Objective:To investigate the risk factors and prognosis of postoperative atrial fibrillation(POAF) and delayed-onset POAF(dPOAF).Methods:In a retrospective cohort study involving consecutive patients who underwent cardiac surgery across provincial cardiovascular consortium consisted of 57 hospitals in Jiangsu Province from January 2015 to December 2022, the incidence and implications of dPOAF were examined. dPOAF was defined as being diagnosed within 30 days of discharge.Results:Among 2 788 patients with postoperative new-onset POAF, 154(5.5%)cases had dPOAF, median onset time 21(15, 26)days following surgery. Compared to in-patient diagnosed POAF, dPOAF was associated with increased rates of hypertension(28.6% vs. 9.0%, P<0.001), diabetes(10.4% vs. 3.2%, P<0.001), heart failure(39.6% vs. 19.3%, P<0.001), peripheral vascular disease(13.6% vs. 2.2%, P<0.001), and higher CHA2DS2-VASc score(≥2)(59.8% vs. 43.2%, P<0.001). Female patients were less likely to develop dPOAF( OR=0.44, 95% CI: 0.30-0.63, P<0.001). During follow-up period, there was no significant difference in major adverse cardiovascular events(MACEs)( HR=1.33, 95% CI: 0.82-2.17), overall mortality( HR=0.58, 95% CI: 0.07-4.67), or thromboembolism events( HR=0.57, 95% CI: 0.26-1.25). Conclusion:This study underscores the risk factors and prognosis associated with dPOAF compared to in-hospital POAF. It highlights the imperative for vigilant monitoring and individualized management strategies tailored to patients at risk of dPOAF.

Objective:To investigate the risk factors and prognosis of postoperative atrial fibrillation(POAF) and delayed-onset POAF(dPOAF).Methods:In a retrospective cohort study involving consecutive patients who underwent cardiac surgery across provincial cardiovascular consortium consisted of 57 hospitals in Jiangsu Province from January 2015 to December 2022, the incidence and implications of dPOAF were examined. dPOAF was defined as being diagnosed within 30 days of discharge.Results:Among 2 788 patients with postoperative new-onset POAF, 154(5.5%)cases had dPOAF, median onset time 21(15, 26)days following surgery. Compared to in-patient diagnosed POAF, dPOAF was associated with increased rates of hypertension(28.6% vs. 9.0%, P<0.001), diabetes(10.4% vs. 3.2%, P<0.001), heart failure(39.6% vs. 19.3%, P<0.001), peripheral vascular disease(13.6% vs. 2.2%, P<0.001), and higher CHA2DS2-VASc score(≥2)(59.8% vs. 43.2%, P<0.001). Female patients were less likely to develop dPOAF( OR=0.44, 95% CI: 0.30-0.63, P<0.001). During follow-up period, there was no significant difference in major adverse cardiovascular events(MACEs)( HR=1.33, 95% CI: 0.82-2.17), overall mortality( HR=0.58, 95% CI: 0.07-4.67), or thromboembolism events( HR=0.57, 95% CI: 0.26-1.25). Conclusion:This study underscores the risk factors and prognosis associated with dPOAF compared to in-hospital POAF. It highlights the imperative for vigilant monitoring and individualized management strategies tailored to patients at risk of dPOAF.

Objective To understand the incidence and mortality of gastric cancer in middle-aged and elderly population after Helicobacter pylori eradication , and provide theoretical guidance for the prevention of this disease in Luzhou area. Methods A total of 541 patients with Helicobacter pylori eradication from 2019 to 2021 were selected , they were divided into control group and observation group according to whether they developed gastric cancer in later stage, patients with gastric cancer due to Helicobacter pylori infection were selected as positive control group (N=205) . In addition, the expression of tumor markers such as CEA, CA199, CA125 and proliferation-related factor Ki67 were compared among the three groups, binary Logistic regression was used to analyze the risk factors of gastric cancer in the middle-aged and elderly population after Helicobacter pylori eradication. Results Among the 39(7.21%) of 541 patients developed gastric cancer after HP eradication , including 23males and 16females, with no gender difference (P>0.05) .The positive rate of moderate and severe atrophy of gastric mucosa and the ratio of PPI ≥1 year in the observation group were higher than those in the control group (P<0.05) . In addition , serum CEA , CA199 , CA125 levels were the highest in the positive control group , followed by the observation group , Ki67 expression was also the same. Logistic regression analysis showed that PPI ≥1 year (OR=1.642) , gastric mucosal atrophy (OR=1.459) or severe (OR=3.271) and presence of IM (OR= 3.669) were independent risk factors for gastric cancer after Hp eradication. Conclusion The risk of developing gastric cancer was higher in the middle-aged and elderly after Helicobacter pylori eradication , and the risk of developing gastric cancer was higher in patients with moderate or severe atrophy of gastric mucosa , PPI ≥1 year and having IM , gastroscopic screening should be strengthened to prevent gastric cancer..

