Secondary prevention reinfarction Israeli nifedipine trial (SPRINT).: A randomized intervention trial of nifedipine in patients with acute myocardial infarction

The efficacy of nifedipine in the prevention of post-infarctionmorbidity and mortality was evaluated in a double-blind clinicaltrial of 2276 survivors of acute myocardial infarction recruitedfrom the cardiac departments of 14 Israeli hospitals. The patientswere randomized to either nifedipine 30 mg day^–1 or placebobetween 7 and 21 days after their hospitalization for the acuteevent. Baseline characteristics of patients in each group werevirtually identical for most pertinent variables. Mortality during an average 10-month follow-up period was 5.7%in the placebo group and 5.8% among those receiving nifedipine.Nonfatal recurrent myocardial infarction occurred in 4.8% and4.4% of placebo and nifedipine patients, respectively. Administrationof nifedipine according to the protocol used in the presentstudy had no effect on cardiac events in survivors of acutemyocardial infarction.     

Multifactorial trial in the prevention of coronary heart disease: 3. Incidence and mortality results

Incidence and mortality results are presented from an internationalcontrolled trial of multifactorial prevention of coronary heartdisease, involving randomization of 66 factories (49 781 men)in U.K., Belgium, Italy and Poland (Cracow). Results for Poland(Warsaw) are not yet complete. Net average reductions in riskfactors (all subjects) were 1.2% for plasma cholesterol, 8.9%for daily cigarettes, 0.4% for weight, 2.0% for systolic bloodpressure, and 11.1% for a combined risk estimate. Greater reductionsoccurred in high-risk subjects (19.4% for the combined estimate). The net overall reduction in CHD rates was 7.4% (95% confidenceinterval –29 to +15%) for deaths (722 cases), and 3.9%(95% confidence interval –10 to + 2%) for fatal CHD +non-fatal myocardial infarction (1502 cases). Among men aged40–49 the reduction for this end-point was 15%; at ages50–59 there was a small net increase. All-causes deathsafter an early adverse trend showed 2.7% reduction overall.There were large differences between centres, ranging from a5% net increase in CHD for U.K. to a decrease of 24% in Belgium.In Belgium the decrease both in CHD and in all deaths was significantat the 5% level. The effect on CHD in the different centrescorrelated broadly with their changes in risk factors. It isconcluded that reduction in major coronary risk factors in industrialpopulations is possible, but it depends on adequate resources;the results support the hypotheses that CHD risk in middle-agedmen is reversible and that community intervention can be beneficial.     

Correlates of care seeking for infertility treatment in Europe: Implications for health services and research

Study: To compare care seeking and non-care seeking coupleswith infertility in order to describe potential differenceswhich may have consequences for health care planning and research.Design: multicentre surveys of randomly selected women of child-bearingage. Setting: seven centres in five countries: Denmark, Germany(two centres), Italy (two centres), Poland and Spain. Data werecollected from 1991 to 1993 as part of a European concertedaction. Participants: population-based samples of women between25 and 44 years. The samples ranged from 442 women in Polandto 2, 729 women in Italy. The participation rates ranged from54% in Germany to 88% in Poland. Data: data were collected duringface to face interviews by means of highly structured questionnaires.Questions were asked about life style factors, work exposures,pregnancy history, fecundity and care seeking behaviour. Mainoutcome measures: seeking medical advice and help for infertilityamong couples who had tried to become pregnant for more than12 months. Main results: nulliparity was the strongest predictorfor seeking help in all the European centres and more than 50%of the nulliparous women sought help in all the centres. Thefrequency of care seeking among couples with secondary infertilityvaried to a large extent between the different centres. Womenwith a paid job and smokers were less likely to seek help inmost centres (except in Spain and Italy). Conclusion: far fromall those with an infertility problem seek medical advice andhelp, and the correlates of care seeking differ to a large extentbetween different cultural and health care settings. Researchbased upon clinical samples could easily be biased if the topicof research correlates with care seeking behaviour.     

GIANT GROUP A MARKER CHROMOSOME lN THREE HUMAN LYMPHOBLASTOID CELL STRAINS FROM NASOPHARYNGEAL CARCINOMA

In 1976, at the Kwangtung Conference on Nasopharyngeal Carcinoma (NPC)(1), we reported the presence of a giant submetar:en- tric group A marker chromosome of com- posite structure (1;3p) cytogenetically demons_ trated by banding analysis in 2 NPC lympho- blastoid cell strains from a male and female patient. Meamvhile, the Cancer Institute of Chungshan Medical College, Kxvangchow（2), also reported their findings by conventional karyotyping technic of a giant A rn相似文献   

Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study

BACKGROUND: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m(-2) < BMI < or = 30 kg m(-2)) or obesity (BMI >30 kg m(-2)) and VTE risk has not been investigated. METHODS: We carried a multicenter case-control study of VTE among postmenopausal women aged 45-70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. RESULTS: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7-3.7] for overweight and 3.9 (95% CI: 2.2-6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6-7.7 and OR = 1.1; 95% CI: 0.7-1.7, respectively). Compared with non-users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5-30.2 and OR = 20.6; 95% CI: 4.8-88.1, respectively). However, transdermal users with increased BMI had similar risk as non-users with increased BMI (OR = 2.9; 95% CI: 1.5-5.8 and OR = 2.7; 95% CI: 1.7-4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1-14.1 and OR = 4.0; 95% CI: 2.1-7.8 respectively for obesity). CONCLUSIONS: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.     

von Willebrand factor/factor VIII concentrate (Haemate® P) dosing based on pharmacokinetics: a prospective multicenter trial in elective surgery

