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 observe the clinical efficacy and Effects on gastrointestinal dynamics and inflammatory factors levels of combined treatment with electromagnetic stimulation and Shugan Qingwei Tang for reflux esophagitis(RE).Methods:142 cases of liver and stomach depression heat type RE patients who were treated in our hospital from April 2021 to May 2023 were selected.The patients were divided into control group(conventional drug therapy combined with electromagnetic stimulation)and study group(Shugan Qingwei decoction was added to the control group)by random number table method,with 71 cases each.The curative effect,gastrointestinal dynamics indexes,inflammatory factors and adverse reactions were observed between the two groups.Results:Compared with control group after treatment,the clinical total effective rate,serum gastrin(GAS),and motilin(MTL)were higher,while serum tumor necrosis factor-α(TNF-α),c-reactive protein(CRP),interleukin-1β(IL-1β),and interleukin-6(IL-6)were lower in the study group(P＜0.05).There were no obvious adverse reactions between both groups.Conclusion:The combination therapy of Shugan Qingwei Tang and electromagnetic stimulation can improve the clinical treatment effect,improve gastrointestinal function,reduce the level of inflammatory factors,and has good safety for RE patients.

Objective:To observe the clinical efficacy and Effects on gastrointestinal dynamics and inflammatory factors levels of combined treatment with electromagnetic stimulation and Shugan Qingwei Tang for reflux esophagitis(RE).Methods:142 cases of liver and stomach depression heat type RE patients who were treated in our hospital from April 2021 to May 2023 were selected.The patients were divided into control group(conventional drug therapy combined with electromagnetic stimulation)and study group(Shugan Qingwei decoction was added to the control group)by random number table method,with 71 cases each.The curative effect,gastrointestinal dynamics indexes,inflammatory factors and adverse reactions were observed between the two groups.Results:Compared with control group after treatment,the clinical total effective rate,serum gastrin(GAS),and motilin(MTL)were higher,while serum tumor necrosis factor-α(TNF-α),c-reactive protein(CRP),interleukin-1β(IL-1β),and interleukin-6(IL-6)were lower in the study group(P＜0.05).There were no obvious adverse reactions between both groups.Conclusion:The combination therapy of Shugan Qingwei Tang and electromagnetic stimulation can improve the clinical treatment effect,improve gastrointestinal function,reduce the level of inflammatory factors,and has good safety for RE patients.

OBJECTIVE: To evaluate the effectiveness and safety of Chinese medicine (CM) in the treatment of coronavirus disease 2019 (COVID-19) in China. METHODS: A multi-center retrospective cohort study was carried out, with cumulative CM treatment period of ⩾3 days during hospitalization as exposure. Data came from consecutive inpatients from December 19, 2019 to May 16, 2020 in 4 medical centers in Wuhan, China. After data extraction, verification and cleaning, confounding factors were adjusted by inverse probability of treatment weighting (IPTW), and the Cox proportional hazards regression model was used for statistical analysis. RESULTS: A total of 2,272 COVID-19 patients were included. There were 1,684 patients in the CM group and 588 patients in the control group. Compared with the control group, the hazard ratio (HR) for the deterioration rate in the CM group was 0.52 [95% confidence interval (CI): 0.41 to 0.64, P<0.001]. The results were consistent across patients of varying severity at admission, and the robustness of the results were confirmed by 3 sensitivity analyses. In addition, the HR for all-cause mortality in the CM group was 0.29 (95% CI: 0.19 to 0.44, P<0.001). Regarding of safety, the proportion of patients with abnormal liver function or renal function in the CM group was smaller. CONCLUSION This real-world study indicates that the combination of a full-course CM therapy on the basic conventional treatment, may safely reduce the deterioration rate and all-cause mortality of COVID-19 patients. This result can provide the new evidence to support the current treatment of COVID-19. Additional prospective clinical trial is needed to evaluate the efficacy and safety of specific CM interventions. (Registration No. ChiCTR2200062917).
Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; COVID-19/epidemiology* ; COVID-19 Drug Treatment ; Aged ; Medicine, Chinese Traditional/methods* ; Drugs, Chinese Herbal/adverse effects* ; SARS-CoV-2 ; Treatment Outcome ; China/epidemiology* ; Adult

Objective To develop an automatic urine volume detection and collection device to solve the problems of routine urine test.Methods An automatic urine volume detection and collection device was developed with the components of a main control system,a detection system,a prompting system and a grasping and moving system.The main control system consisted of two STM32 microcontrollers and a reset switch;the detection system was made up of a weighing module,an infrared module and indicator lights,which had its urine volume automatic detection algorithm developed based on the Keil5 platform;the prompting system realized voice broadcasting through the voice module fixed on the back panel of the box;the grasping and moving system was composed of a rail drive motor(86CM stepper motor),a photoelectric switch and a motorized gripper.Results The device developed tested urine samples with an accuracy of 99.44％,and could collect qualified samples automatically and quickly.Conclusion The device developed detects urine volume and collects samples automatically,and enhances the accuracy and efficiency of urine examination.[Chinese Medical Equipment Journal,2024,45(4):66-69]

