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Background In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients. Methods In this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death. Results The main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4+T cell level were older and more often male compared to those with higher CD4+T cell level. Reduced CD8+T cell level was an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235–57.671] and CD8+T [HR: 10.883; 95%CI: 3.277–36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients. Conclusions Reductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient’s disease. Only reduced CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients. Trial registration Prognostic Factors of Patients With COVID-19, NCT04292964. Registered 03 March 2020. Retrospectively registered.

Primary synovial sarcoma of the duodenal bulb is a rare mesenchymal tumor with special morphological features. It usually originates from the major joints or tendon sheaths of the extremities and mostly seen in young population, but rarely found in gastrointestinal tract. In this manuscript, we reported the first case of synovial sarcoma arising between the intestinal wall of the duodenal bulb with a concomitant SYT/SSX type of the t(X;18) translocation. A 49-year-old male presented to our hospital with a 2-month history of upper abdominal pain along with a 4-day amply jaundice. Tumor marker testing showed only a slight increase of carbohydrate antigen 19-9 (CA19-9). A computed tomography scan of his abdomen showed that indeterminate tissue occupied the duodenal bulb wall, compressed the surrounding tissues, and measured roughly 5.0 cm × 7.7 cm × 8.7 cm. Since the sarcoma grows between the intestinal wall, which cannot be detected by endoscopy, an initial diagnosis of duodenal wall stromal tumor was made at that time. Postoperative Immunohistochemistry results showed that the tumor was positive for the expression of transducin-like enhancer of split 1, B-cell lymphoma 2, and Vimentin. These pathological findings were indicative of the diagnosis of synovial sarcoma, but still did not provide sufficient diagnostic evidence. Finally we confirmed the diagnosis by using fluorescence in situ hybridization (FISH) with detection of the t(X;18) (SYT-SSX) translocation. No such lesions were found on preoperative examination, so a diagnosis of primary duodenal synovial sarcoma was made. After literature review, we found four reports of duodenal synovial sarcomas, all of which could be detected endoscopically, but there were no results of long-term follow-up. This case is the first reported case of synovial sarcoma arising between the intestinal walls of the duodenal bulb treated twice with ifosfamide and followed up for 13 months without recurrence.

Background The relationship between ambulatory arterial stiffness index (AASI) and left ventricular diastolic dysfunction (LVDD) in patients with heart failure with preserved ejection fraction (HFpEF) is unknown. We aimed to investigate the association between the AASI and LVDD in HFpEF. Methods We prospective enrolled consecutive patients with HFpEF in Chongqing, China. Twenty-four-hour ambulatory blood pressure monitoring (24 h-ABPM) and echocardiography were performed in each patient. AASI was obtained through individual 24 h-ABPM. The relationship between AASI and LVDD was analyzed. Results A total of 107 patients with HFpEF were included. The mean age was 68.45 ± 14.02 years and 63 (59%) were women. The patients were divided into two groups according to the upper normal border of AASI (0.55). AASI > 0.55 group were more likely to be older, to have higher mean systolic blood pressure and worsen left ventricular diastolic function than AASI group ≤ 0.55. AASI was closely positive related to the diastolic function parameters, including mean E/e′ (r = 0.307, P = 0.001), septal E/e′ (r = 0.290, P = 0.002), lateral E/e′ (r = 0.276, P = 0.004) and E (r = 0.274, P = 0.004). After adjusting for conventional risk factors, AASI was still an independent risk factors of mean E/e′ > 10 in patients with HFpEF (OR: 2.929, 95%CI: 1.214–7.064, P = 0.017), and the association between AASI and mean E/e′ > 14 was reduced (OR: 2.457, 95%CI: 1.030–5.860, P = 0.043). AASI had a partial predictive value for mean E/e′ > 10 (AUC = 0.691, P = 0.002), while the predictive value for mean E/e′ > 14 was attenuated (AUC = 0.624, P = 0.034). Conclusion AASI was positive related to E/e′ in HFpEF and might be an independent risk factor for the increase of mean E/e′.