BACKGROUND: While plasma-derived concentrates containing large amounts of von Willebrand factor (VWF) are effective in treating von Willebrand disease (VWD), optimal dosing remains to be fully characterized. OBJECTIVES: To determine the feasibility of dosing Haemate P VWF/factor VIII (FVIII) concentrate based on pharmacokinetics (PK) in the management of surgical subjects with VWD. METHODS: VWD subjects scheduled for elective surgery were enrolled in a prospective multicenter open-label cohort study. A pre-operative loading dose of VWF/FVIII concentrate based upon prior individual subject PK analysis was administered followed by postoperative therapeutic/maintenance infusions. RESULTS: Twenty-eight subjects with types 1, 2A or 3 VWD and one with type 2 M were enrolled. Median in vivo recovery of VWF ristocetin cofactor (VWF:RCo) was 1.9 IU dL(-1) (IU kg(-1))(-1) with an interquartile range (IQR) of 1.6-2.5 IU dL(-1) (IU kg(-1))(-1). Median response, half-life and clearance were 74.0% (IQR, 55.5-100%), 15.6 h (IQR, 9.0-28.4 h) and 3.26 mL kg(-1) h(-1) (IQR, 2.29-5.21 mL kg(-1) h(-1)), respectively. A PK-guided median VWF:RCo loading dose of 62.4 IU kg(-1) (IQR, 50.1-87.0 IU kg(-1)) was administered. Postoperative mean trough VWF:RCo levels of 62-73 IU dL(-1) were sufficient to prevent bleeding. Investigators rated hemostasis excellent or good in 96.3% of subjects on the day of surgery and 100% on the next day and on day 14. A subject with multiple risk factors developed pulmonary embolism, which resolved without sequelae. CONCLUSIONS: Haemate P provided effective and safe hemostasis in VWD subjects undergoing elective surgery. Selection of Haemate P loading dose on the basis of VWF PK proved feasible.     

Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART Study

Summary.  Background:  In Asian patients undergoing surgery, the incidence of venous thromboembolism (VTE) is thought to be low relative to Western patients, and the routine use of thromboprophylaxis is controversial. Objectives:  The aim of this work was to study the epidemiology of VTE in Asian patients undergoing orthopedic surgery without thromboprophylaxis. Patients and methods:  We performed a prospective observational study of a cohort of consecutive Asian patients hospitalized for total hip or knee replacement or hip fracture surgery without thromboprophylaxis. The primary study outcome was the incidence of the composite of symptomatic VTE or sudden death at hospital discharge. This outcome was also assessed at 1 month's follow-up. Results:  Between April 2001 and July 2002, 2420 patients were enrolled. Median age was 68 years and the median duration of hospital stay was 13 days. The rate of symptomatic VTE or sudden death as notified by investigators was 2.3%[55 patients, 99% confidence interval (CI) 1.6, 3.2] and 1.2% (28 patients, 99% CI 0.7, 1.8) after adjudication by an independent committee. Chronic heart failure, varicose veins and a history of VTE were independent risk factors ( P <  0.05) for the occurrence of the primary endpoint. At 1 month's follow-up, the incidence of adjudicated symptomatic VTE or sudden death was 1.5% (35/2264 patients). Conclusion:  In Asian patients, the incidence of symptomatic VTE after major orthopedic surgery is not low, consistent with the rates observed in Western countries. The use of thromboprophylaxis should be considered in Asian patients undergoing such high-risk surgical procedures.     

Efficient Strategy for Detecting Gene × Gene Joint Action and Its Application in Schizophrenia

We propose a new approach to detect gene × gene joint action in genome‐wide association studies (GWASs) for case‐control designs. This approach offers an exhaustive search for all two‐way joint action (including, as a special case, single gene action) that is computationally feasible at the genome‐wide level and has reasonable statistical power under most genetic models. We found that the presence of any gene × gene joint action may imply differences in three types of genetic components: the minor allele frequencies and the amounts of Hardy‐Weinberg disequilibrium may differ between cases and controls, and between the two genetic loci the degree of linkage disequilibrium may differ between cases and controls. Using Fisher's method, it is possible to combine the different sources of genetic information in an overall test for detecting gene × gene joint action. The proposed statistical analysis is efficient and its simplicity makes it applicable to GWASs. In the current study, we applied the proposed approach to a GWAS on schizophrenia and found several potential gene × gene interactions. Our application illustrates the practical advantage of the proposed method.     

An analysis of factors affecting the incidence of inhibitor formation in patients with congenital haemophilia in Japan

Summary. Studies conducted in European and North American countries have demonstrated that various factors including races affect the frequency of inhibitor formation in haemophilia patients. The present study was undertaken to analyse factors affecting the incidence of inhibitor formation in Japanese haemophilia A and B patients. Analytical data were retrospectively collected from haemophilia A and B patients born after 1988, the year when monoclonal antibody‐purified factor VIII products were first marketed in Japan. Various data were collected from 184 patients (153 cases of haemophilia A; 31 cases of haemophilia B). The sample size of haemophilia B cases was too small to reveal any significant differences between the inhibitor formation group and the inhibitor‐free group in any of background variables. For patients with haemophilia A, on the other hand, univariate analysis identified the severity of haemophilia and a positive family history of inhibitor development as risk factors for the formation of inhibitors. In analyses of the clotting factor products used, the incidence of inhibitor formation did not differ significantly between the group treated with plasma‐derived products (29.7%) and the group treated with recombinant products (25.0%). When background variables were compared, age was higher in the group treated with plasma‐derived products but none of the other background variables differed between the two groups. These results suggest that in Japanese haemophilia patients, the type of clotting factor preparations used for therapy has not influenced the incidence of inhibitor formation.