首页 > 最新文献

North American Journal of Medical Sciences最新文献

英文 中文
Hypercalcemia of Malignancy: An Update on Pathogenesis and Management 恶性肿瘤高钙血症:发病机制和治疗的最新进展
Pub Date : 2015-11-01 DOI: 10.4103/1947-2714.170600
A. Mirrakhimov
Hypercalcemia of malignancy is a common finding typically found in patients with advanced stage cancers. We aimed to provide an updated review on the etiology, pathogenesis, clinical presentation, and management of malignancy-related hypercalcemia. We searched PubMed/Medline, Scopus, Embase, and Web of Science for original articles, case reports, and case series articles focused on hypercalcemia of malignancy published from 1950 to December 2014. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and therefore, usually severely symptomatic. Several major mechanisms are responsible for the development of hypercalcemia of malignancy including parathyroid hormone-related peptide-mediated humoral hypercalcemia, osteolytic metastases-related hypercalcemia, 1,25 Vitamin D-mediated hypercalcemia, and parathyroid hormone-mediated hypercalcemia in patients with parathyroid carcinoma and extra parathyroid cancers. Diagnosis should include the history and physical examination as well as measurement of the above mediators of hypercalcemia. Management includes hydration, calcitonin, bisphosphonates, denosumab, and in certain patients, prednisone and cinacalcet. Patients with advanced underlying kidney disease and refractory severe hypercalcemia should be considered for hemodialysis. Hematology or oncology and palliative care specialists should be involved early to guide the options of cancer targeted therapies and help the patients and their closed ones with the discussion of comfort-oriented care.
恶性肿瘤高钙血症是一种常见的发现,通常在晚期癌症患者中发现。我们旨在提供恶性肿瘤相关高钙血症的病因、发病机制、临床表现和治疗的最新综述。我们检索了PubMed/Medline、Scopus、Embase和Web of Science,检索了1950年至2014年12月发表的关于恶性肿瘤高钙血症的原创文章、病例报告和病例系列文章。恶性肿瘤的高钙血症通常表现为钙水平明显升高,因此通常症状严重。恶性肿瘤高钙血症发生的主要机制包括甲状旁腺癌和甲状旁腺癌患者中甲状旁腺激素相关肽介导的体液性高钙血症、溶骨转移相关的高钙血症、1,25维生素d介导的高钙血症和甲状旁腺激素介导的高钙血症。诊断应包括病史和体格检查以及上述高钙血症介质的测定。治疗包括水合作用、降钙素、双膦酸盐、地诺单抗,某些患者使用强的松和cinacalcet。晚期潜在肾脏疾病和难治性严重高钙血症患者应考虑进行血液透析。血液学或肿瘤学和姑息治疗专家应该尽早参与指导癌症靶向治疗的选择,并帮助患者和他们的亲人讨论以舒适为导向的护理。
{"title":"Hypercalcemia of Malignancy: An Update on Pathogenesis and Management","authors":"A. Mirrakhimov","doi":"10.4103/1947-2714.170600","DOIUrl":"https://doi.org/10.4103/1947-2714.170600","url":null,"abstract":"Hypercalcemia of malignancy is a common finding typically found in patients with advanced stage cancers. We aimed to provide an updated review on the etiology, pathogenesis, clinical presentation, and management of malignancy-related hypercalcemia. We searched PubMed/Medline, Scopus, Embase, and Web of Science for original articles, case reports, and case series articles focused on hypercalcemia of malignancy published from 1950 to December 2014. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and therefore, usually severely symptomatic. Several major mechanisms are responsible for the development of hypercalcemia of malignancy including parathyroid hormone-related peptide-mediated humoral hypercalcemia, osteolytic metastases-related hypercalcemia, 1,25 Vitamin D-mediated hypercalcemia, and parathyroid hormone-mediated hypercalcemia in patients with parathyroid carcinoma and extra parathyroid cancers. Diagnosis should include the history and physical examination as well as measurement of the above mediators of hypercalcemia. Management includes hydration, calcitonin, bisphosphonates, denosumab, and in certain patients, prednisone and cinacalcet. Patients with advanced underlying kidney disease and refractory severe hypercalcemia should be considered for hemodialysis. Hematology or oncology and palliative care specialists should be involved early to guide the options of cancer targeted therapies and help the patients and their closed ones with the discussion of comfort-oriented care.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"26 1","pages":"483 - 493"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74407813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 187
Clinical Outcomes of Myasthenia Gravis with Thymoma and Thymic Hyperplasia Undergoing Extended Transsternal Thymectomy: A Single-Center Experience 重症肌无力合并胸腺瘤和胸腺增生行扩展胸腺经胸骨切除术的临床结果:单中心经验
Pub Date : 2015-11-01 DOI: 10.4103/1947-2714.170608
S. Nazarbaghi, M. R. Amiri-Nikpour, R. Mahmodlou, Nasim Arjmand, Yousef Rezaei
Background: Despite the widespread use of thymectomy in myasthenia gravis (MG) patients, it has remained controversial as to whether this procedure is of a similar efficacy and clinical outcome among MG patients with thymoma and thymic hyperplasia. Aim: We sought to determine the long-term clinical outcomes of MG patients who received extended transsternal thymectomy associated with pyridostigmine and prednisolone postoperatively. Materials and Methods: In a retrospective study from January 1999 to December 2013, MG patients who underwent thymectomy were followed up. Out of 41 MG patients admitted in our center, 25 patients had undergone thymectomy adjunctive to pyridostigmine and prednisolone therapy postoperatively. The primary endpoints included improvement in individual diplopia, ptosis, dysphagia, dysarthria, dyspnea, and limb weakness. In addition, according to the MG Foundation of America (MGFA) criteria, response to therapy was defined as complete stable remission (CSR), pharmacologic remission (PR), and minimal manifestation (MM) as secondary endpoints. Results: Majority of the patients were male (60%) and the mean age of the patients was 32.2 ± 13.9 years. Fifteen (60%) and 10 patients (40%) had thymoma and thymic hyperplasia, respectively. All the patients were followed up during a mean period of of 86.9 ± 50.3 months (minimum 10 months and maximum 168 months). The rates of CSR, PR, and MM were comparable between the thymoma and thymic hyperplasia groups (P = 0.584). Based on the Kaplan Meier analysis, the probabilities of CSR, PR, and MM were not significantly different between patients with thymoma and thymic hyperplasia. Conclusion: The extended transsternal thymectomy, along with the postoperative regimen of pyridostigmine and prednisolone was associated with a high rate of clinical improvement among MG patients with thymoma or thymic hyperplasia.
