Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement

ObjectivesThe purpose of the study was to investigate the impact of oral anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter aortic valve replacement (TAVR).BackgroundNon–vitamin K oral anticoagulants (NOACs) are superior to vitamin K antagonists (VKAs) in nonvalvular atrial fibrillation (AF), while their comparative performance among patients in need of OAC undergoing TAVR is underinvestigated.MethodsThe study enrolled 962 consecutive patients who underwent TAVR in 4 tertiary European centers and were discharged on either NOACs (n = 326) or VKAs (n = 636). By using propensity scores for inverse probability of treatment weighting (IPTW), the comparison of treatment groups was adjusted to correct for potential confounding.ResultsMean age and Society of Thoracic Surgeons score of the population were 81.3 ± 6.3 years and 4.5% (interquartile range: 3.0% to 7.3%); 52.5% were women and a balloon-expandable valve was used in 62.7% of cases. The primary outcome of interest, combined incidence of all-cause mortality, myocardial infarction, and any cerebrovascular event at 1-year after TAVR, was 21.2% with NOACs versus 15.0% with VKAs (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.00 to 2.07; p = 0.050, IPTW-adjusted). The 1-year incidence of any Bleeding Academic Research Consortium bleeds and all-cause mortality were comparable between the NOAC and VKA groups, 33.9% versus 34.1% (HR: 0.97; 95% CI: 0.74 to 1.26; p = 0.838, IPTW-adjusted) and 16.5% versus 12.2% (HR: 1.36; 95% CI: 0.90 to 2.06; p = 0.136, IPTW-adjusted), respectively.ConclusionsChronic use of both NOACs and VKAs among patients in need of OAC after TAVR are comparable regarding 1-year bleeding risk. The higher ischemic event rate observed with NOACs needs to be evaluated in large randomized trials.     

BVT.2733影响饮食诱导肥胖小鼠中Visfatin表达的研究

目的:构建高脂饮食诱导肥胖小鼠模型,观察BVT.2733在改善胰岛素抵抗中的作用及对Visfatin表达的影响?方法:构建高脂饮食诱导的肥胖小鼠模型,分为肥胖对照组和BVT.2733治疗组,肥胖对照组给予安慰剂?治疗组给予BVT.2733灌胃2周,同时设正常饮食的小鼠为正常对照组?放射免疫法测小鼠空腹胰岛素水平,生化法检测血糖,实时定量RT-PCR 检测内脏脂肪组织Visfatin的mRNA表达?观察各组小鼠脂肪组织的形态学变化?结果:与正常对照组相比,肥胖对照组小鼠脂肪细胞明显增大,体重增加,空腹血糖?血清胰岛素水平升高(P < 0.05)?与肥胖对照组相比,BVT.2733治疗组小鼠脂肪细胞体积减小,空腹血清胰岛素水平明显下降(P < 0.01),脂肪组织Visfatin mRNA表达显著降低(P < 0.05)?结论:BVT.2733能够降低体重,减少脂肪组织,并且降低Visfatin的表达水平?     

The nociceptive and anti-nociceptive effects of bee venom injection and therapy: A double-edged sword

Bee venom injection as a therapy, like many other complementary and alternative medicine approaches, has been used for thousands of years to attempt to alleviate a range of diseases including arthritis. More recently, additional theraupeutic goals have been added to the list of diseases making this a critical time to evaluate the evidence for the beneficial and adverse effects of bee venom injection. Although reports of pain reduction (analgesic and antinociceptive) and anti-inflammatory effects of bee venom injection are accumulating in the literature, it is common knowledge that bee venom stings are painful and produce inflammation. In addition, a significant number of studies have been performed in the past decade highlighting that injection of bee venom and components of bee venom produce significant signs of pain or nociception, inflammation and many effects at multiple levels of immediate, acute and prolonged pain processes. This report reviews the extensive new data regarding the deleterious effects of bee venom injection in people and animals, our current understanding of the responsible underlying mechanisms and critical venom components, and provides a critical evaluation of reports of the beneficial effects of bee venom injection in people and animals and the proposed underlying mechanisms. Although further studies are required to make firm conclusions, therapeutic bee venom injection may be beneficial for some patients, but may also be harmful. This report highlights key patterns of results, critical shortcomings, and essential areas requiring further study.     

Outcomes of Percutaneous Interventions in Transposed Hemodialysis Fistulas Compared with Nontransposed Fistulas and Grafts

PurposeTo compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs).Materials and MethodsA total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15–91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting). Access characteristics, surgical history, percutaneous interventions, postinterventional primary and secondary access patency, and follow-up data were collected. Cox proportional-hazards regression analyses, Fisher exact tests, and χ² tests were performed.ResultsMean follow-up period was 32 months. Mean access ages at initial percutaneous intervention were 260 days (tAVF), 206 days (nAVF), and 176 days (AVG; P < .01). One-year postinterventional primary patency (PIPP) rates were 25% (tAVF), 24% (nAVF), and 14% (AVG). One-year postinterventional secondary patency (PISP) rates were 77% (tAVF), 61% (nAVF), and 63% (AVG). Median PIPP durations were 138 days (tAVF), 121 days (nAVF), and 79 days (AVG; P = .0001). Median PISP durations were 1,076 days (tAVF), 783 days (nAVF), and 750 days (AVG; P = .019). Total interventions needed to maintain PISP were 2.4 (tAVF), 1.3 (nAVF), and 3.2 (AVG) per patient-year (P < .001), which included 1.9, 1.2, and 1.4 PTAs (P < .01) and 0.45, 0.15, and 1.8 declotting procedures, respectively (P < .001).ConclusionsBased on the number of percutaneous interventions needed to maintain PISP, these results confirm the current Dialysis Outcomes Quality Initiative access preference of nAVFs before tAVFs before AVGs. tAVFs offered superior postinterventional outcomes than AVGs. With additional interventions, tAVFs could even outperform nAVFs in terms of PISP.     

BVT.2733和吡格列酮改善胰岛素抵抗作用机制的研究

目的 观察BVT.2733和吡格列酮(PGZ)对肥胖小鼠干预结果的异同,探讨BVT.2733在改善胰岛素抵抗中的作用机制.方法 构建高脂饮食诱导的肥胖小鼠模型,分为正常对照组、肥胖对照组、BVT.2733治疗组、PGZ治疗组,对照组给予安慰剂,治疗组分别给予BVT.2733、PGZ灌胃2周,放免法检测小鼠空腹胰岛素水平,生化法检测血糖,ELISA法检测血清脂联素含量,实时定量PCR检测脂肪组织脂联素和瘦素的mRNA表达.观察4组小鼠在胰岛素抵抗方面的差异.结果 与正常对照组相比,肥胖对照组小鼠脂肪细胞明显增大,体重增加,空腹血糖、血清胰岛素水平升高(P<0.05).与肥胖对照组比较,BVT.2733、PGZ治疗组鼠脂肪细胞体积减小,空腹血清胰岛素明显下降(P<0.01);PGZ组血清脂联素含量升高、脂肪组织脂联素和瘦素表达明显上调(P<0.05).BVT.2733治疗组小鼠体重明显减轻,而血清脂联素含量、脂肪组织脂联素和瘦素表达变化无统计学意义.结论 BVT.2733能够显著减轻体重,改善胰岛素抵抗,但其不能影响脂肪细胞的分泌功能.