Risks of clinically significant upper gastrointestinal events with etodolac and naproxen: a historical cohort analysis

BACKGROUND AND AIMS: Etodolac is a generic nonsteroidal anti-inflammatory drug (NSAID). Previous in vitro studies have shown that etodolac is a selective inhibitor of cyclooxygenase (COX)-2 with selectivity in between that of other COX-2 inhibitors such as celecoxib and rofecoxib. However, there are no outcomes data assessing clinically significant upper gastrointestinal (CSUGI) events with etodolac. METHODS: A historical cohort study was performed at the Dallas Veterans Affairs Medical Center in which 16,286 veteran patients (5596 patient-years) received etodolac or naproxen during a 3-year period without concurrent use of other ulcerogenic drugs other than low-dose aspirin. The primary outcome was the CSUGI event rate of the etodolac and naproxen groups without concomitant low-dose aspirin. RESULTS: The incidence of CSUGI events was .78% and .24% for naproxen and etodolac, respectively. In the NSAID-naive subset, the incidence of CSUGI events was .99% and .24% for naproxen and etodolac, respectively. Compared with naproxen, etodolac was associated with a reduction in upper gastrointestinal events, corresponding to an odds ratio of .39 (95% confidence interval, .20-.76; P = .006). Concomitantly used low-dose aspirin increased event rates with naproxen 2-fold and etodolac 9-fold. Hence, there was no significant difference in gastrointestinal event rates between etodolac and naproxen when low-dose aspirin was taken concomitantly. CONCLUSIONS: Etodolac is a generic COX-2 selective inhibitor that reduces CSUGI events compared with the nonselective NSAID naproxen. However, concomitant use of low-dose aspirin negates the gastrointestinal safety advantages of etodolac.     

Protective effect of some vitamins against the toxic action of ethanol on liver regeneration induced by partial hepatectomy in rats

AIM： To investigate the effects of vitamins （A, C and E） on liver injury induced by ethanol administration during liver regeneration in rats. METHODS： Male Wistar rats subjected to 70% partial hepatectomy were divided into five groups （groups 1-5）. During the experiment, animals of Group 1 drank only water. The other four groups （2-5） drank 30 mL of ethanol/L of water. Group 3 additionally received vitamin A, those of group 4 vitamin C and those of group 5 received vitamin E. Subsequently serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, albumin and bilirubin were measured colorimetrically. Lipid peroxidation （thiobarbituric-acid reactive substances, TBARS） both in plasma and liver was measured, as well as liver mass gain assessment and total DNA. RESULTS： Compared with sham group, serum AST and ALT increased significantly under ethanol treatment （43% and 93%, respectively, with P 〈 0.05）. Vitamin C and vitamin E treatment attenuated the ethanol-induced increases in ALT and AST activity. Ethanol treatment also decreased serum albumin concentration compared to sham group （3.1 ± 0.4 g/dL vs 4.5 ± 0.2 g/dL; P 〈 0.05）. During liver regeneration vitamins C and E significantly ameliorated liver injury for ethanol administration in hepatic lipid peroxidation （4.92 nmol/mg and 4.25 nmol/mg vs 14.78 nmol/mg, respectively, with P 〈 0.05）. In association with hepatic injury, ethanol administration caused a significant increase in both hepatic and plasma lipid peroxidation. Vitamins （C and E） treatment attenuated hepatic and plasma lipid peroxidation. CONCLUSION： Vitamins C and E protect against liver injury and dysfunction, attenuate lipid peroxidation, and thus appear to be significantly more effective than vitamin A against ethanol-mediated toxic effects during liver regeneration.     

The effects of Ménière's disorder on the patient's significant others

Abstract

Objective: To determine the effects of their partners’ MD on the significant others of the patients. Design: Open-ended questionnaire. Study sample: Significant others of members of the Finnish Ménière's Federation. Results: The predominant responses concerned effects on their lives and lifestyle—participation restrictions (effects on personal and community life)—and on personal contextual factors (uncertainty of life). In contrast they fail to list such effects of the patients, focussing rather on the patients’ symptoms. Five percent of the responses given entailed positive experiences. Conclusions: Significant others of patients with MD listed a wide range of effects of their partner's condition on them. We encourage doctors and therapists to include the significant others in the rehabilitation process to enable them to understand the patient's condition, to help the significant other, and so better support the patients concerned.     

