Excess risk of major vascular diseases associated with airflow obstruction: a 9-year prospective study of 0.5 million Chinese adults

Background: China has high COPD rates, even among never regular smokers. Little is known about non-respiratory disease risks especially vascular morbidity and mortality after developing air flow obstruction (AFO) in China adults. Objective: We aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality. Methods: In 2004-8 a nationwide prospective cohort study recruited 512,891 men and women aged 30-79 from ten diverse localities across China, tracking cause-specific mortality and coded episodes of hospitalisation for 9 years. Cox regression yielded adjusted hazards ratios (HRs) for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without. Results: Of 489,382 participants with no vascular disease at baseline, 6.8% had AFO, with the prevalence rising steeply with age. Individuals with prevalent AFO had significantly increased in vascular mortality (n=1,429; adjusted HR=1.29, 95% CI 1.21-1.36). There were also increased risks of haemorrhagic stroke (n=823; 1.18, 1.09-1.27), major coronary events (n=635; 1.33, 1.22-1.45) and heart failure (n=543; 2.19, 1.98-2.41).andnbsp; For each outcome, the risk increased progressively with increasing COPD severity and persisted among never regular smokers. Conclusions: Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and trea</p

Radiofrequency ablation versus repeat hepatectomy in the treatment of recurrent hepatocellular carcinoma in subcapsular location: a retrospective cohort study

Abstract Background Repeat hepatectomy and radiofrequency ablation (RFA) are widely used to treat early recurrent hepatocellular carcinoma (RHCC) located in the subcapsular region, but the optimal treatment strategy remains to be controversial. Methods A total of 126 RHCC patients in the subcapsular location after initial radical hepatectomy were included in this study between Dec 2014 and Jan 2018. These patients were divided into the RFA group (46 cases) and the repeat hepatectomy group (80 cases). The primary endpoints include repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. The propensity-score matching (PSM) was conducted to minimize the bias. Complications were evaluated using the Clavien-Dindo classification, and severe complications were defined as classification of complications of ≥grade 3. Results There were no significant differences in the incidence of severe complications were observed between RFA group and repeat hepatectomy group in rRFS and OS both before (1-, 2-, and 3-year rRFS rates were 65.2%, 47.5%, and 33.3% vs 72.5%, 51.2%, and 39.2%, respectively, P = 0.48; 1-, 2-, and 3-year OS rates were 93.5%, 80.2%, and 67.9% vs 93.7%, 75.8%, and 64.2%, respectively, P = 0.92) and after PSM (1-, 2-, and 3-year rRFS rates were 68.6%, 51.0%, and 34.0% vs 71.4%, 42.9%, and 32.3%, respectively, P = 0.78; 1-, 2-, and 3-year OS rates were 94.3%, 82.9%, and 71.4% vs 88.6%, 73.8%, and 59.0%, respectively, P = 0.36). Moreover, no significant differences in the incidence of severe complications were observed between the RFA group and repeat hepatectomy group. Conclusion Both repeat hepatectomy and RFA are shown to be effective and safe for the treatment of RHCC located in the subcapsular region. </jats:sec