Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia-bradycardia syndrome: A systematic review and updated meta-analysis.

BACKGROUND: Tachycardia-bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS. METHODS: We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy. RESULTS: Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR] = 0.62 and 95% confidence interval [CI]: 0.14-2.65), procedural complications (OR = 1.53 and 95% CI: 0.67-3.48), and cardiovascular rehospitalization (OR = 0.57 and 95% CI: 0.26-1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (OR = 0.37 and 95% CI: 0.17-0.82), thromboembolism (OR = 0.25 and 95% CI: 0.12-0.49), stroke (OR = 0.28 and 95% CI: 0.13-0.57), heart failure (OR = 0.27 and 95% CI: 0.13-0.56), freedom from AF (OR = 23.32 and 95% CI: 7.46-72.92), and prevention of progression to persistent AF (OR = 0.12 and 95% CI: 0.06-0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (OR = 0.21 and 95% CI: 0.08-0.59). CONCLUSION: AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.

Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution.

PURPOSE: To summarize the outcomes of different surgical treatment modalities for cesarean scar pregnancy (CSP) at a single institution over 8 years. METHODS: A case series of patients diagnosed with CSP who were admitted to Nanjing Drum Tower Hospital from January 2011 to December 2018 was retrospectively studied. Medical records of all the patients were carefully reviewed. Data on patient demographics, pregnancy characteristics, treatment modalities, response to therapy, and subsequent pregnancy outcomes were collected and analyzed. RESULTS: A total of 117 patients undergoing surgical treatments for CSP were included. Thirty-three patients (28.21%) underwent ultrasound-guided curettage; while, 74 (63.25%) and 10 (8.55%) patients received laparoscopy-monitored curettage and laparoscopic CSP resection, respectively. Most of the patients (21/33) who underwent ultrasound-guided surgery had type I CSP; while, 54 out of 84 patients who opted for laparoscopic surgeries had type II CSP. Eleven women underwent a uterine artery embolization procedure before the operation. There was no difference in the use of an intrauterine balloon for hemostasis among the three groups. Only 8 patients needed additional systemic methotrexate treatment. Twenty-four out of 57 women (42.11%) succeeded in conceiving again and gave birth to 21 healthy babies. Only 1 woman (1/24, 4.17%) experienced recurrence of CSP. CONCLUSIONS: These data indicated the safety and efficiency of ultrasound-guided curettage, laparoscopy-monitored curettage, and laparoscopic CSP resection for the treatment of CSP.

Chinese herbal preparations for chronic heart failure: Study protocol for an umbrella review of systematic reviews and meta-analyses.

BACKGROUND: Chinese herbal preparations (CHPs) have been reported to be effective in the management of chronic heart failure (CHF); they are beneficial in improving cardiac function, reducing hospital stays and readmission. However, the credibility of their effectiveness evidence has not been evaluated. We aim to summarize and evaluate current effectiveness evidence of traditional Chinese medicine in the management of CHF. METHODS: We will search PubMed, Embase, the Cochrane Database of Systemic Review (CDSR), and Web of Science from inception to December 2019 for systematic reviews that assessing the effectiveness of CHPs for CHF. The search will be performed without language restriction. Experimental interventions will include any type of CHPs, and control interventions will include placebo, sham interventions, usual care, or no controls. The primary outcome will be the changes in heart function classification defined by the New York Heart Association. Secondary outcomes include left ventricular ejection fraction, Six Minute Walk Test, other efficacy outcomes, and adverse events. We will use I statistics to assess the between-study heterogeneity in each meta-analysis, Eager test to detect publication bias, and the ratio of observed versus expected number of trials with positive findings. We will summarize the evidence and classify them into convincing, highly suggestive, suggestive, or weak. RESULTS: The results of this study will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION: No ethical approval and patient consent are required since this study data is based on published literature. The results of the study will be submitted to a peer-reviewed journal. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD 42019139649 (https://www.crd.york.ac.uk/PROSPERO/#joinuppage).

Simo decoction versus domperidone suspension for post-pyloric spiral nasoenteric tube placement: A multicenter, randomized, non-inferiority trial.

BACKGROUND & AIMS: Leveraging prokinetics to facilitate trans-pyloric migration is a conventional strategy. However, due to restrictions on the use of domperidone suspension, oral prokinetics is relatively modest. The study aims to assess the effectiveness of simo decoction as an alternative to domperidone suspension in facilitating post-pyloric placement of spiral nasoenteric tubes. METHODS: A prospective, open-label, parallel, and non-inferiority randomized controlled trial was performed involving critically ill adults in 6 university hospitals in China between September 2017 and May 2019. Patients were randomly assigned to receive either simo decoction 20 ml q8h, or domperidone suspension 20 mg/20 ml q6h for 24 h. The primary outcome was procedure success defined as post-pyloric placement (spiral nasoenteric tubes reached the first portion of the duodenum or beyond confirmed by abdominal X-ray 24 h after tube insertion). RESULTS: Of 268 patients assessed for eligibility, 224 patients were enrolled and randomly assigned to the simo decoction group or the domperidone suspension group (n = 112 per group). The success rate of post-pyloric placement was 41.1% (46/112) in the simo decoction group, as compared with 47.3% (53/112) in the domperidone suspension group (a risk difference of -6.3%, 95% CI, -19.2% to 6.7%, adjusted risk difference -3.7%, 95% CI -16.3% to 9.0%), in the intention-to-treat analysis, crossing the prespecified margin of -10% for non-inferiority. There were no differences between groups in the success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond) and proximal jejunum placement, the incidences of any adverse events, length of ICU stay or mortality in ICU. CONCLUSIONS: Non-inferiority of simo decoction to domperidone suspension was not confirmed in facilitating post-pyloric placement of spiral nasoenteric tubes. Registration: The trial was registered with the Chinese Clinical Trial Registry at http://www.chictr.org.cn (registration number ChiCTR-INR-17011311).

