Lipoprotein(a) and atherosclerosis: New perspectives on the mechanism of action of an enigmatic lipoprotein

Although elevated plasma concentrations of lipoprotein(a) (Lp(a)) have been identified as a risk factor for coronary heart disease, the pathophysiologic and physiologic roles of Lp(a) continue to elude basic researchers and clinicians alike. Lp(a) is a challenging lipoprotein to study because it has a complex structure consisting of a low-density lipoprotein-like moiety to which is covalently attached the unique glycoprotein apolipoprotein(a) (apo(a)). Apo(a) contains multiply repeated kringle domains that are similar to a sequence found in the fibrinolytic proenzyme plasminogen; differing numbers of kringle sequences in apo(a) give rise to Lp(a) isoform size heterogeneity. In addition to elevated plasma concentrations of Lp(a), apo(a) isoform size has been identified as a risk factor for coronary heart disease, although studies addressing this relationship have been limited. The similarity of Lp(a) to low-density lipoprotein and plasminogen provides an enticing link between the processes of atherosclerosis and thrombosis, although a clear demonstration of this association in vivo has not been provided. Clearly, Lp(a) is a risk factor for both atherothrombotic and purely thrombotic events; a plethora of mechanisms to explain these clinical findings has been provided by both in vitro studies as well as animal models for Lp(a).     

甘露聚糖、壳聚糖、α-酸性糖蛋白和姜黄素对脂蛋白(a)和去唾液酸脂蛋白(a)代谢影响的对比分析

分析多糖和姜黄素对脂蛋白 (a)和去唾液酸脂蛋白 (a)代谢的影响 ,从刺猬腋下静脉注入甘露聚糖、壳聚糖、α -酸性糖蛋白和姜黄素 ,2min后注射12 5I-脂蛋白 (a)或12 5I-去唾液酸脂蛋白 (a) ,1h后处死动物 ,测定血、肝、肾、脾、胆汁和肾上腺的同位素含量。结果发现 ,脂蛋白 (a)去唾液酸后能大量进入肝脏 ,加速在体内的分解代谢 ,使血中浓度迅速降低。α -酸性糖蛋白抑制组织对脂蛋白 (a)和去唾液酸脂蛋白 (a)的摄入 ,使血中脂蛋白 (a)和去唾液酸脂蛋白 (a)含量显著增高。壳聚糖和姜黄素增加肝脏和肾上腺对脂蛋白 (a)的摄取 ,使血中脂蛋白 (a)含量略降低 ,但对去唾液酸脂蛋白 (a)代谢无明显影响。甘露聚糖增加脾脏对脂蛋白 (a)的摄取 ,减少胆囊中脂蛋白 (a)含量 ,但增加肾脏和胆囊对去唾液酸脂蛋白 (a)的摄取 ,降低肾上腺对去唾液酸脂蛋白 (a)的摄取。结果提示 ,脂蛋白 (a)去唾液酸后能使脂蛋白 (a)分解代谢加快 ,脂蛋白 (a)分子中的唾液酸在结构稳定中起重要的作用。α -酸性糖蛋白抑制脂蛋白 (a)和去唾液酸脂蛋白 (a)代谢 ,而壳聚糖和姜黄素则促进脂蛋白 (a)代谢     

Pulse wave velocity progression over a medium‐term follow‐up in hypertensives: Focus on uric acid

The role of uric acid (UA) on the arterial stiffness progression has been evaluated only in three studies. Our aim was to evaluate its role as a possible determinant of the pulse wave velocity (PWV) progression over a 3.7 ± 0.5 years follow‐up period in hypertensive patients. Specific sex analysis was done due to the well‐known sex interaction with UA levels. We enrolled 422 consecutive hypertensive outpatients. At baseline anamnestic, blood pressure (BP) and laboratory data as well as PWV were assessed. PWV was performed again at follow‐up examination. Hyperuricemia was defined as a UA > 6 mg/dL for women and > 7 mg/dL for men. Baseline age was 53.2 ± 13 years, 58% were males, systolic and diastolic BP (SBP/DBP) 141.7 ± 17.7/86.8 ± 10.8 mm Hg, UA 5.2 ± 1.4 mg/dL, and PWV 8.5 ± 1.9 m/s. At follow‐up, despite better BP values (−8.5 ± 24.6 for SBP and −7.5 ± 15.4 for DBP), PWV increases to 9.1 ± 2.3 m/s (P < 0.001) with mean ΔPWV of+ 0.5 ± 2.2 m/s. A total of 61 patients were hyperuricemic (14.4%), and they present higher PWV baseline (9.0 ± 2.5 vs 8.5 ± 1.8 m/s, P = 0.03) without significant differences in ΔPWV. Hyperuricemic female (6.2%, 11 patients) presents higher baseline PWV without significant differences in ΔPWV. No differences were found in arterial stiffness in hyperuricemic males (20.4%, 50 patients). UA showed association with baseline and ΔPWV in the whole population but it loses statistical significance at the linear regression model. Same figures were also for sex analysis. Our findings provide evidence that baseline UA levels are not determinants of PWV progression over a median follow‐up of 3.8 years’ in hypertensive patients.     

