A new model (Alfalfa-Warfarin-GIB) for predicting the risk of major gastrointestinal bleeding in warfarin patients.

BACKGROUND: This study aimed to analyze the factors influencing warfarin-related major gastrointestinal bleeding (GIB) and to develop a score that would provide a reference for assessing the risk of major GIB associated with warfarin treatment. METHODS: This was a retrospective analysis of clinical and follow-up data from warfarin-treated patients. Scores were analyzed using logistic regression. The area under the subject working characteristic curve (AUC), sensitivity, specificity, and Hosmer-Lemeshow test were used to evaluate the scoring performance. RESULTS: A total of 1591 patients who met the requirements for warfarin use were included in this study, and 46 developed major GIB. After univariate analysis as well as multivariate logistic regression analysis, nine factors were found to be associated with increased risk of major GIB, namely age ≥ 65 years, history of peptic ulcer, history of major bleeding, abnormal liver function, abnormal renal function, cancer, anemia, labile international normalized ratio, and combination of antiplatelet agents/non-steroidal anti-inflammatory drugs. The Alfalfa-Warfarin-GIB score was constructed using these nine factors. The AUC and Bootstrap method-corrected AUC of the Alfalfa-Warfarin-GIB score were 0.916 (95% CI: 0.862-0.970, P < 0.001) and 0.919 (95% CI: 0.860-0.967, P < 0.001), respectively, which were higher than those of the HAS-BLED score (AUC = 0.868, 95% CI: 0.812-0.924, P < 0.001). CONCLUSION: Based on nine risk factors, the Alfalfa-Warfarin-GIB score was constructed to predict the risk of warfarin-related major GIB. The newly developed Alfalfa-Warfarin-GIB score has a better predictive value than the HAS-BLED score and may be an effective tool to help reduce the occurrence of major GIB in patients on warfarin.

Downregulated PI3K-Akt-eNOS expression is related to increased atrial fibrillation inducibility in diabetic rats / 中华心血管病杂志

Objective@#To explore the impact of PI3K-Akt-eNOS signaling on atrial fibrillation inducibility in diabetic rats.@*Method@#Eight-week-old male diabetic rats were randomized assigned into GK group, IGF group and L-NAME group (n=8 each) which respectively received normal saline (NS), insulin like growth factor (IGF-1) or L-NAME+IGF-1 through tail vein daily for 4 weeks. Eight 8-week-old male homologous Wister-Kyoto(WKY) rats treated with intravenous NS served as control group (WKY group). Blood glucose was measured once per week. The left atrial diameter (LAD) was measured by echocardiography, the atrial electrical parameters, including the P-wave duration, the atrial effective refractory period (AERP) and its dispersion (AERP-d), the incidence and the duration of atrial fibrillation induced by atrial burst pacing, were evaluated by electro-physiological instrument at 4 weeks post various treatments. Rats were then sacrificed, left atrial (LA) cell morphology was determined on HE stained sections, LA interstitial collagen was determined on Masson stained sections. The protein expression of phosphatidylinositol 3-kinase (PI3K) and phosphate endothelial nitric oxide synthase (p-eNOS) were detected by Western blot.@*Results@#(1) At the beginning of the study, the random blood glucose (GLU) level was significantly higher and LAD was large in GK, IGF and L-NAME groups than in WKY group;after 4 weeks, GLU level and LAD dimension of IGF group were lower than GK and L-NAME groups (P<0.01 or 0.05). (2) One rat in L-NAME group died during operation. Four weeks later, the incidence of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 7/8, 2/8, 6/7 and 3/8. The median duration of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 11.9(9.3, 13.1), 0(0, 1.8), 11.5(4.4, 12.0), and 0(0, 3.0) s. Compare with WKY group, the P-wave duration and PR interval were significantly longer, AERP-d, incidence, and duration of atrial fibrillation were significantly higher in GK group (P<0.01), these changed were significantly reversed in IGF group compared to GK and L-NAME groups (all P<0.01). Heart rate and AERP were similar among the 4 groups on (P>0.05). (3) Four weeks later, the CSA and CVF of LA were significantly larger in GK group than in WKY group (P<0.01), which were significantly reversed in IGF group (P<0.01 vs. GK group), and the beneficial effects of IGF disappeared by co-treatment with L-NAME (P<0.01 vs. IGF group). (4) Four weeks later, compare with WKY group, the protein expression of PI3K (P<0.01) and p-eNOS (P<0.05) of LA were significantly downregulated in GK group, which could be significantly upregulated by IGF (P<0.01 and 0.05 vs. GK group), these effects diminished by co-treatment with L-NAME (P<0.01 or 0.05 vs. IGF group).@*Conclusion@#Increased atrial fibrillation susceptibility in diabetic rat is linked with structural and electrical remodeling in LA, possibly mediated through downregulated PI3K-Akt-eNOS signaling.

