Patient-Reported Outcomes of Postoperative NSCLC Patients with or without Staged Chinese Herb Medicine Therapy during Adjuvant Chemotherapy (NALLC 2): A Randomized, Double-Blind, Placebo-Controlled Trial.

OBJECTIVE: To investigate whether the combination of chemotherapy with staged Chinese herbal medicine (CHM) therapy could enhance health-related quality of life (QoL) in non-small-cell lung cancer (NSCLC) patients and prolong the time before deterioration of lung cancer symptoms, in comparison to chemotherapy alone. METHODS: A prospective, double-blind, randomized, controlled trial was conducted from December 14, 2017 to August 28, 2020. A total of 180 patients with stage I B-IIIA NSCLC from 5 hospitals in Shanghai were randomly divided into chemotherapy combined with CHM (chemo+CHM) group (120 cases) or chemotherapy combined with placebo (chemo+placebo) group (60 cases) using stratified blocking randomization. The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life-Core 30 Scale (QLQ-C30) was used to evaluate the patient-reported outcomes (PROs) during postoperative adjuvant chemotherapy in patients with early-stage NSCLC. Adverse events (AEs) were assessed in the safety analysis. RESULTS: Out of the total 180 patients, 173 patients (116 in the chemo+CHM group and 57 in the chemo+placebo group) were included in the PRO analyses. The initial mean QLQ-C30 Global Health Status (GHS)/QoL scores at baseline were 57.16 ± 1.64 and 57.67 ± 2.25 for the two respective groups (P>0.05). Compared with baseline, the chemo+CHM group had an improvement in EORTC QLQ-C30 GHS/QoL score at week 18 [least squares mean (LSM) change 17.83, 95% confidence interval (CI) 14.29 to 21.38]. Conversely, the chemo+placebo group had a decrease in the score (LSM change -13.67, 95% CI -22.70 to -4.63). A significant between-group difference in the LSM GHS/QoL score was observed, amounting to 31.63 points (95% CI 25.61 to 37.64, P<0.001). The similar trends were observed in physical functioning, fatigue and appetite loss. At week 18, patients in the chemo+CHM group had a higher proportion of improvement or stabilization in GHS/QoL functional and symptom scores compared to chemo+placebo group (P<0.001). The median time to deterioration was longer in the chemo+CHM group for GHS/QoL score [hazard ratio (HR)=0.33, 95% CI 0.23 to 0.48, P<0.0010], physical functioning (HR=0.43, 95% CI 0.25 to 0.75, P=0.0005), fatigue (HR=0.47, 95% CI 0.30 to 0.72, P<0.0001) and appetite loss (HR=0.65, 95% CI 0.42 to 1.00, P=0.0215). The incidence of AEs was lower in the chemo+CHM group than in the chemo+placebo group (9.83% vs. 15.79%, P=0.52). CONCLUSION: The staged CHM therapy could help improve the PROs of postoperative patients with early-stage NSCLC during adjuvant chemotherapy, which is worthy of further clinical research. (Registry No. NCT03372694).

A systematic analysis of the global and regional burden of colon and rectum cancer and the difference between early- and late-onset CRC from 1990 to 2019.

The burden of colorectal cancer (CRC) varies substantially across different geographical locations. However, there was no further quantitative analysis of regional social development and the disease burden of CRC. In addition, the incidence of early- and late-onset CRC has increased rapidly in developed and developing regions. The main purpose of this study was to investigate the trends in CRC burden across different regions, in addition to the epidemiological differences between early and late-onset CRC and their risk factors. In this study, estimated annual percentage change (EAPC) was employed to quantify trends in age-standardized incidence rate (ASIR), mortality rate, and disability-adjusted life-years. Restricted cubic spline models were fitted to quantitatively analyze the relationship between trends in ASIR and Human Development Index (HDI). In addition, the epidemiological characteristics of early- and late-onset CRC were investigated using analyses stratified by age groups and regions. Specifically, meat consumption and antibiotic use were included to explore the differences in the risk factors for early- and late-onset CRC. The quantitative analysis showed that the ASIR of CRC was exponentially and positively correlated with the 2019 HDI in different regions. In addition, the growing trend of ASIR in recent years varied substantially across HDI regions. Specifically, the ASIR of CRC showed a significant increase in developing countries, while it remained stable or decreased in developed countries. Moreover, a linear correlation was found between the ASIR of CRC and meat consumption in different regions, especially in developing countries. Furthermore, a similar correlation was found between the ASIR and antibiotic use in all age groups, with different correlation coefficients for early-onset and late-onset CRC. It is worth mentioning that the early onset of CRC could be attributable to the unrestrained use of antibiotics among young people in developed countries. In summary, for better prevention and control of CRC, governments should pay attention to advocate self-testing and hospital visits among all age groups, especially among young people at high risk of CRC, and strictly control meat consumption and the usage of antibiotics.

