Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to ...Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.展开更多
BACKGROUND Ischemic bowel disease(IBD)is a critical condition caused by reduced blood flow to the intestines,leading to tissue damage and potentially severe complications.Early recognition and timely management are es...BACKGROUND Ischemic bowel disease(IBD)is a critical condition caused by reduced blood flow to the intestines,leading to tissue damage and potentially severe complications.Early recognition and timely management are essential for improving patient outcomes and reducing morbidity and mortality associated with IBD.AIM To evaluate the knowledge,attitude and practice(KAP)of healthcare professionals regarding IBD.METHODS This cross-sectional study was conducted among healthcare professionals in China from November 2023 to December 2023 using a self-designed questionnaire.RESULTS A total of 315 valid questionnaires were analyzed,with 215 participants(68.25%)being female.The mean KAP scores were 17.55±5.35(range:0-24),27.65±2.77(range:8-40),and 18.88±4.23(range:6-30),respectively.Multivariate linear regression analysis revealed the following factors to be independently associated with knowledge:Age 26-35 years(β=2.80,95%CI:0.31-5.30,P=0.028),professional title(β=2.66,95%CI:0.91-4.41,P=0.003),position(β=-3.78,95%CI:-5.45 to-2.11,P<0.001),participation in IBD-related training(β=3.45,95%CI:2.39-4.51,P<0.001),and admission of more than five IBD cases in the past month(β=3.25,95%CI:1.58-4.92,P<0.001).Attitude was independently associated with knowledge(β=0.20,95%CI:0.15-0.26,P<0.001)and being a nurse or nursing supervisor(β=-1.30,95%CI:-2.16 to-0.40,P=0.003).Practice was independently associated with knowledge(β=0.20,95%CI:0.10-0.30,P<0.001)and attitude(β=0.24,95%CI:0.06-0.42,P=0.007).Structural equation modeling demonstrated direct effects of knowledge on attitude(β=0.24,P<0.001)and practice(β=0.26,P<0.001),as well as of attitude on practice(β=0.22,P=0.012).CONCLUSION Healthcare professionals demonstrated adequate knowledge but moderate attitude and inactive practice regarding IBD.Addressing the gaps in attitude and practice through targeted training programs and interventions is essential for improving patient care and outcomes.展开更多
The evaluation of social practice outcomes is a critical component of the social practice mechanisms in colleges and universities,serving as a core index to assess the effectiveness of practice activities and the qual...The evaluation of social practice outcomes is a critical component of the social practice mechanisms in colleges and universities,serving as a core index to assess the effectiveness of practice activities and the quality of student training.This paper employs CiteSpace to analyze references,keyword co-occurrence maps,time zone maps,and time diagrams,identifying key research hotspots in social practice evaluation systems domestically and internationally.These hotspots include the construction of evaluation indicators,evaluation pathways,and methods.Additionally,this study compares and summarizes the evolution of social practice evaluation systems across regions.It highlights that foreign social practice evaluation systems are characterized by diverse interpretative paradigms,an emphasis on students’self-reflection during the evaluation process,and more robust theoretical foundations.These findings provide valuable insights for domestic colleges and universities seeking to build social practice evaluation systems with relevant content and effective results.展开更多
BACKGROUND Breast cancer is one of the most prevalent causes of morbidity and mortality worldwide,presenting an increasing public health challenge,particularly in lowincome and middle-income countries.However,data on ...BACKGROUND Breast cancer is one of the most prevalent causes of morbidity and mortality worldwide,presenting an increasing public health challenge,particularly in lowincome and middle-income countries.However,data on the knowledge,attitudes,and preventive practices regarding breast cancer and the associated factors among females in Wollo,Ethiopia,remain limited.AIM To assess the impact of family history(FH)of breast disease on knowledge,attitudes,and breast cancer preventive practices among reproductive-age females.METHODS A community-based cross-sectional study was conducted in May and June 2022 in Northeast Ethiopia and involved 143 reproductive-age females with FH of breast diseases and 209 without such a history.We selected participants using the systematic random sampling technique.We analyzed the data using Statistical Package for Social Science version 25 software,and logistic regression analysis was employed to determine odds ratios for variable associations,with statistical significance set at P<0.05.RESULTS Among participants with FH of breast diseases,the levels of knowledge,attitudes,and preventive practices were found to be 83.9%[95%confidence interval(CI):77.9-89.9],49.0%(95%CI:40.8-57.1),and 74.1%(95%CI:66.9-81.3),respectively.In contrast,among those without FH of breast diseases,these levels were significantly decreased to 10.5%(95%CI:6.4-14.7),32.1%(95%CI:25.7-38.4),and 16.7%(95%CI:11.7-21.8),respectively.This study also indicated that knowledge,attitudes,and preventive practices related to breast cancer are significantly higher among participants with FH of breast diseases compared to those without HF breast diseases.CONCLUSION Educational status,monthly income,and community health insurance were identified as significant factors associated with the levels of knowledge,attitudes,and preventive practices regarding breast cancer among reproductive-age females.展开更多
Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligen...Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.展开更多
BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have ...BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have been extensively studied,whereas others,like eyelid malposition and thyroid eye disease,have received minimal or no research.AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.METHODS A cross-sectional survey was disseminated among ophthalmologists all over India.The survey included questions related to pre-operative evaluation,anaesthetic and surgical techniques preferred,post-operative care,the use of adjunctive therapies,and patient follow-up patterns.RESULTS A total of 180 ophthalmologists responded to the survey.Most practitioners(89%)felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised.The most common surgical techniques employed were lacrimal drainage procedures(Dacryocystorhinostomy)(63.3%),eyelid malposition repair(36.9%),and ptosis repair(58.7%).Post-operatively,47.7%of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries.Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.CONCLUSION Approximately 50%of ophthalmologists handle prevalent oculoplastic issues themselves,seeking the expertise of an oculoplastic surgeon under particular conditions.Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery.Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.展开更多
The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabete...The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.展开更多
The No.1 Central Document of 2024 emphasizes the need to learn from and apply the experience of the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project to paint a new picture of livable,wo...The No.1 Central Document of 2024 emphasizes the need to learn from and apply the experience of the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project to paint a new picture of livable,workable,harmonious,and beautiful villages,thereby accelerating agricultural and rural modernization and better advancing the construction of Chinese modernization.This paper,based on elucidating the scientific connotations and logical pathways of the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project and"harmonious and beautiful villages",analyzes the practices of building"harmonious and beautiful villages"in Gansu Province.It proposes learning from the experience of coordinated advancement in the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project to strengthen infrastructure and public service construction;learning from the experience of adapting to local conditions to reinforce rural industrial drive and integrated development;learning from the experience of environmental optimization and shaping to accelerate the improvement of human settlements and ecological civilization construction;and learning from the experience of co-construction,co-governance,and sharing to speed up rural governance and spiritual civilization development,thereby aiding the construction of harmonious and beautiful villages in Gansu.展开更多
Objectives To investigate the barriers and facilitators influencing the sustainable implementation of evidence-based practice(EBP)for Peristomal Irritant Contact Dermatitis(PICD)based on the Consolidated Framework for...Objectives To investigate the barriers and facilitators influencing the sustainable implementation of evidence-based practice(EBP)for Peristomal Irritant Contact Dermatitis(PICD)based on the Consolidated Framework for Implementation Research(CFIR).Methods The sample consisted of 17 nurses from three urology wards at a tertiary hospital in Beijing,China,who had participated in the EBP.Guided by the CFIR,we identified constructs influencing the sustainability of implementation by conducting a directed content analysis of the 17 individual in-depth interviews.By rating,the valence and magnitude of each construct were determined.Results This study identified 19 factors across the five domains of the CFIR.Among these determinants,16 were identified as barriers,while three were recognized as facilitators.Common barriers across different contexts were identified,such as delayed evidence updating,the complexity of intervention components and steps,and incompatibility between the implementation process and clinical practices.In contrast,facilitators of intervention implementation were regular communication and feedback,support and drive from principals and a positive cultural atmosphere.In addition,we identified“regular evidence updating”as an independent construct outside of the CFIR,a finding that will provide key information for updating the CFIR framework.Conclusions Regular evidence updating is crucial for the sustainability of EBP implementation.Researchers should receive consistent feedback from practitioners and adjust or modify the EBP as necessary.Additionally,researchers must consider the compatibility or adaptability of the EBP’s content with clinical practice in formulating it rather than adding additional complexity to the original workflow.展开更多
Objective:This randomized controlled trial aimed to assess the impact of a targeted educational intervention on the awareness and practice of genetic screening and counseling among young adults in Calabar Municipality...Objective:This randomized controlled trial aimed to assess the impact of a targeted educational intervention on the awareness and practice of genetic screening and counseling among young adults in Calabar Municipality,Cross River State.Materials and Methods:Participants(aged 18-45)were randomly assigned to either an intervention group receiving structured health education or a control group receiving general health information.Stratified randomization was used between the groups.A sample size of 340 participants was recruited to detect a 20%difference in outcomes with 80%power.Data were collected using prevalidated questionnaires at baseline,immediately after the intervention,and at a 3-month follow-up.The intervention consisted of three weekly 90-min educational sessions covering genetics,the benefits of screening,and practical guidance on accessing genetic services.The primary outcomes were changes in awareness and practices related to genetic screening,with secondary outcomes focusing on attitudes and intentions toward genetic counseling.Results:Findings revealed that awareness of genetic screening was higher in the intervention group,with 65.9%of participants aware of early detection,compared to 59.4%in the control group,although the difference was not statistically significant(P=0.23).In terms of practice,42.9%of the intervention group and 40.0%of the control group engaged in genetic screening programs,with no significant difference(P=0.57).Logistic regression analysis highlighted that age,educational level,and knowledge of teratogens were significant predictors of genetic screening awareness.Participants aged 36 years and above were 1.52 times more likely to be aware(odds ratio[OR]=1.52,P=0.003),and those with tertiary education had nearly double the likelihood of awareness(OR=1.96,P<0.001).Conclusion:The study underscores the importance of targeted education in improving genetic screening awareness.展开更多
