Volume 4, Issue 1 - Special Issue Title: A special issue on cardiovascular disease (Guest Editor: Yaling Han)

Recent recommendations that limits to dietary cholesterol be dropped were probably heavily influenced by propaganda from the egg industry. After conviction for false advertising, the industry has spent hundreds of millions of dollars to convince the public, physicians, and policy makers that dietary cholesterol and egg yolk are harmless. However, there are good reasons for longstanding recommendations that dietary cholesterol be limited to <200 mg/ day in persons at risk of vascular disease. It is seldom understood that this essentially means all people in developed countries who expect to attain an advanced age. There is abundant evidence that dietary cholesterol increases cardiovascular risk. The misdirection of the egg industry focuses on fasting levels of LDL cholesterol, which are only raised by ~ 10% by consumption of egg yolks. However, the main effect of diet is on the post-prandial state: for ~ 4 hours after a high fat/high cholesterol meal, there is oxidative stress, endothelial dysfunction, and arterial inflammation. One large (65 g) egg yolk contains 237 mg of cholesterol, well above the recommended limit—nearly as much as a 12-ounce hamburger. Besides the very high cholesterol content of egg yolk, the phosphatidylcholine in egg yolk leads, via action of the intestinal microbiome, to production of trimethylamine n-oxide (TMAO), which causes atherosclerosis in animal models. Levels of TMAO in the top quartile after a test dose of two egg yolks were associated with a 2.5-fold increase in the 3-year risk of stroke, death, or myocardial infarction among patients referred for coronary angiography. Persons at risk of cardiovascular disease should limit their intake of cholesterol and egg yolk.

Objective To assess the anticoagulant therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in China and to offer the rationale for establishing reasonable strategies to improve the prognosis of NSTE-ACS. Methods A total of 1,502 patients with NSTE-ACS were recruited from 28 third-grade hospitals distributed in 14 provinces and cities in China from December 2009 to December 2011. The strategies for diagnosis and treatment, decided by each hospital respectively, were used for further analysis and comparison of medication, percutaneous coronary intervention (PCI), and end points for efficacy and safety assessment at 9 and 30 days following PCI. Results A lower incidence rate ( P < 0.05) was noted for efficacy and safety in patients with unstable angina (UA) than those with non-ST-segment elevation myocardial infarction (NSTE-MI). The prescription rate of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, PCI, and single medication was 0.61%, 66.42%, 30.61%, 69.64%, and 70.74%, respectively. Conclusion Compared with NSTE-MI, UA is featured with better prognosis, less severity, and different outcome. However, in clinical practice, the therapies for NSTE-MI and UA show no differences, which deserves great attention. In China, the most common anticoagulant therapies for NSTE-ACS are single medication, mainly based on LMWH and PCI.

Background and Objectives Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. Methods From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. Results The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. Conclusion Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.

The world is facing a number of emerging infections. The latest outbreak of Zika virus infection has only added to the suffering. The WHO declared a state of emergency in the affected countries and has issued alarms worldwide. The paucity of literature leading to lack of clear guidelines is one of the most important factors resulting in a higher number of cases. The absence of clinical vaccine and an antiviral drug may prove to be a really grave situation. The present paper throws some light on this new emerging virus that has been known to man since 1947.

Chemotherapy-induced nausea and vomiting (CINV) remains one of the most disturbing side effects of cancer treatment. Research in antiemetic therapy has progressed gradually since the early eighties, and the development of antiemetic agents continues. This review focuses on the current management of CINV based on the most recent guidelines, and adherence to the latter is examined more carefully. Setrons (5HT3 receptor antagonists), corticosteroids, and NK-1 receptor antagonists are the cornerstones of antiemetic therapy. Corticosteroids are one of the oldest agents in the prevention of CINV. They are highly effective, increase the effect of other antiemetic agents, and are cost-effective. The latest developed 5HT3 receptor antagonist palonosetron led to an update of the guidelines of CINV. Other types include benzodiazepines, cannabinoids, and olanzapine. Various factors contribute to the overall risk of developing CINV, such as patient characteristics, emetogenic potency of the chemotherapeutic agents, and correct prevention of CINV. Current guidelines determine which is the right preventive regimen for each cancer patient at risk for experiencing CINV. Adherence to these guidelines and implementation in daily practice seem to be below the optimal level. In Belgium, authorities use the guidelines as a base for reimbursement and this has increased the level of implementation.

Steroids are widely used in oncology and have been demonstrated to possess an anticancer effect or antiswelling effect. They are considered to improve refractory symptoms such as dyspnea or gastrointestinal (GI) obstruction. However, their roles in nonspecific indications are not well proved. Clinical practice and several studies suggest that corticosteroids may be effective in the treatment of bone and neuropathic pain, when administered along with opioids and with other adjuvant analgesics. The decrease in pain intensity is probably connected with both anti-inflammatory and antiswelling effects as well as modulation of neuroimmune interactions and an inhibition of angiogenesis.