Abstract Background The prevalence of vascular risk factors, cardiovascular disease, and restless legs syndrome increases with age. Prior studies analyzing the associations between vascular risk ...factors, cardiovascular disease, and restless legs syndrome found controversial results. We therefore aim to evaluate the associations between prevalent vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome. Methods We conducted a cross-sectional study among 22,786 participants of the US Physicians' Health Studies I and II. Restless legs syndrome was classified according to the 4 minimal diagnostic criteria. Vascular risk factors and restless legs syndrome symptoms were self-reported. Prevalent cardiovascular disease events, including major cardiovascular disease, stroke, and myocardial infarction, were confirmed by medical record review. Age- and multivariable-adjusted logistic regression models were used to evaluate the association among vascular risk factors, prevalent cardiovascular disease events, and restless legs syndrome. Results The mean age of the cohort was 67.8 years. The prevalence of restless legs syndrome was 7.5% and increased significantly with age. Diabetes significantly increased the odds of restless legs syndrome (odds ratio OR, 1.41; 95% confidence interval CI, 1.21-1.65), whereas frequent exercise (OR, 0.78; 95% CI, 0.67-0.91) and alcohol consumption of 1 or more drinks per day (OR, 0.80; 95% CI, 0.69-0.92) significantly reduced the odds of restless legs syndrome in multivariable-adjusted models. Prevalent stroke showed an increased multivariable-adjusted OR of 1.40 (1.05-1.86), whereas men with prevalent myocardial infarction had a decreased OR of 0.73 (0.55-0.97) for restless legs syndrome. Conclusions The restless legs syndrome prevalence among US male physicians is similar to that of men of the same age group in other western countries. A history of diabetes is the most consistent risk factor associated with restless legs syndrome. Prevalent stroke and myocardial infarction are related to restless legs syndrome prevalence.
Abstract Background Previous studies evaluating the association of cardiovascular disease and vascular risk factors with restless legs syndrome showed inconsistent results, especially for the ...potential relation between various vascular risk factors and restless legs syndrome. We therefore aimed to analyze the relationships between vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome. Methods This is a cross-sectional study of 30,262 female health professionals participating in the Women's Health Study (WHS). Restless legs syndrome was defined according to diagnostic criteria of the International Restless Legs Study Group. Information on vascular risk factors (diabetes, hypertension, hypercholesterolemia, body mass index BMI, alcohol, smoking, exercise, and family history of myocardial infarction) was self-reported. Cardiovascular disease events (coronary revascularization, myocardial infarction, and stroke) were confirmed by medical record review. Prevalent major cardiovascular disease was defined as nonfatal stroke or nonfatal myocardial infarction. Logistic regression models were used to evaluate the association between vascular risk factors, prevalent cardiovascular disease, and restless legs syndrome. Results Of the 30,262 participants (mean age: 63.6 years), 3624 (12.0%) reported restless legs syndrome. In multivariable-adjusted models, BMI (odds ratio OR for BMI ≥ 35 kg/m2 , 1.35; 95% confidence interval CI, 1.17-1.56), diabetes (OR, 1.19; 95% CI, 1.04-1.35), hypercholesterolemia (OR, 1.17; 95% CI, 1.09-1.26), smoking status (OR for ≥ 15 cigarettes/day, 1.41; 95% CI, 1.19-1.66), and exercise (OR for exercise ≥ 4 times/week, 0.84; 95% CI, 0.74-0.95) were associated with restless legs syndrome prevalence. We found no association between prevalent cardiovascular disease (major cardiovascular disease, myocardial infarction, and stroke) and restless legs syndrome prevalence. Women who underwent coronary revascularization had a multivariable-adjusted OR of 1.39 (1.10-1.77) for restless legs syndrome. Conclusions In this large cohort of female health professionals, various vascular risk factors are associated with the prevalence of restless legs syndrome. We could not confirm the results of previous reports indicating an association between prevalent cardiovascular disease and restless legs syndrome.
