Detection of atrial fibrillation using a nonlinear Lorenz Scattergram and deep learning in primary care.

BACKGROUND: Atrial fibrillation (AF) is highly correlated with heart failure, stroke and death. Screening increases AF detection and facilitates the early adoption of comprehensive intervention. Long-term wearable devices have become increasingly popular for AF screening in primary care. However, interpreting data obtained by long-term wearable ECG devices is a problem in primary care. To diagnose the disease quickly and accurately, we aimed to build AF episode detection model based on a nonlinear Lorenz scattergram (LS) and deep learning. METHODS: The MIT-BIH Normal Sinus Rhythm Database, MIT-BIH Arrhythmia Database and the Long-Term AF Database were extracted to construct the MIT-BIH Ambulatory Electrocardiograph (MIT-BIH AE) dataset. We converted the long-term ECG into a two-dimensional LSs. The LSs from MIT-BIH AE dataset was randomly divided into training and internal validation sets in a 9:1 ratio, which was used to develop and internally validated model. We built a MOBILE-SCREEN-AF (MS-AF) dataset from a single-lead wearable ECG device in primary care for external validation. Performance was quantified using a confusion matrix and standard classification metrics. RESULTS: During the evaluation of model performance based on the LS, the sensitivity, specificity and accuracy of the model in diagnosing AF were 0.992, 0.973, and 0.983 in the internal validation set respectively. In the external validation set, these metrics were 0.989, 0.956, and 0.967, respectively. Furthermore, when evaluating the model's performance based on ECG records in the MS-AF dataset, the sensitivity, specificity and accuracy of model diagnosis paroxysmal AF were 1.000, 0.870 and 0.876 respectively, and 0.927, 1.000 and 0.973 for the persistent AF. CONCLUSIONS: The model based on the nonlinear LS and deep learning has high accuracy, making it promising for AF screening in primary care. It has potential for generalization and practical application.

Intervention strategies for management of comorbid depression among individuals with hypertension: a scoping review protocol.

INTRODUCTION: Hypertension and depression often coexisted, leading to poor health outcome and significant challenges in healthcare management. Since no guidelines or consensus are available for health professionals to manage this comorbidity, identifying interventions in current literature is crucial for gaining a clear picture of evidence and informing future research directions and clinical practice. This scoping review is designed to address this gap by systematically mapping the range of potential interventions for managing comorbid hypertension and depression. METHODS AND ANALYSIS: Following the Joanna Briggs Institute guidelines for scoping review, this review will comprehensively search databases including PUBMED, Embase, PsycINFO, CINAHL, Cochrane Library Databases, Chinese Biomedical Literature Database and Chinese National Knowledge Infrastructure. Grey literature will be sourced from Google Scholar. A year limit of January 2004-December 2023 will be applied to retrieve the most current peer-reviewed articles in English and Chinese language only. Two reviewers will individually screen and the process will be documented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews. This review will explore a range of non-pharmacological and multicomponent interventions including psychosocial support, educational programmes, telemedicine and integrated healthcare models. Data extraction will follow the Template for Intervention Description and Replication checklist to ensure detailed and standardised reporting of intervention components. The synthesis of findings will employ both quantitative and qualitative methods to provide a comprehensive overview of the intervention landscape. ETHICS AND DISSEMINATION: This scoping review, which involves secondary data analysis of publicly available sources, does not require ethical approval. Findings will be disseminated through peer-reviewed publications and presentations at relevant conferences. STUDY REGISTRATION: Open Science Framework registry (osf.io/j7gt8) in Centre for Open Science on 29 January 2024.

Disagreements in risk of bias assessment for randomized controlled trials in hypertension-related Cochrane reviews.

