Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Peripheral Artery Disease: a Systematic Review and Meta-Analysis.

BACKGROUND: The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin in patients with atrial fibrillation (AF) and peripheral artery disease (PAD) remain largely unknown. Therefore, we conducted a meta-analysis to explore the effects of NOACs versus warfarin in this population. METHODS: We systematically searched the PubMed and Embase databases, with no linguistic restrictions, until December 2019 for relevant randomized controlled trials (RCTs) and observational studies. A random-effects model using an inverse variance method was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: A total of six studies (three post hoc analyses of RCTs and three cohort studies) were included in this meta-analysis. Among AF patients treated with NOACs and warfarin, individuals with PAD had increased rates of all-cause death (RR = 1.26, 95% CI 1.07-1.48) and cardiovascular death (RR = 1.32, 95% CI 1.06-1.64) compared with those without PAD. In AF patients with PAD, we observed a similar risk of thromboembolic events, bleeding, and death with NOACs as with warfarin. In addition, there were no interactions between PAD and non-PAD subgroups regarding any of the reported outcomes of NOACs versus warfarin in AF patients (all Pinteraction > 0.05). CONCLUSIONS: Based on current evidence, AF patients with PAD are at a higher risk of death than those without PAD. Efficacy and safety outcomes with NOACs are comparable to those with warfarin, suggesting that the use of NOACs has effects similar to warfarin in AF patients with concomitant PAD.

Erythropoietin reduces apoptosis of brain tissue cells in rats after cerebral ischemia/reperfusion injury: a characteristic analysis using magnetic resonance imaging.

Some in vitro experiments have shown that erythropoietin (EPO) increases resistance to apoptosis and facilitates neuronal survival following cerebral ischemia. However, results from in vivo studies are rarely reported. Perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) have been applied successfully to distinguish acute cerebral ischemic necrosis and penumbra in living animals; therefore, we hypothesized that PWI and DWI could be used to provide imaging evidence in vivo for the conclusion that EPO could reduce apoptosis in brain areas injured by cerebral ischemia/reperfusion. To validate this hypothesis, we established a rat model of focal cerebral ischemia/reperfusion injury, and treated with intra-cerebroventricular injection of EPO (5,000 U/kg) 20 minutes before injury. Brain tissue in the ischemic injury zone was sampled using MRI-guided localization. The relative area of abnormal tissue, changes in PWI and DWI in the ischemic injury zone, and the number of apoptotic cells based on TdT-mediated dUTP-biotin nick end-labeling (TUNEL) were assessed. Our findings demonstrate that EPO reduces the relative area of abnormally high signal in PWI and DWI, increases cerebral blood volume, and decreases the number of apoptotic cells positive for TUNEL in the area injured by cerebral ischemia/reperfusion. The experiment provides imaging evidence in vivo for EPO treating cerebral ischemia/reperfusion injury.

[SCN5A mutation in patients with Brugada electrocardiographic pattern induced by fever].

OBJECTIVE: To explore the relationship between SCN5A, SCN1b, SCN3b and GPD1L genotypes and the risk of malignant arrhythmia in patients with Brugada electrocardiographic pattern induced by fever. METHODS: The clinical data and peripheral blood of patients with Brugada electrocardiographic pattern induced by fever were collected. Patients with depolarization abnormality associated with hypertension, coronary heart disease, drugs and other factors were excluded. The direct DNA sequencing was used to screen the mutation of candidate gene SCN5A, SCN1b, SCN3b and GPD1L. If gene variation was found, mutation or polymorphism was then determined by comparison with 200 control individuals. The relationship between genotype and phenotype as well as the risk of malignant arrhythmia were analyzed. RESULTS: Five eligible patients with fever-induced Brugada ECG pattern were included in this study. TypeI Brugada ECG was presented in all five patients in fibrile state and disappeared in normothermia. No sudden cardiac death (SCD) occurred and no ventricular arrhythmia was presented in Holter monitor during the 3 to 5 years follow-up period. Six gene variants were found including a novel missense mutation of base C to T, named Arg965 Cys (R965C), which located in 965 codon of the 17 exon in SCN5A, and five SCN5A polymorphisms including A29A (c.87A>G), R1193Q (c.3578G>A), D1819D (c.5457T>C), exon11 -24G>A, exon23 +4A>G. CONCLUSION: SCN5A mutation is related to fever-induced Brugada ECG pattern. However, individuals with Brugada ECG pattern induced by fever bear low risk of malignant arrhythmia and SCD during fibrile state and follow up in this small patient cohort.

[Peutz-Jeghers syndrome complicated with pulmonary mucinous adenocarcinoma: a case report and review of the literature].

OBJECTIVE: To explore the clinical characteristics, complications and prognosis of Peutz-Jeghers syndrome. METHODS: The clinical manifestations, imaging characteristics and pathological data of one patient with Peutz-Jeghers syndrome treated in Shaoxing People's Hospital were presented, and 3 cases of Peutz-Jeghers syndrome complicated with lung cancer reported in the literature were reviewed. The literature review was carried out by searching the Pubmed and CBMdisc database with Peutz-Jeghers syndrome and lung cancer as the key words. RESULTS: The patient treated in our hospital was a 30-year-old female. The primary manifestations were cough, sputum production and hemoptysis. Multiple gastrointestinal hamartomatous polyps were found, and associated with melanin pigmentation of the buccal mucosa, the lips, the hands and the feet. Therefore the diagnosis of Peutz-Jeghers syndrome was made. Chest CT scan showed a peripheral nodule at the right lower lobe, which was confirmed to be lung mucinous adenocarcinoma by surgery and pathology. The 3 cases reported in the literature were males aging from 22 to 43 years old. Cough, expectoration and hemoptysis were defined as the manifestations for 2 patients, and another case was found by physical check-up. They all died within a short period. Pathological study revealed adenocarcinoma of the lung in all the cases. CONCLUSION: Peutz-Jeghers syndrome complicated with lung cancer is rare and has a poor prognosis.

Improvement in imaging time and quality of 3D negative-contrast computed tomography cholangiography with minimum intensity projections: application of vari-slice manual cut and erosion functions.

OBJECTIVE: To investigate the improvement in postprocessing time and image quality of 3D negative-contrast CT cholangiography (nCTC) with minimum intensity projection (minIP). METHODS: Thirty-eight patients with suspected biliary obstruction who underwent portal phase helical CT were retrospectively studied. Three-dimensional nCTC was generated using 3D tools with manual cut function in three methods: one-slice, two-slice, and vari-slice cut slab, respectively. After adjusting the threshold level to about -20 HU, the erosion function with a value of one voxel was employed each time for further cleaning up hypodense interfering voxels such as fat and air that remained and the procedure was stopped before the biliary and pancreatic ducts were overeroded. RESULTS: Mean values of the total postprocessing time of the three manual cut methods for 3D nCTC were 57.8, 29.9, and 20.6 min, respectively. After the first erosion, interfering voxels were removed in more than half of the cases and they could be primarily eliminated following the second erosion. Meanwhile, the pancreaticobiliary ducts showed obvious erosion findings at the third erosion. CONCLUSIONS: The vari-slice manual cut method was shown to be the most timesaving postprocessing method and the image quality for 3D nCTC can be improved when one to two frequencies of erosion are applied.