Comparison of Serum Human Epididymis Protein 4 and Carbohydrate Antigen 125 as Markers in Endometrial Cancer: A Meta-Analysis.

OBJECTIVES: For patients with endometrial cancer (EC), the screening value of serum human epididymis protein 4 (HE4) remains controversial. We performed meta-analyses to compare the screening accuracy of serum HE4 and carbohydrate antigen 125 (CA125) for EC. MATERIALS AND METHODS: A search of diagnostic test studies was performed in 5 English databases: Pubmed, Cochrane Library, Web of Science, Science Direct, and Elton Bryan Stephens Co or EBSCO; and 2 Chinese databases including China National Knowledge Infrastructure or CNKI and VIP (Weipu Database), from their inception dates to early July 2015. Two reviewers independently selected trials, conducted critical appraisal, and extracted data. Meta-analyses were performed to compare the screening accuracy between HE4 and CA125. Summary receiver operating characteristic curve and the area under the summary receiver operating characteristic curve were performed. Subgroup analysis, meta-regression, sensitivity analysis, and Egger plot and the Egger test were also conducted. RESULTS: Twenty-one studies were identified, and the methodological quality was generally fair. Meta-analyses revealed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios for HE4 in screening EC were 0.56, 0.89, 6.41, 0.49, and 14.82, respectively, whereas the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for CA125 in screening EC were 0.32, 0.81, 2.15, 0.83, and 2.74, respectively. The areas under the summary receiver operating characteristic curves for HE4 and CA125 were 0.7778 and 0.5474, respectively. CONCLUSIONS: This study indicates that serum HE4 may be superior to CA125 in screening accuracy of EC. This conclusion has to be interpreted cautiously owing to high heterogeneity and some limitations.

Effectiveness of prolonged clopidogrel-based dual antiplatelet therapy after drug-eluting stent implantation: Evidence-based meta-analysis.

The use of drug-eluting stents (DESs) for patients with coronary artery disease is widespread. DESs have been associated with a lower rate of repeat revascularization, death, and myocardial infarction compared with bare metal stents. However, DESs can lead to a prothrombotic environment in the coronary arteries, resulting in a higher rate of thrombotic events. To counteract this, dual-antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel is recommended. Currently, there are no clear guidelines on the duration of DAPT. We therefore conducted a meta-analysis to assess the effectiveness of prolonged DAPT after DES implantation.

[Prognosis and treatment for 98 patients with carcinoma of nasal cavity].

BACKGROUND & OBJECTIVE: Carcinoma of nasal cavity is a rare disease without standard treatment. This study was designed to evaluate treatment outcome, and prognostic factors of patients with carcinoma of nasal cavity. METHODS: Records of 98 patients with carcinoma of nasal cavity were reviewed,43 patients received radiotherapy alone, 55 patients received surgery plus radiotherapy. Survival analysis was performed by Kaplan-Meier method,differences between groups were tested by log-rank test,multivariate analysis was carried out by Cox proportional hazard model. RESULTS: The overall 5-, and 10-year survival rates were 65.3%, and 37.1%. The 5-, and 10-year survival rates of patients with tumor of stage I, II were 87.3%, and 51.1%, those of patients with tumor of stage III, IV were 56.1%, and 32.2% (P=0.02). The patients with squamous cell carcinoma had lower survival rates than those with adenocarcinoma (P< 0.01). There was significant difference in survival rates between patients received radiotherapy alone and patients received radiotherapy plus surgery in advanced lesions (P=0.04) and in squamous cell carcinoma (P< 0.01), but not in early lesions (P=0.41) and in adenocarcinoma (P=0.73). Patients who were initially diagnosed cervical lymph node metastasis had a reduced survival rate compared with node-negative patients (P=0.01). In Cox's regression, clinical stage and node-positive were independent prognostic factors. CONCLUSIONS: The criteria should be taken into account when choosing treatment method for patients with carcinoma of nasal cavity: radiotherapy plus surgery is preferred for advanced lesions and for squamous cell carcinoma, radiotherapy alone is better for early lesions and for adenocarcinoma. Clinical stage, and node-positive may be independent prognostic factors of patients with carcinoma of nasal cavity.

[Prognostic factors of 60 nasal cavity carcinoma patients].

OBJECTIVE: To evaluate the treatment modalities and the prognostic factors of nasal cavity carcinoma. METHODS: A retrospective study was done on 60 nasal cavity carcinoma patients treated from 1985 to 1992. Thirty-four patients received radiotherapy alone and 26 patients received surgery plus radiotherapy. Kaplan-Meier method was used to evaluate the survival, Log-rank test to assess the difference between these two groups and Cox proportional hazard model by multivariate analysis. RESULTS: The overall 5- and 10-year survival rates were 55.9% and 36.9% respectively. The 5- and 10-year survival rates were 79.0% and 57.9% in patients with early lesions (stage I, II) and 44.1% and 26.0% in patients with advanced lesions (stage III, IV) (P = 0.005). There was no significant difference in the survival rate between radiotherapy alone and radiotherapy plus surgery (P = 0.33). Patients with squamous cell carcinoma had obviously poorer survival rate than patients with adenocarcinoma (P = 0.04). Patients with positive nodes had a lower survival rate compared with negative node patients (P = 0.09). CONCLUSION: Histological type and clinical stage, but not method of treatment or neck node metastasis, are the important prognostic factors.