Elevated Non-high-density Lipoprotein Cholesterol (Non-HDL-C) Predicts Atherosclerotic Cardiovascular Events in Hemodialysis Patients

Summary

Background and objectives

Dialysis patients show “reverse causality” between serum cholesterol and mortality. No previous studies clearly separated the risk of incident cardiovascular disease (CVD) and the risk of death or fatality after such events. We tested a hypothesis that dyslipidemia increases the risk of incident atherosclerotic CVD and that protein energy wasting (PEW) increases the risk of fatality after CVD events in hemodialysis patients.

Design, setting, participants, & measurements

This was an observational cohort study in 45,390 hemodialysis patients without previous history of myocardial infarction (MI), cerebral infarction (CI), or cerebral bleeding (CB) at the end of 2003, extracted from a nationwide dialysis registry in Japan. Outcome measures were new onsets of MI, CI, CB, and death in 1 year.

Results

The incidence rates of MI, CI, and CB were 1.43, 2.53, and 1.01 per 100 person-years, and death rates after these events were 0.23, 0.21, and 0.29 per 100 person-years, respectively. By multivariate logistic regression analysis, incident MI was positively associated with non-HDL cholesterol (non–HDL-C) and inversely with HDL cholesterol (HDL-C). Incident CI was positively associated with non–HDL-C, whereas CB was not significantly associated with these lipid parameters. Among the patients who had new MI, CI, and/or CB, death risk was not associated with HDL-C or non–HDL-C, but with higher age, lower body mass index, and higher C-reactive protein levels.

Conclusions

In this hemodialysis cohort, dyslipidemia was associated with increased risk of incident atherosclerotic CVD, and protein energy wasting/inflammation with increased risk of death after CVD events.     

Computer-assisted measurement of the size of ossification in patients with ossification of the posterior longitudinal ligament in the cervical spine

Background Progression of ossification of the posterior longitudinal ligament in patients may lead to serious neurological deterioration. A government-funded study group established a manual method of measurement on plain radiographs to detect progression of the ossified lesion. However, this method did not gain wide acceptance because it was time-consuming and complicated, for which drawings of many lines and points are required. We have applied a computer-assisted measurement system to this task and have evaluated inter- and intraexaminer reliability, showing that it is quicker to use and more accurate than the manual method. Methods Eight board-certified spine surgeons, acting as the examiners, measured the sizes of the ossified lesions on nine lateral cervical spine radiographs using the computer-assisted measurement system. Following insertion of digitized radiographic image data into a computer, the corners of the vertebral bodies on the displayed images are marked by the examiners, and the software automatically sets reference lines and points. The examiners identify upper, lower, and posterior margins of the ossified lesions, and the software calculates the dimensions of the ossified lesions. Data obtained from eight examiners for length and thickness underwent rigorous statistical analysis by calculating the intraclass correlation coefficients with 95% confidence intervals (CIs) to determine interexaminer reliability and Pearson's correlation coefficients between the two measurements by the same examiner to determine intraexaminer reliability. Results The intraclass correlation coefficients were 0.927 and 0.968 with 95% CIs of 0.883–0.955 and 0.956–0.978 for measurements of length and thickness, respectively, of the ossified lesions. The Pearson's correlation coefficients for the two measurements by the same examiners were 0.943–0.985 for length and 0.957–0.991 for thickness. Conclusions The inter- and intraexaminer reliability using this measurement system was excellent. The method can detect progression of ossification of the posterior longitudinal ligament (OPLL) on plain radiographs with high precision and could become a standard method for measuring the size of OPLL.     

Mid-mediastinal parathyroid lesions: Preoperative localization and surgical approach in two cases

Although hyperfunctioning mediastinal parathyroid lesions that require median sternotomy or thoracotomy for removal are occasionally present, the majority are located in the anterior mediastinum closely associated with the thymus. Only eight cases of ectopic hyperfunctioning parathyroid tumors in the middle mediastinum have been reported. We experienced two cases of either persistent or recurrent hyperparathyroidism in which abnormal parathyroid tissue was located in the aorticopulmonary window. One of the patients had a parathyroid adenoma and the other had metastatic lesions of parathyroid carcinoma. In both cases, thallium scanning proved useful in identifying the lesions while computed tomography scan was effective for mediastinal three-dimensional localization. In one case, single photon emission computed tomography imaging with thallium proved beneficial for both identification and localization of the middle mediastinal lesion. The surgical approach used in both cases was different. In one case, left thoracotomy was performed, after which the ligamentum arteriosum was divided, and an adenoma anterior to the left main bronchus and posterior to the left pulmonary artery removed. In the other case, two metastatic tumors of parathyroid carcinoma anterior to the right main bronchus and posterior to the right pulmonary artery were resected through a median sternotomy and opening of the pericardium.     

一期前路病灶清除加植骨术治疗化脓性脊椎炎

抗生素效力的高度发展已使化脓性脊椎炎患者相对少见。然而,随着糖尿病、恶性肿瘤及滥用毒品等患者的增多,化脓性脊椎炎在这些患者中的发病日益增加[1,2]。传统的治疗包括卧床、支具外固定以及静脉应用抗生素;但上述治疗周期较长,且仍有相当一部分患者治疗无效,病变进行性发展,     

Facilitation of face recognition through the retino-tectal pathway

Humans can shift their gazes faster to human faces than to non-face targets during a task in which they are required to choose between face and non-face targets. However, it remains unclear whether a direct projection from the retina to the superior colliculus is specifically involved in this facilitated recognition of faces. To address this question, we presented a pair of face and non-face pictures to participants modulated in greyscale (luminance-defined stimuli) in one condition and modulated in a blue–yellow scale (S-cone-isolating stimuli) in another. The information of the S-cone-isolating stimuli is conveyed through the retino-geniculate pathway rather than the retino-tectal pathway. For the luminance stimuli, the reaction time was shorter towards a face than towards a non-face target. The facilitatory effect while choosing a face disappeared with the S-cone stimuli. Moreover, fearful faces elicited a significantly larger facilitatory effect relative to neutral faces, when the face (with or without emotion) and non-face stimuli were presented in greyscale. The effect of emotional expressions disappeared with the S-cone stimuli. In contrast to the S-cone stimuli, the face facilitatory effect was still observed with negated stimuli that were prepared by reversing the polarity of the original colour pictures and looked as unusual as the S-cone stimuli but still contained luminance information. These results demonstrate that the face facilitatory effect requires the facial and emotional information defined by luminance, suggesting that the luminance information conveyed through the retino-tectal pathway is responsible for the faster recognition of human faces.