Abatacept Improves Whole-Body Insulin Sensitivity in Rheumatoid Arthritis: An Observational Study

Rheumatoid arthritis (RA) is characterized by increased insulin resistance, a well-known risk factor for diabetes and cardiovascular diseases. The aim of the present study was to evaluate the effect of abatacept on insulin sensitivity in RA patients with moderate to severe disease despite treatment with methotrexate.Fifteen RA patients were recruited for the present study. Patients were evaluated at time 0 and after 6 months of the treatment with i.v. abatacept at the dosage recommended for weight range. Evaluation included oral glucose tolerance test (OGTT) at both time points. Insulin sensitivity was estimated with insulin sensitivity index (ISI) by Matsuda, a measure of whole-body insulin sensitivity.ISI significantly increased after the treatment with abatacept from 3.7 ± 2.6 to 5.0 ± 3.2 (P = 0.003) with a mean difference of 1.23. Analysis of glucose and insulin values during OGTT revealed a reduction of both glucose (303.9 ± 73.4 mg/dL min versus 269.2 ± 69.5 mg/dL min, P = 0.009) and insulin (208.4 ± 119.7 mg/dL min versus 158.0 ± 95.3 mg/dL min, P = 0.01) area under the curves (AUCs). Accordingly also glycated hemoglobin significantly improved (5.5 ± 0.4% versus 5.3 ± 0.3%, P = 0.04). No significant differences were found for measures of β-cell function insulinogenic index (1.11 ± 1.19 versus 1.32 ± 0.82, P = 0.77) and oral disposition index (2.0 ± 5.4 versus 6.0 ± 6.0, P = 0.25).Treatment with abatacept seems to be able to improve whole-body insulin sensitivity in RA patients without affecting β-cell function.     

Association Between Genetic Polymorphisms in the Promoter Regions of Let-7 and Risk of Papillary Thyroid Carcinoma: A Case-Control Study

The aim of this study was to investigate the association between 2 polymorphisms (ie, rs10877887 and rs13293512) in the promoter regions of let-7 and the risk of papillary thyroid carcinoma (PTC).A case-control study of 618 PTC patients and 562 controls was conducted. The rs10877887 polymorphism was genotyped by using polymerase chain reaction-restriction fragment length polymorphism and the rs13293512 polymorphism was genotyped by using a TaqMan Genotyping Assay. The results were confirmed by DNA sequencing.The rs10877887 polymorphism had reduced risks of PTC in heterozygous comparison, dominant model, and overdominant model (TC vs TT: adjusted odds ratio [OR] = 0.73, 95% confidence interval [95% CI] = 0.58–0.94, P = 0.01; TC/CC vs TT: adjusted OR = 0.79, 95% CI = 0.63–1.00, P = 0.047; TC vs TT/CC: adjusted OR = 0.73, 95% CI = 0.57–0.92, P = 0.007, respectively). Stratified analyses showed that PTC patients carrying the rs10877887 CC genotype were more likely to have multiple tumors (adjusted OR = 1.71, 95% CI = 1.03–2.86, P = 0.04), and PTC patients carrying the rs13293512 TC + CC or CC were more likely to develop N0 status (TC/CC vs TT: adjusted OR = 0.64, 95% CI = 0.43–0.94, P = 0.02; CC vs TC/TT: adjusted OR = 0.50, 95% CI = 0.33–0.77, P = 0.001, respectively).Our study suggests that the rs10877887 polymorphism may be associated with the risk of PTC and the rs13293512 polymorphism may correlate to lymph node metastasis in PTC.     

