Publications by authors named "Qibing Wang"

30 Publications

  • Page 1 of 1

Early Goal-Directed Renal Replacement Therapy in Acute Decompensated Heart Failure Patients with Cardiorenal Syndrome.

Blood Purif 2021 Jun 15:1-9. Epub 2021 Jun 15.

Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.

Introduction: The aim of this study was to clarify the efficacy of early goal-directed renal replacement therapy (GDRRT) for treatment of cardiorenal syndrome (CRS) patients after acute decompensated heart failure (ADHF).

Methods: In the retrospective, observational study, we enrolled 54 patients in the early GDRRT group and 63 patients in the late GDRRT group. Baseline characteristics, clinical data at initiation renal replacement therapy time, and the clinical outcome were collected and several parameters were compared and analyzed between 2 groups.

Results: The urine volume at GDRRT initiation time in the early group was higher than that in the late GDRRT group (1,060.3 ± 332.1 vs. 300.5 ± 148.3 mL, p < 0.001). Hemodynamic parameters such as mean artery pressure were higher (70.06 ± 32.99 vs. 54.34 ± 40.88 mm Hg, p = 0.012), the heart rate was slower (80.17 ± 15.26 vs. 99.21 ± 25.45 bpm, p = 0.002), and the diameter of inferior vena cava was narrower (22.00 ± 1.91 vs. 25.77 ± 5.5 mm, p = 0.04) in early GDRRT. Primary end point was inhospital all-cause mortality and cardiovascular mortality, which was obviously lower in the early GDRRT group (respectively 24.1 vs. 60.3%, p = 0.002 and 20.3 vs. 50.8%, p = 0.005). The second end point of kidney recovery in the early GDRRT group was much better than that in the latter GDRRT group (p = 0.018). Moreover, urine volume after GDRRT of the early group was more significant than that of the late group (1,432 ± 172 vs. 702 ± 183 mL, p = 0.005).

Conclusion: This study clarified the effectiveness of the early GDRRT strategy in ADHF patients suffered from CRS, which reduced inhospital mortality and improved the urine output and clinical kidney recovery outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000515826DOI Listing
June 2021

Role of IVUS in the rectification of angiographically judged ramus intermedius and its clinical significance.

BMC Cardiovasc Disord 2021 Apr 30;21(1):218. Epub 2021 Apr 30.

Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.

Background: Due to the technical limitations of coronary artery angiography (CAG), ramus intermedius (RI) is sometimes difficult to distinguish from a high-origin obtuse marginal branch or a high-origin diagonal branch. This study sought to investigate the role of intravascular ultrasonography (IVUS) in the rectification of angiographically judged RI.

Methods: This study retrospectively analyzed 165 patients who were reported to have an RI based on CAG and underwent IVUS implementation from 02/01/2009 to 31/12/2019 in Zhongshan Hospital, Fudan University. Taking IVUS as the gold standard, we calculated the accuracy of RI identification by CAG and evaluated the impact of RI on revascularization strategy.

Results: Among the 165 patients, 89 patients (54%) were demonstrated to have an RI on IVUS (IVUS-RI), 32 patients (19%) were identified to have a high-origin diagonal branch on IVUS (IVUS-h-D), and 44 patients (27%) had an actual high-origin obtuse marginal artery on IVUS (IVUS-h-OM). Among 84 patients who underwent one-stent crossover stenting because of left main furcation lesions (48 patients in the IVUS-RI group, 12 patients in the IVUS-h-D group, and 24 in the IVUS-h-OM group), 14.6% of patients in the IVUS-RI group, 33.3% in the IVUS-h-D group and 0% in the IVUS-h-OM group had CAG-RI compromise (P = 0.02), which was defined as severe stenosis of the RI ostium (> 75%) or significant RI flow impairment (TIMI < 3).

Conclusions: Only 54% of CAG-RIs were confirmed by IVUS, which indicates the necessity of preintervention IVUS to distinguish real RIs from other branches in LM furcation lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12872-021-02034-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086063PMC
April 2021

Ticagrelor Pharmacokinetics and Pharmacodynamics in Chinese Patients with STEMI and NSTEMI Without Opioid Administration.

Adv Ther 2020 10 8;37(10):4220-4232. Epub 2020 Aug 8.

Department of Cardiology, Zhongshan Hospital, Fudan University. Shanghai Institute of Cardiovascular Diseases, Shanghai, China.

Introduction: The pharmacodynamics (PD) and pharmacokinetics (PK) study of ticagrelor loading dose (LD) in Chinese patients with acute coronary syndrome (ACS) without opioid administration has never been investigated. Therefore, the aim of this study was to evaluate the antiplatelet effects and the PK parameters of ticagrelor in Chinese patients with ACS without opioid administration.

Methods: A sample size of 30 eligible patients with ACS were enrolled in this study. Blood samples were obtained predose and 1, 2, 4, 8, and 12 h after 180 mg LD of ticagrelor. P2Y reactivity units (PRU) and plasma concentrations of ticagrelor and its two metabolites were measured.

Results: In total, 15 patients were admitted to ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) groups, respectively. For patients with NSTEMI, PRU declined significantly during the first 4 h and maintained a relatively stable antiplatelet effect from 4 to 12 h after LD. A similar trend was found in the STEMI group without significant differences of PRU in each designed time compared with patients with NSTEMI (P > 0.05). T of metabolite AR-C124910XX was 4 h after LD for both groups. There were no significant differences for drug concentration, C, or AUC of ticagrelor and AR-C124910XX between patients with STEMI and NSTEMI (P > 0.05).

Conclusions: For Chinese patients with ACS, at least 4 h was needed to achieve an adequate antiplatelet effect for ticagrelor LD. There were no differences in PK or PD between Chinese patients with STEMI and NSTEMI.

Clinical Trial Registration: ChiCTR1800014764.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12325-020-01423-wDOI Listing
October 2020

Clinical analysis of sinus bradycardia in patients with severe COVID-19 pneumonia.

Crit Care 2020 May 26;24(1):257. Epub 2020 May 26.

Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Feng Lin Rd., Shanghai, 200032, China.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13054-020-02933-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249977PMC
May 2020

The preservation effect of coronary collateral circulation on left ventricular function in chronic total occlusion and its association with the expression of vascular endothelial growth factor A.

Adv Clin Exp Med 2020 Apr;29(4):493-497

Department of Cardiology, Fudan University Affiliated Zhongshan Hospital, Shanghai, China.

Background: Patients with coronary chronic total occlusion (CTO) typically have collateralization of the distal vessel, and these collaterals can contribute to the relief of ischemia and anginal symptoms and to the preservation of ventricular function.

Objectives: To investigate the preservation effect of coronary collateral circulation on left ventricular (LV) function in coronary CTO, and to explore the potential mechanism behind the development of coronary collateral circulation.

Material And Methods: A total of 102 consecutive patients with coronary CTO were divided into 2 groups: the left ventricular ejection fraction (LVEF)-preserved group (LVEF ≥ 50%; n = 46) and the LVEF-decreased group (LVEF < 50%; n = 56). Clinical, angiographic and laboratory data was collected for all patients. The association between LVEF and coronary collateral circulation in coronary CTO patients was analyzed with multivariate logistic regression analysis, and the serum levels of VEGF-A and the mRNA expression levels of the VEGF-A gene were compared between different grades of coronary collateral circulation.

Results: Multivariate analysis revealed that Rentrop grades 2-3 and coexisting collateral pathways were independent predictors of LVEF preservation in coronary CTO patients. Patients with Rentrop grades 2-3 had smaller left ventricular end diastolic diameters (LVDd) and left ventricular end systolic diameters (LVSd), and they had larger LVEFs than the patients with Rentrop grades 0-1. Patients with Rentrop grades 2-3 also had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in their peripheral blood mononuclear cells (PBMCs) than patients with Rentrop grades 0-1. Patients with coexisting collateral pathways had higher serum levels of VEGF-A and higher mRNA expression levels of the VEGF-A gene in PBMCs than patients without coexisting collateral pathways.

Conclusions: Coronary collateral circulation is significantly associated with LVEF preservation, and VEGF-A might promote the formation of coronary collateral circulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17219/acem/104535DOI Listing
April 2020

D-Dimer Level Predicts Angiographic No-Reflow Phenomenon After Percutaneous Coronary Intervention Within 2-7 Days of Symptom Onset in Patients with ST-Segment Elevation Myocardial Infarction.

J Cardiovasc Transl Res 2020 Mar 24. Epub 2020 Mar 24.

Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.

It remains uncertain whether plasma D-dimer level can predict no-reflow in patients with STEMI who had pPCI after 48 h of symptom onset. This study retrospectively enrolled 229 consecutive patients who had pPCI for acute STEMI within 2-7 days of symptom onset between January 2008 and December 2018. Patients were divided into no-reflow group (TIMI flow grade 0-2) and reflow group (TIMI flow grade 3). Predictors of no-reflow were assessed by univariate and multivariate binary logistic regression analyses. Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7 days of symptom onset (OR 2.52 per 1 mg/L increase, 95% CI 1.16-5.47, p = 0.019). This finding indicated that pPCI may be safe and feasible for STEMI patients within 2-7 days of symptom onset with low D-dimer level. Graphical Abstract Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7 days of symptom onset. pPCI may be safe and feasible for STEMI patients within 2-7 days of symptom onset with low D-dimer level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12265-020-09991-6DOI Listing
March 2020

Platelet Function and Risk of Bleeding in Patients With Acute Coronary Syndrome Following Tirofiban Infusion.

Front Pharmacol 2019 9;10:1158. Epub 2019 Oct 9.

Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.

To assess platelet (PLT) function and bleeding risks in patients with acute coronary syndrome after tirofiban infusion. Patients diagnosed with acute coronary syndrome from May 2016 to February 2018 in the Department of Cardiac Intensive Care Unit, Zhongshan Hospital, were enrolled. They were symmetrically allocated into two groups: tirofiban treatment group or control group (without tirofiban treatment). Blood samples were collected 24 h postoperation for the evaluation of antiplatelet effect of tirofiban. We applied thromboelastography to detect on-treatment PLT reactivity and conducted laboratory tests to assess the risk of bleeding following tirofiban treatment. After discharge, telephone follow-up and outpatient interview were carried out. The primary clinical endpoint was major adverse cardiovascular events, including cardiovascular death, cardiovascular mortality, myocardial infarction, and revascularization for the targeted vascular lesion. There were a total of 196 patients with acute coronary syndrome after screening with the inclusion criteria and the exclusion criteria. Ninety-eight patients were assigned to receive either tirofiban treatment or control treatment. Patients treated with tirofiban had more coronary lesions and stents implanted compared with the control group ( = 0.000). After tirofiban infusion, inhibition of platelet aggregation induced by thromboxane A and adenosine diphosphate was significantly higher compared to patients without tirofiban infusion (80.3% ± 19.6% vs. 72.6% ± 13.0%, = 0.002; and 81.0% ± 19.8% vs. 75.4% ± 12.4%, = 0.020, respectively). There was no significant difference in the reduction of hemoglobin (Hb), hematocrit (Hct), and PLT after administration of tirofiban, compared with baseline ( > 0.05). In addition, no significant differences were identified between the two groups with respect to Hb, Hct, and PLT after tirofiban infusion. However, C-reactive protein level, referred to as an inflammation marker, was significantly lowered after infusion tirofiban compared with the control group (11.9 ± 14.2 vs. 17.9 ± 21.2, = 0.020). During the 1-year follow-up, the incidence rate of major adverse cardiovascular events remains indiscriminate between the two groups ( = 0.208). The assessments of cardiac biomarkers showed that tirofiban could decrease incidence of procedural myocardial infarction (odds ratio [OR] = 0.250, 95% confidence interval [CI] = 0.067-0.925, = 0.027). At follow-up, the morbidity of left atrial dilation in tirofiban-treated patients, defined as enlargement of left atrial diameter >40mm, was lower compared to the control group (OR = 0.533, 95% CI = 0.301-0.945, = 0.031). Tirofiban infusion could decrease PLT activation in patients with acute coronary syndrome without increasing the risk of bleeding. As a concomitant medication, tirofiban shows no benefit in reducing the occurrence of major adverse cardiovascular events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fphar.2019.01158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795056PMC
October 2019

Clopidogrel-associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients.