Objective: To evaluate the efficacy and safety of low dose sublingual nifedipine dripping pills (5 mg) in treating moderate and severe hypertension in comparison with normal dose (10 mg) of sublingual nifedipine dripping pills. Methods: This study was designed as a randomized, double-blind, positive drug parallel controlled, multi-center, non-inferiority clinical trial. Patients with moderate and severe hypertension were enrolled by 14 clinical trial centers, randomly divided into the trial group (sublingual 5 mg nifedipine dripping pills) and the control group (sublingual 10 mg nifedipine dripping pills). The changes in blood pressure were monitored continuously within 2 hours after the initial administration, repeated the dose in 20 minutes interval after the initial administration for up to additional 3 doses (maximum 4 doses) if the antihypertensive efficacy was not satisfactory. The efficacy of antihypertensive therapy between the two groups was evaluated by repeated administration rates and blood pressure changes at 60 minutes post the initial administration, and the safety of treatment was evaluated by recording adverse event rate of the two groups. Results: The anti-hypertensive effective rates at 60 minutes after sublingual administration were 83.5% (202/242) and 86.7% (208/240) respectively between the trial group and control group (χ²=1.307, P=0.253) . On the aspect of antihypertensive effectiveness at 60 minutes after single dose of sublingual administration, the anti-hypertension effective rates of the trial group and the control group were 85.6% (154/180) and 87.2% (164/188) respectively (χ²=0.221, P=0.639). Prevalence of the repeated administration was also similar between the two groups (25.6%(62/242) in the trial group and 21.7% (52/240) in the control group, χ²=1.043, P=0.307). On the safety aspect, there was no adverse events/reactions in the trial group, but there were 15 cases of adverse events/reactions occurred in control group (6.25%, χ²=15.611, P<0.001). Conclusions In the treatment of moderate to severe hypertension, the antihypertensive efficacy of low dose nifedipine dripping pills is similar to that of conventional dosage, and the safety profile of low dose nifedipine dripping pills is better than that of the conventional dose.

Objective To investigate the neuroprotective effect and mechanism of liraglutide on diabetic rats. Methods 24 healthy male SPF Goto-Kakizaki (GK) rats with random blood glucose greater than 11.1 mmol/L were selected as the experimental group, and randomly divided into diabetes mellitus group ( n＝12) and liraglutide group (n＝12). Ten healthy male SPF Wistar rats with the same age and weight as GK rats were selected as normal control group. After adaptively feeded for 2 weeks, the liraglutide group was given liraglutide (400 μg·kg－1·d－1, subcutaneous injection), while the control group and diabetes mellitus group were given the same volume of saline, and continued to be administered for 8 weeks. After 10 weeks, data and biochemical indicators were recorded. Effects of liraglutide on learning and memory in diabetes mellitus rats were detected by Morris water maze test. HE staining observed the hippocampal neurons morphology. Western blotting method detected the expression of p- IκB kinase (IKK) β, p-NF-κB, NF-κB, Klotho, and PRX2 in hippocampus. Results Morris water maze test showed that liraglutide can improve the spatial learning and memory ability of diabetes mellitus rats. HE staining showed that liraglutide significantly reduced the pathological damage of hippocampal neurons of diabetes mellitus rats. Western blotting showed that liraglutide inhibited NF-κB signaling pathway in hippocampus of diabetes mellitus rats. The expression of Klotho protein in hippocampus of diabetes mellitus group was significantly lower than that of control group, while the expression of PRX2 protein was higher than control group (t＝8.298,－7.398,all P<0.01). The expression of Klotho and PRX2 protein in hippocampus of liraglutide group were higher than diabetes mellitus group (t＝－13.059, 14.113, all P<0.01). The expression of Klotho protein of liraglutide group was similar to that of control group ( t ＝ －1. 137, P>0. 05 ). The expression of PRX2 protein was significantly higher than control group (t＝－28.055, P<0.01). Conclusions Liraglutide may enhance the expression of antioxidant stress protein including Klotho and PRX2, by inhibiting NF-κB signaling pathway in hippocampus of diabetes mellitus rats, reduced oxidative stress and improved the injury of hippocampal neuronal in diabetes mellitus rats, which seems to play a neuroprotective effect, to prevent and delay the occurrence of diabetic encephalopathy.

