Levels and Health Risk Assessment of Inorganic Arsenic, Methylmercury, and Heavy Metals in Edible Mushrooms Collected from Online Supermarket in China.

Chromium (Cr), total arsenic (As), inorganic arsenic (iAs), cadmium (Cd), mercury (Hg), methylmercury (MeHg), and lead (Pb) were analyzed in in Agaricus blazei, Tricholoma matsutake, Pholiota nameko, agrocybe aegirit, Boletus edulis, Auricularia auricula, and Lentinus edodes collected from online supermarket in China from 2015 to 2017. The order of mean concentrations for the five heavy metals in edible mushrooms was As > Cd > Cr > Pb > Hg. No positive correlation was found between total As and iAs, nor between total Hg and MeHg. The contents of iAs were at a low level except for A. blazei samples. The contents of MeHg were at a low level in all test mushroom samples. And Cr, Cd, and Pb pollution were common problems in the test mushroom samples. The comprehensive factor pollution index was between 0.569 (A. auricula) and 3.056 (B. edulis). The THQ values for the five heavy metals from P. nameko, A. auricula, A. aegirit, and L. edodes samples were less than 1. The hazard index (HI) values of A. blazei, T. matsutake, and B. edulis samples for adults and children were greater than 1, indicating significant health hazard to the adults and children consumers. The cancer risk (CR) values for iAs ranged from 3.82 × 10- 6 (T. matsutake) to 8.61 × 10- 5 (A. blazei), indicating no potential carcinogenic risk to the consumers. The order for carcinogenic risk of each edible mushroom species was A. blazei > L. edodes > P. nameko > A. aegirit > A. auricula > B. edulis > T. matsutake.

The coupling relationship and driving mechanism between urbanization and ecosystem services in the Yellow River Basin from a multi-spatial scale perspective.

Rapid urbanization has led to ecological destruction and associated issues. Macro policies wield substantial influence over urbanization and its relationship with the environment. Without considering the differences in scale, macro policies may be ineffective at addressing urbanization's adverse impacts on the environment, and even worsen this relationship. We used data on 622 counties, 76 prefectures, and 7 urban agglomerations in the Yellow River Basin to examine the development level, coupling coordination degree, and spatial patterns of urbanization and ecosystem services at three scales during 2000-2020. Further, we explored the driving mechanisms in the relationship between urbanization and ecosystem services. We found that: First, the coupling coordination was relatively low but showed an upward trend. A sizeable spatiotemporal difference existed, with higher (lower) coordination in the east (west). Second, the coupling coordination of each scale exhibited significant spatial positive correlations. The low-value heterogeneous region was embedded around the agglomeration region, and polarization was significant. The larger the scale, the stronger the agglomeration effect. Further, the coupling coordination spatial agglomeration effect of each scale gradually weakened over time. Third, the spatial and temporal distributions of coupling coordination and its agglomeration characteristics at different scales differed. The urban agglomeration scale showed significant overall coordination or agglomeration characteristics, and prefecture and county regions showed local and unique characteristics within urban agglomerations. Fourth, the dominant factors influencing the spatial patterns of the coupling coordination at the county, prefecture, and urban agglomeration scales differed. The interaction and factor detection showed linear and double-factor enhancements. We find that economic development, government policies, environmental protection, and natural factors are the combined effects of urbanization and ecosystem services. Our research method can provide a reference for other river basins, and the results can help governments in formulating policies for sustainable development at different spatial scales.

Exploring the clinical outcomes and safety profile of inetetamab treatment in metastatic breast cancer patients: A multicenter assessment of a Chinese-origin recombinant Anti-HER2 monoclonal antibody.

