Subclinical aortic valve complex (valvular and perivalvular) thrombus is not rare after transcatheter aortic valve replacement (TAVR). The risk factors and clinical implications of these findings ...remain uncertain.
This study sought to evaluate the frequency, predictors, and clinical outcome of aortic valve complex thrombus after TAVR.
In the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) trial comparing edoxaban vs dual antiplatelet therapy in TAVR patients without an indication for chronic anticoagulation, the frequency of valvular (subclinical leaflet thrombus) and perivalvular (supravalvular, subvalvular, and sinus of Valsalva) thrombus was evaluated by 4-dimensional computed tomography at 6 months. The association of these phenomena with new cerebral thromboembolism on brain magnetic resonance imaging, neurologic and neurocognitive dysfunction, and clinical outcomes was assessed.
Among 211 patients with 6-month computed tomography evaluations, 91 patients (43.1%) had thrombus at any aortic valve complex, 30 (14.2%) patients had leaflet thrombus, and 78 (37.0%) patients had perivalvular thrombus. A small maximum diameter of the stent at the valve level and low body surface area were independent predictors of aortic valve complex and perivalvular thrombus, and decreased renal function was an independent predictor of leaflet thrombus. No significant differences were observed in new cerebral lesions, neurologic or neurocognitive functions, or clinical outcomes among patients with or without valvular or perivalvular thrombus.
Subclinical aortic valve complex (valvular and perivalvular) thrombus was common in patients who had undergone successful TAVR. However, these imaging phenomena were not associated with new cerebral thromboembolism, neurologic or neurocognitive dysfunction, or adverse clinical outcomes. (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement ADAPT-TAVR; NCT03284827).
Although betel quid (BQ) is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature regarding the dose-response, BQ types, HNC sites, and BQ cessation. The ...current study was conducted to fill these insufficiencies.
A hospital-based case-control study was conducted to evaluate the association between BQ and HNC. In-person interview was conducted to collect data on BQ chewing. The current analysis included 487 men newly diagnosed with HNC and 617 male controls who were frequency-matched to the cases by age. The association between BQ and HNC was assessed using multivariable unconditional logistic regression.
Ever BQ chewing was associated with an increased HNC risk regardless of the BQ types. A non-linear positive association between BQ and HNC was observed, with a steep rise in HNC risk for the first 5 pack-years or 200,000 minutes of BQ consumption. Every year of BQ cessation was associated with a 2.9% reduction in HNC risk; however, the risk did not reduce to the level of non-BQ chewers even after 20 years of BQ cessation. Eliminating BQ chewing may prevent 51.6% of HNCs, 62.6% of oral cancers, and 41.3% of pharyngeal cancers in Taiwan.
Our results supported the positive association between BQ and HNC. BQ cessation is effective in reducing HNC risk and should be encouraged. Because BQ cessation may not reduce the HNC risk to the level of non-BQ chewers, it is important to prevent the initiation of BQ chewing.
Avilamycin residue in food is regulated as its marker residue dichloroisoeverninic acid (DIA). An isotope dilution liquid chromatography–tandem mass spectrometry method is established for the ...accurate determination of DIA in animal muscles without any pre-extraction and preconcentration prior to alkaline hydrolysis. Optimization of the sample cleanup procedures such as liquid–liquid extraction and solid phase extraction was performed by fine-tuning several critical parameters to reduce the matrix effects. Quantification of DIA in edible muscle was accomplished by using matrix-matched calibration with dichloroisoeverninic acid-d
6
as internal standard. The method was validated with DIA and avilamycin-fortified poultry and porcine muscles at three different levels (25, 50, and 100 μg/kg). Conversion of avilamycin to DIA by alkaline hydrolysis was ≥92 %. The recoveries of DIA in both muscles at three fortification levels ranged from 94 to 106 % and RSDs were ≤11 % in all cases. The estimated limit of detection values in poultry and porcine muscles were 2.7 and 0.7 μg/kg, respectively. The estimated limit of quantitation values in poultry and porcine muscles were 8.3 and 2.4 μg/kg, respectively. This method is suitable for routine monitoring of avilamycin residue in food safety surveillance programs.
It is unknown whether edoxaban versus dual antiplatelet therapy (DAPT) has differential treatment effects on leaflet thrombosis, cerebral thromboembolism, and neurologic or neurocognitive dysfunction ...according to clinical and anatomic factors after transcatheter aortic valve implantation.
To investigate the relative effects of edoxaban and DAPT on leaflet and cerebral thromboembolism in patients with major risk factors.
The primary end point of this study was the incidence of leaflet thrombosis on computed tomography at 6 months. The secondary end points were new cerebral lesions on brain magnetic resonance imaging and neurologic and neurocognitive dysfunction between baseline and 6-month follow-up. Cox regression models assessed the consistency of the treatment effects in the prespecified subgroups.
