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 value of P1 response threshold of cortical auditory evoked potential（CAEP） in evaluating the rehabilitation effect of cochlear implant in young children. Methods:Thirty-three young children after cochlear implantation were divided into groups according to hearing age: Group A（hearing age 1-<2 years old） 10 people; Group B（hearing age 2-<3 years old） 13 people; Group C（hearing age 3-<4 years old） 10 people. The subjective assessment was carried out using the assessment tool for hearing-impaired children- "Criteria and Methods for assessing Auditory and language ability of hearing-impaired children" and objective electrophysiological examination was carried out using CAEP to evaluate the rehabilitation effect. SPSS 25.0 software was used for statistical analysis. Results:The results of subjective assessment of auditory ability and language ability in each group showed an increasing trend with the increase of auditory age. In this study, the P1 response threshold of CAEP in CI implanted children had a significant positive correlation with the 2 kHz hearing threshold after intervention, and the P1 response threshold of CAEP was negatively correlated with many items in subjective auditory ability and language ability assessment. Conclusion:The P1 response threshold of CAEP has a stable correlation with the results of speech audiometry, which can effectively and objectively evaluate the postoperative rehabilitation effect of young children with cochlear implantation.
Humans ; Child, Preschool ; Infant ; Male ; Female ; Evoked Potentials, Auditory ; Cochlear Implantation/rehabilitation* ; Cochlear Implants ; Auditory Threshold

Anti-tumor traditional Chinese medicine has a long history of clinic application, in which the star molecules have always been the hotspot of modern drug research, but they are limited by the solubility, stability, targeting, bioactivity or toxicity of the monomer components of traditional Chinese medicine anti-tumor star molecules and other pharmacokinetic problems, which hinders the traditional Chinese medicine anti-tumor star molecules for further clinical translation and application. Currently, the nanosystems prepared by supramolecular technologies such as molecular self-assembly and nanomaterial encapsulation have broader application prospects in improving the anti-tumor effect of active components of traditional Chinese medicine, which has attracted extensive attention from scholars at home and abroad. In this paper, we systematically review the research progress in preparation of supramolecular nano-systems from anti-tumor star molecule of traditional Chinese medicine, and summarize the two major categories and ten small classes of carrier-free and carrier-based supramolecular nanosystems and their research cases, and the future development direction is put forward. The purpose of this paper is to provide reference for the research and clinical transformation of using supramolecular technology to improve the clinical application of anti-tumor star molecule of traditional Chinese medicine.

Objective To explore clinical efficacy of F-type forceps for assisted reduction in femoral shaft fracture reduc-tion.Methods Forty-five patients with femoral shaft fracture treated with intramedullary nail and internal fixation from January 2019 to December 2021 were retrospectively analyzed and divided into two groups according to different reduction methods.In observation group,there were 21 patients,included 15 males and 6 females,aged from 27 to 92 years old with an average of(53.38±18.81)years old;9 patients on the left side,12 patients on the right side;7 patients were type A,8 patients were type B and 6 patients were type C according to AO fracture classification;the time from injury to operation ranged from 7 to 13 days with an average of(4.62±3.34)days;reduction was assisted by F-shaped forceps.In control group,there were 24 patients,in-cluding 17 males and 7 females,aged from 20 to 92 years old with an average of(51.96±20.43)years old;12 patients on the left side,12 patients on the right side;11 patients were type A,8 patients were type B and 5 patients were type C according to AO fracture classification;the time from injury to operation ranged from 2 to 13 days with an average of(6.29±3.04)days;tra-ditional reset mode was adopted.Operative time,intraoperative blood loss,intraoperative fluoroscopy times,intraoperative open reduction ratio,clinical healing time of fracture,postoperative complications,hospital stay,hospital cost and Lysholm score of knee joint at 6 and 12 months after surgery were compared between two groups to evaluate clinical effect.Results All patients were followed up for 12 to 24 months with an average of(16.60±3.45)months.In observation group,operative time,intraoper-ative blood loss,intraoperative fluoroscopy times,open reduction cases,and clinical healing time of fractures were(58.19±7.93)min,(88.10±44.45)ml,(25.29±5.54)times,0 case,(4.76±0.77)months,respectively;while in control group was(79.33±22.94)min,(222.92±144.45)ml,(47.46±26.25)times,5 cases,(7.13±1.80)months,and the difference between two groups were statistically significant(P＜0.05).There were no significant difference in postoperative complications,length of stay and hospitalization cost between two groups(P＞0.05).At 6 months after surgery,Lysholm score of knee joint in observa-tion group(88.62±4.48)was better than that in control group(79.21±8.91)(F=21.948,P=0.000).There were no significant difference in support use,pain and squat score between two groups(P＞0.05).At 12 months after surgery,Lysholm scores of stair climbing and pain in observation group were(9.62±1.20)and(19.76±1.92),which were better than those in control group(7.83±2.04)and(21.88±2.88)(P＜0.05).There were no significant difference in scores and total scores of other items between two groups(P＞0.05).Conclusion Compared with traditional reduction method,F-type forceps instrument could short-en operation time,reduce intraoperative blood loss,reduce intraoperative fluoroscopy times,accelerate clinical healing of frac-ture,and promote earlier functional recovery of knee joint.

