[Clinical features and prognosis of patients with different types of heart failure in relation to coronary artery disease].

Objective: To analyze whether there is a difference in the influence of coronary artery disease (CAD) on the clinical features and prognosis of three different types of heart failure patients. Methods: Complete clinical data of 1 520 hospitalized patients with heart failure from Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016 was retrospectively reviewed. According to left ventricular ejection fraction (LVEF), the patients were divided into three groups: heart failure with reduced ejection fraction group (HFrEF), heart failure with mid-range ejection fraction group (HFmrEF)and heart failure with preserved ejection fraction group (HFpEF). Each group was further classified into two subgroups according to absence or presence of CAD (No CAD' and 'With CAD'). In the HFrEF group, 197 patients were categorized into 'No CAD' sub-group while 435 patients were into 'With CAD' sub-group. Likewise, 63 patients in HFmrEF group fell into 'No CAD' sub-group while 367 were into 'With CAD' sub-group. Seventy two patients in the HFpEF group were in the 'No CAD' sub-group with 386 in the 'With CAD' sub-group. Clinical features and 2-year prognosis between different subgroups were compared. Results: (1) The relationship between CAD and clinical features of different types of heart failure: the proportions of HFrEF, HFmrEF and HFpEF combined with CAD were 68.8%, 85.3% and 84.3%, respectively (P<0.05). Compared with the 'No CAD' subgroups, patients in the 'With CAD' subgroups were older, and had higher NT-proBNP levels, higher rates of hypertension and diabetes, and lower rates of atrial fibrillation. Also, there were more use of antiplatelet and nitrate drugs in the 'With CAD' sub-groups (P<0.05). (2) Risk of different types of heart failure combined with CAD: after multivariate adjustment, HFrEF had a lower risk of CAD (HFrEF vs HFmrEF: RR=0.389, 95%CI 0.281-0.540; HFrEF vs HFpEF: RR=0.408, 95%CI 0.298-0.560). (3)The influence of CAD on the prognosis of different types of heart failure: CAD increased the risk of mortality in the HFrEF group (HR=1.631, 95%CI 1.119-2.377), and cardiovascular events in all three types of heart failure (HR: HFrEF 1.725, 95%CI 1.325-2.246; HFmrEF 1.815, 95%CI 1.144-2.879; HFpEF 1.900, 95%CI 1.218-2.963). Conclusions: Patients with HFmrEF and HFpEF have a higher prevalence and risk of CAD than patients with HFrEF. CAD is associated with an increased risk of cardiovascular events in all types of heart failure and increases the risk of all-cause mortality among HFrEF group. CAD is an important factor influencing the clinical features and prognosis of patients with all types of heart failure.

[Multicenter retrospectie analysis on clinical characteristics and pharmaceutical therapy of elderly Patients with chronic heart failure].

Objective: To investigate the clinical characteristics and pharmaceutical therapy of elderly patients with chronic heart failure (CHF). Methods: Using the multi-center retrospective cross-sectional survey, we analyzed 1 799 hospitalized patients with CHF as the main cause and NYHA heart function classification Ⅱ-Ⅳ from nine tertiary hospitals of Tianjin during March 2014 to February 2016. According to age, we divided them into non- elderly group(age<65 years), normal elderly group (age ≥65-79 years), and the old elderly group(age≥80 years). We analyzed the clinical characteristics and pharmaceutical therapy of different age groups of CHF patients. Results: One thousand seven hundred and ninety-nine patients with CHF, mean age (70±13) years old. Elderly patients over 65 accounted for 69.87%; men accounted for 61.53%; the average hospitalization days were 11.33 days, hospitalization days of the old elderly group were significantly prolonged to 13.26 days(P<0.05). With increasing age, the proportion of men, NYHA Ⅱ and HFrEF patients gradually decreased, the proportion of women, NYHA Ⅳ and HFpEF patients gradually increased(all P<0.05). The distribution of HFmrEF in different age groups was not statistically significant(P>0.05), accounting for one third. Etiology and comorbidities: the first eight diseases were coronary heart disease, hypertension, hyperlipidemia, diabetes, pulmonary infection, cerebrovascular disease, renal dysfunction and atrial fibrillation. The ratios of old elderly group with pulmonary infection, cerebrovascular disease, renal dysfunction and atrial fibrillation were significantly higher than the non-elderly group( all P<0.05). The numbers of comorbidity in old elderly group and the normal elderly group were higher than the non-elderly group, respectively 3.74, 3.37 and 2.82(all P<0.05). The application rate of ß-blockers and ACEIs in non-elderly group was higher than the other groups (P<0.05). The application rate of ARBs, digitalis, energy metabolites and nitrates in the normal elderly group and the old elderly age group was higher than the non-elderly group (P<0.05). Conclusions: With increasing age, the proportion of men and HFrEF patients with CHF gradually decrease, the proportion of women and HFpEF patients with CHF gradually increase, the proportion of old elderly men and women tend to be equal, HFmrEF maintains the proportion of about 1/3, no change with age. The elderly patients with CHF have more comorbidity, worse heart function, and more serious heart failure.The overall application of anti-HF drugs in elderly CHF patients needs to be improved.

