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1.
Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease
Abhinav Sharma Adrian Coles Nishant K. Sekaran Neha J. Pagidipati Michael T. Lu Daniel B. Mark Kerry L. Lee Hussein R. Al-Khalidi Udo Hoffmann Pamela S. Douglas 《Journal of the American College of Cardiology》2019,73(8):893-902
Background
The optimal noninvasive test (NIT) for patients with diabetes and stable symptoms of coronary artery disease (CAD) is unknown.Objectives
The purpose of this study was to assess whether a diagnostic strategy based on coronary computed tomographic angiography (CTA) is superior to functional stress testing in reducing adverse cardiovascular (CV) outcomes (CV death or myocardial infarction [MI]) among symptomatic patients with diabetes.Methods
PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) was a randomized trial evaluating an initial strategy of CTA versus functional testing in stable outpatients with symptoms suggestive of CAD. The study compared CV outcomes in patients with diabetes (n = 1,908 [21%]) and without diabetes (n = 7,058 [79%]) based on their randomization to CTA or functional testing.Results
Patients with diabetes (vs. without) were similar in age (median 61 years vs. 60 years) and sex (female 54% vs. 52%) but had a greater burden of CV comorbidities. Patients with diabetes who underwent CTA had a lower risk of CV death/MI compared with functional stress testing (CTA: 1.1% [10 of 936] vs. stress testing: 2.6% [25 of 972]; adjusted hazard ratio: 0.38; 95% confidence interval: 0.18 to 0.79; p = 0.01). There was no significant difference in nondiabetic patients (CTA: 1.4% [50 of 3,564] vs. stress testing: 1.3% [45 of 3,494]; adjusted hazard ratio: 1.03; 95% confidence interval: 0.69 to 1.54; p = 0.887; interaction term for diabetes p value = 0.02).Conclusions
In diabetic patients presenting with stable chest pain, a CTA strategy resulted in fewer adverse CV outcomes than a functional testing strategy. CTA may be considered as the initial diagnostic strategy in this subgroup. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550) 相似文献2.
26例胰岛细胞肿瘤的临床诊治 总被引:1,自引:0,他引:1
目的:探讨功能性与无功能性胰岛细胞肿瘤术前定位方法、术中决策及预后。方法:对1989-2000年12年间收治的26例胰岛细胞肿瘤进行回顾性分析。结果:全组26例,功能组20例,无功能者6例;男性9例(34.6%),女性17例(65.4%),年龄范围:15-72岁;术前23例明确诊断,3例为术后病理诊断证实。功能组B超定位准确率55.0%,CT44.5%,MRI60.0%,血管造影(DSA)71.0%;无功能组B超定位准确率100%,CT100%,MRI66.7%。结论:胰岛细胞肿瘤定位:无功能组较功能组诊断阳性率高,肿瘤体积大,经各种检查仍不能定位时,可根据临床表现实行开腹探查;首选胰岛细胞瘤摘除术,必要时可行胰十二指肠切除或胰体尾切除;对无法彻底切除的恶性胰岛细胞肿瘤,应尽量切除原发和转移病灶。无功能组较功能组治愈率低,生存期较短,预后较差。 相似文献
3.
Expression ofnit-3 andnit-6, the structural genes which encode nitrate reductase and nitrite reductase inNeurospora crassa, requires the global-acting NIT2 and the pathway specific NIT4 regulatory proteins. NIT4, which consists of 1090 amino-acid
residues, possesses a Cys6/Zn2 zinc cluster DNA-binding-domain. NIT4 was dissected to localize transactivation domains by fusion of various segments of
NIT4 to the DNA-binding domain of GAL4 for in vivo analysis in yeast. Three separate activation subdomains, and one negative-acting
region, which function in yeast were located in the carboxyl-terminal region of NIT4. The C-terminal tail of 28 amino-acid
residues was identified as a minimal activation domain and consists of a novel leucine-rich, acidic region. Most deletions
which removed even small segments of the NIT4 protein were found to lead to the loss of NIT4 function in vivo inN. crassa, implying that the central region of the protein which lies between the DNA-binding and activation domains is essential for
function. The yeast two-hybrid system was employed to identify regions of NIT4 responsible for dimer formation. A short isoleucine-rich
segment downstream from the zinc cluster, predicted to form a coiled coil, allowed dimerization in vivo; this same isoleucine-rich
region also showed dimerization in vitro when examined via chemical cross linking. The enzyme nitrate reductase has been postulated
to exert autogenous regulation by directly interacting with the NIT4 protein. This possible nitrate reductase-NIT4 interaction
was investigated with the yeast two-hybrid system and by direct in vitro binding assays; both assays failed to identify such
a protein-protein interaction. 相似文献
4.
目的 分析尿白细胞酯酶(LEU)、亚硝酸盐(NIT)、肝素结合蛋白(HBP)及细菌(BACT)计数检测诊断尿路感染的临床价值。方法 选择2019年6月—2020年6月期间本院收治的疑似尿路感染患者168例,所有入选者均检测LEU、NIT、HBP、BACT四项指标。以尿培养为金标准,对比LEU、NIT、HBP、BACT四项指标单独及联合诊断价值。结果 168例疑似患者经尿培养发现59例为尿路感染,占35.12%,其中以革兰阴性杆菌最为常见;各指标联合诊断的阳性检出率均高于各项指标单独检测,差异有统计学意义(P<0.05);绘制ROC曲线结果显示,血清LEU、NIT、HBP、BACT及联合诊断用于诊断尿路感染的曲线下面积分别为:0.679、0.711、0.861、0.728、0.974,各指标联合检测诊断性能最高。结论 尿路感染诊断检测LEU、NIT、HBP、BACT方便快捷,能够及时为临床诊断提供参考,各指标单独检测虽有一定价值,但联合检测诊断价值更高。 相似文献
5.
