In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must...In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must not only be valid, appro- priate, reliable, responsive, and capable of being interpreted, but it must also be simple, fast to complete, easy to score, and provide useful clinical data. The Two-step method of choosing appropriate measures is introduced. Then through comparison of generic instruments with disease-specific instruments, we can conclude that sometimes a combination of generic and disease-specific HRQOL measures may be more appropriate for monitoring changes in a patient’s health status due to an intervention.展开更多
This article provides insight into the status of general practice in Pakistan and challenges to its health care system. The country ranked 122nd on the overall health system attainment and ranked 7th in the world on d...This article provides insight into the status of general practice in Pakistan and challenges to its health care system. The country ranked 122nd on the overall health system attainment and ranked 7th in the world on diabetes prevalence. The public sector health care system in Pakistan is encountered with many problems such as structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. The general practice status in Pakistan requires immediate attention to face the challenges created by chronic diseases in the country. Of particular mention are the patient-doctor interaction, healthcare system delivery, access to the doctors and better utilization of primary health care services.展开更多
Purpose:Strong primary health care(PHC)systems require well‐established PHC education systems to enhance the skills of general practitioners(GPs).However,the literature on the experiences of international collaborati...Purpose:Strong primary health care(PHC)systems require well‐established PHC education systems to enhance the skills of general practitioners(GPs).However,the literature on the experiences of international collaboration in primary care education in low‐and middle‐income countries remains limited.The purpose of this study was to evaluate the implementation and perceived impact of the McGill‐Tongji Blended Education Program for Teacher Leaders in General Practice(referred to as the“Tongji Program”).Methods:In 2020–2021,the McGill Department of Family Medicine(Montreal,Canada)and Tongji University School of Medicine(TUSM,Shanghai,China)jointly implemented the Tongji Program in Shanghai,China to improve the teaching capacity of PHC teachers.We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation.Quantitative(QUAN)data was collected through questionnaire surveys and qualitative(QUAL)data was collected through focus group discussions.Results:The evaluation showed that learners in Tongji Program were primarily female GPs(21/22,95%)with less than 4 years of experience in teaching(16/22,73%).This program was considered a successful learning experience by most participants(19/22,86%)with higher order learning tasks such as critical thinking and problem‐solving.They also agreed that this program helped them feel more prepared to teach(21/22,95%),and developed a positive attitude toward primary care(21/22,95%).The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization,education,and coordination.Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings,the Tongji Program successfully overcame language and technology barriers.Conclusions:Committed partnerships and contextualization were key to the success of the Tongji Program.Future research should focus on how international primary care education programs affect learners'behavior in their practice settings,and explore barriers and facilitators to change.展开更多
BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injur...BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.展开更多
BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-relate...BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.展开更多
AIM To explore primary care physicians' perspectives on possible barriers to the use of insulin.METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Me...AIM To explore primary care physicians' perspectives on possible barriers to the use of insulin.METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched(between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers' perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients' perspectives were excluded. RESULTS A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement. CONCLUSION Primary care physicians' known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.展开更多
It is challenging for general practitioners to make a more correct diagnosis with the least instrument examination. How to make an effective diagnosis has always been an issue. In order to achieve this goal, a clinica...It is challenging for general practitioners to make a more correct diagnosis with the least instrument examination. How to make an effective diagnosis has always been an issue. In order to achieve this goal, a clinical symptom-oriented modular diagnosis scheme based on the concept of the process thinking and Murtaghs General Practice was developed for general practitioners. Five key steps according to the workflow of real reception patients by a general practitioner were promulgated in this design of a modular scheme, which is in line with the actual clinical setting. This thinking concept of diagnosis should help prevent missed and erroneous diagnoses and meet the actual needs of general practitioners.展开更多
Vascular endothelial growth factor and its mimic peptide KLTWQELYQLKYKGI(QK)are widely used as the most potent angiogenic factors for the treatment of multiple ischemic diseases.However,conventional topical drug deliv...Vascular endothelial growth factor and its mimic peptide KLTWQELYQLKYKGI(QK)are widely used as the most potent angiogenic factors for the treatment of multiple ischemic diseases.However,conventional topical drug delivery often results in a burst release of the drug,leading to transient retention(inefficacy)and undesirable diffusion(toxicity)in vivo.Therefore,a drug delivery system that responds to changes in the microenvironment of tissue regeneration and controls vascular endothelial growth factor release is crucial to improve the treatment of ischemic stroke.Matrix metalloproteinase-2(MMP-2)is gradually upregulated after cerebral ischemia.Herein,vascular endothelial growth factor mimic peptide QK was self-assembled with MMP-2-cleaved peptide PLGLAG(TIMP)and customizable peptide amphiphilic(PA)molecules to construct nanofiber hydrogel PA-TIMP-QK.PA-TIMP-QK was found to control the delivery of QK by MMP-2 upregulation after cerebral ischemia/reperfusion and had a similar biological activity with vascular endothelial growth factor in vitro.The results indicated that PA-TIMP-QK promoted neuronal survival,restored local blood circulation,reduced blood-brain barrier permeability,and restored motor function.These findings suggest that the self-assembling nanofiber hydrogel PA-TIMP-QK may provide an intelligent drug delivery system that responds to the microenvironment and promotes regeneration and repair after cerebral ischemia/reperfusion injury.展开更多
BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD i...BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.展开更多
Background and Objectives:Non-Communicable Diseases(NCDs)represent a significant public health burden in China,particularly in cold regions where environmental factors further limit access to healthcare.To address thi...Background and Objectives:Non-Communicable Diseases(NCDs)represent a significant public health burden in China,particularly in cold regions where environmental factors further limit access to healthcare.To address this challenge,China has implemented the National Essential Public Health Service Package(NEPHSP)to improve NCD management through primary healthcare services.However,research on the effectiveness of NEPHSP in cold regions is limited.This study aims to identify the key factors influencing the implementation of NCD management services in cold regions,focusing on both barriers and facilitators.Methods:This qualitative study was conducted in three purposively selected cold regions in Northeast China(Harbin,Qiqihar,and Jiamusi).Data were collected through semi-structured interviews and focus group discussions,guided by the RE-AIM framework.Participants included local health administrators,primary healthcare workers,and community-dwelling individuals with NCDs.Thematic analysis was employed to code and extract key themes from the data.Results:A total of 72 participants(59.7%female,mean age 49.1±6.24 years)took part in the study.Major barriers to NCD management included low health literacy,limited awareness of NCDs,insufficient medical resources,poor public awareness,inadequate multisectoral collaboration,and the absence of effective audit and feedback systems.Key facilitators included the affordability and accessibility of primary healthcare services,strong patient-physician relationships,and the high priority given to NCD management by local governments.Furthermore,harsh environmental conditions and limited healthcare accessibility in cold regions complicated the management of NCDs,highlighting the need for tailored interventions that address the specific challenges of these regions.Conclusion:This study identifies significant facilitators and barriers to the implementation of NCD management services under the NEPHSP in cold regions of China.The unique challenges posed by cold climates necessitate the adaptation of healthcare services to local needs,with a focus on improving health literacy,enhancing healthcare infrastructure,and fostering multisectoral collaboration.These findings provide valuable insights for optimizing NCD prevention and management strategies within China's primary healthcare system.展开更多
The intersection of cannabis use disorder(CUD)and critical illness outcomes in cancer patients represents a burgeoning area of research,particularly as cannabis legalization and therapeutic applications expand globall...The intersection of cannabis use disorder(CUD)and critical illness outcomes in cancer patients represents a burgeoning area of research,particularly as cannabis legalization and therapeutic applications expand globally.Adjusted analyses of a retrospective cohort study by Sager et al revealed significantly lower odds of allcause mortality(adjusted odds ratio(aOR)=0.83)and respiratory failure(aOR=0.8)in CUD-positive patients,alongside elevated hospitalization costs.These findings suggest the potential immunomodulatory and organ-protective effects of cannabinoids on sepsis.Future research must prioritize mechanistic studies,prospective clinical trials,and socioeconomic interventions to translate these findings into actionable clinical strategies,to align policy recommendations with guidelines,including those presented by the National Comprehensive Cancer Network.展开更多
BACKGROUND Primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL),the most prevalent extranodal non-Hodgkin lymphoma,poses significant diagnostic and therapeutic challenges due to its non-specific symptoms ...BACKGROUND Primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL),the most prevalent extranodal non-Hodgkin lymphoma,poses significant diagnostic and therapeutic challenges due to its non-specific symptoms and poor prognosis.AIM To develop and validate a risk model for the early identification of PGI-DLBCL using Least Absolute Shrinkage and Selection-Cox regression,with the aim of guiding clinical decision-making.METHODS The clinical data of patients diagnosed with PGI-DLBCL at the Tumor Hospital Affiliated to Xinjiang Medical University were analyzed retrospectively from January 2010 to April 2022.RESULTS A total of 319 patients with PGI-DLBCL were included and divided into training(n=223)and validation(n=96)cohorts.The median age was 55 years,with 48.9%male and 51.1%female patients.Key clinical features included Eastern Cooperative Oncology Group performance status≥2(40.8%),advanced-stage disease(stage IV:27.6%),extranodal involvement≥2 sites(47%),tumor>5 cm(46.1%),elevated beta-2 microglobulin(50.5%),elevated lactate dehydrogenase(27%),high International Prognostic Index(3-5:69.9%),non-germinal center B-cell-like subtype(59.9%),and B symptoms(55.8%).Immunohistochemical analysis showed frequent expression of CD10(51.1%),B-cell lymphoma 6(53.3%),multiple myeloma oncogene 1(40.1%),Bcell lymphoma 2(49.2%),myelocytomatosis viral oncogene homolog(48.3%),Ki-67(67.1%),and CD5(42.6%);Epstein-Barr virus-encoded RNA was positive in 3.1%.Based on Least Absolute Shrinkage and Selection regression and subsequent univariate and multivariate Cox regression analyses,extranodal sites≥2,B symptoms,mixed lesion type,and negative multiple myeloma oncogene 1 expression were identified as independent risk factors for PGI-DLBCL.The risk model stratified patients into high-and low-risk groups with significantly different overall survival(P<0.05).Area under the curve values for 1-,3-,and 5-year overall survival were 0.625,0.663,and 0.723 in the training cohort,with consistent performance in the validation cohort.Decision curve analysis indicated favorable clinical utility.CONCLUSION PGI-DLBCL in our cohort showed distinctive clinical features and a predominance of the non-germinal center Bcell-like subtype.Decision curve analysis confirmed the clinical applicability of our prognostic model.Although molecular biomarkers will be needed to improve predictive precision,our model offers a practical tool for early risk identification and individualized management in clinical practice.展开更多