To assess the efficacy and safety of catheter-based renal denervation (RDN) for the treatment of uncontrolled hypertension by conducting a systematic review and a meta-analysis.The Medline, Cochrane Library, and Embase databases were searched for clinical studies between January 1, 2009, and July 16, 2018. Studies that evaluated the effect of RDN on uncontrolled hypertension were identified. The primary endpoints were changes in 24-hour ambulatory systolic blood pressure (BP) and office systolic BP. The secondary endpoints included changes in 24-hour ambulatory diastolic BP, office diastolic BP, and major adverse events.After a literature search and detailed evaluation, 12 randomized controlled trials with a total of 1539 individuals were included in the quantitative analysis. Pooled analyses indicated that RDN was associated with a significantly greater reduction of 24-hour systolic BP (mean difference [MD], -4.02 mm Hg; 95% CI, -5.49 to -2.56; P.001) and office systolic BP (MD, -8.93 mm Hg; 95% CI, -14.03 to -3.83; P.001) than controls. Similarly, RDN significantly reduced 24-hour diastolic BP (MD, -2.05 mm Hg; 95% CI, -3.05 to -1.05; P.001) and office diastolic BP (MD, -4.49 mm Hg; 95% CI, -6.46 to -2.52; P.001). RDN was not associated with an increased risk of major adverse events (relative risk, 1.06; 95% CI, 0.72 to 1.57; P=.76).Catheter-based RDN was associated with a significant BP-lowering benefit without increasing major adverse events.

The aim of this study is to investigate clinical characteristics and fatal outcomes of hypertension as well as the role of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) use in patients with severe coronavirus disease 2019 (COVID-19). A total of 220 (female: 51.8%) patients with severe COVID-19 were included. The mean age of included patients was 59.5 years and 70 (31.8%) patients had a history of hypertension. There were 23 patients (32.9%) receiving ACEI/ARB therapy. Patients with hypertension were older and had more comorbidities, and were more likely to suffer from severe inflammatory response and acute cardiac injury. Moreover, patients with hypertension were associated with significantly higher risk of in-hospital mortality than patients without hypertension. After adjustment of potential confounders, the independent correlation was still observed. In addition, ACEI/ARB users were associated with lower level of high-sensitivity cardiac troponin I and creatinine kinase-myocardial band, and lower risk of acute cardiac injury than ACEI/ARB non-users. In conclusion, patients with hypertension were more likely to suffer from severe inflammatory response, acute cardiac injury and had high risk of in-hospital mortality in severe COVID-19. The use of ACEI/ARB may protect patients with COVID-19 from acute cardiac injury.

Background In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Finding markers that predict the prognosis of patients with severe COVID-19 are of great value. Methods In this single-center，retrospective study, 157 patients with severe COVID-19 were recruited from a consecutive series. After screening, a total of 105 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death. Results The dominant symptoms observed in the study included fever on admission, cough, fatigue and shortness of breath. The most frequent comorbidities were hypertension and diabetes. Compared with patients with higher CD4+T cells level, patients with lower CD4+T cells level were older and were more frequently male. In terms of laboratory findings, lymphocyte percentage, lymphocyte absolute value, CD3+T cell count, CD4+T cell count, CD8+T cell count were significantly lower in low group than in high group. The case in-hospital death rate was significant higher in patients with lower CD4+T level than in those with higher CD4+T level. After adjusting for potential confounding factors, CD4+T cells count below normal values showed independent prognostic value for all-cause in-hospital death in patients with severe COVID-19. Conclusions In patients with severe COVID-19, lower CD4+T cells count are independently associated with an increased rate of in-hospital death.

Background In this study, we aimed to investigate the preoperative serum carcinoembryonic antigen (CEA) in the diagnosis of positive lymph node metastasis (LNM), and to evaluated the relationship between CEA and survival in patients with locally advanced gastric cancer (LAGC). Methods The significance of the preoperative serum CEA level for the diagnose of LAGC and prediction of LNM was determined using the receiver operating characteristic (ROC) curve. The areas under the ROC of CEA were compared with those of other tumor markers or imaging examination including CT and MRI. Logistic regression was utilized to identify the risk factors predicting positive LNM. Independent prognosis factors were evaluated using univariate and multivariate COX regression analyses. Results The ROC curves showed that the AUCs of CEA, CA199, and CA125 for diagnosing LAGC were 0.727, 0.594, and 0.566. When used to predict LNM, the AUC of CEA, CA199 and CA125 were 0.696, 0.531, and 0.588. Logistic regression analysis demonstrated that preoperative serum CEA were significantly associated with positive LNM. On combining imaging examination with CEA, the sensitivity and specificity were 85.3 and 79.4%, respectively, with the AUC equal to 0.853. The combination of CEA and imaging examination preformed the highest levels of AUC and sensitivity for diagnosing LNM, which is significantly higher than using either of them alone. Although patients with abnormal CEA have a poor prognosis, two models of multivariate analysis showed that CEA was not the independent prognosis factor for survival. Conclusions CEA can be used to diagnose gastric cancer and determine whether it has LNM. Moreover, combined with CEA could improve the diagnostic sensitivity of imaging examination for lymph node involvement.

