Early clinical outcomes of the domestic KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation: A single-arm, prospective, single-group target value clinical trial / 中国胸心血管外科临床杂志

@#Objective To summarize and analyze the preliminary clinical outcomes of the KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation (DMR). Methods This study was a single-arm, prospective, single-group target value clinical trial that enrolled patients who underwent the KokaclipTM transcatheter edge-to-edge repair (TEER) system for DMR in the Department of Heart Surgery of Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute from June 2022 to January 2023. Differences in the grade of mitral regurgitation (MR) during the perioperative and follow-up periods were compared, and the incidences of adverse events such as all-cause death, thoracotomy conversion, reoperation, and severe recurrence of MR during the study period were investigated. Results The enrolled patient population consisted of 14 (50.0%) females with a mean age of 70.9±5.4 years. Twenty-eight (100.0%) patients were preoperatively diagnosed with typeⅡ DMR, with a prolapse width of 12.5 (11.0, 16.1) mm, a degree of regurgitation 4+ leading to pulmonary venous reflux, and a New York Heart Association cardiac function class≥Ⅲ. All patients completed the TEER procedure successfully, with immediate postoperative improvement of MR to 0, 1+, and 2+ grade in 2 (7.1%), 21 (75.0%), and 5 (17.9%) patients, respectively. Mitral valve gradient was 2.5 (2.0, 3.0) mm Hg. Deaths, thoracotomy conversion, or device complications such as unileaflet clamping, clip dislodgement, or leaflet injury were negative. Twenty-eight (100.0%) patients completed at least 3-month postoperative follow-up with a median follow-up time of 5.9 (3.6, 6.8) months, during which patients had a mean MR grade of 1.0+ (1.0+, 2.0+) grade and a significant improvement from preoperative values (P<0.001). There was no recurrence of ≥3+ regurgitation, pulmonary venous reflux, reoperation, new-onset mitral stenosis, or major adverse cardiovascular events. Twenty-two (78.6%) patients’ cardiac function improved to classⅠorⅡ. Conclusion The domestic KokaclipTM TEER system has shown excellent preliminary clinical results in selected DMR patients with a high safety profile and significant improvement in MR. Additional large sample volume, prospective, multicenter studies, and long-term follow-up are expected to validate the effectiveness of this system in the future.

Establishment and application of a prospective follow-up research method for acute infectious diseases in Shanghai community residents / 上海预防医学

ObjectiveTo present the exploration and application of a prospective follow-up research method for acute infectious disease surveillance based on natural community populations， using COVID-19 infection as an example， and to provide a reference for improving the infectious disease surveillance and early warning system. MethodsA multi-stage probability proportional sampling method was employed to sample residents from all communities of 16 administrative districts in Shanghai， with households as the units. A cohort for acute infectious diseases based on natural community populations was established. The baseline survey was conducted for all cohort subjects， and COVID-19 antigen test kits were distributed. From December 21， 2022 to September 30， 2023， prospective follow-up monitoring of COVID-19 antigen and nucleic acid was carried out on the study subjects on a weekly basis. The baseline characteristics and follow-up information of the cohort subjects were described. ResultsThe cohort for acute infectious diseases included a total of 12 881 subjects， comprising 6 098 males （47.3%） and 6 783 females （52.7%）. The baseline survey revealed that 35.2% （4 540/12 881） of the subjects had a history of COVID-19 infection. During the follow-up period from December 21， 2022 to September 30， 2023， the average incidence density in the cohort was 0.61/person-year， with a higher incidence density in females （0.63/person-year） compared to males （0.59/person-year）. Individuals aged 60 and above （0.64/person-year） and those with underlying health conditions （0.67/person-year） had a higher incidence density. Healthcare workers showed a notably higher incidence density （0.84/person-year） than that in other occupational groups. As of September 30， 2023， a total of 340 subjects in the cohort experienced secondary infections， with a median interval of 170 days between the first and second infections. ConclusionThis study applies cohort study method to acute infectious disease surveillance， providing crucial data support for estimating infection rates and forecasting alerts for acute infectious diseases in the community. This method can be promoted and applied as a new approach for acute infectious disease surveillance.

