Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation / 中华医学杂志(英文版)

BACKGROUND@#Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.@*METHODS@#Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed.@*RESULTS@#A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P  <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P  <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001).@*CONCLUSIONS@#In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.

Analysis of the efficacy of glucocorticoid treatment in advanced thymoma / 中华胸心血管外科杂志

Objective:To explore the clinical efficacy and safety of moderate-dose glucocorticoid treatment in patients with advanced thymoma.Methods:A retrospective analysis was conducted on clinical data of 56 patients with thymoma who received glucocorticoid treatment at Beijing Tongren Hospital, Capital Medical University, from January 2018 to March 2023. Among them, there were 33 males and 23 females; aged from 28 to 72 years old, with a median age of(43.8±11.2)years old. There were 16 cases of type B1 thymoma, 23 cases of type B2, and 17 cases of type B3. There were 17 cases with myasthenia gravis and 1 case with pure red blood cell aplasia. All patients had received radiotherapy or chemotherapy. Patients received moderate-dose glucocorticoid treatment(50 mg/day), and tumor response was evaluated by CT scan after 2 weeks of treatment. The tumor treatment effect and adverse reactions were recorded.Results:Among the patients, 22 cases achieved partial remission, and 3 cases achieved complete remission, resulting in an overall objective response rate (ORR) of 44.6%. Among them, 23 patients had type B2 thymoma, with 17 achieving partial remission and 3 achieving complete remission, resulting in an ORR of 87.0%. Among the 16 patients with type B1 thymoma, 5 achieved partial remission. No efficacy was observed in 17 patients with type B3 thymoma. The follow-up period ranged from 2 to 26 months, and 2 patients experienced thymoma recurrence.Conclusion:Moderate-dose glucocorticoid treatment demonstrates effective and safe outcomes in advanced or invasive thymoma, particularly for the treatment of type B2 thymoma.

Cases analysis and etiology discussion of thymoma with alopecia areata / 中华胸心血管外科杂志

Objective:Analyzed the clinicopathological features of thymoma with alopecia areata, and discussed the pathogenesis and treatment methods.Methods:The clinicopathologic data of patients with thymoma who underwent surgery from August 1, 2015 to July 31, 2020 in Beijing Tongren Hospital, Capital Medical University were reviewed. Transversally analyzed the patients of thymoma with alopecia areata and longitudinally compared with the patients of thymoma without alopecia areata after 1﹕10 matched by propensity score matching.Results:A total of 252 patients of thymoma were enrolled, including 6 patients with alopecia areata, accounting for 2.38%. The anti-AchR antibody, CD4 + /CD8 + T inversion in serum and myasthenia gravis were present in the all 6 thymoma patients with alopecia areata, which were significantly higher than those in the group of thymoma without alopecia areata. Besides myasthenia gravis, the proportion of complicated with other autoimmune diseases in thymoma patients with alopecia areata was significantly higher than that of thymoma patients without alopecia areata[83.33%(5/6) vs. 20.00%(12/60), P=0.003]. After operation, 5 patients’ alopecia areata were improved in 6 thymoma patients with alopecia areata(83.33%, 5/6). Conclusion:The thymoma patients with alopecia areata always complicated with myasthenia gravis and other autoimmune diseases. The pathogenesis may be associated with autoimmune CD8 + T lymphocytes produced by thymoma. At present, surgery is still the most effective way to improve thymoma-associated alopecia areata.