Objective: The importance of culture in nursing lies in its influence on patients’ health perceptions, behaviors, and responses to care. Despite the challenges posed by the complexity of studying culture, there remai...Objective: The importance of culture in nursing lies in its influence on patients’ health perceptions, behaviors, and responses to care. Despite the challenges posed by the complexity of studying culture, there remains a critical need to develop cultural competence in nursing. This study investigated how nursing students in rural Indonesia enhance their cultural competence through education and practice. Methods: This study employed a qualitative descriptive phenomenological approach. It conducted face-to-face interviews with 32 students across 6 regions, selected purposively. Thematic analysis was employed to evaluate the results. Results: Five themes emerge in this research: perceptions of cultural competence, learning cultural competence in the classroom, practical experience, learning expectations related to cultural competence, and cultural learning barriers. Conclusions: Enhancing cultural competence necessitates enriched curricula, adept clinical mentors, and continual student evaluation. This iterative assessment informs tailored strategies for nurturing cultural proficiency.展开更多
This paper considers the notions of common sense and interobjectivity to articulate an understanding of how different cultural realities give rise to different construals of scientific phenomena across distinct cultur...This paper considers the notions of common sense and interobjectivity to articulate an understanding of how different cultural realities give rise to different construals of scientific phenomena across distinct cultures. Our main focus in this paper is on the social sciences. We propose a quadrant of different cultural–scientific stances from which the study of social phenomena is possible, based on the emic–etic dimension pertaining to the study of culture from contrasting perspectives. Although the emic–etic distinction is normal y applied in fields within the science of culture, it is proposed here that the distinction is in some ways germane to scientific practice in general, making it amenable for use in a culture of science(CoS) programme. The four perspectives that emerge from the quadrant are illustrated using exemplars. Different aspects of CoS—that is, scientific practice, scientific conventions and representations of science—are then discussed in further detail, including in two tables illustrating points of convergence and divergence between the East and West when it comes to different aspects of CoS.展开更多
Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using ...Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using a self-administered questionnaire.Multiple logistic regression was conducted to test the associated factors with the dependent variables.Results:Only 9.3%of participants had a standardized level of knowledge,while 68.9%reported adequate skills for neonatal resuscitation.Factors associated with a standardized level of knowledge were age(p=0.001)and supportive supervision(p=0.007).Factors associated with the standardized practice level were the presence of hospital guidelines(p=0.028),previous training of nurses(p=0.011),and the presence of supportive supervision(p<0.001).Conclusions:The majority of emergency nurses in Hebron hospitals demonstrated a substandard level of knowledge of neonatal resuscitation.However,most of those nurses surprisingly reported a standardized practice level.The presence of hospital guidelines,training programs,or direct supervision for nurses are factors that can be considered to improve both knowledge and practice toward neonatal resuscitation among emergency nurses in Hebron.展开更多
Schistosomiasis is a neglected tropical disease (NTD) widespread in sub-Saharan Africa and mostly affects school going children. Côte d’Ivoire is one of the most vulnerable countries to schistosomiasis, and its ...Schistosomiasis is a neglected tropical disease (NTD) widespread in sub-Saharan Africa and mostly affects school going children. Côte d’Ivoire is one of the most vulnerable countries to schistosomiasis, and its prevalence varies by region. This cross-sectional survey was conducted in schools in the Upper Sassandra region to determine the knowledge, attitude, and practices of school children regarding schistosomiasis. In total, 354 students participated in the survey. Our results showed that, compared to the girls, the boys had a higher level of knowledge about schistosomiasis OR = 1.605 and p = 0.05. Regarding the signs, symptoms, and modes of transmission and prevention of schistosomiasis, the participants reported a low level of knowledge p > 0.05 and OR 1. In conclusion, it is important to target health messages in schools to reach the most vulnerable students effectively. This initiative aims to provide children with basic knowledge and skills in the transmission of schistosomiasis.展开更多
