BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia in the elderly. This study aimed to evaluate urban-rural disparities in its prevalence and management in elderly Chinese. METHODS: Consecutive participants aged ≥ 65 years attending outpatient clinics were enrolled for AF screening using handheld single-lead electrocardiogram (ECG) from April 2017 to December 2022. Each ECG rhythm strip was reviewed from the research team. AF or uninterpretable single-lead ECGs were referred for 12-lead ECG. Primary study outcome comparison was between rural and urban areas for the prevalence of AF. The Student's t-test was used to compare mean values of clinical characteristics between rural and urban participants, while the Pearson's chi-square test was used to compare between-group proportions. Multivariate stepwise logistic regression analysis was performed to estimate the association between AF and various patient characteristics. RESULTS: The 29,166 study participants included 13,253 men (45.4%) and had a mean age of 72.2 years. The 7073 rural participants differed significantly (P ≤ 0.02) from the 22,093 urban participants in several major characteristics, such as older age, greater body mass index, and so on. The overall prevalence of AF was 4.6% (n = 1347). AF was more prevalent in 7073 rural participants than 22,093 urban participants (5.6% vs. 4.3%, P < 0.01), before and after adjustment for age, body mass index, blood pressure, pulse rate, cigarette smoking, alcohol consumption and prior medical history. Multivariate logistic regression analysis identified overweight/obesity (OR = 1.35, 95% CI: 1.17-1.54) in urban areas and cigarette smoking (OR = 1.62, 95% CI: 1.20-2.17) and alcohol consumption (OR = 1.42, 95% CI: 1.04-1.93) in rural areas as specific risk factors for prevalent AF. In patients with known AF in urban areas (n = 781) and rural areas (n = 338), 60.6% and 45.9%, respectively, received AF treatment (P < 0.01), and only 22.4% and 17.2%, respectively, received anticoagulation therapy (P = 0.05). CONCLUSIONS In China, there are urban-rural disparities in AF in the elderly, with a higher prevalence and worse management in rural areas than urban areas. Our study findings provide insight for health policymakers to consider urban-rural disparity in the prevention and treatment of AF.

Objective:To explore the application efficacy of Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy in elderly female patients with internalrectal prolapse of qi deficiency type after surgery.Meth-ods:A total of 71 olderly female patients with internal rectal prolapse of qi deficiency type admitted to the Depart-ment of Anorectal Surgery of our Hospital from February 2023 to October 2024 were selected and randomly divided into a treatment group of 36 cases and a control group of 35 cases.Both groups were treated with modified Gant sur-gery.The treatment group received oral administration of Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy after surgery,while the control group received no Traditional Chinese medicine intervention.Results:Post-operative symptoms such as defecation disorders and rectal bearing-down sensation in both groups were significantly improved compared with those before surgery(P<0.05).The treatment group showed significantly better improvement in symptoms such as defecation disorders,rectal bearing-down sensation,and at 6 months after surgery compared with the control group(P<0.05).The scores of the Constipation Severity Index(CSI)in both groups were significantly lower after surgery than before(P<0.05),and the scores of the treatment group at 1 month and 6 months after surgery were significantly lower than those of the control group(P<0.05).The rectal contraction pressure and rectal-anal pres-sure gradient in both groups were higher after surgery than before(P<0.05),and the increase was more significant in the treatment group at 1 month and 6 months after surgery(P<0.05).No serious complications occurred in either group after surgery.Conclusion:Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy can improve postop-erative symptoms,defecation disorders,and anorectal function in elderly female patients with internal rectal prolapse of qi deficiency type,and improve the short-term and long-term efficacy of patients after surgery.

This paper systematically summarizes the practical experience of the 2025 Dingri earthquake emergency medical rescue in Tibet. It analyzes the requirements for earthquake medical rescue under conditions of high-altitude hypoxia, low temperature, and low air pressure. The paper provides a detailed discussion on the strategic layout of earthquake medical rescue at the national level, local government level, and through social participation. It covers the construction of rescue organizational systems, technical systems, material support systems, and information systems. The importance of building rescue teams is emphasized. In high-altitude and cold conditions, rapid response, scientific decision-making, and multi-party collaboration are identified as key elements to enhance rescue efficiency. By optimizing rescue organizational structures, strengthening the development of new equipment, and promoting telemedicine technologies, the precision and effectiveness of medical rescue can be significantly improved, providing important references for future similar disaster rescues.

