With the clinical generalization and popularization of transcatheter aortic valve replacement (TAVR), cerebrovascular events related to TAVR occur more frequently, which significantly impairs neurocognitive function, increases mortality, and seriously affects prognosis and quality of life in these patients. However, the reported incidence rates of TAVR-related stroke differ in literature due to inconsistent diagnostic criteria. According to the onset time, TAVR-related stroke can be divided into acute (≤24 h), subacute (24 h-30 d), early (31 d-1 year) and late (>1 year) types, and the cause of stroke generally varies according to the onset time. Both surgical (balloon aortic valvuloplasty, types of transcatheter heart valve, alternative access) and non-surgical (valvular calcium burden, bicuspid aortic valve, subclinical leaflet thrombosis, postoperative new-onset atrial fibrillation) can be related to the occurrence of TAVR-related stroke. Postprocedural monitoring, postprocedural antithrombotic therapy, and cerebral embolic protection devices are important for the prevention of TAVR-related stoke. This article reviews the research progress on TAVR-related stroke, focusing on its epidemiology, risk factors and preventive measures, aiming to provide reference for the clinical management of stroke in TAVR.
Humans ; Transcatheter Aortic Valve Replacement/adverse effects* ; Stroke/epidemiology* ; Postoperative Complications/etiology* ; Aortic Valve Stenosis/surgery* ; Risk Factors

[Purpose]To analyze the trends of incidence and age at onset of leukemia in Jiangsu cancer registration areas from 2009 to 2019.[Methods]The continuous monitoring data of leukemia from 2009 to 2019 were collected from 16 cancer registries in Jiangsu Province.All datasets were checked and evaluated based on data quality control criteria and were included in the analysis.Crude incidence rate(CIR),age-standardized incidence rate by Chinese standard population(ASIRC),the average annual percentage change(AAPC),the standardized average age at onset,the changes in the age structure of incidence and the changes in the birth cohort by year were calculated.[Results]The incidence rate of leukemia significantly increased from 5.22/105 in 2009 to 7.88/105 in 2019,with a significant upward trend(for CIR,AAPC=4.95％,95％CI:3.82％～6.09％;for ASIRC,AAPC=2.97％,95％CI:1.52％～4.43％).The incidence rates were in-creased in all age groups and increased with the birth cohort by years.There was a tendency of backward shift for the age composition of the population,with the increasing of composition for those over 60 years old.The mean age at onset increased from 48.62 years old in 2009 to 57.96 years old in 2019,with a backward shift in the mean age(β=0.773,P＜0.001),and the mean age at onset increased with the year only in rural areas after standardization(β=0.428,P=0.017).[Conclusion]Leukemia incidence rate in Jiangsu Province increased from 2009 to 2019,and the age at onset has shifted backwards.It's important to strengthen the early prevention and control of leukemia.

Objective To explore the application effect of team-based learning(TBL)teaching method combined with scenario simulation in the team-based cardiopulmonary resuscitation(CPR)training for standardized training of resident physicians in department of emergency.Methods A total of 86 standardized training resident physicians rotating in the department of emergency of Guangdong Provincial People's Hospital Southern Medical University from May 2022 to July 2023 were included as study subjects.These resident physicians were divided into a control group(n=42)and an observation group(n=44)according to different teaching methods.The control group was taught using the conventional teaching method,whereas the observation group was taught using a combination of TBL and scenario simulation-based method.The difference of theoretical assessment scores,practical skill competency and training satisfaction were compared before and after training between groups.Results The theoretical and practice skill assessment scores of both groups significantly improved after training(all P<0.05).However,there was no significant difference in the theoretical assessment scores or the score increase between the two groups before and after training.In the subcategory of theoretical assessment scores,the observation group had significantly higher points than the control group in the precautions category after training(21.09±2.07 vs.20.07±1.85,P<0.05).Compared with the control group,the observation group had significantly higher post-training practical skill scores and a significantly greater score increase(scores:86.77±3.89 vs.81.17±4.18,score increase:11±5.15 vs.8±4.60,both P<0.05).Among the subcategory practical skill scores,the observation group outperformed the control group in communication skills,emergency skills and teamwork+humanistic care(communication skills points:21.36±1.71 vs.20.07±1.54,emergency skills points:21.73±1.35 vs.20.21±1.79,teamwork+humanistic care points:22.27±1.76 vs.19.71±2.71,all P<0.05).The degree of satisfaction in overall training satisfaction,the novelty of the teaching method,teacher affinity,interests in learning,developing teamwork ability,class atmosphere,communication and expression ability,and confidence in skill mastery were significantly higher in the observation group than in the control group[overall training satisfaction:97.73%(43/44)vs.50.00%(21/42),the novelty of the teaching method:90.91%(40/44)vs.47.62%(20/42),teacher affinity:93.18%(41/44)vs.57.14%(24/42),interests in learning:97.73%(43/44)vs.59.52%(25/42),developing teamwork ability:95.45%(42/44)vs.52.38%(22/42),class atmosphere:93.18%(41/44)vs.57.14%(24/42),improve communication and expression ability:100.00%(44/44)vs.50.00%(21/42),and confidence in skill mastery:93.18%(41/44)vs.45.24%(19/42),all P<0.05].Conclusion The application of TBL teaching method combined with scenario simulation in CPR training for standardized training of resident physicians can effectively improve quality of clinical skill training.

