Turnover of apoproteins A-I and A-II of high density lipoprotein and the relationship to other lipoproteins in normal and hyperlipidemic individuals

The kinetics of the major apoproteins of high density lipoproteins (HDL), A-I(apoA-I) and A-II(apoA-II), were studied from the specific activity-time curves of these apoproteins, after reinjection of radioiodine-labeled HDL. In all 20 subjects, HDL apoprotein kinetics conformed to a two-pool model. The total fractional removal rates for the two apoproteins were similar, although the irreversible fractional removal rate appeared to be slightly greater for apoA-I. The mean transport for A-I and A-II was 12.2 mg/kg/day and 5.0 mg/kg/day, respectively. The mass of the apoprotein pools was strongly correlated with apoprotein production rate and also, to a lesser degree and inversely, with the irreversible fractional catabolic rate. Transport was directly correlated with body weight. Higher fractional catabolic rates, including the transfer rates between the two pools, were observed in five hypertriglyceridemic subjects; in contrast, five subjects with familial hypercholesterolemia tended to show lower fractional catabolic rates. These findings were supported by (1) a strongly positive correlation between the transport rates of HDL A-I and of very low density lipoprotein (VLDL) apoB, determined simultaneously in 10 subjects; and (2) a significant inverse correlation between the irreversible fractional removal rate of HDLA-I and the concentration of low density lipoprotein (LDL) apoB, measured in 15 subjects. These observations underline the metabolic interrelationships of the major lipoprotein classes. Two subjects with familial hyperalphalipoproteinemia showed enlarged pool sizes, but normal transport, with irreversible fractional removal rates that were in the lower range for the group of 20 subjects.     

Synovial fluid leukocytosis. A study of extremes.

Three hundred and eighty-eight synovial fluids from 310 patients with definite diagnoses were reviewed. Seventy per cent of the patients with culture-proved infections in the joint space had leukocyte counts above 50,000/mm³ whereas 12.5 per cent of the patients with gout, 10 per cent of those with pseudogout and 4 per cent of those with rheumatoid arthritis had leukocyte counts in this high range.White cell counts ranged from 6,000 to 46,000/mm³ in 30 per cent of the patients with infectious arthritis. However, their fluids contained 90 per cent neutrophils and poor mucin clots, and within 12 to 48 hours repeat aspirations of the same joint showed large increases in the leukocyte count. These patients were divided into two groups, one with mild infections due to Neisseria gonorrhea and Diplococcus pneumoniae, and another consisting of patients with complicated underlying diseases whose infections, usually due to more virulent organisms, were poorly controlled and whose mortality rate was 25 per cent within days of synovial fluid analysis.In one fourth of the fluids with sodium urate crystals and one third of the fluids with calcium pyrophosphate crystals, leukocyte counts were below 2,500/mm³. Compared to patients with gouty arthritis, a larger number of patients with pseudogout had normal mucin precipitates despite higher numbers of leukocytes. These data document the magnitude of overlap at extremes of synovial fluid leukocytosis in common forms of arthritis and suggest a need for a careful search for crystals in fluids with high as well as low leukocyte counts.     

Innominate artery aneurysm with thrombus: detection by two-dimensional echocardiography

A 51 year old man with an innominate artery aneurysm presented with claudication and ischemia of the right forearm and hand. Two-dimensional echocardiography visualized the saccular aneurysm and a pedunculated mobile thrombus within it that were not seen during aortic arch angiography. Two-dimensional echocardiography, shown to be useful in identifying intracardiac masses and aortic aneurysms, may be important in selecting patients with increased risk of embolization.     

Association between fluorescent antinuclear antibodies, capillary patterns, and clinical features in scleroderma spectrum disorders

Antinuclear antibody and in vivo capillary patterns were studied in 33 patients with Raynaud's phenomenon only and in 68 patients with scleroderma spectrum disorders; the results were correlated with clinical and laboratory findings. In addition, antinuclear antibody results in the groups with Raynaud's phenomenon only and scleroderma spectrum disorders were compared with those found in 70 patients with systemic lupus erythematosus (SLE). Distinct antinuclear antibody profiles were observed in the three diagnostic groups. Comparison of patients with anticentromere antibodies with others in the group with scleroderma spectrum disorders demonstrated that anticentromere antibody-positive patients tended to have a milder disease: less skin and visceral involvement, less frequent presence of hypertension, anemia, and elevated sedimentation rate. These differences did not, however, reach statistical significance. Comparison of patients with scleroderma spectrum disorders according to in vivo capillary patterns revealed that those with an "active" pattern had significantly more extensive skin involvement than those with a "slow" pattern. Visceral involvement tended to be greater in all organ systems in the group with an "active" pattern and reached statistical significance for muscle and kidney. Hypertension was also significantly more frequent in the group with an "active" pattern than in the group with a "slow" one. The latter was positively correlated with the presence of anticentromere antibody.     

Five-year effect of medical and surgical therapy on resting left ventricular function in stable angina: Veterans administration cooperative study

The effect of coronary artery bypass grafting (CABG) and medical therapy on 5-year resting left ventricular (LV) function was studied in 194 randomized patients with stable angina in the Veterans Administration Study of Coronary Artery Bypass Surgery. LV ejection fraction (EF) was determined in a central laboratory. The 92 medical and 102 surgical patients were comparable at entry with respect to historic, angiographic and electrocardiographic prognostic indicators. Twenty-eight percent of the medical and 30% of the surgical patients had a baseline EF of < 50%. There was no significant change in mean EF between baseline and 5-year values in either treatment group. The base-line and 5-year values were 56 and 58% in each treatment group. Intervening myocardial infarction (MI) had an adverse effect in medically treated patients (59 to 46%, p < 0.01) and in surgically treated patients with late Ml (58 to 47%, difference not significant). Perioperative MI was not associated with a decrease in EF (56 to 58%, difference not significant). These findings extend the similar results of previous short-term studies of the effect of coronary bypass surgery on resting LV function to 5 years, and provide data in a comparable medical control group.     

