Achieving and maintaining National Cholesterol Education Program low-density lipoprotein cholesterol goals with five statins

PURPOSE: Most patients fail to achieve and maintain low-density lipoprotein (LDL) cholesterol goals established by the National Cholesterol Education Program (NCEP). The Atorvastatin Comparative Cholesterol Efficacy and Safety Study (ACCESS) was a randomized study comparing the efficacy and safety of five statins and their ability reduce LDL cholesterol to the NCEP target level. SUBJECTS AND METHODS: Of 7542 patients screened, 3916 hypercholesterolemic patients were randomly assigned to treatment with a statin, beginning with the lowest recommended dose (atorvastatin, pravastatin, and simvastatin, 10 mg; fluvastatin and lovastatin, 20 mg). If the NCEP target was not achieved, the dose was titrated up to the recommended maximum (atorvastatin, fluvastatin, and lovastatin, 80 mg; pravastatin and simvastatin, 40 mg). The total duration of treatment was 54 weeks. RESULTS: Atorvastatin achieved the greatest mean reduction in LDL cholesterol: 36% +/- 11% at 6 weeks (initial dose) and 42% +/- 13% at 54 weeks. More patients receiving atorvastatin at its initial dose (53%, 997 of 1888) achieved their NCEP target levels than patients receiving simvastatin (38%, 174 of 462), lovastatin (28%, 134 of 472), pravastatin (15%, 71 of 461), or fluvastatin (15%, 69 of 474) at the initial dose. Atorvastatin-treated patients were more likely to maintain their target levels from week 6 to week 54. The percent reduction in LDL cholesterol achieved at the initial dose correlated strongly with the proportion of patients who maintained their goals at 54 weeks (r = -0.84). CONCLUSION: For patients treated with statins, providing a greater margin between the NCEP target level and the achieved LDL cholesterol level enhances the likelihood of maintaining NCEP goal levels.     

Urinary biomarker of oxidative stress correlating with outcome in critically septic patients

Objective To determine whether urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG), an in vivo parameter of oxidative stress, is correlated with the outcome of critically septic patients. Design and setting Clinical outcome study in an adult medical intensive care unit (ICU). Patients 85 consecutive septic patients (59 men, 26 women). Measurements and results Patient characteristics and the clinical course were examined. Urinary 8-OHdG was analyzed using isotope-dilution liquid chromatography with tandem mass spectrometry (LC/MS/MS). ICU mortality was 25.9% (22/85) and hospital mortality 38.8% (33/85). Survivors' APACHE II scores on days 1 and 3 and the difference between them differed significantly from those of nonsurvivors (day 1, 21.0 ± 7.1 vs. 25.9 ± 8.0; day 3, 15.0 ± 5.8 vs. 23.2 ± 8.3; difference, 6.0 ± 5.5 vs. 1.7 ± 6.6). Urinary 8-OHdG was significantly lower in survivors than in nonsurvivors on day 1 (1.8 ± 2.4 vs. 3.0 ± 2.4). The area under receiver operating characteristic curve analysis for the association between day 1 urinary 8-OHdG and ICU mortality was 0.71. The comparison performed upon discharge from hospital revealed similar results. Conclusions This is a preliminary study. Excretion of urinary 8-OHdG, as measured using isotope-dilution LC/MS/MS, and the APACHE II score were correlated with the outcome of critically septic patients in medical ICU.     

