Review and risk information management of neuropathy induced by emerging anti-tumor drugs / 药物流行病学杂志

As an increasing number of emerging anti-tumor drugs are approved and marketed,the imperative for clinical safety monitoring and risk information management has grown significantly.Drug-induced neuropathy associated with these drugs exhibit characteristics such as insidious onset,rapid progression,and challenging treatment,ultimately leading to treatment failures.Therefore,a comprehensive understanding of the risk of neuropathy induced by emerging anti-tumor drugs,coupled with risk surveillance and early warning,as well as management and reporting,can significantly reduce the incidence and severity of drug-related diseases.This paper provides a review of the neuropathy caused by emerging anti-tumor drugs,introduces the pharmacovigilance system and risk information management measures in clinical usage,aiming to provide a reference for guiding the rational clinical use and minimizing the incidence of drug-induced diseases.

Research progress on the diagnosis and treatment of pediatric malocclusion combined with obstructive sleep apnea-hypopnea syndrome / 口腔疾病防治

@#Pediatric malocclusion is common in dentistry. Some children with malocclusion combined with obstructive sleep apnea-hypopnea syndrome (OSAHS) often fail to receive appropriate treatment due to a lack of multidisciplinary diagnosis and treatment. It can cause abnormal ventilation during sleep, affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems. Pediatric OSAHS is caused by the narrowing of the upper respiratory tract, characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion. Due to its diverse clinical manifestations and etiology, the diagnosis and treatment of pediatric OSAHS require an interdisciplinary, personalized, and specialized approach. Questionnaires and physical examinations can be used for preliminary screening. Moreover, children's stomatology and otorhinolaryngology examinations are the basis for disease diagnosis. Polysomnography (PSG) is currently the direct diagnostic method. There are various treatment methods for OSAHS in children, and for OSAHS caused by adenoid tonsil hypertrophy, adenoidectomy and tonsillectomy are the main treatments. Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion. Currently, there is limited research on the correlation between childhood malocclusion and OSAHS, and multidisciplinary combination therapy may improve the cure rate, but there is a lack of sufficient evidence. In the future, the pathogenesis of OSAHS should be further elucidated, and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.

Exploring doctors'motivation of value-based health care delivery in public hospitals in China:Concept construction and measurement / 中国卫生政策研究

The Healthy China construction initiative highlights the concept of patient-centered value-based health care,and the value appeal of doctors'medical service is also increasing.This study attempts to introduce the concept of public service motivation in general public organizations into professional public healthcare organizations——public hospitals,and proposes the concept of"value-based medical service motivation"as an expression of public service motivation for doctors in public hospitals.Through qualitative analysis and quantitative measurement,this paper constructs the concept of"public hospital doctors'value-based medical service motivation",finds its conceptual structure,namely responsibility commitment,professional adherence,reputation maintenance,and norm compliance,and finally forms a value-based medical service motivation scale.This paper confirms that doctors in public hospitals in China have multi-dimensional value-based medical service motivation,present different motivational expressions or behavioral tendencies,and constantly deal with and balance the public value tensions in the practice of realizing the patient-centered value-based medical goal.This scale provides an effective tool for measuring doctors'value-based service motivation,and provides theoretical and practical support for further investigating the influencing factors of doctors'motivation for value-based medical services,improving the medical service capacity of public hospitals,adjusting medical behavior,and advancing doctor-patient trust.

Transesophageal echocardiography for guiding left atrial appendage closure with LAmbre occluder / 中国医学影像技术

Objective To observe the value of transesophageal echocardiography(TEE)for guiding left atrial appendage closure(LAAC)with LAmbre occluder.Methods Data of 40 non-valvular atrial fibrillation(NVAF)patients who underwent LA AC with LAmbre occluder were retrospectively analyzed.CT angiography(CTA)before treatment,TEE and digital subtraction angiography(DSA)findings during LAAC were comparatively observed,and the correlations of the anchor area diameter and left atrial appendage opening diameter measured with the above three as well as occluder size were analyzed,and TEE and DSA for evaluating peri-device leak(PDL)were compared.Results LAAC were successfully performed with LAmbre occlude in all 40 cases.The diameter of the fixed umbrella was positively correlated with anchor area diameter measured with CTA,TEE and DSA(r=0.79,0.82,0.91,all P＜0.01),of occlusion umbrella was positively correlated with left atrial appendage opening diameter measured with CTA,TEE and DSA(r=0.56,0.89,0.86,all P＜0.01).Immediately after the release of occluder in LAAC,PDL occurred in 16 cases and were detected with both TEE and DSA,while in the rest 24 cases no PDL was found with neither TEE nor DSA.Conclusion TEE had comparable value to DSA for guiding LAAC using LAmbre occluder.

