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1. Correlation of Blood Glucose Variability with Infarct Burden and Cognitive Impairment in Patients with Type 2 Diabetes Mellitus Complicated with Recent Small Subcortical Infarct

Author

MENG Qizhe, XI Zhi, WANG Ming, WANG Yang, YANG Xiaopeng

Subjects
diabetes mellitus, type 2, recent small subcortical infarct, glucose variability, cerebral small vessel diseases, infarction burden, cognition disorders, nomograms, Medicine
Abstract

Background Recent small subcortical infarct (RSSI) is one of the manifestations of lacunar infarction. It is a common brain disease and can lead to the clinical outcome of disability or dementia in many patients. However, the relationship of infarction burden and cognitive impairment with blood glucose fluctuation in type 2 diabetes mellitus (T2DM) patients with RSSI is not very clear. Objective To explore the correlation of blood glucose variability (GV) with infarction burden and cognitive impairment in T2DM patients with RSSI, and based on this, to build a risk prediction model. Methods A total of 140 patients with T2DM and RSSI who were treated in the Second Affiliated Hospital of Zhengzhou University from January 2021 to June 2022 were retrospectively selected. The basic clinical data of the patients were collected. The 72-hour continuous blood glucose monitoring was performed. The infarct burden was evaluated by the magnetic resonance imaging performance (the study subjects were divided into the high infarction burden group including 45 cases and the low infarction burden group including 95 cases according to the imaging performance). The cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Spearman correlation analysis was used to explore the correlation between GV and cognitive function (MoCA score). Multivariate Logistic regression analysis was used to explore the influencing factors of infarction burden and cognitive dysfunction in T2DM patients with RSSI. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of GV on cognitive impairment in T2DM patients with RSSI, and the nomogram predictive model was constructed and the predictive value was analyzed. Results In terms of GV-related indicators, the high infarction burden group had higher standard deviation (SD) and percentage of coefficient of variation (%CV) and lower time in range (TIR) than the low infarction burden group, with statistically significant differences (P

Published
2023
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2. Ten-year Development of General Practice in China：Opportunities and Challenges

Author

YANG Hui, HAN Jianjun, XU Yanli, GAO Xiaohuan, WANG Yang, YANG Yunli, CAO Xinyang

Subjects
general practice, general practitioners, industry report, outcome and process assessment, health care, health policy, health manpower, health expenditure, Medicine
Abstract