Shengmai San for Treatment of Cardiotoxicity from Anthracyclines: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically evaluate the efficacy of Shengmai San in patients with cardiotoxicity of anthracyclines. METHODS: Randomized controlled trials (RCTs) were identified by searching China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, and Embase Databases from the inceptions until December 2020. The Cochrane Handbook was used to evaluate the risk of bias in the included studies. Data analysis was conducted using RevMan 5.3 software. RESULTS: Totally 19 RCTs with 2,331 participants were included in this review. Results showed that in improving arrhythmia (13 RCTs, n=1,877, RR=0.37, 95%CI 0.25 to 0.52, P<0.00001), the treatment group was superior to the control group. In terms of reducing left ventricular end-diastolic diameter (LVEDD, 2 RCTs, n=128, MD=-0.79, 95%CI -0.93 to -0.65, P<0.00001) and left ventricular end systolic diameter (LVESD, 2 RCTs, n=128, MD=-0.58, 95%CI -0.82 to -0.35, P<0.00001), the treatment group was also better than the control group. In reducing myocardial enzymes such as creatine kinase (CK) [(3 RCTs, n=256, SMD=-0.80, 95%CI -1.16 to -0.44, P<0.0001), (2 RCTs, n=126, SMD=-0.62, 95%CI -0.98 to -0.26, P=0.0007)], the treatment group was superior to the control group. CONCLUSION: Shengmai San has a positive effect on the treatment of cardiotoxicity from anthracyclines. However, in the future, it is still necessary to conduct high-quality RCTs to verify its efficacy.

Tertiary hospital nurses' ethical sensitivity and its influencing factors: A cross-sectional study.

BACKGROUND: High ethical sensitivity positively affects the quality of nursing care; nevertheless, Chinese nurses' ethical sensitivity and the factors influencing it have not been described. RESEARCH OBJECTIVES: The purpose of this study was to describe ethical sensitivity and to explore factors influencing it among Chinese-registered nurses, to help nursing administrators improve nurses' ethical sensitivity, build harmony between nurses and patients, and promote the patients' health. RESEARCH DESIGN: This was a descriptive, cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: We recruited 500 nurses from several departments in three tertiary hospitals. The Chinese Moral Sensitivity Questionnaire-Revised version and the Jefferson Scale of Empathy-Health Professionals were used to assess the nurses' ethical sensitivity and empathy ability, respectively. Fifteen sociodemographic variables were included in the questionnaires. ETHICAL CONSIDERATIONS: Informed consent was obtained from the participants regarding participation and data storage and handling. This program has been examined and supported by the research center of medical ethics and professional ethics of Guilin Medical University. The Approval No. was 2016RWYB04. The whole research process is conducted strictly according to ethical requirements. RESULTS: The valid response rate was 84.40% (n = 422). The total score of Chinese Moral Sensitivity Questionnaire-Revised was 35.82 ± 8.17. The subscale scores of moral responsibility and strength and sense of moral burden were 21.50 ± 4.91 and 14.33 ± 3.98, respectively. Significant differences were found among age groups, gender, years of working, category of profession, and quality of family communication regarding nurses' ethical sensitivity (p < 0.05). Regression analysis showed that the main factors influencing nurses' ethical sensitivity were gender, years of working, quality of family communication, career satisfaction, and empathic ability. DISCUSSION: Our findings suggest that Chinese nurses' ethical sensitivity in tertiary hospitals in Guilin is at a medium level. CONCLUSION: The director of nursing schools and hospitals in China should pay attention to nurses' ethical sensitivity and should intensify education and training to improve nurses' ethical sensitivity. Further studies should focus on interventions aimed at improving Chinese nurses' ethical sensitivity.

Structure-activity relationship and hypoglycemic activity of tricyclic matrines with advantage of treating diabetic nephropathy.

