Familial risk assessment for early-onset coronary heart disease.

PURPOSE: We examined the performance of a familial risk assessment method that stratifies risk for early-onset coronary heart disease by considering the number of relatives with coronary disease, degree of relationship, lineage, and age at diagnosis. METHODS: By using data from the HealthStyles 2003 survey, we assessed the associations between familial risk and early-onset coronary heart disease, diabetes, hypercholesterolemia, hypertension, and obesity. By using area under the curve statistics, we evaluated the discriminatory ability of various risk assessment models. RESULTS: Of 4,035 respondents, 60% were female and 72% were white, with a mean age of 48.8 years. After adjustment for demographics, strong and moderate risk were significantly associated with approximately a five- and twofold risk of early-onset coronary disease, respectively. After adjustment for demographics and personal history of cardiovascular disease, strong familial risk was also significantly associated with diabetes, hypercholesterolemia, hypertension, and obesity. A risk assessment model that included familial risk, demographics, and personal history of diabetes, hypercholesterolemia, hypertension, and obesity was most optimal with an area under the curve statistic of 87.2% CONCLUSIONS: Familial risk assessment can stratify risk for early-onset coronary heart disease. Several conditions associated with increased familial risk can be prevented. These results have important implications for risk assessment and risk-reducing interventions.     

Acute effects of serotonin on rat bladder contractility.

INTRODUCTION: The purpose of this study is to investigate in vitro the effects of serotonin on the rat detrusor. In particular, it examines which drugs inhibit the serotonin-induced detrusor contractions. MATERIALS AND METHODS: Isometric tension changes of isolated rat bladder muscle strips were recorded in an organ bath using a force transducer. Acute effects of serotonin (0.0001-0.01 mM) on resting tension were assessed. Electrical field stimulation (EFS); bethanechol (0.0001-0.01 mM); ATP (1-3 mM)- or KCl (63.5-254 mM)-induced contractions using an application in an organ bath were compared with serotonin-induced contractions. In order to examine the action mechanism of serotonin-induced stimulation, EFS-, bethanechol-, ATP- or KCl-induced contraction on serotonin treatment (0.001 mM) was assessed and serotonin (0.001-0.1 mM) was cumulatively added to the organ bath following preincubation with propranolol, ketanserin, tropisetron, propiverine, sodium nitroprusside or doxazosin. RESULTS: The serotonin-induced response has two phases: an initial transient contraction and a prolonged tonic phase. Serotonin produced a reversible and dose-dependent contraction of the detrusor strips. Responses to bethanechol significantly increased with a concentration of 0.001 mM serotonin (p < 0.05). There was no effect on the responses to ATP, KCl, or EFS on 0.001 mM serotonin. The 5-HT(2) receptor is mainly responsible for serotonin-induced contractions of the detrusor (p < 0.05), while the 5-HT(1) receptor is partially responsible. Doxazosin and propiverine each significantly suppressed the response to serotonin, while sodium nitroprusside and tropisetron each had no effect (p < 0.05). CONCLUSIONS: Because the 5-HT(2) antagonist blocked the effect of serotonin-induced bladder contractions and the stimulation of the adrenoreceptors, the 5-HT(2) antagonist seems to improve lower urinary tract symptoms.     

Surface properties of endosseous dental implants after NdYAG and CO2 laser treatment at various energies.

OBJECTIVES: Dental lasers have been used for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The objective of this study was to compare the possible alterations of the smooth surface and resorbable blast material (RBM) surface implants after using NdYAG and CO(2) lasers at various energies. MATERIALS AND METHODS: Ten smooth surface implants and 10 RBM surface implants were used. Two smooth surface implants and 2 RBM surface implants served as a control group that was not lased. The remaining implants were treated using NdYAG and CO(2) lasers. The surface of each implant was treated for 10 seconds on the second and third threads. The smooth surface implants (group 1) were treated using a pulsed contact NdYAG laser at power settings of 1, 2, 3.5, and 5 W, which are commonly used for soft tissue surgery; the corresponding energy and frequency were 50 mJ and 20 Hz, 100 mJ and 20 Hz, 350 mJ and 10 Hz, and 250 mJ and 20 Hz, respectively. The group 2 RBM implants were treated using a pulsed contact NdYAG laser. The group 3 smooth surface implants were treated using a pulsed wave non-contact CO(2) laser at 1, 2, 3.5, and 5 W, and the group 4 RBM implants were treated using a pulsed wave non-contact CO(2) laser. Data were analyzed using scanning electron microscopy. RESULTS: The control surface was very regular and smooth. After NdYAG laser treatment, the implant surface showed alterations of all the surfaces. The amount of damage was proportional to the power. A remarkable finding was the similarity of the lased areas on the smooth and RBM surfaces. CO(2) laser at power settings of 1.0 or 2.0 W did not alter the implant surface, regardless of implant type. At settings of 3.5 and 5 W, there was destruction of the micromachined groove and gas formation. CONCLUSION: This study supports that CO(2) laser treatment appears more useful than NdYAG laser treatment and CO(2) laser does not damage titanium implant surface, which should be of value when uncovering submerged implants and treating peri-implantitis.     