[Purpose]To analyze the trends of incidence and age at onset of leukemia in Jiangsu cancer registration areas from 2009 to 2019.[Methods]The continuous monitoring data of leukemia from 2009 to 2019 were collected from 16 cancer registries in Jiangsu Province.All datasets were checked and evaluated based on data quality control criteria and were included in the analysis.Crude incidence rate(CIR),age-standardized incidence rate by Chinese standard population(ASIRC),the average annual percentage change(AAPC),the standardized average age at onset,the changes in the age structure of incidence and the changes in the birth cohort by year were calculated.[Results]The incidence rate of leukemia significantly increased from 5.22/105 in 2009 to 7.88/105 in 2019,with a significant upward trend(for CIR,AAPC=4.95％,95％CI:3.82％～6.09％;for ASIRC,AAPC=2.97％,95％CI:1.52％～4.43％).The incidence rates were in-creased in all age groups and increased with the birth cohort by years.There was a tendency of backward shift for the age composition of the population,with the increasing of composition for those over 60 years old.The mean age at onset increased from 48.62 years old in 2009 to 57.96 years old in 2019,with a backward shift in the mean age(β=0.773,P＜0.001),and the mean age at onset increased with the year only in rural areas after standardization(β=0.428,P=0.017).[Conclusion]Leukemia incidence rate in Jiangsu Province increased from 2009 to 2019,and the age at onset has shifted backwards.It's important to strengthen the early prevention and control of leukemia.

Objective To explore the application effect of team-based learning(TBL)teaching method combined with scenario simulation in the team-based cardiopulmonary resuscitation(CPR)training for standardized training of resident physicians in department of emergency.Methods A total of 86 standardized training resident physicians rotating in the department of emergency of Guangdong Provincial People's Hospital Southern Medical University from May 2022 to July 2023 were included as study subjects.These resident physicians were divided into a control group(n=42)and an observation group(n=44)according to different teaching methods.The control group was taught using the conventional teaching method,whereas the observation group was taught using a combination of TBL and scenario simulation-based method.The difference of theoretical assessment scores,practical skill competency and training satisfaction were compared before and after training between groups.Results The theoretical and practice skill assessment scores of both groups significantly improved after training(all P<0.05).However,there was no significant difference in the theoretical assessment scores or the score increase between the two groups before and after training.In the subcategory of theoretical assessment scores,the observation group had significantly higher points than the control group in the precautions category after training(21.09±2.07 vs.20.07±1.85,P<0.05).Compared with the control group,the observation group had significantly higher post-training practical skill scores and a significantly greater score increase(scores:86.77±3.89 vs.81.17±4.18,score increase:11±5.15 vs.8±4.60,both P<0.05).Among the subcategory practical skill scores,the observation group outperformed the control group in communication skills,emergency skills and teamwork+humanistic care(communication skills points:21.36±1.71 vs.20.07±1.54,emergency skills points:21.73±1.35 vs.20.21±1.79,teamwork+humanistic care points:22.27±1.76 vs.19.71±2.71,all P<0.05).The degree of satisfaction in overall training satisfaction,the novelty of the teaching method,teacher affinity,interests in learning,developing teamwork ability,class atmosphere,communication and expression ability,and confidence in skill mastery were significantly higher in the observation group than in the control group[overall training satisfaction:97.73%(43/44)vs.50.00%(21/42),the novelty of the teaching method:90.91%(40/44)vs.47.62%(20/42),teacher affinity:93.18%(41/44)vs.57.14%(24/42),interests in learning:97.73%(43/44)vs.59.52%(25/42),developing teamwork ability:95.45%(42/44)vs.52.38%(22/42),class atmosphere:93.18%(41/44)vs.57.14%(24/42),improve communication and expression ability:100.00%(44/44)vs.50.00%(21/42),and confidence in skill mastery:93.18%(41/44)vs.45.24%(19/42),all P<0.05].Conclusion The application of TBL teaching method combined with scenario simulation in CPR training for standardized training of resident physicians can effectively improve quality of clinical skill training.