Basic Clin Pharmacol Toxicol 2019 Jan 5;124(1):84-93. Epub 2018 Sep 5.

Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.

Acute coronary syndrome (ACS) has become a vital disease with high mortality worldwide. A combined antiplatelet therapy (aspirin and a P2Y antagonist) is commonly used to prevent re-infarction in ACS patients who have undergone percutaneous coronary intervention (PCI). Clopidogrel, a P2Y antagonist, plays an important role in the inhibition of platelet aggregation (IPA). However, it is a pro-drug requiring biotransformation by cytochrome P450 (CYP450). The aim of this study is to unravel the effect of clopidogrel-associated genetic variants on inhibition of platelet activity and clinical outcomes in ACS patients. In our study, a total of 196 patients with metabolic gene polymorphism of clopidogrel were enrolled, and their antiplatelet effect as well as their cardiovascular events were collected. Approximately 2 mL of venous blood samples were used for genotype detection and another 4 mL were collected for platelet reactivity with thrombelastography. The primary clinical end-point was defined as a combination of cardiovascular mortality and revascularization for targeted vascular lesion. Based on the results of IPA, the prevalence of high on-treatment platelet reactivity (HPR) was 17.3% and the majority of patients (82.7%) obtained normal on-treatment platelet reactivity (NPR). The HPR group had significantly higher body mass index (BMI) and lower arachidonic acid (AA) induced IPA (P < 0.05). Therapy including Glycoprotein (GP) IIb/IIIa antagonist increased IPA (P < 0.05). ADP-induced IPA effect was lower with the presence of CYP2C19*2, *3 and paraoxonase (PON)1 Q192R loss-of-function (LOF) alleles, respectively (P < 0.05). Multivariate logistic regression analysis demonstrated that aspirin resistance (AA-induced IPA < 50%) had a greater risk of the occurrence of major adverse cardiovascular events (MACE) (OR = 3.817; 95% CI: 1.672-8.700; P = 0.002). CYP2C19*2 LOF alleles were associated with high risk of MACE in 1-year post PCI operations (OR = 2.571; 95% CI: 1.143-5.780; P = 0.030). For the ACS patients, the presence of CYP2C19*2 and PON1 Q192R LOF alleles were the major drivers of HPR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bcpt.13110DOI Listing
January 2019

Transfer of polycyclic aromatic hydrocarbons from mother to fetus in relation to pregnancy complications.

Sci Total Environ 2018 Sep 25;636:61-68. Epub 2018 Apr 25.

Stockbridge School of Agriculture, University of Massachusetts, Amherst, MA 01003, USA.

The accumulation and transfer of carcinogens, including polycyclic aromatic hydrocarbons (PAHs), in the human body, especially from mother to fetus, has been the subject of many research studies, but the related data are limited and the mechanisms are unknown. This is the first study to investigate the distribution of PAHs in paired samples of maternal blood, placenta tissue, and umbilical cord blood in relation to pregnancy complications. Sixty-four pairs of samples were collected in Kunming, China; 18 were from healthy pregnant women and 46 were from patients with pregnancy complications. The predominant PAHs in these pregnant women were high-molecular-weight (HMW) compounds, mainly from the incomplete combustion or pyrolysis of biomass. In the control group, the total amount of HMW compounds (ΣPAHs) was significantly higher in maternal blood than in umbilical cord blood, which suggested that placenta may decrease PAH transfer in healthy pregnant women. However, this phenomenon was not observed for low-molecular-weight PAHs or in the case group. In the control group, ΣPAH and ΣPAH in the placenta were higher than those in maternal blood and umbilical cord blood; for the case group, a contrasting result was observed. ΣPAHs in the placenta was significantly higher in the control group than in the case group. The same results were observed after the exclusion of the impact of the genotypes of the PAH metabolic enzymes (both phase I and phase II enzymes). Thus, the decreased PAH transfer from mother to fetus may partially result from the accumulation of PAHs inside the placenta.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2018.04.274DOI Listing
September 2018

Hardware-efficient signal generation of layered/enhanced ACO-OFDM for short-haul fiber-optic links.

Opt Express 2017 Jun;25(12):13359-13371

Layered/enhanced ACO-OFDM is a promising candidate for intensity modulation and direct-detection based short-haul fiber-optic links due to its both power and spectral efficiency. In this paper, we firstly demonstrate a hardware-efficient real-time 9.375 Gb/s QPSK-encoded layered/enhanced asymmetrical clipped optical OFDM (L/E-ACO-OFDM) transmitter using a Virtex-6 FPGA. This L/E-ACO-OFDM signal is successfully transmitted over 20-km uncompensated standard single-mode fiber (S-SMF) using a directly modulated laser. Several methods are explored to reduce the FPGA's logic resource utilization by taking advantage of the L/E-ACO-OFDM's signal characteristics. We show that the logic resource occupation of L/E-ACO-OFDM transmitter is almost the same as that of DC-biased OFDM transmitter when they achieve the same spectral efficiency, proving its great potential to be used in a real-time short-haul optical transmission link.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1364/OE.25.013359DOI Listing
June 2017

A head to head comparison of XINSORB bioresorbable sirolimus-eluting scaffold versus metallic sirolimus-eluting stent: 180 days follow-up in a porcine model.

Int J Cardiovasc Imaging 2017 Oct 21;33(10):1473-1481. Epub 2017 Jun 21.

Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.

