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<p><b>Background</b>Chronic kidney disease (CKD) is closely related to the cardiovascular events in vascular calcification (VC). However, little has known about the characteristics of kidney injury caused by VC. Fibroblast growth factor 21 (FGF21) is an endocrine factor, which takes part in various metabolic actions with the potential to alleviate metabolic disorder diseases. Even FGF21 has been regarded as a biomarker in CKD, the role of FGF21 in CKD remains unclear. Therefore, in this study, we evaluate the FGF21 on the kidney injury in VC rats.</p><p><b>Methods</b>The male Sprague-Dawley rats were divided into three groups: (1) control group, (2) Vitamin D3 plus nicotine (VDN)-induced VC group, (3) FGF21-treated VDN group. After 4 weeks, the rats were killed and the blood was collected for serum creatinine, urea nitrogen, calcium, and phosphate measurement. Moreover, the renal tissues were homogenized for alkaline phosphatases (ALPs) activity and calcium content. The levels of FGF21 protein were measured by radioimmunoassay. The levels of β-Klotho and FGF receptor 1 (FGFR1) protein were measured by enzyme-linked immunosorbent assay (ELISA). The structural damage and calcifications in aortas were stained by Alizarin-red S. Moreover, the structure of kidney was observed by hematoxylin and eosin staining.</p><p><b>Results</b>The renal function impairment caused by VDN modeling was ameliorated by FGF21 treatment, inhibited the elevated serum creatinine and urea level by 20.5% (34.750 ± 4.334 μmol/L vs. 27.630 ± 2.387 μmol/L) and 4.0% (7.038 ± 0.590 mmol/L vs. 6.763 ± 0.374 mmol/L; P < 0.01), respectively, together with the structural damages of glomerular atrophy and renal interstitial fibrosis. FGF21 treatment downregulated the ALP activity, calcium content in the kidney of VC rats by 42.1% (P < 0.01) and 11.7% (P < 0.05) as well as ameliorated the aortic injury and calcification as compared with VDN treatment alone group, indicating an ameliorative effect on VC. ELISA assays showed that the expression of β-Klotho, a component of FGF21 receptor system, was increased in VDN-treated VC rats by 37.4% (6.588 ± 0.957 pg/mg vs. 9.054 ± 0.963 pg/mg; P < 0.01), indicating an FGF21-resistant state. Moreover, FGF21 treatment downregulated the level of β-Klotho in renal tissue by 16.7% (9.054 ± 0.963 pg/mg vs. 7.544 ± 1.362 pg/mg; P < 0.05). However, the level of FGFR1, the receptor of FGF21, kept unchanged under VDN and VDN plus FGF21 administration (0.191 ± 0.0376 ng/mg vs. 0.189 ± 0.032 ng/mg vs. 0.181 ± 0.034 ng/mg; P > 0.05).</p><p><b>Conclusions</b>In the present study, FGF21 was observed to ameliorate the kidney injury in VDN-induced VC rats. FGF21 might be a potential therapeutic factor in CKD by cutting off the vicious circle between VC and kidney injury.</p>
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<p><b>BACKGROUND</b>Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.</p><p><b>METHODS</b>In this retrospective study, patients with abnormal baseline serum creatinine (SCr, > 106 µmol/L) were not included. Included patients (n = 69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.</p><p><b>RESULTS</b>Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R, 2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.</p><p><b>CONCLUSIONS</b>There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardio-pulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cardiopulmonary Bypass , Methods , Hemodynamics , Kidney Function Tests , Renal Artery Obstruction , General Surgery , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To determine whether early catheterization laboratory activation would reduce median door-to-balloon time in patients with ST elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>Consecutive patients with STEMI underwent primary percutaneous coronary intervention (PCI) from January 2006 to December 2008 in Beijing Anzhen Hospital were analyzed. Patients were divided into three groups. Group A included patients without prehospital ECG (n = 168), group B included patients with prehospital ECG (n = 224) and group C included patients with prehospital ECG and early telephonic notification to activate catheterization laboratory (n = 114). Primary end point was door-to-balloon time, secondary end points included peak Troponin I elevation, left ventricular ejection fraction, length of hospital stay, hospital mortality and 30 days follow-up mortality.</p><p><b>RESULTS</b>Baseline characteristics were similar among groups. Door-to-balloon time and door-to-catheter laboratory time (110 minutes, 94 minutes and 85 minutes, respectively, all P < 0.01; 91 minutes, 74 minutes and 64 minutes, respectively, all P < 0.01) were significantly shorter in group B and C than those in group A. The percentage of patients with door-to-balloon time less than 90 minutes increased significantly from 32% in group A to 43% in group B and 59% in group C (P < 0.01).</p><p><b>CONCLUSION</b>Early activation of catheterization laboratory by prehospital ECG and telephonic notification could markedly reduce door-to-balloon time in patients with STEMI.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Electrocardiography , Myocardial Infarction , Therapeutics , Time FactorsABSTRACT
