Faculty Bibliography

PURPOSE/OBJECTIVE:Ways to predict the risk of cardiovascular (CV) events or all-cause mortality have largely been derived from populations in which old and very old subjects were underrepresented. We set out to estimate the incremental prognostic utility of inflammation and atherosclerosis markers in the prediction of all-cause and CV mortality in elderly men. METHODS:In a prospective population-based cohort study, conventional CV risk factors were documented in 403 independently living elderly men. C-reactive protein (CRP) and interleukin (IL)-6 levels were measured. Carotid plaques were assessed by ultrasound. Analyses were performed with proportional hazards analyses, and bootstrapping was used for internal validation. Main outcome was CV and all-cause mortality occurring during 4 years of follow-up. RESULTS:Increasing tertiles of CRP, IL-6, and number of plaques were independently associated with all-cause and CV mortality. With information on age, carotid plaques, IL-6, and CRP yielded good discriminatory power for all-cause and CV mortality: area under the receiver operating characteristic curve (95% confidence interval), 0.76 (0.70-0.82) and 0.74 (0.68-0.80), respectively. Combined use of only IL-6 and plaque burden allowed identification of subjects with low and high mortality risk. The Framingham PROCAM and a Dutch Risk Function poorly predicted mortality risk, similar or worse than a model using age alone. CONCLUSION/CONCLUSIONS:In the old and very old, IL-6 and number of carotid plaques are powerful predictors of mortality risk in the years to come. Conventional risk scores seem to perform unsatisfactorily.

New surveys suggest that the global AIDS epidemic has begun to slow, with a decline in new HIV infections in about 10 countries, the head of the U.N. AIDS program said here Tuesday in the most comprehensive international report ever issued on the disease. Elsewhere, the number of new AIDS infections continues to rise or continues at its current pace. Meanwhile, public health efforts are reaching only a small proportion of people at risk, said Dr. Peter Piot, the U.N. AIDS executive director. In Haiti, the percentage of pregnant women infected with HIV has declined to 3.7 percent in 2003-04 from 9.4 percent in 1993, Piot said in releasing the agency's report at a news conference. The report, issued every other year, comes on the eve of a U.N. General Assembly session. Despite the positive trends, Piot reported grim findings from China, Indonesia, Papua New Guinea, Russia and Vietnam, with signs of outbreaks in Bangladesh and Pakistan, Piot said

New surveys suggest that the global AIDS epidemic has begun to slow, with a decline in new H.I.V. infections in about 10 countries, the leader of the United Nations AIDS program said Tuesday. The report shows that the epicenter of the epidemic remains in sub-Saharan Africa. There the epidemic has reached a peak, but incidence remains unacceptably high, Dr. [Peter Piot] said. Across most of Africa, H.I.V. prevalence among pregnant women attending clinics has remained roughly level for several years. An estimated 38.6 million people worldwide are living with H.I.V., up from 37.3 million in 2005, according to a United Nations report released yesterday. Experts cite drops in H.I.V. prevalence in some of the hardest-hit African nations as evidence that the disease's spread is slowing

In Haiti, the percentage of pregnant women infected with HIV has declined to 3.7 percent in 2003-04 from 9.4 percent in 1993, [Peter Piot] said in releasing the agency's report at a news conference. The report, issued every other year, comes on the eve of a U.N. General Assembly session. Despite the positive trends, Piot reported grim findings from China, Indonesia, Papua New Guinea, Russia and Vietnam, with signs of outbreaks in Bangladesh and Pakistan, Piot said