BACKGROUND Second-line treatment of Crohn’s disease(CD)commonly involves immunosuppressants such as azathioprine,mercaptopurine,or methotrexate(MTX),used either alone or in combination.AIM To investigate the current ...BACKGROUND Second-line treatment of Crohn’s disease(CD)commonly involves immunosuppressants such as azathioprine,mercaptopurine,or methotrexate(MTX),used either alone or in combination.AIM To investigate the current use of MTX among French gastroenterologists.METHODS An online questionnaire was distributed between March and August 2023 to 116 French gastroenterologists managing CD.A total of 87 respondents completed the survey and were included in the analysis.RESULTS Respondents reported a mean annual caseload of 140 CD patients(median:50).Overall,71%prescribed MTX,predominantly in injectable form(92%),either as monotherapy or in combination with biologics or cyclosporin.MTX was prescribed for mild-to-moderate CD by 64%of respondents,and for severe CD by 58%,often in combination with an anti-tumor necrosis factor agent(89%and 94%,respectively).Injectable MTX was favored(84%)in specific clinical scenarios:Patients with articular manifestations(77%),Epstein-Barr virus-negative status(65%),or aged over 65 years(58%).Among the 29%of non-prescribers,the primary reason cited was lack of familiarity with MTX use(60%).Both prescribers and non-prescribers expressed the need for clearer guidelines and real-world data to support MTX use.CONCLUSION Regardless of prescribing habits,most respondents had a favorable opinion of MTX and recognized its good longterm safety profile.French learned societies and medical associations should provide consensus guidelines on MTX use,supported by validated real-world safety and effectiveness data.展开更多
Objective: Adolescent reproduction health (ARH) differs greatly based on religions, religious norms, culture, and ethnicities in the Indonesian context. The value of local wisdom was considered too binding, traditiona...Objective: Adolescent reproduction health (ARH) differs greatly based on religions, religious norms, culture, and ethnicities in the Indonesian context. The value of local wisdom was considered too binding, traditional, and outdated, particularly on ARH in agricultural areas. The purpose of the study was to identify the problems, challenges, and needs, specifically for ARH, in the agricultural area of Indonesia. Methods: A qualitative study was performed among 41 communities, including 28 village officials (VOs), 9 community health volunteers (CHVs), and 9 adolescents. The data were collected through in-depth interviews and FGD. An thematic analysis was used to describe the phenomena. Results: This research obtained results regarding ARH in terms of communication patterns, daily behavior, reproductive practices, and hygiene of adolescent reproductive organs, especially in agricultural areas. Conclusions: The differences in the perspective of ARH are influenced by environment, parental roles, religion, ethnicity, and knowledge.展开更多
The theory of"Life and Practice"education was developed based on Tao Xingzhi's theory of life education from the early 20th century.Tao Xingzhi's theory of life education continues to profoundly infl...The theory of"Life and Practice"education was developed based on Tao Xingzhi's theory of life education from the early 20th century.Tao Xingzhi's theory of life education continues to profoundly influence contemporary and future educational reforms.The 21st century is an era of information and artificial intelligence,with the third major transformation undergoing in the field of education.Compared to the era in which Tao Xingzhi lived,China has experienced tremendous changes in its social structure and educational system.Therefore,to adapt to the requirements of this new era,the theory of"Life and Practiceeducation has emerged by inheriting and developing Tao Xingzhi's theory of life education.The core goal of"Life and Practice"education is to address the disconnect between education and life,school and society,and teaching and practice.展开更多
Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite ...Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.展开更多
Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH...Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH)and the Royal College of Obstetricians and Gynaecologists(RCOG)in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission.Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding.The guideline emphasizes polymerase chain reaction(PCR)testing for accurate diagnosis and advocates a multidisciplinary team(MDT)approach,involving genitourinary medicine(GUM)specialists,obstetricians,and neonatologists for delivery planning and neonatal care.However,the Chinese guidelines offer greater flexibility in the timing of antiviral treatment,tailored to regional resources and specific circumstances.PCR testing is also recommended,particularly in urban hospitals and tertiary care settings.The UK′s MDT model aligns with China′s integrative healthcare approach,presenting opportunities for mutual learning and collaboration.This comparative analysis highlights areas for cross-adaptation in clinical practices,with potential to enhance maternal and neonatal health outcomes globally.展开更多
In this letter,we delve into the groundbreaking research by Lorente et al,which sheds light on the intricate relationship between low salivary uric acid levels and periodontitis.The study not only confirms previous ob...In this letter,we delve into the groundbreaking research by Lorente et al,which sheds light on the intricate relationship between low salivary uric acid levels and periodontitis.The study not only confirms previous observations of reduced salivary uric acid concentrations in periodontitis patients but also establishes,for the first time,an independent association between these two factors,even when controlling for traditional risk factors such as age,smoking status,and arterial hypertension.Moreover,the findings reveal a significant negative correlation between salivary uric acid levels and the severity of periodontitis,suggesting that this biomarker may serve as a valuable indicator of disease progression.These discoveries open new avenues for understanding the pathophysiology of period-ontitis and pave the way for innovative diagnostic and therapeutic strategies.The potential clinical applications of salivary uric acid measurement,such as guiding personalized treatment plans and monitoring disease activity,warrant further exploration to enhance patient care and improve outcomes in this prevalent inflammatory condition.展开更多
文摘Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.
