Objective To provide the China Essential Drugs List with evidence-based data for selecting the antihypertensive drugs in ARBs category. Methods With following search terms such as losartan, atenolol and clinical trial, the relevant clinical trials on losartan and atenolol for treating hypertension in both Chinese and English languages were collected from the EMbase, PubMed, The Cochrane Library, website of clinicaltrials.gov, CNKI, VIP and CBM. Results A total of 52 studies were pooled in this systematic review, of which most focused on the losartan intervention for endpoint reduction in hypertension (LIFE) study. The main results were that: a) With the same effects in lowering blood pressure, losartan was superior to atenolol in toleration and reducing left ventricular hypertrophy; b) Losartan was more effective than atenolol in preventing cardiovascular and cerebrovascular events, especially better in preventing new-onset stroke; c) Losartan was superior to atenolol in the patients complicated with or without diabetes mellitus, with or without atrial fibrillation, and with low hemoglobin or high blood uric acid, as well as in the patients co-treated by aspirin or hydrochlorothiazide; d) No matter either losartan or atenolol used in the aggressive antihypertensive therapy, the risk of sudden cardiac death got increased in hypertensive patients with prolonged QRS duration; e) Losartan was superior to atenolol in treating patients with smoking and drinking habits; and f) There were no significant differences between losartan and atenolol in hypertensive patients of black people, different genders, as well as the patients with mutant angiotensin-converting enzyme (ACE) gene. Conclusion Losartan has the same antihypertensive effects as atenolol dose, but it is more effective in reducing left ventricular hypertrophy, and has more benefits to hypertensive patients beyond lowering blood pressure, such as, reducing urine protein and uric acid rather than high density lipoprotein.
Objective To systematically evaluate anti-platelet effect of clopidogrel influenced by CYP2C192,3 polymorphism in patients with cardiovascular diseases, in order to provide references for its safe medication. Methods Literature was retrieved in electronic databases covering EMbase, PubMed, The Cochrane Library, CBM and CNKI from establishment dates to November, 2011. Observational studies and clinical trials were included, cross-checked, assessed and pooled for meta-analysis. meta-analysis was performed using the software RevMan 5.1. Results A total of 13 articles including 14 trials (n=36 855) were included. The results of meta-analysis showed that: a) there was no significant difference in the incidences of cardiovascular events between CYP2C192,3 carriers and CYP2C191 carriers; b) the risk of stent thrombosis in CYP2C192,3 carriers was significantly higher than that in CYP2C191 carriers (Plt;0.000 1), and the relative risk of CYP2C192,3 carriers increased 92% within one month (Plt;0.000 1); c) as for bleeding events, there were no significant differences between CYP2C192,3 carriers and CYP2C191 carriers. Conclusion Compared with CYP2C191 carriers, CYP2C192,3 carriers have a higher risk of stent thrombosis in clopidogrel-treated patients, but there are few differences in cardiovascular and bleeding events between the two carriers. Therefore, CYP2C192,3 carriers with cardiovascular diseases and ready to receive PCT are suggested to pay more attention to stent thrombosis when using clopidogrel. We propose that patients with cardiovascular diseases and ready to receive PCT should have CYP2C19 tests to determine the use of antiplatelet drug (clopidogrel) to avoid thrombus.
ObjectiveTo evaluate the efficacy and safety of a novel wire for echo-guiding percutaneous atrial septal defect (ASD) closure.MethodsTwenty sheep were randomly divided into two groups, an experimental group and a control group (n=10 in each group). In both groups, an animal model of ASD was established by transthoracic balloon dilatation, and percutaneous closure of atrial septal defect was finished only by echography guiding. The total procedure time, passing time (time needed for the guide wire to enter the left atrium), frequency of delivery sheath dropping into right atrium, frequency of arrhythmias and rate of complications were compared between the two groups.ResultsASD model was uneventfully established in all animals. ASD devices were successfully implanted in all sheep. Compared with the control group, the experimental group had significantly less mean procedure time and mean passing time, lower frequency of guide wire dropping into right atrium and frequency of atrial and ventricular premature contractions, respectively (15.36±4.86 min vs. 25.82±7.85 min, 2.69±0.82 min vs. 5.58±3.34 min, 0% vs. 40.0%, 4.41±2.61 vs. 9.60±3.68, 0.75±0.36 vs. 1.34±0.68; all P<0.05) . Two groups did not have serious complications within postoperative one week.ConclusionThe novel wire system is not only safe and effective in the treatment of ASD occlusion, but also easy to operate.
Objective To explore the secretion law of high mobility group box 1（HMGB1）in rat pancreatic acinar cells induced by trypsin activation peptide（TAP）and release of HMGB1 affected by ethyl pyruvate（EP）. Methods The experiment was performed in 12 SD rats. The pancreatic acinar cells of rats were taken out and then separated into three groups：control group， TAP group， and EP group. TAP was added into TAP group and EP group（keep TAP at a final concentration of 3 nmol/L）， respectively， but EP was added into EP group only （keep EP at a final concentration of 28 mmol/L）. The expressions of HMGB1 mRNA and protein were detected by using real-time quantitative reverse transcription polymerase chain reaction（RT-PCR）or Western blot at 3 h， 6 h， 12 h， and 24 h time point， respectively. The relationship between HMGB1 and TAP action time was explored by rank correlation. Results Compared with control group， the expressions of HMGB1 mRNA and protein were increased with prolongation of the TAP action in TAP group and EP group（P＜0.05）. Compared with TAP group， the expressions of HMGB1 mRNA and protein were decreased in EP group（P＜0.05）. The expressions of HMGB1 mRNA and protein were increased with prolongation of the TAP action（P＜0.05）， and were highest at 12 h time point（P＜0.01）in TAP group. There were positive correlation between the expressions of HMGB1 mRNA and protein and TAP action time（rs=0.971， P＜0.01；rs=0.966， P＜0.01）.Conclusions TAP can induce the release of HMGB1 in pancreatic acinar cells. There is positive relationship between TAP in early stage and HMGB1 in later period of acute pancreatitis. EP can inhibit the release of HMGB1.
ObjectiveTo systematically review the efficacy of three transcranial direct current stimulation protocols (anodal stimulation, cathodal stimulation, and bipolar stimulation) on upper extremity function interventions in stroke patients. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of three transcranial direct current stimulation protocols on upper extremity function interventions in stroke patients from inception to April 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, the network meta-analysis was performed by using R software and ADDIS software. ResultsA total of 64 RCTs involving 3 968 patients were included. The results of network meta-analysis showed that, the probability order of the three stimulation methods on FMA-U, MBI, NIHSS score was: anode>bipolar>cathode>control. In addition, the probability order on ARAT and BBT score was: anode>cathode>bipolar>control. ConclusionCurrent evidence shows that the intervention effect of anodic stimulation on upper limb function of stroke patients may be better. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
ObjectiveTo assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients.MethodsFrom December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year.ResultsThe mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up.ConclusionPercutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.
Objective To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.
Objective To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 yearsvs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kgvs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mmvs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mmvs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuanvs.25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.