The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic ...The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.展开更多
Non-selective beta-blockers(NSBBs) have been at the forefront in the management of portal hypertension in liver cirrhosis for the last three decades, a trusty component in the armamentarium of the Hepatologist. The ro...Non-selective beta-blockers(NSBBs) have been at the forefront in the management of portal hypertension in liver cirrhosis for the last three decades, a trusty component in the armamentarium of the Hepatologist. The role of beta-blockers has been cemented for years in cardiac disease including angina, hypertension and in heart failure, however NSBBs with their non-selective effects on β1 and β2 receptors have led to them fondly being termed "the hepatologist's aspirin". NSBBs' role in reduction of portal pressure in the setting of primary and secondary prophylaxis for variceal haemorrhage has been well established. NSBBs include propranolol, nadolol and carvedilol- with the latter having been shown to be effective in patients who often fail to demonstrate a haemodynamic response to propranolol. Recent observational studies however have served for the Hepatology community to question the beneficial role of NSBBs in portal hypertension, especially in advanced cases with refractory ascites. The deleterious effect in patients with refractory ascites in a few studies led to a U-turn in clinical practice, with some in the Hepatology community withdrawing their usage in patients with advanced cirrhosis. This also led to the "window hypothesis" suggesting there may be only be a finite time frame when NSBBs have a beneficial effect in portal hypertension. The window hypothesis proposed the window for the benefits of NSBBs is closed in early portal hypertension, opening as portal hypertension progresses with it closing in advanced liver disease. The window was proposed to close in conditions such as refractory ascites or spontaneous bacterial peritonitis when patients may not necessarily mount a compensatory haemodynamic response when on NSBBs. Some centres however have continued the practice of NSBBs in advanced cirrhosis with published data challenging the scepticisms of other groups who stop NSBBs. Thus the debate, like the window hypothesis has opened, with more questions to be answered about NSBB's mechanism of action not only in reducing portal hypertension but also their effects on systemic haemodynamics and on the pro-inflammatory pathways often activated in cirrhosis especially in advanced disease. This article serves to review the role of NSBBs in the management of portal hypertension/cirrhosis and concentrate on current concepts and controversies in this field.展开更多
BACKGROUND Hematidrosis is an extremely rare and enigmatic condition characterized by spontaneous bleeding through intact skin or mucosa,typically occurring in response to severe emotional stress.Although its exact pa...BACKGROUND Hematidrosis is an extremely rare and enigmatic condition characterized by spontaneous bleeding through intact skin or mucosa,typically occurring in response to severe emotional stress.Although its exact pathophysiology remains unclear,the condition is thought to involve sympathetic nervous system overactivation and capillary fragility,leading to blood extravasation via sweat glands or hair follicles.AIM To evaluate the efficacy and safety of beta-blockers,particularly propranolol,in the management of hematidrosis.METHODS A systematic literature search was conducted in January 2024 across six major databases to identify studies published between 2014 and 2024 that reported the use of beta-blockers in patients with hematidrosis.Eligible studies included clinical case reports or case series that described beta-blocker treatment outcomes.Data were synthesized narratively in accordance with the PRISMA 2020 guidelines.RESULTS Twenty studies met the inclusion criteria.Among them,propranolol was the most frequently prescribed beta-blocker and was associated with symptomatic improvement in over 75%of cases.Some studies also reported enhanced outcomes when beta-blockers were used in conjunction with psychotherapy.Reported adverse effects were minimal,and treatment was generally well-tolerated.However,the available evidence remains limited to low-level observational data,mostly case reports and small case series.CONCLUSION Beta-blockers,especially propranolol,appear to be an effective and well-tolerated treatment option for hematidrosis,particularly in stress-induced presentations.Despite promising findings,the evidence base is constrained by the lack of high-quality studies.Future research should focus on prospective,controlled trials to establish standardized diagnostic and treatment protocols for this rare condition.展开更多
