Progression of Gastrointestinal Injury During Antiplatelet Therapy After Percutaneous Coronary Intervention: A Secondary Analysis of the OPT-PEACE Randomized Clinical Trial.

Importance: Gastrointestinal injury progression induced by antiplatelet therapy in patients after percutaneous coronary intervention (PCI) has not been well studied. Objective: To assess the association of aspirin, clopidogrel, and their combination with gastrointestinal injury progression among patients without high bleeding risk after PCI. Design, Setting, and Participants: This secondary analysis assessed data from the Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by ANKON Magnetically Controlled Capsule Endoscopy (OPT-PEACE) double-masked, placebo-controlled, multicenter randomized clinical trial. The OPT-PEACE trial was conducted at 28 centers in China, and recruitment took place from July 13, 2017, to July 13, 2019. The trial included patients with stable coronary artery disease or acute coronary syndromes without ST-segment elevation after PCI. Statistical analysis was conducted from September 13, 2022, to January 23, 2023. Interventions: Patients underwent magnetically controlled capsule endoscopy (MCE) at baseline and after 6 months of dual antiplatelet therapy (DAPT) with aspirin (100 mg/d) plus clopidogrel (75 mg/d). Those with no evidence of gastrointestinal ulcers or bleeding (ie, the intention-to-treat [ITT] cohort) were randomized (1:1:1) to aspirin (100 mg/d) plus matching placebo (aspirin alone), clopidogrel (75 mg/d) plus matching placebo (clopidogrel alone), or DAPT for an additional 6 months. A third MCE was performed 12 months after PCI. Main Outcomes and Measures: The primary outcome was the rate of gastric injury progression as assessed with the results of the 3 MCEs (at baseline, 6 months, and 12 months) in the modified intention-to-treat (mITT) population. The key secondary outcome was the rate of small-intestinal injury progression. Gastric or small-intestinal injury progression was defined as a quantitative increase in erosions or ulcers between the second and third MCEs (at 6 and 12 months, respectively). Results: This study included the 394 patients in the mITT cohort. Their mean (SD) age was 56.9 (8.7) years, and most were men (296 [75.1%]). A total of 132 patients were randomized to aspirin alone, 132 to clopidogrel alone, and 130 to DAPT. Gastric injury progression occurred in 49 aspirin users (37.1%), 64 clopidogrel users (48.5%), and 69 DAPT users (53.1%) (P = .02), reflecting a lower rate of gastric injury progression among aspirin users vs DAPT users (risk ratio [RR], 0.70 [95% CI, 0.49-0.99]; P = .009). No significant difference was observed between clopidogrel alone and DAPT (48.5% vs 53.1%; P = .46) or between aspirin alone and clopidogrel alone (37.1% vs 48.5%; P = .06). A total of 51 aspirin users (38.6%), 65 clopidogrel users (49.2%), and 71 DAPT users (54.6%) (P = .03) developed progressive small-intestinal injury, reflecting a lower rate of small-intestinal injury among aspirin users vs DAPT users (RR, 0.71 [95% CI, 0.50-0.99]; P = .01). No difference was observed between patients treated with clopidogrel vs DAPT (49.2% vs 54.6%; P = .38) or with aspirin vs clopidogrel (38.6% vs 49.2%; P = .08). Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, ongoing use of aspirin, clopidogrel, or their combination between 6 and 12 months after PCI was associated with progressive gastric and small-intestinal injury in a substantial proportion of patients, more so with DAPT than with monotherapy. Clopidogrel was at least as likely as aspirin to induce gastrointestinal injury progression. Future research is warranted to determine what impact the findings from MCEs would have on decision-making of antiplatelet therapy. Trial Registration: ClinicalTrials.gov Identifier: NCT03198741.

Endoscopic Ruler for varix size measurement: A multicenter pilot study.

BACKGROUND: We invented Endoscopic Ruler, a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension. AIM: To assess the feasibility and safety of Endoscopic Ruler, and evaluate the agreement on identifying large oesophageal varices (OV) between Endoscopic Ruler and the endoscopists, as well as the interobserver agreement on diagnosing large OV using Endoscopic Ruler. METHODS: We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals, all of whom got esophagogastroduodenoscopy (EGD) with Endoscopic Ruler. The primary study outcome was a successful measurement of the size of varices using Endoscopic Ruler. The secondary outcomes included adverse events, operation time, the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists, together with the interobserver agreement on diagnosing large OV by Endoscopic Ruler. RESULTS: From November 2020 to April 2022, a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse event. The median operation time of Endoscopic Ruler was 3.00 min [interquartile range (IQR): 3.00 min]. The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52, demonstrating a moderate agreement. The kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77, demonstrating a substantial agreement. CONCLUSION: The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal hypertension. Endoscopic Ruler is potential to promote the clinical practice of the two-grade classification system of OV.

Trends in medication use and treatment patterns in Chinese patients with inflammatory bowel disease.

BACKGROUND: Medications for inflammatory bowel disease (IBD) have changed dramatically over time. However, no study on long-term medication profiles has been conducted in the Chinese population. AIM: To evaluate temporal changes in medication use and treatment patterns for Chinese patients with IBD. METHODS: A multicenter retrospective cohort study was conducted among Chinese patients newly diagnosed with Crohn's disease (CD) and ulcerative colitis (UC) between January 1999 and December 2019. Baseline characteristics and drug prescriptions were collected. Trends in medication use and therapeutic patterns were analyzed. RESULTS: In total, 3610 patients were analyzed. During follow-up, 5-aminosalicylates (5-ASA) and corticosteroids (CS) prescriptions gradually decreased, accompanied by a notable increase in immunosuppressants (IMS) and infliximab (IFX) prescriptions in patients with CD. Prescription rates of 5-ASA and CS were stable, whereas IMS and IFX slightly increased since 2007 in patients with UC. Subgroup (n = 957) analyses showed a switch from conventional medications to IFX in patients with CD, while 5-ASA and CS were still steadily prescribed in patients with UC. Logistic regression analyses revealed that surgical history, disease behavior, and disease location were associated with initial therapeutic strategies in patients with CD. However, medications before diagnosis, disease location, and diagnostic year might affect initial strategies in patients with UC. CONCLUSION: Long-term treatment strategies analyses has provided unique insight into the switch from conventional drugs to IFX in Chinese patients with CD.

