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核医学技术:开启个性化诊疗的新时代

北京协和医学院临床医学(八年制)2017级 曹增涵

 近二十年来,随着设备和放射性药物的革新、临床需求的不断增加、国家政策的大力扶持以及全球化合作的开启,核医学技术取得了长足进步。本期《协和医学杂志》主题为:核素诊疗与临床转化,旨在阐述放射性核素(即核医学技术)在临床诊疗中的重要价值。封面创作亦围绕该主题展开。

 本期封面由背景与中心人物轮廓两部分组成。背景涵盖脑、心肌、肝脏、前列腺以及骨骼5种组织/器官。这些靶组织及靶器官均来源于本期重点选题论文,是放射性核素应用的典型代表。中心人物及镶嵌于其中的黑色脏器轮廓模拟了核医学显像。经多位临床专家的提点,我意识到特定核素并非仅可用于单一靶器官的诊疗,而是可在各种疾病中广泛应用,同理,每种脏器相关的疾病也可通过不同核素显像。因此,图中各种常见核素也散在标注于人体各个部位。在不同组织/器官中,我采用了不同颜色进行标注,展示核素可在不同靶组织/器官中发挥其定位或辐射功能。

 人体从宏观上看疑点重重,核医学技术成为黑白疑团中引人注目的彩色亮点,将微观的病生理变化较为直观地展现出来,推动了人类对医学的进一步认知。放射性核素在临床中的应用是多元的,不断创新的,相信随着核医学技术的蓬勃发展,其在未来的临床诊疗中必将发挥更大的价值,助力个性化诊疗的高效实施。

Vol. 14, No. 4 30 07 2023
Chinese Bimonthly CN 11-5882/R ISSN 1674-9081
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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Abstract: With the rapid development of emerging biotechnologies such as high-throughput sequencing, multi-omics and multi-dimensional research models for biological big data have been initiated. Concurrently, the fast-evolving technologies such as mathematical modeling, artificial intelligence, cloud computing, blockchain, big data, the Internet of Things, and 5G have enabled the possibility of developing digital twin. Digital twin is a model mapping of physical objects, processes, and systems in digital space, which has shown great potential in the medical field. On the one hand, digital twin technology can provide visualized 3D structures for human organs and systems to assist diagnosis and treatment. On the other hand, it provides a tangible "skeleton" for data mining in genomics, metabolomics, and phenomics, and can simulate processes for chronic disease management, drug development, and clinical trials, thereby advancing the medical field. This article reviewed the methods and applications of digital twin in the medical field, aiming to provide reference for the development of medical digital twin research in China. more>
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Abstract: Patient and public versions of guidelines (PVG) is receiving more and more interest and attention in China, and their number is also on the rise. This article intends to explore the methods for the development of PVG, introduce and compare different development methods,and incorporate case studies for interpretation, aiming to provide reference for the developers of PVG and further promote the development of PVG in China. more>
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Primary health care institutions should be the main force of China's medical and health service system and the cornerstone of the national health care system. During the COVID-19 epidemic, China's primary health care institutions have played a huge role, but at the same time, many deficiencies and weaknesses have also been highlighted. Through systematic literature search and analysis, this article found that China's primary health care institutions have some problems such as low demand for patient care, weak integration of the health system, weak service foundation, and insufficient emergency response capacity for public health emergencies, etc. Accordingly, we put forward a strategy for the construction of primary health care institutions based on the “Three Forces Theory”, which will help to improving the primary medical and health care service system, upgrading the capacity of primary medical and health care services, and better fulfilling the strategic goal of “Healthy China 2030”.

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Abstract: As a common neurological disease, cognitive impairment is characterized by cognitive decline, memory and attention impairment, which seriously affects the quality of life of patients. It is a hot and difficult point in the field of medical research. The etiology and pathogenesis of cognitive impairment are complex and diverse. Studies have shown that chronic persistent neuroinflammation plays a key role in its development. Microglia and Nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome are closely related to neuroinflammation and cognitive impairment. Regulation of microglia and NLRP3 inflammasome can reduce inflammatory factors, reduce amyloid β-protein (Aβ) deposition, regulate autophagy, maintain synaptic homeostasis, and reduce neuroinflammation. In turn, the role of prevention and treatment of cognitive impairment. Therefore, summarizing and discussing the mechanism of microglia, NLRP3 inflammasome and their interaction in cognitive impairment can provide some reference and basis for the in-depth study of the mechanism of cognitive impairment, clinical prevention and treatment of cognitive impairment, and the subsequent development of more efficient drugs. more>
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This study conducted a comprehensive assessment of the current state of health standards in China by systematically searching the National Health Commission's Health Standards website and various literature databases. By identifying key issues within the domain of health standards, this study subsequently presented targeted strategies and recommendations. These findings serve as a valuable reference for refining China's health standard system and developing policies related to health standards.

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 doi: 10.12290/xhyxzz.2023-0368
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Bone age is the most commonly used and effective indicator for understanding children's growth and development, and plays an important role in the diagnosis and efficacy evaluation of various growth and development disorders.Clinically, X-rays of the left hand and wrist are mostly taken for bone age assessment, but there is a certain radiation risk. Ultrasound can clearly display the epiphysis and secondary ossification center, and can conveniently perform multi-site scanning and dynamic measurement without radiation. In recent years, great progress has been made in the research and clinical application of bone age assessment using ultrasound. This article reviews the latest literature to discuss the value of musculoskeletal ultrasound and quantitative ultrasound in bone age assessment, and puts forward the problems in the study of ultrasound assessment of bone age and improve direction.

