ABSTRACT The intensity of antiplatelet therapy during percutaneous coronary intervention （PCI） is an important deter- minant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphos...ABSTRACT The intensity of antiplatelet therapy during percutaneous coronary intervention （PCI） is an important deter- minant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate （ADP）- receptor antagonist that acts rapidly and has quickly reversible effects.展开更多
Antiplatelet therapy is the cornerstone of the therapeutic arsenal in coronary artery disease.Thanks to a better understanding in physiology,pharmacology and pharmacogenomics huge progress were made in the field of pl...Antiplatelet therapy is the cornerstone of the therapeutic arsenal in coronary artery disease.Thanks to a better understanding in physiology,pharmacology and pharmacogenomics huge progress were made in the field of platelet reactivity inhibition thus allowing theexpansion of percutaneous coronary intervention.Stent implantation requires the combination of two antiplatelet agents acting in a synergistic way.Asprin inhibit the cyclo-oxygenase pathway of platelet activation while clopidogrel is a P2Y12 adenosine diphosphate(ADP)-receptor antagonist.This dual antiplatelet therapy has dramatically improved the prognosis of stented patients.However,due to pharmacological limitations of clopidogrel(interindividual variability in its biological efficacy,slow onset of action,mild platelet reactivity inhibition)ischemic recurrences remained high following stent implantation especially in acute coronary syndrome patients.Thus,more potent P2Y12-ADP receptor inhibitors were developped including prasugrel,ticagrelor and more recently cangrelor to overcome these pitfalls.These new agents reduced the rate of thrombotic events in acute coronary syndrome patients at the cost of an increased bleeding risk.The abundance in antiplatelet agents allow us to tailor our strategy based on the thrombotic/bleeding profile of each patient.Recently,the ACCOAST trial cast a doubt on the benefit of pre treatment in non-ST segment elevation acute coronary syndrome.The aim of the present review is to summarize the results of the main studies dealing with antiplatelet therapy in stented/acute coronary syndromes patients.展开更多
Patients listed for organ transplant frequently have severe coronary artery disease(CAD), which may be treated with drug eluting stents(DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generati...Patients listed for organ transplant frequently have severe coronary artery disease(CAD), which may be treated with drug eluting stents(DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis(ST) in the perioperative period. Dual antiplatelet therapy(DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyN ow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.展开更多
Anxiety disorders are one of the most epidemic and chronic psychiatric disorders.An incom-plete understanding of anxiety pathophysiology has limited the development of highly effective drugs against these disorders.GP...Anxiety disorders are one of the most epidemic and chronic psychiatric disorders.An incom-plete understanding of anxiety pathophysiology has limited the development of highly effective drugs against these disorders.GPR17 has been shown to be involved in multiple sclerosis and some acute brain injury disorders.However,no study has investigated the role of GPR17 in psychiatric disorders.In a well-established chronic restraint stress(CRS)mouse model,using a combination of pharmacological and molecular biology techniques,viral tracing,in vitro electrophysiology recordings,in vivo fiber photom-etry,chemogenetic manipulations and behavioral tests,we demonstrated that CRS induced anxiety-like behaviors and increased the expression of GPR17 in basolateral amygdala(BLA)glutamatergic neurons.Inhibition of GPR17 by cangrelor or knockdown of GPR17 by adeno-associated virus in BLA glutama-tergic neurons effectively improved anxiety-like behaviors.Overexpression of GPR17 in BLA glutama-tergic neurons increased the susceptibility to anxiety-like behaviors.What's more,BLA glutamatergic neuronal activity was required for anxiolytic-like effects of GPR17 antagonist and GPR17 modulated anxiety-like behaviors via BLA to ventral hippocampal CAl glutamatergic projection.Our study finds for the first and highlights the new role of GPR17 in regulating anxiety-like behaviors and it might be a novel potential target for therapy of anxiety disorders.展开更多
文摘ABSTRACT The intensity of antiplatelet therapy during percutaneous coronary intervention （PCI） is an important deter- minant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate （ADP）- receptor antagonist that acts rapidly and has quickly reversible effects.
文摘Antiplatelet therapy is the cornerstone of the therapeutic arsenal in coronary artery disease.Thanks to a better understanding in physiology,pharmacology and pharmacogenomics huge progress were made in the field of platelet reactivity inhibition thus allowing theexpansion of percutaneous coronary intervention.Stent implantation requires the combination of two antiplatelet agents acting in a synergistic way.Asprin inhibit the cyclo-oxygenase pathway of platelet activation while clopidogrel is a P2Y12 adenosine diphosphate(ADP)-receptor antagonist.This dual antiplatelet therapy has dramatically improved the prognosis of stented patients.However,due to pharmacological limitations of clopidogrel(interindividual variability in its biological efficacy,slow onset of action,mild platelet reactivity inhibition)ischemic recurrences remained high following stent implantation especially in acute coronary syndrome patients.Thus,more potent P2Y12-ADP receptor inhibitors were developped including prasugrel,ticagrelor and more recently cangrelor to overcome these pitfalls.These new agents reduced the rate of thrombotic events in acute coronary syndrome patients at the cost of an increased bleeding risk.The abundance in antiplatelet agents allow us to tailor our strategy based on the thrombotic/bleeding profile of each patient.Recently,the ACCOAST trial cast a doubt on the benefit of pre treatment in non-ST segment elevation acute coronary syndrome.The aim of the present review is to summarize the results of the main studies dealing with antiplatelet therapy in stented/acute coronary syndromes patients.
文摘Patients listed for organ transplant frequently have severe coronary artery disease(CAD), which may be treated with drug eluting stents(DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis(ST) in the perioperative period. Dual antiplatelet therapy(DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyN ow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.
基金National Natural Science Foundation of China(82373860 and 82071202 to Susu Tang,82173805 to Hao Hong)National Innovation and Entrepreneurship Training Program for Undergraduate(202410316198,China).
文摘Anxiety disorders are one of the most epidemic and chronic psychiatric disorders.An incom-plete understanding of anxiety pathophysiology has limited the development of highly effective drugs against these disorders.GPR17 has been shown to be involved in multiple sclerosis and some acute brain injury disorders.However,no study has investigated the role of GPR17 in psychiatric disorders.In a well-established chronic restraint stress(CRS)mouse model,using a combination of pharmacological and molecular biology techniques,viral tracing,in vitro electrophysiology recordings,in vivo fiber photom-etry,chemogenetic manipulations and behavioral tests,we demonstrated that CRS induced anxiety-like behaviors and increased the expression of GPR17 in basolateral amygdala(BLA)glutamatergic neurons.Inhibition of GPR17 by cangrelor or knockdown of GPR17 by adeno-associated virus in BLA glutama-tergic neurons effectively improved anxiety-like behaviors.Overexpression of GPR17 in BLA glutama-tergic neurons increased the susceptibility to anxiety-like behaviors.What's more,BLA glutamatergic neuronal activity was required for anxiolytic-like effects of GPR17 antagonist and GPR17 modulated anxiety-like behaviors via BLA to ventral hippocampal CAl glutamatergic projection.Our study finds for the first and highlights the new role of GPR17 in regulating anxiety-like behaviors and it might be a novel potential target for therapy of anxiety disorders.