Heart failure with preserved ejection fraction(HFpEF)is a highly heterogeneous systemic condition and represents the predominant form of heart heart failure(HF)worldwide.Current pharmacotherapies for HFpEF are limited and lack specific targeted drugs.Recent studies suggest that non-pharmacological strategies serve as adjuncts to conventional pharmacological treatment,offering improvements in symptoms,quality of life,and reducing the risk of rehospitalization for HF in patients with HFpEF.These strategies include CD34 stem cell transplantation,the greater splanchnic nerve ablation,atrial septal shunting,atrial pacing,myocardial contractility modulation,left ventricular expander,baroreceptor stimulation,and others.This review comprehensively summarizes the latest clinical evidence on non-pharmacological treatments for HFpEF,with the aim of advancing the understanding of treatment strategies for this condition.

The purpose of this study was to identify the tick species native to Xindi Township,Yumin County,Xinjiang,China.Preliminary morphological identification of parasitic ticks collected from animals in the area was conducted with an ultra-depth of field three-dimensional VHX 600 digital stereo microscope.Total DNA of the ticks was extracted,amplified by PCR based on the COI and ITS2 gene loci,and the posi-tive PCR products were sequenced.The sequence were a-ligned with reference sequences from the NCBI database were aligned with the Basic Local Alignment Search Tool.A genet-ic phylogenetic tree was generated with the neighbor-joining method of MEGA 7.0 software to determine the evolutionary biological characteristics of ticks.Morphological identification showed that the ticks collected from Xindi Township of Yu-min County were consistent with the characteristics of Hya-lomma asiaticum.An evolutionary tree based on the COI and ITS2 gene sequences showed that the ticks collected in this study were clustered with known H.asiaticum sequences.The PCR products of COI and ITS2 were sequenced and compared,which confirmed that the collected tick species were H.asiaticum,in agreement with the morphological and molecular biological results.These findings help to clarify the distribution of ticks in Xindi Township of Xinjiang,and provide basic data for the analysis of tick genetic and evolutionary characteristics,as reference for surveillance and control of ticks in the Xinjiang Uygur Autonomous Region.

Objective To explore the safety and management mode of hysteroscopy in three different modes:outpatient,daily and inpatient.Methods The quality control data of patients who underwent hysteroscopic surgery in Hysterscopy Centre,Obstetrics and Gynecology Hospital,Fudan University from Jan 2019 to Dec 2021 were collected through the electronic information system of the hospital and the monthly quality control report of hysteroscopy center.The amount of surgery,the proportion of grade Ⅳsurgery,the analysis of operation types,the indicator including complications,and unanticipated secondary surgery were retrospectively analyzed.Results From 2019 to 2021,5 162 outpatient hysteroscopic patients,15 331 daily hysteroscopic patients and 5 942 inpatient hysteroscopic patients were admitted in our hospital.The age of inpatient hysteroscopic patients was significantly older than those of outpatient and daily patients(P<0.001).In the past three years,the proportion of daily hysteroscopy gradually increased,and the proportion of inpatient hysteroscopy gradually decreased(P<0.001).The total percentage of grade Ⅳ hysteroscopic surgery was 12.9%,in which inpatient was higher than daily,and daily was higher than outpatient(P<0.001).The incidence of complications and accidents during hysteroscopy was 0.117%(31/26 435),including 17 cases of uterine perforation,7 cases of hysteroscopy failure,3 cases of excessive intraoperative bleeding,2 cases of fluid overload,1 case of intestinal injury,and 1 case of anesthesia accident.The incidence of hysteroscopy in outpatient,daily and inpatient were 0.020%(1/5 162),0.137%(21/15 331)and 0.151%(9/5 942)respectively.Conclusion Hysteroscopy in outpatient,daily and inpatient are all safe and reliable.Outpatient and daily hysteroscopy can improve the efficiency of medical services,which has gradually become a trend.

