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@#Objective To investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data and VIP were searched from inception to August 2021. According to the criteria of inclusion and exclusion, two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. Then, Stata 16.0 software was used for meta-analysis. Subgroup meta-analysis of valve type used and study type was performed. Results Twenty-five studies (12 cohort studies and 13 single-arm studies) were included with 4 370 patients. Meta-analysis results showed that an incidence of device success was 87% (95%CI 0.81-0.92). The success rate of the new generation valve subgroup was 93% (95%CI 0.89-0.96), and the early generation valve subgroup was 66% (95%CI 0.56-0.75). In addition, the 30-day all-cause mortality was 7% (95%CI 0.05-0.10), the 30-day cardiac mortality was 4% (95%CI 0.01-0.07), the incidence of pacemaker implantation was 10% (95%CI 0.08-0.13), and the incidence of conversion to thoraco-tomy was 2% (95%CI 0.01-0.04). The incidence of moderate or higher paravalvular aortic regurgitation was 6% (95%CI 0.03-0.09). Conclusion Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results, but some limitations can not be overcome. Therefore, multicenter randomized controlled trials are needed to confirm our results.
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“Stasis generating deficiency” is considered to be an important pathogenesis of recurrence after catheter ablation of atrial fibrillation （AF）. Blood stasis is commonly seen after ablation together with various pathogens such as phlegm-fire， qi stagnation and retained fluid， and will lead to depletion of zang-fu （脏腑） organs and then the failure of the nourishment of the heart. Therefore， it is advised to emphasize on the importance of considering zang-fu organs depletion caused by blood stasis and various excess pathogens in dealing with the recurrence after catheter ablation. The method of dissolving stasis and supplementing deficiency simultaneously has been proposed before catheter ablation， and it is critical to calm heart and dissolve stasis， regulate and supplement internal deficiency so as to prevent the postoperative recurrence of AF. For recurrence of AF after ablation， attention should be paid to dissolving stasis and dispelling pathogens， regulating vessels and supplementing deficiency， as well as the excess pathogens such as stasis binding and phlegm fire， stasis binding and qi stagnation， stasis binding and retained fluid， and the depletion of zang-fu organs should be considered. Accordingly， the method of dissolving stasis and dispelling phlegm， subduing fire and unblocking vessels， regulating and supplementing heart and spleen； dissolving stasis and move stagnation， unblocking qi and blood， supplementing lung and boosting qi； dispelling stasis and dissolving rheum， warming yang and activating blood， consolidating the root and nourishing heart can be used respectively， so as to treat both the root and the branch simultaneously.
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Coronary microcirculation disorder after myocardial ischemia reperfusion （MIR） is a prominent problem in the treatment of coronary heart disease. According to the physiological commonality between “collaterals-sweat pore qi and fluid” and coronary microcirculation， and the evolution of the course of MIR， it is believed that “heart collateral stasis obstruction， sweat pore constraint and block” is the cause of coronary microcirculation disorder. The evolution of the pathogenesis can be divided into three periods. During the myocardial ischemia period， the pathogenesis is heart collaterals obstruction and sweat pores empty， while during the ischemia reperfusion period， it is internal formulation of deficiency wind， spasms of collaterals or slight heart collaterals obstruction； in the coronary microcirculation disorder period， sweat pores constraint and block， constraint transforming into heat， qi and fluid failing to diffuse are the pathogenesis. The corresponding treatment principle is assisting dredge with supplementation， and supplementing deficiency to dispel stasis； treating wind and blood simultaneously， and extinguishing wind to arrest convulsion； clearing heat and cooling blood， and diffusing qi and unblocking qi and fluid. Moreover， it is recommended to treat the heart and lungs simultaneously， and regulate the heart and liver at the same time.
