Racial differences in expectations of joint replacement surgery outcomes

OBJECTIVE: Prior studies have indicated racial differences in patients' expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a well-validated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust. METHODS: Detailed demographic, clinical, psychological, and social data were collected from 909 male patients (450 African American, 459 white) ages 50-79 years with moderate or severe osteoarthritis (OA) of the hip or knee receiving primary care at 2 veterans affairs medical centers. The previously validated Joint Replacement Expectations Survey was used to assess expectations for pain relief, functional improvement, and psychological well-being after joint replacement. RESULTS: Among knee OA patients (n = 627), the unadjusted mean expectation score (scale 0-76) for African American patients was 48.7 versus 53.6 for white patients (mean difference 4.9, P < 0.001). For hip OA patients (n = 282), the unadjusted mean expectation score (scale 0-72) for African Americans was 45.4 versus 51.5 for whites (mean difference 6.1, P < 0.001). Multivariable adjustment for disease severity, socioeconomic factors, education, social support, literacy, and trust reduced these racial differences to 3.8 points (95% confidence interval [95% CI] 1.2, 6.3) among knee OA patients and 4.2 points (95% CI 0.4, 8.0) among hip patients. CONCLUSION: Among potential candidates for joint replacement, African American patients have significantly lower expectations for surgical outcomes than white patients. This difference is not entirely explained by racial differences in demographics, disease severity, education, income, social support, or trust.     

Multicenter randomized controlled trial of heat‐killed Lactobacillus acidophilus LB in patients with chronic diarrhea

OBJECTIVE: Chronic diarrhea is a common bowel disorder, and disturbance of intestinal microorganisms may play a role in its pathogenesis. The aim of this study was to assess the clinical efficacy of lyophilized heat‐killed Lactobacillus acidophilus LB compared with living lactobacilli in the treatment of chronic diarrhea. METHODS: One hundred and thirty‐seven patients with chronic diarrhea were randomly allocated to receive either a 4‐week course of two capsules of Lacteol Fort twice a day as the Lacteol group (69 patients completed the course) or a 4‐week course of five chewable tablets of Lacidophilin three times a day as the Lacidophilin group (64 patients completed the course). The frequency of stools was recorded quantitatively and the semiquantitative parameters such as stool consistency, abdominal pain, distension and feeling of incomplete evacuation were evaluated. RESULTS: At the second and fourth week of the treatment, the mean bowel frequency was significantly lower in the Lacteol group than in the Lacidophilin group (1.88 ± 1.24 vs 2.64 ± 1.12, 1.39 ± 0.92 vs 2.19 ± 1.05, respectively; P < 0.05). At the end of the treatment, the clinical symptoms were markedly improved in the Lacteol group. CONCLUSIONS: Lactobacillus acidophilus LB is more effective than living lactobacilli in the treatment of chronic diarrhea.     

冠心病患者与正常人凝血因子Ⅶ基因多态性的研究

目的：探讨中国汉族人群中凝血因子Ⅶ基因R353Q、HVR4多态性的分布及其与冠心病和心肌梗死的关系。方法：利用聚合酶链反应和限制性内切酶片段长度多态性核苷酸分型技术，检测234例冠心病患和105名正常对照的凝血因子Ⅶ基因型，并结合选择性冠状动脉造影结果进行分析。结果：基因型频率符合Hardy-Weinberg平衡定律。凝血功能指标凝血酶原时间、部分凝血活酶时间、凝血酶时间不受凝血因子Ⅶ基因多态性的影响。R353Q和HVR4基因多态性与冠心病和狭窄血管支数之间比较差异均无显性。R353Q基因型频率和等位基因频率在非心肌梗死组和心肌梗死组比较有明显差异（χ^2=4.711,P＜0．05，OR＝0．37，95％CI 0．15－0．94），而VR4基因多态性在两组间比较无统计学意义（χ^2=0.142,P＞0．05）。结论：汉族人群中存在凝血因子Ⅶ基因的R353Q和HVR4多态性，其中Q等位基因可能是心肌梗死的遗传保护因子。     