We aimed to investigate the safety and efficacy of XINSORB bioresorbable sirolimus-eluting scaffold in porcine model. XINSORB scaffolds and metallic Firebird2™ stents were randomly implanted into minipigs' coronary arteries. Angiography, optical coherent tomography (OCT) and histopathological analyses were performed at post-procedure and 14-, 28-, 90-, 180-day follow-up. Thirty-two minipigs were enrolled. Eight XINSORB scaffolds and 8 Firebird2 stents were examined at each time point. Quantitative coronary angiography showed that in-scaffold late luminal loss (LLL) of XINSORB scaffold was 0.26 ± 0.13, 0.50 ± 0.16, 0.88 ± 0.29 and 0.43 ± 0.24 mm at 14-, 28, 90-, and 180-day follow-up respectively, and the corresponding diameter stenosis (DS) was 7.3 ± 4.7, 12.0 ± 9.5, 22.1 ± 8.0, and 16.0 ± 9.5%. Neither in-scaffold LLL nor DS of XINSORB scaffold was significantly different in comparison with Firebird2 stent. No difference of luminal area, device area, neointimal hyperplasia, and area stenosis was detected between two devices under OCT. Scaffold area of XINSORB remained steady through the observation. Histopathology revealed the similar findings. The greatest late recoil of XINSORB scaffold was about 4.12% at 90-day follow-up, which was comparable to Firebird2 stent. Both devices showed low injury or inflammation of vessel wall. XINSORB scaffold showed early neointimal coverage on struts within 28 days under scanning electron microscopy. XINSORB scaffold suppressed neointimal hyperplasia as effectively as Firebird2 did without obvious late device recoil during the 180 days follow-up. It is feasible to carry out clinical trial to investigate the safety and efficacy of XINSORB scaffold for patients with coronary artery diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10554-017-1148-5DOI Listing
October 2017

Ticagrelor Compared with Clopidogrel Increased Adenosine and Cyclic Adenosine Monophosphate Plasma Concentration in Acute Coronary Syndrome Patients.

Basic Clin Pharmacol Toxicol 2017 Jun 14;120(6):610-614. Epub 2017 Mar 14.

Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.

Ticagrelor produces a more potent antiplatelet effect than clopidogrel and inhibits cellular uptake of adenosine, which is associated with several cardiovascular consequences. We aimed to explore the correlation between adenosine and cyclic adenosine monophosphate (cAMP) plasma concentration and antiplatelet effect by clopidogrel or ticagrelor in patients with acute coronary syndrome (ACS) receiving dual antiplatelet therapy (DAPT). We conducted a prospective, observational and single-centre cohort study enrolling 68 patients with non-ST-segment elevation ACS from January 2016 to May 2016. We monitored the inhibition of platelet aggregation (IPA) and assessed adenosine, adenosine deaminase (ADA) and cAMP plasma concentrations by immunoassay on admission and 48 hr after coronary angiography. The demographic and clinical data were collected by reviewing their medical records. The two groups exhibited similar baseline characteristics including adenosine, ADA and cAMP. The mean IPA in patients receiving ticagrelor was significantly higher than that in patients receiving clopidogrel (93.5% versus 67.2%; p = 0.000). Also, we observed that patients treated with ticagrelor had a significantly higher increase in levels of adenosine and cAMP compared with those treated with clopidogrel (1.04 (0.86; 1.41) versus 0.04 (-0.25; 0.26); p = 0.029 and 0.78 (-1.67; 1.81) versus 0.60 (-1.91; 4.60); p = 0.037, respectively). And there was a weak correlation between IPA and adenosine as well as cAMP plasma concentration (r = 0.390, p = 0.001 and r = 0.335, p = 0.005, respectively). Ticagrelor increased adenosine and cAMP plasma concentration compared with clopidogrel in patients with ACS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bcpt.12752DOI Listing
June 2017

Effects of functional diversity loss on ecosystem functions are influenced by compensation.

Ecology 2016 Sep;97(9):2293-2302

State Key Laboratory of Vegetation and Environmental Change, Institute of Botany, The Chinese Academy of Sciences, 100093, Beijing, China.

Understanding the impacts of biodiversity loss on ecosystem functioning and services has been a central issue in ecology. Experiments in synthetic communities suggest that biodiversity loss may erode a set of ecosystem functions, but studies in natural communities indicate that the effects of biodiversity loss are usually weak and that multiple functions can be sustained by relatively few species. Yet, the mechanisms by which natural ecosystems are able to maintain multiple functions in the face of diversity loss remain poorly understood. With a long-term and large-scale removal experiment in the Inner Mongolian grassland, here we showed that losses of plant functional groups (PFGs) can reduce multiple ecosystem functions, including biomass production, soil NO -N use, net ecosystem carbon exchange, gross ecosystem productivity, and ecosystem respiration, but the magnitudes of these effects depended largely on which PFGs were removed. Removing the two dominant PFGs (perennial rhizomatous grasses and perennial bunchgrasses) simultaneously resulted in dramatic declines in all examined functions, but such declines were circumvented when either dominant PFG was present. We identify the major mechanism for this as a compensation effect by which each dominant PFG can mitigate the losses of others. This study provides evidence that compensation ensuing from PFG losses can mitigate their negative consequence, and thus natural communities may be more resilient to biodiversity loss than currently thought if the remaining PFGs have strong compensation capabilities. On the other hand, ecosystems without well-developed compensatory functional diversity may be much more vulnerable to biodiversity loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ecy.1460DOI Listing
September 2016

Nursing care of transradial angiography and intervention in a tertiary hospital in Shanghai: a best practice implementation project.

JBI Database System Rev Implement Rep 2016 05;14(5):286-94

Zhongshan Hospital Fudan University, Shanghai, People's Republic of China.

Background: Coronary heart disease is common in the general population and is estimated to cause as many deaths worldwide as cancer. Percutaneous coronary angiography and intervention is the most common method in the diagnosis and treatment of coronary heart disease. To achieve best practice in the nursing care of transradial angiography and intervention, there is an urgent need for clinical knowledge.

Objectives: This aim of this project was to improve clinical nursing care for transradial angiography and intervention in Zhongshan Hospital, Shanghai.