Study on mechanism of berberine inhibiting tumor stem cells proliferation and its in vivo safety evaluation / 中国药房

OBJECTIVE To investigate the in vitro inhibitory mechanism of berberine on the proliferation of tumor stem cells and evaluate its in vivo safety. METHODS Flow cytometry was used to select tumor stem cells from mouse skin melanoma B16F10 cells； CD44， CD133， Nanog homologous box protein （NANOG） and octamer-binding transcription factor 4 （OCT4） were used as indicators to characterize tumor stem cells. Tumor stem cells were divided into control group， all-trans retinoic acid （ATRA） group， and berberine group， and the CCK-8 method was used to detect the effects of berberine on the viability of tumor stem cells； flow cytometry was adopted to detect cell apoptotic rate， the proportion of CD44+/CD133+ and the positive cell rate of sex determining region Y box protein 2 （SOX2）； the morphological changes of tumor balls were recorded after treatment with berberine； the morphology of cell pyroptosis in each group was recorded， and the release rate of lactate dehydrogenase （LDH） was detected； Western blot assay was adopted to detect the expressions of pyroptosis-related protein gasdermin E （GSDME）， GSDME- N， caspase-3 and cleaved caspase-3. Preliminary evaluation of in vivo safety of berberine was conducted by using zebrafish embryo toxicity experiments. RESULTS Compared with B16F10 cells， the proportion of CD44+/CD133+ cells in tumor stem cells and the fluorescence intensity of NANOG and OCT4 were significantly increased （P＜0.000 1）. The half-inhibitory concentration of berberine to tumor stem cells was 50.98 μmol/L. Compared with the control group， the apoptotic rate of cells in the berberine group was significantly increased， while the proportion of CD44+/CD133+ cells and the rate of SOX2 positive cells were reduced significantly （P＜0.000 1）； tumor stem cell spheroids were atrophied， with partial cell death. After treatment with berberine， tumor stem cells exhibited swelling in their outermost layer， the release rate of LDH of cells was significantly increased and the release rate of LDH increased with increasing dose； the protein expressions of GSDME-N and cleaved-caspase-3 of cells in berberine 20， 40 μmol/L groups were significantly increased， and the protein expressions of GSDME and caspase-3 were significantly reduced （except for berberine 20 μmol/L group， P＜0.05）. The embryonic development of zebrafish treated with berberine was almost unaffected， and the survival rate of embryo reached 100%， with no obvious abnormalities observed. CONCLUSIONS Berberine has good activity against the proliferation of tumor stem cells， and its mechanism of action may be related to activating GSDME and promoting cell pyroptosis； berberine has good in vivo safety.

Discussion on the theoretical thinking of fire-needling treatment of patients with stroke flaccid paralysis based on Tongjing Roujin therapy / 国际中医中药杂志

Stroke flaccid paralysis is stroke patients with abnormal physical movement function and muscle tone decline as the main performance and is a kind of common pathological state after apoplectic stroke. The longer the flaccid paralysis is, the worse the prognosis. The theory of TCM holds that stroke is mainly due to "deficiency, wind, fire, phlegm, stasis, qi", and when the pathogenic factor accumulate and block the meridians, which would cause blood stagnation, muscle and tendon damage and flaccidity, resulting in stroke paralysis. Therefore, it is necessary to set up the "Tongjing Roujin" (stimulating the muscle and nourishing the tendon) as its main treatment. Fire-needling has the effect of stimulating muscle, warming yang, nourishing tendon, and relieving pain in the treatment of stroke flaccid paralysis. It can warm yang and dissipate cold, replenish and nourish meridian qi, release muscle nodules, promote the circulation of qi and blood, and nourish all limbs and bones. Fire-needling therapy can promote the recovery of neural pathway, strengthen local metabolism, improve local muscle tension, and thus restore limb function. The high-quality clinical research, acupoint selection rules, and standardized operating techniques of fire-needling treatment for stroke flaccid paralysis need to be further deepened.

