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OBJECTIVE To evaluate the efficacy and safety of different drug regimens in the treatment of children with Kawasaki disease， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from the Cochrane Library， Medline， Embase， CINAHL， Web of Science， ProQuest， Google Scholar， CNKI， Wanfang Data， Baidu academic database， World Health Organization International Clinical Trials Registration Platform and ClinicalTrials. gov， randomized controlled trials （RCTs） about intravenous immunoglobulin （IVIG）+glucocorticoid or cyclosporine or tumor necrosis factor-alpha （TNF-α） blocker （trial group） versus standard IVIG therapy （control group） were collected from the establishment of the database to Feb. 28th， 2023. After screening the literature， extracting data， and evaluating the quality of the literature， Stata 14.2 software was used for network meta-analysis. RESULTS Ten RCTs with a total of 1 323 participants involving six measures were included： standard IVIG therapy， glucocorticoid therapy，cyclosporine therapy， TNF- α blocker therapy， remedial glucocorticoid therapy and remedial TNF- α blocker therapy. Results of network meta-analysis showed that the incidence of coronary artery aneurysms （CAA） at 4-8 weeks was significantly lower in patients receiving glucocorticoid therapy than receiving standard IVIG therapy and TNF-α blocker therapy. The incidences of CAA at 4-8 weeks in children treated with remedial glucocorticoid therapy and remedial TNF- α blocker therapy were significantly higher than those treated with glucocorticoid therapy； there was no significant difference in the incidence of CAA at 4-8 weeks among other interventions （P＞ 0.05）； network meta-order of the incidence was glucocorticoid therapy＜cyclosporine therapy＜standard IVIG therapy＜remedial TNF-α blocker therapy＜remedial glucocorticoid therapy＜TNF-α blocker therapy. The incidence of initial IVIG resistance in children receiving cyclosporine therapy was significantly lower than those receiving standard IVIG therapy； there was no significant difference in the incidence of initial IVIG resistance among other interventions （P＞0.05）； network meta-order of the incidence was cyclosporine therapy＜glucocorticoid therapy＜TNF-α blocker therapy＜standard IVIG therapy. There was no significant difference in the incidence of ADR among different interventions （P＞0.05）； network meta-order of the incidence was remedial TNF-α blocker therapy＜TNF-α blocker therapy＜standard IVIG therapy＜glucocorticoid therapy＜cyclosporine therapy. CONCLUSIONS Glucocorticoid therapy at the initial treatment can significantly reduce the risk of CAA at 4-8 weeks in children with Kawasaki disease； cyclosporine has a significant effect on improving initial IVIG resistance， and the use of TNF-α blocker in the remedial stage may have the lowest incidence of adverse reactions.
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Objective:To investigate the risk factors of hyperglycemia during pregnancy and its correlation with adverse pregnancy outcomes based on the retrospective analysis of glucose metabolism of pregnant women in Chongming area.Methods:A total of 604 singleton pregnant women who underwent prenatal examination and delivered normally in the Chongming branch of Xinhua Hospital from September 2019 to May 2021 were enrolled in the study. All subjects were divided into normal glucose tolerance gestation (NGTG) group and gestational diabetes mellitus (GDM) group. Pregnant women whose blood glucose exceeded normal but did not meet the diagnostic criteria of GDM were classified into the intermediate state gestational blood glucose (ISGBG) group. Questionnaire, physical examination, and relevant laboratory tests were completed. Data were analyzed using the Statistical Product and Service Solutions 13.0 (SPSS, Chicago, IL).Results:The incidence rate of GDM was 20.86% (126/604), ISGBG was 40.39% (244/604), and NGTG was 38.74% (234/604) in 604 pregnant women. Multivariate logistic regression analysis showed that gestational age ( OR=1.092, P<0.001), serum triglyceride ( OR=1.625, P=0.001) and free T 3 levels ( OR=1.995, P=0.002) were independent risk factors for GDM. The incidence of pregnancy-induced hypertension, cesarean section, macrosomia, the total incidence of adverse pregnancy outcomes and fetal birth weight in ISGBG and GDM were significantly higher than those in NGTG ( P<0.05 or P<0.01). Conclusion:The incidence of GDM in Chongming area is high, especially higher in that of ISGBG. As both GDM and ISGBG lead to increased adverse pregnancy outcomes, early monitoring should be paid more attention to pregnant women in ISGBG in addition to the early intervention of GDM.