Methods: Seven criteria identified from evidence by the Joanna Briggs Institute were audited in the coronary care unit of Zhongshan Hospital, Shanghai. Twenty-three nurses and 80 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to examine compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over six months.

Results: This best practice implementation project improved the rates of written discharge instructions and radial artery patency assessment at the first post-procedure from 0% to 100%. Implementation rates for pre-procedural checklist as well as the radial artery patency assessment before discharge were 100% at baseline. Pre-procedural checklists including adequate criteria reached 78%, up from 0%. The implementation rate for regular monitoring of vital signs recorded for the first two hours post-procedure reached 22% from 0%. The implementation rate for details of discharge instructions, including procedure review, limitation of physical activity, general physical status, comorbidities, medication reconciliation and follow-up appointment improved from 36.6% to 100%. Barriers to implementation were identified as: (1) the structured pre-procedural checklist not being ready, (2) nurses lacking knowledge regarding discharge education for transradial angiography and intervention, (3) heavy clinical workload and lack of time, and (4) nurses lacking awareness and enthusiasm for implementing discharge education.

Conclusion: This project achieved significant improvements in establishing evidence-based practice in nursing care of transradial angiography and intervention for patients. Strategies for sustaining best practice should continue to be developed in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11124/JBISRIR-2016-002509DOI Listing
May 2016

Six-month outcomes of the XINSORB bioresorbable sirolimus-eluting scaffold in treating single de novo lesions in human coronary artery.

Catheter Cardiovasc Interv 2016 Mar 10;87 Suppl 1:630-7. Epub 2016 Feb 10.

Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.

Objective: We aimed to investigate short-term outcomes of the XINSORB bioresorbable sirolimus-eluting scaffold in human coronary artery.

Background: Bioresorbable scaffolds are considered to be the fourth milestone in percutaneous coronary intervention.

Methods: Thirty patients with symptomatic ischemic coronary disease were enrolled and treated with the XINSORB scaffolds that were 3.0 × 12, 15, and 18 mm in size. The primary angiographic endpoint was late luminal loss (LLL), whereas the primary clinical endpoint was major adverse cardiac events (MACEs) at the 6 month follow-up. In a subset of 19 patients, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were performed at follow-up.

Results: The success rates of the procedure and the device were both 100%. Twenty-seven patients received angiographic follow-up. All patients were clinically assessed. Neither MACEs nor stent thrombus-related events were recorded. The percentage of diameter stenosis at follow-up was similar to that at postprocedure. In-scaffold and periscaffold LLL were 0.17 ± 0.12 and 0.13 ± 0.24 mm, respectively. No in-stent restenosis was detected. IVUS showed that the mean areas of the lumen, scaffold, and neointima at follow-up were 6.27 ± 0.69, 6.48 ± 0.70, and 0.20 ± 0.09 mm(2) , while in-device stenosis was 3.1 ± 1.3%. OCT showed that 97.9% of the struts presented a preserved box, while 2.1% had an open box after 6 months. A total of 95.9% of the struts were covered by neointima.

Conclusions: This first-in-human study demonstrates the effectiveness and safety of the XINSORB scaffold in treating single de novo coronary lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccd.26404DOI Listing
March 2016

Soil recovery across a chronosequence of restored wetlands in the Florida Everglades.

Sci Rep 2015 Dec 1;5:17630. Epub 2015 Dec 1.

Department of Soil and Water Science, Tropical Research and Education Center, University of Florida, Homestead, FL 33031, USA.

The restoration project in the Hole-in-the-Donut of Everglades National Park in Florida, USA is to reestablish native wetlands by complete removal of the invasive plants and the associated soil. However, there is little information available about changes in properties of the newly formed Marl soils in restored wetlands. In this study, we measured soil physicochemical properties, soil enzymatic activities, and stable isotopes of carbon (δ(13)C) in plants and soil organic carbon (SOC) in an undisturbed natural wetland (UNW) and three wetlands restored respectively in 1989, 1996 and 1999 (WR89, WR96 and WR99). The older restored wetlands (WR89 and WR96) are characterized by greater SOC and mineral nitrogen. The values of soil dehydrogenase and phosphatase activities in the four wetlands follow the order: UNW > WR89 > WR96 > WR99, and are consistent with changes in vegetation coverage. The principal component analysis shows that dehydrogenase and phosphatase activities are the vital variables contributing to the soil of UNW. The similar δ(13)C values of SOC and plants in the restored wetlands suggest the formation of SOC during restoration is mainly derived from the associated plants. These results indicate that the newly restored soils develop toward the soil in the UNW with time since restoration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/srep17630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664932PMC
December 2015

Pathogen infection drives patterns of nutrient resorption in citrus plants.

Sci Rep 2015 Sep 30;5:14675. Epub 2015 Sep 30.

State Key Laboratory of Vegetation and Environmental Change, Institute of Botany, Chinese Academy of Sciences, Beijing 100093, China.

Nutrient resorption processes in the plants infected by pathogen remain poorly understood. Huanglongbing (HLB) is a destructive disease of citrus. HLB-pathogen 'Candidatus Liberibacter asiaticus' grows specifically in the phloem of hosts and may cause problems in the plant vascular system after infection. Therefore, it brings a great concern about the phloem nutrient transport and nutrient intra-cycling in HLB-affected plants. We investigated the effects of 'Ca. L. asiaticus' infection on nitrogen (N) and phosphorus (P) concentrations and resorption in different citrus species (i.e. Citrus reticulata, Citrus limon and Citrus maxima). HLB-pathogen infection had distinctive impacts on nutrient resorption in different species. P resorption efficiency substantially decreased in infected C. reticulata plants relative to the healthy plants in summer, which may account for the marked decrease in the average fruit yield. P resorption was more efficient in infected C. limon plants than in the healthy plants. However, for C. maxima plants, HLB had no significant effects on N:P ratio in live leaves and resorption efficiency as well as on fruit yield. Keeping efficient internal nutrient cycling can be a strategy of citrus species being tolerant to HLB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/srep14675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588592PMC
September 2015

Rhizosphere bacterial communities of dominant steppe plants shift in response to a gradient of simulated nitrogen deposition.