Analysis of clinical maintenance effect of 76 organ donors / 中国现代医生

@#Objective By analyzing the means of donor maintenance from the perspective of intensive care medicine,the difference of clinical indicators before and after donor treatment is obtained,summarizing the treatment experience and effect of clinical maintenance of donor donors,and providing more clinical evidence for the maintenance and treatment of organ donation donors.Methods A retrospective analysis was performed on 76 organ donors collected from the Department of Intensive Care Medicine,Army Medical Center,Chinese People's Liberation Army from January 2014 to December 2021,collected donor maintenance treatment,including mechanical ventilation,continuous renal replacement therapy(CRRT)treatment,enteral nutrition and parenteral nutrition,enteral and parenteral nutrition,plasma exchange,at the same time,the paired t test was used to compare the organ function before and after treatment.Results The lung,liver and kidney of 76 donors were evaluated before and after treatment to determine the number of eligible donors.The difference between the number of eligible donors of kidney and liver before and after treatment was statistically significant(P<0.05).There was no significant difference in lung evaluation(P>0.05).Conclusion Timely and effective organ support therapy for organ transplantation donors is beneficial to the recovery of organ function and improve the utilization rate of organ.

Development and application of regulatory T cells in corneal transplant rejection / 国际眼科杂志(Guoji Yanke Zazhi)

Corneal transplantation is an effective treatment for corneal blindness, and it is the only hope for patients with corneal blindness. Cornea has no blood vessels and no lymphatic vessels, which is called immune privilege organ, so the success rate of corneal transplantation is significantly higher than that of other organ transplantation, but the rejection reaction after corneal transplantation is still the main reason for the failure of corneal transplantation. The directional movement of immune cells to lymphoid tissue and inflammatory sites is the mainly immune response after organ transplantation. And the regulatory T cells(Treg)play a key role in immune regulation, which can induce immune tolerance by regulating and inhibiting the activation of effector T cells and reduce the rejection reaction after corneal transplantation. In addition, this review also discussed the effectiveness of applying cordyceps sinensis extract FTY720 to enhance the function of Treg. Based on this, we briefly reviewed the sources, mechanism of action and treatment of Treg after corneal transplantation, so as to provide some reference for the subsequent clinical application transformation and basic research.

The timing of pericardial drainage catheter removal and restart of the anticoagulation in patients suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran: Experiences from 20 cases / 中华心血管病杂志

Objective: To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation (AF) suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran. Methods: A total of 20 patients with pericardial tamponade, who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021, were included in this retrospective analysis. The clinical characteristics of enrolled patients, information of catheter ablation procedures, pericardial tamponade management, perioperative complications, the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed. Results: All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients. The average drainage volume was (427.8±527.4) ml. Seven cases were treated with idarucizumab, of which 1 patient received surgical repair. The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was (1.4±0.7) and (0.8±0.4) days, respectively. No new bleeding, embolism and death were reported during hospitalization and within 30 days following hospital discharge. Time of removal of pericardial drainage catheter, restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not. Conclusion: It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.

Observation on clinical effect of fire needling for mild to moderate benign prostatic hyperplasia with kidney yang deficiency / 中国针灸

OBJECTIVE@#To observe the effect of fire needling on prostate symptoms, quality of life, average daily number of nightly urination, urine flow rate and prostat volume in patients with mild to moderate benign prostatic hyperplasia (BPH) of kidney yang deficiency.@*METHODS@#A total of 60 patients with mild to moderate BPH of kidney yang deficiency were randomly divided into an observation group (30 cases, 3 cases dropped off) and a control group (30 cases, 4 cases dropped off). The observation group was treated with fire needling at Guanyuan (CV 4), Shuidao (ST 28) and Qugu (CV 2) twice a week (2-3 d interval between each treatment), continuous treatment for 4 weeks. The control group received lifestyle advice and education, once a week for 4 weeks. In the two groups, the international prostate symptom score (IPSS), the quality of life (QoL) score and the average daily number of nightly urination were observed before treatment, after treatment and during the follow-up of the 4th week; the urinary maximum flow rate (Qmax), the average flow rate (Qave), and the prostate volume were assessed before and after treatment in the two groups. The safety was observed in the observation group.@*RESULTS@#After treatment and during follow-up, the IPSS scores, QoL scores, and the average daily number of nightly urination in the observation group were decreased compared with those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax, Qave and prostate volume between the two groups and within the each group (P>0.05). There were no fire needling-related adverse reactions, and no obvious abnormality was found in urine routine and coagulation function tests before and after treatment in the observation group.@*CONCLUSION@#Fire needling can improve lower urinary tract symptoms and quality of life, reduce frequency of nightly urination in patients with mild to moderate BPH of kidney yang deficiency, and has good safety.

