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Li DH, Xie J, Ren YL, Ren YL, Zheng H, Lyu JL, Leng JY, Zhang LL, Zhang J, Fan HL, Liang FR. Effectiveness and Safety of Acupoint Application of Guan Xin Su He Pill () for Patients with Chronic Stable Angina Pectoris: A Multi-Center, Randomized Controlled Trial. Chin J Integr Med 2021; 27:838-845. [PMID: 34387828 DOI: 10.1007/s11655-021-2870-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the clinical effectiveness of acupoint application (AP) of Guan Xin Su He Pill (, GXSHP) for patients with chronic stable angina pectoris (CSAP). METHODS This study was carried out in 3 local hospitals in Chengdu, China. After baseline evaluation, eligible patients were randomly assigned to the placebo application for acupoints (PAA) group or the herbal application for acupoints (HAA) group. Patients in the HAA group underwent AP with herbal powder, which was mainly GXSHP, and patients in the PAA group underwent AP with sham drugs. For each treatment session, unilateral acupoints including Neiguan (PC 6), Danzhong (RN 17), Xinshu (BL 15) and Jueyinshu (BL 14), were stimulated for both groups. AP was performed 3 times a week with a 2-day interval for 4 weeks. The primary outcome was the frequency of angina pectoris attacks per week, while the secondary outcomes included angina pain intensity measured by the Visual Analogue Scale (VAS), dose of rescue oral drugs (nitroglycerin), scores on the Seattle Angina Questionnaire (SAQ), Self-Rating Anxiety Scale scores (SAS) and Self-Rating Depression Scale scores (SDS). Clinical outcomes were measured at week 0, 4 and 8. The safety of AP of GXSHP treatment for CSAP were assessed. RESULTS A total of 121 patients were enrolled. Baseline characteristics were comparable across the 2 groups. After treatment, the angina attack numbers in the HAA group were significantly reduced from 11.00 to 4.81 (P<0.05). While, for PAA group, the angina frequency was not significantly improved (baseline 10.55; post-treatment 11.05). The HAA group had significantly fewer angina attacks than the PAA group (P<0.05). Pain intensity measured by VAS in HAA group was significantly reduced from 4.06 to 3.02 (P<0.05). While, for PAA group, the VAS was significantly increased (baseline 3.62; post-treatment 3.96; P<0.05). Clinical outcomes showed better improvement after treatment in the HAA group than in the PAA group in terms of oral administration of rescue drugs, SAS, SDS and SAQ scores (P<0.05). The adverse events were also reported. CONCLUSION AP of GXSHP is a safe and effective treatment for CSAP patients (Registration No. NCT02029118).
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Affiliation(s)
- De-Hua Li
- Department of Acupuncture and Moxibustion, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Jin Xie
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yu-Lan Ren
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yu-Lan Ren
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Jun-Ling Lyu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Jun-Yan Leng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Ling-Lin Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Jie Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Hai-Long Fan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
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Isma'eel HA, Sakr GE, Serhan M, Lamaa N, Hakim A, Cremer PC, Jaber WA, Garabedian T, Elhajj I, Abchee AB. Artificial neural network-based model enhances risk stratification and reduces non-invasive cardiac stress imaging compared to Diamond-Forrester and Morise risk assessment models: A prospective study. J Nucl Cardiol 2018; 25:1601-1609. [PMID: 28224450 DOI: 10.1007/s12350-017-0823-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) accounts for more than half of all cardiovascular events. Stress testing remains the cornerstone for non-invasive assessment of patients with possible or known CAD. Clinical utilization reviews show that most patients presenting for evaluation of stable CAD by stress testing are categorized as low risk prior to the test. Attempts to enhance risk stratification of individuals who are sent for stress testing seem to be more in need today. The present study compares artificial neural networks (ANN)-based prediction models to the other risk models being used in practice (the Diamond-Forrester and the Morise models). METHODS In our study, we prospectively recruited patients who were 19 years of age or older, and were being evaluated for coronary artery disease with imaging-based stress tests. For ANN, the network architecture employed a systematic method, where the number of neurons is changed incrementally, and bootstrapping was performed to evaluate the accuracy of the models. RESULTS We prospectively enrolled 486 patients. The mean age of patients undergoing stress test was 55.2 ± 11.2 years, 35% were women, and 12% had a positive stress test for ischemic heart disease. When compared to Diamond-Forrester and Morise risk models, the ANN model for predicting ischemia provided higher discriminatory power (DP)(1.61), had a negative predictive value of 98%, Sensitivity 91% [81%-97%], Specificity 65% [60%-79%], positive predictive value 26%, and a potential 59% reduction of non-invasive imaging. CONCLUSION The ANN models improved risk stratification when compared to the other risk scores (Diamond-Forrester and Morise) with a 98% negative predictive value and a significant potential reduction in non-invasive imaging tests.