Techniques for performing laparoscopic liver resection in various hepatic locations

Many studies have recently reported on laparoscopic liver resection, although its development has been slow compared to laparoscopy in other fields. The indications for the location of laparoscopic liver resection have previously been limited to easily accessible lesions. Performing laparoscopic liver resection in the posterior and superior parts of the liver has been considered difficult due to inadequate exposure, the poor operative field and the difficulty with parenchymal dissection. Flexible endoscopy, high definition imaging and various kinds of equipment for parenchymal transection have been introduced for clinical use. In addition, much experience with this procedure has been accumulated at many centers. Accordingly, there are an increasing number of reports on laparoscopic liver resection in difficult locations. At our institution, the location of the tumor is no longer a limitation to laparoscopic liver resection. However, for safer laparoscopic liver resection, the patient positioning and trocar placement should be individualized according to the tumor location. The type of resection also may depend on the remaining liver’s functional capacity. We describe here the technical considerations for performing laparoscopic liver resection, including the technical considerations for performing laparoscopic liver resection for lesions located in the postero-superior segments of the liver.     

腔内聚乙烯十二指肠-空肠导管对体重调节的作用:猪动物模型可行性研究

目的评估十二指肠-空肠导管（Endoluminal Duodeno-Jejunal Tube，EDJT）在活体猪实验动物模型中减缓体重增加的可行性，及其在中短期生存中的安全性。方法本项研究共用8只45kg重的Yorkshire猪，其中3只置入180emEDJT，1只置入360cm EDJT，另4只猪作为对照组。切开十二指肠，将EDJT导管缝合固定在十二指肠近Vater壶腹起始处。结果评估全部猪的不适反应和体重，每日一次，共7周，未发现严重并发症发生。术后7周3组动物的平均体重变化百分率：对照组、180cm组和360cm组分别是22．5％，6％和-2．8％。EDJT组（180cm组、360cm组）体重增加明显减慢，与对照组相比，有统计学意义（P=0．05）。结论EDJT可以安全使用，无肠梗阻、肠套叠或胰腺炎等并发症发生。EDJT可明显减缓体重增加。     

Haemoptysis due to chronic tuberculosis vs. bronchiectasis: comparison of long-term outcome of arterial embolisation.

OBJECTIVE: To evaluate the factors that influence the outcome of bronchial arterial embolisation (BAE) in chronic tuberculosis (TB). In cases of chronic TB, non-bronchial systemic arteries (NBSA) provide a significant source of massive or recurrent haemoptysis. DESIGN: Medical records and radiological findings of 30 consecutive TB patients who underwent BAE were retrospectively analysed and compared with those of 19 bronchiectasis patients. RESULTS: Chronic TB patients had higher numbers of total feeding vessels (4.40 +/- 3.85 vs. 1.79 +/- 1.51, P = 0.007) and NBSA (1.57 +/- 1.63 vs. 0.42 +/- 0.61, P = 0.005) than the bronchiectasis patients. The number of embolisations required for obliterating feeding vessels (3.87 +/- 2.48 vs. 1.95 +/- 1.47, P = 0.004), and the incidence of incomplete embolisation (30% vs. 5.3%, P = 0.033) were also higher in the TB patients. Moreover, recurrence after BAE was more frequent in the TB patients (17/30, 56.7% vs. 5/19, 26.3%, P = 0.037). Male sex, past history of haemoptysis and incomplete embolisation during BAE were associated with higher recurrence of haemoptysis in chronic TB patients. The existence of a fungus ball or significant pleural thickening (>/=10 mm) was not found to influence the recurrence rate of haemoptysis. CONCLUSION: The haemoptysis recurrence rate was higher in chronic TB than in bronchiectasis; this was found to be related to incomplete feeding vessel embolisation.     

Trans fat intake lowers total cholesterol and high-density lipoprotein cholesterol levels without changing insulin sensitivity index in Wistar rats

Epidemiologic studies have demonstrated that trans fat intake increases the risk of some chronic diseases. We hypothesize that trans fat intake would increase the risk of cardiovascular disease and type 2 diabetes mellitus by changing the lipid profile in plasma, the secretion of adipokines in adipose tissue, and the insulin sensitivity. Accordingly, the major objective of present study was to investigate the effect of dietary intake of trans fat on lipid profile, insulin sensitivity, and adipokine levels in plasma. Two groups of Wistar rats were fed a diet containing 4.5% trans fat or a control diet containing no trans fat for 16 weeks. Fasting glucose level was monitored every 2 weeks. At the end of feeding experiment, blood, heart, kidney, liver, omental adipose tissue, and semitendinosus muscle were collected. The trans fat content in organs, lipid profile, adipokine, insulin, and glucose levels in plasma were analyzed. The trans fat content in adipose tissue, heart, kidney, liver, and muscle of rats fed trans fat were 169.9, 0.6, 1.2, 1.7, and 2.5 mg/g samples, respectively. The trans fat content in these organs contributed to 15.9%, 1.2%, 2.3%, 4.3%, and 6.1% of the total fat, respectively. The plasma glucose level, insulin level, and insulin sensitivity index were not significantly different between the trans fat and control groups. The results indicated that trans fat intake might not be related to insulin resistance. However, lipid profile and plasma adipokine levels were significantly changed after trans fat feeding. The trans fat fed group showed significantly lower total cholesterol and high-density lipoprotein cholesterol levels than the control group. The decreased high-density lipoprotein cholesterol level may indicate the detrimental effect of trans fat intake on lipid profile. Adiponectin and resistin levels were significantly higher in the trans fat group than the control group. Leptin levels were significantly lower in the trans fat group than the control group. The results indicated that dietary intake of trans fat can significantly change the adipokine levels, but the possible links between adipokine level change caused by trans fat intake and metabolic effects of this change need further investigations.