Melittin liposomes surface modified with poloxamer 188: in vitro characterization and in vivo evaluation.

Melittin liposomes surface modified with poloxamer 188 were developed, and the effect of poloxamer 188 was investigated with regard to anti-cancer effect and vascular stimulation. Melittin liposomes surface modified with poloxamer 188 at different concentrations (0%, 2%, and 5%) were prepared using the adsorption method, followed by in vitro characterization, including entrapment efficiency, zeta potential, particle size, and morphology. Subsequently, the influence of repeated freeze-thawing on the liposomes was investigated, and the effect of poloxamer 188 on the repeated freeze-thawing process was explored. Vascular stimulation effects of MLT, and MLT liposome that surface coated with or without poloxamer were all studied. Pharmacokinetics of the different MLT preparations were determined and the anticancer activity of the MLT formulations was investigated. The particle size of the liposomes gradually increased with increasing poloxamer 188 content, while the entrapment efficiency did not change significantly. After the first freeze-thaw cycle, size and PDI were both markedly reduced, entrapment efficiency rose, and there was no significant change of zeta potential. The vascular irritation caused by MLT could be reduced to an extent by encapsulation in liposome, but not completely eliminated, while liposomes coated with poloxamer 188 can effectively abolish the phenomenon. Melittin liposomes with surface modified by poloxamer exhibit enhanced bioavailability, effective anticancer activity, and reduced side effects compared with melittin solution. Poloxamer plays an important role in melittin liposomes.

Changes of CSF and spinal pathomorphology after high-concentration ozone injection into the subarachnoid space: an experimental study in pigs.

BACKGROUND AND PURPOSE: Our aim was to explore the changes of CSF and spinal pathomorphology after high-concentration ozone injection into a pig's subarachnoid space. MATERIALS AND METHODS: Eight experimental pigs were randomly divided into 4 groups (n=2 in each group). In groups A, B, C, and D, animals were sacrificed for pathology 1 day, 1 week, 1 month, and 3 months after the injection, respectively. Ozone (10 mL, 90 microg/mL) was injected along the lumbar 4-5 interspace into the subarachnoid space with a 21-ga Chiba needle under fluoroscopy. CSF collection and CT and MR imaging were performed before injection and 30 minutes, 1 week, 1 month, and 3 months after injection, respectively. The spinal cords were observed macroscopically and microscopically. RESULTS: No serious behavior abnormalities were observed in any animals. There were no abnormalities in CSF and spinal cords pathologically and radiologically after injection. CONCLUSION: Our initial study suggests that high-concentration ozone injection into a pig's subarachnoid space will not cause serious sequelae such as chemical arachnoiditis and necrosis of the spinal cord, and this finding provides evidence of the safety of ozone inadvertently injected into subarachnoid space in the clinical treatment of disk herniation.

[Effect of guizhi decoction on adenyl cyclase and phosphodiesterase in hypothalamus of rats models of fever and hypothermia].

OBJECTIVE: To observe the effect of Guizhi Decoction (GZD) on adenyl cyclase (AC) and phosphodiesterase (PDE) activities in hypothalamus of rat models of fever and hypothermia. METHODS: The AC and PDE activities in hypothalamus were determined using radio-isotope method. RESULTS: GZD could lower the AC activity in yeast induced fever rat model (P < 0.05), but cause rise of AC activity in aminopyrine induced hypothermia model (P < 0.05). No significant influence of GZD on PDE activity was shown in both fever or hypothermia models. CONCLUSION: The bi-directional thermo-regulation effect of GZD might be partially due to influence on AC activity.