印度城市人群代谢综合征的患病率

Objectives: To determine prevalence of themetabolic syndrome using United Stat es Adult Treatment Panel-3 (ATP-3) guidelines in an urban Indian population. M ethods: Randomly selected adults >20 years were studied using stratified samplin g. Target study sample was 1800 with population proportionate distribution (men 960, women 840). Evaluati on of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Subjects(1123; response 62.4%) were examined, fasting blood sam ples were available in 1091(532 men, 559 women) and analysed for prevalence of m etabolic syndrome. Atherosclerosis risk factors were determined using the curren t guidelines. Metabolic syndrome was diagnosed when any three of the following w ere present: central obesity, raised triglycerides ≥150 mg/dl (≥1.7 mmol/l), l ow high density lipoprotein (HDL) cholesterol, blood pressure ≥130/≥85mm Hg, and diabetes or fasting glucose >110 mg/dl (>6.1 mmol/l). Intergroup comparisons were performed using t test or chi square test. Results: Metabolic syndrome w as present in 345 (31.6%) subjects; prevalencewas 122 (22.9%) in men and 223 ( 39.9%) in women(p< 0.001); the age adjusted prevalence was 24.9%, 18.4%in me n and 30.9%in women. There was a significant age related increase in its preva lence(Mantel Haenzel χ2 for trend p< 0.05). Prevalence of components of metabo lic syndrome in men and women was: central obesity (waist, men>102 cm, women>88 cm) in 116 (25.6%) and 246 (44.0%); low HDL cholesterol(men<40 mg/dl,<1.0 mmol /l), women< 50 mg/dl,<1.3 mmol/l) in 292 (54.9%) and 504(90.2%); high triglyce rides ≥150 mg/dl(≥1.7 mmol/l) in 172 (32.3%) and 160 (28.6%); and impaired f asting glucose or diabetes in 90(16.9%) and 90 (16.1%). The prevalence of phys ical inactivity, hypertension, hypercholesterolemia(≥200 mg/dl, ≥5.2 mmol/l) a nd high LDL cholesterol (≥130 mg/dl, ≥3.4 mmol/l) was greater in the metabolic syndrome group in both men and women (p< 0.05). Conclusions: There is a high pr evalence of metabolic syndrome in an urban Indian population. Focus of cardiovas cular prevention should be at this high risk group.

内镜下静脉曲张结扎术与普萘洛尔联用长效异乐定或纳多洛尔预防静脉曲张再次出血的评价:肝硬化与非肝硬化患者的比较

Both EVL and drug therapy are effective in the prevention of variceal rebleeding. Comparisons between the two modalities are few, and only in cirrhotics. This prospective randomized controlled trial compared EVL with drug therapy (propranolol + ISMN) in the prevention of rebleeds from esophageal varices in cirrhotic and noncirrhotic portal hypertension (NCPH) patients. One hundred thirty- seven variceal bleeders were randomized to EVL (Group I; n = 71) or drug therapy (Group II; n = 66). In Group I, EVL was done every 2 weeks till obliteration of varices. In Group II, propranolol (dose sufficient to reduce heart rate to 55 bpm/maximum tolerated dose) and ISMN (incremental dose up to 20 mg BD) were administered. Group I and II patients had comparable baseline characteristics, follow- up (12.4 vs. 11.1 months), cirrhotics and noncirrhotics 50(70.4% ) and 21(29.6% ) vs. 51(77.3% ) and 15(22.7% ) and frequency of Child s A (35 vs. 27), B (26 vs. 28), and C (9 vs. 11). The mean daily dose was 109 ± 46 mg propranolol and 34 ± 11 mg ISMN and was comparable in cirrhotic and NCPH patients. Upper GI bleeds occurred in 10 patients in Group I (5 from esophageal varices) and in 18 patients in Group II (15 from esophageal varices) (P = 0.06). The actuarial probability of rebleeding from esophageal varices at 24 months was 22% in Group I and 37% in Group II (P = 0.02). The probability of bleed was significantly higher in Child s C compared to Child s A/B cirrhotics (P = 0.02). On subgroup analysis, in NCPH patients, the actuarial probability of bleed at 24 months was significantly lower in Group I compared to Group II (25% vs 37% ; P = 0.01). In cirrhotics, there was no difference in the probability of rebleeding between patients in Group I and those in Group II (P = 0.74). In Group II, 25.7% patients had adverse effects of drug therapy and 9% patients had to stop propranolol due to serious adverse effects, none required stopping ISMN. There were 10 deaths, 6 in Group I (bleed related, 1) and 4 in Group II (bleed related, 1); the actuarial probability of survival was comparable (P = 0.39). EVL and combination therapy are equally effective in the prevention of variceal rebleeding in cirrhotic patients. EVL is more effective than drug therapy in the prevention of rebleeds in patients with NCPH and, hence, recommended. However, in view of the small number of NCPH patients, further studies are needed before this can be stated conclusively.

