Spontaneous Hemorrhagic Pericardial Effusion as a Consequence of Apixaban Utilization for New-Onset Atrial Fibrillation.

Although anticoagulation stands as a standardized therapeutic approach for mitigating thrombotic risks in atrial fibrillation, the potential for bleeding associated with direct oral anticoagulants (DOACs) is consistently weighed in the risk/benefit analysis prior to initiating therapy for non-valvular atrial fibrillation. While the typical bleeding risks from DOACs predominantly affect the gastrointestinal system, occurrences of spontaneous hemorrhagic pericardial effusions are rare. This case presentation illustrates a patient developing spontaneous hemorrhagic pericardial effusion four days after commencing apixaban therapy and subsequent management.

Drug-Coated Balloon Versus Plain Balloon Angioplasty for Hemodialysis Dysfunction: A Meta-Analysis of Randomized Controlled Trials.

Background Both drug-coated balloon (DCB) angioplasty and conventional plain balloon angioplasty (PBA) can be implemented to treat hemodialysis dysfunction. The present study aims to compare the safety and efficacy of these 2 approaches by conducting a meta-analysis of available randomized controlled trials. Methods and Results PubMed, Cochrane Library, and Embase databases were queried from establishment to January 2021. A total of 18 randomized controlled trials including 877 and 875 patients in the DCB and PBA groups, respectively, were included in the present meta-analysis. Target lesion primary patency, circuit patency, target lesion revascularization, and mortality were pooled. Odds ratios (ORs) were reported with 95% CIs. Publication bias was analyzed with funnel plot and Egger test. Target lesion primary patency was higher among patients who underwent DCB (OR, 2.93 [95% CI, 2.13-4.03], P<0.001 at 6 months; OR, 2.47 [95% CI, 1.53-3.99], P<0.001 at 1 year). Also, the DCB group had a higher dialysis circuit patency at 6 months (OR, 2.42; 95% CI, 1.56-3.77 [P<0.001]) and 1 year (OR, 1.91; 95% CI, 1.22-3.00 [P=0.005]). Compared with the PBA group, the DCB group had lower odds of target lesion revascularization during follow-up (OR, 0.43 [95% CI, 0.23-0.82], P=0.001 at 6 months; OR, 0.74 [95% CI, 0.32-1.73], P=0.490 at 1 year). The OR of mortality was comparable between 2 groups at 6 months (OR, 1.18; 95% CI, 0.42-3.33 [P=0.760]) and 1 year (OR, 0.93; 95% CI, 0.58-1.48 [P=0.750]). Conclusions Based on evidence from 18 randomized controlled trials, DCB angioplasty is superior to PBA in maintaining target lesion primary patency and circuit patency among patients with dialysis circuit stenosis. DCB angioplasty also reduces target lesion revascularization with a similar risk of mortality compared with PBA.

Effect of polyampholyte net charge on complex coacervation between polyampholytes and inorganic polyoxometalate giant anions.

The effect of net charge of zwitterionic polymers on the phase behavior and viscoelastic properties of hybrid polyampholyte-polyoxometalate (POM) complexes in salted aqueous solutions is investigated with polyampholyte copolymers consisting of both positively and negatively charged monomers. Zwitterionic polyampholytes of varied net charge, abbreviated as PAxMy, are synthesized by varying the feeding molar ratio of negatively charged 2-acrylamido-2-methyl-1-propanesulfonic acid (AMPS) to positively charged [3-(methacryloylamino)propyl]trimethylammonium chloride (MAPTAC) monomers in aqueous solution. The coacervate formation between PAxMy and inorganic anionic metatungstate POM ({W12}) in LiCl added aqueous solutions can be enhanced by increasing the molar fraction of positively charged MAPTAC monomer and LiCl concentration. The salt-broadened coacervation, clearly distinct from the salt-suppressed one between oppositely charged polyelectrolytes, suggests the account of zwitterion-anion pairing for PAxMy-{W12} coacervate formation due to stronger binding of multivalent {W12} giant ions with PAxMy than simple ions. Importantly, as AMPS or MAPTAC monomer fraction in polyampholytes is varied by merely ±5% from the effective net neutral case, the viscoelasticity of PAxMy-{W12} coacervates can be modified by 4-5 folds, suggesting a new tuning parameter to fine control the macroionic interactions and material properties of biomimetic complex coacervates.

Citología cervical anormal: manejo sin colposcopio / Anormal cervical cytology: management without colposcope

De 1980 a 1987 analizamos prospectivamente 30 casos de citología anormal los cuales fueron manejados en el Hospital Civil de Guadalajara sin colposcopio. A todas las pacientes se les practicó biopsia dirigida con Schiller y resultado se practicaba conización cervical. De los resultados colpocitológicos estudiados, 20 fueron clase V (66,6%), 6 clase IV (20%), 2 clase III persistente (6.6%) y 2 clase II con lesión clínica sospechosa de cáncer (6.6%). De las 30 pacientes, en 12 (40%) se encontró cáncer invasor por lo que no se practicó conización; en 10 pacientes (33.3%) se encontró el mismo resultado en la biopsia y conización, pero en 8 pacientes (26.6%) fue más severo el resultado de la conización que el de la biopsia. Hubo una citología clase V falsa positiva