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Abstract: Objective To evaluate the clinical value of metagenomic nextgeneration sequencing (mNGS) of cerebrospinal fluid in pathogenic diagnosis of Central nervous system (CNS) infection. Methods Basing on the mNGS platform at Peking Union Medical College Hospital, we retrospectively analyzed the clinical information, laboratory test results and mNGS results of patients diagnosed CNS infection during April 2022 to December 2022. Results Among 39 patients diagnosed CNS infection, pathogen-specific sequences were detected by mNGS in 29 cases (74.4%), which included 11 (37.9%) bacterial cases, three (10.3%) fungal cases, 13 (44.8%) viral cases, one (3.5%) cases with bacteria & virus, and one (3.5%) cases with fungus & virus. Ten (25.6%) false negative cases were detected. The positive rate of mNGS was significantly higher than that of clinical testing including cerebrospinal fluid smear, culture, pathogenic antigen tests, and nucleic acid tests by polymerase chain reaction (74.4% vs. 23.7%). Conclusion Compared with clinical testing, mNGS has a higher positive rate in diagnosing CNS infection and could benefit for early pathogenic diagnosis of CNS infection. more>
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Abstract: Objective To sort out the rare disease drugs in the First Batch of Rare Disease Catalogue, and analyze the differences in the accessibility of drugs at home and abroad, improve and update the status of drug therapy for rare diseases in China, and provide reference for the management and research of drug therapy for rare diseases. Method Orphan drugs approved by the U.S. Food & Drug Administration (FDA) and the European Medicines Agency (EMA) for related indications for the diseases listed in the First Rare Diseases Catalogue were retrieved for reference. Besides, we extracted the varieties approved by the National Medical Products Administration (NMPA), searched the drug varieties approved for rare diseases in the indications of drug instructions, and sorted out the list of rare disease drugs. The accessibility of the above-mentioned drugs was analyzed. Results As of December 31, 2022, 116 rare disease drugs approved by U.S. FDA, EMA or NMPA and marketed in China covered 53 rare diseases. Among them, 74 drugs approved by U.S. FDA, covered 41 diseases. 39 drugs approved by the EMA, covered 27 diseases. 94 drugs approved by the NMPA, covered 38 diseases. Among 116 rare disease drugs, 59 had at least one drug dosage form with domestic approval number, covering 36 rare diseases; 64 drugs had at least one drug form included in the medical insurance and used for rare diseases, and 28 rare diseases were covered. Conclusions At present, 116 orphan drugs listed abroad or approved in Chinese drug specifications have been used for the treatment of diseases in the first Batch of Rare Diseases Catalogue. Compared with the release of the first batch of Rare Diseases Catalogue, the accessibility and the composition of domestic approval numbers of foreign orphan drugs accessibility increased, and the number of items included in the national medical insurance have been further improved. more>
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Abstract: Artificial intelligence(AI) empowers the development of the medical industry, providing precise and intelligent assistance for clinical diagnosis, treatment, and rehabilitation.AI has the potential to facilitate shared decision making (SDM). AI interventions used for SDM are currently in their infancy, with new challenges and opportunities. Therefore, this paper describes the application of AI in SDM, explores the problems and challenges of AI-based decision aid used for SDM, and proposes possible solutions, aiming to provide a guide for the development and implementation of AI-based decision aid. more>
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Abstract: To further standardize the clinical diagnosis and treatment decisions of iodine refractory differentiated thyroid cancer (RAIR-DTC) in China, it is urgent to establish clinical diagnosis and treatment management guidelines based on evidence-based medical data to scientifically guide the diagnosis and treatment of RAIR-DTC. By referring to the World Health Organization Guidelines Development Manual and following the protocol of devising evidence-based guidelines, we will register and write the prospectus of "Guidelines for the Diagnosis, Treatment, and Management of Iodine Refractory Differentiated Thyroid Cancer". We will also devise and release official guidance documents. This guidelines prospectus mainly introduces the significance, purpose, target population, user population, guidelines formulation team members, collection and determination of clinical issues and outcome indicators, acquisition, evaluation, and synthesis of evidence, and generation of recommendations and other guidelines formulation methods and processes of the "Guidelines for the Diagnosis, Treatment, and Management of Iodine Refractory Differentiated Thyroid Cancer". more>
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Respiratory tract infection is one of the most prevalent medical conditions. Rapid and accurate diagnosis of pathogens is crucial prerequisite for precise and effective treatment. However, the sensitivity of traditional microbiological and immunological techniques for respiratory pathogens detection is low. The development and clinical applications of nucleic acid testing technology have dramatically improved the diagnostic ability of respiratory pathogens. The rational usage of appropriate nucleic acid testing techniques, based on the underlying diseases, the type of respiratory tract infections, and pathogen spectrum, as well as correct understanding its diagnostic significance, has become an important clinical problem. For this, the Committee of Chinese Laboratory Medical Education initiated a multi-disciplinary Chinese expert consensus. Basing on the both domestic and international guidelines and literature, the expert consensus conducted an analysis of the clinical application scenarios, technical characteristics, and performance validation requirements pertaining to real-time fluorescence polymerase chain reaction (PCR), isothermal amplification technology, digital PCR, nucleic acid point-of-care testing, and metagenomics Next Generation Sequencing. Furthermore, the consensus of experts also examined the wide-ranging applications of these techniques in diagnosing and managing respiratory tract infections, including acute upper respiratory tract infections, tracheobronchitis, community-acquired pneumonia, hospital-acquired pneumonia/ventilator-associated pneumonia, acute exacerbation of chronic obstructive pulmonary disease, tuberculosis, and respiratory infections in immunocompromised adults. We hope the consensus will provide helpful reference to the clinicians.

