[Exploratory study on preparation of high drug loading granules with traditional Chinese medicine raw powder as carriers].

With Sangtang Yin granule as model drug,and based on the strategy of " unification of medicines and excipients",the feasibility of preparing high drug loading granules with traditional Chinese medicine( TCM) raw powder as carrier was explored. The powder yield,particle size and particle size distribution,fillibility,flowability,hygroscopicity,reconstituability and other key physical properties relating to preparations of 8 herbs( Dioscoreae Rhizoma,Euryales Semen,Atractylodis Macrocephalae Rhizoma,Coicis semen,Poria,Puerariae Lobatae Radix,Puerariae Thomsonii Radix and Coicis Semen by stir-frying with bran) were studied after being smashed,and the feasibility of taking them as excipients of TCM granules was evaluated by co-spray drying,dry granulation and other preparation techniques. According to the results of the physical properties of raw powders,raw powders of Dioscoreae Rhizoma,Euryales Semen and Puerariae Thomsonii Radix had a high powder yield,uniform particle size distribution,good fillibility,poor hygroscopicity and good reconstitutability,with the feature of assisting granule forming. Compared with the prescription of spray dry powder Sangtang Yin without any excipient,the co-sprayed powder had a high yield,good fillibility and compressibility. The yield of dry granules prepared by co-spraying dry powder was increased by more than 10%,and the particles had a uniform color,good fluidity and dissolubility with the drug-loading rate up to 100%. Based on the physical characteristics of TCM raw powder combined with the analysis of the preparation process,Dioscoreae Rhizoma and Puerariae Thomsonii Radix raw powder were selected as the carriers of granule preparations,and Sangtang Yin granule without any excipient was successfully prepared. The findings provide a feasible idea for the preparation of TCM granules with a high drug loading capacity.

Long-Segment or Bone Cement-Augmented Short-Segment Fixation for Kummell Disease with Neurologic Deficits? A Comparative Cohort Study.

BACKGROUND: The standard treatment for Kummell disease with neurologic deficit remains controversial. Traditional posterior long-segment fixation (LSF) has been widely used, but the procedure results in significant trauma and carries the risk of multiple complications. Therefore, bone cement-augmented short-segment fixation (BCASSF) has been recommended for this condition. METHODS: The study included 36 patients treated with LSF or BCASSF between January 2012 and June 2015. The visual analog scale (VAS), Oswestry Disability Index (ODI) score, anterior height of fractured vertebrae, kyphotic Cobb angle, and neurologic function by the Frankel classification were evaluated and compared, and duration of operation, blood loss, length of hospital stay, and complications were recorded. RESULTS: Significant differences were observed in the VAS, ODI, anterior height of affected vertebrae, and kyphotic Cobb angle between preoperatively and 7 days postoperatively and between preoperatively and at the final follow-up, whereas no significant differences were observed between 7 days postoperatively and at final follow-up. No significant differences in the aforementioned parameters were observed between the groups at 7 days postoperatively and at the final follow-up. Neurologic function was improved in both groups; however, no significant differences were observed between the 2 groups either preoperatively or postoperatively. Blood loss and length of hospital stay were significantly lower in the BCASSF group compared with the LSF group, but no significant between-group differences were observed in operation time and complications. CONCLUSIONS: Lower blood loss and shorter hospital stay were associated with BCASSF compared with LSF; the 2 techniques had similar clinical outcomes and radiographic findings. Therefore, we recommend BCASSF for treating patients with Kummell disease with neurologic deficits.

The analysis of MSTMOVCF (Multi-segment thoracolumbar mild osteoporotic fractures surgery or conservative treatment) based on ASTLOF (the assessment system of thoracolumbar osteoporotic fracture).

