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Background Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currently, there is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services. Objective To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou City, Anhui Province, to describe the association between patient medication behavior and patient characteristics, to explore the influencing factors of medication adjustment, and to analyze the rationality of medication use in primary hypertensive patients. Methods Using cluster sampling, from July to August 2021, 48 administrative villages were randomly selected from Jieshou City, Anhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level (2020 Edition) ", the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories: category A includes angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), category B includes beta-blockers, category C includes calcium channel blockers (CCBs), category D includes diuretics, and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study, "combination medication" refers to taking a combination drug or two or more antihypertensive drugs, and "medication adjustment" refers to patients previously taking other antihypertensive drugs. Results A total of 3, 005 hypertensive patients were included in this study, including 1 291 males (43.0%) and 1 714 females (57.0%), with an average age of (65.5±9.8) years. The medication rate of hypertension was 79.1%, and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs, the rates of different types of antihypertensive drugs from high to low were (some patients had combination medication) : category E (39.6%), category C (35.1%), category D (20.3%), category A (20.1%), and category B (3.7%) ; the most frequently taken antihypertensive drug was compound lisinopril (33.7%). For patients with an average annual blood pressure ≥160/100 mmHg, 12.2% and 4.9% still did not take antihypertensive drugs. Patients' combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure≥100 mmHg" and "with complications", the rates of adjusted category A and C antihypertensive drugs increased relatively more; for patients with an average annual "systolic pressure ≥160 mmHg" and "without complications", the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication (OR=1.042, 95%CI=1.031-1.053, P

BackgroundIncreasing cases of diabetes, a general lack of routinely operational prevention, and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians. This applies especially to village doctors who work in rural China where the majority of the nation’s vast population lives. ObjectiveThis study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes (SWAP-DM2) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care. MethodsDevelopment of SWAP-DM2 used evolutionary prototyping. The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective standardized operation procedures (SOPs) for diabetes prevention and Web-based assistance for implementing the SOPs. The resulting SOPs incorporated proven diabetes prevention practices in a synergetic way. SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling. Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment: (1) audio recordings of service encounters; (2) structured exit surveys of patients’ knowledge, self-efficacy, and satisfaction; (3) measurement of fasting glucose, body mass index, and blood pressure; and (4) qualitative interviews with doctors and patients. Data analysis included (1) descriptive statistics of patients who received SWAP-DM2–assisted prevention and those newly diagnosed with prediabetes and diabetes; (2) comparison of the variables assessed between baseline and follow-up assessment; and (3) narratives of qualitative data. ResultsThe 17 participating village doctors identified 2219 patients with elevated diabetes risk. Of these, 84.85% (1885/2219) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months. The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake (17.0%, 43/253 vs 88.7%, 205/231), calorie intake (1.6%, 4/253 vs 71.4%, 165/231), leisure-time exercises (6.3%, 16/253 vs 21.2%, 49/231), body weight (mean 62.12 kg, SD 9.85 vs mean 58.33 kg, SD 9.18), and body mass index (mean 24.80 kg/m2, SD 3.21 vs mean 23.36 kg/m2, SD 2.95). The prediabetic patients showed improvement in self-efficacy for modifying diet (mean 5.31, SD 2.81 vs mean 8.53, SD 2.25), increasing physical activities (mean 4.52, SD 3.35 vs mean 8.06, SD 2.38), engaging relatives (mean 3.93, SD 3.54 vs mean 6.93, SD 2.67), and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity. Most participating doctors and patients viewed SWAP-DM2 as useful and effective. ConclusionsSWAP-DM2 is helpful to village doctors, acceptable to patients, and effective in modifying immediate determinants of diabetes at least in the short term, and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 66772711; http://www.controlled-trials.com/ISRCTN66772711 (Archived by WebCite at http://www.webcitation.org/6OMkAqyEy).

Epidemiological studies suggest that exposure to herbicides during pregnancy might increase risk for autism spectrum disorder (ASD) in offspring. However, the precise mechanisms underlying the risk of ASD by herbicides such as glyphosate remain unclear. Soluble epoxide hydrolase (sEH) in the metabolism of polyunsaturated fatty acids is shown to play a key role in the development of ASD in offspring after maternal immune activation. Here, we found ASD-like behavioral abnormalities in juvenile offspring after maternal exposure to high levels of formulated glyphosate. Furthermore, we found higher levels of sEH in the prefrontal cortex (PFC), hippocampus, and striatum of juvenile offspring, and oxylipin analysis showed decreased levels of epoxy-fatty acids such as 8 (9)-EpETrE in the blood, PFC, hippocampus, and striatum of juvenile offspring after maternal glyphosate exposure, supporting increased activity of sEH in the offspring. Moreover, we found abnormal composition of gut microbiota and short-chain fatty acids in fecal samples of juvenile offspring after maternal glyphosate exposure. Interestingly, oral administration of TPPU (an sEH inhibitor) to pregnant mothers from E5 to P21 prevented ASD-like behaviors such as social interaction deficits and increased grooming time in the juvenile offspring after maternal glyphosate exposure. These findings suggest that maternal exposure to high levels of glyphosate causes ASD-like behavioral abnormalities and abnormal composition of gut microbiota in juvenile offspring, and that increased activity of sEH might play a role in ASD-like behaviors in offspring after maternal glyphosate exposure. Therefore, sEH may represent a target for ASD in offspring after maternal stress from occupational exposure to contaminants.

