Impaired metabolism of high density lipoprotein in uremic patients

Impaired metabolism of high density lipoprotein in uremic patients. We measured lipoproteins, apolipoproteins, lipoprotein lipase (LPL), hepatic triglyceride lipase (HTGL), lecithin: cholesterol acyltransferase (LCAT) and parameters of calcium metabolism to evaluate the roles of these enzymes and hypertriglyceridemia for impaired high-density lipoprotein (HDL) metabolism in chronic renal failure, and to examine the impact of altered calcium homeostasis on the lipoprotein-regulating enzymes. The subjects were 25 healthy volunteers and 66 uremic patients, 24 treated with hemodialysis (HD) and 42 with continuous ambulatory peritoneal dialysis (CAPD). Lipoprotein analysis revealed: (1) reduction in HDL cholesterol especially in HDL2 subfraction; (2) increase in HDL triglyceride; and (3) decreased ratio of HDL2 cholesterol to HDL3 cholesterol in both HD and CAPD patients. Simple regression analysis showed: (1) a positive correlation between VLDL triglyceride and triglycéride/cholestérol ratio of HDL; (2) positive correlations of LPL level in post-heparin plasma to cholesterol concentrations in HDL2, HDL3 and total HDL, and to apolipoproteins A-I and A-II; and (3) inverse correlations of HTGL to HDL2 cholesterol and to the ratio of HDL2 cholesterol/HDL3 cholesterol. Multiple regression analysis of HDL cholesterol indicated positive association with LPL and inverse correlation with VLDL triglyceride. Four variables including LPL, HTGL, LCAT and VLDL triglyceride explained 51.5% of the variation of HDL cholesterol. HDL2 cholesterol was associated positively with LPL and negatively with VLDL triglyceride in the model. HDL3 cholesterol was associated positively with LPL, HTGL and LCAT and inversely with VLDL triglyceride. Stepwise multiple regression analysis indicated that independent predictors of HTGL were gender, parathyroid hormone levels by a mid-portion assay, ionized calcium and age, and that those of LCAT were ionized calcium and age. These results suggest that elevated VLDL and alterations in the enzyme levels contributed to deranged HDL metabolism in uremic patients, and that changes in the enzyme levels were associated with impaired calcium homeostasis

Effects of lipid-lowering drugs on intermediate-density lipoprotein in uremic patients

Effects of lipid-lowering drugs on intermediate-density lipoprotein in uremic patientsBackgroundPatients with chronic renal failure often have alterations in lipoprotein profile including elevated very-low density lipoprotein (VLDL) and intermediate density lipoprotein (IDL), and reduced high density lipoprotein (HDL) levels. Among these changes, raised IDL has been shown as an independent risk factor for atherosclerosis in hemodialysis patients. There are a limited number of studies reporting pharmacological approaches to IDL reduction in a uremic population.MethodsWe therefore summarize the effects of lipid-lowering drugs on IDL levels in patients with chronic renal failure treated by hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).ResultsFirst, a nicotinic acid analog niceritrol was given to hemodialysis patients. The drug increased HDL-cholesterol by 11%, but the reductions in VLDL-, IDL- and LDL-cholesterol were not significant. Second, CAPD patients were treated with a fibric acid derivative clinofibrate, which was excreted mainly into bile unlike other drugs in this class. The fibrate resulted in a remarkable reduction in VLDL-triglycerides, although it did not reduce IDL-cholesterol. Finally, an HMG-CoA reductase inhibitor (statin) pravastatin was used in HD and CAPD patients. Pravastatin reduced IDL- and LDL-cholesterol to the same extent (by 31%). None of these treatments caused serious adverse effects.ConclusionsWe propose that IDL is an important target in the management of uremic dyslipidemia. To date, statins have been shown to be suitable for this purpose, although it remains to be clarified whether such an intervention reduces the risk for atherosclerotic vascular events in the uremic population

Serum levels of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, and 25-hydroxyvitamin D in nondialyzed patients with chronic renal failure