Front Microbiol 2015 12;6:789. Epub 2015 Aug 12.

State Key Laboratory of Vegetation and Environmental Change, Institute of Botany, Chinese Academy of Sciences Beijing, China ; Research Network of Global Change Biology, Beijing Institutes of Life Science, Chinese Academy of Sciences Beijing, China.

We evaluated effects of 9-year simulated nitrogen (N) deposition on microbial composition and diversity in the rhizosphere of two dominant temperate grassland species: grass Stipa krylovii and forb Artemisia frigida. Microbiomes in S. krylovii and A. frigida rhizosphere differed, but changed consistently along the N gradient. These changes were correlated to N-induced shifts to plant community. Hence, as plant biomass changed, so did bacterial rhizosphere communities, a result consistent with the role that N fertilizer has been shown to play in altering plant-microbial mutualisms. A total of 23 bacterial phyla were detected in the two rhizospheric soils by pyrosequencing, with Proteobacteria, Acidobacteria, and Bacteroidetes dominating the sequences of all samples. Bacterioidetes and Proteobacteria tended to increase, while Acidobacteria declined with increase in N addition rates. TM7 increased >5-fold in the high N addition rates, especially in S. krylovii rhizosphere. Nitrogen addition also decreased diversity of OTUs (operational taxonomic units), Shannon and Chao1 indices of rhizospheric microbes regardless of plant species. These results suggest that there were both similar but also specific changes in microbial communities of temperate steppes due to N deposition. These findings would contribute to our mechanistic understanding of impacts of N deposition on grassland ecosystem by linking changes in plant traits to their rhizospheric microbes-mediated processes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fmicb.2015.00789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533001PMC
August 2015

First report of stent thrombosis after a switch therapy resulting from ticagrelor-related dyspnea.

Int J Cardiol 2014 Oct 5;176(3):e127-8. Epub 2014 Aug 5.

Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, China. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2014.07.216DOI Listing
October 2014

Thrombin induced platelet-fibrin clot strength measured by thrombelastography is a novel marker of platelet activation in acute myocardial infarction.

Int J Cardiol 2014 Mar 5;172(1):e24-5. Epub 2014 Jan 5.

Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China; Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2013.12.092DOI Listing
March 2014

Clinical features and prognosis in Chinese patients with acute fulminant myocarditis.

Acta Cardiol 2012 Oct;67(5):571-6

Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.

Objective: There is still a lack of large-scale studies focusing on acute fulminant myocarditis (AFM) and knowledge of this disease is unimpressive. To better understand the clinical features of AFM and improve the diagnosis and treatment of this disease, we analysed the data of consecutive Chinese AFM patients admitted to our department.

Methods: This retrospective observational study analysed the data of 40 patients with a diagnosis of AFM admitted to our hospital between January 2003 and March 2010.

Results: The mean age of patients was 28.5 +/- 18.4 years and 70% of patients were females. 90.0% of patients had a short viral prodrome, 77.5% had cardiogenic shock and 35.0% had multiple organ failure, especially hepatic dysfunction. The most common manifestations in ECG were low voltage in the limb leads (87.5%) and sinus tachycardia (75%). Myocardial infarctions like ECG changes were not uncommon. Left ventricular ejection fraction (LVEF) was significantly reduced (25.3 +/- 7.5%), but the left cardiac sizes were normal. More than 90% of the patients were treated with glucocorticoids. 5.0% needed an intra-aortic balloon pump (IABP), and 35.0% were treated with bi-level positive airway pressure (BiPAP). In all, 39 (95.0%) patients were discharged alive and one man died from ventricular fibrillation. LVEF and left cardiac chambers at follow-up did not change as compared with discharge. No death, new onset heart failure or arrhythmias occurred during the follow-up.

Conclusions: This study describes the clinical features of Chinese AFM patients. The short- and mid-term prognosis of AFM is good. AFM patients may benefit from a treatment with glucocorticoids.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/ac.67.5.2174132DOI Listing
October 2012

Comparison of acute recoil between bioabsorbable poly-L-lactic acid XINSORB stent and metallic stent in porcine model.

J Biomed Biotechnol 2012 3;2012:413956. Epub 2012 Oct 3.

Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai 200032, China.

Objective: To investigate acute recoil of bioabsorbable poly-L-lactic acid (PLLA) stent.

Background: As newly developed coronary stent, bioabsorbable PLLA stent still encountered concern of acute stent recoil.

Methods: Sixteen minipigs were enrolled in our study. Eight PLLA XINSORB stents (Weite Biotechnology Co., Ltd., China) and eight metallic stents (EXCEL, Jiwei Co., Ltd. China) were implanted into coronary arteries. Upon quantitative coronary angiography analysis, acute absolute recoil was defined as the difference between mean diameter of inflated balloon (X) and mean lumen diameter of stent immediately after deployment (Y), while acute percent recoil was defined as (X-Y)/X and expressed as a percentage. Intravascular ultrasound (IVUS) was performed immediately after implantation and 24 hours later to compare cross-sectional area (CSA) between two groups and detect stent malapposition or collapse.

Results: Acute absolute recoil in XINSORB and EXCEL was 0.02 ± 0.13 mm and -0.08 ± 0.08 mm respectively (P = 0.19). Acute percent recoil in XINSORB and EXCEL was 0.66 ± 4.32% and -1.40 ± 3.83%, respectively (P = 0.45). CSA of XINSORB was similar to that of EXCEL immediately after implantation, so was CSA of XINSORB at 24-hours followup. Within XINSORB group, no difference existed between CSA after implantation and CSA at 24-hours followup. No sign of acute stent malapposition was detected by IVUS.

Conclusions: The acute stent recoil of XINSORB is similar to that of EXCEL. No acute stent malapposition or collapse appeared in both kinds of stent. This preclinical study was designed to provide preliminary data for future studies of long-term efficacy and safety of XINSORB stent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2012/413956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470892PMC
January 2013

Effects of CYP2C19 variant alleles on postclopidogrel platelet reactivity and clinical outcomes in an actual clinical setting in China.

