Objective To study the clinical efficacy and safety of dapagliflozin combined with sacubitril-valsartan in the treatment of heart failure with preserved ejection fraction (HFpEF).Methods A total of 128 patients with HFpEF hospitalized in the cardiovascular medicine department of this hospital from March to December 2022 were selected as the study subjects and divided into the observation group and control group by the random number table method,64 cases in each group.The control group was given the conventional an-ti-heart failure therapy and orally took sacubitril-valsartan,and the observation group took the combined ap-plication of dapagliflozin on the basis of the control group.The continuous treatment lasted for 12 months. The left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were com-pleted by the cardiac color Doppler ultrasound determination in 3,6,12 months after treatment,the blood was collected for detecting NT-poBNP and 6 min walking distance (6MWD) determination was completed.The outpatient follow up was conducted monthly,the follow up contents contained the adverse reactions and major adverse cardio vascular event (MACE) events.Results After 3-month treatment,the NT-proBNP level in the two groups was decreased compared with before treatment,moreover the observation group was lower than the control group,and the differences were statistically significant (P<0.05).Compared with before treat-ment,LVEDd after 3-month treatment in the two groups was decreased compared with before treatment,LVEF was increased compared with before treatment,and the differences were statistically significant (P<0.05).LVEDd after 6-,12-month treatment in the observation group was lower than that in the control group,LVEF was higher than that in the control group,and the differences were statistically significant (P<0.05).6MWD after 3-month treatment in the two groups was increased compared with before treatment,and the difference was statistically significant (P<0.05).6MWD after 6-,12-month treatment in the observation group was higher than that in the control group,and the difference was statistically significant (P<0.05). The re-admission rate due to heart failure and MACE total occurrence rate in the observation group were low-er than those in the control group (9.38％ vs. 23.44％,12.50％ vs. 26.50％,P<0.05),and the adverse re-actions occurrence rates had no statistical difference between the two groups (P>0.05).Conclusion Dapagliflozin combined with sacubitril-valsartan could significantly improve the cardiac function in elderly patients with HFpEF,reduce the occurrence rate of MACE,moreover has good safety.

【Objective】 To analyze the characteristics and mobility of the overlapping population of voluntary blood donation and plasmapheresis donation, so as to provide a scientific basis for the formulation of recruitment and retention strategies for blood donation and plasmapheresis donation, and to further propose a scientific reference for the decision-making of blood banks and plasmapheresis station management in China. 【Methods】 The basic information of blood donors and plasmapheresis donors in two counties in Guangyuan, Sichuan Province, which carried out whole blood collection and plasmapheresis collection from the establishment of the station to July 31, 2021 was statistically compared and analzed using the chi-square test and Post hoc testing test. 【Results】 As of July 31, 2021, a total of 50 658 people participated in blood donation and 63 375 people participated in plasmapheresis donation in Jiange County and Cangxi County, with a total overlap of 6 189 people. In the two regions, 16 458 (35.2%) people aged 40 to 50, and 35 558 people (56.1%) were over 50 years old. Among the overlapping population, 2 496 (40.3%) were 40 to 50 years old, accounted for the largest proportion, and 3 146 (50.8%) were males. Significant differences were noticed in age (P<0.001) and gender (P<0.001). There was a shift in dontion in 5 183, including 2 072 people from plasma to blood and 3 111 people from blood to plasma, among which 2 671 (51.5%) were men and 3 632 (70.1%) were over 50 years old, with significant differences in gender (P<0.05) and age (P<0.001). 【Conclusion】 There were a small number of donors donating both blood and plasma in Jiange and Cangxi, and men aged 40 to 50 were the majority, and people over 50 years old were more likely to shift the donation goals. The vast majority of donors have a single and fixed donation goal (blood or plasma), and are not easy to change.