Rural–urban disparities in knowledge,behaviors, and mental health during COVID-19 pandemic: A community-based cross-sectional survey

To examine the knowledge level, behaviors, and psychological status of the Chinese population during the COVID-19 pandemic, and to explore the differences between urban and rural areas.We carried out a cross-sectional survey of the knowledge, behaviors related to COVID-19, and mental health in a probability sample of 3001 community residents in 30 provinces or districts across China from February 16–23, 2020. Convenience sampling and a snowball sampling were adopted. We used General Anxiety Disorder (GAD), the 9-item Patient Health Questionnaire (PHQ-9), and knowledge and behaviors questionnaire of community residents regarding COVID-19 designed by us to investigate the psychological status, disease-related knowledge, and the behavior of Chinese urban and rural residents during the pandemic.The average score of anxiety and depression among urban residents was 9.15 and 11.25, respectively, while the figures in rural areas were 8.69 and 10.57, respectively. There was a statistically significant difference in the levels of anxiety (P < .01) and depression (P < .01). Urban participants reported significantly higher levels of knowledge regarding COVID-19 in all aspects (transmission, prevention measures, symptoms of infection, treatment, and prognosis) (P < .01), compared to their rural counterparts. While a majority of respondents in urban areas obtained knowledge through WeChat, other apps, and the Internet (P < .01), residents in rural areas accessed information through interactions with the community (P < .01). Urban residents fared well in exchanging knowledge about COVID-19 and advising others to take preventive measures (P < .01), but fared poorly in advising people to visit a hospital if they displayed symptoms of the disease, compared to rural residents (P < .01). Regression analysis with behavior showed that being female (OR = 2.106, 95%CI = 1.259–3.522), aged 18 ≤ age < 65 (OR = 4.059, 95%CI = 2.166–7.607), being satisfied with the precautions taken by the community (OR = 2.594, 95%CI = 1.485–4.530), disinfecting public facilities in the community (OR = 2.342, 95%CI = 1.206–4.547), having knowledge of transmission modes (OR = 3.987, 95%CI: 2.039, 7.798), symptoms (OR = 2.045, 95%CI = 1.054–4.003), and outcomes (OR = 2.740, 95%CI = 1.513–4.962) of COVID-19, and not having anxiety symptoms (OR = 2.578, 95%CI = 1.127–5.901) were positively associated with affirmative behavior in urban areas. Being married (OR = 4.960, 95%CI = 2.608–9.434), being satisfied with the precautions taken by the community (OR = 2.484, 95%CI = 1.315–4.691), screening to ensure face mask wearing before entering the community (OR = 8.809, 95%CI = 2.649–19.294), and having knowledge about precautions (OR = 4.886, 95%CI = 2.604–9.167) and outcomes (OR = 2.657, 95%CI = 1.309–5.391) were positively associated with acceptable conduct in rural areas.The status of anxiety and depression among urban residents was more severe compared to those living in rural areas. There was a difference in being positively associated with constructive behaviors between rural and urban areas.     

Digital style design systems from concept to sophisticated shape

This paper reports four digital style design systems to construct a sophisticated shape from a concept or a rough sketch. First one is a system to automatically construct a 3D digital model form key words expressing the product concept. Second one is a system to automatically construct the 3D digital model from a rough sketch drown by a designer. Third one is a system to automatically sophisticate a 3D digital model according to the high light lines indicated by a designer. Fourth one is a system to sophisticate a 3D digital model by forming characteristic lines indicated by a designer.     

