补肾活血复方中药与激素替代治疗绝经后骨质疏松患者血清细胞因子水平的变化

目的:比较补肾活血复方中药与激素替代疗法对绝经后骨质疏松患者血清细胞因子水平的影响。方法:选择深圳市龙岗区南岭医院中医骨伤科收治的绝经1年以上的骨质疏松症女性65例。①实验分组:采用随机数字表法分为补肾活血复方中药组35例和激素替代治疗组30例。实验经医院伦理委员会审批,患者均知情同意。②实验方法:补肾活血复方中药组给予补肾活血方(成分为淫羊霍、鹿角胶、山萸肉、补骨脂、当归、白芍、熟地黄、牛膝、木瓜、何首乌、寄生、续断、水蛭、甘草等)煎服,2次/d;激素替代治疗组给予替勃龙片(利维爱),每天睡前服1次,有子宫者每个周期加服安宫黄体酮6mg/d,服用30d。③实验评估:测定细胞因子水平:取两组患者全血加入2mmol/L谷氨酰胺,100U青霉素,100mg/L链霉素,分布至2mL的孔中,一半孔不作处理为空白对照组;一半孔加入多克隆刺激剂5mg/L植物血凝素和25mg/L脂多糖为刺激组。采用ELISA法测定白细胞介素1β、白细胞介素6、肿瘤坏死因子α。结果:①两组白细胞介素6水平:补肾活血复方中药组低于激素替代治疗组,经多克隆刺激后也低于激素替代治疗组,差异均有显著性意义(P<0.05)。②两组白细胞介素1β、肿瘤坏死因子α水平:空白对照和经多克隆刺激后差异均无显著性意义(P>0.05)。③两组细胞因子相关分析:白细胞介素1β、白细胞介素6、肿瘤坏死因子α水平空白对照和经多克隆刺激后呈正相关,差异有显著性意义(r=0.7125,0.6587,0.8421,P<0.001)。结论:补肾活血复方中药治疗及激素替代治疗对血清白细胞介素1β和肿瘤坏死因子α的作用相近,补肾活血复方中药治疗对白细胞介素6的作用更强。     

朝藿甙甲和朝藿甙乙的结构鉴定

自朝鲜淫羊藿(Epimedium koreanum Nakai)地上部分中分离得到二个黄酮类化合物I和II,根据理化数据及光谱分析,其结构分别鉴定为:脱水淫羊藿素3-O-β-D-(6-乙酰基)吡喃葡萄糖(1→3)-α-L-(4-乙酰基)吡喃鼠李糖甙(I)和脱水淫羊藿素3-O-β-D-(2,6-二乙酰基)吡喃葡萄糖(1→3)-α-L-(4-乙酰基)吡喃鼠李糖-7-O-β-D-吡喃葡萄糖甙(II)。I和I为新化合物,分别命名为朝藿甙甲(korepimedoside A)和朝藿甙乙(korepimedoside B)。     

Relation of depressive mood to plasminogen activator inhibitor, tissue plasminogen activator, and fibrinogen levels in patients with versus without coronary heart disease

The increased risk of coronary heart disease (CHD) associated with depression is well documented. We hypothesized that impaired fibrinolysis is involved in this link. To explore the association of depressive mood and/or vital exhaustion with various measurements of fibrinolysis activity, 231 men (40 to 65 years old; 123 without CHD and taking no medication and 108 with documented CHD), completed the Center of Epidemiologic Studies Depression Scale and the Maastricht Questionnaire for vital exhaustion. Using classic cut-off points (Center of Epidemiologic Studies Depression Scale score >or=17, Maastricht Questionnaire score >or=8), 6.5% and 9.8% of subjects without CHD and 38% and 48.1% of those with CHD were classified as depressed and exhausted, respectively. Patients with CHD were older, had a higher body mass index, and higher levels of total cholesterol, glucose, plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA) antigen, and fibrinogen; 47% were treated for hypertension. Depressed subjects had higher levels of PAI-1 activity (p = 0.006) and exhausted patients had higher levels of PAI-1 activity (p = 0.011) and fibrinogen (p = 0.009). After adjusting for clinical condition (with or without CHD), smoking, hypertension, triglyceride concentration, and body mass index, PAI-1 activity remained higher in depressed subjects (p = 0.03). This association persisted after further adjustment for vital exhaustion or for t-PA antigen and fibrinogen levels. t-PA antigen and fibrinogen levels were not associated with depressive mood in multivariate analyses. No fibrinolytic variable was associated with vital exhaustion in multivariate analyses. In conclusion, depressive mood, but not vital exhaustion, is associated with higher levels of PAI-1 activity, suggesting a possible impairment of fibrinolysis and indicating a potential additional mechanism by which depressive mood may act as a cardiovascular risk factor.     

