Impact of pitavastatin on high-sensitivity C-reactive protein and adiponectin in hypercholesterolemic patients with the metabolic syndrome: the PREMIUM Study.

BACKGROUND: Inflammatory reactions and oxidative stress, which are important in progression of atherosclerosis, are reported to be increased in individuals with metabolic syndrome (MetS). On the other hand, adiponectin levels are lowered. Since effects of pitavastatin on these parameters have not been reported in hypercholesterolemic patients with MetS, the present study was conducted. PURPOSE: To evaluate the effects of pitavastatin on inflammatory reaction, oxidative stress, and plasma adiponectin levels in hypercholesterolemic MetS patients in a multicenter trial. METHODS: This open-label, single group study was performed at 7 hospitals in Japan. Pitavastatin (2mg/day) was administered to 103 consecutive patients with hypercholesterolemia, subdivided into MetS and non-MetS for 12 weeks. Blood samples were collected after overnight fasting at the start of treatment (baseline) and after 12 weeks. RESULTS: In the patients with MetS (n=69), mean values of plasma high-sensitivity C-reactive protein (hs-CRP) were significantly higher and mean values of plasma high-molecular-weight (HMW)-adiponectin significantly lower than in their counterparts without MetS (n=34). The baseline HMW-adiponectin and high-density lipoprotein cholesterol (HDL-C) values significantly correlated only in the MetS patients (r=0.318; p=0.01). In an effectiveness analysis including 94 patients (62 with MetS, 32 without MetS), the level of hs-CRP was significantly decreased in patients with MetS during the drug treatment, whereas HMW-adiponectin did not change. When patients with MetS were divided into two subgroups according to the percent changes in HDL-C, significantly greater increase in HMW-adiponectin by pitavastatin treatment was observed in the HDL-C ≥10% increase subgroup than in the HDL-C <10% increase subgroup (p=0.009). CONCLUSION: Twelve weeks administration of pitavastatin, in addition to the antihyperlipidemic effects, may be beneficial as an anti-atherosclerotic therapy in hypercholesterolemic patients with MetS, taking changes in hs-CRP and HMW-adiponectin into consideration. ClinicalTrials.gov identifier: NCT00444717.

Mitral valve surgery in a patient with spinal progressive muscular atrophy: report of a case.

We describe our experience in treating a 69-year-old man with spinal progressive muscular atrophy (SPMA), who underwent a mitral valve replacement. He was admitted for dyspnea, and surgery was indicated for severe mitral insufficiency associated with inferior myocardial infarction. He had been aware of muscle weakness and received a diagnosis of SPMA 18 years previously. Worsening muscle atrophy had led to the need for him to use a wheelchair in his daily life. A preoperative examination revealed markedly reduced pulmonary function (% volume capacity = 44.8%). Because of an acute exacerbation of heart failure, the patient underwent an urgent mitral valve replacement with a 27-mm pericardial bioprosthesis. Although it took 42h to wean him from the mechanical ventilation and he suffered from pulmonary atelectasis after extubation, he was discharged from our hospital in a wheelchair 16 days after surgery. Respiratory management with bilevel positive airway pressure was thus found to be quite useful for patients with neuromuscular disease.

Dynamics of bone marrow pressure with tapping of titanium and hydroxyapatite implants in rabbits.

The purpose of the present study was to evaluate the difference in stress transfer between titanium (Ti) and hydroxyapatite (HA) by the measurement of bone marrow pressure using a catheter pressure transducer. Ti and HA implants were inserted in the tibiae of rabbits. A hole of 1 mm in diameter was drilled in the bone and a fine catheter pressure transducer was placed in the bone marrow through a tube. The top of the abutment was vertically tapped with an impulse hammer, and the acceleration signal from the hammer and pressure signal from the catheter pressure transducer were examined. The time of contact (impulse duration) recorded in the impulse with Ti and HA was 166+/-17 micro sec and 164 +/- 17 micro sec, respectively. Maximum bone marrow pressure (BMP) with Ti and HA was 54.2 +/- 32.6 and 47.5 +/- 10.0 mmHg, respectively. Variation of the BMP with Ti was significantly larger than that with HA (P < 0.05). A negative correlation coefficient between impulse duration and BMP was found. The results of the present study suggest that the stress transfer is different between Ti and HA implants using dynamics of the bone marrow pressure.