Effects of simvastatin/ezetimibe on microparticles, endothelial progenitor cells and platelet aggregation in subjects with coronary heart disease under antiplatelet therapy

It is not known whether the addition of ezetimibe to statins adds cardiovascular protection beyond the expected changes in lipid levels. Subjects with coronary heart disease were treated with four consecutive 1-week courses of therapy (T) and evaluations. The courses were: T1, 100 mg aspirin alone; T2, 100 mg aspirin and 40 mg simvastatin/10 mg ezetimibe; T3, 40 mg simvastatin/10 mg ezetimibe, and 75 mg clopidogrel (300 mg initial loading dose); T4, 75 mg clopidogrel alone. Platelet aggregation was examined in whole blood. Endothelial microparticles (CD51), platelet microparticles (CD42/CD31), and endothelial progenitor cells (CD34/CD133; CDKDR/CD133, or CD34/KDR) were quantified by flow cytometry. Endothelial function was examined by flow-mediated dilation. Comparisons between therapies revealed differences in lipids (T2 and T3<T1 and T4 for total cholesterol, LDL-C, and triglycerides; P<0.002 for all), as well as for endothelial function (T2>T1 and T4, P=0.001). Decreased platelet aggregation was observed after aspirin (arachidonic acid, T1<T3 and T4, P=0.034) and clopidogrel (adenosine, T3 and T4<T1 and T2, P<0.0001) therapy. Simvastatin/ezetimibe diphosphate did not change platelet aggregation, the amount of circulating endothelial and platelet microparticles, or endothelial progenitor cells. Cardiovascular protection following therapy with simvastatin/ezetimibe seems restricted to lipid changes and improvement of endothelial function not affecting the release of microparticles, mobilization of endothelial progenitor cells or decreased platelet aggregation.

Effects of simvastatin/ezetimibe on microparticles, endothelial progenitor cells and platelet aggregation in subjects with coronary heart disease under antiplatelet therapy.

It is not known whether the addition of ezetimibe to statins adds cardiovascular protection beyond the expected changes in lipid levels. Subjects with coronary heart disease were treated with four consecutive 1-week courses of therapy (T) and evaluations. The courses were: T1, 100 mg aspirin alone; T2, 100 mg aspirin and 40 mg simvastatin/10 mg ezetimibe; T3, 40 mg simvastatin/10 mg ezetimibe, and 75 mg clopidogrel (300 mg initial loading dose); T4, 75 mg clopidogrel alone. Platelet aggregation was examined in whole blood. Endothelial microparticles (CD51), platelet microparticles (CD42/CD31), and endothelial progenitor cells (CD34/CD133; CDKDR/CD133, or CD34/KDR) were quantified by flow cytometry. Endothelial function was examined by flow-mediated dilation. Comparisons between therapies revealed differences in lipids (T2 and T3T1 and T4, P=0.001). Decreased platelet aggregation was observed after aspirin (arachidonic acid, T1

The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients.

BACKGROUND AND AIM: To asses the nutritional status of hospitalised trauma patients and the repercussion on the clinical follow up. METHODS: In a prospective way 161 adult patients admitted to the units of Intensive Care (ICU), General Surgery, Maxillofacial Surgery and Orthopedics of the Centro de Emergencias Médicas in Asunción, Paraguay, from March 2002 to March 2004 were evaluated at admission by using the Subjective Global Assessment (SGA). Patients were followed to determine length of hospital stay, complications and in-hospital mortality. RESULTS: From the trauma patients median age was 27 (14-92) years and 94% were males. Most patients (74%) were from the countryside. The most frequent anatomic sites of trauma were: head 25%, thorax 16.6%, limbs 15.4%, abdomen 14%. The median Injury Severity Score (ISS) was 20 (1-39). From this population of patients, 40% were malnourished or at risk of malnutrition according to the SGA. Multivariate analysis identified as significant risk factors for mortality: malnutrition according to the SGA (p = 0.04, RR = 4 (1-15), and admission to the ICU (p = 0.0001, RR 53 (12-234). Risk factors for complications were malnutrition according to the SGA (p = 0.003, RR 2.9 (1.4-5.8) and ISS over 20 (p = 0.001, RR = 8.4 (2.3-29.9). The risk factors for length of stay were malnutrition according to the Subjective Global Assesment (p = 0.01, RR = 2.3 (1.2-4.7) and Injury Severity Score over 20, p = 0.03, RR = 2.8 (1-7.3). CONCLUSIONS: In the conditions of this study, malnutrition is frequent on admission in trauma patients, and is an independent risk factor for morbidity, mortality, and prolongs the length of hospitalisation. Efforts should be made to quickly assess the nutritional status of these patients and early start nutritional intervention.