[Urban Micro-Scale Thermal Environment Simulation Supported by UAV Thermal Infrared Data].

With further improvements to meet social requirements for healthy and comfortable living, the research of micro-scale thermal environments has been received increasing attention. The key to micro-scale thermal environment study is the underlying surface temperature field simulation, which requires high precision results. Taking a typical area of the Jiangning District, Nanjing City, as a study area, this study used a UAV equipped with a thermal infrared imager to obtain surface temperature data in summer and autumn because of the limitation of the traditional ground measurements. Then, the numerical simulation software of ENVI-met and PALM-4U were utilized to conduct the surface temperature filed simulation. The simulation results were further analyzed combined with measured data. The modeling results indicated that the numerical simulation has high spatial accuracy, which can be applied to the study of the urban micro-thermal environment. Furthermore, the simulation effect of the model on the artificial surface is better than that of the natural surface, and the simulation effect of the open surface is better than that of the non-open surface. The study also found that the simulation effect of ENVI-met under the influence of occlusion was better than that of PALM-4U. The vegetation occlusion PALM-4U was less effective than that of ENVI-met, although both models correctly predicted the ground temperature under the occlusion of buildings. The overall conclusion indicates that the applicability of ENVI-met is superior to that of PLAM-4U for urban micro-thermal environment simulation. The study can provide a reference for the high-resolution remote sensing research of urban micro-scale thermal environments.

Serum autofluorescence, a potential serum marker for the diagnosis of liver fibrosis in rats.

Fluctuations in serum autofluorescence (AF) intensity have recently been widely used as markers of certain diseases such as cancer. To determine the diagnostic value of serum AF intensity for liver fibrosis in rats, we induced liver fibrosis by subcutaneous injection of carbon tetrachloride into rats. The rat serum AF intensities were detected at the excitation wavelength of 337 nm and the emission wavelength of 512 nm. The degree of liver fibrosis was evaluated by Van Gieson's staining. The relationship between serum AF intensity and the degree of liver fibrosis was analyzed by Spearman and Pearson Correlation. The diagnostic sensitivity and specificity of the serum AF was determined by analyzing the receiver operating characteristic (ROC) curves. Our results show that the serum AF intensity in the rat liver fibrosis model increased when compared with control rats eight weeks and twelve weeks post induction of liver fibrosis. However, there was no significant difference in serum AF intensity between fibrotic and control rats at four week post induction. Furthermore, serum AF intensity correlated positively with the severity of the degree of hepatic fibrosis. ROC analysis further suggested that serum AF intensity is a valid marker for staging fibrosis. Therefore, it may potentially be developed as a novel diagnostic tool for hepatic fibrosis.

[Sex determination by discriminant analysis of calcaneal measurements on the lateral digital radiography].

OBJECTIVE: Five measurements of the calcaneus taken on digital radiography (DR) of adults of Han Population of Sichuan Province were selected to determine sex by multivariate discriminant analysis. METHODS: Lateral radiographs of calcaneus taken from 393 subjects were collected. The samples were randomly divided into the experimental group (148 males and 186 females) and the examined group (26 males and 33 females). Five measurements were taken from the radiography. The analysis of variance (AVON) was carried out to determine if there was significant difference between the male and female. The discriminant functions were drawn by Fisher discriminant analysis. The effects of all obtained functions were evaluated with the examined samples. RESULTS: There was statistically significant difference in the five measurements between the males and the females (P<0.05). Six groups of discriminant functions were obtained with an accuracy ranged from 78.4% to 88.9%. When applied on the examined samples, the sex discriminant accuracy varied from 79.7% to 86.4%. CONCLUSION: These five measurements acquired from the lateral radiographs of calcaneus could be used for sex assessment during forensic identification of individuals.

[Relationship between chronic hepatitis C and type II diabetes mellitus].

BACKGROUND: To study the relationship between HCV infection and the development of type II diabetes mellitus. METHODS: 1. The case record files of 126 patients with chronic hepatitis C vs. 227 with chronic hepatitis B were reviewed and the laboratory and demographic data were extracted. 2. Anti-HCV and HBsAg were determined for 160 type II diabetes patients and 223 healthy adults by ELISA. RESULTS: 1. The occurrence of diabetes in patients with chronic hepatitis C was 19.05%, higher than 8.37% in patients with chronic hepatitis B (P<0.01). Age and HCV infection were independent risk factors for diabetes. 2. Five patients with type II diabetes were anti-HCV positive (3.12%) while none of the 223 healthy adults was anti-HCV positive (P<0.05). Seven patients with diabetes (4.37%) and 12 healthy adults (5.38%)were HBsAg positive (P>0.05). CONCLUSIONS: 1. The occurrence of diabetes was significantly higher in patients with HCV related liver disease than in patients with HBV related liver disease. 2. The occurrence of anti HCV was higher in diabetes patients than in healthy adults. HCV may play a role in the development of diabetes mellitus.