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Carvedilol is a new non-selective beta blocker, and studies have proven that the effect of carvedilol in receptor blocking is 2-4 times that of propranolol. Carvedilol is widely used in the treatment of heart failure. However, there are still controversies over its effect in reducing portal pressure and preventing esophageal variceal bleeding. This article analyzes and compares the clinical application of carvedilol, propranolol, and endoscopic variceal ligation in the prevention and treatment of bleeding and summarizes the pharmacological action, clinical effect, dose, and adverse reactions of carvedilol. It is pointed out that carvedilol can significantly improve hemodynamic disorder caused by portal hypertension and thus may become a new drug for the prevention and treatment of esophageal variceal bleeding.
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<p><b>OBJECTIVE</b>To compare the efficacy between left radial approach (LRA) and right radial approach (RRA) for coronary angiography (CAG).</p><p><b>METHODS</b>The following databases were searched, including PubMed, Embase, Web of science, Cochrane Library, CBM, VIP, Wanfang databases and CNKI, from creation of database to January 2013. Two reviewers extracted data independently, according to inclusive criteria, exclusion criteria and methods of Cochrane Collaboration. Statistical analysis was performed using Review Manager Software (RevMan 5.1).</p><p><b>RESULTS</b>Eleven trials with 5 442 patients were included in the systematic review. The results of meta-analysis showed that when compared with RRA, LRA did not increase the failure rate of the procedures (OR = 1.04, 95%CI 0.80-1.35, P > 0.05) and amount of contrast medium (mean difference = 2.39, 95%CI -0.30-5.08), P > 0.05). However, LRA was superior to RRA in reducing fluoroscopy time (standardized mean difference = 0.15, 95%CI 0.06-0.24, P < 0.01). In addition, the incidence of severe tortuosity of subclavian artery was significantly lower with LRA (OR = 4.65, 95%CI 1.98-10.88, P < 0.01).</p><p><b>CONCLUSIONS</b>Based on the current evidence, LRA shares similar safety with RRA for CAG and is superior to RRA in certain respects. LRA can thus be used either as an alternative approach or routine approach for CAG.</p>
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Humanos , Angiografia Coronária , Métodos , Artéria Radial , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Objective To investigate the relationship of the neutrophil/lymphocyte ratio (NLR) on admission and angiographic no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (PCI).Methods 232 patients who had undergone PCI between 2010 and 2013,were included and divided into two groups based upon the thrombolysis in myocardial infarction (TIMI) flow gradings.No-reflow was defined as post-PCI TIMI Grade 0,1 and 2 flows (group Ⅰ).Normal-flow was defined as TIMI 3 flow (group Ⅱ).Receiver operating characteristic curve (ROC) analysis was used to identify the predictive effect of NLR on no-reflow phenomenon.Relationship of NLR and no-reflow was assessed by multivariate logistic regression.All statistical calculations and analyses were performed using SPSS 11.0.Results NLR was significantly higher in group Ⅰ (n=45) compared with group Ⅱ (n=187) [4.1 (2.4-6.5) vs.2.4 (1.7-3.8),P=0.001].In ROC analysis,NLR＞3.2 predicted no reflow with 80％ sensitivity and 73％ specificity.Patients with elevated NLR had a higher incidence of no-reflow phenomenon than those with non-elevated NLR (34.8％ vs.9.3％,P＜0.001).Also,NLR (＞3.2) was an independent predictor of no-reflow development [odds ratio 3.70,95％ confidence interval (1.39-9.80),P=0.009].Conclusion NLR was an independent predicator for no-reflow development in STEMI patients who had undergone PCI.This simple and low-cost parameter could provide useful information for the early risk evaluation on these patients.
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The influencing factors of ultrasonic extraction(UE) and ultrasonic-soxhlet extraction(USE) were analyzed based on orthogonal experimental design. The optimum analytical conditions of two methods were determined. The three different methods: UE, USE and traditional soxhlet extraction(SE) were compared by simultaneous analysis with three different soil samples: fresh contaminated soil, soil after microbial remediation and soil after phytoremediation. The optimum condition of the UE was extracting 4 times with chloroform, 15 mL extractant every time. The optimum condition of the USE method was ultrasonic for 10 min at 60 W, followed by soxhlet extraction with 125 mL extractant for 6 h. Compared the three different methods, USE method showed the best result with the highest average extraction rate of 102.98%, the UE method with average extraction rate of 99.69%, and the SE method with low average extraction rate of 97.31%. The research indicates that USE method is effective in determining soil total petroleum hydrocarbons(TPH) within shorter time and higher efficiency and can be used as a method for determining TPH content in different soils.