文摘BACKGROUND Ischemic bowel disease(IBD)is a critical condition caused by reduced blood flow to the intestines,leading to tissue damage and potentially severe complications.Early recognition and timely management are essential for improving patient outcomes and reducing morbidity and mortality associated with IBD.AIM To evaluate the knowledge,attitude and practice(KAP)of healthcare professionals regarding IBD.METHODS This cross-sectional study was conducted among healthcare professionals in China from November 2023 to December 2023 using a self-designed questionnaire.RESULTS A total of 315 valid questionnaires were analyzed,with 215 participants(68.25%)being female.The mean KAP scores were 17.55±5.35(range:0-24),27.65±2.77(range:8-40),and 18.88±4.23(range:6-30),respectively.Multivariate linear regression analysis revealed the following factors to be independently associated with knowledge:Age 26-35 years(β=2.80,95%CI:0.31-5.30,P=0.028),professional title(β=2.66,95%CI:0.91-4.41,P=0.003),position(β=-3.78,95%CI:-5.45 to-2.11,P<0.001),participation in IBD-related training(β=3.45,95%CI:2.39-4.51,P<0.001),and admission of more than five IBD cases in the past month(β=3.25,95%CI:1.58-4.92,P<0.001).Attitude was independently associated with knowledge(β=0.20,95%CI:0.15-0.26,P<0.001)and being a nurse or nursing supervisor(β=-1.30,95%CI:-2.16 to-0.40,P=0.003).Practice was independently associated with knowledge(β=0.20,95%CI:0.10-0.30,P<0.001)and attitude(β=0.24,95%CI:0.06-0.42,P=0.007).Structural equation modeling demonstrated direct effects of knowledge on attitude(β=0.24,P<0.001)and practice(β=0.26,P<0.001),as well as of attitude on practice(β=0.22,P=0.012).CONCLUSION Healthcare professionals demonstrated adequate knowledge but moderate attitude and inactive practice regarding IBD.Addressing the gaps in attitude and practice through targeted training programs and interventions is essential for improving patient care and outcomes.
基金supported by the Zhejiang Provincial Department of Education’s General Scientific Research Project(Project No.2023-007)the Zhejiang Provincial Graduate Education Association(Project No.2023-007).
文摘The evaluation of social practice outcomes is a critical component of the social practice mechanisms in colleges and universities,serving as a core index to assess the effectiveness of practice activities and the quality of student training.This paper employs CiteSpace to analyze references,keyword co-occurrence maps,time zone maps,and time diagrams,identifying key research hotspots in social practice evaluation systems domestically and internationally.These hotspots include the construction of evaluation indicators,evaluation pathways,and methods.Additionally,this study compares and summarizes the evolution of social practice evaluation systems across regions.It highlights that foreign social practice evaluation systems are characterized by diverse interpretative paradigms,an emphasis on students’self-reflection during the evaluation process,and more robust theoretical foundations.These findings provide valuable insights for domestic colleges and universities seeking to build social practice evaluation systems with relevant content and effective results.
文摘BACKGROUND Breast cancer is one of the most prevalent causes of morbidity and mortality worldwide,presenting an increasing public health challenge,particularly in lowincome and middle-income countries.However,data on the knowledge,attitudes,and preventive practices regarding breast cancer and the associated factors among females in Wollo,Ethiopia,remain limited.AIM To assess the impact of family history(FH)of breast disease on knowledge,attitudes,and breast cancer preventive practices among reproductive-age females.METHODS A community-based cross-sectional study was conducted in May and June 2022 in Northeast Ethiopia and involved 143 reproductive-age females with FH of breast diseases and 209 without such a history.We selected participants using the systematic random sampling technique.We analyzed the data using Statistical Package for Social Science version 25 software,and logistic regression analysis was employed to determine odds ratios for variable associations,with statistical significance set at P<0.05.RESULTS Among participants with FH of breast diseases,the levels of knowledge,attitudes,and preventive practices were found to be 83.9%[95%confidence interval(CI):77.9-89.9],49.0%(95%CI:40.8-57.1),and 74.1%(95%CI:66.9-81.3),respectively.In contrast,among those without FH of breast diseases,these levels were significantly decreased to 10.5%(95%CI:6.4-14.7),32.1%(95%CI:25.7-38.4),and 16.7%(95%CI:11.7-21.8),respectively.This study also indicated that knowledge,attitudes,and preventive practices related to breast cancer are significantly higher among participants with FH of breast diseases compared to those without HF breast diseases.CONCLUSION Educational status,monthly income,and community health insurance were identified as significant factors associated with the levels of knowledge,attitudes,and preventive practices regarding breast cancer among reproductive-age females.
