Tenapanor is a novel phosphorus-lowering drug, which mainly inhibits sodium/hydrogen exchange protein 3 (NHE3), and also reduces intestinal phosphorus absorption by down-regulating the expression of sodium phosphate co-transporter protein (NAPI). Tenapanor is mainly used for the treatment of hyperphosphatemia in patients with end-stage renal disease-hemodialysis (ESRD-HD). Diarrhea is the most common adverse reaction to this product. This article reviews Tenapanor by performing a literature search on its pharmacological effects, pharmacokinetic properties, clinical evaluation, safety, drug interactions and dosage.

Objective To compare the difference of peripheral blood leucocyte percentages in malaria patients among Sysmex‐XE5000 ,CellaVisionDM96 and manual microscope classification ,and to verify the accuracy and reliability of the Sysmex‐XE5000 automatic blood corpuscle detection instrument for detecting the leukocyte classification in blood routine .Methods The leucocyte percentages data in 82 cases of malaria detected by using the Sysmex‐XE5000 in the Shenzhen Municipal Third People′s Hospital from January 2011 to December 2015 were retrospectively collected ;the peripheral blood smear in 82 cases of malaria obtained the percentages after the classification by the CellaVisionDM 96 ;then the peripheral blood smear was performed the leucocyte classifica‐tion by the manual microscopy for calculating the percentage .Results In the pairwise comparison of percentage obtained from the peripheral blood leucocyte classification by Sysmex‐XE5000 ,CellaVisionDM96 and manual microscopy ,only the monocytes percent‐age had statistical difference between CellaVisionDM 96 and manual microscopy (P<0 .05) ,the other differences had no statistical significance (P>0 .05) .Conclusion By comparing the peripheral blood leucocyte percentages data in malaria patients by Sysmex‐XE5000 ,CellaVisionDM96 and manual microscopic classification ,it is indicated that the leukocyte classification data by Sysmex‐XE5000 are accurate and reliable ,malaria parasite does not affect peripheral blood leukocyte classification ,but it is necessary to pay more attention to monocytes classification in CellaVision DM 96 classification .

Objective:To evaluate the value of adenosine triphophate (ATP)stress/rest nuclide myocardial perfusion imaging (MPI)in the diagnosis of female patients with coronary heart disease (CHD).Methods:The clinical materials of 47 female suspected CHD patients were retrospectively analyzed,aged from 39 to 74 years,and the average age was (53.7±6.3)years old.All patients were hospitalized and underwent two-day ATP stress and rest nuclide MPI and coronary angiography (CAG)in two weeks. The results and images of MPI and CAG were evaluated by more than 2 attending physicians. Using CAG as the “gold standard”, the diagnostic efficiency (sensitivity, specificity and accuracy) of MPI for CHD was evaluated. Results:Compared with CAG, the sensitivity,specificity and accuracy of ATP stress MPI in diagnosing the female CHD patients were 81.3% (13/16),77.4% (24/31)and 78.7% (37/47)individually;the positive predictive value and negative predictive value were 65.0% (13/20)and 88.9% (24/27).There were no severe adverse effects in the ATP stress test and the incidence of adverse effects was 85.1%.Conclusion:There is a highly diagnostic efficiency of ATP stress MPI in the CHD patients.It can be the first choice of examination methods for screening without injury and diagnosing the myocardial ischemia in the female patients.

Objective To investigate the clinical characteristics and related pathogenetic factors in Takayasu arteritis with myocardial involvement.Methods We retrospectively analyzed clinical data of Takayasu arteritis patients with myocardial involvement of Peking Union Medical College Hospital from 1987 to 2013.Results Myocardial involvement was diagnosed in 23 patients from 86 Takayasu arteritis patients.Sixty-five percent (15/23) of patients presented with congestive heart failure.Fifteen patients were without coronary artery involvement.Sixty-five percent (15/23) of patients with mild to moderate hypertension.Seventyfour percent(17/23) patients had pulmonary hypertension.Left ventricular ejection fraction was (34.70 ±0.09)％.Glucocorticco costeroid and immunosuppressive therapy could significantly increase left ventricular ejection fraction (t=4.302,P＜0.05).Conclusion We emphasize that myocardial involvement is common in Takayasu arteritis.It is an independent risk factor that impacts the prognosis.Early detection of myocardial involvement and effective therapy can improve the prognosis.

