To evaluate the efficacy and safety of Tolvaptan on treating congestive heart failure patients with hyponatremia.
Methods
This randomised double-blind placebo–controlled trial enrolled 65 patients with congestive heart failure and hyponatremia (serum sodium concentration<135 mmol per liter) in multicenter. Patients were randomised to receive either Tolvaptan 15 mg∼60 mg (n=35) daily or placebo (n=30) according to the change of serum sodium concentration. The primary end points were the change of average daily serum sodium concentration comparing the baseline with the day 4 and the day 7 respectively. Patients9 weight, urine volume, sign of heart failure, heart function, blood pressure, heart rate and all adverse events were observed to evaluate the efficacy and safety of Tolvaptan.
Results
In Tolvaptan group the change in average daily serum sodium concentration from baseline to day 4 and the change from baseline to day 7 was 5.6±3.5 mmol/l and 5.9±3.5 mmol/l respectively, and in placebo group the change was 2.5±3.4 mmol/l and 2.8±3.3 mmol/l respectively. The daily serum sodium concentration increased more in Tolvaptan group than in placebo group, and the increment during the first 4 days was 3.06 mmol/l and during the first 7 days was 2.91 mmol/l. More increased daily urine volume and decreased weight in Tolvaptan group than in placebo group (p<0.05). The change of sign of heart failure, heart function, blood pressure and heart rate was similar between two groups (p>0.05). Drug related adverse events more frequently in Tolvaptan group were thirst (11.4%) and hypernatremia (5.7%). There was 1 possible drug related serious adverse event. The patient was diagnosed as agranulocytosis during therapy period, and finally he was recovered.
Conclusion
Tolvaptan could effectively increase serum sodium concentration, urine volume and improve liquid balance in congestive heart failure patients with hyponatremia. Tolvaptan had low incidence of serious adverse event and an acceptable margin of tolerance.
Objective:Fabry's disease is an uncommon X-linked disorder caused by deficient activity of the lysosomal enzyme a-galactosidase A(α-Gal A).Its'cardiac manifestations have not been well recognized.The purpose of this study was to evaluate its'cardiac manifestations and diagnosis.Method:Seven hospital patitents with Fabry' s disease have been enrolled and only 5of them ith cardiac manifestation were retrospectively analyzed.The gener-al ethic information,past and family history,main symptoms,ECG and echocardiographic findings were recorded for all the patients.The diagnostic criteria of Fabry's disease were based onα-Gal A quantity in white blood cells. Result:Five patients were all male.Their age was from 13 to 40years.Theirα-Gal A quantity was very low.Cardiac symptoms included dyspnea,palpitation and arrthymia.ECG showed left ventricular hypertrophy,ST-T change and sinus pause.Echocardiography showed left ventricular hypertrophy,valve involvement with or without regurgitation and endocardial thickening.Conclusion:Patients with Fabry's disease may have cardiac manifestations. Family history,multisystemic involvement and typical echocardiographic appearance may be helpful to the diagnosis.
To compare the longitudinal, radial, circumferential, rotational and torsional mechanics of the left ventricle (LV) in patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), and detect the new quantitative parameters to differentiate CP and RCM using two-dimensional speckle tracking imaging (2-D STI) method.
Methods
18 patients with CP and 14 patients with RCM were enrolled. Nineteen control subjects were recruited. Two-dimensional imagings of parasternal short-axis (apical, mid, and basal segments) and apical 4-chamber, 3-chamber, 2-chamber views were recorded. Longitudinal, radial, circumferential, rotational and torsional parameters were analysed.
Results
In systole phase, radial strain was significantly lower in RCM than in CP (apex: 14±7% vs 23±12%, p<0.05; mid: 16±7% vs 32±14%, p<0.05; base: 13±11% vs 20±8%, p<0.05)and was reduced in both groups when compared with control subjects (p<0.05 for both). Longitudinal strain was significantly lower in RCM than in CP (apex:−12±4% versus −17±6%, p<0.05; mid: −8±3% versus −16±4%, p<0.05; base: −6±3% versus −16±5%, p<0.05)and was also reduced in the two groups when compared with control subjects. Circumferential strain was reduced both in CP and RCM when compared with control subjects (p<0.05), but no significant difference was found between the two groups. In the LV apex, rotation was significantly reduced in CP compared with RCM and control subjects (4±3° versus 7±3°, 4±3° versus 9±3°, p<0.05 for both). Torsion was significantly lower in CP than in RCM (7±4° vs 12±5°, p<0.05)and was reduced in the two groups when compared with control subjects (p<0.05 for both). Optimal cut-off value for torsion was 9° with sensitivity 72% and specificity 76%.
Conclusions
Torsion, longitudinal and radial strain measured by 2-D STI method can provide useful information to differentiate CP and RCM. Torsion of 9° can differentiate CP and RCM with sensitivity of 72% and specificity 76%.
