Autosomal Recessive Hypercholesterolemia: Long-Term Cardiovascular Outcomes

Background

Autosomal recessive hypercholesterolemia (ARH) is a rare lipid disorder characterized by premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data for clinical management and cardiovascular outcomes in ARH.

Plasma linoleic acid partially mediates the association of bipolar disorder on self-reported mental health scales

We have shown that bipolar individuals have reduced quality diets, including lower intake of polyunsaturated fatty acids (PUFA). We have also reported reduced plasma levels of the n-6 PUFA, linoleic acid (LA), and the n-3 PUFA, eicosapentaenoic acid (EPA) in bipolar subjects. In the current analysis we hypothesized that LA and EPA plasma levels would mediate lower self-reported mental health and life functioning scores in bipolar subjects. In a cross-sectional study, we collected a 7-day diet record in bipolar (n = 56) and control subjects (n = 46) followed by a fasted blood draw. We used structured equation modeling path analysis to test for mediating effects of dietary intake and plasma levels of LA and EPA on self-reported mental health questionnaire scores, including the Life Functioning Questionnaire (LFQ), the Patient Health Questionnaire (PHQ9), and the Short Form Health Survey (SF12), extracting the mental health component summary score (SF12-MH). We adjusted for age, gender, psychiatric medication use, body mass index (BMI), and total caloric intake as covariates with bipolar disorder as the primary predictor. We found a significant path association from bipolar disorder to lower plasma LA levels (p = 0.03) and significant paths from plasma LA to PHQ9 (p = 0.05), LFQ (p = 0.01) and SF12-MH (p = 0.05) scores, such that lower plasma LA predicted worse outcomes. We found no significant paths from plasma EPA levels to any of the outcome measures. These findings suggest that plasma LA levels partially mediate the effect of bipolar disorder on self-reported measures of mental health and life functioning.     

内分泌治疗对乳腺癌术后子宫内膜病变患者生活质量的临床观察#br#

Objective?To investigate the effect of endocrine therapy on the life quality of patients with endometrial lesions after breast cancer surgery. Methods?A total of 69 cases of breast cancer patients with uterine endometrial lesions after endocrine therapy were selected and divided into two groups randomly: ovarian function suppression (OFS) combined with aromatase inhibitor (AI) group (group A, n=34), OFS combined with Moxifen (TAM) group (group T, n=35). The life quality scores, endometrial changes and adverse reactions were compared between the two groups of patients at different periods. Results?The scores of four dimensions of life quality in group A at 6th and 12th months after treatment were higher than those in group T (P<0.05). The 12-month endocrine symptom scores in group A were higher than those in the group T (P<0.05). The incidence rates of endometrial hyperplasia, endometrial atrophy and endometrial polyps in group A were 41.18%, 20.59%, and 17.65%, respectively, which were lower than those in group T (60.00%, 34.29%, 34.29%) (P<0.05). At the 12th month, the endometrial thickness of patients in group A [(7.87±2.54) mm] was higher than that in group T [(6.23±1.18) mm] (P<0.05). Conclusions?Different endocrine drugs have different effects on the life quality and endometrium of patients. In this study, OFS combined with aromatase inhibitor therapy improved the life quality better than OFS combined with tamoxifen.     

Transseptal left heart catheterization a 50-year odyssey

Development in the 1950s of the transseptal technique for left heart catheterization is described. Initial studies in animals and human cadavers were followed up by left atrial puncture with measurements of left atrial and left ventricular (LV) pressure (the latter using a small plastic catheter) in patients with cardiac disease. Many such procedures were performed safely without complications. Subsequent modification of the original technique for percutaneous catheter insertion allowed placement of a larger taper-tipped catheter in the LV chamber for selective LV angiography. Early clinical research studies at the National Heart Institute were performed using the transseptal method; these included investigation of the effects of increasing afterload on the normal and failing left ventricle by means of a graded angiotensin infusion to induce a progressive increase in aortic pressure. A marked decrease in the stroke volume occurred with increased afterload in the failing heart. This finding later led to the concept of afterload mismatch with limited pre-load reserve. Another early transseptal catheterization study in which measurements of LV pressure were made at different locations within the left ventricle as well as in the left atrium confirmed the presence of cavity obliteration in some patients and true obstruction in the LV outflow tract in many others. In addition, left ventriculography showed that obstruction was caused by abnormal anterior position during systole of the anterior mitral valve leaflet. With growing acceptance of retrograde catheterization of the left ventricle, the use of the transseptal technique for diagnostic purposes declined. However, in recent years, substantial renewed application of the transseptal method has occurred for special diagnostic and therapeutic purposes, including balloon valvuloplasties and electrophysiologic ablation procedures within the left heart.     

Area reputation as an under-acknowledged determinant of health inequalities: evidence from a systems evaluation of a major community empowerment initiative in England

Background

Area reputation (AR) refers to the ways that geographical localities are portrayed (eg, in media coverage) either positively or negatively. AR is rarely recognised as a social determinant of health inequalities and is not adequately considered in public health interventions. Using residents' accounts from a study of a major community empowerment initiative in England (Big Local), we aimed to map the potential health consequences of AR and see how it can be challenged through resident-led action.

Aging dilates atrium and pulmonary veins: implications for the genesis of atrial fibrillation

BACKGROUNDS: Aging plays a critical role in the pathophysiology of atrial fibrillation (AF). The left atrium (LA) and pulmonary veins (PVs) are essential components for the genesis and maintenance of AF. The purpose of this study was to investigate the effects of aging on the AF substrate and the initiator (PVs). METHODS: A total of 180 patients undergoing multidetector CT were enrolled and classified into six groups according to the decade of their age. LA, LA appendage (LAA), and orifice of the four PVs were measured. RESULTS: The LA anterior-posterior diameter and wall thickness became increased with aging after the age of 50 years (p < 0.001). Similarly, the LAA and four PV trunks also became dilated after the patients were > 50 years old (p < 0.001). The anterior wall was consistently thicker than the posterior wall in each group. Aging also increased both anterior and posterior wall thickness after the patients became > 50 years old. However, LA diameter, PV diameter, and LA wall thickness in the patients aged 70 to 79 years and > 80 years did not significantly differ. Age correlated well with the four PVs, LA diameter, and wall thickness with linear regression. CONCLUSIONS: Age significantly determines LA and PV structures. These findings show the important contributing effects involved in aging-induced AF in the general population.     

Gastro-esophageal reflux disease: the recent trend in Japan

Gastro-esophageal reflux disease (GERD) has increased in Japan, as in other countries. This is probably due to increased acid secretion among Japanese due to Westernized foods and lifestyle as well as decreased prevalence of Helicobacter pylori infection. Proton pump inhibitor (PPI) is mainly used for treatment of this condition. PPI has recently been approved for treatment of nonerosive reflux disease (NERD) in Japan. NERD is known to have different characteristics to GERD, and effectiveness of PPI in NERD patients is lower than that in reflux esophagitis patients. Regarding therapeutic benefit of treatment, a recent study showed that PPI improved quality of life (QOL) of GERD patients also in Japan. For diagnosis of reflux esophagitis in Japan, we use a unique classification, a modified Los Angeles (LA) classification, which includes minimal change (grade M esophagitis) as one distinct criteria. However, recent studies from Japan showed poor interobserver agreement in diagnosis of grade M, although excess acid reflux in minimal change was shown in another study. Our definition of Barrett’s esophagus is also different from that in the West. Nationwide consensus on diagnosis of reflux esophagitis and Barrett’s esophagus should be achieved in Japan, preferably consistent with world standard.