1 他汀———自然界送给人类的完美礼物 1976年，日本三共制药公司的生物化学家Endo经过6000多次科学实验，在真菌（penicillium citrinum）培养液中偶然提取出了一种新的次生代谢产物———ML-236B，能够抑制胆固醇合成过程中的限速酶3-羟基3-甲基戊二酰辅酶A还原酶（HMG-CoA），从而使胆固醇的合成减少50%。ML-236B后来被命名为康帕丁（compactin）、美伐他汀（mevastatin）。尽管三共制药并没有将其推向市场，但这丝毫掩盖不了Endo成为“他汀之父”的历史地位，美伐他汀是第一个在自然界中发现的他汀（statins）。1987年，美国默克公司通过将美伐他汀化学结构中某个特定碳原子羟基化研制出了第一个半人工合成的他汀———洛伐他汀（lovastatin）。之后，普伐他汀（pravastatin）、辛伐他汀（simvastatin）、氟伐他汀（fluvastatin）、阿托伐他汀（atorvastatin）和瑞舒伐他汀（rosuvastatin）等一系列他汀类药物相继问世，开创了降脂治疗及心血管预防的新时代，他汀的应用使心血管疾病的死亡率总体下降了20%～30%。因此，有科学家将这种神奇的药丸称为“超级他汀（super statins）”、“降低胆固醇的青霉素（penicillin for cholesterol）”，也被誉为自然界送给人类的完美礼物（a gift from nature）。
Objective To evaluate the effects and mechanisms of glucose-insulin-potassium(GIK)on post-procedural myocardial injury(PMI)after percutaneous coronary intervention(PCI).Methods A total of 200 non-diabetic patients with documented coronary heart disease(CHD)were divided into the Group GIK and Group G,with 100 patients in each group.Patients in Group G were given intravenous infusion of glucose solution 2 hours before PCI.As compared,patients in Group GIK were given GIK.Results Both post-procedural creatine phosphokinase isoenzyme MB(CK-MB;62.1±47.8 vs.48.8±52.6 U/L,P=0.007)and cTnI(0.68±0.83 vs.0.19±0.24 ng/mL,P<0.001)in Group GIK were significantly higher than those in Group G.In Group G,9.0%and 4.0%of patients had post-procedural increases in CK-MB 1-3 times and>3 times,which were significantly lower than those in Group GIK(14.0%and 7.0%,respectively;all P values<0.01);13.0%and 7.0%of patients had post-procedural increases in cTnI 1-3 times and>3 times,which were also significantly lower than those in Group GIK(21.0%and 13.0%,respectively;all P<0.001).Pre-procedural(10.2±4.5 vs.5.1±6.3,P<0.001)and post-procedural rapid blood glucose(RBG)levels(8.9±3.9 vs.5.3±5.6,P<0.001)in Group G were higher than those in Group GIK.In adjusted logistic models,usage of GIK(compared with glucose solution)remained significantly and independently associated with higher risk of post-procedural increases in both CK-MB and cTnI levels>3 times.Furthermore,pre-procedural RBG levels<5.0mmol/L were significantly associated with higher risk of post-procedural increases in both CK-MB and cTnI levels.Conclusions In non-diabetic patients with CHD,the administration of GIK may increase the risk of PMI due to hypoglycemia induced by GIK.
OBJECTIVE To access the efficacy and safety of the double-ProGlide technique for the femoral vein access-site closure in cryoballoon ablation with uninterrupted oral anticoagulants(OAC),and its impact on the electrophysiology laboratory time as well as hospital stay after the procedure in this observational study.METHODS Patients with atrial fibrillation undergoing cryoballoon ablation with uninterrupted OAC at Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing,China from May 2019 to May 2021 were enrolled in this study.From October 2020,double-ProGlide technique was consistently used for hemostasis(ProGlide group),and before that conventional manual compression was utilized(manual compression group).The occurrence of vascular and groin complications was accessed during the hospital stay and until the three-month follow-up.RESULTS A total of 140 participants(69.30%of male,mean age:59.21±10.29 years)were evaluated,70 participants being in each group.Immediate hemostasis was achieved in all the patients with ProGlide closure.No major vascular complications were found in the ProGlide group while two major vascular complications were occurred in the manual compression group.The incidence of any groin complication was obviously higher in subjects with manual compression than patients with ProGlide devices(15.71%vs.2.86%,P=0.009).In addition,compared with the manual compression group,the ProGlide group was associated with significantly shorter total time in the electrophysiology laboratory[112.0(93.3–128.8)min vs.123.5(107.3–158.3)min,P=0.006],time from sheath removal until venous site hemostasis[3.8(3.4–4.2)min vs.8.0(7.6–8.5)min,P<0.001],bed rest time[8.0(7.6–8.0)h vs.14.1(12.0–17.6)h,P<0.001]and hospital stay after the procedure[13.8(12.5–17.8)h vs.38.0(21.5–41.0)h,P<0.001].CONCLUSIONS Utilization of the double-ProGlide technique for hemostasis after cryoballoon ablation with uninterrupted OAC is feasible and safe,which has the clinical benefit in reducing the total
