Comparison of outcomes of direct-acting oral anticoagulants vs. vitamin K antagonists in patients with bioprosthetic heart valves or valve repair: a systematic review and meta-analysis.

OBJECTIVE: To compare the outcomes between direct-acting oral anticoagulants and vitamin K antagonists, particularly for risk of stroke and bleeding, among patients with atrial fibrillation (AF) and bioprosthetic heart valve replacement or repair. MATERIALS AND METHODS: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews and Google scholar databases. Studies that were done in patients with AF who underwent bioprosthetic heart valve replacement or repair and that compared the outcomes between the use of direct-acting oral anticoagulants (DOACs) and vitamin K antagonists were eligible for inclusion. Studies that were preferably randomized controlled trials or adopted a cohort approach or retrospective data-based studies were considered for inclusion. The strength of association was presented in the form of pooled hazards risk (HR). Statistical analysis was done using STATA version 16.0. RESULTS: A total of 8 articles were included in the meta-analysis. There were no significant differences in the risk of "all-cause stroke" [HR 0.72, 95% CI: 0.39, 1.34] and ischemic stroke [HR 0.79, 95% CI: 0.49, 1.29] between the two groups. The risk of "any bleeding" [HR 0.74, 95% CI: 0.64, 0.87], major bleeding [HR 0.60, 95% CI: 0.42, 0.86] and intra-cranial bleeding [HR 0.54, 95% CI: 0.36, 0.81] was much lower in those that received DOAC compared to warfarin. Compared to those receiving warfarin, those on DOACs had substantially reduced risk of any clinical thromboembolic events [HR 0.52, 95% CI: 0.39, 0.70]. No significant differences were noted for all-cause mortality [HR 0.88, 95% CI: 0.74, 1.05], cardiovascular events/myocardial infarction (MI) [HR 0.58, 95% CI: 0.33, 1.04] and and readmission rates [HR 0.85, 95% CI: 0.62, 1.18]. CONCLUSIONS: Findings suggest that the use DOACs in patients with AF with bioprosthetic valve replacement or repair is comparatively better than vitamin K antagonists in reducing the risk of bleeding and thrombo-embolic events. Future studies with a randomized design and larger sample sizes are needed to further substantiate these findings.

The presence probability of mandibular lingla and antilingula.

PURPOSE: The lingula and antilingula are crucial surgical landmarks for mandibular setback surgery. The purpose of study was to investigate the correlation of presence probability between lingual and antilingula. MATERIALS AND METHODS: A total of 180 cone-beam computed tomography sides were collected from 90 patients. The probability of absence of the lingula and antilingula was recorded with respect to the gender, mandible (unilateral and bilateral), and skeletal patterns (Class I, II, III); in addition, the correlations between these variables were analysed. RESULTS: Of the 180 sides, 9 sides showed the absence of the lingula (5%) and 34 sides showed the absence of the antilingula (18.9%). Pearson's test revealed that the presence of the lingula and antilingula differed nonsignificantly with respect to gender and skeletal patterns, respectively. The bilateral presence of the lingula was observed in 16 sides (91.1%), and that of the antilingula was observed in 122 sides (67.8%). Pearson's test verified a significant correlation between the presence of the left and right lingula (P<0.05). By contrast, gender and skeletal patterns were nonsignificantly correlated with the presence of the lingula and antilingula. The presence of the lingula was also nonsignificantly correlated with that of the antilingula. CONCLUSION: Gender and skeletal patterns were nonsignificantly correlated with the presence of the lingula and antilingula, respectively. The presence of the lingula was also nonsignificantly correlated with that of the antilingula. Consequently, lingula and antilingula cannot serve as the absolute standards for mandibular setback surgery.

Causes of ozone pollution in summer in Wuhan, Central China.

