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OBJECTIVE To evaluate the clinical effectiveness and safety of domestic generic and imported original clopidogrel for antiplatelet therapy in patients with acute coronary syndrome （ACS）. METHODS The clinical data of ACS patients in Nanjing Drum Tower Hospital of China Pharmaceutical University from January 2020 to June 2021 were retrospectively collected by using electronic medical record system， and the patients were divided into original drug group （321 cases） and generic drug group （328 cases） according to the drug use. Both groups were given dual antiplatelet therapy with clopidogrel and aspirin. The effectiveness and safety outcomes of the two groups were followed up for 12 months and compared， the related influential factors were analyzed. RESULTS Major adverse cardiovascular events （MACE） occurred in 16 and 22 patients in original drug group and generic drug group respectively， including nonfatal myocardial infarction （4 and 5 cases）， stroke （2 and 4 cases）， revascularization （8 and 3 cases）， cardiovascular related death （2 and 4 cases）， and all-cause death （4 and 6 cases）. There were 12 and 7 patients with major bleeding events， 38 and 29 patients with minor bleeding events， and 33 and 21 patients with non-bleeding adverse events. There was no statistically significant difference in the cumulative incidence of related events （P values of Log-Rank tests were all greater than 0.05）. Cox regression analysis showed that the use of generic clopidogrel did not increase the risk of MACE and major bleeding events in ACS patients [hazard ratio of 1.305 and 0.416， 95% confidence interval of （0.678， 2.512） and （0.155， 1.117）， respectively， P＞0.05]， and the combination of proton pump inhibitors （PPI） could reduce the risk of major bleeding events [hazard ratio of 0.196， 95% confidence interval of （0.063， 0.611）， P＜0.05]. CONCLUSIONS Compared with imported original drug， domestic generic clopidogrel has similar clinical effectiveness and good safety. Combined use of PPI may be a beneficial factor to reduce the occurrence of major bleeding events in patients.
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OBJECTIVE To analyze the research status and development trends of the use of sacubitril/valsartan. METHODS Related literature about the use of sacubitril/valsartan were retrieved from CNKI and the core database of Web of Science. CiteSpace 5.8.R3 software was used to analyze authors， countries/areas， institutions and keywords. RESULTS & CONCLUSIONS Totally 1 193 Chinese literature and 1 060 English literature were included. The number of literature increased， with numerous literature covering the United States （429）， the United Kingdom （185） and China （184）. ZHANG Jing （5） and Solomon S D （118） published the highest number of Chinese and English articles. The authors of Chinese literature had less cooperation while the authors of English literature were in close contact. Dept. of Cardiology in the First Affiliated Hospital of Zhengzhou University （9）， Dept. of Cardiology in the Affiliated Hospital of Xuzhou Medical University （9） and Novartis AG （134） had the highest quantity of publications of Chinese and English literature. The institutions of Chinese literature had a small number of overall publications and less cooperation while the institutions of English literature were closely connected. The clinical efficacy of sacubitril/valsartan for heart failure， hypertension and their complications were research hotspots in Chinese and English literature. Chinese scholars and research teams need to strengthen cooperation and communication in the future， as well as conduct research from the perspectives of sacubitril/valsartan in the treatment of heart failure， hypertension and related complication， the improvement of oxidative stress， and the evaluation of the efficacy of combination therapy with dapagliflozin.
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Objective To evaluate the effects of antihypertensive drugs on renal function after percutaneous transluminal coronary angioplasty. Methods A retrospective analysis was performed on 193 patients who underwent percutaneous transluminal coronary angioplasty and took antihypertensive drugs regularly. Those patients were admitted to Nanjing Drum Tower Hospital during January 2020 to December 2020. The patients were divided into ACEI/ARB group, β-blockers, calcium channel blockers and hydration control group. All patients received routine hydration during the perioperative period. The changes of serum creatinine (Scr), blood urea nitrogen (BUN), estimated glomerular filtration rate(eGFR) and endogenous creatinine clearance rate (Ccr) before and after operation were compared. Results The incidence of CIN was 0% in four groups. Compared with the preoperative, there was no significant change in Scr and Ccr in every group. Except for the hydration control group, the BUN levels in three treated groups were reduced after postoperative. Specifically, the BUN reduction in β-blockers group has statistically significant difference compared to the hydration control group and CCB group. In addition, eGFR levels were significantly reduced in the β-blockers group. Preoperative Scr and Ccr levels in patients with high blood pressure (SBP≥140 or DBP≥90) were significantly different from the patients with normal blood pressure (SBP<140 and DBP<90). Conclusion The use of ACEI/ARB and CCB before percutaneous transluminal coronary angioplasty had no effect on renal function in the short term. β-blockers can slightly reduce renal function, especially in patients with high blood pressure, who should receive special attention.
