The purpose of this research was to construct instruments to measure two personality variables that might explain individual differences in preventive behaviors for heart disease and to test the instruments for reliability and validity. The instruments were constructed to measure three concepts: health value orientations and perceived barriers and benefits to undertaking preventive behaviors believed to reduce one's risk for coronary artery disease. The concepts were components of the Preventive Behavior Model which was derived from social learning theory. Seventy-six subjects who had undergone a health screening program were tested. The testing session consisted of completing a Demographic Data Form which obtained information on smoking and exercise behaviors, the Marlowe-Crowne Social Desirability scale, the Likert Barrier/Benefit scale (BASBES), and Likert Value Orientation scale (VOS), and five magnitude estimation scales. Reliability testing included both stability and internal consistency. Test-retest coefficients for the Barrier/Benefit subscales were .52 and .71, and ranged from .32 to .68 for the Value Orientation subscale variations. Test-retest coefficients for the magnitude subscales ranged from .67 to .90, indicating the scaling technique obtained more stable results. Both alpha and theta coefficients were calculated to estimate internal consistency of the Likert scales. Alpha coefficients were .81 and .80 for the Barrier and Benefit subscales respectively and theta was .82 and .81 respectively. Theta coefficients ranged from .46 to .72 for the Value Orientation subscale variations while alphas were much lower, evidence that the items were not parallel. Construct validity was estimated by principal components factor analysis and predictive modeling. The orthogonal solution for the Barrier subscale revealed two components of the concept were being tapped. One factor resulted from rotation of the Benefit subscale. Factor analysis results suggested that many of the items on the VOS were not tapping the concepts as theoretically predicted. Although rotation of the factors resulted in one meaningful factor for each subscale variation, only 40 to 80 percent of the items were loading on the factors as hypothesized. Predictive modeling using stepwise regression analysis indicated that six of the 12 variables tested were impacting on one preventive behavior (exercise) as theorized.

Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment. Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework. Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent. Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes. Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes. / On the day of the public defence of the doctoral thesis the status of article V was Submitted.

Den vård som bedrivs vid akut kranskärlssjukdom är idag bristande när det gäller jämställdhet. Männen har varit och är dominerande i den forskning som bedrivs om kranskärlssjukdom, vilket utsätter kvinnan för risk vid både diagnos och behandling av sjukdomen. Det råder bristande medvetenhet om genusperspektiv vid vårdandet av akut kranskärlssjukdom, och mer forskning behövs för att uppmärksamma sjuksköterskans behov av att tillämpa detta förhållningssätt. Syfte Syftet med denna litteraturöversikt är att beskriva den kvinnliga patientens erfarenhet och upplevelser vid akut kranskärlssjukdom. Metod Studien genomfördes som en litteraturöversikt där tio kvalitativa artiklar granskades. Databaserna PubMed, CINAHL och Google Scholar användes vid sökningen. Resultat Resultaten i denna litteraturöversikt visar hur den inlärda förväntan om typiska symptom och tecken på akut kranskärlssjukdom påverkat kvinnorna vid tolkningen av deras symptom. Under sjukdomsförloppet framkom även hur kvinnorna förminskade och förnekade allvaret i situationen. Symptomen kunde kopplas till mindre allvarliga åkommor, biverkningar av en ny medicin eller bortförklaras med stigande ålder. Slutsats En djupare förståelse för hur kvinnor reagerar vid debuten av akut kranskärlssjukdom är nödvändig för att sjuksköterskor ska kunna agera adekvat då kvinnan inkommer till sjukhuset.

