Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium

ObjectivesThis study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk.BackgroundAlthough CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate.MethodsThe CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD.ResultsDuring the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0.ConclusionsAcross the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.     

Cyclical etidronate increases bone density in the spine and hip of postmenopausal women receiving long term corticosteroid treatment. A double blind, randomised placebo controlled study

OBJECTIVE: To study the effect of cyclic etidronate in secondary prevention of corticosteroid induced osteoporosis. METHODS: A double blind, randomised placebo controlled study comparing cyclic etidronate and placebo during two years in 37 postmenopausal women receiving long term corticosteroid treatment, mainly for polymyalgia rheumatica (40% of the patients) and rheumatoid arthritis (30%). Bone density was measured in the lumbar spine, femoral neck, and femoral trochanter. RESULTS: After two years of treatment there was a significant difference between the groups in mean per cent change from baseline in bone density in the spine in favour of etidronate (p = 0.003). The estimated treatment difference (mean (SD)) was 9.3 (2.1)%. Etidronate increased bone density in the spine (4.9 (2.1)%, p < 0.05) whereas the placebo group lost bone (-2.4 (1.6)%). At the femoral neck there was an estimated difference of 5.3 (2.6)% between the groups (etidronate: 3.6% (1.4)%, p < 0.05, placebo: -2.4 (2.1)%). The estimated difference at the trochanter was 8.2 (3.0) (etidronate: 9.0 (1.5)%, p < 0.0001, placebo: 0.5 (2.3)%). No significant bone loss occurred in the hip in placebo treated patients. CONCLUSIONS: Cyclic etidronate is an effective treatment for postmenopausal women receiving corticosteroid treatment and is well tolerated.     

Beta-adrenergic stimulation of pig myocytes with decreased cytosolic free magnesium prolongs the action potential and enhances triggered activity

INTRODUCTION: Heart failure results in chronic beta-adrenergic stimulation, repolarization lability, and arrhythmias associated with early afterdepolarizations (EADs) and delayed afterdepolarizations (DADs). Having described a significant reduction in intracellular free magnesium ([Mg2+]i) in experimental heart failure, we asked whether a reduction in [Mg2+]i would delay repolarization or facilitate EADs and/or DADs. METHODS AND RESULTS: Left ventricular myocytes were isolated from Yorkshire swine. Cytosolic free [Mg2+] was set at 0.12 mM (LoMg) or 1.2 mM (HiMg) through pipette dialysis. Action potentials (AP), Ca current (I(Ca)), and sodium/calcium exchange current (I(NCX)) were measured in the presence or absence of isoproterenol (2 microM) at 37 degrees C. Under basal conditions (0.1-Hz stimulation, 2 mM external [Ca2+]), reducing [Mg2+]i had no effect on AP duration and I(Ca) but did significantly enhance I(NCX). In contrast, during superfusion with isoproterenol, reduced [Mg2+]i caused a significant increase in AP duration at both 50% and 90% repolarization (APD50 and APD90) compared with HiMg (P < 0.05). LoMg cells manifested a high incidence of triggered activities, including spontaneous AP, EADs, and DADs (83.3% in LoMg, n = 12 vs 38.3% in HiMg, n = 13; P < 0.05). I(Ca) and I(NCX) were significantly increased in LoMg cells compared with HiMg cells (P < 0.05). CONCLUSION: Decreased cytosolic free magnesium prolongs AP duration and increases the incidence of triggered activity during beta-adrenergic stimulation. These effects may be due to increased I(Ca) and I(NCX) in the presence of reduced intracellular [Mg2+]. A magnesium-dependent increase in triggered activity coupled with delayed repolarization during beta-adrenergic stimulation could contribute to the arrhythmogenic substrate in heart failure.     

碳酸镧对维持透析患者高磷血症的疗效分析

目的探讨碳酸镧对维持透析患者高磷血症的短期疗效及耐受性。方法回顾性分析2012年10月²013年10月在我院使用碳酸镧治疗高磷血症透析患者(血液透析或腹膜透析)的临床资料。结果共入组22例患者,其中男13例,女9例,腹膜透析4例,血液透析18例,平均年龄(54.2±15.1)岁,平均透析龄(51.5±21.4)月。治疗前、治疗12周后血磷,血清校正钙、钙磷乘积、iPTH为:(2.94±0.43)vs(2.31±0.39)(p=0.00),(2.23±0.11)vs(2.26±0.10)(p=0.25),(82.2±12.9)vs(65.3±11.1)(p=0.00),(1 462±1 053)vs(1 411±943)(p=0.51)。不良反应主要为胃肠道反应,发生率36.4%,无1例患者因严重不良反应退出。结论碳酸镧是一种对维持透析患者短期疗效好、不良反应轻,耐受性良好的口服磷结合剂。     

新生儿窒息心肌损害应用磷酸肌酸钠治疗的临床观察

目的探讨新生儿窒息心肌损害患者应用磷酸肌酸钠治疗的临床效果。方法以2012年7月²014年6月间收治的84例新生儿窒息继发心肌损伤的患儿为研究对象,随机分为观察组及对照组各42例,对照组进行常规治疗,观察组在此基础上增加使用磷酸肌酸钠,比较两组临床疗效及实验室指标的变化。结果观察组临床治疗显效率高于对照组,其血清磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)和α-羟丁酸酶(HBDH)三项均低于对照组,其差异皆有统计学意义(p<0.05)。结论在常规基础上增加使用磷酸肌酸钠可以有效提高临床治疗新生儿心肌损伤的效果。     