Objective:To explore the application effect of Problem-Based Learning(PBL)teaching method based on situational simulation videos in undergraduate teaching of internal medicine,and to provide practical basis for optimi...Objective:To explore the application effect of Problem-Based Learning(PBL)teaching method based on situational simulation videos in undergraduate teaching of internal medicine,and to provide practical basis for optimizing the undergraduate teaching mode of internal medicine and improving teaching quality.Methods:A total of 32 undergraduate students majoring in clinical medicine(Grade 2021)from Shanghai University of Medicine&Health Sciences were selected as the research subjects.They were divided into an experimental group and a control group by random number table method,with 16 students in each group.The control group adopted the traditional PBL teaching method,while the experimental group used the PBL teaching method based on situational simulation videos.After the teaching,the mastery of theoretical knowledge of students in the two groups was evaluated by examinations;a questionnaire survey was conducted to assess students’self-perceived improvement in clinical thinking,learning interest,self-directed learning ability and teamwork ability;statistical methods were used to analyze the data.Results:The scores of theoretical knowledge examination of students in the experimental group were significantly higher than those in the control group,and the difference was statistically significant(p<0.05).In terms of self-evaluation,the experimental group showed better performance than the control group in the cultivation of clinical thinking,learning interest and selfdirected learning ability,with statistically significant differences(p<0.05);however,there was no statistically significant difference in the self-evaluation of teamwork ability between the two groups(p>0.05).Conclusion:The PBL teaching method based on situational simulation videos can effectively improve students’level of theoretical knowledge,enhance their clinical thinking,learning interest and self-directed learning ability in undergraduate teaching of internal medicine,and is worthy of further promotion and application in undergraduate teaching of internal medicine.展开更多
Objective:To analyze the risk of osteoporosis among middle-aged men in the cold regions of China(Heilongjiang Province)and provide theoretical support for the early identification of high-risk populations.Methods:Bone...Objective:To analyze the risk of osteoporosis among middle-aged men in the cold regions of China(Heilongjiang Province)and provide theoretical support for the early identification of high-risk populations.Methods:Bone mineral density(BMD)data were collected from male subjects aged 50-65 who met the inclusion criteria at the physical examination center of a hospital in Harbin between August to December 2022.General clinical data and dietary information were obtained through face-to-face interviews using a dietary questionnaire survey.Results:The prevalence of osteoporosis and osteopenia was 14.38%and 52.06%,respectively,while normal bone mass accounted for 33.56%.Significant differences were observed among groups in smoking habits,sunlight exposure,exercise levels,and dietary patterns at each bone mass level.The BMD of the lumbar spine,femoral neck,and hip showed a negative correlation with the Dietary Inflammatory Index(DII)score.Multivariate logistic regression analysis revealed that smoking and a diet high in oil and salt were positively associated with the risk of osteoporosis.A pro-inflammatory diet was also positively correlated with osteoporosis risk,with individuals in this group being 7.723 times more likely to develop osteoporosis compared to those in the anti-inflammatory diet group.Conclusion:The high prevalence of osteoporosis and osteopenia observed in this study highlighted that osteoporosis is a significant and pressing issue among middle-aged men.Smoking,limited sunlight exposure,reduced physical activity,diets high in oil and salt,and pro-inflammatory diets were identified as major risk factors for bone loss.These factors are closely linked to the geography,climate,and cultural practices of cold regions in China.Primary healthcare in this region should focus on the screening and prevention of osteoporosis in middle-aged men by promoting smoking cessation,increased sunlight exposure,adequate vitamin D supplementation,regular physical activity,and adherence to a healthy diet to maintain bone health.展开更多
Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifes...Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.展开更多
Background:Small ubiquitin-like modifier(SUMO)-specific proteases(SENPs)cleave the isopeptidic bond between SUMO1/2/3 and protein substrates,thus regulating the structure,activity,and lifetime of a variety of proteins...Background:Small ubiquitin-like modifier(SUMO)-specific proteases(SENPs)cleave the isopeptidic bond between SUMO1/2/3 and protein substrates,thus regulating the structure,activity,and lifetime of a variety of proteins.Recently,accumulating evidence has suggested that SENPs play a role in the initiation and progression of human cancers.Nevertheless,the potential role of the SENP family of proteins in liver cancer has yet to be fully elucidated.Methods:This study conducted a comprehensive bioinformatics analysis of the SENP family in liver cancer,including differential expression profiling,survival analysis,mutation and copy number variations(CNVs)assessment,immune infiltration and drug sensitivity correlation,functional enrichment analyses using data from The Cancer Genome Atlas(TCGA),Clinical Proteomic Tumor Analysis Consortium(CPTAC),LinkedOmics,and other public databases.Furthermore,we performed in vitro experiments using Huh-7 and Hep-3B cell lines to investigate the functional roles of SENP1 and SENP3 in hepatocellular carcinoma cell proliferation,colony formation,and migration.Results:Our results indicated that SENP1,3,and 7 were significantly overexpressed in liver hepatocellular carcinoma(LIHC).Elevated expressions of SENP1,3,and 7 are positively correlated with poor overall survival(OS)in LIHC patients.In addition,SENP1,3,and 7 expressions are related to immune infiltration and drug sensitivity.SENP1,3,and 7 co-expressed genes were enriched in mitochondrial function,ribosomal translation,and cell cycle control.Conclusion:SENP1,3,and 7 are prognostic biomarkers and potential therapeutic targets for LIHC.Knockdown of SENP1 and SENP3 inhibited the proliferation,clonogenicity,and migration of hepatocellular carcinoma cells.展开更多