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Objective:To evaluate the clinical efficacy of Yiqi-Tongmai Decoction on isolated coronary muscle bridge angina patients with qi deficiency and blood stasis syndrome. Methods:A total of 64 patients with isolated coronary artery muscular bridge angina pectoris with qi deficiency and blood stasis syndrome in Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from April 2016 to January 2020 who met the inclusion criteria were divided into 2 groups by random number table method, with 32 patients in each group. The control group took diltiazem hydrochloride tablets orally, and the treatment group took Yiqi-Tongmai Decoction on the basis of the control group. Both groups were treated for 8 weeks. The TCM syndrome scores were observed before and after treatment, and Seattle Angina Questionnaire was assessed for patient's quality of life and functional status. The exercise ECG test was observed before and after treatment, and the cause of angina pectoris need to be recorded, including the movement time and plate movement caused by time of ST segment in electrocardiogram (ecg) and dynamic evolution. Results:The total effective rate of angina pectoris was 84.38% (27/32) in the treatment group, and 53.13% (17/32) in the control group, and the difference between the two groups was statistically significant ( χ2=8.09, P<0.05). After treatment, the degree of physical activity limitation (69.24 ± 14.21 vs. 59.42 ± 11.71, Z=-2.61), stable state of angina (82.25 ± 21.24 vs. 69.11 ± 19.52, Z=2.64), angina (80.24 ± 18.31 vs. 69.11 ± 15.54, Z=2.63), treatment satisfaction (86.16 ± 19.23 vs. 61.19 ± 17.35, Z=2.22), degree of disease cognition (74.41 ± 21.13 vs. 60.43 ± 19.42, Z=2.40) scores in the treatment group were significantly higher than those in the control group ( P<0.05). In the treatment group, the time of exercise-induced angina pectoris [(476.15 ± 62.15)s vs. (399.38 ± 78.42)s, Z=-2.08], the time of ST segment descending 1 mm after exercise [(394.54 ± 75.61)s vs. (309.64 ± 81.62)s, Z=-2.40] in the treatment group were significantly longer than those in the control group ( P<0.05). The total effective rate of TCM syndrome was 93.8% (30/32) in the treatment group and 65.6% (21/32) in the control group, and the difference was statistically significant ( χ2=7.96, P<0.05). The TCM syndrome scores of the treatment group (25.15 ± 6.15 vs. 36.38 ± 10.42, Z=-2.56) in the treatment group were significantly lower than that of the control group ( P<0.05). There were no obvious adverse reactions in both groups during treatment. Conclusion:Yiqi-Tongmai Decoction can improve the clinical symptoms of isolated coronary artery muscle bridge angina pectoris with qi deficiency and blood stasis syndrome, reduce the onset of angina pectoris, delay the time of exercise induced angina pectoris, and improve the clinical efficacy.
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BACKGROUND@#Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE).@*METHODS@#This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE.@*RESULTS@#This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively.@*CONCLUSIONS@#Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.
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Objective:To understand the drug treatment status of echinococcosis patients in Jimusar County, Changji Prefecture, Xinjiang, and to explore the construction of medical cooperation system for echinococcosis patients, and to provide reference for optimization and popularization of medical cooperation system.Methods:Data of echinococcosis patients registered in Jimusar Center for Disease Control and Prevention from 2009 to 2018 were collected. The data of patients' medical records and follow-up information were collected by the principle of double entry. The research methods of combining quantitative and qualitative methods were applied to investigate the baseline of patient prevention and treatment system (including regional distribution, education level, recurrence, follow-up medication, etc). Follow-up was conducted on the whole treatment process of echinococcosis patients in the pilot counties, and comparative analysis was made on the treatment situation before and after the use of medical cooperation system. Logistic regression model was used to analyze the indicators that might affect the follow-up effect. Semistructured questionnaire survey was used to analyze the implementation effect of the medical cooperation system.Results:Patients were mainly distributed in rural areas (81.48%, 154/189), mostly in high schools and below (94.18%, 178/189), 39.68% (75/189) were relapsed and treated again, and 68.25% (129/189) were treated with non-standard medication. Influencing factors of effective follow-up medication in echinococcosis patients showed that patients with no side effects, abnormal liver function during follow-up, two or more times of B-ultrasound examination and multiple cysts had higher effective follow-up medication rate ( P < 0.01 or < 0.05). After the implementation of the integrated medical cooperation system, the proportion of unknown stages of diagnosis of cystic echinococcosis in Jimusar County decreased by 60.18%. The pilot counties initially formed a management model of echinococcosis patients based on outpatient, disease control and health centers. Conclusions:Echinococcosis patients have high recurrence rate in Jimusar County, and the effective follow-up medication rate is low. The medical cooperation system for echinococcosis patients in Xinjiang is explored, and the working mechanism of medical institutions linked with disease control institutions is formed. The working model suggestion is put forward, which could provide a scientific basis for further promotion and comprehensive evaluation of the medical cooperation system.
