Felodipine in patients with chronic heart failure: discrepant haemodynamic and clinical effects.

Previous open studies have suggested that felodipine, a selective calcium antagonist and vasodilator, may be useful in the treatment of heart failure. A double blind placebo controlled crossover trial was therefore conducted to investigate the clinical and haemodynamic effects of felodipine in 15 patients with chronic ischaemic heart failure in New York Heart Association symptom class III. Felodipine significantly increased resting and exercise (25W bicycle ergometry) cardiac output without producing concomitant changes in resting or exercise heart rate or right and left ventricular filling pressures. Felodipine did not significantly improve symptom scores or exercise capacity in the group as a whole. It also resulted in significant fluid retention as shown by a rise in ankle circumference, body weight, and a fall in haematocrit. Further research is required to elucidate the mechanism that is responsible for the discrepancy between the haemodynamic and clinical effects of felodipine in patients with moderately severe heart failure.     

Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome

OBJECTIVE: Polycystic ovary syndrome (PCOS) has been shown to cause a reduction in quality of life. This study examines the extent of different PCOS symptoms on quality-of-life, psychosocial well-being and sexual satisfaction. METHODS: Complete metabolic, hormonal, clinical and psychosocial data were obtained from a total of 120 women with PCOS. Patients were compared with 50 healthy women to establish reductions in quality-of-life and emotional well-being. In addition, the correlation between psychosocial variables and the major clinical PCOS features obesity (body mass index (BMI)), excessive body hair (hirsutism score), acne, hyperandrogenism (serum testosterone levels), disturbed insulin regulation (area under the insulin response curve and homeostasis model assessment of insulin resistance), menstrual cycle disturbances and infertility were analyzed. RESULTS: PCOS patients showed significant reductions in quality-of-life, increased psychological disturbances, and decreased sexual satisfaction when compared with healthy controls. BMI and hirsutism scores, but not the presence of acne, were associated with physical aspects of quality-of-life and sexual satisfaction. No clear effect of androgens or insulin resistance on psychosocial variables was detected. Similarly, the type of menstrual cycle disturbances or infertility had no impact on psychological well-being. CONCLUSION: In PCOS, changes in appearance, particularly obesity and hirsutism, reduce physical dimensions of quality-of-life and decrease sexual satisfaction. The role of biochemical, endocrine and metabolic parameters as well as menstrual irregularities and infertility appeared to be less important. Clinicians should pay attention to the psychosocial dimensions of PCOS on an individual basis, regardless of symptom severity or treatment response.     

宜兴市胃癌手术患者临床特征分析1022例

目的:探讨江苏省宜兴市地区胃癌病例临床特征的变化趋势,为防治胃癌提供依据.方法:宜兴市人民医院1999-2006经病理证实的胃癌手术患者1022例,分析逐年收治病例的临床病理特征及变化趋势,按手术时间先后分成两组:1999-2002组(A组)和2003-2006组(B组).比较两组病例性别、年龄、肿瘤大小、发生部位、分化程度、临床分期和术后辅助化疗情况的差异结果:两组患者发病部位均以胃体、贲门和胃窦处为常见.与A组相比,B组胃癌发生于胃体处患者比例明显下降(X2=21.59,P＜0.05),而发生于胃角的比例升高(X2=33.16,P＜0.05).两组胃癌患者肿瘤分化程度都以低分化及中分化为主,B组低分化比例较A组明显下降(X2=46.11,P＜0.05),而中分化胃癌比例明显升高(X2=37.68,P＜0.05).两组病例的肿瘤直径和pTNM分期构成比方面均无显著差异.结论:宜兴市胃癌发病人数呈逐年上升趋势,而其肿瘤细胞的分化呈逐步升高的趋势.     

Peripheral neuropathy in diabetes: it's not always what it looks like

Background

Hereditary Neuropathy with liability to Pressure Palsies (HNPP) is an autosomal dominant neuropathy, associated with deletion of the Peripheral Myelin Protein‐22 (PMP‐22) gene, causing recurrent painless palsies with age of onset between 10 and 30 years old. Only a few cases of Type 2 Diabetes and HNPP have been described and the coexistence of HNPP and Type 1 diabetes has never been reported.

Case report

A 54‐year old man with a history of Type 1 diabetes, managed with continuous subcutaneous insulin infusion (CSII), presented with deterioration of long‐standing motor and sensory symptoms, previously attributed to golfer's elbow, diabetic neuropathy and spinal degenerative disease. He had multilevel severe spine degenerative changes and L4/L5 and L5/S1 root impingements with a L4/L5 discectomy performed when he was 25 years old. On physical examination he had normal power and distal hypoaesthesia of the digits and plantar aspect of the feet. Investigations revealed normal full blood count, liver and renal function, electrolytes, vitamin B12 and serum folate. He suffered from primary hypothyroidism and thyroid function tests indicated adequate levothyroxine replacement. Nerve conduction studies revealed a generalized demyelinating sensorimotor neuropathy, with more severe involvement of nerves over entrapment sites. Further history that his father suffered from episodes of weakness and numbness was elicited. Genetic analysis revealed one copy of the PMP22 gene at 17p11.2 confirming the diagnosis of HNPP.

