2022 Vol. 13, No. 5

Editorials
Abstract:
The human microbiome, the second genome of the human body, can determine human health status. Microbiome research has prompted humans to re-understand the relationship between microbiota and individuals, as well as microbiota and the ecological environment. A comprehensive and systematic study of the structure and function of human gut microbiome and an analysis of the interaction and regulation mechanism of the relevant core bacteria will bring revolutionary theoretical innovations to solve the health problems of humans, and the resulting disruptive technological innovation has the potential to provide better solutions for microbiome research.
Abstract:
Congenital scoliosis (CS) is a congenital spinal deformity that originates from abnormal spinal development in embryo. Characterized by rapid progression, severe deformity, and many complications, CS brings heavy economic and mental burden to patients and their families. At present, there is no good treatment for the etiology of spinal deformity. Due to the lack of early prediction methods, patients are often not detected until the appearance of malformation, and the treatment is mainly passive, conservative or traumatic treatment with braces or surgery to control the progression of the disease. Therefore, the exploration of early diagnosis methods and effective etiological intervention targets for spinal deformity is currently an international research hotspot. The orthopaedic team of Peking Union Medical College Hospital, focusing on the molecular genetics research and clinical application of CS, has built the world leading genetic research system of skeletal deformity. Through a multi-center large-scale cohort study, the team has found and demonstrated that compound inheritance of a rare null mutation and a hypomorphic allele of TBX6 led to CS. A set of genotype-phenotype integrated analysis method has been established, which successfully defined a new subtype of CS (TBX6-associated congenital scoliosis, TACS) and realized accurate clinical prediction of this unique subtype. With the establishment of the first genetics clinic of skeletal deformity in China, the clinical transformation of research results can thus be realized, providing a new paradigm for the etiology research and clinical application of skeletal deformity.
Specialist Forum
Abstract:
In recent years, with the progress of multi-omics and next-generation sequencing technology, the association between gut microbiome and cardiovascular diseases has attracted great attention around the world. Gut microbiota, as a "microbial organ", directly regulates the host's health status through lipopolysaccharide, metabolites like trimethylamine oxide and short-chain fatty acids, and affects the host's immunity through bacteria and their products. "Gut-heart axis" may be a breakthrough in the prevention and treatment of cardiovascular diseases. The paper briefly discusses the relationship between gut microbiome and cardiovascular diseases, the possible ways in which gut microbes affect cardiovascular health, and the regulation of gut microbiota by various factors.
Abstract:
Gut microbiome regulates host metabolism and immunity via their metabolites, secretions, and cellular components, and protects the host from pathogen invasion. Low diversity and dysfunction of the gut microbiome caused by environmental changes, unhealthy dietary habits and lifestyles, and antibiotics abuse are closely related to disease pathogenesis. Gut microbiome can serve as diagnostic and therapeutic tools for diseases related to gut microbiome dysbiosis. In this article, we aim to review the latest study advances on gut microbiome in the pathogenesis and therapeutics of gastrointestinal diseases, such as Clostridium difficile infection, Helicobacter pylori infection, inflammatory bowel disease, and irritable bowel syndrome, so as to shed light on the prospect of gut microbiome modulations in disease therapies.
Abstract:
Gut microbiota is indispensable for the maintenance of human immune homeostasis. Dysbiosis and translocation of gut microbes as well as aberrance of microbiome metabolites, which are commonly seen in many autoimmune diseases, are suggested to participate in the breakdown of immune tolerance and the excessive inflammatory responses. The involved mechanisms include immune equilibrium skewing, molecular mimicry, bystander activation and epitope spreading, which contributes to the initiation and progression of autoimmune diseases. In addition, the microbial biotransformation of antirheumatic drugs help determine the bioactivity and toxicity of these drugs. Herein, gut microbiota-based intervention may shed light on developing novel strategies for prophylaxis and treatment of autoimmune diseases. In this review, recent advances in exploring the potential pathogenic role of gut microbiota in autoimmunity are summarized and the prospect of applying microbiota-based intervention in systemic autoimmune diseases is addressed.