To investigate the issue that conservative or surgical treatment for multi-segmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF) by applying the assessment system of thoracolumbar osteoporotic fracture (ASTLOF). A single-center prospective cohort study was designed to enroll elderly patients with MSTMOVCF from June 2013 to June 2016, which were divided into conservative and surgery group. The primary outcomes were Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score, with secondary outcomes including SF-36 and imaging measures such as height of anterior and middle column, Beck value, complications. A total of 470 patients with MSTMOVCF were enrolled. 193 patients underwent surgery of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and 277 patients underwent conservative treatment. The VAS score of operation group was significantly lower than that of conservative group (P < 0.0001, for all). The ODI score of the operation group was significantly lower than that of conservative group (P < 0.0001, for all). The SF-36 score, height of anterior and middle column, Beck value in the operation group were higher than those in conservative group (P < 0.0001, for all) at 1-year follow-up. MSTMOVCF underwent surgery can achieve great short-term clinical results. The patient with the sum of revised ASTLOF scores of multiple injured vertebrae ≥ 5 was recommended for surgery.

Surgery for Multisegment Thoracolumbar Mild Osteoporotic Fractures: Revised Assessment System of Thoracolumbar Osteoporotic Fracture.

OBJECTIVE: To examine the Assessment System of Thoracolumbar Osteoporotic Fracture (ASTLOF), which can effectively guide the treatment of single-segmental thoracolumbar osteoporotic vertebral compression fractures but fails to guide the treatment of multisegmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF). METHODS: A prospective case series study was designed to enroll elderly patients with MSTMOVCF who had been treated with percutaneous kyphoplasty/percutaneous vertebroplasty (PKP/PVP) from June 2013 to June 2016. Surgery indication was based on revised ASTLOF. Visual analog scale and Oswestry Disability Index (ODI) scores were used to evaluate the postoperative improvement of back pain, and clinical effects were assessed according to the 36-Item Short Form Health Survey. Some imaging measures, such as height of anterior and middle column and Beck value, were measured before the operation and 12 months after the operation. Complications also were collected. RESULTS: A total of 193 patients underwent PKP/PVP surgery. At postoperative 2 days, 3 months, and 1-year follow-up, whereas VAS and ODI scores decreased (P < 0.0001, for all) significantly as well as SF-36, the height of anterior and middle column increased (P < 0.0001, for all) compared with preoperation. Beck value at 1-year follow-up was greater than preoperation (P = 0.001). The improvement rate of ODI was 86.4 ± 8.3%. CONCLUSIONS: Patients with MSTMOVCF who undergo surgery with PKP/PVP can achieve great clinical results. Patients with the sum of revised ASTLOF scores of multiple injured vertebrae ≥5 should be recommended for surgery. The consistency and repeatability of the revised ASTLOF need further study.

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis.

BACKGROUND This study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease. MATERIAL AND METHODS From June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12-36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification. RESULTS The VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient. CONCLUSIONS Bone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.

Comparison of Percutaneous Kyphoplasty and Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Management of Kümmell Disease.

BACKGROUND The purpose of this study was to compare the efficacy of percutaneous kyphoplasty (PKP) and bone cement-augmented short segmental fixation (BCA+SSF) for treating Kümmell disease. MATERIAL AND METHODS Between June 2013 and December 2015, 60 patients were treated with PKP or BCA+SSF. All patients were followed up for 12-36 months. We retrospectively reviewed outcomes, including Oswestry Disability Index (ODI), visual analogue scale (VAS), and kyphotic Cobb angle. RESULTS VAS, ODI, and Cobb angle, measured postoperatively and at the final follow-up, were lower than those measured preoperatively in both groups (P<0.05). VAS, ODI, and Cobb angle measured postoperatively demonstrated no significant differences when compared with those measured at the final follow-up in the PKP group (P>0.05). In the BCA+SSF group, VAS and ODI at the final follow-up were lower than those measured postoperatively (P<0.05), but no significant difference was found in the Cobb angle (P>0.05). The PKP group had better VAS and ODI than the BCA+SSF group, postoperatively (P<0.05). No significant difference was found in VAS and ODI at the final follow-up (P>0.05) or the Cobb angle measured postoperatively and at the final follow-up (P>0.05) between the 2 groups. Operative time, blood loss, and hospital stay in the PKP group were lower than those in the BCA+SSF group (P<0.05). No significant difference was found in complications (P>0.05). CONCLUSIONS PKP patients had better early clinical outcomes, shorter operation times and hospital admission times, and decreased blood loss, but had similar complications, radiographic results, and long-term clinical outcomes compared with BCA+SSF patients.

