scholarly journals Use of the Cardiovascular Polypill in Secondary Prevention of Cerebrovascular Disease: A Real-Life Tertiary Hospital Cohort Study of 104 Patients

2020 ◽  
Vol 10 (3) ◽  
pp. 166-173
Author(s):  
Victoria Ros-Castelló ◽  
Elena Natera-Villalba ◽  
Ana Gómez-López ◽  
Arantxa Sánchez-Sánchez ◽  
Juan Luis Chico-García ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Treatment Group ◽  
Secondary Prevention ◽  
Cerebrovascular Disease ◽  
Conventional Treatment ◽  
Real Life ◽  
Lipid Lowering ◽  
Conventional Treatment Group ◽  
Clinical Records

<b><i>Background:</i></b> The use of the cardiovascular polypill, a fixed-dose combination treatment, is conceived to improve adherence. However, randomized controlled trials (RCTs) may overestimate it. Studies focusing on cerebrovascular disease and real-life efficacy compared with conventional treatment are lacking. <b><i>Methods:</i></b> This is a retrospective, hospital-based cohort study of acute ischaemic stroke patients who were prescribed a polypill (aspirin 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) versus conventional treatment (aspirin 100 mg and other blood pressure/lipid-lowering agents) in secondary prevention (2017–2018). Clinical records were reviewed 90 days after discharge for stroke recurrence, vascular risk factor control, and safety. Adherence was assessed using the adapted Morisky-Green scale. <b><i>Results:</i></b> A total of 104 patients were included (61% male; mean age 69.7 ± 13.9 years); 54 were treated with the polypill and 50 with conventional treatment. No baseline differences in clinical or demographic variables were detected. No recurrences were registered in the polypill group, compared to 1 recurrence in the conventional treatment group. A significant reduction of systolic blood pressure (SBP) was achieved in the polypill group (12.1 mm Hg) compared to the conventional treatment group (6.8 mm Hg) (<i>p</i> = 0.002). No significant differences were detected regarding the goal of LDL cholesterol ≤70 mg/dL (41 vs. 44%). The adverse events were mild and their frequency was similar in the two groups (9 vs. 2%, ns). Adherence was similarly good in the two groups (93 vs. 88%, ns). Polypill group adherence was similar to that reported in a previous meta-analysis of RCTs (93 vs. 84%, ns). <b><i>Conclusion:</i></b> In our experience, the cardiovascular polypill achieved a higher reduction in SBP levels and was well tolerated. Adherence was similar to that found in the previous literature, which is remarkable given the real-life setting of our study.

scholarly journals Butylphthalide Combined With Conventional Treatment Attenuates MMP-9 Levels and Increases VEGF Levels in Patients With Stroke: A Prospective Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yingqiong Xiong ◽  
Juanjuan Liu ◽  
Yang Xu ◽  
Shu Xie ◽  
Xinhua Zhou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Group ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Conventional Treatment ◽  
National Institutes Of Health ◽  
Enzyme Linked Immunosorbent Assay ◽  
Vascular Endothelial ◽  
Conventional Treatment Group ◽  
Endothelial Growth Factor

Background and Purpose: Butylphtalide increases the vascular endothelial growth factor (VEGF) and decreases matrix metalloproteinase (MMP)-9 in animal models of stroke and might be of use in the management of stroke. To explore whether butylphthalide combined with conventional treatment can change the levels of MMP-9 and VEGF and the National Institutes of Health Stroke Scale (NIHSS) scores of patients with stroke.Methods: This was a prospective cohort study involving inpatients admitted to the Jiangxi Provincial People's Hospital (January–June 2019) due to acute cerebral infarction. The patients received conventional treatments with or without butylphthalide. The changes in the NIHSS scores were compared between groups. Plasma MMP-9 and VEGF were measured by enzyme-linked immunosorbent assay.Results: A total of 24 patients were included in the conventional treatment group and 46 in the butylphthalide group. The butylphthalide group showed lower MMP-9 (130 ± 59 vs. 188 ± 65, p = 0.001) and higher VEGF (441 ± 121 vs. 378 ± 70, p = 0.034) levels on day 6 compared with the conventional treatment group. The changes in MMP-9 and VEGF were significant, starting on day 3 in the butylphthalide group but on day 6 in the conventional treatment group. There were no differences between the two groups in the NIHSS scores at admission and at discharge (p &gt; 0.05). The overall response rate was higher in the butylphthalide group compared with the conventional treatment group (63.0 vs. 37.5%, p = 0.042).Conclusion: Butylphthalide combined with conventional treatment can decrease MMP-9 levels and increase VEGF levels. The patients showed the reduced NIHSS scores, possibly suggesting some improvement in prognosis after stroke. Still, the conclusions need to be confirmed in a larger sample and in different etiological subtypes of stroke.

