Aims: We aimed to assess the association between serum 25-hydroxyvitamin D (25(OH)D) levels with all-cause and cardiovascular mortality in patients with nonalcoholic fatty liver disease (NAFLD). Methods: We performed a retrospective cohort study based on the US National Health and Nutrition Examination Survey 2001–2016 on adults aged ≥20 years. NAFLD was determined as a US Fatty Liver Index score ≥ 30 in the absence of other liver conditions. Weighted Cox proportional hazards regression models were applied to explore the relationship between serum 25(OH)D levels and mortality. Results: 898 all-cause deaths and 305 cardiovascular deaths were recorded over a median follow-up of 8.7 years. Compared with those in the severe deficiency group (below 25.0 nmol/L), the fully adjusted HRs and 95% CIs of NAFLD patients with sufficient serum 25(OH)D concentrations (≥75.0 nmol/L) were 0.36 (0.22, 0.60) for all-cause mortality and 0.14 (0.07, 0.29) for cardiovascular mortality. Each one-unit increase in the natural log-transformed serum 25(OH)D concentration was related to a 41% lower risk for all-cause deaths (HR = 0.59, 95% CI: 0.46, 0.77) and a 65% lower risk for cardiovascular deaths (HR = 0.35, 95% CI: 0.22, 0.58). Conclusions: Among NAFLD patients, increased serum 25(OH)D levels were independently associated with reduced risk for all-cause and cardiovascular deaths.

Background: Since the foundation of appropriate use criteria (AUC) for coronary revascularization, the proportion of inappropriate (later revised as “rarely inappropriate”) percutaneous coronary interventions (PCIs) varied in different populations. However, the pooled inappropriate PCI rate remains unknown. Methods: We searched the PubMed, Cochrane, Embase, and Sinomed databases for studies related to AUC and PCIs. Studies that reported inappropriate/rarely appropriate PCI rates were included. A random effects model was employed in the meta-analysis because of the high statistical heterogeneity. Results: Thirty-seven studies were included in our study, of which eight studies reported the appropriateness of acute PCIs or PCIs in acute coronary syndrome (ACS) patients, 25 studies reported the appropriateness of non-acute/elective PCIs or PCIs in non-ACS/stable ischemic heart disease (SIHD) patients, and 15 studies reported both acute and non-acute PCIs or did not distinguish the urgency of PCI. The pooled inappropriate PCI rate was 4.3% (95% CI: 2.6–6.4%) in acute scenarios, 8.9% (95% CI: 6.7–11.0%) in non-acute scenarios, and 6.1% (95% CI: 4.9–7.3%) overall. The inappropriate/rarely appropriate PCI rate was significantly higher in non-acute than acute scenarios. No difference in the inappropriate PCI rate was detected based on the study location, the country’s level of development, or the presence of chronic total occlusion (CTO). Conclusions: The worldwide inappropriate PCI rate is generally identical but comparatively high, especially under non-acute scenarios.

(1) Background: Acute myocardial infarction (AMI) imposes a great burden on global health. Few studies have demonstrated the effects of valley concentration of air pollutants on AMI hospital admissions. (2) Methods: Hospitalizations for AMI from 1 May 2014 to 31 December 2019 were analyzed. Generalized additive models (GAM) were used to quantify the exposure–response association between the hourly peak, mean, and valley concentration of six air pollutants and AMI hospital admissions. Stratification analyses were conducted to identify the susceptible population. (3) Results: Hourly peak, mean, and valley concentrations of PM_2.5, PM₁₀, SO₂, NO₂, and CO were significantly associated with AMI hospital admissions. Each 10-unit increase in the hourly valley concentration of them led to 0.50% (0.35–0.66%), 0.44 % (0.32–0.56%), 0.84% (0.47–1.22%), 1.86% (0.73–3.01%), and 44.6% (28.99–62.10%) excess risk in AMI hospital admissions, respectively. In addition, the effects of hourly valley concentration were larger than mean and peak concentrations. The effects in the female or older than 65 groups were larger than that in the male or younger than 65 groups. (4) Conclusions: PM_2.5, PM₁₀, SO₂, NO₂, and CO exposure contributed to increased AMI hospital admissions. Hourly valley concentration might be a more potent indicator of adverse cardiovascular events. Females and individuals older than 65 were more susceptible to ambient air pollutant exposure.

