Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

Homocysteine (Hcy) is a sulfur-containing, non-proteinogenic amino acid synthesized through the transmethylation of amino acid methionine from one-carbon metabolism. Elevated plasma total homocysteine (tHcy) level is associated with endothelial dysfunction, increased blood coagulation, and metabolic disturbance, promoting cardiovascular diseases, stroke, and coronary artery disease.^[1,2] Notably, patients with high Hcy levels and concomitant hypertension were suggested to be at particularly higher risk.^[3] Moreover, increasing studies have explored a positive association between advanced Hcy level with all-cause mortality. According to a recent dose-response meta-analysis, for each 5-μmol/L increment of tHcy levels, the risk for all-cause mortality increased by 33.6%.^[4]The ankle-brachial index (ABI) is an effective, well-established measure that is commonly used in the diagnosis of peripheral artery disease (PAD),^[5] meanwhile was well studied as an important indicator of atherosclerosis and CVD events.^[6] Although ankle-brachial index (ABI) ≤ 0.90 has been recognized as the threshold value for abnormal/low ABI, which was proven to increase the risk of all-cause mortality,^[7] a study from the American Heart Association has suggested ABI between 0.91 and 1.00 should be considered as “borderline area” in terms of cardiovascular risks,^[8] considering of prior probability and sensitivity of ABI calculation. Emerging studies have aimed to explore the predictive value of borderline ABI,^[9-11] however, controversy remains because of limited and inconsistent data. The current study aimed to explore the individual and joint effect of borderline ABI and tHcy on all-cause mortality among hypertensive adults. Although ABI level ≤ 0.90 has been and is going to remain significant in clinical practice, we believe broader concern should be placed on borderline ABI, especially for its value in risk differentiation and identification. To the best of our knowledge, there are no similar previous studies.     

经尿道绿激光汽化术治疗前列腺增生(附60例报道)

目的探讨经尿道绿激光前列腺汽化术治疗前列腺增生的手术方法和近期疗效。方法采用骶管或硬膜外阻滞麻醉,应用美国Laserscope公司生产的非接触式绿激光治疗系统,以80W功率对60例前列腺增生患者进行汽化治疗。结果本组手术时间30～120分钟。术后12例未留置导尿管,余患者在术后24～48小时内拔导尿管。术后均无膀胱冲洗。术后患者4天内出院。术前平均尿流率8.2ml/s,术后2周及4周平均尿流率分别是19.8ml/s及19.2ml/s;术前平均国际前列腺症状评分和生活质量评分分别为23.9分和4.2分,术后2周及4周分别下降至8.9分、8.5分和1.4分、1.4分。术中均未输血。结论绿激光前列腺汽化术治疗前列腺增生安全、操作简单、手术时间短、出血少、痛苦小、留置导尿管时间短、康复快,是一种较理想的微创方法。     

中晚期胰腺癌的姑息手术治疗

目的 探讨对中晚期胰腺癌患者实施姑息手术治疗的临床意义.方法 回顾我科14例中晚期胰腺癌患者资料,从用非手术治疗和手术治疗的两组治疗方法进行探讨.结果 从患者的治疗结果、治疗后生活质量和临床症状改善分析,积极的选择姑息手术的方式是可取的.结论 中晚期胰腺癌患者的综合治疗中采取积极的选择姑息手术是有一定的临床意义和社会价值的,值得进一步研究观察.     

吡格列酮对代谢综合征患者超敏C反应蛋白的影响

目的观察吡格列酮对糖耐量受损(IGT)合并代谢综合征(MS)患者超敏C反应蛋白(hsC-RP)的影响。方法对2005年1月至2007年12月厚街医院内科门诊50例新诊断IGT(7.8mmol/L≤餐后2h血糖<11.1mmol/L)合并MS患者,采用吡格列酮干预,比较治疗前和治疗12周后超敏C反应蛋白(hsC-RP)浓度变化。结果治疗前后空腹血糖、HbAlc、胰岛素、HOMA-IR、TG及hsC-RP水平均有明显降低(P<0.01),HDL-C明显升高(P<0.01)。结论吡格列酮改善胰岛索抵抗,降低hs-CRP浓度,改善MS患者的血管炎症反应。     

1 608例妊娠期妇女葡萄糖耐量筛查分析

目的探讨妊娠期妇女葡萄糖耐量筛查意义及其糖代谢异常的相关因素。方法对1 608例孕24~28周的孕妇进行50g葡萄糖耐量筛查,1小时血糖≥7.8mmol/L者再行75g葡萄糖耐量试验。结果妊娠期葡萄糖耐量筛查阳性率为19.80%,糖代谢异常检出率为7.46%,其中妊娠期糖尿病的检出率为2.49%,妊娠期葡萄糖耐量减低发生率为4.98%;糖代谢异常者的平均年龄大于糖代谢正常者(t=6.09,P<0.05),同时年龄≥35岁糖代谢异常孕妇明显多于<35岁者(χ2=23.26,P<0.05);孕前身体质量指数≥25的孕妇发生糖代谢异常高于孕前身体质量指数<25者(χ2=26.08,P<0.05);产次多的孕妇容易发生糖代谢异常,产次≥2的孕妇发生糖代谢异常高于0产次、1产次者(χ2分别为31.60、10.00,均P<0.017)。妊娠期糖代谢异常的高危因素有高龄、肥胖和多产次。结论对妊娠期24~28周孕妇进行50g葡萄糖耐量筛查是必要的,对伴有高危因素的孕妇应重点监测。     

