Brain natriuretic peptide and HIV-related cardiomyopathy

The brain natriuretic peptide (BNP) assay is a new, relatively inexpensive, and simple test that has the potential to be an early, cost-effective, and reliable marker for HIV-related cardiomyopathy. We report 1 case of HIV-related cardiomyopathy and 10 cases of of HIV infection with unknown heart disease in which we measured BNP levels and performed echocardiography. We found a significant inverse relationship between BNP and left ventricular function in these patients. Further basic and epidemiologic research on BNP measurement for the detection of HIV-related cardiomyopathy is needed to support these findings, which if confirmed, could have important clinical and public health implications.     

1例罕见桡侧腕伸肌变异与文献复习

作者于2004年在指导学生对一具90岁男性尸体标本进行解剖时,见其左前臂桡侧腕伸肌区存在有桡侧腕伸副肌(extensor carpi radialis accessorius,ECRA)合并桡侧腕长、短伸肌之间出现两条副肌腱并相互交叉连接的一种罕见的复合变异。     

The cause and incidence of secondary insults in severely head-injured adults and children

The cause and incidence of reductions in cerebral perfusion pressure, and rises in intracranial pressure have been examined in a series of patients with severe head injury defined as an initial Glasgow Coma Sum of less than or equal to 8. Two-hundred-and-seven adults (aged over 16 years) and 84 children admitted to Newcastle General Hospital, who had intracranial pressure monitoring as part of their routine management, were studied. Intracranial pressure (ICP), arterial pressure and cerebral perfusion pressure (CPP) were sampled and recorded every 2 min. Patients' CT findings were classified into distinct groups using the method described by Marshall. Secondary insults were defined using the Edinburgh University Secondary Insult Grades (EUSIG) and the incidence and cause (raised ICP, reduced CPP or a combination of the two) was established. Outcome was assessed at 6 months using the Glasgow Outcome Scale. In the majority of adults with head injury it is the combination of reduced arterial pressure and raised ICP that contributes to the reduction in cerebral perfusion pressure. This was not the case for Diffuse Injury Type I. In children similar characteristics were found across each of the CT classifications. The vast majority of falls in CPP down to 60 mmHg were caused by reduced arterial pressure. Reductions below 50 mmHg were almost always due to a combination of both reduced arterial pressure and raised ICP. The results in adults were similar, but not identical, to those of the paediatric cases. Diffuse Injury Type I stood out from all the other categories as the only one where reductions in perfusion pressure were almost exclusively due to reductions in arterial pressure and not to increases in ICP. The management of these patients should ensure the adequacy of perfusion pressure by maintaining arterial pressure at a satisfactory level. These results suggest that vigilant monitoring of both intracranial pressure and arterial pressure is required to lower the incidence of secondary insults.     

Effect of cigarette smoke on autoimmunity in murine and human systemic lupus erythematosus.

Several studies have found that smoking cigarettes is a risk factor for systemic lupus erythematosus (SLE). To examine this issue in a mouse model, we subjected pre-autoimmune MRL-lpr/lpr mice for 4 weeks to cigarette smoke to provide standardized smoke effluents equivalent to moderate or to heavy smoking habits for people. The spontaneous production of IgG anti-chromatin but not IgM anti-chromatin, anti-denatured DNA, or rheumatoid factor antibodies was lower in mice exposed to 250 mg/m3 particulates from mainstream smoke, and this suppression of autoimmunity was sustained for 8 weeks (p < 0.02). In contrast to control mice anti-chromatin activity in smoke-exposed mice began to increase in 16-week-old mice, reaching levels at 6 months that were two- to three-fold higher than controls for IgG (p < 0.03) and 10-fold higher for IgM (p < 0.001). There was no significant effect on total IgG or IgM. In newly diagnosed SLE patients, smoking was negatively correlated with IgG anti-DNA antibodies (p < 0.03). However, of nine patients who discontinued smoking prior to diagnosis, eight had elevated IgG anti-DNA compared to 29/79 never smokers and 9/31 smokers (p < 0.01 compared to former smokers). Inhaled cigarette smoke appears to have a long-lasting immunosuppressive effect on T-cell-dependent autoimmune responses, although autoantibodies increase to supra-elevated levels after the suppressive effect has abated.     

Health Profile Preferences of Hepatitis C Patients

The side effects of interferon- for chronic hepatitis C are well-known. Patients may differ with respect to their tolerance of these side effects and also with respect to their individual preferences. We administered a brief questionnaire to 67 outpatients with hepatitis C virus infection. Patients were asked to make hypothetical choices between six-month profiles of health. The results were as follows: (1) patients preferred to expedite rather than postpone intervals of poor health; (2) preferences of patients with low quality-of-life were quite similar to preferences of healthier patients; (3) patients' choices satisfied transitivity; (4) patients' choices satisfied preferential independence; and (5) patients gave a variety of reasons for their choices. These results corroborate other investigations of health preferences, and serve to introduce the field of preference elicitation to gastroenterologists.