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BACKGROUND@#Docetaxel is a commonly used anti-tumor drug in clinic, especially as the first-line drug for advanced non-small cell lung cancer (NSCLC). However, the molecular mechanism of docetaxel against NSCLC is still unclear. Increasing studies have shown that metabolic reprogramming of tumor cells plays an important role in tumorigenesis. The aim of this study was to investigate the effects of docetaxel on the metabolic pathway of NSCLC cells based on metabolomics analysis and biological means.@*METHODS@#First, we performed CCK8 assay to analyze the effects of docetaxel on cell viability of NSCLC cells and also to screen the appropriate drug concentration. Then, the differential metabolites of docetaxel-treated and untreated NSCLC cells were analyzed by gas chromatography-mass spectrometry based metabolomics. Finally, the effects of docetaxel on the expression levels of key enzymes that regulate the relevant metabolic pathways were determined by Western blot.@*RESULTS@#Docetaxel inhibited cell viability of A549 and H1299 cells in a concentration- and time-dependent manner. With the prolonged treatment time of docetaxel, the apoptotic sensitive protein poly (ADP-ribose) polymerase (PARP) was gradually activated to form a P89 fragment. Metabolomics analysis showed that eight metabolites were significantly changed in both A549 and H1299 cells following docetaxel treatment, which were mainly in the tricarboxylic acid (TCA) cycle pathway. Moreover, after docetaxel treatment, the protein expression levels of isocitrate dehydrogenases, the key regulators of the TCA cycle, were obviously decreased in both A549 and H1299 cells.@*CONCLUSIONS@#Our findings suggest that the effect of docetaxel-induced proliferation inhibition and apoptosis in NSCLC might be associated with down-regulation of isocitrate dehydrogenases and suppression of the TCA cycle pathway.
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Humans , A549 Cells , Apoptosis , Carcinoma, Non-Small-Cell Lung , Pathology , Docetaxel , Pharmacology , Lung Neoplasms , Pathology , MetabolomicsABSTRACT
AIM:To explore the influence of exogenous hydrogen sulfide ( H2 S) on coagulation and fibrinoly-sis in ferric chloride ( FeCl3 )-induced mouse carotid artery thrombosis .METHODS: The mice were divided into sham control group, model group, different concentrations (12.5, 25 and 50μmol/kg) of sodium hydrosulfide (NaHS, H2S do-nor) groups and 30 mg/kg clopidogrel ( positive control ) group.Intraperitoneal injection of NaHS at different concentra-tions and oral administration of clopidogrel bisulfate were performed for 3 d prior to FeCl 3-induced carotid artery thrombo-sis.The frozen sections of the carotid artery were collected to perform HE staining , and the thrombus pattern and the chan-ges of vascular pathology were observed .The thrombus was weighed to calculate thrombosis inhibitory rate .Prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , fibrinogen ( FIB) and fibrinogen degradation product ( FDP) in the mice were also measured by a coagulometer .The plasma levels of thromboxane B 2 ( TXB2 ) , 6-keto-prostaglandin F 1α(6-keto-PGF1α) and plasminogen activator inhibitor (PAI) were detected by ELISA.RESULTS: Compared with model group, NaHS dose-dependently inhibited the formation of carotid artery thrombus .NaHS treatment reduced the contents of TXB2 and PAI, and recovered 6-keto-PGF1αcontent in thrombosis model group .In NaHS treatment groups , 6-keto-PGF1α/TXB2 and thrombus weight was negatively correlated .NaHS treatment prolonged PT and APTT , reduced the content of FIB, but increased the level of FDP in thrombosis model group .CONCLUSION:Hydrogen sulfide prevents FeCl 3-induced carotid artery thrombosis by inhibiting coagulation and activating fibrinolysis .