scholarly journals Cerebrovascular Disease and Statins

2021 ◽  
Vol 8 ◽  
Author(s):  
Luis M. Beltrán Romero ◽  
Antonio J. Vallejo-Vaz ◽  
Ovidio Muñiz Grijalvo
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Cerebrovascular Disease ◽  
Small Vessel Disease ◽  
Recurrent Stroke ◽  
Public Health Problem ◽  
Lipid Lowering ◽  
Major Public Health Problem ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cholesterol Levels

Elevated low-density lipoprotein-cholesterol (LDL-C) is a causal factor for the development of atherosclerotic cardiovascular disease (ASCVD); accordingly, LDL-C lowering is associated with a decreased risk of progression of atherosclerotic plaques and development of complications. Currently, statins play a central role in any ASCVD management and prevention strategies, in relation to their lipid-lowering action and potentially to pleiotropic effects. After coronary artery disease, stroke is the most frequent cause of ASCVD mortality and the leading cause of acquired disability, a major public health problem. There is often a tendency to aggregate all types of stroke (atherothrombotic, cardioembolic, and haemorrhagic), which have, however, different causes and pathophysiology, what may lead to bias when interpreting the results of the studies. Survivors of a first atherothrombotic ischemic stroke are at high risk for coronary events, recurrent stroke, and vascular death. Although epidemiological studies show a weak relationship between cholesterol levels and cerebrovascular disease as a whole compared with other ASCVD types, statin intervention studies have demonstrated a decrease in the risk of stroke in patients with atherosclerosis of other territories and a decrease in all cardiovascular events in patients who have had a stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial demonstrated the benefit of high doses of atorvastatin in the secondary prevention of ischemic stroke. In this review, we discuss the evidence, use and recommendations of statins in the primary and secondary prevention of stroke, and their role in other scenarios such as the acute phase of ischemic stroke, cerebral hemorrhage, cardioembolic stroke, small vessel disease, and cognitive impairment.

Disparities in Secondary Prevention between Stroke and Coronary Heart Disease in China: Cross-Sectional Community-Based Study, 2014–2016

2021 ◽  
pp. 1-10
Author(s):  
Shijun Xia ◽  
Chi Wang ◽  
Xin Du ◽  
Lizhu Guo ◽  
Jing Du ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Lipid Lowering ◽  
Community Based ◽  
Cross Sectional ◽  
History Of ◽  
Cvd Prevention

<b><i>Background:</i></b> Health care quality and insurance coverage have improved with economic development in China, but the burden of cardiovascular diseases (CVDs) continues to increase with ongoing gaps in prevention. We aimed to compare the uptake of secondary CVD prevention between stroke and coronary heart disease (CHD) patients in China. <b><i>Methods:</i></b> In a cross-sectional community-based survey of 47,841 adults (age ≥45 years) in 7 regions of China between 2014 and 2016, we identified those with a history of stroke or CHD to quantify disparities in conventional secondary CVD prevention strategies in multivariable logistic regression models. <b><i>Results:</i></b> There were 4,105 and 1,022 participants with a history of stroke and CHD, respectively. Compared to participants with CHD, those with a history of stroke were significantly less likely to be taking blood-pressure-lowering (39.7% vs. 53%), lipid-lowering (13.7% vs. 36.8%), and antiplatelet (20.8% vs. 50.6%) agents, at least one (48.9% vs. 70.8%) or all 3 recommended medicines (6.1% vs. 24.0%), and were less likely to achieve a lipid-cholesterol target (30.3% vs. 44.0%). Participants with a history of stroke achieved less optimal secondary prevention goals for medication use, either from any (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.44–0.66) or all 3 medications (aOR 0.27, 95% CI 0.20–0.36), as well as better blood pressure (aOR 0.81, 95% CI 0.66–0.98) and low-density lipoprotein cholesterol (aOR 0.34, 95% CI 0.27–0.43) levels of control. There were no significant differences in weight, smoking, or physical activity between the groups. <b><i>Conclusion:</i></b> Stroke patients had lower use of secondary CVD-preventive medication and achieved lower levels of risk factor control than those of CHD patients in China. Nationwide disease-specific strategies, and better education of participants and health care providers, may narrow these gaps.