【Objective】 To analyze the dynamic relationship between the setting up of plasmapheresis station and the volume of voluntary blood donation collected using panel vector autoregressive model, so as to provide scientific reference for the management policies of blood stations and plasmapheresis stations in China. 【Methods】 The data collected from blood stations in seven administrative regions of Guangyuan, Sichuan Province from 2011 to 2021, as well as plasma collection data from two plasmapheresis stations in the region within two years since their operation, were collected. A panel vector autoregressive model was constructed. Impulse response analysis and variance decomposition analysis were used to analyze the impact and time lag effects of simulated plasmapheresis station settings on the collection volume of voluntary blood donation. Covariance analysis was used to explore whether the establishment of plasmapheresis station had an impact on the volume of voluntary blood donation collected after excluding the impact of initial value differences. 【Results】 The pulse response results showed that after the plasmapheresis station was set up, there was a negative impact effect on the voluntary blood donation collection volume at the first stage, and its impact began to rise after the second stage, reached the highest value in the third stage, and then began to decline. After the seventh stage, it tended to be stable. However, within the 10 stage range, the confidence interval for the response strength of voluntary blood donation collection volume always included 0, indicating that the response of blood collection volume to the plasmapheresis station setting in the region was not statistically significant. The results of variance decomposition showed that the contribution of collection volume of voluntary blood donation to their own impact reached 94.3%. In terms of the contribution of plasmapheresis station factors, the number of plasma donors has a relatively greater impact on the volume of voluntary blood donation collected(2.2%). Covariance analysis showed that after removing the initial confounding factors, whether to establish a plasmapheresis station had no significant impact on blood donation volume in the two groups of regions (P>0.05). 【Conclusion】 The establishment of a new plasmapheresis station will have a certain impact on blood collection volume of blood stations in the region in a short term, but in the long term, it may not directly affect the voluntary blood donation collection in the region.

By reviewing the research context of narrative medicine in China in the past five years and sorting out the development status of narrative medicine in clinical practice in China, this paper pointed out the reasons why narrative medicine is difficult to implement in clinical practice in China at present. It mainly includes three points: the awareness of narrative medicine within the clinical medical community is not high; the humanities community focuses on the development of narrative medicine in medical education, resulting in rather scarce research on narrative medicine based on clinical practice; the research objects of narrative medicine are too narrow, ignoring the importance of the public and the front-line clinical personnel in the clinical practice of narrative medicine. Accordingly, this paper proposed corresponding countermeasures: it is advocated to investigate the awareness of narrative medicine in clinical medicine and the public, and it is suggested to list them as important objects of narrative medicine education. At the same time, it is recommended that the relationship between narrative medicine and doctor-patient communication should be clarified theoretically to guide the construction of a harmonious doctor-patient relationship in clinical practice.

Objective:To deeply understand the evaluation of allergic rhinitis patients on the use of health education accurately linking system, analyze their real experience and needs, so as to provide improvement basis for optimizing intelligent mobile education system.Methods:From January to June 2021, 15 patients with allergic rhinitis were selected from the Otolaryngology and Head and Neck Surgery of Beijing Tongren Hospital affiliated to Capital Medical University by purposive sampling as the interviewee. A total of 15 patients with allergic rhinitis were interviewed semi structurally, and the results were analyzed by thematic analysis.Results:The experience of the health education accurately linking system was refined into three themes, namely, the practicality of the health education content, the effectiveness of the health education form, and the shortcomings of the education content and form.Conclusions:Through the health education accurately linking system as the carrier, the system presents standardized health education knowledge as the core of clinical application interviews. It is necessary to increase access to health information. The content of propaganda and education can mainly be short videos. The disease knowledge module can be improved according to the severity of the disease, so as to improve the quality of health education and promote the occurrence of health behaviors.

OBJECTIVE: To compare the mid- and long-term outcomes of patients receiving mitral valve replacement through robotically assisted and conventional median sternotomy approach. METHODS: The data of 47 patients who underwent da Vinci robotic mitral valve replacement in our hospital between January, 2007 and December, 2015 were collected retrospectively (robotic group). From a total of 286 patients undergoing mitral valve replacement through the median thoracotomy approach between March, 2002 and June, 2014, 47 patients were selected as the median sternotomy group for matching with the robotic group at a 1:1 ratio. The perioperative data and follow-up data of the patients were collected, and the quality of life (QOL) of the patients at 30 days and 6 months was evaluated using the Quality of Life Short Form Survey (SF-12). The time of returning to work postoperatively and the patients' satisfaction with the surgical incision were compared between the two groups. RESULTS: All the patients in both groups completed mitral valve replacement successfully, and no death occurred during the operation. In the robotic group, only one patient experienced postoperative complication (pleural effusion); in median sternotomy group, one patient received a secondary thoracotomy for management of bleeding resulting from excessive postoperative drainage, and one patient died of septic shock after the operation. The volume of postoperative drainage, postoperative monitoring time, ventilation time, and postoperative hospital stay were significantly smaller or shorter in the robotic group than in the thoracotomy group ( CONCLUSIONS Robotically assisted mitral valve replacement is safe and reliable. Compared with the median sternotomy approach, the robotic approach is less invasive and promotes faster postoperative recovery of the patients, who have better satisfaction with the quality of life and wound recovery.
COVID-19/drug therapy* ; Humans ; Mitral Valve/surgery* ; Quality of Life ; Retrospective Studies ; Robotic Surgical Procedures ; Sternotomy ; Thoracotomy ; Treatment Outcome

