Objective. Ghrelin is a brain-gut peptide that is mainly secreted from gastric endocrine cells (X/A like cells). In addition to promoting growth-hormone release and appetite, ghrelin also affects gastric motility and ...Objective. Ghrelin is a brain-gut peptide that is mainly secreted from gastric endocrine cells (X/A like cells). In addition to promoting growth-hormone release and appetite, ghrelin also affects gastric motility and secretion. Circulating ghrelin levels are related to appetite and energy balance. Functional dyspepsia (FD) is a disorder characterized by the presence of chronic or recurrent symptoms of upper abdominal pain or discomfort. Although no known specific organic abnormalities are present in FD, abnormalities in gastrointestinal motility and sensitivity are thought to play a role in a substantial subgroup of patients. In addition, some patients also suffer from anorexia and body-weight loss. To investigate the role of ghrelin in the pathophysiology of FD, circulating ghrelin levels in affected patients were measured. Material and methods. Eighteen Japanese female patients with functional dyspepsia and 18 healthy volunteers were recruited for the study. Acylated and desacyl forms of ghrelin were measured using commercially available enzyme-linked immunosorbent assay kits. Results. Although plasma levels of acylated or desacyl ghrelin were not significantly different between healthy subjects and FDpatients, plasma acylated, but not desacyl ghrelin, levels were correlated with a subjective symptom score in FD patients. In addition, the ratio of acylated to desacyl ghrelin (A/D ratio) was correlated strongly with acylated, but not desacyl, ghrelin levels. Conclusions. The correlation of circulating acylated ghrelin levels with the subjective symptom score and the A/D ratio in FD patients suggest that acylated ghrelin may play a role in the pathophysiology of FD.展开更多
Background and Purpose -Perioperative risk and long-term benefit of carot id endarterectomy (CE) are not detailed in women with symptomatic internal carot id artery (ICA) stenosis. Our aim was to compare the efficacy ...Background and Purpose -Perioperative risk and long-term benefit of carot id endarterectomy (CE) are not detailed in women with symptomatic internal carot id artery (ICA) stenosis. Our aim was to compare the efficacy of CE versus medic al therapy in women and men with symptomatic ICA stenosis. Methods -Data were taken from the North Amercan Symptomatic Carotid Endarterectomy Trial (873 wome n, 2012 men) and the ASA and Carotid Endarterectomy trial (335 women, 813 men). Results -The 30-day perioperative risk of death was higher in women than in men (2.3% versus 0.8% , P=0.002). Higher perioperative risk of stroke and dea th was also observed (7.6% versus 5.9% ) but not statistically significant. W ith ≥ 70% stenosis, the 5-year absolute risk reduction (ARR)-in stroke fr om CE was similar between women (15.1% ) and men (17.3% ). With 50% to 69% stenosis, CE was not beneficial in women (ARR=3.0% , P=0.94), contrary to men (ARR=10.0% , P=0.02). Medically treated women had low risk for stroke. A stroke prognosis instrument (SPI-II) assigned points to 7 factors that identified hi gher risk for medically treated women: 3 points for hemispheric (not retinal) ev ent, history of diabetes, previous stroke; 2 for age older than 70 years, stroke (not transient ischemic attack); 1 for severe hypertension, history of myocardi al infarction. CE was beneficial only for 29.0% of women with 50% to 69% s tenosis who had the highest total score of 8 to 15 (ARR=8.9% ). Conclusions - Women and men with ≥ 70% symptomatic stenosis had similar long-term benefit from CE,although the perioperative risks were higher for women. CE was not bene ficial for women with 50% to 69% stenosis without other risk factors for str oke.展开更多
In clinical trials β-blockers(BB) are well tolerated in patients with systolic congestive heart failure(CHF). In contrast, in daily practice treatment initiation and titration appear to be more difficult and may diff...In clinical trials β-blockers(BB) are well tolerated in patients with systolic congestive heart failure(CHF). In contrast, in daily practice treatment initiation and titration appear to be more difficult and may differ in various BB-but systematic data are lacking. We randomized 87 patients with systolic CHF(mean age 70.1±10.6 years, 24%females, LVEF 0.28±0.10, NYHA Ⅲ-Ⅳ29%) to treatment with either bisoprolol or carvedilol, in order to assess and compare the maximally achievable number of patients on treatment with these BB and the maximally achieved dosage during a minimum of 2 months attendance at our out patient heart failure clinic. In those randomized to bisoprolol,mean dose at 2 months was 33%of target dose (3.1±2.6 mg ) and 41%at discharge. In those on carvedilol, the mean dose at 2 months was 27%of target dose(13.4±14.0 mg) and 32%at discharge. Thirty-nine and 40%of the bisoprolol and carvedilol treated patients, respectively, had stopped treatment at discharge. None of the figures differed significantly between the two treatment groups and no baseline parameter predicted BB tolerability. Thus, almost twice the number of unselected patients with systolic CHF attending a heart failure clinic focusing on systematic medical titration were intolerant to BB treatment and only a minority reached target dose treatment. The present data reveal no clear difference with respect to tolerability of carvedilol and bisoprolol, and no parameter predicts tolerability.展开更多