Prospective effects of dietary intake on lung function of pupils in Chengdu City / 中国学校卫生

Objective@#To investigate the prospective effects of intake of each food group on the development of lung function of pupils,so as to provide theoretical basis for promoting the healthy development of lung function and preventing chronic respiratory diseases in Chinese children.@*Methods@#A cluster stratified sampling method was used to select a total of 893 pupils in grades 2-5 from Chengdu in November 2021. Dietary data of respondents were collected using a food frequency questionnaire within the past year,then the food group intake was categorized into T1, T2 and T3 from low to high by the trichotomous method, and anthropometric measurements including lung capacity were obtained in 2022. Logistic regression models and test for trend were used to analyze the prospective effects of intake of each food group on lung function development of pupils.@*Results@#Among male students, consumption of vegetables [118.6(50.5, 188.2)g/d] and milk and dairy products [200.0(73.3, 250.0)g/d] were higher in the excellent lung capacity group than in the non excellent lung capacity group [90.0(37.1, 192.9), and 178.6(35.7, 250.0)g/d],with statistically significant differences ( Z =-1.98, -2.24); among girls, the group with excellent lung capacity consumed less staple food [391.1(273.6, 511.4)g/d] than the group with non excellent lung capacity [407.4(309.5, 594.3)g/d], and the group with excellent lung capacity consumed more aquatic products [31.2(14.6, 69.8)g/d] and milk and dairy products [215.0(107.1, 250.1) g/d ] than that of the non excellent lung capacity [19.4(10.7, 58.3), 114.3(35.7, 250.0)g/d] ( Z =-2.01, -3.33, -5.10)( P < 0.05 ). After adjusting for energy, body mass index Z score(BMI Z ), mother s education level, averge family income monthly, whether presence of smokers in the living environment, and whether participation in physical activities during the past week, among male students, T3 group of vegetable intake ( OR =0.48, 95% CI = 0.27-0.86), T2 group of bean and soy product intake ( OR = 0.52 , 95% CI =0.27-0.96)，T2 and T3 groups of milk and dairy products intake (T2： OR =0.54, 95% CI =0.31-0.93; T3： OR = 0.52 , 95% CI =0.30-0.90) were negatively associated with non excellent lung capacity ( P <0.05). Among girls, T3 group of aquatic product intake( OR =0.52, 95% CI =0.28-0.97), T2 and T3 groups of milk and dairy product (T2: OR =0.44, 95% CI =0.25- 0.76 ;T3: OR =0.33, 95% CI =0.19-0.59) were negatively associated with nonexcellent lung capacity, whereas the T2 group of red meat intake ( OR =2.51, 95% CI =1.37-4.67) was positively associated with non excellent lung capacity. Non excellent lung capacity was found to be negatively associated with vegetable and milk and dairy product intake in boys by test for trend; in girls, milk and dairy products intake was negatively associated with non excellent lung capacity, whereas red meat intake was positively associated with non excellent lung capacity ( t =-1.13，-0.44；-3.03，1.95, P trend <0.05).@*Conclusions@#Milk and dariy products intakes reduce the risk of non excellent lung capacity in pupils, vegetables intakes reduce the risk of non excellent lung capacity in boys, and the intake of red meat increases the risk of non excellent lung capacity in girls. Promoting rational food choices is necessary for children to improve healthy lung development.

Development and internal validation of a clinical prediction model for spontaneous abortion risk in early pregnancy

Abstract Objective: This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy. Methods: This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed. Results: The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87‒0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27). Conclusions: The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application.

Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Timing of Surgery and Pre-operative Physiological Parameters as Clinical Predictors of Surgical Outcomes in Traumatic Subaxial Cervical Spine Fractures and Dislocations / Momento da cirurgia e parâmetros fisiológicos pré-operatórios como fatores preditivos clínicos de desfechos cirúrgicos em fraturas e luxações traumáticas subaxiais da coluna cervical

Abstract Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as Uearly, Ulate, Searly and Slate. All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