NIT2, the major nitrogen regulatory protein of Neurospora crassa mediates nitrogen catabolite derepression of the structural genes which specify enzymes of nitrogen catabolism. The promoter of the structural gene for L-amino acid oxidase, a nitrogen-regulated enzyme, was found to contain two NIT2 binding sites, each with two copies of a GATA core consensus sequence. Site-directed mutagenesis was employed to create amino-acid substitutions within the single zinc-finger region of NIT2, which serves as the DNA-binding domain. The affect of those mutations upon NIT2 function in vivo in the activation of three separate structural genes was examined by transformation assays and relevant enzyme activities, and DNA-binding activity in vitro was determined by gel band mobility-shift assays. It was shown that specific amino-acid residues within the zinc-finger loop region of NIT2 are important for DNA-binding activity, whereas other residues influence the specificity of DNA binding. Mutant NIT2 proteins were obtained which retain DNA-binding activity and alter the specificity of DNA recognition, thus allowing a distinction between related DNA elements. 相似文献
6.
AIM: To compare the percentage of filled canal area in mandibular molar roots after using conventional root-canal hand instrumentation or after a noninstrumentation technique (NIT). METHODOLOGY: Forty mandibular molars were used shortly after extraction. The root canals of 20 molars in the manual group were conventionally prepared using hand instruments and then filled with warm vertical compaction of gutta-percha. The 20 teeth in the second group were cleaned and obturated by NIT. In each case, the entire molar, including the crown and the roots, was embedded in an acrylic resin cylinder before NIT. Horizontal sections were cut at 2, 4, 6 and 8 mm from the apex. Images of the sections were taken using a microscope at x40 magnification and a digital camera; the images were scanned as Tagged Image File Format (TIFF) images into a PC. The cross-sectional area of the canal with the filling materials was measured using an image analysis programme. The percentage of filled area was calculated. The difference in the percentage of filled canal area between the two groups was analysed using a Student's t-test. RESULTS: At all levels, 93-100% of the canal area was filled in both groups. No significant difference was found between the manual technique and the NIT technique at any level (P>0.05). CONCLUSIONS: Within the limitations of this study, following the cleaning and filling of root canals using NIT, the percentage of filled root canal was similar to that using warm vertical compaction of gutta-percha after conventional root-canal instrumentation. 相似文献
7.
To investigate the potential carcinogenicity of cyadox, an antimicrobial agent, four groups of Sprague-Dawley rats (50 rats/sex/group) were fed diets containing cyadox (0, 200, 600 or 2000 mg/kg) for up to two years. There were significant decreases in body weight, feed intake and feed efficiency in both genders during most of the period in the 2000 mg/kg group. Significant decreases in serum ALT were observed in the 2000 mg/kg group at weeks 52, 78 and 104. For the control, 200, 600, and 2000 mg/kg groups, the tumor incidence in females was 33.3%, 37.2%, 40.0% and 19.0%, while it in males it was 18.9%, 2.6%, 17.1% and 13.6%, respectively. At histopathology, no increases in tumor incidence were attributed to treatment with cyadox. The mild swelling and fatty degeneration in hepatocytes, and mild swelling and tubular necrosis in the kidney were observed in 2000 mg/kg group. The no-observed-effect-level (NOEL) for carcinogenicity of cyadox fed to rats was 2000 mg/kg diet (132.18–156.28 mg/kg b.w./day). In conclusion, cyadox was not carcinogenic to rats with the liver and kidney as the target organs, and the side chain may be involved in toxicity and carcinogenicity mediated by QdNOs. 相似文献
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Benzodiazepines have wide-spread used in pharmacotherapy for their anxiolytic, myorelaxant, hypnotic, amnesic and anticonvulsive properties. Despite benzodiazepines are used in clinics over 50 years, they have not been surprisingly tested for capability to induce major drug-metabolizing cytochromes P450. In the current study, we have examined the potency of Alprazolam, Bromazepam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam, Medazepam, Midazolam, Nitrazepam, Oxazepam, Tetrazepam and Triazolam to induce CYP1A2 and CYP3A4 in primary cultures of human hepatocytes. Benzodiazepines were tested in therapeutic concentrations and in concentrations corresponding to their plasma levels in intoxicated patients. We found weak but significant induction of CYP3A4 mRNA by Midazolam and Medazepam, while other benzodiazepines did not induce CYP3A4 expression. None of the tested compounds induced CYP1A2 mRNA in three independent human hepatocytes cultures. In addition, employing gene reporter assays with transiently transfected hepatocarcinoma cells, we found that tested benzodiazepines did not activate aryl hydrocarbon receptor (AhR), whereas Midazolam and Medazepam slightly activated pregnane X receptor (PXR). Consistently, two-hybrid mammalian assay using hybrid fusion plasmids GAL4-PXR ligand-binding domain (LBD) and VP16-SRC-1-receptor-interacting domain (RID) confirmed PXR activation by Midazolam and Medazepam. In conclusion, Alprazolam, Bromazepam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam, Nitrazepam, Oxazepam, Tetrazepam and Triazolam can be considered as safe drugs in term of their inability to induce PXR- and AhR-dependent cytochrome P450 enzymes CYP1A2 and CYP3A4. Medazepam and Midazolam slightly activated pregnane X receptor and displayed weak potency to induce CYP3A4 mRNA in human hepatocytes. 相似文献