Abstract:
The gut microbiota and their metabolites play a critical role in the maintenance of host immune homeostasis. The dysbiosis and gut microbiota-derived metabolites are closely associated with the initiation and development of multiple autoimmune diseases. Among the microbiota metabolites, short-chain fatty acids, tryptophan and its derivatives, and bile acids are the most widely studied. In this review, the metabolic pathway of the microbiota metabolites, their functions in the immune response and the current findings on their correlation with autoimmune diseases are summarized, with the hope of revealing the role of gut microbiota-derived metabolites on the pathogenesis of autoimmune diseases.
Abstract:
Autism spectrum disorder (ASD), a neurodevelopmental disorder during early childhood, currently has no effective treatment. The prevalence of ASD has been increasing, which brings a heavy burden to the family of the patients and the society. Children with ASD are accompanied by gastrointestinal symptoms and have an imbalance of intestinal microbiota. Fecal microbiota transplantation (FMT) can improve autism-related symptoms in children with ASD. This review aims to summarize the research progress of FMT for treating ASD to provide a novel strategy for this untreatable disease.
China Healthcare Big Data
Abstract:
Glioma, the most prevalent primary malignant tumor of the central nervous system, has a high degree of malignancy and poor prognosis for patients. At present, the researches of glioma mainly focus on the investigation of the mechanism of tumor occurrence and the discovery of new therapeutic methods and agents. In-depth researches have also been conducted on the optimization of molecular pathological typing of glioma, improvement of diagnostic imaging techniques and formulation of comprehensive treatment guidelines. In this review, we summarize the achievements and important progress made by Chinese medical scientists in the field of glioma in 2021, and propose possible future research directions with the aim of providing reference for clinical research.
Guideline and Consensus
Abstract:
After regular anti-epileptic drug treatment, the symptoms of most patients with epilepsy can be well controlled or relieved, but 30%-40% of patients with epilepsy, after long-term drug treatment, still suffer from repeated seizures and develop refractory epilepsy. Lennox-Gastaut syndrome, Dravet syndrome and epilepsy with myoclonic-atonic seizures are all refractory epilepsy that originate in childhood and seriously threaten the physical and mental health of patients. In 2011, clobazam was approved by the US Food and Drug Administration for the adjunctive treatment of epileptic seizures in patients with Lennox-Gastaut syndrome aged≥2 years. The drug has also been used in the treatment of Dravet syndrome and epilepsy with myoclonic-atonic seizures. Currently, the mechanism of action of clobazam is still unclear, but it may exert pharmacological effects by binding to the benzodiazepine site on the γ-aminobutyric acid A receptor. In vivo, clobazam and N-desmethylclobazam are mainly metabolized by CYP3A4 and CYP2C19, and the interaction with other drugs should require vigilance in clinical application. Meanwhile, attention should also be paid to the blood concentration of N-desmethylclobazam and monitoring of drug-related adverse reactions in CYP2C19 poor metabolizers. To promote further standardization of clinical application of clobazam in our country, and to ensure the effectiveness and safety of clobazam, the Multi-disciplinary Team for Rare Diseases, Peking Union Medical College Hospital and the National Rare Diseases Committee organized experts and scholars in related fields, and after many discussions and revisions, finally formed this consensus for clinical reference.
Abstract:
To address the challenges of the new era and promote the rational application of clinical epidemiology and evidence-based medicine methods in traditional Chinese medicine (TCM), Chinese Medicine Group, the Clinical Epidemiology and Evidence-based Medicine Association of Chinese Medical Association, gathered the related experts from all over the country and developed a consensus to improve the application of clinical epidemiology and evidence-based medicine methods in TCM. Delphi survey, consensus meetings and nominal groups were adopted in the process. This consensus summarizes the major challenges in the research of TCM and provides theoretical guidance for the development and application of clinical epidemiology and evidence-based medicine in TCM.
