In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019.

OBJECTIVES: The optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections. DESIGN: A retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019. SETTING: The CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China. PARTICIPANTS: Patients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample. METHODS: Patients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies. RESULTS: Rhythm control therapies were used in 16.9% of patients with no significant trends (p trend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (p trend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95% CI 0.967 to 0.980), valvular AF (OR 0.618, 95% CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95% CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95% CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95% CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1-2: OR 0.630, 95% CI 0.529 to 0.750; CCI≥3: OR 0.551, 95% CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95% CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95% CI 2.369 to 8.483; catheter ablation: OR 4.957, 95% CI 3.072 to 7.997) were positively associated with rhythm control strategies. CONCLUSION: In China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted. STUDY REGISTRATION NUMBER: NCT02309398.

Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review.

BACKGROUND: Clopidogrel is a widely-used antiplatelet and acts as an adenosine diphosphate receptor inhibitor. Neutropenia is a rare but serious adverse effect of clopidogrel. It is unknown whether this adverse effect has any association with impaired kidney function. CASE PRESENTATION: An 80-year-old male with chronic kidney disease was diagnosed with non-ST elevation myocardial infarction and underwent percutaneous coronary intervention. During hospitalization, the patient was diagnosed with contrast-induced nephropathy, treated symptomatically, and discharged with a back-to-baseline creatinine level. Two weeks later, the patient presented to the emergency department with fever and chills. Complete blood count showed leukopenia (0.84 × 103/mm3) and severe neutropenia (0.13 × 103/mm3). Blood cultures were positive for Pseudomonas aeruginosa. Clopidogrel was stopped immediately and switched into ticagrelor. Imipenem and granulocyte colony-stimulating factor were administered to the patient. The patient's white blood cell and absolute neutrophil count were within the normal range after four days of treatment. The patient was discharged after a 10-day hospitalization, and his complete blood counts were normal during further follow-ups. CONCLUSIONS: Clopidogrel was the most likely primary cause of neutropenia in our case. The incidence of clopidogrel-induced neutropenia is low and the exact mechanism is not fully explained. We provide suggestions on the management of clopidogrel-associated neutropenia, and summarize all five cases of clopidogrel-induced neutropenia in patients with impaired kidney function.

Effects of Small Gaps on the Relationship Among Soil Properties, Topography, and Plant Species in Subtropical Rhododendron Secondary Forest, Southwest China.

Background: The secondary forests have become the major forest type worldwide, and forest gap was also a common small disturbance in secondary forests. We aimed to analyze the effects of small gap disturbance on the plant species richness of subtropical secondary forest with natural regeneration barriers and examine the relationship between soil topography and plant species in a subtropical Rhododendron secondary forest of the Baili Rhododendron National Nature Reserve. Methods: The major plant species and soil topography gradient factors of the small gaps and closed canopy (control group) were analyzed using two-way ANOVA, multivariate permutational analysis of variance, nonmetric multi-dimensional scaling, random forest, canonical correspondence analysis, redundancy analysis, and a generalized linear model. Results: Small gaps had significant impact on the distribution of soil available potassium (AK), organic carbon to total phosphorus (C/P) ratio rather than slope position for soil pH and calcium (Ca) under closed canopy. Soil pH and AK followed by total phosphorus (TP) were the most important variables explaining the spatial distributions of soil properties in both habitats. Determining the spatial distribution of individual woody plant species were soil pH in small gaps, instead of lower altitude, TP, total potassium (TK) and sodium (Na) concentrations for both habitats. Moreover, Ericaceae and Fagaceae were strongly associated with pH in the small gaps. However, there was soil Na for the herbaceous plant in the closed canopy. The species richness of woody plant species in small gaps was affected significantly by pH, soil water content (SWC), and TK, instead of soil organic carbon (SOC), SWC and C/P ratio in both habitats. Conclusions: Small gaps were not always significantly improved the composition of soil nutrients, but provided a good microenvironment for plant growth, species richness of major woody plant differed between habitats.

How an uncertain cue modulates subsequent monetary outcome evaluation: an ERP study.

People avert uncertain situations more than certain ones, and the neural correlates of such acts have gained increasing attention in past decade. However, the electrophysiological bases of how subjects respond to uncertain cues, and how such cues affect subsequent outcome evaluations have rarely been explored. In the present study, participants completed a gambling task while their neural activities were recorded through electroencephalography. The results indicated that subjects were sensitive to the uncertain cue as represented by feedback-related negativity (FRN). This uncertain cue further enhanced the neural response to outcome evaluation represented by P200, FRN, and P300 temporally. The enhanced P200 outcome may reflect the negative bias of the emotional reaction, which is a reflection of uncertain deviation at an early stage. The discrepancies of differentiated feedback-related negativity between uncertain and certain condition indicated increased motivation or prediction error toward the outcome. Finally, the increased P300 amplitude under uncertain outcome compared with certain one, as well as its sensitivity to the valence of the outcome under uncertain condition, embodies the increased arousal of the affective response. Therefore, uncertain cue effects observed in the current study suggest that uncertainty induces a larger motivational/affective and expectation response toward outcome revelation.