肿瘤坏死因子α基因多态性与2型糖尿病胰岛素抵抗的相关性

目的　探讨肿瘤坏死因子α(TNF α)水平及其基因第 3 0 8位G→A变异与 2型糖尿病 (DM )胰岛素抵抗 (IR)的相关情况。方法　 ( 1)放射免疫法检测 70例 2型DM患者和 60例健康对照者空腹血清胰岛素 (FINS)、TNF α水平。 ( 2 )以PCR RFLP检测TNF α基因型。 ( 3 )用自我平衡模型分析法(HOMA)评价IR。结果　 ( 1) 2型DM组及对照组血清TNF α水平分别为 ( 1.2 6± 0 .2 8) μg/L和 ( 1.15±0 .2 4) μg/L(P <0 .0 5 ) ;FINS分别为 ( 11.3 1± 4.3 1)mIU/L和 ( 14 .67± 4.96)mIU /L(P <0 .0 1) ;HOMA IR分别为 5 .5 4± 2 .2 5和 3 .3 9± 1.48(P <0 .0 1)。 ( 2 ) 2型DM组和对照组GA +AA基因型频率分别为0 .3 0和 0 .13 ,A等位基因频率分别为 0 .16和 0 .0 7(P <0 .0 5 )。 ( 3 ) 2型DMGA +AA基因型组及GG基因型组TNF α分别为 ( 1.3 5± 0 .2 5 ) μg/L和 ( 1.2 2± 0 .16) μg/L(P <0 .0 5 ) ;FINS分别为 ( 13 .42± 4.73 )mIU /L和 ( 10 .40± 3 .63 )mIU/L(P <0 .0 1) ;HOMA IR分别为 7.42± 1.93和 4.11± 1.3 1(P <0 .0 1)。( 4 )多元逐步回归分析显示 :HOMA IR与TNF α及TNF α基因型呈显著正相关。结论　TNF α第 3 0 8位G→A变异与中国闽南人 2型DM的发生有关 ,A等位基因可能通过增加TNF α的释放     

卡巴胆碱减轻大鼠烫伤休克期肠内补液时肠组织氧自由基的损伤

目的:研究拟胆碱药卡巴胆碱(carbachol,CAR)对大鼠烫伤休克期肠内补液时肠组织氧自由基损伤的影响.方法:38只♂ Wistar大鼠,采用沸水法(100℃,10 s)造成35%TBSAⅢ度烫伤.随机分为不复苏组(单烫组,n=8)、葡萄糖-电解质溶液(glucose electrolyte solution)复苏组(GES组,n=10)、单纯卡巴胆碱治疗组(CAR组,n=10)和GES CAR复苏组(GES/CAR组,n=10).两液体复苏组在伤后30 min将GES经十二指肠造口匀速泵入,按Parkland公式设定补液速率,CAR组和GES/CAR组在伤后30 min将CAR以60 μg/kg溶于0.5 mL生理盐水中一次注入十二指肠.所有大鼠在伤后4 h处死,取空肠组织测定脂质过氧化物丙二醛(malondialdehyde.MDA)含量、黄嘌呤氧化酶(xanthine oxidase,XOD)和髓过氧化物酶(myeloperoxidase,MPO)活性,并观察肠组织病理学变化.结果:烫伤后GES组肠组织XOD、MP0活性和MDA含量分别高于单烫组13.2%、21.3%和21.1%,并有统计学意义(P＜0.05);GES/CAR组XOD,MPO和MDA均较GES组明显下降(1.36±0.37 vs 2.5l±0.56;0.47±0.14 vs 0.83±0.21;3.97±1.57 vs 6.59±1.50,P＜0.01);CAR组各指标数值最低.肠组织病理损伤也表现为CAR组和GES/CAR组最轻,单烫组次之,GES组损伤最重.结论:卡巴胆碱能有效减轻烫伤休克大鼠肠内复苏时的肠道氧自由基损伤,机制可能与其抗炎作用和抑制黄嘌呤氧化酶活性、减少氧自由基生成有关.     

腺病毒介导gax基因转染在培养的血管平滑肌细胞中的表达

目的 以腺病毒介导gax基因转染血管平滑肌细胞(VSMC)，增强VSMC中gax基因的表达。方法 采用位置特异性重组方法构建携带大鼠gax基因表达序列的复制缺陷型5型腺病毒载体(AdCMV-gax)，经293细胞扩增，纯化制备高滴度病毒转染液；以病毒转染液常规转染VSMC后，应用RT—PCR、流式细胞仪和免疫细胞化学等方法分别检测VSMC中gax mRNA和蛋白质的表达。结果 流式细胞仪检测和免疫细胞化学染色均显示．AdCMV—gax转染VSMC后，VSMC的Gax蛋白表达率明显增高，转染后24小时即可达80％左右，高水平的表达可维持5天以上；AdCMV—gax转染前，PDGF—BB对gax基因转录和翻译水平的表达均有下调作用，AdCMV—gax转染后，无论有无PDGF—BB刺激，VSMC中gax基因的表达均比转染前显著增高。结论 腺病毒载体可有效地介导gax基因转染VSMC，并且表达为蛋白质。这有利于进一步研究gax基因对VSMC生物学行为的影响。     

Interferon-gamma and tumor necrosis factor synergize to induce nitric oxide production and inhibit mitochondrial respiration in vascular smooth muscle cells.