BACKGROUND: Inetetamab is a novel recombinant humanized anti-HER2 monoclonal antibody. This study aimed to evaluate the efficacy and safety of inetetamab and predictive factors for response in HER2-positive metastatic breast cancer (MBC) patients. METHODS: A cohort of HER2-positive MBC patients who received inetetamab-based therapy between June 2020 and August 2021 was evaluated. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included objective response rate (ORR) and disease control rate (DCR). Adverse events (AEs) were graded according to the National Cancer Institute Common Toxicity Criteria. RESULTS: A total of 141 patients were included in the final analysis. The median PFS of the entire cohort was 7.1 months. The median number of treatment lines administered was three. The ORR was 36.9 %, and the DCR was 80.9 %. The most frequently employed treatment strategy was inetetamab + chemotherapy (49/141, 34.8 %), followed by inetetamab + HER2-tyrosine kinase inhibitors (HER2-TKIs) + chemotherapy, inetetamab + pertuzumab + chemotherapy, inetetamab + endocrine treatment and inetetamab + HER2-TKIs. Cox multivariate analysis revealed that PFS was associated with liver metastasis (hazard ratio [HR] 2.112, 95 % confidence interval [CI] 1.334-3.343, p = 0.001), previous HER2-TKI treatment (HR 2.019, 95 % CI 1.133-3.597, p = 0.017) and estrogen receptor positivity (HR 0.587, 95 % CI 0.370-0.934, p = 0.024). The toxicity was tolerable, with neutropenia being the most common treatment-related grade 3/4 AE (14.9 %). CONCLUSION: Inetetamab demonstrates effectiveness with a manageable safety profile, offering a promising therapeutic option for HER2-positive breast cancer patients who have shown resistance to prior anti-HER2 treatments.

How marital events explain the suicide rate among Chinese.

AIMS: The aims for this study was to prove the impacts of marital events (marriage rate, divorce rate and marriage squeeze), economic development, and social development on the suicide rate among urban and rural Chinese and reveal the differences in these impacts between urban and rural areas and between genders. METHODS: An explanatory time-series analysis methodology was adopted to analyze the nation-wide data ranging from 1987-2017. RESULTS: Marriage rate was a protective factor against the suicide rate among urban and rural men, and rural women; however, divorce rate was a protective factor against the suicide rate only among rural women. For the four groups, the economic development level measured by per capita GDP is a protective factor, while social development measured by urbanization and rural-urban labor migration rates in rural areas plays different roles. CONCLUSIONS: Marriage and divorce rates were found to have different meanings for the four groups. This study offers a reference for designing relevant policies and projects to intervene in suicidal behaviors among different groups.

Automatic segmentation of the female pelvic floor muscles on MRI for pelvic floor function assessment.

Background: Pelvic organ prolapse (POP) is a pelvic floor dysfunction disease which affects females. The volume of pelvic floor muscle, especially the levator ani muscle (LAM), is an important indicator of pelvic floor function. However, muscle volume measurements depend on manual segmentation, which is clinically time-consuming. In this work, we present an efficient automatic segmentation model of pelvic floor muscles with magnetic resonance imaging (MRI) based on DenseUnet, to achieve muscle volume calculation and provide a reference for the assessment of pelvic floor function. Methods: A total of 49 female pelvic floor magnetic resonance (MR) series were retrospectively enrolled from the First Affiliated Hospital of Army Military Medical University between 2013 and 2021, including 21 normal participants and 28 patients with stage 1-4 POP. The LAM, internal obturator muscle (IOM), and external anal sphincter (EAS) were manually segmented. An improved DenseUnet was proposed for automatic segmentation of these 3 muscles. The Dice similarity coefficient (DSC), Hausdorff distance (HD), and average symmetrical surface distance (ASSD) were used to evaluate segmentation results. The segmentation performance of the improved DenseUnet was compared with those of standard DenseUnet, ResUnet, Unet++, and Unet. Results: The improved DenseUnet showed a good performance. The average DSC and standard deviation of the LAM, IOM, and EAS was 0.758±0.151, 0.716±0.173, and 0.810±0.147, respectively. The average HD was 22.41, 19.00, and 36.01 mm, respectively; and the average ASSD was 3.66, 3.80, and 5.23 mm, respectively. The average DSC and standard deviation of the normal group and POP group was 0.779±0.166 and 0.757±0.154, respectively. There was no significant difference between the muscle volume of the improved DenseUnet and manual segmentation (all P values >0.05). The average total segmentation time for 1 case was 10.18 s on our setup, which is much lower than the manual segmentation time of 45 minutes. Conclusions: The improved DenseUnet segments the pelvic floor muscles in MRI quickly and efficiently, with good precision and faster speed than those of manual segmentation. This can assist doctors in quickly segmenting pelvic floor muscles, calculating muscle volume, and further evaluating pelvic floor function.

Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications.

Intracranial atherosclerotic disease (ICAD) is a common cause of ischaemic stroke and transient ischaemic attack (TIA) with a high recurrence rate. It is often referred to as intracranial atherosclerotic stenosis (ICAS), when the plaque has caused significant narrowing of the vessel lumen. The lesion is usually considered 'symptomatic ICAD/ICAS' (sICAD/sICAS) when it has caused an ischaemic stroke or TIA. The severity of luminal stenosis has long been established as a prognostic factor for stroke relapse in sICAS. Yet, accumulating studies have also reported the important roles of plaque vulnerability, cerebral haemodynamics, collateral circulation, cerebral autoregulation and other factors in altering the stroke risks across patients with sICAS. In this review article, we focus on cerebral haemodynamics in sICAS. We reviewed imaging modalities/methods in assessing cerebral haemodynamics, the haemodynamic metrics provided by these methods and application of these methods in research and clinical practice. More importantly, we reviewed the significance of these haemodynamic features in governing the risk of stroke recurrence in sICAS. We also discussed other clinical implications of these haemodynamic features in sICAS, such as the associations with collateral recruitment and evolution of the lesion under medical treatment, and indications for more individualised blood pressure management for secondary stroke prevention. We then put forward some knowledge gaps and future directions on these topics.

Family and social class differences in sports behavior motivation among college students: An empirical study based on the latent class model.

Objective: This article aims to explore the potential categories of college students' sports behavior motivation and the differences between different family social classes on potential categories. Participants: In total, 1,092 college students were investigated in this study. Methods: This article used the "College Students' Sports Behavior Motivation Questionnaire" to survey 1,092 college students using the whole group sampling method. The potential profile analysis method was applied to classify the types of college students' sports behavior motivation and further analyze the characteristics of different family social classes and sports behavior motivation. Results: College students' sports behavior motivation types can be divided into the following four categories: "low motivation type" (0.82%), "healthy appearance type" (11.45%), "healthy fun type" (37.36%), and "high motivation type" (50.37%). The higher the family's social class, the more the sports behavior motivation of college students tends to be healthy appearance, health, fun, and high motivation. The lower the family social class, the more motivational sports behavior of college students tends to be low motivation. The better the perception of health, the higher the probability that college students belong to the high-motivation type. The fewer chronic diseases that college students have are associated with a healthy appearance and high motivation. Conclusion: There is a certain relationship between the type of college students' sports behavior motivation and their family social class. Therefore, in school physical education, we should open all kinds of sports activities according to college students' sports behavior motivation needs and focus on college students with lower family social class in order to intervene precisely on their motivation for sports behaviors, improve participation, and promote the overall health of college students.

Release of microplastics from breastmilk storage bags and assessment of intake by infants: A preliminary study.

The occurrence of microplastic contaminants in food intended for human consumption has been widely explored. Yet, investigations on plastic and other particle debris in baby food packaging remain scarce to date. Our study shows the release of abundant micro-sized and submicron-sized particles, floccules (<300 µm), and fragments (1-50 µm) during the simulated use of commercially available single-use breastmilk storage bags. Six best-selling products of breastmilk storage bags were selected in our study. Most of the particles released from breastmilk storage bags that were identified as plastics were found to be polyethylene (PE), polyethylene terephthalate (PET), and nylon-6 using micro-Raman spectroscopy. The weight of the particles released from three randomly selected bags of the same product type was determined to be in the range of 0.22 and 0.47 mg. Submicron-sized particles (<0.8 µm) with irregular spherical or oval shapes were present. Microplastics and other particles ingested by infants from the use of breastmilk storage bags were estimated to be 0.61-0.89 mg/day based on the average daily breastmilk intake by infants. This study provides new insights into the exposure to microplastics and other particle debris in commonly used infant products.

Linking environmental management accounting to green organisational behaviour: The mediating role of green human resource management.

