OBJECTIVES:To compare clinical outcomes of type 2 diabetic patients with and without TZDs therapy after patients receiving DES. METHODS: We conducted a retrospective cohort study using the National Health Insurance Database (NHIRD). The type 2 diabetes mellitus patients were included if they received first limuseluting stent or paclitaxel-eluting stent placement and were identified by presence of a hospital claim during the period from December 1, 2006, through December 31, 2007. Follow-up data were available through December 31, 2008. Patients were classified into two groups based on the antidiabetic agents they took from pharmacy records for use of TZD (rosiglitazone, pioglitazone) or non-TZD within 3 months after the index date of hospitalization. A total of 1,743 patients who received stents during the study period were identified as the study subjects. Our measure of effectiveness was the prevalence of death, myocardial infarction and repeat revascularization, defined as any PCI, whether or not the patient received a stent, or crossed over to CABG within one year after index hospitalization. RESULTS: There were 268 patients in TZD group, 1,475 patients in non-TZD group. Compared with non-TZD group, there were no significant difference in adjusted hazard ratio of death, myocardial infarction and repeat revascularization between limus-eluting stent group and paclitaxel-eluting stent group. In stratified analysis, patients who received limus-eluting stent with history of myocardial infarction and treated with TZDs were associated with a higher risk of myocardial infarction (HRϭ 5.292,. CONCLUSIONS: Our findings suggest that TZDs could not improve clinical outcomes in type 2 diabetes patients after drug-eluting stent implantation. TZDs may contribute to higher risk of myocardial infarction in patient with limus-eluting stent and history of myocardial infarction. For the pleiotropic effects of TZDs, balance between benefit and risk for cardiovascular events to different subgroups, may be different.Further studies are required to investigate this relationship.
Introduction Chronic obstructive pulmonary disease (COPD) is an increasingly serious global health problem that is associated with significant morbidity and mortality. The main pathological feature of COPD is the persistent limitation of respiratory airflow, which leads to fatigue, dyspnea and decreased physical activity. Dyspnea is a cardinal symptom of COPD and increases in severity as the course of COPD progresses. Therefore, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommended in 2011 that COPD assessment should be based on the combination of symptoms, lung function and the risk of exacerbations. Acupuncture has become a popular treatment for various medical conditions. Whether acupuncture can improve lung function and exercise capacity in COPD patients by attenuating the dyspnea and fatigue associated with COPD is unclear. In our review, we discuss the latest assessment criteria for COPD according to the revised GOLD guidelines and summarise the most common outcome measures used to assess COPD patients. We also discuss the results of clinical trials of acupuncture treatment for COPD. The concept of the minimal clinically important difference score of outcome measures in COPD is also addressed. Conclusion COPD is a heterogeneous, multicomponent disease that is associated with significant clinical burden and increasing mortality. Dyspnea is a common symptom. Pulmonary rehabilitation and acupuncture are effective methods of treatment in COPD patients. We call for further studies into acupuncture as a treatment method to further our understanding.
Leukocyte telomere length (LTL) may function as a marker of health, the immune system and cancer survival. We evaluated whether premenopausal breast cancer survivors (PBCS) that successfully increased exercise levels also increased LTL. This study is the first to describe LTLs in a population-based sample of PBCS before and after an exercise intervention. We analyzed LTL before and after the Exercise for Bone Health Intervention, a randomized, controlled trial of 273 premenopausal women 55 years of age or younger at diagnosis that started the intervention within 2 years of receipt of initial chemotherapy. This pilot analysis included 60 women with the greatest increase in exercise from pre to post intervention. Those with longer LTLs at pre-intervention (PRE) had LTLs that grew shorter during the study, however, they still had longer LTLs at post-intervention (POST) than those who started with shorter LTLs. The group whose LTLs shortened the most during the study were those with longer LTLs and more exercise at PRE, ANOVA across four levels P = 0.030. In multivariable regression models of LTL change adjusted for age and LTL at PRE, factors that were independently associated with LTLs that became shorter were older age (P = 0.017), longer telomeres at PRE (P = 0.0004), higher levels of exercise (P = 0.013), higher income (P = 0.011), feeling down-hearted and blue (P = 0.003), higher levels of sociability (P = 0.015), more chronic medical conditions (P = 0.018), and higher levels of insulin-like grown factor-1 at POST (P = 0.003). While this is a pilot sub-study and requires additional confirmation, we postulate that women accustomed to exercising and being highly sociable pre-diagnosis may have experienced a greater impact on their lifestyles post-diagnosis resulting in a more rapid rate of LTL shortening. We hypothesize that time to return to LTL homeostasis for YBCS may be dependent upon a combination of physical health and psychosocial networks pre and post diagnosis and the immune system may be an important modifier. Further studies combining new technology to improve the capture of exercise and psychosocial well-being, and monitor levels of inflammation are needed to determine whether lifestyle interventions can be used to impact biomarkers of health in YBCS.
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