Effectiveness of microperimetry in evaluating anti-vascular endothelial growth factor therapy for diabetic macular edema patients with relatively good vision: A retrospective observational study

No studies have evaluated the retinal sensitivity (RS) for diabetic macular edema (DME) patients with good vision. Therefore, this study aimed to determine the effectiveness of microperimetry in evaluating the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) treatment for DME patients with relatively good vision.Twenty-seven eyes of 27 patients (mean age, 61.3 ± 11.2 years) with DME and decimal best-corrected visual acuity (BCVA) ≥0.6 were studied. All patients received 3 consecutive monthly injections of intravitreal anti-VEGF agents. The BCVA, central subfield macular thickness (CMT), and RS were evaluated by microperimetry (MAIA) within the 10 degree of the foveal center. To determine significant differences between the values, we used paired t tests.Patients were evaluated at baseline and 4 weeks after the third injection. The BCVA improved significantly from 0.18 ± 0.06 logarithm of the minimum angle of resolution (logMAR) units to 0.13 ± 0.13 logMAR units (P = .002; paired t test). The CMT decreased significantly from 464.3 ± 91.8 μm to 393.4 ± 129.0 μm (P = .005), and the RS also improved significantly from 21.8 ± 3.1 dB to 24.1 ± 2.8 dB at 4 weeks after treatment (P = .006). Among the patients with a decimal BCVA of 0.7 or better at baseline, there was no significant improvement in the BCVA (P = .28). However, the CMT decreased significantly from 479.5 ± 79.1 μm to 394.0 ± 99.8 μm at 4 weeks after treatment (P = .007). The RS also improved significantly from 22.0 ± 2.4 dB to 24.0 ± 3.1 dB at 4 weeks after treatment (P = .004).Measuring RS by microperimetry is a good option for evaluating the effectiveness of anti-VEGF treatment for DME patients with a relatively good BCVA.     

A simple approach for the reduction of knotted coronary catheter in the radial artery during the transradial approach

Development of a catheter knot is uncommon but still a matter of concern for a catheterizing cardiologist. There are only a few case reports of percutaneous catheter unknotting in the literature. We describe for the first time a case of catheter unknotting in a radial artery using a simple technique via the transradial approach. We concluded that percutaneous catheter unknotting in a radial artery using basic and simple hardware is a good alternative option to surgical management.     

Magnetic stimulation of carotid sinus as a treatment for hypertension

Previously, we reported that magnetic stimulation of carotid sinus (MSCS) could lower arterial pressure in rabbits. In this randomized, sham‐controlled pilot study, we evaluated the effects of MSCS on blood pressure in pre‐hypertensive and hypertensive subjects. A total of 15 subjects with blood pressure higher than 130/80 mm Hg were randomized to receive sham or 1Hz MSCS. The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MAP) during treatment were compared between groups. The heart rate variability (HRV) and baroreflex sensitivity (BRS) before, during, and after treatments were analyzed. Reduction of SBP was significantly greater in subjects with MSCS than those with sham stimulation (6.6 ± 0.4 vs −2.5 ± 0.4 mm Hg, P < 0.001). Reduction of DBP was significantly greater in subjects with MSCS than those with sham stimulation (1.2 ± 0.2 vs −2.8 ± 0.2 mm Hg, P < 0.001). Reduction of MAP was significantly greater in subjects with MSCS than those with sham stimulation (1.4 ± 0.3 mm Hg vs −4.0 ± 0.3 mm Hg, P < 0.001). Reduction of HR was significantly greater in subjects with MSCS than those with sham stimulation (0.5 ± 0.5 vs −1.9 ± 0.3 beats/min, P = 0.002). BRS increased from 6.85 ± 0.77 to 8.79 ± 0.95 ms/mm Hg after MSCS compared with that at baseline (P = 0.027). Thus, MSCS can lower blood pressure and heart rate in pre‐hypertensive and hypertensive subject, warranting further study for establishing MSCS as a treatment for hypertension.     

丙型肝炎病毒非编码区ABC程序酶切分型研究

目的为进一步了解中国是否存在HCV 3b基因及1a、2b和6a基因型感染，建立HCV 5′端非编码区(5′ NCR)不同基因型的基因库。方法分型方法按ABC程序进行，A应用BHH′(BsrBⅠ、HaeⅡ、HinfⅠ)复介内切酶消化5′NCR cDNA，可将不同基因型划分为5组：1a、1b，6a，2a、2b，3a，3b、4a。B应用BstU Ⅰ内切酶鉴别1a、1b。C应用Hae Ⅲ内切酶鉴别2a、2b、3b、4a及6a。电泳检测片段大小。结果(1)la、1b、2a、2b、3a、3b、4a、6a 8种基因型参比品的ABC分型结果表明，该8种基因型获得良好的分型效果。(2)93份HCV RNA阳性患者ABC分型结果表明，1b型感染率占66．67％，2a型18．28％，1b／2b型、3b型及2b型均为3．23％，2a／2b型和1b／2a型各为2．15％，1a型1．08％。结论结果表明应用HCV 5′-NCR ABC分型技术既保证了HCV RNA检测的灵敏度，又能完成1a-6a型中的8种基因型的鉴别。     

C4a: the third anaphylatoxin of the human complement system.

