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OBJECTIVE： To systematically evaluate the effects of dual-antiplatelet medication time on efficacy and safety of postoperative complications after transcatheter aortic valve implantation （TAVI）， and to provide evidence-based reference for the formulation of antiplatelet therapy after TAVI. METHODS： Retrieved from Cochrane clinical controlled trial registration center， PubMed， Embase， Web of Science， Wanfang database and CJFD， during database establishment to Feb. 2019， RCTs and observational study about efficacy （all-cause mortality and incidence of stroke） and safety （the incidence of major bleeding events） the effects of dual-antiplatelet therapy for postoperative complications after TAVI at different time points were collected. After data extraction of clinical studies met inclusion criteria， quality evaluation with Cochrane bias risk evaluation tool 5.1.0 （for RCT） or Newcastle- Ottawa Scale （for observational study）， Meta-analysis was conducted by using Rev Man 5.3 and Stata 14.0 statistical software. Meta-regression analysis was also conducted for outcome and different treatment duration. RESULTS： A total of 3 RCTs and 10 observational studies were included， involving 2 868 patients. The results of Meta-analysis showed that the incidence of all-cause mortality one month and 6 months after medication were 0.05 [95％CI （0.03， 0.07）， P＜0.001] and 0.07 [95％CI （0.05， 0.08）， P＜0.001]. The incidence of major bleeding events 1， 3 and 6 months after medication were 0.14 [95％CI （0.08，0.19）， P＜0.001]， 0.11 [95％CI （0.03， 0.19）， P＝0.007] and 0.13 [95％CI （0.05， 0.22）， P＝0.002]. The incidence of stroke after one month after medication was 0.04 [95％CI （0.03， 0.05）， P＜0.001]. Results of Meta-regression analysis showed that the all-caused mortality [regression coefficient＝0.005 7， 95％CI （－0.001 6， 0.013 0）， P＝0.116]， major bleeding [regression coefficient＝－0.000 5，95％CI（－0.022 4，0.021 4）， P＝0.959] or the incidence of stroke [regression coefficient＝0.001 4， 95％CI （－0.003 8， 0.006 5）， P＝0.570] were not related to medication duration of dual-antiplatelet therapy. CONCLUSIONS： The prolongation of the medication time of the dual-antiplatelet therapy has no significant effect on the efficacy and safety of TAVI.
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OBJECTIVE： To systematically evaluate effectiveness and safety of single antiplatelet therapy （SAPT） versus dual antiplatelet therapy （DAPT） on short-term complications after transcatheter aortic valve implantation （TAVI）， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Cochrane clinical controlled trials registry， Web of Science， CNKI， Wanfang database， CBM and Chinese Clinical Trial Registry， RCTs and observational studies about effectiveness （all-cause mortality， incidence of stroke and incidence of myocardial infarction 30 days after operation） and safety （the incidence of bleeding events at 30 days after operation） of SAPT versus DAPT on short-term complications of TAVI were collected during the date of database establishment to Jan. 2019. After data extraction of included studies and quality evaluation with Cochrane system evaluator manual 5.1.0 （for RCT） and the Newcastle-Ottawa Scale （NOS） （for observational studies）， Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS： Totally 3 RCTs and 7 cohort studies were included， involving 3 188 patients. Results of Meta-analysis showed that the incidence of all-cause mortality 30 days after operation [OR＝0.48， 95％ CI （0.32， 0.73）， P＜0.001] and the incidence of bleeding events 30 days after operation [OR＝0.43， 95％CI （0.30， 0.59）， P＜0.001] in SAPT group were significantly lower than DAPT group， with statistical significance. There was no statistical significance in the incidence of stroke 30 days after operation [OR＝0.63， 95％CI （0.38， 1.06） ， P＝0.08] or the incidence of myocardial infarction 30 days after operation [OR＝1.09， 95％CI （0.46， 2.59）， P＝0.85] between 2 groups. CONCLUSIONS： Compared with DAPT， SAPT can decrease the incidence of all-cause mortality 30 days after TAVI and the incidence of bleeding events 30 days after TAVI.
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Objective To compare the clinical characteristics,and outcomes of patients with heart failure with different left ventricular ejection fractions (LVEF).Methods A total of 1 182 hospitalized patients with heart failure (HF) were enrolled and retrospectively studied in the present study.The patients were stratified by LVEF as reduced (HFrEF,LVEF ＜ 40％,n =313),mid-range (HFmrEF,40％ ≤ LVEF ＜50％,n =287) and preserved (HFpEF,LVEF≥50％,n =582) ejection fraction groups.Among the 1 182 cases,941 of them (81.3％,84.9％,and 84.0％ inHFrEF,HFmrEF and HFpEF groups,respectively) were followed up for an median duration of 27.3 months.Results (1) Among the study patients,26.5％ were in HFrEF,24.3％ in HFmrEF,and 49.2％ in HFpEF groups.(2) Ischemic heart disease with HFmrEF was more frequent than that in patients with HFrEF.The average age,percentage of female subjects,systolic blood pressure,uric acid,N terminal B-type natriuretic peptide precursor (NT-proBNP),hemoglobin,and the incidence of hypertensive heart disease,anemia,atrial fibrillation in patients with HFmrEF were higher than those in patients with HFrEF,but lower than those in patients with HFpEF (all P ＜0.01).(3) The all-cause cumulative mortality was 10.8％ at 1 year,20.6％ at 2 years and 35.9％ at 5 years.No difference was observed in the all-cause cumulative mortality at 1 year,2 years,5 years among the three groups (all P ＞ 0.05).Conclusions The HFmrEF patients,as a new and distinct group,were with many intermediate characteristics compared with HFrEF and HFpEF subjects.However,the all-cause mortality was not significantly differeut among HF patients with different LVEF.