背景:尽管在重症肌无力(MG)患者中广泛应用胸腺切除术,但对于该手术在合并胸腺瘤和胸腺增生的重症肌无力患者中是否具有相似的疗效和临床结果仍然存在争议。目的:我们试图确定MG患者术后接受延长经胸骨胸腺切除术联合吡哆斯的明和强的松龙的长期临床结果。材料与方法:对1999年1月至2013年12月行胸腺切除术的MG患者进行回顾性随访。在我们中心收治的41例MG患者中,25例患者术后行胸腺切除术,并辅以吡哆斯的明和强的松龙治疗。主要终点包括个体复视、上睑下垂、吞咽困难、构音障碍、呼吸困难和肢体无力的改善。此外,根据美国MG基金会(MGFA)的标准,对治疗的反应被定义为完全稳定缓解(CSR),药理学缓解(PR)和最小表现(MM)作为次要终点。结果:患者以男性居多(60%),平均年龄32.2±13.9岁。胸腺瘤15例(60%),胸腺增生10例(40%)。所有患者的平均随访时间为86.9±50.3个月(最短10个月,最长168个月)。胸腺瘤组和胸腺增生组的CSR、PR和MM率具有可比性(P = 0.584)。根据Kaplan Meier分析,胸腺瘤和胸腺增生患者发生CSR、PR和MM的概率无显著差异。结论:胸腺瘤或胸腺增生的MG患者,经胸骨胸腺切除术及术后给予吡地斯的明和强的松龙治疗可提高临床改善率。
{"title":"Clinical Outcomes of Myasthenia Gravis with Thymoma and Thymic Hyperplasia Undergoing Extended Transsternal Thymectomy: A Single-Center Experience","authors":"S. Nazarbaghi, M. R. Amiri-Nikpour, R. Mahmodlou, Nasim Arjmand, Yousef Rezaei","doi":"10.4103/1947-2714.170608","DOIUrl":"https://doi.org/10.4103/1947-2714.170608","url":null,"abstract":"Background: Despite the widespread use of thymectomy in myasthenia gravis (MG) patients, it has remained controversial as to whether this procedure is of a similar efficacy and clinical outcome among MG patients with thymoma and thymic hyperplasia. Aim: We sought to determine the long-term clinical outcomes of MG patients who received extended transsternal thymectomy associated with pyridostigmine and prednisolone postoperatively. Materials and Methods: In a retrospective study from January 1999 to December 2013, MG patients who underwent thymectomy were followed up. Out of 41 MG patients admitted in our center, 25 patients had undergone thymectomy adjunctive to pyridostigmine and prednisolone therapy postoperatively. The primary endpoints included improvement in individual diplopia, ptosis, dysphagia, dysarthria, dyspnea, and limb weakness. In addition, according to the MG Foundation of America (MGFA) criteria, response to therapy was defined as complete stable remission (CSR), pharmacologic remission (PR), and minimal manifestation (MM) as secondary endpoints. Results: Majority of the patients were male (60%) and the mean age of the patients was 32.2 ± 13.9 years. Fifteen (60%) and 10 patients (40%) had thymoma and thymic hyperplasia, respectively. All the patients were followed up during a mean period of of 86.9 ± 50.3 months (minimum 10 months and maximum 168 months). The rates of CSR, PR, and MM were comparable between the thymoma and thymic hyperplasia groups (P = 0.584). Based on the Kaplan Meier analysis, the probabilities of CSR, PR, and MM were not significantly different between patients with thymoma and thymic hyperplasia. Conclusion: The extended transsternal thymectomy, along with the postoperative regimen of pyridostigmine and prednisolone was associated with a high rate of clinical improvement among MG patients with thymoma or thymic hyperplasia.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"43 1","pages":"503 - 508"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74427631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
Groove Pancreatitis: A Rare form of Chronic Pancreatitis 沟状胰腺炎:一种罕见的慢性胰腺炎
Pub Date : 2015-11-01 DOI: 10.4103/1947-2714.170624
Bharivi Jani, Fadi Rzouq, S. Saligram, A. Nawabi, Marian Nicola, Katie Dennis, Carly Ernst, Ali Abbaszadeh, John A Bonino, M. Olyaee
Context: Groove pancreatitis is a rare form of chronic pancreatitis affecting the "groove" of the pancreas among the pancreatic head, duodenum, and common bile duct. The exact cause is unknown, although there are associations with long-term alcohol abuse, smoking, peptic ulcer disease, heterotopic pancreas, gastric resection, biliary disease, and anatomical or functional obstruction of the minor papilla. The diagnosis can be challenging. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography are the preferred imaging modalities. The treatment of choice is conservative although surgical intervention can sometimes be required. Case Report: A 57-year-old male with a history of human immunodeficiency virus and hepatitis B presented with 4 days of epigastric pain. Abdominal exam revealed absent bowel sounds and epigastric tenderness. He had a creatinine of 1.72 mg/dL, potassium of 2.9 mmol/L, and a normal lipase level of 86 U/L. Liver enzymes and total bilirubin were normal. Computed tomography abdomen showed high-grade obstruction of the second portion of the duodenum without