BACKGROUND Heart failure with preserved ejection fraction(HFpEF)accounts for approximately half of heart failure cases and is associated with high morbidity and mortality.Beta-blockers(BB)and calcium channel blockers(...BACKGROUND Heart failure with preserved ejection fraction(HFpEF)accounts for approximately half of heart failure cases and is associated with high morbidity and mortality.Beta-blockers(BB)and calcium channel blockers(CCB)are commonly used for symptom control and comorbidity management,but their comparative effectiveness and safety remain unclear.AIM To compare the effectiveness and safety of BB vs CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.METHODS Simulated data for 4000 HFpEF patients(2000 BB,2000 CCB)were generated based on distributions extracted from electronic medical records spanning 2014-2023.Inclusion criteria included adults with left ventricular ejection fraction≥50%and initiation of BB or CCB.Effectiveness outcomes encompassed mortality,heart failure hospitalizations,and changes in clinical parameters.Safety outcomes included bradycardia,hypotension,and drug discontinuation.Statistical analyses used t-tests,χ2 tests,Cox proportional hazards models for hazard ratios(HR),and incidence rate ratios(IRR)in R software.Propensity score matching(PSM)was performed to balance baseline characteristics,with outcomes reassessed in the matched cohort.RESULTS Baseline characteristics were largely balanced,with minor differences in sex,chronic kidney disease,systolic blood pressure,and left atrial volume index.BB demonstrated lower all-cause mortality(crude HR 0.78,95%CI:0.70-0.87,P=0.003),heart failure hospitalization(crude HR 0.86,95%CI:0.77-0.96,P=0.031),and composite endpoint(crude HR 0.85,95%CI:0.79-0.91,P<0.001)rates compared to CCB.IRR for heart failure hospitalizations and emergency visits favored BB.Safety profiles showed higher symptomatic bradycardia(9.2%vs 4.9%,P<0.001)and drug discontinuation(11.3%vs 9.3%,P=0.043)with BB,and higher hypotension(7.2%vs 11.5%,P<0.001)with CCB.Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB vs 0.0649 for CCB(HR 0.96,95%CI:0.85-1.08),heart failure hospitalization rates of 0.0751 vs 0.0888(HR 0.84,95%CI:0.75-0.94),and IRR for number of heart failure hospitalizations of 1.65 for CCB vs BB(95%CI:1.51-1.80,P<0.001).CONCLUSION BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB,with distinct safety considerations.PSM confirmed these trends with reduced confounding.Personalized therapy is recommended,warranting prospective trials for validation.展开更多
AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A m...AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.展开更多
OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ej...OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.展开更多
AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwe...AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.展开更多
Reduced graphene oxide(rGO)membranes have been intensively evaluated for desalination and ionic sieving applications,benefiting from their stable and well-confined interlayer channels.However,rGO membranes generally s...Reduced graphene oxide(rGO)membranes have been intensively evaluated for desalination and ionic sieving applications,benefiting from their stable and well-confined interlayer channels.However,rGO membranes generally suffer from low permeability due to the high transport resistance resulting from the narrowed two-dimensional(2D)channels.Although high permeability can be realized by reducing membrane thickness,membrane selectivity normally declines because of the formation of nonselective defects,in particular pinholes.In this study,we demonstrate that the non-selective defects in ultrathin rGO membranes can be effectively minimised by a facile posttreatment via surfacedeposition of graphene quantum dots(GQDs).The resultant GQDs/rGO membranes obtained a good trade-off between water permeance(14 L·m^(-2)·h^(-1).MPa^(-1))and NaCl rejection(91%).This work provides new insights into the design of high quality ultrathin 2D laminar membranes for desalination,molecular/ionic sieving and other separation applications.展开更多
A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB ana...A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB analysis.Both chromato- grams and mass spectrometric data were obtained from full scanning mode.This method is suitable for routine screening and confirmation of β-blockers in doping control.展开更多
To handle the thermal budget in SiGe BiCMOS process, a non-selective graphic epitaxial technology using molecular beam epitaxial （MBE） has been developed. SEM, AFM, XRD, and dislocation density measurements are carr...To handle the thermal budget in SiGe BiCMOS process, a non-selective graphic epitaxial technology using molecular beam epitaxial （MBE） has been developed. SEM, AFM, XRD, and dislocation density measurements are carried out. The SiGe film＇s RMS roughness is 0.45nm, and dislocation density is 0.3×10^3cm^-2-1.2×10^3cm^-2. No dislocation accumulation exists on the boundary of the windows; this indicates the high quality of the SiGe film. The experiment results show that the technology presented in this paper meets the fabrication requirements of SiGe BiCMOS.展开更多
Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin re...Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin receptor blockers (ARB) therapy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods A total 11,288 NSTEMI patients who underwent PCI with DES were enrolled and they were divided into two groups,the BB with ACEI group (n = 7600) and the BB with ARB group (n = 3688).The major clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death,recurrent myocardial infarction (re-MI),total revascularization [target lesion revascularization (TLR),target vessel revascularization (TVR),non-TVR] rate during the 2-year follow-up period.Results After propensity score-matched (PSM) analysis,two PSM groups (3317 pairs,n = 6634,C-statistic = 0.695) were generated.Although the cumulative incidences of all-cause death,cardiac death,TLR,and non-TVR were similar between the two groups,MACE (HR = 0.832,95% CI: 0.704?0.982,P = 0.030),total revascularization rate (HR = 0.767,95% CI: 0.598?0.984,P = 0.037),and TVR rate (HR = 0.646,95% CI: 0.470?0.888,P = 0.007) were significantly lower in the BB with ACEI group after PSM.Conclusions In this study,we suggest that the combination of BB with ACEI may be beneficial for reducing the cumulative incidences of MACE,total revascularization rate,and TVR rather than the BB with ARB after PCI with DES in NSTEMI patients.展开更多
Objective To investigate the risk factors of symptomatic bradyarrhythrnias in relation to β-blockers use. Methods A hospital-based case-control study [228 patients： 108 with symptomatic bradyarrhythmias （cases） an...Objective To investigate the risk factors of symptomatic bradyarrhythrnias in relation to β-blockers use. Methods A hospital-based case-control study [228 patients： 108 with symptomatic bradyarrhythmias （cases） and 120 controls] was conducted in Sultanah Aminah Hospital, Malaysia between January 2011 and January 2014. Results The mean age was 61.1 ~ 13.3 years with a majority of men （68.9%）. Cases were likely than control to be older, hypertensive, lower body mass index and concomitant use of rate-controlling drugs （such as digoxin, verapamil, diltiazem, ivabradine or amiodarone）. Significantly higher level of serum potassium, urea, creatinine and lower level of estimated glomerular filtration rate （eGFR） were observed among cases as compared to controls. On univariate analysis among patients on β-blockers, older age （crude OR： 1.07; 95% CI： 1.03-1.11, P = 0.000）, hypertension （crude OR： 5.6; 95% CI： 1.51-20.72, P = 0.010）, lower sodium （crude OR： 0.04; 95% CI： 0.81-0.99, P = 0.036）, higher potassium （crude OR： 2.36; 95% CI： 1.31-4.26, P = 0.004） and higher urea （crude OR： 1.23; 95% CI： 1.11-1.38, P = 0.000） were associated with increased risk of symptomatic bradyarrhythmias; eGFR was inversely and significantly associated with symptomatic bradyarrhythmias in both ＇β-blockers＇ （crude OR： 0.97; 95% CI： 0.964）.98, P = 0.000） and ＇non-β-blockers＇ （crude OR： 0.99; 95% CI： 0.97-0.99, P = 0.023） arms. However, eGFR was not significantly associated with symptomatic bradyarrhythmias in the final model of both ＇β-blockers＇ （adjusted OR： 0.98; 95% CI： 0.96-0.98, P = 0.103） and ＇non-p-blockers＇ （adjusted OR： 0.99; 95% CI： 0.97-1.01, P = 0.328） arms. Importantly, older age was a significant predictor of symptomatic bradyarrhythmias in the ＇β-blockers＇ as compared to the ＇non-β-blockers＇ arms （adjusted OR： 1.09; 95% CI： 1.03-1.15, P = 0.003 vs. adjusted OR： 1.03; 95% CI： 0.98-1.09, P = 0.232, respectively）. Conclusion Older age was a significant predictor of symptomatic bradyarrhythmias in patients on β-blockers than those without β-blockers.展开更多
OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with...OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.展开更多
1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the benef...1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4]However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.展开更多
Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association...Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.展开更多
This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Sev...This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.展开更多
Management of portal hypertension has been the focus of the Baveno guidelines since 1990.This article explores the evolution of these recommendations and their impact on clinical practice.Initially reliant on invasive...Management of portal hypertension has been the focus of the Baveno guidelines since 1990.This article explores the evolution of these recommendations and their impact on clinical practice.Initially reliant on invasive diagnostics such as the hepatic venous pressure gradient,later editions have incorporated non-invasive methods such as elastography and serum biomarkers.Management strategies have evolved substantially.Endoscopic surveillance has shifted from routine annual endoscopy to an individualized approach based on liver stiffness and platelet count.The role of non-selective beta-blockers(NSBBs)in primary prophylaxis has expanded.Endoscopic band ligation has become the preferred alternative for patients intolerant to NSBBs.In secondary prophylaxis,Baveno II replaced sclerotherapy with band ligation,and later guidelines confirmed the superiority of NSBBs combined with ligation.Transjugular intrahepatic portosystemic shunt emerged as the preferred rescue therapy,with early use emphasized in high-risk patients.Ongoing advancements continue to refine diagnostic and therapeutic strategies,further improving patient outcomes.展开更多