BACKGROUND: The inter-reviewer reliability of the risk of bias (RoB) assessment lacked agreement in previous studies. It is important to analyse these disagreements to improve the repeatability of RoB assessment. The objective of the study was to evaluate the frequency and reasons for disagreements in RoB assessments for randomised controlled trials (RCTs) that were included in multiple Cochrane reviews in the field of hypertension. METHODS: A cross-sectional study was employed. We retrieved any RCTs that had been included in multiple Cochrane reviews in the field of hypertension from ARCHIE. The results of the RoB assessments were extracted, and the distributions of agreements and possible reasons for disagreement were analyzed. RESULTS: Twenty-six Cochrane reviews were included in this study. A total of 78 RCTs appeared in more than one Cochrane review. The level of agreement ranged from domain to domain. "Blinding of outcome assessment" showed a reasonably high level of agreement (94.9%), while "incomplete outcome data", "selective outcome reporting" and "other sources of bias" showed moderate levels of agreement (74.6%, 79.2% and 75.6%, respectively). However, the domains of "allocation concealment", "random sequence generation" and "blinding of participants and personnel" showed low levels of agreement (24.4%, 23.5%, and 47.4%, respectively). In the domains of "allocation concealment" and "blinding of participants and personnel", the agreement group had higher proportion of publication year ≤ 1996 than the disagreement group (P = 0.008 and P < 0.001, respectively). In the "blinding of participants and personnel", the impact factor was higher in the agreement group (P < 0.001). By analyzing the support text, we found that the most likely reason for disagreement was extracting different information from the same RCT. CONCLUSION: For Cochrane reviews in the field of hypertension using the 2011 version of the RoB tool, there was a large disagreement in the RoB assessment. It is suggested that the results of RoB assessments in systematic reviews that used the 2011 version of the RoB tool need to be interpreted with caution. More accurate information from RCTs needs to be collected when we synthesize clinical evidence.

The impact of communication training on the clinical care of hypertension in general practice: a cluster randomized controlled trial in China.

BACKGROUND: Hypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management. METHODS: A cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs' communication skills after one month, patients' knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes. RESULTS: After the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP's communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients' knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP's communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient's knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up. CONCLUSION: Communication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs. TRIAL REGISTRATION: The trial was registered on Chinese Clinical Trials Registry on 2019-04-03. (ChiCTR1900022278).

Development of the China's list of ambulatory care sensitive conditions (ACSCs): a study protocol.

BACKGROUND: The hospitalization rate of ambulatory care sensitive conditions (ACSCs) has been recognized as an essential indicator reflective of the overall performance of healthcare system. At present, ACSCs has been widely used in practice and research to evaluate health service quality and efficiency worldwide. The definition of ACSCs varies across countries due to different challenges posed on healthcare systems. However, China does not have its own list of ACSCs. The study aims to develop a list to meet health system monitoring, reporting and evaluation needs in China. METHODS: To develop the list, we will combine the best methodological evidence available with real-world evidence, adopt a systematic and rigorous process and absorb multidisciplinary expertise. Specific steps include: (1) establishment of working groups; (2) generations of the initial list (review of already published lists, semi-structured interviews, calculations of hospitalization rate); (3) optimization of the list (evidence evaluation, Delphi consensus survey); and (4) approval of a final version of China's ACSCs list. Within each step of the process, we will calculate frequencies and proportions, use descriptive analysis to summarize and draw conclusions, discuss the results, draft a report, and refine the list. DISCUSSION: Once completed, China's list of ACSCs can be used to comprehensively evaluate the current situation and performance of health services, identify flaws and deficiencies embedded in the healthcare system to provide evidence-based implications to inform decision-makings towards the optimization of China's healthcare system. The experiences might be broadly applicable and serve the purpose of being a prime example for nations with similar conditions.

Copublication promotes dissemination hypertension guidelines: a retrospective cohort study.

To evaluate the impact of copublication on hypertension-related clinical practice guidelines' citation, we searched the Web of Science Core Collection and guide.medlive.cn until 31 December 2017 using the terms "hypertension" and "guideline". The copublished group was matched with the noncopublished group at a 1:2 ratio. Primary outcomes were total citations and citations within the first five years after publication. Secondary outcomes included the adjusted impact factor ratio (excluding copublished guidelines) to the actual impact factor of the journal. Altmetric scores were compared using Altmetric explorer data. 21 copublished and 42 noncopublished guidelines were included. The copublished group had higher median current total citations [387.0 (90.0, 1806.0) vs 70.5 (23.25, 158.25)], and higher median citations at one, two, three, four, and five years [7.0 (0.5, 58.5) vs 1.0 (0.0, 5.5), 33.0 (14.0, 142.0) vs 5.5 (1.75, 26.25), 46.0 (24.5, 216.0) vs 10.5 (3, 25.75), 50.0 (19.0, 229.0) vs 9.0 (3.0, 19.0), 52.0 (13.5, 147.0) vs 7.0 (2.0, 20.0), all p < 0.05]. The adjusted IF analysis showed that if they had not copublished the guidelines, 10 of 24 and 11 of 24 journals would have had a lower IF in the first and second years. Median altmetric scores were significantly higher for copublished guidelines [38.5 (9.5, 90.5) vs 3.5 (1.0, 9.0)] (p < 0.05). Copublication is associated with a higher citation frequency of hypertension guidelines and may increase the journal IF. Positive impacts extend beyond academia, benefiting society through broader guideline application and dissemination. This facilitates broader application of guidelines and promotes their dissemination. We conducted a retrospective cohort study to demonstrate how copublication promotes the dissemination of hypertension guidelines.