[Causes prevention and treatment for cerebrospinal leak after lumbar revision surgery].

OBJECTIVE: To analyze the causes and explore the measures of prevention and treatment of the cerebrospinal leak after lumbar revision surgery. METHODS: The clinical data of 24 patients(17.78%) with cerebrospinal leak among 135 cases after lumbar revision surgery from January 2011 to January 2016 was retrospectively studied. Of them, 12 cases due to severe adhesion caused by scar formation; 4 cases due to yellow ligament hyperplasia adhesion with dura mater occurred dural tears when separating adhesion; 2 cases with severe hyperplasia and ossification of lumbar posterior longitudinal ligament occurred dural tears when revealing intervertebral disk; 2 cases due to improper nailing happened dural tears during operation. And the other 4 cases without obvious dural tears in surgery, occurred cerebrospinal leak one to two days after surgery. And the 24 patients were treated with the measures of prevention and treatment preoperatively, intraoperatively, and postoperatively. RESULTS: Twenty-four patients with cerebrospinal leak were cured after treatment and were follow-up for 6 to 30 months. No recurrence of cerebrospinal leake or local and systemic complications were found. CONCLUSIONS: Scar formation is the main cause of cerebrospinal leak in lumbar revision surgery. As for lumbar revision surgery, as long as the standard control measures are taken, it can significantly reduce the incidence of cerebrospinal leak, achieve better clinical efficacy, and fundamentally solve the cerebrospinal leak problem that has plagued both doctors and patients for a long time.

[Therapeutic progress in lumbar spinal stenosis].

Along with the population aging in China, patients with lumbar spinal stenosis(LSS) caused by recessive change incessantly increase. At present, there is no adequate evidence to recommend any specific nonoperative treatment for LSS, and surgery is still an effective method. The cilincal symptoms of the patients without conservative treatment got improvement after surgery, which is the strongest evidence base. Spinal instability after simple decompression promotes the development of fusion technique, and the accelerated adjacent segment degeneration and no relief in symptoms after fusion lead to dynamic fixation technology emerge as the times require. Patients with spinal canal decompression whether need bone fusion or not is still controversial. For the past few years, the operation of simple decompression for LSS obviously decreased, whereas the decompression plus fusion surgery showed sustainable growth. Decompression complicated with fusion was more and more adopted in LSS, in order to reduce the hidden risk of spinal instability and deformity. Although decompressive operation has determinate effect, now it is still unclear if the therapeutic effect of decompression complicated with fusion is better than simple decompression. This article reviews the current studies to explore whether decompression plus bone fusion is applicable for LSS. To further explore the best choice of surgical treatment for LSS, we focused on evidence-based therapeutic options.

[Clinical study of combined treatment of remifemin and paroxetine for perimenopausal depression].

OBJECTIVE: To explore the efficacies and safety of combined treatment of remifemin and paroxetine for perimenopausal depression. METHODS: A total of 120 patients with perimenopausal depression were digital randomly divided into the treatment and control groups (n = 60 each). The treatment group received oral remifemin one tablet twice daily and paroxetine 20 mg once daily for 2 months while the control group oral paroxetine 20 mg once daily for 2 months. The Hamilton depression scale (HAMD) and Kupperman scale were used to assess the therapeutic efficacies. Blood and urine routine, electrocardiography, liver function, kidney function and blood pressure before and after treatment were examined to assess the side effects. RESULTS: For the improvement of perimenopausal depression on HAMD, the total effective rates of the treatment and control groups were 88.3% and 78.3% respectively. The therapeutic efficacy of the treatment group was significantly higher than that of the control group (P < 0.05). After 8-week treatment, Kupperman menopausal indices of the treatment and control groups were 9.89 ± 3.76 and 15.75 ± 5.84 respectively. There was also significant difference (P < 0.01). No significant changes existed in blood routine, urine routine, liver function, kidney function, blood pressure, ECG or blood pressure before and after treatment (P > 0.05). CONCLUSION: The combined treatment of remifemin and paroxetine for perimenopausal depression can improve the efficacies. It is easily accepted by patients for its higher safety and fewer side-effects. It is worthy of a wider application and further researches.