Objective:Effective Chronic Kidney Disease(CKD)management is particularly important in cold regions of China,where climate and lifestyle factors play significant roles.However,there is a lack of relevant studies in th...Objective:Effective Chronic Kidney Disease(CKD)management is particularly important in cold regions of China,where climate and lifestyle factors play significant roles.However,there is a lack of relevant studies in this area.Therefore,the purpose of this study was:(1)to assess the status of self-management capacity in individuals with CKD in cold regions of China and analyze the factors influencing it;(2)to identify strategies to improve CKD management in primary care settings in these regions;and(3)to understand patients'attitudes toward eHealth services.Methods:This was a regional,cross-sectional observational study.A questionnaire measuring CKD patients'self-management abilities was derived from the Perceived Kidney Disease Self-Management Scale,the Kidney Disease Behavioral Inventory(KDBI),and the Health Literacy Questionnaire.Data were collected from hospitalized CKD patients in Heilongjiang Province and analyzed using One-Way Analysis of Variance(ANOVA),Hierarchical Regression Analysis,and K-prototype cluster analysis.Results:A total of 957 participants were tested.Of these,70.64%had less than a bachelor's degree,and 56.27%had been diagnosed with hypertensive or diabetic nephropathy.The KDBI scale showed a lower overall score compared to the PKDSMS.Factors such as CKD stage 4(F=2.367,P=0.042),last year's medical expenses(F=3.974,P=0.004),and poor self-rated health(F=33.352,P<0.01)were found to influence scores on both scales.The health literacy questionnaire revealed significant differences(P<0.01)in health knowledge,except by sex.Additionally,healthcare expenditures and poor self-rated health were negatively associated with self-management capacity.Conclusion:This study provides valuable insights into the self-management challenges faced by CKD patients in cold regions of China.Despite some difficulties in improving self-management,patients showed positive attitudes toward enhancing CKD management services in primary care and developing digital management tools.These findings offer useful references and recommendations for future clinical practice and research in this field.展开更多
BACKGROUND Signet ring cell carcinoma originating from the appendix is extremely rare,and the lack of specific clinical symptoms and imaging features makes preoperative diagnosis particularly challenging.CASE SUMMARY ...BACKGROUND Signet ring cell carcinoma originating from the appendix is extremely rare,and the lack of specific clinical symptoms and imaging features makes preoperative diagnosis particularly challenging.CASE SUMMARY We report a case of a 49-year-old woman who presented with irregular vaginal bleeding lasting more than five months.Computed tomography(CT)and magnetic resonance imaging(MRI)revealed an enlarged appendix with a thickened wall and progressive enhancement after contrast administration.The uterine myometrium and cervix were markedly thickened,with heterogeneous density and signal intensity,along with progressive enhancement.The uterine serosal surface remained intact.Preoperative MRI suggested diffuse uterine adenomyosis;however,postoperative histopathology confirmed Signet ring cell carcinoma originating from the appendix with implantation involving the entire uterus.CONCLUSION Imaging showed appendiceal wall thickening and marked thickening of the uterine myometrium,with lesions demonstrating progressive enhancement after contrast administration.These findings should raise suspicion for the implantation of Signet ring cell carcinoma originating from the appendix and involving the uterus.Signet ring cell carcinoma originating from the appendix is relatively rare,and its imaging features are seldom reported,making preoperative diagnosis extremely challenging.This study retrospectively analyzes a case of Signet ring cell carcinoma originating from the appendix with implantation involving the entire uterus.The imaging characteristics of the appendix and the uterus were evaluated using CT and MRI to enhance awareness of this disease.展开更多
Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesio...Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesions remain unclear.Long non-coding RNAs(lnc RNAs)have been shown to influence the occurrence and development of these lesions.We previously identified lnc_011797 as a biomarker of white matter lesions by high-throughput sequencing.To investigate the mechanism by which lnc_011797 regulates white matter lesions,we established subjected human umbilical vein endothelial cells to oxygenglucose deprivation to simulate conditions associated with white matter lesions.The cells were transfected with lnc_011797 overexpression or knockdown lentiviruses.Our findings indicate that lnc_011797 promoted ferroptosis in these cells,leading to the formation of white matter lesions.Furthermore,lnc_011797 functioned as a competitive endogenous RNA(ce RNA)for mi R-193b-3p,thereby regulating the expression of WNK1 and its downstream ferroptosis-related proteins.To validate the role of lnc_011797 in vivo,we established a mouse model of white matter lesions through bilateral common carotid artery stenosis.The results from this model confirmed that lnc_011797 regulates ferroptosis via WNK1 and promotes the development of white matter lesions.These findings clarify the mechanism by which lnc RNAs regulate white matter lesions,providing a new target for the diagnosis and treatment of white matter lesions.展开更多
AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 pat...AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.RESULTS A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period. CONCLUSION ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.展开更多
文摘In more recent times, health-related quality of life (HRQOL) measurements have formed an important part of as- sessing the quality of routine care in general practice. For a measure to have clinical usefulness it must not only be valid, appro- priate, reliable, responsive, and capable of being interpreted, but it must also be simple, fast to complete, easy to score, and provide useful clinical data. The Two-step method of choosing appropriate measures is introduced. Then through comparison of generic instruments with disease-specific instruments, we can conclude that sometimes a combination of generic and disease-specific HRQOL measures may be more appropriate for monitoring changes in a patient’s health status due to an intervention.