Progress of circulating cell-free DNA in B-cell neoplasms / 白血病·淋巴瘤

Circulating cell-free DNA (cfDNA) is a kind of free DNA in circulating blood, including circulating tumor DNA (ctDNA) deriving from tumor cells and DNA deriving from normal tissue cells. CtDNA is a specific tumor DNA in cfDNA. CfDNA could reflect the status of tumor to a certain extent, which plays an important role in tumor diagnosis, disease monitoring, treatment evaluation, prognosis and recurrence judgement, and has a potential clinical value as a simple, effective and noninvasive "liquid biopsy"technology. As a new concept, the number of cfDNA analysis in B-cell tumors is increasing, such as the relationship between tumor-specific gene mutations, methylation changes, minimal residual disease (MRD) and prognosis, recurrence, monitoring of treatment effects, targeted therapy by using cfDNA sequencing technology.

Qishen Yiqi Drop Pill improves cardiac function after myocardial ischemia.

Myocardial ischemia (MI) is one of the leading causes of death, while Qishen Yiqi Drop Pill (QYDP) is a representative traditional Chinese medicine to treat this disease. Unveiling the pharmacological mechanism of QYDP will provide a great opportunity to promote the development of novel drugs to treat MI. 64 male Sprague-Dawley (SD) rats were divided into four groups: MI model group, sham operation group, QYDP treatment group and Fosinopril treatment group. Echocardiography results showed that QYDP exhibited significantly larger LV end-diastolic dimension (LVEDd) and LV end-systolic dimension (LVEDs), compared with the MI model group, indicating the improved cardiac function by QYDP. (1)H-NMR based metabonomics further identify 9 significantly changed metabolites in the QYDP treatment group, and the QYDP-related proteins based on the protein-metabolite interaction networks and the corresponding pathways were explored, involving the pyruvate metabolism pathway, the retinol metabolism pathway, the tyrosine metabolism pathway and the purine metabolism pathway, suggesting that QYDP was closely associated with blood circulation. ELISA tests were further employed to identify NO synthase (iNOS) and cathepsin K (CTSK) in the networks. For the first time, our work combined experimental and computational methods to study the mechanism of the formula of traditional Chinese medicine.

Systematic evaluation and meta analysis of children bronchial pneumonia treated with tanreqing injection / 中国医师杂志

Objective To evaluate the effectiveness and safety of tanreqing injection to children bronchial pneumonia.Methods PubMed,Ovid,CNKI,and data retrieval system of all places were searched to identify relevant studies from 2003 to November of 2014.The final documents were examined with inclusive and exclusive criteria.Results were pooled with meta-analysis on RevMan software to assess the efficacy of tanreqing injection to children bronchial pneumonia.Results The database was derived from 13 qualified studies that included a total of 1479 patients.Meta analysis showed that,compared to the control group,tanreqing injection treatment group resulted in higher effective rate [OR =2.96,95％ CI (2.22,3.96),P ＜0.01],shorter time of recovering the normal temperature [MD----0.53,95％ CI (-0.77,-0.29),P ＜ 0.01],shorter time of disappearance of cough [MD =-1.25,95％ CI (-2.14,-0.37),P ＜0.01],shorter time of lungrale [MD=-1.00,95％ CI(-1.4,-0.6),P ＜0.01],and shorter time of hospitalization time [MD =-1.35,95％ CI (-1.83,-0.86),P ＜ 0.01].Significant difference was observed between control and treatment groups.Conclusions This study showed that tanreqing injection appeared to be more effective for children bronchial pneumonia.However,methodology showed low quality.The efficacy needs high-quality clinical trials to verify.

