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Objective: To investigate the relationship between KCNE family gene polymorphisms of potassium channel gene and the susceptibility of atrial fibrillation (AF). Methods: In the case-control study, a total of 648 subjects were studied, of which 338 patients with atrial fibrillation were selected from the Department of Cardiovascular Medicine, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2019 to December 2019, and 310 healthy people were selected from the physical examination population during the same period. DNA sequencing technology and polymerase chain reaction (PCR) were used to detect the genotype and allele frequency of rs1805127 of KCNE1, rs9984281 of KCNE2, rs9516, rs626930 of KCNE3 and rs12621643 of KCNE4. Results: The ages of subjects in atrial fibrillation group and control group were (69±13) and (73±8) years, respectively ( P =0.077). Men subjects accounted for 57.70% (195 men) and 40.00% (124 men) in the two groups, respectively ( P =0.092). The distribution frequencies of the allele C at rs1805127 of gene KCNE1, the allele A at rs9984281 of gene KCNE2 and the allele G at rs12621643 of gene KCNE4 were significantly different between groups ( P <0.05). After adjustment for sex, smoking, hypertension, cardiac insufficiency and other factors, it was found that the increase in the frequency of the above three loci would increase the risk of atrial fibrillation (rs1805127 OR =7.064, 95% CI :1.559-31.997; rs9984281 OR =4.210, 95% CI :1.118-15.850; rs12621643 OR =2.679, 95% CI :1.025-6.998). Conclusion: The rs1805127 of KCNE1, the rs9984281 of KCNE2,the rs12621643 of KCNE4 were significantly associated with the susceptibility to atrial fibrillation.

To understand the recent characteristics of atmospheric environmental changes in the Twain-Hu(Hunan-Hubei) Basin, including the middle reaches of the Yangtze River, this paper uses near-surface PM 2.5 and PM 10 observational data for the Twain-Hu Basin in the winters of 2015 to 2019, combined with wind-speed, topography, the normalized difference vegetation index(NDVI), and other datasets. The results show that:① PM 2.5 pollution occurred frequently in the winters of 2015-2019 in the Twain-Hu Basin, and Xiangyang and Jingmen in the western part of the basin, experience PM 2.5 pollution on an average of 62 and 61 days in winter(PM 2.5 >75 μg·m -3 ). And the heavy pollution days in Xiangyang reached 19 more days(PM 2.5 >150 μg·m -3 ), indicating that the Twain-Hu Basin is an air pollution center in the middle reaches of the Yangtze River Basin; ② Spatially, pollution in the Twain-Hu Basin is heavier in the northwest than in the southeast, and in the urban agglomeration, which is mainly related to the regional transport of air pollutants by the winter monsoon and the high levels of emissions from urban areas; ③ A "U-shaped" nonlinear relationship was observed between near-surface wind speeds and PM 2.5 and PM 10 concentrations. The inflection points of PM 2.5 and PM 10 concentrations were 153 and 210 μg·m -3 , respectively. This implies that the accumulation of local atmospheric particulate matter in the Twain-Hu Basin dominates light/medium pollution, while the regional transport of air pollutants dominates period of severe pollution; and ④ PM 2.5 and PM 10 in winter were significantly negatively correlated with terrain height and the NDVI, which reflects the atmospheric environmental effects of topography and urbanization.

Background: Research in Taiwan has indicated that advance care planning is rarely undertaken in long-term care facilities. The purpose of this study was to develop an advance care planning interview guideline and care model to facilitate the process of advance care planning for residents and their families in long-term care facilities., Methods: This study follows an action research design. Cycles of planning, action, observation, and reflection were planned and modified based on the results of interviews with residents and their families as well as meetings with staff. To establish the interview guideline and care model through this action research study, residents and their families were interviewed separately. The researcher subsequently held meetings with staff members to evaluate the results and identify problems during each advance care planning process. This information was synthesised and used to modify the care model for implementation with the next resident-family pair. This process was performed a total of ten times., Results: This study included residents (N = 10), their families (N = 20), and medical staff (N = 4) at a long-term care facility. The interviews and meetings were audio recorded, transcribed, and subjected to a simple thematic analysis together with the field notes and reflection logs. Four themes emerged from the data related to: opening the conversation with the interview guidelines about the life story of residents; continuing life stories to the quality of remaining years of the residents; gradually changing the topic to the end-of-life care issues; and concluding the conversation by explaining the content of advance directives and hospice care., Conclusions: The advance care planning care model was implemented following logical thinking from a Chinese perspective. This consisted of opening, developing, changing, and concluding through the views of Confucianism, Buddhism, and Taoism. The research findings indicate that the model successfully facilitated the process of advance care planning for residents and their families.

Aim: The treatment effects of spironolactone on heart failure with reduced (HFrEF LVEF <40%) and preserved (HFpEF LVEF ≥50%) ejection fraction are well characterized. It is not clear whether heart failure patients with mid-range ejection fraction (HFmrEF, LVEF 40-49%) benefit from spironolactone. The present study aims to evaluate the efficacy of spironolactone in HFmrEF patients., Method: This study compared a high dosage of spironolactone (50 mg daily), a low dosage of spironolactone (25 mg daily), and an untreated group for the prevention of major adverse cardiovascular events (MACE) in 279 patients admitted to hospital diagnosed with HFmrEF., Results: With a mean follow-up duration of 1 year, the death and HF-rehospitalization rate demonstrated significantly lower incidence in those taking spironolactone, compared with the untreated group (21.3% vs 34.5%, p = .014, respectively). Further analysis showed no difference between two spironolactone groups (21.8% vs 20.7%, p = .861). Kaplan-Meier analysis of outcome-free survival illustrated a significant difference in survival rate among three groups (log-rank testing, p = .045). Compared with the baseline level, patients receiving 25 mg spironolactone had a lower physical score (p < .05) at 1-year follow-up. MLHFQ total scores in the two spironolactone groups markedly improved compared with the untreated group (p < .001); similar results were observed in the MLHFQ physical scores (p = .025, .001, respectively) and emotional sub-scale (p = .023, .011, respectively); however, paired comparison between the two spironolactone groups showed no difference., Conclusions: In patients with HFmrEF, treatment with spironolactone significantly reduced the incidence of the primary composite outcomes of all-cause death, and rehospitalization for the management of heart failure compared with placebo, and a high dosage of spironolactone did not show trends of reduction in MACE.

The reproductive ability of 24 men exposed to lead was observed and the same number of no-exposed men were taken as controls. The influential factors, such as age, smoking and drinking were controlled. The finding shows higher prevalence of congenital epilepsy and heart disease in the filial generation of workers exposed to lead and high rate of teratospermia in the exposed workers. Meanwhile hypospermia, as well as decreased lactate dehydrogenase-x(LDH-x) and succinodehydrogenase (SDH) in sperm were found in exposed group.