Myocardial dysfunction and adrenergic innervation in patients with Type 1 diabetes mellitus

In this study we assess the mechanisms of exercise-induced left ventricular (LV) dysfunction in asymptomatic patients with Type 1 diabetes mellitus (T1DM) without coronary artery disease. Fourteen patients and 10 volunteers were enrolled. LV volume, LV ejection fraction (LVEF) and end-systolic wall stress were calculated by two-dimensional echocardiography at rest and during isometric exercise. Myocardial iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy was performed to assess adrenergic cardiac innervation. Diabetic subjects were classified into group A (n=7), with an abnormal LVEF response to handgrip (42 +/- 7%), and group B (n=7), with a normal response (72 +/- 8%). Baseline LVEF was normal in both group A and B patients. In group A patients, the LV circumferential wall stress-LVEF relation showed an impairment in LVEF disproportionate to the level of LV after load. No significant changes in LVEF occurred during dobutamine, whereas post-extrasystolic potentiation (PESP) significantly increased LVEF (60 +/- 6% vs 74 +/- 6%,p < 0.001); PESP at peak handgrip normalized the abnormal LVEF (42 +/- 7% vs 72 +/- 5%, p < 0.001); and MIBG uptake normalized for body weight or for LV mass was lower than in normal subjects (1.69 +/- 0.30 vs 2.98 +/- 0.82 cpm/MBq per g,p = 0.01) and group B diabetic patients (vs 2.79 +/- 0.94 cpm/MBq per g,p = 0.01). A linear correlation between LVEF at peak handgrip and myocardial MIBG uptake normalized for LV mass was demonstrated in the study patients. A defective blunted recruitment of myocardial contractility plays an important role in determining exercise LV dysfunction in the early phase of diabetic cardiomyopathy. This abnormal response to exercise is strongly related to an impairment of cardiac sympathetic innervation.     

The impact of IVUS guided bare metal stent implantation for non-small vessel

Previous studies have shown larger target vessel or greater stent area contribute to reduced restenosis rate. Thus, intravascular ultrasound (IVUS)-guided bare metal stent (BMS) implantation for selected lesions might achieve drug-eluting stent-like outcomes. The aim was to examine the long-term outcomes of BMS using IVUS-guided optimization. METHODS: Consecutive 103 coronary artery lesions suitable for IVUS were enrolled. Using IVUS, final stent balloon size selected was 90 percent of media-to-media diameter at the lesion or distal reference. The balloon size was listed as follows: group A (3.0-3.5 mm, n = 15), group B (3.5-3.75 mm, n = 64), and group C (3.75-4.5 mm, n = 24). RESULTS: At post-intervention, average stent area increased by the balloon size (A: 7.2 +/- 1.4 mm2, B: 8.9 +/- 1.5 mm2, and C: 12.1 +/- 2.0 mm2, respectively p < 0.001). At 6 month follow up, the average lumen area increased by balloon size (A: 4.1 +/- 1.7 mm2, B: 5.7 +/- 1.2 mm2, and C: 8.1 +/- 2.0 mm2, respectively p < 0.001). Accordingly, group B and C revealed lower restenosis, compared to group A (A: 46.7%, B: 10.9%, C: 8.3%, A vs B: p = 0.001; C vs A: p = 0.015). Moreover, target lesion revascularization was less in group B and C than group A (A 26.6%, B 3.1%, C 0%, A vs B: p = 0.011; C vs A: p = 0.017). CONCLUSIONS: For non-small vessels, IVUS-guided BMS implantation showed less restenosis and target lesion revascularization compared to small vessels, mainly due to larger initial gain. These study results suggest that IVUS-guided optimal BMS implantation for selected lesions might result in favorable long-term outcomes similar to those seen using drug-eluting stents. For a decade, coronary stenting has become a standard therapy for coronary artery disease due to favorable long-term outcomes and simple treatment procedure. Furthermore, for the last two years, drug-eluting stents (DES), releasing antiproliferative agents from bare metal backbone, revealed the restenosis rates less than half of those seen using conventional bare metal stents (BMS). While target lesions especially suitable for DES continue to be identified, earlier BMS studies showed that larger target vessel or greater stent area contributed to less restenosis. Thus, optimal IVUS-guided BMS implantation for selected lesions might achieve DES-like long-term outcomes. This study was designed to examine the long-term outcomes of BMS with intravascular ultrasound (IVUS)-guided optimization, using coronary angiography and IVUS data.     