Resumo Objetivo Avaliar os fatores de risco e os desfechos em indivíduos submetidos ao tratamento cirúrgico de lesões subaxiais da coluna cervical em relação ao momento da cirurgia e aos parâmetros fisiológicos pré-operatórios dos pacientes. Métodos O estudo incluiu 26 pacientes com fraturas e luxações subaxiais da coluna cervical. Dados demográficos, investigação radiológica apropriada e parâmetros fisiológicos, como frequência respiratória, pressão arterial, frequência cardíaca, pressão parcial de oxigênio (PaO2) e escalas de disfunção da American Spine Injury Association (ASIA), foram documentados. No período pré-operatório, os pacientes foram divididos em dois grupos. O grupo instável (I) continha pacientes com parâmetros fisiológicos anormais e o grupo estável (E) era composto por pacientes com parâmetros fisiológicos dentro da faixa de normalidade. Os pacientes foram ainda subdivididos em grupos de tratamento precoce e tardio de acordo com o momento da cirurgia como Iprecoce, Itardio, Eprecoce e Etardio. Todos os pacientes foram chamados para consultas de acompanhamento em 1, 6 e 12 meses. Resultados Cinquenta e seis por cento dos pacientes do grupo E apresentaram melhora neurológica em um grau ASIA e desfecho bom independentemente do momento da cirurgia. Os desfechos em pacientes do grupo I com parâmetros fisiológicos instáveis e submetidos à intervenção cirúrgica precoce foram maus. Conclusão Este estudo conclui que a intervenção cirúrgica precoce em pacientes com instabilidade fisiológica teve forte associação como fator de risco no desfecho final em termos de mortalidade e morbidade. Além disso, não foi possível estabelecer nenhuma associação positiva de melhora em pacientes com estabilidade fisiológica em relação ao momento da cirurgia.

Antibody Response to SARS-COV-2 Vaccination in Healthcare Workers of Uttarakhand: A Prospective Follow-up Study

Background: Countries around the world are now racing to vaccinate people against SARS-CoV-2, the virus that causes COVID-19. The Government of India also rolled out its vaccination drive from 16th January ‘2021. Aims: To estimate the antibody response of the COVID-19 vaccine in the form of SARS-COV-2 IgG antibodies in vaccinated healthcare workers. Methods: Prospective follow-up was study conducted on healthcare workers (HCWs) of a Medical college in Dehradun, Uttarakhand. Healthcare workers who have been vaccinated for COVID-19 were tested for SARS-CoV-2-IgG antibodies at regular intervals i.e at 4 weeks after the 1st dose and then again at 4 weeks after the 2nd dose. The third sample was taken 6 months after the 2nd dose. Results: A total of 302 HCWs were enrolled in the study who gave their samples for IgG antibody estimation after the Covishield vaccine. After 4 weeks of completion of both doses, 96% HCWs formed SARS-COV-2 IgG antibodies, whereas 4% didn’t. Then after 6 months of follow-up, 14% HCWs have become negative for antibodies and better immunity is seen in people who also got infected with COVID-19 during this time. Conclusion: This study concludes that the immunity gained after vaccination is waning off in around 6 months and there is a need for a booster dose, especially for people at high risk. The infection control practices still play a crucial role in the prevention of this deadly disease.

The relationship between miR-3187-5p and postoperative atrial fibrillation after coronary artery bypass grafting: A prospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To investigate the relationship between miR-3187-5p in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and postoperative atrial fibrillation (POAF). Methods     Patients who underwent CABG in the Heart Center of Beijing Chao-Yang Hospital from March to May 2022 were enrolled. Peripheral blood and pericardial drainage were collected at 0 h after surgery (immediate time for patients to return to ICU from operating room) to detect miR-3187-5p, and perioperative confounding factors were also collected. The miR-3187-5p was measured by quantitative real-time PCR and its regulated target genes were analyzed by bioinformatics. Results     A total of 15 patients were enrolled, including 9 males and 6 females with an average age of 65.6±8.2 years. The incidence rate of POAF was 40.0%. miR-3187-5p in pericardial drainage at 0 h after surgery was an independent predictor for POAF. A total of 1 642 target genes of miR-3187-5p were predicted. GO function enrichment analysis and KEGG signal pathway enrichment analysis showed that target genes of miR-3187-5p were enriched in TGF-β, MAPK, Wnt and other classical collagen metabolic signal pathways, which might activate collagen metabolism by negatively regulating SMAD6 and other inhibitors of the pathways. Conclusion     This study is the first to find that miR-3187-5p in pericardial drainage at 0 h  after surgery is a potential, novel, and predictive factor for POAF, which may be related to the regulation of myocardial fibrosis signal pathways like TGF-β, MAPK and Wnt pathways, promoting the early collagen metabolism imbalance after CABG, increasing the collagen deposition in the atrium, and then promoting the early structural reconstruction after CABG and leading to the occurrence of POAF. The result provides a research basis for the accurate prediction and prevention of clinical POAF.

