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Objective:To explore the risk factors for atrial fibrillation(AF)in elderly Chinese patients with severe valvular heart disease(VHD).Methods:This was a cross-sectional study and consecutively enrolled 978 elderly patients with severe VHD diagnosed in 18 Class A tertiary hospitals across the country from September 2021 to March 2022, including 322(32.9%)patients with concurrent AF.Clinical and echocardiographic data were collected to analyze the risk factors for AF.Results:Among VHD patients, compared with the non-AF group, the AF group was older, had a higher female ratio, higher diastolic blood pressure, higher proportions with cerebrovascular disease and chronic kidney disease, lower serum low density lipoprotein cholesterol and higher serum creatinine, amino-terminal A-type natriuretion peptide and glycosylated hemoglobin.As for echocardiographic parameters, the left atrial diameter was larger, the left ventricular end-diastolic diameter, interventricular septum thickness, and left ventricular posterior wall thickness were smaller in the AF group than in the non-AF group.All of the differences were statistically significant(all P<0.05). The results of multivariate Logistic regression analysis showed that the left atrial anteroposterior diameter increased( OR=1.166, P<0.01), the left ventricular end-diastolic diameter decreased( OR=0.929, P<0.01), and advanced age( OR=1.051, P<0.05)was an independent risk factor for elderly VHD patients with concurrent AF. Conclusions:In elderly patients with severe VHD, advanced age, an increased left atrial anteroposterior diameter, and a decreased left ventricular end-diastolic diameter were independently associated with AF.Therefore, evaluation of cardiac structure and regular follow-up should be performed in elderly patients with severe VHD for early intervention to reduce the incidence of AF.
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Rivaroxaban is one of the new oral anticoagulants (NOAC) for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation. It has clear pharmacokinetic parameters, stable plasma concentration, less drug-drug interaction and higher compliance of patients. However, the discrepancy of pharmacokinetics between individuals and drug-induced hemorrhage events frequently occur clinically, therefore the association of gene polymorphism with drug metabolism has become a research hotspot. This article reviews the research progress on pharmacokinetic characteristics of rivaroxaban and its relationship with gene polymorphism, to provide a reference for the individualized rational use of rivaroxaban.
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Objective:To study the correlation between the Rivaroxaban concentration and bleeding events in patients with nonvalvular atrial fibrillation(NVAF).Methods:This was a retrospective study.According to the inclusion and exclusion criteria, 369 patients with NVAF taking Rivaroxaban admitted to Beijing Hospital or Tianjin Medical University General Hospital from January 2018 to June 2019 were enrolled.Clinical data including sex, height, weight, liver and kidney function, drug valley concentrations and peak concentrations, doses, CHADS2 scores and bleeding events after 6 months of medication were recorded.Results:The average drug valley concentration was (44.92±38.39) mg/L, the average drug peak concentration was (226.96±139.34) mg/L, and the average CHADS2 score was (2.8±1.2). Among the 369 patients, 22 had bleeding events.The peak drug concentration and valley drug concentration were similar between those with or without bleeding events( P=0.324 and 0.960, respectively). With the increase of age, the peak drug concentration and valley drug concentration were significantly elevated(all P<0.001). In addition, compared with those without bleeding events, patients with bleeding events had a significantly higher average valley concentration( P=0.009), valley/dose ratio( P=0.001), peak/dose ratio( P=0.028)and similar peak drug concentration( P=0.360). Conclusions:Age affects the peak and valley drug concentration of Rivaroxaban, especially for the elderly, who should be given appropriately reduced doses.Monitoring the peak and valley drug concentration is of great significance for patients at high-risk for bleeding.
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Objective To investigate the sleep quality of inland military officers and soldiers stationed and trained at plateau and its possible influence factors.Methods A total of 459 military officers and soldiers stationed and trained at plateau were performed the on site psychological assessment by adopting the psychological stress self-evaluation test (PSET),Pittsburgh Sleep Quality Index (PSQI),work related fatigue feelings (WRFFQ) and self compiled general data questionnaire.Results (1) The mean value of overall sleep quality in militaries stationed and trained at plateau was 5.61-±-3.48.40.5 ％ of respondents had good sleep quality,25.3％ had poor sleep quality and 34.2％ had general sleep quality.(2)The fatigue and psychological stress scores in the militaries with poor sleep quality were significantly higher than those in the militaries with good sleep quality (t1 =10.70,t2 =-9.68,P＜0.01).(3)The psychological stress,fatigue degree,confidence level of self-assessment health status had significantly positive correlation(r =0.517,0.488,0.259,0.352,P＜ 0.01).(4) The psychological stress,fatigue degree,confidence level of self-assessment health status entered the PSQI total score regression equation,moreover the predictive variation amount was 36.1％.Conclusion The psychological stress status and fatigue level in the militaries at plateau affect the sleep quality,and the confidence degree and health status assessment of officers and soldiers on exercise also produce the active influence on sleep.
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ObjectiveTo explore the relationship of rejection sensitivity,social inhibition and negative affect in army recruits.Methods358 recruits were measured with rejection sensitivity questionnaire,type D personality scale,and positive affect and negative affect scale.Results(1)The score of intimates' rejection sensitivity was highest(9.33±3.88),peers' rejection sensitivity was in the middle(8.59±3.27),teachers' rejection sensitivity was lowest(6.79±2.90),with statistical significance(F(2,355)=53.76,P<0.01).(2)Rejection sensitivity had significantly positive correlation with social inhibition(r=0.346,P<0.01).Negative affect had significantly positive correlation with rejection sensitivity (r=0.233,P<0.01) and social inhibition(r=0.351,P<0.01).(3)Social inhibition partially mediated the relationships between rejection sensitivity and negative affect(the value of mediating effect was 45.7%).ConclusionRejection sensitivity has direct effects on negative affect and indirect effects through social inhibition.