any obvious mass. An esophagogastroduodenoscopy showed a mass at the duodenal bulb causing luminal narrowing, with biopsies negative for malignancy. Magnetic resonance imaging revealed a mass in the region of the pancreatic head and descending duodenum. EUS revealed a 3 cm mass in the region of pancreatic head with irregular borders and no vascular invasion. Fine needle aspiration (FNA) was nondiagnostic. The patient then underwent a Whipple′s procedure. Pathology of these specimens was negative for malignancy but was consistent with para-duodenal or groove pancreatitis. Conclusion: The low incidence of groove pancreatitis is partly due to lack of familiarity with the disease. Groove pancreatitis should be considered in the differential for patients presenting with pancreatic head lesions and no cholestatic jaundice, especially when a duodenal obstruction is present, and neither duodenal biopsies nor pancreatic head FNA confirm adenocarcinoma.
背景:沟状胰腺炎是一种罕见的慢性胰腺炎,影响胰头、十二指肠和胆总管之间的胰腺“沟”。确切原因尚不清楚,但与长期酗酒、吸烟、消化性溃疡疾病、胰腺异位、胃切除术、胆道疾病和小乳头解剖或功能性梗阻有关。诊断可能具有挑战性。超声内镜(EUS)和磁共振胰胆管造影是首选的成像方式。治疗的选择是保守的,尽管有时需要手术干预。病例报告:一名57岁男性,有人类免疫缺陷病毒和乙型肝炎病史,腹痛4天。腹部检查显示没有肠音和上腹压痛。肌酐1.72 mg/dL,钾2.9 mmol/L,脂肪酶正常86 U/L。肝酶和总胆红素正常。腹部电脑断层显示十二指肠第二段高度梗阻,未见明显肿块。食管胃十二指肠镜检查显示十二指肠球部肿块引起管腔狭窄,活检阴性。磁共振成像显示胰腺头及十二指肠降区有肿块。EUS示胰头区一3cm肿块,边界不规则,未见血管浸润。细针穿刺(FNA)不能诊断。病人随后接受了惠普尔手术。这些标本的病理表现为恶性肿瘤阴性,但符合十二指肠旁或沟状胰腺炎。结论:沟状胰腺炎发病率低与对该病不熟悉有关。对于有胰头病变而无胆汁淤积性黄疸的患者,特别是当存在十二指肠梗阻,且十二指肠活检和胰头FNA均未证实腺癌时,应考虑沟状胰腺炎。
{"title":"Groove Pancreatitis: A Rare form of Chronic Pancreatitis","authors":"Bharivi Jani, Fadi Rzouq, S. Saligram, A. Nawabi, Marian Nicola, Katie Dennis, Carly Ernst, Ali Abbaszadeh, John A Bonino, M. Olyaee","doi":"10.4103/1947-2714.170624","DOIUrl":"https://doi.org/10.4103/1947-2714.170624","url":null,"abstract":"Context: Groove pancreatitis is a rare form of chronic pancreatitis affecting the \"groove\" of the pancreas among the pancreatic head, duodenum, and common bile duct. The exact cause is unknown, although there are associations with long-term alcohol abuse, smoking, peptic ulcer disease, heterotopic pancreas, gastric resection, biliary disease, and anatomical or functional obstruction of the minor papilla. The diagnosis can be challenging. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography are the preferred imaging modalities. The treatment of choice is conservative although surgical intervention can sometimes be required. Case Report: A 57-year-old male with a history of human immunodeficiency virus and hepatitis B presented with 4 days of epigastric pain. Abdominal exam revealed absent bowel sounds and epigastric tenderness. He had a creatinine of 1.72 mg/dL, potassium of 2.9 mmol/L, and a normal lipase level of 86 U/L. Liver enzymes and total bilirubin were normal. Computed tomography abdomen showed high-grade obstruction of the second portion of the duodenum without any obvious mass. An esophagogastroduodenoscopy showed a mass at the duodenal bulb causing luminal narrowing, with biopsies negative for malignancy. Magnetic resonance imaging revealed a mass in the region of the pancreatic head and descending duodenum. EUS revealed a 3 cm mass in the region of pancreatic head with irregular borders and no vascular invasion. Fine needle aspiration (FNA) was nondiagnostic. The patient then underwent a Whipple′s procedure. Pathology of these specimens was negative for malignancy but was consistent with para-duodenal or groove pancreatitis. Conclusion: The low incidence of groove pancreatitis is partly due to lack of familiarity with the disease. Groove pancreatitis should be considered in the differential for patients presenting with pancreatic head lesions and no cholestatic jaundice, especially when a duodenal obstruction is present, and neither duodenal biopsies nor pancreatic head FNA confirm adenocarcinoma.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"48 1","pages":"529 - 532"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79855458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases 华法林治疗后继发的上气道血肿:报告病例的系统回顾
Pub Date : 2015-11-01 DOI: 10.4103/1947-2714.170606
P. Karmacharya, R. Pathak, Sailu Ghimire, P. Shrestha, Sushil Ghimire, D. Poudel, Raju Khanal, Shirin Shah, M. Aryal, R. Alweis
Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0.All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.
