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Echinococcosis is a serious zoonotic parasitic disease caused by infections with larval Echinococcus. The life cycle of Echinococcus involves a variety of animal hosts, including hoofed animals and rodents as intermediate hosts and carnivores as definitive hosts. The transmission of human echinococcosis is closely associated with the life cycle of E. granulosus and E. multilocularis among animal hosts in nature. This review summarizes the recent advances in the prevalence and influencing factors of E. granulosus and E. multilocularis infections in animal hosts, so as to provide insights into precision control of echinococcosis.
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OBJECTIVE@#To investigate the combined anti-inflammatory effect of activating blood circulation and detoxifying Chinese medicines in unstable angina (UA) patients.@*METHODS@#This study was an open-labeled, randomized controlled trial conducted in 5 centers in Beijing. A total of 154 patients were randomized into two groups at a 1:1 ratio by random numbers. Based on the conventional treatment, patients in the activating blood circulation (ABC) group were treated with Guanxin Danshen Droping Pill (, 0.4 g, thrice daily), and patients in the activating blood circulation and detoxifying (ABCD) group were treated with Guanxin Danshen Droping Pill (0.4 g, thrice daily) and Andrographis tablet (0.2 g, thrice daily) for 4 weeks. The primary outcome was the serum level of high sensitive C reaction protein (hs-CRP), and the secondary outcome index included the serum levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), soluble CD40 ligand (sCD40L), thrombomodulin (TM), the score of angina pectoris, the score of blood stasis syndrome, and the score of Chinese medicine symptoms, observed at week 0 and week 4.@*RESULTS@#A total of 144 patients completed the trial (ABC group, n=70; ABCD group, n=74). There were no significant differences in the clinical baseline characteristics between the two groups. When compared with the ABC group, ABCD group showed better performance in reducing the level of inflammatory factors, especially hs-CRP (P<0.05), IL-6 (P<0.01) and TNF-α (P<0.01). In term of clinical symptoms, ABCD group played a better role in improving the scores of angina pectoris and blood stasis syndrome than ABC group (all P<0.05).@*CONCLUSIONS@#The combination of Guanxin Danshen Dropping Pill and Andrographis tablet exert significant anti-inflammatory effect on UA patients, which is superior to single Guanxin Danshen Dropping Pill. (Registration No. ChiCTR-TRC-13004072).
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Humans , Angina Pectoris/drug therapy , Angina, Unstable/drug therapy , Anti-Inflammatory Agents/therapeutic use , China , Drugs, Chinese Herbal/therapeutic use , Percutaneous Coronary InterventionABSTRACT
Objective To analyze the advantages, disadvantages, opportunities and challenges for schistosomiasis elimination in Laos, so as to propose the corresponding healthy policies and suggestions. Methods A SWOT analysis was performed to analyze the strength, weakness, opportunity and threat for the schistosomiasis elimination program in Laos, and the corresponding policy suggestions were proposed. Results The national schistosomiasis elimination program of Laos receives governmental emphases and great supports. A strategy based on mass drug administration was proposed and a sentinel site-bases surveillance system has been built for schistosomiasis elimination in Laos; however, there are several challenges for the national schistosomiasis elimination program in Laos, including insufficient financial supports, inadequate professional capability, weak schistosomiasis control awareness in community populations and difficulty in vector control. Conclusions Persistent governmental leadership, increasing financial supports, strengthening professional team building and improving schistosomiasis control awareness in community populations are required to facilitate the progress towards schistosomiasis elimination in Laos.
