Association of heart rate and diabetes among 0.5 million adults in the China Kadoorie biobank: Results from observational and Mendelian randomization analyses

Background and aimsObservational studies have associated resting heart rate with incident diabetes. Whether the associations are causal remains unclear. We aimed to examine the shape and strength of the associations and assessed the causal relevance of such associations in Chinese adults.Methods and resultsThe China Kadoorie Biobank enrolled 512,891 adults in China. Cox proportional hazard regression models was conducted to estimate hazard ratios (HRs) for the associations of resting heart rate with type 2 diabetes and total diabetes. Among 92,724 participants, 36 single-nucleotide polymorphisms (SNPs) related to resting heart rate were used to construct genetic risk score. We used Mendelian randomization analyses to make the causal inferences. During a median follow-up of 9 years, 7872 incident type 2 diabetes and 13,349 incident total diabetes were documented. After regression dilution bias adjustment, each 10 bpm higher heart rate was associated with about a 26% higher risk of type 2 diabetes (HR, 1.26 [95% CI, 1.23, 1.29]) and 23% higher risk of total diabetes (HR, 1.23 [95% CI, 1.20, 1.26]). Instrumental variable analyses showed participants at top quintile compared with those at bottom quintile had 30% higher risk for type 2 diabetes (HR, 1.30 [95% CI, 1.17, 1.43]), and 10% higher risk for total diabetes (HR, 1.10 [95% CI, 1.02, 1.20]).ConclusionsThis study provides evidence that resting heart rate is an important risk factor for diabetes risk. The results suggest that novel treatment approaches targeting reduction of high heart rate for incidence of diabetes may be worth further investigation.     

Robust T-tubulation and maturation of cardiomyocytes using tissue-engineered epicardial mimetics

Complex three-dimensional (3-D) heart structure is an important determinant of cardiac electrical and mechanical function. In this study, we set to develop a versatile tissue-engineered system that can promote important aspects of cardiac functional maturation and reproduce variations in myofiber directions present in native ventricular epicardium. We cultured neonatal rat cardiomyocytes within a 3-D hydrogel environment using microfabricated elastomeric molds with hexagonal posts. By varying individual post orientations along the directions derived from diffusion tensor magnetic resonance imaging (DTMRI) maps of human ventricle, we created large (2.5 × 2.5 cm²) 3-D cardiac tissue patches with cardiomyocyte alignment that replicated human epicardial fiber orientations. After 3 weeks of culture, the advanced structural and functional maturation of the engineered 3-D cardiac tissues compared to age-matched 2-D monolayers was evident from: 1) the presence of dense, aligned and electromechanically-coupled cardiomyocytes, quiescent fibroblasts, and interspersed capillary-like structures, 2) action potential propagation with near-adult conduction velocity and directional dependence on local cardiomyocyte orientation, and 3) robust formation of T-tubules aligned with Z-disks, co-localization of L-type Ca²⁺ channels and ryanodine receptors, and accelerated Ca²⁺ transient kinetics. This biomimetic tissue-engineered platform can enable systematic in vitro studies of cardiac structure–function relationships and promote the development of advanced tissue engineering strategies for cardiac repair and regeneration.     

Nanomedicine for acute respiratory distress syndrome: The latest application,targeting strategy,and rational design

Acute respiratory distress syndrome (ARDS) is characterized by the severe inflammation and destruction of the lung air–blood barrier, leading to irreversible and substantial respiratory function damage. Patients with coronavirus disease 2019 (COVID-19) have been encountered with a high risk of ARDS, underscoring the urgency for exploiting effective therapy. However, proper medications for ARDS are still lacking due to poor pharmacokinetics, non-specific side effects, inability to surmount pulmonary barrier, and inadequate management of heterogeneity. The increased lung permeability in the pathological environment of ARDS may contribute to nanoparticle-mediated passive targeting delivery. Nanomedicine has demonstrated unique advantages in solving the dilemma of ARDS drug therapy, which can address the shortcomings and limitations of traditional anti-inflammatory or antioxidant drug treatment. Through passive, active, or physicochemical targeting, nanocarriers can interact with lung epithelium/endothelium and inflammatory cells to reverse abnormal changes and restore homeostasis of the pulmonary environment, thereby showing good therapeutic activity and reduced toxicity. This article reviews the latest applications of nanomedicine in pre-clinical ARDS therapy, highlights the strategies for targeted treatment of lung inflammation, presents the innovative drug delivery systems, and provides inspiration for strengthening the therapeutic effect of nanomedicine-based treatment.     

护理员认知障碍照护核心技能指标体系的构建

目的 构建护理员认知障碍照护相关的核心技能指标体系。方法 基于“以人为中心”的认知障碍照护理论，拟定护理员认知障碍照护需具备的相关技能指标初稿，选择15名专家进行2轮德尔菲专家函询。结果 专家权威系数为0.870,肯德尔和谐系数为0.318(P<0.01)。护理员认知障碍照护核心技能指标体系包括5个一级指标，分别为沟通与建立良好关系、环境利用与保障安全、日常生活能力支持、参与计划与促进有益活动、精神行为症状的管理，共21个二级指标。结论 护理员认知障碍照护核心技能指标体系体现了以人为中心的照护理念，可作为护理员认知障碍照护能力评价及培训的参考。     

桌面虚拟现实技术在医学多媒体课件中的设计与应用

介绍了桌面虚拟现实技术在课件制作中的设计思路及实现方法。指出将虚拟现实技术与课件教学内容的知识点相整合,可强化课件的学习自主性和知识交互性,从而提高学习效率和教学质量。     

糖尿病病人胰岛素泵应用及相关知识调查

[目的]探讨糖尿病病人应用胰岛素泵强化治疗的相关知识及需求情况.[方法]采用自行设计的问卷调查表,对60例糖尿病胰岛素泵强化治疗病人进行调查.[结果]病人对胰岛素泵了解甚少,相关知识缺乏,希望接受胰岛素泵知识教育.[结论]胰岛素泵应用现状存在较多问题,影响病人血糖的良好控制,应提高病人对胰岛素泵的认可程度和依从性,提高生活质量.     

国外医院绩效评价对我国的启示

绩效评价是促进公立医院公益性、引导其医疗服务质量持续改进的有效方法。然而目前国内尚无一套统一、科学、合理的公立医院绩效考核制度, 对医改背景下的公立医院绩效进行考核, 已成为困扰我国卫生事业发展的重要问题。本文在借鉴国外医院绩效评价先进经验措施的基础上, 结合我国现状, 对医院绩效评价提出了一些针对性的建议和意见。