Objective
The aim of this study was to set up a large, longitudinal and prospective database to investigate epidemiology, pathogenesis,the diagnosis, and prognosis of ankylosing spondylitis (AS) in Chinese population.
Methods
Four hundreds, and forty-nine consecutive outpatients with confirmed AS were recruited and followed annually. Characteristics of registration and demography (age, gender, time of back pain onset diagnosis, presence of AS-related clinical manifestations features, family history) and the current condition (disease activity, severity, treatment, laboratory tests) were collected at the clinic by rheumatologists. Dichotomous parameters were compared between groups using the χ2 test. Continuous parameters were compared using the analysis of variance.
Results
Four hundreds and forty-nine patients [(mean age: (29±8) years, male 84.0% (377/449), human leukocyte antigen (HLA)-B27 positive in 81.5% (309/379)] were included in the analysis. In this cross-sectional analysis only data at the first visit were used (from May 2014 to December2014). Differences in symptom duration (≤5 years, >5 years to ≤10 years and >10 years) were analyzed. The 3 groups did not differ in the frequency of gender, HLA-B27 positivity, family history, arthritis, enthesitis, inflammatory bowel disease, psoriasis, and abnormal C reactive protein (CRP). More patients with a higher prevalence of anterior chest wall [16.4%(27/165), 17.4%(26/149) vs 28.1%(38/135), χ2=7.477, P=0.024] and uveitis [5.5%(9/165), 8.9% (23/149) vs 18.5% (25/135), χ2=14.244, P<0.01].
Conclusion
This large cohort may improve our knowledge on the characteristics, pathogenesis and natural in chinese patienes with AS.
Key words:
Spondylitis, ankylosing; Prospective cohort; Symptom duration; Mobile health
Since 2003, the number of pilot areas of the New Rural Cooperative Medical System (NRCMS) has increased in rural China. And the major efforts have been concentrated on the enrollment of prospective members. In this study, we examined the satisfaction of the rural residents with the NRCMS as well as factors affecting their attitudes towards the NRCMS.The data for this study were collected from a survey involving twenty counties in Liaoning Province. Interviews and focus groups were conducted between 10th January and 20th August 2008. A total of 2,780 people aged 18-72 were randomly selected and interviewed. Data were evaluated by nonparametric tests and ordinal regression models.71.6% of the study subjects were satisfied with the NRCMS. Single factor analysis showed that attitudes towards the NRCMS were influenced by gender, age, marital status, and self-rated health status. In the ordinal regression analysis, gender, age, and self-rated health status affect satisfaction (P < 0.05).We found that a considerable proportion of farmers were satisfied with the NRCMS. Gender, age, and self-rated health status had significant effects on farmers' attitudes towards the NRCMS. The Chinese Central Government attempted to adopt active measures in the future to continuously improve the NRCMS, including initiating educational programs, building new medical facilities and increasing financial investment.
Cardiac tamponade is a rare but life-threatening complication during atrial fibrillation (AF) catheter ablation. Contact force (CF)–sensing catheters improve ablation effectiveness. However, the impact of the application of CF-sensing catheters on the occurrence of cardiac tamponade remains unclear. The aim of this study is to evaluate the "real-world" impact of CF-sensing catheters on cardiac tamponade during AF ablation in an experienced medical center. This was a retrospective study of consecutive de novo AF ablation procedures at Beijing Anzhen Hospital between 2013 and 2016. The ablation procedure was divided into a CF group and a non-CF group. Logistic regression analysis was used to evaluate the association between the use of CF-sensing catheters and the risk of cardiac tamponade. A total of 5313 patients with AF were involved in this study. The incidence of cardiac tamponade in the CF group was significantly higher than that in the non-CF group (1.07% vs. 0.44%, P = 0.009). Of the cardiac tamponade cases in the non-CF group, 45.45% were delayed compared with 10% in the CF group (P = 0.011). Multivariate logistic regression analysis showed that CF-sensing catheters increased the risk of cardiac tamponade (OR = 2.34, 95% CI = 1.17–4.26, P = 0.015). Stratified analysis revealed patients with a smaller left atrium dimension, lower ejection fraction, longer procedure duration, or longer ablation duration had a greater risk of cardiac tamponade during ablation with CF-sensing catheters. CF-sensing catheters increase the risk of cardiac tamponade during AF ablation.
This thesis introduces the characteristics of the municipal utility industry,and the current devel-opment status and direction of reform.The current popular mode of financing the project is BOT model which is almost used in the field of infrastructure construction,as a result of restrictions on Municipal util-ity industry’s own characteristics,traditional BOT model is not entirely applicable to municipal utility in-dustry.The newly emerging PPP-BASED BOT model to improve the mode of BOT model,which intro-duces the government departments effectively,is more appropriate for municipal utility industry.Through the specific analysis on Lanzhou Veolia cooperation project,this thesis can summary that PPP-BASED BOT model has a realistic operational possiblity.