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Abstract: Objective This study explores the essential factors during the consensus process in guideline development, aiming to improve the quality of the consensus process by providing methodological suggestions for enhancing standardization. Methods Semi-structured qualitative interviews were used to interview guideline leaders, working groups and consensus groups to explore the relevant factors affecting the credibility of the consensus and their views on the composition and process of the consensus method. Results The researchers interviewed 26 individuals. After summarization, 212 codes were deepened into five areas:establishment of a consensus group, patient participation, meeting moderator, preparation of consensus and the influencing factors of consensus. Summarized the three basic steps of constructing a consensus group and the 17 basic principles of the application of the consensus method. Conclusion In the future guideline development, it is recommended to increase the methodological training before the consensus process and the full participation of methodologists, encourage experts to treat differences reasonably, pay attention to the methodology and evidence materials. The process should involve openly disclosing the selection of consensus group members, increasing patient participation, and managing and reporting conflicts of interest to reduce bias and enhance transparency, reliability, and scientific rigor of consensus outcomes. more>
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Abstract: Objective To investigate the predictive value of albumin-bilirubin (ALBI) score combined with liver function index and carcinoembryonic antigen (CEA) for liver metastasis of colorectal cancer. Methods The clinical data of patients with colorectal cancer who underwent surgical treatment in the Second Hospital of Lanzhou University from January 2016 to July 2021 and were followed up for 24 months were retrospectively analyzed. According to the follow-up results, the enrolled patients were divided into liver metastasis group and non-liver metastasis group, and were randomly divided into modeling group and validation group according to the ratio of 2:1. The risk factors of liver metastasis in patients with colorectal cancer were analyzed. Lasso-Logistic regression was used to construct the prediction model. Bootstrap method was used for internal verification. Receiver operating characteristic curve, calibration curve and clinical decision curve were used to evaluate the reliability of the prediction model. Finally, a nomogram was drawn to show the prediction results. Results A total of 195 patients who met the inclusion and exclusion criteria were enrolled, including 130 in the modeling group and 65 in the validation group. Through Lasso regression variable screening and Logistic regression analysis, the results showed that ALBI (OR=8.062,95% CI:2.545~25.540), alanine transaminase (ALT) (OR=1.037,95% CI:1.004~1.071) and CEA (OR=1.025,95% CI:1.008~1.043) were independent predictors of liver metastasis in colorectal cancer. The area under curve (AUC) of the combined prediction of liver metastasis of colorectal cancer in the modeling group was 0.921, the sensitivity was 78%, the specificity was 95%, the C-index was 0.921, the H-L fitting curve X2=0.851, P=0.654, and the slope of the calibration curve was close to 1, suggesting that the accuracy of the model was high, and the DCA curve showed that the model had good clinical application value. For the data of the modeling group, the Bootstrap method was used for internal verification of 1000 resamplings. The accuracy was 0.869, the kappa consistency was 0.709, and the AUC was 0.913. When ALBI, ALT and CEA were used to diagnose liver metastasis of colorectal cancer alone, the AUC of CEA was the largest (0.897), and the combination of the three had the highest efficacy in the diagnosis of liver metastasis of colorectal cancer. In the validation group, the AUC, sensitivity, specificity, Cindex and H-L curve of the combined prediction of liver metastasis of colorectal cancer were 0.918, 85%, 95.6%, 0.918, X2=0.586, P=0.746, respectively. Conclusion ALBI, ALT and CEA have certain predictive value for liver metastasis of colorectal cancer. The combined diagnosis of liver metastasis of colorectal cancer has high efficacy, and the risk prediction model constructed by them has a good predictive effect. more>
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Metabolic associated fatty liver disease (MAFLD) was renamed from the nonalcoholic fatty liver disease (NAFLD). At present, about the pathogenesis of MAFLD, people generally accept the "multiple strike" theory, which involves the interaction of genetic and environmental factors. These attacks include insulin resistance, lipid disorder, oxidative stress, intestinal microbiota, etc. However, there is no approved drug for MAFLD. Recent studies have found that vitamin D is involved in many metabolic processes, which may be involved in the development of MAFLD by influencing liver lipid metabolism, promoting insulin resistance and inflammatory response, participating in immune regulation, gene regulation and maintaining intestinal homeostasis. Therefore, this article summarizes the relationship between vitamin D and MAFLD, reveals the potential mechanism of vitamin D in the pathogenesis of MAFLD, and provides clinical ideas for the treatment of MAFLD.