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Objective: To screen the differentially expressed proteins of saponins in Pulsatillae Radix inhibiting the proliferation and induce apoptosis on NCI-H460 tumor cells based on proteome technology using nano LC-LTQ-Orbitrap-MS/MS, and preliminarily speculate the potential mechanism. Method: NCI-H460, SK-OV-3 and SGC-7901 tumor cells were cultured in vitro. Methylthiazoletetrazolium (MTT) assay was used to detect the inhibitory rate of saponins in Pulsatillae Radix on three tumor cell lines. Effect of saponins in Pulsatillae Radix on apoptosis was analyzed by Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining flow cytometry and 4',6-diamidino-2-phenylindole (DAPI) staining. Apoptosis was analyzed using flow cytometry and DAPI stain. Nano LC-LTQ-Orbitrap-MS/MS was used to investigate the changes in the protein profiles on NCI-H460 cells treated with saponins in Pulsatillae Radix. Proteins exhibiting differential expression were analyzed by DAVID Bioinformatics Resources 6.8 and Kyoto encyclopedia of genes and genomes (KEGG) database. The differentially expressed proteins were verified by Western blot. Result: Saponins in Pulsatillae Radix could inhibit the proliferation of NCI-H460, SK-OV-3 and SGC-7901 tumor cells and induce apoptosis of NCI-H460 tumor cells. Effect of Saponins in Pulsatillae Radix on the proliferation and apoptosis of NCI-H460 tumor cells was mainly related to the regulation of biological function of ribosome, glycolysis/gluconeogenesis and other biological processes. It was possible to induce apoptosis of NCI-H460 tumor cells by interfering mitogen-activated protein kinase (MAPK) signaling pathway and regulating the Caspase pathway. Conclusion: Saponins in Pulsatillae Radix can inhibit the proliferation and induce the apoptosis of NCI-H460 tumor cells, the mechanism may be related to the intervention of MAPK signaling pathway and the regulation of Caspase pathway. These findings are helpful to elucidate the molecular mechanism of the anti-tumor effect of saponins in Pulsatillae Radix.
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Objective: The study was designed to investigate the antitumor effect of Pulsatilla chinensis saponins components and the synergistic effect of its effect components on tumor glycolysis. Methods: NCI-H460 cell lines were cultured in vitro, MTT assay was used to detect the inhibitory rate of various components of Pulsatilla chinensis saponins. The compatibility and synergistic antitumor effect of different effect components were studied by Calcusyn 3.0 software. Biochemical assay and Elisa assay were used to detect the glycolysis related metabolites (pyruvate, lactic acid, and glucose) and enzymes (GLUT1, HK, PKM2, and LDHA). Energy metabolism related gene members from KEGG pathway database and key protein (ERK1/2, Ras, GLUT1, MCT4) were detected by qRT-PCR and Western blotting. Results: The antitumor results in vitro showed that PSD, R13 and PSA in Pulsatilla chinensis saponins had the strongest antitumor activity for human lung cancer NCI-H460 cells and the IC50 were 5.2, 4.6, and 7.9 μg/mL, respectively. Using Calcusyn 3.0 software to confirm the distribution ratio of three effective monomers in Pulsatilla chinensis saponins and determine the synergistic antitumor effect after compatibility. The results of biochemical and Elisa assay showed that the content of pyruvate, lacate, glucose, HK, PKM2 and LDHA were significantly decreased and the GLUT1 content was significantly increased compared with the blank group (P < 0.05),; Compared with each monomer group, the content of pyruvic acid, lactic acid, glucose, HK, PKM2 and LDHA in the combined group were significantly decreased and the content of GLUT1 was significantly increased (P < 0.05). Real-time PCR results show that the combinations group has the most nodes in the network diagram, and its target was more than each monomer group. Western blotting results showed that compared with the blank group, the combinations group significantly decreased the expression of ERK1/2, Ras, GLUT1, and MCT4 protein (P < 0.05). Conclusion: The combination of effect components of Pulsatilla chinensis saponins has synergistic antitumor effect on NCI-H460 cells and the antitumor mechanism may be associated with the regulation of glycolysis.
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The best time of tumor intervention is before the formation of tumor. However,due to the limited number of tumor cells,it is difficult to quantify tumor cells and immunity by the current methods available( such as CTC,ct DNA). This affects the tumor prevention in this period,and the in-depth detection,intervention and evaluation of traditional Chinese medicine( TCM)( tumor) prevention. Due to the limitations of the current detection,the evaluation system turns to detect tumor neoantigen-specific CTL( naCTL) that are directly relating to tumor cells and proliferate to high order of magnitudes after activation,and immune repertoire( TCR/BCR/HLA) effective diversity,introduces immune checkpoints,uses information of " disease" in Western medicine and " syndrome" in TCM( prevention),and sets up a multi-dimensional statistical immunity model using a variety of data analysis and related algorithms. This model can amplify the ultra-early information of tumor,indirectly evaluate the quantity and status of tumor cells,and provide quantitative measurement and new evaluation methods for the normalization of immunity and TCM( tumor) prevention. This model is not only one of important evaluation methods for resisting tumor immunity and treating TCM( tumor) prevention,but also will reveal the scientific connotation of TCM syndrome from the perspective of immunology.
