Objective:To evaluate the effectiveness and safety of anticoagulant therapy with rivaroxaban in atrial fibrillation( AF) pa-tients after radiofrequency catheter ablation( RFCA) . Methods:A retrospective analysis was performed in the study. Totally 141 AF pa-tients with RFCA in our hospital were enrolled from January 2014 to October 2015. The patients were divided into rivaroxaban group(70 patients)and warfarin group (71 patients). In rivaroxaban group,rivaroxaban(10 mg, po,qd)was given for at least 3 months after RFCA. In warfarin group,low molecular heparin (100 IU·kg-1,ih) was given before RFCA, and standard dose of warfarin (3-5 mg,po,qd) was given for at least 3 months by adjusting the INR within the range of 2. 0-3. 0 after RFCA as bridging therapy. The death rate, throm-boem bolism events and bleeding events between the groups were evaluated and companed groups. Results: There were no significant differences in baseline characteristics between the groups except the diastolic pressure. There were no significant differences in the death and thromboembolism events(transient cerebral ischemia , ischemic encephalopathy, 2/70 vs 4/71,P>0. 05)between the groups. There were no TIMI major bleeding events in both groups. There were no significant differences in minor bleeding events between the groups (3/70 vs 4/71,P>0. 05). Conclusion: Compared with those of warfarin,the effectiveness and safety of rivaroxaban show the similar effect in AF patients after RFCA. Rivaroxaban can be safely and effectively used in AF patients with low or middle risk of thromboembo-lism after RFCA.

Objective To introduce the surgical strategy of enlarged laminectomy (with partial facet joint dissection to expose the nerve root), and to discuss its benefit for cervical ossification of the posterior longitudinal ligament(OPLL) with myelopathy. Methods Totally 82 patients with cervical OPLL were treated by enlarged laminectomy from January 1998 to December 2005. There were 47 males and 35 females, with an average age of 57 years (ranged, 39-84 years). Among them, there were 31 cases of the solitary type, 40 cases of the continuous type, and 11 cases of the mixed type. JOA scoring system and the visual analogue scale (VAS) scoring were applied to evaluate the neurological function and neck/shoulder pain respectively.Ishihara method was employed to measure cervical curvature index(CCI). The degree of spinal cord backward expanding and displacement were calculated in MR1. Results The mean decompression length was 5.2 (4-6) segments. The mean follow-up duration was 41 months (ranged, 13-58 months). JOA score has improved from 10.9(7-15) preoperatively to 13.9(11-17) postoperatively (t=14.65, P＜0.01). The excellent and good rate was 98.7%. The palsy of C5 nerve root occurred in only 2 patients, both recovered after surgery. Zhe mean postoperative VAS score was 1.4(1-3), comparing with the preoperative score of 5.3 (4-6). The pain in neck/shoulder was alleviated obviously (t=15.46, P＜0.01 ). CCI decreased from 18.8% to 10.5%(t=5.03, P＜0.01 ),but did not follow by neuron function deterioration. MRI indicated that the cross-sectional area at the level of maximum compression of the dural sac increased from 85.4 mm2 preoperatively to 153.8 mm2 postoperatively (t=16.33, P＜0.01), and the mean spinal cord posterior shift was 6.2 mm (t=15.35, P＜0.01). Conclusion The enlarged laminectomy is proved to be effective in treating cervical OPLL, in terms of significant posterior shift of the spinal cord, relief of cervical/shoulder pain, lower rate of the palsy of C5 nerve root, with no recurrence of spinal cord compression symptom.

OBJECTIVE:To compare the efficacy and safety of dabigatran and warfarin respectively used in atrial fibrillation patients after radiofrequency ablation(RFCA). METHODS:Data of 141 nonvalvular atrial fibrillation patients,who scheduled for RFCA,were retrospectively analyzed and divided into warfarin group(71 cases)and dabigatran group(70 cases)by different med-ication. Patients in warfarin group should stop warfarin if they took before,then changed to Low molecular weight heparin calcium injection 100 U/kg,subcutaneous injection,taking RFCA when INR was lower than 1.5,stopping low molecular weight heparin 12 h before surgery;Low molecular weight heparin calcium injection 100 U/kg was intravenously injected when surgery;orally tak-ing Warfarin sodium tablet 4.5 mg after 4-6 h,once a day,meanwhile bridged overlapping treated at least 3-5 d with low molecu-lar weight heparin;monitoring once INR every 3 d after surgery,maintaining INR 2.0-3.0,taking warfalin at least 3 months. Pa-tients in dabigatran group stopped taking the anticoagulant drugs when admission,then changed to Dabigatran etexilate capsule 110 mg(age≥70 years old or body mass<60 kg)or 150 mg(age<70 years old or body mass≥60 mg),twice a day;stopping dabig-atran 24 h before surgery,the same medication as warfalin group when surgery;orally taking dabigatran after 6 h,taking at least 3 months. The total mortality rate,incidence of stroke(transient cerebral ischemia,ischemic encephalopathy),peripheral thrombosis rate and incidence of bleeding after 1 and 3 month(s)in 2 groups were observed. RESULTS:There were no significant differences in the total mortality rate,incidence of stroke,peripheral thrombosis rate and incidence of bleeding after 1 and 3 month(s) in 2 groups(P>0.05). CONCLUSIONS:Dabigatran has similar anticoagulant efficacy and safety with warfarin in atrial fibrillation pa-tients after RFCA.