Two putative novel serotypes of Tibet orbivirus isolated from Culicoides spp.in Yunnan, China

Tibet orbivirus (TIBOV) was identified as a novel orbivirus in 2014. Antibodies against TIBOV were detected in cattle, Asian buffalo, and goats, while all the sequenced TIBOV strains were isolated from mosquitos and Culicoides. The known TIBOV strains have been classified into four putative serotypes. In this study, two TIBOV strains isolated from Culicoides spp. in Shizong County of Yunnan Province, China, were fully sequenced. The phylogenetic analysis of outer capsid protein 2 (VP2) indicated that these two viral strains belong to two novel putative serotypes of TIBOV. The updated putative serotypes may help in an investigation of the distribution and virulence of TIBOV.

Kaufman Oculocerebrofacial syndrome in a newborn: a case report and literature review / 中国新生儿科杂志

Objective:To study the clinical features, treatment, and prognostic features of Kaufman Oculocerebrofacial syndrome.Methods:The clinical characteristics of a newborn with Kaufman Oculocerebrofacial syndrome admitted to the neonatal unit of Guiyang Maternal and Child Health Care Hospital was reported. Using "Kaufman Oculocerebrofacial syndrome", "Blepharophimosis-ptosis-intellectual disability syndrome" and "UBE3B gene" as keywords, databases including CNKI, VIP database, Wanfang database, Chinese medical journals full-text database, PubMed, Web of Science database and Embase database were searched from the date of establishment to June 2022. The clinical characteristics, treatment and prognosis of Kaufman Oculocerebrofacial syndrome from published literature were summarized.Results:The proband was a boy presenting with small lid fissure, wide eye spacing and feeding difficulties. Whole exome sequencing revealed compound heterozygous mutation in the UBE3B gene, c.1445_1448dupTCAC inherited from his father and c.1703dupA inherited from his mother, both variants had not been reported in the domestic and foreign literature thus far. A total of 34 newborn cases were summarized from 11 case reports, including this report. The main clinical manifestations were developmental delay (35/35), peculiar facial features (35/35), narrow eye slits (35/35), feeding difficulties (33/35), ear abnormalities (33/35), hypotonia (32/35), mouth abnormalities (31/35), breathing difficulties (26/35), small jaws (25/35) and low birth weight (16/35).There is no effective treatment available, and a total of 4 cases followed up to over 16 years old have been reported, all of which have severe mental retardation, language deficiency, along with other serious neurological diseases.Conclusions:when children exhibit symptoms such as narrow eye fissures, feeding difficulties, hypotonia, developmental delays, and peculiar facial features in the neonatal period, whole exome sequence can be used to aid diagnosis and evaluate for Kaufman Oculocerebrofacial syndrome. Families with children of Kaufman Oculocerebrofacial syndrome may undergo prenatal diagnosis based on genetic findings.

Combination immunotherapy of glioblastoma with dendritic cell cancer vaccines,anti-PD-1 and poly I:C / 药物分析学报