Conclusion

In people with diabetes the evaluation of peripheral neuropathy should include a careful history, a comprehensive physical examination, blood tests and in some cases nerve conduction studies and genetic testing.

     

Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone. METHODS: A total of 293 patients (211 males, 82 females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50 females) received epinephrine injection therapy while 91 patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied. RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range 24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years). Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11% in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis, rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different. CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.     

Erectile Impotence in Chronic Alcoholics

Erectile impotence is a common complaint in alcoholics, but its mechanism is unknown. We have studied nocturnal penile erection in 13 alcoholics who complained of impotence. Seven had normal erections and their impotence was therefore psychogenic. Six were found to have diminished or absent nocturnal erections. Plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were elevated in this latter group, with the exception of one patient who had only raised FSH. They also had more evidence of neurological damage than the other seven alcoholics, and two had evidence of damage to the parasympathetic nervous system. Investigation of erection during sleep in alcoholic patients with impotence may be useful in differentiating clinically between patients with psychogenic causes and patients with organic causes of impotence.     

胰岛素抵抗对糖耐量正常冠心病患者冠脉病变的影响

目的探讨胰岛素抵抗对糖耐量正常冠心病患者冠脉病变的影响。方法以112例冠心病患者为研究对象,采用自我平衡模型分析法(homeostasismodelassessment,HOMA)指数作为评价胰岛素抵抗的指标,将患者分为胰岛素抵抗组和胰岛素敏感组,应用多元逐步回归分析对相关危险因素进行分析。结果两组患者多支冠脉病变的发生率差异有统计学意义,弥漫性病变的发生率差异有极显著性意义,体重指数、收缩压、空腹血浆胰岛素、总胆固醇、甘油三酯与冠脉病变程度正相关,高密度脂蛋白-胆固醇与之呈负相关。结论冠心病合并胰岛素抵抗患者冠脉多支病变、多处病变及弥漫性病变的发生率高,提示胰岛素抵抗及其所造成的肥胖、高血压、脂质代谢紊乱是冠心病的独立危险因素。     

Cardiac tamponade in acute rheumatic carditis.

In patients with valvular heart disease, fever, and cardiomegaly echocardiography is an invaluable noninvasive tool. In this report we describe a young female presenting with cardiac tamponade due to acute rheumatic carditis. Echocardiography showed an exudative pericardial effusion which was haemorrhagic on pericardiocentesis. She responded to steroid therapy with resolution of carditis and pericardial effusion.     

临床用血管理考核指标的设立及实施效果评价

目的设立临床用血管理质量考核指标,定期督导落实,逐步规范临床用血管理,提高科学合理用血水平。方法检查2013年上半年临床输血申请单、输血终末病历,统计分析包括临床用血趋势、临床输血申请、输血文书记录等6项指标的完成情况。结果临床用血趋势分析显示,2013年上半年全院总用血量与2012年同期相比增长率(-30.92%)低于同期出院患者增长率(-6.82%),手术科室用血量增长率(-23.90%)低于手术台数增长率(-12.59%),人均用血量呈负增长(-5.89%)。上半年全院成分输血率为99.93%;输血申请分级管理符合率、申请单审核合格率总体呈上升趋势,直至6月底均达到100%;用血适应证合格率也不断提高,直至6月底手术科室和非手术科室合格率分别达到94.5%和96.7%。输血文书记录合格率和临床用血计划符合率无明显提高。结论临床用血管理考核指标的设立及评价,有效促进了我院临床用血的规范化管理,达到了科学合理用血的目的。     

Hypermethylation of TFPI2 correlates with cervical cancer incidence in the Uygur and Han populations of Xinjiang,China

Tissue factor pathway inhibitor 2 (TFPI2) is a Kunitz-type serine proteinase inhibitor, which plays an important role in the etiology of human malignancies. DNA methylation is a common epigenetic modification of the genome that is involved in regulating many cellular processes. In addition to human papilloma virus (HPV) infection, DNA methylation may play a role in the carcinogenesis of cervical cancer. Methylation of 22 CpG sites in the promoter region of the TFPI2 gene was detected by MassARRAY spectrometry and a gene mass spectrogram was drawn using MALDI-TOF MS. HPV16 was detected by PCR. We show that aberrant methylation of TFPI2 is present in a higher proportion of invasive cervical carcinoma (ICC) clinical samples as compared to normal cervical samples in Uygur and Han. Across the four pathologic lesions of the progression of cervical cancer, ICC showed the highest level of aberrant methylation, and with a stronger correlation between CpG site and lesion grade in Uygur than in Han. Moreover, a difference in TFPI2 methylation between Uygur patients positive and negative for HPV16 infection was observed at CpG_6 (P = 0.028) and CpG_15 (P = 0.007). Altogether, these results indicate that DNA methylation of TFPI2 may play an important role in the carcinogenesis of cervical cancer and that the differential methylation of TFPI2 may at least partially explain the disparity in cervical cancer incidence between Uygur and Han women.