Study on nomograph predicting the risk of type 2 diabetes mellitus in Beijing community adults / 中华内科杂志

Objective:Development and validation of a nomogram for predicting the 4-year incidence of type-2 diabetes mellitus (T2DM) in a Chinese population was attempted.Methods:This prospective cohort study was conducted in Shijingshan District Pingguoyuan Community (Beijing, China) from December 2011 to April 2012 among adults aged≥40 years not suffering from T2DM. Finally, 8 058 adults free of T2DM were included with a median duration of follow-up of 4 years. Participants were divided into a modeling group and verification group using simple random sampling at a ratio of 7∶3. Univariate and multivariate Cox proportional risk models were applied to identify the independent risk predictors in the modeling group. A nomogram was constructed to predict the 4-year incidence of T2DM based on the results of multivariate analysis. The Concordance Index and calibration plots were used to evaluate the differentiation and calibration of the nomogram in both groups.Results:A total of 5 641 individuals were in the modeling group and 2 417 people were in the validation group, of which 265 and 106 had T2DM, respectively, at 4-year follow-up. In the modeling group, age ( HR=1.349, 95% CI 1.011-1.800), body mass index ( HR=1.347, 95% CI 1.038-1.746), hyperlipidemia ( HR=1.504, 95% CI 1.133-1.996), fasting blood glucose ( HR=4.189, 95% CI 3.010-5.830), 2-h blood glucose level according to the oral glucose tolerance test ( HR=3.005, 95% CI 2.129-4.241), level of glycosylated hemoglobin ( HR=3.162, 95% CI 2.283-4.380), and level of γ-glutamyl transferase ( HR=1.920, 95% CI 1.385-2.661) were independent risk factors for T2DM. Validation of the nomogram revealed the Concordance Index of the modeling group and validation group to be 0.906 (95% CI 0.888-0.925) and 0.844 (95% CI 0.796-0.892), respectively. Calibration plots showed good calibration in both groups. Conclusion:These data suggest that our nomogram could be a simple and reliable tool for predicting the 4-year risk of developing T2DM in a high-risk Chinese population.

Efficacy of implant surface culture in identification of microorganisms for fracture device-related infection: a preliminary analysis / 中华创伤骨科杂志

Objective:To evaluate the efficacy of implant surface culture in identification of pathogens for fracture device-related infection.Methods:A prospective study was conducted to include the eligible patients who were diagnosed with infection after fracture fixation and needed surgical removal of the implants according to treatment principles at Division of Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, Nanfang Hospital from November 2020 to January 2023. With informed consent, after rinsing with aseptic normal saline twice, their implants were gently covered with a thin layer of tryptone soy agar medium. Thereafter, the implants were incubated at 37 ℃ with 5% CO 2. Changes on the surface and in the surroundings of the implants were observed every day for consecutive 2 weeks to avoid drying up by supplementing the medium when necessary. Once pathogen colonies formed, samples were collected at 3 independent sites using sterile swabs for laboratory identification. Comparisons were made between the samples from implant surface culture and the intraoperative multisite samples from conventional culture. Results:Included were a total of 75 patients [56 males and 19 females with an age of (46.2±15.4) years]. The most common infection site was the tibia (37 cases), and the most common type of implants was plate and screw (59 cases). The positive rate of implant surface culture was significantly higher than that of conventional culture (86.7% vs. 52.0%, P<0.001). 80.5% (29/36) of the negative patients detected by the conventional culture obtained positive results by the implant surface culture; three of the positive patients detected by the conventional culture obtained negative results by the implant surface culture. The culture results were positive by both culture methods in 36 patients, and consistent by both culture methods in 35 patients, yielding a consistent rate of 97.2% (35/36). The time for implant surface culture was significantly shorter than that for conventional culture [1 (1, 2) d versus 3 (3, 4) d] ( P<0.001). Of the 65 positive patients by the implant surface culture, 59 were detected with monomicrobial infection, with Staphylococcus aureus on the top (29 cases). Conclusion:As the implant surface culture, a novel method, may be superior to the conventional culture in a significantly higher positive rate and a shorter culture time, it may be used as an effective adjunct to the conventional culture in identification of pathogens for fracture device-related infection.

