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OBJECTIVE: To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice. DESIGN: A multicentre prospective survey of sociodemographic characteristics, medical history, clinical features, in-hospital investigations, treatment practices and major events among patients with suspected ACS. SETTING: Large urban public hospitals. PATIENTS: Consecutive patients admitted to in-patient facilities with a diagnosis of suspected acute myocardial infarction (MI) or unstable angina pectoris. MAIN OUTCOME MEASURES: Myocardial infarction/re-infarction, heart failure, death. RESULTS: Between September 2004 and May 2005, data were collected prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of China. An initial diagnosis of ST elevation MI, non-ST elevation MI and unstable angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was inconsistent with objective measures in up to 20% of cases. At both tertiary and non-tertiary centres, there was little evidence that clinical risk stratification was used to determine the intensity of investigation and management. The mortality rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary centres, but reported in-hospital re-infarction rates (8%) and heart failure rates (16%) were substantially higher at non-tertiary centres. CONCLUSION: This study has identified a number of areas in the management of ACS patients, including diagnosis and risk stratification, which deviate from current guidelines. These findings will help inform the introduction of widely used quality improvement initiatives such as clinical pathways. [ABSTRACT FROM AUTHOR]

Objective: To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice. Design: A multicentre prospective survey of socio-demographic characteristics, medical history, clinical features, in-hospital investigations, treatment practices and major events among patients with suspected ACS. Setting: Large urban public hospitals. Patients: Consecutive patients admitted to in-patient facilities with a diagnosis of suspected acute myocardial infarction (Ml) or unstable angina pectoris. Main outcome measures: Myocardial infarction/re- infarction, heart failure, death. Results: Between September 2004 and May 2005, data were collected prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of China. An initial diagnosis of ST elevation Ml, non-ST elevation Ml and unstable angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was inconsistent with objective measures in up to 20% of cases. At both tertiary and non-tertiary centres, there was little evidence that clinical risk stratification was used to determine the intensity of investigation and management. The mortality rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary centres, but reported in-hospital re-infarction rates (8%) and heart failure rates (16%) were substantially higher at non-tertiary centres. Conclusion: This study has identified a number of areas in the management of ACS patients, including diagnosis and risk stratification, which deviate from current guide- lines. These findings will help inform the introduction of widely used quality improvement initiatives such as clinical pathways. [ABSTRACT FROM AUTHOR]

Background: Connective tissue growth factor (CCN2) is upregulated in pancreatic fibrosis and desmoplastic pancreatic tumours. CCN2 interacts with integrin α5β1 on pancreatic stellate cells (PSC) in which it stimulates fibrogenesis, adhesion, migration, and proliferation. Aim: To determine the structural domain(s) in CCN2 that interact with integrin α5β1 to regulation PSC functions. Methods: Primary activated rat PSC were tested for their adherence to isoforms of CCN2 comprising modules 1-4 (CCN21-4), modules 3-4 (CCN23-4), module 3 alone (CCN23), or module 4 alone (CCN24). Adhesion studies were performed in the presence of EDTA, divalent cations, anti-integrin α5β1 antibodies, CCN2 synthetic peptides, or heparin, or after pretreatment of the cells with heparinase, chondroitinase, or sodium chlorate. CCN2 integrin α5β1 binding was analysed in cell free systems. The ability of CCN21-4, CCN23-4, or CCN24 to stimulate PSC migration was evaluated in the presence of anti-integrin α5β1 or heparin. Results: PSC adhesion was stimulated by CCN21-4, CCN23-4, or CCN24 and supported by Mg2+ but not Ca2+. CCN24 supported PSC adhesion or migration were blocked by anti-integrin α5β1 antibodies or by treatment of cells with heparinase or sodium chlorate. A direct interaction between CCN24 and integrin α5β1 was demonstrated in cell free assays. The sequence GVCTDGR in module 4 mediated the binding between CCN24 and integrin α5β1 as well as CCN24 mediated PSC adhesion and migration. Conclusions: A GVCTDGR sequence in module 4 of CCN2 is a novel integrin α5β1 binding site that is essential for CCN2 stimulated functions in PSC and which represents a new therapeutic target in PSC mediated fibrogenesis. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of an aspirin-clopidogrel combination with those of the specific glycoprotein IIb/IIIa inhibitor tirofiban on myocardial no-reflow, nitric oxide concentration and activity of nitric oxide synthase (NOS) isoforms in a mini-swine model of acute myocardial infarction and reperfusion. Methods: Area of no-reflow was determined by both myocardial contrast echocardiography and pathological means in 40 mini-swine randomly assigned to five study groups: eight controls, eight pretreated with aspirin-clopidogrel combination for three days, eight given an intravenous infusion of tirofiban, eight treated with ischaemic preconditioning and eight sham operated. The acute myocardial infarction and reperfusion model was created with 3 h occlusion of the left anterior descending coronary artery followed by 1 h reperfusion. Results: Compared with the control group, tirofiban significantly decreased the area of no-reflow assessed echocardiographically and pathologically, from 78.5% to 22.8% and 82.3% to 23.2%, respectively (both p < 0.01), and increased blood nitric oxide concentration (p < 0.05), enhanced constitutive NOS activity from 0.51 to 0.81 U/mg protein and mRNA expression from 0.47% to 0.66%, but decreased inducible NOS activity from 0.76 to 0.41 U/mg protein and mRNA expression from 0.54% to 0.39% in reflow myocardium (all p < 0.05-0.01). In contrast, the aspirin-clopidogrel combination did not significantly modify the above parameters (all p > 0.05) except for decreasing inducible NOS activity from 0.76 to 0.39 U/mg protein (p < 0.01) and mRNA expression from 0.54% to 0.40% (p <0.05). Conclusions: Tirofiban is very effective in attenuating myocardial no-reflow; in contrast, aspirin-clopidogrel combination is totally ineffective. These findings also support the concept that endothelial protection, apart from platelet inhibition, contributes to the beneficial effect of tirofiban on myocardial no-reflow. [ABSTRACT FROM AUTHOR]

The article investigates the effect of interleukin 10 concentration within two weeks in patients with unstable angina in Great Britain. This study found that the admission of simvastatin to patients not only significantly reduces low density lipoprotein cholesterol and CRP concentrations within two weeks, but also dramatically increases the concentration of the anti-inflammatory cytokine interleukin 10.