Gut Microbiota Regulation by Acupuncture and Moxibustion: A Systematic Review and Meta-Analysis.

There have been numerous studies investigating the impact of acupuncture and/or moxibustion on the gut microbiota, but the results have been inconclusive. Therefore, we conducted a systematic review and meta-analysis that included both preclinical and clinical studies to assess the current evidence regarding the effects of acupuncture on gut microbiota changes. We collected relevant studies from EMBASE and PubMed, collected outcomes including diversity and relative abundance measures of the gut microbiome, and the summarized effect estimates were calculated using the ratio of means (ROM) with 95% confidence intervals. Our analysis identified three clinical studies and 20 preclinical studies, encompassing various diseases and models, including colitis and obesity. The pooled results indicated no significant difference in alpha diversity changes between treatment groups and controls, except for the Simpson index measure, which was significantly higher in the treatment groups. Additionally, the pooled results showed an increase in the Firmicutes and a decrease in the Bacteroidetes in the treatment groups, along with increases in the Lactobacillus and Ruminococcus genera. These findings suggest acupuncture treatment can target the modification of specific phyla and genera of gut microbiota. However, it is important to note that the effects of acupuncture on the gut microbiome are heterogeneous across studies, particularly in different disease models.

Ventricular reverse remodeling early after mitral valve repair for severe chronic mitral regurgitation with atrial fibrillation.

OBJECTIVE: Chronic mitral regurgitation (MR) results in volume overload followed by left ventricular (LV) and left atrial remodeling. The aim of this study was to investigate the relation of clinical, echocardiographic findings and N-terminal B-type natriuretic peptide (NT-proBNP) to LV reverse remodeling (LVRR) early after valve repair for severe chronic MR concomitant with modified maze procedure for atrial fibrillation (AF). METHODS: We retrospectively evaluated 60 patients who were surgically treated for severe chronic MR and AF. Plasma NT-proBNP and echocardiographic measurements were performed before surgery, before discharge and 12 months after surgery. Echocardiogram was additionally performed at 6 months. LVRR was assessed by looking at regression of LV mass index (LVMI) using echocardiography. RESULTS: Fifty-two patients (87%) were classified in the LVRR group, defined as having a postoperative reduction in LVMI. The remaining patients were classified in the non-LVRR group. The non-LVRR group was older (p = 0.004), had a significantly higher ratio of patients with hypertension (p = 0.022), higher NT-proBNP levels (p = 0.007) and lower ejection fraction (p = 0.034) compared to the LVRR group. In multivariate analysis, age (odds ratio 0.874, p = 0.013) and NT-proBNP levels (odds ratio 0.185, p = 0.040) were independent predictors of LVRR. CONCLUSIONS: Preoperative lower NT-proBNP levels and younger age may predict LVRR early after surgical correction of chronic MR with AF.

Pulse wave velocity is more closely associated with cardiovascular risk than augmentation index in the relatively low-risk population.

Pulse wave velocity (PWV) and augmentation index (AI) are both indirect indicators of arterial stiffness, which is an independent predictor of morbidity and mortality in cardiovascular diseases. The aim of this study was to assess the association between carotid AI (CAI), carotid-femoral PWV (CFPWV), and Framingham risk score (FRS), and to evaluate the factors determining CAI and CFPWV. Carotid AI and CFPWV were measured by applanation tonometry in 177 consecutive subjects without evidence of significant cardiovascular disease. Correlations between CAI and FRS and CFPWV and FRS were analyzed and major determinants of CAI and CFPWV were assessed. The mean age was 60.5 +/- 11.9 years and 112 (63%) of study patients were men. There was a significant association between CFPWV and FRS (r = 0.417, P < 0.001) and a weaker but also significant relation between CAI and FRS (r = 0.267, P < 0.001). CFPWV was significantly related to FRS in both men and women (P < 0.001 in both sexes), whereas the relation between CAI and FRS was significant only in women (P < 0.001). Our results suggest that CFPWV may be associated with CVD risk irrespective of sex, whereas CAI may be associated with CVD risk in women only.

Coronary artery graft dilatation aided by multidetector computed tomography.

Coronary angiography is the standard method of follow-up for patients with coronary artery bypass grafts, but it is an invasive and costly procedure that is not risk-free. Recently, 64-slice multidetector computed tomography has allowed reliable visualization of coronary artery grafts and their anastomotic status, with high spatial resolution. We describe a successful case of percutaneous coronary intervention for occluded coronary artery bypass grafts with the aid of multidetector computed tomography.

Clinical characteristics, ballooning pattern, and long-term prognosis of transient left ventricular ballooning syndrome.

OBJECTIVE: Although patients with transient left ventricular ballooning syndrome (TLVBS), also known as Takotsubo cardiomyopathy, improve rapidly and recover left ventricular systolic function, the long-term prognosis is not well-known. This study investigated the clinical features of TLVBS, and its in-hospital and long-term (in-hospital plus postdischarge) mortality. METHODS AND RESULTS: We evaluated 87 patients diagnosed with TLVBS. The median follow-up was 42 months (interquartile range, 19 to 72 months). During follow-up, no recurrences were reported, but 20 (23%) patients died. Two nonsurvivors (2%) were suspected of dying from sudden cardiac death. The in-hospital total mortality rate was 9%, but the in-hospital cardiac mortality rate was 0%. Most deaths were associated with underlying noncardiac diseases. Baseline characteristics were mostly similar between survivors and nonsurvivors. However, nonsurvivors were older, and more likely to be smokers compared with survivors. Underlying noncardiac diseases were the only independent predictors of long-term mortality (hazard ratio, 3.954; 95% confidence interval, 1.369 to 11.422; P=.011). There were no significant differences in long-term mortality, according to the preceding stress events or ballooning patterns. CONCLUSIONS: Although a substantial number of patients with TLVBS die, the long-term cardiac mortality is low. The severity of heart failure owing to TLVBS may influence in-hospital mortality, whereas underlying noncardiac diseases have a more significant correlation with the long-term prognosis than does TLVBS itself.

[The anaylsis of mortality rate according to CTP score and MELD score in patients with liver cirrhosis].

BACKGROUND/AIMS: The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The MELD score is a reliable measurement of mortality risk and is suitable for a disease severity index in patients with end-stage liver disease. We examined the validity of the MELD as a disease severity index for patients with end-stage liver disease. METHODS: We investigated the 379 patients with liver cirrhosis hospitalized between January 1995 and May 2001. We retrospectively reviewed the hospital records to verify the diagnosis of cirrhosis and to collect exact patient information about their demographic data, portal hypertensive complications and laboratory data. The ability to classify patients with liver cirrhosis according to their risk of death was examined using the concordance c-statistic. RESULTS: The MELD score performed well in predicting death within 3 months with a c-statistic of 0.73 with etiology and 0.71 without etiology. The significant clinical, laboratory variables on 3 month survival in patients with liver cirrhosis are serum bilirubin, ascites and hepatic encephalopathy. The addition of portal hypertensive complications to the MELD score did not improve the accuracy of the MELD score. CONCLUSIONS: The MELD score is a useful disease severity index for the patients with end-stage liver disease and provides reliable measurement of short term survival over a wide range of liver disease severity and diverse etiology.