Impact of renin-angiotensin-aldosterone-system inhibitor drugs on mortality in patients with atrial fibrillation and hypertension.

BACKGROUND: Renin-angiotensin-aldosterone-system inhibitors markedly play an active role in the primary prevention of atrial fibrillation (AF), but the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the mortality of patients with AF remains unclear. This study aimed to examine the relationship between treatment with ACEIs or ARBs and mortality in emergency department (ED) patients with AF and hypertension. METHODS: This multicenter study enrolled 2016 ED patients from September 2008 to April 2011; 1110 patients with AF and hypertension were analyzed. Patients were grouped according to whether they were treated with ACEI/ARB or not and completed a 1-year follow-up to evaluate outcomes including all-cause death, cardiovascular death, stroke, and major adverse events (MAEs). RESULTS: Among the 1110 patients with AF and hypertension, 574 (51.7%) received ACEI/ARB treatment. During the 1-year follow-up, 169 all-cause deaths (15.2%) and 100 cardiovascular deaths (9.0%) occurred, while 98 strokes (8.8%) and 255 MAEs (23.0%) occurred. According to the multivariate Cox regression analysis, ACEI/ARB therapy was significantly associated with a reduced risk of all-cause death (HR, 0.605; 95% CI 0.431-0.849; P = 0.004). Moreover, ACEI/ARB therapy was independently associated with a reduced risk of cardiovascular death (HR 0.585; 95% CI 0.372-0.921; P = 0.020) and MAEs (HR 0.651, 95% CI 0.496-0.855, P = 0.002) after adjusting for other risk factors. CONCLUSIONS: Our results revealed that ACEI/ARB therapy was independently associated with a reduced risk of all-cause death, cardiovascular death, and MAEs in ED patients with AF and hypertension. These results provide evidence for a tertiary preventive treatment for patients with AF and hypertension.

Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis.

BACKGROUND: Screening is often recommended as a first step in frailty management. Many guidelines call to implicate frailty screening into practice in the primary care setting. However, few countries or organizations implement it. Understanding and clarifying the stakeholders' views and issues faced by the implementation is essential to the successful implementation of frailty screening. However, the systematic review on stakeholders' views of frailty screening in primary care is decidedly limited. Our objective was to explore the perspective of older adults, caregivers, and healthcare providers on frailty screening and determine the enablers and barriers to implementing frailty screening in primary care. METHODS: A systematic search of six databases and other resources was conducted following JBI's three-step search strategy. The search resulted in 7362 articles, of which 97 were identified for further assessment according to the inclusion criteria. After the full-text screening, quality assessment and data extraction were carried out using the tools from Joanna Briggs Institute (JBI). Moreover, reviewers used the approach of meta-aggregative of JBI to analyze data and synthesis the findings. RESULTS: Six studies were included. A total of 63 findings were aggregated into 12 categories and then further grouped into three synthesized findings:1) capacity of healthcare providers and older adults; 2) opportunity in the implementation of frailty screening; 3) motivation in the implementation of frailty screening. These themes can help identify what influences the implementation of screening from the perspective of stakeholders. CONCLUSIONS: This meta-synthesis provides evidence on the barriers and enablers of frailty screening in primary care, from the aspects of psychological, physical, social, material, etc. However, stakeholder perspectives of frailty screening have not been adequately studied. More research and efforts are needed to explore the influencing factors and address the existing barriers.

Furazolidone treatment for Helicobacter Pylori infection: A systematic review and meta-analysis.