文摘This article provides insight into the status of general practice in Pakistan and challenges to its health care system. The country ranked 122nd on the overall health system attainment and ranked 7th in the world on diabetes prevalence. The public sector health care system in Pakistan is encountered with many problems such as structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. The general practice status in Pakistan requires immediate attention to face the challenges created by chronic diseases in the country. Of particular mention are the patient-doctor interaction, healthcare system delivery, access to the doctors and better utilization of primary health care services.
基金China Scholarship Council,Grant/Award Number:202000610047McGill University+4 种基金Fonds de recherche du Québec–Santé,Grant/Award Number:315852Québec Ministry of HealthCanadian Institutes for Health Research,Strategy for Patient‐Oriented Research Mentorship ChairGlobal Health Scholars ProgramFonds de recherche du Québec‐Santé,Grant/Award Number:311200。
文摘Purpose:Strong primary health care(PHC)systems require well‐established PHC education systems to enhance the skills of general practitioners(GPs).However,the literature on the experiences of international collaboration in primary care education in low‐and middle‐income countries remains limited.The purpose of this study was to evaluate the implementation and perceived impact of the McGill‐Tongji Blended Education Program for Teacher Leaders in General Practice(referred to as the“Tongji Program”).Methods:In 2020–2021,the McGill Department of Family Medicine(Montreal,Canada)and Tongji University School of Medicine(TUSM,Shanghai,China)jointly implemented the Tongji Program in Shanghai,China to improve the teaching capacity of PHC teachers.We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation.Quantitative(QUAN)data was collected through questionnaire surveys and qualitative(QUAL)data was collected through focus group discussions.Results:The evaluation showed that learners in Tongji Program were primarily female GPs(21/22,95%)with less than 4 years of experience in teaching(16/22,73%).This program was considered a successful learning experience by most participants(19/22,86%)with higher order learning tasks such as critical thinking and problem‐solving.They also agreed that this program helped them feel more prepared to teach(21/22,95%),and developed a positive attitude toward primary care(21/22,95%).The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization,education,and coordination.Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings,the Tongji Program successfully overcame language and technology barriers.Conclusions:Committed partnerships and contextualization were key to the success of the Tongji Program.Future research should focus on how international primary care education programs affect learners'behavior in their practice settings,and explore barriers and facilitators to change.
文摘BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.
基金supported by a grant from the National Scientific and Technological Major Project of China(2013ZX10004904-001-005)
文摘BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.
文摘AIM To explore primary care physicians' perspectives on possible barriers to the use of insulin.METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched(between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers' perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients' perspectives were excluded. RESULTS A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement. CONCLUSION Primary care physicians' known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.
文摘It is challenging for general practitioners to make a more correct diagnosis with the least instrument examination. How to make an effective diagnosis has always been an issue. In order to achieve this goal, a clinical symptom-oriented modular diagnosis scheme based on the concept of the process thinking and Murtaghs General Practice was developed for general practitioners. Five key steps according to the workflow of real reception patients by a general practitioner were promulgated in this design of a modular scheme, which is in line with the actual clinical setting. This thinking concept of diagnosis should help prevent missed and erroneous diagnoses and meet the actual needs of general practitioners.
基金supported by the Natural Science Foundation of Shandong Province,No.ZR2023MC168the National Natural Science Foundation of China,No.31670989the Key R&D Program of Shandong Province,No.2019GSF107037(all to CS).
文摘Vascular endothelial growth factor and its mimic peptide KLTWQELYQLKYKGI(QK)are widely used as the most potent angiogenic factors for the treatment of multiple ischemic diseases.However,conventional topical drug delivery often results in a burst release of the drug,leading to transient retention(inefficacy)and undesirable diffusion(toxicity)in vivo.Therefore,a drug delivery system that responds to changes in the microenvironment of tissue regeneration and controls vascular endothelial growth factor release is crucial to improve the treatment of ischemic stroke.Matrix metalloproteinase-2(MMP-2)is gradually upregulated after cerebral ischemia.Herein,vascular endothelial growth factor mimic peptide QK was self-assembled with MMP-2-cleaved peptide PLGLAG(TIMP)and customizable peptide amphiphilic(PA)molecules to construct nanofiber hydrogel PA-TIMP-QK.PA-TIMP-QK was found to control the delivery of QK by MMP-2 upregulation after cerebral ischemia/reperfusion and had a similar biological activity with vascular endothelial growth factor in vitro.The results indicated that PA-TIMP-QK promoted neuronal survival,restored local blood circulation,reduced blood-brain barrier permeability,and restored motor function.These findings suggest that the self-assembling nanofiber hydrogel PA-TIMP-QK may provide an intelligent drug delivery system that responds to the microenvironment and promotes regeneration and repair after cerebral ischemia/reperfusion injury.
