Nonvalvular atrial fibrillation (NVAF) is the most common type of arrhythmia and an independent risk factor for ischemic stroke.Warfarin effectively decreases the risk factors for ischemic stroke in patients with NVAF,but substantially increases the risk for severe bleeding.Currently,most clinical guidelines recommend using the CHADS2 score for stroke risk stratification in NVAF patients to guide antithrombotic treatment.Although its application is simple and convenient,the CHADS2 score has been debated because of many limitations; especially some common stroke risk factors were not included.By comparison,the CHA2 DS2-VASc scores have included more risk factors for stroke.It can better identify the truly low-risk patients.Among the AF patients with CHADS2 score of 0 to 1,CHA2DS2-VASc scores may provide the important information for stroke risk,and thus help the decision-making of the anticoagulant therapy.

ObjectiveIn order to provide reliable sufficient information for making a policy to develop Emergency Departments in Chinese Medical Hospitals, a countrywide investigation on current situations of such departments was carried out.Methods Firstly, questionnaires which could be responded by filling out on line and paper were made respectively. The Departments of Emergency in 300 Chinese Medical Hospitals widely distributed in 27 provinces of China (municipalities directly under the central government) with technique level 2 or above were observed in this study by Red Cap database or Email.Results All together 280 questionnaires were sent out, and 200 questionnaires were responded. The information from 200 emergency departments of Chinese medical hospitals in 24 provinces was collected, the recovery rate being 71.42%. The investigative results were as follows: ① All Chinese medical hospitals involved in this study were equipped with an independent emergency department. The average occupation of ground area, numbers of ward beds and ambulances in these emergency departments were 713.6 m2, 18.93 and 2.81 respectively, and 75.8% of the hospitals were of the first aid local network units.② There were 26 emergency departments having internal, surgical, women and children emergency clinics, 83 hospitals had internal and surgical emergency clinics only, and in 91 hospitals there was no any special clinic in emergency department. In addition, only did 81 hospitals have intensive care units (ICU).③ The number of clinicians was 11.86±9.28 on average, and 26 hospitals even had no emergency specialists. In 39 hospitals, there were no emergency clinicians with high rank title, most of these clinicians had bachelor or master's degree, and only did 30 hospitals have emergency clinicians with PhD degree.④ The annual average patient admitted in emergency departments of these hospitals was 2.36 thousand cases, including 1197.38 rescue ones. The clinicians who could accomplish abdominocentesis and thoracentesis independently were accounting for 90.7% and 89.0%, respectively, 8.2% hospitals could carry out percutaneous coronary intervention (PCI), and more than 70% hospitals already had the emergency green channel.⑤ About 93.5% hospitals had established a management system of medical quality control, and 89.0% hospitals had already had a medical quality control group.⑥ 65.5% hospitals had assessment index of Utilization rate of traditional Chinese Medicine, and 52.5%hospitals routinely conducted discussions on cases treated primarily by Chinese medicine (CM).Conclusions The development levels of emergency departments of all Chinese medical hospitals involved are very uneven, on which more attention should be paid. The enhanced investment is required to construct the emergency clinics and improve medical techniques in order to meet the growing need of the first aid in our society.

OBJECTIVETo determine the relationship between vitamin D receptor (VDR) gene polymorphism and osteoporosis in postmenopausal women.

METHODSThe polymerase chain reaction-restriction fragment length polymorphism was used to detect VDR genotype in 40 patients with osteoporosis and 21 healthy postmenopausal women.

RESULTSIn the patients with osteoporosis, the bb, Bb, and BB genotype accounted for 82.5%, 17.5% and 0, respectively; in healthy groups, they were 85.71%, 14.29% and 0, respectively (P>0.05).

CONCLUSIONSignificant association between VDR genotype and osteoporosis in Chinese women was observed in this study.

DNA ; genetics ; metabolism ; Deoxyribonucleases, Type II Site-Specific ; metabolism ; Female ; Gene Frequency ; Genotype ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal ; genetics ; Polymorphism, Genetic ; Receptors, Calcitriol ; genetics

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.

Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; therapy

BackgroundSchizophrenic patients have metabolic disorders， impaired language and information processing function. Inflammatory factors may play an important role in the occurrence and development of schizophrenia. ObjectiveTo explore the relationship of the inflammatory factor levels with metabolic levels， language fluency and information processing function in patients with schizophrenia， so as to provide references for clinical understanding of the neuropathological mechanisms of schizophrenia. MethodsA total of 96 patients with schizophrenia were included in the study group， who were hospitalized in the Fourth People's Hospital of Hefei from January 2021 to December 2022 as well as met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and Mini-International Neuropsychiatric Interview （MINI） 6.0 .Meanwhile， population who underwent physical examination at the same hospital were included in the control group （n=42）. A high-sensitivity multi factor electrochemiluminescence analyzer was used to detect the levels of inflammatory factors IL-4， IL-5， IL-7， IL-8， IL-10 and IL-13. A fully automated biochemical analyzer was used to detect the levels of metabolic indicators such as fasting blood glucose， triglycerides， high-density lipoprotein， apolipoprotein A， creatinine and urea nitrogen. Verbal fluency and information processing function of all participants were assessed by using Verbal Fluency Test （VFT） and Stroop Color Word Test （SCWT）. ResultsThere were statistically significant differences in the levels of IL-4， IL-5， IL-7， IL-8， IL-10， IL-13 and IL-15 between the study group and the control group （P<0.05）. There were statistically significant differences in BMI， waist circumference， fasting blood glucose， triglycerides， high-density lipoprotein， urea nitrogen， apolipoprotein A and creatinine levels between the two groups （P<0.05）. The differences in the correct number of household appliances， animals， fruits， vegetables， names starting with "water" and "self" in VFT between the two groups were statistically significant （P<0.05）. The differences in point reaction time， character reaction time and character color reaction time in SCWT between the two groups were statistically significant （P<0.05）. Correlation analysis showed that except for creatinine levels， the levels of IL-4 and IL-5 in patients with schizophrenia were correlated with other indicators （P<0.05）. IL-7 levels were correlated with creatinine levels， household appliances， animals， fruits， correct number of names starting with "water" in VFT， point reaction time and word reaction time in SCWT （P<0.05）. IL-8 levels were correlated with triglyceride levels， household appliances， animals， fruits， vegetables， correct number of names starting with "water" and "self" in VFT and word reaction time in SCWT （P<0.05）. Except for creatinine levels and the correct number of names starting with "self"， IL-10 levels were correlated with all other indicators （P<0.05）. Except for creatinine and urea nitrogen levels， IL-13 levels were correlated with other indicators （P<0.05）. ConclusionThe levels of inflammatory factors in patients with schizophrenia may be related to their metabolic levels， language fluency and information processing function. ［Funded by Anhui Province Key Research and Development Plan Project （number， 2022e07020002）］