Objective: To discuss the pharmaceutical care experience of clinical pharmacists in the antibacterial agents application in one patient with infection after coronary artery bypass graft ( CABG) . Methods:The clinical pharmacist participated in the treatment of the patient after CABG. According to the relevant laboratory indices and the extent of the infection combined with the vital signs of the patient, the pharmacist formulated and adjusted the anti-infection therapeutic regimen. The therapeutic effects and adverse reactions were observed as well. Results: Safte and high-quality individualized pharmaceutical service was provided to the patient by the pharmaceutical care of the clinical pharmacist in anti-infection treatment. Conclusion:Through the above practice, clinical pharmacists have played a positive role in reasonable using of anti-infective drugs in patients with cardiac surgery.

Objective:To compare the efficacy of lateral elbow dislocation approach with non-dislocation approach for open reduction and internal fixation of distal humeral coronal fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with distal humeral coronal fracture admitted to Qilu Hospital (Qingdao) of Shandong University from January 2018 to October 2021, including 10 males and 16 females, aged 15-80 years [(51.6±4.9)years]. According to Dubberley classification, there were 10 patients with type 2A, 5 with type 2B, 6 with type 3A and 5 with type 3B. Overall, 12 patients were operated via lateral elbow dislocation approach (dislocation approach group) and 14 via lateral elbow non-dislocation approach (non-dislocation approach group). The operation time, intraoperative bleeding volume, incision healing, three-dimensional CT assessment of the reduction within one week after surgery (separation or step>2 mm as poor), Mayo elbow performance score (MEPS) at 3 months after surgery and fracture healing at the last follow-up were recorded in both groups. Complications were also compared between the two groups.Results:All patients were followed up for 3-18 months [(10.5±3.3)months]. The operation time was (146.9±15.5)minutes in dislocation approach and (122.7±11.1)minutes in non-dislocation approach group ( P>0.05). The intraoperative bleeding volume was (113.3±9.7)ml in dislocation approach and (112.9±10.1)ml in non-dislocation approach group ( P>0.05). All incisions healed uneventfully in stage I. All patients had good reduction in dislocation group, while only 7 patients had good reduction and the other 7 patients presented a separation or step>2 mm in non-dislocation group ( P<0.05). The MEPS was (90.0±1.4)points in dislocation approach group at 3 months after surgery, including 9 patients being rated as excellent and 3 good, with the excellent and good rate of 100%. In constrast, the MEPS was (78.9±2.9)points in non-dislocation approach group at 3 months after surgery, including 5 patients being rated as excellent, 4 good, 4 fair and 1 poor, with the excellent and good rate of 64.3% ( P<0.05). All fractures were healed at the last follow-up. In non-dislocation approach group, osteoarthritis occurred in 7 patients, including 3 with screw protrusion, 2 with heterotopic ossification and 2 of advanced age with osteophyte formation around the joint. In dislocation approach group, osteoarthritis occurred only in 2 patients of advanced age, showing osteophyte formation around the elbow joint, with no screw cutting or heterotopic ossification. Conclusion:For distal humeral coronal fracture, the lateral elbow dislocation approach is able to provide complete exposure of the articular surface, obtain anatomic reduction, restore elbow function and reduce complications when compared with the non-dislocation approach.

Exosome is a specific subset of vesicles from intracellular origin vesicles containing varies of microRNAs, mRNAs, proteins and lipids. It has been demonstrated that contents of exosomes could be altered due to different physiological and pathological stress, which could be used as clinical biomarker to reveal the disease state. In addition, according to previous studies, exosomes could exert protective roles for cardiovascular diseases such as atherosclerosis, myocardial infarction and ischemia/reperfusion injury, etc. The aim of this review is to summarize current research progress on exosomes, related implications in diagnosis and treatment of cardiovascular diseases and corresponding mechanisms.