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PURPOSE: Evidence on the contribution of genes to the hereditary predisposition to pulmonary arterial hypertension (PAH) is limited. MATERIALS AND METHODS: In this study, we hypothesized that single nucleotide variants in vascular endothelial growth factor (VEGF) gene may alter gene function and expression and may be associated with PAH risk. Five putatively functional loci (rs699947C>A and rs833061T>C in the promoter, rs3025040C>T, rs10434G>A and rs3025053G>A in the 3'-UTR) in the VEGF gene were genotyped and analyzed in a retrospective study of 587 patients with PAH and 736 healthy subjects from southern China. RESULTS: We found that the rs833061T>C polymorphism was significantly associated with PAH risk, while the other single nucleotide polymorphisms were not. Compared to carriers with TT genotype, those with rs833061C variant genotype (CT/CC) had an increased risk of PAH (odds ratio=1.47, 95% confidence interval=1.18–1.83, p=0.001). Functional assays indicated that CT/CC variant genotype had significantly higher mRNA levels of VEGF in peripheral blood mononuclear cells than TT genotype (p=0.021). Luciferase reporter assay indicated that having a C allele conferred a significantly higher transcription activity than that with a T allele. CONCLUSION: Our findings suggest that the functional polymorphism rs833061T>C in VEGF gene promoter modulates VEGF expression and may be a valuable biomarker for predicting PAH susceptibility.
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Humans , Alleles , Asian People , China , Genotype , Healthy Volunteers , Hypertension , Luciferases , Polymorphism, Single Nucleotide , Retrospective Studies , RNA, Messenger , Vascular Endothelial Growth Factor AABSTRACT
Objective: To explore the relationship between serum levels of immunoglobulin E (IgE) and calciifc aortic valve disease (CAVD) in relevant patients. Methods: A total of 394 patients were enrolled in our study. Based on echocardiography presentation, the patients were divided into 2 groups: CAVD group,n=169 and Non-CAVD group,n=225. Serum levels of IgE were examined by chemiluminescence method. The IgE levels were compared between 2 groups and the relationship between serum IgE level and CAVD was analyzed. Results: Serum levels of IgE in CAVD group was significantly higher than Non-CAVD group 113.30 IU/ml vs 63.76 IU/ml (P Conclusion: Serum IgE level is obviously increased in CAVD patients. IgE is an independent biochemical indicator of CAVD, it may play the important role in CAVD pathogenesis.
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Objective To investigate the expression of pro-irtilammatory mediator in peripheral blood of patients with severe sepsis treated by different therapeutic dose of high-volume hemofiltration (HVHF). Methods According to the standard of severe sepsis, 83 cases were randomly divided into three groups, A group [60 ml/(kg·h)], S group[80 ml/(kg·h)], C group[100 ml/(kg·h)], respectively. The levels of TNF-α, IL-1, IL-8 in plasma of patients were measured by enzyme-linked immunosorbent assay (ELISA) before treatment and at 2, 4, 6, 8, 10 h after treatment, and the grades of APACHEⅢ were evaluated at every time-point simultaneously. Results The grades of APACHEⅢ were lower after treatment than those before treatment (P<0.05), but the decreases between every group had no significant deviation (P>0.05). The levels of TNF-Ⅲ, IL-1, IL-8 in plasma of patients were all decreased gradually after treatment. Compared with those before treatment, the levels of TNF-α,IL-1 and IL-8 at 2, 4 and 6 h after HVHF were obviously decreased (P<0.05). The levels of TNF-α, IL-1 and IL-8 were lightly increases at 4 and 6 h after HVHF, but they were lower that those before treatment (P<0.05). At every time-point, the levels of TNF-α, IL-1, IL-8 trended to decrease following the increase, of displacement liquid volume, the mean levels of pro-inflammatory mediator in C group were markedly reduced compared with the levels in A group (P<0.05). Conclusion HVHF can decrease the levels of pro-inflammatory mediator in peripheral blood of patients with severe sepsis and the grades of APACHEⅢ, the more the therapeutic dose of HVHF, the lower the levels of pro-inflammatory mediator.
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0.05).As compared with pre-treatment,The bcore of the two gromps were significantly decreased,but were more quickly decreased in group B(P0.05).Conclusions Xuebijing Zhusheye can improve curative effect and degrade the case-fatality rates in the elderly with sepsis.The possible mechanism may be associated with the decreased serum TNF?,IL-1? and IL-6 levels and the increased IL-10 levels.