Application of single-arm objective performance criteria/performance goal in acupuncture-moxibustion clinical trials / 中国针灸

Due to various constraints, such as clinical implementation conditions and unique characteristics of acupuncture-moxibustion, some randomized controlled trials (RCTs) of acupuncture-moxibustion still suffer from relatively low quality and limited applicability. The single-arm objective performance criteria/performance goal can be considered as an ideal supplementary and alternative research approach to RCTs. In this paper, the feasibility of applying the single-arm objective performance criteria/performance goal in acupuncture-moxibustion clinical research is explored from the limitations of conducting acupuncture-moxibustion RCTs, the principles, the essential design considerations and key statistical steps. In addition, illustrative examples are provided. The objective is to offer insights into resolving practical difficulties in acupuncture-moxibustion clinical research.

ABC-AF-Stroke score predicts thromboembolism in non-anticoagulated patients following successful atrial fibrillation ablation: a report from the Chinese Atrial Fibrillation Registry / 中华医学杂志(英文版)

BACKGROUND@#The age, biomarkers, and clinical history (ABC)-atrial fibrillation (AF)-Stroke score have been proposed to refine stroke risk stratification, beyond what clinical risk scores such as the CHA2DS2-VASc score can offer. This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.@*METHODS@#A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry (CAFR) between 2013 and 2019 were included. Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk. The ABC-AF-Stroke score was evaluated in terms of discrimination, including concordance index (C-index), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), clinical utilization by decision curve analysis (DCA), and calibration by comparing the predicted risk with the observed annualized event rate.@*RESULTS@#After a median follow-up of 3.5 years, 64 patients experienced thromboembolism events. Age, prior history of stroke/transient ischemic attack (TIA), high-sensitivity cardiac troponin T (cTnT-hs), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were independently associated with thromboembolism risk. The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index (0.67, 95% confidence interval [CI]: 0.59-0.74 vs. 0.60, 95% CI: 0.52-0.67, P = 0.030) and reclassification capacity. The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score. The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.@*CONCLUSIONS@#In this real-world study enrolling non-anticoagulated AF patients following successful ablations, age, prior history of stroke/TIA, level of NT-proBNP, and cTnT-hs were independently associated with an increased risk of thromboembolism. The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.

Current use of oral anticoagulation therapy and influencing factors among coronary artery disease patients with nonvalvular atrial fibrillation in China / 中华心血管病杂志

Objective: To investigate current use of oral anticoagulant (OAC) therapy and influencing factors among coronary artery disease (CAD) patients with nonvalvular atrial fibrillation (NVAF) in China. Methods: Results of this study derived from "China Atrial Fibrillation Registry Study", the study prospectively enrolled atrial fibrillation (AF) patients from 31 hospitals, and patients with valvular AF or treated with catheter ablation were excluded. Baseline data such as age, sex and type of atrial fibrillation were collected, and drug history, history of concomitant diseases, laboratory results and echocardiography results were recorded. CHA2DS2-VASc score and HAS-BLED score were calculated. The patients were followed up at the 3rd and 6th months after enrollment and every 6 months thereafter. Patients were divided according to whether they had coronary artery disease and whether they took OAC. Results: 11 067 NVAF patients fulfilling guideline criteria for OAC treatment were included in this study, including 1 837 patients with CAD. 95.4% of NVAF patients with CAD had CHA2DS2-VASc score≥2, and 59.7% of patients had HAS-BLED≥3, which was significantly higher than NVAF patients without CAD (P<0.001). Only 34.6% of NVAF patients with CAD were treated with OAC at enrollment. The proportion of HAS-BLED≥3 in the OAC group was significantly lower than in the no-OAC group (36.7% vs. 71.8%, P<0.001). After adjustment with multivariable logistic regression analysis, thromboembolism(OR=2.48,95%CI 1.50-4.10,P<0.001), left atrial diameter≥40 mm(OR=1.89,95%CI 1.23-2.91,P=0.004), stain use (OR=1.83,95%CI 1.01-3.03, P=0.020) and β blocker use (OR=1.74,95%CI 1.13-2.68,P=0.012)were influence factors of OAC treatment. However, the influence factors of no-OAC use were female(OR=0.54,95%CI 0.34-0.86,P=0.001), HAS-BLED≥3 (OR=0.33,95%CI 0.19-0.57,P<0.001), and antiplatelet drug(OR=0.04,95%CI 0.03-0.07,P<0.001). Conclusion: The rate of OAC treatment in NVAF patients with CAD is still low and needs to be further improved. The training and assessment of medical personnel should be strengthened to improve the utilization rate of OAC in these patients.