Serum levels of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, and 25-hydroxyvitamin D in nondialyzed patients with chronic renal failure.BackgroundIn patients with chronic renal failure (CRF), abnormalities in vitamin D metabolism are known to be present, and several factors could contribute to the abnormalities.MethodsWe measured serum levels of three vitamin D metabolites, 1,25(OH)2D, 24,25(OH)2D and 25(OH)D, and analyzed factors affecting their levels in 76 nondialyzed patients with CRF (serum creatinine> 1.6 and < 9.0 mg/dl), 37 of whom had diabetes mellitus (DM-CRF) and 39 of whom were nondiabetic (nonDM-CRF).ResultsSerum levels of 1,25(OH)2D were positively correlated with estimated creatinine clearance (CCr; r = 0.429; P < 0.0001), and levels of 24,25(OH)2D were weakly correlated with CCr (r = 0.252, P < 0.05); no correlation was noted for 25(OH)D. Serum levels of all three vitamin D metabolites were significantly and positively correlated with serum albumin. Although there were no significant differences in age, sex, estimated CCr, calcium and phosphate between DM-CRF and nonDM-CRF, all three vitamin D metabolites were significantly lower in DM-CRF than in nonDM-CRF. To analyze factors influencing vitamin D metabolite levels, we performed multiple regression analyses. Serum 25(OH)D levels were significantly and independently associated with serum albumin, presence of DM and serum phosphate (R2 = 0.599; P < 0.0001). 24,25(OH)2D levels were significantly and strongly associated with 25(OH)D (β; = 0.772; R2 = 0.446; P < 0.0001). Serum 1,25(OH)2D levels were significantly associated only with estimated CCr (R2 = 0.409; P < 0.0001).ConclusionsThese results suggest that hypoalbuminemia and the presence of DM independently affect serum 25(OH)D levels, probably via diabetic nephropathy and poor nutritional status associated with diabetes, and that 25(OH)D is actively catalyzed to 24,25(OH)2D in CRF, probably largely via extrarenal 24-hydroxylase. Serum levels of 1,25(OH)2D were significantly affected by the degree of renal failure. Thus, this study indicates that patients with CRF, particularly those with DM, should receive supplements containing the active form of vitamin D prior to dialysis

肩甲骨に発生した好酸球性肉芽腫の1例

8歳,男児.右肩痛で発症し,腫脹および圧痛が著明であった.X線像で,肩甲骨に鶏卵大の骨吸収像を認め,白血球数増多,赤沈値亢進,CRP強陽性であった.open-biopsyを施行し,病理組織診断は好酸球性肉芽腫であった.以後,経過観察にて腫脹および疼痛は消失し,X線像,CT像においても腫瘍縮小が見られ治癒が進んでいると判断した.A case of eosinophilic granuloma of the bone was reported. An eight-year-old boy was admitted to our hospital because of pain and remarkable swelling of the right shoulder. Laboratory data on admission revealed an erythrocyte sedimentation rate of 68mm/1 hr, C-reactive protein of 8mg/dl and a white blood-count of 14,600/μl. Plain X-ray films and a CT scan of the scapula disclosed a hen-egg sized osteolytic lesion. The histological diagnosis of eosinophilic granuloma was confirmed by open-biopsy. Subsequent observations indicated satisfactory clinical improvement

慢性関節リウマチによる環軸椎亜脱臼に対する後方固定術の経験

慢性関節リウマチにおける環軸椎亜脱臼はまれなものではなく,またその多くは保存的治療によって対処すべきものである.しかし頸髄損傷,椎骨動脈圧迫による突然死の可能性もあるため,神経学的症状がある場合には手術的治療の対象となる.その場合には,臨床症状を把握したうえで安全でかつ確実な手術方法を検討しなければならない.今回われわれは,慢性関節リウマチによる環軸椎亜脱臼に対してMcGraw-Rusch法による環軸椎後方固定術とHalo-jacketによる外固定を併用し,良好な経過をとった73歳女性の症例を経験したので,環軸椎亜脱臼の頻度,神経学的合併症と手術適応について検討を加え報告する.In rheumatoid arthritis atlanto-axial subluxation is not infrequent and can usually be managed by conservative treatment. Surgical treatment, however, is necessary when there is neural involvement that may threaten the integrity of the spinal cord, leading to severe symptoms or sudden death. It is therefore essential that the orthopaedic surgeon should not only recognize this conditions, but should know the indications for stabilization and practice a safe and reliable technique of arthrodesis. We reviewed a case of a seventy-three years old woman with progressive atlanto-axial subluxation in rheumatoid arthritis, she was treated with the use of the McGraw and Rusch technique in combination with Halo-jacket. The purpose of this paper is not examine the incidence of atlanto-axial subluxation in rheumatoid arthritis, to describe the neural involvements and to mention the indications for atlanto-axial arthrodesis

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements