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41.
Percutaneous coronary interventions in diabetic patients: is complete revascularization important? 总被引:1,自引:0,他引:1
Nikolsky E Gruberg L Patil CV Roguin A Kapeliovich M Petcherski S Boulos M Grenadier E Amikam S Linn S Markiewicz W Beyar R 《The Journal of invasive cardiology》2004,16(3):102-106
BACKGROUND: The long-term prognosis of diabetic patients with multivessel coronary artery disease (CAD) treated by surgical or percutaneous coronary revascularization is significantly worse as compared to non-diabetics. Lower rates of complete revascularization may be one factor that influences the poor long-term outcome in the diabetic population. Our study assessed the impact of complete revascularization on the long-term prognosis in diabetic patients with CAD treated by percutaneous coronary intervention (PCI). The study included 658 consecutive diabetic patients (mean age, 60.9+/-10.1 years) who underwent PCI. Multivessel disease was present in 352 patients (53.5%). Revascularization was complete in 94 (26.7%) and incomplete in 258 (73.3%) patients with multivessel disease. Reasons for incomplete revascularization included angioplasty of only the culprit lesion (43.4%); small vessel size (22.8%); moderate lesion, defined as diameter stenosis 50-69% (18.6%); chronic total occlusion of the non-intervened vessel (6.6%); and others (8.5%). Overall survival rate at 5 years was 87.4%. Patients who underwent complete revascularization had a 94.5% survival rate, compared to 83.0% for those with incomplete revascularization (p<0.001). Similarly, the rates of myocardial infarction-free survival were significantly higher in patients with complete versus incomplete revascularization (92.9% versus 79.9%, respectively). Incomplete revascularization was the most powerful independent predictor of mortality at follow-up (relative risk 95% confidence interval, 1.54-7.69; p=0.003). Our data suggest that complete myocardial revascularization may improve the long-term prognosis after PCI of diabetic patients with multivessel CAD. 相似文献
42.
Nikolsky E Halabi M Roguin A Zdorovyak A Gruberg L Hir J Grenadier E Boulos M Markiewicz W Linn S Beyar R 《American heart journal》2002,143(6):1017-1026
Background Percutaneous coronary interventions (PCIs) in patients with multivessel coronary artery disease (CAD) may be staged or performed in a single session. No data exist about the relative safety and efficacy of these 2 strategies. Our aim was to compare short-term and long-term outcomes of patients with multivessel CAD who underwent PCI in 1 versus 2 sessions. Methods and Results The study included 264 consecutive patients who underwent treatment in our center during 1997 and 1998. PCI was conducted in a single session in 129 patients and was staged in 135 patients. The mean interval between the sessions in the staged group was 45.6 ± 22.3 days. The rates of major adverse cardiac events (MACEs) during in-hospital stay did not differ significantly between the staged (combined for both stages) and nonstaged groups (2.2% vs 4.6%; P = .28). A trend for lower event rates at 30-day (2.9% vs 6.9%; P = .13) and 1-year follow-up (26.1 vs 35.9; P = .08) favored the staged arm. Diameter stenosis ≥50% was found in 17% of patients in the staged group in the second session and was successfully retreated in most of them. No MACE occurred between the sessions. Multivariate analysis identified staging of the procedure as a single independent predictor of MACE at 1-year follow-up (P = .05). Conclusion Our results suggest that a practical staging strategy within 4 to 8 weeks is safe and allows for identification and treatment of potential excessive proliferative response in the previously intervened lesions during the second procedure. (Am Heart J 2002;143:1017-26.) 相似文献
43.
目的 探讨第187位苏氨酸(Thr187)磷酸化的细胞周期素依赖性激酶抑制蛋白(p27kip1,简称p27)(P-p27Thr187)在结直肠癌发生、发展中的作用及其与结直肠癌临床病理特征的关系。方法 收集行手术切除的80例结直肠癌组织标本,以及6对新鲜结直肠癌和相应癌旁正常组织标本;采用免疫组织化学EnVision二步法和蛋白质印迹法检测结直肠癌组织及相应癌旁正常组织中P-p27Thr187和p27的表达;并分析其与结直肠癌临床病理特征的关系。结果免疫组织化学和蛋白质印迹结果均显示,P-p27Thr187在结直肠癌组织中的阳性表达率明显高于癌旁正常组织;结直肠癌组织中P-p27Thr187阳性表达率为100.0%(80/80),高表达者52例(65.0%,52/80),低表达者28例(35.0%,28/80);而癌旁正常组织中P-p27Thr187阳性表达率为13.8%(11/80),与结直肠癌组织比较差异有统计学意义(P<0.05);p27在结直肠癌组织中的阳性表达率为48.8%(39/80),癌旁正常组织中为90.0%(72/80),两组比较差异有统计学意义(P<0.05);P-p27Thr187阳性表达与肿瘤细胞分化程度和TNM分期有关(均P<0.05);P-p27Thr187表达强度与细胞增殖指标Ki-67表达强度呈正相关(r=0.487,P<0.05),与p27表达强度呈负相关(r=-0.394,P<0.05)。结论结直肠癌组织中P-p27Thr187的异常表达可能参与了结直肠癌的发生、发展过程,其有助于综合评估结直肠癌的生物学行为,对结直肠癌的预后判断及诊治具有一定的参考价值。 相似文献
44.
