Metabolism: clinical and experimental
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Hemostatic processes are important in precipitating myocardial infarction and stroke. Elevated plasma fibrinogen is considered a risk factor for cardiovascular diseases (CVDs), but the results of previous studies on the association of plasma factor VIIc activity with CVD and diabetes have been inconsistent. The aim of the present study was to explore the association of plasma fibrinogen and factor VIIc to clinical characteristics and estimated coronary heart disease (CHD) risk in Aboriginal and Torres Strait Islander peoples. ⋯ For Aboriginal women, levels of fibrinogen and factor VIIc were significantly higher for persons at high risk than those at below average risk. The data suggest that plasma fibrinogen and factor VIIc might be important factors mediating the elevated CVD in Australian Indigenous Peoples. These data may have implications for prevention and treatment of CVD in Australian Indigenous communities.
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Clinical coagulopathy frequently occurs in the presence of hypothermia. The primary purpose of this study was to investigate the effects of hypothermia on clotting protein fibrinogen metabolism and on coagulation function in a swine model. Twelve pigs were randomly allocated into control and hypothermia groups. ⋯ Hypothermia caused no significant changes in clot strength (maximum amplitude) and clot lysis (LY(60)). We concluded that hypothermia caused a potential deficit in fibrinogen availability and a delay in thrombin generation, consequently inhibiting coagulation function. Our data support the current practices of rewarming and prescribing recombinant factor VIIa for hypothermic patients with coagulation defects.
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Critical illness is characterized by a hypermetabolic state associated with increased mortality, which is partly ascribed to the occurrence of hyperglycemia caused by enhanced endogenous glucose production and insulin resistance (IR). Insulin resistance is well described in patients after surgery and trauma. However, it is less clearly quantified in critically ill medical patients. ⋯ In conclusion, insulin sensitivity was found to be reduced by 70% in critically ill medical patients. The severity of IR was associated with the severity of illness, body mass index, and resting energy expenditure, but not with substrate oxidation rates. In addition, the severity of IR did not vary among patients with different admission diagnoses.
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Polymorphisms in the APOC3 and APOA5 genes, from the APOA1/APOC3/APOA4/APOA5 gene cluster on chromosome 11q23, have been associated with interindividual variation in plasma triglycerides. APOA5 polymorphisms implicated include 2 in the promoter region (-1131 T/C and -3 A/G) and 1 in exon 2 (+56 C/G). APOC3 polymorphisms implicated include 1 (SstI) in the 3' untranslated region and 1 (-2854 G/T) in the APOC3-APOA4 intergenic region. ⋯ Haplotypes comprising the 3 loci implicated by genotype analyses (SstI, -1131 T/C, and +56 C/G) were also tested: haplotypes C_C_C and G_T_G significantly raised triglycerides, even after adjustment for multiple comparisons (P < .002 for both), with each copy of C_C_C expected to raise triglycerides by approximately 7 mg/dL and each copy of G_T_G by approximately 15 mg/dL. Overall, our findings support those of others in associating specific polymorphisms and haplotypes in the APOA1/C3/A4/A5 gene cluster with higher serum triglyceride levels. However, the degree to which polymorphisms in the APOC3 and APOA5 genes may be independently associated with triglyceride levels remains to be determined.
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HIV has classically been a wasting disease. However, in the United States, obesity is increasingly common among HIV-infected individuals receiving effective antiviral treatment. The risks of obesity are unclear in HIV, although the increased prevalence of diabetes and cardiovascular disease in the presence or absence of obesity causes growing concern. ⋯ There was no significant change in CD4 count or HIV viral load. In conclusion, moderate weight loss achieved by a short-term program of diet and exercise in obese HIV-positive women appears safe and induces loss of adiposity in both the subcutaneous adipose tissue and visceral adipose tissue regions. Despite reduced food intake, weight and fat loss, as well as improvements in strength, fitness, and QOL, the lack of improvement in metabolic parameters suggests that additional interventions may be necessary to reduce the risk of diabetes and cardiovascular disease in this population.