BACKGROUND: Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China. METHODS: Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate. RESULTS: Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05). CONCLUSIONS: This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics. REGISTRATION ClinicalTrials.gov , NCT03484806.
Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Heart Valve Diseases/therapy* ; Kaplan-Meier Estimate ; Tertiary Care Centers ; Treatment Outcome

Teaching clinics represent a unique form of outpatient training of resident physicians and serve as a crucial instrument and core component of standardized training of general practice residents. This article reviews the common model and innovations of teaching clinics of general practice in China, and analyzes their reported effectiveness in enhancing the capabilities of consultation of resident physicians, the teaching capabilities of general practice trainers, as well as satisfaction levels of involved participants. It outlines the challenges encountered in implementing teaching clinics, including inadequate teaching facilities and equipment, incomplete incentive system for teaching, difficulties in patient recruitment, and weaknesses in the teaching capabilities of trainers. To address these challenges, this article proposes corresponding strategies based on realistic needs, including the improvement of facilities and equipment in teaching clinics, the establishment of incentive systems for teaching clinics, the expansion of patient recruitment channels for teaching clinics, and the enhancement of training for trainers' teaching capabilities. This is envisaged to provide both theoretical bases and practical guidance for the effective execution and standardized development of teaching clinics in general practice residency training bases.

This study introduced the development, qualification requirements, training contents and methods, practice authority and field, practice management and safety of specialist nurses' multi-sitepractice, elaborated the development status of multi-site practice of nurses in foreign countries, summarized international experience, combined with the national conditions, explored the development mode of multi-point practice of specialist nurses in China, with a view to providing domestic specialized nurses with multi-site practice. It also provides suggestions for managers to formulate relevant policies and develop localized multi-site practice.

0bjective The cognitive intervention effects of different forms of virtual reality technology in mild cognitive impairment (MCI) patients were systematically evaluated to find the best form of virtual reality intervention in MCI patients. Methods The computer searched of CNKI, Wanfang, VIP, CBM, PubMed, Embase and Cochrane Library included literatures on virtual reality technology intervention for MCI patients for evaluation. Results 5 randomized controlled trials were included, a total of 232 participants were in, the intervention group was 115 participants,control group was 117 participants, the results showed that virtual reality memory training had greatly improved cognitive function (P<0.01), Virtual reality program training, double interactive virtual reality technology therapy and virtual reality rehabilitation training system combined with primary meridian acupuncture therapy can improve the cognitive ability of MCI patients (P<0.05). The virtual reality dual task training has no statistical significance for the improvement of cognitive function (P>0.05). Conclusions Virtual reality technology intervention for MCI patients is an effective way to improve the cognitive ability of patients.

This paper summarizes the application of virtual reality technology in rehabilitation management of breast cancer patients, and its impact on rehabilitation management of breast cancer patients. It mainly involves: improving psychological status, reducing anxiety; reducing the incidence of cancer-related fatigue; reducing pain, improving quality of life; improving patient compliance, effectively promoting the recovery of body function; increasing patients' knowledge of disease awareness rate. It is pointed out that the research of virtual reality in China is at the initial stage, and the types of virtual situation intervention are relatively few. In the future development, the evaluation criteria of rehabilitation training should be improved on the basis of adding virtual situation.

Objective This paper analyzes the current development trends and present situation of health management specialist in China and aims to lay a foundation for an exploration of the new domestic health management model. Methods Using "health management specialist" as a theme in the CNKI database from June 2005 to May 2018, 476 results were retrieved after refining, and the CiteSpace software was introduced to analyze the network, organization, and time development trends of the key words. The family group was analyzed and verified. Results Research on health management specialist showed an increasing trend between June 2005 and May 2018. By 2013, the annual number of articles fluctuated from 15 to 35. Since 2014, the growth rate has been relatively fast, with the highest volume in 2018, reaching 75; the top four high-frequency keywords were"health management specialist""health management""health examination"and"hierarchical medical system". The regional and institutional distribution of health management specialist is mainly in southern cities. Conclusions The related research on health management specialist shows an increasing trend year by year, and is focused on health management, physical examination, and grading treatment. The distribution of health management specialist in China is obviously uneven.