The activation peptide C4a was isolated from C1s-cleaved C4, the fourth component of complement. The peptide appeared to be homogeneous by electrophoresis on cellulose acetate and by polyacrylamide gel electrophoresis. C4a has a molecular weight of 8650 and an electrophoretic mobility at pH 8.6 of +2.1 x 10(-5) cm2V-1 sec-1. Carboxypeptidase B released approximately 1 mol of arginine per mol of C4a. The partial COOH-terminal sequence was determined to be Leu-Gln-Arg-COOH. The isolated C4a was spasmogenic for guinea pig ileum at a concentration of 1 microM and it desensitized the muscle (i.e., produced tachyphylaxis) with respect to human C3a anaphylatoxin (at 0.33 microM) but not with respect to human C5a anaphylatoxin. Increased vascular permeability was observed in human skin after intradermal injection of 1 nmol of C4a, as evidenced by immediate erythema and edema formation. The spasmogenic, tachyphylactic, and vascular activities of C4a were abrogated by removal of the COOH-terminal arginine, a property that is characteristic also of the C3a and C5a anaphylatoxins. Contamination of C4a with either C3a or C5a has been ruled out by using radioimmunoassays for these peptides. Although C4a is considerably less active than are C3a and C5a, the present observations suggest that C4a constitutes a heretofore unrecognized anaphylatoxin that is related biologically and chemically to the activation peptides of C3 and C5.     

Disposable versus reusable biopsy forceps. A prospective cost analysis in the gastrointestinal endoscopy unit of the Dijon University Hospital]

AIMS: The goal of this study was to compare the cost of a biopsy session performed with a disposable and a reusable endoscopic biopsy forceps.MATERIAL AND METHODS: Over a 10-month period, 15 new reusable forceps (10 gastric and 5 colonic) were prospectively tracked. A biopsy session performed with a reusable forceps included its current purchase price, the sterilization cost and the number of uses. A biopsy session performed with a disposable forceps was calculated with its current purchase price and its incineration cost.RESULTS: At the end of the study, only one reusable forceps had broken and the number of uses was 65. The cost of a biopsy session performed with a gastric reusable forceps was euro 7.52 (including euro 1.92 of sterilization cost) and euro 8.67 for a reusable colonic forceps (with the same sterilization cost). The cost of a biopsy session performed with a gastric or a colonic disposable forceps was euro 11.98. From 44 uses for a colonic forceps and 37 uses for a gastric one, a biopsy session performed with a reusable forceps was already cheaper.CONCLUSION: In this study, a biopsy session performed with a reusable forceps was less expensive than with a disposable one. However, the extra cost generated by the disposable forceps may be offset by an easier inventory control and the reduction of the cross contamination risk.     

N-acetylcysteine and serum concentrations of lipoprotein(a).

A high plasma concentration of lipoprotein(a) [Lp(a)], a complex of low-density lipoprotein linked by disulphide bridges to apoprotein(a), is correlated with premature atherosclerosis. We determined whether the serum Lp(a) concentration could be decreased in vitro and in vivo by the reducing agent N-acetylcysteine (NAC), a drug used as a mucolytic agent, which acts by cleaving disulphide bonds. High concentrations of NAC (greater than or equal to 8 mg ml-1) resulted in dissociation of the Lp(a) antigen in vitro. However, the plasma level of Lp(a) was not changed by administration of NAC 1.2 g d-1 for 4 weeks in 7 subjects with a median Lp(a) concentration of 14.3 mg dl-1 (range 2.1-21.0 mg dl-1) or by doubling the dose to 2.4 g d-1 for a further 2 weeks. In 12 subjects with a high plasma level of Lp(a), median 87.0 mg dl-1 (range 42.0-201.6 mg dl-1), a small but significant decrease in Lp(a) concentration of 7% (P = 0.02) was observed after administration of NAC in a dose of 1.2 g d-1 for 6 weeks. These results indicate that NAC has only a limited capacity to reduce the concentration of Lp(a), which is not clinically significant.     

