Objective:To investigate the factors affecting the recurrence of atrial fibrillation(AF)after atrial fibril-lation cryoablation and the diagnostic value of miRNA-320a for it.Methods:A total of 210 AF patients who un-derwent atrial fibrillation cryoablation in Zhenjiang First People's Hospital between September 2017 and December 2023 were enrolled.According to the recurrence at 6 months after surgery,the patients were divided into no recur-rence group and recurrence group.Multivariate Logistic regression analysis was conducted to analyze the risk factors of recurrence in AF patients after atrial fibrillation cryoablation and nomogram model was established.Receiver op-erating characteristic(ROC)curve was plotted to analyze the diagnostic value of miRNA-320a for the recurrence of AF patients after atrial fibrillation cryoablation.Results:Within 6 months after surgery,98 cases(46.7％)re-curred,and 112 cases did not recur,and 4 recurrent cases were lost,and 6 non-recurrent cases were lost during fol-low-up.Compared with patients in the no recurrence group,those in recurrence group had significant higher pro-portion of persistent AF(59.6％vs.32.1％),left atrial diameter(LAD)[(44.30±5.05)mm vs.(36.40±4.07)mm],uric acid(UA)level[(346.17±46.98)μmol/L vs.(306.46±41.79)μmol/L],miRNA-320a expression[(1.16±0.07)vs.(0.79±0.06)],and significant lower left ventricular ejection fraction(LVEF)[(58.21±3.64)％vs.(62.54±5.71)％](P＜0.001 all).Multivariate Logistic regression analysis showed that persistent AF,LAD,UA and miRNA-320a were independent risk factors for AF recurrence after atrial fibrillation cryoabla-tion(OR=2.301～3.645,P＜0.01 all),while LVEF was its independent protective factor(OR=0.301,P＜0.001).The nomogram model of AF recurrence was 4.656+0.427 × persistent AF+0.516 × LAD+0.551 × LVEF+0.547 × UA+0.413 × miRNA-320a.ROC curve analysis showed that miRNA-320a had a good diagnostic value for AF recurrence after atrial fibrillation cryoablation,and the AUC was 0.892(95％CI 0.814～0.945).In decision curve analysis(DCA),the threshold probability of miRNA-320a on the recurrence detection model of AF patients after atrial fibrillation cryoablation was over 75％,and the P value of goodness of fit test of calibration curve was 0.078.Conclusion:Persistent AF,LAD,LVEF,UA and miRNA-320a are factors affecting AF recurrence in AF patients after atrial fibrillation cryoablation.On this basis,a nomogram model could be established to evaluate the risk of AF recurrence,and miRNA-320a has good diagnostic value for it.

Objective:To investigate the factors affecting the recurrence of atrial fibrillation(AF)after atrial fibril-lation cryoablation and the diagnostic value of miRNA-320a for it.Methods:A total of 210 AF patients who un-derwent atrial fibrillation cryoablation in Zhenjiang First People's Hospital between September 2017 and December 2023 were enrolled.According to the recurrence at 6 months after surgery,the patients were divided into no recur-rence group and recurrence group.Multivariate Logistic regression analysis was conducted to analyze the risk factors of recurrence in AF patients after atrial fibrillation cryoablation and nomogram model was established.Receiver op-erating characteristic(ROC)curve was plotted to analyze the diagnostic value of miRNA-320a for the recurrence of AF patients after atrial fibrillation cryoablation.Results:Within 6 months after surgery,98 cases(46.7％)re-curred,and 112 cases did not recur,and 4 recurrent cases were lost,and 6 non-recurrent cases were lost during fol-low-up.Compared with patients in the no recurrence group,those in recurrence group had significant higher pro-portion of persistent AF(59.6％vs.32.1％),left atrial diameter(LAD)[(44.30±5.05)mm vs.(36.40±4.07)mm],uric acid(UA)level[(346.17±46.98)μmol/L vs.(306.46±41.79)μmol/L],miRNA-320a expression[(1.16±0.07)vs.(0.79±0.06)],and significant lower left ventricular ejection fraction(LVEF)[(58.21±3.64)％vs.(62.54±5.71)％](P＜0.001 all).Multivariate Logistic regression analysis showed that persistent AF,LAD,UA and miRNA-320a were independent risk factors for AF recurrence after atrial fibrillation cryoabla-tion(OR=2.301～3.645,P＜0.01 all),while LVEF was its independent protective factor(OR=0.301,P＜0.001).The nomogram model of AF recurrence was 4.656+0.427 × persistent AF+0.516 × LAD+0.551 × LVEF+0.547 × UA+0.413 × miRNA-320a.ROC curve analysis showed that miRNA-320a had a good diagnostic value for AF recurrence after atrial fibrillation cryoablation,and the AUC was 0.892(95％CI 0.814～0.945).In decision curve analysis(DCA),the threshold probability of miRNA-320a on the recurrence detection model of AF patients after atrial fibrillation cryoablation was over 75％,and the P value of goodness of fit test of calibration curve was 0.078.Conclusion:Persistent AF,LAD,LVEF,UA and miRNA-320a are factors affecting AF recurrence in AF patients after atrial fibrillation cryoablation.On this basis,a nomogram model could be established to evaluate the risk of AF recurrence,and miRNA-320a has good diagnostic value for it.