Antibiotic resistance is a major cause of Helicobacter pylori (H. pylori) treatment failures. Because the resistance rate of H. pylori to furazolidone is low, we aimed to assess the efficacy and safety of furazolidone. We searched the PubMed, Web of Science, Cochrane Library, and Embase databases and included randomized controlled trials (RCT) that either compared furazolidone to other antibiotics or changed the administered dose of furazolidone. A total of 18 articles were included in the meta-analysis. According to the intention-to-treat (ITT) analysis, the total eradication rates of furazolidone-containing therapy were superior to those of other antibiotic-containing therapies (relative risk [RR] 1.07, 95% confidence interval [CI] 1.01-1.14) (13 RCTs). Specifically, the eradication rates of furazolidone-containing therapy were better than those for metronidazole-containing therapy (RR 1.10, 95% CI: 1.01-1.21 for ITT). The eradication rate of furazolidone-containing bismuth-containing quadruple therapy was 92.9% (95% CI: 90.7%-95.1%) (PP). In addition, a higher daily dose of furazolidone increased the eradication rate (RR 1.17, 95% CI: 1.05-1.31). And the incidence of some adverse effects, such as fever and anorexia, was higher in the furazolidone group than in the control group, the overall incidences of total side effects and severe side effects showed no significant differences between the groups. Furazolidone-containing treatments could achieve satisfactory eradication rates and did not increase the incidence of total or severe adverse effects, but the incidence of milder side effects, such as fever and anorexia, should be considered when prescribing furazolidone-containing treatments to patients.

Iatrogenic factors of Helicobacter pylori eradication failure: lessons from the frontline.

BACKGROUND: Iatrogenic factors play an important role in H. pylori eradication failure, whereas it can be easily missed. Therefore, we aimed to investigate and analyze these related iatrogenic factors of H. pylori eradication failure. METHODS: A total of 508 patients who experienced H. pylori eradication failure were included in this study conducted from December 2019 to February 2022. All the patients filled out a questionnaire including demographic characteristics, duration of treatment, regimens, dosage, and time intervals in rescue treatment. RESULTS: In the first-line treatment, 89 patients (17.5%, 89/508) used at least one antibiotic with high resistance rate in triple therapy and 57 patients (11.2%, 57/508) used two antibiotics with high resistance rates or other not recommended antibiotics in quadruple therapy. In the rescue therapy, 85 regimens were repeatedly used as salvage regimens in 58 patients (22.6%, 58/257) and 178 regimens containing antibiotics with high resistance rates were repeatedly used in 85 patients (33.1%, 85/257). CONCLUSION: To decrease the risk of H. pylori eradication failure, iatrogenic factors need to gain more attention. Clinicians should enhance their education and training to standardize the treatment regimens, better manage the H. pylori infection, and improve the eradication rate eventually.

Hook plate fixation with versus without coracoclavicular reconstruction for distal clavicular fractures.

PURPOSE: Hook plate fixation is one of the most frequently used methods for unstable distal clavicular fractures, but it is still unknown if there is a need for coracoclavicular (CC) reconstruction. This study aimed to compare the efficacy of hook plate fixation with versus without CC reconstruction for distal clavicular fractures. METHODS: Eighty-one patients who underwent hook plate fixation (HP group, n = 45) or hook plate fixation plus suture anchor reconstruction (HPA group, n = 36) for Neer type II or V clavicular fractures were enrolled. Demographics, fracture characteristics, and surgical data were recorded. Union time, coracoclavicular distance (CCD), post-operative complications, Constant score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score were compared between HPA and HP groups. RESULTS: Constant score in the HPA group was higher than that in the HP group (91.8 ± 3.6 vs 88.8 ± 6.0, P = 0.007). However, there were no significant differences in union time, DASH score, CCD, and post-operative complications between the two groups (P > 0.05). Hook plate fixation combined with CC reconstruction costed more (3023.7 ± 202.6 vs 2416.2 ± 167.6 EUR, P < 0.001) and prolonged operative duration (78.2 ± 9.2 vs 73.7 ± 8.3 min, P = 0.023) compared with hook plate fixation alone. CONCLUSION: Hook plate fixation with or without suture anchor reconstruction achieved satisfactory outcomes for Neer type II or V clavicular fractures. However, hook plate fixation plus CC reconstruction showed better functional outcomes compared with hook plate fixation alone.

Barriers and facilitators of digital interventions use to reduce loneliness among older adults: a protocol for a qualitative systematic review.

