Investigation of the effect of ginger on the lipid levels. A double blind controlled clinical trial

OBJECTIVE: To study the effect of fine powder of ginger on lipid level in volunteer patients. METHODS: This is a double blind controlled clinical trial study in 2 cardiac clinics Cardiac Disease Clinic, Babol, north of Iran, between April to May 2004. We randomly divided the patients with hyperlipidemia into 2 groups, treatment group (receiving ginger capsules 3 g/day in 3 divided doses) and placebo group (lactose capsule 3 g/day in 3 divided doses) for 45 days. All subjects with diabetes mellitus, hypothyroidism, nephrotic syndrome, and alcohol drinking, pregnancy and peptic ulcer were excluded. Lipid concentrations profile before and after treatment was measured by enzymatic assay. RESULTS: Forty-five patients in the treatment group and 40 patients in placebo group participated in this study. There was a significant reduce in triglyceride, cholesterol, low density lipoprotein (LDL), very low density lipoprotein (VLDL), levels of before and after study separately in each group (p<0.05). Mean changes in triglyceride and cholesterol levels of ginger group were significantly higher than placebo group (p<0.05). Mean reduction in LDL level and increase in high density lipoprotein level of ginger group were higher than the placebo group, but in VLDL level of placebo was higher than ginger (p>0.05). CONCLUSION: The results show that ginger has a significant lipid lowering effect compared to placebo.     

Acute esophageal variceal sclerotherapy. Results of a prospective randomized controlled trial

Within 48 hours of variceal hemorrhage, 82 patients were randomly assigned to conventional treatment including balloon tamponade or to conventional treatment supplemented by sclerotherapy. The prerandomization general clinical characteristics of the two groups were similar. Seventy-nine percent of patients were alcoholic and 57% were in Child's class C. In the sclerotherapy group of 44 patients, sclerotherapy was performed twice in 28 patients and thrice in 13 patients over the two weeks of follow-up. The number of patients who rebled was significantly lower in the sclerotherapy group than in the group treated conventionally (23% vs 53%). The number of bleeding episodes also was significantly lower in the sclerotherapy group (15 vs 32). Moreover, blood transfusion requirements were significantly decreased in the sclerotherapy group. This was true even for patients who were bleeding at the time of randomization or who were in Child's class C, but this primarily was because fewer patients who underwent sclerotherapy (10 of 24 vs 18 of 23) required transfusions. Although there was no difference in survival between the two groups, we conclude that sclerotherapy is better than conventional treatment in the acute management of variceal bleeding.     

饮食习惯对血脂水平的影响

目的探讨饮食习惯对血脂水平的影响,为当地人群合理营养指导提供科学依据。方法将1 500例正常饮食的人群(普食组)和800例寺院僧侣(素食组)随机分为两组:40岁以上组和40岁以下组,并测试所有人员体内总胆固醇,甘油三酯,高密度脂蛋白胆固醇与低密度脂蛋白胆固醇含量。结果对于40岁以上组和40岁以下组人群,素食组血液中TCH、TG、LDL-C含量均低于普食组,而HDL-C较普食组高,差异有统计学意义(P<0.05)。素食组血液中TCH、TG、LDL-C和HDL-C的血脂异常率较普食组低(P<0.05)。结论血脂水平与饮食习惯有关;摄取平衡饮食并建立良好的生活饮食习惯,加上坚持体育锻炼,有利于降低高脂血症和心脑血管疾病发生率。     

Early return to work after uncomplicated myocardial infarction. Results of a randomized trial