ObjectiveTo review the strengths and limitations of the development of general practice in China during the last decade (2010—2020) and to assess the opportunities and challenges for its future development.MethodsData were collected from statistic reports, journal articles and official policies and guidelines regarding general practice development in China from 2010—2020. Donabedian model was applied to examine and assess the quality of essential general practice services in China. SWOT analysis was used to identify internal and external determinants of general practice development in China.Results(1) Structural quality of general practice: the ten-year policies about general practice development were a continuation of the past relevant policies in essence but with developments, with highlights on continuous construction of general practice workforce and discipline, tiered diagnosis and treatment and regional medical consortium, but relevant fiscal and management policies still need improvements. The number of general medical workers has increased rapidly, while the lion's share of them are still allocated at tertiary hospitals. Full-time equivalent is suggested to be used to predict the staffing and assess the performance of these workers. The number of community health centres showed a steady increase, but its growth rate was still slower than that of hospital facilities. Relevant health economics data need to be further supplemented. (2) Process quality of general practice: in 2020, there were 2.045 billion visits in community health centers (stations) and township health centers, that is, 1.5 visits per person per year on average. There was a significant development when found only 1 visit per person per year for primary care in 2010. However, the frequency of visits for primary care was still lower than that of visiting hospital-based outpatients (an average of 2.7 visits per person per year) . The COVID-19 pandemic had a significant impact on community health services/general medical services, and the number of outpatient visits dropped by about 20%. The number of general practice research articles reached a peak in 2018, mainly focusing on bi-directional referrals, tiered diagnosis and treatment, general practitioners (GPs) /family doctors, general medicine, community health services, chronic disease management (especially hypertension and diabetes) , and analysis of factors associated with aspects involved in general medical services. General practice research is expected to provide more support for developing innovative and critical thoughts, more practice-based evidence for clinical services, and more assistance for service quality and patient outcomes improvement as the discipline advances. (3) Results of implementing general medical services: there is no sufficient evidence on the influence of general medical services on people's health. The experiences and views of people including healthy individuals and patients indicated that those receiving general medical services or contracted family doctor services perceived positive experience and expressed high satisfaction, but perceptions and views of general population in the community toward general medical services need to be explored. GPs' own experience and opinions on general practice were quite different. Gender, age, professional title, urban and rural areas, and geographical location may be associated with their experience and job satisfaction. There may be instability in the general practice workforce, mainly due to personal income, workload and time pressure. (4) The major strengths of developing general practice in China are as follows: strong policy-based promotion and government leadership; rapidly constructing and developing GPs teams owing to the excellent resource allocating ability shown by the centralized system from central to all local governments; significantly enhanced general practice education and training systems; increased core professionals as general practice educators and trainers; special development of general practice characterized by the integration of medical sciences and Chinese traditional humanistic theories. (5) The development of general practice in China has been facing limitations similar to those in other countries. Besides that, its special limitations include late development of the discipline, unsatisfactory quality of workforce, high work pressure and high prevalence of burnout in the workforce, as well as impact of generation gap on education and practice among GPs. In addition, the relation between specialists and GPs is on transition of from undifferentiated attachment to self-recognised uniquity, and further seeking transdisciplinary. The teaching competences of GPs teachers, especially those teaching community and clinical care, are inadequate. GPs team building and management need to advance from the formation to the storming and performing phases. (6) Opportunities for further development of general practice in China include strategies for achieving the goals of Healthy China, and an all-round well-off society, the important role of primary health care in sustainable development and universal health coverage reaffirmed by the Declaration of Astana, as well as significantly improved health literacy of people. (7) Challenges for the development of general practice in China include population ageing, and aging-related changes in burden of disease and socio-economic status, the aging and dynamic changes of GPs human resources, the variation of urban and rural areas and regional differences, and the inverted pyramid structure of allocation of medical and health resources (namely, the largest part is allocated to tertiary care while the smallest to primary care) . Relevant recommendations to address these challenges comprise strengthening the advocacy of the development of general practice services, establishing a wide-ranging community collaborative network, and developing general practice professional organizations.ConclusionThe development of general practice in China is advancing, which is manifested as rapidly increased number of general medical workers, strong government promotion, quickly improved accessibility of essential medical services, and notably increased utilization rate of primary care services. However, the development is facing challenges, such as high discipline and social expectations regarding general practice, instability in the workforce due to high work pressure of the knowledge- and labor-intensive job, GPs' insufficient recognition of their self-identity, and unclear status of financial funding for general practice development. Given that there are unprecedented favorable conditions for general practice development, medical industries and general medical workers are suggested to make efforts to turn challenges into opportunities to develop general medical services, thereby universal health outcomes will be improved.

Published
2022
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3. Associations of atrial fibrillation progression with clinical risk factors and clinical prognosis: A report from the Chinese Atrial Fibrillation Registry study

Author

Hong-Wei Li, Changsheng Ma, Jian-Zeng Dong, Xin Du, Liu He, Ameenathul M Fawzy, Wang-Yang Yang, and Gregory Y.H. Lip

Subjects
medicine.medical_specialty, China, 030204 cardiovascular system & hematology, ablation, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, atrial fibrillation, 030212 general & internal medicine, Registries, Risk factor, Aged, Fibrillation, business.industry, Incidence (epidemiology), Hazard ratio, Atrial fibrillation, medicine.disease, Prognosis, risk factor, Heart failure, Cohort, Cardiology, Catheter Ablation, prognosis, progression, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
Abstract

