Background:Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients.Methods:Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old). The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated.Results:Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612–0.746) and 0.655 (95% CI: 0.584–0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively.Conclusions:The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

Objectives We aimed to determine the predictive value of cardiopulmonary exercise testing (CPX) in the prognosis of patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). Methods We conducted a retrospective study including patients who underwent CPX within 1 year of PCI between September 2012 and October 2017. Patients were followed-up until the occurrence of a major adverse cardiac event (MACE) or administrative censoring (September 2019). A Cox regression model was used to identify significant predictors of a MACE. Model performance was evaluated in terms of discrimination (C-statistic) and calibration (calibration-in-the-large). Results In total, 184 patients were included and followed-up for a median 51 months (interquartile range: 36–67 months) and 32 events occurred. Multivariable analysis revealed that body mass index and Gensini score were significant predictors of a MACE. Four CPX-related variables were found to be predictive of a MACE: premature CPX termination, peak oxygen uptake, heart rate reserve, and ventilatory equivalent for carbon dioxide slope. The final prediction model had a C-statistic of 0.92 and calibration-in-the-large 0.58%. Conclusion CPX-related parameters may have high predictive value for poor outcomes in patients with ACS who undergo PCI, indicating a need for appropriate treatment and timely management.

Preeclampsia (PE), a hypertensive multisystem disorder, can lead to increased maternal and fetal mortality and morbidity. Sphingosine-1-phosphate (S1P) plays various roles, depending on the cell type, by binding to S1P receptors (S1PR). The present study evaluated the changes of S1PRs and investigated the potential role of S1PRs in pregnancy-induced hypertension. PE rats were established by reduced uterine perfusion pressure. The involvement of S1PR2 was evaluated using JTE-013, a specific S1PR2 antagonist, in PE rats. After the treatment, inflammatory cytokines were evaluated using enzyme linked immunosorbent assay, and the expression of vascular endothelial growth factor (VEGF), inducible nitric oxide synthase (iNOS) activation and endothelial nitric oxide synthase (eNOS) were evaluated by reverse transcription-quantitative PCR and western blotting. Results showed that S1PR2, but not S1PR1 and S1PR3, was significantly increased in the serum and placenta tissues of PE rats. Notably, JTE-013 significantly decreased blood pressure, attenuated infiltration of inflammatory cells and decreased inflammation, as indicated by the decreased expression of inflammatory cytokines, including tumor necrosis factor-α, interleukin-1β (IL-1β) and IL-6, in placental tissues. Mechanistic studies demonstrated that JTE-013 significantly increased the expression of VEGF and decreased the expression of fms-like tyrosine kinase 1 in placental tissue. Furthermore, JTE-013 prevented iNOS activation and increased eNOS in placental tissue. In summary, the present study demonstrated that S1PR2 contributed to hypertension and angiogenesis imbalance in PE rats.

The prognostic impact of incomplete revascularization (ICR) on patients underwent percutaneous coronary intervention (PCI) was vague. Our research aimed to objectify the level of ICR by residual SYNTAX score (rSS) and evaluate the impact of ICR on exercise tolerance. We enrolled 87 patients who completed cardiopulmonary exercise testing (CPET) within 12 months after PCI, retrospectively. According to rSS, patients were divided into rSS = 0 group, 0 < rSS ≤ 8 group, and rSS > 8 group. The CPET variables--including peak metabolic equivalent (MET peak ), percentages of predicting value of MET peak (MET peak %pred), MET at anaerobic threshold (AT), peak oxygen uptake (VO 2peak ), percentages of predicting value of VO 2peak (VO 2peak %pred), VO 2 at AT--were collected and compared. Among rSS = 0, 0 < rSS ≤ 8 and rSS > 8 groups, patients with higher rSS had progressively lower MET peak , MET peak %pred, VO 2peak %pred, VO 2 at AT, and MET at AT, which indicate reduced exercise tolerance. And further multiple comparisons showed that there were no statistically significant differences between rSS = 0 and 0 < rSS ≤ 8 groups, while the aforementioned CPET variables were significantly lower in rSS > 8 group compared with rSS = 0 group. Logistic regression analysis showed that rSS was an independent risk factor for reduced exercise tolerance. 1. There was no significant difference in exercise tolerance between rSS = 0 and 0 < rSS ≤ 8 groups. However, the exercise tolerance of patients in rSS = 0 and 0 < rSS ≤ 8 groups was better than that of patients in rSS > 8 group; 2. rSS was an independent risk factors for reduced exercise tolerance.

Background: Desloratadine is a drug with a phenotypic polymorphism in metabolism and has been approved for use in many countries to treat allergic diseases. CYP2C8 and UGT2B10 are metabolic enzymes, which may be involved in the metabolism of desloratadine Objective: This study was aimed to demonstrate bioequivalence between the test product (desloratadine tablet) and reference product AERIUS (5mg) both orally. And we directly examine the role of UGT2B10 and CYP2C8 genotypes in Chinese healthy subjects with different Desloratadine metabolic phenotypes. Results: The mean serum concentration-time curves of desloratadine and 3-OH-desloratadine were similar between the test product and reference product. For the PK similarity comparison, the 90% CIs for the geometric mean ratios of Cmax, AUC0- t, and AUC0-∞ of desloratadine and 3-OH-desloratadine of test and reference product were completely within 80-125%. None of all 56 subjects had serious adverse events. Only 2 subjects were poor-metabolizers in 56 healthy subjects. There was no significant correlation between investigated genotypes of CYP2C8 and UGT2B10 and the metabolic ratio. Conclusions: The test desloratadine tablet was bioequivalent to the reference product. No direct relationship between CYP2C8 and UGT2B10 genotypes and desloratadine metabolic ratio was identified.