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Online adaptive radiotherapy( OART) is considered to be a revolutionary technology after intensity-modulated radiotherapy. The first Chinese OART platform based on iterative cone beam computed tomography (iCBCT) has been applied in clinical treatment in Peking Union Medical College Hospital. This article reports the workflow and efficacy of first case with cervical cancer who received radical OART. After treatment, the patient achieved clinical complete remission with only a grade 1 radiation toxicity in the lower gastrointestinal tract. This article analyzes and discusses the clinical treatment process and follow-up data of this patient, aiming to provide clinical evidence for the subsequent large-scale application of artificial intelligence-driven CBCT-guided OART technology.

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Abstract: The pathogenesis of autoimmune diseases (AID) is a complex process. Recent evidence has increasingly shown that infection plays a key role in driving the occurrence and progression of AID, particularly in individuals with underlying genetic predisposition. This provides a new and broader perspective for clinical examination of the causes and potential mechanisms of AID. In this review, we aim to summarize the latest research progress on the relationship between pathogenic microorganisms and autoimmunity/AID, with the goal of exploring the etiology and pathogenesis of common AID from an etiological perspective. By integrating existing evidence, we hope to deepen the understanding of AID pathogenesis and provide valuable insights for disease prevention, clinical diagnosis, and treatment. more>
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Abstract: Objective To investigate the relationship between the thresholds of intraoperative facial nerve response and postoperative facial nerve function recovery in patients with Bell’s palsy. Methods Clinical data from Bell’s palsy patients who underwent facial nerve decompression surgery at Beijing Tiantan Hospital from October 2015 to October 2022 were collected. Patients who had intraoperative facial nerve monitoring with accurate recording of the facial nerve direct stimulation threshold and had at least 1 year of detailed follow-up were selected for analysis. Patients with postoperative facial nerve function recovery to grade I-II (HB grading) were defined as having good recovery, while those who recovered to grade III or higher were defined as having poor recovery. Patients were divided into two groups (A and B) according to facial nerve reaction excitability, with group A having a direct stimulation threshold of ≤1.5 mA and group B having a direct stimulation threshold of >1.5 mA or an increase in stimulation volume to 3mA, but no neural response waveform was recorded. The relationship between postoperative facial nerve function recovery and facial nerve direct stimulation threshold was compared. Results A total of 36 Bell’s palsy patients were included in this study and underwent facial nerve decompression surgery through the transmastoid-epitympanum approach within 1-3 months after onset. Of the 36 patients, 24 (66.7%) had good recovery and 12 (33.3%) had poor recovery. Only 20 (55.6%, 20/36) patients had facial nerve direct stimulation threshold recorded during the operation, and all were ≤1.5mA (0.1-1.5 mA). The reaction waveforms of 16 (44.4%, 16/36) patients could not be recorded even when facial nerve stimulation increased to 3mA. There was no significant difference in age, gender, lateral discourse, timing of surgery , and preoperative electroneurography (ENoG) in group A and group B, but the good recovery rate of patients in Group A was significantly higher than that in Group B, and the difference was statistically significant (P=0.009). Conclusion For patients with Bell’s palsy undergoing decompression surgery of the facial nerve, the intraoperative direct stimulation threshold of the facial nerve may have some predictive value for postoperative facial nerve function recovery. more>
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Abstract: The development of clinical practice guidelines involves a series of evidencebased decision-making processes, of which the formation of recommendations being a particularly challenging aspect. It demands decision-makers to have a thorough and precise understanding of the evidence, weigh the potential benefits and risks of interventions, and make value judgments and clinical choices. Compared to traditional approaches of presenting evidence information, the use of visualization tools can facilitate the communication and analysis of evidence, simplify information interpretation, and improve the efficiency of decision-making. Based on previous studies, this paper proposes a visualization tool, Vitruvian plot, for summarizing evidence and provides illustrative examples to demonstrate its usage and application effects, aiming to offer valuable guidance for researchers. more>
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Abstract: The classical Child-Pugh classification and the Model for End-Stage Liver Disease (MELD) are now widely used clinically for preoperative assessment of liver failure and prognosis in patients with hepatocellular carcinoma (HCC) treated with radical hepatectomy. However, there are limitations in the conditions of use of both due to factors such as albumin, ascites, and blood creatinine. Review the relevant literature at home and abroad about liver failure and prognosis of HCC patients after radical Hepatectomy: albumin bilirubin score (ALBI), platelet albumin bilirubin score (PALBI), Glasgow Prognostic Score (GPS) and new predictive models have good application prospects in evaluating liver failure and prognosis of HCC patients after Hepatectomy. Combined with the literature, the study of the classic, new liver function scores and new predictive models after Hepatectomy in HCC patients shows that the PALBI score has good application value at present. more>
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Abstract: With the prevalence of novel coronavirus infection (COVID-19), the national prevention and control policies for Class B infectious diseases have gone from“Class A control” to “Class B control” in the past three years. In this context , it is necessary to reexamine the biosafety risks, carry out corresponding biosafety protection practices, and formulate management measures for clinical Biobank during conducting sample preservation activities. It is imperative to improve the biosafety protection system in view of the constantly mutating characteristics and potential risks of novel coronavirus. Professional Committee of Clinical Data and Sample Resource Database of China Research Hospital Association and the Human Genetic Resource Conservation and Application Society of Guangdong Province jointly drafted and formulated this consensus. The aim is to provide practical guidance on biosafety protection for sample preservation activities, reduce biosafety risks, and assure the safe and efficient implementation of sample preservation activities. more>
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Abstract: Castleman disease (CD) is a group of rare and heterogenous hematological diseases which is included in the ‘ Rare disease catalogue’ of China. Among the different clinical subtypes of CD, idiopathic Multicentric Castleman Disease (iMCD) is characterized by symptomatic inflammatory symptoms with poor prognosis. Interleukin-6 (IL-6) targeted therapy (eg. siltuximab) is now considered as the most important treatment option according to international and domestic treatment guidelines and consensus. Since July, 2022, siltuximab became available in Chinese market which heralds the era of IL-6 targeted therapy in China. Thus, it is a good time point to review the state-of-the-art in the field of diagnosis and treatment of CD. We also would highlight some of the clinical investigations conducted by Chinese researchers in this commentary. more>