Effect of simvastatin therapy on endothelial function of hypercholesteremic patients with syndrome X

INTRODUCTION: Cardiac syndrome X patients often have both reduced coronary circulation and impaired systemic endothelial function. AIMS: The aim of our study was to assess the effect of chronic statin therapy on exercise-induced "ischemic like" ST segment depression and on systemic endothelial function in cardiac syndrome X patients with hypercholesterolemia. PATIENTS/METHODS: In 25 hypercholesterolemic patients (15 males, mean age 55 +/- 3 years) with a normal coronary angiogram and positive exercise ECG test (> 0.1 mV ST segment depression) the flow mediated dilatation (FMD) was assessed by measuring the change in brachial artery diameter in response to hyperemic flow by vascular ultrasound. All patients were treated with 20 mg simvastatin in duration of 12 weeks. Following the treatment the exercise ECG and the vascular ultrasound studies were repeated. RESULTS: There was a significant decrease in total serum cholesterol level (baseline = 5.82 +/- 0.19 mmol/L vs. study end = 4.49 +/- 0.17 mmol/L, p < 0.01) and significant increase in the serum HDL level (baseline = 1.05 +/- 0.16 mmol/L vs. study end = 1.11 +/- 0.14 mmol/L, p < 0.01) following the statin treatment. Parallelly brachial artery FMD increased significantly (baseline = 3.97 +/- 0.91% vs. study end = 6.84 +/- 0.89%, p < 0.05). Responses to nitroglycerin were similar during the time course of the study. The ischemia free stress test time was also higher at the study end (baseline = 5.18 +/- 2.01 min vs. study end = 6.01 +/- 1.94 min, p < 0.001). CONCLUSIONS: The chronic statin therapy exerts beneficial effects both on systemic and coronary endothelial function in hypercholesterolemic patients with cardiac syndrome X.     

直接置入国产药物洗脱支架治疗急性心肌梗死的可行性研究

目的评价无球囊预扩张直接置入国产药物洗脱支架治疗急性心肌梗死（acute myocardial infarction,AMI）的安全性和有效性。方法将100例ST段抬高型AMI患者随机分为无球囊预扩张直接置入国产药物洗脱支架组（直接支架组）和球囊预扩张后置入冠状动脉内支架组（预扩张组）,应用心肌梗死溶栓治疗试验（thrombolysis in myocardial infarction,TIMI）血流分级、心肌呈色分级（myocardial blush grading,MBG）两种方法评价AMI患者的心肌灌注情况,并对主要不良心脏事件（major adverse cardiac events,MACE）及冠脉造影随访6个月。结果虽然两组术后即刻TIMI3级血流分级差异无统计学意义（94％ vs 90％,P〉0．05）,但直接支架组与预扩张组比较,术后即刻MBG分级2～3级明显增高（90％ vs 74％,P〈0．05）,无复流（no—reflow,NR）发生率明冠降低（10％ vs 26％,P〈0．05）。两组6个月MACE差异无统计学意义（6％ vs 10％,P〉0．05）,冠脉造影再狭窄发生率及支架内最小管腔直径、节段内最小管腔直径、支架内晚期管腔丢失、节段内晚期管腔丢失差异均无统计学意义[分别为5．5％VS7．7％,（2．91±0．25）mm vs（2．94±0．35）mm、（2．87±0．18）mm vs（2．84±0．25）mm、（0．12±0．09）mm vs（0．12±0,08）mm、（0,14±0．12）mm vs（0．13±0．10）mm,P值均〉0．05]。结论无球衰预扩张直接置入国产药物洗脱支架治疗AMI安全可行,可降低AMI血管再通后心肌无复流的发生。     

冠心病患者P-选择素水平及其与冠状动脉病变程度间的关系

目的观察冠心病不同类型患者中P选择素水平的变化及其与冠状动脉粥样硬化狭窄程度的数量关系,探讨急性冠状动脉综合征临床识别和预测的炎症指标。方法应用酶联免疫吸附法检测血浆可溶性P选择素水平,对冠状动脉粥样硬化病变程度按照病变支数、Gensini评分和ACC/AHA冠状动脉病变A、B、C分型进行数量评估。结果①冠心病组P选择素水平高于正常对照组(180.6ng/L±60.5ng/Lvs.145.3ng/L±21.7ng/L,P<0.05);②急性冠状动脉综合征组P选择素水平高于稳定型心绞痛组(191.4ng/L±63.7ng/Lvs.141.3ng/L±17.9ng/L,P<0.01);③冠状动脉多支病变组P选择素水平高于单支病变组(190.1ng/L±64.2ng/Lvs.157.2ng/L±43.4ng/L,P<0.05)。P选择素水平与冠状动脉病变数量呈Spearman正相关(rs=0.349,P=0.003);与A、B、C型冠状动脉病变程度呈Spearman正相关(rs=0.358,P=0.002);与Gensini法评分呈线性正相关(r=0.391,P=0.001)。结论①细胞黏附分子P选择素水平受冠状动脉粥样硬化程度、数量的影响,与冠状动脉粥样硬化狭窄病变程度和数量呈正相关。②P选择素水平与急性冠状动脉综合征的发生有关,是急性冠状动脉综合征临床识别和预测的炎症指标。     

Effects of a very-low-calorie diet on metabolic control and cardiovascular risk factors in the treatment of obese non-insulin-dependent diabetics

