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BACKGROUND@#Preliminary studies have indicated that Shexiang Baoxin Pill (MUSKARDIA) has a coronary artery dilation effect and increases the coronary blood flow, relieving the symptoms of angina. This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease (CAD) and diabetes mellitus (DM).@*METHODS@#This was a subgroup analysis of a multicenter, randomized, placebo-controlled phase IV trial. CAD patients with a medical history of DM or baseline fasting blood glucose (FBG) ≥7.0 mmol/L were grouped according to the treatment (standard therapy plus MUSKARDIA or placebo). The primary outcome was major adverse cardiovascular events (MACEs), which was the composite outcome of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary outcome was the composite outcome of all-cause death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina or heart failure, and coronary angioplasty.@*RESULTS@#MACEs occurred in 2.6% (9/340) and 4.8% (18/376) of patients in the MUSKARDIA and placebo groups, respectively ( P = 0.192). Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo (15.3% [52/340] vs . 22.6% [85/376], P = 0.017). Risk of MACEs (hazard ratio [HR] = 0.69, 95% confidence interval [CI]: 0.31-1.57) was comparable between two groups. In patients with uncontrolled DM (≥4 measurements of FBG ≥7 mmol/L in five times of follow-up), the risk of secondary outcome was significantly lower with MUSKARDIA (5/83, 6.0%) than with placebo (15/91, 16.5%) (HR = 0.35, 95%CI: 0.13-0.95).@*CONCLUSION@#As an add-on to standard therapy, MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM. Furthermore, MUSKARDIA may reduce the frequency of all-cause death, hospitalization, and coronary angioplasty in this population, especially in those with uncontrolled DM.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR-TRC-12003513.
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Humans , Coronary Artery Disease/complications , Diabetes Mellitus, Type 2/drug therapy , Myocardial Infarction/complications , Stroke/epidemiologyABSTRACT
Objective:To investigate the survival prognosis of patients with primary liver cancer and its influencing factors.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 3 106 patients with primary liver cancer who had health insurance for special illness in the Chongqing Malignant Tumor Treatment System from January 2000 to August 2018 were collected. There were 2 559 males and 547 females, aged (60±13)years, with a range from 19 to 95 years. Observation indicators: (1) demographic characteristics; (2) clinical treatment and pathological examination; (3) follow-up and survival; (4) analysis of prognostic factors. Follow-up using telephone interview, outpatient or inpatient reexamination was preformed to detect survival of patients. Follow-up was done once every 3 months within the first year and once a year thereafter up to December 2018. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represent as M (range). Count data were expressed as absolute numbers or percentages. Survival analysis was done after excluding missing data of follow-up. The survival rate was calculated and survival curve was drawn by Kaplan-Meier method. The prognostic factors were analyzed after excluding missing data of follow-up, pathological type, and TNM staging. The log-rank test was used for univariate analysis, and COX proportional hazard model was used for multivariate analysis. Results:(1) Demographic characteristics: of the 3 106 patients with primary liver cancer, the number of males and females (gender), cases with age < 30 years, from 30 to 44 years, from 45 to 59 years, from 60 to 74 years, ≥75 years, cases of Han nationality or other ethnic groups, cases being married or other status (marital status), cases with occupation as enterprise unit staff and (or) workers, public institution personnel and (or) civil servants, freelancers and (or) self-employed entrepreneurs, unemployed, company staff, and other professionals were 2 559, 547, 35, 362, 1 131, 1 163, 415, 3 053, 53, 2 896, 210, 880, 342, 130, 101, 124, and 1 529, respectively. (2) Clinical treatment and pathological examination: of the 3 106 patients with primary liver cancer, cases with hospitalization time < 10 days, from 10 to 19 days, from 20 to 29 days, ≥30 days, cases without surgery or with surgery, cases with hepatocellular carcinoma, cholangiocarcinoma, hybrid type and other pathological types, cases of stage Ⅰ, Ⅱ, Ⅲ, Ⅳ of TNM staging were respectively 771, 1 312, 661, 362, 915, 2 191, 836, 63, 24, 29, 28, 90, 624. There were 2 183 out of 3 106 patients without pathological data and 2 335 without TNM staging data. (3) Follow-up and survival: of the 3 106 patients with primary liver cancer, 2 561 were followed up for 3.0-96.0 months, with a median follow-up time of 27.6 months. The 2 561 patients had survived for 1.0-96.0 months, with a median survival time of 24.7 months. The 1-, 3-, 5-year survival rates were 63.2%, 42.3%, 29.5%, respectively. (4) Analysis of prognostic factors: results of univariate analysis showed that age, marital status, occupation, hospitalization time, surgical treatment, pathological types, and TNM staging were related factors for prognosis of patients ( χ2=31.820, 6.752, 39.100, 120.889, 226.700, 10.452, 48.602, P<0.05). Results of multivariate analysis showed that being married, hospitalization time no less than 30 days, surgical treatment were independent protective factors for prognosis ( hazard ratio=1.463, 0.572, 0.575, 95% confidence interval: 1.044-2.049, 0.413-0.793, 0.438-0.755, P<0.05), stage Ⅲ and Ⅳ of TNM staging were independent risk factors for prognosis of patients ( hazard ratio=3.941, 5.036, 95% confidence interval: 1.687-9.211, 2.237-11.335, P<0.05). Conclusions:Patients with primary liver cancer have poor prognosis. Being married, hospitalization time no less than 30 days, and surgical treatment are independent protective factors for prognosis, stage Ⅲ and Ⅳ of TNM staging are independent risk factors for prognosis.