Glioblastoma(GBM)is a lethal cancer with limited therapeutic options.Dendritic cell(DC)-based cancer vaccines provide a promising approach for GBM treatment.Clinical studies suggest that other immu-notherapeutic agents may be combined with DC vaccines to further enhance antitumor activity.Here,we report a GBM case with combination immunotherapy consisting of DC vaccines,anti-programmed death-1(anti-PD-1)and poly I:C as well as the chemotherapeutic agent cyclophosphamide that was integrated with standard chemoradiation therapy,and the patient remained disease-free for 69 months.The patient received DC vaccines loaded with multiple forms of tumor antigens,including mRNA-tumor associated antigens(TAA),mRNA-neoantigens,and hypochlorous acid(HOCl)-oxidized tumor lysates.Furthermore,mRNA-TAAAs were modified with a novel TriVac technology that fuses TAAs with a destabilization domain and inserts TAAs into full-length lysosomal associated membrane protein-1 to enhance major histo-compatibility complex(MHC)class Ⅰ and Ⅱ antigen presentation.The treatment consisted of 42 DC cancer vaccine infusions,26 anti-PD-1 antibody nivolumab administrations and 126 poly I:C injections for DC infusions.The patient also received 28 doses of cyclophosphamide for depletion of regulatory T cells.No immunotherapy-related adverse events were observed during the treatment.Robust antitumor CD4+and CD8+T-cell responses were detected.The patient remains free of disease progression.This is the first case report on the combination of the above three agents to treat glioblastoma patients.Our results suggest that integrated combination immunotherapy is safe and feasible for long-term treatment in this patient.A large-scale trial to validate these findings is warranted.

Application value of S-Detect combined with contrast-enhanced ultrasound in the Breast Imaging Reporting and Data System 4 breast lesions / 中华超声影像学杂志

Objective:To assess the value of S-Detect and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of Breast Imaging Reporting and Data System(BI-RADS) 4 breast lesions.Methods:A total of 104 breast lesions in 100 patients diagnosed as BI-RADS category 4 by conventional ultrasound were prospectively enrolled, and all of them were received S-Detect and CEUS examination at the same time. Taking pathology as the gold standard, ROC curve was constructed to compare the diagnostic efficacy of conventional ultrasound, S-Detect, CEUS and their combination.Results:Among the 104 BI-RADS category 4 breast lesions, 63 were benign and 41 were malignant. The sensitivities of conventional ultrasound, S-Detect, CEUS and S-Detect combined with CEUS were 73.17%, 87.80%, 87.80%, 90.24%; the specificities were 57.14%, 60.32%, 68.25%, 77.78%; the positive predictive values were 52.63%, 59.02%, 64.29% and 72.55%; the negative predictive values were 76.60%, 88.37%, 89.59% and 92.45%; the accuracies were 63.46%, 71.15%, 75.96% and 82.69%; and the areas under the ROC curve (AUC) were 0.652, 0.741, 0.780 and 0.840. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of S-Detect and CEUS diagnosis were improved compared with conventional ultrasound. The AUC of combined diagnosis was higher than that of S-Detect, CEUS alone, and the differences were statistically significant(all P<0.05). The AUC of CEUS was higher than that of conventional ultrasound, and the difference was statistically significant ( P<0.05). There were no significant differences in AUC between any two of other groups (all P>0.05). Conclusions:The combined application of S-Detect and CEUS could achieve complementary advantages, which is of great significance for the differential diagnosis of benign and malignant in BI-RADS 4 breast lesions.

Progress in diagnosis and treatment of orthostatic intolerance / 中华老年医学杂志

Orthostatic intolerance is a syndrome characterized by a series of symptoms that occur when standing upright, resulting in the loss of ability to maintain an upright position.This condition can be further classified into orthostatic hypotension, postural orthostatic tachycardia syndrome, and vasovagal syncope.Some scholars suggest that orthostatic hypertension may also be considered a part of this syndrome.The most significant risk associated with orthostatic intolerance is falls, which can lead to physical injury and psychological distress.This article aims to review the advancements made in the diagnosis and treatment of orthostatic intolerance, so as to enhance the standardization of clinical diagnosis and improve the effectiveness of treatment.

