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Wan Kee Kim Ho Jin Kim Joon Bum Kim Sung-Ho Jung Suk Jung Choo Cheol Hyun Chung Jae Won Lee 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1519-1528.e5
Objective
Efficacy of atrial fibrillation ablation in rheumatic mitral valve disease has been regarded inferior to that in nonrheumatic diseases. This study aimed to evaluate net clinical benefits by the addition of concomitant atrial fibrillation ablation in rheumatic mitral valve surgery.Methods
Among 1229 consecutive patients with atrial fibrillation from 1997 to 2016 (54.4 ± 11.7 years; 68.2% were female), 812 (66.1%) received concomitant ablation of atrial fibrillation (ablation group), and 417 (33.9%) underwent valve surgery alone (no ablation group). Death and thromboembolic events were compared between these groups. Mortality was regarded as a competing risk to evaluate thromboembolic outcomes. To reduce selection bias, inverse probability of treatment weighting methods were performed.Results
Freedom from atrial fibrillation occurrence at 5 years was 76.5% ± 1.8% and 5.3% ± 1.1% in the ablation and no ablation groups, respectively (P < .001). The ablation group had significantly lower risks for death (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.52-0.93) and thromboembolic events (HR, 0.49; 95% CI, 0.32-0.76) than the no ablation group. Time-varying Cox analysis revealed that the occurrence of stroke after surgery was significantly associated with death (HR, 3.97; 95% CI, 2.36-6.69). In subgroup analyses, the reduction in the composite risk of death and thromboembolic events was observed in all mechanical (n = 829; HR, 0.53; 95% CI, 0.39-0.73), bioprosthetic replacement (n = 239; HR, 0.67; 95% CI, 0.41-1.08), and repair (n = 161; HR, 0.17; 95% CI, 0.06-0.52) subgroups (P for interaction = .47).Conclusions
Surgical atrial fibrillation ablation during rheumatic mitral valve surgery was associated with a lower risk of long-term mortality and thromboembolic events. Therefore, atrial fibrillation ablation for rheumatic mitral valve disease may be a reasonable option. 相似文献4.
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Multidrug-resistant Salmonella is a well-recognised problem worldwide, especially in developing countries such as India, where non-typhoidal Salmonella infections and enteric fever are endemic. Antimicrobial resistance, particularly to fluoroquinolones, is common and leads to the frequent use of alternative agents, such as azithromycin. We herein describe the first reported case of azithromycin-resistant Salmonella gastroenteritis in a Singaporean patient. 相似文献
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Liu Shuling Matthew Lau Sie Kuei Seyed Ehsan Saffari Zheng Jiayun Tan Tse Yeun Jessie Phoon Wai Leng Veronique Viardot-Foucault Sadhana Nadarajah Jerry Kok Yen Chan Tan Heng Hao 《Reproductive biomedicine online》2019,38(1):39-45
Research question
Previous studies of aromatase inhibitors on male infertility have focused on men with low testosterone–oestradiol ratio of less than 10. Can aromatase inhibitors improve spermatogenesis in men with idiopathic male infertility with normal testosterone–oestradiol ratio?Design
Prospective study of men with idiopathic severe oligozoospermia (sperm concentration <5 million/ml) carried out between February 2015 and March 2017. The objective was to assess if semen-analysis parameters improved after treatment with letrozole. Secondary objectives were to monitor the safety of letrozole in men, and to measure the alterations in serum FSH, LH, oestradiol and testosterone levels.Results
Fifteen men with normal testosterone–oestradiol ratio (>10) were treated with letrozole 2.5 mg daily for 4 months. This produced a 5.5-fold increase in sperm concentration (P?=?0.0068). All men had increased total serum testosterone and suppressed oestradiol levels after treatment, thus raising the overall testosterone–oestradiol ratio (P < 0.0001). Adverse effects from letrozole were relatively minor and included loss of libido (54%), headaches (25%), fatigue (21%), weakness (13%), loss of hair (8%) and dry mouth (8%).Conclusions
Letrozole improves sperm concentration and increases testosterone–oestradiol ratio for men with oligozoospermia who have normal testosterone–oestradiol ratio; its role in the treatment of male infertility may be extended to this group of patients. In addition, it is a relatively well-tolerated drug with no serious adverse effects. 相似文献9.
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