Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome: a meta-analysis.

BACKGROUND & AIMS: Ticagrelor has been acknowledged as a new oral antagonist of P2Y12-adenosine diphosphate receptor, as a strategy with more rapid onset as well as more significant platelet inhibition function in acute coronary syndrome (ACS) patients. The clinical benefit of ticagrelor compared with clopidogrel remains controversial. The current meta-analysis was conducted to better evaluate the role of ticagrelor in comparison of clopidogrel in treating ACS patients. METHODS: The publications involving the safety as well as the efficacy of clopidogrel versus ticagrelor were screened and identified updated to June 2018. After rigorous review, eligible randomized controlled trials (RCTs) were extracted and propensity score matching (PSM) analysis was conducted. To analyze the summary odds ratios (ORs) of the endpoints of interest, we applied Meta-analysis Revman 5.3 software. RESULTS: There were a total of 10 studies that met our inclusion criteria, of which the risk of bleeding rate (P = 0.43), MI (P = 0.14), and stroke (P = 0.70) had no association with significant differences between patients receiving ticagrelor or clopidogrel. Nonetheless, higher rate of dyspnea was observed in ticagrelor group (OR = 1.87, 95% CI: 1.70-2.05, P<0.00001 = . CONCLUSIONS: Our present findings suggest similar efficacy and safety profiles for clopidogrel and ticagrelor Ticagrelor should be considered as a valuable option to reduce the risk of bleeding, MI and stroke, whereas potentially increases the incidence of dyspnea. Given the metabolic process, ticagrelor may be a valid and even more potent antiplatelet drug than clopidogrel, as an alternative strategy in treating patients with clopidogrel intolerance or resistance.

Fibroblast growth factor-21 concentration in serum and synovial fluid is associated with radiographic bone loss of knee osteoarthritis.

We aimed to evaluate whether FGF-21 concentration in serum and synovial fluid (SF) is associated with radiographic bone loss of knee osteoarthritis (OA). A total of 186 OA patients and 108 controls were recruited. The radiographic bone loss of knee OA was assessed by the Ahlbäck grading scale. FGF-21 concentration in serum and SF was measured by enzyme-linked immunosorbent assay (ELISA). We demonstrated that OA patients had significantly higher serum FGF-21 concentration compared with controls (204.30 [range 158.25-279.16] ng/L vs. 130.72 [range 94.93-218.03] ng/L, p < 0.01). FGF-21 concentration in serum was well correlated with that in paired SF samples (r = 0.668, p < 0.001). In OA patients, those with a higher Ahlbäck grade had significantly higher serum and SF FGF-21 concentration (p < 0.001 for both). FGF-21 concentration in serum and SF was significantly and independently associated with the Ahlbäck grade (r = 0.403, p < 0.001 and r = 0.410, p < 0.001; respectively). These findings indicated that FGF-21 might be a potential biomarker for predicting bone loss of OA. Therapeutic interventions by blocking FGF-21 signaling pathways to delay the degenerative process of OA warrants further investigations.

Flavonoids from Podocarpus macrophyllus and their cardioprotective activities.

One new 8-aryl flavone, podocarflavone A (1), together with 15 previously reported flavonoids were isolated from the twigs and leaves of Podocarpus macrophyllus. Their structures were established on the basis of extensive spectroscopic analysis and by the comparison with spectroscopic data reported in the literature. Antioxidant capacities of the isolated substances were determined using the 1,1-diphenyl-2-picrylhydrazyl, ferrous ions, and 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) radical in vitro assays, and their cytoprotective activities were also tested on H2O2-induced apoptosis in H9c2 cardiomyocytes. The results showed that those flavonoids exhibited significant cardioprotective effects by decreasing the H2O2-induced death of H9c2 cell, and the levels of lactate dehydrogenase and creatine kinase, and by inhibiting the elevated intracellular concentration of reactive oxygen species.

