Expression of synovial fluid and articular cartilage VIP in human osteoarthritic knee: A new indicator of disease severity?

Objectives

Vasoactive intestinal peptide (VIP) is a molecule shared by the neuroendocrine immune network and is considered to be a potential candidate for treatment of inflammatory and autoimmune diseases. Although some recent studies demonstrate that VIP has a protective role in animal RA models, its variant in different disease grade of OA remains uncertain.

Design and methods

Fifty patients with primary knee OA and ten controls with severe trauma were enrolled. Synovial fluid and articular cartilage samples were collected from specimens of total knee arthroplasty (TKA) or knee above amputation. VIP levels in these samples were assessed by ELISA and immunohistochemistry. Kellgren–Lawrence criteria and Mankin score were taken to determine the disease severity.

Results

Compared to the controls, OA patients have lower VIP concentration in synovial fluid (659.70 ± 112.79, 95%CI 579.01–740.38 vs 470.83 ± 156.40, 95%CI 426.38–515.28 pg/mL, P < 0.001) and articular cartilage (0.26 ± 0.02, 95%CI 0.24–0.28 vs 0.20 ± 0.04, 95%CI 0.18–0.21, P < 0.001). Subsequent analysis show that the VIP expression in synovial fluid is markedly correlated with its OD in articular cartilage (Pearson's r = 0.580, P < 0.001). Furthermore, the synovial fluid and articular cartilage levels of VIP both demonstrated to be negatively correlated with severity of disease (Spearman's ρ = 0.838, P < 0.001; Spearman's ρ = 0.814, P < 0.001).

Conclusions

VIP in synovial fluid and articular cartilage is negatively associated with progressive joint damage in OA and is a potential indictor of disease severity.     

Oxidative stress biomarkers and chromogranin A in uremic patients: Effects of dialytic treatment

Objective

To evaluate oxidative stress in uremia and dialysis and chromogranin A, a stress hormone that could be related to oxidative processes.

Methods

Plasma oxidative stress biomarkers (–SH, 8-OHdG, and ox-LDL) and chromogranin A were measured in 89 outpatients (21 uremic patients, 17 in peritoneal dialysis, and 51 in haemodialysis), and in 18 subjects with normal renal function.

Results

–SH groups were significantly reduced in heamodialysis, peritoneal, and uremic patients as compared with the control group (p = 0.01), while 8-OHdG was increased (p < 0.01). No differences were observed for ox-LDL. Chromogranin A was increased in uremic, peritoneal and haemodialysis patients (p < 0.01), showing a positive correlation to 8-OHdG (p < 0.01).

Conclusion

Oxidative stress biomarkers and chromogranin A levels differ between control subjects when compared to both uremic and dialysis patients. No differences were observed between uremic and dialysis patients, suggesting that uremia is the major source of the increase in oxidative stress and CgA levels in patients with end stage renal disease.     

Reference values for serum ferritin in Chinese Han ethnic males: results from a Chinese male population survey

Objectives

We calculated central-95-interpercentile reference values for serum ferritin (SF).

Design and methods

Serum samples were collected from the Fangchenggang Area Male Health and Examination Survey (FAMHES). After screening, we enrolled a total of 1,223 Chinese Han men between the ages of 20 and 69 years. SF values were measured by electrochemiluminescence immunoassay. The two-sided 95-percentile reference values were calculated using both parametric and nonparametric statistical methods.

Results

SF values were distributed log-normally. The central-95-percentile reference values for SF were 88.2–771.7 μg/L (nonparametric) or 104.0–832.2 μg/L (parametric). Neither the non-smoking and smoking group (P = 0.921) nor the non-drinking and drinking group (P = 0.584) exhibited any difference in SF. Higher concentrations of SF were associated with a higher Body Mass Index (BMI) (r = 0.266, P < 10^{− 5}) but not with increasing age of the participants (P = 0.808).

Conclusion

The reference values for SF calculated in this study are higher than previously-reported reference levels.     

Correlation of plasma and synovial fluid osteopontin with disease severity in knee osteoarthritis

Objectives

The purposes of this study were to examine osteopontin levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease.

Design and methods

Thirty-two patients aged 53-83 years with knee OA and 15 healthy controls were enrolled in this study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren-Lawrence criteria. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay.

