AIM: To study the interactive relationship of gallbladder motor function, plasma cholecystokinin (CCK) and cholecystokinin A receptor (CCK-R) of gallbladder in patients with cholesterol stone disease.METHODS: Gallblad...AIM: To study the interactive relationship of gallbladder motor function, plasma cholecystokinin (CCK) and cholecystokinin A receptor (CCK-R) of gallbladder in patients with cholesterol stone disease.METHODS: Gallbladder motility was studied by ultrasonography in 33 patients with gallbladder stone and 10 health subjects as controls. Plasma CCK concentration was measured by radioimmunoassay in fasting status (CCK-f) and in 30 min after lipid test meal (CCK-30).Radioligand method was employed to analyze the amount and activity of CCK-R from 33 gallstone patients having cholecystectomy and 8 persons without gallstone died of severe trauma as controls.RESULTS: The percentage of cholesterol in the gallstone composition was more than 70%. The cholesterol stone type was indicated for the patients with gallbladder stone in this study. Based on the criterion of gallbladder residual fraction of the control group, 33 gallstone patients were divided into two subgroups, contractor group (14 cases)and non-contractor group (19 cases), The concentration of CCK-30 was significantly higher in non-contractor group than that in both contractor group and control group (55.86±3.86 pmol/l vs 37.85±0.88 pmol/l and 37.95±0.74 pmol/L, P＜0.01), but there was no difference between contractor group and control group. Meanwhile no significant difference of the concentration of CCK-f could be observed among three groups. The amount of CCK-R was lower in non-contractor group than those in both control group and contractor group (10.27±0.94 fmol/mg vs24.59±2.39 fmol/mg and 22.66±0.55 fmol/mg, P＜0.01).The activity of CCK-R shown as KD in non-contractor group decreased compared to that in control group and contractor group. Only was the activity of CCK-R lower in contractor group than that in control group. The ejection fraction correlated closely with the amount of CCK-R (r = 0.9683,P＜0.01), and the concentration of CCK-30 correlated negatively with the amount of CCK-R closely (r = -0.9627,P＜0.01).CONCLUSION: The distinctive interactive relationship of gallbladder emptying, plasma CCK and CCK-R in gallbladder from this study suggested that the defect of CCK-R may be a key point leading to the impairment of gallbladder motor function and the pathogenesis of cholesterol gallstoneformation may differ in two subgroups of gallstone patient,gallbladder non-contractor group or contractor group.展开更多
In 2014 the American College of Cardiology/American Heart Association issued four new guidelines for cardiovascular disease prevention that focused on cardiovascular risk assessment,lifestyle management,obesity manage...In 2014 the American College of Cardiology/American Heart Association issued four new guidelines for cardiovascular disease prevention that focused on cardiovascular risk assessment,lifestyle management,obesity management,and blood cholesterol management.The development of an atherosclerotic cardiovascular disease risk calculator formed the basis of the risk assessment guideline,and the lifestyle management guideline focused on recommending an evidence-based dietary pattern.The blood cholesterol management guideline specifi cally identifi ed four groups of patients shown to benefi t from moderate-intensity or high-intensity statin therapy from previous clinical trials and abandoned the use of specifi c low-density lipoprotein(LDL)cholesterol(LDL-C)goal levels on the basis of the lack of clinical trial evidence.The recommendations for treatment with moderate-intensity or high-intensity statin therapy are based on rigorous evidence from randomized clinical trials.Guidance has since been provided for the use of nonstatin therapies,including cholesterol absorption inhibitor and proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapy when adequate reduction of LDL-C levels is not achieved with maximally tolerated statin therapy.The recent development and application of these therapies have resulted in remarkable reductions in LDL-C levels that are well tolerated,and preliminary outcome data are promising in showing substantial atherosclerotic cardiovascular disease event reductions beyond statin therapy.展开更多
The roles of dietary fibers and nutraceuticals for primary prevention of cardiovascular disease from childhood are reviewed. Nutrition as an epigenetic modifier and the roles of endothelium, risk factors, epidemiologi...The roles of dietary fibers and nutraceuticals for primary prevention of cardiovascular disease from childhood are reviewed. Nutrition as an epigenetic modifier and the roles of endothelium, risk factors, epidemiological evidence and Mediterranean diet are critically analysed. Overfeeding in childhood can lead to the development of obesity and/or atherosclerosis in adult life. In particular, a high intake of nutrients affects the in utero programming with the adverse consequences of insulin resistance an endothelial dysfunction that lead to early atherosclerosis. Dietary fibers have important health benefits in childhood and research suggests that they may prevent obesity and lower blood cholesterol levels with a favourable impact on the risk of future cardiovascular disease incidence. However, it is for further studies to assess whether also in Southern European Countries, practicing Mediterranean diet as a normal habit, dietary fibers may contribute to modify the relatively low proportion of hyperlipemia observed in our population.展开更多
Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in r...Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.展开更多