Rice often suffers from pests,diseases,and weeds throughout its life cycle.The management of pests,diseases,and weeds with agrochemicals increases production costs and results in pesticide residues.Developing new germ...Rice often suffers from pests,diseases,and weeds throughout its life cycle.The management of pests,diseases,and weeds with agrochemicals increases production costs and results in pesticide residues.Developing new germplasm and varieties with multiple resistances is the most economical,sustainable,and efficient way to solve these problems.In this study,marker-assisted backcrossing was used to pyramid multiple resistance genes,resulting in the development of a penta-resistance restorer line,B2A1920.This line was evaluated for its agronomic traits and resistance to diseases,pests,and herbicides.It was confirmed that B2A1920 contains the herbicide resistance gene Bar,the lepidopteran pest resistance gene Cry2Aa,the bacterial blight(BB)resistance gene Xa23,the blast resistance gene Pi2,and the brown planthopper(BPH)resistance genes Bph14 and Bph15.These genes confer resistance to glufosinate,lepidopteran pests,BB,blast,and BPH,respectively,while the line also exhibits elite agronomic traits.Its hybrids,Gui A×B2A1920,Quan 9311A×B2A1920,Yexiang A×B2A1920,Xianglong A×B2A1920,Tiantai A×B2A1920,and Shen 9A×B2A1920,likewise showed penta-resistance and superior agronomic performance.These results indicate the successful development of a cytoplasmic male sterile restorer line with high combining ability and penta-resistance.展开更多
BACKGROUND The six-minute walk test(6MWT)allows to determine,in addition to the main parameters,the time of heart rate recovery(THRR),cardiac function,adaptation index(AI),which characterize the compensatory reserve o...BACKGROUND The six-minute walk test(6MWT)allows to determine,in addition to the main parameters,the time of heart rate recovery(THRR),cardiac function,adaptation index(AI),which characterize the compensatory reserve of patients with chronic heart failure(CHF).At the same time,the significance of these parameters in patients taking beta-blockers for CHF is insufficiently studied,taking into account the negative chronotropic effect of drugs.In this regard,it is relevant to identify factors that can characterize the compensatory capabilities of a patient with CHF during 6MWT,not related to the calculation of heart rate.AIM To identify hemodynamic indicators of the adaptive capabilities of patients with CHF during paired 6MWT depending on their intake of beta-blockers.METHODS Seventy-four patients with compensated CHF due to coronary heart disease and/or hypertension formed the main group,comprising 46 individuals who were taking beta-blockers,and a comparison group comprising 28 individuals who had not been taking beta-blockers for at least one month before 6MWT.All participants underwent Doppler echocardiography(DECG),paired 6MWT,with assessment of hemodynamic parameters before and after both the first and second test.AI,THRR,blood pressure variability(BPV)were calculated.Multivariate,correlation analyses,univariate analysis of variance were used.RESULTS There were no significant associations between adaptation characteristics and DECG parameters or functional class(FC)of CHF in patients of the main group.In the comparison group,the indicators of compensatory reserve were significantly and directly associated with left ventricular ejection fraction(LVEF),and inversely with FC CHF and cardiac cavity size.In both groups,a greater difference in systolic blood pressure between the end of the first and the beginning of the second 6MWT was significantly associated with a higher index of right ventricular systolic dysfunction(Tricuspid annular plane systolic excursion)and LVEF,as well as a smaller left ventricular size and mass,and a lower pulmonary artery systolic pressure in patients in the main group.CONCLUSION Systolic BPV,measured immediately after 6MWT and 20 minutes after its completion,can indirectly characterize the compensatory reserve in patients with CHF,regardless of their beta-blocker intake.展开更多
The pharmacokinetic-pharmacodynamics of propranolol (PPL) and its activemetabolite 4-hydroxypropranolol (4-OH-P) was studied on Chinese subJects by single or multipleoral administration. The efficiency of beta-blockad...The pharmacokinetic-pharmacodynamics of propranolol (PPL) and its activemetabolite 4-hydroxypropranolol (4-OH-P) was studied on Chinese subJects by single or multipleoral administration. The efficiency of beta-blockade was measured as the reduction of heart rates orblood pressure in the supine and upnght positions during rest or exercise period. After a single doseof 40 mg PPL, the plasma concentration of 4-OH-P was quite high, C (m) max and AUC (m) were26. 1±13.2 ng/ml and 180±69 ng.h/ml respectively, which were 50% and 73% of those of PPL.Whileafter multiple dose administration, the plasma PPL concentration increased much greater than that insingle administration and the 4-OH-P/PPL plasma level ratio fell from 0.79±0.64 at single dose toonly 0.48±0.32 at steady-state. The pharmacodynamic half-life of PPL on inbibiting exercising heart-rate was much longer than the halflife of drug concentration (8.78±2.27 vs 4.23±1.33 h. P<0.0 1).The Css 50. plasma concentration at steady-state producing 50% maximal efficacy, was 44.66±35.24ng/ml. The study showed that 4-OH-P is an important active metabolite of PPL and one of thepossible factors causing the considering variations in the response to PPL in Chinese people.展开更多
文摘The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.
