ABSTRACT
Aim of the Study: The role of direct-acting oral anticoagulants in the treatment of venous thromboembolism (VTE) in cancer patients compared with the current standard of low-molecular-weight heparin (LMWH) treatment remains unclear. This meta-analysis aimed to evaluate the efficacy and safety of direct factor Xa inhibitors compared with those of LMWH in the treatment of cancer-associated VTE. Materials and Methods: We systematically searched PubMed, EMBASE, Cochrane library, and Web of Science for potential randomized controlled clinical trials and retrospective cohort studies. Data on recurrent VTE (efficacy) and major and minor bleeding events (safety) were extracted, and the odds risks (OR) were analyzed using a random-effect model. Results: A total of nine studies involving 4208 cancer patients with VTE were included in these analyses. Pooled analysis showed that direct factor Xa inhibitors were significantly superior to LMWH in reducing the risk of recurrent VTE (OR = 0.67; 95% confidence interval [CI]: 0.54–0.82). There was no significant difference in the rate of major bleeding between the direct factor Xa inhibitor and LMWH treatments (OR = 1.25; 95% CI: 0.94–1.65). However, the rate of minor bleeding events was higher when a direct factor Xa inhibitor was used instead of LMWH (OR = 1.80; 95% CI: 1.05–3.07). Conclusions: Direct factor Xa inhibitors are superior to LMWH in efficacy in the treatment of VTE in cancer patients, and the safety between the two regimens is comparable except for a slightly higher rate of minor bleeding when the former is used
ABSTRACT
Objective To explore the interaction between a serotonin transporter gene promoter region polymorphism(5-HTTPR) and stress in predicting anxiety symptoms.Methods Through random cluster sampling,a total of 252 healthy adolescents participated in this study.During the initial assessment,all participants completed the Adolescent Life Events Questionnaire (ALEQ) and Multidimensional Anxiety Scale for Children (MASC) to assess their levels of stress and anxiety and were genotyped for the 5-HTTLPR polymorphism.Participants subsequently completed MASC and ALEQ once every three months during the subsequent 24 months.A multilevel model was used to investigate the interaction between 5-HTTLPR and stress that predict anxiety symptoms.Results The results indicated no major effect of 5-HTTLPR in males (β=0.80,P＞0.05)or females(β=-0.21,P＞0.05).There were major effects of stress in males(β=0.30,P＜0.01) and females (β=0.33,P＜0.01)and a significant interaction between 5-HTTLPR and stress.Females with at least one 5-HTTLPR S allele(β=0.11,P＜ 0.01)and males with at least one 5-HTTLPR L allele(β=-0.10,P＜0.01)exhibited more anxiety symptoms under stressful situations.Conclusion The interaction between 5-HTTLPR and stress can predict anxiety symptoms in adolescents.There are gender differences on the 5-HTTLPR × stress interaction.
ABSTRACT
Objective To investigate the etiology of papular urticaria: is it caused only by arthropod-like insects-bite allergy, or by multiple factors such as food allergy, disturbance of gastrointestinal function and infection? Methods We searched, by computer and manually, the foreign and domestic literature related to the etiology of papular urticaria published since 1950s, and according to the methods of evidence-based medicine, systematically evaluated the evidence supporting either the insect-bite theory or the multiple factor theory. Results Twenty-nine articles ( 22 English and 7 Chinese ) supported the theory of hypersensitivity to bites from certain insects such as mosquitoes, gnats, fleas, mites, bedbugs etc. Two articles in Chinese mentioned the possibilities other than insect-bite, but the reliability was unconvincing, because the authors did not present the source of data or statistical methods used in the articles. The evidence from epidemiology, histopathology, laboratory and clinical researches all supported the insects-bite theory. No proven evidence was found supporting other aetiological hypotheses. Conclusion Our results suggest that papular urticaria is caused only by the allergy to stings or bites of arthropods, and other hypotheses still lack convincing evidence.