Objective:To explore the application efficacy of Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy in elderly female patients with internalrectal prolapse of qi deficiency type after surgery.Meth-ods:A total of 71 olderly female patients with internal rectal prolapse of qi deficiency type admitted to the Depart-ment of Anorectal Surgery of our Hospital from February 2023 to October 2024 were selected and randomly divided into a treatment group of 36 cases and a control group of 35 cases.Both groups were treated with modified Gant sur-gery.The treatment group received oral administration of Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy after surgery,while the control group received no Traditional Chinese medicine intervention.Results:Post-operative symptoms such as defecation disorders and rectal bearing-down sensation in both groups were significantly improved compared with those before surgery(P<0.05).The treatment group showed significantly better improvement in symptoms such as defecation disorders,rectal bearing-down sensation,and at 6 months after surgery compared with the control group(P<0.05).The scores of the Constipation Severity Index(CSI)in both groups were significantly lower after surgery than before(P<0.05),and the scores of the treatment group at 1 month and 6 months after surgery were significantly lower than those of the control group(P<0.05).The rectal contraction pressure and rectal-anal pres-sure gradient in both groups were higher after surgery than before(P<0.05),and the increase was more significant in the treatment group at 1 month and 6 months after surgery(P<0.05).No serious complications occurred in either group after surgery.Conclusion:Buzhong Yiqi Decoction combined with Chinese Herbal Pack Therapy can improve postop-erative symptoms,defecation disorders,and anorectal function in elderly female patients with internal rectal prolapse of qi deficiency type,and improve the short-term and long-term efficacy of patients after surgery.

Objective:To analyze the clinical characteristics,treatment,and prognosis of adult patients with early T-cell precursor acute lymphoblastic leukemia/lymphoma(ETP-ALL/LBL).Methods:Clinical data of 113 T lymphoblastic leukemia/lymphoma(T-ALL/LBL)patients from January 2006 to January 2019 were collected from three hematology research centers,including Peking University Third Hospital,the First Medical Center of Chinese PLA General Hospital and Institute of Hematology and Blood Diseases Hospital,Chinese Medical University.The clinical characteristics and prognosis of ETP-ALL/LBL patients were analyzed compared with non-ETP-ALL/LBL patients.Results:In 113 T-ALL/LBL patients,13 cases(11.5％)were diagnosed as ETP-ALL/LBL,including 11 males,with a median age of 28(18-53)years.Compared with non-ETP-ALL/LBL patients,there were no significant differences in age,sex,incidence of large mediastinal mass,clinical stage,international prognostic index(IPI)score,white blood cell(WBC)count and lactate dehydrogenase(LDH)level among ETP-ALL/LBL patients.Among 13 ETP-ALL/LBL patients,9 cases(69.2％)achieved complete remission(CR),and there was no statistically significant difference in response rate induced by chemotherapy between ETP-ALL/LBL patients and non-ETP-ALL/LBL patients.Among patients who received chemotherapy without allogeneic hematopoietic stem cell transplantation(allo-HSCT),ETP-ALL/LBL group had a worse 5-year overall survival(OS)rate compared with non-ETP-ALL/LBL group(0 vs 7.1％,P=0.008),while in patients with allo-HSCT,there was no significant difference for 5-year OS rate between the two group(37.5％vs 40.2％,P＞0.05).Multivariate Cox regression analysis showed that CR after induction therapy,allo-HSCT,and LDH level were independent prognostic factors affecting T-ALL/LBL patients.Conclusion:No significant difference in response rate induced by chemotherapy is observed between ETP-ALL/LBL and non-ETP-ALL/LBL patients.Allo-HSCT consolidation after induction of remission therapy may have significant favorable influence on OS for patients with ETP-ALL/LBL.