Objective There is little research on the relationship of gene polymorphism of CYP2C19 and clopidogrel response after percutaneous transluminal angioplasty and stenting ( PTAS) in patients with ischemic cerebrovascular disease.The study aimed to investigate the relationship between gene polymorphism and high on-treatment platelet reactivity ( HTPR ) after PTAS and 6 months of regular dual antiplatelet administration in patients. Methods A total of 145 Chinese patients treated with PTAS in our de-partment from January 2011 to March 2014 were enrolled in this study.According to the gene sequencing, patients were divided into wild-type group(CYP2C19*1/*1,69 cases) and mutation group(heterozygous mutation CYP2C19*1/*2 and homozygous mutation CYP2C19*2/*2, 76 cases).Patients received a 100mg/d aspirin and 75mg/d clopidogrel maintenance dose (MD) as dual anti-platelet therapy after PTAS.The clopidogrel inhibition effect was measured by thrombelastography ( TEG) system 6 months after PTAS. Routine cerebral artery digital subtraction angiography was applied to evaluate whether there was restenosis in stent and logistic regres-sion analysis was used to analyze the influential factors of HTPR after PTAS and clopidogrel adminstration. Results After 6 months'regular administration of clopidogrel after PTAS, the platelet adenosine diphosphate ( ADP ) receptor inhibition rates in wild-type group, heterozygous mutation and homozygous mutation group were respectively (58.43 ±21.98)%, (47.80 ±22.93)%, (37.53 ± 21.84)%.The platelet ADP receptor inhibition rate was significantly decreased compared with wild-type group(P=0.001).Carriers of at least one CYP2C19 loss-of-function ( LOF) allele had a higher frequency of clopidogrel HTPR (35.5% vs17.4 % for patients with and without LOF alleles, respectively;P=0.014) .Using multivariate logistic regression analysis, the carriage of CYP2C19 LOF alleles was an independent predictor of the post-procedure HTPR (OR=2.356, 95% CI:1.053-5.272, P=0.037).The rate of ISR was remarkably higher in patients with at least one CYP2C19*2 alleles compared with wild-type patients(11.8%vs 1.4%, P=0.019) . Conclusion In patients with ischemic cerebrovascular disease, the CYP2C19 LOF allele had significant impact on post-procedure clopidogrel HTPR and the prognosis of ISR after PTAS.

Objective To varify contrast-enhanced ultrasound (CEUS) quantitative analysis plaque enhancement is able to assess the intraplaque neovascularization.Methods The abdominal aortas were examined with CEUS in 9 atherosclerosis rabbits established by feeding high-fat diet.Sonographic examinations were performed with ultrasound instruments equipped with low mechanical index contrast imaging software.Contrast agent SonoVue was used with a dose of 0.2 ml,The enhanced intensity (EI) with the plaque and the ratio of EI within the plaque to that in the lumen of the carotid artery was calculated with QLab software,Each aorta specimen was stained with F8 (von willebrand factor) for mierovessel.The quantitative parameters EI and ratio were compared with the immunohistochemical study results.Results The mean value of EI and ratio were (3.91 ± 0.87)dB and 0.30 ± 0.06,respectively.Five specimens showed positive F8 staining and 4 showed negative.EI and ratio were significantly greater in positive group than in negative group [(4.47 ± 0.60) dB vs (3.22 ± 0.62) dB,0.34 ± 0.05 vs 0.25 ± 0.05].CEUS quantitative parameters EI ( r =0.779,P =0.013) and ratio ( r =0.693,P =0.019) were correlated to microvessels marked with F8,respectively.Conclusions It is histologically validated that CEUS quantifies the neovascularization in atherosclerosis plaques.CEUS provides a window for plaque risk stratification.

Objective Observing the effect of Shuganyishen formula on hormone-dependant metastatic breast cancer and the mechanisms of anti-resistance and endocrine therapy. Methods 226 ITT cases were divided into two cohorts by treatment. 126 cases were treated with the combination of Shuganyishen formula and standard western medicine including endocrine therapy, and 100 cases were treated with western medicine alone. The end points were time to progress (TTP) and overall survival and quality of life (QOF). The effect of Shuganyishen formula on growth of TAM-resistance cell line in vitro was observed. Results There were statistical significances of median TTP between combination and western medicine in Luminal A (ER+ /PR+, HER2-) as well as Luminal B (ER+/PR+, HER2+), but no significances of OS; The extent and incidence of hot flush, sweat and syndromes related to bone were decreased significantly in combination treated group. Shuganyishen formula could reverse resistance to TAM. Conclusion Patients with LuminalA and LuminalB metastatic breast cancer benefit from Shuganyishen formula, which maybe related with its reverse resistance to endocrine therapy.

Objective To explore the features of immune responsed activated by polysaccharides from herbal medicines and provide basis for immunomodulation of polysaccharides. Methods The mice were immuned by polysaccharides of Angelica, Atractylodes and Giant typhonium rhizome respectively, then the corresponeding antibodies and cross-reactive antibodies in serum were detected by ELISA. Results Three kinds of polysaccharides from herbal medicines could all activated the mice to produce not only the corresponding antibodies, but also the cross-reactive antibodies, the ranges of non-specific antibodies activated by distinct polysaccharide were different. Conclusions Polysaccharides from herbal medicines may be a kind of non-specific and broad-spectrum immunomodulators.