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Humans , Drugs, Chinese Herbal , HLA Antigens , Medicine, Chinese Traditional , Neoplasms , Allergy and Immunology , Receptors, Antigen, B-Cell , Receptors, Antigen, T-CellABSTRACT
Objective: The study was designed to investigate the molecular mechanism of quercitrin on osteogenic differentiation and adipogenic differentiation of rBMSCs. Methods: rBMSCs were harvested from SD rats, and determination of alkaline phosphatase (ALP) activity, quantification of mineralization by Alizarin Red S staining, and the mRNA expression of osteogenic differentiation markers (Runx2, BMP-2, and OSX) by RT-PCR after rBMSCs stimulated by osteogenic induction with (0.1–10) µg/mL of quercitrin, quantification of Lipid droplet by Oil Red O staining and the mRNA expression of adipogenic differentiation marker (PPARγ C/EBPα and aP2) by RT-PCR after rBMSCs stimulated by adipogenic induction with (0.1-10) µg/mL of quercitrin. Results: Quercitrin can up-regulate the mRNA expression of osteogenic differentiation markers (Runx2, BMP-2, and OSX) and increase ALP activity and mineralization after osteogenic induction, on the other hand quercitrin can suppress the mRNA expression of adipogenic differentiation markers (PPARγ C/EBPα and aP2) and decrease lipid droplet after adipogenic induction. Conclusion: This study suggested that quercitrin not only stimulated osteogenic differentiation but also inhibited adipogenic differentiation of rBMSCs, which was associated with the up-regulation of Runx2, BMP-2, and OSX mRNA expression and the down-regulation of PPARγ C/EBPα and aP2 mRNA expression.
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Based on the systematic summary of the results of the fourth general survey of traditional Chinese medicine resources, the cultivation of large varieties of Chinese material medica and the latest research on health industrial development, the novel concepts and scientific connotations of generalized science of Chinese material medica are put forward, and the basic ideas and methods of a new Chinese medicine academic system, the cultivation system of large varieties of Chinese medicinal materials and the application system of the large health industry are constructed. This kind of generalized science of Chinese material medica, rooted in the traditional Chinese culture and the theory of "preventive treatment of disease", can avoid the narrow prospect induced by the increasing specialization and refinement of knowledge of science of Chinese material medica. It will play an important role in the modernization, industrialization, internationalization of traditional Chinese medicine.
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Humans , Drug Industry , Materia Medica , Therapeutic Uses , Medicine, Chinese Traditional , ResearchABSTRACT
For the basic research on the traditional Chinese medicine(TCM), objective syndrome of traditional Chinese medicine and evaluation criteria of traditional Chinese medicine compounds are hardly to break though. While, the modern immunology points out that the body is a counterbalance state and immune imbalance is the root of sickness. The thinking mode of treating diseases in traditional Chinese medicine is also "balance", considering disease is the result of bias which present the imbalance of "Yin counters Yang", "exterior counters interior", "cold counters heat" and "weak counters strong". The Chinese herbal compound formula preparation was applied on disease therapy based on theory of Chinese medicine, which was confirmed by long period clinical application. It is composed of multi-compounds and has the characteristic of multi-targeting. Integrative medicine has spawned pan-immunomics, and the evaluation of immune function (immune balance) has become an important basis for diagnosis and treatment models of integrative medicine. In addition, balance is the core idea of whole-systemic conception of traditional Chinese medicine. Therefore, we speculate that immune balance under pan-immunomic can bridge the traditional Chinese medicine and modern integrative medicine and is the important basis for objective syndrome of traditional Chinese medicine and evaluation criteria of traditional Chinese medicine compounds. According to the bridging theory, we attempt to utilize informatics and statistical methods to construct an evaluation system for pharmacodynamics of traditional Chinese medicine based on its moderate regulation and the balanced adjustment of immunity under pan-immunomic, which further reveal the scientific essence of the whole-systemic view of traditional Chinese medicine. This research brings out a new valuable strategy and provides a theoretical basis for accelerating the transformation of traditional Chinese medicine, especially the exploitation of Chinese herbal compound formula, and constructing the new drug innovation and review system for traditional Chinese medicine. Besides as a reference for traditional Chinese medicine objective syndrome and pharmacodynamics of traditional Chinese medicine compounds, the evaluation system can screen the immunity of sub-health population also. With the continuous accumulation of clinical sample and data, the evaluation system will be more accurate and intelligent.
