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مختارات \أحاديث كونفوشيوس\ = The essentials of analects of Confucius
في هذا الكتاب مختارات من «أحاديث كونفوشيوس» وهو عبارة عن حكم ومواعظ وأمثال جاءت في أربعة محاور: الأول بعنوان \"الإيمان والنظام الاجتماعي\" والثاني بعنوان \"الأسر والمجتمع\" والثالث بعنوان \"التعامل مع الناس والعالم\" والرابع بعنوان \"مستوى شخصيته وذكائه ومدى نظره\". هذه المحاور الأربعة يتلخص فيها المذهب الأخلاقي عند كونفوشيوس والذي يقوم على أن أي نظامٍ اجتماعي صحيح ومتكامل، إنما يقوم على تزويد الأفراد بالأخلاق الحميدة وهذا يتحقق بالتربية والتعليم إلى جانب وجود حاكمٍ على خلق قويم يكون نموذجا يحتذي به الجميع. ويرى كونفوشيوس أيضا أن الأخلاق إذا وصلت في المجتمع إلى مستواها المنشود أغنت عن القوانين والتشريعات والقضاء.
BOOK
Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network
Asia is a large continent and there is significant diversity between countries and regions. Over the last 30 years, absolute blood pressure (BP) levels in Asia have increased to a greater extent than those in other regions. In diverse Asia‐Pacific populations, for choosing an Asia‐specific approach to hypertension management is important to prevent target organ damage and cardiovascular diseases. In this consensus document of HOPE Asia Network, we introduce seven action approaches for management of hypertension in Asia.
Journal Article
Cardiovascular risk assessment tools in Asia
Cardiovascular disease (CVD) is becoming the most important burden to health care systems in most part of the world, especially in Asia. Aiming at identifying high risk individuals and tailoring preventive treatment, many cardiovascular risk assessment tools have been established and most of them were developed in Western countries. However, these cardiovascular risk assessment tools cannot be used interchangeably without recalibration because of the different risk factor profiles (ie, greater absolute burden of hypertension and lower level of total‐cholesterol in Asians and higher prevalence of metabolic disorders in South Asians) and different CVD profiles (higher ratio of stroke/coronary heart disease in Asians) between Western and Asian populations. Original risk models such as Prediction for ASCVD Risk in China (China‐PAR) and Japan Arteriosclerosis Longitudinal Study (JALS) score have been developed and well validated for specific countries, while most of countries/regions in Asia are using established models. Due to higher incidence of stroke in Asians, risk factors like hypertension should weigh more in cardiovascular risk assessment comparing with Western populations, but their actual proportions should be based on CVD profiles in specific countries/regions. The authors encourage the development of new cardiovascular risk assessment tools for Asians, if possible. Still, modifying established models with native epidemiological data of risk factor as well as CVD is acceptable in regions where health care resources are insufficient.
Journal Article
The HOPE Asia network 2022 up‐date consensus statement on morning hypertension management
Morning hypertension is an important clinical target in the management of hypertension for perfect 24‐h blood pressure (BP) control. Morning hypertension is generally categorized into two types: “morning surge” type and “sustained nocturnal and morning hypertension” type. The “morning surge” type is characterized by an exaggerated morning blood pressure surge (MBPS), and the “sustained nocturnal and morning hypertension” type with continuous hypertension from nighttime to morning (non‐dipper/riser type). They can be detected by home and ambulatory blood pressure measurements (HBPM and ABPM). These two forms of morning hypertension both increase the risk of cardiovascular and renal diseases, but may occur via different pathogenic mechanisms and are associated with different conditions. Morning hypertension should be treated to achieve a morning BP level of < 135/85 mmHg, regardless of the office BP. The second target morning BP levels is < 125/75 mmHg for high‐risk patients with morning hypertension and concomitant diseases. Morning hypertension is more frequently found in Asians, than in Westerners. Thus, the management of morning hypertension is especially important in Asia. The detection of morning hypertension and the individual home BP‐guided treatment approach targeting morning BP in combination with ABPM, and the optimal treatment of morning hypertension would reduce cardiovascular events in Asia.