Introdução: Freqüentemente a progressão da doença coronariana aterosclerótica é observada por angiogramas seqüenciais e atribuída ao aumento da incidência de eventos coronarianos.O significado prognóstico desta progressão em pacientes randomizados e submetidos a diferentes formas terapêuticas ainda é pouco conhecido. Este estudo compara a progressão da aterosclerose nas artérias coronárias nativas de pacientes submetidos a tratamento clinico, cirúrgico ou através da angioplastia. Métodos: 611 pacientes portadores de DAC multiarterial estável com função ventricular preservada, foram estudados e submetidos de maneira randomizada, a três formas terapêuticas habituais. Após cinco anos de evolução, 392 pacientes (64%) foram submetidos à cinecoronariografia. A progressão da doença foi definida como surgimento de estenose de, pelo menos, 20% de obstrução em um segmento arterial, admitido previamente como normal. A progressão foi avaliada nas artérias nativas que correspondem a DA, CX, CD dos três grupos terapêuticos. Resultados: 392 pacientes estudados, 136 eram do grupo Cirúrgico, 146 do grupo Angioplastia e 110 do grupo Clínico. Os grupos eram homogêneos em relação às características basais. A análise de progressão entre os grupos terapêuticos mostrou maior progressão da doença na artéria DA do grupo angioplastia. Entre os fatores relacionados à progressão da doença a presença de HAS influenciou significativamente (p= 0,048). Em relação à oclusão total, houve maior incidência no sexo masculino (p= 0,0078) e novo IAM (p= 0,0006). Não se observou relação estatística entre eventos coronarianos e progressão da doença na amostra estudada. Conclusão: Nessa amostra observou-se a progressão da aterosclerose independente da opção terapêutica. Todavia, encontrou-se menor progressão da doença nos pacientes do grupo cirúrgico. Exceto pela presença de hipertensão, nenhum outro fator de risco parece ter influenciado nesta condição. / Introduction: The progression of atherosclerotic in the coronary artery disease (CAD) is observed through consecutive angiograms. The prognosis of this progression randomized patients is not clear. This study compared the progression of native coronary arteries and bypass graft in patients undergoing to surgery (CABG), angioplasty (PCI), or medical strategy (MT). Methods: Six hundred eleven patients with stable multivessel CAD and preserved ventricular function were randomly assigned to the 3 therapeutic options: MT, PCI, or CABG. After a 5-year of follow-up, 392 patients (64%) underwent routine coronary angiogram. Progression was defined as stenosis of at least 20% in an artery segment previously considered normal. Progression was assessed in the native arteries irrigating the three territories, left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). Uni and multivariate analysis were performed in all therapeutic groups. Results: Of the 392 patients, 136 were to CABG, 146 PCI, and 110 MT. Baseline characteristics of three treatment were homogeneous. Analysis of progression within the three groups showed a more significant progression of atherosclerosis in the LAD territories of the PCI group. Among the factors related to the progression, there was a significant influence by hypertension (p = 0.048). Males presented a higher incidence of occlusion (p= 0.0078) and new Myocardial Infarction. (p= 0.0006). There was no statistical difference between coronary events and the development of progression in the sample studied. Conclusion: In this study, we have observed the occurrence of atherosclerosis progression, regardless the treatment option. However, we?ve found less progression of disease in patients from the surgery group. Except for hypertension, any other risk factor seems to have no influence on the increase of this condition.