上呼吸道血肿(UAH)是一种罕见但危及生命的口服抗凝剂并发症,需要早期识别。然而,关于最佳治疗方法尚无共识。因此,我们试图系统地回顾已发表的关于UAH的文献,以详细阐述其人口学和临床特征、治疗、并发症和结果。对PubMed和EMBASE进行系统的电子检索,检索自成立(1950年11月)至2015年3月期间发表的与华法林相关的UAH病例报告、病例系列和相关文章。分类变量用百分比表示,连续变量用均数±标准差(SD)表示。统计分析使用社会科学统计软件包(SPSS) 20.0版本。据报道,所有病例都有UAH作为华法林抗凝治疗的并发症。对UAH的人口学、临床特点、治疗、并发症及转归进行了研究。从文献中的34例报告中鉴定出38例UAH。无性别优势(男性= 52.78%),平均发病年龄为60.11±12.50岁。吞咽困难、喉咙痛和颈部肿胀是最常见的症状,就诊时的平均国际标准化比(INR)为8.07±4.04。以舌下血肿居多(66.57%),其次为咽后血肿(27.03%)。48.65%的病例采用保守治疗,其余病例采用环甲环切开术或插管治疗,缓解时间为7.69±5.44天。UAH是华法林治疗中一种罕见但潜在的严重并发症。在治疗性INR的老年人群中更为常见;煽动性事件在很多情况下都存在。总的来说,它有良好的预后,只有当伴有呼吸损害时才会出现显著的发病率。在大多数情况下,在气道受损的情况下,低阈值抗凝逆转人工气道放置导致良好的结果。
{"title":"Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases","authors":"P. Karmacharya, R. Pathak, Sailu Ghimire, P. Shrestha, Sushil Ghimire, D. Poudel, Raju Khanal, Shirin Shah, M. Aryal, R. Alweis","doi":"10.4103/1947-2714.170606","DOIUrl":"https://doi.org/10.4103/1947-2714.170606","url":null,"abstract":"Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0.All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"59 1","pages":"494 - 502"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86459591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 28
Misleading Presentation of Euglycemic Diabetic Ketoacidosis: Implication for Low-Mid-Income Communities 低血糖型糖尿病酮症酸中毒的误导表现:对中低收入社区的影响
Pub Date : 2015-11-01 DOI: 10.4103/1947-2714.170629
E. Nwose, P. Bwititi
Dear Editor, In a recent Case Study article, Thawabi and Studyvin reported two cases of euglycemic diabetic ketoacidosis (euglycemic DKA) that were misleading at initial presentation.[1] The authors meticulously attended to the patients, including performing physical examinations and requesting robust pathology tests. It is established that DKA is a complex metabolic disorder and that understanding the pathophysiology is essential for optimal management.[2,3] It is important to mention that DKA is a clinical condition that has recently generated debate over its dysfunctional metabolic basis,[4,5] and it is pertinent to highlight that ketonuria can be absent or masked by alkalosis in some cases.[6] Therefore, there could be false negative ketonuria with normoglycemia, and without other biochemistry criteria it is possible to miss a diagnosis of DKA. It has been recommended that “careful search for the precipitating cause … and that patient education incorporating a variety of healthcare beliefs and socioeconomic issues are critical to an effective prevention program,”[3] and the significance and success of preventive mechanisms have been reported.[7,8] The pathophysiology of DKA is comprised of four causes, which are dehydration, fasting, insulin deficiency, and stress hormone excess; and it needs to be emphasized that “stress in any form can lead to metabolic decompensation.”[9] What is being brought to the fore is the apparent difficulty to adopt guidelines and the need for careful search for the precipitating cause, especially in the low-mid-income communities (LMIC). In other words, it is pertinent to appreciate in the report of Thawabi and Studyvin the following: Some of what was done may be difficult to do in LMIC. What can be done, which is feasible in LMIC? What was done, which may be difficult to do in LMIC: For instance, the clinical biochemistry profile for diagnosis of DKA shows blood glucose greater than 200 mg/dL, blood ketone level greater than 3 mmol/L with positive ketonuria, and venous bicarbonate <15 mEq/L or pH <7.3.[6,10] The authors assessed arterial pH, perhaps as part of blood investigations including partial pressure of carbon dioxide (pCO2). It is easier to collect venous samples and it is known that arterial and venous pH compare well.[11,12] Thus, where collection of arterial blood is a challenge, venous pH can be measured. Reports of this nature have implications for LMIC: It is arguable that clinical practice guidelines are neither rules nor procedures to comply with and, by default, clinicians in the LMIC may not have the resources to implement such guidelines. Hence, some communities lack access to modern health-care services such as blood gas analyzers. The implication is that if a patient presents with euglycemia, where the resources to perform blood gas analysis as well as ketonemia tests are unavailable, a clinician may be subjected to make diagnosis of DKA based on keton
这在低收入和中等收入国家的含义是,可能没有必要的健康教育,但如果有,结果是明显的,包括在保健服务成本和避免住院方面可能带来的好处。尽管是假设,但很有可能许多血糖DKA未被诊断并具有误导性,因为无法获得血气分析和酮血症测试,而酮尿可能被错误地报告为阴性。我们提出了LMIC的两个含义,首先是评估血糖DKA应该多样化,超越通常的临床生化特征,包括饥饿和应激的作用。其次,血糖正常的DKA的管理应限于初级卫生保健专业人员,并应多样化,包括联合卫生专业人员,并教育糖尿病患者避免禁食和压力的重要性。财政支持及赞助无。利益冲突没有利益冲突。