Ten obese non-insulin-dependent diabetics (six men, four women) with secondary drug failure were treated with a hypocaloric diet only (2100-3350 kJ/d) for 3 mo to assess the effects of weight reduction on metabolic control, energy production rate, and cardiovascular risk factors. During the 3 mo of follow-up the mean body weight decreased from 101.0 +/- 7.2 (means +/- SEM) to 87.2 +/- 5.5 kg (p less than 0.001). Basal energy production rate (kJ/min) decreased by 8.5%. Fasting blood glucose declined from 12.3 +/- 0.4 to 10.5 +/- 0.7 mmol/L (p less than 0.05) but mean diurnal glucose and glycosylated hemoglobin A1c did not change significantly. Serum total cholesterol was decreased at 2 wk but at 3 mo it did not differ significantly from the baseline value. A marked reduction was observed in serum triglycerides after 3 mo (4.57 +/- 1.0 vs 2.18 +/- 0.26 mmol/L, p = 0.012). The high-density lipoprotein (HDL) cholesterol increased after weight reduction (0.96 +/- 0.06 vs 1.11 +/- 0.05 mmol/L, p = 0.009). A significant decline was found in both systolic (152 +/- 6 vs 133 +/- 3 mm Hg, p = 0.004) and diastolic blood pressure (92 +/- 3 vs 81 +/- 3 mm Hg, p = 0.007). There was no evidence of linoleic acid deficiency after this diet.     

Connection between microalbuminuria and subclinical cardiovascular autonomic neuropathy in diabetic children]

Cardiovascular tests were investigated in 16 microalbuminuric, in 20 normoalbuminuric diabetic children and a control group of 20 healthy children. Comparing to the control group, in both of two diabetic groups a similar increase in resting heart rate (74.5 +/- 2.5/min vs. 87.8 +/- 3.5/min, p less than 0.01, and 83.6 +/- 3.2/min, p less than 0.05) and a decrease in hyperventilatory arrhythmia (32.3 +/- 1.2/min vs. 20.1 +/- 0.8/min, p less than 0.01, and 17.2 +/- 0.8/min, p less than 0.01) was observed. In the diabetic group with microalbuminuria in comparison with both the control group and the normoalbuminuric group there was a lower standing/lying heart rate ratio (1.02 +/- 0.03 vs. 1.30 +/- 0.05, p less than 0.01, and 1.22 +/- 0.05, p less than 0.05), a pronounced orthostatic decrease in blood pressure (15.1 +/- 0.3 mmHg vs. 2.0 +/- 0.1 mmHg, p less than 0.001, and 5.0 +/- 0.2 mmHg, p less than 0.01) and a diminished increase in blood pressure during sustained handgrip (6.3 +/- 0.2 mmHg vs. 14.0 +/- 0.3 mmHg, p less than 0.01, and 12.2 +/- 0.3 mmHg, p less than 0.05). The occurrence of cases with distinct autonomic dysfunction (3 or more abnormal cardiovascular tests) proved to be more frequent in the group with microalbuminuria than in the diabetic group with normal albumin excretion (6/16 vs. 1/20, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Carotid intima-media thickness in patients with Type 2 diabetes and hypercholesterolemia

Both patients with Type 2 diabetes mellitus (T2DM) and with hypercholesterolemia have a more extensive and accelerated atherosclerosis with higher common carotid artery intima-media thickness (CIMT) values than the general population. The aim of this study was to compare the CIMT in polygenic hypercholesterolemia (HP; n=41: 30 females and 11 males, aged 52+/-15 yr) and in T2DM (n=43: 22 females and 21 males, aged 59+/-11 yr), with a duration of disease less than 5 yr and no evidence of coronary heart disease. A control group (C) of 40 sex- and age-matched healthy subjects was studied. We evaluated the CIMT on the far wall of the distal segment of the common carotid arteries on sites free of plaque. The mean of the CIMT measurements (Tmean; 9 on each side) and the maximal CIMT measured (Tmax) were used as the representative values for each subject. Tmax values were 0.96+/-0.2 mm and 0.82+/-0.2 mm in T2DM and HP, respectively, which were significantly higher than C (0.74+/-0.1 mm). Corresponding values of Tmean were 0.8+/-0.1 mm and 0.71+/-0.2 mm, both significantly higher than C (0.68+/-0.1 mm). In HP, both Tmax and Tmean values were positively correlated to age (p=0.0001 and p=0.0001, respectively), body mass index (BMI; p=0.05 and p=0.05, respectively), presence of hypertension (p=0.003 and p=0.0008, respectively) and fibrinogen (p=0.0009 and p=0.001, respectively); Tmean was also correlated to apolipoprotein B (ApoB; p=0.03). The multiple "stepwise" regression analysis revealed fibrinogen and age as the only significant determinants of Tmax and Tmean. In T2DM Tmax and Tmean were positively correlated to age only (p=0.04 and p=0.01, respectively). In conclusion, T2DM patients have a more accelerated atherosclerosis than subjects with HP. This is evident after a short duration of disease, probably for a longer latency period of disease and the presence of multiple risk factors.     

