Statin use and cognitive function in middle-aged adults with type 1 diabetes

AIM To test associations between statin use and cognitive impairment in adults with childhood-onset type 1 diabetes(T1D).METHODS In 2010-13, n = 108 middle-aged participants from ongoing observational Pittsburgh Epidemiology of Diabetes Complications Study underwent neurocognitive assessment(mean age and T1 D duration of 49 and 41 years, respectively). All were diagnosed with childhoodonset(i.e., prior to age 18) T1 D between 1950 and 1980 and were seen within one year of diagnosis at Children's Hospital of Pittsburgh. Self-reported statin use(yes/no and if yes, name of statin) was collected biennially from parent study baseline(1986-1988) to time of neurocognitive testing. Logistic regression models tested associations between statin use groups and cognitive impairment(defined as having two or more cognitive test scores 1.5SD or worse than published norms) while linear regression models tested associations between statin use groups and cognitive domain z-scores(domains: Verbal IQ, memory, executive function, psychomotor speed, and visuo-construction). All models controlled for education and age. To address confounding by indication, models were repeated using a propensity score for statin use.RESULTS Of the 108 participants, 51 reported never using statins. Median duration of statin use among the 57 ever users was 6 years. These 57 ever statin users were split to create two groups(≤ or > median years of statin use): 1-6 years(n = 25), and 7-12 years(n = 32). Compared with never users, using statins 1-6 years tripled the odds of cognitive impairment(OR = 3.16; 95%CI: 0.93-10.72; P = 0.06) and using statins 7-12 years almost quintupled the odds of cognitive impairment(OR = 4.84; 95%CI: 1.63-14.44; P = 0.005). Compared with never users, using statins 1-6 or 7-12 years was related to worse performance in the memory domain(β =-0.52; P = 0.003, and-0.39; P = 0.014, respectively). Adjusting for coronary artery disease, low density lipoprotein cholesterol, and Apo E4 status did not substantially alter results, and none of these covariates were significantly related to cognitive outcomes(all P > 0.05). Propensity score analyses support that associations between poor cognitive outcomes and statin use were not due merely to confounding by indication. CONCLUSION Statin use was associated with cognitive impairment, particularly affecting memory, in these middle-aged adults with childhood-onset T1 D, whom at this age, should not yet manifest age-related memory deficits.

肝上腔静脉成形术联合肝后腔静脉扩展术在肝移植中的应用:首次115例经验报道

目的：本文介绍原位肝移植中腔静脉成形术的方法并评估其结果。方法：１９９４年１１月至２０００年９月，我们对连续１１５例原位肝移植（包括６例左外侧叶及２例右叶移植）病人采用了腔静脉成形术。 在起初的４年里，５３例（６６．３％）移植病人需行股－腋静脉体外转流，而以后的２年内该比例降至８例（２２．９％）。无一例病人需中转为背驮式或经典术式。结果：中位手术时间４．５ｈ，中位热缺血时间２５ｍｉｎ，中位输血量６Ｕ浓缩红细胞。上述结果在首次移植及再次移植间无差异。本组无与腔静脉成形技术相关的围手术期死亡。包括活体原位肝移植在内，均未观察到肝静脉流出道梗阻。没有病人因急性肾功能衰竭而需术后血透。病人留置于ＩＣＵ的中位天数２ｄ，中位住院天数为１０ｄ。结论：腔静脉成形术无需解剖肝后腔静脉、肝静脉或肝短静脉，肝下腔静脉也得以保留，并因此更有利于肝切除及维持稳定的血流动力学，在再次移植中优势更为明显。大开口的三角形腔静脉吻合容易操作，能在较短时间内完成供肝植入，且易与吻合血管口径的匹配，并可避免流出道阻塞。操作时间的缩短减少了静脉体外转流的可能。我们认为腔静脉成形技术能适用于所有病人，且相应手术的并发症少。