Analysis of dyslipidemia management status in atrial fibrillation patients with very high and high risk of atherosclerotic cardiovascular disease / 中华心血管病杂志

Objective: To analyze the status of statins use and low-density lipoprotein cholesterol (LDL-C) management in patients with atrial fibrillation (AF) and very high/high risk of atherosclerotic cardiovascular disease (ASCVD) from Chinese Atrial Fibrillation Registry (CAFR). Methods: A total of 9 119 patients with AF were recruited in CAFR between January 1, 2015 to December 31, 2018, patients at very high and high risk of ASCVD were included in this study. Demographics, medical history, cardiovascular risk factors, and laboratory test results were collected. In patients with very high-risk, a threshold of 1.8 mmol/L was used as LDL-C management target and in patients with high risk, a threshold of 2.6 mmol/L was used as LDL-C management target. Statins use and LDL-C compliance rate were analyzed, multiple regression analysis was performed to explore the influencing factors of statins use. Results: 3 833 patients were selected (1 912 (21.0%) in very high risk of ASCVD group and 1 921 (21.1%) in high risk of ASCVD group). The proportion of patients with very high and high risk of ASCVD taking statins was 60.2% (1 151/1 912) and 38.6% (741/1 921), respectively. Attainment rate of LDL-C management target in patients with very high and high risk were 26.7% (511/1 912) and 36.4% (700/1 921), respectively. Conclusion: The proportion of statins use and attainment rate of LDL-C management target are low in AF patients with very high and high risk of ASCVD in this cohort. The comprehensive management in AF patients should be further strengthened, especially the primary prevention of cardiovascular disease in AF patients with very high and high risk of ASCVD.

Efficacy of Venetoclax Plus Azacitidine in Relapsed/Refractory Acute Myeloid Leukemia Patients with FLT3-ITD Mutation / 中国实验血液学杂志

OBJECTIVE@#To explore the efficacy of venetoclax (VEN) plus azacitidine (AZA) in patients with FLT3-ITD mutated relapsed/refractory acute myeloid leukemia (FLT3-ITDmut R/R AML) and analyze the molecular genetic characteristics of the patients.@*METHODS@#Clinical baseline characteristics and follow-up data of 16 R/R AML patients treatd with VEN plus AZA in the hematology department of Shenzhen Second People's Hospital from November 2018 to April 2021 were collected. Leukemia related genes were detected by next-generation sequencing(NGS) or PCR. The relationship between the efficacy of VEN plus AZA and molecular genetics characteristics of patients with FLT3-ITDmut R/R AML were analyzed.@*RESULTS@#14.3% (1/7) of the patients in FLT3-ITDmut group and 22.2% (2/9) of the patients in FLT3-ITDwt group achieved complete remission (CR)/CR with incomplete blood count recovery (CRi), respectively, with no significant difference (P=0.69). There was no significant difference in overall response rate (ORR) (CR/CRi+PR) between FLT3-ITDmut group and FLT3-ITDwt group [42.9%(3/7) vs 44.4%(4/9), P=0.95], too. The median overall survival (OS) time of FLT3-ITDmut patients was significantly shorter than that of FLT3-ITDwt patients (130 vs 300 days, respectively) (P =0.02). Co-existing mutations of FLT3-ITD and IDH1 were detected in one patient who achieved CR. Co-existing mutations of FLT3-ITD and SF3B1 were found in one patient who achieved PR. Three FLT3-ITDmut R/R AML patients accompanied with NPM1 mutation had no response to VEN plus AZA.@*CONCLUSION@#VEN plus AZA showed a certain effect on patients with FLT3-ITDmut R/R AML. To improve OS of the patients, bridging transplantation is need. IDH1 and SF3B1 mutations might predict that patients with FLT3-ITDmut R/R AML have treatment response to VEN plus AZA, while the combination of NPM1 mutation may indicate poor response.

Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history: a prospective propensity score-matched cohort study / 老年心脏病学杂志（英文版）

BACKGROUND@#Patients with atrial fibrillation (AF) and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy. It is unclear whether catheter ablation (CA) has further benefits in these patients.@*METHODS@#AF patients with a previous history of stroke or systemic embolism (SE) from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis. Patients were matched in a 1:1 ratio to CA or medical treatment (MT) based on propensity score. The primary outcome was a composite of all-cause death or ischemic stroke (IS)/SE.@*RESULTS@#During a total of 4.1 ± 2.3 years of follow-up, the primary outcome occurred in 111 patients in the CA group (3.3 per 100 person-years) and in 229 patients in the MT group (5.7 per 100 person-years). The CA group had a lower risk of the primary outcome compared to the MT group [hazard ratio (HR) = 0.59, 95% CI: 0.47-0.74, P < 0.001]. There was a significant decreasing risk of all-cause mortality (HR = 0.43, 95% CI: 0.31-0.61, P < 0.001), IS/SE (HR = 0.73, 95% CI: 0.54-0.97, P = 0.033), cardiovascular mortality (HR = 0.32, 95% CI: 0.19-0.54, P < 0.001) and AF recurrence (HR = 0.33, 95% CI: 0.30-0.37, P < 0.001) in the CA group compared to that in the MT group. Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.@*CONCLUSIONS@#In AF patients with a prior stroke history, CA was associated with a lower combined risk of all-cause death or IS/SE. Further clinical trials are warranted to confirm the benefits of CA in these patients.

Effects of Jin's three needles combined with neuromuscular electrical stimulation on electromyography, muscle strength, and lower limb motor function in patients with hemiplegia after stroke / 中国基层医药