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Humans , Drugs, Chinese Herbal , Pharmacology , Immune System , Medicine, Chinese Traditional , Syndrome , Yin-YangABSTRACT
Objectives To understand the risk factors of cystic echinococcosis in Tibetan population,so as to provide the reference for development of prevention and control strategies.Methods Four cystic echinococcosis highly-prevalent townships were selected from Naqu County of Tibet and Shiqu County of Sichuan Province,which had similar environmental and altitude conditions,from August to September,2017.Applying the 1:1 case-control study,a household survey was conducted to investi-gate the risk factors of echinococcosis in humans. Results A total of 378 residents were investigated,of which the numbers of cases and non-cases were both 189.The univariate analysis showed that the years of keeping dogs(OR=1.032,P<0.05),the number of keeping dogs(OR=1.260,P<0.05),the way of raising dogs(OR=1.434,P<0.05),feeding with raw viscera (OR=1.531,P<0.05),and there being stray dogs around(OR=1.946,P<0.05)were the risk factors of echinococcosis.As a result of the multivariate logistic regression analysis,only three risk factors,feeding with raw viscera,there being stray dogs around,and drinking water resource,were included in the regression model.Conclusion Feeding with raw viscera,there be-ing stray dogs around,and drinking water resource are the risk factors of echinococcosis in humans.
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Objective To investigate the effect of short-term global health training on tropical diseases in China,so as to provide the reference in professional trainings.Methods The study took the short-term global health training project on tropical diseases in China as an example.The structured questionnaires were distributed to each trainee pre-and post-training course. Results A total of 89 trainees were included in the survey,and 68.5%(61 cases)of the trainees were older than 35 years and 85.4%(76 cases)of the trainees came from provincial institutes.The passing rate for the test of global health knowledge was sig-nificantly improved from the pre-training test(18.0%,16/89)to the post one(68.2%,58/85)(χ2=44.930,P<0.05).The knowledge of global health was closely related to the professionals'capacity,i.e.,the education level,age,professional title, and experience of international cooperation,but was not statistically related to their genders. Conclusion This kind of short-term trainings not only greatly improves the professionals'knowledge of tropical diseases control,but also is expected to play a leading role in the international cooperation of global health and tropical diseases control in the future.
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The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses(RNAS+)plays an important role in promoting the research and control of helminthes in Asia.The development course of RNAS+is summarized in this article and the information of RNAS+annual meeting is collected.The questionnaire survey and expert interview are used to evaluate the role of RNAS+in promoting the prevention and control of helminthes in various Asian countries.The experience of RNAS+operation and its future development are summarized.
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The present study was designed to evaluate the cardioprotective effect of latifolin on pituitrin(Pit) or isoproterenol(ISO)-induced myocardial injury in rats, and further investigate its underlying mechanisms. Rats were administrated sublingually with pituitrin or subcutaneously with isoproterenol to induce acute myocardial ischemia in rats, and lead II electrocardiograph was recorded. In rats with isoproterenol, ELISA assay or colorimetric method was used to detect the content or activity of myocardial injury markers in serum, and the SOD activity and MDA content in myocardium were detected by colorimetric assay; histopathological examination was conducted by HE staining; the frozen section of myocardial tissues was used for DCFH-DA fluorescent staining to detect the content of ROS in myocardium; Western blot was used to detect the protein expression levels of Nrf2, Keap1, HO-1 and NQO1 in myocardium. Results showed that latifolin significantly inhibited ST-segment changes induced by pituitrin or isoproterenol, and increased heart rate. Further mechanism study showed that latifolin reduced cardiac troponin I(cTnI) level, aspartate transaminase(AST) and lactate dehydrogenase(LDH) activities in serum, increased myocardial superoxide dismutase(SOD) activity and reduced myocardial malondialdehyde(MDA) level, and protected myocardium with less necrosis, infiltration of inflammatory cells and fracture of myocardial fibers. Furthermore, latifolin obviously reduced ROS level in myocardium, inhibited the expression of Kelch-like ECH-associated protein-1(Keap1), increased the nuclear translocation of nuclear factor erythroid 2 related factor 2(Nrf2), and promoted the expression of Heme oxygenase-1(HO-1) and NAD(P)H quinone oxidoreductase-1 (NQO1) in myocardial tissues. Our data suggest that latifolin has a potent protective effect against pituitrin or isoproterenol-induced myocardial injury, which may be related to inhibition of oxidative stress by activating Nrf2 signaling pathway.