Effectiveness of angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers on total and cardiovascular mortality and morbidity in primary prevention: A nationwide study based on French Health Insurance Data (SNDS)

Angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) both inhibit the renin‐angiotensin system (RAS) but have different sites of action. Whether clinically meaningful differences exist is still debated. The authors set up a population‐based nationwide retrospective cohort study with at least 5 years of follow‐up based on the comprehensive French Health Insurance Database linked to the French hospital discharge database. Patients aged 50 or above, identified as ARB or ACE inhibitor new users in 2009 (at least one delivery during the year and no such delivery in 2008) were eligible. Exclusion criteria included history of cancer, cardiovascular disease, or chronic renal insufficiency. Main outcome measure was overall mortality. Secondary outcomes were cardiovascular deaths, major cardiovascular events, and major or other cardiovascular events. Out of 407 815 eligible patients, 233 682 (57%) were ARB users; two‐third had no previous exposure to antihypertensive drug. Based on propensity‐score based Cox model, ARB new user group had a better overall (HR: .878, 95%CI, .854 to .902), and cardiovascular (HR: .841, 95%CI, .800 to .84) survival and had a lower risk for major cardiovascular events (HR: .886, 95%CI, .868 to .905). Statistically significant quantitative interactions were detected with diabetes. Considering subgroup analyses, ARBs had a better survival than ACE inhibitors in nondiabetic patients.     

Epidemiology of colorectal cancer in Asia

The prevalence of colorectal cancer is increasing in Asia. However, the age‐standardized rate has reached a plateau in some countries. Some studies have shown a male predominance difference and increasing risk in the elderly, but not in the younger population. ‘Right shifting’ of colorectal cancer, not accountable by difference in age or the indications for endoscopic examination, has also been noted. Westernized diet is associated with colorectal cancer, but controversy remains on how it causes colorectal cancer. Alcohol consumption, obesity, diabetes mellitus, consumption of red and processed meat and cigarette smoking are linked to bowel cancer epidemiologically. Only high dietary calcium has a consistent negative (or ‘protective’) effect. The efficacy of fish oil, vitamin D, soy, phytoestrogens, folate, methionine, riboflavin and vitamin B6 has not been established. Aspirin and non‐steroidal anti‐inflammatory drugs use decrease risk of colorectal cancer after 5–10 years of use. There is no evidence for a detrimental effect of proton pump inhibitors or benefit of statins in colorectal cancer. In conclusion, there is a rising trend and prevalence of colorectal cancer in Asia. Dietary modification or supplementation may not be effective in preventing colorectal cancer. Surveillance of colorectal cancer in high‐risk groups, according to current recommendation, is probably most effective.     

A J-shaped association between plasma testosterone and risk of ischemic arterial event in elderly men: The French 3C cohort study

Objectives

Low plasma testosterone is associated with increased mortality in men. However, the relation between testosterone and cardiovascular disease is uncertain. We assessed the association of plasma sex hormones with the incidence of ischemic arterial disease (IAD) in elderly men.

Methods

We used data from the French Three-City prospective cohort study (3650 men aged >65 years). A case-cohort design was set up including a random sample of 495 men and 146 incident cases of first IAD event (112 coronary heart disease (CHD) and 34 strokes) after a 4-year follow-up. Plasma total and bioavailable testosterone, total estradiol and sex hormone-binding globulin (SHBG) were measured at baseline. Multivariate hazard ratios (HRs) and 95% confidence intervals for IAD were assessed using Cox model.

Results

After adjustment for cardiovascular risk factors, a J-shaped association between plasma total testosterone and IAD risk was found (p < 0.01). The HRs associated with the lowest and the highest total testosterone quintiles relative to the second quintile were 2.23 (95% CI: 1.02; 4.88) and 3.61 (95% CI: 1.55; 8.45) respectively. Additional analysis for CHD showed similar results (HR: 3.11, 95% CI: 1.27; 7.63 and HR: 4.75, 95% CI: 1.75; 12.92, respectively). Similar J-shaped association was observed between bioavailable testosterone and IAD risk (p = 0.01). No significant association of estradiol and SHBG with IAD was found.

Conclusion

High and low plasma testosterone levels are associated with an increased risk of IAD in elderly men. Optimal range of plasma testosterone may confer cardiovascular protection and these results may have clinical implications in the management of testosterone deficiency.     

Assessment of information and education about topical corticosteroids in dermatology outpatient departments: experience from Turkey

BACKGROUND: Topical corticosteroids are commonly used in dermatological practice. The aim of this study was to assess the baseline level of knowledge about topical steroids in a group of dermatology patients and to evaluate the impact of educational materials on patients' level of information. METHODS: A 10-item questionnaire was developed, and 126 patients who were prescribed topical steroids for several dermatologic diseases were asked mostly about side-effects of the drugs. Three different educational methods were used in parallel to the questionnaire: verbal (n = 42), written (n = 42) or verbal and written (n = 42). The same questions were asked again 1 or 2 weeks later. RESULTS: Only 7.1% of the study group mentioned that they were informed by doctors about the side-effects of topical steroids before they were administered. The baseline information scores about topical corticosteroids were higher in high school and college graduates and in those who noted side-effects or who were informed about side-effects before administration. A statistically significant difference was detected between pre- and posteducation scores of patients in the whole group and within the three groups of different educational methods (P < 0.001). Posteducation scores of the combined verbal- and written-educated group were higher than the written-educated group or the verbal-educated group. CONCLUSION: The present study indicated that patient knowledge is enhanced by any kind of educational method, and particularly written information supported by verbal instructions given in dermatology outpatient departments. Moreover, we conclude that the 10-item questionnaire can be used in Turkey to assess patients' knowledge about topical corticosteroids.