Gender differences in antidepressant effect of raw Rehmanniae Radix / 中国中药杂志

For the first time, this study evaluated the gender differences and mechanisms of the antidepressant effects of raw Rehmanniae Radix(RRR) based on the classic depression model with traditional Chinese medicine syndrome of Yin deficiency and internal heat. The depression model with Yin deficiency and internal heat was established by the widely recognized and applied method of thyroxine induction of the classic depression model with Yin deficiency and internal heat(chronic unpredictable mild stress). Male and female mice were simultaneously treated with RRR. The study analyzed indicators of nourishing Yin and clearing heat, conventional antidepressant efficacy test indicators, and important biomolecules reflecting the pathogenesis and prevention and treatment mechanisms of depression, and conducted a correlation analysis of antidepressant efficacy, Yin-nourishing and heat-clearing efficacy, and biological mechanism in different genders, thereby comprehensively assessing the antidepressant effects of RRR on depression of Yin deficiency and internal heat, as well as its gender differences and mechanisms. RRR exhibited antidepressant effects in both male and female mouse models, and its antidepressant efficacy showed gender differences, with a superior effect observed in females. Moreover, the effects of RRR on enhancing or improving hippocampal neuronal pathology, nucleus-positive areas, postsynaptic dense area protein 95, and synaptophysin protein expression were more significant in females than in males. In addition, RRR significantly reversed the abnormal upregulation of nuclear factor(NF)-κB/cyclooxygenase 2(COX2)/NOD-like receptor thermal protein domain associated protein 3(NLRP3) pathway proteins in the hippocampus of both male and female mouse models. The antidepressant effects of RRR were more pronounced in depression female mice with Yin deficiency and internal heat syndrome, possibly due to the improvement of neuronal damage and enhancement of neuroplasticity. The antidepressant mechanisms of RRR for depression with Yin deficiency and internal heat syndrome may be associated with the downregulation of the NF-κB/COX2/NLRP3 pathway to reduce neuronal damage and enhance neuroplasticity.

Thermal Ablation Therapy for Breast Cancer / 中国医学影像学杂志

Breast cancer is the most common malignancy of women in China.It seriously affects the quality of life of patients.With the progress of medical technology,minimally invasive treatment has gradually become an important part of breast cancer management.Thermal ablation technology has been proved to have great potential in the treatment of breast cancer.Compared with surgery,it has similar therapeutic effect and more safer.Targeted ablation of breast cancer is expected to become a new treatment mode under the integration of diagnosis and treatment.This article reviews the current status and development trend of thermal ablation therapy for breast cancer.

Sperm-specific protein ACTL7A as a biomarker for fertilization outcomes of assisted reproductive technology / 亚洲男科学杂志(英文版)

Obtaining high-quality embryos is one of the key factors to improve the clinical pregnancy rate of assisted reproductive technologies (ART). So far, the clinical evaluation of embryo quality depends on embryo morphology. However, the clinical pregnancy rate is still low. Therefore, new indicators are needed to further improve the evaluation of embryo quality. Several studies have shown that the decrease of sperm-specific protein actin-like 7A (ACTL7A) leaded to low fertilization rate, poor embryo development, and even infertility. The aim of this study was to study whether the different expression levels of ACTL7A on sperm can be used as a biomarker for predicting embryo quality. In this study, excluding the factors of severe female infertility, a total of 281 sperm samples were collected to compare the ACTL7A expression levels of sperms with high and low effective embryo rates and analyze the correlation between protein levels and in-vitro fertilization (IVF) laboratory outcomes. Our results indicated that the ACTL7A levels were significantly reduced in sperm samples presenting poor embryo quality. Furthermore, the protein levels showed a significant correlation with fertilization outcomes of ART. ACTL7A has the potential to be a biomarker for predicting success rate of fertilization and effective embryo and the possibility of embryo arrest. In conclusion, sperm-specific protein ACTL7A has a strong correlation with IVF laboratory outcomes and plays important roles in fertilization and embryo development.

Value of contrast-enhanced ultrasound in diagnosis of malignant endometrial lesions / 中华超声影像学杂志