Purpose The aim of this study was to investigate maxillofacial injuries sustained in both skiing and snowboarding accidents and correlate injury mechanisms and patterns evaluating a large population. ...Materials and Methods Between 1991 and 2003, all patients with maxillofacial injuries due to skiing and snowboarding accidents (1,393 cases) were reviewed and statistically analyzed according to age, gender, type of injury, cause of accident, location of trauma, and associated injuries. Results Skiing accidents resulted in a total of 1,250 injuries, and snowboarding resulted in 143. In this study 686 skiers presented with 1,452 facial bone fractures and 80 snowboarders sustained 160 fractures of the face. Skiers had dentoalveolar trauma in 810 cases and 1,295 soft tissue injuries, whereas snowboarders had 88 dental injuries and 187 soft tissue lesions. Mechanisms of injury included 542 cases due to skiing and 85 falls due to snowboarding (a 1.79-fold higher risk for snowboarders). The gender distribution showed a male-female ratio of 3:1 in skiers and 5.5:1 in snowboarders. In both groups male patients were more prone to have a facial bone fracture than female patients. Snowboarders aged between 10 and 29 years had a 2.14-fold higher risk of sustaining a maxillofacial injury than skiers. Conclusions In both groups facial bone fractures occurred more often in male patients, and they were more likely to result from falls and collisions with other persons. Young snowboarders had a higher risk of maxillofacial injuries (especially soft tissue lesions) than skiers, whereas for children and old persons, skiing posed a much higher risk. Wearing a helmet while skiing and snowboarding should be mandatory to prevent serious trauma to the head.
Background Few studies have investigated the impact of neighborhood characteristics on mortality after stroke. Aim of our study was to analyze the influence of district unemployment as indicator of ...neighborhood socioeconomic status (SES-NH) on poststroke mortality, and to compare these results with the mortality in the underlying general population. Methods Our analyses involve 2 prospective cohort studies from the city of Dortmund, Germany. In the Dortmund Stroke Register (DOST), consecutive stroke patients (N = 1883) were recruited from acute care hospitals. In the Dortmund Health Study (DHS), a random general population sample was drawn (n = 2291; response rate 66.9%). Vital status was ascertained in the city's registration office and information on district unemployment was obtained from the city's statistical office. We performed multilevel survival analyses to examine the association between district unemployment and mortality. Results The association between neighborhood unemployment and mortality was weak and not statistically significant in the stroke cohort. Only stroke patients exposed to the highest district unemployment (fourth quartile) had slightly higher mortality risks. In the general population sample, higher district unemployment was significantly associated with higher mortality following a social gradient. After adjustment for education, health-related behavior and morbidity was made the strength of this association decreased. Conclusions The impact of SES-NH on mortality was different for stroke patients and the general population. Differences in the association between SES-NH and mortality may be partly explained by disease-related characteristics of the stroke cohort such as homogeneous lifestyles, similar morbidity profiles, medical factors, and old age.
Infection with the intracellular bacterium Coxiella (C.) burnetii can cause chronic Q fever with severe complications and limited treatment options. Here, we identify the enzyme cis‐aconitate ...decarboxylase 1 (ACOD1 or IRG1) and its product itaconate as protective host immune pathway in Q fever. Infection of mice with C. burnetii induced expression of several anti‐microbial candidate genes, including Acod1. In macrophages, Acod1 was essential for restricting C. burnetii replication, while other antimicrobial pathways were dispensable. Intratracheal or intraperitoneal infection of Acod1−/− mice caused increased C. burnetii burden, weight loss and stronger inflammatory gene expression. Exogenously added itaconate restored pathogen control in Acod1−/− mouse macrophages and blocked replication in human macrophages. In axenic cultures, itaconate directly inhibited growth of C. burnetii. Finally, treatment of infected Acod1−/− mice with itaconate efficiently reduced the tissue pathogen load. Thus, ACOD1‐derived itaconate is a key factor in the macrophage‐mediated defense against C. burnetii and may be exploited for novel therapeutic approaches in chronic Q fever.
Synopsis
The intracellular bacterium Coxiella burnetii causes the anthropozoonotic infection Q fever. Most patients control and resolve infection, but some develop chronic disease. Finding out how macrophages inhibit bacterial replication may explain susceptibility and suggest new therapies.
Coxiella burnetii induces expression of the enzyme Aconitate Decarboxylase 1 (ACOD1) in mouse and human macrophages.
Acod1−/− mice and macrophages do not generate the immunometabolite itaconate and fail to control C. burnetii replication in vitro and in vivo.
Itaconate directly blocks C. burnetii replication at physiological concentrations.
Treatment with itaconate restores control of C. burnetii in macrophages and in mice.
Human macrophages generate less itaconate and allow C. burnetii replication, which is inhibited by exogenous itaconate.
The intracellular bacterium Coxiella burnetii causes the anthropozoonotic infection Q fever. Most patients control and resolve infection, but some develop chronic disease. Finding out how macrophages inhibit bacterial replication may explain susceptibility and suggest new therapies.
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