Objective To investigate the knowledge,attitude,and behavior(Knowledge-Attitude/belief-Practice,KAP)of residents in Hezhou City regarding the safety risks of using traditional Chinese medicine(TCM).Methods A stratified cluster random sampling method was used to select residents from different areas of Hezhou City.A questionnaire based on the KAP model was designed for the survey.Descriptive analysis,univariate analysis,and multiple linear regression analysis were conducted to explore the factors influencing the KAP of TCM safety behavior.Results Among the 2 000 questionnaires distribu-ted,all were conducted online.Of these,98 were incomplete,resulting in a total of 1 902 valid responses,with a valid response rate of 95.10％.In the survey of 2 000 residents of Hezhou City,the average knowledge score was(54.34±2.50),the average behavior score was(64.32±2.44),and the average attitude score was(62.44±3.07).The differences in knowledge scores among residents with different places of residence,educational levels,medical insurance status,monthly incomes,and other de-mographic characteristics were statistically significant(P＜0.05).The differences in behavior scores among residents with differ-ent medical insurance status and occupations were statistically significant(P＜0.05).The differences in attitude scores among residents with different monthly incomes and medical insurance status were also statistically significant(P＜0.05).Results of multiple linear regression analysis indicated that place of residence,medical insurance(self-paid),educational level(junior high school and below),and monthly income(below 2 000 yuan,2 001-4 000 yuan)were influencing factors for the knowledge score on safe use of proprietary Chinese medicines(P＜0.05).Medical insurance(self-paid)and occupation(enterprise work-er,freelancer,student)were influencing factors for the behavioral risk score regarding safe use of proprietary Chinese medicines(P＜0.05).Medical insurance(self-paid)and monthly income(below 2 000 yuan)were influencing factors for the attitudinal risk score regarding safe use of proprietary Chinese medicines(P＜0.05).Conclusion The overall KAP level regarding the safety of using traditional Chinese medicine among residents in Hezhou City is relatively low,and medication safety is closely re-lated to place of residence,medical insurance,monthly income,occupation,etc.

Objective:To analyze the economic operation and efficiency of village clinics in Jiangsu Province,explore the issues and put forward the countermeasures.Methods:Descriptive statistic method was applied to analyze the income,expenditure and balance of village clinics.Malmquist index was applied to analyze the input-output efficiency of village clinics from 2013 to 2022.Results:The proportion of medical income to total income of village clinics decreased continuously from 2016 to 2022 in Jiangsu province.The proportion of medical income to total income was 56.34%in 2022.The proportion of drug income to medical income was 75.77%.The average subsidy from the superiors per institution was 71 800 yuan in 2022.The proportion of personnel expenditure to total expenditure of village clinics was 49.24%in 2022,and per capita personnel expenditure was 41 500 yuan.The income-expenditure balance of drugs declined continuously from 2016 to 2020.The average income-expenditure balance per village clinic was 15 600 yuan in 2022.The Malmquist index results showed that the average value of Total Factor Productivity(TFP)index of village clinics in Jiangsu was 0.992 from 2013 to 2022 in Jiangsu province.The value of TFP index of 8 village clinics was less than 1.0 in eight cities.Conclusions:The proportion of drug income to medical income was high.The personnel funds were relatively low in village clinics.The average income-expenditure balance of village clinics was insufficient.The input-output efficiency of village clinics was low in some regions.It is needed to further improve the compensation mechanism of income,increase the financial subsidies and improve the service ability and service level of village clinics.

