What is the best predictor of the atherogenic LDL subclass phenotype 'pattern B' in patients with type 2 diabetes mellitus?

BACKGROUND: The atherogenic lipoprotein phenotype 'pattern B' comprises a predominance of small-dense low-density lipoprotein (sdLDL). Gradient gel electrophoresis (GGE) is considered a 'gold standard' method for identifying this phenotype, but is impractical for routine laboratory use. The low-density lipoprotein cholesterol:apolipoprotein-B (LDL-C:Apo-B) ratio has been advocated as a surrogate marker for sdLDL and a direct assay for sdLDL has recently become available. We compared the sdLDL assay and LDL-C:Apo-B with more established lipid parameters to predict the presence of 'pattern B' phenotype. METHOD: Blood was collected from 97 fasted subjects on three separate occasions. Total cholesterol, triglyceride, Apo-B and sdLDL were measured; LDL- and HDL-cholesterol were determined after ultracentrifugation. The predominant LDL particle size and phenotype were assigned by GGE. RESULTS: 'Pattern B' phenotype was identified in 36% of samples. Peak particle size showed a positive correlation with HDL-cholesterol and a negative correlation with triglyceride and Apo-B. Receiver operating curve (ROC) analysis showed triglyceride:HDL-C ratio and triglyceride alone to be the best predictors of 'pattern B' phenotype, with area under the curve (AUC) being 0.87 and 0.84, respectively. AUCs for sdLDL (0.74) and LDL-C:Apo-B (0.71) were significantly lower (P < 0.05). A high sdLDL concentration had the greatest specificity (95%) and positive predictive value (74%) for 'pattern B' phenotype, but low sensitivity (43%). CONCLUSION: Direct measurement of sdLDL provided the most specific predictor of 'pattern B' phenotype, whereas triglyceride:HDL-C ratio or triglycerides alone, parameters readily available in most laboratories, were the best predictors by ROC analysis.

Medical practice mergers--a flexible combination of individual practices into an integrated multispecialty group.

This article outlines requirements for the establishment of new medical groups by previously independent physicians. Those interested in forming groups may want to use the information in this paper as a checklist for establishing an operational system of integrated practices that can deal more effectively with the increasing pressures of today's health care marketplace.

Psoriasis day care centers.

With the rapidly mounting cost of medical care in hospitals, physicians must seek alternative forms of therapy for illnesses that could conceivably be treated by less confining methods. One appraoch to this problem is the Psoriasis Day Care Center, where psoriasis patients with extensive disease are treated during the day and allowed to return home at night. The advantages include reduced cost, accessibility for more patients, and superior therapeutic results. This day care center concept could be equally applicable to other diseases now routinely treated by complete hospitalization.