The biodiversity of the mycobiome, an important component of the oral microbial community, and the roles of fungal-bacterial and fungal-immune system interactions in the pathogenesis of oral lichen planus (OLP) remain largely uncharacterized. In this study, we sequenced the salivary mycobiome and bacteriome associated with OLP. First, we described the dysbiosis of the microbiome in OLP patients, which exhibits lower levels of fungi and higher levels of bacteria. Significantly higher abundances of the fungi Candida and Aspergillus in patients with reticular OLP and of Alternaria and Sclerotiniaceae_unidentified in patients with erosive OLP were observed compared to the healthy controls. Aspergillus was identified as an "OLP-associated" fungus because of its detection at a higher frequency than in the healthy controls. Second, the co-occurrence patterns of the salivary mycobiome-bacteriome demonstrated negative associations between specific fungal and bacterial taxa identified in the healthy controls, which diminished in the reticular OLP group and even became positive in the erosive OLP group. Moreover, the oral cavities of OLP patients were colonized by dysbiotic oral flora with lower ecological network complexity and decreased fungal-Firmicutes and increased fungal-Bacteroidetes sub-networks. Third, several keystone fungal genera (Bovista, Erysiphe, Psathyrella, etc.) demonstrated significant correlations with clinical scores and IL-17 levels. Thus, we established that fungal dysbiosis is associated with the aggravation of OLP. Fungal dysbiosis could alter the salivary bacteriome or may reflect a direct effect of host immunity, which participates in OLP pathogenesis.
Adult ; Bacteria ; isolation & purification ; Case-Control Studies ; Dysbiosis ; complications ; microbiology ; Female ; Humans ; Lichen Planus, Oral ; complications ; microbiology ; Male ; Microbiota ; Middle Aged ; Mouth Mucosa ; microbiology ; Mycobiome ; Saliva ; microbiology

To unravel the genetic mechanisms of disease and physiological traits, it requires comprehensive sequencing analysis of large sample size in Chinese populations. Here, we report the primary results of the Chinese Academy of Sciences Precision Medicine Initiative (CASPMI) project launched by the Chinese Academy of Sciences, including the de novo assembly of a northern Han reference genome (NH1.0) and whole genome analyses of 597 healthy people coming from most areas in China. Given the two existing reference genomes for Han Chinese (YH and HX1) were both from the south, we constructed NH1.0, a new reference genome from a northern individual, by combining the sequencing strategies of PacBio, 10× Genomics, and Bionano mapping. Using this integrated approach, we obtained an N50 scaffold size of 46.63 Mb for the NH1.0 genome and performed a comparative genome analysis of NH1.0 with YH and HX1. In order to generate a genomic variation map of Chinese populations, we performed the whole-genome sequencing of 597 participants and identified 24.85 million (M) single nucleotide variants (SNVs), 3.85 M small indels, and 106,382 structural variations. In the association analysis with collected phenotypes, we found that the T allele of rs1549293 in KAT8 significantly correlated with the waist circumference in northern Han males. Moreover, significant genetic diversity in MTHFR, TCN2, FADS1, and FADS2, which associate with circulating folate, vitamin B12, or lipid metabolism, was observed between northerners and southerners. Especially, for the homocysteine-increasing allele of rs1801133 (MTHFR 677T), we hypothesize that there exists a "comfort" zone for a high frequency of 677T between latitudes of 35-45 degree North. Taken together, our results provide a high-quality northern Han reference genome and novel population-specific data sets of genetic variants for use in the personalized and precision medicine.