Insomnia is related to long-term atrial fibrillation recurrence following radiofrequency ablation.

OBJECTIVE: Atrial fibrillation (AF), the most common cardiac arrhythmia, presents significant health challenges, and the intricate connection between insomnia and AF has garnered substantial attention. This cohort study aims to investigate the relationship between insomnia and AF recurrences following radiofrequency ablation. MATERIALS AND METHODS: Data were retrieved from an electronic database of patients who underwent radiofrequency ablation for AF. The primary endpoint was AF recurrence. We utilized a multivariable Cox model, coupled with three propensity score methods, for analysis. RESULTS: Between January 1, 2017, and June 1, 2022, 541 patients who underwent radiofrequency ablation for AF were recorded in the database. After excluding 185 patients, the final cohort comprised 356 patients. Among them, 68 were afflicted by insomnia, while 288 were not. Over a median follow-up of 755 days, one patient died, and 130 (36.5%) experienced AF recurrence. Multivariate Cox regression analysis revealed that the insomnia group had a higher risk of AF recurrence compared to the non-insomnia group (HR: 1.83, 95% CI: 1.16-2.89). Further landmark analysis showed no significant difference in AF recurrence rates during the initial 1-year follow-up. However, beyond 1 year, the insomnia group demonstrated a significantly higher AF recurrence rate. As the number of insomnia symptoms increased, the risk of AF recurrence also rose significantly, indicating a dose-response relationship. CONCLUSION: This study establishes a significant link between insomnia and long-term AF recurrence following radiofrequency ablation. It underscores the importance of identifying and addressing insomnia in patients with AF undergoing radiofrequency ablation.

Association of visceral adiposity index and lipid accumulation products with prediabetes in US adults from NHANES 2007-2020: A cross-sectional study.

BACKGROUND: The lipid accumulation product (LAP) and the visceral adiposity index (VAI) are suggested as dependable measures for assessing visceral fat levels. Prediabetes is recognized as a condition that precedes the potential onset of diabetes. The objective of this research is to investigate how VAI and LAP are related to prediabetes among the adult population in the United States. METHODS: Information from the 2007-2020 National Health and Nutrition Examination Survey (NHANES) was scrutinized in a cross-sectional study. To evaluate the connection between VAI or LAP and the presence of prediabetes, both univariate analysis and multivariate logistic regression were utilized. Threshold effect analysis and fitted smoothing curves were used to delve into the non-linear association between VAI or LAP and prediabetes. Additional analyses were performed on specific subgroups, along with tests to explore potential interactions. RESULTS: In general, 12,564 American adults were included. After full adjustment, prediabetes with VAI (OR: 1.128, 95% CI: 1.073-1.185) or LAP (OR: 1.006, 95% CI: 1.004-1.008) showed a positive correlation. Individuals in the 4th VAI quartile group faced a significant 61.9% elevated risk for prediabetes (OR: 1.619, 95% CI: 1.354-1.937) when contrasted to those in the 1st VAI quartile. Participants in the 4th LAP quartile group had a significant 116.4% elevated risk for prediabetes (OR: 2.164, 95% CI: 1.747-2.681) when contrasted to individuals of the 1st LAP quartile. Smooth curve fitting analysis revealed a nonlinear correlation of VAI or LAP and prediabetes, and threshold effect analysis was used to determine an inflection point of 4.090 for VAI and 68.168 for LAP. CONCLUSIONS: The values of VAI and LAP are positively associated with the prevalence of prediabetes. The VAI and LAP indices may be used as predictors of prediabetes.

Amygdalin and exercise training exert a synergistic effect in improving cardiac performance and ameliorating cardiac inflammation and fibrosis in a rat model of myocardial infarction.