Emerging Trends in Teledermatology Research: A Scientometric Analysis from 2002 to 2021.

Background: With advances in technology, teledermatology (TD) research has increased. However, an updated comprehensive quantitative analysis of TD research, especially one that identifies emerging trends of TD research in the coronavirus disease 2019 (COVID-19) era, is lacking. Objective: To conduct a scientometric analysis of TD research documents between 2002 and 2021 and explore the emerging trends. Methods: CiteSpace was used to perform scientometric analysis and yielded visualized network maps with corresponding metric values. Emerging trends were identified mainly through burst detection of keywords/terms, co-cited reference clustering analysis, and structural variability analysis (SVA). Results: A total of 932 documents, containing 27,958 cited references were identified from 2002 to 2021. Most TD research was published in journals from the "Dermatology" and "Health Care Sciences & Services" categories. American, Australian, and European researchers contributed the most research and formed close collaborations. Keywords/terms with strong burst values to date were "primary care," "historical perspective," "emerging technique," "improve access," "mobile teledermoscopy (TDS)," "access," "skin cancer," "telehealth," "recent finding," "artificial intelligence (AI)," "dermatological care," and "dermatological condition." Co-cited reference clustering analysis showed that the recently active cluster labels included "COVID-19 pandemic," "skin cancer," "deep neural network," and "underserved population." The SVA identified two reviews (Tognetti et al. and Mckoy et al.) that may be highly cited in the future. Conclusion: During and after the COVID-19 era, emerging trends in research on TD (especially mobile TDS) may be related to skin cancer and AI as well as further exploration of primary care in underserved areas.

Association between metabolic dysfunction-associated fatty liver disease and abdominal aortic aneurysm.

BACKGROUND AND AIMS: Abdominal aortic aneurysm (AAA) is the second most common aortic pathological manifestation. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a wide impact on the cardiovascular system and may be a risk factor for AAA. The aim of this study was to investigate whether MAFLD is associated with the risk of AAA. METHODS AND RESULTS: We used data from the prospective UK Biobank cohort study. MAFLD is defined as hepatic steatosis plus metabolic abnormality, type 2 diabetes, or overweight/obesity. AAA is collected by ICD-10 code. Cox regression was established to analyze the association between MAFLD and AAA. A total of 370203 participants were included; the average age of the participants was 56.7 ± 8.0 years, and 134649 (36.4 %) were diagnosed with MAFLD. During the 12.5 years of follow-up, 1561 (0.4 %) participants developed AAA. After fully adjusting for confounding factors, individuals with MAFLD had a significantly increased risk of AAA (HR 1.521, 95 % CI 1.351-1.712, p < 0.001). Importantly, the risk of AAA increases with the severity of MAFLD as assessed by fibrosis scores. These associations were consistent according to sex, weight, and alcohol consumption but weaker in elderly or diabetics (P for interaction <0.05). The association between the MAFLD phenotype and AAA was independent of the polygenic risk score. Additionally, MAFLD was not associated with thoracic aortic aneurysm or aortic dissection events. CONCLUSIONS: There was a significant relationship between MAFLD and AAA. These findings strongly recommend early prevention of AAA by intervening in MAFLD.

Association between cognitive impairment and risk of atrial fibrillation: The Atherosclerosis Risk in Communities study.