In August 2016, continuous measurements of volatile organic compounds (VOCs) and trace gases were conducted at an urban site in Wuhan. Four high-ozone (O3) days and twenty-seven non-high-O3 days were identified according to the China's National Standard Level II (∼100 ppbv). The occurrence of high-O3 days was accompanied by tropical cyclones. Much higher concentrations of VOCs and carbon monoxide (CO) were observed on the high-O3 days (p < 0.01). Model simulations revealed that vehicle exhausts were the dominant sources of VOCs, contributing 45.4 ±â€¯5.2% and 37.3 ±â€¯2.9% during high-O3 and non-high-O3 days, respectively. Both vehicle exhausts and stationary combustion made significantly larger contributions to O3 production on high-O3 days (p < 0.01). Analysis using a chemical transport model found that local photochemical formation accounted for 74.7 ±â€¯5.8% of the daytime O3, around twice the regional transport (32.2 ±â€¯5.4%), while the nighttime O3 was mainly attributable to regional transport (59.1 ±â€¯9.9%). The local O3 formation was generally limited by VOCs in urban Wuhan. To effectively control O3 pollution, the reduction ratio of VOCs to NOx concentrations should not be lower than 0.73, and the most efficient O3 abatement could be achieved by reducing VOCs from vehicle exhausts. This study contributes to the worldwide database of O3-VOC-NOx sensitivity research. Its findings will be helpful in formulating and implementing emission control strategies for dealing with O3 pollution in Wuhan.

A meta-analysis and systematic review of prophylactic endoscopic treatments for postpolypectomy bleeding.

PURPOSE: The aim of this meta-analysis and systematic review was to determine whether bleeding prophylaxis benefits patients after colonoscopic polypectomy. METHODS: A systematic review of the literature was performed to find prospective randomized controlled trials of postpolypectomy hemorrhage prophylaxis. Studies were selected according to specific criteria and analyzed to generate pooled data. RESULTS: Eight studies encompassing 2,595 polyps met the criteria for the meta-analysis. The rate of early bleeding was significantly decreased relative to the control when a single prophylactic technique was used [2.58% vs. 8.15%, OR = 0.34 (95% CI, 0.20-0.58), P < 0.0001]. The use of multiple prophylactic techniques resulted in a lower early postpolypectomy hemorrhage rate compared with the use of a single prophylactic technique [0% vs. 8.41%, OR = 0.12 (95% CI, 0.03-0.47), P = 0.002]. The late bleeding rate did not differ significantly between the monotherapy and control groups [0.61% vs. 1.39%, OR = 0.37 (95% CI, 0.11-1.28), P = 0.12], and the use of combined preventative techniques did not significantly decrease the late postpolypectomy bleeding (PPB) rate compared with use of a single prophylactic method [1.43% vs. 2.05%, OR = 0.70 (95% CI, 0.32-1.55), P = 0.38]. CONCLUSION: Prophylactic endoscopic treatments are effective at reducing early PPB after colonoscopic polypectomy. However, patients with late PPB may not benefit from bleeding prophylaxis.

Gene construction, expression, and characterization of double-copy truncated form of human insulin-like growth factor I.

AIM: To increase the production of recombinant truncated form of insulin-like growth factor I [des(1-3)IGF-I], purify the expressed product, and compare its bioactivity with that of standard IGF-I. METHODS: The second copy of des(1-3)IGF-I gene was inserted into the previously constructed pExSec1/IGF-I to form a pExSec1/2(IGF-I) expression plasmid, then the plasmid was transformed into a protease-deficient E coli strain BL21(DE3). The engineered bacteria were cultured and induced by IPTG at 12 degrees C. The expressed product was purified through ultrafiltration and Sephadex G-50 gelfiltration. The bioactivity of the preliminarily purified protein was tested by MTT method and compared with standard IGF-I. RESULTS: The amount of des(1-3)IGF-I expressed by pExSec1/2(IGF-I) reached up to 20 % of the total soluble bacterial protein, which was higher than the amount (12 %) expressed by a single copy of pExSec1/IGF-I gene. The purity of recombinant des(1-3)IGF-I reached 49 % and 82 % after ultrafiltration and gelfiltration. The bioactivity of des(1-3)IGF-I after gelfiltration was about 77 % of standard IGF-I at the same concentration. CONCLUSION: The yield of recombinant des(1-3)IGF-I was increased about 8 % by construction of expression plasmid with two copies of des(1-3)IGF-I gene compared with only one copy of gene, and preliminarily purified des(1-3)IGF-I showed about 77 % bioactivity compared with standard IGF-I.

Life events, frontal electroencephalogram laterality, and functional immune status after acute psychological stressors in adolescents.