水通道蛋白与脂肪代谢的研究进展

水以及其他小分子物质通过细胞膜运动是物质代谢中一个很重要的方面;水通道中的水甘油通道不仅是水分子选择性通过的孔道,还是甘油等小分子物质的重要通道,在人和其他生物的许多脏器中广泛分布:脂肪组织是储存能量的器官,为了维持全身的能量平衡,脂肪组织中经常发生脂肪的合成和分解.研究发现,水通道中的水甘油通道参与脂肪的合成和分解等一系列重要的物质代谢过程.已证明,水甘油通道的表达、功能和(或)调节的改变是导致皮肤病、肥胖、糖尿病、胰岛素抵抗等疾病的基础.     

B7-H4在卵巢癌中的研究进展

B7-H4分子又称B7S1和B7x,是最近发现的T细胞共刺激分子B7家族中的新成员,能负性调控T细胞的免疫应答、阻碍细胞因子的产生和细胞周期的进程.同时大量表达B7-H4分子可以保护表皮细胞免于失巢凋亡,促进上皮细胞的恶性转化,在恶性肿瘤的发生、进展和转归的免疫逃逸机制中发挥重要作用.B7-H4分子在质膜上的定位及其在卵巢癌组织和细胞上的过度表达使其具有非常诱人的应用前景,能潜在地作为卵巢癌早期诊断新的生物标志,并为临床上卵巢癌的靶向治疗提供了思路.     

11C-胆碱PET在前列腺癌中的临床应用探讨

前列腺癌是老年男性的常见恶性肿瘤,但是常规显像困难.11C-胆碱是新近研究较多的一种正电子肿瘤阳性显像剂,因它不通过泌尿系统排泄而被用于前列腺癌的临床诊断中.通过11C-胆碱、18F-氟脱氧葡萄糖、11C-乙酸和11C-甲硫氨酸在前列腺癌PET结果的比较,总结了11C-胆碱PET在前列腺癌的临床应用近况.     

南华大学临床技能学课程金课实践

高等学校本科教育质量评价的重点在于课程质量。金课是教育部提出的具有高阶性、创新性和挑战度特点的高质量课程标准,是国家教育部对于建设一流本科教育的要求。文章介绍了南华大学衡阳医学院临床技能学课程在教学实践中,以金课的标准和要求贯彻课程教学,广泛调动了学生的积极性和主动性,取得了更好的教学效果,是提高课程质量的有效方法,应该大力倡导并尽可能推广到其他医学课程中去。     

SETD5介导AKT1磷酸化调控结肠癌细胞的迁移和5-FU敏感性

目的：探讨含SET结构域蛋白5（SETD5）对结肠癌细胞增殖、迁移和对5-氟尿嘧啶（5-FU）药物敏感性的影响及机制。方法：常规培养结肠癌细胞,用Lipofectamine 2000将siSETD5-NC、si-SETD5-1~3质粒转染至HT-29细胞中,将其分为对照组（未处理）、si-SETD5-NC组、si-SETD5组和si-SETD5+SC79组,si-SETD5+SC79组HT-29细胞转染质粒的同时用10 μmol/L SC79处理。qPCR法检测NCM460、HT-29和LoVo细胞中SETD5 mRNA表达,流式细胞术、细胞划痕法、WB法和CCK-8法分别检测各组HT-29细胞的凋亡情况、迁移能力、相关蛋白的表达,以及对5-FU 的敏感性。结果：SETD5 mRNA在HT-29、LoVo细胞中均呈高表达（均P<0.01）。在HT-29细胞中成功地敲减了SETD5 mRNA（P<0.01）。敲减SETD5 mRNA可明显抑制HT-29细胞的增殖活性（P<0.01）、迁移能力（P<0.01）、相关蛋白（SETD5、p-PI3K、p-AKT1、p-mTOR 蛋白）的表达（均P<0.01）、促进细胞凋亡（P<0.01）,且提高其对 5-FU 的敏感性（P<0.01）,这些作用均可被 AKT 激活剂 SC79 部分阻挡（P<0.05 或 P<0.01）。结论：SETD5在HT-29、LoVo细胞中高表达,SETD5通过PI3K/AKT1通路促进结肠癌HT-29细胞的增殖、迁移,且降低其对5-FU的敏感性,SETD5是结肠癌临床诊断、治疗的潜在靶点。