Store-operated calcium entry in neuroglia

Neuroglial cells are homeostatic neural cells. Generally, they are electrically non-excitable and their activation is associated with the generation of complex intracellular Ca²⁺ signals that define the “Ca²⁺ excitability” of glia. In mammalian glial cells the major source of Ca²⁺ for this excitability is the lumen of the endoplasmic reticulum (ER), which is ultimately (re)filled from the extracellular space. This occurs via store-operated Ca²⁺ entry (SOCE) which is supported by a specific signaling system connecting the ER with plasmalemmal Ca²⁺ entry. Here, emptying of the ER Ca²⁺ store is necessary and sufficient for the activation of SOCE, and without Ca²⁺ influx via SOCE the ER store cannot be refilled. The molecular arrangements underlying SOCE are relatively complex and include plasmalemmal channels, ER Ca²⁺ sensors, such as stromal interaction molecule, and possibly ER Ca²⁺ pumps (of the SERCA type). There are at least two sets of plasmalemmal channels mediating SOCE, the Ca²⁺-release activated channels, Orai, and transient receptor potential (TRP) channels. The molecular identity of neuroglial SOCE has not been yet identified unequivocally. However, it seems that Orai is predominantly expressed in microglia, whereas astrocytes and oligodendrocytes rely more on TRP channels to produce SOCE. In physiological conditions the SOCE pathway is instrumental for the sustained phase of the Ca²⁺ signal observed following stimulation of metabotropic receptors on glial cells.     

鲑鱼降钙素联合低钙透析液治疗血透患者高磷血症的临床研究

目的：探讨低钙透析液联合鲑鱼降钙素对维持血透（Maintenance hemodialysis, MHD）患者高磷血症的影响。方法选取我院近期维持性血液透析患者中高磷血症患者40例,采用随机数字表法分为对照组21例,给予常规钙透析液＋活性维生素D3治疗;试验组19例,给予低钙透析液联合鲑鱼降钙素注射液治疗。观察两组患者治疗后第3、6个月时血清钙磷代谢等指标有无差别。结果对照组治疗后血清钙较治疗前无明显变化（P＞0.05）,但血磷和甲状旁腺激素（iPTH）较透析前明显增加（P〈0.05）;试验组治疗后血清钙、iPTH无明显变化（P＞0.05）,血磷显著降低（P〈0.05）。结论鲑鱼降钙素联合低钙透析液治疗MHD能有效降低患者血磷水平且不致影响iPTH。     

补充钙、锌、维生素 A对儿童生长发育的影响

目的：探讨补充钙、锌、维生素A（VA）对儿童生长发育的作用。方法选择2009年1月至2010年12月来南平妇幼保健院就诊的156例3～5岁儿童为受试对象,按照年龄、性别大致相匹配原则,将其分为4组：对照组、Zn组、Zn＋Ca组、Zn＋Ca＋VA 组,分别给予Zn 3．5mg、Ca 250mg、VA 200μg,每周5天共持续12个月。营养素补充期限为12个月,期间每4个月进行一次体格检查及膳食调查,实验前后各测骨龄1次。结果锌补充组在第12个月末身高与对照组相比出现显著差异（ t＝3．432, P＜0．05）,Zn＋Ca组在第8个月末及第12个月末与对照组相比,身高出现统计学差异（t值分别为4．383和4．464,均P＜0．05）, Zn＋Ca＋VA 组在第8个月末及第12个月末与对照组相比,身高亦出现统计学差异（t值分别为5．432和3．289,均P＜0．05）。Zn＋Ca补充组体重在第12个月末与对照组相比出现显著差异（t＝3．866,P＜0．05）。 Zn＋Ca＋VA 组体重分别在第8个月末及第12个月末与对照组相比,均出现统计学差异（t值分别为5．221和3．2373,均P＜0．05）。 Zn组,Zn＋Ca组及Zn＋Ca＋VA 组与对照组两两比较,骨龄的增长均无显著性差异（t值分别为1．277、1．747和1．958,均P＞0．05）。结论 Zn＋Ca＋VA 可增加儿童身高、体重增长速率,缓解骨龄滞后现象,但不加速骨骼的成熟。     

离子色谱法测定无水磷酸氢二钠中阴离子及不同级别产品质量比较

摘 要 目的：建立离子色谱法同时测定无水磷酸氢二钠中的氟离子、氯离子、硝酸根和硫酸根离子的含量,并评价不同级别无水磷酸氢二钠的质量状况。 方法: 采用Dionex IonPac AS18(4 mm×250 mm)色谱柱,以10,40 mmol·L-1 氢氧化钾淋洗液梯度洗脱,流速为1.0 ml·min -1 ,进样量为25 μl。 结果: 氟离子、氯离子、硝酸根和硫酸根离子质量浓度分别在0.02～0.40,0.01~0.80,0.06~1.00和0.10~5.00 μg·ml-1 范围内与峰面积均呈良好线性关系,r分别为0.999 5,0.999 7,0.999 9和0.999 5,平均回收率分别为92.26%,93.17%,99.80%,91.81%,RSD分别为0.87%,2.32%,3.07%,1.49%(n=6),供试品溶液在30 h内稳定。 结论: 本方法准确度高、重复性好,可用于测定无水磷酸氢二钠中的氟离子、氯离子、硝酸根和硫酸根离子的含量,为建立无水磷酸氢二钠的质量标准提供参考。