ObjectiveTo evaluate the clinical effectiveness and safety of Modified Zhigancao Granules （炙甘草汤加味颗粒） for preventing the early recurrence following radiofrequency ablation in patients with atrial fibrillation （AF） of qi-yin deficiency syndrome. MethodsA multi-center， randomized， double-blind， placebo-controlled trial was designed. A total of 116 patients with atrial fibrillation of qi-yin deficiency syndrome who underwent radiofrequency ablation for the first time were enrolled from 3 centers， and they were randomly divided into a treatment group （59 cases） and a control group （57 cases）. Both groups received basic western medicine treatment after surgery. In addition， the treatment group was given oral Modified Zhigancao Granules， while the control group was given oral placebo granules. The dosage for both groups was 20 g each time， twice a day， with continuous treatment for 12 weeks. The recurrence of atrial fibrillation in both groups was recorded at 24 hours， 4 weeks， 8 weeks， and 12 weeks after surgery. The serum levels of B-type natriuretic peptide （BNP）， interleukin-6 （IL-6）， high-sensitivity C-reactive protein （hs-CRP）， and tumor necrosis factor-α （TNF-α） were detected before treatment and 12 weeks after treatment in both groups. The scores of Atrial Fibrillation Effect on QualiTy-of-life （AFEQT） Questionnaire （including scores of the daily life dimension， symptom dimension， treatment worry dimension， treatment satisfaction dimension， and total score） and traditional Chinese medicine （TCM） syndrome scores were compared before treatment and at 4 weeks， 8 weeks， and 12 weeks between groups. Safety indicators such as blood routine， urine routine， liver function， and renal function were monitored before and after treatment. ResultsNine of the treatment group and seven of the control group dropped out. Finally， 50 patients in each group were included in the statistical analysis. At 24 hours， 4 weeks， 8 weeks， and 12 weeks after surgery， the recurrence rates of AF in the treatment group were 2.0% （1/50）， 2.0% （1/50）， 4.0% （2/50）， and 10.0% （5/50）， respectively； while those in the control group were 2.0% （1/50）， 26.0% （13/50）， 28.0% （14/50）， and 34.0% （17/50）， respectively. Compared with the control group at the same time points， the early recurrence rates of AF in the treatment group were significantly lower at 4 weeks， 8 weeks， and 12 weeks after surgery （P＜0.01）. Compared with the baseline within group， BNP， hs-CRP， IL-6， and TNF-α in the treatment group all decreased after 12 weeks of treatment （P＜0.05）； the difference in hs-CRP levels （before vs. after treatment） in the treatment group was higher than that in the control group （P＜0.01）. Compared with the baseline within group， both groups showed decreases in the total score of AFEQT Questionnaire， scores of the daily life dimension， treatment worry dimension， symptom dimension， and TCM syndrome scores at 4 weeks， 8 weeks， and 12 weeks after treatment. Meanwhile， the score of the treatment satisfaction dimension of AFEQT increased in both groups （P＜0.01）， and the improvements in all the above scores in the treatment group were superior to those in the control group at all time points （P＜0.05 or P＜0.01）. All safety indicators of patients in both groups were within the normal range before treatment and at 12 weeks after treatment， and no adverse reactions or adverse events occurred in either group. ConclusionModified Zhigancao Granules can reduce the early recurrence rate following radiofrequency ablation in AF patients with qi-yin deficiency syndrome， improve clinical symptoms and quality of life， suppress inflammatory response， and show good safety.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To investigate the similarities and differences of Doppler echocardiographic parameters in healthy adults among Chinese (EMINCA study), Japanese (JAMP study) and Europeans (NORRE study).Methods:Based on the published Doppler echocardiographic data of JAMP and NORRE studies, the corresponding Doppler parameters were selected from the original database of EMINCA study and stratified by sex and age groups accordingly. Independent-samples t-test, summary t-test, and one-way analysis of variance (ANOVA) were used to test the differences between groups. Results:①Common Doppler parameters in three studies included: peak velocities of early diastolic (E) and late diastolic waves (A) of mitral valve inflow, E/A ratio, deceleration time (DT) of E wave, tissue velocities of early diastole (e′ ) and late diastole (a′ ) at both septal and lateral sites of the mitral annulus and the average value of e′ at both sites (average-e′), ratios of E to septal e′ (septal-E/e′), E to lateral e′ (lateral-E/e′), and E to average e′ (average-E/e′). ②Differences between genders: There existed significant gender differences for 5/10 of parameters in EMINCA study, 8/10 in JAMP study and 3/12 in NORRE study (all P<0.05). ③Stratification by sex and age groups: Except for DT for men in EMINCA study, significant differences were found in all 12 Doppler parameters both for men and women in all three studies (all P<0.05). ④Comparison between EMINCA and JAMP studies: There were statistically significant differences in 8/10 and 9/10 of parameters for men and women, respectively (all P<0.05). ⑤Comparison between EMINCA and NORRE studies: 7/12 of parameters both in men and women were significantly different between the two studies (all P<0.05). ⑥For the three studies, 6/10 of parameters both in men and women correlated positively with age ( r=0.12-0.66, all P<0.001), while 4/10 correlated negatively with age ( r=-0.27--0.72, all P<0.001). Conclusions:Doppler echocardiographic measurements in healthy adults are significantly different with genders, ages and races/nationalities. Therefore, gender, age and race/nationality-specific reference values of Doppler echocardiography parameters should be encouraged in clinical practice.

