A simulation approach for power calculation in large cohort studies based on multistate models

Realistic power calculations for large cohort studies and nested case control studies are essential for successfully answering important and complex research questions in epidemiology and clinical medicine. For this, we provide a methodical framework for general realistic power calculations via simulations that we put into practice by means of an R‐based template. We consider staggered recruitment and individual hazard rates, competing risks, interaction effects, and the misclassification of covariates. The study cohort is assembled with respect to given age‐, gender‐, and community distributions. Nested case‐control analyses with a varying number of controls enable comparisons of power with a full cohort analysis. Time‐to‐event generation under competing risks, including delayed study‐entry times, is realized on the basis of a six‐state Markov model. Incidence rates, prevalence of risk factors and prefixed hazard ratios allow for the assignment of age‐dependent transition rates given in the form of Cox models. These provide the basis for a central simulation‐algorithm, which is used for the generation of sample paths of the underlying time‐inhomogeneous Markov processes. With the inclusion of frailty terms into the Cox models the Markov property is specifically biased. An “individual Markov process given frailty” creates some unobserved heterogeneity between individuals. Different left‐truncation‐ and right‐censoring patterns call for the use of Cox models for data analysis. p‐values are recorded over repeated simulation runs to allow for the desired power calculations. For illustration, we consider scenarios with a “testing” character as well as realistic scenarios. This enables the validation of a correct implementation of theoretical concepts and concrete sample size recommendations against an actual epidemiological background, here given with possible substudy designs within the German National Cohort.     

肾上腺皮质激素对心房钠尿肽基因表达的促进作用

给完整的及切除肾上腺的雌性 Wistar 大鼠分別注射地塞米松、去氧皮质酮或地塞米松加去氧皮质酮;冷酚法提取心房总 RNA,用α-~(32P)标记的大鼠心房肽 cDNA 探针与之杂交。完整大鼠接受地塞米松和切除肾上腺后接受地塞米松加去氧皮质酮的大鼠,心房肽基因转录产物增加2倍,其余组无显著变化。结果提示糖皮质激素可促进心房肽基因表达,但此作用依赖于盐皮质激素的同时存在,单纯盐皮质激素不能增强该基因的表达。     

Rigorous conformational analysis of right and left DNA helices and junction between them

On the basis of complete scanning through conformational space of dihedral angles, twelve structural genera were obtained. Subsequent energy minimization within these genera yielded a limited set of duplexes with stacking: right-handed B-form (Wilkins type), B2-form (Watson and Crick type) and left-handed Ll-form (Sasisekharan type) and the new L2-form. In the polymeric DNA only right-handed double-helices are possible, the left-handed helices are forbidden due to poor 1–5 interchain contacts. In contrast, for short fragments the left- and right-handed helicek have practically the same energies providing some physical ground for side-by-side form, which biologically is possible as recombination form and may be as replication form.     

β2-Adrenoceptor activation by zinterol causes protein phosphorylation,contractile effects and relaxant effects through a cAMP pathway in human atrium

Evidence from ventricular preparations of cat, sheep, rat and dog suggests that both ₁-adrenoceptors (₁AR) and ₂-adrenoceptors (₂AR) mediate positive inotropic effects but that only ₁AR do it through activation of a cAMP pathway. On the other hand, our evidence has shown that both ₁ AR and ₂ AR hasten relaxation of isolated human myocardium consistent with a common cAMP pathway. We have now investigated in the isolated human right atrial appendage, a tissue whose -AR comprise around 2/3 of ₁AR and 1/3 of ₂AR, whether or not ₂AR-mediated effects occur via activation of a cAMP pathway. We carried out experiments on atria obtained from patients without advanced heart failure undergoing open heart surgery. To activate ₂AR, we used the ₂AR-selective ligand zinterol. Experiments were carried out on paced atrial strips (1 Hz) and tissue homogenates and membrane particles. Zinterol caused positive inotropic and lusitropic (i.e. reduction of t_1:2 of relaxation) effects with EC₅₀ values of 3 and 2 nM, respectively. The zinterol-evoked effects were unaffected by the AR-selective antagonist CGP 20712A (300 nM) but blocked surmountably by the ₂AR-selective antagonist ICI 118551 (50 nM) which reduced both EC₅₀ values to 1 M. Zinterol stimulated adenylyl cyclase activity with an EC₅₀ of 30 nM and intrinsic activity of 0.75 with respect to (–)-isoprenaline (600 M); the effects were resistant to blockade by CGP 20712A (300 nM) but antagonised surmountably by ICI 118551 (50 nM). Zinterol bound to membrane PAR labelled with (–)-[¹²⁵I] cyanopindolol with higher affinity for ₂AR than for - 1 AR; the binding to ₂AR but not to - BAR was reduced by GTPyS (10 M). In the presence of CGP 20712A (300 nM) (–)-isoprenaline (400 M); (to activate both ₁AR and ₂AR maximally) and zinterol (10 M); increased contractile force 3.4-fold and 2.5-fold respectively and reduced relaxation tut by 32% and 18% respectively. These effects of (–)-isoprenaline and zinterol were associated (5 min incubation) with phosphorylation (pmol P/mg supernatant protein) of troponin I and C-protein to values of 8.4 ± 2.0 vs 12.4 ± 2.3 and 10.1 ± 2.5 vs 8.6 ± 1.6 respectively. (–)-Isoprenaline and zinterol also caused phosphorylation of phospholamban (1.8 ± 0.3 vs 0.4 ± 0.1 pmol P/mg respectively) specifically at serine residues. We conclude that in human atrial myocardium activation of both ₁AR and ₂AR leads to cAMP-dependent phosphorylation of proteins involved in augmenting both contractility and relaxation.     

