Benefits and risks of prolonged dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with stable coronary artery disease and diabetes / 中华心血管病杂志

Objective: To compare the efficacy and safety of prolonged dual antiplatelet therapy (DAPT>1 year) in patients with stable coronary artery disease (CAD) and diabetes who were event-free at 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in a large and contemporary PCI registry. Methods: A total of 1 661 eligible patients were selected from the Fuwai PCI Registry, of which 1 193 received DAPT>1 year and 468 received DAPT ≤1 year. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) and Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding, MACCE was defined as a composite of all-cause death, myocardial infarction or stroke. Multivariate Cox regression analysis and inverse probability of treatment weighting (IPTW) Cox regression analysis were performed. Results: After a median follow-up of 2.5 years, patients who received DAPT>1 year were associated with lower risks of MACCE (1.4% vs. 3.2%; hazard ratio (HR) 0.412, 95% confidence interval (CI) 0.205-0.827) compared with DAPT ≤1 year, which was primarily caused by the lower all-cause mortality (0.1% vs. 2.6%; HR 0.031, 95%CI 0.004-0.236). Risks of cardiac death (0.1% vs. 1.5%; HR 0.051, 95%CI 0.006-0.416) and definite/probable ST (0.3% vs. 1.1%; HR 0.218, 95%CI 0.052-0.917) were also lower in patients received DAPT>1 year than those received DAPT ≤ 1 year. No difference was found between the two groups in terms of BARC type 2, 3, or 5 bleeding (5.3% vs. 4.1%; HR 1.088, 95%CI 0.650-1.821). Conclusions: In patients with stable CAD and diabetes who were event-free at 1 year after PCI with DES, prolonged DAPT (>1 year) provides a substantial reduction in ischemic cardiovascular events, including MACCE, all-cause mortality, cardiac mortality, and definite/probable ST, without increasing the clinically relevant bleeding risk compared with ≤ 1-year DAPT. Further well-designed, large-scale randomized trials are needed to verify the beneficial effect of prolonged DAPT in this population.

Application Value of Residual SYNTAX Score in Coronary Artery Disease Patients With Percutaneous Coronary Intervention in China / 中国循环杂志

Objective: Residual SYNTAX score (rSS) can be used as the independent predictor for clinical prognosis and the tool for quantifying incomplete revascularization (IR) in coronary artery disease (CAD) patients with percutaneous coronary intervention (PCI). Our work assessed the prognostic value of rSS on large-scale PCI patients in China. Methods: A total of 10 724 CAD patients undergoing PCI in our hospital in 2013 were studied; 381 patients with previous CABG and hybrid procedure were excluded, 10 343 patients were finally enrolled. Baseline SYNTAX score (bSS) and rSS were calculated before and after PCI. Complete revascularization (CR) was defined by rSS=0 and IR was defined by rSS≥1. The patients were followed-up for 30 months. Clinical endpoint events included MACE, a composite event of all-cause death, myocardial infarction (MI) and revascularization; all-cause death, cardiac death, MI, all-cause death/MI and revascularization.Results: There were 5 050/10 343 (48.8%) patients having CR and 5 293 having IR including 1 908 (18.4%) patients with 1≤rSS≤4, 1 777 (17.2%) with 4<rSS≤9 and 1608 (15.5%) with rSS>9. Patients with the higher rSS had more clinical comorbidity and more complicated coronary lesions. Compared with CR patients, IR patients had the higher incidences of 30-month clinical endpoint events. As rSS increasing, the incidence of MACE was elevating accordingly. Multivariate regression analysis indicated that rSS was the independent predictor for MACE and all other endpoints occurrence. Conclusion: IR patients especially those with rSS>9 had the higher incidence of adverse clinical outcomes. rSS has been a good tool for quantifying revascularization and assessing prognosis in PCI patients in China.

Clinical experience of supplying sodium chloride for the treatment of patients with severe heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the effect and safety of supplying sodium chloride in the treatment of patients with severe heart failure.</p><p><b>METHODS</b>Consecutive 51 hospitalized patients with severe heart failure and cardiac edema were included in this study. Normal diet (6 g NaCl/d) was supplied to all patients. On the basis of controlling fluid intake and treating related etiological factors as well as standard medications including furosemide for severe heart failure, patients with mild hyponatremia (serum sodium level 130 - 134 mmol/L) ate additional salted vegetables, patients with moderate hyponatremia (serum sodium level 125 - 129 mmol/L) and severe hyponatremia (serum sodium level < 125 mmol/L) ate additional salted vegetables and were received additionally intravenous 3%NaCl hypertonic saline infusion (10 ml/h) until reaching normal serum sodium level.</p><p><b>RESULTS</b>On admission, 37.25% (19/51) patients had hyponatremia. During the first two weeks hospitalization period, 88.24% (45/51) patients were treated with intravenous diuretics and total incidence of hyponatremia was 64.71% (33/51), mild hyponatremia was 50.98% (26/51), middle and severe hyponatremia was 13.73% (7/51); among them, hyponatremia lasted less than 3 d in 57.58% (19/33) patients and ≥ 3 d in 42.42% (14/33) patients. Heart failure exacerbation and hypernatremia were not observed in patients receiving additional sodium chloride therapy. Hospitalization time was similar among patients with different blood natrium levels [average (16 ± 12) d]. Fifty out of 51 (98%) patients discharged from the hospital with improved heart failure symptoms and signs.</p><p><b>CONCLUSION</b>Supplying additional sodium chloride could rapid correct hyponatremia in heart failure patients with or without intravenous diuretics therapy which might contribute to a favorable prognosis in hospitalized heart failure patients.</p>