INTRODUÇÃO: Uma alta prevalência de apnéia obstrutiva do sono (AOS) tem sido relatada em paciente com doença arterial coronária (DAC). Vários mecanismos relacionados à AOS, incluindo dessaturação da oxi-hemoglobina e aumento da demanda de oxigênio, aumento da atividade simpática bem como estado pro trombótico, podem ser perigosos nos pacientes com DAC. Entretanto, a AOS é pouco reconhecida e não é rotineiramente pesquisada nos pacientes admitidos em unidade de cuidados coronários (UCC) com DAC. O padrão ouro para o diagnóstico de AOS é a polissonografia noturna (PSG), método impraticável na UCC, pois implica no deslocamento do paciente para o laboratório de sono. OBJETIVOS: Construir e validar um monitor de oximetria para diagnóstico de AOS em pacientes admitidos na UCC com diagnóstico de DAC aguda. MÉTODOS: Foi inicialmente desenvolvido monitor de oximetria continua que registra os dados derivados dos monitores da UCC e permite a determinação do índice de dessaturação da oxi-hemoglobina (IDO) através de análise visual da curva de oximetria. O monitor foi então utilizado em pacientes consecutivos admitidos na UCC com diagnóstico de DAC aguda. Uma amostra desta população foi também estudada através de PSG, num período máximo de três meses após a alta. RESULTADOS: Trinta e sete pacientes foram estudados através de monitorização de oximetria durante a noite na UCC. PSG foi também realizada em vinte pacientes. AOS, diagnosticada pelo monitor de oximetria contínua (IDO > 5/hora), estava presente em 43% dos pacientes. AOS foi diagnosticada em 45% dos pacientes estudados com PSG (índice de apnéia e hipopnéia > 15 eventos por hora). Houve um bom nível de concordância entre o diagnóstico de AOS pelo monitor de oximetria na UCC e pela polissonografia - kappa = 0.898; p < 0.0001. O IDO determinado pelo monitor se correlacionou de forma significativa com o índice de apnéia e hipopnéia (r = 0.737; p < 0.0001). O diagnóstico de AOS através do monitor demonstrou sensibilidade de 88,9% e especificidade de 100%. CONCLUSÃO: O monitor desenvolvido no presente trabalho, que permite o registro da oximetria contínua a partir de dados que já são habitualmente coletados na UCC, é um método simples e preciso para o diagnóstico de AOS na UCC. / BACKGROND: A high prevalence of Obstructive sleep apnea (OSA) has been reported in patients with coronary artery disease (CAD). Several OSA related mechanisms, such as oxygen desaturation, high sympathetic activity, increased cardiac oxygen demand and a prothrombotic state, may be particularly dangerous in acute CAD patients. Nevertheless, OSA is frequently underdiagnosed and patients with CAD are not routinely screened for OSA when admitted to the Coronary Care Unit (CCU). OBJECTIVES: To build and validate a continuous overnight oximetry, by recording oximetry data derived from the CCU monitor, for the detection of OSA in acute CAD patients. DESIGN: We studied consecutive patients recruited on the basis of the presence of acute CAD requiring CCU, analyzed overnight continuous oximetry data and further compared it with full overnight polysomnography (PSG). RESULTS: Thirty-seven patients underwent overnight oxygen saturation monitoring in the CCU and 20 of these patients were submitted to PSG, performed within 3 months after hospital discharge. OSA was present in 43% and 45% of the patients studied by overnight oxygen saturation monitoring and PSG, respectively. The oxymetry derived oxygen desaturation index and the PSG derived apnea hypopnea index were strongly correlated (r = 0,737; p < 0,0001). There was a good level of agreement between abnormal oxymetric results and abnormal PSG results (kappa = 0.898; p < 0,0001). Overnight oximetry had a sensitivity of 88.9% and a specificity of 100% for OSA diagnosis. CONCLUSIONS: Continuous overnight oximetry derived from monitors that are already present in the CCU is a simple and accurate method for the diagnosis of OSA in the CCU.

Introdução: Embora a intervenção coronária percutânea esteja associada a baixos índices de complicações, o infarto do miocárdio periprocedimento tem sido apontado como um fator negativo nos resultados clínicos. Os ensaios clínicos randomizados e as revisões sistemáticas recentes confirmaram que uma alta dose de estatina antes da intervenção coronária percutânea eletiva reduz o risco para a ocorrência do infarto do miocárdio periprocedimento. Objetivos: O objetivo desta pesquisa foi aferir a eficácia da pré-administração de uma dose de ataque de rosuvastatina na redução do infarto do miocárdio periprocedimento em pacientes submetidos à intervenção coronária percutânea eletiva com stent coronário. Métodos: De março de 2011 a dezembro de 2013, um total de 528 pacientes portadores de doença coronária estável em uso de estatina (há mais de 7 dias), submetidos à intervenção coronária percutânea eletiva em artéria coronária nativa (e lesão não reestenótica) foram randomizados prospectivamente em único centro, para