汉族人群去甲肾上腺素转运体T182C基因多态性与人格特征的关联性

目的:目前,关于去甲肾上腺素转运体基因T182C多态性与人格关联性的报道较少见,仅有的研究多以健康人群为对象。探讨汉族人群去甲肾上腺素转运体T182C基因多态性与人格特征的关联性。方法:选择2004-04/2005-04于山西医科大学第一医院精神卫生科门诊就诊的汉族重性抑郁患者100例和同期本院汉族健康体检者100名。本次调查于2005-05完成。人格评定采用Eysency编制,龚耀先修订的艾森克人格问卷,计算精神质,内外向,神经质3个个性维度的标准分,并以50分为界,将各维度分为两个等级:非精神病倾向型(精神质<50),精神病倾向型(精神质≥50);内倾型(内外向<50),外倾型(内外向≥50);非神经质倾向型(神经质<50),神经质倾向型(神经质≥50)。取肘静脉血5mL,不加抗凝剂,弃血清,血凝块常规酚氯仿提取基因组DNA,进行PCR分析。PCR产物应用焦磷酸测序PSQ96MA测序仪进行SNP检测,用质谱法进行及等位基因频率分析。检测T,C两种等位基因。结果:纳入的100例重性抑郁患者和100名健康体检者均进入结果分析。男性健康人群检测结果:在精神质维度,C,T等位基因均数分别为46.32±8.17和42.42±7.77,二者比较,差异明显(t=-2.094,P=0.039);C等位基因频率在精神病倾向型人格中为45.5%,明显高于非精神病倾向型人格(22.7%,χ2=4.190,P=0.041);男性重性抑郁患者检测结果:不同等位基因艾森克人格问卷各维度均数及频数分布的比较均无明显差异(P>0.05)。女性检测结果:无论是健康人群还是重性抑郁人群,不同等位基因间艾森克人格问卷各维度均数比较以及艾森克人格问卷各维度分级后的频数分布均无显著性意义(P>0.05)。结论:去甲肾上腺素转运体基因T182C多态性的C等位基因可能是健康男性精神病倾向型人格和重性抑郁男性神经质倾向型人格的危险因素。     

Multiple molecular forms of human alanine aminopeptidase: immunochemical properties

Human pancreas, kidney, and liver alanine aminopeptidases have similar if not identical antigenic determinants even though these three isoenzymes have distinctly different electrophoretic mobilities. Single precipitin lines without spur formation were obtained for all three enzymes with antisera obtained from rabbits immunized with these three purified enzymes. Treatment of these enzymes with neuraminidase eliminated the differences in their electrophoretic migration on polyacrylamide gels and on agarose immunoelectrophoresis gels. Treatment of the pancreas, kidney, and liver alanine aminopeptidases with their respective antibodies yielded enzymes that displayed non-competitive inhibition when the dependence of velocity upon substrate concentration was determined for each enzyme, i.e. the antibodies did not cause a change in the Km values obtained in the absence of the antibody whereas kcat was reduced to the same extent for each enzyme. The removal of sialic acid(s) from these enzymes did not alter their immunochemical characteristics or their kinetic characteristics.     

Main applications of hybrid PET‐MRI contrast agents: a review

In medical imaging, the continuous quest to improve diagnostic performance and optimize treatment strategies has led to the use of combined imaging modalities. Positron emission tomography (PET) and computed tomography (CT) is a hybrid imaging existing already for many years. The high spatial and contrast resolution of magnetic resonance imaging (MRI) and the high sensitivity and molecular information from PET imaging are leading to the development of this new hybrid imaging along with hybrid contrast agents. To create a hybrid contrast agent for PET‐MRI device, a PET radiotracer needs to be combined with an MRI contrast agent. The most common approach is to add a radioactive isotope to the surface of a small superparamagnetic iron oxide (SPIO) particle. The resulting agents offer a wide range of applications, such as pH variation monitoring, non‐invasive angiography and early imaging diagnosis of atherosclerosis. Oncology is the most promising field with the detection of sentinel lymph nodes and the targeting of tumor neoangiogenesis. Oncology and cardiovascular imaging are thus major areas of development for hybrid PET‐MRI imaging systems and hybrid contrast agents. The aim is to combine high spatial resolution, high sensitivity, morphological and functional information. Future prospects include the use of specific antibodies and hybrid multimodal PET‐MRI‐ultrasound‐fluorescence imaging with the potential to provide overall pre‐, intra‐ and postoperative patient care. Copyright © 2015 John Wiley & Sons, Ltd.     