Results

The mean plasma osteopontin concentration of the knee OA patients was significantly higher compared with that of healthy controls (168.8 ± 15.6 vs 67.2 ± 7.7 ng/mL, P < 0.0001). Osteopontin levels in synovial fluid were significantly higher with respect to paired plasma samples (272.1 ± 15.0 vs 168.8 ± 15.6 ng/mL, P < 0.001). In addition, plasma osteopontin levels showed a positive correlation with synovial fluid osteopontin levels (r = 0.373, P = 0.035). Subsequent analysis showed that plasma osteopontin levels significantly correlated with severity of disease (r = 0.592, P < 0.001). Furthermore, the synovial fluid levels of osteopontin also correlated with disease severity (r = 0.451, P = 0.01).

Conclusion

The data suggest that osteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity and could be predictive of prognosis with respect to the progression of knee OA.     

Soluble P selectin in synovial fluid level is correlated with the radiographic severity of knee osteoarthritis

BackgroundRecent studies provide evidence that inflammation is a feature of the disease process in Osteoarthritis (OA). The clinical significance of P selectin (Ps) in OA has not been adequately studied and the association between Ps level and OA severity remains unknown.MethodsWe enrolled 120 knee OA subjects and 45 controls. All patients were scored for Kellgren–Lawrence grade (0–4). The Ps in serum and synovial fluid (SF) as well as serum C-reactive protein (CRP) levels were detected.ResultsThe mean Ps level in OA subjects was markedly increased than that in controls. In OA patients, the SF Ps levels increased with the severity of KL scores and significantly correlated with severity of disease (r = 0.546, P < 0.001) and serum CRP level (r = 0.488, P < 0.001). However, the serum Ps level did not show a significant correlation with the severity of OA.ConclusionThe Ps levels in SF were significantly correlated with the severity of OA, suggesting that it may be used as a biomarker to evaluate the progression of OA.     

Association of MIF in serum and synovial fluid with severity of knee osteoarthritis

ObjectiveRecent evidences suggest that inflammation contributes to the development and progression of osteoarthritis (OA). This study aims to determine macrophage migration inhibitory factor (MIF) levels in serum and synovial fluid (SF) of patients with knee OA and to analyze the association of MIF levels with the radiographic severity of OA.Design and methods224 patients with knee OA and 186 healthy controls were enrolled in this study.ResultsHigher levels of serum MIF were found in knee OA patients compared with healthy controls. Knee OA patients with Kellgren and Lawrence (KL) grade 4 showed significantly elevated MIF levels in serum and SF compared with those with KL grade 2 and 3. MIF levels in serum and SF of knee OA patients were significantly related to disease severity evaluated by KL grading criteria.ConclusionMIF levels in serum and SF were closely related to the radiographic severity of OA.     

Serum galectin-3 levels in patients with nonalcoholic fatty liver disease

Objectives

Galectin-3 might serve as a biomarker of human metabolic alterations. We measured serum levels of galectin-3 in patients with nonalcoholic fatty liver disease (NAFLD) and examined their association with clinical and histological phenotypes.

Design and methods

Serum levels of galectin-3 were assayed in 71 patients with biopsy-proven NAFLD and 39 controls.

Results

Serum galectin-3 levels did not differ in patients with NAFLD (median 4.1 ng/mL; interquartile range: 1.5–5.5 ng/mL) compared with healthy controls (median 3.1 ng/mL; interquartile range: 0.8–7.5 ng/mL, P = 0.93). Among patients with NAFLD, however, serum galectin-3 levels correlated significantly with BMI (r = 0.267, P < 0.05). This association persisted after adjustment for potential confounders (β = 0.30; t = 2.11, P < 0.05).

Conclusions

Although galectin-3 was modestly associated with BMI, our results do not support the hypothesis that levels of this molecule are altered in patients with NAFLD.     

¹H nuclear magnetic resonance based metabolic urinary profiling of patients with ischemic heart failure

Objectives

We sought to identify metabolic pathways characterizing human heart failure (HF) using ¹NMR based urinary metabolomic analysis in conjunction with multivariate statistics.

