Safety and efficacy analysis of one‐stop intervention for treating nonvalvular atrial fibrillation

1 Background

Nonvalvular atrial fibrillation (AF) is a common arrhythmia. The treatment strategy for AF mainly includes controlling symptoms and decreasing the rate of complications. Our study aimed to evaluate the safety and efficacy of combination treatment of catheter ablation and left atrial appendage (LAA) closure (one‐stop intervention) in patients with nonvalvular AF.

2 Methods and results

Thirty‐four patients with symptomatic AF (mean CHA₂DS₂‐VASc score 4.1 ± 1.3, mean HAS‐BLED score 3.8 ± 1.2) were included. Patients first received radiofrequency‐based left atrial ablation, and then the Watchman device (Boston Scientific, Natick, MA, USA) or AMPLATZER Cardiac Plug (ACP) (St. Jude Medical, Inc., St. Paul, MN, USA) was implanted for LAA closure. Follow‐up was performed at 45 days and 3 months after LAA closure to assess for recurrence of AF and prevent stroke. Radiofrequency ablation and LAA closure were successful in 100% of patients without evidence of residual flow at the final transesophageal echocardiography evaluation. A Watchman device was implanted in 29 (85.3%) patients, and an ACP was implanted in five (14.7%) patients. No device‐related thrombus formation or embolization was identified at the 45‐day or 3‐month follow‐up. Serious complications, including death, transient ischemic attack, ischemic or hemorrhagic stroke, or major bleeding, were also not identified during the follow‐ups.

3 Conclusion

For symptomatic patients with nonvalvular AF and a high risk of stroke, the one‐stop intervention is feasible, safe, and efficacious.     

Congruence Between Latent Class and K-Modes Analyses in the Identification of Oncology Patients With Distinct Symptom Experiences

Context

Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods.

LC-MS-based plasma metabolomics reveals metabolic variations in ovariectomy-induced osteoporosis in female Wistar rats

Osteoporosis with a reduction in bone mineral density has become one of the most common metabolic bone diseases. Postmenopausal women are a high-risk group that suffers from osteoporosis when the production of estrogen in their body rapidly declines. Early prediction and diagnosis of osteoporosis will be conducive to having a greater chance to control the deterioration in condition of osteoporosis patients; however, there are still no effective measures in practice. In this study, we aimed at exploring metabolic variations in postmenopausal osteoporosis using ovariectomized female rats as an animal model. The research was performed using liquid chromatography/mass spectrometry (LC/MS) combined with multivariate statistical analysis for plasma metabolome analysis. The results reveal that metabolic variations of ovariectomized-induced osteoporosis involve 18 differentially expressed metabolites and 13 related metabolism pathways such as valine, leucine and isoleucine biosynthesis as well as arachidonic acid and glycerophospholipid metabolism. Notably, the ingenuity pathway analysis platform for further understanding the relationship between metabolic alteration and osteoporosis shows that the change in the levels of metabolites mainly lead to the abnormal state of cellular compromise, cell signaling, inflammation, molecular transport and lipid metabolism. Metabolomics, as a novel way to characterize resolute endogenous small metabolites in organisms, describes the variation in the early stages of metabolic alteration for offering valuable information on pathogenic mechanisms.

Osteoporosis with a reduction in bone mineral density has become one of the most common metabolic bone diseases.     

PDR术后继发新生血管性青光眼围手术期血压和血糖波动性的研究

目的:研究增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)行玻璃体切除硅油取出术后继发新生血管性青光眼(neovascular glaucoma,NVG)围手术期血压、血糖的波动性.方法:回顾性分析增殖性糖尿病视网膜病变行23G玻璃体切除、联合白内障超声乳化、人工晶状体植入、硅油充填术的271例271眼,行硅油取出术后继发新生血管性青光眼的14例14眼,对照组(none neovascular glaucoma,NNVG)为随机抽取同期手术后未继发NVG的同年龄、同手术方式、排除对侧眼做对比,分析发生NVG的时间、围手术期血压、血糖变异性,随访时间为手术后1 ～ 12mo,用SPSS 11.0统计学软件分析本组新生血管性青光眼的发病率、发病时间、围手术期血糖、血压、糖化血红蛋白(Hbc％)的变异性.结果:患者271例14眼继发NVG,占5.2％;男10眼(71.4％),女4眼(28.6％);年龄49 ～ 68(平均57.07)岁;继发NVG的时间为玻璃体切除术后107 ～ 135d,硅油取出术后7 ～ 45(平均31.78)d;糖尿病史10 ～ 15(平均13.2)a.NVG组:围手术期空腹血糖波动4.0 ～10.2(平均8.52±3.24)mmol/L,变异系数0.48.NNVG组:围手术期空腹血糖波动5.0 ～8.2(平均7.22±0.24)mmol/L,变异系数0.43,两组变异系数差异有显著差异(P＜0.05).Hbc％ NVG组:(10.52±0.27)％,NNVG组:(7.60±1.34)％,两组比较差异有统计学意义(P＜0.05).NVG组:围手术期收缩压140 ～180(平均152.3±15.1)mmHg,变异系数0.099,舒张压50 ～ 110(平均92.3±11.1)mmHg,变异系数0.11;NNVG组:围手术期收缩压120 ～150(平均131.4±0.1)mmHg,变异系数0.061,舒张压80～100(平均87.3±8.1)mmHg,变异系数0.08;两组相比,变异系数有差异(P＜0.05),NVG组围手术期空腹血糖的变异性明显大于NNVG组.而两组之间昼夜血压的变异性相比,NVG组白天的收缩压(systolic blood pressure,SBP)以及夜晚的舒张压(diastolic blood pressure,DBP)的变异性均大于NNVG组,均有统计学意义(P＜0.05).14例患者取油术与玻璃体切除硅油注入手术围手术期血糖的变异性、血压的变异性相比无统计学意义.结论:PDR继发NVG患者围手术期空腹血糖的变异性、白天收缩压、夜间舒张压的变异性大,最早可发生在硅油取出术后1wk.     

iNOS和CD34与复发性翼状胬肉的关联

目的：研究分析诱导型一氧化碳合成酶(inducible nitric oxide synthase,iNOS)和血管内皮因子CD34与复发性翼状胬肉发病之间的联系。

方法：选取2012-03/2014-10本院收治的复发性翼状胬肉患者15例作为本次研究的实验组,另选取同期15例单纯性胬肉患者作为对照组。通过免疫组化Envision法对两组患者的手术标本中的iNOS与CD34检测,并计算微血管密度(microvessel density,MVD),比较两组患者的iNOS与CD34阳性表达率和MVD值,分析iNOS和CD34对复发性翼状胬肉的影响作用。

结果：对照组中15例单纯性胬肉患者iNOS阳性表达率为7%(1例),实验组中15例复发性翼状胬肉患者iNOS阳性表达率为87%(13例); 对照组CD34阳性表达率为13%(2例),实验组CD34阳性表达率为80%(12例)。iNos与CD34在复发性翼状胬肉患者中较结膜正常人群中的阳性表达率明显增高,且均存在显著性差异(P<0.01)。实验组MVD值为46.02±10.88,对照组MVD为23.48±5.68,实验组MVD值明显高于对照组且两组存在统计差异(P<0.01)。

结论：iNOS与CD34在复发性翼状胬肉患者中阳性显著表达率高,说明iNOS与CD34与复发性翼状胬肉疾病的发生、发展存在一定联系。