Activity

6; 95% confidence interval, 0.4-0.7). Prior use of direct-acting oral anticoagulants and antiarrhythmics, and the presence of an implantable cardioverter-defibrillator were also predictors for CA treatment (P less then 0.05 for all). Conclusion In a real-world population, CA was infrequently used to treat AF among patients with HF, and the likelihood of CA was further reduced in women. Because patients with CA had few comorbidities, future studies need to be conducted to determine whether CA can be beneficial in subjects whose clinical characteristics are more representative of the AF-HF population.Background Transcatheter aortic valve implantation (TAVI) is an effective alternative to surgical valve replacement in high-risk patients with severe aortic stenosis. Although measures of frailty have been used to attempt to predict outcomes in this population, few studies have demonstrated changes in these measures. Methods We performed a prospective, observational study of 171 patients undergoing TAVI, of whom 44 had maximal follow-up of 1 month and 50 had maximal follow-up of 1 year. Quality of life was assessed using the Minnesota Living With Heart Failure Questionnaire, Katz Index of Independence in Activities of Daily Living questionnaire, and patient perception of overall well-being. Frailty was measured using the 10-m walk test and handgrip strength testing. Results In the overall cohort, participants demonstrated improvements in quality of life metrics, but deterioration in 10-m walk test and handgrip at 1 month. These trends continued at 1 year. However, patients in the lowest quintile of handgrip and 10-m walk test demonstrated a trend of improvements in these metrics during follow-up. Conclusions Despite improvements in quality of life after TAVI, no improvements in frailty were observed in patients at 1 year.Background & aims Nucleos(t)ide analogues (NUCs) effectively suppress serum HBV DNA. Previously, we have identified 21 patients with undetectable covalently closed circular DNA (cccDNA) upon long-term NUC therapy. This study investigated the effect of NUC withdrawal in patients with undetectable cccDNA. Methods Nineteen patients on long term NUCs (median 13.4 years) were recruited 13 were randomized to discontinue NUCs; 6 to continue taking NUCs. All had undetectable cccDNA at the time of last liver biopsy (median time 2.9 years prior to randomization). Serum HBV DNA, hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg), liver biochemistry, and serum HBV RNA were monitored. Results At the time of randomization, all patients had undetectable serum HBV DNA and HBV RNA. Twelve of the 13 patients had HBV DNA rebound to 100 IU/ml within 20 weeks of NUC discontinuation. The thirteenth patient had HBV DNA rebound at week 70. Three patients experienced biochemical flares after re-treatment win these patients and found that viral relapse could occur in patients with undetectable viral DNA. Further research is required to determine whether nucleos(t)ide analogue treatment can be discontinued in specific patients with chronic hepatitis B.Background Over 100 million children are parented by migrant workers in China. The aim of this study was to investigate how self-reported adolescent physical and mental health are associated with parental migration. Azacitidine datasheet Methods Based on cross-sectional data of 13996 students in 112 schools drawn from a nationally representative sample of middle school students in China, this study used self-reported measures for adolescent physical and mental health. Ordered logistic regression was used for the analysis of self-reported physical health, and linear regression was used for the analysis of self-reported mental health, both adjusting for socio-economic covariates and school fixed effects, to determine how adolescent health is associated with parental migration. Findings In urban areas, migrant adolescents were physically healthier (OR=1.19, 95% CI 1.03-1.36), and similarly mentally healthy (b=-0.07, 95% CI -0.37-0.23), compared to urban adolescents from intact families; in rural areas, left-behind adolescents were less physically (OR=0.84, 95% CI 0.76-0.94) and mentally (b=0.45, 95% CI 0.24-0.66) healthy than rural-intact adolescents, holding other variables constant. Left-behind adolescents had less close parent-adolescent relationships than rural-intact adolescents with both father (OR=0.63, 95% CI 0.56-0.71) and mother (OR=0.62, 95% CI 0.54-0.70). Interpretation Our study highlights a great need for health interventions aimed at left-behind adolescents in China and globally, and the important roles of parent-adolescent relationships in addressing the health needs of left-behind adolescents.Background End-of-life intensive care may be futile and can be a cause of distress to both patients and their families. This study aimed to understand the utilization of intensive care and its associated factors in patients with End-stage liver disease (ESLD) during terminal hospitalization. Methods Population-based retrospective cohort study using the National Health Institute Research Database of Taiwan. All adult patients with ESLD who died during their hospitalization in 2010-2013 were included. Findings Of the 14,247 patients with ESLD, the majority (60·8%) was comorbid with hepatocellular carcinoma (HCC). Patients with ESLD only were younger, more deprived, more alcohol-related, and less likely to receive palliative care prior to terminal hospitalization (6·0% vs 29·2% with HCC). Compared to patients with comorbid HCC, relatively more patients without HCC were admitted to ICU (59·6% vs 22·3%), receiving CPR (11·1% vs 4·3%) and mechanical ventilation (36·3% vs 12·5%) during terminal hospitalization. Etiology of alcoholic hepatitis, esophageal varices, septicemia, pneumonia and respiratory failure, and renal failure were associated with a higher probability of ICU admission (adjusted rate ratio (aRR) range 1·09-2·09). Prior palliative care was associated with lower probability of ICU admission (aRR range 0·24-0·38). Interpretation The intensive care utilization by patients with ESLD in their terminal hospitalization was substantial in Taiwan. Those who are not comorbid with HCC need more attention, especially in terms of their palliative care needs, choices regarding intensive care, and their healthcare utilization. Funding National Institute of Health Research Health Applied Research Collaboration (ARC) South London.