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Objective:To investigate the clinical efficacy and prognosis of sacubatrovalsartan combined with dapagliflozin in patients with heart failure with reduced ejection fraction (HFrEF).Methods:Totally 206 consecutive patients with HFrEF in our hospital from March 2021 to September 2021 were enrolled and randomly(random number) divided into the control group ( n = 51), the sacubatrovalsartan group ( n = 52), the dapagliflozin group ( n=51) and the combined treatment group ( n= 52). The baseline clinical data of patients and laboratory examination results were collected. The changes of related results before and after treatment in each group were analyzed and compared. After discharge, the enrolled patients were followed up by outpatient or telephone for an average of 6 months to determine whether the patients had heart failure rehospitalization, ventricular arrhythmia, major adverse cardiovascular events (MACE), etc. Results:After anti-heart failure treatment, there were significant differences in NT-proBNP, left ventricular ejection fraction (LVEF) and soluble growth stimulating gene 2 protein (ST2) among the four groups. NT-proBNP and ST2 in the combined treatment group were significantly lower than those in the other groups, and LVEF was significantly higher. Compared with the control group, the rehospitalization due to heart failure and MACE events in the other three groups were significantly lower ( P < 0.05), and the combined treatment group had the lowest ( P < 0.05). The Kaplan-Meier survival curve showed that the survival probability of the other groups was significantly higher than that of the control group, and was the highest in the combined treatment group. Conclusions:The clinical efficacy and prognosis of HFrEF patients could be significantly improved after the treatment of sacubatrovalsartan combined with dapagliflozin.
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Background and Objectives@#Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), is highly prevalent in in-hospital HF patients and contributes to worse prognoses. However, the risk of VTE in out-patients with HF in long-term period is controversial. This study aimed to evaluate the associations between HF and the risk of VTE in a long-term follow-up duration. @*Methods@#We searched for studies investigating the risk of VTE, PE, and DVT in patients with HF before April 15, 2020, in PubMed, MEDLINE, and Embase databases. Cohort studies and post hoc analysis of RCTs were eligible for inclusion if they reported relative risk of VTE, DVT or PE in patients with HF in more than 3-month follow-up period. @*Results@#We identified 31 studies that enrolled over 530,641 HF patients. Overall, patients with HF were associated with an increased risk of VTE (risk ratio [RR]=1.57, 95% confidence interval [CI]=1.34–1.84) and PE (RR=2.00, 95% CI=1.38–2.89). However, the risk of DVT was not significantly increased in HF patients (RR=1.33, 95% CI=0.67–2.63). Subgroup analysis showed that patients with chronic HF (RR=1.54, 95% CI=1.32–1.80) had a higher risk of VTE than those with acute HF (RR=0.95, 95% CI=0.68–1.32). @*Conclusions@#In conclusion, HF was an independent risk for VTE and PE but not DVT in a longterm follow-up period. Patients with chronic HF were prone to suffer from VTE than acute HF.
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Background and Objectives@#Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE), is highly prevalent in in-hospital HF patients and contributes to worse prognoses. However, the risk of VTE in out-patients with HF in long-term period is controversial. This study aimed to evaluate the associations between HF and the risk of VTE in a long-term follow-up duration. @*Methods@#We searched for studies investigating the risk of VTE, PE, and DVT in patients with HF before April 15, 2020, in PubMed, MEDLINE, and Embase databases. Cohort studies and post hoc analysis of RCTs were eligible for inclusion if they reported relative risk of VTE, DVT or PE in patients with HF in more than 3-month follow-up period. @*Results@#We identified 31 studies that enrolled over 530,641 HF patients. Overall, patients with HF were associated with an increased risk of VTE (risk ratio [RR]=1.57, 95% confidence interval [CI]=1.34–1.84) and PE (RR=2.00, 95% CI=1.38–2.89). However, the risk of DVT was not significantly increased in HF patients (RR=1.33, 95% CI=0.67–2.63). Subgroup analysis showed that patients with chronic HF (RR=1.54, 95% CI=1.32–1.80) had a higher risk of VTE than those with acute HF (RR=0.95, 95% CI=0.68–1.32). @*Conclusions@#In conclusion, HF was an independent risk for VTE and PE but not DVT in a longterm follow-up period. Patients with chronic HF were prone to suffer from VTE than acute HF.
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Objective To assess the relationship of CYP2C19 gene polymorphism with clopidogrel respon-siveness and the level of EETs in patients with ACS. Methods A total of 123 patients with ACS receiving aspirin combined with clopidogrel dual antiplatelet were enrolled. According to the results of CYP2C19 genotype,patients were divided into three groups:fast metabolic type ,medium metabolic type ,and slow metabolism type. The concentration of EETs and PAIR were compared between three groups. Logistic analysis was used to analyze the risk factors of LCR. Results There were differences statistically in level of EETs and PAIR among the three groups(P<0.05). Logistic analysis showed that the slow metabolism of CYP2C19 gene and lower EETs level were risk factors for LCR. The area under the ROC curve was 0.893(P < 0.05)by EETs level to predict the CYP2C19 genotype. Conclusion The slow metabolism of CYP2C19 gene was an independent risk factor for LCR,while the increase of plasma EETs level was a protective factor.