Objective To assess the clinical value of lung ultrasound (LUS) B-lines in diagnosis of rheumatoid arthritis (RA) associated interstitial lung diseases (RA-ILD).Methods Forty-five consecutive patients with RA who underwent a high resolution computed tomography (HRCT) scan of the chest,were also examined by LUS for detection of B-lines(within 1 month independently in all patients).The B-lines score was obtained by summing the number of total 50 inter-costal spaces (ICSs) of chest wall.Pulmonary fibrosis was quantified by HRCT as previously described by the 30-point Warrick score.Results B-lines score significantly correlated with the Warrick score [(r=0.778,95％CI(0.627,0.872),P＜0.05].Receiver operating characteristic (ROC) curve confirmed that B-lines cut-off point 77[sensitivity of 100％,specificity of 64.3％ respectively,area under curve [AUC] =0.86,95％CI(0.724,0.945)] and 108[sensitivity of 90％,specificity of 88.6％ respectively,AUC=0.879,95％CI(0.747,0.957)] had an optimal power to discriminate mild (Warrick score＜8) and severe fibrosis (Warrick score＞15):Conclusion The data confirm that LUS is a useful technique to identify ILD in RA.In RA-ILD,B-lines correlate significantly with HRCT and are able to identify mild and severe degree of fibrosis.LUS is a promising non-invasive and non-ionizing strategy for screening RA-ILD.

Objective To investigate the metabolite changes in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric symptoms using magnetic resonance spectroscopy (MRS) and explore the associations between image findings and clinical variables. Methods Twenty-two SLE patients with neuropsychiatric symptoms (NPSLE), twenty-one SLE patients without neuropsychiatric symptoms (non-NPSLE) and twenty healthy controls (HCs) underwent routine MRI scan and multivoxel magnetic reson-ance spectroscopy (MVS). The absolute metabolite concentrations were measured bilaterally in the posterior cingulate gyrus (PCG), dorsal thalamus (DT), lentiform nucleus (LN) and posterior paratrigonal white matter (PWM) using LCModel and SAGE software. The relationships between metabolite con-centrations and cognitive function scores were analyzed by Spearman rank correlation. Single-factor Chi-square analysis and t-test were used for analysis. Results ① Compared to control subjects, NPSLE patients had significantly lower N-acetylaspartate (NAA) values in bilateral PCG and DT, with the mean differences of -1.504 [95% confidence interval ( CI) (-2.335, -0.672), P=0.001], -1.460 [95%CI (-2.349, -0.570), P=0.002], -1.259 [95%CI (-1.894, -0.625), P=0.000] and -1.022[95%CI (-1.688, -0.356), P=0.003] for RPCG, LPCG, RDT and LDT, respectively. The concentration of total creatinine were observed to decline in RPCG and RDT, with the mean differences of-1.094 [95%CI (-1.845, -0.342), P=0.003], -0.955 [95%CI (-1.630, -0.280), P=0.006], -1.259 [95%CI (-1.894,-0.625), P=0.006] respectively. Glutamine and glutamate-values decreased significantly in RDT [mean difference=-2.586, 95%CI (-4.139, -1.033), P=0.002]. ② Compared to non-NPSLE patients, NPSLE patients had a lower NAA level in LPCG [mean difference=-1.256, 95%CI (-2.146, -0.367), P=0.006]. Positive correlations between mini-mental state examination scores [RPCG: rs=0.312, P<0.05; LPCG: rs=0.355, P<0.01], Montreal cognitive assessment scores (RPCG: rs=0.362, P<0.01; LPCG: rs=0.285, P<0.05) and NAA values in bilateral PCG were detected. Conclusion Both NPSLE and non-NPSLE patients may have metabolite dysfun-ctions in different brain regions. The cognitive disorder in SLE patients may be interpreted by neuronic damage of PCG.