Objective:To explore the structural equation model to explore the levels of work-related musculoskeletal disorders (WMSDs) and various risk factors in the feet and ankle of China's occupational population, providing scientific basis for for preventing WMSDs in feet and ankles.Methods:Data of 73497 national occupational epidemiological cases were selected from June 2018 to December 2023 used the Chinese version of the Electronic Questionnaire on Musculoskeletal Disorders. The adverse ergonomic factors and their source classification standard and confirmatory factor analysis were used to investigate foot and ankle WMSDs and their related risk factors (including individual factors, work organization, work posture, work type, fatigue, etc.) in key occupational groups in China, and structural equation model hypothesis, fitting, verification, and path and intermediary effect analysis were carried out. The model fit evaluation indexes included Chi-square specific degrees of freedom ( χ2/ df), gauge fit index (NFI), Tucker Lewis index (TLI), goodness of Fit index (GFI), adjusted Goodness of Fit index (AGFI) and approximate root mean square error (RMSEA) . Results:A total of 73497 occupational workers were surveyed, with local muscle fatigue and WMSDs incidence rates in the feet and ankles being 17.17% and 12.06%, respectively. The fitting index of the adjusted structural equation model basically meets the standard (GFI=1, AGFI=1, RMESA=0.042, NFI=0.716, TLI=0.663). The top three factors affecting feet and ankle WMSDs are feet and ankle muscle fatigue, work type, and work organization, with standardized path coefficients of 0.221, 0.105, and 0.095, respectively. The top two factors affecting feet and ankle muscle fatigue are work organization and work type, with standardized path coefficients of 0.548 and 0.383, respectively. Feet and ankle muscle fatigue, work type, work organization, and work posture have a direct effect on feet and ankle WMSDs, with effect values of 0.221, 0.105, 0.095, and 0.077, respectively. The organization and type of work can also have indirect effects through feet and ankle muscle fatigue, with effect values of 0.121 and 0.084, respectively.Conclusion:Feet and ankle muscle fatigue has a direct impact on WMSDs, and plays a mediating role between ankle and ankle WMSDs caused by work organization and work type. Feet and ankle muscle fatigue is an important pathway leading to feet and ankle WMSDs. It is recommended that employers and managers detect job fatigue early and take corresponding prevention and intervention measures, which can play a key role in preventing feet and ankle WMSDs.

Objective:To explore the structural equation model to explore the levels of work-related musculoskeletal disorders (WMSDs) and various risk factors in the feet and ankle of China's occupational population, providing scientific basis for for preventing WMSDs in feet and ankles.Methods:Data of 73497 national occupational epidemiological cases were selected from June 2018 to December 2023 used the Chinese version of the Electronic Questionnaire on Musculoskeletal Disorders. The adverse ergonomic factors and their source classification standard and confirmatory factor analysis were used to investigate foot and ankle WMSDs and their related risk factors (including individual factors, work organization, work posture, work type, fatigue, etc.) in key occupational groups in China, and structural equation model hypothesis, fitting, verification, and path and intermediary effect analysis were carried out. The model fit evaluation indexes included Chi-square specific degrees of freedom ( χ2/ df), gauge fit index (NFI), Tucker Lewis index (TLI), goodness of Fit index (GFI), adjusted Goodness of Fit index (AGFI) and approximate root mean square error (RMSEA) . Results:A total of 73497 occupational workers were surveyed, with local muscle fatigue and WMSDs incidence rates in the feet and ankles being 17.17% and 12.06%, respectively. The fitting index of the adjusted structural equation model basically meets the standard (GFI=1, AGFI=1, RMESA=0.042, NFI=0.716, TLI=0.663). The top three factors affecting feet and ankle WMSDs are feet and ankle muscle fatigue, work type, and work organization, with standardized path coefficients of 0.221, 0.105, and 0.095, respectively. The top two factors affecting feet and ankle muscle fatigue are work organization and work type, with standardized path coefficients of 0.548 and 0.383, respectively. Feet and ankle muscle fatigue, work type, work organization, and work posture have a direct effect on feet and ankle WMSDs, with effect values of 0.221, 0.105, 0.095, and 0.077, respectively. The organization and type of work can also have indirect effects through feet and ankle muscle fatigue, with effect values of 0.121 and 0.084, respectively.Conclusion:Feet and ankle muscle fatigue has a direct impact on WMSDs, and plays a mediating role between ankle and ankle WMSDs caused by work organization and work type. Feet and ankle muscle fatigue is an important pathway leading to feet and ankle WMSDs. It is recommended that employers and managers detect job fatigue early and take corresponding prevention and intervention measures, which can play a key role in preventing feet and ankle WMSDs.