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Abstract: Objective This study aimed to investigate the understanding of palliative care and experience of palliative sedation for end-stage patients in Chinese anesthesiologists. Methods From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The questionnaire in this study included general information, working experience, familiarity with palliative care, feelings with end-stage cases, experience in sedation for critical/end-stage patients and choice of medication. Results A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. 572 (22.6%, 572/2536) reported that they were familiar with palliative medicine. Anesthesiologists who had experience in critical/end-stage patients care, pain management, and whose hospitals set up with institutional palliative care team reported more familiarity with palliative care. Over 40% of anesthesiologists felt powerless, helpless, and undecisive when facing end-stage patients. Anesthesiologists with knowledge of palliative care were more likely to show confidence in their management of critical/end-stage patients (9.8% vs 4.4%, P = 0.001). 734 anesthesiologists had experience of conducting sedation in end-stage patients, among whom 151 anesthesiologists (20.6%, 151/734) improperly used opioids as the only medication in sedation protocol. Conclusion The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China was still very limited. Development of palliative care team, education and training on palliative care may help to build the confidence of anesthesiologists when facing critical/end-stage patients and to improve the quality of care in end-stage patients. more>
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Abstract: Despite the rapid development of antitumor drugs, the limited drug response rate and adverse drug reactions severely limit their clinical application. In recent years, the concept of "pharmacomicrobiomics" has emerged, and more and more studies have shown that the microbiota plays an important role in the treatment of antitumor drugs. Herein, the interaction between microbiota and antitumor drugs was reviewed from the aspects of chemotherapeutics, molecular targeted drugs and immunotherapy drugs, the mechanism involved immune regulation, hormone regulation, metabolite regulation, drug biotransformation and transmembrane transport regulation. The microbiota regulation strategies that can improve the efficacy and reduce adverse reactions of antitumor drugs are reviewed, in order to provide reference for the individualized treatment of clinical antitumor drugs. more>
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Abstract: Objective This study aims to systematically assess the applicability of the clinical practice guidelines (CPGs) integrating Chinese and Western medicine, thereby providing a reference point for enhancing their future usability. Methods PubMed, Web of Science, Embase, SinoMed, WanFang Data, and CNKI databases were searched for guidelines for integration of Chinese and Western medicine, supplemented by searches of the Dangdang, Chinese Medical Association, Chinese Medicine Administration, MedSci websites, Website of China Association of Chinese Medicine, medlive, Chinese Association of Integrative Medicine and World Federation of Traditional Chinese Medicine Societies from inception to December 31, 2022. Four reviewers independently evaluated the implementability of clinical practice guidelines by using “Clinical Practice Guideline (CPG) implementation evaluation tool”. Results A total of 61 integrative Chinese and Western Medicine guidelines were included. Of the guidelines assessed, 9 guidelines (14.75%) exhibited strong implementability, 39 (63.93%) demonstrated average implementability, and 12 (19.67%) demonstrated poor implementability. Among the 5 domains, the dimensions of "accessibility" and "implementability" were found to be of high quality, while "communication", "ease of identification" and "applicability" were relatively poor. Notably, compared to guidelines published before 2016, those published between 2017-2022 showed improvements in the areas of “identification” and “application”. Conclusion The implementabilityof the existing clinical practice guidelines of the integrative Chinese and Western Medicine is average and needs to be improved. In the future, emphasis should be placed on the integration of medical education and research, increasing the publicity of the guidelines, strengthening the application of the guidelines by clinicians, enhancing continuing medical education and training, presenting recommendations in a more concise form, and improving the implementability of the integrative Chinese and Western Medicine guideline. more>
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Abstract: The development of rapid, living guidelines aims to keep the recommendations in the guideline up-to-date timely. Compared with the conventional guideline, the rapid, living guideline can make better use of the existing evidence and apply and transform the evidence in a timely and rapid manner. Therefore, this paper introduces the advantages and usage of rapid, living guidelines, the development process and existing challenges, and provides some reflections on rapid, living guidelines, in order to provide reference for domestic guideline development organizations and scholars. more>
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Abstract: Objective To analyze the clinical characteristics and inflammatory indicators of hospitalized patients infected with Omicron BA. 5.2 variant, and screen for possible prognostic diagnostic markers. Methods We retrospectively collected clinical data from hospitalized patients with Omicron BA. 5.2 variant infection admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from August 1 to November 30, 2022. The patients were divided into mild, common, severe, and critically ill patient groups based on the severity of the disease. The differences in clinical data between the four groups were compared, and binary logistic regression was used to analyze inflammation indicators related to the severity of the disease. Multiple logistic regression method and receiver operator characteristic (ROC) curve were used to analyze the correlation between various indicators and patient prognosis, as well as the evaluation value for disease severity and prognosis. Results A total of 3006 patients who met the inclusion and exclusion criteria were included, including 1522 males (50.63%) and 1484 females (49.37%), with an average age of (58.72 ±18.01) years. According to the severity of the disease, they were classified into mild (40.98%, 1232/3006), ordinary (52.56%, 1580/3006), severe (4.26%, 128/3006), and critically severe (2.20%, 66/3006) groups. There was a significant difference (P<0.01) in the merging of underlying diseases including cardiac disease, diabetes, hypertension, kidney disease, lung disease, malignant tumor, brain disease, viral hepatitis and autoimmune disease among each group. During the hospitalization period, a total of 74 cases (2.43%) died, including 46 cases of severe illness (63.01%), 19 cases of severe illness (26.03%), 7 cases of ordinary illness (9.60%), and 2 cases of mild illness (2.74%). The proportion of death patients aged ≥ 70 years old was 75.68%(56/74), and all deaths were among those with underlying diseases. CRP and albumin levels were independent risk factors for disease severity, and C-reactive protein (CRP) was significantly positively correlated with disease severity (P=0.002), while albumin levels were significantly negatively correlated with disease severity (P<0.001). CRP, systemic inflammatory response index (SIRI), and systemic immune inflammation index (SII) were independent risk factors for disease prognosis, and CRP and SIRI were significantly positively correlated with disease prognosis (P=0.027, P=0.025), while SII was significantly negatively correlated with disease prognosis (P=0.021). CRP, interleukin-6 (IL-6), D-dimer, and neutrophil lymphocyte ratio (NLR) had high diagnostic value for disease severity classification, while CRP, IL-6, procalcitonin (PCT), D-dimer, troponin T (TnT), troponin I (TnI), neutrophil lymphocyte ratio (NLR), SII, platelet to lymphocyte ratio (PLR), the monocyte lymphocyte ratio (MLR) had a high prognostic diagnostic value for death or survival. Conclusion There were significant differences in clinical characteristics among hospitalized patients infected with Omicron BA. 5.2 variant strains with different disease severity. Combining CRP, IL-6, D-dimer, PCT, D-dimer, TnT, TnI, NLR, SII, PLR, and MLR prediction models may enable early identification of high-risk populations among hospitalized patients infected with Omicron BA. 5.2 variant strains, and provide timely diagnosis and treatment. more>
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Vaccine is the most effective method to prevent the spread of communicable diseases, but the immune response it induces varies significantly among individuals and populations in different regions. Recent studies have shown that the composition and function of the gut microbiota play a key role in the immune response following vaccination. This article aims to explain the differences in gut microbiota among different populations and animals when vaccinated, discuss how the gut microbiota affects the immune efficacy of the vaccine, and summarize strategies for targeting the gut microbiota to improve vaccine efficacy.