Objective:To explore the influence of"Internet+"family empowerment health management on nursing effect and cardiac function and its safety in patients with acute myocardial infarction(AMI).Methods:This ran-domized controlled study enrolled 200 AMI patients treated in Affiliated Hospital of Qinghai University between January 2020 and January 2022.They were divided into control group(n=100,routine nursing care)and interven-tion group(n=100,family empowerment health management based on routine nursing care).Left ventricular ejec-tion fraction(LVEF),stroke volume(SV),scores of Morisky Medication Adherence Scale(MMAS-8),General Self-Efficacy Scale(GSES),Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS),and inci-dence of major adverse cardiovascular events(MACE)were compared between two groups at discharge and 3 months after discharge.Results:Compared with patients in control group 3 months after discharge,those in inter-vention group had significant higher scores of GSES[(33.35±1.30)points vs.(37.47±1.33)points],MMAS-8[(5.60±0.20)points vs.(6.64±0.40)points],LVEF[(49.06±1.72)％vs.(54.49±1.91)％]and SV[(32.34±1.31)ml vs.(41.74±2.26)ml],and significant lower scores of SAS[(28.85±2.32)points vs.(18.93±1.14)points],SDS[(30.05±1.16)points vs.(19.30±3.60)points]and incidence of MACE(18.00％vs.8.00％)(P＜0.05 or＜0.01).Conclusion:The"Internet+"family empowerment management model can improve self-efficacy,medication compliance and cardiac function,and can effectively reduce negative emotions and the risk of MACE in patients with acute myocardial infarction,which is worthy of clinical promotion.

Objective To observe the clinical efficacy of Shuangye San(the prescription mainly composed of Mori Folium and Nelumbinis Folium)in the treatment of type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)of spleen deficiency and phlegm stasis type.Methods A total of 80 patients with T2DM complicated with NAFLD of spleen deficiency and phlegm stasis type were randomly divided into a treatment group and a control group,with 40 cases in each group.The control group was treated with conventional western medicine for lowering blood glucose and lipid,protecting liver and lowering enzymes.The treatment group was treated with the granules of Shuangye San orally on the basis of treatment for the control group.The course of treatment lasted for three months.The changes of traditional Chinese medicine(TCM)syndrome scores,homeostasis model assessment of insulin resistance(HOMA-IR),fasting insulin(FINS),fasting blood glucose(FBG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1C),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),liver function indicators and B-ultrasound grading of fatty liver in the two groups were observed before and after treatment.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)After three months of treatment,the total effective rate of the treatment group was 85.00％(34/40),and that of the control group was 70.00％(28/40).The intergroup comparison(tested by chi-square test)showed that the efficacy of the treatment group was significantly superior to that of the control group(P＜0.01).(2)After treatment,the scores of TCM symptoms of obese physique,heaviness and weakness in the limbs,shortness of breath and unwilling to talk,tightness and stabbing pain in the chest,abdominal distension and poor appetite in the two groups were decreased compared with those before treatment(P＜0.05),and the decrease of TCM syndrome scores in the treatment group was significantly superior to that in the control group(P＜0.05).(3)After treatment,the levels of glucose and lipid metabolism indicators of FINS,HOMA-IR,FBG,2hPG,HbA1C,TC,TG and LDL-C in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the level of HDL-C was significantly increased compared with that before treatment(P＜0.05).The decrease of FINS,HOMA-IR,FBG,2hPG,HbA1C,TC,TG and LDL-C levels and the increase of HDL-C levels in the treatment group were significantly superior to those in the control group(P＜0.05).(4)After treatment,the levels of liver function indicators of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and gamma-glutamyl transpeptidase(GGT)in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of liver function indicators in the treatment group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the B-ultrasound grading of fatty liver of the two groups was significantly improved compared with that before treatment(P＜0.05),and the improvement of fatty liver B-ultrasound grading in the treatment group was significantly superior to that in the control group,and the difference was statistically significant(P＜0.05).(6)During the treatment,there were no adverse reactions such as impairment of liver and kidney function and abnormalities in routine blood,urine and stool test in the two groups.Conclusion Shuangye San exerts certain effect in the treatment of T2DM complicated with NAFLD of spleen deficiency and phlegm stasis type.It can alleviate the clinical symptoms of patients,correct the disorder of glucose and lipid metabolism,and improve liver function and fatty liver B-ultrasound grading.