scholarly journals Effect of regional arterial infusion combined with early enteral nutrition on severe acute pancreatitis

2019 ◽  
Vol 47 (12) ◽  
pp. 6235-6243
Author(s):  
Xiaojuan Wang ◽  
Jinbu Xu ◽  
Jiguang Li ◽  
Yajuan Cheng ◽  
Lu Liu ◽  
...  
Keyword(s):  
Treatment Group ◽  
Combination Therapy ◽  
Conventional Treatment ◽  
Therapy Group ◽  
Early Enteral Nutrition ◽  
Combination Therapy Group ◽  
Arterial Infusion ◽  
Conventional Treatment Group ◽  
Effectiveness Rate ◽  
Biochemical Indices

Objective To measure the therapeutic effects of regional arterial infusion (RAI) in combination with early enteral nutrition (EEN) in patients with severe acute pancreatitis (SAP). Methods A prospective randomized controlled study enrolled patients with SAP. They were randomly divided into a conventional treatment group that served as the control and a combination therapy group that received RAI combined with EEN. The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) scores, the levels of serum biochemical indices, functional recovery, the incidence of complications and total effectiveness rate were evaluated. Results A total of 100 patients were enrolled in the study. The APACHE II scores and the concentrations of blood glucose, serum amylase, white blood cell count, C-reactive protein, tumour necrosis factor-α, interleukin (IL)-6, IL-10 and IL-17 were significantly decreased, while albumin and serum calcium and total effectiveness rate in the combination therapy group were significantly higher than in the conventional treatment group. The combination therapy group had a significantly reduced time to abdominal pain relief, time of first defaecation, hospital stay and incidence of complications compared with the conventional treatment group. Conclusion The combination of RAI and EEN improved clinical biochemical indices, reduced the incidence of complications and promoted early recovery in patients with SAP.

scholarly journals A Modified Hypothermic Circulatory Arrest Technique Improves Early and Near-Midterm Results in Patients with Acute Type A Aortic Dissection

2021 ◽  
Vol 24 (4) ◽  
pp. E675-E679
Author(s):  
Huadong Li ◽  
Hong Yu ◽  
Nianguo Dong ◽  
Long Wu
Keyword(s):  
Treatment Group ◽  
Aortic Dissection ◽  
Conventional Treatment ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Midterm Results ◽  
Type A Aortic Dissection ◽  
Conventional Treatment Group

Background: The hypothermic circulatory arrest (HCA) is an indispensable step in the surgical treatment of an acute type A aortic dissection (ATAAD), which could greatly affect the postoperative outcome. We modified the HCA technique and validated the feasibility and superiority of the new approach relative to the conventional method. Methods and results: Eighty-eight patients with ATAAD were enrolled in this study between May 2016 and April 2018. Of those, 36 patients in the Conventional treatment group had circulatory arrest at 25°C for about 16-28 minutes, while 52 patients in the Modification group underwent a circulatory arrest at 28°C for only 1-3 minutes. The preoperative clinical data and postoperative clinical outcomes were compared between the two groups. No intraoperative mortality occurred in any of the cases. No significant differences were observed in the aortic cross-clamp times during the cardiopulmonary bypass (CPB) between the two groups. In the Modification group, several indicators, such as mechanical ventilation time, postoperative 48-h drainage volume, blood transfusion volume, the ICU-stay time and postoperative hospital stay, were reduced significantly as compared with those in the Conventional group. Whereas three postoperative deaths in the hospital occurred in the Conventional treatment group, all the patients in the Modification group were cured. There is no difference in the incidence of postoperative complications between the two groups. The patients had a 100% follow up with a mean of 17 ± 6 months. Conclusions: A moderate hypothermia with a short circulatory arrest is a safe and effective HCA approach that provides satisfactory early and near-midterm results in the patients who received ATAAD treatment.

