Baseline characterization of patients aged 70 years and above with hepatocellular carcinoma

AIM: To characterize the baseline profiles of patients aged 70 years and above with hepatocellular carcinoma (HCC). METHODS: A series of 127 consecutive patients with HCC were enrolled between 2000 and 2004, and none of them had been diagnosed as having HCC previously. Baseline profiles, including parameters of hepatic function such as serum transaminase and prothrombin time [PT (% activity)] were compared between patients aged ≥70 and <70 years. RESULTS: Patients ≥70 years old showed significantly lower levels of aspartate aminotransferase (P=0.04) and alanine aminotransferase (P= 0.01), and significantly higher PTs (P = 0.04) and platelet counts (P = 0.02). Concomitantly, among ≥70-year-old patients, HCC was more common in non-cirrhotics, whereas among patients <70 years old, HCC was more common in cirrhotics. There was no significant difference between the groups in the number or size of tumors. CONCLUSION: Older HCC patients showed less inflammation and better preservation of hepatic function, indicating that not only cirrhotic patients but also non-cirrhotic patients should be considered as a high-risk group among the elderly.     

Ischemic Stroke With Cerebral Protection System During Transcatheter Aortic Valve Replacement

ObjectivesThe objective of this study was to evaluate in-hospital outcomes with use of the Sentinel cerebral protection system (CPS) in transcatheter aortic valve replacement (TAVR).BackgroundThe role of the Sentinel CPS in preventing clinical ischemic stroke has been controversial.MethodsThe Nationwide Inpatient Sample database from the last three quarters of 2017, after the approval of the Sentinel CPS device, was queried to identify hospitalizations for TAVR. A 1:2 propensity score–matched analysis to compare in-hospital outcomes with versus without use of the CPS. The primary outcome was the occurrence of ischemic strokes.ResultsA total of 36,220 weighted discharges of patients who underwent TAVR (525 with the CPS and 35,695 without) were identified. The overall percentages of ischemic and hemorrhagic strokes were 2.4% and 0.2%, respectively. After propensity score matching (525 CPS, 1,050 no CPS), the risk for ischemic stroke was lower with use of the CPS (1 % vs. 3.8%, odd ratio [OR]: 0.243 (95% confidence interval: 0.095 to 0.619); p = 0.003). The cost of the index hospitalization was higher with use of the CPS ($47,783 vs. $44,578; p = 0.002). In multivariate regression analysis, use of the CPS was independently associated with a lower risk for ischemic stroke (OR: 0.380; 95% confidence interval: 0.157 to 0.992; p = 0.032).ConclusionsUse of the Sentinel CPS in patients undergoing TAVR is associated with a lower incidence of ischemic stroke and in-hospital mortality, without an increased risk for procedural complications but with an increased cost of the index hospitalization.     

Synovial lipoma arborescens of the hip

Summary Lipoma arborescens is a rare intra-articular tumor usually found in the knee joint. The reported lesion involved the inferomedial recess of the right hip synovium, in a 29-year-old male. The clinical findings were nonspecific. Both arthrography and computerized tomography (CT) of the hip disclosed the tumor which, on CT examination, showed an inhomogeneous low density, due to its fat content. The final diagnosis was given by histological examination of the resected mass. No recurrence was observed after one year. The long-term prognosis probably depends more on the underlying disorder of the joint than on the lipoma itself.     

Proposed Stages of Myocardial Phenotype Development in Fabry Disease

ObjectivesThis study sought to explore the Fabry myocardium in relation to storage, age, sex, structure, function, electrocardiogram changes, blood biomarkers, and inflammation/fibrosis.BackgroundFabry disease (FD) is a rare, x-linked lysosomal storage disorder. Mortality is mainly cardiovascular with men exhibiting cardiac symptoms earlier than women. By cardiovascular magnetic resonance, native T1 is low in FD because of sphingolipid accumulation.MethodsA prospective, observational study of 182 FD (167 adults, 15 children; mean age 42 ± 17 years, 37% male) who underwent cardiovascular magnetic resonance including native T1, late gadolinium enhancement (LGE), and extracellular volume fraction, 12-lead electrocardiogram, and blood biomarkers (troponin and N-terminal pro-brain natriuretic peptide).ResultsIn children, T1 was never below the normal range, but was lower with age (9 ms/year, r = −0.78 children; r = −0.41 whole cohort; both p < 0.001). Over the whole cohort, the T1 reduction with age was greater and more marked in men (men: −1.9 ms/year, r = −0.51, p < 0.001; women: −1.4 ms/year, r = −0.47 women, p < 0.001). Left ventricular hypertrophy (LVH), LGE, and electrocardiogram abnormalities occur earlier in men. Once LVH occurs, T1 demonstrates major sex dimorphism: with increasing LVH in women, T1 and LVH become uncorrelated (r = −0.239, p = 0.196) but in men, the correlation reverses and T1 increases (toward normal) with LVH (r = 0.631, p < 0.001), a U-shaped relationship of T1 to indexed left ventricular mass in men.ConclusionsThese data suggest that myocyte storage starts in childhood and accumulates faster in men before triggering 2 processes: a sex-independent scar/inflammation regional response (LGE) and, in men, apparent myocyte hypertrophy diluting the T1 lowering of sphingolipid.     

