The prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma (GC) has been widely reported and is still under debate. Here, we evaluated the prognostic significance of preoperative serum CA125, CA19-9 and CEA in patients with GC. 1692 patients with GC who underwent gastrectomy were divided into the training (from January 2005 to December 2011, n = 1024) and the validation (from January 2012 to December 2013, n = 668) cohorts. Positive groups of CA125 (> 13.72 U/ml), CA19-9 (> 23.36 U/ml) and CEA (> 4.28 ng/ml) were significantly associated with more advanced clinicopathological traits and worse outcomes than that of negative groups (all P < 0.01). In Cox regression analysis, tumor size (P < 0.001, P = 0.005), pTNM stage (P < 0.001, P < 0.001) and CA125 (P = 0.026, P = 0.005) were independent prognostic factors both in two cohorts. Nomograms of these two cohorts based on the number of positive serum tumor markers (NPTM) were more accurate in prognostic prediction than TNM stage alone. Our findings suggested that elevated preoperative serum CA125, CA19-9 and CEA were associated with more advanced clinicopathological traits and less favorable outcomes. In addition, CA125 as an independent prognostic factor should be further investigated. Nomogram based on NPTM could accurately predict the prognosis of GC patients.

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Background: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAC in the elderly versus the non-elderly. Methods: We screened PubMed, EMBASE, Cochrane Library, and Web of Science. Procedural endpoints of interest included successful implantation LAAC rates, in-hospital mortality, major bleeding events, pericardial effusion/tamponade, stroke, and vascular access complications related to LAAC. Long-term outcomes included all-cause mortality, major bleeding events, and stroke/transient ischemic attack (TIA) during follow-up. Results: Finally, 12 studies were included in the analysis; these included a total of 25,094 people in the elderly group and 36,035 people in the non-elderly group. The successful implantation LAAC rates did not differ between the groups, while the elderly patients experienced more periprocedural mortality (OR 2.62; 95% CI 1.79–3.83, p < 0.01; I2 = 0%), pericardial effusion/tamponade (OR 1.39; 95% CI: 1.06–1.82, p < 0.01; I2 = 0%), major bleeding events (OR 1.32; 95% CI 1.17–1.48, p < 0.01; I2 = 0%), and vascular access complications (OR 1.34; 95% CI 1.16–1.55, p < 0.01; I2 = 0%) than the non-elderly patients. The long-term stroke/TIA rates did not differ between the elderly and the non-elderly at least one year after follow-up. Conclusions: Even though successful implantation LAAC rates are similar, elderly patients have a significantly higher incidence of periprocedural mortality, major bleeding events, vascular access complications, and pericardial effusion/tamponade after LAAC than non-elderly patients. The stroke/TIA rates did not differ between both groups after at least one-year follow-up.

ObjectiveIt has long been debated whether rhythm control vs. rate control strategies have differing effects on mortality and morbidity for atrial fibrillation (AF). Recently, several randomized controlled studies (RCTs) and observational trials described that an early rhythm management method was linked to a lower likelihood of negative clinical outcomes in individuals with AF. We wanted to see if an early rhythm management method may help patients with AF.MethodsWe performed a systematic search to retrieve studies assessing the outcomes of early rhythm control vs. rate control in AF by using PubMed, Web of Science, Cochrane Library, and Embase published between 01/01/2000 and 15/04/2022.ResultsFinally, two RCTs, one retrospective analysis of RCTs, and four observational studies were identified. Compared with rate control, early rhythm control has been linked to lower all-cause mortality. [risk ratio (RR), 0.76; 95% CI 0.69–0.83; P &lt; 0.00001; I2 = 77%]. The early rhythm control group was also associated with a lower risk of cardiovascular mortality (RR, 0.68; 95% CI 0.63–0.74; P &lt; 0.00001; I2 = 33), stroke (RR, 0.77; 95% CI 0.67–0.87; P &lt; 0.001; I2 = 64), and heart failure hospitalization (RR, 0.74; 95% CI 0.59–0.93; P = 0.0009; I2 = 93%). We found no significant difference in nights spent in hospital per year, acute coronary syndrome, major bleeding, and cardiac arrest/ventricular arrhythmia between the groups.ConclusionIn this meta-analysis, early rhythm therapy was linked to a lower risk of all-cause mortality, cardiovascular mortality, stroke, and heart failure hospitalization compared with the rate control group.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022333592.

Purpose: The flow velocity of the left atrial appendage (LAA), which is closely linked to thrombus or spontaneous echo contrast of the LAA, is one of the significant risk factors for stroke. Therefore, a non-invasive and effective method for determining LAA flow velocity that is as accurate as transesophageal echocardiography (TEE) would be of significant therapeutic value. The aim of this study was to construct nomograms for predicting lower LAA flow velocity by using non-invasive methods.Patients and methods: Data were obtained from 1910 non-valvular atrial fibrillation (NVAF) patients who underwent TEE. A nomogram was constructed by using univariate and multivariate logistic regression analysis. We calculated the area under the curve to determine how well the risk scores predicted outcomes. Furthermore, the nomogram's performance was evaluated using calibration.Results: In the training and validation groups, reduced LAA flow velocity was recorded in 344 (27.8%) and 302 (44.9%), respectively. Left atrial diameter, previous stroke or transient ischemic attack, left ventricular ejection fraction, hypertension, estimated glomerular filtration rate, and non-paroxysmal AF was found to be independent factors for decreased LAA flow velocity in multivariate analysis, and a nomogram was created by using these variables. In the training and validation groups, the nomogram had strong concordance scores of 0.760 and 0.791 in predicting decreased LAA flow velocity.Conclusion: In this study, a nomogram was constructed that incorporated five characteristics of AF patients. The nomogram may be of great value to predicting LAA flow velocity and provide a new direction for the evaluation of LAA flow velocity or function