{"title":"Misleading Presentation of Euglycemic Diabetic Ketoacidosis: Implication for Low-Mid-Income Communities","authors":"E. Nwose, P. Bwititi","doi":"10.4103/1947-2714.170629","DOIUrl":"https://doi.org/10.4103/1947-2714.170629","url":null,"abstract":"Dear Editor, \u0000 \u0000In a recent Case Study article, Thawabi and Studyvin reported two cases of euglycemic diabetic ketoacidosis (euglycemic DKA) that were misleading at initial presentation.[1] The authors meticulously attended to the patients, including performing physical examinations and requesting robust pathology tests. \u0000 \u0000It is established that DKA is a complex metabolic disorder and that understanding the pathophysiology is essential for optimal management.[2,3] It is important to mention that DKA is a clinical condition that has recently generated debate over its dysfunctional metabolic basis,[4,5] and it is pertinent to highlight that ketonuria can be absent or masked by alkalosis in some cases.[6] Therefore, there could be false negative ketonuria with normoglycemia, and without other biochemistry criteria it is possible to miss a diagnosis of DKA. \u0000 \u0000It has been recommended that “careful search for the precipitating cause … and that patient education incorporating a variety of healthcare beliefs and socioeconomic issues are critical to an effective prevention program,”[3] and the significance and success of preventive mechanisms have been reported.[7,8] The pathophysiology of DKA is comprised of four causes, which are dehydration, fasting, insulin deficiency, and stress hormone excess; and it needs to be emphasized that “stress in any form can lead to metabolic decompensation.”[9] What is being brought to the fore is the apparent difficulty to adopt guidelines and the need for careful search for the precipitating cause, especially in the low-mid-income communities (LMIC). In other words, it is pertinent to appreciate in the report of Thawabi and Studyvin the following: \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Some of what was done may be difficult to do in LMIC. \u0000 \u0000 \u0000What can be done, which is feasible in LMIC? \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000What was done, which may be difficult to do in LMIC: For instance, the clinical biochemistry profile for diagnosis of DKA shows blood glucose greater than 200 mg/dL, blood ketone level greater than 3 mmol/L with positive ketonuria, and venous bicarbonate <15 mEq/L or pH <7.3.[6,10] The authors assessed arterial pH, perhaps as part of blood investigations including partial pressure of carbon dioxide (pCO2). It is easier to collect venous samples and it is known that arterial and venous pH compare well.[11,12] Thus, where collection of arterial blood is a challenge, venous pH can be measured. \u0000 \u0000Reports of this nature have implications for LMIC: It is arguable that clinical practice guidelines are neither rules nor procedures to comply with and, by default, clinicians in the LMIC may not have the resources to implement such guidelines. Hence, some communities lack access to modern health-care services such as blood gas analyzers. The implication is that if a patient presents with euglycemia, where the resources to perform blood gas analysis as well as ketonemia tests are unavailable, a clinician may be subjected to make diagnosis of DKA based on keton","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"75 1","pages":"537 - 539"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74081889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diabetes Insipidus: An Unusual Presentation of Adenocarcinoma of the Lung in a Patient with no Identifiable Lung Mass 尿崩症:一种不寻常的肺腺癌的表现,患者没有可识别的肺肿块
Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168677
S. Gulati, C. Kiefer, N. Karim
Context: Lung cancers are known to metastasize to unusual sites. Despite this knowledge often times the diagnosis of a primary lung cancer gets delayed especially when the patient presents without respiratory symptoms. Case Report: The patient discussed in our review is a 47-year-old female, smoker who had presented to several hospitals with months of headache, nausea and intermittent episodes of vomiting. She was noted to have hypernatremia due to diabetes insipidus and a pituitary lesion on her magnetic resonance images. The pituitary mass on biopsy was found to represent a metastatic focus from a primary lung adenocarcinoma. Conclusion: Clinicians should be aware of malignancies that are well known to metastasize to the posterior pituitary. Conversely, since not every patient presents with symptoms of metastasis, there is a need to recognize the clinical syndromes (e. g., diabetes insipidus-like symptoms or more subtle symptoms like cranial nerve palsies) associated with potential metastasis to the pituitary.