receberem dose única de ataque de rosuvastatina (40 mg via oral, 2 a 6 horas prévio ao procedimento; grupo rosuvastatina; n=264) versus tratamento padrão (ausência da administração de rosuvastatina; grupo controle; n=264). O objetivo primário foi analisar a incidência intra-hospitalar de infarto do miocárdio periprocedimento (elevação da fração miocárdica da creatina-quinase massa maior que 3 vezes o limite superior do normal). Os objetivos secundários foram analisar a incidência da elevação da fração miocárdica da creatina-quinase massa acima de 1 vez o limite superior do normal e a incidência de eventos adversos graves como infarto agudo do miocárdio com supra desnível do segmento ST, revascularização emergencial do vaso-alvo (percutânea ou cirúrgica) e óbito intra-hospitalar. Resultados: O desfecho primário ocorreu em 7,6% dos pacientes tratados com rosuvastatina e em 4,8% no grupo controle (p = 0,200); ao consideramos o desfecho secundário (elevação da fração miocárdica da creatina-quinase maior que uma vez o limite superior do normal), verificamos que o grupo rosuvastatina apresentou mais desfechos quando comparado ao grupo controle (26,2% vs 18,4%, p = 0,039). Não houve diferença nos eventos adversos graves intra-hospitalar sendo 0% no grupo da rosuvastatina e 0,8% no controle devido a infarto agudo do miocárdio com supradesnível do segmento ST. Conclusões: Esta pesquisa sugere que a administração de dose de ataque de rosuvastatina prévio à intervenção coronária percutânea eletiva, em pacientes com doença coronária estável e em uso de estatina, aumenta a chance de elevação da fração miocárdica da creatina-quinase massa. Este efeito não foi significante para o desfecho primário (infarto do miocárdio periprocedimento) que foi pouco frequente neste estudo, mas foi significante para o desfecho secundário (elevação da creatina-quinase massa acima de 1 vez o limite superior do normal). As taxas de eventos clínicos adversos graves intra-hospitalar não foram afetadas pelo tratamento. / of complications, periprocedural myocardial infarction has been appointed as a negative factor in clinical outcomes. Randomized clinical trials and recent systematic reviews have confirmed that a high dose of statin before elective percutaneous coronary intervention reduces the risk of periprocedural myocardial infarction. Objectives: The objective of this study was to assess the efficacy of a loading dose of rosuvastatin pre-administration in reducing periprocedural myocardial infarction, in patients undergoing elective percutaneous coronary intervention with stable coronary artery disease on statin use for more than 7 days. Methods: From March 2011 to December 2013, a total of 528 patients with stable coronary artery disease on statin use (more than 7 days) who underwent elective percutaneous coronary intervention in native artery (and non restenosis lesion) were prospectively randomized in a single center to receive either a pre-procedural loading dose of Rosuvastatin (40 mg oral, 2 to 6 hours prior to the procedure; rosuvastatin group, n=264) or standard treatment (without administration of rosuvastatin; control group, n = 264). The primary endpoint was in-hospital stay incidence of periprocedural myocardial infarction (creatine kinase-myocardial band elevation greater than the three times the upper limit of normal). The secondary end points were in hospital stay incidence of creatine kinase-myocardial band elevation greater than once the upper limit of normal and the incidence of major adverse events as acute myocardial infarction with ST segment elevation, emergency target vessel revascularization (percutaneous or surgical) and death. Results: The primary end point occurred in 7.6% of patients treated with rosuvastatin loading dose and in 4.8% in the control group (p = 0.200); there was a higher incidence in elevation of post-procedural creatine kinase-myocardial band greater than once the upper limit of normal in the rosuvastatin group (26.2% vs 18.4%, p = 0.039). There were no differences in the rate of major adverse events with 0% in the rosuvastatin group and 0.8% in control driven by acute myocardial infarction with ST-segment elevation in hospital stay. Conclusions: This study suggest that loading dose of rosuvastatin prior to elective percutaneous coronary intervention, in patients with stable coronary disease on prior statin use increases the chance of creatine kinase-myocardial band elevation. This effect was not significant for the primary outcome (periprocedural myocardial infarction) that was uncommon in this study, but was significant for the secondary outcome (creatine-kinase elevation once the upper limit of normal). The rates of major adverse major events were not affected by treatment during hospital stay.