Parkinson's disease is the second most common neurodegenerative disease worldwide, leading to a wide range of disability and medical complications. Managing patients with Parkinson's disease in the perioperative hospital setting can be particularly challenging. Suboptimal management can lead to medical complications, prolonged hospital stays, and delayed recovery. This review aims to address the most important issues related to caring for patients with Parkinson's disease perioperatively who are undergoing emergent or planned general surgery. It also intends to help hospitalists, internists, and other health care providers mitigate potential in-hospital morbidity and prevent prolonged recovery. Challenges in managing patients with Parkinson's disease in the perioperative hospital setting include disruption of medication schedules, “nothing by mouth” status, reduced mobility, and medication interactions and their side effects. Patients with Parkinson's disease are more prone to immobility and developing dysphagia, respiratory dysfunction, urinary retention, and psychiatric symptoms. These issues lead to higher rates of pneumonia, urinary tract infections, deconditioning, and falls compared with patients without Parkinson's disease, as well as prolonged hospital stays and a greater need for post-hospitalization rehabilitation. Steps can be taken to decrease these complications, including minimizing nothing by mouth status duration, using alternative routes of drugs administration when unable to give medications orally, avoiding drug interactions and medications that can worsen parkinsonism, assessing swallowing ability frequently, encouraging incentive spirometry, performing bladder scans, avoiding Foley catheters, and providing aggressive physical therapy. Knowing and anticipating these potential complications allow hospital physicians to mitigate nosocomial morbidity and shorten recovery times and hospital stays. 相似文献
45.
Meidjie Ang Christian Meyer Mathias D. Brendel Reinhard G. Bretzel Thomas Linn 《Diabetologia》2014,57(3):623-632
Aims/hypothesis
Pancreatic islet transplantation stabilises glycaemic control in type 1 diabetes mellitus patients with neuroglycopoenia, despite them not achieving insulin independence because of limited graft function. However, the extent and underlying metabolic pathways of restored glucose counterregulation are unknown. We therefore compared systemic glucose turnover, including lactate gluconeogenesis (GN) and muscle glucose uptake, in individuals with type 1 diabetes who were transplant recipients with partial graft function (T1DM/ITx+), matched non-transplanted individuals with type 1 diabetes (T1DM/ITx?) and matched healthy non-diabetic individuals.Methods
Participants (n?=?12 in each group) underwent a euglycaemic and a hypoglycaemic (2.5–2.8 mmol/l) hyperinsulinaemic clamp (0.8 mU kg?1 min?1) in a randomised crossover fashion. Systemic and skeletal muscle glucose and lactate kinetics were assessed using a combination of isotopic and forearm balance techniques.Results
Whole-body glucose counterregulation, the difference in glucose infusion rates required to maintain the glycaemic goal between the hypoglycaemic and euglycaemic clamps, was improved in T1DM/ITx+ (7.8?±?1.3 μmol kg?1 min?1) compared with T1DM/ITx? (0.3?±?0.9 μmol kg?1 min?1), but was ~45% lower than in controls (14.1?±?2.1 μmol kg?1 min?1). Increased endogenous glucose production (EGP) and decreased systemic glucose disposal accounted for 49% and 39% of glucose counterregulation in T1DM/ITx+, respectively, compared with 60% and 36% in controls. Lactate GN increased in T1DM/ITx+ (2.7?±?0.4 μmol kg?1 min?1) and controls (1.7?±?0.5 μmol kg?1 min?1), such that it accounted for 70% and 20% of the increased EGP, respectively. Skeletal muscle accounted for similar proportions of the decrease in systemic glucose disposal in controls (49%) and T1DM/ITx+ (41%).Conclusions/interpretation
Partial islet graft function improves hypoglycaemia counterregulation by increasing EGP, largely via lactate GN and decreasing systemic glucose disposal. This may explain the reduction in severe hypoglycaemic events in T1DM/ITx+ individuals. Trial registration: ClinicalTrials.gov NCT01668485 相似文献46.