文摘Objective. Ghrelin is a brain-gut peptide that is mainly secreted from gastric endocrine cells (X/A like cells). In addition to promoting growth-hormone release and appetite, ghrelin also affects gastric motility and secretion. Circulating ghrelin levels are related to appetite and energy balance. Functional dyspepsia (FD) is a disorder characterized by the presence of chronic or recurrent symptoms of upper abdominal pain or discomfort. Although no known specific organic abnormalities are present in FD, abnormalities in gastrointestinal motility and sensitivity are thought to play a role in a substantial subgroup of patients. In addition, some patients also suffer from anorexia and body-weight loss. To investigate the role of ghrelin in the pathophysiology of FD, circulating ghrelin levels in affected patients were measured. Material and methods. Eighteen Japanese female patients with functional dyspepsia and 18 healthy volunteers were recruited for the study. Acylated and desacyl forms of ghrelin were measured using commercially available enzyme-linked immunosorbent assay kits. Results. Although plasma levels of acylated or desacyl ghrelin were not significantly different between healthy subjects and FDpatients, plasma acylated, but not desacyl ghrelin, levels were correlated with a subjective symptom score in FD patients. In addition, the ratio of acylated to desacyl ghrelin (A/D ratio) was correlated strongly with acylated, but not desacyl, ghrelin levels. Conclusions. The correlation of circulating acylated ghrelin levels with the subjective symptom score and the A/D ratio in FD patients suggest that acylated ghrelin may play a role in the pathophysiology of FD.
文摘Background and Purpose -Perioperative risk and long-term benefit of carot id endarterectomy (CE) are not detailed in women with symptomatic internal carot id artery (ICA) stenosis. Our aim was to compare the efficacy of CE versus medic al therapy in women and men with symptomatic ICA stenosis. Methods -Data were taken from the North Amercan Symptomatic Carotid Endarterectomy Trial (873 wome n, 2012 men) and the ASA and Carotid Endarterectomy trial (335 women, 813 men). Results -The 30-day perioperative risk of death was higher in women than in men (2.3% versus 0.8% , P=0.002). Higher perioperative risk of stroke and dea th was also observed (7.6% versus 5.9% ) but not statistically significant. W ith ≥ 70% stenosis, the 5-year absolute risk reduction (ARR)-in stroke fr om CE was similar between women (15.1% ) and men (17.3% ). With 50% to 69% stenosis, CE was not beneficial in women (ARR=3.0% , P=0.94), contrary to men (ARR=10.0% , P=0.02). Medically treated women had low risk for stroke. A stroke prognosis instrument (SPI-II) assigned points to 7 factors that identified hi gher risk for medically treated women: 3 points for hemispheric (not retinal) ev ent, history of diabetes, previous stroke; 2 for age older than 70 years, stroke (not transient ischemic attack); 1 for severe hypertension, history of myocardi al infarction. CE was beneficial only for 29.0% of women with 50% to 69% s tenosis who had the highest total score of 8 to 15 (ARR=8.9% ). Conclusions - Women and men with ≥ 70% symptomatic stenosis had similar long-term benefit from CE,although the perioperative risks were higher for women. CE was not bene ficial for women with 50% to 69% stenosis without other risk factors for str oke.
文摘In clinical trials β-blockers(BB) are well tolerated in patients with systolic congestive heart failure(CHF). In contrast, in daily practice treatment initiation and titration appear to be more difficult and may differ in various BB-but systematic data are lacking. We randomized 87 patients with systolic CHF(mean age 70.1±10.6 years, 24%females, LVEF 0.28±0.10, NYHA Ⅲ-Ⅳ29%) to treatment with either bisoprolol or carvedilol, in order to assess and compare the maximally achievable number of patients on treatment with these BB and the maximally achieved dosage during a minimum of 2 months attendance at our out patient heart failure clinic. In those randomized to bisoprolol,mean dose at 2 months was 33%of target dose (3.1±2.6 mg ) and 41%at discharge. In those on carvedilol, the mean dose at 2 months was 27%of target dose(13.4±14.0 mg) and 32%at discharge. Thirty-nine and 40%of the bisoprolol and carvedilol treated patients, respectively, had stopped treatment at discharge. None of the figures differed significantly between the two treatment groups and no baseline parameter predicted BB tolerability. Thus, almost twice the number of unselected patients with systolic CHF attending a heart failure clinic focusing on systematic medical titration were intolerant to BB treatment and only a minority reached target dose treatment. The present data reveal no clear difference with respect to tolerability of carvedilol and bisoprolol, and no parameter predicts tolerability.
