The effect of trimetazidine on cardiac function in diabetic patients with idiopathic dilated cardiomyopathy.

AIMS: Trimetazidine is an anti-ischemic metabolic agent which improves myocardial glucose utilization. Whether it may improve cardiac function and physical tolerance in diabetic patients with idiopathic dilated cardiomyopathy is still not confirmed. In this study we have investigated the effectiveness of trimetazidine in these patients. MAIN METHODS: Volunteers with diabetes and idiopathic dilated cardiomyopathy were recruited for participation in this study. Patients were randomized into two groups. One group received trimetazidine (20mg, t.i.d.) for 6 months (n=40), while another group received a placebo during the same period (n=40). All patients received an echocardiographic examination, 6-minute walk test and an inflammation biochemical analysis (C reactive protein) at baseline and after 6 months of treatment. KEY FINDINGS: No significant adverse events or changes in clinical or biochemical parameters were detected through the study. After 6 months, TMZ-treated patients had a significant improvement in systolic function as compared with control patients associated with an increased ratio of E/A. C reactive protein concentrations remained stable throughout the study in trimetazidine group at baseline and at the 6 month on follow up. In comparison, it increased significantly in the control group at the 6-month follow up. The NT-pro BNP levels did not change in the control group, whereas they significantly decreased in the trimetazidine group. The physical activity tolerance level improved in the trimetazidine group compared to the control group. SIGNIFICANCE: Trimetazidine treatment was associated with a significant improvement of cardiac function and physical tolerance. Results also suggested that the inflammatory response was decreased in trimetazidine group as compared with control patients.

[Clinicopathologic analysis of Langerhans cell histiocytosis in adults].

OBJECTIVE: To explore the clinical features, pathomorphology, immunohistochemical characteristics and prognosis of Langerhans cell histiocytosis (LCH) in adults. METHODS: Twenty-three cases of adult LCH were retrieved from Ningbo Diagnostic Pathology Center during the period from January 2005 to December 2011. And their clinical presentation, pathomorphology and immunohistochemical characteristics were analyzed. RESULTS: The mean age of patients was 37.2 years (range: 20 - 58). The male-to-female ratio was 1.6:1. Of 23 LCH patients, 26 lesions were found including 14 bone tissue lesions (53.8%), followed by 4 lymph node lesions and 4 skin lesions (both 15.4%), as well as 1 soft tissue, liver, parotid and buccal lesion respectively (all 3.8%). Clinically, uni-system and unifocal disease was predominant (19 cases, 82.6%), followed by uni-system and multifocal disease (1 case, 4.3%), multi-system disease (3 cases, 13.0%). Histologically, all cases of LCH revealed diffused distribution of Langerhans cells, accompanied by a variable number of eosinophils, lymphocytes, neutrophils and multinucleated giant cells. Immunohistochemically, the expression of CD1a, Langerin, S-100 protein and CD68 was 100% (23/23), 100% (20/20), 95.6% (22/23) and 90.5% (19/21) respectively. All lesions were treated by surgical therapy. Sixteen patients were available for follow-up examination and 14 patients survived. The 3 and 5-year cumulative survival rates were 92.9% and 79.6% respectively. CONCLUSIONS: LCH of adults occurs predominantly in bone and presents mainly as uni-system or unifocal defects. Surgical excision is generally effective and the prognosis is fair.