MPEG－SOD对急性低氧下鼠左心功能的保护作用

单甲氧基聚乙二醇（ＭＰＥＧ）活化后与超氧化物歧化酶（ＳＯＤ）偶联,经纯化后得到ＭＰＥＧ－ＳＯＤ,鉴定其分子量约为７．０×１０５Ｄａｔｉｏｎ。其在血液循环中酶活性半衰期超过３０ｈ,远大于天然ＳＯＤ（６－１０ｍｉｎ）。ＳＤ雄性大鼠分三组．对照组（ｎ＝８．由股静脉注入０．２ｍｌ生理盐水）、ＮａｔｉｖｅＳＯＤ组（ｎ＝８,注以０．２ｍｌ生理盐水配的８００ＵＳＯＤ）和ＭＰＥＧ－ＳＯＤ组（ｎ＝９,注以８００ＵＭＰＥＧ－ＳＯＤ）。低氧前三组鼠的心率（ＨＲ）、左室内峰压（ＬＶＰ）、左室压微分（ＬＶ±ｄｐ／ｄｔｍａｘ）和股动脉压（ＡＰ）均无统计学差别。在模拟６０００—６５００ｍ高度急性低氧１．８．１４ｍｉｎ记录上述各项指标,结果如下：除ＨＲ外,ＮａｔｉｖｅＳＯＤ组与对照组各指标均无统计学差别,ＭＰＥＧ－ＳＯＤ组的各项指标均明显高于对照组。表明ＭＰＥＧ－ＳＯＤ对急性低氧导致的左心室力学指标的减弱有明显保护作用,提示超氧自由基（Ｏ２－）在急性低氧导致左心室功能损伤中起重要作用,即可能是由Ｏ２－及其衍生的其它自由基损害心肌细胞生物膜系统所致。     

Matching models of left ventricle and systemic artery

To reveal how the matching models of the left ventricle and its afterload affect the pressure and flow in the aortic root, the differences between the measured pressure and flow waveforms and those determined by three kinds of matching model were compared. The results showed that, compared with the results by both matching models 1 and 2, the pressure and flow waveforms determined by matching model 3 established in this work were in the closest agreement with the corresponding experimental waveforms, therefore indicating that matching model 3 was a matching model that closely and rationally characterized the match between the left ventricle and the systemic artery.     

麻黄碱对兔主动脉和心房作用机制的研究

麻黄碱(E,×10~(-4)—3.3×10~(-3)M)和去甲肾上腺素(NA,6×10~(-8)—6×10~(-5)M)均能引起离体兔主动脉条浓度依赖性收缩。可卡因能明显地增强 NA 的作用,但明显地减弱麻黄碱的作用,用可卡因后麻黄碱的作用为用可卡因前的10—92.6%。利血平处理后,麻黄碱和 NA的作用都明显增强,但利血平对前者的增强作用比后者更甚。在利血平处理及未处理肌条上,麻黄碱的作用均可被酚妥拉明阻断。麻黄碱(3.3×10~(-6)—3.3×10~(-5)M)和异丙肾上腺素(ISP,10~(-9)—10~(-5)M)均能引起离体兔心房率的增加。可卡因明显地减弱麻黄碱的这一作用,即为对照组的8.8—29.1%,但不影响 ISP 的作用。利血平处理后,麻黄碱对兔心房的作用也明显减弱,为对照纽的15.4—28.4%;而 ISP 作用则略增加。3×10~(-4)麻黄碱可明显增加[3~H]NA 从兔主动脉条的流出量,此作用在给药后5min内即开始,可持续30 min 以上。上述结果提示,对于兔主动脉和心房,麻黄碱兼具直接作用于效应器细胞和通过释放末梢中 NA 的间接作用;直接作用在主动脉占优势,间接作用在心房占优势。     

高原人体左心室舒张功能和顺应性的改变

应用同步描记心电图、心音图、颈动脉搏动图和心尖搏动图以测定高原人体的左心室舒张功能和顺应性。在4个不同海拔高度进行实验,即76m(海平对照)、2161m、3270m和4179m,每一高度40名健康男性青年,高原3组世居、移居各20名。结果显示:随着海拔增高,主动舒张时间指数(TRTI)有减小趋势,RF波相对振幅(F/H)逐渐降低,A波相对振幅(A/D)则渐趋增大,3270m以上增大明显(p<0.05),舒张振幅时间指数(DATI)逐渐降低,3270m以上差异极显著(p<0.001)。高原世居与移居者相比,在海拔4179m出现明显差别,移居组TRTI、DATI、F/H较低而A/D较高(D<0.05)。测定射血前期与左室射血时间比值(PEP/LVET)、射血分数(EF)及左室周径纤维平均缩短速度(mVcf)3项指标作对照,显示在此高度左室收缩功能仍能保持。高原慢性心肌缺氧可能是导致左室舒张功能和顺应性轻度降低的原因。     

Anticoagulation for the Acute Management of Ischemic Stroke

Few prospective studies support the use of anticoagulation during the acute phase of ischemic stroke, though observational data suggest a role in certain populations. Depending on the mechanism of stroke, systemic anticoagulation may prevent recurrent cerebral infarction, but concomitantly carries a risk of hemorrhagic transformation. In this article, we describe a case where anticoagulation shows promise for ischemic stroke and review the evidence that has discredited its use in some circumstances while showing its potential in others.     

Neural Correlates of Body Integrity Dysphoria

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