Guideline Interpretation
Abstract:
Since the publication of the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2019 Edition), many new high-level evidence in line with evidence-based medicine has emerged in the diagnosis and treatment of liver cancer at home and abroad, especially, a number of research results in line with Chinese liver cancer patients have been published. In order to further standardize the diagnosis and treatment of liver cancer in China, the National Health Commission organized multidisciplinary experts in the field of liver cancer to revise and update the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition), aiming to increase the overall cancer 5-year survival rate by 15%, a goal mentioned in the " Healthy China 2030" Planning Outline. We interpret the main update points of the 2022 version, with the hope of promoting the widespread discussion and dissemination of the new version.
Abstract:
The gastrointestinal tract is the largest organ connecting the human body and the outside world. The gastrointestinal mucosa is not only an important barrier connecting the internal body and the outside world, but also plays a key role in maintaining normal functions of the gastrointestinal tract. The injuries of gastrointestinal mucosal barrier are the common pathogenesis mechanisms in the occurrence and development of gastrointestinal diseases. However, there is still a lack of deep and systematic understanding of gastrointestinal mucosa, especially small intestinal mucosa. In clinical practice, more attentions have been paid to the role of injury factors, but the importance of mucosal protection is ignored. In order to improve the understanding of gastrointestinal mucosa protection and standardize the clinical application of gastrointestinal mucosal protective agents, the Gastrointestinal Hormone and Mucosal Barrier Group, Chinese Society of Gastroenterology, Chinese Medical Association formulated the first expert consensus on gastrointestinal mucosal protection in China, which was offi- cially published at the end of 2021. This paper interprets the background, process and main content of this consensus, so as to raise awareness among medical staff, and standardize clinical diagnosis and treatment.
Original Contributions
Abstract:
  Objective  To investigate the gut microbiome composition and changes and its association with disease severity in patients with acute pancreatitis (AP).  Methods  This study was a prospective cross-sectional analysis. The subjects of the study were AP patients in Peking Union Medical College Hospital from June 2018 to January 2022 and healthy volunteers. The clinical data and stool samples of the two groups were collected, the 16S rRNA of the gut microbiome was DNA sequenced, and bioinformatic analysis was performed. The differences in gut microbiome between the two groups were compared, and the correlation between the intestinal flora and the severity of AP was analyzed by receiver operating characteristic(ROC) curve.  Results  A total of 60 AP patients and 20 healthy volunteers were enrolled. Among the AP patients, 20 were mild AP, 20 were moderately severe AP, and 20 were severe AP. During hospitalization, 22 cases were transferred to ICU, while 38 cases were not. In α diversity analysis, the Shannon index of AP patients was significant decreased compared to healthy volunteers (P < 0.05). β diversity of the two groups was significantly different. At the phylum, family, genus and species levels, there were also significant differences in the microbiome composition between the two groups. Linear discriminant analysis effect size analysis revealed that g_Escherichia-Shigella, g_Enterococcus, and f_Enterococcaceae were dominant in AP patients while g_Blautia, and g_Bifidobacterium were dominant in healthy volunteers. Function analysis found that multiple amino acid biosynthesis pathways were blocked in gut microbiome of AP patients, and potential pathogenicity and migration ability of gut microbiome increased significantly. In subgroup analysis, g_Enterococcus was increased and g_Bacteroidaceae was decreased in ICU patients compared to non-ICU patients. Based on the probability of disease index, the ROC curve showed that the area under the curve for identifying AP patients and AP patients transferred to ICU were 0.996 and 0.743.  Conclusions  The pathogenic bacteria increased and the beneficial bacteria decreased in the gut microbiome of AP patients. Changes in gut microbiota are related to the severity of AP disease and therefore have the potential to be used as novel biomarkers for AP.
