Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer.

PURPOSE: The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. METHODS: We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. RESULTS: The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach's alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). CONCLUSION: In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

The role of EORTC QLQ-C15-PAL scores and inflammatory biomarkers in predicting survival in terminally ill patients with cancer.

BACKGROUND: The clinical use of patient-reported outcomes as compared to inflammatory biomarkers for predicting cancer survival remains a challenge in palliative care settings. We evaluated the role of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores (EORTC QLQ-C15-PAL) and the inflammatory biomarkers C-reactive protein (CRP), albumin (Alb), and neutrophil-lymphocyte ratio (NLR) for survival prediction in patients with advanced cancer. METHODS: This was an observational study in terminally ill patients with cancer hospitalized in a palliative care unit between June 2018 and December 2019. Patients' data collected at the time of hospitalization were analyzed. Cox regression was performed to examine significant factors influencing survival. A receiver operating characteristic (ROC) analysis was performed to estimate cut-off values for predicting survival within 3 weeks, and a log-rank test was performed to compare survival curves between groups divided by the cut-off values. RESULTS: Totally, 130 patients participated in the study. Cox regression suggested that the QLQ-C15-PAL dyspnea and fatigue scores and levels of CRP, Alb, and NLR were significantly associated with survival time, and cut-off values were 66.67, 66.67, 3.0 mg/dL, 2.5 g/dL, and 8.2, respectively. The areas under ROC curves of these variables were 0.6-0.7. There were statistically significant differences in the survival curves between groups categorized using each of these cut-off values (p < .05 for all cases). CONCLUSION: Our findings suggest that the assessment of not only objective indicators for the systemic inflammatory response but also patient-reported outcomes using EORTC QLQ-C15-PAL is beneficial for the prediction of short-term survival in terminally ill patients with cancer.

Local diagnostic reference level based on size-specific dose estimates: assessment of pediatric abdominal/pelvic computed tomography at a Japanese national children's hospital.

BACKGROUND: A child's body size is not accurately reflected by volume CT dose index (CTDIvol) and dose-length product (DLP). Size-specific dose estimation (SSDE) was introduced recently as a new index of radiation dose. However, it has not yet been established as a diagnostic reference level (DRL). OBJECTIVE: To calculate the SSDE of abdominal/pelvic CT and compare the SSDE with CTDIvol. To calculate the DRLs of CTDIvol and SSDE. Our hypotheses are: SSDE values will be greater than CTDIvol, and our DRL will be smaller than the known DRLs of other countries. MATERIALS AND METHODS: The CTDIvol and DLP of 117 children who underwent abdominal/pelvic CT were collected retrospectively. The SSDE was calculated from the sum of the lateral and anteroposterior diameters. The relationships between body weight and effective diameter and between effective diameter and CTDIvol/SSDE were compared. Further, the local DRL was compared with the DRLs of other countries. RESULTS: Body weight and effective diameter and effective diameter and SSDE were positively correlated. In children ages 1, 5 and 10 years, the SSDE is closer to the exposure dose of CTDIvol for the 16-cm phantom, while in children ages 15 years, the SSDE falls between CTDIvol for the 16-cm phantom and that for the 32-cm phantom. The local DRL was lower than those of other countries. CONCLUSION: With SSDE, the radiation dose increased with increasing body weight. Since SSDE takes body size into account, it proved to be a useful indicator for estimating the exposure dose.

[Differences in Measured Values among Homogenous Assay Reagents of LDL-C in LP-X Positive Serum Samples].

The LDL-C level measures with homogeneous (direct) assays in almost of clinical laboratories. Several reports however showed differences in measured values among the assay reagents. We investigated the differences in LDL-C values among direct assays and Friedewald formula (F-f) in 58 LP-X positive serum samples from jaundice patients by comparing LDL-C values measured by anion-exchange chromatography (AEX-HPLC), largely comparable to ultracentrifugation method. Changes in LDL-C values during the treatment of 8 patients were also investigated. Direct assay reagents from Sekisui Medical (S-r), Denka-Seiken (D-r), Wako Chemical (W-r), and Kyowa Medics (K-r) were used for comparison. F-f, S-r, and D-r correlated with AEX-HPLC with r values < 0.6 while W-r and K-r correlated with AEX-HPLC with r-vales > 0.6. Two samples in which F-f values provided 500 mg/dL plus bias to AEX-HPLC (LDL-C value of 220 mg/dL) demonstrated increased levels of IDL-C before treatment. LDL-C values (S-r and D-r) of the 2 samples were relatively high and near to F-f data while LDL-C values (W-r and K-r) were relatively low and close to AEX-HPLC data. The jaundice treatment decreased LDL-C values (S-r and D-r) and converged to 220 mg/dL, indicating that S-r and D-r might react markedly to IDL. These changes were consistent with decreases in serum free cholesterol and phospholipid in support of LP-X. By contrast, W-r and K-r data showed upward tendency and also converged to 220 mg/dL. These results suggest that LDL-C direct assay reagents would be classified into 2 groups with respect to the reagent reactivity to LP-X.

