Prev Med. 2010 Jul 20.

[Epub ahead of print]

A randomized clinical trial of home-based exercise combined with a
slight caloric restriction on obesity prevention among women.
Mediano MF, et al.
Abstract
OBJECTIVE: The study investigated the effectiveness of home-based
exercise combined with a slight caloric restriction on weight change during
12months in non obese women. METHODS: A randomized clinical trial with
a factorial design was conducted from 2003 to 2005. Two hundred three
middle-aged women (Rio de Janeiro/Brazil), 25-45years, were randomly
assigned to one of two groups: control (CG) and home-based exercise (HB).
The HB group received a booklet on aerobic exercise that could be practiced
at home (3 times/week - 40min/session), in low-moderate intensity, during
12months. Both groups received dietary counseling aimed at a slight energy
restriction of 100-300 calories per day. RESULTS: The HB experienced a
greater weight loss in the first 6months (-1.4 vs. -0.8kg; p=0.04), but after
12months there was no differences between groups (-1.1 vs. -1.0; p=0.20).
Of the serum biochemical markers, HDL-cholesterol showed major change,
with an increase at month 12 of 18.3mg/dl in the HB compared to 9.5 in the
CG (p<0.01). CONCLUSION: Home-based exercise promoted greater weight
reduction during the first six months after which no further benefits are
observed. Continuous favorable changes in HDL-cholesterol after 1year
suggest that home-based exercise promote health benefits.

honghua Xin Xue Guan Bing Za Zhi. 2010 Apr;38(4):315-20.

[Effects of low-dose aspirin on primary prevention of cardiovascular
events: a systematic review.]
Tang HQ, et al.
Abstract
OBJECTIVE: To evaluate the effect and safety of low-dose aspirin for primary
prevention of cardiovascular events. METHODS: We searched for
randomized controlled trials (RCT) in the following electronic databases:
MEDLINE, EMbase, the Cochrane Library (Issue 3, 2008), CBM, CNKI. Quality
assessment and data extraction were conducted by two reviewers
independently. All data were analyzed using Review Manager 4.2. RESULTS:
Six studies (TPT, HOT, PPP, WHS, POPADAD, J-PAD) involving a total of 72 466
participants met the inclusion criteria. Meta-analysis results showed that: (1)
Compared with placebo, the incidences of total cardiovascular events (RR =
0.85, 95%CI: 0.80 - 0.92), stroke (RR = 0.87, 95%CI: 0.77 - 0.98), nonfatal
stroke (RR = 0.81, 95%CI: 0.70 - 0.95) and transient ischemic attack (RR =
0.76, 95%CI: 0.64 - 0.90) were significantly lower in low-dose aspirin group
than those in placebo control group (all P < 0.05). (2) Nonfatal myocardial
infarction (RR = 0.89, 95%CI: 0.77 - 1.02), death from cardiovascular causes
(RR = 0.98, 95%CI: 0.86 - 1.13) and death from any cause (RR = 0.95,
95%CI: 0.88 - 1.02) were similar between the 2 groups (all P > 0.05). (3) The
risk of coronary heart disease was reduced in low-dose aspirin group in the
elderly (RR = 0.81, 95%CI: 0.70 - 0.94, P < 0.05). (4) The risk of bleeding
was higher in low aspirin group compared to placebo group (RR = 1.15,
95%CI: 1.12 - 1.18, P < 0.01). CONCLUSIONS: Low-dose aspirin use could
reduce the incidences of total cardiovascular events, stroke, nonfatal stroke
and transient ischemic attack but increase the risk of bleeding, the incidence
of nonfatal myocardial infarction, death from cardiovascular causes and
death from any cause was not affected by low-dose aspirin use. Low-dose
aspirin use was also significantly reduced the risk of coronary heart disease
in the elderly.

PLoS One. 2010 Jun 11;5(6):e11086.

