Risk of myocardial infarction with non-steroidal anti-inflammatory drugs北大核心CSCD

BACKGROUND AND OBJECTIVE Inflammatory spondyloarthritis (SPA)has been associated with an increased risk of myocardial infarction (MI).Additionally,non-steroidal anti-inflammatory drugs (NSAIDs)have been associated with an increased risk of cardiovascular events.This study examined the effect of NSAIDs use on the risk of MI in patients with inflammatory arthritis or osteoarthritis (OA).     

结肠高危性腺瘤50例临床分析

目的探讨结肠高危性腺瘤患者与临床的关系。方法根据息肉数量、病理检验结果将152例结肠息肉患者分成高危性组腺瘤、低危性腺瘤组及非腺瘤性息肉组,并对相关临床参数进行统计学处理。结果发现高危性组与其他两组之间在性别上差异无统计学意义(P=0.873),在年龄方面高危腺瘤组与低危性腺瘤组有年龄上差异(P=0.04),而与非腺瘤性息肉组比较差异无统计学意义(P=0.783)。另外在出现血便的症状方面以高危性组较多,而发生在直肠部位的息肉推测以高危性腺瘤组居多,而发生在横结肠部位的息肉则可能以低危性腺瘤组相对较多。结论发生在直肠部位的腺瘤以及出现血便推测以高危性组居多,而发生在横结肠部位的息肉则可能以低危性腺瘤组相对较多,高危性息肉可出现结肠任何部位,有条件尽量做全结肠镜检查。     

IgVH gene mutation status and genomic imbalances in chronic lymphocytic leukaemia with increased prolymphocytes (CLL/PL)

Chronic lymphocytic leukaemia (CLL) with increased prolymphocytes (CLL/PL) has been defined by the World Health Organization (WHO) classification and considered as a progressive and clinically aggressive variant of CLL. To further characterize the biological features of this disease, we performed IgVH gene mutational status, FISH and high-resolution comparative genomic hybridization (HR-CGH) analysis in 17 cases of CLL/PL. All CLL/PL utilized members of VH1, VH3 and VH4 families, with the highest prevalence of the VH1-69 gene. In all but one cases analyzed, the VH genes were unmutated. The FISH and HR-CGH analyses showed frequent occurrence of trisomy 12, del(11)(q23), del(17)(p13) and genetic imbalances, but recurrent genetic lesion characteristic for CLL/PL was not found. The follow-up HR-CGH analysis of two cases showed that increase of prolymphocytes in the course of CLL or CLL/PL are associated with clonal evolution and selection of the tumour clone. In conclusion, this study suggests that CLL/PL is a relatively homogeneous disease regarding VH gene mutation, but heterogeneous regarding genetic lesions. The heterogeneity and high number of genomic imbalances found in CLL/PL suggest that a genome-wide instability of the neoplastic cells may play a role in the development of the disease.     

The H-Wave® small muscle fiber stimulator,a nonpharmacologic alternative for the treatment of chronic soft-tissue injury and neuropathic pain: an extended population observational study

In a previous study, the H-Wave small-muscle fiber stimulator significantly reduced chronic pain and restored physical function among patients with pain in the lower and upper extremities and spine. In this extended population observational study, a cross-sectional, computer-administered 10-item survey was administered to 6774 patients (3367 men [49.7%], 3406 women [50.3%], and 1 sex not reported [<1%]; mean±SD age, 45.28±10.08 y; range, 18–65 y) with chronic soft-tissue injury or neuropathic pain to assess their therapeutic response. The mean±SE duration of self-administered H-Wave treatment before the survey was completed was 87.35±1.39 d. Sixty-five percent of study participants reported a reduced or eliminated need for pain medication; 79% reported improved functional capacity or activity; and 78% reported 25% or greater reduction of pain. This cross-sectional evaluation represents the largest outcome study on the benefits of the H-Wave device in patients with chronic soft-tissue injury or neuropathic pain. The results suggest that this nonpharmacologic approach may provide an important alternative to standard pharmacologic treatment.     

Effect of 2 days of intensive resistance training on appetite‐related hormone and anabolic hormone responses

This study was designed to determine endocrine responses during 2 days of strenuous resistance training. Ten healthy men performed resistance training twice a day for two successive days to induce acute fatigue (excessive physical stress). The resistance training consisted of four exercises for the lower body in the morning and seven exercises for the upper body in the afternoon. Maximal isometric and isokinetic strengths were measured from day 1 (before the training period) to day 3 (after the training period). Fasting blood samples were taken on days 1–3. Maximal isometric and isokinetic strengths significantly decreased with two successive days of training (P<0·05), with significant increases in serum creatine phosphokinase and myoglobin concentrations (P<0·05). Significant reductions in the fasting concentrations of serum insulin‐like growth factor‐1, free testosterone, insulin and high‐molecular‐weight adiponectin were observed on day 3 (P<0·05), whereas there were no changes in the serum cortisol concentration or the free testosterone/cortisol ratio. Plasma active ghrelin and serum leptin concentrations decreased by ?20·7 ± 2·8% and ?29·6 ± 4·1%, respectively (P<0·05). Two days strenuous resistance training significantly affects the profiles of anabolic hormone and endocrine regulators of appetite and energy balance, such as ghrelin and leptin. The present findings suggest that decreased ghrelin and leptin concentrations might reflect excessive physical stress and may be early signs of accumulated fatigue.     