To determine if an occupational work evaluation could shorten the time to return to work, 201 employed men aged 49 +/- 7 years who were recovering from uncomplicated myocardial infarction were randomized to usual care (n = 102) or to an occupational work evaluation (n = 99). The occupational work evaluation consisted of a symptom-limited treadmill test performed 23 +/- 3 days after myocardial infarction and a formal recommendation to the patient and primary physician that the patient return to work within the next two weeks. The groups did not differ in age, medical status, comorbid disease, occupation type, or years on the job. At six months, 92% of patients receiving the intervention and 88% of patients receiving usual care were working either full- or part-time. Return to full-time work occurred at a median of 51 days in patients receiving the intervention and 75 days in patients receiving usual care. This 32% reduction in the convalescence period was associated with +2102 of additional earned salary per intervention patient in the six months after myocardial infarction. One or more recurrent cardiac events occurred in 14 intervention patients (one death, one nonfatal myocardial infarction, three angioplasties, and nine coronary surgeries) and in 13 usual-care patients (two deaths, three nonfatal myocardial infarctions, six angioplasties, and seven coronary surgeries) in the six months after myocardial infarction. The early return to work of low-risk patients based on an occupational work evaluation is associated with important economic benefits.     

Relation of gemfibrozil treatment and lipid levels with major coronary events: VA-HIT: a randomized controlled trial

CONTEXT: A low plasma level of high-density lipoprotein cholesterol (HDL-C) is a major risk factor for coronary heart disease (CHD). A secondary prevention study, the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT), demonstrated that CHD events were significantly reduced during a median follow-up of 5.1 years by treating patients with the fibric acid derivative gemfibrozil when the predominant lipid abnormality was low HDL-C. OBJECTIVE: To determine if the reduction in major CHD events with gemfibrozil in VA-HIT could be attributed to changes in major plasma lipid levels. DESIGN: Multicenter, randomized, double-blind, placebo-controlled trial conducted from September 1991 to August 1998. SETTING: The Department of Veterans Affairs Cooperative Studies Program, in which 20 VA medical centers were participating sites. PARTICIPANTS: A total of 2531 men with a history of CHD who had low HDL-C levels (mean, 32 mg/dL [0.83 mmol/L] ) and low low-density lipoprotein cholesterol (LDL-C) levels (mean, 111 mg/dL [2.88 mmol/L]). INTERVENTION: Participants were randomly assigned to receive gemfibrozil, 1200 mg/d (n = 1264), or matching placebo (n = 1267). MAIN OUTCOME MEASURE: Relation of lipid levels at baseline and averaged during the first 18 months of gemfibrozil treatment with the combined incidence of nonfatal myocardial infarction and CHD death. RESULTS: Concentrations of HDL-C were inversely related to CHD events. Multivariable Cox proportional hazards analysis showed that CHD events were reduced by 11% with gemfibrozil for every 5-mg/dL (0.13-mmol/L) increase in HDL-C (P =.02). Events were reduced even further with gemfibrozil beyond that explained by increases in HDL-C values, particularly in the second through fourth quintiles of HDL-C values during treatment. During gemfibrozil treatment, only the increase in HDL-C significantly predicted a lower risk of CHD events; by multivariable analysis, neither triglyceride nor LDL-C levels at baseline or during the trial predicted CHD events. CONCLUSIONS: Concentrations of HDL-C achieved with gemfibrozil treatment predicted a significant reduction in CHD events in patients with low HDL-C levels. However, the change in HDL-C levels only partially explained the beneficial effect of gemfibrozil.     

Effects of avocado as a source of monounsaturated fatty acids on plasma lipid levels.

To examine the effects of avocado on plasma lipid concentrations, a three-diet trial involving 16 healthy volunteers was carried out. A diet rich in monounsaturated fatty acids using avocado as their major source (30% of the total energy was consumed as fat: 75% of the total fat from the avocado), with restriction of saturated fats and less than 300 mg of cholesterol per day was evaluated. Subjects also were in a free-diet period with the addition of the same amount of avocado. Finally, volunteers received a low-saturated fat diet without avocado. The first and third diets were designed to simulate a usual diet and volunteers carried on their normal activities during the trial, only the three daily meals were eaten in our clinical unit. Diets lasted 2 weeks and they were assigned in a randomized order. In both rich-monounsaturated fat (RMF) and low-saturated fat (LSF) diets, there were similar reductions in the plasma total cholesterol and low-density lipoprotein cholesterol levels. The levels of high-density lipoprotein cholesterol significantly decreased (p < 0.05) after 2 weeks of the LSF and free monounsaturated-enriched (FME) diets. The plasma triacyglycerol levels lessened after RMF and FME diets, while LSF diet increased them. In total cholesterol and in low-lipoprotein cholesterol levels, there were statistically significant differences between the FME and the LSF diet periods. Avocado is an excellent source of monounsaturated fatty acid in diets designed to avoid hyperlipidemia without the undesirable effects of low-saturated fat diets on HDL-cholesterol and triacylglycerol concentrations.     