The effect of controlled and uncontrolled dynamic lower extremity training in the rehabilitation of patients with chronic obstructive pulmonary disease

Pulmonary rehabilitation has become a part of the integrated management of patients with chronic obstructive pulmonary disease (COPD). The lower extremity dynamic training has been proved to be the most effective element of the program. OBJECTIVE: Does the supervised training have more favorable effect in case of similar program? PATIENTS AND METHODS: In two groups: 54 patients, supervised (group K, n = 22) and not supervised (group NK, n = 32) by physiotherapists, chosen at random have been investigated. Both groups consisted of hospitalized patients of the same severity (forced expiratory volume in one second) [FEV1 (average +/- SD)]: K: 51.0 +/- 16.1 vs. NK: 51.9 +/- 15.6% pred). Group K performed physiotherapist-supervised cycling training in the Pulmonology Ambulance Unit 3-4 times a week for 45 minutes doing an 8-week period and group NK performed training in the form of cycling, stepping on stairs or dynamic walking at home with the same duration, weekly periodicity and time interval. RESULTS: After rehabilitation vital capacity (VC) (K: 3.0 +/- 0.8 vs. 3.3 +/- 0.7 l, p < 0.05), emphysema ratio (RV/TLC): K: 53.5 +/- 10.1 vs. 51.6 +/- 9.9, p < 0.05) in the supervised group, and alveolar volume (VA) in the not supervised group (NK: 4.3 +/- 0.9 vs. 4.7 +/- 0.9 l, p < 0.05) significantly improved. Improvement of exercise capacity was more effective in group K (K: 92.7 +/- 33.9 vs. 106.4 +/- 34.5 W, p < 0.001; NK: 95.8 +/- 36.7 vs. 99.9 +/- 35.1 W, p < 0.05). In both groups aerobic capacity (VO2: K: 1.2 +/- 0.4 vs. 1.3 +/- 0.4 l/min, p < 0.01, NK: 1.1 +/- 0.4 vs. 1.2 +/- 0.4 l/min, p < 0.01; VO2/kg: K: 16.1 +/- 5.5 vs. 17.5 +/- 5.8 ml/kg/mm, p < 0.01, NK: 16.2 +/- 5.3 vs. 16.7 +/- 4.8 ml/kg/ min, p < 0.01) and anaerobic threshold level [AT (pred VO2%)] (K: 36.6 +/- 9.8 vs. 42.8 +/- 10.2%, p < 0.001; NK: 40.8 +/- 12.0 vs. 44.6 + 11.6%, p < 0.001) significantly improved. Heart rate reserve: (K: 17.7 +/- 22.7 vs. 28.8 +/- 31.5 l/min, p < 0.01; NK: 20.4 +/- 21.2 vs. 25.0 +/- 21.6 l/min, p < 0.01) improved at the same level of exercise. The Borg scale of dyspnea (0-10): (K: 6.4 +/- 2.5 vs. 5.7 +/- 2.7, p < 0.05; NK: 7.5 +/- 1.8 vs. 6.9 +/- 2.2, p < 0.05) was reduced and quality of life score (0-24): K: 11.5 +/- 0.7 vs. 9.0 +/- 2.8, p < 0.005; NK: 11.6 +/- 2.3 vs. 7.0 +/- 1.9, p < 0.005) was improved. CONCLUSION: In both group dynamic lower extremity training caused improvement in exercise capacity. The favorable metabolic effect of training was shown by the change of anaerobic threshold resulting in less carbon dioxide production during analogous exercise. This reduction led to less ventilation reducing the work of breathing in supervised group. The more favorable adaptation taking place in the group supervised by physiotherapists might have resulted from the controlled higher intensity of the training.     

Inhalation of concentrated ambient air particles exacerbates myocardial ischemia in conscious dogs

Short-term increases in ambient air pollution have been associated with an increased incidence of acute cardiac events. We assessed the effect of inhalation exposure to concentrated ambient particles (CAPs) on myocardial ischemia in a canine model of coronary artery occlusion. Six mongrel dogs underwent thoracotomy for implantation of a vascular occluder around the left anterior descending coronary artery and tracheostomy to facilitate particulate exposure. After recovery (5-13 weeks), pairs of subjects were exposed for 6 hr/day on 3 or 4 consecutive days. Within each pair, one subject was randomly assigned to breathe CAPs on the second exposure day and filtered air at other times. The second subject breathed CAPs on the third exposure day and filtered air at other times. Immediately after each exposure, subjects underwent 5-min coronary artery occlusion. We determined ST-segment elevation, a measure of myocardial ischemia heart rate, and arrhythmia incidence during occlusion from continuous electrocardiograms. Exposure to CAPs (median, 285.7; range, 161.3-957.3 microg/m3) significantly (p = 0.007) enhanced occlusion-induced peak ST-segment elevation in precordial leads V4 (9.4 +/- 1.7 vs. 6.2 +/- 0.9 mm, CAPs vs. filtered air, respectively) and V5 (9.2 +/- 1.3 vs. 7.5 +/- 0.9 mm). ST-segment elevation was significantly correlated with the silicon concentration of the particles and other crustal elements possibly associated with urban street dust (p = 0.003 for Si). No associations were found with CAPs mass or number concentrations. Heart rate was not affected by CAPs exposure. These results suggest that exacerbation of myocardial ischemia during coronary artery occlusion may be an important mechanism of environmentally related acute cardiac events.     