Do atendimento a cardiopatas internados, criou-se a categoria vivência de perdas, desencadeada por evento(s) significativo(s) que implica no processo do luto. Segundo Freud (1916), o luto é um trabalho psíquico que requer um tempo para elaboração da perda e de transformação da realidade psíquica, desestruturada pela falta do objeto perdido. Entende-se que o luto é o correlato psicodinâmico da reação manifesta de depressão. Com estes fundamentos, esta pesquisa teve por objetivo geral: investigar vivência de perdas, estados de luto e de depressão. Foram avaliados 44 pacientes com os diagnósticos médicos de infarto agudo do miocárdio e angina, de 33 a 65 anos, 50% mulheres e 50% homens. Utilizados três instrumentos: entrevista semi-estruturada, para avaliação do luto; Inventário de Depressão de Beck, para depressão; Escala de Avaliação e Reajustamento Social de Holmes e Rahe, que avalia porcentagem de probabilidade de apresentar problemas de saúde. Os resultados foram relacionados através do programa Statistical Package for Social Sciences, versão 11.0. Apresenta estado de luto 65,9%, sendo significativas as relações entre: luto e depressão (p<0,05); luto e gênero (p=0,000); presente em 90,9% das mulheres; depressão e gênero (p<0,05). Os eventos significativos relatados com maior freqüência foram: morte de familiares, 47% ou de pessoa próxima, 13%. Também é significativa a relação estatística entre luto e quantidade de mortes relatadas por participante como evento significativo (p<0,05). Sugere vivência de perdas como indicativo de risco psicológico para doença arterial coronariana, apontando para a associação entre luto e depressão / Since the attendance of hospitalized cardiac patients was created the category experience of losses caused by significative(s) event(s) that implicated in the mourning process. According to Freud (1916), mourning is a psychic process that requires time for the loss elaboration and changing of the psychic reality, shaped by the lost object missing. Mourning is understood as a psychodynamic correlation of the manifested depression reaction. On this basis, this research aimed: investigate experience of losses, mourning and depression. 44 patients with medical diagnosis of severe heart attack and angina were evaluated, from 33 to 65 years old, 50% women and 50 % men. Three instruments were used: semi-structured interview for mourning evaluation; Beck Depression Inventory, for depression; Holmes and Rahe Social Readjustment Rating Scale, which evaluates the probability of presenting health problems. The results were treated by the software Statistical Package for Social Sciences version 11.0 . 65,9% presented state of mourning and the association between : mourning and depression were significative (p<0,05); mourning and gender (p=0,000), presented in 90,9% of the women; depression and gender (p<0,05). The significative events more frequently reported were: death of a relative 47%, or closer person 13%. It is also significative the statistical relation between mourning and deaths related by the participants as significative event (p<0,05). Experience of losses is suggested as indicative of psychological risk for coronary artery disease, highlighting the association with mourning and depression

A doença arterial coronária (DAC) avançada caracteriza-se pela presença de vasos calcificados e difusamente estenosados, o que reduz a acurácia da angiografia coronária não-invasiva por meio dos atuais aparelhos de tomografia computadorizada (CT) com 16 colunas de detectores (16-MDCTA). O principal objetivo deste estudo foi tentar demonstrar uma acurácia diagnóstica global de pelo menos 90% para a detecção de estenoses coronárias >= 50% em pacientes com DAC avançada e alta probabilidade de possuírem escores de cálcio coronário elevados, mediante a utilização de um sistema de CT com 32 colunas de detectores, todas capazes de adquirir simultaneamente cortes com 0,5 mm de espessura (32x0,5-MDCTA). Angiografias