Feasibility of a Home-based Exercise Program after Abdominally Based Autologous Breast Surgery Reconstruction：An Observational Study / The Japanese Journal of Rehabilitation Medicine

Objective：We aimed to evaluate the feasibility of our rehabilitation program for abdominally based rehabilitation following autologous breast reconstruction, and investigate the changes in physical function and health-related quality of life in the early postoperative period.Methods：Fifteen patients who underwent breast reconstruction between September 2020 and October 2021 were included in this prospective, observational case series.The program composed of prehabilitation and postoperative home-based exercise until 12 weeks post-surgery. Adherence to home exercise program was surveyed using a self-reported workout check list. At postoperative 4th, 8th, 12th, and 24th weeks, a physio-/occupational therapist assessed the following objectives：i) Range of motion, muscle strength, and disability of upper extremity and trunk, ii) Quality of life using EQ-5D questionnaire, and iii) Patients' daily activities.Results：No adverse events were observed, and all patients completed the program. Overall adherence to daily exercise was 71.1％．Physical function of the upper extremities recovered in 8th postoperative week；however, truncal function, quality of life, and daily activities in 12th postoperative week remained lower than those observed preoperatively. Nevertheless, the program appeared useful for many patients, although some reported difficulty in continuing the exercise after returning to work.Conclusion：Rehabilitation programs directed by physio/occupational therapists may play a potentially advantageous role in facilitating a return to baseline function and quality of life during the early postoperative period.

Effects of acupuncture on hemorrhagic transformation and motor function in stroke patients after intravenous thrombolysis with rt-PA: a prospective cohort study / 中国针灸

OBJECTIVE@#To observe the effects of the Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on hemorrhagic transformation and limb motor function after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in stroke patients.@*METHODS@#A total of 130 stroke patients after rt-PA thrombolytic were divided into an acupuncture group (58 cases, 1 case dropped off) and a non-acupuncture group (72 cases, 7 cases dropped off) according to whether they received acupuncture treatment. Propensity score matching (PSM) was used to match each group, with 38 patients in each group. The patients in the non-acupuncture group received rt-PA thrombolytic therapy and western medical basic treatment. In addition to the basic treatment, the patients in the acupuncture group received Xingnao Kaiqiao acupuncture at Shuigou (GV 26), bilateral Neiguan (PC 6), and ipsilateral Sanyinjiao (SP 6), Chize (LU 5), once a day for 14 days. The incidence of hemorrhagic transformation within 30 days after onset was compared between the two groups. The Fugl-Meyer assessment (FMA) score and activities of daily living (ADL) score were observed at baseline and 30 days, 6 months, 1 year after onset in the two groups. The disability rate at 6 months and 1 year after onset was recorded, and safety was evaluated in both groups.@*RESULTS@#The incidence of hemorrhagic transformation in the acupuncture group was 5.3% (2/38), which was lower than 21.1% (8/38) in the non-acupuncture group (P<0.05). At 30 days, 6 month, and 1 year after onset, the FMA and ADL scores of both groups were higher than those at baseline (P<0.01), and the scores in the acupuncture group were higher than those in the non-acupuncture group (P<0.01). The disability rate in the acupuncture group at 1 year after onset was 10.5% (4/38), which was lower than 28.9% (11/38) in the non-acupuncture group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).@*CONCLUSION@#The Xingnao Kaiqiao acupuncture method could reduce the incidence of hemorrhagic transformation in stroke patients after intravenous thrombolysis with rt-PA, improve their motor function and daily living ability, and reduce the long-term disability rate.

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women / 世界急诊医学杂志（英文）

@#BACKGROUND: We aimed to examine prospective associations between different intensities and different types of physical activity (PA) in early pregnancy and hypertensive disorders of pregnancy (HDP) among Chinese women. METHODS: A total of 6,820 pregnant women from the Tongji-Shuangliu Birth Cohort were included in this study. The pregnancy physical activity questionnaire (PPAQ) was used to assess PA, including household/caregiving, occupational, sports/exercise, and transportation activities in the first trimester of pregnancy. The diagnosis of HDP was collected, including gestational hypertension (GH) and preeclampsia (PE). Data were analyzed by unconditional multivariate logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 178 (2.6%) of the 6,820 women were diagnosed with HDP, of which 126 (1.8%) were GH and 52 (0.8%) were PE. Overall, we found no association between PA in early pregnancy and PE. A trend toward lower risk was found only among women with GH and among those with higher levels of moderate-to-vigorous intensity physical activity (MVPA) (adjusted OR 0.54, 95% CI 0.31-0.96). No association was observed between PA and HDP in early pregnancy, regardless of different intensities or types of PA. CONCLUSION: MVPA in the first trimester is an influencing factor of HDP. Encouraging pregnant women to engage in MVPA in the first trimester may help to prevent GH.

