BACKGROUND During the perioperative period, the characteristic therapy of traditional Chinese medicine is effective in improving postoperative rehabilitation. In large-scale hospitals practicing traditional Chinese me...BACKGROUND During the perioperative period, the characteristic therapy of traditional Chinese medicine is effective in improving postoperative rehabilitation. In large-scale hospitals practicing traditional Chinese medicine, there is accumulating experience related to the promotion of fast recovery in the perioperative period.AIM To evaluate the efficacy and safety of Yikou-Sizi powder hot compress on Shenque acupuncture point combined with rapid rehabilitation technique.METHODS This prospective, multicenter, randomized, controlled study included two groups: Treatment group and control group. The patients in the treatment group and control group received Yikou-Sizi powder hot compress on Shenque acupuncture point combined with rapid rehabilitation technique and routine treatment, respectively. Clinical observation regarding postoperative recovery of gastrointestinal function was performed, including the times to first passage of flatus, first defecation, and first normal bowel sounds. The comparison between groups was conducted through descriptive analysis, χ~2, t, F, and rank-sum tests.RESULTS There was a statistically significant difference in the time to postoperative first defecation between the treatment and control group(87.16 ± 32.09 vs 109.79 ±40.25 h, respectively;P < 0.05). Similarly, the time to initial recovery of bowel sounds in the treatment group was significantly shorter than that in the control group(61.17 ± 26.75 vs 79.19 ± 33.35 h, respectively;P < 0.05). However, there was no statistically significant difference in the time to initial exhaust between the treatment and control groups(51.54 ± 23.66 vs 62.24 ± 25.95 h, respectively;P >0.05). The hospitalization expenses for the two groups of patients were 62283.45 ±12413.90 and 62059.42 ± 11350.51 yuan, respectively. Although the cost of hospitalization was decreased in the control group, the difference was not statistically significant(P > 0.05). This clinical trial was safe without reports of any adverse reaction or event.CONCLUSION The rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes the recovery of postoperative gastrointestinal function and is significantly better than standard approach for patients after colorectal surgery.展开更多
Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly...Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.展开更多
Background:Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation(AF).Even though only 6%to 8%of AF patients die from stroke,about 90%are indicated for...Background:Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation(AF).Even though only 6%to 8%of AF patients die from stroke,about 90%are indicated for anticoagulants according to the current AF management guidelines.Therefore,we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events(TEs)in Chinese AF patients.Methods:From the prospective China Atrial Fibrillation Registry cohort study,we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline.We selected the most important variables by the extreme gradient boosting(XGBoost)algorithm and developed a simplified risk model for predicting 1-year TEs.The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score(excluding female sex from the CHA2DS2-VASc score).Results:Up to the follow-up of 1 year,163 TEs(ischemic stroke or systemic embolism)occurred.Using the XGBoost algorithm,we selected the three most important variables(congestive heart failure or left ventricular dysfunction,age,and prior stroke,abbreviated as CAS model)to predict 1-year TE risk.We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients.The CAS scheme classified 30.8%(2033/6601)of the patients as low risk for TE(CAS score=0),with a corresponding 1-year TE risk of 0.81%(95%confidence interval[CI]:0.41%–1.19%).In our cohort,the C-statistic of CAS model was 0.69(95%CI:0.65–0.73),higher than that of CHA2DS2-VA score(0.66,95%CI:0.62–0.70,Z=2.01,P=0.045).The overall net reclassification improvement from CHA2DS2-VA categories(low=0/high≥1)to CAS categories(low=0/high≥1)was 12.2%(95%CI:8.7%–15.7%).Conclusion:In Chinese AF patients,a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs,which could potentially improve anticoagulation decision-making.Trial Registration:www.chictr.org.cn(Unique identifier No.ChiCTR-OCH-13003729).展开更多
Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an ass...Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.展开更多
To the Editor:As acute coronary syndromes(ACS)is common causes of morbidity and mortality in China,they serve as an important case example to assess the impact of these health reforms on the quality,safety,and efficie...To the Editor:As acute coronary syndromes(ACS)is common causes of morbidity and mortality in China,they serve as an important case example to assess the impact of these health reforms on the quality,safety,and efficiency of healthcare.[1]ACS comprises a wide spectrum of disease subgroups,including ST-segment elevation myocardial infarction(STEMI),unstable angina(UA),and non-ST-segment elevation myocardial infarction(NSTEMI).Previous studies have shown increases in the intensity of testing and treatment while stable in-hospital mortality for STEMI in China between 2001 and 2011.[2]As non-ST-segment elevation acute coronary syndrome(NSTE-ACS)patients,who account for about two-thirds of ACS patients,have a wide spectrum of disease severity,risk-stratified management is recommended to ensure appropriate allocation of resources,especially in limited-resource settings of China.As limited data exist on the use of medical services and clinical outcomes in relation to health reforms,we aimed to determine temporal trends in diagnosis,treatment,and outcome for hospitalized NSTE-ACS patients in three regions of China between 2008 and 2015.展开更多