Objective To investigate the clinical effect of total hip replacement(THA)in the treatment of traumatic arthritis secondary to acetabular fracture.Methods From October 2019 to June 2022,15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA.There were 8 males and 7 females,aged from 40 to 76 years old with an average of(59.20±9.46)years old.Prosthesis loosening,dislocation of hip joint,range of motion of hip joint,nerve injury and other conditions were recorded before and after surgery.Harris score,visual analogue scale(VAS)and imaging were used to e-valuate hip joint function and surgical effect.Results Follow-up time ranged 6 to 39 months with an average of(18.33±9.27)months.All the 15 patients successfully completed the operation,no nerve and blood vessel injury during the operation,post-operative wound healing was stage Ⅰ,no infection,one case of acetabular side prosthesis loosening at half a year after opera-tion,and recovered well after revision surgery,one case of hip dislocation was cured after open reduction treatment,no adverse consequences.Harris score at the last postoperative follow-up was(88.60±4.01)points,compared with the preoperative(47.20±1 1.77)points,the difference was statistically significant(P＜0.05),and VAS at the lateat postoperative follow-up was 1(1)points,compared with the preoperative 8(2)points,the difference was statistically significant(P＜0.05).At the last follow-up,the pain symptoms were relieved or disappeared,and the joint function was satisfactory.The imaging data of the latest fol-low-up showed joint was well pseudoradiated,no abnormal ossification occurred,and the prosthesis was not loose.Conclusion THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients.Preoperative comprehensive evaluation and bone defect evaluation of patients,and intraoperative manage-ment of acetabulum,femur,internal fixation and bone defect are key factors for the success of surgery.

OBJECTIVE: To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men. METHODS: Our study participants were elderly (≥ 60 years) men recruited in a suburban town of Shanghai. Cigarette smoking status was categorized as never smoking, remote (cessation > 5 years) and recent former smoking (cessation ≤ 5 years), and light-to-moderate (≤ 20 cigarettes/day) and heavy current smoking (> 20 cigarettes/day). Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest. RESULTS: The 1568 participants had a mean age of 68.6 ± 7.1 years. Of all participants, 311 were never smokers, 201 were remote former smokers, 133 were recent former smokers, 783 were light-to-moderate current smokers and 140 were heavy current smokers. During a median follow-up of 7.9 years, all-cause, cardiovascular and non-cardiovascular deaths occurred in 267, 106 and 161 participants, respectively. Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality, with an adjusted hazard ratio (HR) of 2.30 (95% CI: 1.34-4.07) and 3.98 (95% CI: 2.03-7.83) versus never smokers, respectively. Recent former smokers also had a higher risk of all-cause (HR = 1.62, 95% CI: 1.04-2.52) and non-cardiovascular mortality (HR = 2.40, 95% CI: 1.32-4.37) than never smokers. Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter. Further subgroup analyses showed interaction between smoking status and pulse rate (≥ 70 beats/min vs. < 70 beats/min) in relation to the risk of all-cause and non-cardiovascular mortality, with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min. CONCLUSIONS Cigarette smoking in elderly Chinese confers significant risks of mortality, especially when recent former smoking is considered together with current smoking.

Objective: To explore the prognostic factors of extracellular NK/T cell lymphoma (ENKTL) treated with pegaspargase/L-asparaginase. Methods: The clinical data of 656 ENKTL patients diagnosed at 11 medical centers in the Huaihai Lymphoma Working Group from March 2014 to April 2021 were retrospectively analyzed. The patients were randomly divided into two groups: a training set (460 cases) and a validation set (196 cases) at 7∶3, and the prognostic factors of the patients were analyzed. A prognostic scoring system was established, and the predictive performance of different models was compared. Results: Patients' median age was 46 (34, 57) years, with 456 males (69.5% ) and 561 nasal involvement (85.5% ). 203 patients (30.9% ) received a chemotherapy regimen based on L-asparaginase combined with anthracyclines, and the 5-year overall survival rate of patients treated with P-GEMOX regimen (pegaspargase+gemcitabine+oxaliplatin) was better than those treated with SMILE regimen (methotrexate+dexamethasone+cyclophosphamide+L-asparaginase+etoposide) (85.9% vs 63.8% ; P=0.004). The results of multivariate analysis showed that gender, CA stage, the Eastern Cooperative Oncology Group performance status (ECOG PS) score, HGB, and EB virus DNA were independent influencing factors for the prognosis of ENKTL patients (P<0.05). In this study, the predictive performance of the prognostic factors is superior to the international prognostic index, Korean prognostic index, and prognostic index of natural killer lymphoma. Conclusion: Gender, CA stage, ECOG PS score, HGB, and EB virus DNA are prognostic factors for ENKTL patients treated with pegaspargase/L-asparaginase.
Male ; Humans ; Middle Aged ; Asparaginase/therapeutic use* ; Prognosis ; Retrospective Studies ; Lymphoma, Extranodal NK-T-Cell/drug therapy* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Etoposide ; Cyclophosphamide ; Methotrexate/therapeutic use* ; DNA/therapeutic use* ; Treatment Outcome