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Affiliation(s)
- Hussain A Isma'eel
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, PO-BOX 11-0236, Riad el Solh, Beirut, 11072020, Lebanon.
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.
| | - George E Sakr
- École Superieurd'Ing. de Beirut (ESIB), St Joseph University, Beirut, Lebanon
| | - Mustapha Serhan
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, PO-BOX 11-0236, Riad el Solh, Beirut, 11072020, Lebanon
| | - Nader Lamaa
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, PO-BOX 11-0236, Riad el Solh, Beirut, 11072020, Lebanon
| | - Ayman Hakim
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, PO-BOX 11-0236, Riad el Solh, Beirut, 11072020, Lebanon
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Torkom Garabedian
- Department of Internal Medicine, Saint Elizabeth's Medical Center, Boston, MA, USA
| | - Imad Elhajj
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Electrical & Computer Engineering, American University of Beirut, PO-BOX 11-023, Riad el Solh, Beirut, 11072020, Lebanon
| | - Antoine B Abchee
- Division of Cardiology, Department of Internal Medicine, American University of Beirut, PO-BOX 11-0236, Riad el Solh, Beirut, 11072020, Lebanon
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon
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Mur Gimeno P, Parias Ángel N, Crespín Crespín M, Ceres Alabau F, Llamazares R, Sancho Calatrava E. Anafilaxia poco frecuente y adenoma suprarrenal funcionante. Rev Clin Esp 2015; 215:e17-9. [DOI: 10.1016/j.rce.2014.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/14/2014] [Accepted: 10/19/2014] [Indexed: 11/28/2022]
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Hidalgo-Vega A, Ramos-Goñi JM, Villoro R. Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:917-925. [PMID: 24122303 DOI: 10.1007/s10198-013-0534-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/17/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Ranolazine is an antianginal agent that was approved in the EU in 2008 as an add-on therapy for symptomatic chronic angina pectoris treatment in patients who are inadequately controlled by, or are intolerant to, first-line antianginal therapies. These patients' quality of life is significantly affected by more frequent angina events, which increase the risk of revascularization. OBJECTIVE To assess the cost-utility of ranolazine versus placebo as an add-on therapy for the symptomatic treatment of patients with chronic angina pectoris in Spain. METHODS A decision tree model with 1-year time horizon was designed. Transition probabilities and utility values for different angina frequencies were obtained from the literature. Costs were obtained from Spanish official DRGs for patients with chronic angina pectoris. We calculated the incremental cost-utility ratio of using ranolazine compared with a placebo. Sensitivity analyses, by means of Monte Carlo simulations, were performed. Acceptability curves and expected value of perfect information were calculated. RESULTS The incremental cost-utility ratio was €8,455 per quality-adjusted life-year (QALY) per patient in Spain. Sensitivity analyses showed that if the decision makers' willingness to pay is €15,000 per QALY, the treatment with ranolazine will be cost effective at a 95 % level of confidence. The incremental cost-utility ratio is particularly sensitive to changes in utility values of those non-hospitalized patients with mild or moderate angina frequency. CONCLUSIONS Ranolazine is a highly efficient add-on therapy for the symptomatic treatment of chronic angina pectoris in patients who are inadequately controlled by, or intolerant to, first-line antianginal therapies in Spain.
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Khan AN, Shuaib W, Nikolic B, Khan MK, Kang J, Khosa F. Absorbed radiation dose in radiosensitive organs using 64- and 320-row multidetector computed tomography: a comparative study. SCIENTIFICA 2014; 2014:305942. [PMID: 25170427 PMCID: PMC4142155 DOI: 10.1155/2014/305942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
Aim. To determine absorbed radiation dose (ARD) in radiosensitive organs during prospective and full phase dose modulation using ECG-gated MDCTA scanner under 64- and 320-row detector modes. Methods. Female phantom was used to measure organ radiation dose. Five DP-3 radiation detectors were used to measure ARD to lungs, breast, and thyroid using the Aquilion ONE scanner in 64- and 320-row modes using both prospective and dose modulation in full phase acquisition. Five measurements were made using three tube voltages: 100, 120, and 135 kVp at 400 mA at heart rate (HR) of 60 and 75 bpm for each protocol. Mean acquisition was recorded in milligrays (mGy). Results. Mean ARD was less for 320-row versus 64-row mode for each imaging protocol. Prospective EKG-gated imaging protocol resulted in a statistically lower ARD using 320-row versus 64-row modes for midbreast (6.728 versus 19.687 mGy, P < 0.001), lung (6.102 versus 21.841 mGy, P < 0.001), and thyroid gland (0.208 versus 0.913 mGy; P < 0.001). Retrospective imaging using 320- versus 64-row modes showed lower ARD for midbreast (10.839 versus 43.169 mGy, P < 0.001), lung (8.848 versus 47.877 mGy, P < 0.001), and thyroid gland (0.057 versus 2.091 mGy; P < 0.001). ARD reduction was observed at lower kVp and heart rate. Conclusions. Dose reduction to radiosensitive organs is achieved using 320-row compared to 64-row modes for both prospective and retrospective gating, whereas 64-row mode is equivalent to the same model 64-row MDCT scanner.
