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Alternative Therapies in Health and... Jun 2024To analyze the effects of trimetazidine on ventricular remodeling and serum cystatin C (Cys C) and endothelin-1 (ET-1) levels in patients with chronic heart failure...
OBJECTIVE
To analyze the effects of trimetazidine on ventricular remodeling and serum cystatin C (Cys C) and endothelin-1 (ET-1) levels in patients with chronic heart failure (CHF).
METHODS
A total of 96 patients with CHF admitted to the fifth affiliated hospital of Xinjiang medical university. were enrolled as the research objects between June 2012 and June 2023. They were randomly divided into a control and observation groups, with 48 cases in each group. The control group was given routine treatment, while the observation group was additionally treated with trimetazidine hydrochloride tablets. All were continuously treated for 6 months. The clinical curative effect between the two groups was compared. The left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) were measured by cardiac echocardiography before and after treatment. 6MVT before and after treatment was recorded. A full-automatic biochemical analyzer detected the level of serum Cys C before and after treatment. The levels of serum ET-1, galectin-3 (Gal-3), brain natriuretic peptide (BNP), and atrial natriuretic peptide (ANP) were detected by enzyme-linked immunosorbent assay before and after treatment. The incidence of adverse events in the two groups of CHF patients was compared.
RESULTS
The total response rate of treatment in the observation group was significantly higher than that in the control group (91.67% vs 79.17%) (P = .037). After treatment, LVEDD and LVESD decreased, while LVEF and 6MVT increased in both groups. LVEDD and LVESD in the observation group were significantly lower than those in the control group, while LVEF and 6MVT were significantly higher than those in the control group (P < .05). After treatment, serum Cys C, ET-1, Gal-3, BNP, and ANP levels in both groups were significantly decreased, significantly lower in the observation group than in the control group (P < .05). The readmission rate of the observation group was lower than that of the control group (P = .045). There was no significant difference in mortality between the two groups (P = .315).
CONCLUSION
Trimetazidine is effective in treating patients with CHF. It can improve cardiac function and reduce the rate of re-hospitalization.
PubMed: 38940778
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024To compare the operation-related indexes, complication rates, and cardiac function indexes of bioresorbable scaffolds with drug-eluting scaffolds in coronary non-left...
AIM
To compare the operation-related indexes, complication rates, and cardiac function indexes of bioresorbable scaffolds with drug-eluting scaffolds in coronary non-left main stem lesions and to clarify the clinical value of bioresorbable scaffolds in percutaneous coronary intervention for non-left main stem lesions.
METHODS
The retrospective study sample consisted of 60 non-left main stem lesions treated using bioresorbable stent or drug-eluting stents between June 2022 and June 2023. Comparison of surgical operation-related indexes, intraoperative and postoperative complications, cardiac function indexes, adverse cardiovascular events, and surgical success rate between the two groups.
RESULTS
The surgical operation time and X-ray exposure time of the experimental group were shorter than those of the control group, and contrast agent dosage was lower than that of the control group (P < .05). Left ventricular ejection fraction (LVEF) was higher than that in the control group at one month after surgery, and left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) in the experimental group was lower than that in the control group, and the difference was statistically significant (P < .05). The total incidence of major adverse cardiovascular events was lower in the experimental group than in the control group (15.6% VS. 71.4%)(P < .05).
CONCLUSION
Bioresorbable scaffolds are more effective than drug-eluting scaffolds in treating non-left main stem lesions by percutaneous coronary intervention. Furthermore, bioresorbable scaffolds could be considered a preferable option for certain patients undergoing percutaneous coronary intervention for non-left main stem lesions.
PubMed: 38940777
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Congenital anal atresia poses a significant challenge in pediatric surgery, necessitating precise and effective interventions to ensure optimal outcomes. While...
BACKGROUND
Congenital anal atresia poses a significant challenge in pediatric surgery, necessitating precise and effective interventions to ensure optimal outcomes. While traditional anterior sagittal approach anoplasty has been a standard procedure, emerging evidence suggests potential benefits of anal dimple anorectoplasty.
OBJECTIVE
This study aims to assess the clinical efficacy of anal dimple anorectoplasty in treating congenital anal atresia.
METHODS
We conducted a rigorous systematic review and meta-analysis, extensively searching various databases such as Wanfang, CNKI, VIP, PubMed, Web of Science, and the Cochrane Library. Our aim was to identify randomized controlled trials comparing the efficacy of traditional anterior sagittal approach anoplasty with anal dimple anorectoplasty in treating congenital anal atresia. Search terms included "anal dimple anorectoplasty," "congenital anal atresia," and "RCT." Data regarding operation time, postoperative hospitalization duration, and complication rates were collected.