BACKGROUND: Atrial fibrillation (AF) is reportedly a risk factor for cognitive impairment. Interestingly, recent studies have emphasized that impaired cognition is probably an initiating factor of cardiovascular disease. Thus, we aimed to explore the association between impaired cognition and the risk of AF, and clarify the potential mechanisms. METHODS: Participants of visit 2 (1991-1993) in the Atherosclerosis Risk in Communities study were included. Global cognition z-scores and factor scores were calculated using the word fluency, delayed word recall, and digit symbol substitution tests. AF incidents were diagnosed by electrocardiography and inpatient records. The association of cognitive decline with AF risk and left atrial volume index (LAVI) was explored using Cox proportional hazards and linear regression models, respectively. RESULTS: During the median follow-up of 18.2 ± 6.2 years, 2056/11,675 (17.6%) participants developed AF. Participants in the lowest quartile of global cognition z- and factor scores had a higher risk of AF (hazard ratio [HR]: 1.271, 95% confidence interval [CI]: 1.094-1.477, p = 0.002; HR: 1.305, 95% CI: 1.110-1.535, p = 0.001, respectively) than those in the highest quartile. Global cognition z- and factor scores were negatively correlated with the LAVI (B: -0.411, 95% CI: -0.749 to -0.074, p = 0.017; B: -0.425, 95% CI: -0.833 to -0.017, p = 0.041, respectively). CONCLUSION: S: : Cognitive decline is significantly associated with a higher risk of AF, with atrial remodeling being a potential mechanism. Our results extend previous findings of the brain-heart axis and indicate the effects of cognitive injury on cardiac function and structure. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; unique identifier: NCT00005131.

Multi-system diseases and death trajectory of metabolic dysfunction-associated fatty liver disease: findings from the UK Biobank.

BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a newly defined condition encompassing hepatic steatosis and metabolic dysfunction. However, the relationship between MAFLD and multi-system diseases remains unclear, and the time-dependent sequence of these diseases requires further clarification. METHODS: After propensity score matching, 163,303 MAFLD subjects and 163,303 matched subjects were included in the community-based UK Biobank study. The International Classification of Diseases, Tenth Revision (ICD-10), was used to reclassify medical conditions into 490 and 16 specific causes of death. We conducted a disease trajectory analysis to map the key pathways linking MAFLD to various health conditions, providing an overview of their interconnections. RESULTS: Participants aged 59 (51-64) years, predominantly males (62.5%), were included in the study. During the 12.9-year follow-up period, MAFLD participants were found to have a higher risk of 113 medical conditions and eight causes of death, determined through phenome-wide association analysis using Cox regression models. Temporal disease trajectories of MAFLD were established using disease pairing, revealing intermediary diseases such as asthma, diabetes, hypertension, hypothyroid conditions, tobacco abuse, diverticulosis, chronic ischemic heart disease, obesity, benign tumors, and inflammatory arthritis. These trajectories primarily resulted in acute myocardial infarction, disorders of fluid, electrolyte, and acid-base balance, infectious gastroenteritis and colitis, and functional intestinal disorders. Regarding death trajectories of MAFLD, malignant neoplasms, cardiovascular diseases, and respiratory system deaths were the main causes, and organ failure, infective disease, and internal environment disorder were the primary end-stage conditions. Disease trajectory analysis based on the level of genetic susceptibility to MAFLD yielded consistent results. CONCLUSIONS: Individuals with MAFLD have a risk of a number of different medical conditions and causes of death. Notably, these diseases and potential causes of death constitute many pathways that may be promising targets for preventing general health decline in patients with MAFLD.

Association between malnutrition and stroke-associated pneumonia in patients with ischemic stroke.