Design and methods

Patients with systolic HF of ischemic origin (n = 15) and healthy controls (n = 20) participated in this study. Patients with type 2 diabetes mellitus were excluded.

Results

The results showed that the urine of the HF patients had higher levels of metabolites for acetate (p < 0.05) and acetone (p < 0.01) compared to the healthy controls. In addition, there was a perturbation in methylmalonate metabolism as shown by increased urinary levels of methylmalonic acid (p < 0.001) in the HF patients. HF patients also had increased urinary levels of cytosine (p < 0.01) and phenylacetylglycine (p < 0.01) and decreased 1-methylnicotinamide (p < 0.05) compared to healthy controls.

Conclusions

TCA cycle metabolites and fatty acid metabolism were modified in the HF patients, indicating altered energy metabolism. Moreover, perturbations of metabolism in nucleotide and methylmalonate were observed.     

Increased serum levels of S100B are related to the severity of cardiac dysfunction, renal insufficiency and major cardiac events in patients with chronic heart failure

Objective

To investigate the correlations between S100B and the severity of cardiac dysfunction, renal insufficiency (RI) and prognosis in chronic heart failure (CHF).

Method

Serum levels of S100B, TNF-α, high sensitivity CRP and NT-proBNP were determined in CHF patients with (n = 96) and without RI (n = 146). Patients with RI only (n = 62) and control subjects (n = 64) served for comparison. Patients were followed up for one year.

Results

S100B levels were higher in CHF patients with a further elevation in those with RI (P < 0.01). Serum S100B levels correlated with left ventricular ejection fraction, left ventricular end-diastolic volume and NT-proBNP in CHF patients, and eGFR in patients with RI (all P < 0.05). Increased S100B levels were associated with major cardiac events (MCE), and were independently associated with the presence of CHF (all P < 0.05).

Conclusion

Increased serum S100B levels were associated with the severity of cardiac dysfunction, RI and an adverse prognosis in CHF patients. It represents an independent risk factor for CHF.     

Freezing of gait and activity limitations in people with Parkinson's disease

Tan DM, McGinley JL, Danoudis ME, Iansek R, Morris ME. Freezing of gait and activity limitations in people with Parkinson's disease.

Objectives

To investigate the relationships between freezing of gait (FOG) and activity limitations in ambulant people with Parkinson's disease (PD), and to explore the contribution of FOG and gait hypokinesia to activity limitations after adjusting for the effects of disease severity.

Design

Retrospective, cross-sectional design.

Setting

Participants were recruited from neurologists' clinics and the general public in metropolitan Melbourne, Australia.

Participants

Volunteers were screened for eligibility using the following inclusion criteria: diagnosis of idiopathic PD, modified Hoehn and Yahr stages 0 to IV, without dementia. Participants (N=210) were tested (mean age ± SD, 67.9±9.6y; mean PD duration ± SD, 6.7±5.6y; median Hoehn and Yahr stage=2.5).

Interventions

Not applicable.

Main Outcome Measures

FOG was measured using the FOG questionnaire. Gait hypokinesia was quantified using both the 6-meter walk test and the Timed Up and Go test. Activity limitation was measured using the modified Unified Parkinson's Disease Rating Scale activities of daily living (ADL) section and the Schwab and England ADL scale.

Results

Severity of gait freezing correlated significantly with the level of activity limitation (Spearman correlation coefficient, ρ=−.49 to .48; P<.001). A hierarchic regression model showed that disease severity explained 37.5% of the variance in Schwab and England ADL score (P<.001). Gait hypokinesia and FOG severity scores explained an additional 9.1% of the variance in activity limitation (R² change=.091; P<.001).

Conclusions

FOG severity and gait hypokinesia were associated with reduced levels of activity after adjusting for disease severity.     

The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury

Myaskovsky L, Burkitt KH, Lichy AM, Ljungberg IH, Fyffe DC, Ozawa H, Switzer GE, Fine MJ, Boninger ML. The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury.

Objective

To examine the association of race and cultural factors with quality-of-life factors (participation, life satisfaction, perceived health status) in people with spinal cord injury (SCI).

Design

Cross-sectional multisite study using structured questionnaires.

Setting

Six National SCI Model Systems centers.