Effects of sex hormones on genioglossal muscle activities, estrogen and androgen receptor expression in adult rat / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To explore gene expression of estrogen receptor (ERalpha, ERbeta) and androgen receptor (AR) in genioglossal muscle (GG) of adult male rats, and to investigate the effects of sex hormones on GG activities, ERalpha, ERbeta and AR expression.</p><p><b>METHODS</b>GG samples were collected from 10 healthy adult male rats. Total RNA were extracted and subjected to fluorescent quantitative reverse transcription-polymerase chain reaction (FQ RT-PCR) for quantitative measurement of ERalpha, ERbeta and AR mRNAs. The other 24 male rats were randomly divided into 3 groups: control group, estrogen group (intramuscular injection of estrogen 0.1 mg/kg, twice a week) and androgen group (intramuscular injection of androgen 2.5 mg/kg, twice a week). The electromyographic activities (EMG) and contract tension of GG were investigated after 4-week treatment. The expression of ERalpha, ERbeta and AR was assessed by Western blot.</p><p><b>RESULTS</b>The mRNA expression ratios of AR/GAPDH, ERalpha/GAPDH, ERbeta/GAPDH and ERalpha/ERbeta were (295.80 +/- 127.20), (2042.00 +/- 921.57), (65.96 +/- 29.57) and (36.83 +/- 19.66), respectively. The mRNA level of ERalpha was significantly higher than that of ERbeta (P < 0.01). Compared with the control group, the EMG of GG was intensified in the estrogen group (P < 0.01). GG contractility did not change significantly (P > 0.05), and ERalpha expression in GG was up-regulated by estrogen (P < 0.05); while in the androgen group, the EMG of GG was weakened (P < 0.05). P(t) and P(0) were slightly increased (P > 0.05) and the decline rate of P(0) was markedly quickened (P < 0.05). AR and ERbeta expressions were down-regulated by androgen (P < 0.05).</p><p><b>CONCLUSIONS</b>Both AR and ER were expressed in GG of adult male rats, and ERalpha was expressed more abundantly than ERbeta. Estrogen could greatly improve activities of GG and stimulate the expression of ERalpha. Whereas, androgen could restrain activities of GG, impair its fatigue resistance capacity and inhibit the expression of AR and ERbeta.</p>

Arsenic trioxide-induced hela cell death is partially prevented by K+ channel blockers / 药学学报

<p><b>AIM</b>To investigate the effects of K+ channel blockers on arsenic trioxide-induced HeLa cell death.</p><p><b>METHODS</b>Viability of HeLa cells was assessed by mitochondrial dehydrogenase activity using colorimetric MTT assay and the voltage-dependent K+ currents were recorded by using patch-clamp technique.</p><p><b>RESULTS</b>Exposure of As2O3 (5 micromol x L(-1)) for 24 h caused marked HeLa cell death. The rest living cells after As2O3 24 h-incubation showed significant increase of K+ currents densities. At +80 mV, the densities of K+ currents (61 +/- 18) pA/10 pF (n = 8) in As2O3 24 h-incubation group were significantly more than that in the control group (38 +/- 10) pA/10 pF (n = 8, P < 0.05). The HeLa cells were prevented partially from As2O3-induced cell death by co-application for 24 h with typical voltage-dependent K+ channel blockers, 4-aminopyridine (3 mmol x L(-1)) or tetraethylammonium (5 mmol x L(-1)). 4-Aminopyridine (3 mmol x L(-1)) or tetraethylammonium (5 mmol x L(-1)) did not show any toxic effects on HeLa cells.</p><p><b>CONCLUSION</b>Chronic treatment with As2O3 increased voltage-dependent K+ currents in HeLa cells and the cell death induced by As2O3 was reduced partially by voltage-dependent K+ channel blockers, 4-aminopyridine or tetraethylammonium.</p>