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Objective To evaluate the effect of the bird exercises of Wuqinxi bird exercises combined with simple breath exercises on the quality of life and immune function in patients with chronic obstructive pulmonary disease (COPD). Methods Sixty-eight COPD patients were allocated into observation group (N=32) and control group (N=36)according to the intention of the patients. The control group was given conventional inhalation of Seretide and Tiotropium Bromide,and the observation group did Wuqinxi bird exercises and simple breath exercises plus the conventional inhalation therapy. Before and after treatment,we compared the BODE indexes such as body mass index (BMI), air flow obstruction index of forced expiratory volume in one second (FEV1%), dyspnea scores,exercise capacity (6-min walking distance)as well as COPD assessment test (CAT)scores between the two groups before and after treatment. Meanwhile, the changes of T lymphocyte subtype CD3, CD4, CD8, CD4/CD8 levels and serum immunoglobulin M (IgM),IgA,IgG levels were also monitored. Results(1)After intervention, dyspnea scores of the observation group were obviously improved (P < 0.01), while the control group showed no obvious changes in dyspnea scores (P > 0.05). The observation group had better effect on improving dyspnea scores and 6-min walking distance than the control group (P < 0.05 or P <0.01).(2)After intervention,BODE index and CAT scores were improved in the observation group(P<0.01),BODE index was improved in the control group (P < 0.05), and the improvement of BODE index and CAT scores in the observation group was superior to that in the control group (P < 0.05 or P < 0.01). (3)After intervention, T lymphocyte subtype CD3 and CD4 levels as well as the serum IgM, IgA, IgG levels in the observation group were increased (P < 0.05 or P < 0.01),and IgA level in the control group was also increased (P < 0.05). The observation group had stronger effect on increasing T lymphocyte subtype CD3 and CD4 levels than the control group(P < 0.05 or P < 0.01).(4)The difference of adverse reaction incidence was insignificant between the two groups (P > 0.05). Conclusion Application of Wuqinxi bird exercises and simple breath exercises based on conventional inhalation therapy is effective on improving dyspnea, 6-min walking distance, BODE index and CAT scores, and on increasing T lymphocyte subtype CD3 and CD4 levels as well as the serum IgM and IgG levels of COPD patients.
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The isotopic fingerprints of plutonium are extremely important for nuclear safeguards and nuclear forensics. An analytical method was developed for direct determination of 240 Pu / 239 Pu ratio in plutonium-containing particles by laser ablation multiple collector inductively coupled plasma mass spectrometry ( LA-MC-ICP-MS). The risk of ablated particles leakage was reduced by leak detection, exhaust hood, and swiping the laser cell. Scanning mobility particle sizer (SMPS) was used to measure the effect of ablation parameters on the size distribution of ablated particles. The results showed that the majority of ablation material presented as particles from 40 -500 nm and the sweep time after laser ablation should be longer than 15 min. The particle size was evaluated to guide LA-MC-ICP-MS system. By using external normalization method for correction of the mass fractionation correction factor and ion counter efficiencies measured by nebulizer-coupled MC-ICP-MS, a LA-MC-ICP-MS method was established for analysis of 239 Pu / 240 Pu ratio in plutonium particles. Spot size, ablation rate and laser dwell time were set at 30 μm, 5 Hz and 5 s, respectively. Laser energy density was controlled to ensure that the intensities of 239 Pu for plutonium-containing particles were about 2×104 cps and 2×105 cps, respectively. The analytical results showed that the relative uncertainties for 239 Pu / 240 Pu was less than 1. 4% ( n = 6), and the measured value deviated by less than 4. 7% from the reference value. The time for adjusting system and determining 239 Pu / 240 Pu ratio in single plutonium particle was 9 h and 0. 5 h, respectively. The results demonstrated that this technique was rapid, precise and accurate, and could be used for determination of 239 Pu / 240 Pu in plutonium-containing particles.
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Silicosis is one of the most serious occupational diseases in China and dates back to centuries ago. In this study, we successfully established a rat model of silicosis by intratracheal silica injection for 28 days and determined hydroxyproline levels to evaluate collagen metabolism in lung homogenates. Oxidative stress status was evaluated by detecting catalase and glutathione peroxidase activities. Expression levels of peroxiredoxins (Prx I and Prx VI) were detected by Western blotting. Pulmonary surfactant protein A (SP-A) levels in rat serum and lung tissue were analyzed by ELISA, and SP-A and Prx expression levels in lung tissues were detected by immunohistochemistry. The results suggest that Prx proteins may be involved in pulmonary fibrosis induced by silica. Downregulation of SP-A expression caused due to silica is an important factor in the occurrence and development of silicosis.