Participants

People with SCI (N=275; age ≥16y; SCI with discernable neurologic impairments; used power or manual wheelchair for >1y as primary means of mobility; nonambulatory except for exercise purposes).

Interventions

None.

Main Outcome Measures

Participation (Craig Handicap Assessment and Reporting Technique Short Form); satisfaction (Satisfaction With Life Scale); and perceived health status (2 items from 36-Item Short Form Health Survey).

Results

African American (n=96) with SCI reported more experiences of discrimination in health care, greater perceived racism, more health care system distrust, and lower health literacy than whites (n=156; P range, <.001–<.05). Participants who reported experiencing more discrimination in health care reported better occupational functioning (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.07–2.09; P<.05). Those who perceived more racism in health care settings reported better occupational functioning (OR, 1.65; 95% CI, 1.12–2.43; P<.05) and greater perceived health (β=.36; 95% CI, .05–.68; P<.05). Those who reported more distrust in the health care system reported better current health compared with 1 year ago (β=.38; 95% CI, .06–.69; P<.05). Those who reported better communication with their health care provider reported higher levels of mobility (OR, 1.5; 95% CI, 1.05–2.13; P<.05) and better general health (β=.27; 95% CI, .01–.53; P<.05).

Conclusions

In this cross-sectional study of people with SCI, higher levels of perceived discrimination and racism and better communication with health care providers were associated with an increase in participation and functioning and improvements in perceptions of well-being. These associations are different from those reported in other study populations and warrant confirmation in future prospective studies.     

Handgrip strength test as a complementary tool in the assessment of fibromyalgia severity in women

Aparicio VA, Ortega FB, Heredia JM, Carbonell-Baeza A, Sjöström M, Delgado-Fernandez M. Handgrip strength test as a complementary tool in the assessment of fibromyalgia severity in women.

Objectives

To determine the ability of handgrip strength test to discriminate between presence and absence of fibromyalgia (FM) and FM severity in women.

Design

A case-control study.

Setting

Granada, south Spain.

Participants

Women with FM (mean age ± SD, n=81; 50.0±7y) and healthy women (mean age ± SD, n=44; 47.7±6y).

Interventions

Not applicable.

Main Outcome Measures

Handgrip strength was measured in both hands (average score was used in the analyses) by a maximal isometric test using a hand dynamometer. Patients were classed as having moderate FM if the score in the Fibromyalgia Impact Questionnaire (FIQ) was less than 70 and as having severe FM if the FIQ was 70 or greater.

Results

Handgrip strength levels were lower in patients with FM than healthy women (19.3 vs 27.9kg; P<.001) and in women with severe FM (FIQ≥70) compared with those with moderate FM (FIQ<70) (16.9 vs 20.2kg; P=.02). Receiver operating characteristic curve analyses revealed that the handgrip strength threshold that best discriminated between the presence and absence of FM was 23.1kg (area under the curve [AUC]=.88; 95% confidence interval [CI], 0.82–0.94; P<.001), whereas the handgrip strength threshold that best discriminate between severe and moderate FM was 16.9kg (AUC=.67; 95% CI, 0.53–0.80; P<.05). Logistic regression analysis showed that handgrip strength 23.1kg or less was associated with 33.8 times higher odds (95% CI, 9.4–121.5) for having FM after adjustment for age. In the FM group, handgrip strength 16.9kg or less was associated with 5.3 times higher odds (95% CI, 1.9–14.5) for having severe FM.

Conclusions

Handgrip strength is reduced in women with FM as well as those with severe FM from their peers with moderate FM. Identification of women who fail to meet the suggested standards can be a helpful and informative tool for clinician.     

Prooxidant-anti-oxidant balance is not associated with extent of coronary artery disease

Objective

We have measured the pro-oxidant–antioxidant-balance (PAB) levels in patients with defined coronary artery disease (CAD) and compared them with concentrations in healthy subjects.

Design and methods

Based on angiography results, 400 patients with stable CAD were divided into CAD− and CAD+, this being further subcategorized into groups with single-, double- and triple-vessel disease (VD).