Abstract:
  Objective  To investigate the differences of intestinal flora in Vitamin D adequacy and deficiency groups of children with autism spectrum disorder(ASD) and the correlation between serum total 25-hydroxyvitamin D [T-25(OH)D] levels and intestinal flora.  Methods  ASD children who attended the outpatient clinic of the department of Rheumatology and Clinical Immunology of Peking Union Medical College Hospital during October 2009 and February 2022 were retrospectively included in the study. According to the serum T-25(OH)D levels, they were divided into Vitamin D adequacy group[T-25(OH)D > 30 μg/L], Vitamin D insufficiency group[20 μg/L≤T-25(OH)D≤30 μg/L] and Vitamin D deficiency group[T-25(OH)D < 20 μg/L].Serum T-25(OH)D levels were measured using liquid chromatography-tandem mass spectrometry. Human gut metagenome data from these children with ASD were analyzed using bioinformatics methods.  Results  46 children with ASD who met the inclusion and exclusion criteria were included in the study. The numbers of patients in Vitamin D adequacy group, Vitamin D insufficiency group and Vitamin D deficiency group were respectively 15, 16 and 15. Linear discriminant analysis revealed that the bacteria abundance of Bilophila wadsworthia, Adlercreutzia equolifaciens, Asaccharobacter celatus and Escherichia coli were significantly enriched, while the bacteria abundance of Bacteroides fragilis and Hungatella hathewayi were significantly lower in the Vitamin D deficiency group. The relative abundance of Bilophila wadsworthia and Adlercreutzia equolifaciens were negatively correlated with serum T-25(OH)D levels(r=-0.45, fdr=0.055, P=0.002;r=-0.44, fdr=0.055, P=0.003), and the relative abundance of Bacteroides fragilis was positively correlated with serum T-25(OH)D levels (r=0.42, fdr=0.073, P=0.004).  Conclusions  Vitamin D deficiency in ASD may exacerbate ASD flora disorders, and decreased serum T-25(OH)D levels may facilitate potentially harmful bacteria but inhibit probiotic colonization. This study provides partial evidence that children with ASD should be actively supplemented with vitamin D.
Abstract:
  Objective  To investigate the characteristics of gut microbiome and their associations with lymphocyte subsets and disease activity in patients with ankylosing spondylitis (AS).  Methods  This study was a retrospective analysis. The subjects of the study were AS patients who were hospitalized in the Second Hospital of Shanxi Medical University from December 2019 to June 2020, as well as gender- and age-matched healthy controls (HCs). The fecal samples were collected, and the V3-V4 variable regions of 16S rRNA gene of gut microbiome were sequenced for bioinformatics analysis. Peripheral venous blood was collected from AS patients to determine peripheral blood lymphocyte subsets and disease activity indicators. Spearman correlation test was used to analyze the correlations between the relative abundances of gut microbiota and peripheral blood lymphocyte subsets as well as disease activity in AS patients.  Results  A total of 62 AS patients (11 with low disease activity, 26 with high disease activity, and 25 with extremely high disease activity) and 62 healthy people who met the inclusion and exclusion criteria were enrolled. As for α-diversity, ACE and Chao1 indices were lower in AS than in HCs(P < 0.05). Bray curtis distance-based β-diversity analysis revealed significant difference in the microbial community between AS and HCs (P < 0.01). As for the composition of the gut microbiome, Firmicutes, Bacteroidetes, and Proteobacteria were the dominant phyla in the gut microbiota of both groups, but there were differences in the abundance of various bacteria at the phylum and genus levels. In Stamp analysis, fecal microbial communities in AS differed significantly from those in HCs, which were characterized by higher abundances of phylum Proteobacteria and Patescibacteria(all P < 0.05) and a lower abundance of phylum Firmicutes and Fusobacteriota (all P < 0.05). At the genus level, the abundances of Escherichia-Shigella, Klebsiella and Enterococcus were increased while those of Prevotella and Faecalibacterium were decreased in AS patients compared to HCs(all P < 0.05). Spearman correlation analysis showed that the relative abundances of Faecalibacterium, Ruminococcus and Klebsiella in AS patients were significantly positively correlated with disease activity or its related indicators(all P < 0.05). There were positive correlations between Agathobacter and T cell (r=0.302, P=0.017), CD4+T cell (r=0.310, P=0.014), B cell (r=0.292, P=0.021), Th2 cell (r=0.429, P < 0.001), Th17 cell (r=0.288, P=0.023), Streptococcus and B cell (r=0.270, P=0.034), Prevotella and Th1 cell (r=0.279, P=0.028), Th17 cell (r=0.262, P=0.040), CAG-352 and Th1 cell (r=0.283, P=0.030). There were negative correlations between Escherichia-Shigella and Th2 cell(r=-0.261, P=0.040), other Enterobacteriaceae and CD4+T cell (r=-0.255, P=0.046).  Conclusions  The diversity of gut microbiota is reduced in AS patients. The abundance of pathogenic bacteria in AS patients is increased, which is correlated with changes in peripheral blood lymphocyte subsets and disease activity. Dysbiosis may be involved in the occurrence and development of AS.