[Temporary use of centrifugal pump for pump thrombosis in patients with paracorporeal ventricular assist device].

Nipro paracorporeal ventricular assist device( VAD) is often associated with pump thrombosis which causes severe complications such as brain infarction, often requiring pump change. However, Nipro VAD pump is an expensive device and it is difficult to change pumps frequently at a short interval. We have temporarily used Rotaflow centrifugal pump for recurrent pump thrombosis in patients with Nipro VADs. From January 2012 through December 2013, 19 patients underwent Nipro VADs implantation at our institution, and 9 of them underwent pump change from Nipro pumps to Rotaflow centrifugal pumps. A total of 25 Rotaflow centrifugal pumps were used in these 9 patients, with the total circulatory support duration of 526 days. The median support period was 15 days (range;2-128 days). There were 2 cerebrovascular accidents and 1 Rotaflow pump circuit thrombosis during this period. Change from Rotaflow to Nipro VAD pump resulted in decrease in hematocrit by about 3 point. There was no difference in liver or renal function between before and after the pump change. Our results suggest that temporary use of Rotaflow centrifugal pump for recurrent pump thrombosis in patients with Nipro VADs may be a promising alternative.

Increased white blood cell count is associated with an increased demand for unfractionated heparin during veno-arterial extracorporeal oxygenation in lung transplantation.

BACKGROUND: This retrospective observational study aimed to examine whether clinical inflammatory parameters were associated with the requirement dosage of unfractionated heparin (UFH) to maintain the range of ACT in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during lung transplantation surgery. METHODS: Among all patients who underwent lung transplantation using V-A ECMO from January 2021 to May 2022, 27 patients were included. These patients were divided into two groups based on whether the infusion rate of UFH was increased from the initial infusion rate (7-8 units/kg/h) (increased group, n = 10) or the infusion rate was maintained or decreased (non-increased group, n = 17). The infusion rate was adjusted with an activated clotting time (ACT) target of 160-200 s. RESULTS: At 1-2 h after starting ECMO, ACT was significantly lower (179.0 (166.5-188.5) versus 224.0 (193.0-242.0) sec, p = 0.006) and white blood cell (WBC) counts were higher in the increased group (12.6 ± 3.3 versus 9.5 ± 4.0 × 103/µL, p = 0.046). The UFH infusion rates were higher in the increased group during the surgery. The cutoff value of WBC count at 1-2 h after starting ECMO for discriminating the need for increasing the UFH dosage was determined as 10.2 × 103/µL (sensitivity 90.0%, specificity 58.8%, area under the curve 0.712) and discrimination of this cut-off value was confirmed as statistically significant (p = 0.018). CONCLUSION: These data suggested that WBC count was associated with the requirement of an increase in the UFH infusion rate of V-A ECMO during lung transplantation surgery. Further evaluation is necessary to clarify the role of WBC count in determining the optimal UFH dosage.

Survival Prediction of Patients Who Were Terminally Ill Using the EORTC QLQ-C15-PAL Scores and Laboratory Test Values.

Background: Prognostics for patients with cancer is especially important for the supportive care of those who are terminally ill. We previously found that symptom scores as patient-reported outcomes (PROs)-such as dyspnea and fatigue scores-some biochemical parameters, the palliative performance scale (PPS) scores, and symptom clusters were useful prognostic factors; however, the predictability of a prognosis based on these factors remains unclear. Objective: To identify appropriate three-week survival predictive factor(s), in terms of performance, in patients who were terminally ill. Design: We collected symptom scores as PROs using the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL). Setting/Subjects: We used data from terminally ill patients with cancer who were hospitalized at the palliative care unit of the Higashisumiyoshi-Morimoto Hospital (Osaka, Japan) from June 2018 to December 2019 (n = 130), as well as additional data obtained from the same clinical study from January to March 2020 (n = 31). Measurements: To evaluate predictive performance, indices such as sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated. Results: We found that the presence of a symptom cluster showed high sensitivity but low specificity and that a higher PPS value (>30) showed high specificity but low sensitivity, suggesting that these factors could provide relevant information for survival prognosis (less than or equal to three weeks). Conclusion: Symptom clusters obtained from patients is important for effective supportive care of those who are terminally ill.

