Elevated Non-high-density Lipoprotein Cholesterol (Non-HDL-C) Predicts Atherosclerotic Cardiovascular Events in Hemodialysis Patients

Summary

Background and objectives

Dialysis patients show “reverse causality” between serum cholesterol and mortality. No previous studies clearly separated the risk of incident cardiovascular disease (CVD) and the risk of death or fatality after such events. We tested a hypothesis that dyslipidemia increases the risk of incident atherosclerotic CVD and that protein energy wasting (PEW) increases the risk of fatality after CVD events in hemodialysis patients.

Design, setting, participants, & measurements

This was an observational cohort study in 45,390 hemodialysis patients without previous history of myocardial infarction (MI), cerebral infarction (CI), or cerebral bleeding (CB) at the end of 2003, extracted from a nationwide dialysis registry in Japan. Outcome measures were new onsets of MI, CI, CB, and death in 1 year.

Results

The incidence rates of MI, CI, and CB were 1.43, 2.53, and 1.01 per 100 person-years, and death rates after these events were 0.23, 0.21, and 0.29 per 100 person-years, respectively. By multivariate logistic regression analysis, incident MI was positively associated with non-HDL cholesterol (non–HDL-C) and inversely with HDL cholesterol (HDL-C). Incident CI was positively associated with non–HDL-C, whereas CB was not significantly associated with these lipid parameters. Among the patients who had new MI, CI, and/or CB, death risk was not associated with HDL-C or non–HDL-C, but with higher age, lower body mass index, and higher C-reactive protein levels.

Conclusions

In this hemodialysis cohort, dyslipidemia was associated with increased risk of incident atherosclerotic CVD, and protein energy wasting/inflammation with increased risk of death after CVD events.     

Radiation therapy for advanced gastric cancer

A retrospective study of 75 patients with advanced inoperable gastric cancers, referred to the National Cancer Center Hospital between 1962 and 1982, was performed. According to the Borrmann classification based on X ray findings, Type 1 was found in 3 patients, Type 2 in 5, Type 3 in 40, and Type 4 in 15. Twelve patients could not be classified. The histological type was papillary adenocarcinoma in 7 patients, tubular adenocarcinoma in 23, mucinous carcinoma in 6, poorly differentiated adenocarcinoma in 14, signet ring cell carcinoma in 12 and others in 13. The site of remote metastasis in 19 patients was Virchow's lymph node in 8 patients, Douglas pouch in 3, liver and lung in 2 each and others in 4. All patients were treated by a either telecobalt 60 unit or a linear accelerator using 6 Mv photon and the total dose to primary lesion was 4000 cGy in 5 weeks to 7000 cGy in 8-9 weeks. Complete response (CR) was achieved in 6 patients or 8.0%, partial response (PR) in 46 or 61.3%, and no change (NC) in 23 or 30.7%. The response rate based on the sum of CR and PR was about 70%. The 50% survival period in months was 26.5, 7.3, and 3.2, respectively for patients with CR, PR, and NC. For the response of advanced gastric cancer to chemotherapy in the National Cancer Center Hospital, the combined use of UFT and Mitomycin C gave the highest rate, 46%. As for as local response is concerned, the response rate to radiation was 70%, a better result than that of chemotherapy alone.     

Phase II study of twice-daily high-dose thoracic radiotherapy alternating with cisplatin and vindesine for unresectable stage III non-small-cell lung cancer: Japan Clinical Oncology Group Study 9306.

PURPOSE: To evaluate the efficacy and toxicity of high-dose thoracic radiotherapy (TRT) alternating with chemotherapy (CH) for unresectable stage III non--small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Forty-one patients received TRT with 1.5 Gy twice daily, 5 days a week, on weeks 1, 2, 5, 6, and 9, up to a total dose of 66 to 72 Gy, alternating with cisplatin 80 mg/m(2) on day 1 and vindesine 3 mg/m(2) on days 1 and 8, repeated every 4 weeks, for two or three courses beginning on week 3. RESULTS: The median (range) total dose of TRT and number of CH courses were 72 Gy (16.5 to 72 Gy) and three (zero to three), respectively. Delay in TRT > or = 5 days was observed in 24 (75%) of 32 patients who completed the projected treatment, due to leukopenia in 12, esophagitis in seven, infection in two, and other causes in three patients. Partial responses were obtained in 36 patients (88%). The median survival time and 3- and 5-year survival rates were 18.4 months, 24%, and 10%, respectively. Grade 3 or 4 leukopenia and esophagitis developed in 32 and seven patients, respectively. Grade 3 or 4 late esophageal toxicity developed in two patients. CONCLUSION: Alternating high-dose TRT and CH for stage III NSCLC produced a high response rate with median and long-term survival comparable to prior trials utilizing standard approaches in this population. Acute and late esophageal toxicity was observed and interruption of TRT was required in most of the patients.     