OBJECTIVE: To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP). METHODS: A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively. RESULTS: All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(P>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05). CONCLUSION For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.
Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Case-Control Studies ; Female ; Fractures, Bone/surgery* ; Humans ; Male ; Pelvic Bones/surgery* ; Retrospective Studies

Objective:To investigate the feasibility and clinical value of MRI quantitative evaluation technique in detecting sternocleidomastoid muscle fibrosis in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.Methods:From August 2019 to March 2021, 45 patients with clinically confirmed NPC after radiotherapy and 30 healthy controls who underwent physical examination in Lishui Hospital of Zhejiang University were enrolled in our study. According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) classification criteria of late radiation reactions respectively, the sternocleidomastoid muscle injury in the NPC group was divided into grade Ⅰ, Ⅱ and Ⅲ, which included 8, 32 and 5 patients respectively. All patients underwent T 1 mapping and T 2 mapping imaging of the neck. Firstly, the mapping images of sternocleidomastoid muscle between the two groups were analyzed and compared. Using NUMARIS/4 software of Siemens image post-processing workstation, the region of interest was manually drawn along the edge of sternocleidomastoid muscle at the level of laryngeal chamber in axial mapping diagram. Then, T 1 and T 2 values and the long and short diameters of sternocleidomastoid muscle were measured respectively. Finally, the differences of the parameters between the two groups were compared by independent sample t-test, Spearman rank correlation was used to analyze the relationship between the average T 1 and T 2 values of bilateral sternocleidomastoid muscles and the grade of late radiation injury. Results:Compared with the control group, the shape of sternocleidomastoid muscle in the NPC group was smaller in shape, with irregular edge and uneven increase of T 1 mapping color scale. There was no significant difference in muscle signal in T 2 mapping. The T 1 values of left and right sternocleidomastoid muscles in the NPC group were (1 524.7±97.6) and (1 496.5±93.2) ms respectively, which were significantly higher than those in the normal control group [(1 231.5±85.3) and (1 275.9±90.9) ms] ( P<0.05), and the T 2 values of left and right sternocleidomastoid muscles in the NPC group were (28.4±4.8) and (28.4±3.6) ms respectively, which were lower than those in the normal control group [(30.4±3.5) and (30.4±3.5) ms] ( P<0.05). The long and short diameters of bilateral sternocleidomastoid muscles in the NPC group were shorter than those in the control group ( P<0.05). The average T 1 and T 2 values of bilateral sternocleidomastoid muscles in NPC patients after radiotherapy were (1 510.6±95.4) and (28.4±4.2) ms respectively, The T 1 value was positively correlated with the classification of advanced radiation injury ( r=0.78, P<0.001), and T 2 value was negatively correlated with the level of advanced radiation injury ( r=-0.87, P<0.001). Conclusion:Mapping quantitative evaluation technique can noninvasively and objectively detect and evaluate sternocleidomastoid muscle fibrosis after NPC radiotherapy, which has potential clinical application value.

OBJECTIVE: To investigate the clinical effect of subchondral blocking technique combined with plate and screw biplane fixation in the treatment of complex acetabular posterior wall fractures. METHODS: From July 2015 to December 2019, a total of 47 cases of acetabular posterior wall fractures were treated. According to the different internal fixation techniques, they were divided into the external blocking fixation group supported by lateral plate and screw(control group of 23 cases) and the subchondral blocking technique combined with lateral plate and screw support biplane fixation group(study group of 24 cases). In the control group, there were 15 males and 8 females, aged 18 to 68 years old with an average of (40.9±7.2) years;preoperative preparation was 4 to 13 days with an average of (7.9±1.5) days. In the study group, there were 14 males and 10 females, aged 20 to 71 years old with an average of (41.7±7.9) years;preoperative preparation was 4 to 12 days with an average of (7.5±1.9) days. Kocher-Langenbeck approach was used in both groups and all patients were followed up for at least 1 year. The operation time, intraoperative blood loss, hospitalization time, quality of fracture reduction after operation, modified Merle D'Aubigne Postel score of hip joint one year after operation and postoperative complication rate of two groups were statistically analyzed and compared. RESULTS: The patients in both groups were followed up for at least 1 year. One year after operation, the Merled'Aubigne Postel score(16.042±1.517) of hip function improvement in the study group was significantly higher than that in the control group (14.696±1.222)(P<0.05). There was no significant difference in operation time and intraoperative bleeding between the two groups(P>0.05). One year after operation, there was a significant difference between two groups in the evaluation results of Matta fracture reduction quality(P<0.05). There was no significant difference in postoperative complications between two groups(P>0.05). CONCLUSION The treatment of complex acetabular posterior wall fracture with subchondral blocking technique combined with plate and screw biplane fixation technique has lower postoperative complication rate, better functional recovery of hip joint and satisfactory clinical effect.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Acetabulum/injuries* ; Bone Screws ; Hip Fractures/surgery* ; Spinal Fractures ; Treatment Outcome ; Postoperative Complications