[Purpose]To analyze the incidence trend and age at diagnosis of thyroid cancer in can-cer registration areas of Jiangsu Province from 2009 to 2019.[Methods]The continuous and com-plete cancer data from 2009 to 2019 meeting quality control requirements were collected from 16 registries in Jiangsu Province.Thyroid cancer was coded as C73 according to ICD-10.The crude incidence rate,age-standardized incidence rate by Chinese standard population(ASIRC),the mean diagnostic age and adjusted mean diagnostic age of thyroid cancer were calculated by sex,age groups and regions.The trends of above indicators were analyzed and the average annual per-centage change(AAPC)was calculated.[Results]The crude incidence rate and ASIRC of thyroid cancer for men in Jiangsu cancer registration areas in 2009 and 2019 were 1.25/105,1.00/105 and 7.32/105,6.48/105,respectively.For women those were 3.64/105,3.06/105 and 24.91/105,20.94/105,respectively.The AAPC of crude incidence rate and ASIRC of thyroid cancer from 2009 to 2019 were 22.05％(95％CI:19.70％～24.45％)and 22.55％(95％CI:20.06％～25.08％),respectively.The adjusted mean diagnostic age of thyroid cancer declined from 46.27 years old in 2009 to 43.03 years old in 2019(β=-0.243,P＜0.001).[Conclusion]The incidence rate of thyroid cancer showed an increasing trend in cancer registration areas of Jiangsu Province from 2009 to 2019,while the diagnostic age showed a downward trend during the same period.

Objective Neuromuscular electrical stimulation(NMES)-evoked kinesthetic information in muscle spindle can be purely extracted from the mixed motor and sensory afferents using Ischemic nerve block(INB).This study aims to investigate the somatosensory cortical response evoked by NMES activating muscle spindle afferents in forearm.Methods All subjects performed four experimental tasks designed according to a 2×2 factors,including one factor of the INB state(without INB and within INB)and the other of the stimulation intensity(above and below motor threshold).During the experiment,we recorded EEG data with 64 channels and then beta event-related desynchronization(Beta ERD)were utilized quantize somatosensory cortical excitability evoked by the tasks.The subjective perception about the sensation and movement of the right hand were evaluated by a psychophysical test after the right wrist was performed by INB.Results INB significantly reduced beta ERD on the contralateral somatosensory cortex evoked by NMES above the motor threshold,and there was significant difference of NMES-evoked beta ERD values on the contralateral somatosensory cortex between above and below motor threshold.Meanwhile,contralateral dominance of NMES-evoked beta ERD on the somatosensory cortex was transferred to ipsilateral hemisphere under INB.Conclusion INB can significantly reduce NMES-evoked somatosensory cortical response above motor threshold and decrease cortical perception on the stimulus intensity,which may be due to INB resulting in rapid functional reorganization of somatosensory cortex.

