活血通脉胶囊对冠心病心血瘀阻证患者血浆小分子代谢产物的调节研究

目的：观察活血通脉胶囊对冠心病心血瘀阻证患者血浆小分子代谢产物的调节作用。方法采用前瞻性研究方法,选择2009年1月至2013年12月在天津市大港地区就诊的136例冠心病心血瘀阻证患者,按简单随机抽样方法分成两组。对照组（68例）采用硝酸酯类、β受体阻滞剂、钙离子拮抗剂及肠溶阿司匹林等常规疗法;活血通脉胶囊组（68例）在常规治疗基础上给予活血通脉胶囊,每次4粒（每粒0.25 g）,每日3次,30 d为1个疗程,共3个疗程。评定两组治疗后临床疗效和心电图疗效;采用酶联免疫吸附试验（ELISA）检测血浆和肽素、肿瘤坏死因子-α（TNF-α）及白细胞介素-10（IL-10）水平,计算TNF-α/IL-10比值。结果活血通脉胶囊组临床疗效及心电图疗效均明显高于对照组〔临床总有效率：89.71%（61/68）比80.88%（55/68）;心电图总有效率：57.35%（39/68）比48.53%（33/68）,均P＜0.05〕。两组治疗后和肽素及TNF-α/IL-10比值均较治疗前明显降低,且以活血通脉胶囊组降低更显著〔和肽素（ng/L）：0.22±0.04比0.31±0.05,TNF-α/IL-10比值：0.49±0.11比0.65±0.09,均P＜0.05〕。结论在常规疗法基础上加用活血通脉胶囊能通过降低和肽素水平及TNF/IL-10比值来改善冠心病心血瘀阻证患者的治疗效果。     

Graft Copolymers with Complex Polyether Structures: Poly(ethylene oxide)‐graft‐Poly(isobutyl vinyl ether) by Combination of Living Anionic and Photoinduced Cationic Graft Polymerization

A novel polymerization mechanism transformation strategy, involving anionic ring‐opening polymerization and photoinduced cationic polymerization, is successfully applied for the synthesis of poly(ethylene oxide)‐graft‐poly(isobutyl vinyl ether) (PEO‐g‐PIBVE). First, poly(ethylene oxide‐co‐ethoxyl vinyl glycidyl ether) [P(EO‐co‐EVGE)] is synthesized by living anionic polymerization. The vinyl moieties of the functional PEO‐based polymer are converted to the hydrogen iodide adduct by photolysis of diphenyliodonium iodide, monitored using NMR spectroscopy. A modified mode of Lewis acid‐catalyzed living cationic polymerization is performed as a “grafting from” method to generate PIBVE segments grafted onto the PEO main chain. Both the intermediates and the final graft copolymers are characterized by gel‐permeation chromato­graphy (GPC) and ¹H NMR analysis.

     

Photochemically Mediated Atom Transfer Radical Polymerization Using Polymeric Semiconductor Mesoporous Graphitic Carbon Nitride

Photochemically mediated atom transfer radical polymerization of vinyl monomers is successfully activated by ecofriendly heterogeneous mesoporous graphitic carbon nitride (mpg‐C₃N₄). This method pertains to the use of mpg‐C₃N₄ as photoactivator for reduction of initially loaded copper(II) species, thus promoting the in situ formation of the copper(I) species. The controlled nature of the polymerizations in both natural sunlight and UV‐light irradiation at ambient temperature is confirmed by the good agreement of the kinetics of the ­polymerization with theoretical values. The light on–off experiments ­demonstrate that polymerizations are clearly initiated and moderated by either UV light or sunlight.

     

Hypertensive response to exercise in dipper and non-dipper normotensive diabetics

Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5?±?7 and 10 male) in group 1 and 37 patients (mean age 53.1?±?10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p?=?0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r?=?0.611, p?r?=?0.266, p?=?0.002) and age (r?=?0.321, p?=?0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080–1.313; p?p?=?0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.     

DCE‐MRI findings of invasive aspergillosis in patient with acute myeloid leukemia

Thoracic radiography and high resolution computerized tomography is used to diagnose pulmonary infections in immunosuppressed patients, although in some cases these do not provide enough information about the lesion. Dynamic contrast‐enhanced magnetic resonance imaging may be useful in these cases, especially for the characterization of cavitary lesions and assessment of their contrast diffusion.     