Promoting cancer prevention activities by primary care physicians. Results of a randomized, controlled trial

BACKGROUND. Previous interventions to promote performance of cancer prevention activities have largely targeted physicians in university-based practices. METHODS. We randomly assigned 40 primary care physicians in community-based practices to either (1) Cancer Prevention Reminders, computer-generated lists of overdue screening tests, and smoking and dietary assessment and counseling, supplemented by cancer education materials; or (2) controls. For each physician, we reviewed a random sample of 60 medical records for data about screening test, assessment, and counseling performance during 12-month preintervention and intervention periods. We calculated performance scores as percentage compliance with American Cancer Society and/or National Cancer Institute recommendations. Multiple regression analyses provided estimates of incremental differences in performance scores between intervention and control groups. RESULTS. Controlling for preintervention performance levels, significant incremental differences in performance scores between intervention and control groups (P less than .05) were achieved for nine maneuvers: stool occult-blood test, +14.5; rectal examination, +10.5; pelvic examination, +11.8; Papanicolaou's smear, +30.7; breast examination, +8.7; smoking assessment, +10.2; smoking counseling, +17.3; dietary assessment, +12.3; and dietary counseling, +13.9. Increments for sigmoidoscopy and mammography were not significant. CONCLUSION. Computerized reminders can significantly increase physicians' performance of cancer prevention activities in community-based practices.     

Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial

Seventy-one heavy smokers who had failed in previous attempts to stop smoking participated in a randomized clinical trial to test the efficacy of clonidine as an aid in smoking cessation. The success rate in clonidine-treated subjects (verified by serum cotinine concentration) was more than twice that in the placebo-treated subjects. When the data were stratified by gender, a strong effect present in women was not apparent in men. After six months, cessation rates remained significantly higher among smokers treated with clonidine than those receiving placebo. The data also revealed an unexpectedly high prevalence (61%) of a history of major depression in this sample and a significant negative effect of such a history on cessation regardless of treatment. These findings, highly suggestive of an important role of clonidine in smoking cessation, warrant further studies to establish the long-term (greater than or equal to 12 months) efficacy of this drug and to replicate the association between nicotine dependence and depression.     

瘦素受体基因多态性与2型糖尿病的关系及其对血脂的影响

目的:探讨瘦素受体(Lepr)基因多态性与2型糖尿病的关系及其对血脂水平的影响,并验证用口腔脱落细胞制备DNA模板的可行性. 方法:同时取口腔脱落细胞和静脉血白细胞,应用半巢式聚合酶链反应,结合限制性酶切片段长度多态性(PCR-RFLP), 和PCR产物测序技术,检测106例2型糖尿病患者,102例正常糖耐量组的Lepr外显子20的基因多态性,常规方法测定血脂水平. 结果:口腔脱落细胞和静脉血白细胞分子生物学检测的结果完全一致. 在所测对象中, 2927位核苷酸的等位基因均为A,而3057位核苷酸G→A变异频率为75.0%. 糖尿病组3057位基因变异频率高于正常糖耐量组(P＜0.05). 且变异后的2型糖尿病患者AA型具有更高的三酰甘油和低密度脂蛋白胆固醇水平(P＜0.05),和更低的高密度脂蛋白胆固醇水平(P＜0.01). 结论:Lepr第3057位核苷酸基因多态性可能通过调节机体脂质代谢、影响机体局部体脂分布等途径参与2型糖尿病的发生.     