Objective To investigate the sleep features in the patients with irritable bowel syndrome (IBS) and compare the sleep quality between those IBS patients who were with and without anxiety and depression.Methods Pittsburgh sleep quality index questionnaire (PSQI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were measured in the 145 IBS patients and 59 regular physical examination volunteers.IBS patients were also divided into two subgroups-patients with or without anxiety and depression based on cutoff scores of SAS and SDS.Comparisons of sleep quality were made between subgroups, and between IBS patients and volunteer controls.Results Compared with the controls,the SAS raw score, SDS raw score and SAS positive incidence in IBS patients were shown statistically significant differences (P ＜ 0.05 ), while the SDS positive incidence had no statistically significant difference(P ＞ 0.05 ).PSQI total scores were significantly higher in the IBS patients without anxiety and depression (P ＜ 0.05), 3 domains (sleep quality, sleep disturbances and daytime function disorder) were also found statistically significant differences ( P ＜ 0.05 ), compared with the controls.The IBS patients with anxiety and depression were statistically significantly different from the controls ( P ＜ 0.05 ) in 6 domains (sleep quality, sleep latency, sleep efficiency, sleep disturbances, sleep time and daytime function disorder) and significantly higher PSQI total scores( P ＜ 0.05 ).Statistically significant differences (P ＜0.05) were also found in all 7 domains and with higher PSQI total scores in IBS patients with anxiety and depression, compared with IBS patients without anxiety and depression.Conclusions IBS patients were more likely to have sleep abnormality, mainly in sleep quality, sleep disturbances and daytime function disorder and PSQI total scores.The abnormalities of these factors were independent of emotional disorder.However, emotional disorder worsened the sleep disorder in IBS patients.

Background and purpose: Multidrug resistance (MDR) of tumor cell is the main reason for clinical chemotherapy failure as well as cancer recurrence and metastasis. This study was to construct a lentiveral vector of RNA interference of MDR1 gene and observe its inhibitive role on the expression of MDR1 in A549 and A549/DDP cells. Methods: Oligos of base pairs for hairpin RNA targeting MDR1 were chemically synthesized. Via annealing and inserting them into the down-stream of H1 promoter of linearized pSUPER, we obtained the siRNA constructs for MDR1, which were afterwards transfected into A549, a human lung cancer cell line expressing high level MDR1, the impact of constructs was observed on the expression and interference efficiency of siRNA against MDR1. The effective sequence of siRNA targeting MDR1 gene was confirmed. Both sense and antisence oligo DNA of the targeting sequence was designed, synthesized and cloned into the PTM vector, containing a promoter and a green fluorescent protein (GFP). The resulting lentiviral vector containing MDR1 siRNA was named PTM-siMDR1 and then transfected into A549 and A549/DDP cells after being confirmed by PCR and sequencing. Results: Restriction digestion and DNA sequencing showed that the siRNA constructs for MDR1 were successfully produced and the expressed siRNA could effectively down-regnlate the expression of MDRI. PCR demonstrated that the lentivirus RNAi vector of MDR1 producing PTM-siMDR1 was constructed successfully. The chemosensitivity of A549/DDP cells to cisplatin were enhanced obviously after trartsfection. Conclusion: The lentivirus RNAi vector of MDR1 can significantly revise the resistance ofA549/ DDP cells with eisplatin after infection.

OBJECTIVE:To analysis the distribution and antibiotic resistance of common isolated pathogenic bacteria in urinary-tract infection cases in our hospital so as to provide scientific basis for the rational clinical use of antibacterials.MET-HODS:625 urine samples were collected from urinary-tract infection cases in our hospital in 2006,from which,344 strains of bacteria were isolated,which were cultured and subjected to drug sensitivity test.RESULTS:Of the 344 strains of bacteria,Gram-negative bacilli took the lead,accounting for 60.2% of the total,followed by Gram-positive cocci(33.4%) and fungi(6.4%).The detection rates of ESBLs-producing Escherichia coli.and Klebsiella pneumoniae were 49.2% and 27.3%,respectively.The bacteria had different resistant rate to different antibiotics and were multidrug resistant.CONCLUSION:Bacterial culture of urine and drug-sensitivity test should be performed promptly and drugs should be used with prudence for urinary infection cases to reduce drug-resistance bacteria.