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Objective:To investigate the efficacy and safety of different doses of rivaroxaban in the treatment of lower extremity deep venous thrombosis after catheter directed thrombolysis.Methods:Clinical data of 92 patients with lower extremity deep venous thrombosis received catheter directed thrombolysis at Nanjing Drum Tower Hospital from Jun 2017 to Dec 2018 were collected and analyzed. Patients were divided into Rivaroxaban group (10 mg qd), Rivaroxaban group (20 mg qd) and Warfarin group according to the anticoagulant therapy, and followed up for 6 months. The change of limb swelling rate, lower limb venous patency rate, venous clinical severity score(VCSS), score of chronic venous insufficiency questionnaire(CIVIQ) and adverse reactions were analyzed to evaluate the curative effect and safety during 6 months of follow-up.Results:There was no significant difference in the change of limb swelling rate, lower limb venous patency rate, VCSS score, and CIVIQ score between the three groups(all P>0.05). The total hemorrhage events in warfarin group were significantly higher than the other two groups. Conclusions:The efficacy and safety of low-dose rivaroxaban (10 mg qd) in the treatment of lower extremity deep venous thrombosis after catheter directed thrombolysis were comparable to that of Rivaroxaban (20 mg qd).
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OBJECTIVE： To construct prediction model for initial dose of levothyroxine （L-T4） in differentiated thyroid cancer （DTC） patients after surgery. METHODS： A total of 100 DTC patients underwent surgery were selected from thyroid and breast surgery department in Nanjing Drum Tower Hospital. General information of patients such as gender， age， height， body mass， body mass index （BMI） and regular follow-up information after discharge were collected. Related data of thyroid function and adjusted dose of L-T4 were recorded. Single factor variance analysis and t-test were used to analyze the predictors that had significant correlation with the initial dose of L-T4. The prediction model of L-T4 initial dose was established by linear regression analysis， and was verified by prospective experiments. RESULTS： The initial dose of L-T4 in DTC post-surgery patients were significantly correlated with age （P＝0.01，F＝3.993）， body weight （P＜0.001，F＝6.910） and BMI （P＜0.001，F＝7.698）. Linear regression analysis showed that prediction model of initial dose of L-T4 was L-T4（μg/kg）＝2.971-0.033×BMI-0.005×age. DTC post-operative patients were given L-T4 empirically， and only 16％ （16/100） of the patients met the criteriaat the first follow-up of thyroicl function. In the validation test， L-T4 was given at the initial dose calculated by the prediction model， and 63.7％ （44/69） of the patients reached the standard at the first follow-up. CONCLUSIONS： The established prediction model of L-T4 initial dose after DTC surgery has a certain practicality.
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Objective To investigate the inhibition effect of liraglutide (lira) on high glucose-induced adhesion of endothelial cells to monocyte.Methods Human umbilical vascular endothelial cells (HUVECs) induced by high glucose (20 mmol/L) were incubated with different concentrations of liraglutide (0,0.3,3,30 nmol/L) for different time.THP-1 cells were pre-labeled with Calcein-AM and then incubated with HUVECs for 1 h,M199 medium were used for washing the nonadherent cells for 3 times,and the adhesion of HUVECs to THP-1 cells were measured by Fluorence microplate reader;real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) were employed to detect the mRNA and protein expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1),respectively.Western blot was used to measure the content of IκBα,p-IκBα and the distribution of p65 in plasma and nuclear.GST-IκBα was introduced as substrate to test the activity of IκB-kinase (IKK).Results The adhesion of HUVECs to THP-1 (P ＜ 0.01),the mRNA and protein expression of VCAM-1 and ICAM-1 (P ＜ 0.05,P ＜ 0.01),the phosphorylation of κBα (P ＜ 0.05,P ＜ 0.01),the translocation of p65 subunit from plasma to nuclear and the activity of IKK (P ＜ 0.01) in HUVECs were all elevated by stimulation with 20 mmol/L glucose,and the content of IκBα was decreased accordingly (P ＜0.01).Pre-incubation with lira could reverse the above effect of high concentration of glucose.Conclusions Lira could reduce VCAM-1 and ICAM-1 expression through IKK/NF-κB pathways in 20 mmol/L glucose-induced HUVECs,which finally suppress THP-1-HUVECs adhesion.
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OBJECTIVE@#To detect the expression of nucleolin in cardiac hypertrophy rats induced by pressure overload.@*METHODS@#A total of 40 SD rats with body weight 180 g and 220 g were recruited and randomly divided into 2 groups: a transverse aortic constriction (TAC) group and a sham surgery group. Cardiac hypertrophy model was employed by transverse aortic constriction surgery. Then 2 weeks and 4 weeks after the experiment, the heart mass index (HMI), left ventricle mass index (LVMI) were measured. β-MHC mRNA in the heart tissue was detected with RT-PCR. Nucleolin in the heart, brain and kidney was respectively detected with Western blot.@*RESULTS@#Compared with the sham surgery group, HMI, LVMI in the TAC group increased significantly (P<0.01) 4 weeks after the surgery; the expression of β-MHC mRNA in the heart tissue increased (P<0.05) in the TAC group 4 weeks after the surgery; and the expression of nucleolin protein in the heart tissue of the TAC group was remarkably upregulated (P<0.05) 2 weeks after the surgery, with no change in the brain and kidney tissue between the 2 groups.@*CONCLUSION@#Expression of nucleolin protein has been upregulated in response to pressure overload, which may suggest that nucleolin plays a role in cardiac hypertrophy induced by pressure overload.