BACKGROUND: Malnutrition is associated with a high risk of mortality in adults with ischemic stroke (IS). This study aimed to investigate the relationship between malnutrition and the risk of stroke-associated pneumonia (SAP) as only a few studies examined the relationship between malnutrition and the risk of SAP in IS. METHODS: Patients were included from emergency departments of five tertiary hospitals in the REtrospective Multicenter study for Ischemic Stroke Evaluation (REMISE) study from January 2020 to December 2020. Malnutrition was defined according to the Controlling Nutritional Status (CONUT), Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI) systems. Multivariable logistic regression analysis was used to explore the association between malnutrition and risk of SAP. RESULTS: We enrolled 915 patients with IS, 193 (14.75%), 495 (54.1%), and 148 (16.2%) of whom were malnourished according to the PNI, CONUT, and GNRI scores, respectively. SAP occurred in 294 (32.1%) patients. After adjusting for confounding influencing factors in the logistic regression analysis, malnutrition (moderate and severe risk vs. absent malnutrition) was independently associated with an increased risk of SAP based on the PNI (odds ratio [OR], 5.038; 95% confidence interval [CI] 2.435-10.421, P < 0.001), CONUT (OR, 6.941; 95% CI 3.034-15.878, P < 0.001), and GNRI (OR, 2.007; 95% CI 1.186-3.119, P = 0.005) scores. Furthermore, adding malnutrition assessment indices to the A2DS2 score significantly improved the ability to predict SAP by analysis of receiver operating characteristic curves and net reclassification improvement. CONCLUSION: Malnutrition was notably prevalent in patients with IS and independently associated with an increased risk of SAP. Further studies are required to identify the effect of interventions on malnutrition to reduce the risk of SAP.

Citation of updated and co-published Cochrane Methodology Reviews.

BACKGROUND: To evaluate the number of citations for Cochrane Methodology Reviews after they have been updated or co-published in another journal, and the effect of co-publishing the review on the co-publishing journal's impact factor (IF). METHODS: We identified all Cochrane Methodology Reviews published in the Cochrane Database of Systematic Reviews (CDSR) before 2018 and searched for co-published versions in the Web of Science Core Collection database up to 16 August 2022. The included reviews were in two cohorts: those that had been published and updated in CDSR and those that had been published in CDSR and co-published in another journal. The primary outcome measured the citation number to updated and original reviews in the first five years after publication of the updated review, and assessed the citation number of co-published and non-co-published reviews in the first five years after publication of the co-published version. The secondary outcome was the ratio of an adjusted IF and the actual IF of the co-publishing journal. RESULTS: Eight updated and six original reviews were identified for the updated cohort of reviews, and four co-published reviews were included in the co-published cohort. The original reviews continued to be cited after the update was published but the median for the total number of citations was non-significantly higher for the updated reviews than for their original version[161 (Interquartile range (IQR) 85, 198) versus 113 (IQR 15, 433)]. The median number of total citations [362 (IQR 179, 840) versus 145 (IQR 75, 445)] and the median number of citations to the review in the first five years after co-publication combined and in each of those years was higher in the co-published group than in the non-co-published group. One of the three journals that co-published Reviews in the first year and two journals in the second year had a lower IF after co-publication. CONCLUSIONS: Earlier versions of Cochrane Methodology Reviews continue to be cited after an update is published, which raises doubts about whether those citing are using the most recent evidence or are aware of the update. Co-publication facilitates broader application and dissemination of Cochrane methodology evidence.

Causal associations between inflammatory bowel disease and primary biliary cholangitis: a two-sample bidirectional Mendelian randomization study.

Inflammatory bowel disease (IBD) has been reported to be associated with hepatobiliary diseases. Previous observational and Mendelian randomization (MR) studies have suggested a causal association between IBD and primary sclerosing cholangitis (PSC). However, it is unclear whether IBD has a causal association with primary biliary cholangitis (PBC): another autoimmune liver disease. We obtained genome-wide association study (GWAS) statistics from published GWASs for PBC, UC, and CD. We screened qualified instrumental variables (IVs) based on the three major assumptions of MR. To determine the causal relationships between UC or CD and PBC, two-sample MR analyses were performed using inverse variance-weighted (IVW), MR-Egger, and weighted median (WM) methods, and sensitivity analyses were conducted to validate the robustness of the results. We also conducted reverse MR analysis to reveal the causal association between PBC and UC or CD. UC was associated with a higher risk of PBC (OR 1.35, 95% CI 1.05-1.73, P = 0.02) in the IVW method, and CD was associated with an increased risk of PBC (OR 1.18, 95% CI 1.03-1.36, P = 0.02) in IVW. The weighted median and MR-Egger regression of both diseases showed a consistent direction but were not statistically significant. Results of the reverse MR analysis did not suggest genetic susceptibility that PBC was associated with an increased risk of UC (OR 1.05, 95% CI 0.95-1.17, P = 0.34) or CD (OR 1.1, 95% CI 0.99-1.20, P = 0.06). The present study revealed that IBD subtypes could increase the incidence of PBC, but in turn, PBC did not increase the incidence of IBD subtypes. Understanding that IBD and PBC constitute mutual risk factors can help with the clinical management of both diseases.

Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia.

Background: Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia. Methods: A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3. Results: ACEs had a significant direct effect on depression (ß = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (ß = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (ß = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (ß = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%. Limitations: This cross-sectional study prevented us from establishing causality. Conclusion: This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study.

Introduction: Atrial fibrillation (AF) is a challenging cardiovascular disease worldwide. Wearable electrocardiograph devices (WEDs) have great potential to improve the detection rate of AF in primary care. However, the factors that influence general practitioners' (GPs) perception and acceptance of WEDs are not well understood. To identify factors that influence the intention of GPs to utilize WEDs in a clinical setting to screen patients for AF. Method: The research hypotheses and questionnaire items were designed and developed based on the unified theory of acceptance and technology (UTAUT) framework. We used stratified sampling and obtained the data through an online survey. Structural equation modeling was used to analyze the collected data.Results: A total of 1,004 valid questionnaires from GPs across Sichuan province in China were collected. Three factors increased GPs' intention to utilize WEDs to screen patients for AF, including performance expectancy (ß = 0.121, p = 0.004), social influence (ß = 0.356, p < 0.001), and price perception (ß = 0.587, p < 0.001). Perception risk (ß = -0.059, p < 0.001) decreased usage intention, while effort expectancy (ß = -0.079, p = 0.155) and facilitating conditions (ß = -0.014, p = 0.868) did not affect usage intention. Gender (ß = -0.022, p = 0.179), age (ß = 0.006, p = 0.699), education level (ß = -0.22, p = 0.184) and training (ß = 0.007, p = 0.69) were not significantly correlated with usage intention, and these four factors had no moderating effect on the path coefficients. Discussion: GPs' intention to utilize WEDs is affected by performance expectancy, price perception, perception risk and social influence. Researcher should improve the usability and perception of WEDs for screening and carry out studies to provide high-quality evidence for the security and efficacy of wearable devices.

Working status and risk of Alzheimer's disease: A Mendelian randomization study.

BACKGROUND: Alzheimer's disease (AD) has become a common illness affecting the elderly, adding to society's social and financial burden. We used two-sample Mendelian randomization (MR) in this study to determine the association between working status and AD. METHODS: We performed a two-sample MR analysis. The genetic associations were derived from the UK Biobank (n = 263,615) and the International Genomics of Alzheimer's Project (n = 63,926). Inverse variance weighted (IVW), MR-Egger, and weighted median were used in the MR analysis. The funnel plot, Cochran's Q test, MR-Egger intercept test, and leave-one-out analysis were used in sensitivity analyses. Further risk factor analyses were carried out to look into the potential mediators. RESULTS: Jobs involve heavy manual or physical work (OR = 2.13, 95%CI 1.36-3.36; p = .0011), job involves mainly walking or standing (OR = 1.74, 95%CI 1.19-2.54; p = .004), and job involves shift work (OR = 2.78, 95%CI 1.14-6.80; p = .02) increased the risk of AD in the IVW analysis. There was no heterogeneity and no horizontal pleiotropy in the sensitivity analysis. Risk factor analysis suggested that each of the above association may be mediated by different risk factors. CONCLUSION: Our study adds to the evidence that the development of AD is associated with the working status (job involves heavy manual or physical work, job involves mainly walking or standing, and job involves shift work) by using extensive human genetic data.

Angiogenesis in Aortic Aneurysm and Dissection: A Literature Review.