Nitric oxide (NO) is an important signal substance in cell-cell communication and can induce relaxation of blood vessels by activating guanylate cyclase in smooth muscle cells (SMCs). NO is synthesized from L-arginine by the enzyme NO synthase, which is present in endothelial cells. It was recently shown that SMCs may themselves produce NO or an NO-related compound. We have studied NO production and its effects on energy metabolism in cultured rat aortic smooth muscle cells. It was observed that the cytokines, interferon-gamma and tumor necrosis factor-alpha, synergistically induced an arginine-dependent production of NO in these cells. This was associated with an inhibition of complex I (NADH: ubiquinone oxidoreductase) and complex II (succinate: ubiquinone oxidoreductase) activities of the mitochondrial respiratory chain, suggesting that NO blocks mitochondrial respiration in these cells. Lactate accumulated in the media of the cells, implying an increased anaerobic glycolysis, but there was no reduction of viability. An NO-dependent inhibition of mitochondrial respiration and a switch to anaerobic glycolysis would reduce energy production of the SMCs. This would in turn reduce the contractile capacity of the cell and might represent another NO-dependent vasodilatory mechanism. It could be of particular importance in inflammation, since cytokines released by inflammatory cells may induce autocrine NO production in SMCs.     

Relationship between CT grouping and complications of liver cirrhosis

BACKGROUND: Imaging examination is important for hepatic cirrhosis. But the relationship between magnetic resonance (MR), computed tomography (CT) or ultrasound findings and pathological groups, degree, or reserve function of the cirrhotic liver is not clear. In this study, we investigated the relationship between the CT groupings of liver cirrhosis and its complications and clinical conditions. METHODS: The CT findings in 357 patients with liver cirrhosis were grouped. The complications were analyzed, included splenomegaly, varicose collateral veins, ascites, pleurorrhea, primary liver carcinoma, gallbladder stone, etc. Blood routine (BRt), and serum usea nitrogen (SUN), creatinine and uric acid were measured and hypersplenia and liver-kidney syndrome were estimated. RESULTS: Three hundred and fifty-seven patients with cirrhosis were divided into homogeneous group (87 patients, 24.4%), segmental group (41, 11.5%), and nodal group (229, 64.2%). The grade of spleen enlargement in the segmental and the nodal groups was significantly greater than that in the homogeneous group (P <0. 01 and P<0.001). The patients with varices were shown in a descending order in the segmental group (70.7%), the nodal group (17.0%) and the homogeneous group (2.3%), respectively. Significant difference was observed among the 3 groups ( P < 0.001). Ascites was seen in 182 patients (79.5%) of the nodal group, in 11 patients (26.8%) of the segmental group and in 9 patients ( 10.3%) of the homogeneous group (P<0.001). Sixty-eight patients (29.7%) in the nodal group had primary liver carcinoma and 1 (2.4%) in the segmental group and 5 (5.8%) in the homogeneous group (P<0.001). The number of patients with decreased concentration of hematoglobin in the nodal group was more than that in the homogeneous group ( P < 0. 001). The mean values of hematoglobin and platelet in the nodal group and the segmental group were significantly lower than those in the homogeneous group ( P < 0. 05 ). The number of patients with increased concentration of SUN in the nodal group and the segmental group was more than that in the homogeneous group (P<0.005). The concentration of SUN in the nodal group was significantly higher than that in the homogeneous group (P <0.002). CONCLUSION: There is a close relationship between the grouping of liver cirrhosis by CT findings and complications caused by the cirrhosis. The grouping is significant for estimating clinical conditions.     

Effect of rhBNP on renal function in STEMI-HF patients with mild renal insufficiency undergoing primary PCI

This study aims to investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on renal function and contrast-induced nephropathy (CIN) incidence in ST-segment elevation myocardial infarction and heart failure (STEMI-HF) patients with mild renal insufficiency undergoing primary percutaneous coronary intervention (PCI). A total of 116 participants were randomized into rhBNP (rhBNP, n = 57) and nitroglycerin group (NIT, n = 59), receiving intravenous rhBNP or nitroglycerin from admission to 72 h after PCI. Renal function was assessed by serum creatinine (SCr), estimated glomerular filtration rate (eGFR), Cystatin-C (Cys-C) and β₂-microglobulin before and after primary PCI, and calculated the incidence of CIN within 72 h after PCI. There were no significant differences in SCr, eGFR and β₂-microglobulin between the two groups (P > 0.05, respectively). Compared with the NIT group, the total urinary volume within 72 h was higher while the level of Cys-C at 24 and 72 h after PCI was lower in the rhBNP group. rhBNP was associated with a decline in the incidence of CIN (12.28 vs. 28.81 %, P < 0.05). No differences were detected in mortality and re-hospitalization in 3 months between the two groups. The incidence of renal injury was not different between rhBNP and nitroglycerin in STEMI-HF patients with mild renal insufficiency. However, infusion of rhBNP was associated with a decline in incidence of CIN.