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Proton pump inhibitor can effectively prevent recurrent peptic ulcers among atherosclerotic patients receiving clopidogrel monotherapy. However, the interaction between proton pump inhibitors and clopidogrel has raised concerns over the safety of combined use of the two medicines in clinical practice. The aims of this randomized-controlled, double-blind and double-dummy trial were to investigate the efficacy of histamine-2 receptor antagonist (H2RA) in the prevention of recurrent peptic ulcer in patients undergoing thienopyridine monotherapy.From January 2012 to 2016, long-termed thienopyridine users with a peptic ulcer history who did not have peptic ulcers at initial endoscopy were randomly assigned to receive either famotidine (40 mg, before bedtime) or placebo (before bedtime) for 6 months. Follow-up endoscopy was performed at the end of the 6th month and whenever dyspepsia, hematemesis, or melena occurred.The cumulative incidence of recurrent peptic ulcer during the 6-month period was 7.0% in famotidine group (n=114) and 11.4% in the placebo group (n=114). The two patient groups had comparable cumulative incidence of peptic ulcer (difference, 4.4%; 95% confidence interval (CI), -11.7 to 2.9%; P=0.239). Additionally, there was no difference in the cumulative incidence of ulcer bleeding (2.6% vs. 1.8%; difference, 0.8%; 95% CI, -0.6 to 2.4%, P=1.000) between famotidine and placebo groups. However, the former had a lower incidence of gastroduodenal erosion than the latter (21.1% vs. 36.8%; difference, 15.7%; 95% CI, -27.3 to -4.1%; P=0.013).Famotidine cannot decrease the incidence of peptic ulcer or ulcer bleeding in thienopyridine users with atherosclerotic disease and a history of peptic ulcer.

Acute cardiomyopathy is a health problem worldwide. Few studies have shown an association between acute cardiomyopathy and low vitamin D status. Paricalcitol, a vitamin D receptor activator, clinically benefits patients with advanced kidney disease. The effect of paricalcitol supplement on cardiac remodeling in cardiomyopathic rats is unknown. This experimental study investigated the effect of paricalcitol in rats with cardiomyopathy induced by isoproterenol.Prospective, randomized, controlled experimental study.Hospital-affiliated animal research institution.Eight-week-old male Wistar-Kyoto rats.Male Wistar-Kyoto rats were first injected intraperitoneally with isoproterenol to create a rat model of acute cardiomyopathy. Then paricalcitol was administered intraperitoneally to isoproterenol-injected rats at a dosage of 200 ng three times a week for 3 weeks. Relevant cardiomyopathy-related variables were measured regularly in three groups of rats, controls, isoproterenol, and isoproterenol plus paricalcitol. Rat hearts were obtained for evaluation of cardiac fibrosis using Masson trichrome staining and commercially available software, and evaluation of cell transition using immunofluorescence staining analysis.Isoproterenol infusions generated significant cardiac fibrosis (p0.001). Subsequent paricalcitol treatment attenuated the isoproterenol-induced cardiac fibrosis (p = 0.006). Fluorescence showed colocalization of endothelial and fibroblast cell markers (cluster differentiation 31 and α-smooth muscle actin, respectively) in the isoproterenol-treated hearts. Paricalcitol injections attenuated the isoproterenol-induced fluorescence intensity of two cell markers (p0.01).Paricalcitol injections may ameliorate isoproterenol-induced cardiac fibrosis possibly through regulating cell transition.

Syncope is a sudden and brief loss of consciousness with postural tone. Its recovery is usually spontaneous. There are various causes of syncope including cardiac, vascular, neurologic, metabolic and miscellaneous origins. The tracing is usually time-consuming and costly. The diagnosis of carotid sinus syncope may sometimes be difficult since the symptoms are nonspecific, especially in older persons. Here, we report the case of a 72-year-old woman who sought medical attention at our hospital due to repeated syncope episodes over the previous 5 years. Neurologic examinations showed negative results (including brain computed tomography). Twenty-four-hour ambulatory electrocardiogram monitoring showed atrial and ventricular premature contractions only. Electrophysiologic study disclosed prolonged corrected sinus node recovery time (1,737 ms) with poor atrioventricular conduction. Drop of blood pressure together with sinus bradycardia developed after left side carotid sinus massage. Both carotid sinus hypersensitivity with sick sinus syndrome contributed to this patient's syncope, and after pacemaker placement together with selective serotonin reuptake inhibitor treatment, she was free from syncope thereafter.

