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Objective@#To evaluate the efficacy and safety of ivabradine for the treatment of Chinese patients with chronic heart failure based on the Chinese subgroup data of the systolic heart failure treatment with the If inhibitor ivabradine trial (SHIFT).@*Method@#A total of 6 558 stable outpatients who presented symptoms of heart failure, with a left ventricular ejection fraction (LVEF) ≤35%, sinus rhythms with a heart rate ≥70 bpm participated in the randomized, double-blind, placebo-controlled, international multicenter clinical study.The subset of Chinese patients with heart rate ≥75 bpm was enrolled in the post-hoc subgroup analyses.Patients were randomly allocated by computer-generated assignment through a telephone interactive voice response system to ivabradine group (starting dose 5 mg bid, which was then uptitrated to the maximum 7.5 mg bid) or matched placebo group.The clinical baseline characteristics of participants were obtained and analyzed.The primary outcome endpoint was a composite endpoint of cardiovascular death or hospitalization resulting from worsening HF.The primary safety endpoint included total incidence of adverse events during the study, bradycardia, and adverse visual reaction (phosphenes).@*Results@#A total of 49 Chinese centers enrolled a total of 225 patients with chronic heart failure, of whom, 106 patients were randomized to the ivabradine group and the other 119 patients to the placebo group, and the mean follow-up time was (15.6±5.1) months.By the end of the study, mean heart rate (71.0 bpm vs. 80.3 bpm, P<0.05) and incidence of the primary endpoint events (18.9% (20/106) vs. 31.9%(38/119), HR=0.56, 95%CI 0.33-0.97, P=0.039) were significantly lower, while the percentage of patients with improvement in heart functional class NYHA (53.8% (56/106) vs. 34.5% (41/119), P=0.006 1) was significantly higher in the ivabradine group than in the placebo group.The total number of adverse events (129 events, 49.6% PY) in the ivabradine group was lower than that in the placebo group (203 events, 50.8% PY). In the ivabradine group and the placebo group, there were respectively 2 patients (1.9%) and 0 patients experienced bradycardia, 3 patients (2.9%) and 1 patient (0.8%) experienced adverse visual reaction (phosphenes).@*Conclusions@#Ivabradine significantly reduced heart rate and improved the clinical outcomes and NYHA function class in Chinese patients with chronic heart failure, these beneficial effects are achieved without inducing remarkable adverse reactions.The results of Chinese subgroup analysis were thus consistent with the overall results of the SHIFT study.@*Clinical Trial Registry@#International standard randomized controlled trials registry, ISRCTN 70429960.
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Objective To evaluated the feasibility and accuracy of obtaining the myocardial perfusion image and coronary artery image of pig models of acute myocardial infarction by the second generation dual-source CT dual-energy myocardial perfusion one-stop scanning. Methods The pig models of acute myocardial infarction was established by using the interventional gelatin sponge embolism method on 5 pigs. The myocardial perfusion scanning and coronary angiography were respectively used 20 min before and 24-48 h after modeling. The heart were taken out immediately after the inspection for multiple punch biopsy and HE staining, then the heart was sliced for triphenyltetrazolium chloride (TTC) staining. According to the gold standard of coronary angiography and pathological staining, the sensibility and speciifcity of the coronary artery image of acute myocardial infarction of pig reconstructed by myocardial perfusion scanning and the myocardial perfusion image were respectively evaluated, and the consistency of the results was veriifed by Kappa test. Results Compared with the pathologic gold standard, the sensitivity, speciifcity, of myocardial perfusion iodine image obtained by myocardial perfusion scanning were 93%, 91%; and Kappa value was 0.68. Compared with the coronary angiography gold standard, the sensitivity and speciifcity of coronary artery image obtained by myocardial perfusion scanning were 93%, 81%, and Kappa value was 0.71. Conclusions The second generation dual-source CT dual-energy myocardial perfusionone-stopscanning can accurately get the coronary artery and myocardial perfusion images of the pig models of acute myocardial infarction.
