Introduction In 2014, the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) has shown that sacubitril/valsartan can reduce the risk of hospitalization and death from cardiovascular causes more effectively than enalapril (an ACEI) in heart failure patients with reduced ejection fraction (HFrEF). Similarly, the PARADIGM-HF trial (Comparison of Sacubitril-Valsartan vs. Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode) came to similar conclusions and extended the PARADIGM-HF trial results in 2019. Since then, numerous new studies have provided further insight in HFrEF, sacubitril/valsartan can reduce N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, increase left ventricular ejection fraction (LVEF), reverse ventricular remodeling, and reduce other non-fatal manifestations of clinical deterioration as compared to ACEI/ARB. However, few trials have compared the effects of these drugs in patients shortly after AMI. Therefore, it is necessary to further explore the clinical efficacy and safety of sacubitril/valsartan vs. valsartan in patients with AMI. Methods We conducted an open-label, prospective, randomized controlled trial to determine the superiority in ameliorating ventricular remodeling and preventing of heart failure in patients with AMI after percutaneous coronary intervention (PCI), 148 patients were randomly assigned (85 to sacubitril/valsartan and 63 to valsartan). Results LAV, LVDV, and LVSV were all decreased in the sacubitril/valsartan group when compared with before treatment, but there was no difference between the sacubitril/valsartan group and the valsartan group. In addition, compared with before treatment in the sacubitril/valsartan group, the heart global work index (GWI) and the global work efficiency (GWE) increased, while the heart global wasted work (GWW) decreased. Patients in the sacubitril/valsartan group have similar MACE and adverse side effects to those in the valsartan group. Conclusion Sacubitril/valsartan has the same performance as valsartan in inhibiting ventricular remodeling and preventing heart failure after PCI in patients with AMI, and its clinical application is safe. It provides a clinical foundation for the application of sacubitril/valsartan in patients with AMI.

/pdf/effects-of-sacubitril-valsartan-on-cardiac-reverse-2rvb7h0b.pdf

Effects of sacubitril/valsartan on cardiac reverse remodeling and cardiac resynchronization in patients with acute myocardial infarction

Background The angiotensin-receptor neprilysin inhibitor (ARNI) sacubitril/valsartan was shown to be superior to the angiotensin receptor blocker (ARB) valsartan in terms of reversing heart failure classification (NYHA classification), reducing N-terminal pro-brain natriuretic peptide (NT-proBNP) level and cardiovascular mortality in many studies. Yet, the efficacy of ARNI did not come from patients with acute myocardial infarction (AMI). Methods We searched databases for research published from inception to July 29, 2022, that reported cardiac reverse remodeling (CRR) or security indices. Two reviewers independently screened literature, extracted data, and assessed the risk of bias. Nine studies enrolling 1,369 patients were included to perform a meta-analysis. There were 716 patients in the ARNI group and 653 in the ARB group. Results ARNI outperformed ARBs in terms of CRR indices, with striking changes in left ventricular ejection fraction (EF) (MD: 4.12%, 95%CI: 2.36, 5.88, P < 0.0001), diameter (MD: –3.40 mm, 95%CI: –4.30, –2.94, P < 0.00001, I2 = 0%) and left atrial diameter (MD: –2.41 mm, 95%CI: –3.85, –0.97, P = 0.001, I2 = 0%), other indices there showed no significant improvements. The incidences of major adverse cardiac events (RR: 0.47, 95%CI: 0.34–0.65, P < 0.00001, I2 = 0%), the heart failure (RR: 0.37, 95%CI: 0.23–0.61, P < 0.0001, I2 = 0%), readmission (RR: 0.54, 95%CI: 0.36–0.80, P = 0.003, I2 = 29%) in the sacubitril/valsartan group were lower than the ARB group, while the incidences of cardiac death (RR: 0.56, 95%CI: 0.28, 1.09, P = 0.09), the myocardial infarction (RR: 0.83, 95% CI: 0.39, 1.77, P = 0.63), adverse side effects (RR: 1.67, 95% CI: 0.89, 3.13, P = 0.11) showed no difference. Conclusion This research indicated that early initiation of sacubitril/valsartan in patients after AMI was superior to ARBs in reducing the risks of major adverse cardiac events, heart failure, readmission, and enhancing left ventricular EF, decreasing diameter, left atrial diameter. As for the other outcomes (the incidences of cardiac death, myocardial infarction, and adverse side effects), sacubitril/valsartan demonstrated no obvious advantage over ARBs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier [CRD42022307237].