Microcomputer-aided removable partial denture design.

A microcomputer-based program for the design of removable partial dentures is described that has an interactive user interface to conduct a heuristic search of removable partial denture design data and produces computer-generated design graphics. The program is useful educationally and clinically.

Transcranial radiographs in the evaluation of craniomandibular (TMJ) disorders.

To use a radiographic technique to evaluate patients, one must be aware of the limitations of the study. A TR can be used to show both structural and positional changes of the lateral third of the condyle and fossa. TR obtained at vertical angulations greater than 20 degrees will add significant distortion to the full open-mouth radiograph. The structural changes seen in the joints of patients with the TR who had further diagnostic studies were confirmed with tomography. The changes seen with tomography were either as severe or more extensive than those noted on the TR. Three patients who had extensive structural changes on both the condyle and fossa were shown by arthrography to have a perforation in the joint's soft tissues. While the lateral position of the condyle does not represent the entire joint, this study has shown that it may qualitatively serve as a positional indicator for the joint. The TR together with the rest of a patient's examination data can be used in the treatment. For the patient who has not responded to therapy or whose TR disagrees with the clinical examination, tomographic and arthrotomographic studies are suggested. In the group of 61 patients, 11 (18%) fell into this category. Further diagnostic studies were not felt to be necessary for the remaining 50 patients.

The remodeling of the edentulous mandible.

In a sample of mandibles having complete or nearly complete loss of dentition, the left half of each mandible was serially sectioned. The entire perimeter of each section was analyzed for the distribution of resorptive and depository periosteal surfaces, and from this information, the fields of remodeling were mapped for the mandible as a whole. The most common patterns of combined resorption-deposition and the range of variations were then determined. The over-all distribution of remodeling fields in the edentulous mandible differs markedly from that in the young, growing mandible. In most of the edentulous specimens, the surface of the basal bone on both the medial and lateral sides of the corpus is of a depository nature. The overlying alveolar regions on both the lingual and buccal sides, however, are characteristically resorptive. Significantly, the placement of the reversal line between the alveolar resorptive and the basal depository areas is much lower (i.e., at the level of the mental foramen) on the buccal side. Except for its inferior part, the lateral side of the ramus tends to be largely resorptive in character, and the posterior half of the lingual side also tends to be resorptive. Unlike the child's mandible, the posterior border of the ramus is resorptive, and the posteroanterior dimension of the ramus (not the whole mandible) becomes reduced and narrowed in conjunction with resorption along the anterior border. However, the amount removed from the anterior ramus is actually added to the dimension of the corpus, which becomes longer. Further, removal from the posterior ramus border does not affect the over-all length of the mandible unless condylar reduction is also involved. Also, over-all arch length is not decreased, because the surface of the mental protuberance is retained as a depository type of field (or at least does not become actively resorptive). The corpus-ramus angle (not gonial angle) is increased in the antegonial region. Because of the opening of this angle, over-all mandibular length as well as arch length is increased. In about half of the specimens, arch width was not decreased, because the lateral side of the corpus is usually of a depository nature. Notching of the anterior side of the condylar neck and the inferior part of the anterior ramus border is associated with resorptive fields in these regions, changes that are presumed to be a consequence of pressure contacts made with the articular tubercle and the maxillary tuberosity, respectively, in conjunction with a forward rotation of the whole mandible. The inferior direction of corpus realignment relative to the basal part of the ramus also increases the notching effect in the antegonial region, an effect augmented by the presence of the resorptive field in the notch itself. Certain specific variations commonly occur in several major regions of the mandible on both the lateral and medial sides...