Comparative study of the reno-protective effect of short- and long-acting antihypertensive agents in IgA nephropathy]

The progression of IgA-NP is influenced unfavourably by development and existence of hypertension. The treatment of hypertension (HTN) has an important role in these patients. Both short- and long-acting formulations of angiotensin convertase enzim inhibitors (ACEi) and calcium channel blockers (CCB) lower blood-pressure, however long-acting preparations may provide better control and may have more renoprotective effect. Verifying this hypothesis, 22 IgA-NP patients were followed for 7.25 +/- 2.36 years. The patients were on short-acting ACEi (captopril, n = 9) or dihydropyridine type CCB (nifedipin, n = 2) or both (captopril + nifedipine n = 11), after at least 3 years the medication was changed to long-acting ACEI (enalapril, n = 4; cilazapril, n = 1), or non dihydropyridine type CCB (diltiazem hydrochlorid, n = 1) or both (n = 16). Just before changing the medication these patients underwent 24 hour ambulatory blood pressure monitoring and at the same time the level of proteinuria and the creatine clearance were measured. Values of serum-creatinine were measured in every 3-4 months within a 3 years period before and after the exchange of antihypertensive drugs. The regression of 1/creatinine was a = -5.28.10(-5) +/- 1.16.10(-4) before and a = 1.03.10(-4) +/- 2.05.10(-4) after the change of medication. Using paired t-test there was a significant difference between the regressions of 1/creatine (p < 0.005). Systolic blood pressure (SBP) (128 +/- 81 Hgmm vs. 126.09 +/- 11.67 Hgmm) was not different, however, diastolic blood pressure (DBP) (84.15 +/- 7.94 Hgmm vs. 79.78 +/- 7.17 Hgmm), diastolic percent time elevation index (HTI) (43.58 +/- 23.57% vs. 25.61 +/- 20.1%) and 24-hour diastolic hyperbaric impact (114.71 +/- 81.9 vs. 51.51 +/- 51.4, p < 0.05) was lower with long-acting antihypertensive agents, as was the proteinuria (1.18 +/- 0.94 g/die vs. 0.69 +/- 1.08 g/die, p < 0.05). Diurnal variation and systolic percent time elevation index were not different. We conclude that long-acting ACEi and non dihydropyridine type CCB formulations result in better outcomes in IgA nephropathy patients compared to short-acting drugs, probably because of better and smoother blood pressure control, lowering of proteinuria and better compliance of the patients.     

Carbohydrate-protein drinks do not enhance recovery from exercise-induced muscle injury

This study examined the effects of carbohydrate (CHO), carbohydrate-protein (CHO+PRO), or placebo (PLA) beverages on recovery from novel eccentric exercise. Female participants performed 30 min of downhill treadmill running (-12% grade, 8.0 mph), followed by consumption of a CHO, CHO+PRO, or PLA beverage immediately, 30, and 60 min after exercise. CHO and CHO+PRO groups (n=6 per group) consumed 1.2 g x kg body weight(-1) x hr(-1) CHO, with the CHO+PRO group consuming an additional 0.3 g x kg body weight(-1) x hr(-1) PRO. The PLA group (n=6) received an isovolumetric noncaloric beverage. Maximal isometric quadriceps strength (QUAD), lower extremity muscle soreness (SOR), and serum creatine kinase (CK) were assessed preinjury (PRE) and immediately and 1, 2, and 3 d postinjury to assess exercise-induced muscle injury and rate of recovery. There was no effect of treatment on recovery of QUAD (p= .21), SOR (p= .56), or CK (p= .59). In all groups, QUAD was reduced compared with PRE by 20.6%+/-1.5%, 17.2%+/-2.3%, and 11.3%+/-2.3% immediately, 1, and 2 d postinjury, respectively (p< .05). SOR peaked at 2 d postinjury (PRE vs. 2 d, 3.1+/-1.0 vs. 54.0+/-4.8 mm, p< .01), and serum CK peaked 1 d postinjury (PRE vs. 1 d, 138+/-47 vs. 757+/-144 U/L, p< .01). In conclusion, consuming a CHO+PRO or CHO beverage immediately after novel eccentric exercise failed to enhance recovery of exercise-induced muscle injury differently than what was observed with a PLA drink.     

Evaluation of a diet containing probiotics and zinc for the treatment of mild diarrheal illness in children younger than one year of age

OBJECTIVES: Supplementation of probiotics and supplementation of zinc during acute gastroenteritis in children have been shown to exert positive effects on diarrhea duration and severity. Our aim was to evaluate a new diet enriched with zinc and probiotic bacteria in the treatment of acute gastroenteritis in young children. METHODS: In a double blind prospective study, 65 children aged 6-12 months were randomized to receive 6 x 10(9) colony forming units of Streptococcus thermophilus, Bifidobacterium lactis, Lactobacillus acidophilus (2 x 10(9) of each strain), 10 mg of zinc/day, and 0.3 grams of fructo-oligosaccharides in the supplemented group (n = 33) or placebo (n = 32), given in a soy protein based rice cereal. For each child, age, sex, weight, degree of dehydration, the presence of fever or vomiting, stool frequency and consistency were recorded daily until diarrhea resolution. RESULTS: Diarrhea resolution occurred after 1.43 +/- 0.71 days in the supplemented group vs. 1.96 +/- 1.24 in the control group (p = 0.017). In the subset of children who presented with vomiting, time to vomiting resolution was 0.27 +/- 0.59 vs. 0.81 +/- 0.91 days in the supplemented and control groups, respectively (p = 0.06). On day 3, there was only 1 child with watery stools in the supplemented group versus 10 children in the control group (p = 0.02). CONCLUSIONS: In our series, the feeding of a cereal containing Streptococcus thermophilus, Bifidobacterium lactis, Lactobacillus acidophilus and zinc, reduced the severity and duration of acute gastroenteritis in young children. However, whether this combination is better than either the addition of probiotics or zinc alone is yet to be determined.     

Supplementation of omega-3 fatty acids in parenteral nutrition beneficially alters phospholipid fatty acid pattern

BACKGROUND: The clinical safety and the uptake of omega-3 polyunsaturated fatty acids (PUFA) into the serum phospholipids and erythrocyte membranes after administration of fish-oil-supplemented parenteral nutrition (PN) was investigated in colorectal surgical patients. METHODS: Forty patients undergoing colorectal surgery (n = 40) and with an indication for PN were enrolled in a prospective, double-blind, randomized study to receive an omega-3 PUFA-supplemented 20% lipid emulsion (Lipoplus; B. Braun Melsungen, Melsungen, Germany; test group, n = 19) for 5 days postoperatively. The control group received a standard 20% fat emulsion (Lipofundin MCT/LCT, B. Braun Melsungen, Melsungen, Germany, control group, n = 21). Clinical outcome parameters and safety were assessed by means of adverse events recording clinical parameters and hematologic analyses. The contents of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as arachidonic acid (AA), in phospholipid fractions in plasma and in erythrocytes were analyzed preoperatively, on postoperative days 1, 6, and 10 using liquid gas chromatography. RESULTS: Both fat emulsions were well tolerated, and none of the adverse events was considered to be related to treatment. Postoperative infectious complications occurred in 4 patients of the omega-3 PUFA group vs 7 patients in the control group. As compared with the control group, the omega-3 PUFA group had significantly increased levels of EPA in the membranes of the erythrocytes in postoperative day 6 (2.0% +/- 0.9% vs 0.8% +/- 0.5% fatty acid methyl esters, [FAME]) and postoperative day 10 (2.1% +/- 0.8% vs 0.9% +/- 0.7% FAME, p < .05). Also, the EPA levels in the serum phospholipids were significantly higher than in the control group on the same postoperative days (7.0% +/- 2.6% vs 1.3% +/- 0.8% and 3.6% +/- 1.0% vs 1.0% +/- 0.4% FAME, p < .05). The DHA levels in the serum phospholipids were significantly higher in the omega-3 PUFA group compared with the control on postoperative days 6 and 10 (11.8% +/- 1.9% vs 8.4% +/- 1.5% and 11.2% +/- 1.6% vs 8.5% +/- 1.4% FAME, p < .05). AA levels were not significantly different in the both groups. CONCLUSIONS: Omega-3-fatty-acids-supplemented fat emulsions for parenteral administration are safe and very well tolerated. This study demonstrates that parenteral administration of omega-3-PUFA-enriched fat emulsions leads to increased incorporation of EPA and DHA into phospholipids in serum and erythrocytes, whereas AA levels remain unchanged. Thus, postoperative parenteral administration of omega-3-PUFA-enriched lipid emulsions could have an impact on the postoperative inflammatory response after abdominal surgery and could be used in standard postoperative care when PN is indicated.     

放射CT血管造影对冠状动脉疾病诊断的临床应用

目的评价放射CT血管造影对冠状动脉钙化斑块检出的影响。方法52例病人采用放射CT血管造影扫描心电门控技术行冠状动脉钙化积分检查,每一病例原始数据进行2种不同层厚(1mm和3mm)重建。结果3mm组检出的钙化斑块数最多为52个,其中小钙化斑块数达到45个。以1mm组检出的钙化斑块数及其中的小钙化斑块数为标准,3mm检出的钙化斑块及小钙化斑块敏感性相对较低。结论采用放射CT血管造影容积扫描回顾性心电门控技术检出钙化斑块时,3mm层厚是不适宜的,1mm层厚较3mm层厚可以检出更多的钙化斑块,尤其是小钙化斑块,对于临床确定钙化斑块的存在是适合的。     

Non-attendance at secondary prevention clinics: the effect on lipid management

BACKGROUND: Secondary prevention of coronary artery disease is effective in reducing morbitiy and mortality. Our aim was to assess lipid management following non-attendance to a hospital based secondary prevention clinic. METHODS: Data were collected over 5 years on statin usage and total cholesterol levels for patients with coronary artery disease following attendance at a cardiac nurse led outpatient clinic. Lipid levels were taken from a central laboratory database, for both patients discharged from clinic and non-attenders. RESULTS: From 935 inpatients discharged from hospital, 248 (29%) defaulted from outpatient follow up. Lipid lowering drug usage was similar (72% vs. 74% for non-attenders, p=NS). Attenders at the nurse led outpatient clinic were more likely to achieve a total cholesterol <5 mmol/L at discharge than non-attenders (70% vs. 43%; p < 0.001), with a lower mean total cholesterol (4.75 +/- 0.06 mmol/L vs. 5.33 +/- 0.08 mmol/L; p < 0.001). Non-attenders subsequently had a greater number of cholesterol measurements than those who were discharged from the hospital based clinic (range 0-12, c2 23.8 on 12 df p < 0.005). Lipid profiles in hospital non-attenders remained inferior with fewer achieving a total cholesterol <5 mmol/L (61% vs. 78%; p < 0.001), and having greater mean total cholesterol levels (4.85 +/- 0.06 mmol/L vs. 4.52 +/- 0.05 mmol/L; p < 0.001). CONCLUSIONS: Patients defaulting from hospital follow up have higher total cholesterols with fewer at target level compared to attenders. Though non-attenders receive subsequent lipid measurement, inferior lipid profiles persist compared to patients who completed hospital follow up to be discharged. Further implementation strategies are needed with regard to lipid management in this patient group.     

Direct comparison of dietary portfolio vs statin on C-reactive protein

BACKGROUND: 3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) markedly reduce serum cholesterol and have anti-inflammatory effects. The effect of cholesterol-lowering diets on inflammatory biomarkers is less well known. OBJECTIVE: To compare the efficacy of a dietary combination (portfolio) of cholesterol-lowering foods vs a statin in reducing C-reactive protein (CRP) as a biomarker of inflammation linked to increased cardiovascular disease risk. METHODS: In all, 34 hyperlipidemic subjects completed three 1-month treatments as outpatients in random order: a very low-saturated fat diet (control); the same diet with 20 mg lovastatin (statin); and a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (portfolio). Fasting blood samples were obtained at weeks 0, 2, and 4. RESULTS: Using the complete data, no treatment reduced serum CRP. However, when subjects with CRP levels above the 75th percentile for previously reported studies (> 3.5 mg/l) were excluded, CRP was reduced similarly on both statin, -16.3 +/- 6.7% (n = 23, P = 0.013) and dietary portfolio, -23.8 +/- 6.9% (n = 25, P = 0.001) but not the control, 15.3 +/- 13.6% (n = 28, P = 0.907). The percentage CRP change from baseline on the portfolio treatment (n = 25) was greater than the control (n = 28, P = 0.004) but similar to statin treatment (n = 23, P = 0.349). Both statin and portfolio treatments were similar in reducing CRP and numerically more effective than control but only the change in portfolio was significant after the Bonferroni adjustment. CONCLUSIONS: A combination of cholesterol-lowering foods reduced C-reactive protein to a similar extent as the starting dose of a first-generation statin.     

Psychological factors considerably influence the results of 6-min walk test after coronary bypass surgery