Objective To promote the Institutional Review Board(IRB) construction and development via paying more attention to the detail management and providing better protection of subjects' rights and interests in ethical review of clinical trials and scientific research projects.Methods Assessment criteria were established according to the domestic and international laws and regulations on the management of ethical and scientific research project.Ethical site visit was performed on the 37 clinical trials/scientific research projects approved by IRB during the year 2012-2015.Results Clinical trials/scientific research projects were divided into tree types:the registered clinical trials,the post-marketing clinical trials and the researcher initiated scientific research project.All the types met with the following assessment criteria:satisfy the requirement of equipment,facilities and qualifications of drug preservation required for conducting clinical research;subjects were given compensation according to the protocol;informed consent were obtained.Among them,the registered clinical trials meet more criteria than other research types.Regarding to the standard of informed consent implementation,all types met with the following assessment criteria:all the subjects enrolled signed informed consent forms,informed consent forms are well documented;investigators and subjects/ the guardian signed the forms.However,during the site visit,some other criteria were also neglected more or less.Particularly,only few project recorded the consent process and time spots singed the forms.Conclusions Investigators should pay more attention to the activities and behaviors taken place during the research implementation process.Researchers and management staffs should pay attention to ethical detail management to guarantee better protection of subjects' rights and interests.

Objective To investigate the clinical effect of placement of distal tibiofibular screw which is parallel to tibial in treating ankle fracture with tibiofibular syndesmosis separation.Methods Data of 59 cases with ankle fracture combined with tibiofibular syndesmosis separation from May 2014 to December 2015 were retrospectively analyzed.According to the direction of distal tibiofibular syndesmosis screw,59 cases were divided into two groups.There were 27 cases (18 males and 9 females) in Group A (parallel nailing group),with an average age of 42.00± 11.35 years.According to Lauge-Hansen classification,6 cases were supination extension-rotation Ⅲ and 9 were supination extension-rotation Ⅳ°,3 pronation extension-rotation Ⅲ and 7 pronation extension-rotation Ⅳ,2 pronation abduction ⅢL In group B (traditional nailing group),there were 32 cases (20 males and 12 females),with an average age of 44.00±13.34 years.According to Lauge-Hansen classification,5 cases were supination extension-rotation Ⅲ° and 12 supination extension-rotation Ⅳ°,4 pronation extension-rotation Ⅲ° and 8 pronation extension-rotation Ⅳ°,3 pronation abduction Ⅲ°.Two groups were compared of the flexion and extension angle of ankle joint after operation and function of ankle joint according to Baird-Jackson score.Results All the patients were followed up for 18 months.The fracture healing time of parallel nailing group was 2.5 to 5 months with an average of 3.4 months.While the fracture healing time of traditional nailing group was 2.5 to 6 months with the average of 3.8 months.The excellent rate of planting nail for group A was 100％ (24 cases for excellent and 3 for good),and for group B was 53.13％ (5 cases for excellent and 12 for good).There was significant difference between two groups (x2=16.97,P=0.0001).The excellent rate of group A was better than that in group B.6 weeks after operation,the flexion and extension angle of ankle joint was 25.00°±6.33° in group A and 17.00°±4.46° in group B with significant difference between two groups (t=5.82,P=0.0002).12 weeks after operation,the flexion and extension angle of ankle joint was 31.00°±7.75° in group A and 19.00°±5.58° in group B,with significant difference between two groups (t=7.54,P=0.0008).The flexion and extension angle of group A was better than that in group B for early postoperative period.6 months after operation,according to BairdJackson score,the excellent rate of ankle function of group A was 44.44％ (2 cases for excellent and 10 for good),and group B was 12.50％ (4 cases for good),with significant difference between two groups (x2=7.56,P=0.007).12 months after operation,the excellent rate of group A was 77.78％ (6 cases for excellent and 15 for good),group B was 34.38％ (2 cases for excellent and 9 for good),with significant difference between two groups (x2=11.11,P=0.001).18 months after operation,the excellent rate of ankle function of group A was 88.89％ (17 cases for excellent and 7 for good),and group B was 78.13％ (10 cases for excellent and 15 for good),with no significant differences (x2=0.56,P=0.23).One year after operation,the ankle function of group A was better than that in group B,while 18 months after operation,there was no statistical differences between the two groups.The data of 18 months after operation were further studied,using the method of stratified analysis,and the rate of excellent of group A was 59.26％ (16/27),while group B was 34.38％ (11/32),with significant difference between two groups (x2=3.65,P=0.049).The ankle function of group A was better than that of group B 18 months after operation.Conclusion Compared with the traditional method,this kind of method could accurately locate the distal tibiofibular syndesmosis screw.About early and mid-term postoperative period,it is superior to the traditional method for ankle function.