A randomized, double-blind, placebo-controlled study to evaluate the efficacy and tolerability of Fufang Danshen (Salvia miltiorrhiza) as add-on antihypertensive therapy in Taiwanese patients with uncontrolled hypertension

Hypertension generally requires the use of a combination therapy to achieve the satisfactory control of blood pressure. A traditional Chinese herb, Danshen (Salvia miltiorrhiza), has been shown to have cardioprotective effects in animals and humans. The study investigated the add-on effect of Fufang Danshen extract capsule in Taiwanese hypertensive patients with uncontrolled blood pressure. This was a double-blind, placebo-controlled, randomized, single-center study clinical trial. Fifty-five patients with uncontrolled mild to moderate hypertension were enrolled under current conventional antihypertensive treatment, randomized equally to receive a Fufang Danshen capsule (formula mixture) 1000 mg twice-daily or a placebo capsule for 12 weeks. Primary endpoints were the control rate and the response rate. By ITT analysis at week 12, the control rates were 25.5% in the Fufang Danshen group and 7.3% in the control group (p = 0.016). The response rates were 45.6% in the Fufang Danshen group and 38.2% in the placebo group (p = 0.946). A significant reduction of systolic blood pressure at week 12 was noted in the Fufang Danshen group compared with the placebo group (13.8 vs 4.2 mmHg, p = 0.005). A decrease of pulse rate was also noted in the Fufang Danshen group (- 3.2 vs +2.7/min, p = 0.027). Adverse events were not statistically different between the two groups. It was concluded that Fufang Danshen (Salvia miltiorrhiza) extract reduced systolic blood pressure and pulse rate, and was well tolerated in patients with hypertension.

Predictors of mortality in skin and soft-tissue infections caused by Vibrio vulnificus

BACKGROUND

Vibrio vulnificus infection can progress rapidly in skin or soft tissue, and it is potentially life-threatening. The purpose of the present study was to explore the predictors of mortality in patients with V. vulnificus infections of skin or soft tissue.

METHODS

The medical records of 119 consecutive patients aged > or =18 years, hospitalized for V. vulnificus infections of skin or soft tissue between January 2000 and December 2007 were reviewed. Co-morbidities, clinical manifestations, laboratory studies, treatments, and outcomes were analyzed. Multiple logistic regression with the exact method was performed.

RESULTS

The mean age of the patients was 63.7 +/- 12.0 years. Twenty-four patients died, yielding an overall case fatality rate of 20%. Of the 24 deaths, 20 (83%) occurred within 72 h after hospital admission. Of 119 patients, 45 patients had primary septicemia, and 74 patients had wound infection. Multivariate analysis revealed that the following factors were associated with mortality: hemorrhagic bullous skin lesions/necrotizing fasciitis (p = 0.003), primary septicemia (p = 0.042), a greater organ dysfunction and/or infection score (p = 0.005), absence of leukocytosis (p = 0.0001), and hypoalbuminemia (p = 0.003). Treatment with surgical intervention plus antibiotics (p = 0.038) and surgical intervention within 24 h after admission (p = 0.017) were protective factors.

CONCLUSIONS

This study demonstrates that the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis, primary septicemia, a greater severity-of-illness, absence of leukocytosis, and hypoalbuminemia were the significant risk factors for mortality in these patients. Moreover, patients treated with surgery plus antibiotics, especially those receiving a prompt surgical evaluation within 24 h after hospital admission, may have a better prognosis.

The causes and outcomes of inadequate implementation of existing guidelines for antiplatelet treatment in patients with acute coronary syndrome: the experience from Taiwan Acute Coronary Syndrome Descriptive Registry (T-ACCORD Registry)

BACKGROUND

Benefits of antiplatelet agents in preventing future cardiovascular events have been well established. However, the prescription pattern of antiplatelet usage in patients with acute coronary syndrome (ACS) is rarely investigated. Hence, Taiwan ACute CORonary Syndrome Descriptive Registry (T-ACCORD Registry) aimed to evaluate medical practices in Taiwan in managing ACS patients.

HYPOTHESIS

The guidelines of antiplatelet treatment is not properly implanted in the management of ACS patients.

METHODS

This prospective observational study was performed between April 2004 and December 2006 in 27 hospitals in Taiwan. A total of 1331 patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI) discharged from hospitals was analyzed.

