Direct oral anticoagulants versus warfarin in patients with antiphospholipid syndrome: A meta-analysis of randomized controlled trials.

OBJECTIVE: This study aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) versus warfarin in patients with antiphospholipid syndrome (APS). METHODS: We performed a literature search using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. We also performed a meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness and safety of DOACs versus warfarin in patients with APS. RESULTS: Five RCTs involving 648 patients with APS (330 in DOAC-treated and 318 in control groups) were included in the meta-analysis. Among the patients included in the analysis, 29 (8.8%) patients experienced recurrent thrombosis in the DOAC treatment group, and 10 patients (3.1%) had thrombosis recurrence in the warfarin treatment group, resulting in a higher incidence in DOAC-treated than in the warfarin-treated groups [odds ratio (OR) = 2.163, 95% CI = 0.985-4.748, p = 0.055]. Incidence of arterial thrombosis was significantly higher in DOAC-treated patients than in warfarin-treated patients (OR = 5.168, 95% CI = 1.567-17.04, p = 0.007). Stroke and thrombosis occurrences were significantly higher in the triple positivity group than in the warfarin therapy group (OR = 12.03, 95% CI = 2.249-64.36, p = 0.004; OR = 2.940, 95% CI = 1.016-8.504, p = 0.047). However, venous thrombosis occurrences did not differ significantly between the DOAC-treated and warfarin-treated groups. There were no significant differences between the DOAC and warfarin groups in terms of any bleeding, major bleeding, minor bleeding, and all-cause mortality. CONCLUSION: DOACs were associated with higher rates of arterial thrombosis than warfarin in patients with APS, especially in the triple-positive group. However, a higher risk of recurrent venous thrombosis was not found in APS patients treated with DOACs compared to those treated with warfarin.

Lack of association of TNF-alpha promoter polymorphisms with ankylosing spondylitis: a meta-analysis.

OBJECTIVES: Genetic factors, in addition to the HLA-B27, could play a role in the pathogenesis of AS. TNF-alpha promoter polymorphisms have been reported to be associated with AS susceptibility, but the results of these previous studies have been inconsistent. The aim of this study was to explore whether TNF-alpha promoter polymorphisms confer susceptibility to AS. METHODS: We conducted a random effect meta-analysis on the association of the A/A genotype (the recessive effect), the A/A + A/G genotype (the dominant effect) and the A allele of the TNF-alpha -308 and -238 polymorphisms with AS. RESULTS: Eight studies, consisting of seven European studies and one Latin American study, were included in this meta-analysis. Any association between AS and the TNF-alpha -308 A allele was not found [odds ratio (OR) = 0.911; 95% CI 0.512, 1.286; P = 0.636; I(2) = 73.8]. There was also no association of the TNF-alpha -308 AA and AA+AG genotypes with AS. Meta-analysis of the TNF-alpha -238 polymorphisms showed no association with AS (OR for A allele = 0.930; 95% CI 0.498, 1.737; P = 0.821; I(2) = 71.6). Subgroup analysis by ethnicity and HLA-B27 positivity did not change the results for the association of the TNF-alpha -308 and -238 polymorphisms with AS. CONCLUSIONS: This meta-analysis including 2247 subjects has shown that there is a lack of association of the TNF-alpha -308 A/G and -238 A/G polymorphisms with AS.

Serum uric acid levels and hormone therapy type: a retrospective cohort study of postmenopausal women.

OBJECTIVE: Serum uric acid levels increase in postmenopausal women, but decrease when hormone therapy (HT) is administered. No study has, however, evaluated the effects of different types of HT on serum uric acid levels. We therefore examined whether estrogen therapy (ET), estrogen plus progestogen therapy (EPT), and tibolone use affected serum uric acid levels in this population. METHODS: We performed a retrospective cohort study of postmenopausal women. From 2005 to 2015, postmenopausal women who had undergone blood uric acid-level testing at least twice were enrolled. Participants were grouped according to HT regimen: ET, EPT, or tibolone. The nonhormone therapy group did not receive HT. Differences in serum uric acid levels were examined in each group. Our analysis was adjusted to accommodate different follow-up intervals for individual participants. Multiple variables were adjusted using the Tukey-Kramer method. Age, body mass index, hypertension, diabetes mellitus, dyslipidemia, estimated glomerular filtration rate, alcohol consumption, smoking status, and comedications were also adjusted. RESULTS: After adjusting for multiple variables, the serum uric acid level increased to 0.87 ±â€Š0.27 mg/dL (least squares mean ±â€Šstandard error) in the nonhormone therapy group, and serum uric levels in the EPT group were found to be significantly lower (-0.38 ±â€Š0.29 mg/dL, P < 0.001). The serum uric acid levels in the ET and tibolone groups did not, however, differ significantly from the nonhormone therapy group level. CONCLUSIONS: We attribute our findings to the effects of progestogen, rather than estrogen.

Diagnosis of Paget's disease of the pelvis using F-18 FDG PET/CT.

Sclerotic lesions of the right iliac bone were discovered incidentally in a 52-year-old Korean woman. In this case, imaging of the right iliac bone showed intense osteoblastic activity on the bone scan and very mild F-18-fluoro-2-deoxyglucose (FDG) uptake on positron emission tomography (PET). Since Paget's disease is rare in Koreans, we aimed to rule out other bone diseases such as osteoblastic metastasis or osteomyelitis. These results allowed us to exclude chronic osteomyelitis or malignancy and clarify the diagnosis of Paget's disease of the iliac bone. This case illustrates how F-18 FDG PET/CT can be a useful tool in the differential diagnosis of various bone diseases.