Objective To explore the application effect and safety of general anesthesia with different doses of remimazolam during vascular intervention anesthesia of intracranial aneurysms.Methods Patients with intracranial aneurysms were divided into high,middle and low dose groups according to the random number table method.The venous access was opened after the patients entered the room,and the vital signs were closely monitored.The low,middle and high dose groups were intravenously injected with 0.25,0.30 and 0.35 mg·kg-1remazolam,respectively.After the loss of consciousness,alfentanil and mivacurium chloride were given for anesthesia induction.The anesthetic effect,recovery quality,hemodynamic indexes,cerebral hemodynamic indexes and neurological function indexes before anesthesia induction(T0),at the time of laryngeal mask insertion(T1),embolization(T2),5 min after operation(T3)and 30 min after operation(T4)were compared among the three groups.The incidence of postoperative cerebral vasospasm(CVS),delayed ischemic neurological dysfunction(DIND)and the incidence of adverse drug reactions related to anesthesia were counted.Results The onset times of anesthesia in the high,middle,and low dose groups were(5.03±1.28),(5.17±1.09),and(7.21±1.15)min,respectively;the number of anesthesia rescue interventions were(0.12±0.02),(0.21±0.06),and(1.51±0.23)times,respectively.There was statistically significant difference in the number of rescue interventions between the high and middle dose groups compared to the low dose group(all P＜0.05).The therapeutic efficacy rates of flumazenil in the high,middle,and low dose groups were 18.18％,11.11％and 2.86％,respectively.the mean arterial pressure(MAP)at T2 were(87.06±6.02),(86.85±5.61)and(81.09±5.37)mmHg;the MAP at T4 were(92.05±5.13),(87.57±6.29)and(84.42±5.16)mmHg,respectively.There was statistically significant difference in MAP between the high and low dose groups(all P＜0.05).There were no statistically significant differences in heart rate(HR),oxygen saturation(SpO2),left peak systolic velocity of middle cerebral artery(Vp-MCA),left mean systolic velocity of middle cerebral artery(Vm-MC)and pulsatility index(PI),S100β protein,and neuron-specific enolase(NSE)levels among the three groups at different time points(all P＞0.05).There were no statistically significant differences in the incidence rates of cardiovascular system complications,delayed postoperative cognitive dysfunction,or anesthesia-related adverse reactions between the three groups(all P＞0.05).Conclusion The safety of different doses of remimazolam general anesthesia in the vascular interventional therapy of intracranial aneurysms is high,and the effects on cerebral hemodynamics and neurological function are similar.However,high-dose remimazolam have shorter general anesthesia induction time and less intraoperative anesthesia remedy frequency while the high-dose remimazolam has higher postoperative flumazenil antagonist therapy.

Objective To study the correlation between traditional Chinese medicine(TCM)constitution and pathogenic factors in patients with ankylosing spondylitis(AS).Methods One hundred patients of AS and their family members who had medical consultation in the Fifth Hospital of Xi'an(i.e.,Shaanxi Hospital of Integrated Traditional Chinese and Western Medicine)in August 2019 and September 2020 were selected as the study subjects.The guidelines of Classification and Determination of Traditional Chinese Medicine Constitution issued by the China Association of Chinese Medicine were adopted to determine the traditional Chinese medicine(TCM)constitution types of the study subjects.The sociodemographic information,living habits,clinical symptoms,and TCM constitution types of the AS patients and their family members were collected by means of questionnaires and clinical investigations,and then the pathogenic factors of the patients with AS were investigated.The binomial Logistic regression model was used to analyze the correlation between TCM constitution types and pathogenic factors in patients with AS.Results(1)Among the 100 AS patients,the majority of them had the biased constitutions,and the biased constitutions with the occurrence frequency in descending order were yang deficiency constitution,qi deficiency constitution,and damp-heat constitution,which accounted for 33.00%,14.00%,and 18.00%,respectively.(2)The prevalence rates of AS in the first-,second-,and third-degree relatives of AS patients were 56.25%,40.00%and 25.00%,respectively.For the positive rates of human leukocyte antigen B27(HLA-B27)in AS patients and their family members,HLA-B27 in AS patients was all positive,while the positive rates of HLA-B27 in the first-,second-,and third-degree relatives of AS patients were 44.31%,30.67%and 15.63%,respectively.(3)The results of regression analysis showed that the disease duration of AS patients was significantly correlated with qi deficiency constitution,the grading of sacroiliac arthritis was correlated with qi stagnation constitution,and age was correlated with blood stasis constitution(P＜0.05 or P＜0.01).The results indicated that disease duration and age were the important factors affecting the constitution types of AS patients,and disease duration was closely related to qi deficiency while age was closely related to blood stasis.Conclusion AS is a highly hereditary autoimmune disease,and its onset is associated with HLA-B27.Yang deficiency is the basic constitution type of AS,and damp-heat constitution is the main constitution type in the progression of AS(especially in the active stage of the disease).The prolongation of the disease will exacerbate the illness condition of AS and then the manifestations of qi deficiency will be more obvious.