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Objective: To study the relationship between plasma NT-ProBNP level and the severity of coronary artery lesions including left anterior descending (LAD) involvement in acute ST-elevation myocardial infarction (STEMI) patients with normal left ventricular ejection fraction (LVEF) while without diastolic heart failure. Methods: A total of 280 qualiifed patients were collected, plasma NT-proBNP level was examined in all patients within 24-hour of admission. The patients were divided into 3 sets of groups. By Gensini score system: Gensini score60 group,n=99; by the number of coronary branch lesions: Single branch group,n=78, Double branch group,n=105 and Triple branch group,n=97; by LAD condition: Criminal LAD group,n=146 and Non-criminal LAD group,n=134. Relevant comparison was conducted in all patients. Results: Plasma NT-proBNP level in Gensini score>60 group was higher than the other 2 Gensini groups, it was higher in Gensini score (30-60) group than Gensini score<30 group; the more branches were involved, the higher NT-proBNP were found (1176.70±492.50) pg/ml vs (608.70±331.20) pg/ml vs (336.90±176.70) pg/ml; NT-proBNP was higher in Criminal LAD group than Non-criminal LAD group (1199.40±725.00) pg/ml vs (607.40±244.20) pg/ml, allP<0.05. Pearson correlation analysis showed that NT-proBNP was positively related to Gensini score (r=0.278,P<0.05). Conclusion: Plasma NT-proBNP level was positively related to severity of coronary lesions, it had certain predictivevalue for triple vessel disease and criminal LAD; routine NT-proBNP examination was helpful for risk stratiifcation and clinical treatment in acute STEMI patients.
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Objective To explore the effects of military stress on memory function in battlefield environment confined intensive training of peace-keeping soldiers.Methods 41 peace-keeping soldiers were chosen as the research objects.They were tested the memory function,respectively after they trained intensely in the domestic and in Sudan for five months.The memory function included verbal memory:WHO-UCLA auditory verbal learning test (immediate recall,the insert test,the short time delay memories,long delayed recall,long delayed recognition,visual memory) using the Rey Ostereitb Complex Figure (graphics copy and graphic delayed recall).Results The peace-keeping soldiers got lower scores in the insert tested(4.59±2.03) and graphics copy(35.85± 0.36) than in the domestic (4.85 ± 2.21,35.71 ± 0.46,P＞ 0.05),but there was no significant difference.They got lower scores in the immediate recall (41.68±9.87),the short time delay memories (9.27±2.77),long delayed recall (9.12±2.99),long delayed recognition (27.56± 1.70),and graphic delayed recall (16.90± 6.16) than those in the domestic(51.68±8.63,11.73±2.15,12.24± 1.96,29.00± 1.43,23.15±7.16,P＜0.01),and the difference was statistically significant.Conclusion The peace-keeping soldiers battlefield environment stress has a certain effect on the soldiers' memory function.