Objective:To investigate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of malignant endometrial lesions.Methods:A total of 142 patients with endometrial lesions who underwent contrast-enhanced ultrasound examination in Beijing Tiantan Hospital, Capital Medical University from January 2019 to September 2021 were selected. The endometrial lesions were divided into benign group (including endometrial hyperplasia and endometrial polyps) and malignant group (endometrial cancer) according to the pathological results of surgery, and the differences of contrast enhancement patterns between benign group and malignant group were compared. The sensitivity, specificity of CEUS in the diagnosis of endometrial cancer were calculated, and the Kappa value was calculated with the initial enhancement time earlier than or equal to the muscularity or the peak time earlier than the muscularity as the diagnostic index for the diagnosis of endometrial malignant lesions. The sensitivity, specificity, and Kappa value of CEUS in the diagnosis of endometrial cancer and endometrial cancer with thickness ≥10 mm were calculated.Results:A total of 108 patients underwent surgery with clear pathological results, including 66 patients in the benign lesion group and 42 patients in the malignant lesion group. The thickness of malignant lesions was significantly larger than that of benign lesions, and the difference was statistically significant( t=4.039, P<0.05), but there was no significant difference of hemodynamic parameters between the two groups ( P>0.05). The initial enhancement time, peak time and peak intensity of benign lesions were significantly different from those of malignant lesions(all P<0.05). The sensitivity, specificity, and Kappa value of CEUS in the diagnosis of endometrial cancer were 64.3%, 100% and 0.668, respectively. The sensitivity, specificity and Kappa value of CEUS in the diagnosis of endometrial carcinoma with lesion thickness ≥10 mm were 75.0%, 100% and 0.795, respectively. Conclusions:For the diagnosis of endometrial lesions, especially the malignant endometrial lesions with thickness and diameter greater than or equal to 10mm, there is a high diagnostic coincidence rate between CEUS and pathological diagnosis, and endometrial malignant lesions have more specific CEUS manifestations.

Ultrasound characteristics and diagnostic model prediction of benign and malignant endometrial lesions in elderly women / 中华老年医学杂志

Objective:To investigate the ultrasound characteristics of benign and malignant endometrial lesions in postmenopausal women terminology.Methods:Patients with endometrial lesions who underwent transvaginal ultrasound examination in Beijing Tiantan Hospital affiliated to Capital Medical University from January 2019 to November 2021 were selected.Pathological diagnosis after surgery was used as the gold standard, and endometrial lesions were divided into a benign group(including endometrial hyperplasia and endometrial polyps)and a malignant group(endometrial cancer)according to surgical pathology results.Endometrial thickness and Doppler flow parameters were compared between the benign group and the malignant group.The chi-square test was used to compare the echogenicity, the presence or absence of cystic areas, the integrity of the endometrial-myometrial junction, the blood flow score, and the blood supply vessels between the benign and malignant groups.A prediction model was established according to the ultrasonic characteristics.Results:A total of 136 participants received surgery at our hospital with definitive pathological diagnoses, including 72 patients in the benign group and 64 patients in the malignant group.Peak systolic velocity(PSV) and end diastolic velocity(EDV) in malignant lesions were higher than those in benign lesions[(28.75±14.66)cm/s vs.(22.94±13.62)cm/s, (14.75±8.10)cm/s vs.(11.56±6.21)cm/s]. The thickness of malignant lesions was significantly greater than that of benign lesions[(19.31±8.97)mm vs.10.14±4.31)mm], and the blood flow resistance index was lower than that of benign lesions(14.75±8.10 vs.11.56±6.21). The differences were statistically significant( t=2.393, 2.597, 7.452, 2.028, all P<0.05). The prediction model was established based on the above ultrasonic characteristics.The area under the ROC curve for ultrasound physicians to diagnose benign and malignant endometrial lesions was 0.905( P<0.001), indicating that the prediction model had high diagnostic value. Conclusions:Both benign and malignant endometrial lesions in postmenopausal women have different ultrasonic characteristics.Malignant lesions tend to have a larger lesion thickness, an interrupted or irregular endometrial-myometrial junction, higher blood flow signal scores, and multiple blood supply patterns.The ultrasonic prediction model has high diagnostic value for benign and malignant endometrial lesions.