Pharmacogenet Genomics 2012 Dec;22(12):887-90

Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital bFudan-VARI Center for Genetic Epidemiology, School of Life Science, Fudan University, Shanghai, China.

Whether the current pharmacogenetic knowledge of clopidogrel could be translated into Chinese clinical practice is yet to be defined. To address this issue, we assessed the relation of single nucleotide polymorphisms within genes modulating clopidogrel absorption (ABCB1), metabolic activation (CYP2B6, CYP2D6, CYP3A4, CYP2C9, and CYP2C19), and biologic activity (P2RY12) to the response of clopidogrel as measured by ex-vivo platelet reactivity and ischemic events during half a year of follow-up. Only CYP2C19*2 and *3, of the investigated polymorphisms, were associated with postclopidogrel platelet aggregation and the presence of high platelet reactivity. Moreover, the effect of the CYP2C19*2 versus the *3 allele on platelet reactivity did not differ. Although the carriage of one or two CYP2C19 loss-of-function alleles, irrespective of the CYP2C19*2 or *3 allele, increased the propensity for high platelet reactivity, only the two loss-of-function allele carriage was associated with clinical outcome in the first 6 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/FPC.0b013e328359253aDOI Listing
December 2012

Association of CYP2C19 genotype with periprocedural myocardial infarction after uneventful stent implantation in Chinese patients receiving clopidogrel pretreatment.

Circ J 2012 25;76(12):2773-8. Epub 2012 Aug 25.

Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.

Background: High platelet reactivity (HPR) after clopidogrel treatment is linked to an increased risk of periprocedural myocardial infarction (PMI). The occurrence of PMI that could be associated with CYP2C19 genotype status was our hypothesis.

Methods And Results: A total of 233 patients with non-ST elevation acute coronary syndromes (NSTACS) undergoing uneventful elective percutaneous coronary intervention were included. Platelet reactivity was assessed by thrombelastograph at 24 h after 300 mg clopidogrel loading. HPR was defined as ≥70% adenosine diphosphate-induced platelet aggregation. The CYP2C19*2 and *3 loss-of-function (LOF) alleles were determined using DNA microarray method. Patients with PMI had significantly higher on-clopidogrel platelet reactivity compared to those without PMI (60.0±24.4% vs. 43.0±24.0%, P<0.001). HPR was more frequently observed in patients with PMI and was the strongest risk factor of PMI in multivariate analysis (OR(adj)=4.348, 95% CI: 1.846-10.241, P=0.001). Furthermore, the incidence of HPR was significantly associated with the carriage of 2 CYP2C19 LOF alleles. Compared with non-carriers, patients carrying 2 CYP2C19 LOF alleles had a 3.000-fold increased risk (95% CI: 1.071-8.400, P=0.037) for PMI in multivariate analysis. However, inclusion of HPR as a covariate in the regression model changed the significant relationship between the carriage of 2 CYP2C19 LOF alleles and PMI.

Conclusions: Among Chinese patients with NSTACS, carriers with 2 CYP2C19 LOF alleles are more prone to HPR, which is associated with an increased risk for PMI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1253/circj.cj-12-0635DOI Listing
May 2013

Comparison of various niches for endothelial progenitor cell therapy on ischemic myocardial repair: coexistence of host collateralization and Akt-mediated angiogenesis produces a superior microenvironment.

Arterioscler Thromb Vasc Biol 2012 Apr 9;32(4):910-23. Epub 2012 Feb 9.

Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, China.

Objective: Comparative studies are lacking that show the effects of different microenvironments on the activity of engrafted stem cells after myocardial infarction (MI). Here, we analyzed the temporal and spatial variations of angiogenesis, collateralization, and the expression of Akt-related signals after MI to test whether the effects of endothelial progenitor cells (EPCs) were different.

Methods And Results: After the induction of MI, pigs were selected that did not develop a collateral coronary circulation (R0) or developed a significant collateral coronary circulation (R2). Both sets were allocated randomly to 4 groups: phosphate-buffered saline (intramyocardial injection of phosphate-buffered saline), EPC transplantation, LY294002 (intramyocardial injection of an Akt inhibitor), and EPCs plus LY294002. Infarcted porcine hearts at different time points and under different collateralized conditions exhibited a variety of vascular microenvironments. At 14 days post-MI, angiogenesis and the expression of Akt-mediated angiogenic cytokines predominated in R2 porcine hearts. When grafted into this microenvironment, EPCs induced the greatest effects in impeding the development of heart failure, preserving left ventricular function and dimensions, and inhibiting infarct expansion. LY294002 significantly reduced these effects.

Conclusions: These findings suggest that the microenvironment that coexists with collateralization and Akt-mediated angiogenesis appears to be more beneficial to cardiac repair induced by EPC therapy than other niches after MI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/ATVBAHA.111.244970DOI Listing
April 2012

Analysis of serum cardiac biomarkers and treadmill exercise test-electrocardiogram for the diagnosis of coronary heart disease in suspected patients.

Acta Biochim Biophys Sin (Shanghai) 2010 Jan;42(1):39-44

Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.

The serum proteins creatine kinase isoenzyme MB (CKMB) and cardiac troponin T are classic biomarkers of cardiac ischemic damage in clinical practice, which can sensitively detect myocardial necrosis, while other two serum proteins, ischemia-modified albumin and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have been recently identified as novel biomarkers of myocardial ischemia. In this study, the four biomarkers were detected in sera from 44 eligible patients with suspected coronary heart disease (CHD) before and after treadmill exercise test (TET), electrocardiogram (ECG) was measured during TET (TET-ECG) and invasive examination of coronary angiography (CAG), which is the 'gold standard' of CHD diagnosis, was also performed. For CAG, 25 patients were positive and 19 were negative, whereas for TET-ECG the numbers were 19 and 25, respectively. Among these four biomarkers, the NT-proBNP level in CAG positive group was much higher than those in CAG negative group both before and after TET, with statistical significance before TET (P=0.008). Furthermore, according to receiver operating characteristic (ROC) curve, the serum biomarker NTproBNP showed diagnostic effect of CHD and its cutoff value was 67 pg/ml, thus 30 of the patients in this study were NT-proBNP positive and 14 were negative. And it was found that NT-proBNP obviously enhanced the sensitivity of examinations whether analyzed alone or in combination with TET-ECG. More importantly, all the patients who were negative in both NT-proBNP and TET-ECG tests turned out to be CAG negative, which means that the combination of these two non-invasive examinations might take the place of invasive examination of CAG for CHD diagnosis. Further studies with more patients are warranted to validate the findings in this paper.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/abbs/gmp103DOI Listing
January 2010

Repeated autologous bone marrow mononuclear cell therapy in patients with large myocardial infarction.

