Lipid Abnormalities in Persons Living With HIV Infection

Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug–drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.     

Placebo controlled evaluation of Xilei San,a herbal preparation in patients with intractable ulcerative proctitis

Background and Aim: Topical mesalamine or corticosteroid has shown efficacy in patients with ulcerative proctitis, but patients often become refractory to these interventions. Xilei San is a herbal preparation with evidence of anti‐inflammatory effects. We evaluated the efficacy of topical Xilei San in ulcerative proctitis patients. Methods: In a double blind setting, 30 patients with intractable ulcerative proctitis despite ≥ 4 weeks of topical mesalamine or corticosteroid were randomly assigned to True (n = 15) and placebo (n = 15). Patients in True received suppository Xilei San (0.1 g/dose per day of Xilei San), the other 15 received placebo suppository. The initial efficacy was evaluated on day 14. Primary endpoint of the trial was avoiding relapse during 180 days, relapse meant recurrence of active disease. Riley's index was applied for endoscopic and histological evaluations, while patients' quality of life was evaluated by an inflammatory bowel disease questionnaire. Results: On day 14, the number of patients who achieved remission, clinical activity index ≤ 4 in True was significantly higher versus placebo (P < 0.04). Likewise, at day 180, an 81.8% of patients in True were without relapse versus 16.7% in placebo (P < 0.001). Further, significant endoscopic (P < 0.01), histological (P < 0.02) and inflammatory bowel disease questionnaire (P < 0.04) improvements were observed in True, but not in placebo. Conclusions: This is the first controlled investigation showing significant clinical and endoscopic efficacy for Xilei San in patients with intractable ulcerative proctitis. Topical Xilei San was well tolerated, and was without safety concerns.     

丹栀逍遥散治疗伴抑郁的溃疡性结肠炎疗效观察

为观察丹栀逍遥散对伴抑郁的溃疡性结肠炎（UC）的疗效，采用Zung抑郁自评量表进行测评，评分结果换算成抑郁严重度指数。从139例活动期UC患者中筛选出抑郁指数〉0．5者79例，随机分为治疗组40例，对照组39例，比较两组疗效。结果显示，治疗组与对照组的总有效率分别为85．0％和64．1％（P〈0．05）。结果表明，伴有抑郁的UC患者服用丹栀逍遥散可提高疗效。     

不同剂量~(60)Co-γ射线辐照对三黄片中大黄粉含量及消毒效果的影响

为了解不同辐射剂量60Co-γ射线辐照灭菌对三黄片主要成分大黄素、大黄酚含量及消毒效果的影响,采用高效液相色谱法及细菌检验方法,对辐照处理的三黄片中大黄素、大黄酚和辐照消毒效果进行了检测。结果,三黄片经不同辐照剂量60Co-γ射线辐照前后,其主要成分大黄素、大黄酚的含量无明显的变化;辐照剂量为2 kGy的照度下即可以达到消毒要求。结论,三黄片用60Co-γ射线辐照消毒方法对其有效成分基本无影响,消毒效果可靠。     

3-Hydroxy-3-methylglutaric aciduria: a new assay of 3-hydroxy-3-methylglutaryl-CoA lyase using high performance liquid chromatography

A new assay has been developed for 3-hydroxy-3-methylglutaryl-CoA lyase, the final enzyme in the leucine degradative pathway. The assay was performed by incubating lysates of fibroblasts with [glutaryl-3-¹⁴C](d,l)-3-hydroxy-3-methylglutaryl coenzyme A. The products were analysed by high performance liquid chromatography with continuous liquid scintillation counting. This provided simultaneous identification and quantification of one of the enzymatic products, [3-¹⁴C] acetoacetic acid. The mean 3-hydroxy-3-methylglutaryl-CoA lyase activity in fibroblasts from five controls was 732 ± 81 (SD) pmol/min · mg protein. Using this assay, we have studied skin fibroblasts cultured from a patient with 3-hydroxy-3-methylglutaric aciduria and found 3% of normal 3-hydroxy-3-methylglutaryl-CoA lyase activity. The activities in skin fibroblasts cultured from the parents were 46 and 53% of control activity which is consistent with heterozygocity. Kinetic studies of 3-hydroxy-3-methylglutaryl-CoA lyase in skin fibroblasts cultured from two normal subjects yielded K_m values of 14.4 and 18.8 μmol/l for 3-hydroxy-3-methylglutaryl-CoA.     