Results

The mean PAB values in the healthy subjects, was significantly lower than for other groups (P < 0.001). In CAD− patients, PAB levels were 123.2 ± 43.9, which was not statistically different compared to groups with SVD, 2VD and 3VD (P > 0.05). In the CAD+ group, PAB values in 1VD, 2VD and 3VD were not significantly different among patients with SVD, 2VD and 3VD (P > 0.05).

Conclusions

In conclusion, we found higher levels of oxidative stress in CAD+ patients compared to healthy subjects. The oxidation level was not related to measures of the extent of CAD such as number of stenosed vessels.     

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

Objective

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

Patients and methods

In a pre–post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire – PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children – STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12× 30 min.).

Results

With acupuncture, the peak expiratory flow variability differs significantly (p < 0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

Conclusion

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.     

Maternal severity of illness across levels of care: A prospective, cross-sectional study

Background

The severity of illness of women experiencing severe maternal morbidity has not been quantified outside of the intensive care setting yet is likely to have a bearing on clinical needs.

Aim

To examine severity of illness in women with severe maternal morbidity.

Methods

A prospective observational study of critically ill pregnant and postpartum women was undertaken in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals in Melbourne, during 2002–2004. Severity of illness was scored using the Acute Physiology and Chronic Health Evaluation version II (APACHE II) and Therapeutic Intervention Scoring System 28 items (TISS 28).

Results

137 women participated in the study: ICU (n = 33), HDU (n = 46) and DS (n = 58). The mean APACHE II score was 8.6 (95% CI 7.7–9.5) and mean TISS 28 score was 22.5 (95% CI 21.2–23.9). Women in ICU were sicker according to both APACHE II (mean 12.6, 95% CI 8.3–16.9) and TISS 28 (mean 31.5, 95% CI 28.2–35.5) compared to women not admitted to ICU (p < .005). There was no difference in the mean APACHE II scores of women in HDU (7.7, 95% CI 5.5–9.9) and DS (7.0, 95% CI 5.2–8.8; p = .20). Women born outside of Australia were more likely to be admitted to ICU (OR 3.27, 95% CI 1.19–8.97). Known risk factors like multiple pregnancy, age ≥35 years and nulliparity were not associated with ICU admission.

Conclusions

There was no difference in the severity of illness in women cared for in HDU and DS. It was not possible to predict which women would require ICU admission. Measurement of severity of illness adds a valuable dimension to the study of severe maternal morbidity.     

Hyperhomocysteinemia, paraoxonase concentration and cardiovascular complications in Tunisian patients with nondiabetic renal disease

Objectives

Hyperhomocysteinemia is associated with an increased risk of cardiovascular diseases. We determine homocysteine levels (Hcy), paraoxonase (PON1) concentration and their relationship on cardiovascular complications in patients with chronic renal disease (CRD).

Design and methods

The study population included 100 CRD patients and 120 healthy controls. Renal function was assessed using the eGFR by the MDRD study equation. Patients were considered to have CRD when the eGFR was < 60 mL/min/1.73 m². Hcy concentrations were determined by direct chemiluminescence assay. PON1 concentration was measured spectrophotometrically using phenylacetate as a substrate.

Results

We found an increased Hcy levels and a decreased eGFR and PON1 concentration in CRD patients compared to the control group (P < 0.001, P < 0.001, P < 0.01 respectively). Patients with cardiovascular complications showed an increased Hcy levels and a lower PON1 concentration than patients without cardiovascular complications (P < 0.001, P < 0.01 respectively).

Conclusion

We showed that hyperhomocysteinemia and low PON1 concentration are associated with CRD and markedly associated in patients with cardiovascular complications. Additional effects contribute to the severity of renal disease and increase the incidence of cardiovascular disease.     

Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study

Meeus M, van Eupen I, van Baarle E, De Boeck V, Luyckx A, Kos D, Nijs J. Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study.

Objectives

To compare the activity pattern of patients with chronic fatigue syndrome (CFS) with healthy sedentary subjects and examine the relationship between the different parameters of performed activity (registered by an accelerometer device) and symptom severity and fluctuation (registered by questionnaires) in patients with CFS.

Design

Case-control study. Participants were asked to wear an accelerometer device on the nondominant hand for 6 consecutive days. Every morning, afternoon, and evening patients scored the intensity of their pain, fatigue, and concentration difficulties on a visual analog scale.