This study investigated the effects of amygdalin (AMY, a cyanogenic glycoside widely distributed in the fruits and seeds of Rosaceae plants) on cardiac performance and ventricular remodeling in a rat model of myocardial infarction (MI). We also investigated whether the combination of AMY with exercise training (ExT) has a beneficial synergistic effect in treating MI rats. MI was induced by the ligation of the left anterior descending coronary artery in male SD rats. ExT or AMY treatment was started 1 week after MI and continued for 1 week (short-term) or 8 weeks (long-term). Cardiac function was evaluated by echocardiographic and hemodynamic parameters. Heart tissues were harvested and subjected to 2,3,5-triphenyl-tetrazolium chloride, Masson's trichrome, hematoxylin-eosin, and immunohistochemical staining. Gene expression was determined by quantitative polymerase chain reaction. Western blot gave a qualitative assessment of protein levels. AMY or ExT improved cardiac function and reduced infarct size in MI rats. AMY or ExT also suppressed myocardial fibrosis and attenuated inflammation in the infarct border zone of hearts from MI rats, as evidenced by inhibition of collagen deposition, inflammatory cell infiltration, and pro-inflammatory markers (interleukin 1ß, interleukin 6, tumor necrosis factor-α, and cyclooxygenase 2). Notably, the effects of AMY combined with ExT were superior to those of AMY alone or ExT alone. Mechanistically, these beneficial functions were correlated with the inhibition of MI-induced activation of the transforming growth factor-ß/Smad pathway. Collectively, AMY and ExT exert a synergistic effect on improving cardiac performance and ameliorating cardiac inflammation and fibrosis after MI, and the effects of long-term intervention were better than short-term intervention.

Pharmacological actions of the bioactive compounds of Epimedium on the male reproductive system: current status and future perspective.

ABSTRACT: Compounds isolated from Epimedium include the total flavonoids of Epimedium, icariin, and its metabolites (icaritin, icariside I, and icariside II), which have similar molecular structures. Modern pharmacological research and clinical practice have proved that Epimedium and its active components have a wide range of pharmacological effects, especially in improving sexual function, hormone regulation, anti-osteoporosis, immune function regulation, anti-oxidation, and anti-tumor activity. To date, we still need a comprehensive source of knowledge about the pharmacological effects of Epimedium and its bioactive compounds on the male reproductive system. However, their actions in other tissues have been reviewed in recent years. This review critically focuses on the Epimedium, its bioactive compounds, and the biochemical and molecular mechanisms that modulate vital pathways associated with the male reproductive system. Such intrinsic knowledge will significantly further studies on the Epimedium and its bioactive compounds that protect the male reproductive system and provide some guidances for clinical treatment of related male reproductive disorders.

Olivibacter jilunii sp. nov., isolated from DDT-contaminated soil.

Bacterial strain 14-2A(T), isolated from a long-term DDT-contaminated soil in China, was characterized by using a polyphasic approach to clarify its taxonomic position. Strain 14-2A(T) was found to be Gram-negative, aerobic, non-spore-forming, non-motile, non-flagellated and rod-shaped. The new isolate was able to grow at 4-42 °C, pH 6.0-9.0 and with 0-5 % NaCl. Phylogenetic analysis based on 16S rRNA gene sequences indicated that the isolate belongs to the family Sphingobacteriaceae. The 16S rRNA gene sequence of strain 14-2A(T) showed the highest similarity with Olivibacter oleidegradans TBF2/20.2(T) (99.4 %), followed by Pseudosphingobacterium domesticum DC-186(T) (93.8 %), Olivibacter ginsengisoli Gsoil 060(T) (93.6 %), Olivibacter terrae Jip13(T) (93.1 %), Olivibacter soli Gsoil 034(T) (92.8 %) and Olivibacter sitiensis AW-6(T) (89.6 %). The DNA-DNA hybridization value between strains 14-2A(T) and O. oleidegradans TBF2/20.2(T) was 34.45±2.11 %. Strain 14-2A(T) contained phosphatidylethanolamine, phosphatidylmonomethylethanolamine, aminophospholipid and phosphatidylinositol mannoside as the major polar lipids. The DNA G+C content was 41.2 mol%. MK-7 is the major isoprenoid quinone. Summed feature 3 (C16 : 1ω7c and/or C16 : 1ω6c), iso-C15 : 0 and iso-C17 : 0 3-OH are the major fatty acids. The phenotypic and chemotaxonomic data confirmed the affiliation of strain 14-2A(T) to the genus Olivibacter. On the basis of the phylogenetic and phenotypic characteristics, and chemotaxonomic data, strain 14-2A(T) is considered to represent a novel species of the genus Olivibacter, for which the name Olivibacter jilunii sp. nov. is proposed; the type strain is 14-2A(T) ( = KCTC 23098(T) = CCTCC AB 2010105(T)).