老年心力衰竭患者血浆脑钠肽前体质量浓度与QTc间期关系及对预后的预测

目的:分析老年充血性心力衰竭患者血浆脑钠肽前体与QTc间期的关系、以及二者对充血性心力衰竭预后的判断价值。方法:选择2003-05/2005-07在桂林医学院附属医院心内科住院的充血性心力衰竭患者208例[年龄(66.1±13.5)岁]。①使用罗氏2010全自动分析仪测定其脑钠肽前体质量浓度,根据测定值把患者分为<2000ng/L组,2000-3999ng/L组,4000-5999ng/L组和≥6000ng/L组4组。②12导同步心电图自动测算QTc间期,同时人工测量QT间期离散度,比较4组间的差异。③对患者随访2年,比较死亡和生存者QTc间期和QT间期离散度的差异。④采用直线相关回归分析法分析脑钠肽前体质量浓度与心脏各腔室直径、左室射血分数值、QTc间期和QT间期离散度的关系。结果:①随着脑钠肽前体质量浓度的增加,QTc也随之增宽,<2000ng/L组QTc间期比其他3组窄(P<0.01);QTd的改变只显示≥6000ng/L组宽于<2000ng/L组(P<0.05)。②随访期间的死亡率为15.4%(32/208),死亡者的平均QTc间期大于生存者[(430.80±39.16),(423.01±29.42)ms,P<0.01],但间期离散度差别不显著[(52.72±10.09),(53.38±18.89)ms,P>0.05]。③相关回归分析示脑钠肽前体质量浓度,左心房及左心室直径与QTc间期呈直线正相关(P<0.05-0.01),QTc间期与QT间期离散度呈直线正相关(P<0.014)。结论:①充血性心力衰竭患者患者血浆脑钠肽前体质量浓度与QTc间期有很好的相关性。②二者联合应用有助于充血性心力衰竭患者危险程度的分层,同时增高示预后不良。     

金属对金属髋关节表面置换假体的临床应用及其效果

目的:总结采用金属对金属假体行全髋关节表面置换术治疗成人髋关节疾病的疗效。方法:①解放军总医院骨科于2004-03/2006-01对17例患者,23个髋关节进行了全髋关节表面置换术,男6例,女11例;平均年龄41岁(20～55岁)。②假体类型为Wright公司Conserveplus金属对金属全髋假体,髋臼为非骨水泥型,壁厚3mm,股骨头为骨水泥型。假体规格为;髋臼48～52mm,股骨头相应减小6mm,中心柄长度59～65mm。③手术方法按照Amstutz和Nelson提出的标准方法进行。④术后患者均进行定期临床与放射学随访,平均随访12个月。手术前后的髋关节功能按Harris标准评定,即优:90～100分;良:80～90分;尚可:70～79分;差:<70分。将Hungerford标准作为判断手术是否成功的标准,即Harris评分>80分定为成功,<80分定为失败。每例患者拍摄骨盆前后位片、髋关节侧位片。结果:所有患者切口均一期愈合,临床效果满意,无股骨颈骨折、感染、关节脱位、假体松动、神经血管损伤等并发症。术后Harris评分83～97分,平均为91.2分。评价:优20髋,良3髋,优良率100%。影像学分析假体位置良好。结论:金属对金属髋关节表面置换假体治疗年轻成人髋关节疾病,近期随访结果满意。     

三种后牙树脂聚合体积收缩及显微硬度的性能比较

目的:目前各种后牙复合树脂的物理机械性能所测定的条件及指标不一致,具体数据缺乏可比性,因此比较3种临床常用的光固化后牙树脂(EcuSphere-Carat,Filtek P60,Tetric Ceram HB)固化后聚合体积收缩及硬度的差异,为临床应用提供参考。方法:实验于2006-02/10在中山大学南校区测试中心和广东出入境检验检疫局检验检疫技术中心化矿金属材料实验室完成。①将EcuSphere-Carat、FiltekP60和TetricCeram HB三种树脂充填入直径0.7cm、高0.4cm的圆柱状容器中,分层固化,每次0.2cm厚度,固化40s,每种树脂10个样本,采用扫描电镜观测光固化后树脂充填体与充填容器边缘裂隙宽度,评价聚合体积收缩的差异。②同样方法制备树脂样本,每种树脂7个样本,采用显微硬度计测量三种树脂固化后样本表面和底面的维氏显微硬度差异。结果:①EcuSphere-Carat、FiltekP60和TetricCeramHB光固化后边缘裂隙宽度分别比较差异无统计学意义(P>0.05)。②三种树脂表面显微硬度分别为(116.76±12.00),(159.14±5.90),(119.59±5.00)MPa;底面显微硬度分别为(93.03±3.53),(141.80±5.98)和(100.07±7.86)MPa。同种树脂表面硬度高于底面硬度(P<0.05);FiltekP60表面及底面显微硬度均高于另两种树脂(P<0.05)。结论:①三种后牙树脂光固化后均产生体积收缩,同一实验条件下收缩率没有差别。②FiltekP60硬度较其他两种为高;同种树脂表面硬度高于底面硬度。③3种树脂操作性不同,临床上应根据后牙缺损部位,选用合适的后牙复合树脂。