基金Supported by National Key Research and Development Program of China,No.2022YFC3600903Key Discipline Project under Shanghai's Three-Year Action Plan for Strengthening the Public Health System(2023-2025),No.GWVI-11.1-44.
文摘BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.
文摘Background and Objectives:Non-Communicable Diseases(NCDs)represent a significant public health burden in China,particularly in cold regions where environmental factors further limit access to healthcare.To address this challenge,China has implemented the National Essential Public Health Service Package(NEPHSP)to improve NCD management through primary healthcare services.However,research on the effectiveness of NEPHSP in cold regions is limited.This study aims to identify the key factors influencing the implementation of NCD management services in cold regions,focusing on both barriers and facilitators.Methods:This qualitative study was conducted in three purposively selected cold regions in Northeast China(Harbin,Qiqihar,and Jiamusi).Data were collected through semi-structured interviews and focus group discussions,guided by the RE-AIM framework.Participants included local health administrators,primary healthcare workers,and community-dwelling individuals with NCDs.Thematic analysis was employed to code and extract key themes from the data.Results:A total of 72 participants(59.7%female,mean age 49.1±6.24 years)took part in the study.Major barriers to NCD management included low health literacy,limited awareness of NCDs,insufficient medical resources,poor public awareness,inadequate multisectoral collaboration,and the absence of effective audit and feedback systems.Key facilitators included the affordability and accessibility of primary healthcare services,strong patient-physician relationships,and the high priority given to NCD management by local governments.Furthermore,harsh environmental conditions and limited healthcare accessibility in cold regions complicated the management of NCDs,highlighting the need for tailored interventions that address the specific challenges of these regions.Conclusion:This study identifies significant facilitators and barriers to the implementation of NCD management services under the NEPHSP in cold regions of China.The unique challenges posed by cold climates necessitate the adaptation of healthcare services to local needs,with a focus on improving health literacy,enhancing healthcare infrastructure,and fostering multisectoral collaboration.These findings provide valuable insights for optimizing NCD prevention and management strategies within China's primary healthcare system.
基金Supported by the Scientific Research Fund of Hangzhou Health Department,China,No.A20251639.
文摘The intersection of cannabis use disorder(CUD)and critical illness outcomes in cancer patients represents a burgeoning area of research,particularly as cannabis legalization and therapeutic applications expand globally.Adjusted analyses of a retrospective cohort study by Sager et al revealed significantly lower odds of allcause mortality(adjusted odds ratio(aOR)=0.83)and respiratory failure(aOR=0.8)in CUD-positive patients,alongside elevated hospitalization costs.These findings suggest the potential immunomodulatory and organ-protective effects of cannabinoids on sepsis.Future research must prioritize mechanistic studies,prospective clinical trials,and socioeconomic interventions to translate these findings into actionable clinical strategies,to align policy recommendations with guidelines,including those presented by the National Comprehensive Cancer Network.
基金Supported by the Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01D21“Tianshan Talents”Cultivation Program of Xinjiang Uygur Autonomous Region,No.2024TSYCLJ0025National Natural Science Foundation of China,No.82360037.
文摘BACKGROUND Primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL),the most prevalent extranodal non-Hodgkin lymphoma,poses significant diagnostic and therapeutic challenges due to its non-specific symptoms and poor prognosis.AIM To develop and validate a risk model for the early identification of PGI-DLBCL using Least Absolute Shrinkage and Selection-Cox regression,with the aim of guiding clinical decision-making.METHODS The clinical data of patients diagnosed with PGI-DLBCL at the Tumor Hospital Affiliated to Xinjiang Medical University were analyzed retrospectively from January 2010 to April 2022.RESULTS A total of 319 patients with PGI-DLBCL were included and divided into training(n=223)and validation(n=96)cohorts.The median age was 55 years,with 48.9%male and 51.1%female patients.Key clinical features included Eastern Cooperative Oncology Group performance status≥2(40.8%),advanced-stage disease(stage IV:27.6%),extranodal involvement≥2 sites(47%),tumor>5 cm(46.1%),elevated beta-2 microglobulin(50.5%),elevated lactate dehydrogenase(27%),high International Prognostic Index(3-5:69.9%),non-germinal center B-cell-like subtype(59.9%),and B symptoms(55.8%).Immunohistochemical analysis showed frequent expression of CD10(51.1%),B-cell lymphoma 6(53.3%),multiple myeloma oncogene 1(40.1%),Bcell lymphoma 2(49.2%),myelocytomatosis viral oncogene homolog(48.3%),Ki-67(67.1%),and CD5(42.6%);Epstein-Barr virus-encoded RNA was positive in 3.1%.Based on Least Absolute Shrinkage and Selection regression and subsequent univariate and multivariate Cox regression analyses,extranodal sites≥2,B symptoms,mixed lesion type,and negative multiple myeloma oncogene 1 expression were identified as independent risk factors for PGI-DLBCL.The risk model stratified patients into high-and low-risk groups with significantly different overall survival(P<0.05).Area under the curve values for 1-,3-,and 5-year overall survival were 0.625,0.663,and 0.723 in the training cohort,with consistent performance in the validation cohort.Decision curve analysis indicated favorable clinical utility.CONCLUSION PGI-DLBCL in our cohort showed distinctive clinical features and a predominance of the non-germinal center Bcell-like subtype.Decision curve analysis confirmed the clinical applicability of our prognostic model.Although molecular biomarkers will be needed to improve predictive precision,our model offers a practical tool for early risk identification and individualized management in clinical practice.