Background The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China has been declared a public health emergency of international concern. The cardiac injury is a common condition among the hospitalized patients with COVID-19. However, whether N terminal pro B type natriuretic peptide (NT-proBNP) predicted outcome of severe COVID-19 patients was unknown. Methods The study initially enrolled 102 patients with severe COVID-19 from a continuous sample. After screening out the ineligible cases, 54 patients were analyzed in this study. The primary outcome was in-hospital death defined as the case fatality rate. Research information and following-up data were obtained from their medical records. Results The best cut-off value of NT-proBNP for predicting in-hospital death was 88.64 pg/mL with the sensitivity for 100% and the specificity for 66.67%. Patients with high NT-proBNP values (> 88.64 pg/mL) had a significantly increased risk of death during the days of following-up compared with those with low values (≤88.64 pg/mL). After adjustment for potential risk factors, NT-proBNP was independently correlated with in-hospital death. Conclusion NT-proBNP might be an independent risk factor for in-hospital death in patients with severe COVID-19. Trial registration ClinicalTrials, NCT04292964. Registered 03 March 2020

Tissue nonspecific alkaline phosphatase (TNAP) is expressed widely in different tissues, modulating functions of metabolism and inflammation. However, the effect of TNAP on cardiac fibrosis remains controversial and needs to be further studied. The present study aims to investigate the role of TNAP on myocardial infarction (MI)-induced fibrosis and its mechanism. TNAP was upregulated in patients with MI, both in serum and injured hearts, and predicted in-hospital mortality. TNAP was also significantly upregulated after MI in rats, mostly in the border zone of the infarcted hearts combined with collagen synthesis. Administration of TNAP inhibitor, tetramisole, markedly improved cardiac function and fibrosis after MI. In the primary cultures of neonatal rat cardiac fibroblasts (CFs), TNAP inhibition significantly attenuated migration, differentiation, and expression of collagen-related genes. The TGF-β1/Smads signaling suppression, and p-AMPK and p53 upregulation were involved in the process. When p53 inhibitor was administered, the antifibrotic effect of TNAP inhibition can be blocked. This study provides a direct evidence that inhibition of TNAP might be a novel regulator in cardiac fibrosis and exert an antifibrotic effect mainly through AMPK-TGF-β1/Smads and p53 signals.

Background Although the preoperative immune status is associated with the prognosis in some tumors, less is known about the prognostic significance of immune status change during the treatment of patients with locally advanced gastric cancer (LAGC).Methods The records of 210 patients with LAGC were retrospectively analysed. The pre-, and post-treatment (after gastrectomy and three cycles of chemotherapy) values of lymphocyte-to-monocyte ratio (LMR) and change of LMR (cLMR) were evaluated. A novel immunity change score (ICS) incorporated both preoperative LMR (pLMR) and cLMR was developed and its prognostic value was evaluated.Results cLMR was an independent predictor and patients with cLMR >1 after treatment had a favorable survival compared with the others (51 vs 31 months, P < 0.001). Based on the cLMR and pLMR, the ICS was defined as follows: ICS=1 (pLMR≤4.53 and cLMR≤1); ICS=2 (pLMR≤4.53 and cLMR>1, or pLMR>4.53 and cLMR≤1); and ICS=3 (pLMR>4.53 and cLMR>1). Multivariate analysis revealed that the ICS was a significant independent biomarker ( P < 0.001). The performances of ICS in terms of the time-dependent receiver operating characteristics (t-ROC) curve and concordance index (C-index) analysis were better than those of pLMR and cLMR. Then we established a nomogram incorporated the ICS, CEA, and TNM stage to predict the 3- and 5- year survival. Decision curve analysis and calibration curve demonstrated that the nomogram was clinically useful.Conclusion The dynamic change of immune status is significantly associated with prognosis for LAGC patients. Combining with the cLMR and pLMR could improve the prognostication for LAGC patients.