Elevated peroxidative glutathione redox status in atherosclerotic patients with increased thickness of carotid intima media.

BACKGROUND: Atherosclerosis is a chronic inflammatory disease. Accumulated evidences suggest a deep involvement of oxidative damage in the development of atherosclerosis, but little is discussed over the relationship between plasma glutathione redox status as the most important intrinsic antioxidant defensive mechanism and the atherosclerosis. METHODS: A total of 132 patients suspected with atherosclerosis were assigned to three groups by high frequency ultrasonic examination of the carotid artery. With the thickness of intima of the carotid artery as an index of degree of atherosclerosis progression, 56 were included in plaque-forming group (A), 42 in carotid artery intima-thickening group (B), and 34 in normal carotid artery intima-thickness group (C). All patients were subjected to the measurement of plasma glutathione (GSH) (reduced form GSH and oxidized form GSSG), nicotinamide adenine dinucleotide phosphate (NADP) (reduced form NADPH and oxidized form NADP(+)), oxidized low density lipoprotein (oxLDL), and malondialdehyde (MDA). The GSH/GSSG and NADPH/NADP(+) redox potentials were calculated according to the Nernst equation, and their correlation with intima thickness and oxLDL was analyzed. RESULTS: With the thickening of artery intima (from group C to A), GSH concentration and the ratio of GSH/GSSG gradually reduced, and GSSG and GSH/GSSG redox potential gradually increased (more positive) (P < 0.05). The NADPH and NADPH/NADP(+) redox status also showed similar but milder changes. The products of oxidative stress oxLDL and MDA increased significantly along with the thickening of artery intima (P < 0.05). The analysis of the relationship between GSH/GSSG redox potential, intima thickness, and oxLDL showed positive correlations (P < 0.05). The plasma GSH/GSSG redox status was positively correlated with the intima thickness of the carotid artery and the oxidized injury of LDL. The redox status shifted to oxidizing direction along with the intima thickening and plaque-forming. CONCLUSION: Elevated peroxidative glutathione redox status was deeply implicated in atherosclerosis progressing, and it may be a sensitive and reliable index for monitoring oxidative status in atherosclerosis.

[Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism].

OBJECTIVE: To investigate the protective effects of potassium magnesium aspartate against oxidative stress status and lipid oxidative damage in the patients with angina and arrhythmia due to coronary artery disease, its therapeutic effect on arrhythmia and its possible mechanism. METHODS: With single blind protocol, 98 patients with angina and arrhythmia due to coronary artery disease were randomly divided into (1)Experiment group (n = 65), who received routine remedy for coronary heart disease plus potassium magnesium aspartate. (2)Control group (n = 33), who received only routine therapy for coronary heart disease without potassium magnesium aspartate. Reduced glutathione (GSH), oxidized glutathione (GSSG), malondialdehyde (MDA) and oxidized low density lipoprotein (ox-LDL) in plasma of all patients were examined before and one week after treatment, all patients with arrhythmia were equipped with Holter for continuous monitoring of cardiac rhythm. RESULTS: After one week's treatment, the GSH level in plasma of experiment group and the ratio of GSH and GSSG (GSH/GSSG) were significantly increased comparing with control group (both P<0.01), while GSSG, MDA and ox-LDL levels significantly lowered comparing with control group(all P<0.01). The premature beats diminished 86.5% in experiment group, but the decrease rate in control group was only 47.4% (P<0.01). The improvement in indexes of oxidative stress status (including GSH/GSSG, MDA and ox-LDL) and the reduction of premature beats showed close correlation with each other (all P<0.01). No adverse effects of the drug were found after one week of administration of Potassium magnesium aspartate. CONCLUSION: Potassium magnesium aspartate can strikingly improve oxidative stress status and decrease lipid oxidative damage in the patients with coronary heart disease, and the frequent premature beats were also significantly reduced by potassium magnesium aspartate. The analysis of above results reveals an intrinsic relationship between the improvement of oxidative stress status and the good therapeutic effects on frequent premature beats by potassium magnesium aspartate, which may suggest an involvement of oxidative stress in the pathogenesis of arrhythmias.