OBJECTIVE: To investigate the effectiveness of Xuanshen Yishen Decoction (XYD) in the treatment of hypertension. METHODS: Hospital electronic medical records from 2019-2023 were utilized to emulate a randomized pragmatic clinical trial. Hypertensive participants were eligible if they were aged ⩾40 years with baseline systolic blood pressure (BP) ⩾140 mm Hg. Patients treated with XYD plus antihypertensive regimen were assigned to the treatment group, whereas those who followed only antihypertensive regimen were assigned to the control group. The primary outcome assessed was the attainment rate of intensive BP control at discharge, with the secondary outcome focusing on the 6-month all-cause readmission rate. RESULTS: The study included 3,302 patients, comprising 2,943 individuals in the control group and 359 in the treatment group. Compared with the control group, a higher proportion in the treatment group achieved the target BP for intensive BP control [8.09% vs. 17.5%; odds ratio (OR)=2.29, 95% confidence interval (CI)=1.68 to 3.13; P<0.001], particularly in individuals with high homocysteine levels (OR=3.13; 95% CI=1.72 to 5.71; P<0.001; P for interaction=0.041). Furthermore, the 6-month all-cause readmission rate in the treatment group was lower than in the control group (hazard ratio=0.58; 95% CI=0.36 to 0.91; P=0.019), and the robustness of the results was confirmed by sensitivity analyse. CONCLUSIONS XYD could be a complementary therapy for intensive BP control. Our study offers real-world evidence and guides the choice of complementary and alternative therapies. (Registration No. ChiCTR2400086589).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Antihypertensive Agents/pharmacology* ; Blood Pressure/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Hypertension/physiopathology* ; Patient Readmission ; Treatment Outcome

Coronary artery calcification often appears a variety of complex lesions,increasing coronary intervention of the difficulty of treatment,especially the severe calcification lesions,usually cannot be fully dilated,resulting in a reduced success rate of surgery,an increased rate of acute stent thrombosis and restenosis,and even a serious impact on the prognosis of patients.Intravascular lithotripsy(IVL)is increasingly used in calcified lesions.There is more and more evidence of using in stable angina pectoris and unstable angina pectoris,but its use in acute ST-segment elevation myocardial infarction is limited,and only a few cases have been reported abroad.Moreover,the consensus of Chinese experts in the diagnosis and treatment of coronary artery calcification in 2021 edition lists thrombotic lesions as contraindications of shock wave balloon.This case is the first time in China to report the use of shock wave balloon in patients with acute ST elevation myocardial infarction complicated with thrombus.In this case,the patient with acute ST elevation myocardial infarction complicated with thrombus was severely under expanded stent after stent implantation,and obtain good curative effect using shockwave balloon at selected time in hospital after intensive anticoagulant therapy.

Coronary artery calcification often appears a variety of complex lesions,increasing coronary intervention of the difficulty of treatment,especially the severe calcification lesions,usually cannot be fully dilated,resulting in a reduced success rate of surgery,an increased rate of acute stent thrombosis and restenosis,and even a serious impact on the prognosis of patients.Intravascular lithotripsy(IVL)is increasingly used in calcified lesions.There is more and more evidence of using in stable angina pectoris and unstable angina pectoris,but its use in acute ST-segment elevation myocardial infarction is limited,and only a few cases have been reported abroad.Moreover,the consensus of Chinese experts in the diagnosis and treatment of coronary artery calcification in 2021 edition lists thrombotic lesions as contraindications of shock wave balloon.This case is the first time in China to report the use of shock wave balloon in patients with acute ST elevation myocardial infarction complicated with thrombus.In this case,the patient with acute ST elevation myocardial infarction complicated with thrombus was severely under expanded stent after stent implantation,and obtain good curative effect using shockwave balloon at selected time in hospital after intensive anticoagulant therapy.