Factors affecting cataract among the elderly population / 预防医学

Objective@#To investigate the factors affecting cataract among the elderly, so as to provide insights into cataract control.@*Methods@#Based on the major public health monitoring project of Zhejiang Province, residents at ages of 60 years and older were selected from 7 districts (counties) using a multi-stage stratified cluster random sampling method, and were followed up every other year from 2014 to 2020. Demographics, lifestyle, dietary habits and cataract incidence were collected, and factors affecting the incidence of cataract were identified using a multivariable Cox proportional hazard regression model.@*Results@# Totally 9 642 residents were investigated, with a mean age of (68.89±7.39) years, and including 4 635 males (48.07%). There were 828 incident cataract cases, with an incidence rate of 20.946/1 000 person-years. Multivariable Cox proportional hazard regression analysis showed that women (HR=1.695, 95%CI: 1.377-2.088), age of 65 years and older (HR=1.707-5.044, 95%CI: 1.400-7.327), overweight/obesity (HR=1.313, 95%CI: 1.131-1.524), educational level (primary school, HR=1.642, 95%CI: 1.400, 1.926; junior high school, HR=1.553, 95%CI: 1.148-2.102), annual family income (10 000 to 50 000 Yuan, HR=1.353, 95%CI: 1.155-1.585; 50 000 to 100 000 Yuan, HR=0.663, 95%CI: 0.500-0.881; 100 000 to 150 000 Yuan, HR=0.340, 95%CI: 0.204-0.565), smoking (HR=0.649, 95%CI: 0.494-0.853), frequency of vegetable intake of >3 days/week (HR=0.693, 95%CI: 0.527-0.912), frequency of fruit intake of >3 days/ week (HR=0.833, 95%CI: 0.694-0.899), frequency of egg intake of >3 days/week (HR=0.579, 95%CI: 0.450-0.745), frequency of soy products intake of >3 days/week (HR=0.706, 95%CI: 0.588-0.849), frequency of dairy products intake of >3 days/week (HR=1.510, 95%CI: 1.199-1.901) and frequency of nut intake of >3 days/week (HR=1.733, 95%CI: 1.162-2.586) were statistically associated with the development of cataract among the elderly. @*Conclusion @#Gender, age, body mass index, educational level, income, smoking, and frequency of vegetables, fruits, eggs, soy products, dairy products and nuts intake are associated with the development of cataracts.

Injury profile in male collegiate rugby union players / 体力科学

The purpose of this study was to describe the incidence, severity, and burden of injuries in Japanese male collegiate rugby union players. Initially, 170 male collegiate rugby union players from one university club were registered in this epidemiological surveillance study. The occurrence of injuries was recorded by a team medical staff during the 2017–2021 playing seasons. The incidence of injuries was 6.87 injuries/1000 h. This incidence was significantly higher during matches (100.37 injuries/1000 h) than that during training (3.63 injuries/1000 h). The severity of injuries was 31.0 days, and there were no significant differences between matches and training, or forwards and backs. The burden of injuries was 213.1 days/1000 h. This burden was significantly higher during matches (2887.8 days/1000 h) compared to training (120.1 days/1000 h). Matches had higher incidence of ankle sprain/ligament injuries (15.80 injuries/1000 h) and concussion (15.36 injuries/1000 h). The most common injury site was the ankle (1.24 injuries/1000 h). However, the greatest severity and burden were observed for knee injuries (severity: 59.1 days, burden: 48.6 days/1000 h). Furthermore, the greatest burden of injury type was knee sprain/ligament injuries (39.4 days/1000 h). In addition, the incidence of acromioclavicular joint injury was significantly higher in forwards, whereas hamstring strain was significantly higher in backs. The common injury mechanisms identified were being tackled (16.0%) and tackling (14.7%), followed by overuse (12.1%). In order to improve the player welfare of the Japanese collegiate rugby union players, it is necessary to work on the prevention strategy considering the injury profile.