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Animals , Humans , Male , Rats , Disease Models, Animal , Lung , Metabolism , Oxidative Stress , Peroxiredoxin VI , Genetics , Metabolism , Peroxiredoxins , Genetics , Metabolism , Pulmonary Surfactant-Associated Protein A , Genetics , Metabolism , Silicon Dioxide , Toxicity , Silicosis , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To describe the influenza viruses antibody levels and contact patterns of individuals in rural and urban regions of Guangzhou and to understand how contact patterns and other factors would correlate with the levels on the titers of antibody.</p><p><b>METHODS</b>"Google Map" was used to randomly select the study points from the administrative areas in Guangzhou region. Each participant was required to provide 5 ml blood serum sample to be tested against different strains of H1N1 and H3N2 influenza viruses.</p><p><b>RESULTS</b>1) Using "Google map", 50 study points were selected but only 40 study points would meet the inclusion criteria. The cohort of this study consisted 856 households with 2 801 individuals. 1 821 participants (65% of the total number individuals in the cohort) completed the questionnaires. Among the 1 821 participants, 77.3% (1 407/1 821) and 22.7% (414/1 821) of them were from rural and urban areas respectively. There were more male participants in the rural but more female participants in the urban regions. Majority of the participants were from age group 18-59 followed by group 60 with aged 2-17 the least, in both rural and urban areas. 2) 78.1% (1 423/1 821) of the participants provided their serum samples. There appeared a strong correlation between age of the participants and the strength of their antibodies against that strain when a strain first circulated. In particular, seroprevalence was the highest at the age group 2-17. 3) 'Contact' was defined as persons having physical touch or/and conversation within one meter with the participants. Participants reported all having had large number of contacts. The proportion of participants having contacts with ten persons or above was the highest, ranging from 49.8% to 72.6%, particularly in age group 6-17. Compared to weekdays, participants had fewer contact persons on weekends.</p><p><b>CONCLUSION</b>There was a strong correlation between the age of participants at the time when the strains first circulated and the seroprevalence against influenza virus strains of H1N1 and H3N2. Also, age of the participants and the frequencies of their contacts to people, was also correlated.</p>
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Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Antibodies, Viral , Blood , China , Epidemiology , Contact Tracing , Influenza A Virus, H1N1 Subtype , Allergy and Immunology , Influenza A Virus, H3N2 Subtype , Allergy and Immunology , Influenza, Human , Epidemiology , Seroepidemiologic StudiesABSTRACT
<p><b>BACKGROUND</b>Coronary stents are widely used in percutaneous coronary intervention (PCI) procedures. We aimed to explore the incidence, predictors and characteristics of stent thrombosis (ST) after coronary stent implantation in routine clinical practice.</p><p><b>METHODS</b>From data of 18 063 consecutive patients who underwent successful stent implantation in Shenyang Northern Hospital from 2004 to 2010, we identified patients with definite ST (n = 140) and control patients (n = 280) matched on age, diagnosis, sex, current antiplatelet medication and stent type. The incidence, predictors and characteristics of ST after coronary stent implantation were investigated.</p><p><b>RESULTS</b>The incidence of angiographically confirmed ST was 0.78% (140/18 063). The time distribution of ST was acute in 43 (30.7%), subacute in 50 (35.7%), and late in 47 (33.6%) patients. Binary Logistic regression analysis identied the angiotensin-converting enzyme inhibitor (ACEI) (odds ratio (OR) = 0.472, 95%CI: 0.276 - 0.807, P = 0.006) and heparin (OR = 0.477, 95%CI: 0.278 - 0.819, P = 0.007) were associated with an reduced risk of cumulative ST. Stent length (OR = 1.042, 95%CI: 1.026 - 1.058, P < 0.001), serum creatinine total (OR = 1.020, 95%CI: 1.004 - 1.035, P = 0.04), cholesterol (OR = 1.267, 95%CI: 1.021 - 1.573, P = 0.032), glucose (OR = 1.086, 95%CI: 1.002 - 1.176, P = 0.044), and platelet aggregation (OR = 1.113, 95%CI: 1.075 - 1.154, P < 0.001) were associated with an increased risk of cumulative ST.</p><p><b>CONCLUSION</b>ST is associated with longer stent length and higher level of total cholesterol, glucose and platelet aggregation.</p>