Journal Article
Faculty appointment and promotion in Taiwan’s medical schools, a systematic analysis
Background
A rigorous faculty appointment and promotion (FAP) system is vital for the success of any academic institution. However, studies examining the FAP system in Asian universities are lacking. We surveyed the FAP policies of Taiwan’s medical schools and identified an overreliance on the CJA score (manuscript Category, Journal quality, and Author order). The potential shortcomings of this metric and recommendations for refinement were discussed.
Methods
We obtained the FAP documents from all 12 medical schools in Taiwan, and analyzed their use of traditional versus non-traditional criteria for FAP according to a published methodology. The influence of the journal impact factor (JIF) on the FAP process was quantified by comparing its relative weight between papers with two extreme JIFs. To better understand the research impact and international standing of each school, we utilized the public bibliographic database to rank universities by the number of papers, and the proportions of papers within the top 10% or 50% citation.
Results
Compared with other countries, Taiwan’s medical schools focus more on the quantifiable quality of the research, mostly using a “CJA” score that integrates the category, JIF or ranking, and authorship of a paper, with the JIF being the most influential factor. The CJA score for an article with a JIF of 20 can be up to three times the threshold for promotion to Assistant Professor. The emphasis on JIF is based on a presumed correlation between JIF and citation counts. However, our analysis shows that Taiwan’s medical schools have lower-than-average citation counts despite a competitive rank in the number of publications.
Conclusions
The JIF plays an unrivaled role in determining the outcome of FAP in Taiwan’s medical schools, mostly via the CJA system. The questionable effectiveness of the current system in elevating the international standing of Taiwan’s higher-education institutions calls for a re-examination of the FAP system. We recommend a reduction in the relative importance of CJA score in the FAP system, adopting more rigorous metrics such as the h-index for evaluating research quality, and supporting more research aimed at improving the FAP system.
Journal Article
Adverse childhood experiences and hearing loss: the mediating role of sleep disorders in a Chinese cohort
Introduction
Adverse childhood experiences (ACE) are robustly associated with chronic diseases, yet their link to hearing loss (HL) and potential mediators remains poorly understood. We tested whether sleep disorders mediate the ACE–HL relationship in middle-aged and older Chinese adults.
Methods
Data from 7,534 CHARLS participants aged ≥ 45 years were analyzed. ACE were retrospectively assessed via 12 items and summarized as a continuous score (0–12) and quartiles. HL was defined by self-reported fair/poor hearing or hearing-aid use. Sleep disorders were indicated by restless sleep ≥ 1 day/week. Logistic regression and causal mediation models adjusted for sociodemographic, behavioral and clinical covariates.
Results
Mean ACE score was 3.6 ± 1.8; 47.2% reported sleep disorders. Participants with ≥ 5 ACE had 1.63-fold higher odds of HL than those with 0 ACE (95% CI: 1.22–2.18;
p
< 0.001). Sleep disorders mediated 13.3% (95% CI: 5.2–28.5%) of the total ACE effect on HL. Stratified analyses showed consistent associations across subgroups.
Discussion
ACE increase HL risk both directly and indirectly through sleep disturbances. Targeting sleep problems among individuals with high ACE exposure may attenuate HL progression and offers a novel public-health strategy to reduce age-related hearing impairment.
Clinical trial number
Not applicable.
Journal Article
Effectiveness of salt substitute on cardiovascular outcomes: A systematic review and meta‐analysis
Hypertension‐related death is the leading cause of mortality worldwide, making blood pressure (BP) control an important issue. Salt substitute is a non‐pharmaceutical strategy to improve hypertension control. The goal of this study was to evaluate the effect of salt substitute on BP and cardiovascular disease. The authors searched the Cochrane Library and PubMed databases through March 2022, and assessed the risk‐of‐bias for included studies by the Cochrane risk‐of‐bias tool. Twenty‐three randomized controlled trials with 32073 patients were included in our systematic review. A meta‐analysis with random effects was performed to analyze the effects of salt substitute on systolic and diastolic BP, 24‐h urinary sodium and potassium, and cardiovascular and all‐cause mortality. In the random‐effects model, participants consuming salt substitute showed significant reduction in systolic BP (mean difference (MD) −4.80 mmHg, 95% confidence interval (CI) −6.12 to −3.48, P < 0.0001) and diastolic BP (MD −1.48 mmHg, 95% CI −2.06 to −0.90, P < 0.0001) compared with participants consuming normal salt. In the urine electrolyte analysis, the salt substitute group had significant reduction in 24‐h urine sodium (MD −22.96 mmol/24‐h, P = 0.0001) and significant elevation in 24‐h urine potassium (MD 14.41 mmol/24‐h, P < 0.0001). Of the five studies with mortality outcome data, salt substitute significantly reduced all‐cause mortality (hazard ratio 0.88, P = 0.0003). In conclusion, our analyses showed that salt substitute has a strong effect on lowering BP and reducing all‐cause mortality. By modifying the daily diet with salt substitute, the authors can improve BP control by using this non‐pharmaceutical management.