Objective To investigate effect of preimplantation genetic testing for aneuploidies(PGT-A)on the reproductive outcomes of women of advanced maternal age(AMA)(≥ 38 years),and to analyze factors influencing the live birth rate in AMA women who have received PGT-A.Methods A retrospective cohort study was conducted.AMA women undergoing PGT-A were enrolled in the PGT-A group.All of them underwent their first oocyte retrieval cycle between January 2019 and June 2023.AMA women undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and their first oocyte retrieval cycle over the same period of time were enrolled in the control group(the non-PGT-A group)via propensity score matching.The PGT-A group and the non-PGT-A group each included 193 cycles,which were followed up until January 2024.Follow-up concerning live births was completed for all oocyte retrieval cycles conducted between January 2019 and October 2022.The reproductive outcomes were compared between the two groups.The primary outcome indicator was cumulative live birth rate(CLBR)per oocyte retrieval,while the secondary outcome indicators were cumulative clinical pregnancy rate(CCPR)per oocyte retrieval and spontaneous abortion rate.For the 145 cycles in the PGT-A group with completed live birth follow-up,binary logistic regression analysis and receiver operator characteristic(ROC)curves were used to analyze the influencing factors of live birth rates.Results A total of 145 cycles in the PGT-A group and 161 cycles in the non-PGT-A group completed follow-up for live births.The CLBR per oocyte retrieval of the PGT-A group was 25.52％(37/145),while that of the non-PGT-A group was 28.50％(46/161),with no significant difference being observed between the two groups(P＜0.05).Of the 193 oocyte retrieval cycles in each group,53 cycles in the PGT-A group and 72 cycles in the non-PGT-A group resulted in clinical pregnancies,with the difference in the CCPR per oocyte retrieval being statistically significant(27.46％vs.37.31％,P＜0.05).Concerning clinical pregnancies,the spontaneous abortion rate of the PGT-A group was lower than that of the non-PGT-A group,with the difference being statistically significant(7.55％vs.25.00％,P＜0.05).In AMA women who had undergone PGT-A for reproductive assistance,maternal age(odds ratio[OR]=0.786,95％confidence interval[CI]:0.635-0.973)and the antral follicle count(AFC)(OR=1.110,95％CI:1.013-1.216)were correlated with the outcome of live births outcome.The probability of live births decreased with increasing maternal age and decreasing AFC.When the female age was ≥ 42 years or when AFC ≤ 8,the expected live birth outcome of PGT-A assisted pregnancy was poor.Conclusion PGT-A does not affect the CLBR per oocyte retrieval in AMA women,but it can effectively reduce the risks of implantation failure and spontaneous abortion due to fetal aneuploidies.For PGT-A-assisted pregnancy in AMA women,maternal age and AFC are important factors affecting the live birth outcomes.

This study aimed to investigate the therapeutic effects of Morinda officinalis iridoid glycosides (MOIG) on bone loss of rheumatoid arthritis (RA) rats, and the mechanism of osteoclast function and activity induced by lipopolysaccharide (LPS). RA rats were established by injecting bovin type II collagen. The Bio-ethic Committee of Zhejiang Chinese Medical University approved all experimental protocols associated with this study (IACUC-20180410-03). The collagen-induced arthritis (CIA) rats were administered drug by gavage for 8 weeks; the femoral trabecular micro-structure changes were observed in CIA rats by micro-CT; the LPS-induced osteoclasts model further observed the effect and mechanism of anti-inflammatory osteoporosis in vitro. The results indicated that MOIG could markedly increase bone mineral density (BMD) in CIA rats, improve trabecular micro-structure. In vitro studies demonstrated that MOIG could significantly inhibit osteoclastogensis and differentiation, suppress tartrate resistant acid phosphatase (TRAP) activity, F-actin ring formation, TNF receptor associated factor 6 (TRAF6) recruitment, and inhibitor of nuclear factor kappa-Bα (IκBα) degradation as well as p65 phosphorylation, thereby repressing nuclear factor kappa-B (NF-κB) signaling pathway activation. Subsequently, MOIG effectively inhibited osteoclast nuclear factor of activated T-cells c1 (NFATc1) and cellular oncogene Fos (c-Fos) expression, as well as bone resorption related protein activity including matrix metalloprotein 9 (MMP-9) and cathepsin K (CtsK). Meanwhile, MOIG also repressed the phosphorylation expression of Janus activating kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3), thereby inhibiting JAK2/STAT3 signaling pathway activation. Moreover, further studies found that MOIG could suppress glycogen synthase kinase-3β (GSK-3β) activity, and GSK-3β gene silencing could markedly inhibit oetsoclast F-actin ring formation as well as the phosphorylation expression of p65 and STAT3. Of note, compared with GSK-3β gene silencing group, there was no significant difference in the group treated with both MOIG with GSK-3β gene silencing simultaneously. Thus, the results suggested that MOIG may inhibit NF-κB signaling pathway and JAK2/STAT3 signaling pathway activation via regulating GSK-3β, thereby alleviating bone destruction in RA.