替格瑞洛联合替罗非班在急性冠脉综合征患者PCI术中的应用价值

目的观察替格瑞洛联合替罗非班在急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)中的应用效果。方法 166例行PCI术治疗的ACS患者随机分为观察组85例和对照组81例,再依据发病类型的不同将两组分别进一步分为2个亚组:观察组中的急性心肌梗死(SMI)患者50例设为观察组A,观察组中的不稳定型心绞痛(UAP)患者35例设为观察组B;对照组中的SMI病例47例设为对照组A;对照组中的UAP病例34例设为对照组B。对照组应用替罗非班,观察组在对照组的基础上给予替格瑞洛。观察各组术前及术后8 d心肌微循环指标(AT、APT、PI、A、β及A×β)和氧化应激指标(SOD、MDA、MPO及LPO)的差异。结果 (1)术后第8天各组心肌微循环指标的比较差异有统计学意义(P<0.05),各指标均较同组术前下降(P<0.05),且观察组A、观察组B的下降幅度分别低于对照组A、对照组B。(2)术后第8天各组氧化应激指标的比较差异有统计学意义(P<0.05),SOD较同组术前上升而MDA、MPO、LPO较同组术前下降(P<0.05),且观察组A、观察组B的变化幅度分别低于对照组A、对照组B。(3)术前观察组A与对照组A、观察组B与对照组B的血清炎症因子hs-CRP、TNF-α、IL-6及Hcy水平比较差异无统计学意义(P>0.05),术后第8天各组血清炎症因子hs-CRP、TNF-α、IL-6及Hcy水平比较差异有统计学意义(P<0.05),均较本组术前下降(P<0.05),且观察组A、观察组B的变化幅度分别低于对照组A、对照组B。结论替格瑞洛能改善ACS患者PCI术后心肌微循环,对氧化应激反应和炎症反应也有抑制。

妊娠高血压合并急性心肌梗死救治1例并文献复习

妊娠高血压合并急性心肌梗死的救治具有一定挑战性。本文讨论1例34岁妊娠高血压患者突发急性ST段抬高型心肌梗死(下壁)时的救治难点,提供成功救治危及该高龄孕产妇与胎儿的心血管重疾的经验与依据。本文同时检索国内外类似病例报道,冀以探讨此类少见但风险极高的孕产妇合并心血管疾病的处理策略。

Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator(rt-PA) on the onset of acute cerebral infarction(ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale(NIHSS) scores were statistically decreased in both groups(P>0.05) at 24 hours and 7 days after ACI.There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups(P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rtPA within 4.5 hours after the onset of this disease.Therefore,intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe.

Lipoprotein(a)and Benefit of PCSK9 Inhibition in Emergency Complex Higher-risk and Indicated Patients

Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.

Two cases of intercoronary communication between circumflex artery and right coronary artery

Intercoronary communication is an uncommon congenital coronary variation.[1] There is a connection between two or more coronary arteries whose blood flow can be either unidirectional or bidirectional.[2] Therefore,this anomalous intercoronary communications may be mistaken as a functional collateral vessel seen in the obstructive coronary artery disease (CAD). Coronary collateral vessels are usually related to severe coronary stenosis or total occlusions,while intercoronary communication is usually found in angiographically normal coronary arteries. Intercoronary communication differentiates coronary collateral vessels by angiographic features and histological structure.[3,4] The functional importance of intercoronary communication remains controversial.[1,3] We report two cases about this rare communication between left circumflex artery (LCx) and right coronary artery (RCA).

Detection of an anti-angina therapeutic module in the effective population treated by a multi-target drug Danhong injection:a randomized trial

It's a challenge for detecting the therapeutic targets of a polypharmacological drug from variations in the responsed networks in thedfferentiated populations with complex diseases,as stable coronary heart disease.Here,in an adaptive,31-center,randomized,double-blind trial invoving 920 patients with moderate symptomatic stable angina treated by 14-day Danhong injection(DHI),a kind of polyphamacological drug with high quality control,or placebo(0.9%saline),with 76-day following-up,we firstly confrmed that DHl couldincrease the proportion of patients with clinically significant changes on angina-frequency assessed by Seattle Angina Questionnaire(ASAQ-AF220)(12.78%at Day 30,95%confidence interval[C]5.86-19.71%,P=0.0003,13.82%at Day 6C0,95%CI 6.82-20.82%,P=0.0001and 8.95%at Day 90,95%CI 2.06-15.85%,P=0.01).We also found that there were no significant differences in new-onset major vascularevents(P=0.8502)and serious adverse events(P=0.9105)between DHl and placebo.After performing the RNA sequencing in 62 selectedpatients,we developed a systemic modular approach tp identfy differentilly expressed modules(DEMs)of DHI with the Z_(summay)valueless than 0 compared with the control group,calculated by weighted gene co-expression network analysis(WGCNA),and sketched out thebasic framework on a modular map with 25 functional modules targeted by DII.Furthermore,the effective therapeutic module(ETM),defined as the highest corelation value with the phenotype alteration(SAQ-AF,the change in SAQ-AF at Day 30 from baseline)calculatedby WGCNA,was identifed in the population with the best effect(ASAQ-AF240),which is related to anticoagulation and regulation ofcholesterol metabolism.We assessed the modular flexbility of this ETM using the global topological D value based on Euclidean distance,which is corelated with phenotype alteration(r^(2):0.8204,P=0.019)by linear regression.Our study identified the ant-angina therapeuticmodule in the effective population treated by the multi-target drug.Modular methods facilitate the discovery of network pharmacologicalmechanisms and the advancement of precision medicine.(ClinicalTrials.gov identifier:NCTO1681316).

Aristolochic Acid-Induced Genotoxicity and Toxicogenomic Changes in Rodents

Aristolochic acid(AA)is a group of structurally related nitrophenanthrene carboxylic acids found in many plants that are widely used by many cultures as traditional herbal medicines.AA is a causative agent for Chinese herbs nephropathy,a term replaced later by AA nephropathy.Evidence indicates that AA is nephrotoxic,genotoxic,and carcinogenic in humans;and it also induces tumors in the forestomach,kidney,renal pelvis,urinary bladder,and lung of rats and mice.Therefore,plants containing AA have been classified as carcinogenic to humans(Group 1)bytheInternational AgencyforResearchonCancer.In our laboratories,we have conducted a series of genotoxicity and toxicogenomic studies in the rats exposed to AA of 0.1–10 mg/kg for 12 weeks.Our results demonstrated that AA treatments induced DNA adducts and mutations in the kidney,liver,and spleen of rats,as well as significant alteration of gene expression in both its target and nontarget tissues.AA treatments altered mutagenesis-or carcinogenesis-related microRNA expression in rat kidney and resulted in significant changes in protein expression profiling.We also applied benchmark dose(BMD)modeling to the 3-month AA-induced genotoxicity data.The obtained BMDL10(the lower 95%confidence interval of the BMD10 that is a 10%increase over the background level)for AA-induced mutations in the kidney of rats was about 7μg/kg body weight per day.This review constitutes an overview of our investigations on AA-induced genotoxicity and toxicogenomic changes including gene expression,microRNA expression,and proteomics;and presents updated information focused on AA-induced genotoxicity in rodents.