The favorable effect of edoxaban versus DAPT on the leaflet thrombosis was consistent across multiple clinical or anatomic subgroups, without significant interaction between the drug effect and each subgroup (p for interaction for age = 0.597, gender = 0.557, body mass index = 0.866, Society of Thoracic Surgeons score = 0.307, valve type = 0.702, edoxaban reduction criteria = 0.604, and valve morphology = 0.688). However, the incidence of new cerebral lesions on brain magnetic resonance imaging and worsening of neurologic and neurocognitive function were not significantly different between the groups among the various key subgroups.
The relative effects of edoxaban and DAPT on the risk of leaflet thrombosis, cerebral thromboembolism, and neurologic dysfunction were consistent across a diverse spectrum of clinical or anatomical factors. Further studies are required to define tailored antithrombotic therapy for high-risk groups with specific clinical or anatomic characteristics.
This study sought to evaluate the optimal treatment for in-stent restenosis (ISR) of drug-eluting stents (DESs).
This is a prospective, multicenter, open-label, randomized study comparing the use of ...drug-eluting balloon (DEB) versus second-generation everolimus-eluting stent for the treatment of DES ISR. The primary end point was in-segment late loss at 9-month routine angiographic follow-up.
A total of 172 patients were enrolled, and 74 (43.0%) patients underwent the angiographic follow-up. The primary end point was not different between the 2 treatment groups (DEB group 0.15±0.49 mm vs DES group 0.19±0.41 mm, P=.54). The secondary end points of in-segment minimal luminal diameter (MLD) (1.80±0.69 mm vs 2.09±0.46 mm, P=.03), in-stent MLD (1.90±0.71 mm vs 2.29±0.48 mm, P=.005), in-segment percent diameter stenosis (34%±21% vs 26%±15%, P=.05), and in-stent percent diameter stenosis (33%±21% vs 21%±15%, P=.002) were more favorable in the DES group. The composite of death, myocardial infarction, or target lesion revascularization at 1 year was comparable between the 2 groups (DEB group 7.0% vs DES group 4.7%, P=.51).
Treatment of DES ISR using DEB or second-generation DES did not differ in terms of late loss at 9-month angiographic follow-up, whereas DES showed better angiographic results regarding minimal MLD and percent diameter stenosis. Both treatment strategies were safe and effective up to 1year after the procedure.
Background
Carriers of the ALDH2*2 allele have impaired alcohol metabolism and are more susceptible to the development of alcohol‐related cancers, including head and neck cancer (HNC). Screening for ...ALDH2*2 allele may identify high‐risk individuals for alcohol health education. Although genotyping of ALDH2 is the most accurate way to identify ALDH2 deficiency, it may not be practical due to the cost and requirement for genotyping service.
Methods
This study evaluated the accuracy of the alcohol flushing questionnaire to identify ALDH2 deficiency in a case–control study of HNC conducted in Taiwan using data collected from 904 patients with HNC and 1,078 controls.
Results
Overall, alcohol flushing questionnaire had a high sensitivity (89%) of identifying ALDH2*2 carriers among the control subjects and a good sensitivity (79%) among the patients with HNC. The sensitivity of the alcohol flushing questionnaire in identifying ALDH2*2 carriers was affected by alcohol use, with a lower sensitivity among individuals who consumed alcohol, particularly among current regular (drinking alcohol once per week or more) alcohol drinkers.
Conclusions
The current validation study showed that the alcohol flushing questionnaire may be a reasonable method to identify ALDH2‐deficient individuals. However, current regular users of alcohol who reported no alcohol flushing may need to undergo genotyping of ALDH2 for a more accurate assessment of the ALDH2 status.
In this validation study of the alcohol flushing questionnaire with subjects from a hospital‐based case‐control study of head and neck cancerconducted in Taiwan, we found that the alcohol flushing questionnaire had a high sensitivity (89%) of identifying ALDH2*2carriers among the control subjects and a good sensitivity(79%) among the HNC patients. The sensitivity of the alcohol flushing questionnaire in identifying ALDH2*2carriers was affected by alcohol use, with a lower sensitivity among current regular alcohol drinkers.
The risks of leaflet thrombosis and the associated cerebral thromboembolism are unknown according to different anticoagulation dosing after transcatheter aortic valve replacement (TAVR). The aim was ...to evaluate the incidence of leaflet thrombosis and cerebral thromboembolism between low-dose (30 mg) or standard-dose (60 mg) edoxaban and dual antiplatelet therapy (DAPT) after TAVR.
In this prespecified subgroup analysis of the ADAPT-TAVR trial, the primary endpoint was the incidence of leaflet thrombosis on 4-dimensional computed tomography at 6-months. Key secondary endpoints were new cerebral lesions on brain magnetic resonance imaging and neurological and neurocognitive dysfunction.