scholarly journals Pediatric Tuina in children with autism spectrum disorder: A study protocol for a randomized controlled trial

2021 ◽  
Author(s):  
Xiang Feng ◽  
Jun Yu ◽  
Wu Li ◽  
Tao Li ◽  
Quanrui Jiang ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Treatment Group ◽  
Conventional Treatment ◽  
Autism Spectrum ◽  
Clinical Treatment ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Pediatric Tuina ◽  
Conventional Treatment Group ◽  
Children With Asd

Abstract Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by repetitive stereotypical behaviour and communication disorders. Currently, it lacks a specific clinical treatment method. Pediatric Tuina is a recent therapy in traditional Chinese medicine; however, there have been studies on the treatment of children with ASD by Tuina. Nonetheless, it remains uncommon given the lack of large-scale evidence-based medical studies. This study aims to compare the efficacy of Tuina and conventional treatment in children with ASD. Methods Eligible children will be randomly divided into the pediatric Tuina plus conventional treatment group or conventional treatment group based on a random table at a ratio of 1:1. Effectiveness will be evaluated using a scale; moreover, the primary outcome will be the Childhood Autism Rating Scale. The secondary outcome will be the Autism Treatment Evaluation Checklist. All participants will be assessed on the scale by a third party not involved in the study. Baseline values of the participants will be determined at the registration time. Outcomes will be evaluated after the 30th treatment session. The follow-up period will last for 6 post-treatment months. Discussion This study will evaluate the effectiveness and safety of Tuina in ASD treatment, which could provide reliable evidence-based findings to improve clinical treatment. Trial registration: Chinese Clinical Trial Registry (CHICTR), ChiCTR2000040452. Registered on 28 November 2020

scholarly journals Efficacy of glucocorticoids for the treatment of macrolide refractory mycoplasma pneumonia in children: meta-analysis of randomized controlled trials

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hwan Soo Kim ◽  
In Suk Sol ◽  
Donghe Li ◽  
Miyoung Choi ◽  
Yun Jung Choi ◽  
...  
Keyword(s):  
Treatment Group ◽  
Hospital Stay ◽  
Randomized Controlled Trials ◽  
Conventional Treatment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Glucocorticoid Treatment ◽  
Conventional Treatment Group ◽  
Randomized Controlled ◽  
The Mean

Abstract Background Mycoplasma pneumoniae is one of the most common pathogens causing community acquired pneumonia in children. Although the rate of macrolide-refractory Mycoplasma pneumoniae (MRMP) has increased, systemic glucocorticoids as a treatment option has not been validated yet. The purpose of this study was to assess the efficacy of glucocorticoids add-on in the treatment of MRMP in children through systematic review and meta-analysis. Methods Data sources A systematic literature search was conducted using ten electronic bibliographic databases including English, Korean, Chinese and Japanese languages, up to March 8, 2018. Study selection The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and selected randomized control trials which compared the efficacy of glucocorticoids add-on to macrolide in the treatment of MRMP in children. Data extraction Two independent reviewers extracted: primary outcomes as hospital days, fever duration, and change in C-reactive protein (CRP) and main analysis was performed through meta-analysis with random effects model. Results Twenty-four unique randomized controlled trials met the inclusion criteria. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in conventional macrolide-treatment group (Weighted mean difference (WMD) = − 4.03 days). The mean length of fever duration was significantly shorter in the glucocorticoid treatment group in comparison with the conventional treatment group (WMD = -3.32 days). Level of CRP after treatment was significantly lower in the glucocorticoid treatment group than that in the conventional treatment group (WMD = -16.03). Sensitivity analysis and subgroup analysis showed no significant improvement in heterogeneity. As limitations of the study, most of the studies included were from a single country and we were unable to control for heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies. Conclusions Glucocorticoid add-on treatment for MRMP can significantly shorten the duration of fever and hospital stay and decrease the level of CRP. These results should be confirmed by adequately powered studies in the future.