INTRODUCTION: Digital interventions are considered as a potential solution to loneliness in older adults. However, this type of intervention has had limited acceptance among older adults (aged ≥60 years). To ensure the use of digital interventions in older adults, possible barriers and facilitating factors should be better understood from the user's perspective. We aim to systematically examine the barriers and facilitators to the implementation of digital interventions designed to reduce loneliness in older adults by identifying, evaluating and synthesising qualitative studies. METHODS AND ANALYSIS: A comprehensive search of qualitative studies for barriers and facilitators for use of digital interventions will be conducted in the following databases: PubMed, MEDLINE, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. Studies reported in English will be considered for this review. Grey literature will not be included. Two reviewers (HZ and XL) will independently screen the literatures, and any differences will be solved by turning to the third reviewer (JN). The Joanna Briggs Institute (JBI) Qualitative Research Critical Appraisal Checklist will be used by two reviewers to independently assess the validity of the methods used. Relevant data about the populations, context, culture, geographical location, study methods and barriers and facilitators to the implementation of digital interventions will be extracted using the JBI standardised data extraction tool. JBI meta-aggregation methods will be implemented to synthesise the data, which will generate themes and categories based on the data. The final synthesis will establish confidence levels using the JBI ConQual approach. ETHICS AND DISSEMINATION: The protocol does not require ethical approval. The data are based on published scientific databases. The results will be disseminated through journal articles and scientific conference presentations (if feasible). PROSPERO REGISTRATION NUMBER: CRD42022328609.

Health Promotion Capacity Among Chinese Healthcare Professionals and Its Influence on Preventive Health Service Practices.

BACKGROUND: This study evaluated the current health promotion capacity level of Chinese healthcare professionals and explored the association between health promotion capacity and preventive health service practices. METHODS: A total of 124 doctors and 72 nurses were recruited from 6 county hospitals and 12 community health centers from June to August 2019 in Zhejiang Province, China. Health promotion capacity was measured using the revised Chinese version of the Health Promotion Professionals Core Competency Scale. RESULTS: The mean total score on the health promotion capacity scale was 45.04 (SD = 7.30). Total health promotion capacity score was negatively associated with county hospitals (ß = -0.32, p < 0.001; Ref: community health center) and positively associated with a monthly income of more than 5001 RMB ($786.39) (ß = 0.25, p = 0.004; Ref: less than 5000 RMB ($786.24)). All domain scores of the health promotion capacity scale were positively related to preventive health service practices. CONCLUSION: Health promotion capacity is one of the most important capacities among healthcare professionals, and there is a particular need to improve nurses' capacity. A higher level of health promotion capacity is beneficial for implementing preventive health services.

A qualitative study of the first batch of medical assistance team's first-hand experience in supporting the nursing homes in Wuhan against COVID-19.

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) has global impact, Wuhan in Hubei province is a high-risk area. And the older people in nursing homes are the most susceptible group to COVID-19. The aim of this study was to describe the practice and experience of the first-line medical team, to provide insights of coping with COVID-19 in China. METHOD: This qualitative study used a descriptive phenomenological design to describe the experience of medical staff supported the nursing homes in Wuhan fighting against COVID-19. Unstructured interviews via online video were conducted with seven medical staffs who supported the nursing homes in Wuhan. Data were analyzed using content analysis in five main themes: for nursing homes, we interviewed the difficulties faced at the most difficult time, services for the older people, and prevention and management strategies, for the medical staff, the psychological experience were interviewed, and the implications for public health emergencies were also reported. CONCLUSIONS: It is imperative that effective preventive and response measures be implemented to face the outbreak of COVID-19 and meet the care needs of older people in the context of COVID-19. IMPLICATIONS: Findings will inform managers of some reasonable instructional strategies for implementing effective infection management. Nursing homes need to provide targeted services to help alleviating their bad psychology for residents.

Clinical effectiveness of matrine sitz bath in treating perianal infection after chemotherapy for acute leukemia.