[Triglyceride (TG) and remnant lipoproteins].

Lowering low-density lipoprotein (LDL) cholesterol (LDL-C) can reduce the risk of cardiovascular disease (CVD) by approximately 30%, and the remaining 70% should be the second front of CVD risk reduction. Such residual risks include high triglyceride (TG) concentrations and low levels of high-density lipoprotein (HDL) cholesterol (HDL-C) in terms of dyslipidemia. TG-rich lipoproteins are heterogenous and composed of a variety of subfractions, all of which are not necessarily relevant to atherosclerosis and CVD risk. However, remnant lipoproteins, TG-rich lipoproteins, are atherogenic and related to CVD risk. Two different methods (RLP-C and RemL-C) have been developed to measure cholesterol levels of remnant lipoproteins. Although there is a difference in affinity to intermediate-density lipoprotein (IDL) between the two methods, they may be better qualified as biomarkers of CVD risk than TG itself. TG measurements play a certain role in the evaluation of CVD risk, but the remnant lipoprotein cholesterol measurement can provide better screening for patients at high CVD risk than TG and may be a useful examination in both quantity and quality.

Comparison of Patient Self-Reported Quality of Life and Health Care Professional-Assessed Symptoms in Terminally ill Patients With Cancer.

BACKGROUND: Few studies evaluated whether health care professionals accurately assess several symptoms for patients with cancer in palliative care units. We determined the agreement level for several symptoms related to quality of life (QOL) between patient-reported QOL assessment and health care professional-assessed symptoms based on the Support Team Assessment Schedule (STAS). METHOD: An observational study was performed with terminally ill patients with cancer hospitalized in the palliative care unit between June 2018 and December 2019. Patients and health care professionals independently assessed 7 symptoms at the time of hospitalization and after 1 week. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL). In examining the proportions of exact agreement, "exact agreement" referred to the pairs of the scores (QLQ-C15-PAL vs STAS) being (1 vs 0), (2 vs 1), (3 vs 2 or 3), or (4 vs 4). The relationships of physical functioning between QLQ-C15-PAL and Palliative Performance Scale (PPS) were examined. RESULTS: Of 130 patients, approximately 60% had PPS scores from 40 to 60. The highest mean score on QLQ-C15-PAL was for fatigue (63.8). The exact agreement on symptoms between patients and health care professionals ranged from 15.4% (fatigue) to 57.7% (nausea and vomiting). The mean of the transformed QLQ-C15-PAL and proportions of exact agreement were negatively correlated (R 2 = 0.949, P < .05). The physical function scores in QLQ-C15-PAL for each PPS group showed no differences. CONCLUSION: We expect patient-reported outcomes including QLQ-C15-PAL to be added to health care professionals' assessment of serious symptoms such as fatigue in terminally ill patients with cancer.

Analysis of cholesterol levels in lipoprotein(a) with anion-exchange chromatography.

We previously established an analysis method for determining the cholesterol levels of five major lipoprotein classes [HDL, LDL, intermediate density lipoprotein (IDL), VLDL, and chylomicrons] in serum by an anion-exchange (AEX)-HPLC method, but lipoprotein(a) [Lp(a)], a well-known risk factor for atherosclerotic diseases, was not determinable. Therefore, we established new AEX-HPLC separation conditions for analyzing the cholesterol levels of six lipoprotein classes, including Lp(a). Serum lipoproteins were separated by HPLC with a diethylaminoethyl-ligand nonporous polymer-based column by elution with a stepwise gradient of the sodium perchlorate concentration. In this improved method, HDL, LDL, IDL, VLDL, chylomicrons, and Lp(a) were each eluted from the column. The cholesterol levels of the eluted lipoproteins were measured enzymatically by a postcolumn reaction. The within-day assay and between-day assay coefficients of variation for the lipoprotein cholesterol levels were in the ranges of 0.29-11.86% and 0.57-11.99%, respectively. The Lp(a) cholesterol levels determined by AEX-HPLC were significantly correlated with the amounts of Lp(a) protein measured by an immunoturbidimetry method available commercially (r = 0.9503, P < 0.0001). Taken together, this AEX-HPLC method may be effectively applied to the analysis of serum lipoproteins with high levels of Lp(a).