Objective To investigate the knowledge,attitude,and behavior(Knowledge-Attitude/belief-Practice,KAP)of residents in Hezhou City regarding the safety risks of using traditional Chinese medicine(TCM).Methods A stratified cluster random sampling method was used to select residents from different areas of Hezhou City.A questionnaire based on the KAP model was designed for the survey.Descriptive analysis,univariate analysis,and multiple linear regression analysis were conducted to explore the factors influencing the KAP of TCM safety behavior.Results Among the 2 000 questionnaires distribu-ted,all were conducted online.Of these,98 were incomplete,resulting in a total of 1 902 valid responses,with a valid response rate of 95.10％.In the survey of 2 000 residents of Hezhou City,the average knowledge score was(54.34±2.50),the average behavior score was(64.32±2.44),and the average attitude score was(62.44±3.07).The differences in knowledge scores among residents with different places of residence,educational levels,medical insurance status,monthly incomes,and other de-mographic characteristics were statistically significant(P＜0.05).The differences in behavior scores among residents with differ-ent medical insurance status and occupations were statistically significant(P＜0.05).The differences in attitude scores among residents with different monthly incomes and medical insurance status were also statistically significant(P＜0.05).Results of multiple linear regression analysis indicated that place of residence,medical insurance(self-paid),educational level(junior high school and below),and monthly income(below 2 000 yuan,2 001-4 000 yuan)were influencing factors for the knowledge score on safe use of proprietary Chinese medicines(P＜0.05).Medical insurance(self-paid)and occupation(enterprise work-er,freelancer,student)were influencing factors for the behavioral risk score regarding safe use of proprietary Chinese medicines(P＜0.05).Medical insurance(self-paid)and monthly income(below 2 000 yuan)were influencing factors for the attitudinal risk score regarding safe use of proprietary Chinese medicines(P＜0.05).Conclusion The overall KAP level regarding the safety of using traditional Chinese medicine among residents in Hezhou City is relatively low,and medication safety is closely re-lated to place of residence,medical insurance,monthly income,occupation,etc.

Objective:To analyze the economic operation and efficiency of village clinics in Jiangsu Province,explore the issues and put forward the countermeasures.Methods:Descriptive statistic method was applied to analyze the income,expenditure and balance of village clinics.Malmquist index was applied to analyze the input-output efficiency of village clinics from 2013 to 2022.Results:The proportion of medical income to total income of village clinics decreased continuously from 2016 to 2022 in Jiangsu province.The proportion of medical income to total income was 56.34%in 2022.The proportion of drug income to medical income was 75.77%.The average subsidy from the superiors per institution was 71 800 yuan in 2022.The proportion of personnel expenditure to total expenditure of village clinics was 49.24%in 2022,and per capita personnel expenditure was 41 500 yuan.The income-expenditure balance of drugs declined continuously from 2016 to 2020.The average income-expenditure balance per village clinic was 15 600 yuan in 2022.The Malmquist index results showed that the average value of Total Factor Productivity(TFP)index of village clinics in Jiangsu was 0.992 from 2013 to 2022 in Jiangsu province.The value of TFP index of 8 village clinics was less than 1.0 in eight cities.Conclusions:The proportion of drug income to medical income was high.The personnel funds were relatively low in village clinics.The average income-expenditure balance of village clinics was insufficient.The input-output efficiency of village clinics was low in some regions.It is needed to further improve the compensation mechanism of income,increase the financial subsidies and improve the service ability and service level of village clinics.

Objective:To investigate the correlation between atmospheric particulate matter 2.5 (PM 2.5) concentration and the number of chronic kidney disease (CKD) hospital admissions in the elderly in Taiyuan city. Methods:The atmospheric PM 2.5 concentration in Taiyuan city during 2019—2021 was used as the environmental exposure data, and the number of CKD admission of the elderly patients (> 60 years old) in Taiyuan city at the same time was used as the disease progression index. The distributed lag nonlinear model was used to analyze overall and lag effects of PM 2.5 average daily concentration on the elderly patients admitted to CKD. Results:A total of 6 037 cases elderly patients with CKD admitted to hospital were included, with a male-to-female ratio of 1.36∶1. The average daily concentration of PM 2.5 was 52.80 μg/m 3, which did not exceed China's air quality standard (75 μg/m3); But in autumn and winter, the average daily concentration of PM 2.5 significantly exceeded the normal reference value, with the highest value reaching 302 μg/m 3. The relationship between the average daily concentration of PM 2.5 and the number of elderly patients admitted to CKD was nonlinear and there was a lag effect. The relative risk ( RR) value reached the maximum when PM 2.5 average daily concentration was 87 μg/m 3 with lag time of 11 days [1.074(95% CI 1.018-1.321)]. The subgroup analysis results showed that the risk of admission of elderly female CKD patients was higher than that of male patients with lag time of 10 days, and the RR was 1.073(95% CI 1.001-1.151). Elderly CKD patients with hypertension (PM 2.5 87 μg/m 3) and diabetes (PM 2.5 88 μg/m 3) had a higher risk of admission when exposed to PM 2.5, with maximum RR values of 1.067(95% CI 1.002-1.136) and 1.162(95% CI 1.021-1.320), respectively. Conclusions:High atmospheric PM 2.5 concentration in Taiyuan city can increase the risk of admission in elderly patients with CKD, especially in women and patients with hypertension or diabetes.