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Objectives To investigate the image quality,influencing factors and radiation doses of prospectively ECG-triggered spiral acquisition mode (Flash spiral mode)coronary computed tomography angiography (CCTA) using high-pitch dual-source CT in patients with different heart rates.Methods One hundred and thirty-four consecutive patients with mean heart rate (HR) ＞ 65 beats per minute (bpm) and ≤ 100 bpm were included in this study as group A using Flash spiral mode setting at 20％ -30％ of the R-R interval and 134 consecutive patients with mean HR ≤65 bpm were enrolled as group B using Flash spiral scan mode at 55％ of the R-R interval; 134 consecutive patients with mean HR ＞ 65 and≤100 bpm using spiral scan mode were included as group C. The image quality scores, effective radiation dose and influencing factors of image quality in three groups were assessed. All statistical analyses were performed using SPSS.Results (1)The non-diagnostic coronary artery segments in group A (28/1842,1.52％) were more than in group B (8/1819,0.44％ ) ( x2 =10.97,P =0.001 ) and there was no significant difference between group A and group C (32/1838,1.74％) ( x2 =0.280,P =0.345).The number of patients with non-diagnostic coronary segments in group A( 10/134,7.5 ％ )was more than in group B (2/134,1.5 ％,x2 =5.52,P =0.018 ),while there was no significant difference between group A and group C (9/134,6.7％,x2 =0.057,P =0.812).(2)The average heart rate variability (HRV) of patients with different image scores in the three groups wcrc significantly different. In group A,the HRV of score 1,2 and 3 were (2.29 ± 1.06),(5.17 ± 1.37),(8.88 ± 1.53) bpm,respectively (F =170.402,P =0.001 ).In group B were (2.26±1.01),(5.97 ±1.82),(12.00 ±9.64) bpm,respectively (F=95.843,P=0.001).In group C were (2.61 ±1.85),(7.90 ±3.97),(11.22 ±5.62) bpm,respectively (F=68.629,P=0.001 ). (3) The average effective radiation doses in groups A and B were significant lower than in group C [ A group was 1.04 ± 0.16,B group was 1.03 ± 0.16 and C group was 7.05 ± 1.05,t =65.5 ( A vs C),P ＜0.01 ( A vs C) ].Conclusions Flash spiral mode of high-pitch dual-source provides high image quality with significant reduction of radiation exposure in patients with HR ≤ 65 bpm. Patients with heart rates ＞65 bpm and ≤100 bpm without cardiac arrhythmia can perform CCTA using Flash spiral mode with image acquisition time setting at 20％-30％ of the R-R interval.
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Objective To evaluate the clinical application of serum CYFRA21-1 detection during the diagnosis of lung cancer. Methods Serum level of CYFRA21-1 in 196 patients with lung cancer and 39 healthy controls were determined by the Elctro-chemiluminescence Immuno-assay ( ECLIA) , respectively. Results Serum level of CYFRA21 -1 ( range from 0. 30 μgg/L to 500.00 μg/L) in patients with lung cancer were significantly higher than those in the healthy control ( range from 0. 27 μg/L to 3. 29 μg/L,Z = -4. 65,P < 0.01). ROC analysis of diagnosis efficiency showed that the area under curve ( AUC) was 0. 735 (P < 0. 001 ). The confidence interval of 95% was from 0. 663 to 0. 807. Positive detection rate of CYFRA21-1 was 48. 8% (39/80) in squamous,31.7% (20/63) in adenocarcinoma and 22. 6% (12/53) in small cell lung cancer (SCLC) respectively, as well as total positive rate was 36. 2% (71/196). Stepwise regression analysis showed that serum level of CYFRA21-1 had a linear correlation with the squamous and the metastasis to liver or bone (r =0. 505 ,P <0. 05). Conclusions Serum level of CYFRA21-1 increases the diagnostic sensitivity, which is helpful for determining histological types, monitoring the metastasis of liver and bone, and evaluating the treatment response in patients with lung cancer.
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OBJECTIVE To study the frequency of fungal infection and its drug resistance in tumor patients, and to provide the reference for clinical treatment. METHODS From Aug 2006 to Jul 2008, the drug sensitivity test and pathogen distribution of 960 patients in our hospital were retrospectively analyzed. RESULTS A total of 308 fungal strains were detected from 960 patients (32.1%). Candida albicans infection rate reached 73.1%, and C. krusei and C. glabrata were 13.3% and 9.1%, respectively. Drug sensitivity showed that the drug resistance of C. albicans to ECC, KET and MIC was 43.9%, 34.2 and 27.1%, respectively, and that of the C. krusei to the ECC, KET and MIC were 53.3%, 42.2% and 48.8%, respectively, while their fungal infection was depressed by AMB, NYS and 5-FC. CONCLUSIONS C. albicans is the major fungus in patients of tumor hospital, and the infection rate of C. krusei and C. glabrata is also high. Clinical doctors should control the distribution and drug resistance of fungal infection in therapeutic process for a reasonable antibiotics usage.