/pdf/efficacy-and-safety-of-sacubitril-valsartan-vs-valsartan-in-3karthof.pdf

Efficacy and safety of sacubitril/valsartan vs. valsartan in patients with acute myocardial infarction: A meta-analysis

The prevalence of hyperuricemia is increasing worldwide. The emergent concerns have provoked investigations into the management of AUH. While there are existing reviews discussing the pharmacological treatment of AUH based on randomized controlled trials, an updated review specifically focusing on the safety and effectiveness of pharmacological interventions in real-world settings for AUH is currently lacking. For that reason, the objective of this review was to provide a comprehensive summary of the existing evidence extracted from the available research studies that focused on the safety and effectiveness of the adopted medical treatment approaches for AUH in real-world settings. Based on the analysis verdicts, benzbromarone appeared to be the most effective urate-lowering therapy (ULT) in achieving the desired serum uric acid (sUA) levels and in lowering the incidence of initial gout flares. Febuxostat also demonstrated valuable effectiveness in our analysis. On the other hand, based on the safety of the popular allopurinol medication, one real-world study identified skin-related adverse effects associated with it. However, it is important to note that the studies included in the analysis were predominantly conducted in Japan and Taiwan, which limits the generalizability of these findings. To enhance the applicability of the review outcomes, future global studies should cover a wider assortment of populations from various countries and regions.

An Up-to-date Systematic Review on Real-world Evidence for the Management of Asymptomatic Hyperuricemia

1Guangdong Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine, Foshan, People’s Republic of China; 2The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China; 3Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, People’s Republic of China; 4The Ninth People’s Hospital of Nanhai District, Foshan, People’s Republic of China

https://www.dovepress.com/getfile.php?fileID=79460

Efficacy of Moxibustion Smoke for Stage 1 Post-Stroke Shoulder-Hand Syndrome: Protocol for a Multi-Center, Single-Blind Randomized Sham-Controlled Trial [Letter]

Objective To explore the clinical effect of Hufu copper scraping on shoulder-hand syndrome after stroke. Methods A total of 60 patients with shoulder-hand syndrome after stroke admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine were enrolled between January 2020 and June 2021. According to the random number table method, they were divided into the control group (n = 30) and the intervention group (n = 30). The control group was given routine rehabilitation intervention, while the intervention group was additionally given Hufu copper scraping. The intervention effect, occurrence of adverse reactions during the intervention, pain, swelling degree of affected hands, serum calcitonin gene-related peptide (CGRP), substance P (SP), and Barthel index before and after 2 months of intervention were compared between the two groups. Results After intervention, the total response rate of the intervention group was significantly higher than that of the control group (96.67% vs 80.00%) (P < 0.05). After intervention, the score of the visual analogue scale (VAS) and water displacement in the intervention group were lower than those in the control group (P < 0.05). After intervention, levels of CGRP and SP in the intervention group were lower than those in the control group, while the Barthel index was higher compared to the control group (P < 0.05). Conclusion The intervention effect of Hufu copper scraping is good, which can promote the recovery of related symptoms, relieve pain and swelling of affected hands, downregulate levels of disease-promoting markers, and accelerate recovery of related function in patients with shoulder-hand syndrome after stroke.

https://downloads.hindawi.com/journals/emi/2022/9165141.pdf

Clinical Effect of Hufu Copper Scraping on Shoulder-Hand Syndrome after Stroke

Introduction:Prognostic benefits of zofenopril over ramipril in the early phase of acute myocardial infarction have been reported by the SMILE study, but these benefits have not been tested in clin...

https://journals.sagepub.com/doi/pdf/10.1177/1470320320946530

Zofenopril versus ramipril in the early phase of acute myocardial infarction with systolic dysfunction: A retrospective study.