Openings through endothelial cells associated with increased microvascular permeability

Rapid increases in microvascular permeability are associated with the appearance of openings in microvascular endothelium, which are believed to develop between the endothelial cells of venules. Reconstruction of these openings, from electron micrographs of serial sections of the endothelium reveal that many pass through the periphery of the endothelial cells close to intact intercellular junctions. Transcellular pathways are the principal type of opening induced in microvascular endothelium by the ionophore A23187, by VEGF, and by high transmural pressures. Some mediators induce the fusion of vacuoles with the luminal and abluminal surfaces of the endothelium, and it is suggested that the transcellular openings may develop from vacuolar channels.     

A randomised controlled trial of a psychoeducational intervention for women at increased risk of breast cancer

This study aimed to compare the impact of two versions of a psychoeducational written intervention on cancer worry and objective knowledge of breast cancer risk-related topics in women who had been living with an increased risk of familial breast cancer for several years. Participants were randomised to three conditions: scientific and psychosocial information pack (Group 1), scientific information pack only (Group 2) or standard care control (Group 3). They completed postal questionnaires at baseline (n=163) and 4 weeks (n=151). As predicted, there was a significant decrease in cancer worry for Group 1, but not Group 2. Objective knowledge significantly improved for both Group 1 and Group 2 as expected, but not Group 3. However, there was an unpredicted decline in cancer worry for Group 3. This study supports the value of a scientific and psychosocial information pack in providing up-to-date information related to familial risk of breast cancer for long-term attendees of a familial breast cancer clinic. Further research is warranted to determine how the information pack could be incorporated into the existing clinical service, thus providing these women with the type of ongoing psychosocial support that many familial breast cancer clinics are currently lacking.     

How Should We Inform Women at Higher Risk of Breast Cancer About Tamoxifen? An Approach with a Decision Guide

Summary Background. Tamoxifen has been shown to reduce the incidence of invasive breast cancer in women at higher risk. Translating these research results to clinical practice is challenging. Our objective was to develop and evaluate a decision-making guide and process that can be used in clinical practice to inform eligible women of chemoprevention with tamoxifen. Methods. A decision guide explaining the benefits and risks of tamoxifen was developed with input from health care professionals and two focus groups of women both with and without cancer. Following consent, 51 eligible women presenting to a multi-disciplinary diagnostic facility for breast problems were given the decision guide/questionnaire to read, fill out and return by mail. Women with further questions or wanting to take tamoxifen were encouraged to re-contact their physicians. Results. Atypia was seen in 60% of subjects. Median 5-year Gail risk was 3.7 (range 1.7–9.4). Only 6 (11.8% 95% CI = 2.9, 20.6%) women reported they would like to take tamoxifen while 6 (11.8% 95% CI = 2.9, 20.6%) remained uncertain. Conclusion. We have developed a decision-making guide and process that is acceptable to providers and women to identify and inform women at higher risk of breast cancer with regard to chemoprevention with tamoxifen. Few women in this select group, when provided with a balanced decision guide, wished to pursue chemoprevention with tamoxifesn     

Microvascular structure and function in salt-sensitive hypertension

In many individuals with essential hypertension, dietary salt can further increase blood pressure by augmentation of an already elevated total peripheral resistance. There is little information on the microvascular changes that contribute to salt-sensitive hypertension in humans, but studies in the Dahl salt-sensitive rat have provided some knowledge of the microcirculation in this form of hypertension. These studies, most of which have used intravital microscopy or isolated vessel technology, are the focus of this review. The salt-induced exacerbation of hypertension in Dahl rats is due to a uniform increase in hemodynamic resistance throughout most of the peripheral vasculature. In the spinotrapezius muscle, this resistance increase is largely due to the intense constriction of proximal arterioles. The mechanisms responsible for this increased arteriolar tone include increased responsiveness to oxygen and a loss of tonic nitric oxide (NO) availability caused by reduced endothelial NO production and/or accelerated NO degradation by reactive oxygen species. Within the last decade, it has become increasingly clear that high salt intake can also lead to changes in microvascular structure and function in the absence of increased arterial pressure. This effect must also be considered when evaluating microvascular changes and their functional consequences in salt-sensitive hypertension.     

Improved digital SEM of cancellous bone: scanning direction of detection,through focus for in-focus and sample orientation

Three-dimensional (3D) study of cancellous bone tissue organization is necessary to understand how modelling and remodelling processes regulate bone structure and connectivity. It requires imaging methods that have both sufficient resolution power and width and depth of field. Since clinical imaging methods fall far short of the first requirement, we can only study prepared tissue in isolation from the body. Scanning electron microscopy (SEM) of macerated plane parallel slices is the most productive method, but we meet special technical problems in imaging porous bone because samples need to be relatively thick to maintain both continuity and context. Problems due to charging under the electron beam can be controlled by imaging with only high-energy backscattered electrons (BSE). This gives an important additional benefit that the direction of apparent illumination can be manipulated by positioning the detector, and multiple detector positions can be employed strategically to generate images in which colour is used to help in coding surface morphology. However, we next confront the difficulty of the limited depth of field. This can be improved by taking series of images, moving the sample along the electron optic axis, and combining these to generate a single extended-focus image. SEM imaging geometry gives a change in magnification with change of working distance, and it is shown that this must be corrected for each image of the through-focus sequence. Colour coding the lighting direction and increasing the depth of field are approaches that can be combined, and are well matched to the possibilities offered by communication by digital data projection. Finally, the latter means also offer another powerful technique for 3D representation through the display of through tilt image sequences. The novel routines considered here are generally applicable to all classes of microanatomical SEM sample.