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Abstract: Object To evaluate the in vitro antimicrobial activities of a total sixteen agents against clinical Gram-positive isolates to provide susceptibility data for the rational clinical use of drugs. Mechods From January 1 to December 31 in 2019, Gram-positive isolates were collected from 24 hospitals in China. All strains were identified by the MALDITOF MS apparatus. Antimicrobial susceptibility testing was performed using the CLSI broth microdilution reference method. The results were interpreted in accordance with CLSI 2022 criteria. Then the resistance rate of gram-positive isolates and their influencing factors were analyzed. Results A total of 500 Gram-positive strains were mostly Staphylococcus aureus (n=255) and Enterococcus (n=233) accounted for 51.0% and 46.6%, respectively. The drug susceptibility testing results showed that Gram-positive isolates had high resistance rates to erythromycin, penicillin, oxacillin and clindamycin(55.5-71.5%), but maintained low resistance rates to vancomycin, norvancomycin, linezolid and teicoplanin (0.2-1.0%). Linezolid could completely inhibite S. aureus and E. faecium strains, but 4.4% of E. faecalis strains were resistant. All S. aureus and E.faecalis strains were susceptible to vancomycin, but 1.8% of Enterococcus faecium was resistant. Fusidic acid maintain good activity to S. aureus strains, only 2.7% was resistant. Vancomycin and norvancomycin had the same MIC50 and MIC90 to S. aureus strains, which were 1mg/L and 2mg/L, respectively. Conclusions Vancomycin, norvancomycin and linezolid were highly active against clinical isolates of S. aureus and Enterococcus spp. Fusidic acid showed potent in vitro activity against S. aureus. However, there are still strains that are resistant to the four antimicrobials mentioned above. more>
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Abstract: Health equity can narrow the health gap between different groups and enable citizens to enjoy fair health services. Clinical practice guideline makers pay more and more attention to the consideration of health equity, and make some exploration and application in the corresponding guidelines. However, currently, there is little structured and systematic consideration of health equity in the process of clinical practice guideline development, and the guidance for the guideline is limited. This paper aims to put forward methodological suggestions for in-depth consideration of health equity in the key links of clinical practice guideline development, in order to provide reference for guideline developers. more>
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Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was first detected in Botswana and subsequently led to a worldwide surge in infections. Until now, Omicron and its lineages were the most highly mutated strains among variants of concern (VOC) and contained at least 50 mutations in the entire genome. Mutations give the virus certain fitness advantages, such as the enhanced affinity of receptor binding domain (RBD) with human angiotensin converting enzyme 2 (ACE2) receptors leading to the high transmission of the virus, and the weakened ability of virus replication leading to mild symptoms in patients with COVID-19. In addition, Omicron has high environmental stability, partially escapes the host immune response induced by vaccination or prior infection, and is highly resistant to most therapeutic antibodies. In this paper, key mutations, virological characteristics, pathogenicity, and immune escape of the Omicron variant were summarized, in order to provide scientific reference for dealing with the new situation of the epidemic, as well as improving the epidemic prevention and control strategy and public health measures. more>
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Abstract:

Micro RNAs are involved in the pathophysiological processes of many diseases. Stably present in tissues, cells and blood, they can be used as potential markers of many diseases. They play an important role in the pathogenesis of liver fibrosis caused by various chronic liver diseases. It has been shown that miRNAs can participate in the process of liver fibrosis by targeting the down-regulation of liver fibrosis-related gene expression. In this review, we discuss the research progress on the role of miRNAs in liver fibrosis, with the hope of providing reference for diagnosis and molecularly targeted treatment.

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Abstract:

In the era of evidence-based medicine, it is necessary to explore the unique advantages of traditional Chinese medicine (TCM) based on standardized technical methods and operating procedures in order to achieve the modernization and internationalization of TCM and benefit humanity. The proposal of a three-pronged evidence system combining TCM theory, human experience and experimental evidence marks an important progress in the thinking method of the TCM evaluation system. The multi-evidence body integrated through appropriate methods is a strong support for the clinical guideline recommendations and evidence-based health decisionmaking in TCM. Based on the current methodological progress of international evidence synthesis and grading, this paper proposes a novel approach for integrating multi-evidence in traditional Chinese medicine: the MERGE framework. The aim is to establish a solid foundation for the development of this methodology and to provide guidance for the advancement of the evidencebased medicine framework in traditional Chinese medicine.