Introduction: Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by the increased vascular resistance and the remodeling of pulmonary arteries. Evidences of accumulated inflammatory cells in the lung suggested that chronic inflammation might play a role in PAH. Regenerative cell therapy emerged as a potential treatment for PAH through regulating the host’s immune response. Hypothesis: The secretome of induced pluripotent stem cells (iPSCs) was investigated for their preventive and therapeutic effects in the pathogenesis of monocrotaline (MCT)-induced PAH rat. Methods: PAH was developed by the subcutaneous injection of MCT in rats. The conditioned medium of cultured iPSCs (iPSC CM) was applied daily in prevention (an hour after MCT injection) or reversal (14 days after MCT injection) by IP injection throughout the full 28 days of experiment. The effects of iPSC CM were interpreted by the analyses of systolic pressure (RVSP) and the hypertrophy index of right ventricle, also the regulation of inflammation in lung and the underlying mechanism. Results: Both prevention and reversal, the hemodynamic values of RVSP and hypertrophy index were significantly improved in MCT-induced PAH rats after iPSC CM treatment. Attenuated expression of pro-inflammatory M1 macrophage markers was observed in either the lung of MCT-induced PAH rats or in co-cultured human M1 macrophages after iPSC CM treatment. To investigate the potential molecules secreted by iPSCs into iPSC CM, two major ingredients, named α1-antitrypsin and feutin-a, were identified by protein mass spectrometry and confirmed by western blotting with specific antibodies. Both components were mentioned to be involved in the anti-inflammatory effects observed in various lung diseases. Conclusions: In this study, iPSC CM represented therapeutic benefits on MCT-induced PAH rats though attenuating inflammation. Molecules exhibit anti-inflammatory potential existed in the iPSC CM, such as α1-antitrypsin and feutin-a, might hold the promise as new therapeutics of regenerative cell therapy via paracrine mechanism.

An aberrant right subclavian artery (arteria lusoria) arising from the descending thoracic aorta is an uncommon congenital variant that occurs in about 0.2-1.7% of the population. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, we present the first report of an iatrogenic dissection of arteria lusoria during transradial coronary angiography evaluated by multidetector computed tomography. Computed tomography is useful for assessing the severity and extension of the dissection to guide the clinical management of this complication.

Whole-body positron emission tomography/computed tomography with the glucose analog 2-[18F]fluoro-2-deoxy-d-glucose (FDG-PET/CT) has been extensively used to screen for underlying malignancies in asymptomatic individuals. We were able to survey a cohort of hospital employees using FDG-PET/CT and to report the results herein. A total of 116 hospital employees older than 55 years old were offered whole-body FDG-PET in our hospital. Ninety-seven employees (83.6%) completed the assessment from February 2014 to August 2014 in our PET center. The final confirmation of cancer was based on pathologic examination and follow-up after more than 1 year. Among the 97 participants, 92 were asymptomatic and 5 presented with previously diagnosed cancers. Six of the 92 asymptomatic participants (6.6%) with significant nodular lesions were referred for histological or cytological evaluation of the possibility of malignancy, and 1 case was considered clinically important and required surgical resection. The cancer discovery rate was 3.3% (3/92) with positive predictive value of 50% (3/6). In the 5 participants with previously identified cancers, no recurrence or metastasis was detected. The offer of whole-body FDG-PET for cancer screening was welcomed with enthusiasm by most of the hospital employees. PET/CT combines the merits of PET and CT and can be administered to and provide benefits to a select group of hospital employees.

To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.

A 72-year-old man was referred to our emergency department from another hospital because of a coronary complication that occurred during coronary angiographic examination for suspected chronic stable angina 1 day previously. Although angina progressed, there was no evidence of myocardial infarction by enzyme markers or ECG. To investigate the complicated coronary artery safely and precisely before rescue intervention, 16-slice computed tomography (CT) was acquired with 0.75-mm-thick slices and ECG gating after an intravenous injection …