AIM： Endoscopic sphincterotomy （ES） is a well-established therapeutic modality for the removal of common bile duct （CBD） stones. Alter ES there are still around 10% of patients that experience recurrent CBD stone...AIM： Endoscopic sphincterotomy （ES） is a well-established therapeutic modality for the removal of common bile duct （CBD） stones. Alter ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and alter ES and its clinical significance in Chinese patients.METHODS： From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared （IR） spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.RESULTS： In the initial 266 stone samples, 217 （82%） were bilirubinate stones, 42 （16%） were cholesterol stones,3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones （66＋13 years vs 56＋17 years, P = 0.001）. In the 44 recurrent stone samples, 38 （86%） were bilirubinate stones, 3 （7%） were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained,23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.CONCLUSION： Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients, The composition of CBD stones may be different from initial stones afl：er ES,展开更多
Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurre...Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their effciency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guide-lines are useful in promoting public health and deve-loping nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient’s nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing litho-genic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy.展开更多
Background: The chemical composition of gallstones is essential to study aetiopathogenesis of gallstone disease. Objective: To determine the composition of gallstones in a Sudanese population. Patients and methods: It...Background: The chemical composition of gallstones is essential to study aetiopathogenesis of gallstone disease. Objective: To determine the composition of gallstones in a Sudanese population. Patients and methods: It describes an extensive quantitative analysis of gallstones from patients presented with symptomatic gall stone disease and treated by cholecystectomy after the acceptance of the pre-given informed consent in Khartoum teaching hospital in the period between Jan 2010 and Dec 2010. Using a pretested questionnaire data collected from and analyzed statistically by SPSS computer program version 21. Results: Data are analyzed from 94 patients (six males and 88 females). Cholesterol stones showed a significantly higher cholesterol content than pigment stones (p = 0.0042), though not significantly higher than mixed stones. Their phospholipids content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with mixed stones (p = 0.0402). In mixed stones, the cholesterol, bile acids, and bilirubin were intermediate between cholesterol and pigment stones, whereas triglycerides were significantly more than pigment stones (p = 0.0007). Bilirubin (p = 0.0021) and bile acids (p = 0.0016) were significantly higher than cholesterol stones (p = 0.0001) and (p = 0.0001) respectively. However, they contained the lowest amounts of sodium, potassium, magnesium, and oxalate. In pigment stones, bilirubin was significantly higher (p = 0.0001) than both groups. Conclusion: Collaborations between surgeons, nutritionists, biochemists, and physicians should be stimulated in future studies to define the different types of gall stones in different areas in Sudan and the relevancy of such types with diets’ traditions.展开更多
Coronary heart disease (CHD) remains the number one killer of men and women in the United States of America despite major advances in interventional technologies for the treatment of coronary artery disease. CHD is ra...Coronary heart disease (CHD) remains the number one killer of men and women in the United States of America despite major advances in interventional technologies for the treatment of coronary artery disease. CHD is rapidly becoming a major cause of morbidity and mortality in developing nations as well and is now recognized as the leading cause of death worldwide.展开更多
基金Supported by the Science Development Foundation of Shanghai,No. 95411902
文摘AIM: To study the interactive relationship of gallbladder motor function, plasma cholecystokinin (CCK) and cholecystokinin A receptor (CCK-R) of gallbladder in patients with cholesterol stone disease.METHODS: Gallbladder motility was studied by ultrasonography in 33 patients with gallbladder stone and 10 health subjects as controls. Plasma CCK concentration was measured by radioimmunoassay in fasting status (CCK-f) and in 30 min after lipid test meal (CCK-30).Radioligand method was employed to analyze the amount and activity of CCK-R from 33 gallstone patients having cholecystectomy and 8 persons without gallstone died of severe trauma as controls.RESULTS: The percentage of cholesterol in the gallstone composition was more than 70%. The cholesterol stone type was indicated for the patients with gallbladder stone in this study. Based on the criterion of gallbladder residual fraction of the control group, 33 gallstone patients were divided into two subgroups, contractor group (14 cases)and non-contractor group (19 cases), The concentration of CCK-30 was significantly higher in non-contractor group than that in both contractor group and control group (55.86±3.86 pmol/l vs 37.85±0.88 pmol/l and 37.95±0.74 pmol/L, P＜0.01), but there was no difference between contractor group and control group. Meanwhile no significant difference of the concentration of CCK-f could be observed among three groups. The amount of CCK-R was lower in non-contractor group than those in both control group and contractor group (10.27±0.94 fmol/mg vs24.59±2.39 fmol/mg and 22.66±0.55 fmol/mg, P＜0.01).The activity of CCK-R shown as KD in non-contractor group decreased compared to that in control group and contractor group. Only was the activity of CCK-R lower in contractor group than that in control group. The ejection fraction correlated closely with the amount of CCK-R (r = 0.9683,P＜0.01), and the concentration of CCK-30 correlated negatively with the amount of CCK-R closely (r = -0.9627,P＜0.01).CONCLUSION: The distinctive interactive relationship of gallbladder emptying, plasma CCK and CCK-R in gallbladder from this study suggested that the defect of CCK-R may be a key point leading to the impairment of gallbladder motor function and the pathogenesis of cholesterol gallstoneformation may differ in two subgroups of gallstone patient,gallbladder non-contractor group or contractor group.
