Humans ; Lung Transplantation/adverse effects* ; Risk Factors

Humans ; Female ; Receptors, Estrogen/metabolism* ; Breast Neoplasms/metabolism* ; Receptors, Progesterone/metabolism* ; Immunohistochemistry ; Estrogen Receptor alpha

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.

Exercise has long been recognized as an important component of treatment for various diseases. However, the benefits and risks of exercise interventions must be carefully evaluated to ensure the former outweighs the latter. As cancer patients undergo diverse treatment modalities with distinct objectives, a systematic approach partitioning the cancer journey into distinct phases is necessary to inform tailored exercise prescriptions. This narrative review summarizes exercise benefits and mechanisms for cancer patients and survivors across four distinct survivorship periods—before surgery, after surgery and before adjuvant treatment, during nonsurgical treatment (adjuvant and neoadjuvant), and during extended survival. In summary, exercise reduces the risks of complications and declines in physical functioning while improving fatigue, quality of life, and the ability to manage treatment effects. Although additional research is warranted, existing evidence is sufficient to integrate exercise into clinical oncology practice and cancer survivorship programs.

BACKGROUND: Several studies have reported that polygenic risk scores (PRSs) can enhance risk prediction of coronary artery disease (CAD) in European populations. However, research on this topic is far from sufficient in non-European countries, including China. We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population. METHODS: Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training ( n = 28,490) and testing sets ( n = 72,150). Ten previously developed PRSs were evaluated, and new ones were developed using clumping and thresholding or LDpred method. The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set. Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms. Prediction of the 10-year first CAD events was assessed using hazard ratios (HRs) and measures of model discrimination, calibration, and net reclassification improvement (NRI). Hard CAD (nonfatal I21-I23 and fatal I20-I25) and soft CAD (all fatal or nonfatal I20-I25) were analyzed separately. RESULTS: In the testing set, 1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years. The HR per standard deviation of the optimal PRS was 1.26 (95% CI:1.19-1.33) for hard CAD. Based on a traditional CAD risk prediction model containing only non-laboratory-based information, the addition of PRS for hard CAD increased Harrell's C index by 0.001 (-0.001 to 0.003) in women and 0.003 (0.001 to 0.005) in men. Among the different high-risk thresholds ranging from 1% to 10%, the highest categorical NRI was 3.2% (95% CI: 0.4-6.0%) at a high-risk threshold of 10.0% in women. The association of the PRS with soft CAD was much weaker than with hard CAD, leading to minimal or no improvement in the soft CAD model. CONCLUSIONS In this Chinese population sample, the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD. Therefore, this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.
Male ; Humans ; Female ; Coronary Artery Disease/genetics* ; Biological Specimen Banks ; East Asian People ; Risk Assessment/methods* ; Genetic Predisposition to Disease/genetics* ; Risk Factors ; Genome-Wide Association Study

BACKGROUND: The age, biomarkers, and clinical history (ABC)-atrial fibrillation (AF)-Stroke score have been proposed to refine stroke risk stratification, beyond what clinical risk scores such as the CHA2DS2-VASc score can offer. This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations. METHODS: A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry (CAFR) between 2013 and 2019 were included. Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk. The ABC-AF-Stroke score was evaluated in terms of discrimination, including concordance index (C-index), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), clinical utilization by decision curve analysis (DCA), and calibration by comparing the predicted risk with the observed annualized event rate. RESULTS: After a median follow-up of 3.5 years, 64 patients experienced thromboembolism events. Age, prior history of stroke/transient ischemic attack (TIA), high-sensitivity cardiac troponin T (cTnT-hs), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were independently associated with thromboembolism risk. The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index (0.67, 95% confidence interval [CI]: 0.59-0.74 vs. 0.60, 95% CI: 0.52-0.67, P = 0.030) and reclassification capacity. The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score. The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population. CONCLUSIONS In this real-world study enrolling non-anticoagulated AF patients following successful ablations, age, prior history of stroke/TIA, level of NT-proBNP, and cTnT-hs were independently associated with an increased risk of thromboembolism. The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.
Humans ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications* ; East Asian People ; Ischemic Attack, Transient ; Registries ; Risk Assessment ; Risk Factors ; Stroke/etiology* ; Thromboembolism/etiology* ; Troponin T