文摘Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.
文摘BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have been extensively studied,whereas others,like eyelid malposition and thyroid eye disease,have received minimal or no research.AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.METHODS A cross-sectional survey was disseminated among ophthalmologists all over India.The survey included questions related to pre-operative evaluation,anaesthetic and surgical techniques preferred,post-operative care,the use of adjunctive therapies,and patient follow-up patterns.RESULTS A total of 180 ophthalmologists responded to the survey.Most practitioners(89%)felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised.The most common surgical techniques employed were lacrimal drainage procedures(Dacryocystorhinostomy)(63.3%),eyelid malposition repair(36.9%),and ptosis repair(58.7%).Post-operatively,47.7%of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries.Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.CONCLUSION Approximately 50%of ophthalmologists handle prevalent oculoplastic issues themselves,seeking the expertise of an oculoplastic surgeon under particular conditions.Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery.Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.
文摘The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.
基金Supported by 2025 Gansu Provincial Party School(Institute of Administration)System Social Science Planning Project(QSDXYB2025046).
文摘The No.1 Central Document of 2024 emphasizes the need to learn from and apply the experience of the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project to paint a new picture of livable,workable,harmonious,and beautiful villages,thereby accelerating agricultural and rural modernization and better advancing the construction of Chinese modernization.This paper,based on elucidating the scientific connotations and logical pathways of the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project and"harmonious and beautiful villages",analyzes the practices of building"harmonious and beautiful villages"in Gansu Province.It proposes learning from the experience of coordinated advancement in the"Thousand-Village Demonstration,Ten-Thousand-Village Renovation"project to strengthen infrastructure and public service construction;learning from the experience of adapting to local conditions to reinforce rural industrial drive and integrated development;learning from the experience of environmental optimization and shaping to accelerate the improvement of human settlements and ecological civilization construction;and learning from the experience of co-construction,co-governance,and sharing to speed up rural governance and spiritual civilization development,thereby aiding the construction of harmonious and beautiful villages in Gansu.
基金supported by the Peking University Nursing Discipline Research Development Fund(No.TYZH2023001)。
文摘Objectives To investigate the barriers and facilitators influencing the sustainable implementation of evidence-based practice(EBP)for Peristomal Irritant Contact Dermatitis(PICD)based on the Consolidated Framework for Implementation Research(CFIR).Methods The sample consisted of 17 nurses from three urology wards at a tertiary hospital in Beijing,China,who had participated in the EBP.Guided by the CFIR,we identified constructs influencing the sustainability of implementation by conducting a directed content analysis of the 17 individual in-depth interviews.By rating,the valence and magnitude of each construct were determined.Results This study identified 19 factors across the five domains of the CFIR.Among these determinants,16 were identified as barriers,while three were recognized as facilitators.Common barriers across different contexts were identified,such as delayed evidence updating,the complexity of intervention components and steps,and incompatibility between the implementation process and clinical practices.In contrast,facilitators of intervention implementation were regular communication and feedback,support and drive from principals and a positive cultural atmosphere.In addition,we identified“regular evidence updating”as an independent construct outside of the CFIR,a finding that will provide key information for updating the CFIR framework.Conclusions Regular evidence updating is crucial for the sustainability of EBP implementation.Researchers should receive consistent feedback from practitioners and adjust or modify the EBP as necessary.Additionally,researchers must consider the compatibility or adaptability of the EBP’s content with clinical practice in formulating it rather than adding additional complexity to the original workflow.