Setting

Patients were recruited from a specialized chronic fatigue clinic in the university hospital, where all subjects were invited for 2 appointments (for questionnaire and accelerometer adjustments). In between, activity data were collected in the subject's normal home environment.

Participants

Female patients (n=67) with CFS and female age-matched healthy sedentary controls.

Interventions

Not applicable.

Main Outcome Measures

Accelerometry (average activity counts, peak activity counts, ratio peak/average, minutes spent per activity category) and symptom severity (intensity of pain, fatigue, and concentration difficulties).

Results

Patients with CFS were less active, spent more time sedentary, and less time lightly active (P<.05). The course of the activity level during the registration period (P interaction>.05), peak activity, and the staggering of activities (ratio peak/average) on 1 day were not different between groups (P>.05). Negative correlations (–.242 varying to –.307) were observed for sedentary activity and the ratio with symptom severity and variation on the same and the next day. Light, moderate, and vigorous, as well as the average activity and the peak activity, were positively correlated (.242 varying to .421) with symptom severity and variation.

Conclusions

The more patients with CFS are sedentary and the better activity is dispersed, the fewer symptoms and variations they experience on the same and next day. Inversely, more symptoms and variability is experienced when patients were more active that day or the previous day. The direction of these relations cannot be determined in a cross-sectional study and requires further study.     

Cancer-related pain and disability: a longitudinal study

Context

Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied.

Objectives

Data from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months.

Methods

A total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression.

Results

Baseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b = −0.17, t = −5.33, P < 0.001) and ≥14 disability days in the past month (odds ratio = 0.85; 95% confidence interval, 0.79–0.93; P < 0.001).

Conclusion

Disability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.     

Gas chromatography analysis of serum cholesterol synthesis and absorption markers used to predict the efficacy of simvastatin in patients with coronary heart disease

Objectives

We investigated the changes in cholesterol absorption and synthesis markers before and after simvastatin therapy in Chinese patients with coronary heart disease.

Design and method

We developed a gas chromatography method to identify cholesterol synthesis and absorption markers and measured them in patients with coronary heart disease. We then tested their use in predicting the efficacy of simvastatin in lowering cholesterol. Serum samples from 45 patients and 38 healthy humans (controls) were analyzed in a gas chromatography–flame ionization detector.

Results

Squalene and five non-cholesterol sterols—desmosterol and lathosterol (synthesis markers) and campesterol, stigmasterol, and sitosterol (absorption markers)—were detected. The recovery rates of the markers were 95–102%. After simvastatin treatment for four weeks, the total cholesterol and low-density lipoprotein cholesterol levels had significantly decreased from the baseline values (p < 0.05). The baseline lathosterol level was significantly higher in good responders than in poor responders (p < 0.05), and the stigmasterol level was significantly lower in good responders than in poor responders (p < 0.05).

Conclusions

This method should be suitable for the detection of serum squalene and non-cholesterol markers and can be used to predict the efficacy of simvastatin in patients with coronary heart disease.     

Explore the influence of BMI in the optimal time of weaning from sequential mechanical ventilation for severity chronic obstructive pulmonary disease

Objective

To study the clinical effect of body mass index (BMI) in the optimal time of weaning from sequential invasive-noninvasive mechanical ventilation (MV) by treating severity chronic obstructive pulmonary disease (COPD) patients.

Methods

94 patients with severity COPD were divided into the control group (BMI<21) and the study group (BMI>21). These two groups were treated by similar symptomatic therapies such as mechanical ventilation, antibacterial, antispasmodic, relieving asthma, antitussive, expectorant, correction of electrolyte imbalance and acid-base balance disorders, strengthen nutritional support, etc.

Results

Compared with the control group, the study group had shorter duration of invasive mechanical ventilation, non-invasive mechanical ventilation time, total mechanical ventilation time, total hospital stay (P<0.01). There are significant differences between these two groups in re-intubation rate, VAP occurred in the number of case, hospital mortality rate in 28 days (P<0.05).

Conclusions

It is difficult to wean successfully from sequential mechanical ventilation for severity COPD patients (BMI<21), so BMI as one of important reference index can be used to estimate the optimal time for weaning from sequential mechanical ventilation for severity COPD patients.