Forty-three tricyclic matrinic derivatives with a unique scaffold were prepared and evaluated for their stimulation effects on glucose consumption in HepG2 cells. The structure-activity relationship was systematically elucidated for the first time. Among them, compound 17a exhibited the most promising potency, and dose-dependently increased glucose consumption in L6 myotubes. It significantly lowered blood glucose, glucosylated haemoglobin and AGE level, and improved glucose tolerance and insulin resistance in KK-Ay mice as well. More importantly, 17a effectively ameliorated diabetic nephropathy (DN), as indicated by the improvement of renal function and pathological changes, and decrease of urinary protein. Furthermore, 17a could induce glycolysis but suppressed aerobic oxidation of glucose, in a similar mechanism to Metform. Our results indicated that in addition to hyperglycemia, 17a may be developed to treat diabetic complication such as DN.

Erratum to: Continuous production of biohythane from hydrothermal liquefied cornstalk biomass via two-stage high-rate anaerobic reactors.

[This corrects the article DOI: 10.1186/s13068-016-0666-z.].

Continuous production of biohythane from hydrothermal liquefied cornstalk biomass via two-stage high-rate anaerobic reactors.

BACKGROUND: Biohythane production via two-stage fermentation is a promising direction for sustainable energy recovery from lignocellulosic biomass. However, the utilization of lignocellulosic biomass suffers from specific natural recalcitrance. Hydrothermal liquefaction (HTL) is an emerging technology for the liquefaction of biomass, but there are still several challenges for the coupling of HTL and two-stage fermentation. One particular challenge is the limited efficiency of fermentation reactors at a high solid content of the treated feedstock. Another is the conversion of potential inhibitors during fermentation. Here, we report a novel strategy for the continuous production of biohythane from cornstalk through the integration of HTL and two-stage fermentation. Cornstalk was converted to solid and liquid via HTL, and the resulting liquid could be subsequently fed into the two-stage fermentation systems. The systems consisted of two typical high-rate reactors: an upflow anaerobic sludge blanket (UASB) and a packed bed reactor (PBR). The liquid could be efficiently converted into biohythane via the UASB and PBR with a high density of microbes at a high organic loading rate. RESULTS: Biohydrogen production decreased from 2.34 L/L/day in UASB (1.01 L/L/day in PBR) to 0 L/L/day as the organic loading rate (OLR) of the HTL liquid products increased to 16 g/L/day. The methane production rate achieved a value of 2.53 (UASB) and 2.54 L/L/day (PBR), respectively. The energy and carbon recovery of the integrated HTL and biohythane fermentation system reached up to 79.0 and 67.7%, respectively. The fermentation inhibitors, i.e., 5-hydroxymethyl furfural (41.4-41.9% of the initial quantity detected) and furfural (74.7-85.0% of the initial quantity detected), were degraded during hydrogen fermentation. Compared with single-stage fermentation, the methane process during two-stage fermentation had a more efficient methane production rate, acetogenesis, and COD removal. The microbial distribution via Illumina MiSeq sequencing clarified that the biohydrogen process in the two-stage systems functioned not only for biohydrogen production, but also for the degradation of potential inhibitors. The higher distribution of the detoxification family Clostridiaceae, Bacillaceae, and Pseudomonadaceae was found in the biohydrogen process. In addition, a higher distribution of acetate-oxidizing bacteria (Spirochaetaceae) was observed in the biomethane process of the two-stage systems, revealing improved acetogenesis accompanied with an efficient conversion of acetate. CONCLUSIONS: Biohythane production could be a promising process for the recovery of energy and degradation of organic compounds from hydrothermal liquefied biomass. The two-stage process not only contributed to the improved quality of the gas fuels but also strengthened the biotransformation process, which resulted from the function of detoxification during biohydrogen production and enhanced acetogenesis during biomethane production.

Cytotoxic genes from traditional Chinese medicine inhibit tumor growth both in vitro and in vivo.