BACKGROUND: An understanding of the risk factors for atrial fibrillation (AF) progression and the associated impacts on clinical prognosis are important for the future management of this common arrhythmia. We aimed to investigate the rate of progression from paroxysmal (PAF) to more sustained subtypes of AF (SAF), the associated risk factors for this progression, and its impact on adverse clinical outcomes.METHODS AND RESULTS: Using data from the Chinese trial Fibrillation Registry study, we included 8290 PAF patients. Half of them underwent initial AF ablation at enrollment. The main outcomes were ischemic stroke/systemic embolism (IS/SE), cardiovascular hospitalization, cardiovascular death, and all-cause mortality. The median follow-up duration was 1091 (704, 1634) days, and progression from PAF to SAF occurred in 881 (22.5%) nonablated patients, while 130 (3.0%) ablated patients had AF recurrence and developed SAF. The incidence rate of AF progression for the cohort was 3.87 (95% confidence interval [CI] = 3.64-4.12) per 100 patient-years, being higher in nonablated compared to ablated patients. Older age, longer AF history, heart failure, hypertension, coronary artery disease, respiratory diseases, and larger atrial diameter were associated with a higher incidence of AF progression, while antiarrhythmic drug use and AF ablation were inversely related to it. For nonablated patients, AF progression was independently associated with an increased risk of IS/SE (hazard ratio [HR] = 1.52, 95% CI = 1.15-2.01) and cardiovascular hospitalizations (HR = 1.40, 95% CI = 1.23-1.58).CONCLUSION: AF progression was common in its natural course. It was related to comorbidities and whether rhythm control strategies were used, and was associated with an increased risk of IS/SE and cardiovascular hospitalization.

Published
2020

4. The safety of discontinuation of oral anticoagulation therapy after apparently successful atrial fibrillation ablation:a report from the Chinese Atrial Fibrillation Registry study

Author

Liu He, Changsheng Ma, Rong-Hui Yu, Lu Wang, Xin Du, Shijun Xia, Cai-Hua Sang, Song-Nan Li, Nian Liu, Ri-Bo Tang, San-Shuai Chang, Wang-Yang Yang, Gregory Y.H. Lip, Xue-Yuan Guo, De-Yong Long, Rong Bai, Chang Liu, Ameenathul M Fawzy, Chen-Xi Jiang, Jianzeng Dong, and Chao Jiang

Subjects
medicine.medical_specialty, China, Registry, medicine.medical_treatment, Administration, Oral, Catheter ablation, law.invention, Brain Ischemia, Anticoagulation, Randomized controlled trial, law, Risk Factors, Physiology (medical), Internal medicine, Thromboembolism, Atrial Fibrillation, medicine, Humans, Registries, Stroke, Intention-to-treat analysis, business.industry, Hazard ratio, Anticoagulants, Atrial fibrillation, medicine.disease, Discontinuation, Embolism, Catheter Ablation, Cardiology and Cardiovascular Medicine, business
Abstract

Aims We aimed to investigate the safety of discontinuing oral anticoagulation (OAC) therapy after apparently successful atrial fibrillation (AF) ablation, using data from the Chinese Atrial Fibrillation Registry study. Methods and results We identified 4512 consecutive patients who underwent successful AF ablation between August 2011 and December 2017. Of them, 3149 discontinued OAC 3 months post-ablation (Off-OAC group) and 1363 continued OAC beyond this period (On-OAC group). Regular follow-up examinations were undertaken to detect AF recurrence, monitor OAC therapy, and measure clinical outcomes. Primary outcomes included thromboembolic and major bleeding (MB) events experienced beyond 3 months after ablation. Low thromboembolic and MB event rates were noted in the on-treatment analysis. The incidence rates for thromboembolism were 0.54 [95% confidence interval (CI) 0.39–0.76] and 0.86 (95% CI 0.56–1.30) per 100 patient-years, and that for MB events were 0.19 (95% CI 0.11–0.34) and 0.35 (95% CI 0.18–0.67) per 100 patient-years, for the Off-OAC and On-OAC groups over mean follow-up periods of 24.2 ± 14.7 and 23.0 ± 13.6 months, respectively. Similar results were observed in the intention-to-treat analysis. Previous history of ischaemic stroke (IS)/transient ischaemic attack (TIA)/systemic embolism (SE) [hazard ratio (HR) 3.40, 95% CI 1.92–6.02; P Conclusions This study suggests that it may be safe to discontinue OAC in post-ablation patients under diligent monitoring, in the absence of AF recurrence, history of IS/TIA/SE, and diabetes mellitus. However, further large-scale randomized trials are required to confirm this. Trial registration Chinese Clinical Trial Registry ChiCTR-OCH-13003729. URL: http://www.chictr.org.cn/showproj.aspx?proj=5831.