背景:肺癌是已知的转移到不寻常的部位。尽管有这些知识,但原发性肺癌的诊断常常被推迟,特别是当患者没有呼吸道症状时。病例报告:在我们的回顾中讨论的患者是一名47岁的女性,吸烟者,因数月的头痛,恶心和间歇性呕吐而就诊于几家医院。她被发现有尿崩症引起的高钠血症,并在磁共振图像上发现垂体病变。活检发现垂体肿块是原发性肺腺癌的转移灶。结论:临床医生应注意垂体后叶转移的恶性肿瘤。相反,由于并非每个患者都表现出转移症状,因此有必要认识到与垂体潜在转移相关的临床综合征(例如,尿崩症样症状或更细微的症状,如脑神经麻痹)。
{"title":"Diabetes Insipidus: An Unusual Presentation of Adenocarcinoma of the Lung in a Patient with no Identifiable Lung Mass","authors":"S. Gulati, C. Kiefer, N. Karim","doi":"10.4103/1947-2714.168677","DOIUrl":"https://doi.org/10.4103/1947-2714.168677","url":null,"abstract":"Context: Lung cancers are known to metastasize to unusual sites. Despite this knowledge often times the diagnosis of a primary lung cancer gets delayed especially when the patient presents without respiratory symptoms. Case Report: The patient discussed in our review is a 47-year-old female, smoker who had presented to several hospitals with months of headache, nausea and intermittent episodes of vomiting. She was noted to have hypernatremia due to diabetes insipidus and a pituitary lesion on her magnetic resonance images. The pituitary mass on biopsy was found to represent a metastatic focus from a primary lung adenocarcinoma. Conclusion: Clinicians should be aware of malignancies that are well known to metastasize to the posterior pituitary. Conversely, since not every patient presents with symptoms of metastasis, there is a need to recognize the clinical syndromes (e. g., diabetes insipidus-like symptoms or more subtle symptoms like cranial nerve palsies) associated with potential metastasis to the pituitary.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"41 1","pages":"476 - 479"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74200132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Septic Arthritis in the Temporomandibular Joint 颞下颌关节脓毒性关节炎
Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168678
H. Al-khalisy, I. Nikiforov, Qurat Mansoora, J. Goldman, P. Cheriyath
Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male. Case Report: A 24-year-old male presented to the emergency department with periauricular swelling, erythema, fever, myalgia′s and generalized joint pain. He had previously sought medical attention and was placed on ciprofloxacin. However, he developed facial swelling and a rash and had to discontinue the antibiotic. On physical exam the patient had a large swelling and tenderness in his left periauricular area, with erythema and deviation of the right mandible which limited his ability to open the mouth. A computed tomography showed mild asymmetric soft tissue swelling in the left pharyngeal region but did not show joint effusion. Subsequent magnetic resonance imaging did show effusion of the joint space. The effusion was drained, and the synovial fluid was submitted for gram stain, culture, and sensitivity. The cultures grew menthicillin sensitive Staphyloccocus Aureus. The patient was discharged to complete a two week course of intravenous (IV) Ceftriaxone and IV Vancomycin via home infusion. Conclusion: Septic Arthritis of the TMJ is a rare event with very specific clinical symptoms. Due to the low sensitivity of the computed tomography scan, magnetic resonance imaging should be considered when computed tomography scan is negative for TMJ effusion.
