Objective To evaluate the efficacy of n-3 PUFAs (fish oil) for prevention of cardiovascular events. Methods Randomized controlled trials (RCTs) were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library (Issue 1, 2009), CBM, and CNKI. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using Review Manager 4.2 software. Results Five studies involving 37 689 participants met the inclusion criteria. Meta-analysis results showed that: 1) Compared with placebo, the incidence rates of the cardiovascular death (RR=0.91, 95% CI 0.84 to 0.98), cardiovascular events (RR=0.95, 95%CI 0.91 to 0.98), angina (RR=0.79, 95%CI 0.64 to 0.96), and myocardial infarction (RR=0.79, 95%CI 0.65 to 0.96) could be reduced by n-3 PUFAs (fish oil). 2) There were no significant differences in death from any cause, the hospitalization rates of cardiovascular disease, sudden death, and heart failure (RR=0.95, 95%CI 0.90 to 1.00; RR=0.97, 95%CI 0.93 to 1.02; RR=0.90, 95%CI 0.79 to 1.01; RR=0.98, 95%CI 0.91 to 1.06). 3) Compared with placebo, the incidence rates of the arrhythmia and stroke could be increased, but there were no significant differences (RR=1.14, 95%CI: 0.80 to 1.62; RR=1.12, 95%CI 0.97 to 1.30). Conclusion Compared with placebo, n-3 PUFAs (fish oil) has good effects on reducing the incidence rates of total cardiovascular events, cardiovascular death, myocardial infarction, and angina pectoris, and it has the same efficacy in death from all cause, sudden death, heart failure, and the hospitalization rates of cardiovascular disease. There are no significant differences in the increased rates of arrhythmia and stroke.
Cardiovascular disease is the leading cause of death worldwide, accounting for 48.0% of all deaths in Europe and 34.3% in the United States. Studies have shown that arterial stiffness takes precedence over vascular structural changes and is therefore considered to be an independent predictor of many cardiovascular diseases. At the same time, the characteristics of Korotkoff signal is related to vascular compliance. The purpose of this study is to explore the feasibility of detecting vascular stiffness based on the characteristics of Korotkoff signal. First, the Korotkoff signals of normal and stiff vessels were collected and preprocessed. Then the scattering features of Korotkoff signal were extracted by wavelet scattering network. Next, the long short-term memory (LSTM) network was established as a classification model to classify the normal and stiff vessels according to the scattering features. Finally, the performance of the classification model was evaluated by some parameters, such as accuracy, sensitivity, and specificity. In this study, 97 cases of Korotkoff signal were collected, including 47 cases from normal vessels and 50 cases from stiff vessels, which were divided into training set and test set according to the ratio of 8 : 2. The accuracy, sensitivity and specificity of the final classification model was 86.4%, 92.3% and 77.8%, respectively. At present, non-invasive screening method for vascular stiffness is very limited. The results of this study show that the characteristics of Korotkoff signal are affected by vascular compliance, and it is feasible to use the characteristics of Korotkoff signal to detect vascular stiffness. This study might be providing a new idea for non-invasive detection of vascular stiffness.
The cardiovascular surgery in China has reached a stable platform, with notable progress been achieved in the past several decades. However, significant divergency regarding the healthcare quality was also observed, which requiring effective intervention to start the transition from the focus on "quantity" to the pursuit of "quality". Quality improvement program, including the establishment of a national cardiovascular surgery database, the conformation of a standard key quality evaluation indicator system, and the conduction of quality intervention and improvement initiatives, are promising to consolidate and expand the advantages of cardiac surgery and lead to better patient outcomes.