Purpose: The human epidermal growth factor receptor 2 (HER2) is an established therapeutic target for various kinds of solid tumors. HER2 amplification occurs in approximately 1% to 6% of colorectal cancer. In this study, we aimed to assess the efficacy and safety of trastuzumab in combination with chemotherapy in HER2-positive metastatic colorectal cancer (mCRC). Materials and Methods: An open-label, phase II trial (Clinicaltrials.gov: NCT03185988) was designed to evaluate the antitumor activity of trastuzumab and chemotherapy in HER2-positive digestive cancers excluding gastric cancer in 2017. Patients from this trial with HER2-positive, KRAS/BRAF wild-type, unresectable mCRC were analyzed in this manuscript. Eligible patients were treated with trastuzumab (8 mg/kg loading dose and then 6 mg/kg every 3 weeks) and irinotecan (120 mg/m2 days 1 and 8 every 3 weeks). The primary endpoint was the objective response rate. Results: Twenty-one HER2-positive mCRC patients were enrolled in this study. Seven patients (33.3%) achieved an objective res-ponse, and 11 patients (52.4%) had stable disease as their best response. The median progression-free survival (PFS) was 4.3 months (95% confidence interval, 2.7 to 5.9). Four of the 21 patients (19.0%) had grade 3 adverse events, including leukopenia, neutropenia, urinary tract infection, and diarrhea. No treatment-related death was reported. Exploratory analyses revealed that high tumor tissue HER2 copy number was associated with better therapeutic response and PFS. Alterations in the mitogen-activated protein kinase pathway, HER2 gene, phosphoinositide 3-kinase/AKT pathway, and cell cycle control genes were potential drivers of trastuzumab resistance in mCRC. Conclusion Trastuzumab combined with chemotherapy is a potentially effective and well-tolerated therapeutic regimen in mCRC with a high HER2 copy number.

Objective:To analyze the different clinicopathological features of intrahepatic cholangiocarcinoma with and without viral hepatitis.Methods:The clinicopathological data of 79 intrahepatic cholangiocarcinoma cases from Mar 2012 to Sep 2018 at Henan Provincial People's Hospital were retrospectively analyzed.Results:Twenty-five of the 79 patients with intrahepatic cholangiocarcinoma were accompanied by viral hepatitis. Those with viral hepatitis had a lower mean age at onset than those without [(53±11) years vs. (60±11) years, P=0.011], higher proportion of male patients (80% vs. 52%, P=0.017), higher AFP positive rate (40% vs. 19%, P=0.041), lower CA19-9 positive rate (48% vs. 72%, P=0.036), tend to occur in the right liver lobe (76% vs. 44%, P=0.009), a lower rate of bile duct invasion (16% vs. 41%, P=0.03), and were more likely to be mass type (mass type proportion 96% vs. 72%, P=0.032). Conclusions:Viral hepatitis is common in intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma with and without viral hepatitis differ in clinicopathology. Intrahepatic cholangiocarcinoma with viral hepatitis is more likely to have the characteristics of hepatocellular carcinoma, while intrahepatic cholangiocarcinoma without viral hepatitis is more likely to have the characteristics of cholangiocarcinoma.

The end of the COVID-19 infection peak in 2022 prompts a backlog of cardiovascular surgical patients to gradually return to the hospital, resulting in a surge in cardiovascular surgeries. However, against the backdrop of the COVID-19 pandemic, the clinical practice of cardiovascular surgery faces many problems. Therefore, organized by Beijing Anzhen Hospital, experts in cardiovascular surgery and related fields have formulated hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19. This article summarizes the clinical decision-making of patients requiring cardiovascular surgery after COVID-19 infection, and advises on the corresponding recommendations according to the existing evidence-based medical evidence as well as the actual clinical practice experience of relevant experts. The main content of the article includes special requirements for cardiovascular surgical treatment indications in patients with COVID-19 infection, selection of surgical timing, special requirements of preoperative, intraoperative and postoperative management, etc., which aims to provide COVID-19-infected patients with guidance on rational decision-making when receiving cardiovascular surgery.

OBJECTIVE: To investigate the classification of idiopathic inflammatory myopathies (IIM) based on clinical manifestations and myositis- specific antibodies using cluster analysis. METHODS: We retrospectively analyzed the data of patients with IIM admitted in Nanfang Hospital in 2015-2019. The clinical data of the patients including serum creatine kinase (CK), interstitial lung disease (ILD), cancer, and myositis-specific antibodies were collected for two-step cluster analysis to identify the distinct clusters of patients, whose clinical characteristics were subsequently analysed. RESULTS: A total of 71 patients with IIM were included in this study, including 30 (42.3%) with polymyositis (PM), 20 (28.2%) with classic dermatomyositis (DM), 16 (22.5%) with amyopathic dermatomyositis (CADM), and 5 (7.0%) with immune-mediated necrotizing myopathy (IMNM). Two-step cluster analysis identified 3 distinctive subgroups: Cluster 1 of 15 (51.7%) patients characterized by rash, positive anti-MDA5 antibody and hypoproteinemia ( < 0.05) with normal or slightly elevated CK level, mainly corresponding to CADM; Cluster 2 of 4 (57.1%) patients with significantly elevated CK and positive anti-SRP antibody ( < 0.001) corresponding to IMNM; and Cluster 3 of 17 (48.6%) patients consisting primarily of patients with PM, characterized by positivity for anti- aminoacyl transfer RNA synthetases antibodies (=0.022) corresponding to antisynthetase syndrome (ASS). CONCLUSIONS Patients with IIM can be divided into 3 subgroups based on their clinical and serological characteristics (especially myositis-specific antibodies), and among them ASS may represent an independent IIM subgroup with unique clinical characteristics.
Antibodies ; metabolism ; Humans ; Myositis ; classification ; physiopathology ; Retrospective Studies