Meningitis dipstick rapid test: evaluating diagnostic performance
during an urban Neisseria meningitidis serogroup A outbreak,
Burkina Faso, 2007.
Rose AM, et al
Abstract
Meningococcal meningitis outbreaks occur every year during the dry season
in the "meningitis belt" of sub-Saharan Africa. Identification of the causative
strain is crucial before launching mass vaccination campaigns, to assure use
of the correct vaccine. Rapid agglutination (latex) tests are most commonly
available in district-level laboratories at the beginning of the epidemic
season; limitations include a short shelf-life and the need for refrigeration
and good technical skills. Recently, a new dipstick rapid diagnostic test (RDT)
was developed to identify and differentiate disease caused by meningococcal
serogroups A, W135, C and Y. We evaluated the diagnostic performance of
this dipstick RDT during an urban outbreak of meningitis caused by N.
meningitidis serogroup A in Ouagadougou, Burkina Faso; first against an incountry reference standard of culture and/or multiplex PCR; and second
against culture and/or a highly sensitive nested PCR technique performed in
Oslo, Norway. We included 267 patients with suspected acute bacterial
meningitis. Using the in-country reference standard, 50 samples (19%) were
positive. Dipstick RDT sensitivity (N = 265) was 70% (95%CI 55-82) and
specificity 97% (95%CI 93-99). Using culture and/or nested PCR, 126/259
(49%) samples were positive; dipstick RDT sensitivity (N = 257) was 32%
(95%CI 24-41), and specificity was 99% (95%CI 95-100). We found dipstick
RDT sensitivity lower than values reported from (i) assessments under ideal
laboratory conditions (>90%), and (ii) a prior field evaluation in Niger [89%
(95%CI 80-95)]. Specificity, however, was similar to (i), and higher than (ii)
[62% (95%CI 48-75)]. At this stage in development, therefore, other tests
(e.g., latex) might be preferred for use in peripheral health centres. We
highlight the value of field evaluations for new diagnostic tests, and note
relatively low sensitivity of a reference standard using multiplex vs. nested
PCR. Although the former is the current standard for bacterial meningitis
surveillance in the meningitis belt, nested PCR performed in a certified
laboratory should be used as an absolute reference when evaluating new
diagnostic tests.

Neurology
2003 American Academy of Neurology

2003;61:199-205

Mild hypercholesterolemia is an early risk factor for the development of

Alzheimer amyloid pathology
M.A. Pappolla, et al.
Background: Epidemiologic and experimental data suggest that cholesterol
may play a role in the pathogenesis of AD. Modulation of cholesterolemia in
transgenic animal models of AD strongly alters amyloid pathology.
Objective: To determine whether a relationship exists between amyloid
deposition and total cholesterolemia (TC) in the human brain.
Methods: The authors reviewed autopsy cases of patients older than 40
years and correlated cholesterolemia and presence or absence of amyloid
deposition (amyloid positive vs amyloid negative subjects) and
cholesterolemia and amyloid load. Amyloid load in human brains was
measured by immunohistochemistry and image analysis. To remove the
effect of apoE isoforms on cholesterol levels, cases were genotyped and
duplicate analyses were performed on apoE3/3 subjects.
Results: Cholesterolemia correlates with presence of amyloid deposition in
the youngest subjects (40 to 55 years) with early amyloid deposition (diffuse
type of senile plaques) (p = 0.000 for all apoE isoforms; p = 0.009 for
apoE3/3 subjects). In this group, increases in cholesterolemia from 181 to
200 almost tripled the odds for developing amyloid, independent of apoE
isoform. A logistic regression model showed consistent results (McFadden 2 =
0.445). The difference in mean TC between subjects with and without
amyloid disappeared as the age of the sample increased (>55 years: p =
0.491), possibly reflecting the effect of cardiovascular deaths among other
possibilities. TC and amyloid load were not linearly correlated, indicating that
there are additional factors involved in amyloid accumulation.
Conclusions: Serum hypercholesterolemia may be an early risk factor
for the development of AD amyloid pathology.