Objective:To investigate the effects of Jin's three needles combined with neuromuscular electrical stimulation on electromyography (EMG), muscle strength, and lower limb motor function in patients with hemiplegia after stroke.Methods:A total of 102 patients with hemiplegia after ischemic stroke who received treatment in Dongyang People's Hospital from July 2021 to August 2022 were included in this randomized controlled study. They were divided into a treatment group and a control group ( n = 51 per group) using a random number table method. The treatment group was given Jin's three needles combined with neuromuscular electrical stimulation, and the control group was given neuromuscular electrical stimulation alone. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological impairment. The modified Barthel Index (MBI) score was used to assess a patient's self-care ability. EMG was performed to record myoelectric signals. The Fugl-Meyer Assessment Scale was used to evaluate a patient's lower limb motor function. Manual Muscle Testing was performed to measure a patient's muscle strength. The degree of nerve defect, self-care ability, lower limb motor function, hip flexion muscle strength, knee extensor muscle strength, and ankle dorsalis extensor muscle strength were compared before treatment and after 2 weeks of treatment. Results:After treatment, the NIHSS score in the treatment and control groups significantly decreased compared with those before treatment [(10.14 ± 3.45) points vs. (3.80 ± 1.92) points, (10.10 ± 3.17) points vs. (6.18 ± 2.15) points, t = 17.31, 19.08, both P < 0.05]. After treatment, the NIHSS score in the treatment group was lower than that in the control group ( t = -5.87, P < 0.001). After treatment, the integral EMG values of the tibialis anterior muscle, gastrocnemius muscle, and quadriceps femoris in the treatment and control groups were increased compared with those before treatment [(20.43 ± 5.26) points vs. (48.14 ± 10.41) points, (16.20 ± 2.62) points vs. (24.69 ± 4.07) points, (32.62 ± 3.42) points vs. (43.40 ± 4.69) points; (20.40 ± 5.19) points vs. (35.45 ± 7.41) points, (16.32 ± 2.51) points vs. (20.91 ± 3.45) points, (32.59 ± 3.37) points vs. (37.39 ± 4.06) points, t = -23.79, -16.11, -19.89; -21.92, -10.86, -8.71, all P < 0.05]. After treatment, the integral EMG values of the tibialis anterior muscle, gastrocnemius muscle, and quadriceps femoris in the treatment group were significantly higher than those in the control group ( t = 7.09, 5.05, 6.92, all P < 0.001). After treatment, The Fugl-Meyer Assessment scale score in the treatment and control groups were significantly increased compared with that before treatment [(17.61 ± 8.93) points vs. (27.16 ± 5.84) points, (17.53 ± 7.59) points vs. (22.22 ± 6.66) points, t = -14.64, -10.72, both P < 0.05). After treatment, The Fugl-Meyer Assessment scale score in the treatment group was significantly higher than that in the control group ( t = 3.98, P < 0.001). After treatment, hip flexion muscle strength, knee extensor muscle strength, and ankle dorsalis extensor muscle strength in the treatment and control groups increased compared with those before treatment. After treatment, hip flexion muscle strength, knee extensor muscle strength, and ankle dorsalis extensor muscle strength in the treatment group were significantly higher than those in the control group [(3.75 ± 0.63) grades vs. (3.31 ± 0.65) grades, (3.51 ± 0.67) grades vs. (3.08 ± 0.87) grades, (2.98 ± 0.81) grades vs.(2.35 ± 1.06) grades, t = 3.41, 2.80, and 3.36, all P < 0.05]. Conclusion:Jin's three needles combined with neuromuscular electrical stimulation can improve EMG findings, increase muscle strength, and lower limb motor function in patients with hemiplegia after stroke

Levels and significance of γδ T cells and their subpopulations in the bone marrow of MDS patients / 实用医学杂志

Objective To investigate the levels of γδ T cells and their subpopulations in bone marrow(BM)of patients with myelodysplastic syndrome(MDS),it aims to explore the immune deficiency status of BM microenvi-ronment in MDS patients.Methods BM samples were collected from MDS patients before and after treatment,as well as from normal donors.Multicolor flow cytometry was utilized to detect bone marrow γδ T cells and subpopulation levels.The changes of the T cell subsets after treatment were also analyzed.Results The levels of BM γδ T cells and follicular helper γδ T cells from MDS patients were significantly lower than those of normal donors(P<0.05).Among γδ T cells at different stages of differentiation,only the frequencies of na?ve γδ T cells from MDS patients decreased significantly(P = 0.037),and there was no significant difference observed about central memory,effector memory,and terminally differentiated γδ T cells in MDS patients compared to normal donors(P>0.05).Although there was a slight decrease in PD1+γδ T cells and an increase in TIM3+γδ T cells,these differences were not statistically significant(P>0.05).In patients who achieved a curative effect,the proportions of γδ T cells and naive γδ T cells increased significantly after treatment,and the effector memory γδ T cells decreased significantly after treatment(P<0.05).After treatment,85.71%(6/7)of MDS patients showed a decrease in γδ+TIM3+ T cell levels to varying degrees.Conclusions The levels of γδ T cells and their subpopulations in the BM microenvironment of patients with MDS exhibit varying degrees of abnormalities.However,in patients who receive effective treatment,these abnormal γδ T cells can recover.By detecting the levels of γδ T cells and subpopulations,we can gain insights into the immune deficiency status of MDS.This information might serve as an indicator to assess treatment efficacy and provide valuable insights for anti-tumor immunotherapy.