Dimethyl 3,3'-(phenyl-methyl-ene)bis-(1H-indole-2-carboxyl-ate).

In the title compound, C27H22N2O4, the two indole ring systems are approximately perpendicular to each other, with a dihedral angle of 84.5 (5)° between their planes; the benzene ring is twisted with respect to the two indole ring systems at angles of 78.5 (5) and 86.5 (3)°. In the crystal, mol-ecules are linked by N-H⋯O hydrogen bonds, weak C-H⋯O and C-H⋯N hydrogen bonds, and C-H⋯π inter-actions into a three-dimensional supra-molecular architecture.

GAS6-AS1, a long noncoding RNA, functions as a key candidate gene in atrial fibrillation related stroke determined by ceRNA network analysis and WGCNA.

BACKGROUND: Stroke attributable to atrial fibrillation (AF related stroke, AFST) accounts for 13 ~ 26% of ischemic stroke. It has been found that AFST patients have a higher risk of disability and mortality than those without AF. Additionally, it's still a great challenge to treat AFST patients because its exact mechanism at the molecular level remains unclear. Thus, it's vital to investigate the mechanism of AFST and search for molecular targets of treatment. Long non-coding RNAs (lncRNAs) are related to the pathogenesis of various diseases. However, the role of lncRNAs in AFST remains unclear. In this study, AFST-related lncRNAs are explored using competing endogenous RNA (ceRNA) network analysis and weighted gene co-expression network analysis (WGCNA). METHODS: GSE66724 and GSE58294 datasets were downloaded from GEO database. After data preprocessing and probe reannotation, differentially expressed lncRNAs (DELs) and differentially expressed mRNAs (DEMs) between AFST and AF samples were explored. Then, functional enrichment analysis and protein-protein interaction (PPI) network analysis of the DEMs were performed. At the meantime, ceRNA network analysis and WGCNA were performed to identify hub lncRNAs. The hub lncRNAs identified both by ceRNA network analysis and WGCNA were further validated by Comparative Toxicogenomics Database (CTD). RESULTS: In all, 19 DELs and 317 DEMs were identified between the AFST and AF samples. Functional enrichment analysis suggested that the DEMs associated with AFST were mainly enriched in the activation of the immune response. Two lncRNAs which overlapped between the three lncRNAs identified by the ceRNA network analysis and the 28 lncRNAs identified by the WGCNA were screened as hub lncRNAs for further validation. Finally, lncRNA GAS6-AS1 turned out to be associated with AFST by CTD validation. CONCLUSION: These findings suggested that low expression of GAS6-AS1 might exert an essential role in AFST through downregulating its downstream target mRNAs GOLGA8A and BACH2, and GAS6-AS1 might be a potential target for AFST therapy.

The emerging role of exosomes in the development of testicular.