Objective:To systematically evaluate the qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus, so as to provide reference for the subsequent formulation of intervention strategies.Methods:The qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus in the Cochrane Library, CINAHL, EMbase, PubMed, PsycINFO, ProQuest, Web of Science, China National Knowledge Internet, Wanfang, VIP and Chinese Biomedical Database were searched from inception to May 2022. The JBI Critical Appraisal Tool for qualitative studies in Australia (2016) was used to evaluate the literature quality, and research results were summarized and integrated by integrating methods.Results:A total of 13 studies were included, 56 themes were extracted, and they were summarized into 9 categories, forming 3 integrated results as following, lack of personalized and professional information on blood glucose management, worring about the influence of blood glucose management on the health of mothers and children, conflict between daily life and blood glucose management plan.Conclusions:Health care workers should provide gestational diabetes mellitus patients with adequate personalized professional information support on blood glucose management to facilitate scientific decision-making during pregnancy, and also analyze the benefits and risks of different decisions for patients to help them make the best decision and strengthen their external support system to help them implement blood glucose management decisions.

Background::The ideal blood pressure (BP) target for patients with atrial fibrillation (AF) is still unclear. The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF.Methods::This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011. All participants were followed for 1 year ± 1 month. The primary endpoint was all-cause mortality.Results::During the follow-up, 276 (13.9%) all-cause deaths occurred. Kaplan-Meier curves showed that a systolic blood pressure (SBP) ≤110 mmHg or >160 mmHg was associated with a higher risk of all-cause mortality (log-rank test, P = 0.014), and a diastolic blood pressure (DBP) <70 mmHg was associated with the highest risk of all-cause mortality (log-rank test, P = 0.002). After adjusting for confounders, the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP ≤110 mmHg (hazard ratio [HR], 1.963; 95% confidence interval [CI], 1.306-2.951), and DBP <70 mmHg (HR, 1.628; 95% CI, 1.163-2.281). In the restricted cubic splines, relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations (non-linear P <0.001 and P = 0.010, respectively). The risk of all-cause mortality notably increased at a lower baseline SBP and DBP. Conclusions::Having a baseline SBP ≤110 mmHg or DBP <70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF. An excessively low BP may not be an optimal target for patients with AF.

Objective:To investigate the baseline characteristics and 1-year follow-up prognosis of elderly (age ≥75 years) emergency department (ED) patients with atrial fibrillation (AF).Methods:From 2009 to 2011, patients with AF aged ≥75 years were continuously enrolled in the ED in 20 hospitals. The baseline characteristics and treatment status of the patients were collected and followed up for 1 year. The primary endpoint was all-cause death; Secondary endpoints were cardiovascular death, stroke, major bleeding and major adverse events. Uni- and multivariate Cox regression models were used to analyze the independent risk factors for the above events.Results:A total of 766 elderly ED patients with AF were enrolled, the average age was 80.76±4.66 years old, and 56.9% were female. The 1-year all-cause mortality was 24.3%, cardiovascular mortality was 12.8%, stroke rate was 10.6%, major adverse event rate was 33.6%, and the readmission rate was 32%. Multivariate Cox regression analysis showed that age ( HR1.073, 95% CI 1.042-1.105), heart rate ( HR1.008, 95% CI 1.002-1.013), history of dementia/cognitive impairment ( HR1.849, 95% CI 1.016) ~3.365), and history of chronic obstructive pulmonary disease ( HR1.824, 95% CI 1.303-2.551) were independent risk factors for death in elderly patients with AF in 1-year follow-up; female (HR1.664, 95% CI 1.036-2.675), and history of hypertension ( HR2.035, 95% CI 1.080-3.836), history of dementia/cognitive impairment ( HR2.773, 95% CI 1.220-6.302) were independent risk factors for 1-year stroke in elderly patients with AF. Conclusions:The prognosis of elderly ED patients with AF is poor. Age, heart rate, history of dementia/cognitive impairment, and history of chronic obstructive pulmonary disease are independent risk factors for 1-year all-cause death and major adverse events in elderly ED patients with AF. Female, history of hypertension, and history of dementia/ cognitive impairment are independent risk factors for stroke in elderly ED patients with AF.