RESULTS
Anal dimple anorectoplasty exhibited significantly greater clinical efficacy (odds ratio [OR]=4.91, 95% confidence interval [CI]: 2.02-11.94, P < .00001), along with markedly reduced postoperative hospitalization duration (95% CI: -1.27 to -0.57, P < .00001), and a substantially lower incidence of complications (OR=0.1, 95% CI: 0.04-0.25, P < .00001) compared to traditional anterior sagittal approach anoplasty. These findings underscore the clear advantage of anal dimple anorectoplasty over conventional methods, indicating its potential as a preferred surgical approach for congenital anal atresia.
CONCLUSIONS
Anal dimple anorectoplasty emerges as a highly effective intervention for pediatric patients with congenital anal atresia, demonstrating a notable decrease in postoperative complications. These findings highlight its potential as a preferred surgical approach to enhance patient outcomes and minimize adverse events.
PubMed: 38940776
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Neonatal pneumonia is a common respiratory disease in the neonatal period, often accompanied by respiratory failure. In addition to timely treatment, effective nursing...
BACKGROUND
Neonatal pneumonia is a common respiratory disease in the neonatal period, often accompanied by respiratory failure. In addition to timely treatment, effective nursing is essential.
OBJECTIVE
We attempted to determine the clinical effect of refined nursing applied to the nursing of patients with severe neonatal pneumonia accompanied by respiratory failure.
DESIGN
This was a randomized controlled study.
SETTING
This study was performed in the Neonatal Department, The First Hospital of China Medical University.
PARTICIPANTS
A total of 60 newborns with severe pneumonia and respiratory failure diagnosed and treated in the neonatal intensive care unit of our hospital between January 2022 and December 2022 were selected and assigned to either the control group (CG) or the experimental group (EG) based on the random number table method, with 30 patients in each group.
INTERVENTIONS
The CG received conventional nursing intervention and the EG received refined nursing intervention.
PRIMARY OUTCOME MEASURES
(1) Symptom improvement time; (2) blood gas indicators; (3) vital signs; (4) complication occurrence rate and (5) nursing satisfaction.
RESULTS
The improvement time of cough, shortness of breath and wheezing in the EG was decreased compared with the CG (P < .05). After nursing, the EG exhibited higher partial arterial oxygen pressure and blood oxygen saturation levels and lower partial arterial carbon dioxide pressure relative to the control group (P < .05). After nursing, the heart and respiratory rates in both groups were decreased compared with before nursing, and in the EG group were decreased in comparison with the CG (P < .05). The incidence of adverse events in the EG was lower in comparison with the CG (P < .05). Nursing satisfaction in the EG was higher compared with the CG.
CONCLUSION
The application of refined nursing in the clinical nursing of patients with neonatal pneumonia accompanied by respiratory failure can facilitate improvement in their condition, improve blood gas indicators and vital signs and prevent adverse events.
PubMed: 38940774
DOI: No ID Found -
Medeniyet Medical Journal Jun 2024Dipeptidyl-peptidase 4 inhibitors (DPP4i) are commonly used as antidiabetic medications. Although these drugs are generally recognized for their favorable clinical...
Dipeptidyl-peptidase 4 inhibitors (DPP4i) are commonly used as antidiabetic medications. Although these drugs are generally recognized for their favorable clinical safety profile, emerging evidence points to the potential for adverse events associated with DPP4i. Notably, cases of bullous pemphigoid (BP) linked to DPP4i therapy have recently been documented in the medical literature. This report presents four cases of BP in elderly patients resulting from DPP4i treatment, involving two cases with ligandliptin and two with vildagliptin use. Successful remission was achieved in all cases through discontinuation of the implicated medication and implementation of topical corticosteroid therapy. It is imperative for clinicians to be vigilant about the potential risk of BP development when employing DPP4i drugs, particularly in the context of elderly patients with diabetes.
PubMed: 38940531
DOI: 10.4274/MMJ.galenos.2024.76508 -
The Oncologist Jun 2024There is little evidence on the safety, efficacy, and survival benefit of restarting immune checkpoint inhibitors (ICI) in patients with cancer after discontinuation due...
BACKGROUNDS
There is little evidence on the safety, efficacy, and survival benefit of restarting immune checkpoint inhibitors (ICI) in patients with cancer after discontinuation due to immune-related adverse events (irAEs) or progressive disease (PD). Here, we performed a meta-analysis to elucidate the possible benefits of ICI rechallenge in patients with cancer.
METHODS
Systematic searches were conducted using PubMed, Embase, and Cochrane Library databases. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and incidence of irAEs were the outcomes of interest.