Effects of life satisfaction and shift work and their interaction on cumulative fatigue in petrochemical employees / 环境与职业医学

Background Cumulative fatigue without intervention will seriously threaten the physical and mental health of workers. Shift work and life satisfaction are strongly associated with fatigue accumulation. Objective To explore the effects of life satisfaction, shift work, and their interaction on cumulative fatigue in petrochemical employees, and to provide a scientific basis for preventing cumulative fatigue. Methods All staff of a petrochemical enterprise were selected by cluster sampling for a cross-sectional study from July to October 2021 in Jiangsu Province. A questionnaire designed by the project team was used to collect information on shift work; and life satisfaction and cumulative fatigue were investigated by the World Health Organization Five-item Well-Being Index and the Self-diagnosis Checklist for Assessment of Worker’s Fatigue Accumulation respectively. A logistic regression model was used to analyze the influences of life satisfaction and shift work on cumulative fatigue. Multiplicative and additive models were applied to analyze the interaction effect of life satisfaction and shift work. Results A total of 4066 questionnaires were returned, of which 3763 were valid, with an effective recovery rate of 92.5%. The percentage of cumulative fatigue in the petrochemical employees was 63.2% (2377/3763), and the percentages of low life satisfaction and shift work in the petrochemical employees were 53.6% (2016/3763) and 54.2% (2041/3763), respectively. The results of univariate analysis showed no significant difference in cumulative fatigue among different marital status groups (P=0.176), and there were statistically significant differences in cumulative fatigue among the petrochemical employees in different groups of age, gender, educational level, average monthly income, job title, length of service, working hours, night shift, smoking, drinking, physical exercise, life satisfaction, and shift work (P<0.001). After adjustment for covariates such as age, gender, educational level, average monthly income, job title, length of service, working hours, night shift, smoking, drinking, and physical activity, the unconditional logistic regression model showed that the risk of reporting cumulative fatigue in high life satisfaction participants was 0.129 (95%CI: 0.109, 0.154) times of that in participants of low life satisfaction; the risk of reporting cumulative fatigue in shift work participants was 3.792 (95%CI: 2.713, 5.300) times of that in no shift work participants; and the risk of reporting cumulative fatigue in participants with both high life satisfaction and shift work was 0.105 (95%CI: 0.081, 0.135) times of that in participants with low life satisfaction and shift work. The relative excess risk due to interaction, the attributable proportion due to interaction, and the synergy index of coexisting life satisfaction and shift work were −5.504 (95%CI: −7.247, −3.760), −4.728 (95%CI: −7.575, −1.880), and 0.029 (95%CI: 0.002, 0.351) respectively, which suggested that life satisfaction and shift work have an additive interaction effect on cumulative fatigue. A significant multiplicative interaction was also found between life satisfaction and shift work (OR=0.688, 95%CI: 0.476, 0.936). Conclusion Life satisfaction and shift work are the influencing factors of cumulative fatigue among petrochemical employees, and they interact with each other on the risk of cumulative fatigue. High life satisfaction can reduce the risk of accumulated fatigue associated with shift work.

Progress of venetoclax in treatment of hematologic malignancies / 白血病·淋巴瘤

The anti-apoptotic protein bcl-2, a key regulator of the intrinsic apoptotic pathway, is frequently overexpressed in cells of hematologic malignancies, and the small molecule inhibitor venetoclax that targets this apoptotic pathway has shown promising efficacy in the treatment of chronic lymphocytic leukemia and small lymphocytic lymphoma. The survival and prognosis of patients with acute myeloid leukemia who are of advanced age or who are unsuitable for strong induction chemotherapy because of comorbidities also have significantly improved, but some patients develop progressive drug resistance during the course of venetoclax treatment, which affects the efficacy of medical therapy. This article reviews the action mechanism, therapeutic progress and resistance mechanism of venetoclax in hematologic malignancies.