This study conducted a bibliometric analysis of the literature related to the field of hemodialysis arteriovenous fistula from the Web of Science database. The current and future research hotspots and development trends in this field were visualized by sorting and interpreting the research data and drawing a visualization chart. This study suggests that there are certain academic barriers between China and developed countries, and international multicenter clinical trials should be conducted in the future with early identification of arteriovenous fistula dysfunction and emerging diagnostic tools as the academic development direction.

Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines, we generated the Delphi survey statements with five evaluation dimensions, including the definition of preterm birth, exclusion of risk factors for preterm birth, prevention, and prediction of preterm birth, treatment of preterm birth, and evaluation of intervention outcomes of preterm birth. Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey. All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel. Mean scores, rank sum, full score ratio, and the lowest score ratio were calculated to reflect the concentration of expert opinions. The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement. Results::The expert response rate for both rounds of surveys was 100% (41/41). Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round. A total of 49 statements (mean scores ≥3, full score ratio ≥20%, coefficient of variation ≤0.3) were explicitly included in this guideline to form recommendations, while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality. The Kendall W coefficient in the two rounds of the Delphi survey were 0.20 ( P < 0.001) and 0.29 ( P < 0.001). Conclusion::The five dimensions and 49 statements, agreed upon through a two-round Delphi study, determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China. The defined lower limit is set at ≥28 gestational weeks; however, an update has been made to the definition of premature birth, specifying that "with the consent of the mother and her family, treatment is not abandoned for viable infants ≥26 gestational weeks."

Objective::This study aimed to determine the likelihood of gestational diabetes mellitus (GDM) in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods::This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018. Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further. Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy, and the characteristics and GDM risk of these groups were compared. A univariate analysis of potential risk factors was performed using the Chi-squared test and/or t-test for qualitative or quantitative variables, respectively. Associations with P values <0.1 were chosen to be included in the multivariate binary logistic regression model. Results::In primary analysis of 6204 women, the incidence of GDM in subsequent pregnancy is 48.9% (490/1002) in women with GDM history and 16.1% (835/5202) in women without GDM history. In a further analysis for 5180 women without GDM at index pregnancy, compared with the non-GDM group, the GDM group had a significantly higher age, prepregnancy body mass index, and blood glucose value at each oral glucose tolerance test (OGTT) timepoint (fasting, 1 h and 2 h) during the index and subsequent pregnancies, as well as higher weight retention during the interval between the two pregnancies ( P<0.001). Age above 35 years in subsequent pregnancy (odds ratio ( OR)=1.540, 95% confidence interval ( CI) = 1.257-1.886, P<0.001), macrosomia in index pregnancy ( OR=1.749, 95% CI=1.277-2.395, P=0.001), OGTT blood glucose values in index pregnancy (fasting, OR=2.487, 95% CI=1.883-3.285, P<0.001; 1 h, OR=1.142, 95% CI=1.051-1.241, P=0.002; 2 h, OR=1.290, 95% CI=1.162-1.432, P<0.001) and weight retention ( OR=1.052, 95% CI=1.035-1.068, P<0.001) were independent risk factors for GDM in subsequent pregnancy. Conclusion::For women without GDM history, GDM risk factors including age, macrosomia history, OGTT value, and weight retention, these can be evaluated before a subsequent pregnancy. Early warning and interventions are needed for women at high risk.

Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines, we generated the Delphi survey statements with five evaluation dimensions, including the definition of preterm birth, exclusion of risk factors for preterm birth, prevention, and prediction of preterm birth, treatment of preterm birth, and evaluation of intervention outcomes of preterm birth. Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey. All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel. Mean scores, rank sum, full score ratio, and the lowest score ratio were calculated to reflect the concentration of expert opinions. The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement. Results::The expert response rate for both rounds of surveys was 100% (41/41). Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round. A total of 49 statements (mean scores ≥3, full score ratio ≥20%, coefficient of variation ≤0.3) were explicitly included in this guideline to form recommendations, while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality. The Kendall W coefficient in the two rounds of the Delphi survey were 0.20 ( P < 0.001) and 0.29 ( P < 0.001). Conclusion::The five dimensions and 49 statements, agreed upon through a two-round Delphi study, determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China. The defined lower limit is set at ≥28 gestational weeks; however, an update has been made to the definition of premature birth, specifying that "with the consent of the mother and her family, treatment is not abandoned for viable infants ≥26 gestational weeks."