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Objective: To observe the relationship between 1h, 2h post-load plasma glucose (PG) elevation and carotid intima-media thickness (CIMT) in healthy population. Methods: The healthy subjects from normal physical examinations in our hospital from 2013-09 to 2015-05 were selected and oral glucose tolerance test (OGTT) was conducted in them, plasma levels of fasting glucose (FPG), 1hPG and 2hPG were monitored. Finally, 482 subjects with normal fasting glucose, without diabetes were enrolled and divided into 4 groups:①Normal glucose tolerance (NGT) group,n=201,②1hHPG group, the subjects with 1h post-load high and 2h post-load normal glucose,n=83,③2hHPG group, the subjects with 1h post-load normal and 2h post-load high glucose,n=101 and④1hHPG/2hHPG group,n=97. The gender, age, BMI, blood pressure and lipid levels in all subjects were recorded, CIMT was evaluated by Doppler ultrasound; the relationship between 1hHPG, 2hHPG and CIMT were analyzed. Results:①The gender, age, BMI, systemic blood pressure (SBP), DBP and the levels of TC, TG, LDL-C were similar among 4 groups,P>0.05.②For CIMT at both side, both bifurcations and both internal carotid arteries, 1hHPG/2hHPG group was higher than those in 1hHPG group and 2hHPG group; 1hHPG group was higher than 2hHPG group; CIMT in above 3 groups were all higher than NGT group, allP Conclusion: Abnormal 1hHPG and 2hHPG were related to increased CIMT.
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Objective To investigate the relationship between HIF-1αand bevacizumab resistant in o-vary cancer,and explore the influence on ovary cancer cell by HIF-1α.Methods The correlation was analyzed between HIF-1αexpression and clinicopathological parameters using immunohistochemistry in 62 patients with ovarian cancer.In addition,the expression of HIF-1αand VEGF were evaluated by real time PCR or Western Blot in SKOV3 and ES-2 cell under CoCl 2 treatment.Results HIF-1αwas overexpressed in cancer tissue, and its high levels were related to CA125(P=0.027)and resistant to bevacizumab(P<0.001).Moreover,CoCl2 could induce high expressions of HIF-1αand VEGF,when compared to normal condition.Conclusion Our findings suggest that HIF-1αis associated with resistant to bevacizumab.It is more chemotherapeutic sensitivity when combined with bevacizumab and HIF-1αantibody.
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Objective To explore the clinical results and complications of the traditional skeletal traction through olecranon on treating the irreducible humeral supracondylar fracture in children with of ulna.Methods Ninety-eight children patients of humeral supracondylar fracture with failure of reduction manipulation were selected as our subjects.The towel clamp-skeletal traction through olecranon of ulna was applied as the additional treatment methods.Meanwhile 5-24 months' follow-up were performed.Results According to Flynn elbow joint function evaluation standard.The curative effect was as followed.71 patients (74.7％) got the excellent outcome,17 patients (17.9％) for good outcome and 7 patients for improved utcome(7.3％).Therefore,the ratio of excellent operation reached to 92.6％.Conclusion The towel clampskeletal traction through olecranon of ulna might be an effective method to treat reliable fixation regarding of its high curing rate and simple process of performance.
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Angiotensin I-converting enzyme (ACE, EC3.4.15.1) plays an important role in regulating blood pressure. The C-domain of ACE has been identified as the main catalytic site of angiotensin I cleavage in vivo. The ACE gene fragment of the C-domain was amplified by PCR and cloned into the pPIC9K secretory expression plasmid. The recombinant plasmid was transformed into Pichia pastoris strain GS115. Positive clones were selected and subject to electroporation. Antibiotic G418 was used for the screening of multicopy inserts. After optimization of the expression system, the protein yield reached 0.5 g/L by flask-shaking culture fermentation, and enzyme activity reached 7.178 U/mL in the fermentation supernatant. The purity of the target protein obtained was 97% after Ni+ affinity chromatography. Enzyme inhibitory activity assay using Captopril showed that it is promising to use ACE-C domain as new generation of target for screening ACE inhibitor antihypertensive drugs.
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Humans , Angiotensin-Converting Enzyme Inhibitors , Catalytic Domain , Genetics , Electroporation , Peptidyl-Dipeptidase A , Genetics , Pichia , Genetics , Metabolism , Recombinant Proteins , GeneticsABSTRACT
Angiotensin converting enzyme (ACE, EC 3.4.15.1) is a membrane-bound, zinc dependent dipeptidase that catalyzes the conversion of the decapeptide angiotensin I to the potent vasopressor ocatapeptide angiotensin II, by removing two C-terminal amino acids. ACE is well known as a key part of the renin angiotenisn system that regulates blood pressure, and its inhibitors have potential for the treatment of hypertension. This paper reviewed the characteristics of ACE in aspects of its structure-function relationship, gene polymorphism and inhibitor development. In particular, the catalytic mechanisms of the two active sites of somatic ACE in the cleavage of angiotensin I and bradykin are different. Therefore, it would likely provide a new way for exploiting novel ACE inhibitors with fewer side-effects by specifically-targeting the individual active sites of somatic ACE.
