Renal function after renal artery stenting

Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ～ 7% of persons over 65 years of age1 and in ～ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.

Correlation between Diastolic Function and Mass and Geometry of Left Ventricle in Essential Hypertension

Object Diastolic function' s assessment is vital in order to produce information relevant to patients' functional class, management and prognosis. We sought to investigate diastolic dysfunction in essential hypertension (EH) with or without coronary heart disease (CAD) using color M - mode Doppler echocardiography and to study the relation between diastolic dysfunction and left ventricular mass index (LVMI) and geometry of LV, and to demonstrate partly the cause of increased cardiovascular risk of an echocardiographic pattern of LV geometry. Methods36 normal subjects (Group Ⅰ) and 107 patients with essential hypertension (Group II) were studied using color M - mode Doppler echocardiography. Four different LV anatomic adaptation to hypertension were i-dentified by categorizing patients according to values of end - diastolic relative wall thickness (RWT) and LVMI. We measured the rate of propagation of peak early filling flow velocity (Vp), time delay (TD) of the peak early filling flow velocity from mitral tips to the apex and Vp/E. Results The geometry of LV was classified into four types according to the LVMI and RWT. The normal limits of LVMI and RWT were obtained from the upper limits of the 95 % confidence interval from mean of LVMI and RWT in healthy control group respectively, which were 115.2 g/m2 and 0. 44. The definition of each type was as follows: Type I (normal group): LVMI≤115. 2 g/m2 and RWT≤ 0.44; Type Ⅱ (concentric remodeling): LVMI≤ 115. 2 g/m2 and RWT > 0. 44; Type III (eccentric hypertrophy): LVMI> 115.2 g/m2 and RWT≤0.44; Type Ⅳ (concentric hypertrophy): LVMI> 115.2 g/m2 and RWT>0.44. Most parameters of diastolic function in each geometry type differed significantly from those in the control group, but the difference among each geometry type was not significant. When compared with type Ⅰ, there was a tendency that TD was longer and Vp/E smaller in Type Ⅱ, Ⅲ and Ⅳ groups. The correlation between LVMI and Vp and TD had statistical significance ( P < 0. 01); the correlation coefficients were-0.21 and 0.29, respectively. Conclusions There is diastolic dysfunction in different LV geometry in patients with essential hypertension, even in patients with LV normal geometry there is diastolic dysfunction. LVMI has negative correlation to Vp, and positive correlation to TD. It may indicate that the greater the LVMI is, the worse the LV diastolic function.

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

To investigate the effects of patient-controlled intravenous analgesia (PCIA) with lornoxicam and fentanyl on arrhythmia and the expression of platelet membrane glycoproteins in patients with coronary artery disease (CAD) after abdominal surgery.Methods Eighty ASA Ⅱ or Ⅲ patients with CAD aged 51～66 yrs weighing 59～68 kg presenting for abdominal surgery participated in this study.CAD was diagnosed by clinical symptoms and ischemic changes on ECG.The patients were premedicated with intramuscular henobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with fentanyl,droperidol,propofol and vecuronium and maintained with propofol,fentanyl and vecuronium.The patients received PCIA after operation.The PCIA solution contained fentanyl 0.9 mg and droperidol 5 mg in 100 ml of normal saline (N.S.) in group A (n=40) or lornoxicam 56 mg,fentanyl 0.2 mg and droperidol 5 mg in 100 ml N.S. in group B (n=40).In group A the loading dose was fentanyl 0.05 mg and group B lornoxicam 4 mg.PCIA included a background infusion at 2 ml·h -1 and a bolus of 0.5 ml with a 15 min lock-out.VAS(0=no pain,10= worst pain) was used to measure pain intensity.In addition to BP,HR and SpO2 monitoring ECG was continuously monitored with a Holter monitor after operation.Blood samples were taken from peripheral vein before and 6 h after operation and on the 1st,2nd,7th and 8th postoperative days for determination of the expression of CD 62p ,CD 63 and CD 41 /CD 61 on the platelet membrane,platelet count,prothrombin time (PT) thrombin time (TT) and partial thromboplastin time (PTT).Results The two groups were comparable with respect to sex,age,body weight,severity of CAD,duration of operation and intraoperative blood loss.The patients received no blood transfusion during operation.There was no significant difference in VAS score,platelet count,PT,TT and PTT between the two groups.The incidence of atrial and ventricular premature beat on ECG and the expression of CD 41 /CD 61 ,CD 62p and CD 63 on the platelet membrane were significantly lower in group B than in group A on the 7th and 8th postoperative days(P<0.05 or 0.01).Conclusion Postoperative PCIA with lornoxicam and fentanyl can more effectively reduce the incidence of postoperative arrhythmia in patients with CAD.Suppression of activation of platelets by lornoxicam may contribute to the mechanism.10 refs,3 tabs.