Objective::This study aimed to determine the likelihood of gestational diabetes mellitus (GDM) in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods::This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018. Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further. Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy, and the characteristics and GDM risk of these groups were compared. A univariate analysis of potential risk factors was performed using the Chi-squared test and/or t-test for qualitative or quantitative variables, respectively. Associations with P values <0.1 were chosen to be included in the multivariate binary logistic regression model. Results::In primary analysis of 6204 women, the incidence of GDM in subsequent pregnancy is 48.9% (490/1002) in women with GDM history and 16.1% (835/5202) in women without GDM history. In a further analysis for 5180 women without GDM at index pregnancy, compared with the non-GDM group, the GDM group had a significantly higher age, prepregnancy body mass index, and blood glucose value at each oral glucose tolerance test (OGTT) timepoint (fasting, 1 h and 2 h) during the index and subsequent pregnancies, as well as higher weight retention during the interval between the two pregnancies ( P<0.001). Age above 35 years in subsequent pregnancy (odds ratio ( OR)=1.540, 95% confidence interval ( CI) = 1.257-1.886, P<0.001), macrosomia in index pregnancy ( OR=1.749, 95% CI=1.277-2.395, P=0.001), OGTT blood glucose values in index pregnancy (fasting, OR=2.487, 95% CI=1.883-3.285, P<0.001; 1 h, OR=1.142, 95% CI=1.051-1.241, P=0.002; 2 h, OR=1.290, 95% CI=1.162-1.432, P<0.001) and weight retention ( OR=1.052, 95% CI=1.035-1.068, P<0.001) were independent risk factors for GDM in subsequent pregnancy. Conclusion::For women without GDM history, GDM risk factors including age, macrosomia history, OGTT value, and weight retention, these can be evaluated before a subsequent pregnancy. Early warning and interventions are needed for women at high risk.

Objective:To understand the actual situation of the implementation of “Diagnosis and therapy guideline of preterm birth（2014）”, “Guideline” for short, by front-line obstetricians, and to provide reference for the further update and supplement of the “Guideline”.Methods:This study designed a structured questionnaire for the prominent problems in the prevention and treatment of preterm birth, which was determined by the expert team drafting the “Guideline”. In October to November 2021, a cross-sectional survey was conducted among obstetricians, including members of the Perinatal Medicine Branch of Jiangsu Medical Association and the Obstetrics Subgroup,Chinese society of Obstetrics and Gynecology, Chinese Medical Association, on the implementation status of the “Guideline”. The recommendations of the “Guideline” were used as standard answers to determine the implementation rate. A total of 328 valid questionnaires were collected. The total score of the questionnaire was 12 points. The questionnaire was divided into low executive ability group (<7 points) and high executive ability group (≥7 points) with a score of 7 as the threshold value, and the differences in baseline information such as hospital grade and professional title between the two groups were compared.Results:The score of 328 obstetricians was (7.6±1.6) points, including 250 (76.2%, 250/328) in the high execution group and 78 (23.8%, 78/328) in the low execution group. The execution rates of “the use of uterine contraction inhibitors for short courses”[97.0% (318/328)], “late umbilical cord breakage after birth of premature infants”[87.8% (288/328)] and “should preterm patients with intact membranes be treated with antibiotics”[86.6% (284/328)] were all over 80%, indicating good implementation. Multiple logistic regression analysis showed that hospital grade and professional title were independent factors influencing the performance of the “Guideline”(all P<0.05), and secondary hospitals had lower scores and worse execution than tertiary hospitals ( OR=0.42, 95% CI: 0.23-0.77; P=0.005). Senior titles had higher scores and better execution than junior titles ( OR=5.33, 95% CI: 2.35-12.07; P<0.001). When answering the question “gestational week at which premature infants could survive in your hospital”, only 3.4% (11/328) answered 22 weeks, and 44.5% (146/328) answered 28 weeks, accounted for the highest proportion. The gestational week of surviving premature infants in tertiary hospitals was earlier than that in secondary hospitals ( P<0.05). The gestational week of surviving premature infants answered by senior titles was earlier than that of junior titles ( P<0.05). Conclusions:Obstetricians generally have a good implementation of the “Guideline”, and their understanding of some recommended clauses in the guidelines needs to be improved. In the future, training of primary hospitals and physicians with junior titles should be strengthened.