Published
2020

5. Safety of direct oral anticoagulants in real-world clinical practice: translating the trials to everyday clinical management

Author

Wang-Yang Yang, Ameenathul M Fawzy, and Gregory Y.H. Lip

Subjects
medicine.medical_specialty, Administration, Oral, Hemorrhage, 030204 cardiovascular system & hematology, Real world evidence, Dabigatran, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Edoxaban, medicine, Humans, Pharmacology (medical), Intensive care medicine, Aged, Randomized Controlled Trials as Topic, Rivaroxaban, business.industry, Anticoagulants, Atrial fibrillation, General Medicine, medicine.disease, Clinical Practice, Stroke, chemistry, 030220 oncology & carcinogenesis, Apixaban, Warfarin, business, medicine.drug
Abstract

Direct oral anticoagulants (DOACs) may be regarded as some of the most successful innovations in recent times. These drugs which were specifically developed to overcome the challenges posed by warfarin did just that and in the process, have changed the outlook towards stroke prevention with anticoagulation. The decade of experience with these drugs that has resulted in the availability of large scale data on their safety profile has aided this. Areas covered: This review examines existing real-world studies (RWS) and their interpretation to better appreciate how they either complement or contradict findings from the hallmark trials. Specific focus has been made on the safety of DOACs, on their risks of major bleeding, intra-cranial haemorrhage (ICH), gastro-intestinal (GI) bleeding and all-cause mortality compared to warfarin and each other. DOAC use in the elderly and other sub-groups are briefly discussed. Expert opinion: Results for safety outcomes according to 'real world evidence' (RWE) are in-keeping with randomised controlled trials (RCTs) and currently, all 4 DOACs have been deemed at least as effective as warfarin, while demonstrating superiority in some aspects. While real world studies act as a complementary source of knowledge, traditional RCTs remain the gold standard for determining cause-effect relationships.

Published
2019

6. Establishment of Neurobehavioral Assessment System in Tree Shrew SCT Model

Author

Liu-Lin Xiong, Yang-Yang Wang, Lei Wang, Qi-Qin Dan, Qing-Jie Xia, Jie-Dong Wang, Ting-Hua Wang, Wang, Yang-Yang, Wang, Jie-Dong, Wang, Lei, Dan, Qi-Qin, Xia, Qing-Jie, Wang, Ting-Hua, and Xiong, Liu-Lin

Subjects
0301 basic medicine, medicine.medical_specialty, Neurology, Movement, medicine.medical_treatment, Tree shrew, White matter, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, medicine, Animals, Spinal cord injury, Spinal Cord Injuries, medicine.diagnostic_test, business.industry, Shrews, motor function, Laminectomy, Magnetic resonance imaging, General Medicine, Anatomy, medicine.disease, Spinal cord, spinal cord injury, Disease Models, Animal, 030104 developmental biology, medicine.anatomical_structure, Spinal Cord, neurobehavioral assessment scale, business, tree shrew, 030217 neurology & neurosurgery, Diffusion MRI
Abstract

Tree shrews, possessing higher developed motor function than rats, were more suitable to study neurological behavior after spinal cord injury (SCI). Here, we established a feasible behavioral assessment method to detect the degree of ethology recovery in treeshrew subjected to spinal cord transection (SCT). Tree shrews were divided into normal group, sham group, and SCT group. The tree shrew in sham group was subjected to laminectomy without SCI, while the tree shrews in the SCT group were subjected to a complete SCT in thoracic 10 (T10). A novel neurobehavior assessment scale was established, in which, the behavior index including slow advancement, fast advancement, standing, shaking head, voluntary jump, lateral movement, and tail status, was determined, respectively. Meanwhile, magnetic resonance imaging (MRI) was applied to observe the structure of the spinal cord,and diffusion tensor imaging (DTI)-based white matter mapping was used to show the fibers of the spinal cord. As a result, a marked decrease in locomotor function and consciousness was seen in tree shrews with SCT, and the detection of MRI showed the collapsing of nerve fibers after SCTis completely cut and there is corresponding to the behavior change. Together, the present study provided a novel and feasible method that can be used to assess the neurobehavior in SCT model from tree shrews, which may be useful to the SCI translational study in future preclinic trial. Refereed/Peer-reviewed