Evaluation of Four Predictive Models for Identifying Malignancy of Solitary Pulmonary Nodules in Health Check-up Population / 肿瘤防治研究

Objective To compare and validate the efficiency of four models predicting the malignancy of solitary pulmonary nodules (SPN). Methods Patients diagnosed with SPN during health check-up were selected as the research subjects. Risk assessment was conducted using four predictive models. Outcomes were obtained through prospective follow-up. Statistical description and univariate analysis were performed for all risk factors of the four models. ROC curve was applied to compare the efficiency of the four predictive models. Results A total of 479 cases were included in this study. Among these patients, 82 were diagnosed with lung tumor, and the malignant rate was 17.12%. Age, nodule diameter, smoking, family history of tumor, history of extrapulmonary tumor ≥5 years, upper lobe site, unclear boundary, and spiculation rates were higher in the malignancy group than those in the benign group (P < 0.05). The efficiency of Brock model was the best. Its AUC was 0.833, sensitivity was 80.49%, and specificity was 74.31%. Its Youden index, positive likelihood ratio, positive predictive value, and negative predictive value were the highest, and its negative likelihood ratio was the lowest. The AUC, sensitivity, and specificity of Mayo model were 0.815, 81.71%, and 67.51%, respectively; those of PKUPH model were 0.754, 69.51%, and 73.55%, respectively; and those of VA model were 0.738, 68.29%, and 67.55%, respectively. Conclusion The Brock model might be the most appropriate predictive model for the risk assessment of SPN among the health check-up population, and the VA model is the worst. The combination of Brock, Mayo, and PKUPH models requires further study.

Feasibility of a Home-based Exercise Program after Abdominally Based Autologous Breast Surgery Reconstruction：An Observational Study / The Japanese Journal of Rehabilitation Medicine

Objective：We aimed to evaluate the feasibility of our rehabilitation program for abdominally based rehabilitation following autologous breast reconstruction, and investigate the changes in physical function and health-related quality of life in the early postoperative period.Methods：Fifteen patients who underwent breast reconstruction between September 2020 and October 2021 were included in this prospective, observational case series.The program composed of prehabilitation and postoperative home-based exercise until 12 weeks post-surgery. Adherence to home exercise program was surveyed using a self-reported workout check list. At postoperative 4th, 8th, 12th, and 24th weeks, a physio-/occupational therapist assessed the following objectives：i) Range of motion, muscle strength, and disability of upper extremity and trunk, ii) Quality of life using EQ-5D questionnaire, and iii) Patients' daily activities.Results：No adverse events were observed, and all patients completed the program. Overall adherence to daily exercise was 71.1％．Physical function of the upper extremities recovered in 8th postoperative week；however, truncal function, quality of life, and daily activities in 12th postoperative week remained lower than those observed preoperatively. Nevertheless, the program appeared useful for many patients, although some reported difficulty in continuing the exercise after returning to work.Conclusion：Rehabilitation programs directed by physio/occupational therapists may play a potentially advantageous role in facilitating a return to baseline function and quality of life during the early postoperative period.

Efficacy and safety of multiple-dose intravenous tranexamic acid for reducing blood loss in complex tibial plateau fractures: A prospective randomized controlled trial / 中国修复重建外科杂志