文摘Non-selective beta-blockers(NSBBs) have been at the forefront in the management of portal hypertension in liver cirrhosis for the last three decades, a trusty component in the armamentarium of the Hepatologist. The role of beta-blockers has been cemented for years in cardiac disease including angina, hypertension and in heart failure, however NSBBs with their non-selective effects on β1 and β2 receptors have led to them fondly being termed "the hepatologist's aspirin". NSBBs' role in reduction of portal pressure in the setting of primary and secondary prophylaxis for variceal haemorrhage has been well established. NSBBs include propranolol, nadolol and carvedilol- with the latter having been shown to be effective in patients who often fail to demonstrate a haemodynamic response to propranolol. Recent observational studies however have served for the Hepatology community to question the beneficial role of NSBBs in portal hypertension, especially in advanced cases with refractory ascites. The deleterious effect in patients with refractory ascites in a few studies led to a U-turn in clinical practice, with some in the Hepatology community withdrawing their usage in patients with advanced cirrhosis. This also led to the "window hypothesis" suggesting there may be only be a finite time frame when NSBBs have a beneficial effect in portal hypertension. The window hypothesis proposed the window for the benefits of NSBBs is closed in early portal hypertension, opening as portal hypertension progresses with it closing in advanced liver disease. The window was proposed to close in conditions such as refractory ascites or spontaneous bacterial peritonitis when patients may not necessarily mount a compensatory haemodynamic response when on NSBBs. Some centres however have continued the practice of NSBBs in advanced cirrhosis with published data challenging the scepticisms of other groups who stop NSBBs. Thus the debate, like the window hypothesis has opened, with more questions to be answered about NSBB's mechanism of action not only in reducing portal hypertension but also their effects on systemic haemodynamics and on the pro-inflammatory pathways often activated in cirrhosis especially in advanced disease. This article serves to review the role of NSBBs in the management of portal hypertension/cirrhosis and concentrate on current concepts and controversies in this field.
文摘BACKGROUND Hematidrosis is an extremely rare and enigmatic condition characterized by spontaneous bleeding through intact skin or mucosa,typically occurring in response to severe emotional stress.Although its exact pathophysiology remains unclear,the condition is thought to involve sympathetic nervous system overactivation and capillary fragility,leading to blood extravasation via sweat glands or hair follicles.AIM To evaluate the efficacy and safety of beta-blockers,particularly propranolol,in the management of hematidrosis.METHODS A systematic literature search was conducted in January 2024 across six major databases to identify studies published between 2014 and 2024 that reported the use of beta-blockers in patients with hematidrosis.Eligible studies included clinical case reports or case series that described beta-blocker treatment outcomes.Data were synthesized narratively in accordance with the PRISMA 2020 guidelines.RESULTS Twenty studies met the inclusion criteria.Among them,propranolol was the most frequently prescribed beta-blocker and was associated with symptomatic improvement in over 75%of cases.Some studies also reported enhanced outcomes when beta-blockers were used in conjunction with psychotherapy.Reported adverse effects were minimal,and treatment was generally well-tolerated.However,the available evidence remains limited to low-level observational data,mostly case reports and small case series.CONCLUSION Beta-blockers,especially propranolol,appear to be an effective and well-tolerated treatment option for hematidrosis,particularly in stress-induced presentations.Despite promising findings,the evidence base is constrained by the lack of high-quality studies.Future research should focus on prospective,controlled trials to establish standardized diagnostic and treatment protocols for this rare condition.
文摘BACKGROUND Heart failure with preserved ejection fraction(HFpEF)accounts for approximately half of heart failure cases and is associated with high morbidity and mortality.Beta-blockers(BB)and calcium channel blockers(CCB)are commonly used for symptom control and comorbidity management,but their comparative effectiveness and safety remain unclear.AIM To compare the effectiveness and safety of BB vs CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.METHODS Simulated data for 4000 HFpEF patients(2000 BB,2000 CCB)were generated based on distributions extracted from electronic medical records spanning 2014-2023.Inclusion criteria included adults with left ventricular ejection fraction≥50%and initiation of BB or CCB.Effectiveness outcomes encompassed mortality,heart failure hospitalizations,and changes in clinical parameters.Safety outcomes included bradycardia,hypotension,and drug discontinuation.Statistical analyses used t-tests,χ2 tests,Cox proportional hazards models for hazard ratios(HR),and incidence rate ratios(IRR)in R software.Propensity score matching(PSM)was performed to balance baseline characteristics,with outcomes reassessed in the matched cohort.RESULTS Baseline characteristics were largely balanced,with minor differences in sex,chronic kidney disease,systolic blood pressure,and left atrial volume index.BB demonstrated lower all-cause mortality(crude HR 0.78,95%CI:0.70-0.87,P=0.003),heart failure hospitalization(crude HR 0.86,95%CI:0.77-0.96,P=0.031),and composite endpoint(crude HR 0.85,95%CI:0.79-0.91,P<0.001)rates compared to CCB.IRR for heart failure hospitalizations and emergency visits favored BB.Safety profiles showed higher symptomatic bradycardia(9.2%vs 4.9%,P<0.001)and drug discontinuation(11.3%vs 9.3%,P=0.043)with BB,and higher hypotension(7.2%vs 11.5%,P<0.001)with CCB.Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB vs 0.0649 for CCB(HR 0.96,95%CI:0.85-1.08),heart failure hospitalization rates of 0.0751 vs 0.0888(HR 0.84,95%CI:0.75-0.94),and IRR for number of heart failure hospitalizations of 1.65 for CCB vs BB(95%CI:1.51-1.80,P<0.001).CONCLUSION BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB,with distinct safety considerations.PSM confirmed these trends with reduced confounding.Personalized therapy is recommended,warranting prospective trials for validation.