Abstract： Arginine vasopressin （AVP） is closely related to the pathogenesis of a variety of cardiovascular diseases and kidney diseases. Currently it is often used for the treatment of severe peripheral vasodilatory shock， and particularly beneficial for patients with refractory catecholamine-resistant vasodilatory shock. For some patients who do not have adequate AVP level in plasma after cardiovascular surgery， external low-dose AVP infusion is helpful to decrease the heart rate, and the dosage and duration of catecholamine use. Early initiation of low-dose AVP infusion may be beneficial for postoperative patients’ hemodynamic recovery without adverse complications. More randomized control trials are needed to provide evidence for rational usage， dosage and duration of AVP administration.
Objective To observe and analysis the features of images of fundus fluorescein angriography (FFA) in low-perfused retinopathy caused by cephalo-cervical peripheral vascular stenosis or occlusion. Methods The results of FFA of 27 patients diagnosed with carotid artery stenosis or occlusion by digital subtraction angiography (DSA) and examination of Doppler and vascular-pulsation were retrospectively analyzed. Result All of the patients had a delayed arm-retinal circulation duration from 20.0 to 81.08 seconds with the mean of 32.1 seconds; a delayed retinal arteriovenous filling duration from 6 to 64.0 seconds with the mean of 24.2 seconds. Delayed arm-retinal circulation duration and retinal a rteriovenous filling duration in 10 cases (37.0%); microangioma, vascular wall staining, nonperfused capillary area in 11 (40.7%); and anterior ischemic syndrome in 6 (22.2%) were found. In the 6 patients with anterior ischemic syndrome, 4 cases had narrow retinal artery, segmental changes of blood stream, vascular atresia, and abnormal arterio-venous anastomosis, and 2 cases had bold vascular loops. Conclusions The main manifestations of FFA in patients with low-perfused retinopathy are malperfusion and retinal ischemia, whose degrees relate to the extend of carotid artery stenosis or atresia, and the process of the disease.Serious retinal ischemia may combined with anterior ischemic syndrome. (Chin J Ocul Fundus Dis，2004，20：84-86)
Objective To explore the difference of cardiovascular risk factors and coronary artery lesion between Hui nationality and Han nationality patients with premature coronary heart disease. Methods A total of 316 patients with premature coronary heart disease were divided into two groups, including the Hui group (78 cases) and the Han group (238 cases). Eight risk factors for premature coronary heart disease (including age, gender, body mass index, familial heredity, diabetes, hypertension, dyslipidemia and smoking history) and coronary artery lesion characteristics were compared between the two groups. Results Compared with the Han group, the Hui group had a higher prevalence of smoking history and myocardial infarction, but a lower prevalence of angina (Plt;0.05). Type A disease was the major type in both Hui and Han groups. Compared with the Han group, the rate of type C were higher. Single-vessel lesion was the major lesion in both Hui and Han groups. The incidence of three-vessel lesion in the Han group was significantly lower than that in the Hui group. Gensini score in the Hui group was higher than that in the Han group, with a significant difference (Plt;0.05). Conclusion Hui patients with premature coronary artery disease are more than Han patients with premature coronary artery disease in proportions of smoking, diabetes, and the lesions of the left anterior descending artery, the right coronary artery disease, three-vessel disease rate, and C-type lesions. The coronary artery disease of the Hui group is more serious.
Abstract: The amniotic fluidderived stem cells (AFSC) possess considerable advantageous characteristics including high proliferation potential, easy availability, low immunogenicity and oncogenicity，and accordance with medical ethnics. Moreover, they do not require the sacrifice of human embryos for their isolation and the cells can differentiate into all three kinds of germs. Accordingly，they initiate a new and very promising field in stem cell research and they will be a potential source of stem cells for therapies related to regeneration medicine of cardiovascular diseases. The research about the AFSC utilization in cardiovascular diseases is just started. Though there were some exciting breakthroughs, there still remain many challenges. In the article，we will discuss AFSC characteristics, influence of amniotic fluid harvesting time on stem cells, isolation and purification, emphasizing mainly on the potential of AFSC differentiation into cardiovascular cells, current situation and problems in this field.