The mechanisms of testicular development in mammals are complex. Testis is an organ that produces sperm and secretes androgens. It is rich in exosomes and cytokines that mediate signal transduction between tubule germ cells and distal cells, promoting testicular development and spermatogenesis. Exosomes are nanoscale extracellular vesicles that transmit information between cells. By transmitting information, exosomes play an important role in male infertility diseases such as azoospermia, varicocele, and testicular torsion. However, due to the wide range of sources of exosomes, extraction methods are numerous and complex. Therefore, there are many difficulties in studying the mechanisms of exosomal effects on normal development and male infertility. Therefore, in this review, first, we introduce the formation of exosomes and methods for culturing testis and sperm. Then, we introduce the effects of exosomes on different stages of testicular development. Finally, we summarize the prospects and shortcomings of exosomes when used in clinical applications. We lay the theoretical foundation for the mechanism of the influence of exosomes on normal development and male infertility.

Theoretical prediction of the reaction of s-triazine with nitrate radical: a new possible route to generate oxy-s-triazine.

Oxy-s-triazine (OST) is one of the important Hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) decomposition products, while it is yet not fully clear how it is formed up to now. The study systematically investigates the reaction of s-triazine (TAZ) with nitrate radical (NO(3)) using computational chemistry methods, for which three entrance channels are devised, resulting in the formation of four isomers of OST. Based on the analysis of the barrier heights and the reaction exothermicities, the pathway to form OST3 through hydrogen atom abstraction and rebound mechanism is likely to be the main channel in the reactions of TAZ with NO(3) radical. Our study puts forward a new possible route to generate OST.

[The efficacy of antihypertensive treatment on diabetes mellitus or impaired glucose tolerance patients with blood pressure below 140/90 mm Hg: a meta-analysis].

OBJECTIVE: To investigate whether antihypertensive treatment is beneficial to patients with diabetes mellitus when their blood pressure (BP) is below 140/90 mm Hg (1 mm Hg = 0.133 kPa). METHODS: MEDLINE, EMBASE, IPA database and secondary resources were searched with terms including blood pressure, hypertension and anti-hypertension drug. INCLUSION CRITERIA: random control study; subjects were patients with diabetes mellitus or impaired glucose tolerance; endpoint BP ≤ 140/90 mm Hg; endpoint BP between two groups had significant differences. There were 16 studies meet inclusive criteria with a total of 51 470 patients. RR and 95%CI were used as index to judge the difference of clinical outcomes between aggressive antihypertensive treatment group and standard antihypertensive treatment group. RevMan5.0 software was used for statistical analysis. RESULTS: When BP of patients with diabetes mellitus were below 140/90 mm Hg, anti-hypertensive treatment could reduce incidence rate of cardiovascular event (RR 0.91, 95%CI 0.87 - 0.96, P = 0.0004) and stroke (RR 0.75, 95%CI 0.63 - 0.88, P = 0.0005), and increased incidence rate of symptomatic hypotension (RR 3.57, 95%CI 1.41 - 11.20, P = 0.03) and hyperpotassemia (RR 1.57, 95%CI 1.05 - 2.33, P = 0.03). There were no significant differences in all-cause mortality (RR 0.94, 95%CI 0.87 - 1.01, P = 0.08), cardiovascular mortality (RR 0.95, 95%CI 0.85 - 1.08, P = 0.05), myocardial infarction (RR 0.93, 95%CI 0.82 - 1.05, P = 0.26), heart failure (RR 0.90, 95%CI 0.76 - 1.06, P = 0.21) between the aggressive antihypertensive treatment group and standard antihypertensive treatment group. CONCLUSIONS: When blood pressure of patients with diabetes mellitus was below 140 mm Hg, there was little benefit from aggressive antihypertensive treatment, and the risk of serious adverse events even increased.

[Insertion technique and clinical application of regional method axis pedicle screw].