RESULTS
Thirty-six studies involving 2026 patients were analyzed. ICI rechallenge was associated with a lower incidence of all-grade (OR, 0.05; 95%CI, 0.02-0.13, P < .05) and high-grade irAEs (OR, 0.37; 95%CI, 0.21-0.64, P < .05) when compared with initial ICI treatment. Though no significant difference was observed between rechallenge and initial treatment regarding ORR (OR, 0.69; 95%CI, 0.39-1.20, P = .29) and DCR (OR, 0.85; 95%CI, 0.51-1.40, P = 0.52), patients receiving rechallenge had improved PFS (HR, 0.56; 95%CI, 0.43-0.73, P < .05) and OS (HR, 0.55; 95%CI, 0.43-0.72, P < .05) than those who discontinued ICI therapy permanently. Subgroup analysis revealed that for patients who stopped initial ICI treatment because of irAEs, rechallenge showed similar safety and efficacy with initial treatment, while for patients who discontinued ICI treatment due to PD, rechallenge caused a significant increase in the incidence of high-grade irAEs (OR, 4.97; 95%CI, 1.98-12.5, P < .05) and a decrease in ORR (OR, 0.48; 95%CI, 0.24-0.95, P < .05).
CONCLUSION
ICI rechallenge is generally an active and feasible strategy that is associated with relative safety, similar efficacy, and improved survival outcomes. Rechallenge should be considered individually with circumspection, and randomized controlled trials are required to confirm these findings.
PubMed: 38940446
DOI: 10.1093/oncolo/oyae134 -
Frontiers in Pharmacology 2024Tivozanib, a vascular endothelial growth factor tyrosine kinase inhibitor, has demonstrated efficacy in a phase III clinical trials for the treatment of renal cell...
BACKGROUND
Tivozanib, a vascular endothelial growth factor tyrosine kinase inhibitor, has demonstrated efficacy in a phase III clinical trials for the treatment of renal cell carcinoma. However, comprehensive evaluation of its long-term safety profile in a large sample population remains elusive. The current study assessed Tivozanib-related adverse events of real-world through data mining of the US Food and Drug Administration Adverse Event Reporting System FDA Adverse Event Reporting System.
METHODS
Disproportionality analyses, utilizing reporting odds ratio proportional reporting ratio Bayesian confidence propagation neural network and multi-item gamma Poisson shrinker (MGPS) algorithms, were conducted to quantify signals of Tivozanib-related AEs. Weibull distribution was used to predict the varying risk incidence of AEs over time.
RESULTS
Out of 5,361,420 reports collected from the FAERS database, 1,366 reports of Tivozanib-associated AEs were identified. A total of 94 significant disproportionality preferred terms (PTs) conforming to the four algorithms simultaneously were retained. The most common AEs included fatigue, diarrhea, nausea, blood pressure increased, decreased appetite, and dysphonia, consistent with prior specifications and clinical trials. Unexpected significant AEs such as dyspnea, constipation, pain in extremity, stomatitis, and palmar-plantar erythrodysaesthesia syndrome was observed. The median onset time of Tivozanib-related AEs was 37 days (interquartile range [IQR] 11.75-91 days), with a majority (n = 127, 46.35%) occurring within the initial month following Tivozanib initiation.
CONCLUSION
Our observations align with clinical assertions regarding Tivozanib's safety profile. Additionally, we unveil potential novel and unexpected AE signatures associated with Tivozanib administration, highlighting the imperative for prospective clinical studies to validate these findings and elucidate their causal relationships. These results furnish valuable evidence to steer future clinical inquiries aimed at elucidating the safety profile of Tivozanib.
PubMed: 38939844
DOI: 10.3389/fphar.2024.1408135 -
JACC. Advances Jan 2024It is unknown how well cardiologists predict which Fontan patients are at risk for major adverse events (MAEs).
BACKGROUND
It is unknown how well cardiologists predict which Fontan patients are at risk for major adverse events (MAEs).
OBJECTIVES
The purpose of this study was to examine the accuracy of cardiologists' ability to identify the "good Fontan" patient, free from MAE within the following year, and compare that predicted risk cohort to patients who experienced MAE.
METHODS
This prospective, multicenter study included patients ≥10 years with lateral tunnel or extracardiac Fontan. The cardiologist was asked the yes/no "surprise" question: would you be surprised if your patient has a MAE in the next year? After 12 months, the cardiologist was surveyed to assess MAE. Agreement between cardiologist predictions of MAE and observed MAE was determined using the simple kappa coefficient. Multivariable generalized linear mixed effects models were performed to identify factors associated with MAE.
