Dyslipidemia and coronary artery disease

Genetically determined and metabolically induced disturbances in lipid metabolism, as manifested in several types of dyslipidemia, have been shown to be causally related to the development of coronary artery disease (CAD). A diversity of clinical and angiographic studies has been made to evaluate the linkage between plasma lipid-control therapy in the development of initial and recurrent cardiovascular events. The plan of treatment invariably begins with a low-fat, low-cholesterol diet before initiation of drug therapy. However, many patients have difficulty in adhering to the low-fat diet. Fortunately, metabolic studies show that foods which contain fats rich in stearic (saturated) and oleic (monounsaturated) fatty acids may be given in limited amounts to boost patients' compliance to a low-fat diet and to prevent their blood lipids from rising to abnormal levels. A bile acid sequestrant (cholestyramine or colestipol) is the first-line drug for control of hypercholesterolemia. Either gemfibrozil or gemfibrozil plus niacin is prescribed to raise high-density lipoprotein (HDL) levels of CAD patients. Approval of two HMG CoA reductase inhibitors, pravastatin and simvastatin, by the FDA gives physicians the additional flexibility of employing a single or a combination drug therapy for optimal control of dyslipidemia. The association of low serum cholesterol level (< 160mg/dl) with increase in noncardiac mortality has prompted health professionals to consider modifying the universal screening and treatment of serum cholesterol in children and young women and to use hypolipidemic drugs in patients judiciously.     

蒙特利尔认知评估量表在中国帕金森氏病患者中筛查痴呆的应用

背景：痴呆是帕金森氏病（PD）相关的最痛苦和最繁重的健康问题之一。蒙特利尔认知评估量表（MOCA）被广泛用于帕金森氏症患者的痴呆筛查，但是不知道怎样的诊断划界分适用于中国的帕金森病患者。目的：确定中国版蒙特利尔认知评估量表（MoCA—C）在中国帕金森氏症患者中的诊断划界分和了解经MoCA—C筛查痴呆阳性的帕金森氏症患者的特征方法：采用运动障碍学会工作组标准（金标准诊断）确定616例PD患者和85名社区对照中是否存在痴呆。我们对这些人进行了MoCA-C测试，并运用受试者工作特征（ROC）曲线来确定能够最有效地识别帕金森氏症患者和社区对照中痴呆的MoCA-C划界分。比较经MoCA—C筛查为痴呆阳性与阴性的PD患者的人口学和临床特征。结果：MoCA-C23分是诊断帕金森氏患者及对照组痴呆的最佳划界分。使用该划界分，PD患者的MoCA—C敏感性和特异性分别为0．70和0．77，阳性和阴性预测值分别为0．59和0．85，整体一致性（kappa【95％可信区间】）为0．45（0．39·0．52）。社区对照相应的kappa值（一致性）仅为0．25（0．05-0．45）。与筛查为痴呆阴性的PD患者相比，筛查为痴呆阳性的PD患者所有认知功能都有显著受损，包括视觉空间和执行功能，命名，注意力，语言，抽象，延迟回忆和定向（均P〈O．001）。在帕金森氏症患者中，筛查为痴呆阳性与年老，文化程度低，女性以及严重运动障碍独立相关。结论：通常建议的痴呆划界分26对于中国帕金森病患者来说过高：23分划界分更加合适。中国的帕金森氏症患者发生痴呆的可能危险因素包括年龄，文化程度较低，以及PD严重的运动障碍症状。     

Power spectral analysis of electromyographic and systemic arterial pressure signals during fentanyl-induced muscular rigidity in the rat

We have measured electromyographic (EMG) and systemic arterialpressure (SAP) signals during fentanyi-induced muscular rigidityin adult male Sprague-Dawley rats anaesthetized initially withketamine 120 mg kg^–1 i.p. during controlled ventilation.Fentanyl 100 µg kg^–1 i.v. induced significant increasein EMG activity, recorded from the sacrococcygeus dorsi lateralismuscle. Power spectral analysis revealed that this was producedby an increase in the root mean square and a decrease in themean power frequency values of the signals, signifying recruitmentand synchronous activation of motor units. Together with transienthypotension and bradycardia, power spectral analysis of theSA P signals demonstrated a reduced but maintained power densityof the frequency components that represent respiratory, baroreceptorand vasomotor activities. All these effects were only demonstratedunequivocally in rats maintained by i.v. infusion of ketamineuntil 10 min before the administration of fentanyl. We concludethat analysis of the temporal alterations in the spectral componentsof the EMG and SAP signals in rats during mechanical ventilationprovides a sensitive method of measuring fentanyi-induced muscularrigidity and the accompanying alterations in haemodynamic variables.(Br. J. Anaesth. 1994; 72: 328–334)     

Initial evaluation of an intracorporeal oxygenation device

We describe a recently developed intracorporeal gas transfer device, its potential applications and hazards. To date, patients with potentially reversible respiratory failure have been treated with controlled oxygen therapy and positive pressure ventilation, but this treatment may itself contribute to lung parenchymal damage from barotrauma and oxygen toxicity. Total or partial extracorporeal gas exchange can be used to reduce these risks, but this treatment is complex and has significant morbidity and mortality. This gas exchange device has been designed to provide partial gas transfer with simplicity of insertion and use. The oxygenator lies in the vena cava to provide prepulmonary gas exchange. In preliminary studies with three calves we have shown that the device increases both mean mixed venous and arterial oxygen content and reduces mean arterial carbon dioxide tension.