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Affiliation(s)
- Atif N. Khan
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
| | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Mohammad K. Khan
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
| | - Jian Kang
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
| | - Faisal Khosa
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA 30308, USA
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Fernández Peralbo MA, Priego-Capote F, Galache-Osuna JG, Luque de Castro MD. Targeted analysis of omega-6-derived eicosanoids in human serum by SPE-LC-MS/MS for evaluation of coronary artery disease. Electrophoresis 2014; 34:2901-9. [PMID: 24228265 DOI: 10.1002/elps.201200603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A targeted approach has been applied to quantitative analysis of eicosanoids derived from omega-6 fatty acids in serum from individuals diagnosed with coronary artery disease (CAD). The target metabolites were series-2 prostaglandins, thromboxane B2, hydroxyeicosatetraenoic acids, and hydroxyoctadecadienoic acids. The method was based on SPELC-MS/MS in selected reaction monitoring mode for highly selective and sensitive determination of the target eicosanoids. The combination of SPE and LC-MS/MS involved the benefits from both direct analysis of serum without a step for protein precipitation and fully automation of the analysis. The method allowed comparison of omega-6-derived eicosanoids in serum from patients diagnosed with CAD and from control individuals. The effect of treatment with aspirin on the profile of the target compounds was evaluated through its incidence on the different pathways. Finally, the serum levels of the target metabolites in patients diagnosed with CAD were also statistically examined according to the severity of the coronary lesion stratified as stable angina, non-ST-elevation acute coronary syndrome, and acute myocardial infarction.
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Estudio de la angina estable en España y su impacto en la calidad de vida del paciente. Registro AVANCE. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2012.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Borrás X, Garcia-Moll X, Gómez-Doblas JJ, Zapata A, Artigas R. Stable angina in Spain and its impact on quality of life. The AVANCE registry. ACTA ACUST UNITED AC 2012; 65:734-41. [PMID: 22739550 DOI: 10.1016/j.rec.2012.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 03/04/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Mortality from acute coronary syndrome has fallen but a substantial number of chronic patients remain symptomatic. The present study was designed to determine the clinical characteristics and therapeutic treatment of patients with stable angina and its impact on their quality of life. METHODS A cross-sectional, multicenter, observational study of 2039 patients with stable angina attended in outpatient clinics was performed. Data were collected on clinical variables and on the subjective perception of the severity of angina and the resulting limitations. Patients completed questionnaires on their perception of severity and quality of life. RESULTS We analyzed data on 2024 patients; 73% were men (mean age 68[10] years). Some 50.3% were asymptomatic (<1 angina attack per week in the previous 4 weeks), 39.2% reported 1-3 attacks per week and 10.5% reported >3 attacks per week; 66% had previously undergone revascularization, and 59% of these developed recurrent angina. Patients rated the severity of their condition higher than did their physicians (4.5 [2.5] vs 4.3 [2.3]; P=.002). Physicians' and patients' perceptions of the repercussions of angina showed little concordance (kappa<0.3). The patients believed their condition was much more severe, more debilitating, and had a greater negative impact on their quality of life. CONCLUSIONS A high proportion of patients with stable angina remains symptomatic and their quality of life is impaired. Their perception of the condition is worse than that of their physicians.
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Affiliation(s)
- Xavier Borrás
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Juffé-Stein A. Nuevas guías de revascularización miocárdica. Punto de vista del cirujano. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Earls JP, Leipsic J. Cardiac Computed Tomography Technology and Dose-reduction Strategies. Radiol Clin North Am 2010; 48:657-74. [PMID: 20705164 DOI: 10.1016/j.rcl.2010.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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