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Abstract: Evidence synthesis is the synthesis of existing research using a systematic and appropriate method. There are various types of evidence synthesis used nowadays. However, correctly choosing and applying the best evidence synthesis method is crucial that researchers , policymakers , and stakeholders pay attention to. Thus , based on summarizing the current situation , progress , and classification of evidence synthesis methods, we introduced the definition and characteristics of common evidence synthesis methods and problems in the application of evidence synthesis methods, and put forward thoughts and suggestions for the problems faced by the application of evidence synthesis methods. more>
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Abstract: Traditional microbial detection methods have difficulty meeting the needs of pathogen detection in the clinic. In recent years, metagenomic next-generation sequencing (mNGS) technology has emerged and been widely used in the diagnosis of various infectious diseases, the etiological analysis of emerging infectious diseases, the detection of drug resistance genes and the analysis of the host immune response. The mNGS workflow is complicated, and the variation introduced in each step will influence the accuracy of the detection results. The absence of standardized methods, the lack of personnel knowledge and ability, and the expensive cost of instruments and reagents are the main obstacles to the clinical application of mNGS. The standardization and normalization of methods as well as the improvement of personnel knowledge and ability are currently urgently needed for mNGS detection. The integration of pathogen, transcriptome and antibiotic resistance genes information to comprehensively improve the clinical management level of patients with infectious diseases is an important direction of mNGS detection. more>
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Abstract: Professional competence is defined as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice. This article reviews the assessment methods and dimensions of professional competence, and the research progress of professional competence in China, aiming to provide a reference for Chinese medical education and physician career development. At present, many studies focused on the application of professional competence to medical education and position evaluation in China. Theoretical and empirical research is still needed, which may contribute to Chinese medical education and physician career development. more>
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Abstract: China Consortium of Elite Teaching Hospitals (the Consortium) is dedicated to exploring the reform and development of graduate medical education and promoting the training of high-level medical talents in line with international standards on the basis of standardized residency training.The Consortium has made in-depth exploration in deepening the collaboration of medical practice and medical education , promoting the commitment of competency-based medical education (CBME) and facilitating the establishment of milestone evaluation system.In this paper, the establishment of the Consortium Consensus on Core Competency Framework and the milestone evaluation system were expounded.The challenges and prospects of the implementation of the competency framework and milestone evaluation system were analyzed. It concluded that the establishment and implementation of the milestone framework will help the Consortium play a leading role in CBME and promote the overall level of medical education in China. more>
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Abstract: Decision to withdrawal of life-sustaining medical interventions(LSMI) is a common ethical issue in clinical practice. This paper review and analyze the ethical arguments for withdrawing LSMI from three aspects:respect for autonomy, medical futility, and patients' best interests. The authors argue that withdrawal of LSMI can be ethically justified when any of the following conditions are met:when patient gives valid consent, LSMI is judged to be medical futility, or in the patients' best interests. This paper proposes practical suggestions for the withdrawal of LSMI in clinical practice, and presents several policy suggestions. Finally, the authors identified several challenges of withdrawing LSMI in practice and possible pathways to address them. more>
Editorials
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Abstract: Nuclear medicine is a novel technique of theranostics that uses radiopharmaceuticals. Nuclear medicine dated back to a century ago. Owing to the development of nuclear medicine devices and radiopharmaceuticals, increasing clinical demand, government support, and global cooperations, nuclear medicine has witnessed a rapid development. Nowadays, nuclear medicine has played an important and unique role in diagnosis and therapy. There are opportunities and challenges in future development of nuclear medicine, and more progress will be made in nuclear medicine imaging, radionuclide therapy, and artificial intelligence. more>
Editorials
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Abstract: Issues related to the impact of ChatGPT-like artificial intelligence generated content (AIGC) and artificial general intelligence (AGI) technologies on medicine and medicare have been presented and discussed. We believe that advances in medical foundation models, scenarios engineering, and medical operations with operating systems would lead to parallel doctors in parallel hospitals, i.e., digital, robotic, and human doctors working in parallel within cyber-physical-social spaces under three modes: autonomous, parallel, and expert/emergency operations. Under decentralized/distributed autonomous organizations/operations (DAO) and DeSci, as well as DeMed and DeHospitals, the vision for individual patients with her/his personalized digital hospital could be a reality in the future. more>
Specialist Forum
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Abstract: Targeted radionuclide therapy (TRT) provides an immunogenic microenvironment for immune checkpoint inhibitor (ICI) therapy by inducing DNA double-strand break, activating the cGAS-STING, NF-κB/IRF3 and STAT1/3-IRF1 pathways, up-regulating the expression of PD-L1, and increasing the infiltration of pro-inflammatory cytokines, CD8+ T cells and CD4+ T cells in tumors. The combined therapy could increase the infiltration of memory effector T cells, M1 macrophages and dendritic cells which positively regulate immune response, and downregulate immunosuppressive regulatory T cells, M2 macrophages and myeloid-derived suppressor cells. Partial complete remission and immune memory were achieved in tumor-bearing mice treated with combined therapy. It is worth noting that radiodiagnostic agent 2-[18F]FDG combined with anti-PD-L1 mAb could also reprogram the immune microenvironment and significantly improve therapeutic effect. This review presents typical combination therapy strategies, emphasizes the time window of combination therapy and different combinations of therapy that may improve the therapeutic effect, and proposes that radiodiagnostic agents combined with tumor immunotherapy are expected to become a new paradigm and a direction for further research in the future. more>
Specialist Forum
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Abstract: Myocardial perfusion single photon emission computed tomography (SPECT) imaging is an important routine diagnostic modality for coronary artery disease. In recent years, there have been continuous advancements in cardiac SPECT imaging instrument technology and image algorithm techniques, with a growing focus on quantitative assessment of myocardial blood flow, a research hotspot that integrates technical and clinical research. This article provides an overview of the development path of cardiac SPECT systems in terms of detector technology, system structure, collimation techniques, as well as SPECT image reconstruction algorithms and myocardial blood flow quantification methods. We briefly discuss the recent research hotspots and progress, highlighting the clinical value enhancement made possible by advancements in instrument technology. more>
Specialist Forum
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Abstract: Boron neutron capture therapy (BNCT) is an advanced radiation therapy technique that is rapidly developing in the field of cancer treatment. This technique, an atomic-level binary targeted therapy, kills cancer cells by causing a 10B(n, α)7Li nuclear reaction within the cancer cells, and its clinical implementation requires professional technology and device support. The core elements of BNCT include appropriate neutron sources and neutron capture drugs. Compared with traditional radiotherapy techniques, BNCT shows outstanding advantages in treating locally recurrent tumors, such as central nervous system tumors and head and neck tumors. Furthermore, it can better protect normal organs, especially for tumors that have already significantly invaded surrounding organs, demonstrating its promising future prospects. This article mainly elaborates on the technical principles, core elements, and clinical applications of BNCT, in hope of providing reference for clinical diagnosis and treatment. more>
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Guideline and Consensus
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Abstract: The 2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia is an update of the 2017 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia. It is intended to provide patient-centric recommendations for clinicians to prevent and manage inadvertent hypothermia. It offers advice on assessing patient's risk of hypothermia, measuring and monitoring temperature as well as preventing patients from hypothermia before, during and after surgery. It also provides new evidence on hypothermia and adverse outcomes, and temprature management for special patients care considerations including pediatric, pregnancy, trauma, liver transplantation and sepsis. more>
Guideline and Consensus
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Abstract: Bartter syndrome (BS) is a rare inherited salt-losing renal tubular disorder characterized by secondary hyperaldosteronism with hypokalemia and hypochloremic metabolic alkalosis, and normal or low blood pressure. In severe cases, preterm delivery, hypovolemia, ventricular arrhythmia, rhabdomyolysis, renal failure, growth failure and sensorineural deafness may occur. In recent years, research on BS has made significant progress. The Bartter Syndrome Consensus Working Group has performed a systematic literature review, and based on evidence-based medicine, summarized aspects related to BS, including clinical manifestations and classification, diagnosis, treatment strategies, and management of complications. This consensus provides an important reference for the better diagnosis and treatment of BS. more>