Effect of Chinese Herbal Medicine for Calming Gan(肝) and Suppressing Hyperactive Yang on Arterial Elasticity Function and Circadian Rhythm of Blood Pressure in Patients with Essential Hypertension

Objective：To observe the effect of Chinese herbal medicine for calming Gan（肝） and suppressing hyperactive yang（平肝潜阳,CGSHY） on arterial elasticity function and the circadian rhythm of blood pressure in patients with essential hypertension（EH）.Methods：Adopting a parallel,randomized design,sixty-four patients with EH of stagesⅠandⅡwere randomly divided into two groups according to a random number table,with 32 in each group.The patients in the treatment group were treated with CGSHY and those in the control group were treated with Enalapril.All patients were given 24-h ambulatory blood pressure monitoring（ABPM） before and after a 12-week treatment.Trough/peak（T/P） ratios of systolic and diastolic blood pressure（SBP DBP） of each group were calculated.The circadian rhythm of their blood pressure was observed at the same time. The changes in elasticity of the carotid artery in the patients,including stiffness parameter（β）,pressure-strain elastic modulus（Ep）,arterial compliance（AC）,augmentation index（Al）,and pulse wave velocity（PVWβ） were determined by the echo-tracking technique before and after a 12-week treatment.In the meantime,their levels of nitric oxide（NO） and endothelin-1（ET-1） were measured respectively.Results：After treatment,all parameters in the 24-h ABPM and the elasticity of the carotid artery（β,Ep,AC and PVWβ） were markedly improved,the level of NO was increased,and ET-1 was decreased in both groups as compared with values before treatment （P0.05 or P0.01）.Further,the improvements in the ratio of T/P of SBP DBP and in the level of NO and ET-1 in the treatment group were more significant than those in the control group（P0.05）.There were no significant differences in all parameters in the ABPM monitoring and the elasticity of the carotid artery,the recovery of blood pressure circadian rhythm,and the therapeutic effect of antihypertension in EH patients between the two groups （P0.05）.Conclusions：Chinese herbal medicine for CGSHY may lower the blood pressure smoothly and recover the circadian rhythm of blood pressure in EH patients.They may also improve the carotid elasticity of EH patients similar to that of Enalapril.The mechanism of action of Chinese herbs on EH might be related to the regulation of vascular endothelium function.

Lipocalin-2-induced proliferative endoplasmic reticulum stress participates in Kawasaki disease-related pulmonary arterial abnormalities

Clinical cases have reported pulmonary arterial structural and functional abnormalities in patients with Kawasaki disease(KD);however,the underlying mechanisms are unclear.In this study,a KD rat model was established via the intraperitoneal injection of Lactobacillus casei cell wall extract(LCWE).The results showed that pulmonary arterial functional and structural abnormalities were observed in KD rats.Furthermore,proliferative endoplasmic reticulum stress(ER stress)was observed in the pulmonary arteries of KD rats.Notably,the level of lipocalin-2(Lcn 2),a trigger factor of inflammation,was remarkably elevated in the plasma and lung tissues of KD rats;increased Lcn 2 levels following LCWE stimulation may result from polymorphonuclear neutrophils(PMNs).Correspondingly,in cultured pulmonary artery smooth muscle cells(PASMCs),Lcn 2 markedly augmented the cleavage and nuclear localization of activating transcription factor-6(ATF6),upregulated the transcription of glucose regulated protein 78(GRP78)and neurite outgrowth inhibitor(NOGO),and promoted PASMCs proliferation.However,proapoptotic C/EBP homologous protein(CHOP)and caspase 12 levels were not elevated.Treatment with 4-phenyl butyric acid(4-PBA,a specific inhibitor of ER stress)inhibited PASMCs proliferation induced by Lcn 2 and attenuated pulmonary arterial abnormalities and right ventricular hypertrophy and reduced right ventricular systolic pressure in KD rats.In conclusion,Lcn 2 remarkably facilitates proliferative ER stress in PASMCs,which probably accounts for KD-related pulmonary arterial abnormalities.

Effects of renal artery stenting on renal function and blood pressure in patients with atherosclerotic renovascular disease

Objective To study the effects of percutaneous renal artery intervention on renal function and blood pressure in patients with renal artery stenosis. Methods Eighty-seven patients with severe uni- or bi-lateral renal artery stenosis (luminal diameter narrowing ≥70%) and clinical hypertension received renal artery stenting between January 2002 and December 2002. The changes in blood pressure and serum creatinine level and creatinine clearance (CCr) 48 hours after intervention and during 6 months of follow-up were assessed.Results Renal stenting was performed in 98 stenotic arteries of 87 patients,and the procedural success rate was 100%. Serum creatinine level was slightly elevated from (176±21) μmol/L to (179±11) μmol/L ( P =0.15) 48 hours after the procedure,but significantly decreased to (149±15) μmol/L at 6 months ( P <0.001). CCr was also greatly improved [(37±11) ml/min before versus (51±8) ml/min at 6 months,P <0.001]. During follow-up,61% of the patients experienced a normal renal function. Despite conventional medical treatment,systolic and diastolic blood pressures were also significantly decreased after stenting [(163±23)/(96±13) mm Hg before versus (148±12)/(79±15) mm Hg at 6 months,all P <0.001],and hypertension was well controlled in 67% of the patients at 6 months’ follow-up.Conclusion Renal artery stenting has a high success rate and is effective in improving renal function and blood pressure for patients with severe renal artery stenosis.

Outcomes of anatomical versus functional testing for coronary artery disease

Background Many patients have symptoms suggestive of coronary artery disease （CAD） and are often eval- uated with the use of diagnostic testing, although there are limited data from randomized trials to guide care.

Assessment of the Endothelial Function with Changed Volume of Brachial Artery by Menstrual Cycle

The endothelial function has been proven to be an important factor in the pathogenesis of atheroscle-rosis, hypertension and heart failure. The flow-mediated vasodilation (FMD) of the peripheral artery is an endothelium-dependent function. Brachial-artery ultrasound scanning is the popular method for evaluat-ing FMD.