气象对胃经五输阻抗值影响的初探

目的:观察数据中不同季节因素对人体胃经五输穴的阻抗值是否有显著影响,用以判断季节因素是否对人体胃脏有显著影响。方法:试用自行研制脏腑疾病诊断仪DM-Ⅰ,测试180例无胃病及其循行经脉病的健康人胃经五输体表阻抗值。结果:经过统计方法处理,发现α=0.05水平下,季节对各个穴位的测试值没有显著性差异(p>0.05)。结论:可以排除季节变化因素对胃输五经阻抗值测定的影响。     

血清铁蛋白诊断慢性肝病显著纤维化和肝硬化的临床价值

目的探讨血清铁蛋白在慢性肝病显著纤维化和肝硬化中的诊断价值。方法收集来我院诊疗的122例慢性肝病患者资料,均进行肝组织病理学检查,检测患者的肝纤维化4项、肝功能以及血清铁蛋白的水平,以肝穿刺的病理结果作为依据,比较血清铁蛋白与肝纤维化4项、血常规等指标对显著肝纤维化和肝硬化诊断价值的优劣,并采用Logistic回归分析探讨相关影响因素。结果血清铁蛋白、肝纤维化四项指标水平均与肝纤维化程度呈正相关,均随着肝纤维化分期增加而增加,并且在肝硬化时期最高(P<0.05)。对纤维化或肝硬化的可能影响因素进行单因素分析,结果发现血小板透明质酸、层黏蛋白、Ⅳ型胶原、Ⅲ型前胶原、血清铁蛋白等因素与显著纤维化有关;而白细胞计数、血小板、白蛋白、层黏蛋白、Ⅳ型胶原、Ⅲ型前胶原、血清铁蛋白等因素与肝硬化有关。ROC曲线分析血清铁蛋白对显著纤维化的诊断效能,曲线下面积为0.816(0.803~0.910),血清铁蛋白在截点值为138.17 ng/mL时,敏感度为82.0%,特异度为91.2%。ROC曲线分析血清铁蛋白对肝硬化的诊断效能,曲线下面积(AUC)为0.827(0.817~0.846),血清铁蛋白在截点值为160.25 ng/mL时,敏感度为82.4%,特异度为91.5%。结论血清铁蛋白、肝纤维化四项与慢性肝病显著纤维化和肝硬化程度有关,且以上方式简便、创伤性小、可重复性较强,对检测肝纤维化以及肝硬化程度具有良好的提示作用。     

Tpeak-Tend interval as a new risk factor for arrhythmic event in patient with Brugada syndrome

Objective:To evaluate Tpeak-Tend (Tp-e) interval in surface standard ECG as a new risk factor for arrhythmic event in patient with Brugada syndrome. Methods: 23 male patients with Brugada syndrome and 20 male patients with paroxysmal supraventricular tachycardia (PSVT) as the control group were investigated in this study. Tp-e interval in surface standard ECG was compared between BrS and PSVT patients. Results: Tp-e interval in BrS patients was significantly longer than that in PSVT patients (109.57±22.86 ms vs. 88.50±13.08ms, P＜0.05). There was significant difference in Tp-e interval between 16 BrS patients with arrhythmic events (including syncope, clinical ventricular fibrillation [VF] and programmed electrical stimulation [PES]-induced VF) and 7 BrS patients without arrhythmic events and PSVT patients (118.12±20.40ms vs.90.00±15.27ms, P＜0.05; 118.12±20.40ms vs. 88.50±13.08ms, P＜0.05). However, Tp-e interval was similar in BrS patients without arrhythmic events and PSVT patients (90.00±15.27ms vs 88.50±13.08ms, P＞0.05). Conclusion: The prolongation of Tp-e interval could serve as a new noninvasive event predictor for arrhythmic events in patients with Brugada syndrome.     