文摘AIM:To explore effects of nonselective beta-blockers(NSBBs) in cirrhotic patients with no or small varices.METHODS:The Pub Med,EMBASE,Science Direct,and Cochrane library databases were searched for relevant papers.A meta-analysis was performed using ORs with 95%CI as the effect sizes.Subgroup analysis was conducted according to the studies including patients without varices and those with small varices.RESULTS:Overall,784 papers were initially retrieved from the database searches,of which six randomized controlled trials were included in the meta-analysis.The incidences of large varices development(OR = 1.05,95%CI:0.25-4.36;P = 0.95),first upper gastrointestinal bleeding(OR = 0.59,95%CI:0.24-1.47;P = 0.26),and death(OR = 0.70,95%CI:0.45-1.10;P = 0.12) were similar between NSBB and placebo groups.However,the incidence of adverse events was significantly higher in the NSBB group compared with the placebo group(OR = 3.47,95%CI:1.45-8.33;P = 0.005).The results of subgroup analyses were similar to those of overall analyses.CONCLUSION:The results of this meta-analysis indicate that NSBBs should not be recommended for cirrhotic patients with no or small varices.
基金supported by the National Key Research and Development Program from the Ministry of Science and Technology of China(grant number:2018YFC1312400)the CAMS Innovation Fund for Medical Science(grant number:2016-I2M-2-004,2017-I2M-2-002)+1 种基金the National Key Technology R&D Program from the Ministry of Science and Technology of China(grant number:2015BAI12B02)the 111 Project from the Ministry of Education of China(grant number:B16005)。
文摘OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.
基金Supported by the Paul B.Beeson Career Development Award in Aging Research,No.K23AG048337
文摘AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.
基金supported by the Australian Government Depart-ment of Industry,Innovation,and Science through the Australia-China Science and Research Fund(ACSRF48154)collaboration with the Australia Research Council Research Hub for Energy-efficient Separation(IH 170100009).
文摘Reduced graphene oxide(rGO)membranes have been intensively evaluated for desalination and ionic sieving applications,benefiting from their stable and well-confined interlayer channels.However,rGO membranes generally suffer from low permeability due to the high transport resistance resulting from the narrowed two-dimensional(2D)channels.Although high permeability can be realized by reducing membrane thickness,membrane selectivity normally declines because of the formation of nonselective defects,in particular pinholes.In this study,we demonstrate that the non-selective defects in ultrathin rGO membranes can be effectively minimised by a facile posttreatment via surfacedeposition of graphene quantum dots(GQDs).The resultant GQDs/rGO membranes obtained a good trade-off between water permeance(14 L·m^(-2)·h^(-1).MPa^(-1))and NaCl rejection(91%).This work provides new insights into the design of high quality ultrathin 2D laminar membranes for desalination,molecular/ionic sieving and other separation applications.
文摘A retiabte and sensitive method is developed for the detection of β-blockers which are excreted in free or conjugated forms in human urine.9 β-blockers were derivatized by MSTFA and MBTFA and subjected to GC/MSB analysis.Both chromato- grams and mass spectrometric data were obtained from full scanning mode.This method is suitable for routine screening and confirmation of β-blockers in doping control.
基金This work was supported by the National Key Laboratory Foundation of China under Grant No. 51439010204DZ0219.
文摘To handle the thermal budget in SiGe BiCMOS process, a non-selective graphic epitaxial technology using molecular beam epitaxial （MBE） has been developed. SEM, AFM, XRD, and dislocation density measurements are carried out. The SiGe film＇s RMS roughness is 0.45nm, and dislocation density is 0.3×10^3cm^-2-1.2×10^3cm^-2. No dislocation accumulation exists on the boundary of the windows; this indicates the high quality of the SiGe film. The experiment results show that the technology presented in this paper meets the fabrication requirements of SiGe BiCMOS.