Journal Article
Deep Learning-Enabled Diagnosis of Abdominal Aortic Aneurysm Using Pulse Volume Recording Waveforms: An In Silico Study
This paper investigates the feasibility of diagnosing abdominal aortic aneurysm (AAA) via deep learning (DL)-enabled analysis of non-invasive arterial pulse waveform signals. We generated arterial blood pressure (BP) and pulse volume recording (PVR) waveform signals across a diverse synthetic patient cohort using a systemic arterial circulation model coupled with a viscoelastic model relating arterial BP to PVR while simulating a range of AAA severity levels. We confirmed the plausibility of the synthetic data by comparing the alterations in the simulated waveform signals due to AAA against previously reported in vivo findings. Then, we developed a convolutional neural network (CNN) with continuous property-adversarial regularization that can estimate AAA severity from brachial and tibial PVR signals. We evaluated the algorithm’s performance in comparison with an identical CNN trained on invasive arterial BP waveform signals. The DL-enabled PVR-based algorithm achieved robust AAA detection across different severity thresholds with area under the ROC curve values >0.89, and showed reasonable accuracy in severity estimation, though slightly lower than its invasive BP counterpart (MAE: 12.6% vs. 10.3%). These findings suggest that DL-enabled analysis of PVR waveform signals offers a non-invasive and cost-effective approach for AAA diagnosis, potentially enabling accessible screening through operator-agnostic and point-of-care technologies.
Journal Article
Hypertensive emergencies in Asia: A brief review
Hypertensive emergency is one of the most challenging conditions to treat in the emergency department (ED). From previous studies, about 1%–3% of hypertensive individuals experienced hypertensive emergencies. Its prevalence varied by country and region throughout Asia. Asian populations have more different biological and cultural backgrounds than Caucasians and even within Asian countries. However, there is a scarcity of research on clinical features, treatment, and outcomes in multinational Asian populations. The authors aimed to review the current evidence about epidemiology, clinical characteristics and outcomes, and practice guidelines in Asia.
Five observational studies and nine clinical practice guidelines across Asia were reviewed. The prevalence of hypertensive emergencies ranged from .1% to 1.5%. Stroke was the most common target organ involvement in Asians who presented with hypertensive emergencies. Although most hypertensive emergency patients required hospitalization, the mortality rate was low. Given the current lack of data among Asian countries, a multinational data repository and Asian guidelines on hypertensive emergency management are mandatory.
Journal Article
Blood pressure variability and cognitive dysfunction: A systematic review and meta‐analysis of longitudinal cohort studies
The variability of blood pressure (BPV) has been suggested as a clinical indicator for cognitive dysfunction, yet the results from clinical studies are variable. This study investigated the relationship between BPV and the risk of cognitive decline or dementia. Bibliographic databases, including PubMed, Scopus, and Embase, were searched systematically for longitudinal cohort studies with BPV measurements and neuropsychological examinations or dementia diagnosis. A traditional meta‐analysis with subgroup analysis, and a further dose‐response meta‐analysis were conducted. Twenty cohort studies with 7 924 168 persons were included in this review. The results showed that a higher systolic BPV (SBPV), when measured with the coefficient of variation (SBP‐CV) or standard deviation (SBP‐SD), was associated with a higher risk of all‐cause dementia diagnosis but not incidence of cognitive decline on neuropsychological examinations. In subgroup analysis, the effect was more prominent when using BPV of shorter timeframes, during shorter follow‐ups, or among the elderly aged more than 65 years. No dose‐response relationship could be found. Our study suggested possible positive associations between SBPV and the risk of dementia. Further studies are required to validate these findings.
Journal Article