The China's economy is developing rapidly, and it affects the environment on several levels. Therefore, this study examines the effect of environmental management accounting, green human resource management (HRM), on green organisational behaviour (OB). We collected 383 questionnaires completed by human resource managers and accounting managers in the Chinese hospitality industry. We used a covariance-based structural equation model to test the hypotheses in this study. The empirical evidence shows a positive and significant effect between environmental management accounting (monetary environmental management accounting, and physical environmental management accounting) and green HRM (ß = 0.262, p < 0.01, ß = 0.378, p< 0.01). Green HRM mediates the influence of environmental management accounting (monetary environmental management accounting, ß = 0.059, p < 0.01; physical environmental management accounting, ß = 0.084, p< 0.01) on green OB. The analysis confirmed the importance of environmental management accounting (as opposed to green human resource management) in predicting green behaviour and the critical role of green human resource management in connecting environmental management accounting and green OB. Thus, this study extends the literature's perspective on green OB to environmental management accounting and green HRM.

Validation of a Risk Assessment Tool for Unplanned Endotracheal Extubation: An Observational Study.

The purpose of this study was to validate and determine the sensitivity and specificity of the risk assessment tool for unplanned endotracheal extubation. Unplanned endotracheal extubation is a common adverse event. The rate of unplanned endotracheal extubation is an indicator to measure patient safety and medical quality. This study was conducted in five intensive care units in a tertiary-A hospital. A total of 227 samples encounters were obtained from 147 unique patients. The content validity was 0.91, and the item content validity ranged from 0.80 to 1.00. Cronbach's α was .58, the interrater reliability was .93. The area under the curve was 0.89 (95% CI [0.84, 0.94], p < 0.01), the sensitivity was 87.80%, and the specificity was 74.20%. This tool presented good reliability and validity and can be used to assess the risk of unplanned endotracheal extubation in patients with artificial airways.

Small vessel disease burden may not portend unfavorable outcome after thrombectomy for acute large vessel occlusion.

OBJECTIVES: We aimed to investigate the correlation between an overall cerebral small vessel disease (CSVD) burden and outcomes after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). METHODS: In a multicenter registry study, we enrolled patients with EVT for anterior-circulation LVO-stroke. In 3.0-T MR imaging, we assessed 4 CSVD imaging markers, lacunes, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces, each assigned a score of 0 or 1 and summed up to an overall CSVD burden score of 0-4. We dichotomized the overall CSVD severity as none to mild (score 0-2) and moderate to severe (3-4). Primary outcome was 90-day functional dependence or death (modified Rankin Scale (mRS) 3-6). Secondary outcomes included increase in NIH Stroke Scale ≥ 4 within 24 h (early neurological deterioration (END)) and within 7 days, symptomatic intracranial hemorrhage, 90-day mRS 2-6, and 90-day mortality. RESULTS: Among 311 patients (63.0% male; mean age 65.1 ± 12.7 years), 260 (83.6%) had none-to-mild and 51 (16.4%) had moderate-to-severe overall CSVD burden. Moderate-to-severe CSVD burden was not significantly associated with the primary outcome (47.1% versus 45.4%; p > 0.05 in univariate and multivariate logistic regression), or the secondary outcomes except for a higher risk of END (11.8% versus 3.1%; p < 0.05 in multivariate analyses). Sensitivity analyses with 0-1 versus 2-4 of the CSVD burden score, and the score as an ordinal variable, showed similar results. CONCLUSIONS: An overall moderate-to-severe CSVD burden was not associated with 90-day functional dependence or death, after EVT for anterior-circulation LVO. TRIAL REGISTRATION: ChiCTR1900022154 KEY POINTS: • Moderate-to-severe cerebral small vessel disease burden on MRI should not be an exclusion indicator in determining the eligibility of an acute ischemic stroke patient for endovascular treatment.

The Effect of Confucianism on Job Crafting Using Psychological Contract Fulfilment as the Mediating Variable and Distributive Justice as the Moderating Variable.

