Drug-eluting stent implantation could be associated with long-term coronary endothelial dysfunction

Drug-eluting stent (DES) implantation may be associated with endothelial dysfunction. However, changes in long-term endothelial function based on the type of DES remain largely unknown. We assessed coronary endothelial function after DES implantation compared to bare-metal stents (BMS) and determined the differences according to DES type. Patients who had single BMS or DES implantation in the left anterior descending artery and showed no restenosis in follow-up angiography at 6 to 9 months were assigned to the BMS group (5 patients) or DES group (9 sirolimus-eluting stents, SES, and 8 paclitaxel-eluting stents, PES). Endothelium-dependent vasomotion, after intracoronary infusion of acetylcholine, was determined by quantitative coronary angiography. Also, endothelium-independent vasomotion was assessed after nitrate infusion. In the distal and far distal segments, the SES (SES versus BMS, distal: -27.6 +/- 16.3% versus -0.6 +/- 1.6%; P = 0.01, far distal: -24.8 +/- 13.2% versus -0.9 +/- 1.3%; P = 0.02) and PES groups (PES versus BMS, distal: -25.4 +/- 17.1% versus -0.6 +/- 1.6%; P = 0.01, far distal: -26.6 +/- 15.9% versus -0.9 +/- 1.3%; P = 0.01) had similar patterns showing significant vasoconstriction compared with the BMS group. In addition, the DES group showed a significant reduction of diameter in distal (SES: P = 0.001, PES: P = 0.04) and far distal segments (SES: P = 0.002, PES: P = 0.001) compared with proximal and near proximal segments. However, the BMS group did not demonstrate significantly different vasomotion between proximal and distal segments. Vasodilatation by nitrate infusion was preserved in all subjects. SES or PES implantation could be associated with the similar pattern of endothelial dysfunction identified predominantly in the long distal portion of the treated vessel.     

Hepatic vena cava disease: Etiologic relation to bacterial infection

Aim: Hepatic vena cava disease is a primary obliterative disease of the hepatic portion of the inferior vena cava (IVC) that often causes liver cirrhosis and hepatocellular carcinoma. Its geographic prevalence is inversely related to the standard of community hygiene. The disease is endemic in Nepal and is commonly associated with bacterial infection. The cause of the disease is not known. It was previously thought to be congenital. Thrombosis due to hypercoagulable condition is suggested as a possible cause of the disease. This study looks at the relation of the disease to bacterial infection. Methods: Ultrasonography is sensitive and specific for the diagnosis of acute and chronic lesions of hepatic vena cava disease. Patients attending the Liver Clinic with pyrexia with and without bacteremia were examined by ultrasonography for acute "thrombophlebitic" lesion of the IVC, and five patients with bacterial infection with acute lesion in the hepatic portion of the IVC were followed. Results: Sixty eight percent of the patients with bacteremia had ultrasonographic evidence of acute lesion in the hepatic portion of the IVC, compared to 18% patients without bacteremia. A follow-up study of five patients showed transformation of the acute lesion into chronic obliterative lesion - stenosis or complete obstruction. Conclusion: Bacterial infection is probably the cause of hepatic vena cava disease seen in developing countries.     

Effect of adding sitagliptin, a dipeptidyl peptidase-4 inhibitor, to metformin on 24-h glycaemic control and beta-cell function in patients with type 2 diabetes