Experimental study on the effects of granulocyte colony stimulating factor on myocardial apoptosis following coronary microembolization / 中华老年医学杂志

ObjectiveTo investigate the effects of granuloeyte colony stimulating factor (G-CSF) on myocardial apoptosis and left ventricular function following coronary mieroembolization (CME).MethodsA total of 68 male Sprague Dawley rats were randomized into control group(n=24), G-CSF-treated group(n= 24) and sham-operated group(n= 20). The control group and G-CSF -treated group underwent injection of homologous microthrombotic particle suspension into left ventricle when clamping the ascending aorta. The sham-operated group were treated with saline.rhG-CSF(100 yg · kg<'-1> · d<'-1>) were injected subcutaneously for 5 days since 2 h after operation in C-CSF group, meanwhile, the control group and sham-operated group were treated with saline respectively. The rats were sacrificed at day 3,7,14 and 28 after operation. The mRNA expressions of Bcl-2, Bax, Fas, FasL and glyceraldehyde phosphate dehydrogenase (GAPDH) were evaluated by real time PCR. The ratio of Bcl-2/Bax was calculated. The protein expressions of easpase-3 and cleaved poly ADP-ribose polymerase (PARP) were detected by Western blot. Myocardial apoptosis and leftventricular function were checked byterminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL)staining and hemodynamics respectively. ResultsCompared with sham-operated group,the mRNA expression of Bcl-2, Bax, Fas and FasL were increased whereas the ratio of Bcl-2/Bax markedly decreased in control group(0.28±0.04 vs. 2.98±0.49), P<0.05.Simultaneously, the protein expressions of caspase-3 and cleaved PARP enhanced (0.762±0.129 vs. 0.133±0.027;0.992±0.146 vs. 0.386+0.074) ,all P<0.05. The myocardial apoptosis index was elevated(17.2±1.9 vs. 1.2±0.6)and the left ventricular function decreased significantly (P<0.05). Compared with control group, the mRNA expression of Bct-2 increased and that of Bax, Fas and FasL decreased in G-CSF-treated group. Meanwhile, the ratio of Bcl-2/Bax markedly increased(2.07±0.29 vs. 0.28±0.04)and the protein expression of caspase-3 and cleaved PARP decreased(0.371±0.041 vs. 0.762±0.129;0.548±0.093 vs. 0.992±0.146, all P<0.05). The myocardial apoptosis index was reduced (6.1±1.0 vs. 17.2±1.9)and the left ventricular function increased significantly (P<0.05).ConclusionsG-CSF could lighten the myocardial apoptosis and improve the left ventrieular functionafter CME.

Observation of Therapeutic Effects of Shenfu Injection on Sick Sinus Syndrome / 中国药房

OBJECTIVE:To study the therapeutic effect of Shenfu injection on sick sinus syndrome. METHODS: 125 patients with sick sinus syndrome were divided into two groups. 63 patients were given Shenfu by intravenous drip for 14 days as treatment group. The other 62 patients were given glucose insulin potassium(GIK) for 14 days as control group. The changes of clinical manifestations, electrocardiogram(ECG and DCG) and esophagus electrophysiological examination were compared between two groups with a randomized single blind design. RESULTS: Clinical therapeutic effect: The total effective rate of the treatment group was 87.3% ,while that of control group was 40.3% .There was significant difference between them(P

Procedural difficulty and immediate outcome of percutaneous coronary intervention in patients with myocardial infarction / 介入放射学杂志

Objective To compare the procedural difficulty index (PDI) and immediate outcome (IM) of percutaneous coronary intervention (PCI) in patients with various stages of myocardial infarction.Methods Ninety-four patients with myocardial infarction were divided into three groups, direct PCI(n=38), delayed PCI(n=22) and late PCI(n=34). The characteristics of infarct-related coronary artery, PDI and IM of PCI were evaluated angiographically, and severe procedural complications (SPC) and major adverse cardiac events (MACE) during hospitalstay were documented. Results In the three groups, PDI was 1.47 ?1.79, 1.82 ?1.72 and 2.85 ?2.83, respectively (P