急性卒中时对颈内动脉阻塞的脑外部分采用急诊支架术时的血管再通率较高

Background and Purpose -Acute ischemic stroke attributable to extracranial internal carotid artery (ICA) occlusion is frequently associated with severe disability or death. In selected cases, revascularization with carotid artery stenting has been reported, but the safety, recanalization rate, and clinical outcomes in consecutive case series are not known. Methods -We retrospectively reviewed all of the cases of ICA occlusions that underwent cerebral angiography with the intent to revascularize over a 38-month period. Two groups were identified: (1) patients who presented with an acute clinical presentation within 6 hours of symptom onset (n=15); and (2) patients who presented subacutely with neurologic fluctuations because of the ICA occlusion (n=10). Results -Twenty-five patients with a mean age of 62±11 years and median National Institutes of Health Stroke Scale (NIHSS) of 14 were identified. Twenty-three of the 25 patients (92%) were successfully revascularized with carotid artery stenting. Patients in group 1 were younger and more likely to have a tandem occlusion and higher baseline NIHSS when compared with group 2. Patients in group 2 were more likely to show early clinical improvement defined as a reduction of their NIHSS by ≥4 points and a modified Rankin Score of ≤2 at 30-day follow-up. Two clinically insignificant adverse events were noted: 1 asymptomatic hemorrhage and 1 nonflow-limiting dissection. Conclusions -Endovascular treatment of acute ICA occlusion appears to have a high-recanalization rate and be relatively safe in our cohort of patien ts with acute ICA occlusion. Future prospective studies are necessary to determi ne which patients are most likely to benefit from this form of therapy.

维替泊芬光动力学疗法治疗体外照射放疗后持续性中心凹下脉络膜新生血管1年研究结果

PURPOSE: To determine the safety and efficacy of verteporfin photodynamic ther apy (PDT) for the treatment of persistent choroidal neovascularization (CNV) pre viously treated with external beam radiotherapy (EBRT). DESIGN: Retrospective ca se series. METHODS: Verteporfin PDT was performed on 14 eyes of 13 patients with symptomatic leakage from CNV previously treated by EBRT. Principal outcome measures were: comparison of visual acuity at 12 months post -PDT with baseline and the recording of any ocular or systemic adverse events. RESULTS: At baseline, the mean logMAR (±SD) VA was 0.81 ±0.33, whereas at the 12-month point it was 0.89 ±0.43 (P=.326). At the 12-month examination 10 eye s had lost less than 3 lines of VA, and 8 eyes had lost less than 1.5 lines. Dur ing this time, there were 2.1 PDT treatment sessions per eye on average (range=1 to 4). There were no ocular or systemic adverse events recorded. CONCLUSIONS: T his short-term study shows that verteporfin PDT is safe after EBRT and may be o f benefit for recalcitrant CNV.

稳定性冠心病患者中N末端脑利钠肽前体与死亡率、心血管事件的关系

背景：识别心血管事件高危个体对于一级和二级预防的优化利用十分重要。目的：研究血浆N末端脑利钠肽前体（NT-proBNP）水平能否独立预测心血管事件或死亡。设计、地点和参与者：该前瞻性队列研究（2000-2002年）纳入加利福尼亚州参与心脏与精神研究的稳定性冠心病患者987例，随访3．7（极差0．1～5．3）年。主要观察指标：基线NT-proBNP水平与死亡和心血管事件（心肌梗死、卒中或心力衰竭）的关系。校正传统临床危险因素、超声心动图指标、缺血、其他生化指标及NYHA心功能分级，以确定NT-proBNP是否具有独立于其它预后因素的预测价值。采用受试者操作特征（ROC）曲线评价NT-proBNP联合其他预后指标的增加预测价值。