AIM: The aim of this study was to assess the effect of sitagliptin, a dipeptidyl peptidase-4 inhibitor, on 24-h glucose control when added to the regimen of patients with type 2 diabetes who had inadequate glycaemic control on metformin therapy. METHODS: In a double-blind, randomized, placebo-controlled, two-period crossover study, patients with type 2 diabetes with inadequate glycaemic control on metformin monotherapy (i.e. on a stable dose of > or = 1500 mg/day for > or = 6 weeks prior to the screening visit and an haemoglobin A(1c) (HbA(1c)) > or = 6.5% and <10% and fasting plasma glucose (FPG) < or = 240 mg/dl) were recruited for participation. A total of 28 patients (baseline HbA(1c) range = 6.5-9.6%) receiving metformin were randomized into one of two treatment sequences: the addition of placebo for 4 weeks followed by the addition of sitagliptin 50 mg twice daily (b.i.d.) for 4 weeks, or vice versa. At the end of each treatment period, patients were domiciled for frequent blood sampling over 24 h. The primary endpoint was 24-h weighted mean glucose (WMG) and secondary endpoints included change in FPG, mean of 7 daily self-blood glucose measurements (MDG) and fructosamine. beta-cell function was assessed from glucose and C-peptide concentrations were measured during the 5-h period after a standard breakfast meal by using the C-peptide minimal model. RESULTS: Despite a carryover effect from period 1 to period 2, the combined period 1 and period 2 results for glycaemic endpoints were statistically significant for sitagliptin relative to placebo when added to ongoing metformin therapy. To account for the carryover effect, the period 1 results were also compared between the groups. Following period 1, there were significant least-squares (LS) mean reductions in 24-h WMG of 32.8 mg/dl, significant LS mean reduction from baseline in MDG of 28 mg/dl, FPG of 20.3 mg/dl and fructosamine of 33.7 mmol/l in patients treated with sitagliptin relative to placebo (p < 0.05). When added to ongoing metformin therapy, parameters of beta-cell function were significantly improved with sitagliptin compared with placebo. No weight gain or increases in gastrointestinal adverse events or hypoglycaemia events were observed with sitagliptin relative to placebo during this study. CONCLUSIONS: In this study, the addition of sitagliptin 50 mg b.i.d. to ongoing metformin therapy improved 24-h glycaemic control and beta-cell function, and was generally well tolerated in patients with type 2 diabetes.     

Locus of control among spinal cord injury patients with different levels of posttraumatic stress disorder

Two hypotheses were investigated in the present study: 1) Patients with full posttraumatic stress symptoms following spinal cord injury (SCI) would experience more general health problems than those with partial posttraumatic stress disorder (PTSD), with no-PTSD and the control group; 2) Patients with full PTSD would endorse the external locus of control more than those with partial PTSD, no-PTSD and the control group. Sixty-two patients were recruited from a specialized rehabilitation clinic for spinal cord injury. The control group comprised 60 participants without SCI. Patients with SCI were assessed using the Posttraumatic Stress Disorder Checklist, the General Health Questionnaire-28 (GHQ-28) and the Multidimensional Health Locus of Control (MHLC). The control group was assessed using the GHQ-28 and the MHLC. The full PTSD group experienced more somatic problems, anxiety, social dysfunction and depression than the partial PTSD, the no-PTSD and the control groups. The results also showed that the full PTSD group endorsed significantly more external health locus of control than the control group. However, no significant differences were found between the three patient groups in health locus of control. The three PTSD sub-scales were positively correlated with general health problems. Further analyses showed that partial PTSD patients with paraplegia and partial PTSD patients whose SCI had a medically related cause were more likely to report less internal locus of control than other patients. Patients who suffered from full PTSD experienced more general health problems than those with fewer PTSD symptoms and those without SCI. External locus of control was a distinctive strategy that SCI-PTSD patients used in coping with the effects of SCI-PTSD.     

Glial cell line-derived neurotrophic factor protects astrocytes from staurosporine- and ischemia- induced apoptosis

Glial cell line-derived neurotrophic factor (GDNF) promotes the survival and functions of neurons. It has been shown to be a promising candidate in the treatment of ischemia and other neurodegenerative diseases. We transfected mouse astrocytes in primary cultures with a human GDNF gene and found that their conditioned medium could not only support the growth and survival of cultured dopaminergic neurons but also protect astrocytes from staurosporine- and ischemia-induced apoptosis. This indicated that these transfected astrocytes could release GDNF. A similar protective effect on astrocytes against apoptosis was evident when recombinant human GDNF was used. Moreover, GDNF reduced caspase-3 activity but not that of caspase-1 in cultured astrocytes after ischemia treatment. Thus, GDNF protects astrocytes from apoptosis by inhibiting the activation of caspase-3.     

