Objective:To evaluate the effectiveness of a family physician-integrated "Pulmonary Health Home" (PHH) grid management model for community-based prevention and management of chronic obstructive pulmonary disease (COPD).Methods:A randomized controlled trial (RCT) was conducted in Machong Town of Dongguan City from October 1st 2021 to September 30th 2024. The PHH platform was established, screening high-risk populations using the COPD Screening Questionnaire (COPD-SQ). Individuals scoring ≥16 underwent confirmatory pulmonary function tests (post-bronchodilator FEV?/FVC<0.7). A total of 120 clinically stable COPD patients were randomized to either the intervention group (PHH platform management) or control group (routine care). Outcomes including smoking behavior, COPD Assessment Test (CAT) scores, modified Medical Research Council (mMRC) dyspnea scale scores, frequency of acute exacerbations, and other indicators were assessed before the preintervention and after one year of management.Results:Among 4 572 screened individuals, 345 COPD cases were confirmed (detection rate: 7.55%), representing a 259% increase from the pre-intervention baseline (96 cases). After one year, compared to controls, the intervention group showed: significantly lower annual cigarette consumption (165.8±61.3 vs. 321.3±70.2, t=12.856),greater reduction in CAT scores (16.06±5.92 vs. 19.25±5.24, t=3.182), fewer acute exacerbations (0.71±0.32 vs. 2.46±0.48 times/year, t=24.503), higher patient satisfaction (87.9%(51/58) vs. 62.5%(35/56), χ2=10.203), better mastery of inhalation technique (82.4% (48/58) vs. 48.2%(27/56), χ2=13.843), increased clinician-patient interactions (13.5±3.2 vs. 4.2±1.5 times/year, t=19.876) (all P<0.05). Conclusion:The family physician-integrated PHH grid management model significantly enhances community-based COPD outcomes.

Objective:To evaluate the effectiveness of a family physician-integrated "Pulmonary Health Home" (PHH) grid management model for community-based prevention and management of chronic obstructive pulmonary disease (COPD).Methods:A randomized controlled trial (RCT) was conducted in Machong Town of Dongguan City from October 1st 2021 to September 30th 2024. The PHH platform was established, screening high-risk populations using the COPD Screening Questionnaire (COPD-SQ). Individuals scoring ≥16 underwent confirmatory pulmonary function tests (post-bronchodilator FEV?/FVC<0.7). A total of 120 clinically stable COPD patients were randomized to either the intervention group (PHH platform management) or control group (routine care). Outcomes including smoking behavior, COPD Assessment Test (CAT) scores, modified Medical Research Council (mMRC) dyspnea scale scores, frequency of acute exacerbations, and other indicators were assessed before the preintervention and after one year of management.Results:Among 4 572 screened individuals, 345 COPD cases were confirmed (detection rate: 7.55%), representing a 259% increase from the pre-intervention baseline (96 cases). After one year, compared to controls, the intervention group showed: significantly lower annual cigarette consumption (165.8±61.3 vs. 321.3±70.2, t=12.856),greater reduction in CAT scores (16.06±5.92 vs. 19.25±5.24, t=3.182), fewer acute exacerbations (0.71±0.32 vs. 2.46±0.48 times/year, t=24.503), higher patient satisfaction (87.9%(51/58) vs. 62.5%(35/56), χ2=10.203), better mastery of inhalation technique (82.4% (48/58) vs. 48.2%(27/56), χ2=13.843), increased clinician-patient interactions (13.5±3.2 vs. 4.2±1.5 times/year, t=19.876) (all P<0.05). Conclusion:The family physician-integrated PHH grid management model significantly enhances community-based COPD outcomes.

Objective:To compare the differences in low-level physical activity (PA) and related influencing factors in patients with diabetes mellitus in China and the United Kingdom (UK).Methods:Using baseline survey data from the China Kadoorie Biobank and the UK Biobank, we analyzed the association between diabetes mellitus and low-level PA using logistic regression, with the participants' self-reported whether they had diabetes mellitus as the independent variable, and low-level PA as the dependent variable.Results:We included 509 254 Chinese adults and 359 763 British adults in the analysis. After adjusting for multiple factors, we found that both Chinese and British patients with diabetes mellitus were at elevated risk for low-level PA, with corresponding ORs (95% CIs) of 1.15 (1.12-1.19) and 1.37 (1.32-1.41), respectively. Patients with diabetes mellitus with longer disease duration and poorer glycemic control were at greater risk of having low-level of PA. Female, rural-distributed, employed, never-smoking Chinese diabetics, and male, urban-distributed, retired/unemployed, quit-smoking British diabetics were more likely to have low-level PA. Conclusions:Chinese and British patients with diabetes mellitus were more likely to have low-level PA compared with the general population, but the risk of low-level PA for patients in both countries varied by population characteristics. Therefore, PA guidelines and intervention measures should be based on the characteristics of individuals in the target countries and regions, which could improve PA levels among patients with diabetes mellitus.