coronárias sincronizadas ao traçado de ECG foram obtidas por meio da 32x0,5-MDCTA (32 cortes de 0,5 mm, voxels isotrópicos de 0,35x0,35x0,35 mm³, rotação do gantry a 400 ms) em 30 pacientes consecutivos (25 do sexo masculino, com idade média igual a 59±13 anos e índice de massa corpórea médio de 26,2±4,9 Kg/m²) e portadores de DAC avançada. As principais artérias nativas, incluindo seus ramos de primeira ordem com diâmetro >= 1,5 mm bem como os enxertos coronários existentes, foram avaliados de forma independente quanto à presença de estenoses >= 50%. Os stents foram excluídos. As angiografias coronarianas convencionais (realizadas em média 18±12 dias antes das respectivas 32x0,5-MDCTAs) foram analisadas de maneira quantitativa (angiografia coronária quantitativa). A mediana do escore de cálcio de Agatston foi igual a 510 (variação entre 3 e 5066). A sensibilidade, a especificidade e os valores preditivos positivo e negativo para a detecção de estenoses >= 50% nas artérias coronárias nativas foram seguintes: 76% (29/38), 94% (190/202), 71% (29/41), e 96% (190/199), respectivamente. A acurácia diagnóstica global foi de 91% (219/240). Do total de vasos analisados, 20% (69/352) foram excluídos devido à existência de um dos seguintes artefatos: movimento, ruído e baixo realce do contraste radiológico isoladamente ou em conjunto (45/69 ou 65%), distorção da imagem secundária à presença de eletrodo de desfibrilador ou marcapasso (18/69 ou26%), e calcificação arterial excessiva (6/69 ou 9%). Conclui-se que a 32x0,5-MDCTA exclui com precisão as estenoses coronarianas >= 50% em pacientes com DAC avançada e escore de cálcio coronário elevado, com acurácia diagnóstica global de 91% / Advanced coronary artery disease (CAD) is characterized by calcified and diffusely stenotic vessels, hampering accuracy of noninvasive coronary angiography with current 16-detector computed tomography (CT) scanners. The main purpose of this study was to try to demonstrate an overall diagnostic accuracy of at least 90% for detection of coronary stenoses >= 50% by half-millimeter 32-detector CT angiography (32x0.5-MDCTA) in patients with advanced CAD and a high likelihood of having elevated coronary calcium scores. ECG-gated coronary 32x0.5-MDCTA (32x0.5 mm cross-sections, 0.35x0.35x0.35 mm³ isotropic voxels, 400 ms gantry rotation) was performed in 30 consecutive patients (25 male, 59±13 years-old, 26.2±4.9 Kg/m²) with advanced CAD. Major coronary arteries, including >=1.5-mm first order branches, and bypass grafts were independently evaluated for >= 50% stenoses. Stents were excluded. Conventional coronary angiography (performed on average 18±12 days before their corresponding 32x0.5-MDCTAs) was analyzed by quantitative coronary angiography. Median Agatston calcium score was 510 (3-5066 range). Sensitivity, specificity, positive and negative predictive values for detection of >= 50% stenoses in the native coronary arteries were: 76% (29/38), 94% (190/202), 71% (29/41), and 96% (190/199), respectively. Overall diagnostic accuracy was 91% (219/240). Twenty percent (69/352) of the vessels were excluded from the analysis due to one of the following artifacts: motion, noise, and low contrast enhancement isolated or in combination (45/69 or 65%), image distortion secondary to an ICD or pacemaker lead (18/69 or 26%), and severe arterial calcification (6/69 or 9%). We concluded that 32x0.5-MDCTA accurately excludes >= 50% coronary stenoses in patients with advanced CAD and high calcium scores, showing an overall diagnostic accuracy of 91%

by Lee Hon Kit. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 80-89). / Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- Lipids and Lipoproteins --- p.1 / Chapter 1.1.1 --- Chemistry and Classification of Lipids --- p.1 / Chapter 1.1.2 --- Lipoprotein and Apolipoprotein --- p.3 / Chapter 1.1.2.1 --- Lipoprotein: Structure and Classification --- p.3 / Chapter 1.1.2.2 --- Apolipoprotein: Structure and Function --- p.5 / Chapter 1.1.2.3 --- Lipoprotein (a) and Apolipoprotein (a) --- p.8 / Chapter 1.1.3 --- Outline of Lipid and Lipoprotein Metabolism --- p.10 / Chapter 1.1.3.1 --- Exogenous Lipid Metabolism --- p.10 / Chapter 1.1.3.2 --- Endogenous Lipid Pathway --- p.13 / Chapter 1.2 --- "Dyslipidaemia: Definition, Classification and Coronary Heart Disease" --- p.20 / Chapter 1.2.1 --- Definition --- p.20 / Chapter 