The 6-min walk test (6MWT) is a simple, low-cost method for estimating physical exercise capacity of cardiac patients, when exercise test cannot be performed, as in patients early after coronary artery bypass surgery. As the test requests active cooperation of patients, possibly not only somatic, but psychological factors can influence the results. 358 patients who arrived to Phase II residential cardiac rehabilitation after their first coronary artery bypass surgery were included in the prospective study. 6-MWT was performed at the beginning and at the end of 3 weeks program. Hospital Anxiety and Depression Scale (HADS), Type-D personality test were filled in 3 weeks after surgery. RESULTS: Patients characterized as Type-D personality (8.5%) covered considerably shorter distance than non-Type-D patients both at the beginning (255 +/- 91 m vs. 319 +/- 106 m, p < 0.01) and at the end of 6MWT (361 +/- 91 m vs. 411 +/- 106 m, p < 0.05) without any substantial differences in heart rate or rating of perceived exertion. Patients with high level of anxiety (16.5%) had lower walking distance compared to non anxious patients both at the beginning and the ending test (274 +/- 97 m vs. 320 +/- 106 m, p < 0.01 and 374 +/- 110 m vs. 413 +/- 104 m, p < 0.05), and evaluated higher rate of perceived exertion (12.5 +/- 1.1 vs. 11.9 +/- 1.4, p < 0.05 and 11.7 +/- 0.8 vs. 11.3 +/- 1.3, p < 0.05). Patients who were depressed according to HADS (14%) walked shorter distance than non depressed patients both at the beginning (267 +/- 88 m vs. 320 +/- 107 m, p < 0.01), and end of 6MWT (347 +/- 99 m vs. 416 +/- 104 m, p < 0.001). There were no differences in somatic function of patients with and without psychological alternations. CONCLUSION: Psychological factors (Type D personality, anxiety and depression) considerably influence 6MWT walking distance after coronary artery bypass surgery.     

In utero malnutrition influences wound healing of newborn rats as measured by tensile strength and collagen deposition

BACKGROUND: Studies have investigated the consequences of intrauterine malnutrition on birth weight and overall survival but not on wound healing. This study aims to assess the influence of in utero malnutrition on wound healing of newborn rats. METHODS: Pregnant Wistar rats were divided into 2 groups. Study rats were given 50% of the food intake of controls throughout pregnancy in a pair-fed manner. The body weight and length of the newborns were measured. Newborns were breast-fed until day 21, when a laparotomy was performed. The effect of the laparotomy was assessed by measure of the wound strength and collagen deposition at postoperative day (POD) 7 (n = 15) and POD 21 (n = 15). RESULTS: The body weight and length of newborns of malnourished mothers were significantly smaller at birth compared with controls (respectively, 4.5 +/- 0.1 g vs 5.8 +/- 0.1 g, p = .0003 and 4.6 +/- 0.1 cm vs 5.2 +/- 0.1 cm, p = .0003). Maximum, rupture, and tensile strength of malnourished newborns were smaller than controls on POD 7 (0.281 +/- 0.031 vs 0.470 +/- 0.031, p = .0061, 0.112 +/- 0.06 kgf vs 0.173 +/- 0.08 kgf, p = .0495 and 0.019 +/- 0.002 kgf/mm2 vs 0.024 +/- 0.003 kgf/mm2, p = .050, respectively). On POD 21, only tensile strength remained lower (0.044 +/- 0.003 kgf/mm2 vs 0.058 +/- 0.003 kgf/mm2, p = .0477). Type I collagen deposition of malnourished newborns was similar to controls on POD 7 (57.69 +/- 10.06 vs 48.34 +/- 15.65, p = .3187) and on POD 21 (75.6 +/- 7.21 vs 80.0 +/- 9.92, p = .4212). CONCLUSIONS: In utero malnutrition decreases the abdominal wound strength of newborn rats but not the collagen deposition, suggesting that breast-feeding nutrition is effective in recovering the collagen deposition but not overall wound strength.     

心包脂肪组织体积与冠状动脉CT血管造影管腔狭窄程度的相关性研究

目的：评估心包脂肪组织（PAT）体积与320排冠状动脉CT造影（CCTA）动脉管腔狭窄程度的关系。方法：选取因可疑冠心病而接受320排CCTA检查的患者1597例,其中发现存在动脉斑块的患者382例,分别比较1支、2支、3支以及4支冠状动脉病变和无狭窄或管腔不规则狭窄、轻度狭窄、中度狭窄、重度狭窄以及闭塞者的PAT体积。同时比较了存在斑块、钙化斑块（CP）、非钙化斑块（NCP）和混合斑块（MP）与无冠心病者的PAT体积。结果：Pearson相关回归分析显示,PAT体积分别与冠状动脉病变支数和冠状动脉管腔狭窄程度呈正相关。单因素分析显示存在CP、NCP、MP及多支病变者的PAT体积大于无斑块者分别为（211.4±93.6）cm3、（233.2±95）cm3、（257.3±82.1）cm3及（261.5±101.7）cm3,与无斑块者（173.7±98.1）cm3比较差异有统计学意义（t=4.89,t=7.11,t=9.66,t=11.65;P〈0.05）。在多因素Cox比例风险回归模型分析中,只有PAT体积明显增大是存在MP者的独立预测因子（危害比=4.79（2.03-13.16）（95%CI）,P〈0.001）。结论：PAT体积与冠状动脉病变支数和狭窄程度呈正相关。PAT体积明显增大是存在MP者的独立预测因子,PAT体积是冠心病重要的危险因素之一。