Objective To study the anti-proliferation,pro-apoptosis and cell cycle blocking effects of arsenic trioxide(As_(2)O_(3)) on rat vascular smooth muscle cells(VSMCs).Methods The effects of As_(2)O_(3) on VSMCs viability,growth and proliferation were assayed by MTT,trypan blue exclusion and()~3H-thymidine incorporation methods.Change of cell cycle and apoptosis of VSMCs induced by As_(2)O_(3) were observed by flow cytometry and DNA laddering methods.Western blot was applied to detect the expression changes of P53 and P21()~(waf1/cip1) proteins.As_(2)O_(3) inhibited the growth and DNA synthesis of VSMCs both time-and dose-dependently,while had no obvious cytotoxic effects on cell viability at the concentrations from 1 to(16 μmol/L).(8 μmol/L) of As_(2)O_(3) significantly blocked the cell cycle progression,decreased the S phase and increased G_(0)G_(1) phase partition with sub-G_(1) apoptotic distribution. Results Typical DNA fragmentation of VSMCs induced by(16 μmol/L) of As_(2)O_(3) was observed at different time points.(8 μmol/L) of As_(2)O_(3) significantly up-regulated P53and P21()~(wif1/cip1) expression in a time-dependent manner.Conclusion These results suggest that As_(2)O_(3) inhibited the proliferation,accelerated the apoptosis and blocked the cell cycle progression in VSMCs which may relate to P53 and P21~(waf1/cip1) pathway.
Objective The effects of PTCA on acute and chronic total coronary artery occlusions were studied.Methods PTCA or stent implantation were performed in 32 patients with 38 total vessel occlusion. Results The results showed 100% success rate in 4 direct and 8 rescure PTCA for acute myocardial infarction and 70% success rate in 20 selective PTCA. Conclusion It was found that the longer occlusion of the lower success in PTCA intervention. No severe complications occurred during this procedure.
Objective To evaluate the influence of functional mitral regurgitation(MR) on prognosis of patients with chronic heart failure.Methods Ninety-six systolic heart failure patients with functional MR were enrolled.The clinical and echocardiographic data,concentration of hs-CRP were analyzed retrospectively.All patients were followed up for 8±4 months.Results Among these patients,MR was severe in 22(22.9%),moderate in 34(35.4%) and mild in 40(41.7%).The severity of MR correlated with severity of systolic dysfunction,internal diameters of left ventricle and left atrium,diastolic dysfunction and pulmonary artery pressure(P0.05).The concentration of hs-CRP was significantly increased with increasing the severity of CHF and MR.The severity of MR was correlated with fatality rate and re-hospitalization rate(P0.05).Conclusion Functional MR is common in patients with chronic heart failure.Severity of MR correlates with heart function and prognosis of patients with chronic heart failure.
AIM:To evaluate the effect of shikonin on the transgenic TNF-α promoter activity in cultured vascular smooth muscle cells(VSMCs) and macrophages(Mφs).METHODS:Human TNF-α promoter was constructed by reporter gene system and was transiently transfected into VSMCs and Mφs in vitro.Promoter activity was tested by luciferase activity with or without LPS and Ang Ⅱ stimulation,before or after different doses of shikonin treatment.RESULTS:TNF-α promoter was stably expressed in VSMCs and Mφs compared with CMV promoter(58.3% and 55.6%,respectively).Both LPS and Ang Ⅱ significantly up-regulated TNF-α promoter activity compared with un-stimulated ones(P0.05).Shikonin significantly inhibited,both intact and LPS/Ang Ⅱ stimulated TNF-α promoter activity,in a dose dependent manner(P0.05),and in both cell types.CONCLUSION:The inhibitory effect of shikonin on the activity of human TNF-α promoter indicates its potential suppression on pro-inflammatory cytokine gene expression at transcriptional level and its potential anti-inflammatory property in cardiovascular system.
Objective:To evaluate the efficacy and tolerability of perindopril (2 mg) and indapamide (0. 623 mg) compound versus indapamide sustained-released tablets in patients with mild to moderate hypertension. Methods: A randomized, double blind, multicenter,parallel control clinical study enrolled 231 patients (aged 18 to 65 years old) with essential hypertension (95 mmHg≤sitting DBP 115 mmHg and SBP 180 mmHg). After the patients experienced a 2-week washed out period, they were randomized to administer either perindopril 2 mg / indapamide 0. 625 mg (n = 116) compound or indapamide SR 1. 5 mg alone ( n = 115 ) once daily for 6 weeks. At the end of this 6-week course of therapy, patients with sitting DBP 90 mmHg continued the medication regimen, and patients with sitting DBP≥95 mmHg were tapered onto the perindopril 4 mg / indapamide 1. 25 mg compound once daily in the bi-therapy group or received an added-on therapy with indapamide SR 1. 5 plus metoprolol 50 mg once daily in the mono-therapy group for additional 6 weeks. Patients underwent an ABPM pre-treatment and post the 12-week course of therapy. Results:52 out of the 107 patients (48. 6% ) tapered the drug regimen up in the bi-therapy group and 52 out of the 96 patients (54. 2% ) received the adjunctive therapy in the mono-therapy group after the first 6-week course of the therapy; the P value of changing drug regimens in the bi-therapy and the mono-therapy group showed no statistical difference ( P = 0. 43 ). The patients in the bi-therapy and added-on-therapy experienced a reduction of DBP ( average down value 12.4 mmHg versus 13.6 mmHg,P =0. 191 ) and a decrease of SBP (average down value 15.4 mmHg versus 15. 7 mmHg) at the end of the second 6-week course of therapy. The ABPM values showed significant improvements during the treatment in both groups. The mean trough/peak ratio (TPR) of DBP in the bi-therapy and added-on-therapy group was 80% and 47% , respectively. Common adverse events included cough, rhinitis and hypokalaemia. No significant difference was found in the incidence rate of these adverse events in patients with bi-therapy and added-on-therapy. Conclusion: The perindopril and indapamide compound offered an alternative therapy for patients with hypertension.
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