Rationale and design of the SPRING trail: effectivity and safety of Pfo closuRe vs medIcine in alleviatiNg migraine, a multicenter, randomized and open-label trail.

BACKGROUND: Migraine is a leading cause of disability worldwide. Several retrospective studies have suggested that the closure of the Patent Foramen Ovale (PFO) may provide relief from migraines. However, three randomized controlled trials did not meet their primary endpoints regarding migraine cessation, reduction in monthly migraine days, and responder rates. METHODS: The SPRING study is a multicenter, prospective, randomized, and open-label trial designed to compare the effectiveness and safety of PFO closure versus medication in the relief of migraines. The primary endpoint is the total cessation of migraines, as recorded in patient headache diaries during the follow-up period. Additional diagnostic tools include echocardiography with agitated saline contrast, transcranial Doppler, and routine laboratory measurements. CONCLUSION: The SPRING trial aims to assess the effectiveness and safety of PFO closure versus medication in mitigating migraines in real-world settings. (Clinical Trails ID: NCT04946734).

Model for screening adult congenital heart disease surgery eligibility with echocardiography parameters.

OBJECTIVES: This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters. METHODS: A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis. RESULTS: Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84-0.90, p < 0.01), 0.86 (95% CI: 0.82-0.91, p < 0.01), and 0.85 (95% CI: 0.79-0.90, p < 0.01), respectively. CONCLUSIONS: This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC.

Effects of Polygonum multiflorum on kidney injury and renal cell apoptosis in SD rats / 中国比较医学杂志

Objective To investigate the effects of decoction, ethanol extract, and formulated granules of different processed products of Polygonum multiflorum in conventional doses on kidney injury, renal cell apoptosis and expression of related protein in SD rats. Methods Half male and half female SD rats were randomly divided into 7 groups according to their body weight:normal control group, traditional water extract of raw Polygonum multiflorum group(SW group),traditional water extract of prepared Polygonum multiflorum group(ZW group), 70% alcohol extract of raw Polygonum multiflorum group(SA group),70% alcohol extract of prepared Polygonum multiflorum group(ZA group), raw Polygonum multiflorum granules without water decocting extraction group(SK group)and prepared Polygonum multiflorum granules without water decocting extraction group(ZK group). Among them,the rats in the normal group were intragastrically given distilled water,and the other groups were treated with the corresponding drug liquids[6 g/(kg·d)of crude drug]for consecutive 30 days. At the end of the experiment,changes in the levels of blood urea nitrogen(BUN), creatinine(Crea), uric acid(UA)and β2-microglobulin(β2-MG)were measured by a semiautomatic biochemical analyzer. In addition,the histopathological changes of kidney tissues were examined,renal cell apoptosis was detected by TUNEL assay, and the expression of Bcl-2 and BAX was determined by immunohistochemical analysis. Results Compared with the normal control group,the levels of BUN in each drug administration group were significantly lower(P<0.05,P < 0.01). The levels of Crea, UA, and β2-MG in each drug administration group all showed an increasing tendency compared with the normal control group, especially, the level of β2-MG in the ZA group was significantly increased(P< 0.05). The result of TUNEL assay showed that the average optical density in each drug administration group was significantly higher than that in the normal control group(P< 0.01). In addition,the expression level of BAX in the SA group was significantly increased(P < 0.01), but expression of Bcl-2 showed no significant difference among the groups(P> 0.05). Conclusions Our findings indicate that the long-term administration of Polygonum multiflorum with a daily dose of 6 g/kg of crude drug can cause some damages to the kidneys, and the degrees of kidney injuries are ranked as alcohol extract > formulated granules > water extract. We would suggest that for patients with impaired renal fuction,Polygonum multiflorum should be used with caution, and do not used for patients with severely impaired renal function. For people long-term using Polygonum multiflorum for health care purposes, it is recommended only to use its water extract,and to control renal function,especially,β2-microglobulin,at regular intervals,to avoid irreversible kidney injury.

Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension / 中华心血管病杂志

Objective@#The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients.@*Methods@#One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n=97) and severe PH group (Rp/Rs>0.6, n=76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation.@*Results@#Uric acid was positively correlated with pulmonary vascular resistance(r=0.398, P<0.01), systemic vascular resistance(r=0.244, P<0.01) and mean right atrial pressure (r=0.26, P<0.01), and was negatively correlated with cardiac index(r=-0.278, P<0.01)and mixed venous oxygen saturation (r=-0.322, P<0.01)in PH patients. Serum uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both P<0.05). According to the receiver operating characteristic curve (ROC), 425.5 μmol/L was found to be the best cut-off value of serum uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid <425.5 μmol/L(P=0.027).@*Conclusion@#Our findings suggests that uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.