[Hypermethylation in promoter area of LDLR gene in atherosclerosis patients].

To investigate the methylation pattern of 12 CpG dinucleotide sites in promoter region of LDLR gene in atherosclerosis patients, peripheral blood DNA samples were prepared from 61 atherosclerosis patients and 28 healthy subjects. The methylation status of CpG islands in LDLR gene promoter region was measured by using a modified coordinative method with nested-PCR, Touchdown-PCR and methylation-sensitive-single-strand conformation analysis (MS-SSCA). Three types of methylation patterns were detected in promoter region of LDLR gene in peripheral blood genome of atherosclerosis patients: full-methylation, part-methylation and none-methylation. 2 cases were full-methylation and 13 cases were part-methylation, the methylation frequency was 24.59% in atherosclerosis patients. While in 28 healthy control, only 1 half-methylation sample was found, the methylation frequency was 3.57%, which is much lower than that in atherosclerosis patients (P < 0.05). A significantly higher methylation degree in promoter region of LDLR gene was found in peripheral blood genome of atherosclerosis patients compared with the controlled healthy subjects, which may suggest an involvement of aberrant methylation of LDLR gene in initiation and development of AS. The modified coordinative method with nested-PCR, Touchdown-PCR and MS-SSCA manifests merits of convenience, cheap and high efficiency, which lowers the requirement for the DNA template and increases the sensitivity and specificity.

[Plasma glutathione of patients with coronary heart disease measured by fluorospectrophotometer].

The standard samples of reduction form glutathione (GSH) and oxidization form glutathione (GSSG) were scanned with full-wavelength range to determine the excitation wavelength lambda(ex) 334.4 nm, the emission wavelength lambda(em) 424 nm, and the spectral bandwidth 5 nm respectively. Phosphate buffer saline (PBS) of pH 8. 3 served as buffer solution. GSH was incubated for 30 min with 100 microL o-phthaldehyde (OPA) of 10 mmol x L(-1) methyl alcohol solution for derivatization, and then fluorescence intensities were measured. With standard glutathione concentration being independent variable and fluorescence intensity being dependent variable, the linear equations for GSH and GSSG were deduced: Y(GSH) = 6.9 + 8.6X (r2 = 0.994) and Y(GSSG) = 6.2 + 17.2X (r2 = 0.999). Standard curves were done hereby. The plasma glutathione of three groups was then measured, and GSH/ GSSG redox potential was calculated according to Nernst equation. The results indicated that, from normal control group to prophase coronary heart disease group, then to coronary heart disease group, the GSH and GSH/GSSG ratio gradually reduced, GSSG and GSH/GSSG redox potential gradually increased (more positive) (all P < 0.05), and the redox potential shifted to oxidization direction along with the development of coronary heart disease. This fluorospectrophotometry method showed simple operation, and fine precision and accuracy.

[The relationship between oxidized form glutathione, coenzyme II and carotid artery atherosclerosis].