BACKGROUND: Perianal infection is a common complication in patients with acute leukemia receiving chemotherapy. It usually manifests as a perianal mass, with redness/swelling, heat, and pain, and can affect physical and mental health in severe cases. The purpose of this study was to investigate the effectiveness of matrine sitz bath (MSB) in treating perianal infection after chemotherapy for acute leukemia. METHODS: A total of 216 acute leukemia patients with perianal infection that developed during chemotherapy were enrolled in this study and equally randomized into an MSB group and control group. The control group was treated with the conventional potassium permanganate sitz bath. After 14 days of treatment, the clinical efficacy and symptom/sign scores were compared between these 2 groups. The serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-10(IL-10), erythrocyte sedimentation rate (ESR), and prostaglandin E2 (PGE2) were detected by using enzyme-linked immunosorbent assay (ELISA). RESULTS: The clinical efficacy of MSB group was significantly superior to that of the control group (P<0.05). The scores of anal pain, systemic symptoms, mass size, and mass texture were significantly decreased after treatment in both groups (P<0.05), and they were significantly lower in the MSB group than in the control group (P<0.05). After treatment, the serum levels of hs-CRP, TNF-α, ESR, and PGE2 in these 2 groups significantly dropped (P<0.05), and they were significantly lower in the MSB group than in the control group (P<0.05); IL-10 level significantly rose in both groups (P<0.05), and it was significantly higher in the MSB group than in the control group (P<0.05). CONCLUSIONS: MSB is effective in treating perianal infection after chemotherapy for acute leukemia as it can effectively improve symptoms and signs and alleviate inflammatory reactions.

Effectiveness of Xinglou Chengqi decoction on constipation in patients with acute ischemic stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of traditional Chinese herbal Xinglouchengqi (XLCQ) decoction for the treatment of constipation in acute ischemic stroke patients, and figure out the role that bowel movements play in the treatment of acute ischemic stroke. METHODS: A total of 317 eligible patients were recruited and randomized to the XLCQ group (211 patients) or the control group (106 patients). In addition to conventional standard medical care and rehabilitation, participants in the XLCQ group received XLCQ decoction, while the control group received clysis therapy using glycerin enemas or lactulose oral solution. Both groups were given treatment for 3 to 6 d, during which they received daily visits to record defecation features and accompanying symptoms. Neurological assessments using the National Institutes of Health Stroke Scale (NIHSS) were conducted before and 1 month after treatment. RESULTS: Patients in the XLCQ group had lower aggregate constipation scores compared with the control group on days 3 and 5 (P < 0.05). Spontaneous bowel movements tended to reappear more rapidly after taking the XLCQ decoction than after conventional laxative treatment. Both the average aggregate constipation score and the time taken to achieve spontaneous bowel movements showed positive correlations with NIHSS scores before and 1 month after treatment (P < 0.01). CONCLUSION: Treatment with XLCQ decoction effectively alleviated the overall symptoms of constipation in acute ischemic stroke patients. The status of bowel movements in acute ischemic stroke can reflect the severity of neurological impairment and predict neurological outcomes at 1 month.

[Clinical observation of high thoracic epidural anesthesia therapy for patients with congestive heart failure secondary to ischemic cardiomyopathy].