Published
2019

7. Suppression of PDGF induces neuronal apoptosis after neonatal cerebral hypoxia and ischemia by inhibiting P-PI3K and P-AKT signaling pathways

Author

Qing-Jie Xia, Qiao Hu, Jia Liu, Ya Jiang, You-Cui Wang, Zheng Ma, Lu-Lu Xue, Ying Zhang, Liu-Lin Xiong, Yuan Jin, Yang-Yang Wang, Ting-Hua Wang, Xiong, Liu-Lin, Xue, Lu-Lu, Jiang, Ya, Ma, Zheng, Jin, Yuan, Wang, You-Cui, Wang, Yang-Yang, Xia, Qing-Jie, Zhang, Ying, Hu, Qiao, Liu, Jia, and Wang, Ting-Hua

Subjects
Male, 0301 basic medicine, Hippocampus, Apoptosis, PI3K, Rats, Sprague-Dawley, Phosphatidylinositol 3-Kinases, 0302 clinical medicine, Ischemia, shRNA, Phosphorylation, Lung, Cerebral Cortex, Neurons, Platelet-Derived Growth Factor, biology, medicine.diagnostic_test, General Neuroscience, Brain, Cerebral hypoxia, PDGF, Hypoxia-Ischemia, Brain, Female, Signal transduction, Platelet-derived growth factor receptor, Signal Transduction, Brain Infarction, medicine.medical_specialty, 03 medical and health sciences, Western blot, Internal medicine, medicine, Animals, Molecular Biology, Protein kinase B, PI3K/AKT/mTOR pathway, business.industry, AKT, medicine.disease, Rats, Disease Models, Animal, 030104 developmental biology, Endocrinology, Animals, Newborn, biology.protein, Neonatal hypoxic-ischemic encephalopathy, Neurology (clinical), NeuN, business, Proto-Oncogene Proteins c-akt, 030217 neurology & neurosurgery, Developmental Biology
Abstract

Neonatal hypoxic-ischemic encephalopathy (HIE) always results in severe neurologic dysfunction, nevertheless effective treatments are limited and the underlying mechanism also remains unclear. In this study, we firstly established the neonatal HIE model in the postnatal day 7 SD rats, Zea-Longa score and TTC staining were employed to assess the neurological behavior and infarct volume of the brain after cerebral hypoxia-ischemia(HI). Afterwards, protein chip was adopted to detect the differential proteins in the right cortex, hippocampus and lung, ultimately, PDGF was noticed. Then, immunohistochemistry, immunofluorescence double staining ofNeuN/PDGF, and western blot were used to validate the expression level of PDGF in the cortex and hippocampus at 6 hours (h), 12 h and 24 h after HI. To determine the role of PDGF, the primary cortical neurons were prepared and performed PDGF shRNA administration. The results showed that HIE induced a severe behavioral dysfunction and brain infarction in neonatal rats, and the expression of PDGF in right cortex and hippocampus was remarkably increased after HI. Whereas, suppressing PDGF resulted in a significant loss of neurons and inhibition of neurite growth. Moreover, the protein level of P-PI3K and P-AKT signaling pathways were largely decreased following PDGF-shRNA application in the cortical neurons. In conclusion, PDGF suppression aggravated neuronal dysfunction, and the underlying mechanism is associated with inhibiting the phosphorylation of P-PI3K and P-AKT. Together, PDGF regulating PI3K and AKT may be an important panel in HIE events and therefore may provide possible strategy for the treatment of HIE in future clinic trail. Refereed/Peer-reviewed

Published
2019

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