Objective: To investigate the impact of coronary lesion calcification on the long-term outcome of patients with coronary heart disease after percutaneous coronary intervention. Methods: In this prospective observational study, a total of 10 119 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention from January 1 to December 31, 2 103 in our hospital were enrolled. The patients were divided into non/mild calcification group (8 268 cases) and moderate/severe calcification group (1 851 cases) according to the angiographic results. The primary endpoint was one-year major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, and target vessel revascularization. Results: The patients were (58.3±10.3) years old, and there were 2 355 females (23.3%). Compared with non/mild calcification group, patients in the moderate/severe calcification group were older ((60.0±10.6) years vs. (57.9±10.2) years, P<0.01), and had higher proportion of female (25.4% (470/1 851) vs. 22.8% (1 885/8 268), P=0.02), debates (33.9% (628/1 851) vs. 29.0% (2 399/8 268), P<0.01), hypertension (68.0% (1 259/1 851) vs. 63.7% (5 264/8 268), P<0.01), coronary artery bypass grafting (4.6% (85/1 851) vs. 3.2% (268/8 268), P<0.01), stroke (12.6% (233/1 851) vs. 10.4% (861/8 268), P=0.01), and renal dysfunction (6.2% (115/1 851) vs. 3.7% (303/8 268), P<0.01). Compared with non/mild calcification group, patients in themoderate/severe calcification group experienced longer procedure time (37 (24, 61) min vs. 27 (17,40) min, P<0.01) and stent length was longer (32 (23,48) mm vs. 27 (18,38) mm, P<0.01), and percent of rotational atherectomy was higher (2.56%(57/2 229) vs. 0.03% (3/11 930), P<0.01). One-year follow-up results showed that MACE (7.5% (139/1 846) vs. 4.9% (402/8 243), P<0.01), all-cause death (1.0% (19/1 846) vs. 0.6% (49/8 243), P=0.04), myocardial infarction (2.2% (41/1 846) vs. 1.4% (114/8 243), P=0.01), and target vessel revascularization (5.0% (92/1 846) vs. 3.2% (266/8 243), P<0.01) were all significantly higher in moderate/severe calcification group than in non/mild group. Multivariate Cox regression analysis showed that moderate/severe calcification was an independent predictor of MACE at one-year after the procedure (HR=1.41, 95%CI 1.16-1.72, P<0.01). Conclusion Moderate/severe calcification in coronary lesion is an independent predictor of long-term poor prognosis in coronary heart disease patients undergoing percutaneous coronary intervention.

Objective: To observe the safety and impact of short-term anticoagulant therapy on prognosis after selective percutaneous coronary intervention (PCI) in patients with coronary artery disease. Methods: From January 2013 to December 2013, 9 769 consecutive patients underwent selective PCI in Fuwai Hospital were retrospectively included in this study. Patients were divided into two groups, including non-post-PCI anticoagulant therapy group and low-dose and short-time post-PCI anticoagulant therapy group (enoxaparin 0.4 ml/12 h or fondaparinux 2.5 mg/day by subcutaneous injection for 2-3 days after PCI). All patients were evaluated at 30 days, 180 days and 12 months for major adverse coronary and cerebral events (MACCE) including all-cause death, myocardial infarction, revascularization and stroke as well as in-stent thrombosis and bleeding events. Data from 1 755 pairs of patients were analysis after propensity score matching. The clinical outcomes were compared between groups by using Kaplan-Meier survival analysis before and after propensity score matching. Multivariable Cox analysis was used to define the impact and determinants of post-PCI anticoagulation on clinical outcomes. Results: one thousand seven hundred and fifty-five (18.0%) patients didn′t receive post-PCI anticoagulation and 8 014 (82.0%) patients received post-PCI anticoagulation, 5 666 (58.0%) patients received enoxaparin and 2 348 (24.0%) patients received fondaparinux. Patients were younger and incidence of female patients was less, incidence of renal dysfunction and acute coronary syndrome were higher in low-dose and short-time post-PCI anticoagulant therapy group than in non-post-PCI anticoagulation group (all P<0.05). Similarly, patients with post-PCI anticoagulation were associated with more left main coronary artery lesion and branch lesion (P<0.05). Post-PCI anticoagulation patients were associated with less trans-femoral process, more drug-eluting stents implantation and less simple balloon dilatation (all P<0.05). Nine thousand seven hundred and seventeen (99.5%) patients completed 2 years follow up. Post-PCI anticoagulation patients had significantly lower 30-day all-cause death (0.05% (4 cases) vs. 0.46% (8 cases), P<0.001) and stroke (0 vs. 0.11% (2 cases), P=0.003), lower 180-day all-cause death (0.17% (14 cases) vs. 0.57% (10 cases), P=0.002), revascularization (2.07% (166 cases) vs. 3.71% (65 cases), P<0.001) and MACCE (3.49% (280 cases) vs. 5.47% (96 cases), P<0.001), lower 2-year revascularization (7.61% (610 cases) vs. 12.84% (225 cases), P<0.001) and MACCE (10.92 (875 cases) vs. 16.01% (281 cases), P<0.001). Multivariable Cox regression analysis showed that post-PCI anticoagulant therapy was an independent protective factor of 30-day (HR=0.17, 95%CI 0.05-0.62, P=0.007), 180-day all-cause death (HR=0.37, 95%CI 0.16-0.87, P=0.023) and MACCE (HR=0.74, 95%CI 0.58-0.94, P=0.013), 2-year MACCE (HR=0.71, 95%CI 0.62-0.81, P<0.001). After propensity score matching, post-PCI anticoagulation therapy remained as an independent protective factor of 30-day all-cause death (HR=0.11, 95%CI 0.01-0.92, P=0.042) and 2-year MACCE (HR=0.81, 95%CI 0.68-0.96, P=0.015). Conclusions Low-dose and short-time post-PCI anticoagulant therapy may decrease 30-day all-cause death, 180-day all-cause death and MACCE and 2-year MACCE, and meanwhile this option does not increase bleeding risk in patients underwent selective PCI.