An anthropomorphic pelvis phantom for optimization of the diagnosis of lymph node metastases in the pelvis.

OBJECTIVE: An anthropomorphic pelvis phantom was made by the modification of a National Electrical Manufacturers Association (NEMA) phantom, currently the most popular one, and its clinical usefulness was evaluated. METHODS: The NEMA plus bone phantom was made by placing the pelvic bone model in the NEMA phantom. The NEMA plus bladder phantom was made by placing an imitation of the urinary bladder in the NEMA phantom. The pelvis phantom was also made by placing both the pelvic bone model and the bladder in the NEMA phantom. Four kinds of phantoms were imaged by both 2D and 3D dynamic modes, and for each phantom, prompt coincidence count rates, random ones, true plus scatter ones, and single photon rates were measured and these coincidence count rates were compared with those from the actual clinical data. After image reconstruction, the contrast ratio and image noise were also investigated. RESULTS: For the random coincidence count rate, the data obtained from each phantom showed good correspondence to the clinical data. The prompt coincidence count rates and true plus scatter ones of the clinical data were different from those obtained from NEMA phantom, NEMA plus bone one and NEMA plus bladder one, whereas there was a good correspondence between the data of the pelvis phantom and the clinical data. For the contrast ratio and image noise, there were discrepancies between the data of NEMA phantom and pelvis phantoms. CONCLUSIONS: We made an anthropomorphic pelvis phantom by the simple modification of a NEMA phantom. This phantom showed performance similar to that of the actual human pelvis, suggesting clinical usefulness in the evaluation of new acquisition protocols and reconstruction algorithms.

Reductive coupling of metal triangles in sandwich complexes.

The one-electron reduction of [Pd3(C7H7)2(CH3CN)3][BF4]2 in acetonitrile resulted in the formation of the dimer dication [Pd6(C7H7)4(CH3CN)4][BF4]2, whose structure containing a novel bitriangle hexapalladium skeleton was determined by X-ray crystallographic analysis. The dimer is stable in CD3CN at ambient temperature for several days but is highly air-sensitive. Similarly, the cycloheptatriene tripalladium complex [Pd3(C7H7R)2(CH3CN)3][BF4]2 (R = H, t-Bu) dimerized upon one-electron reduction. Both monomer and dimer of cycloheptatriene complexes were structurally determined by X-ray crystallographic analyses.

Structures of two haptotropic isomers generated by the sliding of 1,3,5-triene ligands on a Pd-Pd-Pd chain.

Two haptotropic isomers of [Pd3(micro3-DMVC)2(CH3CN)2][BF4]2 (DMVC=1,2-di-(E)-carbomethoxyvinylcyclopentene) were structurally determined by X-ray crystallographic analyses; a monoclinic crystal contained a symmetric sandwich complex (micro3-eta2:eta2:eta2-coordination of DMVC ligands) and a triclinic crystal contained an unsymmetric sandwich complex (micro3-eta2:eta3:eta1-coordination of DMVC ligands), where the latter are connected to each other by C-HO hydrogen bonds.

A stable zerovalent palladium chain enveloped by a pi-electron sheath of conjugated polyene ligands.

A surprisingly stable homoleptic Pd(0)(4) chain complex of non-activated olefins was isolated and structurally characterized by X-ray crystallographic analysis, and the unique structure and bonding are compared to those of the corresponding dicationic [Pd(4)](2+) chain sandwich complex.

Nickeladihydrofuran. Key intermediate for nickel-catalyzed reaction of alkyne and aldehyde.

The formation of a nickeladihydrofuran by oxidative cyclization of an alkyne and an aldehyde with nickel(0) has been demonstrated; the transformation of the nickeladihydrofuran into an enone by decomposition, a lactone by carbonylation and an allylic alcohol by treatment with ZnMe(2) suggests that nickeladihydrofuran is an important key intermediate in a variety of catalytic reactions.

Characteristic comparison of triglyceride-rich remnant lipoprotein measurement between a new homogenous assay (RemL-C) and a conventional immunoseparation method (RLP-C).