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Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Angiotensin-Converting Enzyme Inhibitors , Metabolism , Coronary Angiography , Coronary Thrombosis , Epidemiology , Metabolism , Drug-Eluting Stents , Heparin , Metabolism , Logistic Models , Myocardial Infarction , Diagnostic Imaging , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To explore the effects of intensive antiplatelet therapy for patients with high on-treatment platelet reactivity (HPR) after coronary stent implantation.</p><p><b>METHODS</b>Between March 2009 and February 2011, a total of 3316 consecutive acute coronary syndrome patients undergoing drug-eluting stent implanting from 3 hospitals were enrolled. Among them, 840 patients (25.3%) were identified as HPR (defined as 20 µmol/L adenosine diphosphate induced platelet aggregation of ≥ 55% at 24 hours after administration of 300 mg clopidogrel loading dose and 300 mg aspirin). The HPR patients were randomly assigned to receive standard (aspirin 300 mg/d and clopidogrel 75 mg/d, n = 280) or intensified (n = 560) antiplatelet therapy by the ratio of 1:2. Patients in the intensive group were initially treated with a double maintenance dose of clopidogrel (150 mg/d) and aspirin (300 mg/d). After 3 days, patients with unsolved HPR received additional cilostazol treatment (50 - 100 mg, bid). The reversion rate of HPR and clinical events were observed.</p><p><b>RESULTS</b>In the intensive group, HPR reversed in 304 out of 560 patients (54.3%) at 3 days post therapy and the remaining 256 patients with HPR were treated with additional cilostazol regimen for another 3 days and the total reversion rate of HPR was 81.1% (454/560). The reversion rate of HPR at 30 days in the intensified group was significantly higher than that of the standard group (69.9% vs. 55.7%, P = 0.000). At 30 days after percutaneous coronary intervention, 1 patient suffered from subacute stent thrombosis (0.2%) in intensified group and no stent thrombosis was observed in standard group (P = 1.000). There were no death, major or minor bleeding in both two groups. Minimal bleeding was also similar in the two groups (intensive: 4.28% vs. standard: 2.14%, P = 0.166).</p><p><b>CONCLUSIONS</b>The intensified antiplatelet therapy regimens could significantly increase the reversion rate of HPR in acute coronary syndrome patients undergoing coronary stenting without increasing the risk of bleeding. The clinic impact of this strategy needs to be elucidated by long term follow-up outcome studies.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome , Therapeutics , Aspirin , Therapeutic Uses , Blood Platelets , Drug Therapy, Combination , Drug-Eluting Stents , Percutaneous Coronary Intervention , Platelet Aggregation , Platelet Aggregation Inhibitors , Therapeutic Uses , Tetrazoles , Therapeutic Uses , Ticlopidine , Therapeutic UsesABSTRACT
<p><b>BACKGROUND</b>Some larger scale, randomized studies have demonstrated the superiority of drug-eluting stents (DES) over bare metal stents (BMS) for the treatment of acute myocardial infarction (AMI). This study aimed to investigate the impact of DES, in comparison with BMS, on the 2-year clinical outcomes in patients with ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>From January 2002 to December 2008, a total of 1301 consecutive STEMI patients treated with coronary stenting in Shenyang Northern Hospital were prospectively registered. Patients received BMS (n = 868) or DES (n = 435) implantation in the infarction related artery according to physician's discretion. A propensity score analysis was performed and two well matched subgroups were selected (BMS, n = 288; DES, n = 288) to evaluate the 2-year clinical outcomes. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, myocardial infarction (MI), or target vessel revascularization (TVR).</p><p><b>RESULTS</b>Survival salvage analysis showed that 2-year cumulative hazards were not significantly different between the two groups with respect to TVR (2.8% vs. 3.1%, log-rank P = 0.780), stent thrombosis (1.7% vs. 4.2%, log-rank P = 0.079) and MACE (8% vs. 10.8%, log-rank P = 0.236). Multivariate analysis showed that DES was an independent protective factor of MI (HR: 0.211, 95%CI: 0.049 to 0.908) and stent thrombosis (HR: 0.327, 95%CI: 0.107 to 0.994).</p><p><b>CONCLUSION</b>DES was associated with similar 2-year clinical outcomes to those of BMS for the treatment of STEMI in daily practice.</p>