OBJECTIVE: Past studies have found that environmental stress affects cellular immune function and that extensive variability exists in the magnitude and direction of stress-induced immune changes. Past research also suggests that individuals with greater right, relative to left, resting frontal electroencephalogram (EEG) activation perceive environmental stress as more aversive and have lower baseline cellular immune function. In this study, we examined environmental stressors, resting frontal EEG laterality, and immune responses to short-term psychological stressors in adolescent boys. METHODS: A sample of twenty-four 14-16 year old right-handed boys underwent a recording of resting EEG and collections of blood taken before and after a laboratory protocol designed to induce psychological stress. Blood samples were used to measure changes in mitogen lymphoproliferative responses, natural killer (NK) cell activity, and T-cell phenotypic subsets. Life events were measured using self-report questionnaires. RESULTS: Life events and frontal laterality showed a first order interaction in predicting changes in lymphocyte proliferation to tetanus toxoid (R2 increment = .26, p < .01) and pokeweed mitogen (R2 increment = .25, p < .02). The interaction also predicted changes in NK activity (R2 increment = .24, p < .02). CONCLUSIONS: Changes in lymphocyte proliferation and NK activity were associated with negative life events only among individuals with greater left frontal cortical activation. Our results suggest that recent psychosocial stress and individual differences in resting frontal cortical activation are together linked to immunologic responses to acute psychological stressors.

Life events, cardiovascular reactivity, and risk behavior in adolescent boys.

BACKGROUND: Risk behavior contributes to injuries, one of the most important sources of morbidity and mortality in adolescents. Although research has shown that environmental stress makes adolescents more likely to engage in risk behavior and to sustain injuries, the magnitude of these associations has been small. Little is known about the role of individual differences in psychobiologic reactivity to stress in moderating the impact of stressful events. In this study, we examined associations among environmental stressors, cardiovascular reactivity to stress, and the level of risk behavior in adolescent boys. METHODS: Twenty-four 14- to 16-year-old boys underwent a laboratory protocol designed to measure responses to psychologically and physically stressful tasks. Changes in heart rate and mean arterial blood pressure were measured serially at standard points in the protocol, and levels of positive and negative life events and recent risk behavior were measured using self-report questionnaires. RESULTS: Neither life events nor cardiovascular reactivity were independently associated with risk behavior. Positive life events and mean arterial blood pressure reactivity significantly interacted, however, in predicting risk behavior (R2 increment = .25). Boys with high reactivity who reported numerous positive life events engaged in markedly less risk behavior than their peers. CONCLUSION: We conclude that adolescents with exaggerated cardiovascular responses to laboratory stressors are associated with less risk behavior in a setting of positive life circumstances. This result suggests that reactivity may exert protective, rather than harmful, influences in some environments.

The psychobiology of childhood stress.

Recent psychobiologic research has provided new insights into the interplay between constitutional and environmental etiologies in stress-induced childhood illness. Individual differences in both psychobiologic reactivity and physiologic self-regulation may substantially influence a child's internal stress responses. In addition, the physiologic consequences of a given environmental stressor may depend critically on the developmental stage in which the stressor occurs. Behavioral changes associated with early exposures to stressors may be linked to alterations in central nervous system monoamine production and metabolism. Evidence for developmental and psychobiologic changes in response to very early, even prenatal, stressors suggests that environmental and genetic contributions to stress response profiles may ultimately be difficult to disentangle.

[Studies of midazolam, diazepam and thiopentone on respiratory and cardiovascular function during induction anesthesia].

In this study, the effects of midazolam (M), diazepam (D) and thiopentone (T) on respiratory and cardiovascular systems were compared. The patients were randomly divided into 6 groups, besides minute ventilatory volume (MV), onset of induction and cardiovascular changes were also observed. Induction was performed by a bolus injection of one of the following: midazolam (0.3 mg/kg), diazepam (0.3 mg/kg) or thiopentone (5 mg/kg). Five minutes later, 5 micrograms/kg fentanyl and 1.5-2.0 mg/kg succinylcholine were administered. The results showed that: (1) Inhibitory effect on MV was not prominent and similar after use of midazolam and diazepam but was remarkable after thiopental; (2) As for the onset, midazolam was faster than diazepam but slower than thiopentone; (3) Hemodynamic changes of midazolam, diazepam and thiopentone were similar, however during intubation, cardiovascular response was the least in midazolam, diazepam the intermediate and thiopentone the most significant. We conclude that midazolam is a water-soluble, safe and effective inductive anesthetic with its short eliminated half-life period, and much lesser venous irritation, and it is certainly superior to both diazepam and thiopentone.