Introduction: Nitric Oxide (NO) is a crucial molecule in cardiovascular biology. Abnormalities in NO are critical in atherosclerosis and impairment of the NO pathway increases risk of cardiovascular disease (CVD). A possible cause of endothelial dysfunction is an elevation (in plasma) of the endogenous inhibitor of NO synthase, asymmetric dimethylarginine (ADMA). ADMA was initially described in renal failure. 80% of ADMA is metabolized by the enzyme dimethylarginine dimethylaminohydrolase (DDAH) in the liver. DDAH-1 is widely distributed and felt to be the major determinant of circulating ADMA levels. Very little data is available regarding the cause and effects of DDAH dysregulation in the liver. Understanding the biology of DDAH represents a target for better understanding of CVD and for novel therapy. Hypothesis: Diabetes and related factors will alter DDAH expression/activity potentially modulating the amount of ADMA. Methods: Liver tissues from control and db/db mice were archival. Human skeletal muscle tissue was obtained from cardiovascular surgical patients. HepG2 cells were used for low/high glucose treatment studies (5mM/25mM). DDAH-1 expression was determined using Western immunoblotting. DDAH activity measurement used a colourimetric assay. Intra/extracellular ADMA were measured in HepG2 cells using an HPLC-MS/MS technique. Results: In skeletal muscle from diabetic cardiac surgery patients DDAH-1 protein expression is increased ( P < 0.05). Further to this, db/db mice livers versus control had a significant increase in DDAH expression and activity. Using HepG2 cells we specifically examined the effect of 25mM glucose on DDAH-1. Treatment increased expression and activity of DDAH-1 ( P Conclusion: These novel results report an alteration of DDAH-1 expression and activity in hepatic tissues and cells in response to elevated glucose - a result which has not been reported previously. This suggests a possible link between the DDAH/ADMA/NOS pathway, diabetes, and glycaemic dysregulation - key risk factors in CVD.

Background: Within the endothelium, Nitric Oxide Synthase (NOS) activity through the conversion of Arginine to Citrulline and Nitric Oxide (NO) is largely seen as beneficial. NO is a powerful bioactive molecule which elicits an antithrombotic and antioxidant effect preventing platelet aggregation and atherosclerosis. In immune cells NOS however is largely thought to be beneficial as a microbicidal agent involved in inflammatory responses. Systemic inflammation is also a common outcome in patients undergoing cardiac surgery and those receiving Cardiopulmonary Bypass (CPB) due to contact with foreign surfaces and surgical trauma. Through the Urea Cycle, Citrulline is converted back to Arginine via intermediate Ornithine. Asymmetric Dimethylmethylarginine (ADMA) is an inhibitor of all NOS isoforms, with circulating ADMA being an independent risk factor for mortality within ICU patients and is associated with an increased cardiovascular disease risk profile. Relatively recent studies have demonstrated the beneficial role of ADMA within diseases where iNOS production is overactive such as pulmonary fibrosis. Hypothesis: Cardiac surgery and CPB will alter NOS inhibitor ADMA and other metabolites . Results: Cardiac surgery patients (n=44) had arterial blood sampled over 4 time points: Morning of surgery (A), Pre (B) and post cardiac injury (C), and post-operative morning (D). Dimethylarginines (ADMA and SDMA) and Urea Cycle intermediates (Arginine, Citrulline and Ornithine) were measured via HPLC-MS/MS. Both Dimethylarginines are released as a function of proteolysis, ADMA remained unchanged over surgery (0.48±0.09μM Vs 0.46±0.08μM Vs 0.50±0.09μM Vs 0.43±0.07μM, p< 0.05) whilst SDMA increased during surgery (B) from morning of the surgery (A) (0.73±0.21μM Vs 0.89±0.25μM; p ) then decreasing post-surgery (D) (0.77±0.33μM) and Arginine (A; 111.83±53.74μM Vs B; 67.91±48.96μM; p D; 60.41±34.26μM, A Vs D; p< 0.001) and other metabolites steadily decreased. Conclusions: These findings indicate that the regulation of circulating ADMA compared to SDMA is homeostatic even within cardiac surgery. NOS substrate Arginine and Urea Cycle intermediates are consumed which may be predictive of post-operative morbidity.

Introduction: Inflammation has an important role in initiation and progression of coronary artery disease (CAD). Different white cell count (WCC) subtypes may reflect different mechanisms of this complex disease, and may be valuable clinically in risk stratification and detection of patients with CAD. Studies on the correlation between WCC subtypes and CAD have yielded conflicting results. Hypothesis: We hypothesized that WCC subtypes are associated with the presence of CAD in high-risk patients over 55 years old. Methods: We analyzed 622 patients over the age of 55 from the BRAVEHEART and MINACS cohort who were referred for coronary angiogram at our institution. Univariate and multivariate logistic regression models were used to compare different WCC subtypes as predictors of presence of CAD, defined as ≥50% stenosis of 1 or more coronary arteries. We adjusted for age, sex and conventional cardiac risk factors. Results: On univariate analysis, patients with CAD had significantly more CVD risk factors compared to control patients. Markers associated with CAD were lower lymphocytes (tertile 2 OR 0.61, 95% CI 0.39-0.98, p=0.040, tertile 3 OR 0.70, 95% CI 0.44-1.12, p=0.139), and higher monocytes (tertile 3 OR 2.51, 95% CI 1.45-4.34, p=0.001), neutrophil-lymphocyte ratio (NLR) (OR 1.70, 95% CI 1.07-2.68, p=0.024), and monocyte-lymphocyte ratio (MLR) (tertile 3 OR 2.62, 95% CI 1.61-4.26, p Conclusions: In high-risk patients over 55 years old, lower lymphocytes, and higher monocytes, NLR and MLR were associated with angiographically determined CAD independent of other risk factors. Monocytes and MLR were the strongest correlates of CAD in high-risk patients over 55. Whether these can be used as biomarkers of CAD in high risk patients warrants further study.