冠状循环中产生的白介素-6对C-反应蛋白生成和冠状微血管阻力的影响

We measured plasma levels of interleukin-6 and C-reactive protein at the orifice of the left coronary artery and at the great cardiac vein in patients who had coronary artery disease and those who had angiographically normal coronary arteries(controls). We also measured coronary microvascular resistance in the control group. We found increased levels of interleukin-6 in the coronary circulation of patients who had coronary artery disease compared with controls. This increase correlated with C-reactive protein production in the coronary circulation and coronary microvascular resistance. These findings suggest that a localized cytokine/inflammatory pathway functions in the coronary circulation and that interleukin-6 is involved in modulating coronary vascular tone.

胃食管反流病相关的呼吸系统症状和疾病的患病率

Aim: Investigation of the prevalence of respiratory symptoms and diseases associated with gastroesophageal reflux disease (GERD). Patients and Methods: 299 subjects with GERD were submitted to upper gastrointestinal endoscopy and 24-hour esophageal pH monitoring and a symptom analysis. Results: Chronic respiratory symptoms or diseases were present in 18%(56/299). Chronic cough was observed in 42/56 patients, while typical reflux symptoms such as heartburn and acid regurgitation were observed in 30/56 and 24/56 cases, respectively. The prevalence of airway diseases was chronic bronchitis 12/56, asthma 10/56, recurrent pneumonia 10/56, chronic sinusitis 7/56 and chronic laryngitis 1/56. In patients with respiratory complications pathologic acid reflux was established in 29/51 cases on the basis of the DeMeester score, while 17/51 had pathologic postprandial, nocturnal or diurnal reflux events. Upper gastrointestinal endoscopy revealed a normal esophageal mucosa in 6/56, Savary-Miller stage I esophagitis in 23/56, stage II in 15/56, stage III in 5/56 and stage IV in 6/56 patients. Conclusions: These investigations have demonstrated an abnormal 24-hour pH score in about half of the patients with GERD-associated respiratory complications, and indicated that short reflux events are characteristic of the reflux activity in one third of this population.

应用甲硝唑治疗日本人群中耐克拉霉素幽门螺杆菌感染的效果

Background: Eradication of Helicobacter pylori has become a common treatment for several diseases. There is an increase in antibiotic-resistant strains, which causes the failure of eradication. The aim of this study was to investigate the usefulness of metronidazole for the treatment of H. pylori infection in patients who failed eradication therapy. Methods: Seventy H. pylori positive patients who had failed eradication treatment with first-line triple therapy, which consisted of a proton pump inhibitor, amoxicillin, and clarithromycin, were enrolled into the study. Before the second-line therapy, patients underwent endoscopy to obtain H. pylori strains to test susceptibility to antibiotics. Lansoprazole (30mg b.d.), amoxicillin (750mg b.d.), and metronidazole (250mg b.d.) were administered for 1 week, and the result was tested by 13C-UBT. Results: H. pylori was isolated from 62 patients, and 52 of them (83.9%) were clarithromycin resistant. There was no amoxicillin-or metronidazole-resistant strain. No major adverse effects were seen, and all the patients completed the 1-week regimen. The eradication rates of lansoprazole-amoxicillin-metronidazole were 96.2%(51/53; 95%CI, 87.0%-99.5%) using both intention-to-treat analysis and per protocol analysis. Conclusions: Lansoprazole-amoxicillin-metronidazole triple therapy is an effective and promising second-line H. pylori eradication therapy in a north Japanese population, which has a low frequency of metronidazole resistance.

非侵入性MRI检测阿托伐他汀降脂治疗对主动脉粥样硬化斑块的作用

Objectives: We sought to elucidate the effects of 20- mg versus 5- mg atorvastatin on thoracic and abdominal aortic plaques. Background: Regression of thoracic aortic plaques by simvastatin was demonstrated using magnetic resonance imaging(MRI). However, the effects of different doses of statin have not been assessed. Methods: Using MRI, we investigated the effects of 20- mg versus 5- mg atorvastatin on thoracic and abdominal aortic plaques in 40 hypercholesterolemic patients who were randomized to receive either dose. Treatment effects were evaluated as changes in vessel wall thickness(VWT) and vessel wall area(VWA) of atherosclerotic lesions from baseline to 12 months of treatment. Results: The 20- mg dose induced a greater low- density lipoprotein(LDL) cholesterol reduction than did the 5- mg dose(- 47% vs.- 34% , p< 0.001). Although 20 mg and 5 mg reduced C- reactive protein(CRP) levels(- 47% and- 28% ), the degree of CRP reduction did not differ between the two doses. The 20- mg dose reduced VWT and VWA of thoracic aortic plaques(- 12% and - 18% , p< 0.001), whereas 5 mg did not(+ 1% and + 4% ). Regarding abdominal aortic plaques, even 20 mg could not reduce VWT or VWA(- 1% and + 3% ), but instead progression was observed with 5mg treatment(+ 5% and + 12% , p< 0.01). Notably, the degree of plaque regression in thoracic aorta correlated with LDL cholesterol(r=0.64) and CRP(r=0.49) reductions. Although changes in abdominal aortic plaques only weakly correlated with LDL cholesterol reduction(r=0.34), they correlated with age(r=0.41). Conclusions: One- year 20- mg atorvastatin treatment induced regression of thoracic aortic plaques with marked LDL cholesterol reduction, whereas it resulted in only retardation of plaque progression in abdominal aorta. Thoracic and abdominal aortic plaques may have different susceptibilities to lipid lowering.

肝细胞性肝癌时金属硫蛋白的免疫组化表达:与肿瘤进程和对铂剂耐药性的关系

Background: Metallothionein (MT), which is known to detoxify heavy metal ions, is considered to serve as a mechanism of resistance to platinum complex compounds. In the present study, MT expression in hepatocellular carcinoma (HCC) was immunohistologically investigated to clarify its relationship to clinical background factors and responsiveness to anticancer drugs. Methods: Specimens from 117 patients with HCC were immunohistologically studied, using a monoclonal anti-MT antibody. the percentage of MT-positive HCC (MT ratio) cells was determined, to evaluate the extent of staining with anti-MT antibody. Staining with an MT ratio of more than 50%was categorized as diffusely positive; an MT ratio of 5%to less than 50%was focally positive; and an MT ratio of less than 5%was negative. Twenty-two patients received repeated arterial infusion chemotherapy with carboplatin (CBDCA), a platinum containing compound, and the MT expression was analyzed in relation to their chemotherapeutic response. Results: The ratio of MT-positive cells in HCC decreased with the degree of histological differentiation and also decreased with higher tumor stage. In patients treated with CBDCA, the ratio of MT positive cells in responders was significantly lower than that in non-responders. Conclusions: MT expression decreases with the degree of histological differentiation and decreases with increasing tumor stage in HCC. In addition, MT expression may lower the antitumor effect of CBDCA.