OBJECTIVE: To explore the clinical efficacies and outcomes of regional method axis pedicle screw insertion technique. METHODS: During the period of April 2004 to June 2010, a total of 23 cases with traumatic instability of upper cervical vertebrae were recruited. There were 19 males and 4 females with a mean age of 45.8 years. They underwent surgical operations after an excellent traction reduction of cervical vertebrae. The entry points were drawn on axial facet joint and all of them distributed in the region of upper inner 1/4 of lower articular process. So the regional method was employed to determine the entry point. All subjects underwent the reconstruction of posterior stability. Axial pedicle screws were inserted by the insertion technique of axial pedicle screw via the "regional method". The entry region was in the upper inner 1/4 area of lower articular process. The entry angle, medial inclination and superior inclination were determined by the direction of inner wall and upper wall of isthmus. Postoperative cervical radiography and CT examination were performed to confirm the screw position. RESULTS: Forty-six axial pedicle screws were implanted. No significant complications occurred. All screws stayed in excellent positions without the invasion of vertebral artery and spinal canal. CONCLUSIONS: The "regional method" insertion technique of axial pedicle screw require no memory of complex entry points and entry angle parameters. And there is no need of identifying the anatomical landmarks. Thus this approach is accurate, safe and suitable for most patients.

Diethyl 3,3'-(phenyl-methyl-ene)bis-(1H-indole-2-carboxyl-ate).

In the title compound, C(29)H(26)N(2)O(4), the benzene ring is twisted by 73.5 (5) and 84.9 (3)° with respect to the mean planes of the two indole ring systems; the mean planes of the indole ring systems are oriented at a dihedral angle of 82.0 (5)°. In the crystal, mol-ecules are linked by pairs of N-H⋯O hydrogen bonds into chains.

Effectiveness of multiple eHealth-delivered lifestyle strategies for preventing or intervening overweight/obesity among children and adolescents: A systematic review and meta-analysis.

Objective: To investigate the effect of multiple eHealth-delivered lifestyle interventions on obesity-related anthropometric outcomes in children and adolescents. Methods: The Medline (via PubMed), Embase, Cochrane Library, Web of Science, CBM, VIP, CNKI, and Wanfang electronic databases were systematically searched from their inception to March 18, 2022, for randomized controlled trials (RCTs). Meta-analyses were performed to investigate the effect of multiple eHealth-delivered lifestyle interventions on obesity-related anthropometric outcomes (body mass index [BMI], BMI Z-score, waist circumference, body weight, and body fat%). Two independent investigators reviewed the studies for accuracy and completeness. All included studies were evaluated using the Cochrane Risk-of-Bias (ROB) Tool. Results: Forty trials comprising 6,403 patients were selected for the meta-analysis. The eligible trials were published from 2006 to 2022. Compared with the control group, the eHealth-intervention group was more effective in reducing BMI (weighted mean difference [WMD] = -0.32, 95% confidence interval [CI]: -0.50 to -0.13, I2 = 85.9%), BMI Z-score (WMD = -0.08, 95% CI: -0.14 to -0.03, I2 = 89.1%), waist circumference (WMD = -0.87, 95% CI: -1.70 to -0.04, I2 = 43.3%), body weight (WMD = -0.96, 95% CI: -1.55 to -0.37, I2 = 0.0%), and body fat% (WMD = -0.59, 95% CI: -1.08 to -0.10, I2 = 0.0%). The subgroup analysis showed that parental or school involvement (WMD = -0.66, 95% CI: -0.98 to -0.34), eHealth-intervention duration of >12 weeks (WMD = -0.67, 95% CI: -0.96 to -0.38), and mobile-based interventions (WMD = -0.78, 95% CI: -1.13 to -0.43) had a significantly greater intervention effect size on BMI. Conclusions: This review recommends that multiple eHealth-delivered lifestyle strategies may be useful for preventing or treating overweight and obesity among children and adolescents. However, our results should be cautiously interpreted due to certain limitations in our study.

The Association Between Subclinical Thyroid Dysfunction and Recurrence of Atrial Fibrillation After Catheter Ablation.