Dictated versus database-generated discharge summaries: a randomized clinical trial

BACKGROUND: Hospital discharge summaries communicate information necessary for continuing patient care. They are most commonly generated by voice dictation and are often of poor quality. The objective of this study was to compare discharge summaries created by voice dictation with those generated from a clinical database. METHODS: A randomized clinical trial was performed in which discharge summaries for patients discharged from a general internal medicine service at a tertiary care teaching hospital in Ottawa were created by voice dictation (151 patients) or from a database (142 patients). Patients had been admitted between September 1996 and June 1997. The trial was preceded by a baseline cohort study in which all summaries were created by dictation. For the database group, information on forms completed by housestaff was entered into a database and collated into a discharge summary. For the dictation group, housestaff dictated narrative letters. The proportion of patients for whom a summary was generated within 4 weeks of discharge was recorded. Physicians receiving the summary rated its quality, completeness, organization and timeliness on a 100-mm visual analogue scale. Housestaff preference was also determined. RESULTS: Patients in the database group and the dictation group were similar. A summary was much more likely to be generated within 4 weeks of discharge for patients in the database group than for those in the dictation group (113 [79.6%] v. 86 [57.0%]; p < 0.001). Summary quality was similar (mean rating 72.7 [standard deviation (SD) 19.3] v. 74.9 [SD 16.6]), as were assessments of completeness (73.4 [SD 19.8] v. 78.2 [SD 14.9]), organization (77.4 [SD 16.3] v. 79.3 [SD 17.2]) and timeliness (70.3 [SD 21.9] v. 66.2 [SD 25.6]). Many information items of interest were more likely to be included in the database-generated summaries. The database system created summaries faster and was preferred by housestaff. Dictated summaries in the baseline and randomized studies were similar, which indicated that the control group was not substantially different from the baseline cohort. INTERPRETATION: The database system significantly increased the likelihood that a discharge summary was created. Housestaff preferred the database system for summary generation. Physicians thought that the quality of summaries generated by the 2 methods was similar. The use of computer databases to create hospital discharge summaries is promising and merits further study and refinement.     

鬼臼毒素固体脂质纳米粒凝胶治疗复发性尖锐湿疣的随机双盲对照研究

目的 评价鬼臼毒素固体脂质纳米粒凝胶治疗复发性尖锐湿疣的疗效和安全性.方法 选择适当的复发性尖锐湿疣患者,采用鬼臼毒素脂质纳米粒凝胶与普通鬼臼毒素凝胶进行随机双盲、对照研究,主要观察近期治疗效果、抗复发情况及局部不良反应.结果 鬼臼毒素脂质纳米粒凝胶对尖锐湿疣的首次清除率(97.1%)与普通的鬼臼毒素凝胶剂(90.6%)相近(P＞0.05),但复发率和不良反应发生率明显偏低(P＜0.01).结论 鬼臼毒素脂质纳米粒凝胶局部外用不良反应轻微,耐受性好,并能降低尖锐湿疣复发率.     

Does capitation affect the health of the chronically mentally ill? Results from a randomized trial.