OBJECTIVETo analyze the phenotype-genotype correlation of MYH7-V878A mutation.

METHODSExonic amplification and high-throughput sequencing of 96-cardiovascular disease-related genes were carried out on probands from 210 pedigrees affected with hypertrophic cardiomyopathy (HCM). For the probands, their family members, and 300 healthy volunteers, the identified MYH7-V878A mutation was verified by Sanger sequencing. Information of the HCM patients and their family members, including clinical data, physical examination, echocardiography (UCG), electrocardiography (ECG), and conserved sequence of the mutation among various species were analyzed.

RESULTSA MYH7-V878A mutation was detected in five HCM pedigrees containing 31 family members. Fourteen members have carried the mutation, among whom 11 were diagnosed with HCM, while 3 did not meet the diagnostic criteria. Some of the fourteen members also carried other mutations. Family members not carrying the mutation had normal UCG and ECG. No MYH7-V878A mutation was found among the 300 healthy volunteers. Analysis of sequence conservation showed that the amino acid is located in highly conserved regions among various species.

CONCLUSIONMYH7-V878A is a hot spot among ethnic Han Chinese with a high penetrance. Functional analysis of the conserved sequences suggested that the mutation may cause significant alteration of the function. MYH7-V878A has a significant value for the early diagnosis of HCM.

Adult ; Amino Acid Sequence ; Asian Continental Ancestry Group ; genetics ; Cardiac Myosins ; genetics ; Cardiomyopathy, Hypertrophic ; genetics ; Female ; Genetic Association Studies ; methods ; Genotype ; Humans ; Male ; Middle Aged ; Mutation ; genetics ; Myosin Heavy Chains ; genetics ; Pedigree ; Phenotype ; Young Adult

OBJECTIVETo explore the relationship between electrocardiographic (ECG) and genetic mutations of patients with hypertrophic cardiomyopathy (HCM), and early ECG changes in HCM patients.

METHODSClinical, 12-lead ECG and echocardiographic examination as well as genetic examinations were made in a three-generation Chinses HCM pedigree with 8 family members (4 males). The clinical characterization and ECG parameters were analyzed and their relationship with genotypes in the family was explored.

RESULTSFour missense mutations (MYH7-H1717Q, MYLK2-K324E, KCNQ1-R190W, TMEM70-I147T) were detected in this pedigree. The proband carried all 4 mutations and 5 members carried 2 mutations. Corrected QTc interval of KCNQ1-H1717Q carriers was significantly prolonged and was consistent with the ECG characterization of long QT syndrome. MYLK2-K324E and KCNQ1-R190W carriers presented with Q wave and(or) depressed ST segment, as well as flatted or reversed T waves in leads from anterolateral and inferior ventricular walls. ECG results showed ST segment depression, flat and inverted T wave in the gene mutation carriers with normal echocardiographic examination results. ECG and echocardiographic results were normal in TMEM70-I147T mutation carrier.

CONCLUSIONSThe combined mutations of the genes associated with cardiac ion channels and HCM are linked with the ECG phenotype changes in this HCM pedigree. The variations in ECG parameters due to the genetic mutation appear earlier than the echocardiography and clinical manifestations. Variation in ECG may become one of the indexes for early diagnostic screening and disease progression of the HCM gene mutation carriers.

Brugada Syndrome ; Cardiac Conduction System Disease ; Cardiac Myosins ; Cardiomyopathy, Hypertrophic ; Echocardiography ; Electrocardiography ; Exons ; Genetic Testing ; Genotype ; Humans ; KCNQ1 Potassium Channel ; Long QT Syndrome ; Mutation ; Mutation, Missense ; Myosin Heavy Chains ; Myosin-Light-Chain Kinase ; Pedigree ; Phenotype