Keshen Wang,1 Yanxian Ren,1 Zhijian Ma,2 Fan Li,1 Xiaocheng Cheng,1 Jingying Xiao,1 Shuze Zhang,1 Zeyuan Yu,1 Hanteng Yang,1 Huinian Zhou,1,2 Yuming Li,1,2 Hongbin Liu,3 Zuo-Yi Jiao1,21Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730010, People’s Republic of China; 2Cui-ying Experimental Center, Lanzhou University Second Hospital, Lanzhou, Gansu 730010, People’s Republic of China; 3Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of People’s Liberation Army, Lanzhou 730050, People’s Republic of ChinaIntroduction: Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) may improve overall survival (OS) in patients with locally advanced gastric cancer (LAGC); however, evidence for its use as a standard treatment has not been established in China. The aim of this study was to investigate the effectiveness, safety, and feasibility of the FLOT regimen as neoadjuvant chemotherapy in Chinese patients with resectable LAGC.Methods: We conducted an observational study to compare the effectiveness of FLOT regimen consisting of docetaxel (60 mg/m2,), oxaliplatin (85 mg/m2,), leucovorin (200 mg/m2,), and 5-fluorouracil (2,600 mg/m2, as a 24 hr infusion), all given on day 1 and administered every 2 weeks versus initial surgery followed by chemotherapy in patients with clinical T3–4 LAGC. OS was compared by using the Cox proportional hazards regression model and the Kaplan–Meier curve adjusted by inverse probability of treatment weighting (IPTW) and propensity score-matched (PSM) analysis. In addition, we performed subgroup analyses to determine the effectiveness of the FLOT regimen in clinically relevant patient subsets.Results: Overall, 47 patients who received initial FLOT chemotherapy and 269 patients who received initial surgery were enrolled in this study. In the PSM analysis, the FLOT-first group showed favorable OS compared with the surgery-first group (41 vs 41 [HR, 0.416; 95% CI, 0.218–0.794; P=0.008]), and 3-year survival rates were 58.7% and 30.9% in the FLOT-first group and surgery-first group, respectively. IPTW analysis showed similar results. However, the effect of FLOT was low (HR, 0.868; 95 CI%, 0.215–3.504) in patients without lymph node metastasis.Conclusion: Our study suggests that preoperative FLOT chemotherapy is safe and feasible. In terms of OS, FLOT may be superior to initial surgery followed by chemotherapy in reducing morbidity with resectable LAGC.Keywords: gastric cancer, preoperative chemotherapy, propensity score, FLOT, prognosis

Background Cardiac fibrosis is the most important pathogenesis leading to cardiac remodeling and heart failure after myocardial infarction (MI). Tissue nonspecific alkaline phosphatase (TNAP) has recently been recognized as a potential prognostic factor for MI. Nevertheless, the role of TNAP in cardiac fibrosis after MI has not been explicitly delineated. Methods A systematic review and meta-analysis was conducted to assess the effect of serum TNAP levels on mortality in patients with ischemic heart disease (IHD). A correlation analysis was performed to investigate the relationship between serum levels of TNAP and biomarkers of fibrosis. Heart biopsies from patients with MI and a mouse model of MI were used to detect the expression and distribution of TNAP. Furthermore, we established adenovirus-mediated knockdown and overexpression of TNAP, using a combination of in vivo and in vitro studies in mice, to determine the role and mechanism of TNAP in cardiac fibrosis after MI. In the in vitro studies, cardiac fibroblasts were cultured on soft plates. Findings After searching the main databases and performing a detailed assessment of the full-text articles, eight studies with 14,816 individuals were included in the quantitative analysis. We found that a high serum TNAP level was associated with an increased risk of mortality in patients with IHD and MI. The correlation analysis revealed a positive correlation between serum TNAP levels and the concentration of fibrosis biomarkers (PICP/PIIINP). The expression of TNAP was upregulated in the myocardium of patients with MI and in a mouse model of MI, accompanied by fibroblast activation and the deposition of collagen fibers. In the in vivo study, TNAP knockdown ameliorated cardiac fibrosis and improved cardiac function in mice. TNAP overexpression aggravated cardiac fibrosis and worsened cardiac function. In the in vitro study, TNAP promoted cardiac fibroblast differentiation, migration and proliferation. Mechanistically, the pro-fibrotic effect of TNAP on cardiac fibroblasts was at least partially achieved by activating the TGF-β1/Smads and ERK1/2 signaling pathways. Interpretation Based on these findings, TNAP plays an important pro-fibrotic role in cardiac fibrosis after MI by activating TGF-β/Smads and ERK1/2 signaling, indicating that it functions as a potential regulator of and therapeutic target in cardiac fibrosis. Funding This work was supported by the National Natural Science Foundation of China.