Abstract:
  Objective  To provide inspiration for the clinical application and development of fecal microbiota transplantation (FMT) by investigating the awareness and acceptance of this technology among clinical medical students of different grades.  Methods  An electronic questionnaire was used to investigate the group of eight-year medical students at Peking Union Medical College, Tsinghua University from Class 2014—2021. The students were divided into clinical medicine group (Class 2014—2016), transitional group (Class 2017—2018) and basic medicine group (Class 2019—2021) according to their grades. The awareness and acceptance of FMT among different groups of medical students were explored through data analysis and comparison between different groups.  Results  A total of 210 questionnaires were distributed and 205 valid questionnaires were recovered, with an effective recovery rate of 97.6%. There were significant differences in FMT awareness among medical students of different grades (P < 0.001). 35.6%(73/205) of the medical students did not know anything about FMT, among which the basic group had the highest proportion, compared with the clinical group and the transition group, and the difference was statistically significant(59.7% vs. 10.3%, P < 0.001; 59.7% vs. 32.0%, P=0.001). 77.1%(158/205) of medical students agreed to use FMT for disease treatment, and the proportion of clinical group(82.8%) and transition group (82.7%) was higher than that of basic group (66.7%). The main concerns of not agreeing to use FMT for the treatment of patients' diseases were "insufficient evidence of evidence-based medicine" and "fear of infection with other unknown diseases". 78.0%(160/205) agreed to use FMT for the treatment of their own diseases, and the proportions of clinical group, transition group and basic group were 77.6%, 81.3% and 75.0%, respectively. Moreover, 83.7%(169 / 202) of medical students were willing to donate their fecal microbiota for disease treatment.  Conclusions  The overall awareness of FMT among medical students is insufficient, but with the increase of years of education, the awareness continues to improve. Meanwhile, most medical students are willing to donate their fecal microbiota and accept FMT as an exploratory attempt for the treatment of patients' and their own diseases, which will help promote the development of FMT related clinical research in China. More attention should be paid to the promotion of FMT related research among medical students, in order to offer more insights and suggestions for the development and improvement of new technologies.
Abstract:
  Objective  To explore the application value of six prediction models reported at home and abroad for adverse outcomes of hypertensive disorders of pregnancy(HDP) in eastern and western China.  Methods  For all patients who delivered in the First Affiliated Hospital of Soochow University and Sichuan Provincial Maternal and Child Health Care Hospital from May 1, 2011 to April 30, 2019 and were diagnosed with HDP, their clinical data were retrospectively analyzed. Six models, fullPIERS, miniPIERS, Zwertbroek, PREP, Ngwenya, and Ma Guojun, were used to predict the risk of adverse outcomes for the patients. The predictive performance of the models was evaluated in terms of discrimination and calibration.  Results  A total of 2978 patients were eligible. Combined adverse outcomes occurred in 13.6% (405/2978) of women within 48 h of admission, and 22.0% (655/2978) at any time during admission. The delivery < 34 weeks (49.4%, 200/405), need for blood product transfusion (43.5%, 176/405), and placental abruption (23.5%, 95/405) were the most common adverse outcomes within 48 hours of admission. The area under of the curve of the six models for predicting adverse outcomes in the patients with HDP within 48 hours of admission/during hospitalization ranged from 0.600 to 0.897, the sensitivity ranged from 57.1% to 69.5%, and the specificity ranged from 60.1% to 76.6%. The Hosmer-Lemeshow test showed that except for the PREP model (which had a small validation population and was not evaluated for calibration), the P-values of all the other 5 models were less than 0.05.  Conclusions  The six prediction models have certain application value in the prediction of adverse outcomes of HDP patients in the eastern and western regions of China, but the fitting is poor. The predictors involved in some models are not routine inspection indicators, and the feasibility of large-scale model application is still open to question. It is still necessary to establish a better prognostic model suitable for local areas based on Chinese characteristics.