Of 229 patients enrolled in this study, 118 patients were DAPT group and 111 were edoxaban group (43 39.1% 60 mg vs 68 61.3% 30 mg). There was a significantly lower incidence of leaflet thrombosis in the standard-dose edoxaban group than in the DAPT group (2.4% vs 18.3%; odds ratio OR 0.11; 95% confidence interval CI, 0.01-0.55; P = .03). However, no significant difference was observed between low-dose edoxaban and DAPT (15.0% vs 18.3%; OR 0.79; 95% CI, 0.32-1.81; P = .58). Irrespective of different antithrombotic regiments, the percentages of patients with new cerebral lesions on brain MRI and worsening neurological or neurocognitive function were not significantly different.
In patients without an indication for anticoagulation after TAVR, the incidence of leaflet thrombosis was significantly lower with standard-dose edoxaban but not with low-dose edoxaban, as compared with DAPT. However, this differential effect of edoxaban on leaflet thrombosis was not associated with a reduction of new cerebral thromboembolism and neurological dysfunction.
OAC = Oral anticoagulation; SLT = Subclinical leaflet thrombosis; TIA = Transient ischemic attack Display omitted
Supernumerary teeth (SNTs) are teeth or tooth-like structures that have erupted or might erupt in addition to the 20 primary or 32 permanent teeth. The simultaneous presentation of multiple SNTs, ...syndrome-related multiple SNTs, SNTs inside the maxillary sinus and treatment outcomes were analyzed to develop improved diagnosis and management plans.
This retrospective study reviewed the medical records of National Cheng Kung University Hospital patients who had undergone surgical intervention with general anesthesia between February 2014 and September 2018; analyzed panoramic radiographs and cone beam computed tomography scans of their multiple SNTs; and used descriptive statistics to discuss treatments and relative complications, especially of unusual SNTs.
The records of 165 patients (127 male and 38 female patients; mean age, 12.4 years) with 241 SNTs (120 patients had 1 SNT, 35 had 2 SNTs, 3 had 3 SNTs, 2 had 4 SNTs, 2 had 5 SNTs, 2 had 6 SNTs, and 1 had 12 SNTs) were reviewed. There were 185 SNTs in the maxilla and 56 in the mandible; 153 were mesiodens and 115 were inverted; 142 were asymptomatic and 137 were conical; and 228 were fully impacted and 210 were partial roots. Two patients had SNTs inside the maxillary sinus, and one had 5 SNTs and Marfan syndrome. Two patients had postoperative lip or chin paresthesia, and two had postoperative sinusitis.
Patient demographic variables provided useful epidemiologic information. We recommend panoramic radiographs or cone beam computed tomography for managing patients with possible multiple SNTs and for extracting SNTs.
Abstract
A fast and high throughput screening method for the determination of amantadine (ADA) in chicken muscle is presented. After acidic extraction and extractive derivatization with ...pentafluorobenzoyl chloride, ADA was analyzed directly without any preconcentration by GC/negative ion chemical ionization-tandem MS/MS. With the selective MS/MS detection, ADA in chicken muscle can be detected at concentrations well below 1 μg/kg. Quantification of ADA in chicken muscle was accomplished by using matrix-matched calibration with memantine as an internal standard. The method was validated with ADA fortified chicken muscle at 1, 2, and 5 μg/kg. The recoveries ranged from 89 to 95%, and RSDs were ≤10% in all cases. The estimated LOD and LOQ in chicken muscle were 0.020 and 0.054 μg/kg, respectively. This method is rapid, robust, and suitable for routine monitoring of ADA residues in chicken muscle samples.
Purpose A voxel-based median plane (optimal symmetry plane OSP) was developed to assess facial bone asymmetry. The purpose of the present study was to introduce a new method of planning surgical ...correction of facial asymmetry using the OSPs as guides and test its effectiveness. Patients and Methods A retrospective study was conducted of 20 facial asymmetry patients with a mandibular deviation of 4 mm or greater or 4° or more that required surgical correction. In the test group (n = 8), the plans for asymmetry correction were formulated using the matching OSP method, in which the OSPs of the facial bones are tracked and matched during the model surgery setup. In the control group (n = 12), traditional planning was conducted. The traditional plans were cross-checked for symmetry through tracking and revised as needed. The symmetry results of the plans were compared between the 2 groups and within the control group. The outcome measures were the deviation distances between the OSPs of the midface and mandible at the anterior or posterior mandible, the occlusal plane cant, and the angle formed by the 2 OSPs. Surgery was performed in accordance with the final plans, and the results were assessed for symmetry. Results The traditional plans left a major mandibular deviation in 5 of the 12 control subjects compared with none in the test group. The test group did significantly better than the control group. The revised plans were significantly better than the initial plans. Postoperatively, significant improvements in symmetry were observed. Conclusion The new method resulted in surgical plans that brought about significantly less postoperative mandibular deviation while maintaining a reasonable occlusion.
PDF
