A Case Summary of the Application of a Drug-eluting Stent Combined with a Drug-Coated Balloon in Left Main Coronary Artery Disease

Objective:To evaluate the clinical efficacy of a drug-eluting stent(DES)combined with a drug-coated balloon(DCB)in the treatment of left main coronary artery bifurcation lesions.Methods:A retrospective analysis was conducted on the clinical data of eight patients with left main coronary artery bifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July 2017.These eight patients all underwent DES treatment for their left main coronary artery and left anterior descending coronary artery lesions,and DCB treatment at the ostium of the left circumflex artery;six of the patients underwent surgical procedures under the guidance of intravascular ultrasonography.Immediate postoperative angiography was used to evaluate the patency of the diseased vessels,and the restenosis rate at the 6-month follow-up after the operation and the incidence of serious clinical events within 6 months were assessed as well.Results:The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions had a low restenosis rate(left main coronary artery(8.4±5.3)%,left anterior descending coronary artery(18.2±5.0)%,left circumflex artery(30.5±16.5)%).No serious clinical events occurred in any patients.Conclusion:A DES combined with a DCB is a safe and effective interventional treatment for left main artery coro-nary bifurcation lesions.

The application of renal sympathetic denervation in cardiovascular and other diseases

Background The role of renal artery sympathetic nerve ablation,widely known as renal sympathetic denervation(RDN)in the treatment of resistant hypertension(RH)has been clarified,and there is more and more evidence to support its effect in the treatment of heart failure,ventricular hypertrophy and arteriosclerosis.Some studies also reported its role in treatment related to respiratory system(pulmonary hypertension,sleep apnea syndrome),endocrine system(metabolic syndrome,blood lipid metabolism,polycystic ovary syndrome),kidney disease(acute renal injury,renal failure)and other inflammation,remodeling,pain and so on.Though most of them were subgroup analysis and small-sample studies,even case reports,they had shed some light on possible use of RDN in the treatment of multi-system diseases.[S Chin J Cardiol 2024;25(1):57-66].

Randomized comparison of intracoronary tirofiban versus urokinase as an adjunct to primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction： results of the ICTUS-AMI trial

Background No randomized trial has been performed to compare the efficacy of an intracoronary bolus of tirofiban versus urokinase during primary percutaneous coronary intervention （PCI）.We investigated whether the effects of adjunctive therapy with an intracoronary bolus of urokinase was noninferior to the effects of an intracoronary bolus of tirofiban in patients with ST-elevation myocardial infarction （STEMI） undergoing PCI.Methods A total of 490 patients with acute STEMI undergoing primary PCI were randomized to an intracoronary bolus of tirofiban （10 μg/kg; n=247） or urokinase （250 kU/20 ml; n=243）.Serum levels of P-selectin,von Willebrand factor （vWF）,CD40 ligand （CD40L）,and serum amyloid A （SAA） in the coronary sinus were measured before and after intracoronary drug administration.The primary endpoint was the rate of complete （＞70％） ST-segment resolution （STR） at 90 minutes after intervention,and the noninferiority margin was set to 15％.Results In the intention-to-treat analysis,complete STR was achieved in 54.4％ of patients treated with an intracoronary bolus of urokinase and in 60.6％ of those treated with an intracoronary bolus of tirofiban （adjusted difference：-7.0％;95％ confidence interval：-15.7％ to 1.8％）.The corrected TIMI frame count of the infarct-related artery was lower,left ventricular ejection fraction was higher,and the 6-month major adverse cardiac event-free survival tended to be better in the intracoronary tirofiban group.An intracoronary bolus of tirofiban resulted in lower levels of P-selectin,vWF,CD40L,and SAA in the coronary sinus compared with an intracoronary bolus of urokinase after primary PCI （P＜0.05）.Conclusions An intracoronary bolus of urokinase as an adjunct to primary PCI for acute STEMI is not equally effective to an intracoronary bolus of tirofiban with respect to improvement in myocardial reperfusion assessed by STR.This may be caused by less reduction in coronary circulatory platelet activation and inflammation.

Traditional Chinese medicinal herbs combined with epidermal growth factor receptor tyrosine kinase inhibitor for advanced non-small cell lung cancer: a systematic review and meta-analysis

BACKGROUND： Epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TKI） targeted treatment has been a standard therapy for advanced non-small cell lung cancer （NSCLC）, but it is not tolerated well by all patients. In China, some studies have reported that traditional Chinese medicinal herbs （TCMHs） may increase efficacy and reduce toxicity when combined with EGFR-TKI, but outside of China few studies of this kind have been attempted. OBJECTIVE： This study is intended to systematically review the existing clinical evidence on TCMHs combined with EGFR-TKI for treatment of advanced NSCLC. SEARCH STRATEGY： PubMed, the Cochrane Library, the Excerpta Medica Database （EMBASE）, the China BioMedical Literature （CBM）, and the China National Knowledge Infrastructure （CNKI） and web site of the American Society of Clinical Oncology （ASCO）, the European Society for Medical Oncology （ESMO）, the World Conference of Lung Cancer （WCLC） were searched; the search included all documents published in English or Chinese before October 2013. INCLUSION CRITERIA： We selected randomized controlled trials based on specific criteria, the most important of which was that a TCMH plus EGFR-TKI treatment group was compared with an EGFR-TKI control group in patients with advanced NSCLC. DATA EXTRACTION AND ANALYSIS： The modified Jadad scale was used to assess the quality of studies. For each included study, patient characteristics, treatment details, therapeutic approach and clinical outcomes were collected on a standardized form. When disagreements on study inclusion or data extracted from a study emerged, the consensus of all coauthors provided the resolution. The clinical outcome metrics consisted of objective response rate （ORR; complete response ＋ partial response divided by the total number of patients）, disease control rate （DCR; complete response ＋ partial response ＋ no change divided by the total number of patients）, survival rate, improved or stabilized Karnofsky performance status （KPS）, and severe toxicity. RevMan 5.0 software was used for data syntheses and analyses. Risk ratio （RR） and 95% confidence interval （CI） were calculated; if the hypothesis of homogeneity was not rejected （P〉0.1, I2〈50%）, the fixed-effect model was used to calculate the summary RR and the 95% CI. Otherwise, a random-effect model was used.

Observations on the Short-term and Long Term Effects of Point Houxi(SI 3) Electroacupuncture on Acute Lumbar Sprain

Objective： To investigate the clinical efficacy of point Houxi（SI 3） electroacupuncture for treating acute lumbar sprain. Methods： Three hundred patients with acute lumbar sprain were randomly grouped with a random number table. The electroacupuncture group was treated by electro-acupuncture at point Houxi （SI 3） and the medication group, with meloxicam. Results： A comparison of the short-term effects showed that the efficacy rate was 97.3% in the electroacupuncture group and 89.3% in the medication group. The average rank of the short-term effect score was lower in the electroacupuncture group than in the medication group （P〈0.01）; there was a significant difference between the two groups. A comparison of the long-term effect showed that the efficacy rate was 99.3% in the electroacupuncture group and 93.2% in the medication group. The average rank of the long-term effect score was lower in the electroacupuncture group than in the medication group （P〈0.01）; there was a significant difference between the two groups, Conclusion： Both point Houxi （S1 3） electroacupuncture and meloxicam have a marked effect on acute lumbar sprain, but the short-term and long-term effects are better in the electroacupuncture group than in the medication group.