PURPOSE: Job crafting can improve employees' performance and competitive advantage. This study integrated the self-determination and equity theories to examine the relation between an individual's Confucianism and job crafting by highlighting the mediating effect of psychological contract fulfilment and the moderating effect of distributive justice on this relation. PARTICIPANTS AND METHODS: Data were collected in two waves from 372 employees in numerous private companies in Guangxi, China. RESULTS: The hypothesized model was supported in part. Specifically, as expected, psychological contract fulfilment mediated the positive relation between Confucianism and task crafting and cognitive crafting. Confucianism had a positive effect on psychological contract fulfilment and relational crafting, while psychological contract fulfilment had no mediating effect and its positive effect on relational crafting was not significant. Distributive justice moderated the relation between psychological contract fulfilment and cognitive crafting and task crafting positively. CONCLUSION: This study reveals the mechanism of Confucianism's effect on job crafting from a new perspective and confirms its differing effects on different types of job crafting. Business managers should give attention to Confucianism and maximize their organization's psychological contract fulfilment to improve employees' job crafting.

Risk Assessment of Hazmat Road Transportation Considering Environmental Risk under Time-Varying Conditions.

Hazardous materials shipments are integral to the development of industrial countries. Significant casualties and severe environmental pollution quickly ensue when accidents occur. Currently, relevant research on risk assessment of hazardous materials' road transportation remains limited when both the population exposure risk and environmental risk are considered, especially in regard to analyzing the differences of accident impacts in different populations and environments. This paper adopts a Gaussian plume model to simulate dynamic areas at three levels of population exposure and assesses the pollution scope of air, groundwater, lakes, and rivers with a variety of diffusion models. Then, we utilize various costs to analyze the differences of accident impacts in population exposure and environmental pollution. Finally, a risk assessment model of hazardous materials road transportation under time-varying conditions is presented by considering the bearing capacity of the assessed area. Furthermore, this model is applied to a case study involving a risk assessment of hazardous materials transportation of a highly populated metropolitan area of Shanghai, China. The resulting analyses reveal that the safety of hazardous materials transportation could be effectively improved by controlling certain model parameters and avoiding road segments with a high risk of catastrophic accident consequences.

Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study.

BACKGROUND: One of the most cost-effective treatments for secondary prevention of stroke and other non-communicable diseases is a long-term medication regimen. However, the complexities of medication adherence extend far beyond individual behavior change, particularly in low- and middle-income countries. The purpose of this study was to examine stakeholder perspectives on barriers to medication adherence for stroke patients in Beijing, China, identifying opportunities to improve care and policy in resource-constrained settings. METHODS: We conducted a qualitative, phenomenological analysis of data obtained from 36 individuals. Participants were patients; caregivers; healthcare providers; and representatives from industry and government, purposively selected to synthesize multiple perspectives on medication management and adherence for stroke secondary prevention in Beijing, China. Data was analyzed by thematic analysis across iterative coding cycles. RESULTS: Four major themes characterized barriers on medication adherence, across stakeholders and geographies: limitations driven by individual patient knowledge / attitudes; lack of patient-provider interaction time; lack of coordination across the stratified health system; and lack of affordability driven by high overall costs and limited insurance policies. CONCLUSIONS: These barriers to medication management and adherence suggest opportunities for policy reform and local practice changes, particularly for multi-tiered health systems. Findings from this study in Beijing, China could be explored for applicability in other low- and middle-income countries with urban centers serving large geographic regions.

Venture capital, control rights, and family enterprise growth.

This research explores and explains the path of family enterprise venture capital equity financing from the perspective of endogenous family control rights. We adopted unbalanced panel data on Chinese listed companies from 2007 to 2018. Empirical research shows that there are significant differences in the impact of venture capital on the growth performance of family enterprises and non-family enterprises. Venture capital negatively affects the growth performance of family enterprises, while the negative impact of venture capital on family enterprises is not significant. In addition, family control positively moderates the negative impact of venture capital on family enterprise growth performance.

[Spatial Distribution Pattern and Influencing Factors of Industrial Pollution Emissions in Yangtze River Economic Belt].

The development of Yangtze River economic belt emphasizes the strategy of "no large-scale development, joint efforts in large-scale protection". The restoration of the Yangtze River environment has become an important part of the development of the region. Therefore, it is important to explore the spatial distribution of industrial pollution emissions and its influencing factors in the Yangtze River economic belt. Using industrial SO2, wastewater, and soot emission data from 102 cities in the Yangtze River economic belt, from 2013 to 2017, this study analyzes the spatial distribution of industrial pollution emissions in the Yangtze River economic belt. This was achieved using spatial autocorrelation analysis and Getis-Ord Gi* methods, and by adopting the logarithmic mean Divisia index model to decompose the influencing factors of industrial pollution emissions in the Yangtze River economic belt. The results show that from 2013 to 2017, the emissions of industrial SO2, wastewater, and soot in the Yangtze River economic belt exhibited a downward trend, with a decrease in the number of high-emission cities and an increase in the number of low-emission cities. The spatial correlation of industrial pollutants increased with time, and technological improvements had the most significant inhibitory effect, making it the most important factor affecting industrial pollution emissions in the Yangtze River economic belt.