Objective:To explore the differences of physical activity levels between Chinese and British patients with cardiovascular disease (CVD) and its influencing factors.Methods:Based on the baseline survey of China Kadoorie Biobank (CKB) and United Kingdom Biobank (UKB), we identified the case and control group according to the self-reported disease history in the questionnaire. Metabolic equivalent of task, as the assessment of physical activity level, was graded according to the tertiles of specific ages and genders. Multiple logistic regression models were used to analyze the correlation between CVD status and physical activity levels.Results:We included 509 170 Chinese adults and 360 360 British adults in the analysis. After adjusting for multiple factors, we found a positive correlation between CVD patients and low physical activity levels in both CKB and UKB populations (CKB: OR=1.21, 95% CI:1.17-1.25; UKB: OR=1.24, 95% CI:1.20-1.28). There was a high correlation between the prevalence of CVD and low physical activity levels in males with CKB ( OR=1.33, 95% CI:1.27-1.40).Unlike the UKB population, as the length of CVD increased, the physical activity levels of CKB patients gradually approached that of the non-CVD population, and stroke was positively correlated with low physical activity levels ( OR=1.46, 95% CI:1.38-1.53). The decline in physical activity was more pronounced among CKB and UKB CVD patients with lower educational levels, current or former smokers or drinkers, and those with other chronic diseases. In CKB, there showed a high correlation between CVD disease and low physical activity levels in rural areas and non-retired populations. In UKB, there appeared a higher correlation between CVD disease and low physical activity levels in urban and non-working populations. Conclusions:The physical activity levels of CVD patients in both China and the UK were lower than that in non-CVD population. In addition to low-educated individuals, current or former smokers or drinkers, and those with other chronic diseases, it is critical to pay attention to the physical activity levels of rural, male, and non-retirees among Chinese patients.

Objective:To compare physical activity and its influencing factors in patients with chronic obstructive pulmonary disease (COPD) between China and the United Kingdom.Methods:We analyzed baseline data from China Kadoorie Biobank and the United Kingdom Biobank among COPD patients who were diagnosed with a one-second rate (FEV 1/FVC) less than 70%. Physical activity level was calculated as metabolic equivalent (MET) and divided into three levels: low, medium, and high, according to tertiles stratified by gender and age. Multiple logistic regression was used to estimate ORs and 95% CIs for COPD and Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade about physical activity level, and subgroup analysis was conducted. Results:A total of 506 073 Chinese adults and 231 884 British adults were included. After adjusting for potential confounders, COPD was associated with lower physical activity levels in both Chinese and British COPD patients, with OR (95% CI) of 1.07(1.03-1.10) and 1.03(1.01-1.06) compared with non COPD patients, respectively. The GOLD grade was inversely correlated with physical activity level, particularly in a dose-response manner in the CKB population (trend test P<0.001). The negative relationship was stronger among the elderly, people with less education and lower economic status, and those with a smoking or chronic disease history. Chinese rural COPD patients were at high risk of decline of physical activity. Conclusions:Physical activity is inversely related to COPD, with a dose-response connection to GOLD grade. Therefore, physical activity maintenance and improvement should be encouraged and promoted in COPD patients, especially in high-risk groups.

Objective:To investigate risk factors of nerve injury after carotid body tumor resection.Methods:From 1991 to 2016, the clinical data of patients with neurologic complications after resection of carotid body tumor was retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors of nerve injury.Results:A total of 132 patients with 142 tumors underwent surgery. 45 patients (46 sides) suffered nerve injury, including 4 strokes and 44 nerve injuries. After active rehabilitation, 18 cases were left with permanent nerve injury, and the 4 patients with strokes regained self-care ability. By multivariate regression analysis, high-lying tumors ( OR=4.345, P=0.005), Shamblin Ⅲ tumor ( OR=4.382, P=0.047) increase the risks of postoperative nerve injury. Resection of high-lying tumors carried a higher risk of developing permanent nerve injury ( OR=7.290, P=0.001). Conclusions:Neurologic complication could be alleviated by rehabilitation. Intraoperative abrupt rupture of carotid artery is the leading cause of stroke. Shamblin Ⅲ and high-lying tumor are the predictors of postoperative nerve injury.

Objective:To examine the mid- and long-term outcomes of endovascular aneurysm repair (EVAR).Methods:This was a retrospective cohort study of 540 patients with abdominal aortic aneurysm who received EVAR at Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University from January 2009 to December 2018. There were 503 males and 37 females, aged of (69±8) years (range: 44 to 87 years). Clinical data including concomitant disease, aneurysm size and surgical data were collected and patients were followed up after operation. The cumulative survival rate was assessed using the Kaplan-Meier estimator and multivariate Cox regression was used to analyze the independent prognosis factors.Results:The technical success rate was 91.1% (492/540). The perioperative mortality rate was 1.3% (7/540) and the follow-up rate was 91.7% (489/533). The median follow-up time was 45(63) months (range: 1 to 133 months). The all-cause mortality rate was 21.3% (104/489) and the aneurysm-related mortality rate was 6.3% (31/489) during follow-up period. The overall cumulative survival rate of 1-, 3-, 5- and 10-year were 95.1%, 84.0%, 69.5% and 38.6%, respectively, while freedom from aneurysm-related death were 98.4%, 93.3%, 88.4% and 84.4%. During the follow-up period, the complications rate was 9.0% (44/489), and the re-intervention rate was 4.9% (24/489). Cox regression analysis showed that elder age ( HR=2.15, 95 %CI: 1.41 to 3.26, P<0.01), preoperative aneurysm rupture ( HR=2.72, 95 %CI: 1.78 to 4.15, P<0.01) and short neck aneurysm ( HR=1.97, 95 %CI: 1.07 to 3.61, P=0.029) were independent prognosis factors for long-term survival after EVAR. Connclusion:EVAR has low perioperative mortality, high technical success rate, and satisfactory mid-and long-term outcomes.