基金supported by Research of Korea Centers for Disease Control and Prevention (2016-ER6304-02)
文摘Background Because limited comparative data are available,we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin receptor blockers (ARB) therapy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Methods A total 11,288 NSTEMI patients who underwent PCI with DES were enrolled and they were divided into two groups,the BB with ACEI group (n = 7600) and the BB with ARB group (n = 3688).The major clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death,recurrent myocardial infarction (re-MI),total revascularization [target lesion revascularization (TLR),target vessel revascularization (TVR),non-TVR] rate during the 2-year follow-up period.Results After propensity score-matched (PSM) analysis,two PSM groups (3317 pairs,n = 6634,C-statistic = 0.695) were generated.Although the cumulative incidences of all-cause death,cardiac death,TLR,and non-TVR were similar between the two groups,MACE (HR = 0.832,95% CI: 0.704?0.982,P = 0.030),total revascularization rate (HR = 0.767,95% CI: 0.598?0.984,P = 0.037),and TVR rate (HR = 0.646,95% CI: 0.470?0.888,P = 0.007) were significantly lower in the BB with ACEI group after PSM.Conclusions In this study,we suggest that the combination of BB with ACEI may be beneficial for reducing the cumulative incidences of MACE,total revascularization rate,and TVR rather than the BB with ARB after PCI with DES in NSTEMI patients.
文摘Objective To investigate the risk factors of symptomatic bradyarrhythrnias in relation to β-blockers use. Methods A hospital-based case-control study [228 patients： 108 with symptomatic bradyarrhythmias （cases） and 120 controls] was conducted in Sultanah Aminah Hospital, Malaysia between January 2011 and January 2014. Results The mean age was 61.1 ~ 13.3 years with a majority of men （68.9%）. Cases were likely than control to be older, hypertensive, lower body mass index and concomitant use of rate-controlling drugs （such as digoxin, verapamil, diltiazem, ivabradine or amiodarone）. Significantly higher level of serum potassium, urea, creatinine and lower level of estimated glomerular filtration rate （eGFR） were observed among cases as compared to controls. On univariate analysis among patients on β-blockers, older age （crude OR： 1.07; 95% CI： 1.03-1.11, P = 0.000）, hypertension （crude OR： 5.6; 95% CI： 1.51-20.72, P = 0.010）, lower sodium （crude OR： 0.04; 95% CI： 0.81-0.99, P = 0.036）, higher potassium （crude OR： 2.36; 95% CI： 1.31-4.26, P = 0.004） and higher urea （crude OR： 1.23; 95% CI： 1.11-1.38, P = 0.000） were associated with increased risk of symptomatic bradyarrhythmias; eGFR was inversely and significantly associated with symptomatic bradyarrhythmias in both ＇β-blockers＇ （crude OR： 0.97; 95% CI： 0.964）.98, P = 0.000） and ＇non-β-blockers＇ （crude OR： 0.99; 95% CI： 0.97-0.99, P = 0.023） arms. However, eGFR was not significantly associated with symptomatic bradyarrhythmias in the final model of both ＇β-blockers＇ （adjusted OR： 0.98; 95% CI： 0.96-0.98, P = 0.103） and ＇non-p-blockers＇ （adjusted OR： 0.99; 95% CI： 0.97-1.01, P = 0.328） arms. Importantly, older age was a significant predictor of symptomatic bradyarrhythmias in the ＇β-blockers＇ as compared to the ＇non-β-blockers＇ arms （adjusted OR： 1.09; 95% CI： 1.03-1.15, P = 0.003 vs. adjusted OR： 1.03; 95% CI： 0.98-1.09, P = 0.232, respectively）. Conclusion Older age was a significant predictor of symptomatic bradyarrhythmias in patients on β-blockers than those without β-blockers.
文摘OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.
文摘1 Introduction Beta-adrenoceptor blocking agents(beta-blockers)are now well established as cornerstone therapy in patients with systolic chronic heart failure(CHF).[1]Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4]However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.
文摘Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome;in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.
文摘This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.
文摘Management of portal hypertension has been the focus of the Baveno guidelines since 1990.This article explores the evolution of these recommendations and their impact on clinical practice.Initially reliant on invasive diagnostics such as the hepatic venous pressure gradient,later editions have incorporated non-invasive methods such as elastography and serum biomarkers.Management strategies have evolved substantially.Endoscopic surveillance has shifted from routine annual endoscopy to an individualized approach based on liver stiffness and platelet count.The role of non-selective beta-blockers(NSBBs)in primary prophylaxis has expanded.Endoscopic band ligation has become the preferred alternative for patients intolerant to NSBBs.In secondary prophylaxis,Baveno II replaced sclerotherapy with band ligation,and later guidelines confirmed the superiority of NSBBs combined with ligation.Transjugular intrahepatic portosystemic shunt emerged as the preferred rescue therapy,with early use emphasized in high-risk patients.Ongoing advancements continue to refine diagnostic and therapeutic strategies,further improving patient outcomes.
基金supported by the Open Competition Program of Hainan Yazhou Bay Seed Laboratory,China(Grant No.B23YQ1513)the Strategic Priority Research Program of the Chinese Academy of Sciences(Precision Seed Design and Breeding)(Grant No.XDA24030201)the National Science and Technology Major Project on Breeding of New Genetically Modified Organisms,China(Grant No.2016ZX08001003-001).