PURPOSE: Studies have shown that diabetes mellitus (DM) is a risk factor for cardiovascular disease, including atrial fibrillation (AF); however, the clinical characteristics and prognostic impact of DM in patients with nonvalvular AF have not been well understood in China. MATERIALS AND METHODS: Included were 1644 consecutive patients with nonvalvular AF. Endpoints included all-cause mortality, cardiovascular mortality, stroke, major bleeding, and combined endpoint events (CEE) during a 1-year follow-up. RESULTS: The prevalence of DM was 16.8% in nonvalvular AF patients. Compared with non-diabetic AF patients, diabetic AF patients were older and tended to coexist with other cardiovascular diseases. Most patients with DM (93.5%) were eligible for anticoagulation, as determined by CHADS2 scores. However, only 11.2% of patients received anticoagulation. During a 1-year follow-up, the all-cause mortality and CEE rate in the DM group were significantly higher than those of the non-DM group, while the incidence of stroke was comparable. After multivariate adjustments, DM was still an independent risk factor for 1-year all-cause mortality [hazard ratio (HR)=1.558; 95% confidence interval (CI) 1.126-2.156; p=0.007], cardiovascular mortality (HR=1.615; 95% CI 1.052-2.479; p=0.028), and CEE (HR=1.523; 95% CI 1.098-2.112; p=0.012), yet not for stroke (HR=1.119; 95% CI 0.724-1.728; p=0.614). CONCLUSION: DM is a common morbidity coexisting with nonvalvular AF and is associated with an increased risk of 1-year all-cause mortality, cardiovascular mortality, and CEE. However, no increased risk of stroke was found during a 1-year follow-up in patients with AF and DM.
Aged ; Atrial Fibrillation/*etiology ; Cause of Death ; China ; Diabetes Complications/*pathology ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Multivariate Analysis ; Proportional Hazards Models ; Risk Factors ; Treatment Outcome

Objective To explore the independent risk factors for the 1 year stroke event in Chinese patients with atrial fibrillation (AF) and hypertension (HT).Methods Data of AF and HT patients in the Chinese Emergency Atrial Fibrillation Registry Study were retrospectively analyzed.The eligible patients were divided into the stroke group and the non-stroke group according to the result of 1 year follow-up.The predictors for the 1 year stroke event were identified by uni-and multi-variate Cox regression analysis with the baseline and therapeutic variables.Results A total of 1 118 AF and HT patients were enrolled in the study with the incidence of 1 year stroke event of 8.7％.All patients were divided into the stroke group (n =97) and the non-stroke group (n =1 021).Compared with the non-stroke group,more female patients were in the stroke group (68.0％ vs 54.5％,P ＜ 0.05) and the patients in the stroke group were older [(76.0 ± 9.4) years vs (71.9 ± 10.6) years,P ＜ 0.01] with higher proportion of previous history of stroke (38.1％ vs 23.8％,P ＜0.01).More patients were observed on the antihypertensive treatment in the non-stroke group (91.6％ vs 85.6％,P ＜ 0.05),while more patients on statins in the stroke group(45.4％vs 34.5％,P ＜ 0.05).Multi-variate Cox regression analysis showed that age (HR =1.036,95％ CI 1.010-1.062),female (HR =1.908,95％ CI 1.170-3.110),previous stroke history (HR =1.680,95％ CI 1.084-2.603),and no antihypertensive treatment (HR =1.955,95％ CI 1.008-3.791) were independent risk factors for the 1 year stroke event in patients with AF and HT.Conclusion Age,female,previous stroke history and no antihypertensive treatment are the independent risk factors for the 1 year stroke event in patients with AF and HT.

Objective To investigate changes in the expression of apurinic/apyrimidinic endonuclease (APE) and the oxidative DNA damage marker 8 OHdG in distant hippocampus regions of the rat brain after focal cerebral ischemia of the middle cerebral artery.Methods SD rats were divided into the sham surgery group and the pMCAO group (induced by middle cerebral artery occlusion).Pathological changes in brain tissues were examined at 2 h,6 h,12 h,24 h,48 h and 72 h.The expression of APE and 8-OHdG was measured by immunohistochemical staining methods.TUNEL staining was performed to detect apoptosis.Results Reduction of APE expression in the CA1 region of the hippocampus on the ischemia side appeared at 2 h in the pMCAO group and continued as ischemia persisted (F=11.91,P＜0.05).The expression of 8OHdG and TUNEL immunoreactivity in the CA1 region of the hippocampus on the ischemia side were first observed at 6h in the pMCAO group and intensified during the remainder of induced ischemia (F=9.23 and 10.46 respectively,P＜0.05 for both).Compared with the sham group,8-OHdG expression and TUNEL immunoreactivity in the pMCAO group were at nearly the same levels from 24 h to 72h.Conclusions Oxidative DNA damage occurs in hippocampus regions of the rat brain after experimentally induced focal cerebral ischemia of the middle cerebral artery.APE expression declines in regions distant from focal cerebral ischemia.Development and accumulation of oxidative DNA damage can induce apoptosis in certain brain regions.