Abstract:
  Objective  To evaluate the safety and clinical value of laparoscopic jejunostomy in minimal invasive McKeown esophagectomy.  Methods  The clinical data of the patients undergoing minimally invasive McKeown esophagectomy in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2013 to June 2020 were retrospectively included, and according to postoperative nutritional support they were divided into oral intake group (January 2013 to October 2017) and jejunostomy group (November 2017 to June 2020). The operation time, postoperative hospital stay, complications, perioperative nutritional status and quality of life scores were compared between the two groups.  Results  A total of 190 patients with esophageal cancer who met the inclusion and exclusion criteria were enrolled. There were 128 cases in jejunostomy group and 62 cases in oral intake group. Compared with the patients in oral intake group, those in jejunostomy group had shorter postoperative hospitalization time [11(9, 13)d vs. 14(13, 20)d, P < 0.001], the completion rate of postoperative adjuvant chemotherapy in the jejunostomy group was higher(95.16% vs. 75.00%, P=0.005). The operation time [335(300, 374)min vs. 330(310, 370)min, P=0.750] and the incidence of surgery-related complications(28.13% vs. 35.48%, P=0.748) showed no significant difference between the two groups. The body mass index in jejunostomy group was higher 1 month [(23.3 ± 3.5)kg/m2 vs. (21.7±3.9)kg/m2, P=0.006] and 3 months[(22.6±3.5)kg/m2 vs. (20.6±4.0)kg/m2, P < 0.001] after surgery, and the body weight decreasing rate was lower 1 month [(3.9 ± 2.2)% vs. (10.3±3.5)%, P < 0.001] and 3 months[(6.5±3.1)% vs. (15.7 ± 4.8)%, P < 0.001] after surgery than those in oral intake group. The quality of life symptom scores in both groups were increased and the physical functioning and summary scores were sharply decreased at day 7 after operation, and all scores were improved in different degrees 1 month after operation. Compared with the measurements in oral intake group, the symptom scores (except pain score 1 month after operation) were decreased, and the physical functioning and summary scores were increased in the jejunostomy group 7 days and 1 month after operation (all P < 0.05).  Conclusion  Compared with oral nutrition, total laparoscopic jejunostomy has greater advantages in postoperative nutritional support and quality of life recovery in patients with esophageal cancer. It is also safe and unlikely to increase surgery-related complications.
Reviews
Abstract:
Death receptor pathway and perforin/granzyme pathway are the main mechanisms for immune system to kill tumor cells. SerpinB9 is the only known human protein that is able to inhibit the proteolytic activity of granzyme B (GrB). Expression of SerpinB9 has been observed in various human tumors, such as lung cancer and prostate cancer, and SerpinB9 can protect tumor cells from cytotoxic lymphocytes-mediated killing through the perforin/GrB pathway. In skin tumors, SerpinB9 expression has been detected in cells of malignant melanoma, cutaneous squamous cell carcinoma, cutaneous lymphomas, in which SerpinB9 contributes to tumor progression by mediating immune escape, resistance to immunotherapy and interference of the tumor microenvironment. In addition, researches have shown that inhibitor of SerpinB9 could retard the growth of melanoma, indicating the potential anti-tumor therapeutic application of SerpinB9 inhibition. The research status of SerpinB9 in skin tumors is reviewed in this paper.