New medical reform program requires at least 100 billion increasing in the government’s financial input, but increased financial input by government is not necessarily to solve the problem.As the main medical servicers,there are still many shortcomings of hospital’s own, such as the distribution of medical resources,the standardizing of industries management,the issue of medical service efficiency and quality, the issues of involvement of social capital,these shortcomings will be a bottleneck of health reform policy. It will propose some personal views of these issues.
Background: "Pill-in-the-pocket" (PIP) treatment with type IC drugs for cardioversion of recent-onset atrial fibrillation (AF) has been recommended in guidelines. Major adverse effects have been often reported, the underlying mechanisms are proposed to be associated with the genetic backgrounds. Methods and Results: A male patient was treated with PIP approach (propafenone 600mg.po) for the conversion of new onset AF. His symptoms got worse and referred to emergency room; ECG showed a typical Brugada syndrome (BrS) type I ECG pattern with sinus rhythm. Genetic screening identified a common SCN5A polymorphism R1193Q. Propafenone blockade of INa was studied in HEK293 cells expressed SCN5A R1193Q channel and WT channel using patch clamp techniques. There was no significant difference in peak current and steady-state gating parameters between R1193Q and WT at baseline. At clinically relevant concentration of 2 μmol/L propafenone, use-dependent block (UDB) of INa was more pronounced in R1193Q versus WT (44.2±7.2% versus 24.8±5.7% at the frequency of 2 Hz, P<0.05); IC50 of UDB was 2.9±0.7 µmol/L for R1193Q and 8.1±1.8 µmol/L for WT respectively. Propafenone produced more left shift of steady-state inactivation and slower recovery from inactivation in R1193Q compared with WT. Conclusion: A common SCN5A polymorphism R1193Q enhances UDB by propafenone and predisposes the patients to drug-induced BrS with PIP treatment. Our data suggest that R1193Q polymorphism is likely to be a genetic marker for the major adverse effects associated with PIP approach for AF patient management.
Background There are distinct results for the relationship between new-onset atrial fibrillation (NOAF) and subsequent incident cancer. To date, no systematic analysis has been conducted on this issue. This study aims to explore the relationship between NOAF and the risk of developing cancer through a meta-analysis with a large sample size. Methods Electronic databases, such as PubMed and EMBASE, were searched for published relevant studies on NOAF patients diagnosed with cancer after and during follow-ups, including reported records of baseline information and the statistical result of morbidity. Two investigators independently reviewed the articles and extracted the data using uniform standards and definitions. The meta-analysis was conducted using the Cochrane Program Review Manager. Results This meta-analysis consisted of five cohort studies and one case-control study, which comprised of 533,514 participants. The pooled relative risk (RR) for incident cancer was 1.24 (95% CI: 1.10-1.39, P=0.0003). The temporal trends analysis demonstrated that an increased risk of cancer was observed during the initial 90 days (RR: 3.44, 95% CI: 2.29-5.57, P<0.00001), but not after that. Lung cancer (RR: 1.51, 95% CI: 1.47-1.55, P<0.00001) was associated with NOAF, but not colorectal cancer and breast cancer. Conclusion This meta-analysis provides evidence that NOAF is associated with increased risk of cancer. The risk of incident cancer particularly increases within 90 days after NOAF diagnosis, but not after that.
Cardiac tamponade is a common life-threatening complication during radiofrequency ablation of atrial fibrillation (RAAF) and is mostly managed by pericardiocentesis. Thus far, the optimal timing for drain removal has not been established.We retrospectively enrolled patients with cardiac tamponade complicating RAAF. The ablation was performed with interrupted novel oral anticoagulants, interrupted warfarin or uninterrupted warfarin protocols. An observation period of at least 30 minutes after the last aspiration via the drain was used to monitor the reaccumulation of pericardial fluid, and then, the patients were divided into an early removal (ER) group in the electrophysiology (EP) laboratory and a delayed removal (DR) group in the ward. A total of 51 patients were included: 25 patients in the ER group and 26 patients in the DR group. There were no significant differences in baseline demographics between the two groups, and no cardiac tamponade reoccurred in either group in the ward. Unlike the DR group, the ER group showed an association with a decreased rate of chest pain (P = .000), fever (P = .001), nausea (P = .000), in-hospital recurrent AF (P = .010), and antibiotic use (P = .012). Anticoagulation was earlier (P = .009), and the median in-hospital stay was shorter (P = .001) in the ER group than in the DR group.ER of the pericardial drain after no evidence of pericardial bleeding for at least 30 minutes in the EP laboratory is safe and associated with a better early hospital course.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