RESULTS

The patients with older age, lower hemoglobin levels, or previous cardiovascular ischemic diseases were less likely to receive aspirin at discharge, whereas patients with NSTEMI were less likely to receive clopidogrel at discharge. The prescription of dual antiplatelet agents declined rapidly from 61.8% at discharge to 12.6% at 12 months. The most common reason for clopidogrel discontinuation was recorded as physician's judgment. Dual antiplatelet treatment for 9 months or longer was associated with lower 1-year mortality. Percutaneous coronary intervention (PCI) was the only factor leading to dual antiplatelet therapy for at least 9 months.

CONCLUSIONS

Our registry showed that underlying medical conditions may affect antiplatelet prescriptions at discharge. During the first year following an ACS episode, the prescription rate of dual antiplatelet therapy declined over time, mainly due to physician's judgment leading to the discontinuation of clopidogrel. Adherence to dual antiplatelet treatment was associated with lower total mortality at 1 year.

Hypoxia inducible factor-1alpha gene polymorphism G1790A and its interaction with tobacco and alcohol consumptions increase susceptibility to hepatocellular carcinoma

BACKGROUND AND OBJECTIVES

The aim of this study was to examine the potential associations of two hypoxia inducible factor-1alpha (HIF-1alpha) gene polymorphisms, C1772T and G1790A, with the susceptibility and clinicopathological status of hepatocellular carcinoma.

METHODS

A total of 449 subjects, including 347 healthy controls and 102 patients with hepatocellular carcinoma, were recruited in this study and subjected to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses to estimate the impact of these two polymorphic variants on hepatocellular carcinoma.

RESULTS

G1790A heterozygotes showed a higher risk for hepatocellular carcinoma, compared with GG genotypes after adjusting for other confounders (AOR = 3.97; 95%CI = 1.70-9.22), indicating a significant association between hepatocellular carcinoma susceptibility and G1790A polymorphism. Moreover, results also revealed the presence of synergistic effect between gene polymorphism of HIF-1alpha G1790A and environmental risk factors, such as tobacco and alcohol consumptions while there was no significant association between HIF-1alpha gene polymorphism and clinicopathological parameters of hepatocellular carcinoma.

CONCLUSIONS

Genetic polymorphism at G1790A of HIF-1alpha is an important factor for determining the susceptibility to hepatocellular carcinoma. The interaction effects of G1790A heterozygotes to tobacco and to alcohol consumption significantly increase the risk to develop hepatocellular carcinoma.

Remodeled left ventricular myocardium remote to infarction sites is the arrhythmogenic substrate for sudden cardiac death

Ventricular tachyarrhythmias are life threatening cardiac arrhythmias and are the most common causes of sudden cardiac death. Greater post-infarction left ventricular remodeling has been shown to have a greater preponderance of ventricular arrhythmias. The hypothesis herein is that adverse structural and electrophysiological remodeling at non-infarcted regions after myocardial infarction constitutes the arrhythmogenic substrate responsible for clinically occurring ventricular arrhythmias leading to sudden cardiac death. Post-infarction patients with more severe left ventricular remodeling (regional hypertrophy) at sites remote to infarction scar might have the highest risk for sudden cardiac death due to lethal ventricular arrhythmias. In the hypertrophic non-infarcted zone, larger action potential duration and repolarization heterogeneity is not in self arrhythmogenic, but can predispose towards arrhythmia development under certain condition, such as transient myocardial ischemia. We should draw more attention to apparently "normal" non-infarction region for further understanding the mechanism of sudden cardiac death.

Relationship of insulin-like growth factors system gene polymorphisms with the susceptibility and pathological development of hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the major causes of cancer-related death worldwide. The insulin-like growth factors (IGFs) system consists of a group of proteins which may induce cell proliferation and inhibit cell apoptosis through several signal pathways, leading to transformation of normal cells into cancer cells. However, the impact of genetic polymorphisms of the IGFs system on HCC has not been clarified.

METHODS

In this case-control study, a total of 102 HCC patients and 306 age- and gender-matched controls were recruited. The genetic polymorphisms of the IGFs system genes, including IGF-1, IGF-2, IGF-1receptor (IGF-1R), IGF-2R, IGF binding protein (IGFBP-3), and insulin (INS) genes, were analyzed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and real-time PCR genotyping analysis.