scholarly journals The Effects of Ultra-early Hyperbaric Oxygen Intervention in the Treatment of Diffuse Axonal Injury

2021 ◽  
Vol 5 (4) ◽  
pp. 238-241
Author(s):  
Xinli Feng ◽  
Meng Sun
Keyword(s):  
Treatment Group ◽  
Hyperbaric Oxygen ◽  
Conventional Treatment ◽  
Oxygen Therapy ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Average Score ◽  
Hyperbaric Oxygen Treatment ◽  
Conventional Treatment Group ◽  
Oxygen Treatment

Objective: To investigate the efficacy and mechanism of ultra-early hyperbaric oxygen intervention in the treatment of diffuse axonal injury (DAI). Methods: Eighty-six patients with diffuse axonal injury were selected and then divided into an ultra-early hyperbaric oxygen treatment group and a conventional treatment group with 43 patients in each group. The Glasgow Coma Scale (GCS) on the 10th day (10d), 20th day (20d), and 30th day (30d) after treatment and the Glasgow Outcome Score (GOS) 6 months later were observed and compared between both the groups. Results: The average score of the GCS at 10d, 20d, and 30d as well as the GOS 6 months later in the ultra-early hyperbaric oxygen treatment group were higher than those in the conventional treatment group (P < 0.05). Conclusion: Hyperbaric oxygen therapy is one of the unique and effective methods in clinical treatment especially for the treatment of DAI patients and it is worthy of promotion.

scholarly journals Efficacy and Safety of Dahuang Zhechong Pill in Silicosis: A Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Wu-Yi-Nuo Tang ◽  
Jing-Tao Liang ◽  
Ju Wu ◽  
Li Liu ◽  
Ming-Zhang Lu ◽  
...  
Keyword(s):  
Treatment Group ◽  
Pulmonary Function ◽  
Conventional Treatment ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Efficacy And Safety ◽  
Conventional Treatment Group ◽  
Randomized Controlled ◽  
Safety Outcomes ◽  
Medicine Prescription

Background. There is no effective therapy for silicosis, and Dahuang Zhechong pill (DHZCP), an ancient Chinese medicine prescription, may have a therapeutic effect on silicosis. This study aims to verify the efficacy and safety of DHZCP in silicosis. Methods. This is a randomized controlled clinical trial done at Panzhihua Second People’s Hospital (Panzhihua City, Sichuan Province, China). Participants diagnosed with silicosis were recruited and randomized to the conventional treatment group (CG) or DHZCP combined with the conventional treatment group (DG). Forced vital capacity % predicted (FVC%), diffusing capacity of the lung for carbon monoxide % predicted (DLCO%), six-minute walk distance (6MWD), peripheral oxygen (SpO2), King’s Brief Interstitial Lung Disease Questionnaire (K-BILD), and safety outcomes were measured at baseline and 9 weeks. Results. Fifty-six participants (28 in each group) completed the study, and 53 of them (26 in DG and 27 in CG) completed pulmonary function. At 9 weeks, compared with no DHZCP, DHZCP treatment was associated with significant improvements in FVC% (mean ± SD, 95%CI) (8.2 ± 3.9, 0.3 to 16.0), DLCO% (8.6 ± 3.5, 1.5 to 15.7), SpO2 (3.8 ± 0.7, 2.3 to 5.2), and K-BILD total score (6.0 ± 2.3, 1.4 to 10.7). And, there were no statistical differences of safety outcomes between the two groups. Eight patients accepting DHZCP developed mild diarrhea during the first week, which subsequently resolved on its own. Conclusion. DHZCP could improve the pulmonary function, the quality of life, and the exercise capacity of silicosis patients.

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