OBJECTIVE: To explore the relationship between plasma redox status and atherosclerosis. METHODS: IVUS was performed in common carotid in the neck of 167 patients with heart diseases. Patients were divided into three groups: plaque-forming group (A, n = 79), intima-thickening group (B, n = 52) and control group (C, n = 36). Plasma glutathione (reduced form GSH and oxidized form GSSG), nicotinamide adenine dinucleotide phosphate (reduced form NADPH and oxidized form NADP(+)), oxidized low density lipoprotein (ox-LDL) and malondialdehyde (MDA) were measured in all patients. The GSH/GSSG and NADPH/NADP(+) redox potential were calculated according to Nernst equation, and correlation analysis performed. RESULTS: GSH and GSH/GSSG gradually reduced and GSH/GSSG redox potential gradually increased in proportion to the thickening of artery intima (from Group C to Group A, P < 0.05). Similar but milder results were shown for NADPH and NADPH/NADP(+) redox status. The products of oxidative stress ox-LDL and MDA also increased significantly (P < 0.05) in proportion to the thickening of artery intima. GSH/GSSG redox potential is positively correlated to ox-LDL (P < 0.05). The redox status shifted to oxidizing direction in proportion to the intima thickness. CONCLUSION: The imbalance of plasma redox status deviating to oxidation might be implicated in oxidized injury of lipid, intima thickening and atherosclerosis progress.

[Effects of xuezhikang capsules on vascular endothelial function and redox status in patients with coronary heart disease].

OBJECTIVE: To explore the effects of Xuezhikang Capsules (ZXKC) and probucol on blood lipids, vascular endothelial functions and redox status in patients with coronary heart disease. METHODS: One hundred and twelve patients with coronary heart disease were randomly divided into XZKC-treated group and probucol-treated group, 56 in each. Before and after 8-week treatment, the blood levels of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), nitric oxide (NO), endothelin-1 (ET-1), reduced glutathione (GSH) and oxidized glutathione (GSSG) were all measured in both groups. The GSH/GSSG redox potential (Eh) was calculated according to the Nernst equation. RESULTS: In the XZKC-treated group, the blood levels of TC, LDL-C and TG were significantly decreased after 8-week treatment as compared with those before treatment. The blood levels of TC and LDL-C were also significantly decreased in the probucol-treated group as compared with those before treatment. In the XZKC-treated group, the blood levels of ET-1 and GSSG and the GSH/GSSG Eh after treatment were all significantly lower than those before treatment, whereas the blood levels of GSH and NO, the NO/ET-1 ratio, and the GSH/GSSG ratio after treatment were all significantly higher than those before treatment. CONCLUSION: The XZKC or probucol treatment can yield a significant decrease in blood lipids in patients with coronary heart disease. Furthermore, XZKC exerts effective protection on vascular endothelial function, and can make GSH/GSSG redox status shift towards deoxidation.

[Effects of irbesartan on remodeling of the left ventricular following acute myocardial infarction].

OBJECTIVE: To compare the inhibitory effects of irbesartan on left ventricular remodeling (LVRM) after acute myocardial infarction (AMI). METHODS: A total of 72 patients with AMI were entered into the study, 36 patients were randomized to conventional treatment group, and 36 patients to irbesartan treatment group. At 2nd week and 24th week after AMI, the left ventricular myocardium weight was measured by echocardiogram, and the parameters of left ventricular systolic and diastolic function were measured by equilibrium radionuclide angiography. RESULTS: At 24th week, interventricular septal thickness (IVST), left ventricular posterior wall thick(LVPWT), left ventricular diastolic diameter (LVDd) and left ventricular mass index(LVMI) in irbesartan treatment group were significantly decreased(P<0.05 or P<0.01) compared with conventional treatment group At 24th week, left ventricular ejection fraction(LVEF), left ventricular peak ejecting rate (LPER) and left ventricular peak filling rate (LPFR) in irbesartan treatment group were significantly increased (P<0.05 or P<0.01) compared with those in conventional treatment group, respectively. Left ventricular time of peak ejecting rate (LTPER) and left ventricular time of peak filling rate (LTPFR) in irbesartan group were decreased(P<0.05 or P<0.01) compared with the conventional treatment group, respectively. CONCLUSION: Irbesartan might significantly reduce myocardial hypertrophy and LVRM after AMI. Irbesartan improves the left ventricular systolic function.