RESULTS

A significant difference (p = 0.02) between case and control group in the distribution frequency of IGF-2 +3580 polymorphism was observed. Multiple regression model analysis showed that the presence of AA or AG at IGF-2R may exhibit a potential protective effect against hepatitis C [odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.15-0.82]. The combination of IGF-2 +3580 AA genotype and IGF-2R GG genotype may present a significantly lower risk of HCC (OR = 0.20, 95% CI = 0.05-0.87). Additionally, no polymorphisms of any IGFs system genes were associated with liver-related clinicopathological markers in serum.

CONCLUSIONS

Among IGFs system genes, IGF-2 and IGF-2R gene polymorphisms and combination could be considered as the most important factors contributing to increased susceptibility and pathological development of HCC.

Relationship of insulin-like growth factors system gene polymorphisms with the susceptibility and pathological development of hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the major causes of cancer-related death worldwide. The insulin-like growth factors (IGFs) system consists of a group of proteins which may induce cell proliferation and inhibit cell apoptosis through several signal pathways, leading to transformation of normal cells into cancer cells. However, the impact of genetic polymorphisms of the IGFs system on HCC has not been clarified.

METHODS

In this case-control study, a total of 102 HCC patients and 306 age- and gender-matched controls were recruited. The genetic polymorphisms of the IGFs system genes, including IGF-1, IGF-2, IGF-1receptor (IGF-1R), IGF-2R, IGF binding protein (IGFBP-3), and insulin (INS) genes, were analyzed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and real-time PCR genotyping analysis.

RESULTS

A significant difference (p = 0.02) between case and control group in the distribution frequency of IGF-2 +3580 polymorphism was observed. Multiple regression model analysis showed that the presence of AA or AG at IGF-2R may exhibit a potential protective effect against hepatitis C [odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.15-0.82]. The combination of IGF-2 +3580 AA genotype and IGF-2R GG genotype may present a significantly lower risk of HCC (OR = 0.20, 95% CI = 0.05-0.87). Additionally, no polymorphisms of any IGFs system genes were associated with liver-related clinicopathological markers in serum.

CONCLUSIONS

Among IGFs system genes, IGF-2 and IGF-2R gene polymorphisms and combination could be considered as the most important factors contributing to increased susceptibility and pathological development of HCC.

Mimetic total coronary sinus occlusion due to superselection with the balloon catheter

A 77-year-old man with dilated cardiomyopathy, atrial fibrillation, QRS duration of 140 ms, and NYHA functional class III was referred for cardiac resynchronization therapy device implantation. Coronary sinus (CS) contrast venography by balloon catheter showed no evidence of tributary veins, mimicking total occlusion of the CS. It was found to be due to superselection of a side branch with the balloon catheter.

Nifedipine OROS in Chinese patients with hypertension – results of a post‐marketing surveillance study in Taiwan

AIMS

This post-marketing surveillance study assessed the efficacy, safety, and tolerability of the treatment with nifedipine OROS in hypertensive patients in Taiwan.

RESULTS

A total of 2044 patients were included in 204 outpatient clinics. Patients received 30 mg or 60 mg of nifedipine OROS. Mean treatment duration was 15.8 weeks. At endpoint, 91.4% of patients were receiving 30 mg nifedipine OROS. Mean blood pressure reduction was 20.6/10.3 mmHg; 46.1% of patients had a systolic blood pressure < 140 mmHg and 66.8% had a diastolic blood pressure <90 mmHg. Total blood pressure control was achieved in 41.2% of all patients. Beta-blockers were the most commonly used (24.0%) concomitant antihypertensive therapy. A total of 2.3% of patients experienced adverse events. Subjective physicians' assessments of efficacy, tolerability, and patient acceptance of nifedipine OROS treatment had ratings of "very good" and "good" in 82.3% (efficacy), 87.5 (tolerability) and 88.1% (patient acceptance) of the study cohort.

CONCLUSIONS

Nifedipine OROS proved to be effective and well tolerated for the treatment of hypertension in 2044 Chinese patients. The results confirm the findings and experience of previously performed controlled clinical studies.

Spontaneous and simultaneous multivessel coronary spasm causing multisite myocardial infarction, cardiogenic shock, atrioventricular block, and ventricular fibrillation

A 57-year-old Taiwanese man with a past history of variant angina developed simultaneous anterior and inferior myocardial infarction, atrioventricular block, cardiogenic shock, and eventually ventricular fibrillation. Left coronary angiography revealed simultaneous occlusion of the left anterior descending and the left circumflex coronary arteries, which was relieved by intracoronary administration of isosorbide dinitrate. This is the first report of such a case in the English-language medical literature.