Atrial synchronous left ventricular only pacing with VDD pacemaker system – A cost effective alternative to conventional cardiac resynchronization therapy

Introduction

Atrial synchronous left ventricular (LV) only pacing using two leads and VDD pacemaker could be a cost effective alternative to conventional cardiac resynchronization therapy (CRT).

Methods

We implanted right atrial (RA) and LV leads with VDD pulse generator (LV only pacing) in five carefully screened heart failure patients who could not afford conventional CRT. All had NYHA class III/IV symptoms despite maximal guideline directed medical therapy. The sensed atrioventricular delay was programmed to pre-excite the LV and achieve fusion beat. Response to treatment was assessed at 6 months.

Results

Four patients were males. The mean age was 58 ± 12 years. At follow up, there was improvement in electrocardiographic, and echocardiographic parameters: Mean QRS duration decreased from 174 ± 17 msec to 128 ± 10.9 msec (p = 0.009), LV end-diastolic diameter decreased from 73.2 ± 12 mm to 65.8 ± 9.6 mm (p = 0.026), LV end-systolic diameter decreased from 65 ± 12 mm to 54 ± 10 mm (p = 0.020). There was a trend towards reduction of LV end-systolic and end-diastolic volumes. LV ejection fraction improved from 25 ± 6% to 34 ± 6% (p = 0.013) and left atrial dimension reduced from 44 ± 4 mm to 39 ± 5 mm (p = 0.045). All patients improved clinically.

Conclusion

RA-LV pacing using VDD pacemaker is a safe and effective technique of CRT. This may be a cost effective alternative to conventional CRT for patients in developing countries.     

Prediction of moderate or severe pulmonary hypertension by main pulmonary artery diameter and main pulmonary artery diameter/ascending aorta diameter in pulmonary embolism

We investigated the accuracy of computed tomographic measurements of main pulmonary artery diameter (MPAD) and of MPAD/ascending aorta diameter (AAD) in predicting moderate or severe pulmonary hypertension in 190 patients with acute pulmonary embolism. A pulmonary artery systolic pressure of > or = 50 mm Hg measured by Doppler echocardiography was considered moderate or severe pulmonary hypertension. A MPAD of > 28.6 mm and a MPAD/AAD ratio of > or = 1.00 measured by computed tomography were considered abnormal. A MPAD of > 28.6 mm had a 75% sensitivity and specificity, a 52% positive predictive value, a 89% negative predictive value, a 3.0 likelihood ratio for a positive test, and a 0.33 likelihood ratio for a negative test in predicting moderate or severe pulmonary hypertension. A MPAD/AAD ratio of > or = 1.00 had a 59% sensitivity, a 82% specificity, a 55% positive predictive value, a 84% negative predictive value, a 3.3 likelihood ratio for a positive test, and a 0.50 likelihood ratio for a negative test.     

Can bipolar transurethral enucleation of the prostate be a better alternative to the bipolar transurethral resection of the prostate?: A prospective comparative study

To analyze the efficacy and safety between bipolar transurethral enucleation of the prostate (BipoLEP) and bipolar transurethral resection of the prostate (B-TURP).One hundred twenty eight patients with benign prostatic hyperplasia were recruited and divided into group 1 (BipoLEP group, n = 72) and group 2 (B-TURP group, n = 56). The study period was from October 2016 to February 2019. All data parameters were prospectively collected and analyzed.In these 2 groups, there were no significant differences of the mean ages (71.88 ± 6.54 years vs 73.05 ± 7.05 years, P = .407), prostate volumes (99.14 ± 9.5 mL vs 95.08 ± 10.93 mL, P = .302) and the mean operation times (93.7 ± 27.5 minutes vs 89.8 ± 22.4 minutes, P = .065). In BipoLEP group, it had more prostate tissue resected (64.2 ± 22.1 g vs 52.7 ± 28.6 g, P = .018), less duration of continuous bladder irrigation (20.7 ± 6.5 hours vs 29.6 ± 8.3 hours, P = .044), shorter catheterization time (4.3 ± 1.5 days vs 5.6 ± 2.1 days, P = .032), shorter hospitalization stay (5.2 ± 1.4 days vs 6.5 ± 1.9 days, P = .031) and less complications (3 cases vs 9 cases, P = .021). There were significant improvements in 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life in each group (p < 0.01). However, there were no significant differences of preoperative and 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life between these 2 groups (P > .05).BipoLEP can produce a more radical prostatic resection with better safety profile and faster postoperative recovery. It may become a more favorable surgical alternative to the B-TURP, especially for the prostate larger than 80 g.     