Relationship between Water Temperature and Floating Time of Aquatic Cadavers / 法医学杂志

OBJECTIVES@#To study the relationship between water temperature and floating time of aquatic cadavers, providing a reference for more precise positioning and searching for floating corpses.@*METHODS@#The floating model of guinea pig after drowning at 17-30 ℃ was established, and the floating times of carcasses were recorded. The collected data of 32 floating corpse cases in the Pearl River were sorted out and analyzed according to the floating time of corpses corresponding to each degree of water temperature. The relationship models between water temperature and the floating time of guinea pig carcass, and between that and the floating time of real cases were established.@*RESULTS@#The floating time of the cadaver was negatively correlated with water temperature. The power function fitting equation of the relationship between floating time and water temperature of guinea pig carcass was y=1×1015x-10.530(R2=0.871, P<0.01), and the power function fitting equation of the relationship between corpse floating time and water temperature was y=3×106x-3.467(R2=0.802, P<0.01).@*CONCLUSIONS@#It is found that average floating cadaver time has a power function with water temperature, which provides a reference for locating floating cadavers and establishing search models.

Determination of dimethyl sulfate in workplace air by pre-column derivatization-high performance liquid chromatography / 中国职业医学

@#Abstract: Objective - - To establish a pre column derivatization high performance liquid chromatography method for detecting Methods dimethyl sulfate (DMS) in workplace air. DMS in workplace air was collected with mercaptopyridine impregnated （ silicone tube. The derivative of DMS and mercaptopyridine was eluted by mobile phase phase A: water, phase B: acetonitrile, ∶ the volume ratio was 40 60) , and separated with a C18 column, then detected with diode array detector and quantitated by a Results - standard curve. The linear range of DMS was 0.17 40.00 mg/L, with the correlation coefficient of 0.999 95. The detection limit and the lower limit of quantitation were 0.05 and 0.17 mg/L respectively. The minimum detection concentration and minimum quantitation concentration were 0.02 and 0.04 mg/m³, respectively (air sample volume of 4.5 L, 1.0 mL sample - - - solution). The average desorption efficiency was 98.40% 102.00%. The within run and between run relative standard deviations - - were 0.61% 3.92% and 1.71% 6.00%, respectively. The samples could be stored at room temperature for at least 14 days. Conclusion This method can be used to detect DMS in workplace air.

Research progress on detection methods for nitrobenzene compounds in air / 中国职业医学

@#Abstract: Nitrobenzene compounds (NBCs) are widely used in the world. It has 40 isomers such as nitrobenzene, dinitrobenzene and nitrotoluene, that are highly toxic and difficult to degrade and can cause harm to human health in different degrees. At pres⁃ ent, there is no unified standard method and occupational exposure limit for the detection of NBCs in the air. In terms of sampling medium, solid adsorption tube is mostly used for trapping vapor state NBCs, and filter membrane and solid adsorption tube are mostly used in series for sampling coexist NBCs in vapor state and aerosol state. In the detection methods, gas chromatography and liquid chromatography are common, and ultraviolet spectrophotometry, Raman spectroscopy, ion migration spectrometry and some other rapid response methods and technologies are also used in the detection of NBCs. In the detection of NBCs by gas chro⁃ matography, capillary column separation is commonly used, and the main detectors are flame ionization detector, electron capture detector and mass spectrometry detector. It is of practical significance to establish a method with high sensitivity, strong practica⁃ bility, convenient operation, and can simultaneously collect and detect a variety of NBCs in different states.

Quantitative Evaluation of Gastrocnemius Medialis Stiffness During Passive Stretching Using Shear Wave Elastography in Patients with Parkinson’s Disease: A Prospective Preliminary Study