Successful use of extracorporeal membrane oxygenation and drotrecogin alpha in patients with acute life-threatening myocarditis

Acute fulminant myocarditis may present with cardiogenic shock refractory to inotropics and intra-aortic balloon pumping (IABP). Benefit of extracorporeal membrane oxygenation (ECMO) support has been established. The effectiveness of combination with ECMO or IABP and activated protein C (drotrecogin alpha; Xigris) in treatment has yet to be defined. Four patients presented with congestive heart failure 3-4 days after flu-like symptoms. Chest roentgenograms showed cardiomegaly and bilateral pulmonary infiltrates. Two-dimensional echocardiograms demonstrated severe myocardial dysfunction with left ventricular ejection fraction (LVEF), measured between 18.4% to 27% (mean, 19.5%). Three patients having been treated with the combination of ECMO or IABP and activated protein C were weaned. Follow-up LVEF measured were 39.9%, 43%, 53%, and 55%, respectively. However, 1 patient died a month later because of systemic lupus erythematosus and repeated infection. There were no neurologic sequelae in the 3 survivors. Serological test and myocardial biopsy for Parvovirus B19 was positive in 3 of 4 patients. Use of circulatory support and activated protein C is an effective alternative for acute life-threatening myocarditis.

An eight-week, multicenter, randomized, double-blind study to evaluate the efficacy and tolerability of fixed-dose amlodipine/benazepril combination in comparison with amlodipine as first-line therapy in chinese patients with mild to moderate hypertension

AIMS

This study sought to compare the antihypertensive efficacy and tolerability of a fixed-dose combination with amlodipine/benazepril with that of amlodipine monotherapy in Chinese hypertensive subjects.

RESULTS

This multicenter, double-blind, 8-week study randomized 111 patients to fixed-dose amlodipine besylate/benazepril HCl (2.5/5 mg/day titrated to 5/10 mg/day as needed at week 4 to reach goal blood pressure (BP) <140/90 mmHg) or amlodipine besylate monotherapy (5 mg/day titrated to 10 mg/day as needed). At week 8, patients randomized to combination therapy compared with monotherapy had a comparable BP control rate (56.0% vs. 46.2%; p = 0.32). Fixed-dose combination resulted in similar reductions in sitting systolic (SBP) and diastolic BP (DBP) compared with monotherapy (SBP: -19.3 +/- 12.5 vs. -20.9 +/- 13.3 mmHg; DBP: -9.2 +/- 10.4 vs. -11.3 +/-9.3 mmHg; both p=NS). Safety profiles did not differ between groups, but cough was more common in the combination group (11.0% vs. 0%; p = 0.013).

CONCLUSIONS

In this group of patients, comparable antihypertensive effects were seen with the fixed-dose combination therapy, compared with amlodipine monotherapy. Both treatments appeared well tolerated in the studied population, but cough was more common in the fixed-dose combination group.

Right atrial substrate properties associated with age in patients with typical atrial flutter

BACKGROUND

Data detailing the age-related difference in the atrial substrate for formation of typical atrial flutter (AFL) are sparse.

OBJECTIVE

The purpose of this study was to characterize the difference in the right atrial substrate related to aging using noncontact mapping of the right atrium.

METHODS

A total of 54 patients (23 young [<60 years; 45 +/- 12 years] and 31 old [>or=60 years; 74 +/- 6 years]) with typical AFL who underwent three-dimensional noncontact mapping of typical AFL were enrolled in the study. The atrial substrate was characterized according to (1) regional wavefront activation mapping, (2) regional conduction velocity, and (3) regional voltage distribution by dynamic substrate mapping.

RESULTS

During activation mapping of the crista terminalis, two activation patterns were observed: (1) around the upper end of the crista terminalis (67%) and (2) through a gap in the crista terminalis. The presence of a crista terminalis gap was associated with a high incidence of induced atypical AFL/atrial fibrillation (P <.001). The conduction velocities of the medial cavotricuspid isthmus were slower in the old group than in the young group. In regional activation mapping of the AFL, the location of the slowest conduction shifted from the lateral cavotricuspid isthmus (71%) in the young group to the medial cavotricuspid isthmus (40%) in the old group. More cases with a low-voltage zone (<or=30% peak negative voltage) extending to the medial side of the cavotricuspid isthmus occurred in the old group than in the young group (55% vs 17%, P = .012).

CONCLUSION

The atrial substrate responsible for formation of typical AFL differed between young and old patient groups.