Elsewhere, the number of new AIDS infections continues to rise or continues at its current pace. And public health efforts are reaching only a small proportion of people at risk, said Dr. Peter Piot, the U.N. AIDS executive director. 'It's a very complex epidemic,' said Piot, adding AIDS should no longer be considered as a single epidemic but as many diverse ones. India, for example, appears to have surpassed South Africa as the country with the largest number of HIV infections. India has 5.7 million infected people, and South Africa has 5.5 million, but the difference may not be statistically meaningful. Showing no sign of decline, South Africa has a prevalence rate of about 19 percent of 47 million people. In India, the rate is less than 1 percent of its population of 1.1 billion. In Haiti, the percentage of pregnant women infected with HIV has declined to 3.7 percent in 2003-04 from 9.4 percent in 1993, Piot said. The report, issued every other year, comes on the eve of a U.N. General Assembly session. Despite the positive trends, Piot reported grim findings from China, Indonesia, Papua New Guinea, Russia and Vietnam, with signs of outbreaks in Bangladesh and Pakistan, Piot said

Gray's Anatomy [Television Program] -- IN the season finale of ABC's 'Grey's Anatomy,' one of the surgical interns, Dr. Izzie Stevens (played by Katherine Heigl), crosses an ethical line by becoming romantically involved with a potential heart transplant patient, Denny Duquette (played by Jeffrey Dean Morgan). He has signed a Do Not Resuscitate order, but Izzie gives him hope that he will get a heart in time. Izzie then deliberately cuts the pump lines of Denny's heart's left ventricular-assisting device. Emergency cases get priority, and his deteriorating condition will move him up the transplant list. Third, interns could never monitor a sick heart patient for such a prolonged period of time without intervention by at least a nurse, if not a more senior physician. In the show, the interns watch Denny's heart stop, resuscitate him, give him emergency medication - - all without observation or intervention. In real life, such a stunt would be cause for Izzie's immediate arrest for attempted murder; the other interns would likely be kicked out of the residency program

By studying chimpanzee droppings in remote African jungles, scientists have found direct evidence of a missing link between a chimpanzee virus and the one that causes human AIDS, they reported. Scientists have long suspected that chimpanzees are the source of the human AIDS pandemic because at least one subspecies carries a simian immune deficiency virus closely related to HIV, the human virus that causes AIDS. But because the simian virus, known as SIVcpz, was identified in chimpanzees in captivity, researchers could not be sure that the same simian virus existed among these apes in the wild. [Beatrice Hahn] reported, her team's findings show 'for the first time a clear picture of the origin of HIV-1 and the seeds of the AIDS pandemic.' HIV-1 is the virus that causes the vast majority of AIDS cases in the world. Studies estimate that the human AIDS virus jumped species between 50 and 75 years ago. But no one knows who the first infected person was or how that person acquired HIV

[Beatrice H. Hahn] reported, the findings show 'for the first time a clear picture of the origin of HIV-1 and the seeds of the AIDS pandemic.' Studies estimate that the human AIDS virus jumped species between 50 and 75 years ago. But no one knows who the first infected person was or how that person acquired HIV. Hahn said her team theorizes that HIV was first transmitted locally somewhere in west central Africa. Because the subspecies of chimpanzees, Pan troglodytes troglodytes, in which the simian virus had been found in captivity, lives in the wild in Cameroon, Gabon and Republic of Congo, the first infection could have been in any of those areas

[Beatrice Hahn] reported, her team's findings show 'for the first time a clear picture of the origin of HIV-1 and the seeds of the AIDS pandemic.' HIV-1 is the virus that causes the vast majority of AIDS cases in the world. The first cases of AIDS were detected in the United States in 1981. Hahn said her team theorizes that HIV was first transmitted locally somewhere in west central Africa. The subspecies of chimpanzees, Pan troglodytes troglo-dytes, in which the simian virus had been found in captivity, lives in the wild in Cameroon, Gabon and Republic of Congo; therefore, the first infection could have been in any of those areas. It is not known whether chimpanzees infected with SIVcpz become ill, Hahn said. Two naturally infected chimpanzees in captivity did not become ill. Some infected chimpanzees that were rescued as orphans because their parents were killed for bush meat died in captivity, but others that were not infected also died, she said, and the deaths were attributed to human infection, poor care and inappropriate diet