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Humans , Angiotensin-Converting Enzyme Inhibitors , Pharmacology , Antihypertensive Agents , Pharmacology , Peptidyl-Dipeptidase A , Chemistry , Genetics , Metabolism , Polymorphism, Genetic , Structure-Activity RelationshipABSTRACT
OBJECTIVE:To discuss the research and clinical application of drug eluting stents,in addition,to explore the effects of drug eluting stents on preventing and curing coronary restenosis. METHODS:The databases of Medline and Chinese CNKI were retrieved using computer from 1993 and 2009,and the literature was selected according to inclusion and exclusion criteria. The rapamycin eluting stent and paclitaxel eluting stent were widely used in preventing and curing in stent restenosis,the problems existed in this process were discussed. RESULTS:Drug eluting stents could prevent in stent restenosis following stent implantation,however,the problems such as poor adherence or stent fracture still occurred in clinic. CONCLUSION:Drug eluting stents exhibit efficiency and safety in preventing restenosis,but there still existed problems need to further explore.
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Objective To study the clinical value of PgCO_2 measurement on the patients in ICU.Methods PgCO_2 were continuous measured 24 hours by using air-automated tonometry for 50 cases admitted in ICU.The heart rate,blood pressure,MAP,CVP,SpO_2,artery blood gas were measured at the same time.According to acute physiologic and chronic health evaluation(APACH Ⅱ) and MODS mark,the patients were divided into 2 groups,high-risk group and light-risk group.20 cases suffered from malignant tumour without functional failure of the organs were looked on as compared group.The results of measurement of every group were compared.Results Comparing with the three groups,the results of PgCO_2,Pg-aCO_2,Pg-etCO_2 were significantly different,but the Pg-aCO_2 and Pg-etCO_2 were the same.Conclusion PgCO_2 is an effective index for observing the conditional change of the high-risk cases.PgCO_2≥45mmHg,Pg-aCO_2≥15mmHg may be considered as a predictive signal that the patient well appears functional failure or death.Pg-etCO_2 may substitute Pg-aCO_2 as a continuous measurement index.
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Objective To implement the informationization management in 80% medical treatment health vocation through the research of clinical information exchange and share system,and truly realize "patient as central" in comprehensive information management. Methods The theories and ways for system engineering and management information system were used and succeed experience of domestic and overseas were referenced by the middleware added to system. Results The clinical information exchange system can accelerate medical treatment decision and promote efficiency and level of management,and cut down cost of medical treatment,which can improve clinical scientific research in further. Conclusion This research not only has practical importance,but also embodiment advancement,prospective,operability and latent social benefit.
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Objective:To detect the changes of tumor necrosis factor-α(TNF-α) in nasopharyngeal secretion of patients with nasopharyngeal carcinoma(NPC).Method: The content of TNF-α in nasopharyngeal secretion was determined by radioimmunoassay (RIA) in 20 controls,52 patients with NPC.Result:The average concentrations of TNF-α were (12.95±4.62)pmol/L in control group,(33.68±15.13) pmol/L in NPC group and (64.00±11.57)pmol/L in NPC with necrosis group. The content of TNF-α in nasopharyngeal secretion in control group was lower significantly than that of patients with NPC (P<0.01).Conclusion:The level of TNF-α in nasopharyngeal secretion of NPC patients was higher than that of normal subjects. To detect the content of TNF-α in nasopharyngeal secretion is a useful test for the study and diagnosis of NPC.
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Objective To evaluate the clinical efficacy of arterial chemotherapy and partial cystotomy for treatment of bladder carcinoma. Methods A total of 171 cases of the bladder carcinoma who would undergo partial cystotomy were randomly diviede into 2 groups:(1)78 patients received arterial chemotherapy before the operation;(2) 93 cases were treated with arterial chemotherapy after the operation.In addition,35 cases who underwent operation alone were selected for the DNA content detection by FCM as control group.All these cases were followed up for 5 years. Results Among the 78 cases with the cystoscopy,the tumors disappeared in 9 cases and the tumors shrank by half or more in 49 cases.The total effective rate was 74.3%(58/78).The pathological examination showed the effective rate was 75.9%(44/58).There was a remarkable change in the carcinoma cells by the electronic microscopy.DNA index,proliferation index,SFR and aneuploid rate were detected by FCM.In the cases of grades Ⅱ and Ⅲ bladder carcinoma there was a statistically significant difference ( P