Objectives:To investigate the outcomes of cochlear implantation in Mandarin-speaking cochlear implant (CI) users with single-sided deafness (SSD).Methods:This study was a single-center prospective cohort study. Eleven Mandarin-speaking adult SSD patients who underwent CI implantation at Capital Medical University Beijing Tongren Hospital from August 2020 to October 2021 were recruited, including 6 males and 5 females, with the age ranging from 24 to 50 years old. In a sound field with 7 loudspeakers distributed at 180°, we measured root-mean-square error(RMSE)in SSD patients at the preoperative, 1-month, 3-month, 6-month, and 12-month after switch-on to assess the improvement of sound source localization. The Mandarin Speech Perception (MSP) was used in the sound field to test the speech reception threshold (SRT) of SSD patients under different signal-to-noise locations in a steady-state noise under conditions of CI off and CI on, to reflect the head shadow effect(S SSDN NH), binaural summation effect(S 0N 0) and squelch effect(S 0N SSD). The Tinnitus Handicap Inventory (THI) and the Visual Analogue Scale (VAS) were used to assess changes in tinnitus severity and tinnitus loudness in SSD patients at each time point. The Speech, Spatial and Qualities of Hearing Scale(SSQ) and the Nijmegen Cochlear Implantation Scale (NCIQ) were used to assess the subjective benefits of spatial speech perception and quality of life in SSD patients after cochlear implantation. SPSS 19.0 software was used for statistical analysis. Results:SSD patients showed a significant improvement in the poorer ear in hearing thresholds with CI-on compared with CI-off; The ability to localize the sound source was significantly improved, with statistically significant differences in RMSE at each follow-up time compared with the preoperative period ( P<0.05). In the S SSDN NH condition, which reflects the head shadow effect, the SRT in binaural hearing was significantly improved by 6.5 dB compared with unaided condition, and the difference was statistically significant ( t=6.25, P=0.001). However, there was no significant improvement in SRT between the binaural hearing condition and unaided conditions in the S 0N 0 and S 0N SSD conditions ( P>0.05). The total score of THI and three dimensions were significant decreased ( P<0.05). Tinnitus VAS scores were significantly lower in binaural hearing compared to the unaided condition ( P<0.001). The total score of SSQ, and the scores of speech and spatial dimensions were significant improved in binaural hearing compared to the unaided condition ( P<0.001). There was no statistical difference in NCIQ questionnaire scores between preoperative and postoperative ( P>0.05), and only the self-efficacy subscore showed a significant increase( Z=-2.497, P=0.013). Conclusion:CI could help Mandarin-speaking SSD patients restore binaural hearing to some extent, improve sound localization and speech recognition in noise. In addition, CI in SSD patients could suppress tinnitus, reduce the loudness of tinnitus, and improve subjective perceptions of spatial hearing and quality of life.

Thrombolytic therapy plays a vital role in reperfusion strategy for ST-segment elevation myocardial infarction(STEMI)patients.Previous Chinese expert consensus focused on pre-hospital thrombolysis therapy in STEMI patients was published in 2018 which tremendously promoted pre-hospital thrombolysis therapy.In recent years,plenty of research progress and results of clinical trials have been released in following areas such as STEMI reperfusion strategy,anti-platelet/anti-coagulants therapy,contemporary facilitated percutaneous coronary intervention,and so on.Meanwhile,the COVID-19 pandemic makes timely reperfusion for STEMI patients even more challenging.Therefore,this consensus has been proposed aiming to summarize recent progress in STEMI thrombolysis therapy and to provide practical & evidence-based instructions conforming to national conditions.We hope this consensus will contribute to the emergency management and long-term prognosis of STEMI patients.