NEUROLOGY
2010 American Academy of Neurology

2010;74:406-412

Prognosis of polyneuropathy due to IgM monoclonal gammopathy

A prospective cohort study
J.M.F. Niermeijer, et a.
Background: The disease course of polyneuropathy associated with
immunoglobulin M monoclonal gammopathy (IgM MGUSP) can be highly
variable. In order to identify factors that influence long-term disease
outcome, a prospective cohort study was performed of 140 patients with
IgM MGUSP over a period of 23 years.
Methods: All patients with IgM MGUSP who were diagnosed in our tertiary
referral center for polyneuropathy were eligible. All patients underwent nerve
conduction studies and were tested for anti-MAG antibodies. The modified
Rankin Scale, graded muscle strength, quantified sensory function, and
laboratory testing were performed at 0, 1, 2, and 5 years and at last visit.
The primary outcome measure was the risk of developing a modified Rankin
Scale score of 3 points.
Results: A total of 140 patients with IgM MGUSP fulfilled inclusion criteria
(101 [72%] demyelinating, 39 [28%] axonal, 63 [44%] MAG positive). The
median age at onset was 59 years (interquartile range 5267), median
disease duration at baseline was 3.2 years (interquartile range 1.96). AntiMAG antibodies were associated with a lower risk of Rankin Scale score 3.
Demyelination and a higher age at onset were associated with a higher risk
for Rankin Scale score 3. Based on these 3 factors, a Web-based prognostic
model was developed that directly allows clinicians to estimate the
probability
of
developing
disability
(http://www.umcutrecht.nl/subsite/Prognosis-MGUS-Neuropathy).
Conclusion: Higher age at onset and demyelination increase the risk,
whereas anti-MAG antibodies decrease the risk, of developing Rankin Scale
score 3 in polyneuropathy associated with immunoglobulin M monoclonal
gammopathy (IgM MGUSP). Our Web-based prognostic model allows
determination of prognosis in IgM MGUSP.

A placebo-controlled trial of lamotrigine add-on therapy for partial

seizures in children. M. Duchowny et al.
OBJECTIVE: To compare the safety and efficacy of add-on lamotrigine and
placebo in the treatment of children and adolescents with partial seizures.
BACKGROUND: Add-on and monotherapy lamotrigine is safe and effective in
adults with partial seizures, and reports of preliminary uncontrolled trials
suggest similar benefits in children.
METHODS: We studied 201 children with diagnoses of partial seizures of any
subtype currently receiving stable conventional regimens of antiepileptic
therapy at 40 study sites in the United States and France. After a baseline
observation period (to confirm that more than four seizures occurred in each
of two consecutive 4-week periods), patients were randomized to add-on
lamotrigine or placebo therapy. A 6-week dose-escalation period was followed
by a 12-week maintenance period.
RESULTS: Compared with placebo, lamotrigine significantly reduced the
frequency of all partial seizures and the frequency of secondarily generalized
partial seizures in these treatment-resistant patients. The most commonly
reported adverse events in the lamotrigine-treated patients were vomiting,
somnolence, and infection; the frequency of these and other adverse events
was similar to that in the placebo-treated group, with the exception of ataxia,
dizziness, tremor, and nausea, which were more frequent in the lamotriginetreated group. The frequency of withdrawals for adverse events was similar
between groups. Two patients were hospitalized for skin rash, which resolved
after discontinuation of lamotrigine therapy.
CONCLUSIONS: Lamotrigine was effective for the adjunctive treatment of
partial seizures in children and demonstrated an acceptable safety profile.

Sensitivity and Specificity of Pediatric Lipid Determinations for

Adult Lipid Status: Findings From the Princeton Lipid Research
Clinics Prevalence Program Follow-up Study
Lisa Aronson Friedman, etal.
OBJECTIVE. The goal was to determine the diagnostic utility of the National
Cholesterol Education Program pediatric guidelines.
METHODS. With the use of pediatric lipid data from the Cincinnati Clinic of
the Lipid Research Clinics Prevalence Study and lipid and cardiovascular
disease data collected for the same subjects as adults in the Princeton
Follow-up Study, the sensitivity and specificity of the National Cholesterol
Education Program pediatric guidelines were calculated overall and according
to age. Furthermore, whether use of parental cardiovascular disease history
during childhood influenced the sensitivity and specificity was assessed.
RESULTS. Overall sensitivities were 43% to 46% and specificities were 82%
to 86% for total and low-density lipoprotein cholesterol levels. There was
considerable variation in sensitivities according to age, with the lowest
sensitivities at ages 14 to 16 years and the highest sensitivities at ages 5 to
10 years and 17 to 19 years. Results were similar whether or not the
population was restricted to children with a positive parental history of
cardiovascular disease.
CONCLUSIONS. Results of our analyses suggest that the sensitivity and
specificity for evaluating total cholesterol or low-density lipoprotein
cholesterol levels that are elevated in adulthood are not improved by
selecting children with a positive parental history. These data also show
the strong role that age (particularly the pubertal years between 10 and
15 years of age) plays in lipid measurements for children and
adolescents. Continued prospective and longitudinal studies designed
with age as well as other risk parameters are needed to determine the
best guidelines for clinical screening in the future. Neurology
2000;54:635