文摘Objective:This randomized controlled trial aimed to assess the impact of a targeted educational intervention on the awareness and practice of genetic screening and counseling among young adults in Calabar Municipality,Cross River State.Materials and Methods:Participants(aged 18-45)were randomly assigned to either an intervention group receiving structured health education or a control group receiving general health information.Stratified randomization was used between the groups.A sample size of 340 participants was recruited to detect a 20%difference in outcomes with 80%power.Data were collected using prevalidated questionnaires at baseline,immediately after the intervention,and at a 3-month follow-up.The intervention consisted of three weekly 90-min educational sessions covering genetics,the benefits of screening,and practical guidance on accessing genetic services.The primary outcomes were changes in awareness and practices related to genetic screening,with secondary outcomes focusing on attitudes and intentions toward genetic counseling.Results:Findings revealed that awareness of genetic screening was higher in the intervention group,with 65.9%of participants aware of early detection,compared to 59.4%in the control group,although the difference was not statistically significant(P=0.23).In terms of practice,42.9%of the intervention group and 40.0%of the control group engaged in genetic screening programs,with no significant difference(P=0.57).Logistic regression analysis highlighted that age,educational level,and knowledge of teratogens were significant predictors of genetic screening awareness.Participants aged 36 years and above were 1.52 times more likely to be aware(odds ratio[OR]=1.52,P=0.003),and those with tertiary education had nearly double the likelihood of awareness(OR=1.96,P<0.001).Conclusion:The study underscores the importance of targeted education in improving genetic screening awareness.
基金supported by an internal grant from Universitas Citra Bangsa(Number 6/VI/LP3M/UCB/22).
文摘Objective: The importance of culture in nursing lies in its influence on patients’ health perceptions, behaviors, and responses to care. Despite the challenges posed by the complexity of studying culture, there remains a critical need to develop cultural competence in nursing. This study investigated how nursing students in rural Indonesia enhance their cultural competence through education and practice. Methods: This study employed a qualitative descriptive phenomenological approach. It conducted face-to-face interviews with 32 students across 6 regions, selected purposively. Thematic analysis was employed to evaluate the results. Results: Five themes emerge in this research: perceptions of cultural competence, learning cultural competence in the classroom, practical experience, learning expectations related to cultural competence, and cultural learning barriers. Conclusions: Enhancing cultural competence necessitates enriched curricula, adept clinical mentors, and continual student evaluation. This iterative assessment informs tailored strategies for nurturing cultural proficiency.
文摘This paper considers the notions of common sense and interobjectivity to articulate an understanding of how different cultural realities give rise to different construals of scientific phenomena across distinct cultures. Our main focus in this paper is on the social sciences. We propose a quadrant of different cultural–scientific stances from which the study of social phenomena is possible, based on the emic–etic dimension pertaining to the study of culture from contrasting perspectives. Although the emic–etic distinction is normal y applied in fields within the science of culture, it is proposed here that the distinction is in some ways germane to scientific practice in general, making it amenable for use in a culture of science(CoS) programme. The four perspectives that emerge from the quadrant are illustrated using exemplars. Different aspects of CoS—that is, scientific practice, scientific conventions and representations of science—are then discussed in further detail, including in two tables illustrating points of convergence and divergence between the East and West when it comes to different aspects of CoS.
文摘Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using a self-administered questionnaire.Multiple logistic regression was conducted to test the associated factors with the dependent variables.Results:Only 9.3%of participants had a standardized level of knowledge,while 68.9%reported adequate skills for neonatal resuscitation.Factors associated with a standardized level of knowledge were age(p=0.001)and supportive supervision(p=0.007).Factors associated with the standardized practice level were the presence of hospital guidelines(p=0.028),previous training of nurses(p=0.011),and the presence of supportive supervision(p<0.001).Conclusions:The majority of emergency nurses in Hebron hospitals demonstrated a substandard level of knowledge of neonatal resuscitation.However,most of those nurses surprisingly reported a standardized practice level.The presence of hospital guidelines,training programs,or direct supervision for nurses are factors that can be considered to improve both knowledge and practice toward neonatal resuscitation among emergency nurses in Hebron.
文摘Schistosomiasis is a neglected tropical disease (NTD) widespread in sub-Saharan Africa and mostly affects school going children. Côte d’Ivoire is one of the most vulnerable countries to schistosomiasis, and its prevalence varies by region. This cross-sectional survey was conducted in schools in the Upper Sassandra region to determine the knowledge, attitude, and practices of school children regarding schistosomiasis. In total, 354 students participated in the survey. Our results showed that, compared to the girls, the boys had a higher level of knowledge about schistosomiasis OR = 1.605 and p = 0.05. Regarding the signs, symptoms, and modes of transmission and prevention of schistosomiasis, the participants reported a low level of knowledge p > 0.05 and OR 1. In conclusion, it is important to target health messages in schools to reach the most vulnerable students effectively. This initiative aims to provide children with basic knowledge and skills in the transmission of schistosomiasis.