OBJECTIVE: Little effort has been made to study the protein-encoding genes isolated from traditional Chinese medicine (TCM) drugs, and the delivery of these genes into malignant cells through recombinant adeno-associated virus (rAAV) vectors has not been attempted. METHODS: We synthesized the cDNAs of five known cytotoxic proteins isolated from TCM drugs and the FLAG epitope-tagged cDNAs were subcloned into a rAAV plasmid vector. The protein expression was confirmed by Western blot assay. Various cancer cell lines were transfected with the above plasmids and cell growth was monitored both in vitro and in vivo. The best cytotoxic gene was further packaged into rAAV vectors, under the control of a liver cancer-specific promoter. The liver tumor growth was then monitored following intratumor administration of the rAAV vectors. RESULTS: The expression plasmids, encoding individual potential cytotoxic genes tagged with FLAG epitope, were successfully generated and sequenced. Among these genes, trichosanthin (TCS) gene yielded the most promising results for the inhibition of cancer cell growth in vitro. The over-expressed TCS functioned as a type I ribosome-inactivating protein, followed by inducing apoptosis that is associated with the Bcl-PARP signaling pathway. Furthermore, intratumor injection of rAAV vectors containing the TCS gene significantly inhibited the growth of human hepatocellular carcinoma tumors in a murine xenograft model. CONCLUSION: Our studies suggest that the use of TCM cytotoxic genes is a useful therapeutic strategy for treating human cancers in general, and liver tumors in particular.

The roles of traditional Chinese medicine in gene therapy.

The field of gene therapy has been increasingly studied in the last four decades, and its clinical application has become a reality in the last 15 years. Traditional Chinese medicine (TCM), an important component of complementary and alternative medicine, has evolved over thousands of years with its own unique system of theories, diagnostics and therapies. TCM is well-known for its various roles in preventing and treating infectious and chronic diseases, and its usage in other modern clinical practice. However, whether TCM can be applied alongside gene therapy is a topic that has not been systematically examined. Here we provide an overview of TCM theories in relation to gene therapy. We believe that TCM theories are congruent with some principles of gene therapy. TCM-derived drugs may also act as gene therapy vehicles, therapeutic genes, synergistic therapeutic treatments, and as co-administrated drugs to reduce side effects. We also discuss in this review some possible approaches to combine TCM and gene therapy.

Pristimerin enhances recombinant adeno-associated virus vector-mediated transgene expression in human cell lines in vitro and murine hepatocytes in vivo.

OBJECTIVE: In the present study, we systemically evaluated the ability of two bioactive compounds from traditional Chinese medicine, celastrol and pristimerin, to enhance recombinant adeno-associated virus (rAAV) serotype vector-mediated transgene expression both in human cell lines in vitro, and in murine hepatocytes in vivo. METHODS: Human cell lines were infected with rAAV vectors with either mock treatment or treatment with celastrol or pristimerin. The transgene expression, percentage of nuclear translocated viral genomes and the ubiquitination of intracellular proteins were investigated post-treatment. In addition, nonobese diabetic/severe combined immunodeficient gamma (NSG) mice were tail vain-injected with rAAV vectors and co-administered with either dimethyl sulfoxide, celastrol, pristimerin or a positive control, bortezomib. The transgene expression in liver was detected and compared over time. RESULTS: We observed that treatment with pristimerin, at as low as 1 µmol/L concentration, significantly enhanced rAAV2 vector-mediated transgene expression in vitro, and intraperitoneal co-administration with pristimerin at 4 mg/(kg·d) for 3 d dramatically facilitated viral transduction in murine hepatocytes in vivo. The transduction efficiency of the tyrosine-mutant rAAV2 vectors as well as that of rAAV8 vectors carrying oversized transgene cassette was also augmented significantly by pristimerin. The underlying molecular mechanisms by which pristimerin mediated the observed increase in the transduction efficiency of rAAV vectors include both inhibition of proteasomal degradation of the intracellular proteins and enhanced nuclear translocation of the vector genomes. CONCLUSION: These studies suggest the potential beneficial use of pristimerin and pristimerin-containing herb extract in future liver-targeted gene therapy with rAAV vectors.

[Analysis of Chinese medical syndrome features of patients with primary liver cancer before and after transcatheter arterial chemoembolization].