1.2.2 --- Classification of Dyslipidaemia --- p.21 / Chapter 1.2.3 --- Dyslipidaemia and CHD --- p.24 / Chapter 1.3 --- Dyslipoproteinaemia and Atherogenesis --- p.25 / Chapter 1.3.1 --- Pathology and Pathogenesis --- p.25 / Chapter 1.3.2 --- Central Role of Oxidised LDL in Atherogenesis --- p.29 / Chapter 1.3.3 --- LDL Heterogeneity and Atherogenesis --- p.37 / Chapter 1.4 --- Management of Dyslipidaemia --- p.41 / Chapter 1.4.1 --- Drug therapy --- p.43 / Chapter 1.4.1.1 --- Triglyceride Lowering Drugs --- p.43 / Chapter 1.4.1.2 --- Cholesterol Lowering Drugs --- p.45 / Chapter 1.4.1.3 --- Combination Drug Therapy --- p.46 / Chapter 1.5 --- Aims of this study --- p.49 / Chapter 2. --- Materials and Methods --- p.50 / Chapter 2.1 --- Materials --- p.50 / Chapter 2.1.1 --- Patients and Controls --- p.50 / Chapter 2.1.2 --- Drug Administration Trials --- p.51 / Chapter 2.1.3 --- Blood Samples --- p.52 / Chapter 2.1.4 --- Chemicals and Solutions --- p.52 / Chapter 2.1.5 --- Apparatus and Equipments --- p.52 / Chapter 2.2 --- Methods --- p.54 / Chapter 2.2.1 --- "Serum Cholesterol, Triglyceride and High Density Lipoprotein cholesterol" --- p.54 / Chapter 2.2.2 --- "Apolipoprotein AI, B-100 and Lipoprotein (a) Assays" --- p.54 / Chapter 2.2.3 --- Ultracentrifugation of LDL Fraction --- p.55 / Chapter 2.2.4 --- In Vitro Assessment of LDL Oxidisability --- p.55 / Chapter 2.2.4.1 --- De-Salting of LDL Fraction --- p.55 / Chapter 2.2.4.2 --- Continuously Diene Formation Monitoring --- p.56 / Chapter 2.2.5 --- LDL Particle Size --- p.56 / Chapter 2.2.6 --- Statistical Analysis --- p.57 / Chapter 3. --- Results --- p.59 / Chapter 3.1 --- Quantitative Measurement of apo B-100 --- p.59 / Chapter 3.2 --- "Associations between Serum Triglyceride, LDL Particle Size and LDL Oxidisability" --- p.60 / Chapter 3.3 --- "Effect of single drug and combination drug therapy on lipids, lipoproteins and apolipoproteins" --- p.64 / Chapter 3.3.1 --- Quantitative Changes of Lipids and Lipoproteins --- p.64 / Chapter 3.3.2 --- Qualitative changes of LDL particles --- p.65 / Chapter 4. --- Discussion --- p.74 / Chapter 4.1 --- "Associations between Triglyceride concentration, HDL Cholesterol concentration, LDL oxidisability and Particle Size" --- p.74 / Chapter 4.2 --- Effects of Fluvastatin and Gemfibrozil on Combined Hyperlipidaemic Patients --- p.76

Sit Ling. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 135-150). / Abstracts in English and Chinese. / Acknowledgment --- p.i / Abbreviations --- p.ii / Abstract --- p.v / Chinese Abstract --- p.vii / Table of Content --- p.ix / Chapter Chapter one: --- General Introduction --- p.1 / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Definition of Dietary Fiber --- p.1 / Chapter 1.3 --- Classification of Dietary Fiber --- p.2 / Chapter 1.4 --- Hypocholesterolemic Effects of Soluble Dietary Fibers --- p.3 / Chapter 1.5 --- Proposed Mechanisms for Hypocholesterolemic Effects --- p.4 / Chapter 1.5.1 --- Alter Eating Pattern --- p.4 / Chapter 1.5.2 --- Delay Gastric Emptying --- p.4 / Chapter 1.5.3 --- Modify Lipid Digestion and Absorption --- p.5 / Chapter 1.5.4 --- Effects of SCFA on Lipid Metabolism --- p.6 / Chapter 1.5.5 --- Enhance Bile Acid Excretion --- p.7 / Chapter 1.6 --- Auricularia polytricha --- p.8 / Chapter Chapter Two: --- Chemical Analysis of Auricularia polytrica --- p.11 / Chapter 2.1 --- Introduction --- p.11 / Chapter 2.2 --- Materials and Methods --- p.12 / Chapter 2.2.1 --- Extraction and Fractionation of Auricularia polytricha --- p.12 / Chapter 2.2.2 --- Determination of Carbohydrate Content --- p.12 / Chapter 2.2.3 --- Determination of Protein Content --- p.13 / Chapter 2.2.4 --- Determination of Uronic Acid Content --- p.13 / Chapter 2.2.5 --- Determination of Molecular Weight by Gel Filtration Chromatography --- p.14 / Chapter 2.2.6 --- Determination of Monosaccharide Components by HPLC --- p.15 / Chapter 2.3 --- Results --- p.18 / Chapter 2.3.1 --- Yield of Auricularia polytricha polysaccharides --- p.18 / Chapter 2.3.2 --- Carbohydrate Content of APPs --- p.18 / Chapter 2.3.3 --- Protein Content of APPs --- p.18 / Chapter 2.3.4 --- Uronic Acid Content of APPs --- p.19 / Chapter 2.3.5 --- Molecular Weight of APPs --- p.22 / Chapter 2.3.6 --- Monosaccharide Components of APPs --- p.27 / Chapter 2.4 --- Discussion --- p.33 / Chapter Chapter Three: --- Hypolipidemic