Cardiovascular diagnosis and therapy最新文献

Background: Patients with congenital heart defects (CHDs) are at higher risk for infectious diseases. This may partly be due to frequent hospital stays and the associated exposure to pathogens. This study aims to provide a comprehensive overview of immunisation coverage among twins in which at least one twin has CHD. Confounding factors from shared environments and genetic components can be controlled through co-twin control analysis, thus minimising confounding effects.

Methods: In the framework of the cross-sectional twin study "Same Same, but different?" twins, with at least one of them having CHD aged 3 to 99 years, were recruited nationwide in Germany between August 2019 and December 2022. Their primary immunisation status based on the German Standing Committee on Vaccination (STIKO) and immunisation against respiratory diseases, including influenza, respiratory syncytial virus (RSV), pneumococci, and coronavirus disease 2019 (COVID-19), were assessed and compared between the twins.

Results: In total, 64 twins (128 individuals) were included for direct twin comparison. Overall, 56.3% of the twins reached complete primary immunisation status, negatively influenced by hospitalisation duration [odds ratio (OR): 0.98; 95% confidence interval (CI): 0.96-0.99; P=0.01]. Compared to their healthy twin, twins with CHD received their rotavirus vaccine significantly later (P=0.04). Only 3.1% of the twins with CHD received the pneumococcal vaccine recommended for high-risk patients. A higher number of catheter interventions can lead to a higher number of patients receiving the pneumococcal vaccine (OR: 1.79; 95% CI: 1.16-2.76; P=0.009). The direct twin comparison showed a significant difference between the twins in vaccination against influenza (P=0.007), although it is recommended for CHD patients and their household contacts-including their twin. A higher number of surgeries (OR: 1.51; 95% CI: 1.12-2.05; P=0.007) and catheter interventions (OR: 1.49; 95% CI: 1.00-2.21; P=0.049) increase the probability of influenza vaccination in CHD patients.

Conclusions: In the direct twin comparison, twins are similarly vaccinated except for RSV and influenza. Immunisation against influenza in twins should be improved. With new upcoming RSV vaccines, existing recommendations must be reconsidered and adapted. Another disturbing fact is that only 30% of infants are vaccinated against pertussis and pneumococcus within the primary recommended timeframe, even though they are exposed at high risk during infancy. Further education of parents, patients, and medical staff might lead to higher vaccination coverage, especially in pneumococcal vaccines recommended for high-risk patients. We must provide sufficient information on the importance of vaccinations and their side effects for parents' and patients' decision-making.

Background: The adherence to the Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines across the journals that initially published the guidelines and if adherence has improved since the guidelines update, remains unknown. We aimed to quantify the level of adherence and analyze factors that might influence reporting quality among these journals.

Methods: This cross-sectional study retrospectively analyzed interventional animal experiments published in journals that released ARRIVE 1.0 and 2.0 guidelines in three periods: 5 years before (Pre-ARRIVE 1.0) and after (Post-ARRIVE 1.0) the publication of ARRIVE 1.0, and 1 year after the publication of ARRIVE 2.0 (Post-ARRIVE 2.0). Reviewers independently assessed adherence to the ARRIVE guidelines. Basic information and potential influencing factors were extracted. Adherence data were presented as frequency (percentages). Statistical factors influencing reporting quality were evaluated using the Chi-square test or Fisher's exact test.

Results: 215, 330, and 398 experiments were included during Pre-ARRIVE 1.0, Post-ARRIVE 1.0 and Post-ARRIVE 2.0 periods, respectively. None of the included 943 studies reported all 38 subitems, showing only 0%, 0%, and 0.25% studies had an "excellent" reporting quality across the three periods. The overall reporting quality was significantly improved among Pre-ARRIVE 1.0, Post-ARRIVE 1.0 and Post-ARRIVE 2.0 (P<0.001). The rate of studies with "average" reporting quality increased sequentially from 53.95% to 73.94% and then to 90.20%, and those with "poor" reporting quality decreased sequentially from 46.05% to 26.06% and then to 9.55% across the three periods. Specifically, 15 out of 38 (39.5%) subitems and 11 out of 27 (40.7%) similar and comparable subitems demonstrated a significant higher percentage of "fully reported" in Post-ARRIVE 1.0 compared to Pre-ARRIVE 1.0 and in Post-ARRIVE 2.0 compared to Post-ARRIVE 1.0, respectively (P<0.05). Country and journal indexing did not significantly affect reporting quality (both P>0.05). However, significant differences in reporting quality were found among the mandatory adherence to the ARRIVE guidelines in the author's instructions and reference to ARRIVE in the manuscript (both P<0.001).

Conclusions: In the journals that initially published the ARRIVE guidelines, compliance with the guidelines still has room for improvement, though it has increased sequentially since introducing the guidelines. Implementing mandatory adherence requirements in the author's instructions and explicitly recognizing adherence to ARRIVE in articles could enhance the reporting quality of interventional animal experiments.