OBJECTIVE: To observe the Chinese medical syndrome features of patients with primary liver cancer before and after transcatheter arterial chemoembolization (TACE). METHODS: Recruited were 106 primary liver cancer (PLC) patients treated with TACE at the Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University from May to November 2009. Using self-control study, the distributions of 8 syndrome types were compared, such as qi stagnation syndrome, blood stasis syndrome, excess-heat syndrome, fluid and damp syndrome, qi deficiency syndrome, blood deficiency syndrome, yin deficiency syndrome, and yang deficiency syndrome. The scoring for each syndrome quantization was performed to all patients before and after TACE. RESULTS: Eight syndromes occurred in the 106 patients before treatment, amounting to 412 cases. The proportions of syndrome types in PLC patients before TACE were ranked from high to low as blood stasis syndrome [(92 cases, 86.8%)], excess-heat syndrome [(73 cases, 68.9%)], qi stagnation syndrome [(62 cases, 58.5%)], qi deficiency syndrome [(62 cases, 58.5%)], yin deficiency syndrome [(60 cases, 56.6%)], blood deficiency syndrome [(30 cases, 28.3%)], yang deficiency syndrome [(18 cases, 17.0%)], fluid and damp syndrome [(15 cases, 14.2%)]. The 8 syndromes occurred in 456 cases after TACE. The proportions of syndrome types in PLC patients after TACE were ranked from high to low as blood stasis syndrome [(89 cases, 84.0%)], qi deficiency syndrome [(87 cases, 82.1%)], excess-heat syndrome [(85 cases, 80.2%)], qi stagnation syndrome [(52 cases, 49.1%)], yin deficiency syndrome [(49 cases, 46.2%)], blood deficiency syndrome [(42 cases, 39.6%)], yang deficiency syndrome [(32 cases, 30.2%)], fluid and damp syndrome [(20 cases, 18.9%)]. After TACE the proportions of qi deficiency syndrome and yang deficiency syndrome increased with statistical difference (P<0.01, P<0.05). There were no statistical difference in terms of other syndromes between before and after TACE (P>0.05). Blood stasis syndrome and qi stagnation syndrome got the highest quantization scores before TACE. After TACE blood stasis syndrome and qi deficiency syndrome got the highest quantization scores. After TACE the score of qi stagnation syndrome decreased, while that of excess-heat syndrome, qi deficiency syndrome, blood deficiency syndrome, yang deficiency syndrome increased (all P<0.05). CONCLUSIONS: It's necessary to pay attention to regulating qi, clearing heat, replenishing qi, and removing stasis for treating liver cancer patients. Clearing heat, replenishing qi, enriching blood, and warming yang after TACE should also be paid equal attention to while using syndrome typing methods.

Total Saponin from Root of Actinidia valvata Dunn Inhibits Hepatoma 22 Growth and Metastasis In Vivo by Suppression Angiogenesis.

The root of Actinidia valvata dunn has been widely used in the treatment of hepatocellular carcinoma (HCC), proved to be beneficial for a longer and better life in China. In present work, total saponin from root of Actinidia valvata Dunn (TSAVD) was extracted, and its effects on hepatoma H22-based mouse in vivo were observed. Primarily transplanted hypodermal hepatoma H22-based mice were used to observe TSAVD effect on tumor growth. The microvessel density (MVD), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) are characterized factors of angiogenesis, which were compared between TSAVD-treated and control groups. Antimetastasis effect on experimental pulmonary metastasis hepatoma mice was also observed in the study. The results demonstrated that TSAVD can effectively inhibit HCC growth and metastasis in vivo, inhibit the formation of microvessel, downregulate expressions of VEGF and bFGF, and retrain angiogenesis of hepatoma 22 which could be one of the reasons.

Mechanisms of inhibiting proliferation of vascular smooth muscle cells by serum of rats treated with Dahuang Zhechong pill.

UNLABELLED: Dahuang Zhechong pill (DHZCP), a famous and classical Chinese herbal prescription, consists of twelve traditional Chinese drugs: Eupolyphaga sinensis Walker., Rheum officinale Baill., Scutellaria baicalensis Georgi., Glycyrrhiza uralensis Fisch., Prunus persica Batsch., Prunus armeniaca L., Paeonia lactiflora Pall., Rehmannia glutinosa Libosch., Toxicodendron vernicifluum F.A. Barkl., Tabanus bivittatus Mats., Hirudo nipponica Whitman. and Holotrichia diomphalia Bates., and is clinically used to treat hepatic diseases, gynecopathy and atherosclerosis in China. Our previous studies confirm that DHZCP is able to significantly inhibit proliferation of vascular smooth muscle cells (VSMCs) in vivo and in vitro. AIM OF THE STUDY: To investigate the mechanisms of inhibition of VSMCs proliferation by DHZCP with the method of Serum Pharmacology. MATERIALS AND METHODS: VSMCs proliferation of rat was assayed by measuring the cell viability with the MTT method, and platelet-derived growth factor (PDGF) expression in VSMCs was examined by the immunocytochemical method. Cycle and apoptosis of VSMCs were evaluated with flow cytometry. RESULTS: The serum of DHZCP-treated rats not only inhibited endothelin-1 (ET-1) stimulated cell proliferation and PDGF expression in VSMCs, but also promoted apoptosis of the proliferated VSMCs. Meanwhile, the serum of rats containing DHZCP interfered with the cycle of PDGF-stimulated VSMCs, increasing proportion of the cells in G(0)/G(1) phases and decreasing proportion of the cells in S and G(2)/M phases. CONCLUSION: These suggest that the inhibitory effect of DHZCP on VSMCs proliferation is partially attributed to depressing PDGF expression in VSMCs, retarding the cell cycle and to promoting apoptosis of VSMCs.