Objective To evaluate the rationality of drug treatment for cardiovascular diseases in aged people and the effects of evidence-based practice. Methods Descriptive study was conducted to compare the therapies for the patients suffering from cardiovascular diseases before and after evidence-based practice by investigating drug use during 1998-1999 (211 cases) and 2002-2003 (211 cases). Results Among antihypertensive drugs, the ACEIs and diuretics played a more important role than before. CCBs and ACEIs were still the most frequently used drugs, and drug combination was more common, comparing to that before evidence-based practice. Lipid lowering drugs and ACEIs were used more common in coronary heart disease. Quality of life of patients was more emphasized and combination use of anti-anxiety drugs was adopted. When treating heart failure, β-receptor blockers, aldadinc and ACEIs were more frequently used. Conclusions After evidence-based practice, drug use is much more based on evidence instead of experience and textbook. As a result, the rate of reaching ideal blood pressure is higher than before. The rate of rational drug use before and after evidence-based practice has increased from 42% to 78%, respectively.
Objective To evaluate the influence of dexmedetomidine on the stress of elderly patients with cardiovascular risk undergoing gastrointestinal laparoscopic surgery. Methods From August 2014 to December 2015, 210 patients undergoing elective laparoscopic gastrointestinal operations were randomly divided into three groups, including the low concentration group (group D1), the high concentration group (group D2), and the control group (group C), with 70 cases in each group. The patients in group D1 and group D2 were injected with dexmedetomidine (0.4 and 0.8 μg/kg respectively) by infusion pump before anesthesia induction, and were continuously pumped with dexmedetomidine [0.4 and 0.8 μg/(kg·h) respectively] until the end of the surgery. Meanwhile, the patients in group C were injected with normal saline of the equal volumes. The heart rate and mean arterial pressure (MAP) was recorded before anesthesia, after endotracheal intubation and extubation. Myocardial ischemia and cardiovascular adverse events thatneeded to be handled were recorded. The concentrations of dopamine, adrenaline (AD) and noradrenaline (NE) were monitored at 15:00 one day before surgery (Ty), one hour after the beginning of surgery (T0), and at 15:00 of the 1st, 2nd, and 3rd day after surgery (T1, T2, T3). Results A total of 178 patients completed the study and were enrolled in this study, including 60 cases in group D1 and 59 cases in group D2 and C respectively. In group D1 and D2, the heart rates after intubation [(80.4±9.6), (68.2±10.5) times/minutes], extubation [(70.1±6.2), (69.7±7.8) times/minutes] and MAP after extubation [(100.2±12.0), (98.0±13.1) mm Hg (1 mm Hg=0.133 kPa)] were lower than those in group C [(98.4±10.5) and (95.2±7.3) times/minutes; (121.8±10.5) mm Hg], and the differences were significant (P<0.05). The bradycardia and hypotension in group D2 (27.12%, 22.03%) was significantly higher than those in group C (3.39%, 8.47%). Hypertension in group D1 and D2 (5.00%, 1.69%) was significantly lower than that in group C (37.29%), and the differences were significant (P<0.05). Compared with the base value at Ty in the three groups, the concentration of dopamine at T0-T3 in group C, at T0-T1 in group D1, and at T0 in group D2 increased significantly (P<0.05); the AD at T0-T3 in group C, at T0-T2 in group D1, and at T0-T1 in group D2 increased significantly (P<0.05); the NE at T0-T2 in group C, and at T1 in group D1 increased significantly (P<0.05). Compared with group C at the same time, the DA at T3 in group D1 and at T1-T3 in group D2, the AD at T2-T3 in group D1 and at T0-T3 in group D2, the NE at T0-T1 in group D1 and T0-T3 in group D2, decreased significantly (P<0.05). Conclusions Dexmedetomidine can effectively restrain the changes of hemodynamics and catecholamine induced by perioperative stress responses in a dose-dependent manner. During the surgery of elderly patients with cardiovascular risk, the concentration of dexmedetomidine should be controlled moderately to gain the optimal effect.
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.