基金Teacher Teaching and Educational Research Project of Shanghai University of Medicine and Health Sciences in 2024(Project No.:CFDY20240035)。
文摘Objective:To explore the application effect of Problem-Based Learning(PBL)teaching method based on situational simulation videos in undergraduate teaching of internal medicine,and to provide practical basis for optimizing the undergraduate teaching mode of internal medicine and improving teaching quality.Methods:A total of 32 undergraduate students majoring in clinical medicine(Grade 2021)from Shanghai University of Medicine&Health Sciences were selected as the research subjects.They were divided into an experimental group and a control group by random number table method,with 16 students in each group.The control group adopted the traditional PBL teaching method,while the experimental group used the PBL teaching method based on situational simulation videos.After the teaching,the mastery of theoretical knowledge of students in the two groups was evaluated by examinations;a questionnaire survey was conducted to assess students’self-perceived improvement in clinical thinking,learning interest,self-directed learning ability and teamwork ability;statistical methods were used to analyze the data.Results:The scores of theoretical knowledge examination of students in the experimental group were significantly higher than those in the control group,and the difference was statistically significant(p<0.05).In terms of self-evaluation,the experimental group showed better performance than the control group in the cultivation of clinical thinking,learning interest and selfdirected learning ability,with statistically significant differences(p<0.05);however,there was no statistically significant difference in the self-evaluation of teamwork ability between the two groups(p>0.05).Conclusion:The PBL teaching method based on situational simulation videos can effectively improve students’level of theoretical knowledge,enhance their clinical thinking,learning interest and self-directed learning ability in undergraduate teaching of internal medicine,and is worthy of further promotion and application in undergraduate teaching of internal medicine.
文摘Objective:To analyze the risk of osteoporosis among middle-aged men in the cold regions of China(Heilongjiang Province)and provide theoretical support for the early identification of high-risk populations.Methods:Bone mineral density(BMD)data were collected from male subjects aged 50-65 who met the inclusion criteria at the physical examination center of a hospital in Harbin between August to December 2022.General clinical data and dietary information were obtained through face-to-face interviews using a dietary questionnaire survey.Results:The prevalence of osteoporosis and osteopenia was 14.38%and 52.06%,respectively,while normal bone mass accounted for 33.56%.Significant differences were observed among groups in smoking habits,sunlight exposure,exercise levels,and dietary patterns at each bone mass level.The BMD of the lumbar spine,femoral neck,and hip showed a negative correlation with the Dietary Inflammatory Index(DII)score.Multivariate logistic regression analysis revealed that smoking and a diet high in oil and salt were positively associated with the risk of osteoporosis.A pro-inflammatory diet was also positively correlated with osteoporosis risk,with individuals in this group being 7.723 times more likely to develop osteoporosis compared to those in the anti-inflammatory diet group.Conclusion:The high prevalence of osteoporosis and osteopenia observed in this study highlighted that osteoporosis is a significant and pressing issue among middle-aged men.Smoking,limited sunlight exposure,reduced physical activity,diets high in oil and salt,and pro-inflammatory diets were identified as major risk factors for bone loss.These factors are closely linked to the geography,climate,and cultural practices of cold regions in China.Primary healthcare in this region should focus on the screening and prevention of osteoporosis in middle-aged men by promoting smoking cessation,increased sunlight exposure,adequate vitamin D supplementation,regular physical activity,and adherence to a healthy diet to maintain bone health.
文摘Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.32070616 and 82170794).
文摘Background:Small ubiquitin-like modifier(SUMO)-specific proteases(SENPs)cleave the isopeptidic bond between SUMO1/2/3 and protein substrates,thus regulating the structure,activity,and lifetime of a variety of proteins.Recently,accumulating evidence has suggested that SENPs play a role in the initiation and progression of human cancers.Nevertheless,the potential role of the SENP family of proteins in liver cancer has yet to be fully elucidated.Methods:This study conducted a comprehensive bioinformatics analysis of the SENP family in liver cancer,including differential expression profiling,survival analysis,mutation and copy number variations(CNVs)assessment,immune infiltration and drug sensitivity correlation,functional enrichment analyses using data from The Cancer Genome Atlas(TCGA),Clinical Proteomic Tumor Analysis Consortium(CPTAC),LinkedOmics,and other public databases.Furthermore,we performed in vitro experiments using Huh-7 and Hep-3B cell lines to investigate the functional roles of SENP1 and SENP3 in hepatocellular carcinoma cell proliferation,colony formation,and migration.Results:Our results indicated that SENP1,3,and 7 were significantly overexpressed in liver hepatocellular carcinoma(LIHC).Elevated expressions of SENP1,3,and 7 are positively correlated with poor overall survival(OS)in LIHC patients.In addition,SENP1,3,and 7 expressions are related to immune infiltration and drug sensitivity.SENP1,3,and 7 co-expressed genes were enriched in mitochondrial function,ribosomal translation,and cell cycle control.Conclusion:SENP1,3,and 7 are prognostic biomarkers and potential therapeutic targets for LIHC.Knockdown of SENP1 and SENP3 inhibited the proliferation,clonogenicity,and migration of hepatocellular carcinoma cells.