OBJECTIVE--To determine the effect on health outcomes of enrollment of chronically mentally ill Medicaid recipients in prepaid plans vs traditional fee-for-service Medicaid. DESIGN--A randomized controlled trial. Clients who were randomly assigned to prepaid care were then permitted to choose among four capitated health plans. Clients returned to fee-for-service care at the end of the demonstration. SETTING--The Medicaid Demonstration Project in Hennepin County, Minnesota, the urban center of which is Minneapolis. PATIENTS--Seven hundred thirty-nine Medicaid clients who were classified as having chronic mental illness on the basis of Medicaid claims. Clients were interviewed at baseline (time 1) and at two follow-up points. Data were available for 96% of participants at the end of the intervention (time 2). Average duration of follow-up was 11 months. A subset of 370 clients with schizophrenia was followed up 11 months after the return of the prepaid group to fee-for-service care (time 3). MAIN OUTCOME MEASURES--General health status, physical functioning, social functioning, and psychiatric symptoms, assessed using the Schedule of Affective Disorders and Schizophrenia-Change version, the Global Assessment Scale, and indicators of community function. RESULTS--No significant differences between prepaid and fee-for-service groups in general health or psychiatric symptoms from baseline to time 2. After regression adjustment, 12% fewer clients in the prepaid group reported being victimized (P less than .01). At the end of time 3, the regression-adjusted Global Assessment Scale scores had worsened by 7.6 points more in the prepaid group in comparison with the fee-for-service group (P less than .02). CONCLUSION--There was no consistent evidence of harmful effects of enrolling chronically mentally ill Medicaid clients in prepaid care, at least in the short run. The generalizability of these findings may be limited to plans that control utilization by methods similar to those used in this study setting. Longer-term outcome studies should be undertaken to clarify the strength of the findings.     

前瞻性临床试验评估维拉帕米对前尿道狭窄术后尿道瘢痕增生及拔管后尿道再狭窄趋势的抑制作用

目的：评估经会阴局部注射维拉帕米对前尿道狭窄吻合术后尿道瘢痕增生的抑制作用。方法：选取2016 年1至5月招募的前尿道狭窄患者32例。按照既往所接受尿道操作次数的多少,将操作次数相近的患者分为一个区 组,前尿道狭窄患者共分为4个区组。在其基础上各区组进一步分为试验组与对照组,其中试验组术中及术后第 2,4,6,8,10周经会阴于尿道吻合口部位浸润注射2 mL维拉帕米,对照组仅接受手术治疗。检测拔管后最大尿 流率,并于术后第12周测量所有患者尿道瘢痕的长横径之和,尿道造影下测量尿道最窄内径,并进行最大尿流率 测定和阴茎彩色B超弹性成像下尿道瘢痕程度检测。从以上4个方面评估维拉帕米抑制瘢痕的疗效。结果：试验组 的区组1~4瘢痕触诊测量的平均长横径之和分别为(22.75±1.03),(21.25±0.25),(20.75±1.03)和(20.0±0.58) mm;对照 组分别为(26.00±0.82),(24.5±1.04),(25.75±1.65)和(28.25±1.75) mm。试验组的区组1~4拔管后平均最大尿流率分别 为(11.85±0.77),(11.33±0.81),(10.23±0.26)和(10.35±0.17) mL/s;对照组拔管后分别为(10.85±0.39),(10.50±0.76), (10.53±1.00)和(12.60±0.39) mL/s。试验组的区组1~4术后12周最大尿流率分别为(11.73±0.87),(10.65±0.25), (10.23±0.19)和(10.35±0.29) mL/s;对照组为(8.05±0.28),(7.73±0.68),(7.53±0.92)和(9.60±0.32) mL/s。试验组的区 组1~4前尿道最窄内径分别为(9.00±0.58),(7.50±2.89),(7.00±0.10)和(7.00±0.41) mm;对照组分别为(5.50±0.29), (5.00±0.41),(4.75±0.48)和(6.75±0.48) mm。试验组的区组1~4彩色B超弹性成像下平均组织应变比分别为6.10±0.22, 6.10±0.17,5.10±0.16和6.90±0.19;对照组分别为8.00±0.25,10.60±0.29,11.30±0.16和8.90±0.33。试验组在瘢痕长横径、 彩色B超弹性成像下瘢痕程度的测量均值小于或轻于对照组,在最大尿流率改善程度及尿道最窄内径的检测上优于对 照组,以上结果差异均具有统计学意义(均P<0.05)。结论：前尿道狭窄患者术中以及术后定期局部注射维拉帕米可有 效抑制手术患者术后尿道瘢痕的过度增生,并减缓其拔除导尿管后尿道腔再狭窄的趋势。