Abstract:
In recent years, with more and more basic research on the POU family, it has been found that POU domain proteins are related to cell development, replication, growth, and cell cycle blocking and differentiation. POU3F2 not only participates in embryonic development and differentiation of central neuroendocrine system, but also has wide expression in malignant tumors, and regulates the proliferation, invasion and metastasis of tumor cells in different ways to affect tumor development. Based on the structure of POU3F2, the review expounds the function and research status of POU3F2 in common malignant tumors, with the hope of further studying its mechanism and preventing diseases.
Complicated and Rare Disease
Abstract:
  Objective  To analyze the clinical, imaging and pathological features of patients with epithelial-myoepithelial carcinoma(EMC).  Methods  The data of a patient with primary EMC of the thymus in Peking Union Medical College Hospital was retrospectively analyzed, and the relevant literature was reviewed.  Results  The patient was a middle-aged male diagnosed with primary EMC of the thymus, and he was the first case currently reported at home and abroad. Even though the patient received comprehensive treatments including surgery, chemotherapy, radiotherapy and molecular targeted therapy, he still experienced disease progression, with a survival time of 22 months after surgery.  Conclusions  Primary EMC of the thymus is extremely rare and has atypical clinical manifestations. The diagnosis mainly depends on histopathological examination. Surgery is currently the major treatment and multidisciplinary treatment is very important to prolong the survival time of EMC patients.
Clinical Research and Evidence Based Medicine
Abstract:
  Objective  To explore the research status of randomized controlled trial (RCT) with the application of artificial intelligence (AI) in the medical field, in order to provide insights for Chinese scholars to carry out AI research.  Methods  AI related RCT researches were obtained by searching PubMed database. The Web of Science was used to obtain the publication year, citations, authors, institutions, and countries of included AI related RCT researches. The VOSviewer 1.6.17 software was used to extract the related information, generate visual cooperation network maps for the country, institutions and authors, and perform cluster analysis for keywords. The Cite Space 5.8.R3 software was used to analyze the burst citation references and keywords.  Results  A total of 1174 RCTs in AI field were included, with an average citation frequency of 36.09. The publication time was from 1989 to 2021, and the number of articles increased rapidly after 2007. Among them, the top 5 countries with the number of published articles were the United States (37.22%, 437 papers), Italy (10.90%, 128 papers), South Korea (8.86%, 104 papers), Germany (8.35%, 98 papers), China (7.84 %, 92 papers); the top 5 research institutions with the most published papers were Harvard University (2.98%, 35 papers), Yonsei University (2.73%, 32 papers), Northwestern University (2.21%, 26 papers), Massachusetts Institute of Technology (2.13%, 25 papers), Stanford University (1.96%, 23 papers), and the top 5 authors were Krebs (22 papers, Massachusetts Institute of Technology, US), Calabro (11 papers, IRCCS Neural Center, Italy), Picelli (11 papers, University of Verona, Italy), Smania (11 papers, University of Verona, Italy), Lin (10 papers, Taiwan University, China). Insufficient cooperation between prolific authors, research institutions, countries. The main hot topics were the application of robot technology in treatment, the application of machine learning in disease diagnosis and management, and the application of AI in rehabilitation training. Combined with strongest citation burst, it was found that robot assistance and machine learning may be the current research hot topics.  Conclusions  AI has great application prospects in the medical field, and the number of AI related RCT medical research has increased rapidly in recent years. Although the developed countries are in the leading position in this field, the researchers and research institutions in China have shown great potential. At present, the cooperation between the authors, research institutions and countries conducting AI related RCT medical research is not close, and the research topic needs to be expanded.