OBJECTIVE: To investigate the effects of high thoracic epidural anesthesia (HTEA) on chronic heart failure (CHF) and its safety. METHODS: 117 patients with ischemic cardiomyopathy (ICM) of NYHA class II - IV and with the LVEF < or = 45%, 90 males and 27 females, aged 45 - 81, were Randomly divided into 2 groups: control group (n = 54, treated with the routine medication) and HTEA group (n = 63, administrated epidurally with 0.5% lidocaine 3 - 5 ml every two hours from 9 a.m. to 11 p.m. everyday via an epidural catheter for one month in addition to the routine treatment). Echocardiography was performed before and after the treatment to examine the cardiac structure and left ventricular systolic function. The plasma brain natriuretic peptide (BNP) was examined before and after the treatment. RESULTS: The clinical symptoms and signs of the HTEA group were improved markedly. The total effective rate was 95.2% in the HTEA group, significantly higher than in the control group (85.2%, P < 0.05). Echocardiographic parameters showed that the diameters of ventricles and atrium decreased by 3 - 5 mm in the HTEA group. The left ventricular end diastolic volume (LVEDV) of the HTEA group reduced from (337 +/- 132) ml before treatment to 274 ml +/- 109 ml after treatment, and the left ventricular end systolic volume (LVESV) of the HTEA group reduced from (215 +/- 99) ml before treatment to (147 +/- 73) ml after treatment (both P < or = 0.001). The regurgitation area of mitral valve of the HTEA group reduced from (6.6 +/- 3.7) cm(2) before treatment to (4.3 +/- 2.7) cm(2) after treatment, and the regurgitation area of tricuspid valve of the HTEA group reduced from (5.4 +/- 3.2) cm(2) before treatment to (3.3 +/- 2.3) cm(2) after treatment (both P < 0.01). No changes were observed in the E/A ratio in both groups. The BNP level fell from (678 +/- 521) ng/L to (237 +/- 225) ng/L in the HTEA group (P < or = 0.05). In the HTEA group, one patient died because of deterioration of cardiac function. HTEA was well tolerated and caused lower incidence of adverse events. CONCLUSIONS: HTEA obviously improves the heart function of the patients with CHS secondary to ICM. Consequently, HTEA is effective and safe in CHF patients with favorable tolerance.

[Repair of the finger proximal and middle segment soft tissue defect with flap transplantation].

OBJECTIVE: To summarize and analyze the surgical methods and therapeutic effects of repair of the finger proximal and middle segment soft tissue defect with three different types of skin flaps. METHODS: From May 2011 to May 2015, 102 patients with 115 fingers proximal and middle segment soft tissue defect underwent reconstruction with three different types of skin flaps. There were 59 males with 70 fingers and 43 females with 45 fingers, aged from 19 to 62 years old with an average of 45.6 years. Twenty-nine patients with 29 fingers were repaired by free peroneal artery perforator flaps, 35 patients with 37 fingers were repaired by the free vascularized flaps based on the wrist cutaneous branch of ulnar artery, 38 patients with 49 fingers were repaired by metacarpal dorsal artery perforator flaps. The soft tissue defect area varied from 1.8 cm×4.0 cm to 2.8 cm×5.4 cm. The flap area varied from 2.0 cm×4.4 cm to 3.1 cm×6.0 cm. The clinical results were evaluated based on flap survival rate, finger function and complications. RESULTS: All flaps survived. Distal skin flap necrosis occurred in 5 flaps, but healed after wound dressing therapy. No deep infection were found in donor site and recipient site. There were 3 cases with partial necrosis of the skin graft, and delayed healing after wound dressing therapy. All patients were followed up from 6 to 28 months with an average of 10.6 months. The appearance and texture of flaps were well. The sensation were good, two-point discrimination was 9 to 13 mm. There were no obvious dysfunction happened in the donor site. The function of the fingers was excellent in 52 cases, good in 41, fair in 9 cases. CONCLUSIONS: About the repair of the finger proximal and middle segment soft tissue defect, the right flap should be choosen based on the difference of the sex and the age in patients, wounds situation, the master degree of the operation method and the hospital's technical conditions.

[Adsorption behavior and mechanisms in dual-solutes of Pb2+ and p-nitrophenol by organobentonites].

The sorption behavior for organobentonites to sorb organic pollutants from metal-organic pollutant systems were investigated. The results suggested that in organobentonite/Pb2+/p-nitrophenol solute systems, Pb2+ can slow the sorption velocity of organobentonite to adsorb p-nitrophenol from water. Pb2+ and p-nitriphenol exhibit a competitive effect. The competitive effects were relevant to ration of p-nitrophenol and Pb2+ and adsorption mechanisms of organobentonites. Bentonite modified with TMAB adsorbing contaminants primarily by an adsorption process, and the process exhibits a stonger competitive effect in multi-solute systems.