The primary efficacy outcome occurred in 4 patients (3.7%) taking warfarin and none taking edoxaban (risk difference, -0.0367; 95% confidence interval, -0.0720 to -0.0014; P<.001 for noninferiority). The primary safety outcome occurred in 1 patient (0.9%) taking warfarin and 3 patients (2.8%) taking edoxaban (risk difference, 0.0183; 95% confidence interval, -0.0172 to 0.0539; P=.013 for noninferiority).

Edoxaban is noninferior to warfarin for preventing thromboembolism and is potentially comparable for risk of major bleeding during the first 3months after surgical bioprosthetic valve implantation or valve repair.

Edoxaban is noninferior to warfarin for preventing thromboembolism and is potentially comparable for risk of major bleeding during the first 3 months after surgical bioprosthetic valve implantation or valve repair.This study was aimed at investigating the time course changes in left ventricular myocardial deformation using layer-specific strain echocardiography, which might provide insights into the cardiac pathophysiology of diabetes mellitus. A total of 36 New Zealand white rabbits were randomly divided into control (n = 18) and diabetes mellitus (DM, n = 18) groups. DM was induced in the DM group by intravenous injection of alloxan (ALX). Echocardiography was performed at 3, 6 and 9 mo to evaluate myocardial deformation. Layer-specific longitudinal and circumferential strains were assessed from the endocardium, mid-myocardium and epicardium by 2-D speckle-tracking echocardiography (STE). Three-layer longitudinal strain (LS) was calculated in the apical three-chamber view, and three-layer circumferential strain (CS) was observed in the short-axis view at the level of the papillary muscle. All rabbits were euthanized after echocardiography, and Masson staining was performed. Compared with the control group, LS and CS decreased gradually from the endocardium to the mid-myocardium to the epicardium. At 3 mo, no significant difference was observed between three-layer LS and three-layer CS (p > 0.05). At 6 mo, the LS of the endocardium (LSendo) and CS of the endocardium (CSendo) were lower in the DM group than in the control group (p > 0.05), whereas at 9 mo, all parameters, except LSendo and CSendo, had significantly decreased (p less then 0.05). In the absence of treatment, the pathologic alterations deteriorated, beginning at 6 mo in the DM group. Layer-specific strain echocardiography may identify subtle cardiac dysfunction in the early phase of DM. Endocardial function is more susceptible to being affected by DM compared with mid-myocardial and epicardial function.

To compare and contrast clinical diagnoses with autopsy findings in order to identify unexpected, relevant discrepancies.

A retrospective observational study of the revision of autopsies of adults and their respective medical records in order to classify them according to referral department and Goldman’s classification was carried out at the Central University Hospital of Asturias between 2008-2017.

694 (52.6%) of 1320 autopsies were included in the study. Discrepancies were observed in 57.6% of cases, although the majority (39.3%) were minor. Type I discrepancies were identified in 63 autopsies (9.1%); malignant neoplasms being the main pathology observed (57.1%), mainly of gastrointestinal origin (about 28%). The second most common discrepancy was found in cases of infectious diseases (23.8%) followed by pulmonary embolism (15.9%). 64 autopsies were classified as type II discrepancies (9.2%), with myocardial infarct the most common (37.5%), especially acute myocardial infarction (18 cases), followed by bronchoaspirations (18.7%), DIC (15.6%), massive haemorrhages (9.4%) and other conditions. It was considered that both the ICU and the Internal Medicine Service were responsible for the largest number of major discrepancies (type I and II), accounting for about 45% of type I and slightly more than 56% for type II.

Autopsies are an essential means of identifying ante-mortem clinical errors. The incidence of major discrepancies in the Central University Hospital of Asturias (18.3%) is comparable to that of leading hospitals worldwide.

Autopsies are an essential means of identifying ante-mortem clinical errors. The incidence of major discrepancies in the Central University Hospital of Asturias (18.3%) is comparable to that of leading hospitals worldwide.

Pulmonary carcinoids are relatively rare neuroendocrine neoplasms, accounting for only 1-2% of malignant thoracic tumours. We describe our experience in the management and follow-up of such an infrequent tumour, with special emphasis on possible problems that might arise.

We present a descriptive retrospective study of all patients diagnosed with carcinoid tumour between January 2013 and January 2018. Demographic, histological and clinical data were collected and analyzed. Survival was recorded. SPSS version 21 was used for the statistical analysis.

42 patients with an average age of 66.26 years were included. The mean period of follow-up was 60 months and the average survival 59.12 months. The only statistically significant factor related to an improved survival time was tumour stage at diagnosis.

Carcinoid tumours are infrequent, which makes the objective collecting of data difficult. For this reason, we hope that the present study will contribute to a better understanding of their evolution.

Carcinoid tumours are infrequent, which makes the objective collecting of data difficult. AZD6094 in vivo For this reason, we hope that the present study will contribute to a better understanding of their evolution.

Retroperitoneal lipomas are extremely rare tumors that must be differentiated from well-differentiated liposarcomas (WD-LPS).

To summarize the evidence about giant retroperitoneal lipomas or liposarcomas; and to elaborate recommendations for their management.

A systematic literature search from January 1985 to December 2019 and a review of our own cases was performed.

Our series comprises four patients, two females and two males. The diagnosis was incidental in two cases. The medium size was 26cm, being two cases located exclusively in the retroperitoneum, one in the inguinal region and one in the buttock via pelvic space. All cases were surgically removed being confirmed the initial diagnosis of retroperitoneal lipomas in two cases, as the rest two cases were classified as WD_LPS after MDM2/CDK4 genetic analysis. The review of the available literature plus our own cases revealed 30 cases, of which 58% were woman. Only two cases were asymptomatic. The main symptom was abdominal mass (53%) followed by abdominal pain (40,6%).