Objective@#To prospectively investigate the feasibility of shear wave elastography (SWE) as a new quantitative and objective method for evaluating the stiffness of the gastrocnemius medialis (GM) muscle during passive stretching in patients with Parkinson’s disease (PD). @*Materials and Methods@#SWE of the GM muscle was performed in 28 patients with PD [13 female and 15 male; mean age ± standard deviation (SD): 63.0 ± 8.5 years] and 12 healthy controls (5 female and 7 male; mean age ± SD: 59.3 ± 6.4 years) during passive ankle rotation. A Young’s modulus-ankle angle curve was constructed. The GM slack angle and baseline Young’s modulus (E 0) were compared between the markedly symptomatic and mildly symptomatic sides of patients with PD, and healthy controls. Additionally, the correlation between the GM slack angle and the severity of rigidity, and the observer reproducibility of SWE in determining the GM slack angle were evaluated. @*Results@#The GM slack angle was smaller on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of -29.13° ± 3.79° and -25.65° ± 3.39°, respectively, vs. -21.22° ± 3.52°; p < 0.001 and p = 0.006, respectively). Additionally, in patients with PD, the GM slack angle on the markedly symptomatic side was smaller than that on the mildly symptomatic side (p = 0.003). The E 0 value was lower on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of 10.11 ± 2.85 kPa and 10.08 ± 1.88 kPa, respectively, vs. 12.23 ± 1.02 kPa; p = 0.012 and p < 0.001, respectively). However, no significant difference was found between the markedly and mildly symptomatic sides in patients with PD (p = 0.634). A negative linear relationship was observed between the GM slack angle and lower limb rigidity score on the markedly symptomatic side in patients with PD (r = -0.719; p < 0.001). The intraclass correlation coefficients for observer reproducibility of SWE ranged from 0.880 to 0.951. @*Conclusion@#The slack angle determined by SWE may be a useful quantitative and reproducible method for evaluating muscle stiffness in patients with PD.

Research progress in workplace spirituality of nurses / 中国实用护理杂志

Workplace spirituality, as a powerful indicator of workplace outcomes, plays an important role in stabilizing nursing talents and improving nursing quality. This article aimed to summarize the overview, measurement tools, related factors and strategies of workplace spirituality from the field of healthcare, so as to promote nursing managers ′ understanding of workplace spirituality and provide a reference for improving the nursing environment.

Causes of death and influencing factors of atrial fibrillation patients undergoing anticoagulation therapy / 中华心血管病杂志

Objective: To investigate the causes of death and predictors in patients with nonvalvular atrial fibrillation (AF) undergoing anticoagulation therapy. Methods: Consecutive anticoagulated nonvalvular AF patients were recruited from the China Atrial Fibrillation Registry (China-AF) Study from August 2011 to December 2018. After exclusion of patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, or loss of follow-up within 1 year, 2 248 patients were included in this analysis. Enrolled patients were followed up were followed up for 3 and 6 months, and then every 6 months. The primary endpoint was death, including cardiovascular death, non-cardiovascular death and undetermined death. The patients were divided into survival group and death group according to the survival status after follow-up. Clinical information such as age and sex was collected. Cox proportional hazards regression was performed to identify associated risk factors for all-cause mortality, and Fine-Gray competing risk model was used to identify associated risk factors for cardiovascular mortality. Results: A total of 2 248 patients with atrial fibrillation receiving anticoagulant therapy died over a mean follow-up of (42±24) months, mean age was (67±10) years old and 41.1% (923/2 248) patients were female. The mortality rate was 2.8 deaths per 100 patient-years. The most common cause of death was cardiovascular deaths, accounted for 55.0% (120/218). Worsening heart failure was the most common cause of cardiovascular deaths (18.3% (40/218)), followed by bleeding events (12.9% (28/218)) and ischemic stroke (8.7% (19/218)). Multivariate Cox regression analysis showed that age (HR = 1.05, 95%CI 1.04-1.07, P<0.001), anemia (HR = 1.81, 95%CI 1.02-3.18, P = 0.041), heart failure (HR=2.40, 95%CI 1.75-3.30, P<0.001), ischemic stroke/transient ischemic attack (TIA)(HR = 1.59, 95%CI 1.21-2.13, P = 0.001) and myocardial infarction (HR = 2.93, 95%CI 1.79-4.81, P<0.001) were independently associated with all-cause death. Fine-Gray competing risk model showed that age (HR=1.05, 95%CI 1.02-1.08, P<0.001), heart failure (HR=2.81, 95%CI 1.79-4.39, P<0.001), ischemic stroke/TIA (HR=1.50, 95%CI 1.02-2.22, P=0.041) and myocardial infarction (HR=3.31, 95%CI 1.72-6.37, P<0.001) were independently associated with cardiovascular death. Conclusions: In anticoagulated nonvalvular AF patients, ischemic stroke represents only a small subset of deaths, whereas worsening heart failure is the most common cause of cardiovascular deaths. Heart failure, ischemic stroke/TIA, and myocardial infarction are associated with increased mortality.