Background: Primary healthcare (PHC) plays a key role in hyperlipidemia (HL) management yet lacks adequate monitoring and feedback. This study aims at identifying pragmatic measures out from routinely collected electronic records to enable automatic monitoring and inform continuous optimization of HL-management at PHC settings. Methods: The study used randomly selected electronic records of PHC (from the province-wide data center of Anhui-province, China) as the main data source and generated both procedure-based and encounter-based measures for assessing HL-management. The procedure-based measures were derived from specific quality-facts of 21 stages/procedures (e.g., lipid lowering medication prescription) using self-designed algorithms. While the encounter-based measures included number or rate of visits for HL, currently-noticed hyperlipidemia (CNHL, or HL noticed during the current consultation), and ever-diagnosed hyperlipidemia (EDHL). Analysis of these measures employed mainly simple descriptives and linear regression modeling. Results: The study revealed interesting findings including: low and varied rates of visits for HL(from 0.01 to 1.43%) and visits by patients with EDHL/CNHL(from 0.13 to 20.54% or from 0.02 to 2.99%) between regions; large differences (5.14 to 22.20 times) between the mean or cumulative proportions of visits by patients with EDHL versus CNHL among clinician groups; consistent increase in the ratio of visits for HL in all cause visits over the study period (from 0.087 to 1.000%) accompanied with relatively stable proportions of patients with CNHL/EDHL; Relatively low scores in the procedure-based measures (ranged from 0.00 to 36.08% for specific procedures by seasons). Conclusions: The measures identified are not only feasible from real-world PHC records but also give some useful metrics about how well current HL-management is going and what future actions are needed. [ABSTRACT FROM AUTHOR]

With the aim of achieving a graded-protection braced frame structure and minimizing the excessive residual deformation of traditional metal dampers under intense seismic action, a graded-yield-type metal self-centering brace (SC-GYMB) is proposed. The brace is composed of X-shaped and U-shaped steel plates with different yield point displacements, which jointly dissipate energy. Additionally, it employs a composite disc spring as a self-centering element to provide restoring force for the brace. The brace's basic structure and working mechanism are described, and the theoretical model for its restoring force is derived. The ABAQUS finite element software (ABAQUS 2021) is utilized to investigate the hysteretic performance of the SC-GYMB under low-cycle reciprocating load, while thoroughly discussing the influence of various model parameters on its key mechanical behavior. The results demonstrate a strong agreement between the theoretical restoring force model and the numerical simulation results. The hysteretic curves of the braces exhibit a distinct "flag" characteristic, indicating excellent energy dissipation capacity and self-centering performance. Moreover, these curves display a hierarchical yield behavior that satisfies the seismic performance requirements for different intensity earthquakes. The deformation mechanism of X-shaped steel sheets transitions from bending deformation during the initial loading stage to tensile deformation in the subsequent loading stage. Increasing the initial pre-compression force of the combined disc spring enhances the restoration performance of the brace. Augmenting the thickness of X-shaped or U-shaped steel sheets modifies the displacement and load at both the first and second yield points, thereby enhancing energy dissipation capacity and bearing capacity of the brace; however, it also leads to increased residual deformation. [ABSTRACT FROM AUTHOR]

As a key step in intensive additive repair, the design of intensive repair materials immediately needs to be explored. In this work, an intensive additive repair study based on laser cladding technology was performed using a self-designed Fe20Co25Ni31Cr8Al9Ti7 high-entropy alloy (HEA) powder and three types of substrates widely used in field equipment (namely, Q235, 17CrNiMo6H, and 304 stainless steel). The results revealed that the HEA repair layer (HEA-RL) consists of a dominant FCC phase and a small amount of BCC phase, and the microstructure shows the columnar-to-equiaxed grain transition behavior. The metallurgical bonding between the HEA-RL and the three substrates has almost no defects. Compared with the three substrates, the HEA-RL has a much higher microhardness (~340 HV) and decent corrosion resistance. Therefore, the underlying mechanisms for the microstructure and performance of the HEA-RL were also discussed. This work provides a new idea for the design of intensive repair materials. [ABSTRACT FROM AUTHOR]