Objective To analyze the independent influencing factors of intimate partner homicide(IPH)cases,construct an IPH prediction model,and provide a basis for criminal profiling.Methods A total of 476 convicted homicide cases in Guangdong Province from January 1,2014,to December 31,2020,were collected as modeling dataset.They were divided into the IPH group(n=180)and the non-intimate partner homicide(N-IPH)group(n=296)based on whether the offender and victim were intimate partners.Logistic regression was used to build the model,the model was evaluated through the receiver operating characteristic(ROC)curve analysis and a nomogram was drawn.Inter-nal validation was conducted using ten-fold cross-validation method.A total of 126 court judgments from outside Guangdong Province from January 1,2011,to December 31,2020,were randomly col-lected for external validation.Results Through multi-factor Logistic regression analysis,7 variables were ultimately selected for inclusion in the model.The Hosmer-Lemeshow goodness of fit test result of the model was χ2=13.158,P=0.068.The ROC area under the curve(AUC)of the model was 0.939(95%CI:0.919-0.959),the cut-off value was 0.292,the sensitivity was 0.900,and the specificity was 0.865.The calibration curve was close to the ideal curve.The ten-fold cross-validation showed the accuracy of 0.863 and a Kappa value of 0.708.The external validation results showed an AUC of 0.922(95%CI:0.872-0.971),a cut-off value of 0.292,a sensitivity of 0.890,and a specificity of 0.886.The calibration curve tended to the ideal curve.Conclusion The IPH prediction model based on forensic field indicators has good predictive ability,reliable accuracy and stability,and can provide a scientific method for criminal profiling.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To investigate the efficacy of the novel bone cement bridging screw system combined with percutaneous vertebroplasty (PVP) in the treatment of symptomatic chronic osteoporotic vertebral fractures (SCOVF) with intravertebral vacuum cleft (IVC).Methods:A retrospective case series study was used to analyze the clinical data of 27 patients with SCOVF admitted to Honghui Hospital affiliated to Xi′an Jiaotong University from August 2016 to August 2018, including 6 males and 21 females; age 69-88 years [(75.2±4.9)years]. All patients were treated by the novel bone cement bridging screw combined with PVP. The operation time, amount of bone cement injected and occurrence of bone cement leakage or displacement were recorded. The vertebral body index (VBI), vertebral body angle (VBA), two-segment Cobb angle (BCA), visual analogue score (VAS) and Oswestry disability index (ODI) were compared preoperatively, at day 1 after operation and at the last follow-up. The results of the MOS 36-item short form health survey (SF-36) and Odom′s criteria were compared preoperatively and at the last follow-up to evaluate pain relief and neurological recovery.Results:All patients were followed up for 36-48 months [(40.2±3.7)months]. The operation time was 37-70 minutes [(49.6±10.8)minutes], with the amount of bone cement injected for 3-6 ml [(34.7±0.9)ml]. Intraoperative bone cement leakage occurred in 4 patients (15%), among which 3 had lateral vertebral leakage and 1 superior intervertebral disc leakage. There was no bone cement displacement during the postoperative period to the last follow-up. The VBI, VBA, BCA, VAS and ODI were (43.1±5.9)%, (21.0±2.6)°, (45.0±6.3)°, 7.6 (7.0, 8.0)points, (79.9±7.6)% preoperatively, were (78.7±2.6)%, (12.7±2.1)°, (26.1±4.7)°, 3.2 (3.0, 4.0)points, (50.0±9.3)% at day 1 after operation, and were (78.0±2.3)%, (13.2±2.4)°, (27.1±4.9)°, 2.0 (2.0, 2.0)points, (22.9±5.1)% at the last follow-up. There were significant differences in above five measures at day 1 after operation and at the final follow-up in comparison with the preoperative values (all P<0.05), and their values measured at day 1 after operation and at the final follow-up were also significantly different (all P<0.05). The SF-36 score in physical function, role physical, body pain, vitality and social function was 45.2 (40.0, 50.0)points, 28.7 (25.0, 50.0)points, 15.9 (10.0, 22.0)points, 48.3 (40.0, 60.0)points, 29.2 (25.0, 37.5)points preoperatively, significantly different from 78.0 (75.0, 85.0)points, 75.0 (75.0, 75.0)points, 68.1 (64.0, 74.0)points, 62.0 (55.0, 70.0)points, 34.7 (25.0, 37.5)points at the last follow-up (all P<0.05). However, there were no significant differences in SF-36 before operation and at the last follow-up in dimensions of general health, emotional function and mental health (all P>0.05). According to Odom′s criteria, 19 patients were graded as excellent, 7 good, 1 fair and 0 poor, with an excellent and good rate of 96%. Conclusion:For SCOVF patients with IVC, the novel bone cement bridging screw system combined with PVP has advantages of no displacement of bone cement, satisfactory fixation, significant pain relief and satisfactory functional recovery.