文摘BACKGROUND Second-line treatment of Crohn’s disease(CD)commonly involves immunosuppressants such as azathioprine,mercaptopurine,or methotrexate(MTX),used either alone or in combination.AIM To investigate the current use of MTX among French gastroenterologists.METHODS An online questionnaire was distributed between March and August 2023 to 116 French gastroenterologists managing CD.A total of 87 respondents completed the survey and were included in the analysis.RESULTS Respondents reported a mean annual caseload of 140 CD patients(median:50).Overall,71%prescribed MTX,predominantly in injectable form(92%),either as monotherapy or in combination with biologics or cyclosporin.MTX was prescribed for mild-to-moderate CD by 64%of respondents,and for severe CD by 58%,often in combination with an anti-tumor necrosis factor agent(89%and 94%,respectively).Injectable MTX was favored(84%)in specific clinical scenarios:Patients with articular manifestations(77%),Epstein-Barr virus-negative status(65%),or aged over 65 years(58%).Among the 29%of non-prescribers,the primary reason cited was lack of familiarity with MTX use(60%).Both prescribers and non-prescribers expressed the need for clearer guidelines and real-world data to support MTX use.CONCLUSION Regardless of prescribing habits,most respondents had a favorable opinion of MTX and recognized its good longterm safety profile.French learned societies and medical associations should provide consensus guidelines on MTX use,supported by validated real-world safety and effectiveness data.
基金supported by Kementerian RisetTeknologi dan Pendidikan Tinggi (Ministry of Research,Technology&Higher Education (RISTEKDIKTI) for funding International Collaboration Hibah Kerjasama International LP2M Universitas Jember 2021
文摘Objective: Adolescent reproduction health (ARH) differs greatly based on religions, religious norms, culture, and ethnicities in the Indonesian context. The value of local wisdom was considered too binding, traditional, and outdated, particularly on ARH in agricultural areas. The purpose of the study was to identify the problems, challenges, and needs, specifically for ARH, in the agricultural area of Indonesia. Methods: A qualitative study was performed among 41 communities, including 28 village officials (VOs), 9 community health volunteers (CHVs), and 9 adolescents. The data were collected through in-depth interviews and FGD. An thematic analysis was used to describe the phenomena. Results: This research obtained results regarding ARH in terms of communication patterns, daily behavior, reproductive practices, and hygiene of adolescent reproductive organs, especially in agricultural areas. Conclusions: The differences in the perspective of ARH are influenced by environment, parental roles, religion, ethnicity, and knowledge.
文摘The theory of"Life and Practice"education was developed based on Tao Xingzhi's theory of life education from the early 20th century.Tao Xingzhi's theory of life education continues to profoundly influence contemporary and future educational reforms.The 21st century is an era of information and artificial intelligence,with the third major transformation undergoing in the field of education.Compared to the era in which Tao Xingzhi lived,China has experienced tremendous changes in its social structure and educational system.Therefore,to adapt to the requirements of this new era,the theory of"Life and Practiceeducation has emerged by inheriting and developing Tao Xingzhi's theory of life education.The core goal of"Life and Practice"education is to address the disconnect between education and life,school and society,and teaching and practice.
文摘Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.
文摘Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH)and the Royal College of Obstetricians and Gynaecologists(RCOG)in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission.Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding.The guideline emphasizes polymerase chain reaction(PCR)testing for accurate diagnosis and advocates a multidisciplinary team(MDT)approach,involving genitourinary medicine(GUM)specialists,obstetricians,and neonatologists for delivery planning and neonatal care.However,the Chinese guidelines offer greater flexibility in the timing of antiviral treatment,tailored to regional resources and specific circumstances.PCR testing is also recommended,particularly in urban hospitals and tertiary care settings.The UK′s MDT model aligns with China′s integrative healthcare approach,presenting opportunities for mutual learning and collaboration.This comparative analysis highlights areas for cross-adaptation in clinical practices,with potential to enhance maternal and neonatal health outcomes globally.
文摘In this letter,we delve into the groundbreaking research by Lorente et al,which sheds light on the intricate relationship between low salivary uric acid levels and periodontitis.The study not only confirms previous observations of reduced salivary uric acid concentrations in periodontitis patients but also establishes,for the first time,an independent association between these two factors,even when controlling for traditional risk factors such as age,smoking status,and arterial hypertension.Moreover,the findings reveal a significant negative correlation between salivary uric acid levels and the severity of periodontitis,suggesting that this biomarker may serve as a valuable indicator of disease progression.These discoveries open new avenues for understanding the pathophysiology of period-ontitis and pave the way for innovative diagnostic and therapeutic strategies.The potential clinical applications of salivary uric acid measurement,such as guiding personalized treatment plans and monitoring disease activity,warrant further exploration to enhance patient care and improve outcomes in this prevalent inflammatory condition.