Disturbances in calcium metabolism and cardiomyocyte necrosis: the role of calcitropic hormones

A synchronized dyshomeostasis of extra- and intracellular Ca(2+), expressed as plasma ionized hypocalcemia and excessive intracellular Ca(2+) accumulation, respectively, represents a common pathophysiologic scenario that accompanies several diverse disorders. These include low-renin and salt-sensitive hypertension, primary aldosteronism and hyperparathyroidism, congestive heart failure, acute and chronic hyperadrenergic stressor states, high dietary Na(+), and low dietary Ca(2+) with hypovitaminosis D. Homeostatic responses are invoked to restore normal extracellular [Ca(2+)](o), including increased plasma levels of parathyroid hormone and 1,25(OH)(2)D(3). However, in cardiomyocytes these calcitropic hormones concurrently promote cytosolic free [Ca(2+)](i) and mitochondrial [Ca(2+)](m) overloading. The latter sets into motion organellar-based oxidative stress, in which the rate of reactive oxygen species generation overwhelms their detoxification by endogenous antioxidant defenses, including those related to intrinsically coupled increments in intracellular Zn(2+). In turn, the opening potential of the mitochondrial permeability transition pore increases, allowing for osmotic swelling and ensuing organellar degeneration. Collectively, these pathophysiologic events represent the major components to a mitochondriocentric signal-transducer-effector pathway to cardiomyocyte necrosis. From necrotic cells, there follows a spillage of intracellular contents, including troponins, and a subsequent wound healing response with reparative fibrosis or scarring. Taken together, the loss of terminally differentiated cardiomyocytes from this postmitotic organ and the ensuing replacement fibrosis each contribute to the adverse structural remodeling of myocardium and progressive nature of heart failure. In conclusion, hormone-induced ionized hypocalcemia and intracellular Ca(2+) overloading comprise a pathophysiologic cascade common to diverse disorders and that initiates a mitochondriocentric pathway to nonischemic cardiomyocyte necrosis.     

Treatment and outcomes of acute coronary syndrome in the cancer population

Background:

Randomized trials have established the benefit of medical therapy and revascularization in the treatment of acute myocardial infarction (MI). Cancer and cardiovascular disease are the 2 most common diseases worldwide. In clinical practice, cancer patients are frequently afflicted with MI. The benefit of medical and/or revascularization therapy in the cancer population with MI is less well known.

Hypothesis:

Medical and revascularization therapy reduces mortality in cancer patients with MI.

Methods:

After approval by the institutional review board, we retrospectively reviewed all patients with a discharge diagnosis of acute MI who were admitted to the University of Texas MD Anderson Cancer Center between December 2000 and October 2006 and evaluated the association between cardiac treatments with survival outcomes.

Results:

A total of 456 patients with a discharge diagnosis of acute MI were identified and included in the study, of which 386 had non–ST‐segment elevation MI (NSTEMI) and 70 had ST‐segment elevation MI (STEMI). Compared with patients with NSTEMI, patients who had STEMI were more often prescribed aspirin (66% vs 43%; P = 0.004), β‐blockers (61% vs 46%; P = 0.018), and thrombolytic therapy (9% vs 0.3%; P = 0.0001). In the multivariable analysis, aspirin use was associated with a 23% decreased risk of death (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.60‐0.98, P = 0.033) and β‐blocker use was associated with a 36% decreased risk of death (HR: 0.64, 95% CI: 0.51–0.81, P = 0.0002). Statins (HR: 0.82, P = 0.18) and catheter‐based revascularization (HR: 0.57, P = 0.09) did not have an impact on the risk of death. Compared with patients with limited cancer, advanced cancer patients were twice as likely to die (HR: 2.12, 95 CI: 1.47–3.04, P < 0.0001). Previous chemotherapy (P = 0.005) and chest radiotherapy (P = 0.017) were associated with increased 1‐year mortality, whereas hyperlipidemia (P = 0.018) was protective.

Conclusions:

In this study of cancer patients with MI, medical therapy with aspirin and β‐blockers was associated with improved survival. The authors have no funding, financial relationships, or conflicts of interest to disclose.