OBJECTIVE@#To investigate the efficacy and safety of multiple-dose intravenous tranexamic acid (TXA) for reducing blood loss in complex tibial plateau fractures with open reduction internal fixation by a prospective randomized controlled trial.@*METHODS@#A study was conducted on patients with Schatzker type Ⅳ-Ⅵ tibial plateau fractures admitted between August 2020 and December 2022. Among them, 88 patients met the selection criteria and were included in the study. They were randomly allocated into 3 groups, the control group (28 cases), single-dose TXA group (31 cases), and multiple-dose TXA group (29 cases), using a random number table method. There was no significant difference ( P>0.05) in terms of age, gender, body mass index, the Schatzker type and side of fracture, laboratory examinations [hemoglobin (Hb), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib), international normalized ratio (INR), D-dimer, and interleukin 6 (IL-6)], and preoperative blood volume. The control group received intravenous infusion of 100 mL saline at 15 minutes before operation and 3, 6, and 24 hours after the first administration. The single-dose TXA group received intravenous infusion of 1 g TXA (dissolved in 100 mL saline) at 15 minutes before operation, followed by an equal amount of saline at each time point after the first administration. The multiple-dose TXA group received intravenous infusion of 1 g TXA (dissolved in 100 mL saline) at each time point. The relevant indicators were recorded and compared between groups to evaluate the effectiveness and safety of TXA, including hospital stays, operation time, occurrence of infection; the occurrence of lower extremity deep vein thrombosis, intermuscular vein thrombosis, and pulmonary embolism at 1 week after operation; the lowest postoperative Hb value and Hb reduction rate, the difference (change value) between pre- and post-operative APTT, PT, Fib, and INR; D-dimer and IL-6 at 24 and 72 hours after operation; total blood loss, intraoperative blood loss, hidden blood loss, drainage flow during 48 hours after operation, and postoperative blood transfusion.@*RESULTS@#① TXA efficacy evaluation: the lowest Hb value in the control group was significantly lower than that in the other two groups ( P<0.05), and there was no significant difference between the single- and multiple-dose TXA groups ( P>0.05). The Hb reduction rate, total blood loss, intraoperative blood loss, drainage flow during 48 hours after operation, and hidden blood loss showed a gradual decrease trend in the control group, single-dose TXA group, and multiple-dose TXA group. And differences were significant ( P<0.05) in the Hb reduction rate and drainage flow during 48 hours after operation between groups, and the total blood loss and hidden blood loss between control group and other two groups. ② TXA safety evaluation: no lower extremity deep vein thrombosis or pulmonary embolism occurred in the three groups after operation, but 3, 4, and 2 cases of intermuscular vein thrombosis occurred in the control group, single-dose TXA group, and multiple-dose TXA group, respectively, and the differences in the incidences between groups were not significant ( P>0.05). There was no significant difference in the operation time between groups ( P>0.05). But the length of hospital stay was significantly longer in the control group than in the other groups ( P<0.05); there was no significant difference between the single- and multiple-dose TXA groups ( P>0.05). ③ Effect of TXA on blood coagulation and inflammatory response: the incisions of the 3 groups healed by first intention, and no infections occurred. The differences in the changes of APTT, PT, Fib, and INR between groups were not significant ( P>0.05). The D-dimer and IL-6 in the three groups showed a trend of first increasing and then decreasing over time, and there was a significant difference between different time points in the three groups ( P<0.05). At 24 and 72 hours after operation, there was no significant difference in D-dimer between groups ( P>0.05), while there was a significant difference in IL-6 between groups ( P<0.05).@*CONCLUSION@#Multiple intravenous applications of TXA can reduce perioperative blood loss and shorten hospital stays in patients undergoing open reduction and internal fixation of complex tibial plateau fractures, provide additional fibrinolysis control and ameliorate postoperative inflammatory response.

HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

Comparing financing models for supplementary healthcare in appendectomy: activity-based costing (fee-for-service) vs. diagnosis related group remuneration (bundled payment): a systematic review and meta-analysis

Purpose: In Brazil, healthcare services traditionally follow a fee-for-service (FFS) payment system, in which each medical procedure incurs a separate charge. An alternative reimbursement with the aim of reducing costs is diagnosis related group (DRG) remuneration, in which all patient care is covered by a fixed amount. This work aimed to perform a systematic review followed by meta-analysis to assess the effectiveness of the Budled Payment for Care Improvement (BPCI) versus FFS. Methods: Our work was performed following the items of the PRISMA report. We included only observational trials, and the primary outcome assessed was the effectiveness of FFS and DRG in appendectomy considering complications. We also assessed the costs and length of hospital stay. Meta-analysis was performed with Rev Man version 5.4. Results: Out of 735 initially identified articles, six met the eligibility criteria. We demonstrated a shorter hospital stay associated with the DRG model (mean difference = 0.39; 95% confidence interval ­ 95%CI ­ 0.38­0.40; p < 0.00001; I2 = 0%), however the hospital readmission rate was higher in this model (odds ratio = 1.57; 95%CI 1.02­2.44, p = 0.04; I2 = 90%). Conclusions: This study reveals a potential decrease in the length of stay for appendectomy patients using the DRG approach. However, no significant differences were observed in other outcomes analysis between the two approaches.