Assessment of Trends in Guideline-Based Oral Anticoagulant Prescription for Patients With Ischemic Stroke and Atrial Fibrillation in China.

Importance: Adherence to oral anticoagulants (OACs) per guideline recommendations is crucial in reducing ischemic stroke and systemic thromboembolism in high-risk patients with ischemic stroke and atrial fibrillation. However, data on OAC use are underreported in China. Objective: To assess adherence to the Chinese Stroke Association or the American Heart Association/American Stroke Association's clinical management guideline-recommended prescription of OACs, the temporal improvement in adherence, and the risk factors associated with OAC prescriptions. Design, Setting, and Participants: This quality improvement study was conducted at 1430 participating hospitals in the Chinese Stroke Center Alliance (CSCA) among patients with ischemic stroke and atrial fibrillation enrolled in the CSCA between August 1, 2015, and July 31, 2019. Exposure: Calendar year. Main Outcomes and Measures: Adherence to the Chinese Stroke Association or the American Heart Association/American Stroke Association's clinical management guideline-recommended prescribing of OACs (warfarin and non-vitamin K OACs, including dabigatran, rivaroxaban, apixaban, and edoxaban) at discharge. Results: Among 35 767 patients (18 785 women [52.5%]; mean [SD] age, 75.5 [9.2] years) with previous atrial fibrillation at admission, the median CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age 65-74 [1 point] or ≥75 years [2 points], diabetes, and stroke, transient ischemic attack or thromboembolism [2 points]-vascular disease, and sex category [female]) score was 4.0 (interquartile range, 3.0-5.0); 6303 (17.6%) were taking OACs prior to hospitalization for stroke, a rate that increased from 14.3% (20 of 140) in the third quarter of 2015 to 21.1% (118 of 560) in the third quarter of 2019 (P < .001 for trend). Of 49 531 eligible patients (26 028 men [52.5%]; mean [SD] age, 73.4 [10.4] years), 20 390 (41.2%) had an OAC prescription at discharge, an increase from 23.2% (36 of 155) in the third quarter of 2015 to 47.1% (403 of 856) in the third quarter of 2019 (P < .001 for trend). Warfarin was the most commonly prescribed OAC (11 956 [24.2%]) and had the largest temporal increase (from 5.8% [9 of 155] to 20.7% [177 of 856]). Older age (adjusted odds ratio [aOR] per 5 year increase, 0.89;95% CI, 0.89-0.90), lower levels of education (aOR for below elementary school, 0.84; 95% CI, 0.74-0.95 ), lower income (aOR for ≤¥1000 [$154], 0.66; 95% CI, 0.59-0.73), having new rural cooperative medical scheme insurance (aOR, 0.92; 95% CI, 0.87-0.96), prior antiplatelet use (aOR, 0.70; 95% CI, 0.66-0.74), having several cardiovascular comorbid conditions (including stroke or transient ischemic attack [aOR, 0.78; 95% CI, 0.75-0.82], hypertension [aOR, 0.84; 95% CI, 0.80-0.89], diabetes [aOR, 0.91; 95% CI, 0.83-0.99], dyslipidemia [aOR, 0.87; 95% CI, 0.80-0.94], carotid stenosis [aOR, 0.83; 95% CI, 0.69-0.98], and peripheral vascular disease [aOR, 0.80; 95% CI, 0.71-0.90]), and admission to secondary hospitals (aOR, 0.71; 95% CI, 0.68-0.74) or hospitals located in the central region of China (aOR, 0.80; 95% CI, 0.75-0.84) were associated with not being prescribed an OAC at discharge. Conclusions and Relevance: This quality improvement study suggests that, despite significant improvement over time, OAC prescriptions remained low. Efforts to increase OAC prescriptions, especially non-vitamin K OACs, are needed for vulnerable subgroups by age, socioeconomic status, and presence of comorbid conditions.