基金supported by the Natural Science Foundation of China(7247042122)the Key Research and Development Project of Heilongjiang Province,China(2024ZX12C06).
文摘Objective:Effective Chronic Kidney Disease(CKD)management is particularly important in cold regions of China,where climate and lifestyle factors play significant roles.However,there is a lack of relevant studies in this area.Therefore,the purpose of this study was:(1)to assess the status of self-management capacity in individuals with CKD in cold regions of China and analyze the factors influencing it;(2)to identify strategies to improve CKD management in primary care settings in these regions;and(3)to understand patients'attitudes toward eHealth services.Methods:This was a regional,cross-sectional observational study.A questionnaire measuring CKD patients'self-management abilities was derived from the Perceived Kidney Disease Self-Management Scale,the Kidney Disease Behavioral Inventory(KDBI),and the Health Literacy Questionnaire.Data were collected from hospitalized CKD patients in Heilongjiang Province and analyzed using One-Way Analysis of Variance(ANOVA),Hierarchical Regression Analysis,and K-prototype cluster analysis.Results:A total of 957 participants were tested.Of these,70.64%had less than a bachelor's degree,and 56.27%had been diagnosed with hypertensive or diabetic nephropathy.The KDBI scale showed a lower overall score compared to the PKDSMS.Factors such as CKD stage 4(F=2.367,P=0.042),last year's medical expenses(F=3.974,P=0.004),and poor self-rated health(F=33.352,P<0.01)were found to influence scores on both scales.The health literacy questionnaire revealed significant differences(P<0.01)in health knowledge,except by sex.Additionally,healthcare expenditures and poor self-rated health were negatively associated with self-management capacity.Conclusion:This study provides valuable insights into the self-management challenges faced by CKD patients in cold regions of China.Despite some difficulties in improving self-management,patients showed positive attitudes toward enhancing CKD management services in primary care and developing digital management tools.These findings offer useful references and recommendations for future clinical practice and research in this field.
文摘BACKGROUND Signet ring cell carcinoma originating from the appendix is extremely rare,and the lack of specific clinical symptoms and imaging features makes preoperative diagnosis particularly challenging.CASE SUMMARY We report a case of a 49-year-old woman who presented with irregular vaginal bleeding lasting more than five months.Computed tomography(CT)and magnetic resonance imaging(MRI)revealed an enlarged appendix with a thickened wall and progressive enhancement after contrast administration.The uterine myometrium and cervix were markedly thickened,with heterogeneous density and signal intensity,along with progressive enhancement.The uterine serosal surface remained intact.Preoperative MRI suggested diffuse uterine adenomyosis;however,postoperative histopathology confirmed Signet ring cell carcinoma originating from the appendix with implantation involving the entire uterus.CONCLUSION Imaging showed appendiceal wall thickening and marked thickening of the uterine myometrium,with lesions demonstrating progressive enhancement after contrast administration.These findings should raise suspicion for the implantation of Signet ring cell carcinoma originating from the appendix and involving the uterus.Signet ring cell carcinoma originating from the appendix is relatively rare,and its imaging features are seldom reported,making preoperative diagnosis extremely challenging.This study retrospectively analyzes a case of Signet ring cell carcinoma originating from the appendix with implantation involving the entire uterus.The imaging characteristics of the appendix and the uterus were evaluated using CT and MRI to enhance awareness of this disease.
基金supported by the Qingdao Medical Health Research Project,No.2023-WJZD212(to XX)。
文摘Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesions remain unclear.Long non-coding RNAs(lnc RNAs)have been shown to influence the occurrence and development of these lesions.We previously identified lnc_011797 as a biomarker of white matter lesions by high-throughput sequencing.To investigate the mechanism by which lnc_011797 regulates white matter lesions,we established subjected human umbilical vein endothelial cells to oxygenglucose deprivation to simulate conditions associated with white matter lesions.The cells were transfected with lnc_011797 overexpression or knockdown lentiviruses.Our findings indicate that lnc_011797 promoted ferroptosis in these cells,leading to the formation of white matter lesions.Furthermore,lnc_011797 functioned as a competitive endogenous RNA(ce RNA)for mi R-193b-3p,thereby regulating the expression of WNK1 and its downstream ferroptosis-related proteins.To validate the role of lnc_011797 in vivo,we established a mouse model of white matter lesions through bilateral common carotid artery stenosis.The results from this model confirmed that lnc_011797 regulates ferroptosis via WNK1 and promotes the development of white matter lesions.These findings clarify the mechanism by which lnc RNAs regulate white matter lesions,providing a new target for the diagnosis and treatment of white matter lesions.
基金Supported by the Science and Technology Department of Sichuan Province for Scientific Research,No.2015SZ0123
文摘AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.RESULTS A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period. CONCLUSION ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.