(1) Background: Whether anticoagulation can be resumed in atrial fibrillation (AF) combined with intracranial hemorrhage (ICH), and which anticoagulation modality is used with better efficacy and safety, is unknown. (2) Method: Randomized controlled trials (RCTs) and observational studies on relevant topics were included by searching five databases: PubMed, EMBASE, EBSCO, Cochrane Central Register of Controlled Trial and ClinicalTrials. Bayesian network meta-analysis was performed to analyze the effect of oral anticoagulant (OAC), new oral anticoagulant (NOAC), warfarin, antiplatelet, left atrial appendage occlusion (LAAO) and no therapy in patients with AF after intracranial hemorrhage. (3) Results: We included 16 studies involving 25,483 patients. Compared with no antithrombotic therapy, the risk of thromboembolism and all-cause mortality were both reduced with OAC (OR: 0.38, 95% CI: 0.21–0.67; OR: 0.45, 95% CI: 0.25–0.8) and LAAO (OR: 0.11, 95% CI: 0.01–0.76; OR: 0.11, 95% CI: 0.01–0.88), and there was no increased risk of recurrent intracranial hemorrhage. Regarding thromboembolism, OAC (OR: 0.28, 95% CI: 0.11–0.69) was superior to antiplatelet therapy, and antiplatelet therapy (OR: 12.59, 95% CI: 1.57–133.50) was associated with a higher risk of thromboembolism than LAAO. There were no significant differences in recurrent intracranial hemorrhage between the interventions. LAAO appeared to be the best option for reducing thromboembolism (SUCRA: 0.96), recurrent intracranial hemorrhage (SUCRA: 0.75) and all-cause mortality (SUCRA: 0.94). (4) Conclusions: Based on this network meta-analysis, we hypothesize that LAAO has the highest likelihood of reducing the risk of thromboembolism and recurrent intracranial hemorrhage, as well as all-cause mortality in patients with AF after intracranial hemorrhage, followed by OAC.

Background: Ethanol infusion into the vein of Marshall (EI-VOM) is widely used to facilitate atrial fibrillation ablation and block of the mitral isthmus. However, it cannot be completed in some anatomically challenging cases. This study aimed to introduce and evaluate a novel reversed U curve method of EI-VOM. Methods: This case-series study enrolled consecutive patients with atrial fibrillation or atrial flutter who were scheduled for EI-VOM. When VOM venography was successfully performed, the conventional EI-VOM method was attempted first. If this approach failed or took ≥20 min, the novel method was applied. The success rate, complications, and applicable anatomical conditions of the new method were summarized. Results: Of the 205 patients enrolled in this study, the novel method was applied to 45 patients, and technical success was achieved in 42 patients (93.3%). Among the patients who underwent the novel method, twenty-four (53.3%) had a long cavotricuspid isthmus, nineteen (42.2%) had a VOM ostium close to the coronary sinus ostium, and sixteen (35.6%) had a prominent Eustachian ridge. The total mean procedure time of EI-VOM using the novel method was 30.00 ± 4.5 min. Acute bidirectional mitral isthmus block was achieved in 40 cases (88.9%), and the mean ethanol volume injected was 8.21 ± 1.5 mL. No serious in-hospital complications were documented in patients treated with the novel method. Conclusions: In this single-center case series, the reversed U curve method appeared feasible as a femoral bailout strategy for EI-VOM in selected anatomically challenging cases. Further prospective, multicenter studies involving multiple operators are required to confirm its reproducibility, efficacy, and safety over conventional approaches.