Objective This study aims to evaluate the safety and efficacy of various levels of moxibustion smoke concentration (MSC), represented by particulate matter 10mm (PM10), on pain and motor dysfunction in patients with stage 1 post-stroke shoulder-hand syndrome (SHS). Materials and Methods In this multi-center, sham-controlled, single-blind, randomized controlled trial (RCT), a total of 140 eligible patients with stage 1 post-stroke SHS will be recruited from March 2022 to February 2023 and randomly allocated to five groups in a ratio of 1:1:1:1:1. Moxibustion, in addition to standard medical care, will be applied to subjects in all groups. No acupoints on the affected upper limb will be utilized. Moxibustion smoke therapy, with varying levels of MSC, will be applied to the five groups as follows: (A) sham control group, (B) zero MSC group, (C) low MSC group, (D) medium MSC group, and (E) high MSC group. Patients in each group will be treated for 20 minutes per session, with five sessions each week, over a course of six weeks, with a total follow-up interval of eight weeks. The primary outcome measure will be a visual analog scale (VAS) assessment of the intensity of regionalized pain in the affected upper limb. Secondary outcome measures will include scoring on the Fugl-Meyer Assessment of the Upper Extremity Scale (FMA-UE), the Modified Barthel Index (MBI) and the measurement of somatosensory evoked potential (SEP). All participants will be evaluated before treatment, during treatment (ie, at two weeks and four weeks), immediately after concluding treatment (ie, at six weeks) and at two weeks post-treatment (ie, at eight weeks). Intention-to-treat analysis will be applied. Trial Registration Number ChiCTR2100043076.

https://www.dovepress.com/getfile.php?fileID=78766

Efficacy of Moxibustion Smoke for Stage 1 Post-Stroke Shoulder-Hand Syndrome: Protocol for a Multi-Center, Single-Blind Randomized Sham-Controlled Trial

Objective To compare the efficacy of febuxostat and allopurinol in the treatment of chronic kidney disease (CKD) at stages 3∼5 with hyperuricemia. Methods A total of 100 patients with stage 3 to 5 CKD with hyperuricemia in our hospital from July 2018 to December 2019 were selected and divided into the control group (n = 50) and the experimental group (n = 50) according to the random number expression method, the control group on the basis of conventional treatment with allopurinol treatment, the experimental group based on conventional treatment using the febuxostat be treatment. The clinical efficacy, incidence of adverse reactions, and renal function indexes, blood urea nitrogen (BUN), serum creatinine (Scr), serum sodium (Na), serum potassium (K), and serum uric acid (UA) before and after treatment were compared between the two groups. Results The total effective rate of the experimental group and the control group was 82.00% and 78.00%, respectively, with little difference (P > 0.05); compared with before treatment, BUN, Scr, and UA of the two groups were decreased (P < 0.05); and the degree of decline in the experimental group was significantly greater than that in the control group (P < 0.05); the incidence of adverse reactions in the control group was 22.00%, which was significantly higher than that in the experimental group (10.00%) (P < 0.05). Conclusion Compared with allopurinol, febuxostat can improve renal function, reduce UA levels, and reduce the occurrence of complications, with high safety, which is worthy of further clinical promotion.

/pdf/comparison-of-febuxostat-and-allopurinol-in-the-treatment-of-2g2imrso.pdf

Comparison of Febuxostat and Allopurinol in the Treatment of Patients with Chronic Kidney Disease Stage 3∼5 with Hyperuricemia

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Papers

Zofenopril versus ramipril in the early phase of acute myocardial infarction with systolic dysfunction: A retrospective study.

Efficacy of Moxibustion Smoke for Stage 1 Post-Stroke Shoulder-Hand Syndrome: Protocol for a Multi-Center, Single-Blind Randomized Sham-Controlled Trial

Comparison of Febuxostat and Allopurinol in the Treatment of Patients with Chronic Kidney Disease Stage 3∼5 with Hyperuricemia