Objective. To investigate the clinical characteristics of patients with unstable angina (UA) who received elective percutaneous coronary intervention (PCI) in a traditional Chinese medicine (TCM) hospital and to analyze the related risk factors of periprocedural myocardial injury (PMI). Methods. On the basis of cross-sectional investigation, the case-control method was adopted. We retrospectively collected clinical data of patients with UA who successfully received elective PCI in Beijing Hospital of TCM from February 2017 to February 2019. Based on the occurrence of PMI, the case-control was formed. The influence of related factors on PMI occurrence was analyzed using the logistic multiple regression equation based on the parameters between the comparison groups. Results. 1. Incidence of PMI and related clinical features: Of the 265 UA patients, the incidence of PMI was 26.4%, nearly one quarter (23.4%) had old myocardial infarction, nearly half (45.3%) had previously received coronary intervention. The prevalence of patients with previous hypertension (75.8%), type 2 diabetes (57%), and high-low-density lipoprotein cholesterolemia (69.3%) exceeded 50%, more than 50% of the patients have triple-vessel disease (50.2%). 2. Features of TCM syndrome elements: The main TCM syndromes of the investigated patients are blood stasis syndrome (81.1%) and Qi deficiency syndrome (77.3%), the others include Phlegm turbidity syndrome (53.2%), Yang deficiency syndrome (50.9%), Yin deficiency syndrome (50.1%), Qi stagnation syndrome (30.1%), and coagulated cold syndrome (17.1%). 3. Factors of PMI occurrence: According to the occurrence of PMI, 265 patients were divided into PMI group (n = 70) and non-PMI group (n = 195). The comparison between groups shows that the preoperative SYNTAX score, the number of stents, and the total length of stents of the patients in the PMI group were higher than those in the non-PMI group ( ); the patients in the PMI group treated by Shen-Yuan-Dan (SYD), a Chinese medicine prescription with Qi-supplementing and blood stasis-purging, were significantly lower than those in the non-PMI group ( ). Brought these four factors (preoperative SYNTAX score, number of stents implanted, total length of implanted stents, and treated by SYD) into the binary logistic regression equation, those who were only treated by SYD have statistical significance in the equation as a protective factor (OR 0.327, 95% CI 0.117–0.916, ). Conclusion. Patients with UA who received elective PCI in TCM institutions may have clinical characteristics including multiple accompanying diseases and high stenosis coronary artery, in which the incidence of poor blood glucose control and high rate of three-vessel coronary disease are particularly significant. The TCM syndromes are mainly Qi deficiency and blood stasis syndromes. The decrease of PMI may be attributed to the application of SYD in the real world. This trial is registered at ChiCTR2100043465.
Surgeons currently use two different wire-based approaches to recanalize coronary chronic total occlusion (CTO): antegrade and retrograde. It has been demonstrated that the retrograde approach has improved the procedural success rate, but it remains unclear whether the retrograde approach is better than the antegrade approach for the long term. In this study, we enrolled a total of 187 patients with a diagnosis of CTOs. We evaluated the baseline characteristics of these patients and performed percutaneous coronary intervention to treat their problems by using either antegrade or retrograde approaches and different techniques in both groups. In the antegrade approach, we used three techniques: single wire, parallel wire, and side branch. The techniques in retrograde included kissing wire, controlled antegrade and retrograde subintimal tracking (CART), and reverse CART. We found that the antegrade and retrograde groups had similar baseline characteristics, with a few minor differences. Most importantly, we found that within 1 yr of the recanalizing procedure, the restenosis rate and major adverse cardiac event rate of the retrograde group were significantly higher compared to the antegrade group. We conclude that the retrograde approach may not be as beneficial as the antegrade approach for long-term clinical outcomes.
ABSTRACT This case report describes a rare occurrence of a 25‐year‐old female diagnosed with both systemic sclerosis (SSc) and ankylosing spondylitis (AS), two distinct autoimmune diseases. The patient presented with a combination of symptoms, including progressive skin tightening, lumbosacral pain, and Raynaud's phenomenon, which complicated the diagnosis. Despite the challenges posed by the coexistence of SSc and AS, a multidisciplinary treatment approach involving corticosteroids, immunosuppressants, and supportive therapies led to significant clinical improvement. Over the course of 3 weeks, the patient's Rodnan Skin Score improved from 18 to 11, and her pain and overall disease activity were markedly reduced. Although skin sclerosis showed substantial improvement, pulmonary involvement remains a concern that requires long‐term monitoring. This case highlights the complexities in diagnosing and managing overlap syndromes, emphasizing the need for personalized treatment strategies and further investigation into the underlying genetic and immunological mechanisms.
Journal Article Accepted manuscript The Silent Stone Armor Beneath the Golden Bell: A Severe Case of Calcinosis Cutis in Dermatomyositis Get access Chen Li, Chen Li Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, ChinaDepartment of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Shao-hui Geng, Shao-hui Geng School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Shu-han Yang, Shu-han Yang School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Hong-xu Liu, Hong-xu Liu School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Fu-wen Deng, Fu-wen Deng School of nursing, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Sheng-guang Li Sheng-guang Li Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, China Corresponding author: Sheng-guang Li, Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, China; E-mail: [email protected] Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, keaf012, https://doi.org/10.1093/rheumatology/keaf012 Published: 07 January 2025 Article history Received: 02 October 2024 Revision received: 09 December 2024 Accepted: 20 December 2024 Published: 07 January 2025
Abnormal collagen deposition, as well as collagen metabolism, plays a crucial role in the formation and progression of vulnerable atherosclerotic plaques (VAPs), which are susceptible to rupture. According to our previous findings, rosiglitazone, a thiazolidinedione, can promote the stability of atherosclerotic plaques in fat‑fed ApoE‑knockout mice; however, it is unknown whether it can modulate collagen deposition and metabolism in VAPs. The present study was designed to determine the effect of rosiglitazone on collagen deposition and metabolism in the plaques of fat‑fed ApoE‑knockout mice. Following 13 weeks of the high‑fat diet, the mice were randomized into three groups (10 mice/group) and intragastrically administered rosiglitazone, simvastatin and distilled water, respectively, for a further 13 weeks. The category of the collagen present in the plaques was evaluated using the picro‑Sirius red polarization method. Additionally, the protein expression of matrix metalloproteinase 9 (MMP‑9) and tissue inhibitor of metalloproteinase‑1 (TIMP‑1) in the plaques was determined using immunohistochemistry. The results showed that rosiglitazone reduced the lipid to collagen and type Ⅲ to type Ⅰ collagen ratios in the plaques, and these reductions were correlated with the reduction in the plaque MMP‑9 to TIMP‑1 ratio. These results suggest that rosiglitazone can modulate collagen deposition and metabolism and promote the stabilization of VAPs.