This study aims to investigate the protective effect and potential mechanism of Jingfang Granules(JF) on the mouse model of chronic fatigue syndrome(CFS). Mice were randomized into normal, model, and low-, medium-, and high-dose(0.9, 1.8, and 3.6 g·kg~(-1)·d~(-1), respectively) JF groups according to the body weight. In addition to the normal group, other groups of mice received exhaustive swimming training and tail suspension training every day for the modeling of CFS. The mice in each administration group were administrated with JF at the corresponding dose by gavage, and those in the other groups were administrated with an equal amount of purified water. The exhaustive swimming and tail suspension tests were conducted in each group. The UV-glutamate dehydrogenase method was used to determine the serum level of urea nitrogen(UREA), and the lactate dehydrogenase(LDH) assay kit was used to determine the LDH level. Enzyme-linked immunosorbent assay was employed to measure the levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the serum, muscle tissue, and brain tissue of mice in each group. Western blot was employed to determine the expression levels of Toll-like receptor 4(TLR4), myeloid differentiation factor 88(MyD88), nuclear factor-kappa B(NF-κB) and their phosphorylated proteins in the muscle tissue of mice. The 16S rDNA sequencing and ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS) were adopted to detect the changes of intestinal flora and intestinal metabolites in mice. Compared with the model group, JF significantly prolonged the swimming exhaustion time and shortened the tail suspension time of the model mice, lowered the levels of LDH and UREA in the serum as well as the levels of IL-6 and TNF-α in the serum, muscle tissue, and brain tissue of CFS mice. In addition, JF down-regulated the expression of TLR4, MyD88, and p-NF-κB/NF-κB in the muscle tissue of CFS mice compared with the model group. The results of 16S rDNA sequencing demonstrated that JF ameliorated the intestinal flora disorder of CFS mice. The results of UPLC-MS/MS revealed that JF significantly affected the histidine metabolism pathway in the intestinal tract of CFS mice. Spearman analysis displayed that histamine, a metabolite involved in histidine metabolism, was negatively correlated with the abundance of Clostridia＿UCG-014, Dubosiella, and RF39 and positively correlated with the abundance of Coriobacteriaceae＿UCG-002. The metabolite imidazole-4-acetaldehyde was negatively correlated with the abundance of Clostridia＿UCG-014, Dubosiella, and RF39 and positively correlated with the abundance of Coriobacteriaceae＿UCG-002. In conclusion, JF can increase the swimming exhaustion time, reduce the immobility time of tail suspension, lower serum LDH and UREA levels, and alleviate inflammation response. It may exert the therapeutic effect by improving intestinal flora homeostasis and inhibiting histidine metabolism by down-regulating the expression of proteins in the TLR4/MyD88/NF-κB signaling pathway, thereby relieving the symptoms of CFS in mice.
Animals ; Mice ; Gastrointestinal Microbiome/drug effects* ; Drugs, Chinese Herbal/administration & dosage* ; Male ; Metabolomics ; Fatigue Syndrome, Chronic/genetics* ; NF-kappa B/genetics* ; Humans ; Interleukin-6/genetics* ; Myeloid Differentiation Factor 88/genetics* ; Toll-Like Receptor 4/genetics* ; Tumor Necrosis Factor-alpha/genetics* ; Disease Models, Animal