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Objective To study the effect ofTiaomai-Yin with the therapy method of clearing heat and cooling blood to treat the tachyarrhythmia with the TCM patterns of deficiency of Qi and Yin, and heat of blood stasis.MethodsA total of 60 patients with tachyarrhythmia were randomly recruited into a control group and a treatment group, 30 patients in each. The treatment group was treated withTiaomai-Yin, while the control group was treated with Metoprolol. After both groups were treated for one month, the changes of TCM symptoms, ECG and 24 h DCG were observed.Results The total effective rate of the treatment groups was significantly better than the control group(86.67%vs. 56.67%;χ2=7.957,P<0.05).Tiaomai-Yin significantly improve the symptoms of shortness of breath (1.40 ± 2.11vs. 2.10 ± 1.87;t=-3.341,P<0.01), tiredness (1.30 ± 2.33vs. 2.10 ± 1.84;t=-3.262,P<0.01), dry mouth (0.09 ± 1.34vs. 2.50 ± 2.41;t=-3.194,P<0.01), and tongue (1.90 ± 1.65vs. 3.90 ± 1.81;t=-3.217,P<0.01) and pulse (2.60 ± 1.71vs. 5.10 ± 2.55;t=-3.283,P<0.01).ConclusionTiaomai-Yin had effects in treating tachyarrhythmia with the TCM patterns of deficiency of Qi and Yin, and heat of blood stasis with improvement of symptoms and fewer side effects.
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Objective To study the genetic diversity in Fujian Sanming Sarcandra Glabra from different geographical provenances;To construct genetic relationship diagram.Methods DNA in leaves was extracted by CTAB. Analysis and evaluation of DNA molecular level of 45 samples of different geographical provenances were conducted by ISSR method. POPgen32 software was used to calculate the genetic diversity and establish gene trees. NTSYS software was used to carry out cluster analysis.Results Six ISSR primers amplified 630 bands. Genetic diversity analysis showed that the average effective number of alleles of 45 varieties was 1.620 2;the average Nei's genetic diversity index was 0.364 5;the average Shannon information index was 0.543 2. Each point had different levels of genetic diversity. Nei's genetic diversity index of the maximum value was 0.497 2, and the minimum value was 0.107 8;Maximum Shannon information index was 0.690 3, and the minimum value was 0.219 2. Cluster analysis results showed that 45 varieties and 14 loci band data were the primitive matrix. 630 genetic similarity coefficients between two different species were obtained. The maximum similarity coefficient among different groups was 1.0, and the minimum was 0.516.Conclusion Different varieties of Fujian Sanming Sarcandra Glabra exist abundant genetic variation and has the molecular basis of abundant species. Using 0.610 as the threshold value can divide Sarcandra Glabra from 45 different geographical provenances into 6 groups. The genetic distance and geographical distance was not related.
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This study was aimed to investigate the effects of Shen-Y uan Y i-Qi Huo-Xue (SYYQHX) capsule com-bined with early percutaneous coronary intervention (PCI) on near-term quality of life (QOL) in unstable angina (UA) patients. Seventy-eight patients diagnosed with UA were selected and randomly divided into the treatment group and control group, with 39 patients in each group. Early PCI was undergone after coronary angiography. Before PCI, the control group was given routine western medication. The treatment group was given routine western medication plus SYYQHX capsule, three pills once, three times daily. The treatment lasted for 30 days. The QOL scores were evalu-ated among patients from both groups before and after treatment in order to determine the efficacy on angina, electro-cardiogram (ECG) and traditional Chinese medicine (TCM) main symptom. The results showed that compared to pre-treatment, the scores of physical limitation (PL), angina stability (AS), angina frequency (AF), and treatment satisfac-tion ( TS ) were significantly increased after treatment ( P < 0 . 05 ) . Compared with the control group , after treat-ment with SYYQHX capsule, the AF, duration time and symptoms of palpitation, fatigue and shortness of breath were obviously improved (P< 0.05). The scores of AS, AF and TS in the treatment group were significantly increased (P < 0.05). It was concluded that SYYQHX capsule combined with early PCI can improve the near-term QOL and TCM main symptoms among UA patients.