Background: Traditional Chinese medicine injections with invigorating blood circulation (TCMI-IBCs), which have been used as antithrombosis therapies, are widely employed by Chinese clinicians as adjuvant therapy for acute myocardial infarction (AMI). Objective: A Bayesian network meta-analysis was conducted to contrast the effectiveness and safety of four TCMI-IBCs in AMI. Methods: Eight Databases were thoroughly searched before 31 December 2023, for randomized controlled trials (RCTs) focusing on the application of TCMI-IBCs combined with conventional treatments (CT) to treat AMI. All-cause mortality (ACM) was the major endpoint. Secondary outcomes included bleeding events, malignant arrhythmia (MA), recurrent myocardial infarction (RMI), left ventricular ejection fraction (LVEF), and adverse events. Stata17.0 and GeMTC software were employed for Bayesian network meta-analysis. Results: A total of 73 eligible RCTs involving 7,504 patients were enrolled. Puerarin injection (PI), Danhong injection (DI), sodium Tanshinone IIA Sulfonate injection (STSI), and Danshen Chuanxiongqin injection (DCI) combined with CT can significantly reduce the occurrence of ACM and improve LVEF in AMI ( P < 0.05), while without significant impact on bleeding events or MA ( P > 0.05). STSI + CT would be the optimal treatment strategy in lowering RMI and ACM. DI + CT was the most likely to be the optimal strategy in reducing MA occurrence and improving LVEF. CT was likely the most effective strategy in reducing bleeding events. However, DI + CT exhibited the least favorable safety. Conclusion: TCMI-IBCs + CT had potential benefits in the treatment of AMI. STSI + CT showed the most favorable performance in treating AMI, followed by DI combined with CT. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=384067 , identifier CRD42022384067.
Importance Tongxinluo, a traditional Chinese medicine compound, has shown promise in in vitro, animal, and small human studies for myocardial infarction, but has not been rigorously evaluated in large randomized clinical trials. Objective To investigate whether Tongxinluo could improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Design, Setting, and Participants Randomized, double-blind, placebo-controlled clinical trial was conducted among patients with STEMI within 24 hours of symptom onset from 124 hospitals in China. Patients were enrolled from May 2019 to December 2020; the last date of follow-up was December 15, 2021. Interventions Patients were randomized 1:1 to receive either Tongxinluo or placebo orally for 12 months (a loading dose of 2.08 g after randomization, followed by the maintenance dose of 1.04 g, 3 times a day), in addition to STEMI guideline-directed treatments. Main Outcomes and Measures The primary end point was 30-day major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial reinfarction, emergent coronary revascularization, and stroke. Follow-up for MACCEs occurred every 3 months to 1 year. Results Among 3797 patients who were randomized, 3777 (Tongxinluo: 1889 and placebo: 1888; mean age, 61 years; 76.9% male) were included in the primary analysis. Thirty-day MACCEs occurred in 64 patients (3.4%) in the Tongxinluo group vs 99 patients (5.2%) in the control group (relative risk [RR], 0.64 [95% CI, 0.47 to 0.88]; risk difference [RD], −1.8% [95% CI, −3.2% to −0.6%]). Individual components of 30-day MACCEs, including cardiac death (56 [3.0%] vs 80 [4.2%]; RR, 0.70 [95% CI, 0.50 to 0.99]; RD, −1.2% [95% CI, −2.5% to −0.1%]), were also significantly lower in the Tongxinluo group than the placebo group. By 1 year, the Tongxinluo group continued to have lower rates of MACCEs (100 [5.3%] vs 157 [8.3%]; HR, 0.64 [95% CI, 0.49 to 0.82]; RD, −3.0% [95% CI, −4.6% to −1.4%]) and cardiac death (85 [4.5%] vs 116 [6.1%]; HR, 0.73 [95% CI, 0.55 to 0.97]; RD, −1.6% [95% CI, −3.1% to −0.2%]). There were no significant differences in other secondary end points including 30-day stroke; major bleeding at 30 days and 1 year; 1-year all-cause mortality; and in-stent thrombosis (&lt;24 hours; 1-30 days; 1-12 months). More adverse drug reactions occurred in the Tongxinluo group than the placebo group (40 [2.1%] vs 21 [1.1%]; P = .02), mainly driven by gastrointestinal symptoms. Conclusions and Relevance In patients with STEMI, the Chinese patent medicine Tongxinluo, as an adjunctive therapy in addition to STEMI guideline-directed treatments, significantly improved both 30-day and 1-year clinical outcomes. Further research is needed to determine the mechanism of action of Tongxinluo in STEMI. Trial Registration ClinicalTrials.gov Identifier: NCT03792035
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