Aortic aneurysm and aortic dissection (AA/AD) are critical aortic diseases with a hidden onset and sudden rupture, usually resulting in an inevitable death. Several pro- and anti-angiogenic factors that induce new capillary formation in the existing blood vessels regulate angiogenesis. In addition, aortic disease mainly manifests as the proliferation and migration of endothelial cells of the adventitia vasa vasorum. An increasing number of studies have shown that angiogenesis is a characteristic change that may promote AA/AD occurrence, progression, and rupture. Furthermore, neocapillaries are leaky and highly susceptible to injury by cytotoxic agents, which promote extracellular matrix remodeling, facilitate inflammatory cell infiltration, and release coagulation factors and proteases within the wall. Mechanistically, inflammation, hypoxia, and angiogenic factor signaling play important roles in angiogenesis in AA/AD under the complex interaction of multiple cell types, such as smooth muscle cells, fibroblasts, macrophages, mast cells, and neutrophils. Therefore, based on current evidence, this review aims to discuss the manifestation, pathological role, and underlying mechanisms of angiogenesis involved in AA/AD, providing insights into the prevention and treatment of AA/AD.

Observational studies of traditional Chinese medicine may provide evidence nearly consistent with the randomized controlled trials: A meta-epidemiological study.

Background: In traditional Chinese medicine (TCM) field, the benefits of observational studies was more significant. Whether the evidence from observational studies agreed with RCTs in the field of TCM was still unclear. Methods: A meta-epidemiological study was conducted. Meta-analyses and systematic reviews including cohort studies and case-control studies of TCM were included. Ratio of odds ratio (ROR) of randomized controlled trials and observational studies were calculated individually and intercomparisons were conducted by pool analysis. Results: A total of 11 studies and 30 outcome pairs were included in the pool analysis. Using results from the observational studies as the reference group, the polled ROR comparing randomized controlled trials with observational studies was 1.23 (95% confidence interval 1.05 to 1.44, and 95% prediction interval 0.90 to 1.68). The ROR by subgroup analysis were 1.15 (95% confidence interval 0.96 to 1.38; 95% prediction interval 0.95 to 1.39) and 1.12 (95% confidence interval 0.86 to 1.46; 95% prediction interval 0.51 to 2.47) for cohort studies and case-control studies, respectively. Conclusions: There is difference in pooled results between randomized controlled studies and observational studies on TCM. However, the prediction interval shows the difference is small, which suggests observational studies of TCM can be included in data analysis to provide evidence for TCM. Future studies are needed to verify the above conclusion.

Potential diabetic cardiomyopathy therapies targeting pyroptosis: A mini review.

Pyroptosis is primarily considered a pro-inflammatory class of caspase-1- and gasdermin D (GSDMD)-dependent programmed cell death. Inflammasome activation promotes the maturation and release of interleukin (IL)-1ß and IL-18, cleavage of GSDMD, and development of pyroptosis. Recent studies have reported that NLRP3 inflammasome activation-mediated pyroptosis aggravates the formation and development of diabetes cardiomyopathy (DCM). These studies provide theoretical mechanisms for exploring a novel approach to treat DCM-associated cardiac dysfunction. Accordingly, this review aims to summarize studies that investigated possible DCM therapies targeting pyroptosis and elucidate the molecular mechanisms underlying NLRP3 inflammasome-mediated pyroptosis, and its potential association with the pathogenesis of DCM. This review may serve as a basis for the development of potential pharmacological agents as novel and effective treatments for managing and treating DCM.

Noncirrhotic portal hypertension due to peripheral T-cell lymphoma, not otherwise specified: A case report.

BACKGROUND: Peripheral T-cell lymphoma (PTCL), an aggressive and rare disease that belongs to a heterogeneous group of mature T-cell lymphomas, develops rapidly and has a poor prognosis. Early detection and treatment are essential to improve patient cure and survival rates. Here, we report a rare case of PTCL with clinical presentation of noncirrhotic portal hypertension, which provides a basis for early vigilance of lymphomas in the future. CASE SUMMARY: A 65-year-old Chinese woman was admitted to our hospital because of abdominal distension for 3 months and pitting oedema of both lower limbs for 2 months. Physical examinations and associated auxiliary examinations showed the presence of hepatosplenomegaly, and her hepatic venous pressure gradient was 10 mmHg. Immunohistochemical analysis of the liver biopsy confirmed the diagnosis of PTCL. The patient underwent combination therapy with dexamethasone, VP-16, and chidamide. Unfortunately, after 41 days of chemotherapy, the patient died of multiple organ failure. CONCLUSION: PCTL accompanied by noncirrhotic portal hypertension is rarely reported. This case report discusses the diagnosis of a patient according to the literature.