Clinical perspective on C-reactive protein in prognostication of major adverse cardiac events in the elderly with established coronary heart disease

The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……

Thiopurine methyltransferase gene polymorphisms and activity in Chinese patients with inflammatory bowel disease treated with azathioprine

Background The thiopurine drugs are well established in the treatment of inflammatory bowel disease （IBD）. However, uncertainty regarding the risk for neutropenia and hepatotoxicity deters its using. Thiopurine methyltransferase （TPMT） is the key enzyme in the metabolism of thiopurine. The aim of this study was to investigate the association of TPMT polymorphisms and activity with azathioprine （AZA）-related adverse events and clinical efficacy in Chinese Han patients with IBD. Methods Fifty-two Han IBD patients treated with AZA were assessed for TPMT＊2, ＊3A, ＊3B, and ＂3C, and for adverse events. Then, using reverse-phase high-performance liquid chromatography, TPMTactivity was measured in 13 patients to analyze its correlation with AZA-related toxicity and clinical efficacy. Results Of the 52 patients, five experienced myelotoxicity and one experienced hepatotoxicity during treatment. No TPMT＊2, ＊3A, ＊3B or ＂3C polymorphisms were detected in any of the 52 patients. In the 13 patients with TPMT activity measurement, TPMT activity ranged from 7.2 to 28.8 U/ml packed red blood cells （pRBCs）. Among the 5 patients who suffered from myelotoxicity, 3 were affected in the early stage of AZA therapy. In these 3 patients, TPMT levels were significantly lower than those in patients without myelotoxicity, which reached statistical significance （（9.3±2.1） U/ml pRBC vs. （18.0±6.2） U/ml pRBC; P=-0.046）. One patient who had higher TPMTactivity （28.8 U/ml pRBC） suffered from hepatotoxicity during AZA therapy. Patients who achieved a clinical response had lower TPMTactivity than those failed to respond （（13.7±3.5） U/ml pRBC vs. （22.0±5.5） U/ml pRBC; P=-0.009）. Conclusions TPMT variants do not completely account for the AZA-related myelotoxicity in Chinese Han IBD patients. However, measurement of TPMT activity may be helpful in reducing the risk of toxicity, and predicting the therapeutic efficacy.

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

Background:Metabolic syndrome(MetS)is relatively common worldwide and an important risk factor for cardiovascular diseases.It is closely linked to arterial stiffness of the carotid artery.However,the association of MetS with the safety of carotid revascularization has been rarely studied.The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients,and investigate the impact on major adverse clinical events(MACEs)after carotid endarterectomy(CEA)or carotid artery stenting(CAS).Methods:From January 2013 to December 2017,patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited.The changes in prevalence of MetS and each component with time were investigated.The primary outcome was 30-day post-operative MACEs.Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS.Results:A total of 2068 patients who underwent CEA(766 cases)or CAS(1302 cases)were included.The rate of MetS was 17.9%;the prevalence rate of MetS increased with time.The occurrence rate of MACEs in CEA was 3.4%(26 cases)and in CAS,3.1%(40 cases).There was no statistical difference between the two groups(3.4%vs.3.1%,P=0.600).For CEA patients,univariate analysis showed that the MACE(+)group had increased diabetes history(53.8%vs.30.9%,P=0.014)and MetS(34.6%vs.15.8%,P=0.023).For CAS patients,univariate analysis showed that the MACE(+)group had increased coronary artery disease history(40.0%vs.21.6%,P=0.006)and internal carotid artery tortuosity(67.5%%vs.37.6%,P<0.001).Furthermore,the MACE(+)group had higher systolic blood pressure(143.38±22.74 vs.135.42±17.17 mmHg,P=0.004).Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes(odds ratio[OR]=2.345;95%confidence interval[CI]=1.057-5.205;P=0.036)and MetS(OR=2.476;95%CI=1.065-5.757;P=0.035).The influencing factors for MACEs in CAS included systolic blood pressure(OR=1.023;95%CI=1.005-1.040;P=0.010),coronary artery disease(OR=2.382;95%CI=1.237-4.587;P=0.009)and internal carotid artery tortuosity(OR=3.221;95%CI=1.637-6.337;P=0.001).Conclusions:The prevalence rate of MetS increased with time in carotid revascularized patients.MetS is a risk for short-term MACEs after CEA,but not CAS.