<p><b>BACKGROUND</b>Emergency medical service plays a key role in the early recognition and treatment of ST-elevation myocardial infarction (STEMI), but studies indicate that the patients experiencing STEMI symptoms often fail to call an ambulance as recommended. This study aimed to examine the current ambulance transport frequency and ascertain predictors and reasons for not choosing ambulance transportation by the patients with STEMI in Beijing.</p><p><b>METHODS</b>A prospective, cross-sectional survey was conducted from January 1, 2006 through until June 30, 2007 in two tertiary hospitals in Beijing and included consecutive patients with STEMI admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review.</p><p><b>RESULTS</b>Of the 572 patients, only 172 (30.1%) used an ambulance, and the remaining 400 (69.9%) presented by self-transport. Multivariate analysis showed that age <65 years (OR: 1.220; 95% CI: 1.001-2.043), lower education level (OR: 1.582; 95% CI: 1.003-2.512), presence of pre-infarction angina (OR: 1.595; 95% CI: 1.086-2.347), and attribution of symptoms to non-cardiac origin (OR: 1.519; 95% CI: 1.011-2.284) were independent predictors for not using an ambulance. However, history of coronary artery disease (CAD), dyspnea, perceiving symptoms to be serious, and knowing the meaning of cardiopulmonary resuscitation appeared to be independent predictors of ambulance use. The main reasons for not using an ambulance were convenience and quickness of self-transport and the decreased severity of symptoms.</p><p><b>CONCLUSIONS</b>A large proportion of patients in Beijing do not call for an ambulance after onset of STEMI symptoms. Several factors including demographics, previous CAD, symptoms and cognitive factors of patients are associated with the ambulance use. The public should be educated that an ambulance is not merely a transportation modality and that it also provides rapid diagnosis and treatment.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Ambulances , China , Epidemiology , Cross-Sectional Studies , Myocardial Infarction , Mortality , Pathology , Psychology , Needs Assessment , Patient Acceptance of Health Care , Psychology , Prospective Studies , Regression Analysis , Transportation of PatientsABSTRACT
Objective To investigate the efficacy and safety of ezctimibe on uncontrolled LDL-C when added to ongoing statin therapy in patients with coronary heart diseases (CHD) and diabetes mellitus (DM). Methods 61 patients with LDL-C level exceeding target goal (<2.07 mmol/L) after 12 weeks' treatment with statins, received ezetimibe in addition to their ongoing statin therapy for 8 weeks. Lipid parameters, alanine aminotransferase(ALT), aspartic aminotransferase(AST) and ereatine kinase(CK) were compared before and after the adding of ezetimibe. Results LDL-C before and after the adding of ezetimibe was (2.74±0.43) mmol/L and (2.19±0.32) mmol/L, respectively (P=0.03) in 61 patients. Ezetimibe added to statin therapy significantly reduced the LDL-C level and TC level by additional 20.1% and 19.1%, respectively (P<0.05). 74%(45/61) patients treated with ezetimibe added to statin reached their target LDL-C goal. No change of TG and HDL-C was observed and no change of AST, ALT and CK was found either. Conclusion Ezetimibe added to statin therapy lowered LDL-C level further and improved the goal attainment in patients with CHD and DM.
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Objective To study the change of baseline clinical characteristics including prehospital delayed time(PDT),modes of transportation and treatment for patients with acute myocardial infarction (AMI)in the past 3 years.Methods We used the same questionnaire to accurately collect and retrospectively analyze the data regarding clinical characteristics of all 1004 patients with AMI,who consecutively presented to the Emergency Unit and Emergency Intensive Care Unit(EICU)of Beijing Anzhen Hospital from March 12th 2004 to March 11th 2007.According to the time of onset of the disease,all patients were divided into 3 groups:group A(from Mar.12th 2004 tO Mar.11th 2005),group B(Mar.12th 2005 to Mar 11th 2006)and group C(Mar.12th 2006 to Mar.11th 2007).Clinieal characteristics and treatment were compared.Results There were significant differences in the number of patients with histories of stroke,coronary artery disease or smoking among the three groups(P＜0.05).No obvious differences in the median of PDT were found among the three groups(P＞0.05).More patients accepted reperfusive therapy in group C compared to group A(P＜0.05),although the mortality rates of AMI among these 3 years were similar.Conclusion Though more people started to have accepted reperfusion therapy,mortality failed to show an obvious decrease.Subject as how tO shorten the PDT called for further study.