Effect of alpha-glucosidase inhibitor on human pancreatic and salivary alpha-amylase

The mode of inhibition of a new complex oligosaccharide that inhibits the alpha-glucoside hydrolase activity of pancreatic and salivary alpha-amylase was studied. Kinetic analysis revealed a non-competitive type of inhibition with a Ki of 1.47 +/- 0.03 micrograms when tested against human pancreatic alpha-amylase and 3.89 +/- 0.08 micrograms against human salivary alpha-amylase. The inhibitory action of alpha-glucoside hydrolase inhibitor (alpha-GHI) on pancreatic amylase was observed over a wide range of pH (6.0--7.9), whereas the inhibition of salivary amylase was optimal at pH 6.5. Column chromatographic investigations suggested the possible formation of an enzyme-inhibitor complex because the mixture of alpha-GHI and pancreatic alpha-amylase was eluted as a single component through a Sephadex G200 column. However, this enzyme-inhibitor complex was easily separated into each component and the enzyme activity was fully recovered after electrophoresis.     

Chromatographic and colorimetric detection of glycosylated hemoglobins: a comparative analysis of two different methods.

The measurement of glycosylated hemoglobins in diabetic patients represents a new approach to the problem of the long-term glycemie control.Chromatographic procedures are usually employed to separate the glycosylated components of hemoglobin; we performed a comparative analysis of two different methods: Chromatographic and colorimetric. Chromatographic separation on small ion-exchange resin columns gives high precision (coefficient of variation = 1.7%) over the whole range of normal and diabetic values of percentage of glycosylated hemoglobin (3.2–15.9%).An alternative technique is the measurement of 5-hydroxymethylfurfural released by oxalic acid hydrolysis of the hexoses bound to hemoglobin, as proposed by Fluckiger and Winterhalter (Fluckiger, R. and Winterhalter, K.H. (1976) FEES Lett. 71, 356–360). Normal values, expressed as 5-hydroxymethylfurfural absorbance per 10 g of total hemoglobin, range from 133 to 235, with mean ± S.D. = 189 ± 26; while diabetic patients show a range from 220 to 443 and mean ± S.D. = 318 ± 65.This last method gives satisfactory precision over the entire range of values examined (coefficient of variation = 4.2%) and has proved simple and inexpensive.The correlation between the two methods is very high (n = 20; r = 0.98; p < 0.001) with a regression line, y = 25. Ix + 40.3.The storage of the hemolysates at ?20°C for up to 70 days for the colorimetric method and up to 260 for the Chromatographic procedure does not decrease the precision of either technique.     

Derivation of decision rules to predict clinically important outcomes in acute flank pain patients

Objective

Routine CT for patients with acute flank pain has not been shown to improve patient outcomes, and it may unnecessarily expose patients to radiation and increased costs. As preliminary steps toward the development of a guideline for selective CT, we sought to determine the prevalence of clinically important outcomes in patients with acute flank pain and derive preliminary decision rules.

柴胡疏肝散加减治疗慢性萎缩性胃炎肝胃不和证的Meta分析*

目的系统评价柴胡疏肝散加减治疗慢性萎缩性胃炎(CAG)肝胃不和证的临床疗效以及安全性。方法 检索Pubmed,Web of Science,Cochrane Library,CNKI,VIP和万方数据库,纳入所有柴胡疏肝散加减治疗慢性萎缩性胃炎肝胃不和证的临床随机对照试验(RCTs),检索时间为建库至2019年10月1日,采用RevMan5.3软件进行Meta分析。结果 最终纳入11项研究,共1 068例患者。Meta分析结果显示:与常规西药治疗相比,柴胡疏肝散能有效提高肝胃不和型萎缩性胃炎患者的临床总有效率[RR=1.25,95%CI(1.19,1.33),P<0.000 01]、症状疗效总有效率[RR=1.57,95%CI(1.30,1.89）,P<0.000 01]及血清胃泌素G17水平[MD=3.61,95%CI(2.89,4.33),P<0.000 01],并能改善胃粘膜萎缩[MD=-1.53,95%CI(-1.93,-1.12),P<0.000 01]、肠上皮化生[MD=-0.79,95%CI(-0.96,-0.63),P<0.000 01]、异型增生度[MD=-0.69,95%CI(-0.84,-0.55),P<0.000 01]的病理检查积分,2组疗效差异具有统计学意义。结论 柴胡疏肝散加减治疗肝胃不和型慢性萎缩性胃炎疗效优于常规西药治疗。