Aims Abnormal expression of long non-coding RNAs (lncRNAs) occurs in several diseases including renal fibrosis. Notably, growth arrest-specific 5 (Gas5) is a lncRNA, which functions as an essential modulator of cell proliferation and growth. However, the role and expression of lncRNA Gas5 associated with renal fibrosis remains controversial. Herein, we investigate the effect of lncRNA Gas5 deficiency in renal fibrosis induced by the operation of unilateral ureteric obstruction (UUO) in mice. Main methods Sera and urine of mice were used to detect markers of renal function. Further, Masson and immunohistochemical staining, western blotting as well as qRT-PCR were performed to observe the distribution and expression of fibrosis marker in the kidney tissue of the mice. Key findings Unlike the wild type mice, the obstructed kidney in Gas5+/− mice showed more severe renal fibrosis and collagen deposition. In the UUO-Gas5+/− group, the serum levels of uric acid, serum creatinine, and the urine levels of albumin-to-creatinine ratio were higher. Moreover, the expression of mRNA and protein of α-smooth muscle actin (α-SMA), vimentin, collagen IV, fibronectin, and matrix metalloproteinase 9 (MMP9) were higher, whereas that of phosphatase and tensin homolog (PTEN) were lower with the difference being statistically significant (p Significance lncRNA Gas5 was up-regulated in renal fibrosis tissues, and its deficiency exacerbated renal fibrosis in the UUO mice model.

Aims The sex-related differences in the clinical outcomes of rhythm and safety after catheter ablation remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for atrial fibrillation (AF) in women and men. Methods and results The Medline and EMBASE databases were searched for published articles up to December 2018. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, stroke/transient ischaemic attack (TIA), and all-cause mortality. After literature search and detailed assessment, 19 observational studies (151 370 patients; 34% women) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was lower in women than men at the 2.4-year follow-up [odds ratio (OR): 0.75, 95% confidence interval (CI) 0.69–0.81; P Conclusions Women who underwent catheter ablation of AF might experience lower efficacy and a higher risk of stroke/TIA and major complications than men. The reasons for these sex-related differences need to be further studied.

Objective The aim of this meta-analysis was to compare the clinical outcomes of transcatheter aortic valve replacement (TAVR) with those of surgical aortic valve replacement (SAVR) in patients with chronic kidney disease (CKD). Design Meta-analysis of 10 observational studies. Setting Hospital. Participants Patients with CKD (9,619) undergoing aortic valve replacement. Interventions None. Measurements and Main Results The Medline, Cochrane Library, and Embase databases were searched for clinical studies published from January 2000 to October 2018. Studies that fulfilled the predefined inclusion criteria were included. The primary clinical outcomes included early all-cause mortality and postoperative stroke. Random-effects modeling was used to calculate odds ratio (OR) and 95% CI. After a literature search of the major databases, 10 observational cohort studies with a total of 9,619 patients were identified. Pooled analysis indicated that, when compared with SAVR, TAVR was associated with a lower risk of early all-cause mortality (6.1% v 10.2%; OR: 0.71; 95% CI: 0.51-0.98) and stroke (1.1% v 2.2%; OR: 0.53; 95% CI: 0.37-0.75). Although TAVR increased the risk of pacemaker implantation (OR: 2.06; 95% CI: 1.16-3.66), it reduced the risk of blood transfusion (OR: 0.50; 95% CI: 0.39-0.65), infection (OR: 0.30; 95% CI: 0.13-0.70), acute kidney injury (AKI) (OR: 0.46; 95% CI: 0.38-0.55), and AKI requiring dialysis (OR: 0.66; 95% CI: 0.58-0.75). There were not significant differences in the incidence rates of cardiac tamponade (OR: 0.60; 95% CI: 0.26-1.36) and major vascular damage (OR: 1.12; 95% CI: 0.81-1.55) between the 2 groups. Conclusion Transcatheter aortic valve replacement might be a preferable approach to SAVR in patients with CKD. A large, prospective, randomized controlled trial is warranted.