Effect of statins on contrast-induced nephropathy in patients with acute myocardial infarction treated with primary angioplasty.

We investigated whether pretreatment with statin may prevent contrast-induced nephropathy in patients who underwent primary coronary intervention for acute myocardial infarction (AMI). A total of 279 consecutive patients who underwent successful primary angioplasty for a first AMI were studied. Contrast-induced nephropathy was defined as an increase in serum creatinine of > or =5 mg/dL after the primary PCI. 56 patients receiving statin treatment before admission had lower incidence of the contrast-induced nephropathy than those without it (7.1% and 20.6%, P<0.01). Multivariable logistic regression analysis revealed that absence of statin pre-treatment was a significant predictor of the reperfusion arrhythmia along with anterior AMI, baseline creatinine value, time-to-reperfusion, higher volume of the contrast agent. Pre-treatment with statin could reduce the contrast-induced nephropathy after primary coronary intervention in patients with AMI.

In vitro inhibition of proliferation of vascular smooth muscle cells by serum of rats treated with Dahuang Zhechong pill.

Dahuang Zhechong pill (DHZCP) is a famous and classical Chinese herbal prescription, which is clinically used to treat hepatic, gynecological and cardiovascular diseases in China. The aim of this study was to observe the effects of the serum of rats treated with DHZCP on the proliferation of cultured rat vascular smooth muscle cells (VSMCs) stimulated by platelet-derived growth factor (PDGF), oxidized low density lipoprotein (ox-LDL) and hyperlipidemic serum (HLS), and on DNA, protein and collagen syntheses of VSMCs induced by PDGF in vitro. VSMCs proliferation was assayed by measuring the cell viability with MTT method, and syntheses of DNA, protein and collagen were evaluated by detecting [(3)H]-thymidine, [(3)H]-leucine and [(3)H]-proline incorporations, respectively. The results showed that PDGF, ox-LDL and HLS stimulated the proliferation of rat VSMCs in vitro. The serum of rats treated with DHZCP significantly inhibited the proliferation of rat VSMCs induced by the above stimulants and the incorporations of [(3)H]-thymidine, [(3)H]-leucine and [(3)H]-proline into rat VSMCs induced by PDGF in comparison with the model control group (P<0.01). The data suggest that DHZCP is able to obviously inhibit VSMCs proliferation via interfering with syntheses of DNA and protein, and to decrease production of extracellular matrix by VSMCs through antagonizing collagen synthesis.

Chronic pretreatment of ACEI reduces no-reflow in patients with acute myocardial infarction treated with primary angioplasty.

BACKGROUND: In animal models, pretreatment with angiotensin-converting enzyme inhibitor (ACEI) can reduce no-reflow. In the present study, we investigated whether pretreatment with ACEI may prevent no-reflow in patients who underwent primary coronary intervention for AMI. METHOD AND RESULTS: A total of 259 consecutive patients who underwent primary angioplasty for a first AMI were studied. No-reflow was defined as a TIMI flow grade < 3. The no-reflow phenomenon was found in 33 of 259 patients. There were no significant differences in clinical characteristics between the patients with and without ACEI pretreatment. However, the 47 patients receiving chronic ACEI treatment before admission had lower incidence of the no-reflow than those without it (4.2 and 14.6%, p<0.05). Multivariable logistic regression analysis revealed that absence of ACEI pretreatment was a significant predictor of the no-reflow along with absence of preinfarction angina, complete occlusion of the culprit lesion, high-burden thrombus, ejection fraction on admission, number of Q-waves, absence of statin pretreatment, and anterior AMI. CONCLUSION: Pretreatment with ACEI could preserve the microvascular integrity after acute myocardial infarction in humans.