Background and objective: Interleukin-6 (IL-6) plays multifaceted roles in cancer and atherosclerosis. Initially recognized for its role in immune response and inflammation, IL-6 promotes tumor progression via the JAK-STAT and MAP kinase pathways and is associated with poor cancer prognoses. In atherosclerosis, IL-6 contributes to endothelial dysfunction and plaque formation. This review highlights the shared inflammatory mechanisms of IL-6 in both diseases and explores the regulatory dynamics of IL-6 signaling, including gene polymorphisms and epigenetic modifications.

Methods: Google Scholar, Scopus, and PubMed were searched for English-language articles on IL-6 and those reporting shared pathogenic mechanisms of IL-6 in cancer and atherosclerosis from their inception through June 2024.

Key content and findings: The investigation into IL-6's mechanisms in cancer and atherosclerosis reveals the intricate and interconnected nature of inflammatory processes in chronic diseases. The role of IL-6 in both conditions underscores its centrality in disease pathology, particularly through its involvement in inflammation, immune modulation, and cellular proliferation. This commonality highlights IL-6 as a key player linking these seemingly distinct diseases.

Conclusions: Given the shared pathogenic mechanism of IL-6 in cancer and atherosclerosis, this narrative review concludes by emphasizing the therapeutic potential of modulating IL-6 in treating both cancer and atherosclerosis. It advocates for personalized treatment strategies that combine targeted therapies with lifestyle modifications. This holistic approach is considered crucial for effective disease management, given the diverse and complex roles IL-6 plays in these widespread conditions.

Background: The correlation between the gamma-glutamyl transferase-to-albumin ratio (GAR) and the risk of bleeding in patients with non-valvular atrial fibrillation (NVAF) undergoing treatment with the dabigatran anticoagulant is poorly understood. This study aims to explore whether GAR is associated with bleeding events among patients with NVAF receiving dabigatran anticoagulant therapy.

Methods: We conducted a multicenter, observational cohort study in 12 Chinese hospitals from six provinces, including Beijing, Shanghai and Guangzhou, to evaluate the effectiveness and safety of dabigatran (110 mg) treatment in NVAF patients who were consecutively enrolled during February 2015 and December 2017. All patients had completed a 3-month follow-up period. The baseline variable of interest was the GAR, and the outcome variable was the occurrence of bleeding events. Both univariate and multivariate Cox proportional hazard models were used to evaluate the relationship between GAR and bleeding outcome.

Results: This prospective cohort study included a total of 834 patients (mean age 65.6±11.1 years; 56.8% male). Overall, 82 subjects experienced bleeding. The patients were categorized based on the tertiles of the GAR. Participants in tertile 2 (0.59-1.03) [hazard ratio (HR): 0.28; 95% confidence interval (CI): 0.14-0.55; P<0.001] and tertile 3 (≥1.04) (HR: 0.47; 95% CI: 0.25-0.89; P=0.02) exhibited a lower rate of bleeding compared to the reference group (T1: ≤0.58). Multivariable models with restricted cubic splines demonstrated a nonlinear relationship between GAR and bleeding outcome, with a GAR inflection point of 0.68. The HR (95% CI) was 0.05 (0.01-0.31) (P=0.002) for GAR values <0.68 and 0.96 (0.70-1.31) (P=0.78) for GAR values ≥0.68. Moreover, the correlation between decreased GAR and an increase in bleeding events remained consistent across various subgroups.

Conclusions: GAR is a prevalent, independent predictor of dabigatran-related bleeding in NVAF patients. Moreover, a significant L-shaped association between GAR and bleeding events has been observed.

Background and objective: The most common valvular heart disease in the US is moderate to severe mitral regurgitation (MR). Function MR or secondary MR comprises many of these cases. Moderate and severe secondary MR are independently associated with increased all-cause mortality and rehospitalization for heart failure. Both ischemic and nonischemic cardiomyopathy can cause secondary MR via similar pathophysiology that leads to inadequate valve leaflets coaptation. The management of secondary MR is complex. The optimal treatment strategy for secondary MR remains controversial, reflected in the vast array of treatment options and the complexity of therapeutic decision-making. Several surgical mitral valve repair techniques have been described in the literature. Many of these aims to facilitate adequate valve leaflet coaptation. In this review, the pathophysiology of MR is described with a focus on evaluating and managing secondary MR.

Methods: A literature review was performed using PubMed and Google Scholar. Clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews were considered from January 1, 1995 through December 31, 2022. Articles published in languages other than English with limited text availability were excluded.

Key content and findings: Optimal therapeutic approach in severe secondary MR is complex and several patient factor should be considered. We provide a framework for the surgical management of secondary MR based on echocardiographic parameters, the presence of ischemia, and myocardial viability.

Conclusions: Further study is needed to guide the selection of patients most likely to benefit from mitral valve repair or replacement in the setting of secondary MR.