Lipoprotein(a) and aortic valve stenosis: A casual or causal association?

AimsThis review aims to provide an update of available methods for imaging calcification activity and potential therapeutic options.Data SynthesisAortic valve calcification represents the most common heart valve condition requiring treatment among adults in Western societies. No medical therapies are proven to be effective in treating symptoms or reducing disease progression. Therefore, surgical or transcatheter aortic valve replacement remains the only available treatment option. Elevated circulating concentrations of lipoprotein(a) is strongly associated with degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies.ConclusionsNew therapeutic targets have been identified and new imaging techniques could be used to test the effectiveness of new agents and further clarify the pathophysiology of AVS. No therapy that specifically lowers Lp (a) levels has been approved for clinical use.     

老年人腰椎和髋部骨密度测定T评分的一致性比较

目的 探讨老年人腰椎和髋部双能X线骨密度(DEXA)测定T评分的一致性及髋部骨密度(BMD)T评分在骨质疏松诊断中的意义。方法 在排除患有影响骨量的疾病及使用影响骨代谢药物者后，选择60-89岁老年人260(其中男123人，女137人)例作为为研究对象。受检者均接受问卷调查、胸腰段脊椎正侧位X线摄片，DEXA测定2-4腰椎(L2-4)椎体前后位和左髋部BMD(若左髋部发生过骨折或存有明显病变则改测右髋部)，并进行有关统计分析。结果 老年男性各年龄组L2-4 BMD T评分比髋部要高(P＜0．01或P＜0.05)；老年女性除在65—69岁、85—89岁年龄组腰椎BMD T评分比髋部要高(P＜0．01和P＜0.05)外，其余各组则差异无显著性。按照WHO标准，以髋部、腰椎和同时以髋部、腰椎BMD T评分为依据，在123例男性中，分别有19、6、5人被诊断为骨质疏松症；在137例女性中，则分别有35、17、14人被诊断为骨质疏松症；单以腰椎和同时以髋部、腰椎BMD T评分为依据所检出的骨质疏松症患者人数均少于单以髋部BMD T评分为依据者(P＜0．01)。结论 在老年人尤其是老年男性，其腰椎BMD T评分明显高于髋部，腰部BMD T评分在骨质疏松诊断中的意义更为重要。     

Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis: The Role of Echocardiography

Objectives

The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD).

Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes

BackgroundPatients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated.MethodsAll consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores.ResultsAmong 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; P = 0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88–0.98; P = 0.010 and OR 0.61; 95% CI 0.41–0.89; P = 0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18–3.73; P = 0.011) were independent risk factors for major bleeding.ConclusionThe classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population.     

特发性肺纤维化患者支气管肺泡灌洗液中白细胞介素13的水平及意义

目的　探讨特发性肺纤维化 (IPF)患者支气管肺泡灌洗液 (BALF)和外周血中白细胞介素 13 (IL 13 )水平的变化及其意义。方法　选择 17例IPF患者 (IPF组 )和 8名无器质性肺疾病者 (对照组 )。采用IL 13特异的酶联免疫吸附法测定 (ELISA)法检测 2组BALF和外周血中IL 13的水平 ,分析患者IL 13水平与其肺功能、血气之间的关系。结果　IPF组BALF和外周血中IL 13水平分别为(3 0 1± 86)ng/L、(178± 3 6)ng/L ;对照组分别为 (10 3± 2 4)ng/L、(55± 15)ng/L ,两者比较差异均有显著性 (P <0 0 1)。IPF组BALF中IL 13水平与BALF中性粒细胞数呈正相关 (r =0 786,P <0 0 1) ,与用力肺活量、一秒钟用力呼气容积、肺一氧化碳弥散量及动脉血氧分压均呈一定的等级负相关 (r分别为 -0 898、-0 878、-0 874、-0 890 ,P均 <0 0 1)。结论　IL 13可能在IPF的发病过程中起一定作用 ,并有可能作为判断病变进展情况的一项指标