摘要感染性颞下颌关节关节炎(TMJ)是一种罕见的疾病,在世界范围内仅报道过几十次。这是一个值得注意的化脓性关节炎的TMJ关节在其他健康的男性。病例报告:一名24岁男性,因耳周肿胀、红斑、发热、肌痛和全身关节痛而就诊于急诊科。他以前曾寻求医疗照顾,并被给予环丙沙星治疗。然而,他出现了面部肿胀和皮疹,不得不停止使用抗生素。体格检查时,患者左侧耳廓周围有大的肿胀和压痛,右下颌骨有红斑和偏曲,限制了他张嘴的能力。计算机断层扫描显示轻度不对称软组织肿胀在左咽区,但没有显示关节积液。随后的磁共振成像确实显示关节间隙积液。排出积液,将滑液进行革兰氏染色、培养和敏感性检查。培养出了对甲氧西林敏感的金黄色葡萄球菌。患者出院,完成两周的静脉注射(IV)头孢曲松和静脉万古霉素通过家庭输注。结论:脓毒性TMJ关节炎是一种罕见的疾病,临床症状非常特殊。由于计算机断层扫描的灵敏度较低,当计算机断层扫描为TMJ积液阴性时,应考虑磁共振成像。
{"title":"Septic Arthritis in the Temporomandibular Joint","authors":"H. Al-khalisy, I. Nikiforov, Qurat Mansoora, J. Goldman, P. Cheriyath","doi":"10.4103/1947-2714.168678","DOIUrl":"https://doi.org/10.4103/1947-2714.168678","url":null,"abstract":"Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male. Case Report: A 24-year-old male presented to the emergency department with periauricular swelling, erythema, fever, myalgia′s and generalized joint pain. He had previously sought medical attention and was placed on ciprofloxacin. However, he developed facial swelling and a rash and had to discontinue the antibiotic. On physical exam the patient had a large swelling and tenderness in his left periauricular area, with erythema and deviation of the right mandible which limited his ability to open the mouth. A computed tomography showed mild asymmetric soft tissue swelling in the left pharyngeal region but did not show joint effusion. Subsequent magnetic resonance imaging did show effusion of the joint space. The effusion was drained, and the synovial fluid was submitted for gram stain, culture, and sensitivity. The cultures grew menthicillin sensitive Staphyloccocus Aureus. The patient was discharged to complete a two week course of intravenous (IV) Ceftriaxone and IV Vancomycin via home infusion. Conclusion: Septic Arthritis of the TMJ is a rare event with very specific clinical symptoms. Due to the low sensitivity of the computed tomography scan, magnetic resonance imaging should be considered when computed tomography scan is negative for TMJ effusion.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"38 1","pages":"480 - 482"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85573271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population 第八届全国联合委员会(JNC-8)指南和非裔美国人高血压门诊管理
Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168669
N. Abel, K. Contino, N. Jain, N. Grewal, Elizabeth Grand, I. Hagans, K. Hunter, Satyajeet Roy
Background: Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups. Aim: Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens. Materials and Methods: African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows - Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed. Results: In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage. Conclusion: Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.
背景:高血压是一种常见的医学疾病,大约三分之一的年轻人和近三分之二的60岁以上的人都有高血压。随着第八届全国预防、检测、评估和治疗联合委员会(JNC-8)指南的发布,不同亚组的血压管理发生了重大变化。目的:比较根据JNC-8高血压管理指南和其他方案治疗的非裔美国成年患者的最佳血压管理和终末器官损伤标志物。材料与方法:纳入2013年1月1日至2013年12月31日在我院内科门诊随访的18岁及以上确诊为高血压的非裔美国人患者;记录他们的收缩压和舒张压读数、心率、体重指数(BMI)、年龄、性别、合并症和用药情况。根据降压治疗方法将患者分为四组:第一组:仅使用利尿剂;第2组:仅钙通道阻滞剂(CCB);第三组:利尿剂和CCB;第4组:其他降压药。分析他们的血压控制、合并症和相关靶器官损伤。结果:323例患者血压均得到良好控制。大多数患者(79.6%)使用利尿剂、CCB或两者兼用。组间比较分析显示,两组患者在平均收缩压、平均舒张压、相关合并症、靶器官损伤频率等方面均无统计学差异。结论:尽管利尿剂或CCBs被推荐为非裔美国患者的一线药物,但我们发现与其他药物相比,在血压的最佳控制和终末器官损伤频率方面没有显著差异。
{"title":"Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population","authors":"N. Abel, K. Contino, N. Jain, N. Grewal, Elizabeth Grand, I. Hagans, K. Hunter, Satyajeet Roy","doi":"10.4103/1947-2714.168669","DOIUrl":"https://doi.org/10.4103/1947-2714.168669","url":null,"abstract":"Background: Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups. Aim: Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens. Materials and Methods: African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows - Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed. Results: In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage. Conclusion: Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"3 1","pages":"438 - 445"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87839108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 47
Cytokeratin 8 in Association with sdLDL and ELISA Development 细胞角蛋白8与sdLDL和ELISA发展相关
Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168673
M. Ashmaig
Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Cytokeratins (CKs) which may also be expressed in vascular smooth muscle cells (SMCs) are generally considered to be markers for the differentiation of epithelial cells. Small, dense, low-density lipoprotein (sdLDL) particles, also termed LDL-IV, independently predict risk of CVD. Aims: The aims of this study were to develop an analytical method, apart from ultracentrifugation capable of isolating sdLDL in order to study any associated proteins. Materials and Methods: Using modified gradient gel electrophoresis (GGE), de-identified sdLDL-enriched plasma was used to physically elute and isolate sdLDL particles. To validate the finding, additional plasma from 77 normal and 48 higher risk subjects were used to measure sdLDL particles and CK8. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting method were used to identify the characteristics of proteins associated with sdLDL. An enzyme-linked immunosorbent assay (ELISA) method was developed and validated for the measurement of CK8 in plasma. Results: The validation of the CK8 ELISA method showed good analytical performance. The isolated sdLDL particles were verified with nondenaturing GGE with the apolipoprotein B component confirmed by Western immunoblotting. Confirmed by SDS-PAGE and Western immunoblotting, CK8 was associated with sdLDL. Two-tailed statistical analysis showed that CK8 and sdLDL particles were significantly higher in the high-risk CVD group compared to control group (P < 0.01 and P < 0.01, respectively). Conclusion: This study reports a novel association between CK8 and sdLDL in individuals with CVD who have a predominance of sdLDL.