Meidjie Ang Andreas S. Müller Florian Wagenlehner Adrian Pilatz Thomas Linn 《Metabolism: clinical and experimental》2012,61(12):1696-1702
ObjectiveA combined load of carbohydrate and protein stimulates insulin secretion. However, results on postprandial glucose responses in type 2 diabetic (T2D) subjects have been inconclusive. Therefore, we investigated the effects of co-ingestion of carbohydrate and protein on glucose and insulin responses in these subjects.MethodsAfter an overnight fast, 30 subjects consumed a drink containing 50 g of slowly-digested isomaltulose (ISO), combined either with a mixture of 21 g whey/soy (ISO + WS) or with 21 g casein (ISO + C) in a randomized order on separate days. In another experiment, the subjects consumed a control drink containing only 50 g ISO.ResultsNo significant differences in glucose responses were observed after ingestion of the drinks. Compared to ingestion of ISO alone, insulin response was ~ 190%–270% higher (P < .001), whereas insulin action was lower (P < .01) after ingestion of ISO + WS and ISO + C. Plasma insulin levels increased more significantly (P < .001) after ingestion of ISO + WS compared to ISO + C and were positively correlated with total amino acid levels (P < .001). Insulin action, however, showed a greater decrease following ingestion of ISO + WS than ISO + C (P < .01).ConclusionsCombining carbohydrate with protein can elevate postprandial insulin levels, but decreases insulin action, and therefore does not improve glucose response in T2D subjects. Our results further suggest that different types of proteins (i.e., fast-absorbing whey/soy vs. slow-absorbing casein) differently modulate insulin response and insulin action. A fast-absorbing protein mixture reduces insulin action to a greater extent than a slow-absorbing protein, and therefore may not be recommended for glycemic control in T2D patients. 相似文献
47.
48.
Single center retrospective analysis of BU-based conditioning regimens in allogeneic transplantation
Wong AM Allen JC Goh YT Linn YC Loh SM Diong CP Chowbay B Hwang WY 《Bone marrow transplantation》2012,47(2):181-189
We performed a single institution retrospective analysis of 114 patients treated with BU-based pretransplant conditioning regimens. Oral BU was administered to 76 patients (total dose 16?mg/kg or 8?mg/kg) and i.v. BU to 38 others (total dose 12.8?mg/kg or 6.4?mg/kg). Either CY (n=74) or fludarabine (n=40) was given in combination with BU. Median age was 35 years in the oral BU group and 48.5 years with i.v. BU (P<0.001). OS and PFS rates at 3-years post HSCT were not different in patients who received either i.v. or oral BU (OS: 41.3 vs 44.0% (P=0.981); PFS: 52.7 vs 54.7% (P=0.526), respectively). The i.v. BU, however, was associated with a significantly shorter time to engraftment (13.5 days vs 16 days, respectively; P<0.001). There were no significant differences in survival or 100-day mortality for patients who received either CY or fludarabine, in combination with BU. After adjustment for confounders, multivariate analysis showed that age of transplant (P=0.002), donor type (sibling or unrelated; P=0.003), GVHD (P<0.05) and route of administration (P=0.023) were significant risk factors for OS. The i.v. BU used in an older age group yielded equivalent survival compared with oral BU used in a younger population. 相似文献
49.
Florian M. E. Wagenlehner Adrian Pilatz Thomas Bschleipfer Thorsten Diemer Thomas Linn Andreas Meinhardt Undraga Schagdarsurengin Temujin Dansranjavin Hans-Christian Schuppe Wolfgang Weidner 《World journal of urology》2013,31(4):711-716
Objectives
The prostatitis syndrome is classified into bacterial prostatitis (acute and chronic), chronic pelvic pain syndrome and asymptomatic prostatitis. The aim of this report is to review current management standards for bacterial prostatitis.Methods
A research was performed on literature dealing with acute and chronic bacterial prostatitis.Results
There is a consensus on diagnostic management of bacterial prostatitis comprising microbiological sampling of midstream urine in acute bacterial prostatitis and performance of a bacterial localisation test in chronic bacterial prostatitis. Approximately 10 % of acute bacterial prostatitis cases eventually develop into chronic bacterial prostatitis and further 10 % into chronic pelvic pain syndrome. Bacterial isolates causing acute bacterial prostatitis are highly virulent strains comprising an array of different virulence factors. Presumably, the additional ability of isolates to form biofilms might be one factor amongst others to facilitate development of chronic bacterial prostatitis. Therapy for infectious prostatitis is standardised with antibiotics as the primary agents, empirically administered in acute prostatitis and after susceptibility testing in chronic bacterial prostatitis. Fluoroquinolones exhibit more favourable pharmacological properties; therefore, fluoroquinolones have been recommended as first-line agents in the treatment for chronic bacterial prostatitis. Antibiotic resistance to fluoroquinolones, however, is increasing and is posing significant clinical problems. Further studies on alternative antibiotics active within the prostate are therefore needed both for prophylaxis in transrectal prostate biopsy, for example, and for therapy of chronic bacterial prostatitis.Conclusions
Bacterial prostatitis has developed into well-managed entities with increasing antimicrobial resistance being the most severe drawback of yielding therapeutic success. 相似文献50.
Matthew Zapf Woody Denham Ermilo Barrera Zeeshan Butt JoAnn Carbray Chih Wang John Linn Michael Ujiki 《Surgical endoscopy》2013,27(12):4491-4498