Shoulder impingement: various risk factors for supraspinatus tendon tear: A case group study

A total of 680 cases of monolateral shoulder pain and functional impairment were included, and Chi-Squared tests was incorporated to test for possible associations.No relation between impingement syndrome and potential risk factors was found, such as presence of down slopping (P = .083), presence of ossification acromiale (P = .102), presence of calcific tendinitis (P = .144), types of acromion (I [P = .600], II [P = .536], III [P = .633] and IV [P = .832]) and grade of acromioclavicular degenerative changes (mild [P = .077], moderate [P = .111], and severe [P = .700]). However, a significant relationship was uncovered between impingement syndrome and risk factors such as gender (X² = 7.004, df = 1, P = .08) (where females were more prone), history of shoulder dislocation (X² = 19.440, df = 1, P = .001), presence of supraspinatus tendon tear or tendinopathy (X² = 69.344, df = 1, P = .001) and supraspinatus complete tear (X² = 13.593, df = 1, P = .001). A significant relationship was found between the type of supraspinatus pathology and factors such as gender (female more prone) (X² = 34.719, df = 3, P = .01), presence of down slopping (X² = 57.765, df = 3, P = .01), history of shoulder dislocation (X² = 148.880, df = 3, P = .001), type III of the acromion (X² = 12.979, df = 3, P = .005), presence of acromioclavicular generative changes mild (X² = 76.408, df = 3, P = .001) and moderate (X² = 29.697, df = 3, P = .001), and acromiohumeral distance of ≤3 mm (X² = 18.915, df = 3, P = .001), 3.1 to 6 mm (X² = 13.212, df = 3, P = .004), and 9.1–12 mm (X² = 15.066, df = 3, P = .002). Overall, the Magnetic Resonance Imaging results yielded high sensitivity for detecting full-thickness supraspinatus tears.Considering the findings, this study may help radiologists understand the salient risk factors and identify which factors are mainly responsible for supraspinatus tendon tears and the respective grade of tear (articular partial, bursal partial, complete, or tendinopathy).     

Identification and comparison of insulin pharmacokinetics injected with a new 4‐mm needle vs 6‐ and 8‐mm needles accounting for endogenous insulin and C‐peptide secretion kinetics in non‐diabetic adult males

Aims/Introduction

Many patients with diabetes now use 5‐, 6‐ or 8‐mm needles for insulin injection. However, it is unclear whether needle length, particularly for shorter needles, affects the pharmacokinetic properties of insulin.

Materials and Methods

This was a three‐way, randomized, cross‐over, single‐center study involving 12 healthy Japanese adult males (age 27.4 ± 4.14 years; weight 64.2 ± 5.2 kg; body fat percentage 18.2 ± 1.5%). Participants received a subcutaneous (abdomen) dose of insulin lispro (1.5 U for participants weighing 55 to <65.0 kg; 2.0 U for participants weighing 65.0 to <80.0 kg) delivered using a 32‐G × 4 mm (32G × 4), 31‐G × 8 mm (31G × 8) or 32‐G × 6 mm (32G × 6) needle with a 3–7‐day washout between doses. Pharmacokinetic parameters of exogenous insulin were identified using non‐linear least squares, where the total insulin concentration was fit to the measured plasma insulin concentration using an overall combined model that accounted for C‐peptide/insulin secretion in addition to the injected dose.

Results

Maximum concentration and area under the curve for 0 to infinity min for insulin were bioequivalent for the 32G × 4 needle relative to the 32G × 6 and the 31G × 8 needles. The time to the maximum insulin concentration was bioequivalent for the 32G × 4 needle relative to the 32G × 6 needle, but not the 31G × 8 needle.

Conclusions

The use of 4‐mm needles is unlikely to change the pharmacokinetic properties of insulin when injected subcutaneously in adults. This trial was registered with UMIN‐CTR (no. UMIN000004469).