Eur J Heart Fail 2009 Jul 6;11(7):691-8. Epub 2009 May 6.

Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.

Aims: We sought to determine whether repeat administration of bone marrow mononuclear cells (BMC) can improve left ventricular function compared with a single infusion in patients with large acute myocardial infarction (AMI).

Methods And Results: Thirty-nine patients with a ST-elevation AMI of the anterior wall and a significantly decreased left ventricular ejection fraction (LVEF 20-39%) were randomly assigned to three groups following primary percutaneous coronary intervention: Group A (n = 12) received a single intracoronary infusion of BMC (1.9 +/- 1.2 x 10(8)) at 3-7 days after AMI; Group B (n = 15) received BMC administration both at 3-7 days (2.0 +/- 1.4 x 10(8)) and at 3 months (2.1 +/- 1.7 x 10(8)); and the control group (CON, n = 12) received one placebo injection at 3-7 days. We noted no severe complications associated with the BMC transfer. The increase in LVEF evaluated by magnetic resonance imaging (MRI) after 12 months in Group B (11.7 +/- 2.6%) was significantly greater than that in Group A (7.2 +/- 1.6%, P < 0.001) or in CON (2.9 +/- 2.0%, P < 0.001). Magnetic resonance imaging-derived myocardial infarct size decreased significantly in Group B compared with Group A (11.3 +/- 2.7% vs. 6.3 +/- 1.6%, P < 0.001).

Conclusion: Data from this preliminary study suggest that repeated BMC administration might be a safe and feasible therapeutic strategy for patients with large AMI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurjhf/hfp062DOI Listing
July 2009

Sirolimus-eluting stents in real-world patients with ST-segment elevation acute myocardial infarction.

Int Heart J 2007 May;48(3):303-11

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.

Recently, the use of sirolimus-eluting stents (SES) has been demonstrated to significantly reduce the rate of adverse events among selected patients with ST-segment elevation acute myocardial infarction (STEMI). We present real-world experience from a single center registry evaluating the safety and efficacy of primary percutaneous coronary intervention (PCI) in unselected patients with STEMI using SES. Clinical outcome at 300-day follow-up in two cohorts of 225 consecutive patients who underwent bare metal stent (BMS) (January 2004-February 2005, n = 123) or SES (March 2005-December 2006, n = 102) implantation was examined. The primary endpoint was a composite of major adverse cardiovascular events (MACE: death, nonfatal reinfarction, and target vessel revascularization [TVR]). The incidence of short-term MACE was similar between the SES group and BMS group (30-day rate of MACE: 4.9% versus 8.9%, P = 0.30). Angiographically documented stent thrombosis within 30 days after primary PCI was not diagnosed in any patient in the SES group and occurred in 1 patient treated with BMS (0 versus 0.8%, P = 1.0). At 300 days, SES implantation significantly reduced the incidence of MACE (7.8% versus 22.8%, hazard ratio [HR] 0.32 [95% confidence interval (CI) 0.15 to 0.71], P = 0.005), mainly due to a marked reduction in the risk of TVR (1.0% versus 17.1%, HR 0.05 [95% CI 0.01 to 0.39], P < 0.001). There was no new onset of documented stent thrombosis between 30 and 300 days in either group. Thus, this real-world registry confirmed the safety and efficacy of SES with remarkably lower rates of TVR and MACE in the setting of primary PCI for unselected patients with STEMI in a real-world scenario.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1536/ihj.48.303DOI Listing
May 2007

Effectiveness and safety of the sirolimus-eluting stents coated with bioabsorbable polymer coating in human coronary arteries.

Catheter Cardiovasc Interv 2007 Feb;69(2):198-202

Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China.

Background: Although the sirolimus-eluting stent (CYPHER, Cordis, USA) has shown a dramatic reduction of restenosis, there are still some concerns about its efficacy and safety. Its durable polymer coating may enhance neointimal proliferation and residual sirolimus, which cannot be released from polymer, may result in incomplete reendothelization. As a drug reservoir, bioabsorbable polymer (polylactic acid, PLA) is more rational.

Objective: We aimed to determine the safety and efficacy of sirolimus-eluting stent coated with PLA (EXCEL, JW Medical Systems, China) in the treatment of human coronary arterial diseases.

Methods: The study included 31 patients with de novo coronary lesions, with vessels 2.5-3.5 mm in diameter. The primary end points included the percentage of in-stent restenosis of the luminal diameter and in-stent late luminal loss at 6 months, as determined by quantitative angiography. The secondary end point was the major adverse cardiac events (MACE) 30 days and 6 months after the index procedure.

Results: Forty-eight EXCEL stents were successfully delivered in the 34 lesions, and multiple stents were implanted in 35.3% of lesions. All patients were discharged without clinical complications and completed clinical follow-up at 1 and 6 months. No MACE had occurred. Twenty patients (30 stents) completed 6 months of angiographic follow-up. No in-stent or in-lesion restenosis (diameter stenosis > or =50%) was observed. In-stent late loss was (0.07 +/- 0.17) mm.

Conclusions: The implantation of EXCEL stent is feasible and safe and elicits minimal neointimal proliferation. This new stent has potential advantages regarding the long-long-term result over the commercially stent as the new stent has no sustained stimulation to the local tissue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccd.20926DOI Listing
February 2007
-->