Inhalation anesthetics suppress the expression of c-Fos protein evoked by noxious somatic stimulation in the deeper layer of the spinal cord in the rat

The effects of inhalation anesthetics, nitrous oxide (N₂O) and halothane, on the expression of c-Fos protein evoked by formalin injection were studied in the spinal cord in the rat. The expression of c-Fos protein was detected by immunocytochemistry following the injection of formalin (5%, 100 μl) into the plantar surface of the left hindpaw. After 15 min of halothane (F) anesthesia, the anesthetics was switched to 40% or 70% of N₂O, 0.5% or 1.5% of F or room air (for control) immediately following the formalin injection. Two hours later the rats were sacrificed and perfused. Sections of the L4 level of spinal cord were immunostained with anti c-Fos antibody. We counted the number of Fos-like immunoreactive (FLI) cells in every specific lamina as follows; superficial layer (laminae I and II), nucleus proprius (laminae III and IV), neck of the dorsal horn (laminae V and VI) and ventral gray (laminae VII–X). Then we compared the results of each category of sample. Both N₂O and halothane suppressed the expression of c-Fos in the neck of the dorsal horn and ventral gray in a dose-dependent manner, but no effects were seen at the superficial layer or nucleus proprius. Suppression of c-Fos expression was greater under N₂O than halothane anesthesia. This finding suggests that N₂O had a stronger analgesic effect than halothane. The current study indicates that inhalation anesthetics do not act equally on every kind of spinal neurons. Both N₂O and halothane have effects on spinal neurons in the deeper layers but not on the neurons existed in laminae I–II, some of which directly receive noxious inputs. Pretreatment with 2 mg/kg of naloxone, which completely reversed the effects of morphine, did not alter the effect of 70%N₂O, suggesting that the analgesic effect of N₂O is not mediated by an intrinsic opioid mechanism at the spinal cord level. ©1977 Elsevier Science B.V. All rights reserved.     

Insulin independence after living-donor distal pancreatectomy and islet allotransplantation

Rising demand for islet transplantation will lead to severe donor shortage in the near future, especially in countries where cadaveric organ donation is scarce. We undertook a successful transplantation of living-donor islets for unstable diabetes. The recipient was a 27-year-old woman who had had brittle, insulin-dependent diabetes mellitus for 12 years. The donor, who was a healthy 56-year-old woman and mother of the recipient, underwent a distal pancreatectomy. After isolation, 408 114 islet equivalents were transplanted immediately. The transplants functioned immediately and the recipient became insulin-independent 22 days after the operation. The donor had no complications and both women showed healthy glucose tolerance. Transplantation of living-donor islets from the distal pancreas can be sufficient to reverse brittle diabetes.     

Synthesis of novel 26-substituted milbemycin A4 derivatives and their acaricidal activities

A series of novel 26-substituted milbemycin A4 derivatives was synthesized from 5-O-t-butyldimethylsilyl-26-hydroxymilbemycin A4 prepared by selenium dioxide oxidation of 5-O-t-butyldimethylsilyl-milbemycin A4. Their acaricidal activities were assessed against the organophosphorus-sensitive two-spotted spider mite (Tetranychus urticae) on the primary leaves of cowpea plants (Vigna sinesis Savi species) by spraying.     

Reperfusion response changes induced by repeated,sustained contractions in normal human masseter muscle

The purpose was to evaluate the intramuscular reperfusion response characteristics associated with repeated isometric contractions in normal human masseter. Intramuscular blood volume was quantified with a near-infrared spectroscopic device that measured the total haemoglobin (Hb) concentration in the muscle. Electromyographic (EMG) activity from the masseter and total bite forces were also recorded. Sixteen healthy volunteers, eight females and eight males, without masticatory muscle pain participated. They were asked first to clench their teeth for as long as possible at 50% of their maximum voluntary contraction (MVC). This was followed by a 60s rest and then immediately by a standard clenching task (50% MVC for 30s) and a 60s recovery period, immediately after which they were asked to repeat exactly the same procedure, with a final 5 min recovery period after the second 30s contraction. Bite force, EMG and Hb concentration were measured continuously and the duration of the two endurance tasks and the amplitudes of all recorded signals were compared (first trial versus second trial). Specifically, the difference between the lowest Hb (trough) seen during the standardised 30s contractions and the highest (peak) seen just after them was assessed. The trough-to-peak difference in Hb concentration of the second standard contraction task was significantly smaller than that of the first standard task (P<0.05, paired t-test). These data show that with sustained effort the post-contraction vasodilatory reperfusion responses of the human masseter are diminished, suggesting a progressive desensitisation of the vasodilatory system.