Objective: The aim of this study was to evaluate the association between subclinical thyroid dysfunction and the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). Methods: We examined the association between subclinical thyroid dysfunction and the recurrence of AF at a large university-affiliated cardiac arrhythmia center in China. Data were collected from consecutive patients who underwent RFCA for AF, excluding those with a history of hypothyroidism, hyperthyroidism, or ongoing medical treatment for hypothyroidism or hyperthyroidism, biochemically defined overt thyroid disease, and long-term use of amiodarone before admission. The primary end point was the recurrence of AF in a time-to-event analysis. We compared outcomes in patients who had subclinical hyperthyroidism or hypothyroidism with those who had euthyroid state, using a multivariable Cox model with inverse probability weighting and propensity score matching. Results: In all, 93 patients were excluded from 435 consecutive patients who underwent RFCA for AF. Of the remaining 342 patients for the analysis, the prevalence of subclinical hyperthyroidism and subclinical hypothyroidism were 26 (7.6%) and 41 (12.0%), respectively; during a median follow-up of 489 days, 91 patients (26.6%) developed a primary end point event. In the main analysis of the multivariable Cox model, only subclinical hyperthyroidism [hazard ratio: 3.07, 95% confidence interval (CI): 1.54-6.14] was associated with an increased risk of end point event after adjusting for potential confounders. However, the association between subclinical hypothyroidism and the end point event was not significant (hazard ratio: 0.66, 95% CI: 0.31-1.43). Results were consistent either in multiple sensitivity analyses or across all subgroups of analysis. Compared with individuals with free triiodothyronine (fT3) in the lowest quintile, those with fT3 in the highest quintile had an HR of 2.23 (95% CI: 1.16-4.28) for recurrence of AF. With the increase of thyroid-stimulating hormone (TSH), a reduction in the risk of recurrence of AF was detected in the adjusted model, and the hazard ratio (HR) per standard deviation (SD) increase was 0.82 (95% CI: 0.68-0.98). Conclusion: In this retrospective cohort study involving patients who underwent RFCA for AF, patients with subclinical hyperthyroidism were associated with a markedly higher prevalence of recurrence of AF, whereas patients with subclinical hypothyroidism had a similar recurrence rate of AF compared to those with the euthyroid state.

Clinical Study on the Application of Preserved Urethral Mucosa at the Prostatic Apex in Transurethral Plasmakinetic Resection of the Prostate.

Objective: To explore the differences in the clinical efficacy, complications, and safety of transurethral plasmakinetic resection of the prostate (PKRP) by the conventional approach versus the approach preserving the urethral mucosa at the prostatic apex in the treatment of benign prostatic hyperplasia (BPH). Methods: A total of 90 patients with PKRP admitted to the First Hospital of Qinhuangdao from December 2018 to March 2021 were selected and divided into a control group (conventional PKRP, n = 45) and an observation group (PKRP with preserved urethral mucosa at the prostatic apex, n = 45). The clinical efficacy, safety, and sexual function of the groups were evaluated using the patients' International Prostate Symptom Score (IPSS), quality of life (QoL), prostate volume, maximum flow rate (Qmax), post-void residual (PVR), blood loss, surgical resection efficiency, and surgical complication data. Results: The differences in the preoperative indicators, glandectomy quality, and glandectomy rate between the groups were not statistically significant (P > 0.05). However, in the observation group, the surgery time and blood loss were significantly lower compared with the control group, and the resection efficiency was significantly higher, with statistical significance (P < 0.05). In the follow-up, one month after surgery, the IPSS and QoL were lower in the observation group than in the control group, and the differences were statistically significant (P < 0.05); three months after surgery, the PVR, IPSS, QoL, and Qmax scores were similar between the groups, with no statistical significance (P > 0.05). In terms of surgical complications, the incidences of urinary incontinence and other complications after catheter extraction were significantly lower in the observation group than in the control group, and the differences between the groups were statistically significant (P < 0.05). Conclusion: Compared with conventional PKRP, PKRP with preserved urethral mucosa at the prostatic apex can lead to immediate urinary continence after catheter extraction, reduce intraoperative blood loss, and shorten the surgery time, thus improving the surgical efficiency.