Study on correlation between C-reactive protein and gestational diabetes mellitus

Objective：To investigate correlation between C-reactive protein（CRP） and gestational diabetes mellitus（GDM）, Methods：Twentyfive GDM women were served as study group, and thirty normal pregnant women were selected as control group. The serum FPG, 2hPG, HbAlc and CRP levels and the leukocyte count were detected in the two groups, in order to observe the relationship between gestational diabetes mellitus and inflammatory markers. Results：The age and gestational week did not show difference in the two groups（P〉 0.05）. But there was a significant difference in body mass index（BMI） between the GDM group and the controtgroup（P 〈 0.05）. The serum FPG, 2hPG, HbAlc and CRP levels and the leukocyte count in the GDM group were higher than those in the control group, and the difference was significant（P 〈 0.05）, There was positive correlation between serum C-reactive protein value and FPG, 2hPG, HbAlc serum levels or the leukocyte count in GDM group. But in the control group there was no correlation between them. Conclusion：The results suggest that there is correlation between C-reactive protein and gestational diabetes mellitus, and inflammation may play an important role in the development of gestational diabetes mellitus.     

Repeated ethanol exposure during adolescence alters the developmental trajectory of dopaminergic output from the nucleus accumbens septi

Individuals who begin using alcohol prior to 14 years of age are 4 times more likely to progress to addiction than those who do not initiate use until 21 years of age. The nucleus accumbens septi undergoes dramatic developmental transitions during the adolescent period, and dopaminergic activity within this region has been identified as a central neurochemical mediator of drug reward, addiction and dependence. Thus, alcohol-induced neurochemical alterations in dopaminergic activity within this brain region likely mediate the heightened vulnerability to addiction observed in adolescent alcohol users. To investigate this idea, Sprague–Dawley rats were exposed to intraperitoneal injections of either saline or ethanol (0.5, 1.0 or 2.0 g/kg) twice daily over four days beginning on postnatal day 21, 31, 41 or 56. Cannulas were implanted toward the nucleus accumbens septi, subsequent in vivo microdialysis was used to collect samples, and both basal and ethanol-stimulated dopamine overflow was measured using high performance liquid chromatography with electrochemical detection. A developmental transition in basal levels of dopamine in the nucleus accumbens septi was apparent with peak levels at postnatal day 45. An ethanol challenge produced unique responses across ages, with greater peak effects relative to baseline in younger animals (postnatal day 25 and 35). Following repeated exposure to ethanol, a significant increase in basal dopamine was apparent for all ages, and when these animals were challenged with ethanol, peak effects relative to baseline were decreased in younger animals, but unchanged in older animals (postnatal day 45 and 60). Results indicate that there is a key developmental transition in the ability of rats to adapt to the effects of repeated ethanol exposure, which occurs between postnatal day 35 and 45. This alteration may explain the increased addiction vulnerability observed in individuals who initiate alcohol use during early adolescence.     

Comparison of BMD precision for Prodigy and Delphi spine and femur scans

Introduction Precision error in bone mineral density (BMD) measurement can be affected by patient positioning, variations in scan analysis, automation of software, and both short- and long-term fluctuations of the densitometry equipment. Minimization and characterization of these errors is essential for reliable assessment of BMD change over time.Methods We compared the short-term precision error of two dual-energy X-ray absorptiometry (DXA) devices: the Lunar Prodigy (GE Healthcare) and the Delphi (Hologic). Both are fan-beam DXA devices predominantly used to measure BMD of the spine and proximal femur. In this study, 87 women (mean age 61.6±8.9 years) were measured in duplicate, with repositioning, on both systems, at one of three clinical centers. The technologists were International Society for Clinical Densitometry (ISCD) certified and followed manufacturer-recommended procedures. All scans were acquired using 30-s scan modes. Precision error was calculated as the root-mean-square standard deviation (RMS-SD) and coefficient of variation (RMS-%CV) for the repeated measurements. Right and left femora were evaluated individually and as a combined dual femur precision. Precision error of Prodigy and Delphi measurements at each measurement region was compared using an F test to determine significance of any observed differences.Results While precision errors for both systems were low, Prodigy precision errors were significantly lower than Delphi at L1–L4 spine (1.0% vs 1.2%), total femur (0.9% vs 1.3%), femoral neck (1.5% vs 1.9%), and dual total femur (0.6% vs 0.9%). Dual femur modes decreased precision errors by approximately 25% compared with single femur results.Conclusions This study suggests that short-term BMD precision errors are skeletal-site and manufacturer specific. In clinical practice, precision should be considered when determining: (a) the minimum time interval between baseline and follow-up scans and (b) whether a statistically significant change in the patient’s BMD has occurred.