BACKGROUND: There are few multi-city studies on the association between temperature and mortality in basin climates. This study was based on the Sichuan Basin in southwest China to assess the association of basin temperature with non-accidental mortality in the population and with the temperature-related mortality burden. METHODS: Daily mortality data, meteorological and air pollution data were collected for four cities in the Sichuan Basin of southwest China. We used a two-stage time-series analysis to quantify the association between temperature and non-accidental mortality in each city, and a multivariate meta-analysis was performed to obtain the overall cumulative risk. The attributable fractions (AFs) were calculated to access the mortality burden attributable to non-optimal temperature. Additionally, we performed a stratified analyses by gender, age group, education level, and marital status. RESULTS: A total of 751,930 non-accidental deaths were collected in our study. Overall, 10.16% of non-accidental deaths could be attributed to non-optimal temperatures. A majority of temperature-related non-accidental deaths were caused by low temperature, accounting for 9.10% (95% eCI: 5.50%, 12.19%), and heat effects accounted for only 1.06% (95% eCI: 0.76%, 1.33%). The mortality burden attributable to non-optimal temperatures was higher among those under 65 years old, females, those with a low education level, and those with an alternative marriage status. CONCLUSIONS Our study suggested that a significant association between non-optimal temperature and non-accidental mortality. Those under 65 years old, females, and those with a low educational level or alternative marriage status had the highest attributable burden.
Female ; Humans ; China/epidemiology* ; Cities ; Cold Temperature ; Hot Temperature ; Mortality ; Temperature ; Time Factors ; Middle Aged ; Male

Objective::Data comparing the outcomes of MiStent (Micell Technologies, Durham, North Carolina, USA) microcrystalline biodegradable polymer (BP) drug-eluting stent (DES) and those of another post-marketing BP-DES, TIVOLI (EssenTech, Beijing, China) are rare. This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent (SES) system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective, single-blinded, multicenter, randomized trial (NCT02448524), which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio. The primary endpoint was a non-inferiority comparison of in-stent late lumen loss (LLL) by quantitative coronary angiography at 9 months. The secondary endpoint was device-related clinical cardiovascular composite events (target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization) and 1-year outcomes. Results::A total of 428 patients (216 patients in the MiStent group and 212 patients in the TIVOLI group) were enrolled and included in an intention-to-treat analysis. MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months ((0.23 ± 0.37) mm vs. (0.34 ± 0.48) mm, P for non-inferiority <0.001, P for superiority = 0.02). Although without significant difference, the rate of TLF in MiStent was quantitatively lower than that in TIVOLI (3.70% vs. 6.60%; P = 0.17). Conclusion::Compared with TIVOLI BP-SES, the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.

Objective::Data comparing the outcomes of MiStent (Micell Technologies, Durham, North Carolina, USA) microcrystalline biodegradable polymer (BP) drug-eluting stent (DES) and those of another post-marketing BP-DES, TIVOLI (EssenTech, Beijing, China) are rare. This study sought to compare the angiographic efficacy and clinical outcomes of the microcrystalline BP sirolimus-eluting stent (SES) system MiStent and those of TIVOLI BP-SES.Methods::The DESSOLVE-C trial was a prospective, single-blinded, multicenter, randomized trial (NCT02448524), which randomly assigned patients with de novo coronary lesions to receive MiStent or TIVOLI BP-SES by a 1:1 ratio. The primary endpoint was a non-inferiority comparison of in-stent late lumen loss (LLL) by quantitative coronary angiography at 9 months. The secondary endpoint was device-related clinical cardiovascular composite events (target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization) and 1-year outcomes. Results::A total of 428 patients (216 patients in the MiStent group and 212 patients in the TIVOLI group) were enrolled and included in an intention-to-treat analysis. MiStent was not only non-inferior but superior to TIVOLI for in-stent LLL at 9 months ((0.23 ± 0.37) mm vs. (0.34 ± 0.48) mm, P for non-inferiority <0.001, P for superiority = 0.02). Although without significant difference, the rate of TLF in MiStent was quantitatively lower than that in TIVOLI (3.70% vs. 6.60%; P = 0.17). Conclusion::Compared with TIVOLI BP-SES, the MiStent system was superior in in-stent LLL at 9 months and had a comparable clinical benefit at 1 year in de novo coronary lesions.