Prospective Randomized Study of Sarpogrelate Versus Clopidogrel-based Dual Antiplatelet Therapies in Patients Undergoing Femoropopliteal Arterial Endovascular Interventions: Preliminary Results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sarpogrelate is a selective 5-hydroxytryptamine (5-HT) receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells. We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization (TLR) rates comparing with that of clopidogrel after percutaneous endovascular interventions (EVIs) of femoropopliteal (FP) arterial lesions.</p><p><b>METHODS</b>This prospective, multicenter, randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012. Patients were randomized to receive either sarpogrelate (100 mg trice daily for 6 months, n = 63) or clopidogrel (75 mg once daily for 6 months, n = 57). All patients also received oral aspirin (100 mg once daily for 12 months). Clinical follow-up was conducted up to 12 months postprocedure.</p><p><b>RESULTS</b>There was no significant difference between the two groups in basic demographic data. The restenosis rate was higher in the clopidogrel group (22.80%) than in sarpogrelate group (17.50%), but there was no significant difference between these two groups (P = 0.465). The TLR rate, ipsilateral amputation rate, mortality in all-cause and bleeding rate were also similar in the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Aspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions. Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.</p>

Clinical significance of anticoagulant proteins detection in patients with thrombotic events / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence and the risk of natural anticoagulants such as plasma protein C (PC), protein S (PS) and antithrombin (AT) deficiency in thromboembolic patients with no evident acquired factors.</p><p><b>METHODS</b>Clotting assays on French STAGO autoanalyzer were used to detect the activity of plasma PC, PS and AT in 85 patients with thrombotic disease and 50 sex and age matched healthy controls.</p><p><b>RESULTS</b>Among the 85 enrolled patients (18 arterial and 67 venous thromboembolism), male to female ratio was 1.4 and the median age was 42 years (17-69). The activity of plasma PC, PS and AT in the pre-therapy thrombotic disease group, the thrombo-recurrence group, and the age < or = 45 years group were significantly lower than that is the healthy control group, the first thrombotic episodes group and the age > 45 years group respectively (P < 0.001, P < 0.01, P < 0.01). The overall deficiency rate of these three natural anticoagulants was 30.6%, PS deficiency was the commonest (10.6%), the second was PC deficiency (8.2%), AT deficiency and combined deficiency each accounted for 5.9%.</p><p><b>CONCLUSION</b>The PC, PS and AT protein deficiencies are frequent in Chinese thromboembolic patients, they are the independent risk factors for the thrombotic events and recurrence.</p>

Expression of TFPI-2 gene in pancreatic carcinoma and its prognostic significance / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To detect the expression of TFPI-2 gene in pancreatic carcinoma, and to evaluate its prognostic significance in patients with pancreatic carcinoma.</p><p><b>METHODS</b>Reverse transcription polymerase chain reaction (RT-PCR) and Western blot were used to detect the expression of TFPI-2 mRNA and protein in the pancreatic carcinoma tissue samples from 41 patients. The correlation of its expression with clinicopathological features and its prognostic significance were analyzed.</p><p><b>RESULTS</b>The expression of TFPI-2 mRNA and protein in moderately or poorly differentiated pancreatic carcinoma tissues, or in cases with nerve-involvement, lymph node and blood vessel invasion was significantly lower than that in the highly differentiated one, or without nerve involvement, or neither lymphatic nor blood vessel invasion (P < 0.05). The median survival time of patients with high expression of TFPI-2 (12.0 months) was significantly longer than that with low expression of TFPI-2 (5.1 months, P < 0.05). The Cox model analysis showed that the expression of TFPI-2 was an independent marker for prognosis in patients with pancreatic carcinoma.</p><p><b>CONCLUSION</b>The expression of TFPI-2 is correlated with clinical stage and differentiation of pancreatic carcinoma, and can be used as a prognostic marker for pancreatic carcinoma.</p>

Small-diameter prosthetic H-graft portacaval shunts in the treatment of portal hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Portasystemic shunts, especially total shunts, are effective tools for reducing portal pressure and controlling variceal bleeding but lead to high risk of encephalopathy and accelerating liver failure. The purpose of this study is to evaluate the clinical effects of small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunts in the treatment of portal hypertension.</p><p><b>METHODS</b>Thirty-one patients with portal hypertension were treated with ePTFE small-diameter H-graft portacaval shunts from December 1995 to April 2002. Twenty-one had externally ringed grafts and 10 had non-ringed grafts; 20 had 10 mm diameter grafts and 11 had 8 mm grafts. The left gastric artery and coronary vein were ligated in 22 patients. Additionally, 6 patients underwent pericardial devascularization, and splenectomies were performed on 30 patients.</p><p><b>RESULTS</b>An average decrease of free portal pressure (FPP) from (32.13 +/- 4.86) cmH2O before shunting to (12.55 +/- 5.57) cmH2O after shunting was observed. Portal blood flow was reduced by 1/3 compared with the levels measured before shunting. Twenty-eight patients survived after the operation, and no upper gastrointestinal rebleeding occurred in the follow-up period (40.2 months on average). We lost contact with one patient. Color Doppler ultrasonography and/or portography revealed the shunts to be patent in 28 cases and occluded in 2 (6.4%) cases. Encephalopathy developed in 4 patients (12.9%).</p><p><b>CONCLUSION</b>Small-diameter ePTFE H-graft portacaval shunts can effectively reduce portal pressure. Moreover, the majority of the hepatopetal flow from the portal vein can be adequately maintained. The reinforced shunts may achieve a higher rate of patency. Morbidity from encephalopathy was less frequent than in patients receiving total shunts. Small-diameter H-graft portacaval shunts are also effective in preventing recurrent variceal bleeding.</p>