Annals of medicine
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Atrial fibrillation (AF) is the most common heart arrhythmia and is associated with poor outcomes. The adverse effects of AF are mediated through multiple pathways, including endothelial dysfunction, as measured by flow-mediated dilatation. Flow-mediated dilatation has demonstrated endothelial dysfunction in several conditions and is associated with poor outcomes including mortality, yet can be improved with medical therapy. ⋯ Endothelial dysfunction is associated with poor outcomes such as stroke, myocardial infarction and death, yet is a reversible condition. Flow-mediated dilatation is a reliable tool to assess endothelial function in patients with atrial fibrillation. Patients with atrial fibrillation should be considered for endothelial function assessment and attempts made to reverse this condition.
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Clostridioides (formerly: Clostridium) difficile infection (CDI) is a major cause of diarrhoea for inpatients as well as outpatients. Usually, CDI is healthcare-associated but the number of community-acquired infections is increasing. CDI is generally associated with changes in the normal intestinal microbiota caused by administration of antibiotics. ⋯ Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence. In recurrent CDI, bezlotoxumab infusion (a monoclonal antibody against C. difficile toxin B) may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence. Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI.
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Comparative Study
Outcomes of anatomical versus non-anatomical resection for hepatocellular carcinoma according to circulating tumour-cell status.
Background and aims: Hepatic resection is the first-line treatment for hepatocellular carcinoma (HCC). Whether to perform anatomical (AR) or non-anatomical resection (NAR) remains controversial. This retrospective study compares the outcomes according to the number and type of circulating tumour cells (CTCs). ⋯ For patients with a high CTC count, the balance between operative risk and prognostic benefit is more important than the resection method performed. Key messagesAnatomic resection may improve the survival of HCC patients, but only those with low CTC count and negative M- and E/M-CTC phenotypes. CTC analysis before surgery can be used to better guide the choice of resection method for HCC.
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Objective: We investigated lipid concentrations, particle sizes and antibodies binding to periodontal bacteria Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and to malondialdehyde-acetaldehyde (MAA) modified low-density lipoprotein in immunoglobulin (Ig) class A, G and M among patients with newly diagnosed rheumatoid arthritis (RA) in a population-based cohort. Methods: Concentrations and sizes of lipoprotein particles analysed by proton nuclear magnetic resonance spectroscopy and antibody levels to MAA modified low-density lipoprotein were studied at baseline and after one-year of follow-up. Serum Ig A and G class antibodies to periodontal bacteria were determined at baseline. ⋯ Key messagesPatients with drug naive rheumatoid arthritis showed proatherogenic lipid profiles. Reversible changes in lipid profiles can be achieved as response to inflammation suppression. Active therapy aimed at remission is essential in all patients with rheumatoid arthritis.