基金Supported by Guangdong Provincial Department of Science and Technology,No.2014A020212278。
文摘BACKGROUND During the perioperative period, the characteristic therapy of traditional Chinese medicine is effective in improving postoperative rehabilitation. In large-scale hospitals practicing traditional Chinese medicine, there is accumulating experience related to the promotion of fast recovery in the perioperative period.AIM To evaluate the efficacy and safety of Yikou-Sizi powder hot compress on Shenque acupuncture point combined with rapid rehabilitation technique.METHODS This prospective, multicenter, randomized, controlled study included two groups: Treatment group and control group. The patients in the treatment group and control group received Yikou-Sizi powder hot compress on Shenque acupuncture point combined with rapid rehabilitation technique and routine treatment, respectively. Clinical observation regarding postoperative recovery of gastrointestinal function was performed, including the times to first passage of flatus, first defecation, and first normal bowel sounds. The comparison between groups was conducted through descriptive analysis, χ~2, t, F, and rank-sum tests.RESULTS There was a statistically significant difference in the time to postoperative first defecation between the treatment and control group(87.16 ± 32.09 vs 109.79 ±40.25 h, respectively;P < 0.05). Similarly, the time to initial recovery of bowel sounds in the treatment group was significantly shorter than that in the control group(61.17 ± 26.75 vs 79.19 ± 33.35 h, respectively;P < 0.05). However, there was no statistically significant difference in the time to initial exhaust between the treatment and control groups(51.54 ± 23.66 vs 62.24 ± 25.95 h, respectively;P >0.05). The hospitalization expenses for the two groups of patients were 62283.45 ±12413.90 and 62059.42 ± 11350.51 yuan, respectively. Although the cost of hospitalization was decreased in the control group, the difference was not statistically significant(P > 0.05). This clinical trial was safe without reports of any adverse reaction or event.CONCLUSION The rapid rehabilitation technique with integrated traditional Chinese and Western medicine promotes the recovery of postoperative gastrointestinal function and is significantly better than standard approach for patients after colorectal surgery.
基金the National Key Research and Development Program of China(2017YFC0908803&2018YFC1312501&2016YFC0900901&2016YFC1301002&2020YFC2004803).
文摘Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.
基金supported by the National Key Research and Development Program of China(Nos.2017YFC0908803,2018YFC1312501,and 2020YFC2004803)a grant from the Beijing Municipal Commission of Science and Technology(No.D171100006817001)supported by grants from Bristol-Myers Squibb,Pfizer,Johnson&Johnson,Boehringer-Ingelheim,and Bayer.
文摘Background:Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation(AF).Even though only 6%to 8%of AF patients die from stroke,about 90%are indicated for anticoagulants according to the current AF management guidelines.Therefore,we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events(TEs)in Chinese AF patients.Methods:From the prospective China Atrial Fibrillation Registry cohort study,we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline.We selected the most important variables by the extreme gradient boosting(XGBoost)algorithm and developed a simplified risk model for predicting 1-year TEs.The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score(excluding female sex from the CHA2DS2-VASc score).Results:Up to the follow-up of 1 year,163 TEs(ischemic stroke or systemic embolism)occurred.Using the XGBoost algorithm,we selected the three most important variables(congestive heart failure or left ventricular dysfunction,age,and prior stroke,abbreviated as CAS model)to predict 1-year TE risk.We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients.The CAS scheme classified 30.8%(2033/6601)of the patients as low risk for TE(CAS score=0),with a corresponding 1-year TE risk of 0.81%(95%confidence interval[CI]:0.41%–1.19%).In our cohort,the C-statistic of CAS model was 0.69(95%CI:0.65–0.73),higher than that of CHA2DS2-VA score(0.66,95%CI:0.62–0.70,Z=2.01,P=0.045).The overall net reclassification improvement from CHA2DS2-VA categories(low=0/high≥1)to CAS categories(low=0/high≥1)was 12.2%(95%CI:8.7%–15.7%).Conclusion:In Chinese AF patients,a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs,which could potentially improve anticoagulation decision-making.Trial Registration:www.chictr.org.cn(Unique identifier No.ChiCTR-OCH-13003729).
文摘Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.
基金the National Key Research and Development Program of the Ministry of Science and Technology of China(2020YFC2004803)the Beijing Municipal Commission of Science and Technology(No.D171100006817001).
文摘To the Editor:As acute coronary syndromes(ACS)is common causes of morbidity and mortality in China,they serve as an important case example to assess the impact of these health reforms on the quality,safety,and efficiency of healthcare.[1]ACS comprises a wide spectrum of disease subgroups,including ST-segment elevation myocardial infarction(STEMI),unstable angina(UA),and non-ST-segment elevation myocardial infarction(NSTEMI).Previous studies have shown increases in the intensity of testing and treatment while stable in-hospital mortality for STEMI in China between 2001 and 2011.[2]As non-ST-segment elevation acute coronary syndrome(NSTE-ACS)patients,who account for about two-thirds of ACS patients,have a wide spectrum of disease severity,risk-stratified management is recommended to ensure appropriate allocation of resources,especially in limited-resource settings of China.As limited data exist on the use of medical services and clinical outcomes in relation to health reforms,we aimed to determine temporal trends in diagnosis,treatment,and outcome for hospitalized NSTE-ACS patients in three regions of China between 2008 and 2015.