Effects of APPs --- p.36 / Chapter 3.1 --- Introduction --- p.36 / Chapter 3.2 --- Materials and Methods --- p.38 / Chapter 3.2.1 --- Golden Syrian Hamster --- p.38 / Chapter 3.2.2 --- Animal Experiments --- p.40 / Chapter 3.2.2.1 --- Protective Effect and Dose Response of APPs (Exp. 1) --- p.40 / Chapter 3.2.2.2 --- Therapeutic Effect of APPs (High-cholesterol Diet) (Exp. 2) --- p.40 / Chapter 3.2.2.3 --- Therapeutic Effect of APPII (Normal Diet) (Exp. 3) --- p.41 / Chapter 3.2.2.4 --- Effect of APPs on HMG-CoA Reductase and AC AT Activity (Exp. 4) --- p.42 / Chapter 3.2.3 --- Determination of Plasma AST and ALT --- p.42 / Chapter 3.2.4 --- "Determination of Plasma TC, LDL-C, HDL-C and TG" --- p.43 / Chapter 3.2.5 --- Quantitative Determination of Hepatic and Heart Cholesterol --- p.43 / Chapter 3.2.6 --- Quantitative Determination of Perirenal Adipose Tissue Triglyceride --- p.44 / Chapter 3.2.7 --- Statistical analysis --- p.45 / Chapter 3.3 --- Results (Exp. 1) --- p.47 / Chapter 3.3.1 --- Food Intake and Growth --- p.47 / Chapter 3.3.2 --- Effect of APPs on Plasma AST and ALT --- p.47 / Chapter 3.3.3 --- "Effect of APPs on Plasma TC, LDL-C, HDL-C and TG" --- p.53 / Chapter 3.3.4 --- Effect of APPs on Hepatic and Heart Cholesterol --- p.59 / Chapter 3.4 --- Discussion (Exp. 1) --- p.64 / Chapter 3.5 --- Results (Exp. 2) --- p.67 / Chapter 3.5.1 --- Food Intake and Growth --- p.67 / Chapter 3.5.2 --- Effect of APPs on Plasma AST and ALT --- p.67 / Chapter 3.5.3 --- "Effect of APPs on Plasma TC, LDL-C, HDL-C and TG" --- p.67 / Chapter 3.5.4 --- Effect of APPs on Hepatic and Heart Cholesterol --- p.71 / Chapter 3.6 --- Discussion (Exp. 2) --- p.74 / Chapter 3.7 --- Results (Exp. 3) --- p.76 / Chapter 3.7.1 --- Food Intake and Growth --- p.76 / Chapter 3.3.2 --- Effect of APPII on Plasma AST and ALT --- p.76 / Chapter 3.7.3 --- "Effect of APPII on Plasma TC, LDL-C, HDL-C and TG" --- p.76 / Chapter 3.7.4 --- Effect of APPII on Hepatic and Heart Cholesterol --- p.80 / Chapter 3.8 --- Discussion (Exp. 3) --- p.83 / Chapter Chapter Four: --- Influences of APPs on Cholesterol Homeostasis --- p.84 / Chapter 4.1 --- Introduction --- p.84 / Chapter 4.2. --- Materials and Methods --- p.87 / Chapter 4.2.1 --- HMG-CoA Reductase Activity Assay --- p.87 / Chapter 4.2.1.1 --- Preparation of Hepatic Microsome --- p.87 / Chapter 4.2.1.2 --- HMG-CoA Reductase Activity Assay --- p.87 / Chapter 4.2.2 --- ACAT Activity Assay --- p.88 / Chapter 4.2.2.1 --- Preparation of Hepatic and Intestinal Microsome --- p.89 / Chapter 4.2.2.2 --- ACAT Activity Assay --- p.89 / Chapter 4.2.3 --- Quantitative Determination of Neutral and Acidic Sterols --- p.90 / Chapter 4.2.3.1 --- Extraction of Neutral and Acidic Sterols --- p.90 / Chapter 4.2.3.2 --- Conversion of Neutral Sterols to its TMS-Ether Derivative --- p.91 / Chapter 4.2.3.3 --- Conversion of Acidic Sterols to its TMS-Ether Derivatives --- p.91 / Chapter 4.2.3.4 --- GLC Analysis of Neutral and Acidic Sterols --- p.92 / Chapter 4.3 --- Statistic Analysis --- p.93 / Chapter 4.4 --- Results (Exp. 4) --- p.94 / Chapter 4.4.1 --- Effect of APPs on Hepatic HMG-CoA Reductase Activity --- p.94 / Chapter 4.4.2 --- Effect of APPs on Hepatic and Intestinal AC AT Activity --- p.94 / Chapter 4.4.3 --- Effect of APPs on Fecal Excretion (Exp. 1 & 4) --- p.98 / Chapter 4.5 --- Discussion (Exp. 4) --- p.105 / Chapter Chapter Five: --- Hypolipidemic and Antiatherosclerotic Effect of APPII in Rabbit --- p.110 / Chapter 5.1 --- Introduction --- p.110 / Chapter 5.2 --- Materials and Methods --- p.113 / Chapter 5.2.1 --- New Zealant White Rabbit --- p.113 / Chapter 5.2.2 --- Hypolipidemic and Anitatherosclerosis Effect of APPII (Exp. 5) --- p.113 / Chapter 5.2.3 --- Measurement of Atheroma Formation --- p.115 / Chapter 5.3 --- Results (Exp. 5) --- p.117 / Chapter 5.3.1 --- Food Intake and Growth --- p.117 / Chapter 5.3.2 --- Effect of APPII on Plasma AST and ALT --- p.117 / Chapter 5.3.3 --- "Effect of APPII on Plasma TC, LDL-C, HDL-C and TG" --- p.117 / Chapter 5.3.4 --- Effect of APPII on Hepatic and Heart Cholesterol --- p.125 / Chapter 5.3.5 --- Effect of APPII on Perirenal Adipose Tissue Triglycerige Composition --- p.125 / Chapter 5.3.6 --- Effect of APPII on the Formation of Atheroma --- p.125 / Chapter 5.4 --- Discussion (Exp. 5) --- p.130 / Chapter Chapter Six: --- Conclusion --- p.132 / References --- p.135