Objective: To investigate the impact of direct bilirubin on long-term prognosis of acute coronary syndrome (ACS) patients post percutaneous coronary intervention(PCI). Methods: As a prospective and observational cohort study, a total of 6 431 consecutive ACS patients underwent PCI from January to December 2013 in Fuwai hospital were included. Patients were divided into 3 groups according to tertiles values of direct bilirubin as follows: low direct bilirubin group(<2.2 μmol/L, n=2 219), moderate direct bilirubin group(2.2-3.0 μmol/L, n=2 016), and high direct bilirubin group(>3 μmol/L, n=2 196). The clinical characteristics were compared among the 3 groups, and the impact of direct bilirubin on clinical adverse events (main adverse cardiovascular and cerebrovascular events included cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis) were analyzed at 2 years after PCI. Results: (1) Percent of male patients was 66.5%(1 475/2 219), 78.0%(1 572/2 016), and 86.2%(1 892/2 196), body mass index was(25.7±3.1), (26.0±3.3),and (26.0±3.2) kg/m², the ratio of the history of old myocardial infarction was 11.9%(264/2 219), 13.0%(263/2 016),and 14.9%(328/2 196), the ratio of the current smoker was 56.3%(1 249/2 219), 59.1%(1 192/2 016),and 60.0%(1 317/2 196) in low, moderate and high direct bilirubin groups respectively, and the differences were statistically significant (P<0.01 or 0.05). (2) Two years after PCI, the all-cause mortality was 0.8%(17/2 219), 1.8%(36/2 016), and 1.5%(33/2 196) (P=0.011),the cardiogenic mortality was 0.5%(12/2 219), 1.3%(26/2 016), and 0.6%(13/2 196) (P=0.010),the ratio of myocardial infarction was 2.2%(49/2 219), 2.4%(49/2 016), and 1.4%(31/2 196)(P=0.044),the ratio of revascularization was 8.8%(195/2 219), 8.3%(168/2 016),and 8.9%(196/2 196)(P=0.783),the ratio of stroke was 1.4%(30/2 219),1.1%(22/2 016), and 1.9%(42/2 196)(P=0.076),the ratio of stent thrombosis was 0.9%(19/2 219), 1.2%(24/2 016),and 0.7%(15/2 196)(P=0.210) in low, moderate and high direct bilirubin groups, respectively. (3) Multivariable Cox regression analysis showed that, patients in moderate direct bilirubin group faced increased the risk of all-cause mortality compared with patients in the low direct bilirubin group (HR=2.23, 95%CI 1.23-4.05, P= 0.009), and the risk of all-cause mortality was similar between high direct bilirubin group and low direct bilirubin group (HR=1.84, 95%CI 0.99-3.38, P= 0.051). There were no statistically significant difference in the risks of main adverse cardiovascular and cerebrovascular events,cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis in moderate and high direct bilirubin groups compared with low direct bilirubin group (all P>0.05). Conclusion Moderate direct bilirubin level is associated with increased risk of all-cause death at 2 years after PCI compared with low level of direct bilirubin group.