背景:心血管疾病(CVD)仍然是世界范围内发病率和死亡率的主要原因。细胞角蛋白(Cytokeratins, ck)也可在血管平滑肌细胞(vascular smooth muscle cells, SMCs)中表达,通常被认为是上皮细胞分化的标志。小而致密的低密度脂蛋白(sdLDL)颗粒,也称为LDL-IV,独立预测心血管疾病的风险。目的:本研究的目的是开发一种除超离心外能够分离sdLDL的分析方法,以研究任何相关蛋白。材料与方法:采用改良梯度凝胶电泳(GGE),用去鉴定的sdLDL富集血浆物理洗脱分离sdLDL颗粒。为了验证这一发现,我们使用了77名正常受试者和48名高危受试者的额外血浆来测量sdLDL颗粒和CK8。采用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)和免疫印迹法鉴定与sdLDL相关的蛋白特征。建立了一种酶联免疫吸附法(ELISA)测定血浆中CK8的方法。结果:CK8酶联免疫吸附试验方法具有良好的分析性能。分离的sdLDL颗粒经非变性GGE验证,载脂蛋白B组分经Western免疫印迹证实。SDS-PAGE和Western免疫印迹证实,CK8与sdLDL相关。双侧统计分析显示,CVD高危组CK8和sdLDL颗粒明显高于对照组(P < 0.01和P < 0.01)。结论:本研究报告了在以sdLDL为主的CVD患者中CK8和sdLDL之间的一种新的关联。
{"title":"Cytokeratin 8 in Association with sdLDL and ELISA Development","authors":"M. Ashmaig","doi":"10.4103/1947-2714.168673","DOIUrl":"https://doi.org/10.4103/1947-2714.168673","url":null,"abstract":"Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Cytokeratins (CKs) which may also be expressed in vascular smooth muscle cells (SMCs) are generally considered to be markers for the differentiation of epithelial cells. Small, dense, low-density lipoprotein (sdLDL) particles, also termed LDL-IV, independently predict risk of CVD. Aims: The aims of this study were to develop an analytical method, apart from ultracentrifugation capable of isolating sdLDL in order to study any associated proteins. Materials and Methods: Using modified gradient gel electrophoresis (GGE), de-identified sdLDL-enriched plasma was used to physically elute and isolate sdLDL particles. To validate the finding, additional plasma from 77 normal and 48 higher risk subjects were used to measure sdLDL particles and CK8. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting method were used to identify the characteristics of proteins associated with sdLDL. An enzyme-linked immunosorbent assay (ELISA) method was developed and validated for the measurement of CK8 in plasma. Results: The validation of the CK8 ELISA method showed good analytical performance. The isolated sdLDL particles were verified with nondenaturing GGE with the apolipoprotein B component confirmed by Western immunoblotting. Confirmed by SDS-PAGE and Western immunoblotting, CK8 was associated with sdLDL. Two-tailed statistical analysis showed that CK8 and sdLDL particles were significantly higher in the high-risk CVD group compared to control group (P < 0.01 and P < 0.01, respectively). Conclusion: This study reports a novel association between CK8 and sdLDL in individuals with CVD who have a predominance of sdLDL.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"20 1","pages":"459 - 466"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78203500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Dyslipidemia in Dermatological Disorders 皮肤疾病中的血脂异常
Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168657
C. Shenoy, M. Shenoy, Gururaja Rao
Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.
血脂异常是常见的代谢性疾病之一。最近,牛皮癣等皮肤病和血脂异常之间的联系已经建立起来。许多皮肤病可能有全身性炎症成分,这解释了这种关联。慢性炎症性皮肤病也可能有其他代谢失衡,可能导致血脂异常。这些代谢异常的存在可能证明常规筛查相关的血脂异常和其他代谢异常以及早期治疗这些合并症以提高生活质量是合理的。皮肤科医生使用的一些药物,如类维生素a,也可能是导致血脂异常的原因。因此,皮肤科医生必须获得有关血脂异常的潜在机制的科学知识,并了解何时进行干预治疗。使用Google Scholar和PubMed对英语文献进行了系统的回顾。在这篇综述中,试图列出与血脂异常相关的皮肤病;简化对潜在机制的理解;简要介绍一下干预措施。
{"title":"Dyslipidemia in Dermatological Disorders","authors":"C. Shenoy, M. Shenoy, Gururaja Rao","doi":"10.4103/1947-2714.168657","DOIUrl":"https://doi.org/10.4103/1947-2714.168657","url":null,"abstract":"Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"132 1","pages":"421 - 428"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85403829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 42
期刊
North American Journal of Medical Sciences
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1