Quinidine for ventricular arrhythmias: value of electrophysiologic testing

Quinidine was evaluated during serial electrophysiologic testing with programmed ventricular stimulation in 89 patients with life-threatening ventricular arrhythmias. In 30 of the 89 patients, quinidine therapy prevented the initiation of ventricular tachycardia (VT) during programmed ventricular stimulation. In 8 additional patients no single drug tested was effective, and quinidine in combination with either mexiletine (7 patients) or propranolol (1 patient) prevented the initiation of VT during electrophysiologic testing. The mean serum concentrations of quinidine in the patients who responded and those who failed to respond were 2.9 +/- 0.8 and 2.8 +/- 1.1 micrograms/ml, respectively; however, but nonresponders were characterized by more severe congestive heart failure and an increased incidence of digitalis use. During chronic therapy (24 +/- 3 months) with quinidine either alone or in combination with a second antiarrhythmic drug in the 38 patients whose arrhythmia had been suppressed during electrophysiologic testing, 32 (84%) remain symptom-free while 3 have had recurrent arrhythmia and 3 discontinued quinidine because of adverse effects. These data demonstrate that quinidine, when selected on the basis of electrophysiologic testing, provides effective long-term prophylaxis against recurrent ventricular arrhythmia and that approximately 40% of patients tested are likely to respond either to quinidine alone or quinidine in combination with another antiarrhythmic agent.     

Pharmacy practice in the domain of assisted dying: A mapping review of the literature

BackgroundThe scope and roles of pharmacists worldwide are undergoing dramatic change. Patient-focused care aimed at caring for people that seek medical assistance in dying is among the newest roles. While pharmacists have been involved in medically assisted dying in some international jurisdictions for over two decades, little is known about their actual lived experiences.ObjectiveTo map the literature concerning pharmacy practice in the assisted dying domain to clarify apparent research gaps.MethodsA mapping review was preformed following a systematic search of Medline, CINAHL and IPA to locate academic papers and reports relating to pharmacists’ involvement in assisted dying published between 1990 and 2019. Searches included articles in English, French, and Dutch. References and citations of articles were searched to identify additional articles.ResultsA total of 43 articles were selected, including commentaries (n = 26), reports (n = 2), a scoping literature review (n = 1), and empirical studies (n = 14). Most commentaries centered on pharmacists' roles, ethico-legal and moral challenges, and educational concerns in relation to participation. Of the 14 empirical studies, 12 studies were designed around surveys that focused on pharmacists' attitudes, and opinions concerning assisted dying. Other methodologies included thematic analysis of moral dilemmas, experimental design identifying attitudes to sedation at end of life, and analysis of documents such as guidelines, position statements, and standards of practice. Two studies utilized a qualitative research approach. A significant gap was found with respect to research exploring the actual experience of pharmacists’ practice in medically assisted dying.ConclusionThere is an absence of studies exploring pharmacists’ actual experiences in assisted dying practice. Research involving pharmacists that participate in legally sanctioned assisted dying will facilitate a meaningful understanding of the lived experience of pharmacy practice in this domain.     

某省主要城市医疗机构药品使用缺陷分析

目的探索提高医疗机构药品使用质量的办法。方法采取回顾性分析方法,通过对2016年9月~2017年9月某省食品药品监督管理局药化流通监管处每月公示药品流通监督检查信息中医疗机构检查信息的汇总,找出医疗机构药品使用中的高频次缺陷项目,归类分析并提出解决对策。结果缺陷主要集中在养护与维护,收货验收,贮存,调剂,采购5个方面,占总缺陷项目的 91.5%。结论应采取措施加大对医疗机构药品使用质量的监管力度和省内不发达地区药品安全教育,提高其药事管理水平,保障最广大人民群众的用药安全。     

医学营养联合运动训练干预妊娠期糖尿病患者对妊娠结局的影响

目的探讨医学营养联合运动训练干预妊娠期糖尿病患者对妊娠结局的影响。方法 100例妊娠期糖尿病患者,随机分为实验组和对照组,每组50例。实验组患者给予医学营养联合运动训练进行干预,对照组患者给予常规方法进行干预。对比两组患者干预前后空腹血糖(FPG)、口服葡萄糖耐量试验(OGTT)1 h血糖、2 h血糖、空腹胰岛素(FINS)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)水平及不良妊娠结局发生情况。结果干预后,实验组患者FPG、OGTT 1 h血糖水平以及OGTT 2 h血糖水平分别为(4.33±0.48)、(8.86±0.62)、(7.16±0.62)mmol/L,均显著低于对照组的(5.01±0.61)、(9.27±0.79)、(8.12±0.58)mmol/L,差异具有统计学意义(P<0.05)。干预后,实验组FINS、HOMA-IR水平低于对照组, HOMA-β水平高于对照组,差异具有统计学意义(P<0.05)。实验组患者不良妊娠结局发生率为6.00%(3/50),显著低于对照组的36.00%(18/50),差异具有统计学意义(P<0.05)。结论针对妊娠期糖尿病患者,通过给予医学营养联合运动训练干预可以显著改善患者胰岛素分泌情况以及血糖水平,对于降低不良妊娠结局发生率、确保母婴安全意义重大。