Objective:To examine the mid- and long-term outcomes of endovascular aneurysm repair (EVAR).Methods:This was a retrospective cohort study of 540 patients with abdominal aortic aneurysm who received EVAR at Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University from January 2009 to December 2018. There were 503 males and 37 females, aged of (69±8) years (range: 44 to 87 years). Clinical data including concomitant disease, aneurysm size and surgical data were collected and patients were followed up after operation. The cumulative survival rate was assessed using the Kaplan-Meier estimator and multivariate Cox regression was used to analyze the independent prognosis factors.Results:The technical success rate was 91.1% (492/540). The perioperative mortality rate was 1.3% (7/540) and the follow-up rate was 91.7% (489/533). The median follow-up time was 45(63) months (range: 1 to 133 months). The all-cause mortality rate was 21.3% (104/489) and the aneurysm-related mortality rate was 6.3% (31/489) during follow-up period. The overall cumulative survival rate of 1-, 3-, 5- and 10-year were 95.1%, 84.0%, 69.5% and 38.6%, respectively, while freedom from aneurysm-related death were 98.4%, 93.3%, 88.4% and 84.4%. During the follow-up period, the complications rate was 9.0% (44/489), and the re-intervention rate was 4.9% (24/489). Cox regression analysis showed that elder age ( HR=2.15, 95 %CI: 1.41 to 3.26, P<0.01), preoperative aneurysm rupture ( HR=2.72, 95 %CI: 1.78 to 4.15, P<0.01) and short neck aneurysm ( HR=1.97, 95 %CI: 1.07 to 3.61, P=0.029) were independent prognosis factors for long-term survival after EVAR. Connclusion:EVAR has low perioperative mortality, high technical success rate, and satisfactory mid-and long-term outcomes.

Objective To investigate the expression characteristics of epidermal growth factor-like domain 7 ( egfl 7 ) in arteriosclerosis obliterans ( ASO) tissues and abdominal aortic aneurysm ( AAA ) tissues, and it's role in atherosclerosis (AS).Methods In this study, 8 normal artery, 11 lower extremity ASO and 34 AAA samples were collected.Immunohistochemistry and in situ hybridization were performed in artery sections to investigate the expression characteristics of egfl 7 at protein and mRNA levels.The relative quantitative detection of egfl 7 mRNA was detected by qRT-PCR.The effect of egfl 7 was examined by RNA interference.Results In ASO and AAA samples, the expression of egfl 7 protein was mainly in the tunica media; The expression site of egfl 7 mRNA was the same as that of egfl 7 protein.Compared with normal artery samples, the expression of egfl 7 mRNA was significantly upregulated in the early stage of ASO samples and AAA samples (325 ± 120 vs.100 ± 36, P ＜ 0.01, 216 ± 133 vs.100 ± 36, P ＜ 0.05 ).Compared with the control group, the proliferative ability of smooth muscle cells was significantly down regulated after egfl 7 interference (0.85 ± 0.05 vs.1.34 ± 0.04, P ＜ 0.01).Conclusions egfl 7 might be a gene that regulates the pathogenic process of atherosclerosis through promoting vascular smooth muscle cell proliferation.

Objective To explore the diagnostic performance of 64-slice spiral CT combined with exercise treadmill test for coronary artery disease ( CAD). Methods Eighty-six patients suspected of CAD were divided into low risk group, intermediate risk group and high risk group according to estimated pretest probabilities of CAD. All patients underwent coronary angiography, 64-slice spiral CT and exercise treadmill test. With coronary artery stenosis rate >50% as positive findings, the sensitivity, specificity, positive predictive value ( PPV), negative predictive value ( NPV) and accuracy of 64-slice spiral CT and 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were calculated. Results With coronary angiography as the "golden criteria", the sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT in diagnosis of CAD were 95.2% , 88.6% , 88.9% , 95.1% and 91.9% , respectively. The sensitivity of low risk group, intermediate risk group and high risk group was 100% , 100% and 92.6%, specificity was 94.4% , 94.1% and 66.7%, PPV was 80.0%, 91.7% and 89.3%, NPV was 100% , 100% and 75.0%, and accuracy was 95.5% , 96.4% and 86.1%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were 97.6%, 97.7%, 97.6%, 97.7% and 97.7%, respectively. Conclusion 64-slice spiral CT combined with exercise treadmill test works well in screening CAD, especially for those with a low or intermediate estimated pretest probability.