Depression and chronic medical illnesses in Asian older adults: the role of subjective health and functional status

OBJECTIVE: Depression in elderly is reportedly associated with a number of specific chronic illnesses. Whether each of these co-morbid associations results uniquely from disease-specific psychobiological responses or is mediated by non-specific factors like subjective health and functional status is unclear. METHOD: Analysis of data of 2,611 community-dwelling Chinese aged 55 and older, including depressive symptoms defined by Geriatric Depression Scale score >or= 5 and self-reports of specific chronic illnesses. RESULTS: The prevalence of depressive symptoms was 13.3%, lower in those without chronic illness (7.5%), and higher in those with illnesses (13.2-24.2%). Crude Odds Ratios (OR) were significantly elevated for hypertension, eye disorders, diabetes, arthritis, ischemic heart disease, asthma/COPD, stroke, osteoporosis, heart failure, thyroid problem, and gastric problem. In multivariable analyses, only asthma/COPD [OR:2.85, 95% Confidence Intervals (CI): 1.36, 5.98], gastric problem (OR:2.64, 95% CI: 1.11, 6.29), arthritis (OR:1.87, 95% CI: 1.02, 3.42) and heart failure (OR:2.11, 95% CI: 0.98, 4.58) remained independently associated with depressive symptoms, after adjusting for comorbidities, subjective health and functional status, cognitive functioning, smoking, alcohol, psychosocial and demographic variables. CONCLUSION: Most comorbid associations of depressive symptoms with specific chronic illnesses are explained by accompanying poor self-reported health and functional status, but some illnesses probably have a direct psychobiological basis.     

结核性胸腔积液病人IL-12、IL-18、TNF-α的水平及变化

目的：探讨三种与结核病（TB）保护性免疫有关的细胞因子白介素-12（IL-12）、白介素-18（IL-18）和肿瘤坏死因子-α（TNF-α）在结核病（TB）免疫发病机制中的作用,为设计新的疫苗和开展辅助性免疫疗法提供依据。方法：检测39例结核性胸腔积液病人胸水中和血清中IL-12、IL-18、TNF-α的水平;并对治疗好转过程中10例Ⅲ型病人和5例Ⅳ型病人这些细胞因子在胸水中的变化进行观测。结果：除IL-18外,其他两种细胞因子胸水中与血清中含量均有显著性差异;IL-12与TNF-α之间有相关关系。治疗好转过程中,Ⅲ型病人绝大多数见IL-12、IL-18水平增高。结论：IL-18用于疫苗佐剂应该优于IL-12;复治组病人IL-12与TNF-α之间呈显著正相关,开展免疫疗法时可参考。     

Vertical Strut Ossiculoplasty: A Versatile Alternate to Conventional Techniques—A Randomized study

IntroductionVarious ossicular reconstruction materials and techniques have been described in literature using autologous ossicle, cortical bone, autologous cartilage, synthetic materials and implants like total/partial ossicular replacement prosthesis (TORP/PORP) etc., but it has always been a topic of controversy in terms of the efficacy, longevity and complications of the material or method used.Material and MethodsThis is a prospective, interventional, comparative, double-blind randomized control study which was done at a tertiary care center to compare outcomes of conventional and carved conchal cartilage (vertical strut) type III Tympanoplasty in terms of graft uptake and hearing gain. A total number of 52 cases were enrolled, randomized and allocated to 2 groups (26 each) i.e. group A (conventional type III) and group B (vertical strut technique).ResultsGraft uptake was seen in 25 (96.16%) patients in group B while it was observed in 23 (88.5%) cases in group A. Hearing gains were also better in group B.ConclusionThis study suggests that Vertical Strut technique can be studied further as it gives better gains in Air Conduction threshold and A-B Gap along with graft uptake as it provides better middle ear space and ossicular / tympanic membrane interface resulting in better hearing.