BACKGROUND: Increased serum remnant lipoproteins are supposed to predict cardiovascular disease in addition to increased LDL. A new homogenous assay for remnant lipoprotein-cholesterol (RemL-C) has been developed as an alternative to remnant-like particle-cholesterol (RLP-C), an immunoseparation assay, widely used for the measurement of remnant lipoprotein cholesterol. METHODS: We evaluated the correlations and data validation between the 2 assays in 83 subjects (49 men and 34 women) without diabetes, hypertension and medications for hyperlipidemia, diabetes, and hypertension, and investigated the characteristics of remnant lipoproteins obtained by the two methods (RLP-C and RemL-C) and their relationships with IDL-cholesterol determined by our developed HPLC method. RESULTS: A positive correlation was significantly found between the two methods (r = 0.853, 95%CI 0.781-0.903, p < 0.0001). Bland & Altman analysis revealed that RemL-C values were likely to be significantly higher than RLP-C values, particularly in samples with high levels of remnant lipoproteins. Several data dissociations between the RemL-C and RLP-C were also observed. The HPLC chromatograms show high concentrations of chylomicron cholesterol in serum samples with RemL-C level < RLP-C level, but high concentrations of IDL-cholesterol in samples with RemL-C level > RLP-C level. RemL-C (r = 0.339, 95%CI 0.152-0.903; p = 0.0005) significantly correlated with IDL-cholesterol, but not RLP-C (r = 0.17, 95%CI -0.047-0.372; p = 0.1237) in all the samples (n = 83). CONCLUSION: These results suggest that there is generally a significant correlation between RemL-C and RLP-C. However, RemL-C assay is likely to reflect IDL more closely than RLP-C.

Improvement of the diagnostic accuracy of lymph node metastases of colorectal cancer in 18F-FDG-PET/CT by optimizing the iteration number for the image reconstruction.

OBJECTIVE: Improvement in the diagnostic accuracy of lymph node (LN) metastases of colorectal cancer by optimizing the reconstruction parameters was studied, including a phantom study and clinical studies. METHODS: In the experimental study, the contrast ratio was evaluated using a standard image quality phantom, changing the iteration number of ordered subsets expectation maximization algorithm from 2 to 6. In the clinical study, 89 patients with preoperative colorectal cancer who received 18F-2-deoxy-2-fluoro-D: -glucose positron emission tomography/computed tomography (PET/CT) were studied. Their LN metastases were visually assessed when systematically changing the iteration number, and the optimal iteration number was determined. After the appropriate cut-off value of maximum standardized uptake value was determined, the improvement of the diagnostic accuracy of LN metastases was evaluated for the proximal nodes and the distal ones using the reconstructed images with the optimal iteration number. This was compared with the conventional method that had an iteration number of 2. RESULTS: In the phantom study, it was confirmed that the contrast ratio improved when the iteration number increased. In clinical evaluation, the optimal iteration number was determined to be 5 by visual assessment. When the cut-off value of 1.5 was used, which happened to be the best number, the sensitivity/specificity/accuracy improved from 52%/91%/72% to 77%/89%/83% for the proximal nodes, and from 63%/90%/84% to 91%85%/87% for the distal nodes, respectively. CONCLUSIONS: When the iteration number of the reconstruction algorithm was optimized, the sensitivity of LN metastasis improved by more than 20%, and the accuracy exceeded 80%. Optimization of the image reconstruction parameters in the diagnosis of LN metastases using PET/CT is clinically important.

Diagnosis supporting algorithm for lymph node metastases from colorectal carcinoma on 18F-FDG PET/CT.

OBJECTIVE: We studied the improvement of the detect-ability of lymph node (LN) metastases from colorectal cancer in (18)F-fluorodeoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) by analyzing the acquired counts with a statistical method. METHODS: Thirty-nine metastatic LNs from 32 cases with colorectal cancer were included in this study. "Uptake region" was defined as the site where counts were higher than the average plus 3 standard deviations (SDs) on each transaxial image of FDG PET. After the initial uptake regions were selected, these high accumulation areas were automatically excluded from consideration thereafter. This method was repeated and new uptake regions were identified. This method was repeated up to five times. After that, the stacked-up uptake regions were compared with computed tomography (CT) images, and the high accumulation areas that were superimposed on the normal structures, such as intestine, vessels, and ureters, were excluded from the consideration. The remaining uptake regions were diagnosed as metastatic LNs, and the detectability of LN metastases was calculated. We then compared these statistical results with the results obtained on the basis of visual assessments by radiologists. RESULTS: Our proposed method showed the best results when the procedures were repeated three times in the light of detectability. After being repeated three times, this method detected 15/23 (65.2%) metastatic LNs in the first LN group, 16/16 (100%) in the second-third LN groups and 31/39 (79.4%) in the total LNs, whereas the radiologists diagnosed 8/23 (34.8%) of metastatic first LNs, 12/16 (75.0%) in the second-third LNs and 20/39 (51.3%) in the total LNs. A statistically significant difference was observed between the result of iteration number 3 and that by radiologists as for the second-third LNs and the total LNs. CONCLUSIONS: This study suggests that our proposed statistical method could improve the detectability of LN metastases from colorectal cancer. Our method will help radiologists to detect small metastatic lesions such as LN metastases.