Changes in inpatient admissions before and during COVID-19 outbreak in a large tertiary hospital in Shanghai.

Background: The coronavirus disease 2019 (COVID-19) outbreak caused a significant strain on healthcare resources and utilization worldwide. However, the impact of COVID-19 outbreak on patient hospitalization was barely known. This study aimed to determine the impact of the outbreak on the pattern of inpatient hospital admissions to help allocate health care resources during a pandemic. Methods: This retrospective study included patients who were hospitalized in a tertiary teaching hospital in Shanghai between 1 January and 30 April across the years 2017 to 2020. The number of hospitalizations during the study period from 2017 to 2020 were 30,605, 31,464, 32,812 and 24,163, respectively. Changes in patient volumes and the frequency of the International Classification of Diseases and Related Health Problem Tenth Edition (ICD-10) codes before and after the onset of the COVID-19 outbreak were analyzed and presented as absolute and relative differences with 95% confidence intervals between periods of different years. Results: Overall inpatient hospital admissions decreased by 26.35% between January and April 2020, compared to the same period in 2019. The average age of patients in 2020 was higher compared to those from 2017 to 2019. Conversely, the proportions of self-paying patients and non-local patients were significantly lower between January and April 2020 compared to the same period in the previous three years. The top five ICD-10 codes remained common before and during the pandemic. Admissions associated with antineoplastic radiation therapy, chemotherapy, and immunotherapy increased in frequency and proportion by 2020 (difference, 5.6%, 95% CI: 4.4% to 6.8%), and increased proportions were observed for liver and intrahepatic bile duct malignancies (2.18%, 95% CI: 1.15% to 3.21%), cerebral infarction (2.27%, 95% CI: 0.54% to 4.00%), and chronic kidney disease (3.56%, 95% CI: 1.79% to 5.33%). Conclusions: There was a significant reduction in the number of inpatients and a marked change in admission diagnoses during the COVID-19 outbreak. Our findings are useful for making informed decisions on hospital management and reallocation of available health care resources during a pandemic.

Safety and Efficacy Evaluation of Antithrombotic Therapy with Rivaroxaban and Clopidogrel After PCI in Chinese Patients.

OBJECTIVE: To investigate the efficacy and safety of the antithrombotic therapy using the oral anticoagulant rivaroxaban and clopidogrel in Chinese patients with acute coronary syndrome complicated with atrial fibrillation after percutaneous coronary intervention. METHODS: A total of 100 patients were selected. Patients were randomly divided into two groups: the treatment group (rivaroxaban group) received a therapy of rivaroxaban and clopidogrel. The control group (warfarin group) receivied a combined treatment of warfarin, clopidogrel, and aspirin. The primary outcome endpoint was evaluated based on the adverse cardiac and cerebrovascular events within 12 months. RESULTS: A total of 8 (8.00%) main adverse cardiac and cerebrovascular events occurred during the 12 months of follow-up, including 5 (9.80%) in the warfarin group and 3 (6.10%) in the rivaroxaban group. The risk of having main adverse cardiac and cerebrovascular events in the two groups was comparable (P = 0.479). A total of 9 patients (9.00%) were found to have bleeding events, among which 8 patients (15.7%) were in the warfarin group, whereas only 1 patient (2.00%) was in the rivaroxaban group. Therefore, the risk of bleeding in the warfarin group was significantly higher than that in the rivaroxaban group (P = 0.047). CONCLUSIONS: In Chinese patients with acute coronary syndrome complicated with atrial fibrillation, the efficacy of the dual therapy of oral anticoagulant rivaroxaban plus clopidogrel after percutaneous coronary intervention was similar to that of the traditional triple therapy combined with warfarin, aspirin and clopidogrel, but it has a better safety property, which has potential to widely apply to antithrombotic therapy after PCI.