Effects of different aerobic exercise training on glycemia in patients with type 2 diabetes: A protocol for systematic review and meta analysis.

BACKGROUND: Type 2 diabetes is an emergent worldwide health crisis, and rates are growing globally. Aerobic exercise is an essential measure for patients with diabetes, which has the advantages of flexible time and low cost. Aerobic exercise is a popular method to reduce blood glucose. Due to the lack of randomized trials to compare the effects of various aerobic exercises, it is difficult to judge the relative efficacy. Therefore, we intend to conduct a network meta-analysis to evaluate these aerobic exercises. METHODS: According to the retrieval strategies, randomized controlled trials on different aerobic exercise training will be obtained from China National Knowledge Infrastructure, WanFang, SinoMed, PubMed, Web of Science, EMBASE, and Cochrane Library, regardless of publication date or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed in Markov Chain Monte Carlo method and carried out with Stata14 and OpenBUGS software. Ultimately, the evidentiary grade for the results will be evaluated. RESULTS: Eighteen literatures with a total of 1134 patients were included for the meta-analysis. In glycemia assessment, Tennis (standard mean difference = 3.59, credible interval 1.52, 5.65), had significantly better effects than the named control group. Tennis (standard mean difference = 3.50, credible interval 1.05, 5.59), had significantly better effects than the named Taiji group. CONCLUSION: All together, these results suggest that tennis may be the best way to improve blood glucose in patients with type 2 diabetes. This study may provide an excellent resource for future control glycemia and may also serve as a springboard for creative undertakings as yet unknown.

Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial.

BACKGROUND: Studies show tranexamic acid can reduce the risk of death and early neurological deterioration after intracranial haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in intracerebral haemorrhage patients susceptible to haemorrhage expansion. METHODS: We did a prospective, double-blind, randomised, placebo-controlled trial at 10 stroke centres in China. Acute supratentorial intracerebral haemorrhage patients were eligible if they had indication of haemorrhage expansion on admission imaging (eg, spot sign, black hole sign or blend sign), and were treatable within 8 hours of symptom onset. Patients were randomly assigned (1:1) to receive either tranexamic acid or a matching placebo. The primary outcome was intracerebral haematoma growth (>33% relative or >6 mL absolute) at 24 hours. Clinical outcomes were assessed at 90 days. RESULTS: Of the 171 included patients, 124 (72.5%) were male, and the mean age was 55.9±11.6 years. 89 patients received tranexamic acid and 82 received placebo. The primary outcome did not differ significantly between the groups: 36 (40.4%) patients in the tranexamic acid group and 34 (41.5%) patients in the placebo group had intracranial haemorrhage growth (OR 0.96, 95% CI 0.52 to 1.77, p=0.89). The proportion of death was lower in the tranexamic acid treatment group than placebo group (8.1% vs 10.0%), but there were no significant differences in secondary outcomes including absolute intracranial haemorrhage growth, death and dependency. CONCLUSIONS: Among patients susceptible to haemorrhage expansion treated within 8 hours of stroke onset, tranexamic acid did not significantly prevent intracerebral haemorrhage growth. Larger studies are needed to assess safety and efficacy of tranexamic acid in intracerebral haemorrhage patients.

Design of assessment tool for unplanned endotracheal extubation of artificial airway patients.

AIM: Unplanned endotracheal extubation (UEE) is one of the most common adverse events reported in patients with artificial airway. Current research in UEE is mostly limited to the summary of risk factors and analysis of prevention strategies. The aim of the study was to develop an assessment tool for medical staff to assess the risk of unplanned extubation in endotracheal intubation patients. DESIGN: The design was a qualitative study. METHODS: Based on literature review, group discussion, pre-investigation, the initial risk assessment scale on unplanned extubation for endotracheal intubation patients was established. Fifteen experts from thirteen tertiary-A hospitals across eight provinces participated in two rounds of Delphi panel. RESULTS: The risk assessment tool on unplanned extubation for endotracheal intubation patients was established by the Delphi method. It was composed of 11 indicators, which got agreement among two rounds panel.