RESULTS
Overall, 146 patients were enrolled, and 99/146 (68%) patients w`ere predicted to be a "good Fontan." After 12 months, 17 (12%) experienced a MAE. The simple kappa coefficient of cardiologists' prediction was 0.17 (95% CI: 0.02-0.32), suggesting prediction of MAE was 17% better than random chance. In the multivariable cardiologist-predicted MAE (N = 47) model, diuretic/beta-blocker use ( ≤ 0.001) and systolic dysfunction ( = 0.005) were associated with MAE. In the observed multivariable MAE (N = 17) model, prior unplanned cardiac admission ( = 0.006), diuretic/beta-blocker use ( = 0.028), and ≥moderate atrioventricular valve regurgitation ( = 0.049) were associated with MAE.
CONCLUSIONS
Cardiologists are marginally able to predict which Fontan patients are at risk for MAE over a year. There was overlap between factors associated with a cardiologist's prediction of risk and observed MAE, namely the use of diuretic/beta-blocker.
PubMed: 38939804
DOI: 10.1016/j.jacadv.2023.100736 -
Journal of Arrhythmia Jun 2024The Mt FUJI study was a multicenter, prospective, randomized, single-blind, controlled trial comparing delivery catheter-based and stylet-based right ventricular (RV)...
BACKGROUND
The Mt FUJI study was a multicenter, prospective, randomized, single-blind, controlled trial comparing delivery catheter-based and stylet-based right ventricular (RV) lead placement at the RV septum. This study extended the follow-up duration to 1 year after implantation.
METHODS
Seventy patients with pacemaker indications for atrioventricular block were randomly assigned to the delivery catheter and stylet groups. We compared the mid-term efficacy and safety between the two groups at 1 year after implantation. The primary outcome was the change in the left ventricular ejection fraction (LVEF), and the secondary outcomes were changes in brain natriuretic peptide (BNP) levels, lead parameters, paced QRS duration, and the incidence of adverse events.
RESULTS
At the 1-year follow-up, no significant differences were observed in the changes in the LVEF (+1.0% ± 8.6% vs. +3.1% ± 8.1%, = .332), BNP levels (+8.0 [-11.1, 26.5] pg/mL vs. -8.7 [-15.3, 13.2] pg/mL, = .193), or lead performance between the delivery catheter and stylet groups. The QRS duration was significantly shorter in the delivery catheter group than in the stylet group (128 ± 23 ms vs. 146 ± 17 ms, < .001). All-cause death, hospitalization for heart failure, new development of atrial fibrillation, and pacing-induced cardiomyopathy occurred in seven patients in the delivery catheter group and five in the stylet group.
CONCLUSION
The delivery catheter system was similarly useful and safe compared to the stylet system in the mid-term follow-up from the Mt FUJI trial. Further long-term evaluations are warranted.
PubMed: 38939791
DOI: 10.1002/joa3.13034 -
Journal of Arrhythmia Jun 2024Warfarin is considered the primary oral anticoagulant for patients with atrial fibrillation and end-stage renal disease (ESRD) requiring dialysis. Although warfarin can...
BACKGROUND
Warfarin is considered the primary oral anticoagulant for patients with atrial fibrillation and end-stage renal disease (ESRD) requiring dialysis. Although warfarin can offer significant stroke prevention in this population, the accompanying major bleeding risks make warfarin nearly prohibitive. Apixaban was shown to be superior to warfarin in preventing stroke or systemic embolism, with a lower risk of bleeding and mortality in a large, randomized trial of individuals with mostly normal renal function but none with ESRD.
METHODS
We systematically reviewed evidence comparing apixaban versus warfarin for atrial fibrillation in this population, and evaluated outcomes of stroke or systemic embolism, and major bleeding using random-effects models. The main safety outcome was major bleeding, and the main effectiveness outcome was stroke or systemic embolism.
RESULTS
We found five observational studies of 10 036 patients (2638 receiving apixaban, and 7398 receiving warfarin) meeting inclusion criteria. Pooled analysis demonstrated a significant reduction in major bleeding with apixaban as compared to warfarin (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.42-0.61; < .0001). Apixaban was also associated with a reduction in intracranial bleeding (OR 0.58, 95% CI 0.37-0.92; = .02) and in gastrointestinal bleeding (OR 0.61, 95% CI 0.51-0.73; < .0001). Furthermore, apixaban was associated with a reduction in stroke/systemic embolism (OR 0.64, 95% CI 0.50-0.82; < .0001).
CONCLUSION
Apixaban was associated with superior outcomes and reduced adverse events compared to warfarin in observational studies of patients with atrial fibrillation on dialysis. Randomized controlled studies are needed to confirm these findings.
PubMed: 38939758
DOI: 10.1002/joa3.13051