The aim of this study was to investigate the association between interleukin (IL)-10-1082 (G/A) promoter polymorphism and acute rejection (AR) in renal transplant recipients.We searched MEDLINE, EMBASE, Web of Science, and Cochrane Central Register from the inception to March 2015 for relevant studies. Data concerning publication information, population characteristics, and transplant information were extracted. Odds ratios (ORs) was calculated for the association between IL-10-1082 GG genotype (or IL-10-1082 G allele) and AR risk.This meta-analysis included 22 case-control studies including 2779 cases of renal transplant recipients. The pooled estimate showed that the IL-10-1082 GG genotype was not significantly associated with AR risk (ORrandom=1.07, 95% CI 0.80-1.43, p = 0.64). Similarly, the pooled estimate showed that the IL-10-1082 G allele was not significantly associated with AR risk (ORfixed=1.02, 95% CI 0.90-1.16, p = 0.74). None of subgroup analyses yielded significant results in the association between IL-10-1082 GG genotype (or IL-10-1082 G allele) and AR risk. Meta-regression confirmed that there was no significant correlation between the pre-selected trial characteristics and our study results.This meta-analysis suggests that IL-10-1082 G/A polymorphism is not significantly associated with AR risk in renal transplant recipients.

therapy were more obvious in studies with isolated valve surgery, resulting in a 1.9% absolute risk and a 38% odds reduction of early mortality (2.4 v 4.3%; OR: 0.62; 95% CI 0.49-0.77, p o 0.0001). A significant reduction by statin therapy also was observed for atrial fibrillation (OR 0.88, 95% CI: 0.80-0.98, p ¼ 0.02). However, statin therapy was not associated with a lower risk of postoperative stroke (OR: 0.74; 95% CI 0.46-1.19, p ¼ 0.21), myocardial infarction (OR: 1.02; 95% CI 0.78-1.34, p ¼ 0.87), and renal failure (OR: 0.91; 95% CI 0.57-1.44, p ¼ 0.68). Conclusions: Preoperative statin therapy was associated with a significantly lower risk of early mortality in patients undergoing isolated valve surgery. A prospective, randomized, controlled trial is warranted. HE 3-HYDROXY-3-METHYLGLUTARYL coenzyme A (HMG-CoA) reductase inhibitors (statins) are potent cholesterol-lowering medications used primarily for hyper- cholesterolemia. Statins have shown more diverse pleiotropic properties, including improvement in endothelial function, inhibition of vascular smooth muscle cell proliferation, pre- vention of cardiac hypertrophy and atherosclerosis, and reduc- tions in oxidative stress and vascular inflammation. 1,2 Cardiopulmonary bypass and cardioplegic cardiac arrest during cardiac surgery are associated with a systemic inflamma- tory response and myocardial injury, which are thought to play a significant role in the outcome of patients. 3,4 Statins may reduce systemic inflammatory response and markers of cardiac myonec- rosis after valvular heart surgery. 5,6 Several meta-analyses revealed that preoperative statin therapy was associated with a pronounced early reduction in adverse cardiovascular events after coronary artery bypass graft (CABG) surgery. 7-9 However, the benefits of preoperative statin therapy in the setting of isolated valvular surgery are not as definitive. The study by Angeloni et al 10 indicated that preoperative statin therapy was associated with a reduced risk of early all-cause mortality. In contrast, Borger et al 11 failed to show an association between preoperative statin therapy and short clinical outcomes. In light of these conflicting findings, the recent European Society of Cardiology guidelines stated that lipid-lowering therapy was not indicated for patients with valvular heart disease without coronary artery disease (Class III, Level of Evidence B). 12 The authors hypothesized that perioperative statin therapy may be beneficial in patients undergoing valve surgery and performed a systematic review and meta-analysis to assess whether preoperative statins therapy would reduce the risk of adverse cardiovascular events.