文摘In 2014 the American College of Cardiology/American Heart Association issued four new guidelines for cardiovascular disease prevention that focused on cardiovascular risk assessment,lifestyle management,obesity management,and blood cholesterol management.The development of an atherosclerotic cardiovascular disease risk calculator formed the basis of the risk assessment guideline,and the lifestyle management guideline focused on recommending an evidence-based dietary pattern.The blood cholesterol management guideline specifi cally identifi ed four groups of patients shown to benefi t from moderate-intensity or high-intensity statin therapy from previous clinical trials and abandoned the use of specifi c low-density lipoprotein(LDL)cholesterol(LDL-C)goal levels on the basis of the lack of clinical trial evidence.The recommendations for treatment with moderate-intensity or high-intensity statin therapy are based on rigorous evidence from randomized clinical trials.Guidance has since been provided for the use of nonstatin therapies,including cholesterol absorption inhibitor and proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapy when adequate reduction of LDL-C levels is not achieved with maximally tolerated statin therapy.The recent development and application of these therapies have resulted in remarkable reductions in LDL-C levels that are well tolerated,and preliminary outcome data are promising in showing substantial atherosclerotic cardiovascular disease event reductions beyond statin therapy.
文摘The roles of dietary fibers and nutraceuticals for primary prevention of cardiovascular disease from childhood are reviewed. Nutrition as an epigenetic modifier and the roles of endothelium, risk factors, epidemiological evidence and Mediterranean diet are critically analysed. Overfeeding in childhood can lead to the development of obesity and/or atherosclerosis in adult life. In particular, a high intake of nutrients affects the in utero programming with the adverse consequences of insulin resistance an endothelial dysfunction that lead to early atherosclerosis. Dietary fibers have important health benefits in childhood and research suggests that they may prevent obesity and lower blood cholesterol levels with a favourable impact on the risk of future cardiovascular disease incidence. However, it is for further studies to assess whether also in Southern European Countries, practicing Mediterranean diet as a normal habit, dietary fibers may contribute to modify the relatively low proportion of hyperlipemia observed in our population.
文摘Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.
基金Supported by the Grants From National Science Council, No.NSC 89-2314-B-075B-007, No. NSC 89-2315-13-075B-003No. NSC 90-2314-B-075B-001
文摘AIM： Endoscopic sphincterotomy （ES） is a well-established therapeutic modality for the removal of common bile duct （CBD） stones. Alter ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and alter ES and its clinical significance in Chinese patients.METHODS： From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared （IR） spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.RESULTS： In the initial 266 stone samples, 217 （82%） were bilirubinate stones, 42 （16%） were cholesterol stones,3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones （66＋13 years vs 56＋17 years, P = 0.001）. In the 44 recurrent stone samples, 38 （86%） were bilirubinate stones, 3 （7%） were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained,23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.CONCLUSION： Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients, The composition of CBD stones may be different from initial stones afl：er ES,
文摘Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their effciency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guide-lines are useful in promoting public health and deve-loping nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient’s nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing litho-genic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy.
文摘Background: The chemical composition of gallstones is essential to study aetiopathogenesis of gallstone disease. Objective: To determine the composition of gallstones in a Sudanese population. Patients and methods: It describes an extensive quantitative analysis of gallstones from patients presented with symptomatic gall stone disease and treated by cholecystectomy after the acceptance of the pre-given informed consent in Khartoum teaching hospital in the period between Jan 2010 and Dec 2010. Using a pretested questionnaire data collected from and analyzed statistically by SPSS computer program version 21. Results: Data are analyzed from 94 patients (six males and 88 females). Cholesterol stones showed a significantly higher cholesterol content than pigment stones (p = 0.0042), though not significantly higher than mixed stones. Their phospholipids content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with mixed stones (p = 0.0402). In mixed stones, the cholesterol, bile acids, and bilirubin were intermediate between cholesterol and pigment stones, whereas triglycerides were significantly more than pigment stones (p = 0.0007). Bilirubin (p = 0.0021) and bile acids (p = 0.0016) were significantly higher than cholesterol stones (p = 0.0001) and (p = 0.0001) respectively. However, they contained the lowest amounts of sodium, potassium, magnesium, and oxalate. In pigment stones, bilirubin was significantly higher (p = 0.0001) than both groups. Conclusion: Collaborations between surgeons, nutritionists, biochemists, and physicians should be stimulated in future studies to define the different types of gall stones in different areas in Sudan and the relevancy of such types with diets’ traditions.
文摘Coronary heart disease (CHD) remains the number one killer of men and women in the United States of America despite major advances in interventional technologies for the treatment of coronary artery disease. CHD is rapidly becoming a major cause of morbidity and mortality in developing nations as well and is now recognized as the leading cause of death worldwide.