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Objective To compare the clinical characteristics,and outcomes of patients with heart failure with different left ventricular ejection fractions (LVEF).Methods A total of 1 182 hospitalized patients with heart failure (HF) were enrolled and retrospectively studied in the present study.The patients were stratified by LVEF as reduced (HFrEF,LVEF ＜ 40％,n =313),mid-range (HFmrEF,40％ ≤ LVEF ＜50％,n =287) and preserved (HFpEF,LVEF≥50％,n =582) ejection fraction groups.Among the 1 182 cases,941 of them (81.3％,84.9％,and 84.0％ inHFrEF,HFmrEF and HFpEF groups,respectively) were followed up for an median duration of 27.3 months.Results (1) Among the study patients,26.5％ were in HFrEF,24.3％ in HFmrEF,and 49.2％ in HFpEF groups.(2) Ischemic heart disease with HFmrEF was more frequent than that in patients with HFrEF.The average age,percentage of female subjects,systolic blood pressure,uric acid,N terminal B-type natriuretic peptide precursor (NT-proBNP),hemoglobin,and the incidence of hypertensive heart disease,anemia,atrial fibrillation in patients with HFmrEF were higher than those in patients with HFrEF,but lower than those in patients with HFpEF (all P ＜0.01).(3) The all-cause cumulative mortality was 10.8％ at 1 year,20.6％ at 2 years and 35.9％ at 5 years.No difference was observed in the all-cause cumulative mortality at 1 year,2 years,5 years among the three groups (all P ＞ 0.05).Conclusions The HFmrEF patients,as a new and distinct group,were with many intermediate characteristics compared with HFrEF and HFpEF subjects.However,the all-cause mortality was not significantly differeut among HF patients with different LVEF.
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Conventional magnetic resonance (MR) pulse sequences typically have an echo time (TE) of 1 ms or longer, providing an excellent contrast between different soft tissues. However, some short T2 tissues appear dark in conventional MR images because the signal from these tissues has decayed to nearly zero before the center of k-space is acquired. Because of the ability of directly imaging short T2 tissues, ultrashort echo time technique has been widely studied in recent years. An overwhelming majority of the studies were carried out at high fields, while many low- field scanner systems are still used in developing countries. To investigate the effects of the delay between analog-to-digital converter sampling and the readout gradient, the TE of the second echo used to calculate the R2 * map, and the undersampling ratio on the results of three-dimensional (3D) ultrashort echo time imaging at a low field, we implemented a 3D ultrashort echo time sequence on a 0. 35T scanner. Different parameters were used and the reconstructed images and R2 * maps were compared. Images reconstructed with slightly varying delays appeared quite different. Different contrast between short and long T2 tissues were found in R2 * maps calculated with different echoes. The result of undersampling study indicated that excessive undersampling could cause unwanted blurring, making it difficult to better visualize the short T2 tissues in the R2 * map. The results suggested that cautions should be taken in the choice of these parameters in 3D ultrashort echo time imaging. Short T2 tissues can be visualized with appropriate imaging parameters at this low field.
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Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Magnetic Resonance Imaging , MethodsABSTRACT
Objective: To explore the endothelial microparticle (EMP) level in elderly patients with acute coronary syndrome (ACS) combining diabetic mellitus (DM)) and to study the relationship between EMP level and ACS combining DM in elder patients. Methods: A total of 208 patients≥65 years with coronary angiography in our hospital were summarized including 124 male with the age of (71.9 ± 5.2) years. The patients were divided into 3 groups, Control group, n=51 normal subjects, ACS without DM group, n=83 and ACS+DM group, n=74. Plasma EMP levels were measured by FACSCalibur lfow cytometry as CD31+/CD42b-EMPS and the vascular stenosis degree was quantitatively calculated with Gensini score. Results: The CD31+/CD42b-EMPs level in ACS + DM group >ACS without DM group > Control group, all P Conclusion: Plasma CD31+/CD42b-EMPs level increased in elderly ACS patients and the elevation level related to vascular lesion degree/combining with DM, which indicated the endothelial dysfunction in such patients.
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<p><b>OBJECTIVE</b>To investigate the effect of atorvastatin on cardiac remodeling and function after acute myocardial infarction (AMI) in rats and whether this effect is mediated by transforming growth factor-β1 (TGF-β1) signaling pathway.</p><p><b>METHODS</b>AMI was induced by left coronary artery ligation in 64 male Sprague-Dawley rats, and 45 surviving rats were randomized into control group (n=15), low-dose atorvastatin group (10 mg/kg, n=15) and high-dose atorvastatin group (20 mg/kg, n=15). Similar surgical procedure was performed in sham-operated rats (n=15) without coronary ligation. Atorvastatin was given daily by gavage from the first day after AMI. Eight weeks later, the cardiac function, left ventricular weight/body mass index (LVMI), collagen volume fraction (CVF), and the expressions of TGF-β1 and Smad2 were compared between the groups.</p><p><b>RESULTS</b>AMI caused significantly reduced cardiac function, increased LVMI and CVF, and upregulated expressions of TGF-β1 and Smad2 mRNA and proteins in the control group (P<0.05). The cardiac function, LVMI, and CVF were improved by atorvastatin, which also down-regulated the expressions of TGF-β1 and Smad2 (P<0.05), and the effects were more prominent in high-dose atorvastatin group (P<0.05).</p><p><b>CONCLUSION</b>Atorvastatin can dose-dependently improve cardiac remodeling and function after AMI in rats, which is mediated by regulating the activity of TGF-β1/Smad2 signaling pathway.</p>