Increased remnant lipoprotein in patients with coronary artery disease--evaluation utilizing a newly developed remnant assay, remnant lipoproteins cholesterol homogenous assay (RemL-C).

AIM: Remnant lipoprotein is an emerging risk factor for coronary artery disease (CAD); however, the development of a specific remnant lipoprotein assay has struggled due to its heterogeneous nature. This study aimed to evaluate the clinical importance of a newly developed assay for remnant lipoprotein, RemL-C, in patients with CAD. METHODS: This assay utilizes surfactant and phospholipase-D to selectively degrade and solubilize remnant lipoprotein. One hundred and sixty consecutive CAD patients who underwent coronary catheterization were recruited. RESULTS: Remnant liporotein, RemL-C, was significantly higher in CAD patients (p< 0.001). Additionally, TG, hs-CRP, ICAM-1, VCAM-1, and homocysteine were significantly higher, but HDL-C and adiponectin were lower with LDL-C unchanged. Since RemL-C levels correlated with plasma TG levels, two subgroups, normotriglycedemic and normolipidemic CAD groups, were extracted. In both groups, RemL-C was still significantly higher than controls. HDL-C, but not RemL-C, was associated with the severity of CAD. RemL-C significantly correlated with TG-rich lipoproteins, in particular VLDL and IDL, when limited to normolipidemic CAD patients. CONCLUSION: Remnant lipoprotein, measured by RemL-C, was increased in CAD patients independent of TG levels, indicating impaired remnant lipoprotein metabolism in these patients. CAD severity was associated with HDL-C, but not with remnant lipoprotein, indicating differential roles of lipoproteins in the development of coronary atherosclerosis. This study therefore provides clinical significance to assess coronary risk by measuring RemL-C, particularly among patients with normal TG levels.

Comparative study between anion-exchange HPLC and homogeneous assay methods in regard to the accuracy of high- and low-density lipoprotein cholesterol measurement.

OBJECTIVES: A convenient method based on anion-exchange HPLC was recently developed to determine cholesterol levels of lipoproteins (HDL, LDL, IDL, VLDL, and chylomicron). The present study was performed to compare this HPLC method to homogenous assay in regard to measurement accuracy of HDL and LDL cholesterol. DESIGN AND METHODS: Serum samples (n=105), including three samples from cholestasis patients, were measured by homogenous assay with Cholestest-LDL and CholestestN-HDL (Daiichi Chemicals, Tokyo) and by HPLC as reported previously (J Lipid Res 2003; 44: 1404-12). RESULTS: The homogenous assay for HDL cholesterol correlated strongly with the HPLC method for HDL cholesterol (r=0.976). Two samples from cholestasis patients could not be measured by homogenous assay but were measured by HPLC. The homogenous assay for LDL cholesterol correlated modestly with the HPLC method for LDL cholesterol (r=0.823). Three outlier samples, from cholestasis patients with serum cholesterol levels >17 mmol/L, were observed in this correlation analysis. Homogenous assay data showed that these LDL cholesterol levels were 15.2-34.7 mmol/L. However, HPLC data showed that these LDL cholesterol levels were 3.6-8.2 mmol/L, and that the major lipoprotein fractions were VLDL and IDL. The difference in LDL cholesterol levels (homogenous assay data minus HPLC data) was positively correlated with VLDL cholesterol levels. CONCLUSIONS: When measuring samples from cholestasis patients, homogenous assay may give inaccurate results. In contrast, the HPLC method is likely to be capable of accurately measuring HDL and LDL cholesterol levels without the involving VLDL.