Clinical Practice Guidelines
Abstract:
  Objective  To investigate the reporting status of abstracts of Chinese clinical practice guidelines published in medical journals in 2019 and provide a reference for related researchers to write guideline abstracts and develop the reporting standard.  Methods  We systematically searched four electronic databases and additional sources for Chinese clinical practice guidelines published in medical journals in 2019. Four researchers independently screened the identified literature and extracted data related to abstracts. We analyzed the current status of abstract report, evaluated the reporting quality of guideline abstracts using the preliminary RIGHT-Abstract reporting checklist (consisting of 7 domains and 19 items) and assessed the consistency between the abstract and the main text.  Results  A total of 226 guidelines were finally included, 96(42.5%) of which included abstracts. Among the 96 guidelines, 79(82.3%, 79/96) were published in Chinese and 17(17.7%, 17/96) were published in English. Among the 79 guidelines in Chinese, 52(65.8%, 52/79) provided bilingual abstracts in both Chinese and English. Of the 96 guidelines with abstracts, only 6(6.3%) guidelines included structured abstracts, and 16(16.7%) guidelines reported the main contents of recommendations in the abstract. The reporting rates in each RIGHT-Abstract domain were as follows: 61.0%(background), 13.0%(methods), 7.3%(results), 1.0%(review), 0(discussion, registry and funding). In terms of the consistency in content between the abstract and the main text, the item with the best consistency was the "diseases and health problems"(91.7%), followed by the "purpose "(78.1%), "target populations "(70.8%), "users"(38.5%) and "developers "(38.5%). For the rest of items, the consistencies were less than 20.0%.  Conclusions  The proportion of Chinese clinical practice guidelines published in medical journals in 2019 that included abstracts was relatively low, especially the structured abstracts, and the guideline abstracts provided limited information. It is necessary to develop and promote the formal reporting standard for the guideline abstracts in the future, so as to provide a guidance for related researchers.
Medical Supports to Tibet & Xinjiang
Abstract:
  Objective  To explore the improvement effect of green channel process optimization in acute ischemic stroke (AIS) on intravenous thrombolysis (IVT) quality in Lhasa.  Methods  All patients with AIS who received IVT by the stroke center of Tibet Autonomous Region from August 2019 to December 2021 were included. According to whether the stroke green channel process was optimized, they were divided into the pre-optimization group (August 2019 to June 2021) and the post-optimization group (July to December 2021). The quality of IVT and stroke prognosis were compared and analyzed between the two groups.  Results  A total of 34 patients with AIS who received IVT were included (an average of 1.2 patients per month), including 16 in the pre-optimization group and 18 in the post-optimization group. The National Institutes of Health Stroke Scale scores at baseline, immediately after thrombolysis, and 24 hours after thrombolysis were 6.5(3.0, 12.0), 3.0(1.0, 5.5)and 2.0(0, 6.3), respectively. The door to needle time in the post-optimization group was significantly shortened, as compared with that of the pre-optimization group[(67.1±37.8)min vs. (108.9±53.8)min, P=0.035]. Onset to needle time [(176.7±69.7)min vs. (199.1±47.8)min, P=0.065], the compliance rate of door to needle time ≤60 min (50.0% vs. 18.8%, P=0.061) and the proportion of good short-term efficacy of thrombolysis (77.8% vs. 62.5%, P=0.336) were improved, but the differences were not statistically significant.  Conclusions  After the process optimization of stroke green channel, the in-hospital delay of IVT for AIS in Lhasa is significantly improved, which is helpful to enhance the first-aid efficiency of early treatment of AIS.
Teaching and Research
Abstract:
The standardized training of residents is an important part of the education of residents, in which the training of anesthesiology is one of the essential contents. Previous studies have shown that residents with different majors and seniority have different needs for training in the Department of Anesthesiology. Therefore, the Department of Anesthesiology of Peking Union Medical College Hospital has explored individualized and stratified sub-department training rules and assessment plans, covering Surgery Department, Critical Care Medicine, Internal Medicine, ENT Department and Emergency Medicine. Since the trial implementation of the training program in August 2021, a total of 77 non-anesthesiology residents have completed the training, and the assessment results have all reached the standard at the end of the training, with 56.2% of the students scoring 80 or above and an overall satisfaction rate of 92%. This program provides a reference for improving the standardized training of anesthesiologists for non-anesthesiology residents.