Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis.

Background: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a stroke prevention strategy in patients with nonvalvular atrial fibrillation (NVAF), and these patients were required to receive antithrombotic therapy post-procedure. However, the optimal antithrombotic strategy after LAAO remains controversial. This study explored the safety and efficacy of different antithrombotic strategies after LAAO through a network comparison method. Methods: We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies that reported the interested efficacy and safety outcomes (stroke, device-related thrombus (DRT), and major bleeding) of different antithrombotic strategies [DAPT (dual antiplatelet therapy), DOACs (direct oral anticoagulants), and VKA (vitamin k antagonist)] in patients who had experienced LAAO. Pairwise comparisons and network meta-analysis were performed for the interested outcomes. Risk ratios (RRs) with their confidence intervals (CIs) were calculated using a random-effects model. The rank of the different strategies was calculated using the surface under the cumulative ranking curve (SUCRA). Results: Finally, 10 observational studies involving 1,674 patients were included. There was no significant difference in stroke, DRT, and major bleeding among the different antithrombotic strategies (DAPT, DOACs, and VKA). Furthermore, DAPT ranked the worst in terms of stroke (SUCRA: 19.8%), DRT (SUCRA: 3.6%), and major bleeding (SUCRA: 6.6%). VKA appeared to be superior to DOACs in terms of stroke (SUCRA: 74.9% vs. 55.3%) and DRT (SUCRA: 82.3% vs. 64.1%) while being slightly inferior to DOACs in terms of major bleeding (SUCRA: 71.0% vs. 72.4%). Conclusion: No significant difference was found among patients receiving DAPT, DOACs, and VKA in terms of stroke, DRT, and major bleeding events after LAAO. The SUCRA indicated that DAPT was ranked the worst among all antithrombotic strategies due to the higher risk of stroke, DRT, and major bleeding events, while VKAs were ranked the preferred antithrombotic strategy. However, DOACs are worthy of consideration due to their advantage of convenience.

[Relationship between levels of antibody to schistosome of armed police officers and soldiers and their camp environment].

OBJECTIVE: To understand the schistosome infection status of armed police officers and soldiers in endemic areas of the middle and lower reaches of the Yangtze River and the impact caused by the camp environment. METHODS: The inside and outside environments of camps were investigated and they were classified as Grade A, B and C according to scores. The levels of antibody to schistosome of the armed police officers and soldiers were tested with ELISA. RESULTS: A total of 23 780 officers and soldiers in 201 camps were investigated. The positive rates of antibody to schistosome of officers and soldiers stationed in the inner embankment areas, river beach areas and island areas were 1.88%, 3.89% and 4.73%, respectively. In the aforementioned three types areas, the positive rates of antibody to schistosome of soldiers and officers in the camp environment scored as Grade A were 1.23%, 3.28% and 3.33%, respectively, while the positive rates in the environment scored as Grade B were 2.03%, 3.81% and 4.24%, respectively, and the positive rates in the environment scored as Grade C were 3.17%, 5.79% and 5.83%, respectively. CONCLUSIONS: There are certain correlation between the prevalence of schistosomiasis in armed police forces and the internal and external environments of their camps. The comprehensive environment management is one of the key measures of schistosomiasis control for armed police forces.

[Endemic situation and control strategies on schistosomiasis in Armed Police Forces in marshland and lake regions].

OBJECTIVE: To investigate the prevalence of schistosomiasis in Armed Police Forces in marshland and lake regions so as to provide the evidence for policy-making of the disease control. METHODS: The different types of duty were selected by the stratified cluster random sampling method in endemic areas of marshland and lake regions, and the snail survey was conducted, and the infectious status and epidemic factors of officers and soldiers who served more than 2 years were investigated. RESULTS: The geographical features included the embankment type, island type and islet type, and the serological positive rates were 1.88%, 4.73% and 3.89% in the 3 types of endemic areas respectively and he total positive rate was 3.10%, that was lower than the national population level in 2009. The infection risk factors included fighting flood, and the contact with infested water in daily life and production. CONCLUSIONS: We should strengthen the surveillance and control of schistosomiasis in this particular group of officers and soldiers, especially in their implementation of fighting flood and other tasks.

[Combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty for obstructive sleep apnea].

OBJECTIVE: Investigate the response of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) patients to combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty. METHODS: Thirty two patients with OSAHS, age ranged from 27 to 54, mean value (x +/- s) 39.1 +/- 7.8, male, body mass index (BMI) ranged from 22.9 to 36. 7 kg/m2, mean value (29.0 +/- 3.6) kg/m2, preoperative apnea and hypopnea index (AHI) was 11.7/h to 113.7/h, mean value (61.8 +/- 21.9)/h, the lowest blood oxygen saturation was 0.10 to 0.85, mean value 0.64 +/- 0. 13. With preoperative endoscopic technique, bony nasopharynx cavity narrowing were present, 14 patients had concomitant tonge-base obstruction. Cephalometric result, SNA ranged from 72.9 degrees to 87.0 degrees, mean value (80.7 +/- 4.1) degrees; SNB 69.50 to 85.0 degrees, mean value (76.8 +/- 4.5) degrees; PAS 0.5 cm to 2.1 cm, mean value (1.2 +/- 0.5) cm; MP-H: ranged from 1.2 cm to 3.5 cm, mean value (2.2 +/- 0.7) cm; PNS ranged from 2.4 cm to 3.5 cm, mean value (2.8 +/- 0.4) cm. All the patients had H-UPPP and concomitant transpalatal advancement pharyngoplasty. Fourteen patients with tonge-base obstruction had chin advancement. Results Six months after the operations, the patients were evaluated the response to the operations using Epworth sleep scale, OSAHS filtration questionnaire scale and polysomnography (PSG). There were 27 patients with the decrease percent of AHI reaching or more than 25% and 22 patients with the decrease percent of AHI reaching or more than 50% including 8 patients with AHI less than 5. The other 5 patients were ineffective. After operation, the Epworth sleep scale decreased from (9.2 +/- 4.5) to (4.7 +/- 2. 8) and OSAHS filtration questionnaire scale decreased form (56.0 +/- 15.3) to (17.5 +/- 11.5). Both of the differences were obvious (P < 0.01). CONCLUSIONS: Combination of transpalatal advancement pharyngoplasty and H-UPPP can improve the efficacity and in some patients with pure retropalatal airway narrowing, the cure rate can be improved.

HLA linked with leprosy in Southern China; HLA-linked resistance alleles to leprosy

According to the World Health Organization recommended multidrug therapy (WHO/MDT), we have carried out this study to investigate the presence of HLA-linked susceptibility or resistance to leprosy in a southern Chinese population. Sixty-nine leprosy patients and 112 healthy controls participated in the study. HLA-DR2 subtypes, HLA-B and MHC Class I chain-related A (MICA) alleles were typed at the DNA level using the polymerase chain reaction-single strand conformation polymorphism method. The frequencies of HLA-DR2-DRB1 alleles did not show any significant differences between the patient and the control groups, suggesting that the disease susceptibility was not associated with the DR2 subtypes in this southern Chinese population. On the other hand, in the multibacillary (MB) patients significantly decreased allele frequencies of HLA-B46 (0.040 in MB patients vs 0.129 in controls) and MICA-A5 (0.200 vs 0.380) were observed compared with the healthy controls. The calculated relative risk (RR) for B46 was 0.28; for MICA-A5, 0.52. In addition, on haplotype analysis the frequency of the HLA-B46/MICA-A5 haplotype was significantly decreased in the MB patients compared to controls (0.060 vs 0.233, RR = 0.22, p < 0.01). These results suggest that an HLA-linked disease-resistant gene to MB leprosy in southern China is in strong linkage disequilibrium with the HLA-B46/MICA-A5 haplotype. In other words, the resistant gene may be located near the HLA-B/MICA region and not in the HLA-DR locus.