文摘Rice often suffers from pests,diseases,and weeds throughout its life cycle.The management of pests,diseases,and weeds with agrochemicals increases production costs and results in pesticide residues.Developing new germplasm and varieties with multiple resistances is the most economical,sustainable,and efficient way to solve these problems.In this study,marker-assisted backcrossing was used to pyramid multiple resistance genes,resulting in the development of a penta-resistance restorer line,B2A1920.This line was evaluated for its agronomic traits and resistance to diseases,pests,and herbicides.It was confirmed that B2A1920 contains the herbicide resistance gene Bar,the lepidopteran pest resistance gene Cry2Aa,the bacterial blight(BB)resistance gene Xa23,the blast resistance gene Pi2,and the brown planthopper(BPH)resistance genes Bph14 and Bph15.These genes confer resistance to glufosinate,lepidopteran pests,BB,blast,and BPH,respectively,while the line also exhibits elite agronomic traits.Its hybrids,Gui A×B2A1920,Quan 9311A×B2A1920,Yexiang A×B2A1920,Xianglong A×B2A1920,Tiantai A×B2A1920,and Shen 9A×B2A1920,likewise showed penta-resistance and superior agronomic performance.These results indicate the successful development of a cytoplasmic male sterile restorer line with high combining ability and penta-resistance.
基金Supported by Ministry of Health of the Russian Federation titled Development of a Hardware-Software Complex for the Non-Invasive Monitoring and Prediction of Circulatory Decompensation in Patients with Chronic Heart Failure,No.125030703255-7.
文摘BACKGROUND The six-minute walk test(6MWT)allows to determine,in addition to the main parameters,the time of heart rate recovery(THRR),cardiac function,adaptation index(AI),which characterize the compensatory reserve of patients with chronic heart failure(CHF).At the same time,the significance of these parameters in patients taking beta-blockers for CHF is insufficiently studied,taking into account the negative chronotropic effect of drugs.In this regard,it is relevant to identify factors that can characterize the compensatory capabilities of a patient with CHF during 6MWT,not related to the calculation of heart rate.AIM To identify hemodynamic indicators of the adaptive capabilities of patients with CHF during paired 6MWT depending on their intake of beta-blockers.METHODS Seventy-four patients with compensated CHF due to coronary heart disease and/or hypertension formed the main group,comprising 46 individuals who were taking beta-blockers,and a comparison group comprising 28 individuals who had not been taking beta-blockers for at least one month before 6MWT.All participants underwent Doppler echocardiography(DECG),paired 6MWT,with assessment of hemodynamic parameters before and after both the first and second test.AI,THRR,blood pressure variability(BPV)were calculated.Multivariate,correlation analyses,univariate analysis of variance were used.RESULTS There were no significant associations between adaptation characteristics and DECG parameters or functional class(FC)of CHF in patients of the main group.In the comparison group,the indicators of compensatory reserve were significantly and directly associated with left ventricular ejection fraction(LVEF),and inversely with FC CHF and cardiac cavity size.In both groups,a greater difference in systolic blood pressure between the end of the first and the beginning of the second 6MWT was significantly associated with a higher index of right ventricular systolic dysfunction(Tricuspid annular plane systolic excursion)and LVEF,as well as a smaller left ventricular size and mass,and a lower pulmonary artery systolic pressure in patients in the main group.CONCLUSION Systolic BPV,measured immediately after 6MWT and 20 minutes after its completion,can indirectly characterize the compensatory reserve in patients with CHF,regardless of their beta-blocker intake.
文摘The pharmacokinetic-pharmacodynamics of propranolol (PPL) and its activemetabolite 4-hydroxypropranolol (4-OH-P) was studied on Chinese subJects by single or multipleoral administration. The efficiency of beta-blockade was measured as the reduction of heart rates orblood pressure in the supine and upnght positions during rest or exercise period. After a single doseof 40 mg PPL, the plasma concentration of 4-OH-P was quite high, C (m) max and AUC (m) were26. 1±13.2 ng/ml and 180±69 ng.h/ml respectively, which were 50% and 73% of those of PPL.Whileafter multiple dose administration, the plasma PPL concentration increased much greater than that insingle administration and the 4-OH-P/PPL plasma level ratio fell from 0.79±0.64 at single dose toonly 0.48±0.32 at steady-state. The pharmacodynamic half-life of PPL on inbibiting exercising heart-rate was much longer than the halflife of drug concentration (8.78±2.27 vs 4.23±1.33 h. P<0.0 1).The Css 50. plasma concentration at steady-state producing 50% maximal efficacy, was 44.66±35.24ng/ml. The study showed that 4-OH-P is an important active metabolite of PPL and one of thepossible factors causing the considering variations in the response to PPL in Chinese people.