The main purpose of this meta-analysis was to compare the long-term efficacy of cryoballoon ablation (CBA) with irrigated radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation (AF).The Medline, Cochrane Library and Embase Database were searched for clinical studies published up to October 2014. Studies that fulfilled our predefined inclusion criteria were included. The primary clinical outcome was the proportion of patients free from AF (follow-up≥3months), and the secondary clinical outcomes included acute pulmonary vein (PV) isolated rate, fluoroscopy time, procedure time and complications.After a literature search in the major databases, three randomized controlled trials (RCTs) and eight retrospective trials with a total of 1216 patients were identified. Pool-analysis demonstrated that, as compared RFCA, CBA was associated with a similar proportion of patients free from AF at a mean 16.5months follow-up (66.9% vs 65.1%; relative risk [RR]: 1.01; 95% CI: 0.94 to 1.07, P=0.87). Acute PV isolation rate (RR: 0.92; 95% CI: 0.82 to 1.03) and fluoroscopy time (weighted mean difference WMD: -8.60; 95% CI: -18.29 to 3.69) were not statistically significant difference. The procedure time was shorter in CBA group ([WMD]: -31.94; 95% CI: -60.43 to -3.45). Transient phrenic nerve palsy was uniquely observed in the CBA group (5.4%, P0.00001) and resolved in all during the follow-up period, total complication was similar in both groups (RR: 1.30; 95% CI: 0.91 to 1.85).CBA was as effective as RFCA for the treatment of atrial fibrillation during long-term follow-up with comparable procedural features.

Purpose The aim of this study was to assess the efficacy and safety of bevacizumab in the treatment of pterygium and to mainly explore its effects on recurrence rate and complications. Methods We searched MEDLINE, EMBASE, Web of Science, and Cochrane Central Register from the inception to July 2013 for relevant randomized controlled trials that examined bevacizumab therapy for pterygium. Data concerning study design, patient characteristics, treatment, and outcomes were extracted. The methodological quality of the studies included was assessed using the Jadad score. Relative risk (RR) was calculated for recurrence rate and complications. Results A total of 474 patients with 482 eyes in 9 randomized controlled trials were analyzed. The pooled estimate showed that bevacizumab had no statistically significant effect on preventing pterygium recurrence [RR 0.90, 95% confidence interval (CI) 0.77-1.07, P = 0.23]. None of the subgroup analyses yielded significant results in favor of bevacizumab (surgery group: RR 0.77, 95% CI 0.50-1.18, P = 0.23; nonsurgery group: RR 0.98, 95% CI 0.86-1.11, P = 0.76; primary pterygium group: RR 0.82, 95% CI 0.53-1.26, P = 0.36; recurrent pterygium group: RR 0.95, 95% CI 0.82-1.09, P = 0.44). There were no statistically significant differences in the complications between the 2 groups (RR 1.00, 95% CI 0.73-1.37, P = 1.00). However, the bevacizumab group was associated with a higher risk of developing subconjunctival hemorrhage (RR 3.34, 95% CI 1.07-10.43, P = 0.04). Conclusions Topical or subconjunctival bevacizumab was relatively safe and well tolerated, but it had no statistically significant effect on preventing pterygium recurrence. A large-scale trial with a suitable dosage and a longer follow-up would be required to rule out the possibility of any treatment benefit.

cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008;155:408–17. [6] Santoro F, Carapelle E, Cieza Ortiz SI, et al. Potential links between neurological disease and Tako-Tsubo cardiomyopathy: a literature review. Int J Cardiol 2013;168(2):688–91. [7] Mansencal N, Auvert B, N'guetta R, et al. Prospective assessment of incidence of Tako-Tsubo cardiomyopathy in a very large urban agglomeration. Int J Cardiol 2013;168(3):2791–5. [8] Demographia, Demographia. Demographia world urban areas: population and projections; 20101–126 [Edition 6.1].