Objective: To evaluate the predictive value of GRACE discharge score on the long-term out-of-hospital coronary thrombotic events (CTE) after percutaneous coronary intervention (PCI) with drug-eluting stents. Methods: Present study was a prospective, observational, single center study. 10 724 consecutive patients underwent PCI in Fuwai Hospital between January and December 2013 were included, stents were implanted with conventional method. After PCI, patients were prescribed aspirin 100 mg once daily indefinitely, and either clopidogrel 75 mg once daily or ticagrelor 90 mg twice daily for at least 1 year. A total of 9 782 patients were included in the final analysis after excluding patients who did not undergo successful stent implantation, who were not discharged on dual anti-platelet therapy (DAPT), who only underwent bare-metal stents, who experienced in-hospital major bleeding, stent thrombosis, myocardial infarction (MI) or death,and who lost follow up. Clinical data were collected from all patients. 9 543 patients with complete baseline data were further analyzed for risk stratification and predictive value of GRACE discharge score. CTE was defined as stent thrombosis or spontaneous myocardial infarction. All patients were followed through Fuwai Hospital Follow-up Center, and evaluated either by phone, letter, or clinic visits or at 1, 6, 12 and 24 months after PCI. Risk stratification was performed according to the GRACE discharge score, and the predictive value of the GRACE discharge score was assessed using the receiver operating characteristic (ROC) curve. Results: After 2 years follow-up, there were 95 CTE among the 9 782 patients. The patients were divided into 2 groups according to the presence or absence of CTE: CTE group (95 cases) and no CTE group (9 687 cases). GRACE discharge score was significantly higher in CTE group than no CTE group (82.98±27.58 vs. 75.51±22.46, t=-2.57, P=0.012). According to risk stratification of GRACE discharge score, the patients were divided into low-risk (≤88) group (n=6 902), moderate-risk (89-118) (n=2 988) and high-risk (>118) (n=343) groups. As compared to the low-risk group, CTE risk in moderate- and high-risk groups was 1.59 times (HR 1.59, 95%CI 1.01-2.52, P=0.046) and 3.89 times higher (HR 3.89, 95%CI 1.98-7.65, P<0.001), respectively. Further analysis showed that the GRACE score had predictive value in the total cohort for CTE (area under the receiver operating characteristic (AUROC) 0.576, 95%CI 0.512-0.640, P=0.012) and in the acute coronary syndromes(ACS) subgroup for CTE: (AUROC 0.594, 95%CI 0.509-0.680, P=0.019), but not in the non-ACS subgroup: (AUROC 0.561, 95%CI 0.466-0.657, P=0.187). Conclusion GRACE discharge score can predict the long-term out-of-hospital CTE in patients undergoing PCI with drug-eluting stents and treated with DAPT, and patients can be stratified into the low-, moderate- and high-risk groups of CTE by the GRACE discharge score.

Objective: To study the correlation between the blood routine indicators and CD₄⁺ T, CD₈⁺ T lymphocytes in AIDS patients without antiviral treatment, and to find a simple, cheap and effective monitoring indicator. Methods: A study of 333 AIDS patients without antiviral treatment was performed.The methods of regression analysis and other statistical methods were applied to research the correlation between WBC, W-SCC and CD₄⁺ T, CD₈⁺ T cell count among HIV/AIDS. Results: The rate of routine blood abnormalities among 333 HIV/AIDS patients was very high, the main test indicators within the reference range only accounted for 30.63%.The proportion of late diagnosis infected with HIV among women was higher than that of males.Significant correlations were observed between CD₄⁺ Tcell count and WBC, W-SCC, W-LCC, RBC, HGB, PLT(r=0.408, 0.541, 0.157, 0.337, 0.338, 0.166). The equation between W-SCC (x) and CD₄⁺ cell count (y) was y=120.913x+ 90.339. Conclusion There is a strong correlation between CD₄⁺ T lymphocyte count and lymphocyte count in AIDS patients without antiviral treatment.It can be used as an important indicator of immune status in patients with AIDS.At the same time, we should strengthen the propaganda of AIDS prevention, promote AIDS early detection, early treatment, and improve the quality of life of AIDS patients.