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循证医学: 临床实践的指路明灯

中国医学科学院北京协和医学院 戴申倩

 循证医学之父David Sackett在1996年就总结出这一经典箴言——慎重、准确和明智地应用当前所能获得的最佳证据, 结合医生技能和经验, 并综合患者价值和意愿, 将三者结合起来作出医疗决策。如今, 这一箴言仍然在临床实践中被反复验证, 并且越来越多的研究者紧密围绕这一核心理念, 用各种科学、系统化的合成及评价方法与模型, 不断探索着循证医学未来的发展, 实现循证医学的更新迭代, 同时又促进了循证科学与更多学科的融合发展。

 为专注于表现"循证医学方法论与实践"这一主题, 让更多临床实践者能够明了并不断加强对现代循证医学核心内容的印象, 封面设计采用了循证医学的核心元素, 即最佳研究证据、临床技能和患者意愿。三元素之间既交融、渗透, 又互相影响, 采用等圆的几何造型并通过色彩叠加可更好地体现三者之间的关系。此外, 医生作为重要的临床实践者, 需时刻关注患者的感受和偏好, 故封面同时体现了"医患共同决策"这一重要理念。需注意的是, 医患共同决策仍然需遵循循证医学研究的最佳证据——临床实践指南来完成, 故在构图中呈现了医生、患者及顶着"guidelines"柱顶的蛇杖这些具象的元素, 提醒临床医生在实践中通过持续学习不断精进自己的能力和水平。

 循证医学的研究成果最终服务于患者, 相信本期主题文章能够启迪更多临床工作者正确运用循证医学的方法, 更好地服务于临床, 服务于患者!

Vol. 14, No. 1 30 01 2023
Chinese Bimonthly CN 11-5882/R ISSN 1674-9081
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Abstract: Pulmonary thromboembolism(PTE)is the third most common cause of cardiovascular death. The management of PTE emphasizes early identification, risk stratification and appropriate treatment. However, only about 20% to 30% of patients with high-risk PTE received systemic thrombolysis in the real world, due to concerns about the risks like major bleeding. Although systemic thrombolysis could decrease all-cause mortality of patients with intermediate-risk PTE, the risk of bleeding outweighs benefits. Therefore, a new thrombolytic treatment with good efficacy and safety records is stilled needed. Ultrasound-assisted catheter-directed thrombolysis could directly deliver thrombolytic drugs to the thrombus with lower dose needed. Moreover, numerous studies have demonstrated that ultrasound could enhance thrombolysis. There has been accumulating evidence on the efficacy and safety of ultrasound-assisted catheter-directed thrombolysis for the treatment of PTE. The present review article will summarize progresses made in this area in recent years. more>
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Abstract: Juvenile localized scleroderma (JLS) is a rare autoimmune disease in children. The lack of specificity in the early symptoms of JLS makes it easy to be misdiagnosed and missed, leading to the continuous progression of the lesions, and even causing the body function damage and growth disorder. For identifying the etiology of JLS and guiding the development and application of effective therapeutic drugs, recent theories about the pathogenesis of JLS have been reviewed, as well as the traditional treatment options and relevant new therapeutic drugs have been summarized, aiming to further enhance the fundamental understanding of JLS and its therapeutic progress. more>
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: Objective To investigate the impact of dynamic adaptive teaching model on surgical education. Methods Due to the COVID-19 pandemic in 2020, we adopted dynamic adaptive teaching model in the Department of Breast Surgery, Peking Union Medical College Hospital, which divided the whole curriculum into several individual modules and recombined different modules to accommodate to student's levels and schedules. Meanwhile, adaptive strategy also increased the proportion of online teaching and fully utilized electronic medical resources. The present study included quantitative teaching score (QTS) recorded from January 2020 to June 2020, and used the corresponding data from 2019 as control. The main endpoint was to explore the impact of dynamic adaptive teaching model on overall QTS and its interaction effect with trainer's experience and student category. Results Totally, 20 trainers and 181 trainees were enrolled in the present study. With implementation of dynamic adaptive strategy, the overall QTS decreased dramatically (1.76±0.84 Vs. 4.91 ± 1.15, t=4.85, P=0.005). The impact was consistent irrespective of trainers' experience (high experience trainers:0.85 ± 0.40 Vs. 2.12 ± 0.44, t=4.98, P=0.004; medium experience trainers:0.85 ± 0.29 Vs. 2.06 ± 0.53, t=4.51, P=0.006; and low experience trainers:0.10 ± 0.16 Vs. 0.44 ± 0.22, t=2.62, P=0.047). For resident (including graduate) and undergraduate student teaching, both QTS was lower with dynamic strategy (residents:0.18 ± 0.34 Vs. 0.97 ± 0.14, t=4.35, P=0.007; undergraduate students 1.57 ± 0.55 Vs. 3.77 ± 1.24, t=3.62, P=0.015), but dynamic strategy was effective for post-doc student subgroup and reached comparable QTS as traditional model (0.00 ± 0.00 Vs. 0.17 ± 0.41, t=1.00, p=0.363). Conclusions Dynamic adaptive teaching strategy could be a useful alternative to traditional teaching model for post-doc students. It could be a novel effective solution for saving teaching resources and providing individualized surgical teaching modality. more>
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Abstract: Objective The clinical features and resuscitation outcome of adult patients with cardiac arrest (CA) in intensive care unit were analyzed, and the related factors affecting the success rate of cardiopulmonary resuscitation in adult patients with CA were discussed. Methods The clinical data of CA patients in the intensive care unit of the First Hospital of Jilin University from September 2019 to December 2020 were retrospectively analyzed, according to the outcome indicators, the patients were divided into return of spontaneous circulation (ROSC) group and non-ROSC group, the survival-discharge group and the death group, the relevant factors affecting resuscitation outcome were discussed. Results A total of 351 patients with CA were included in this study, including 206 males and 145 females; the mean age was 65 years. There were 191 patients with cardiogenic CA and 267 patients with non-defibrillation rhythm (cardiac arrest and no electrical activity) at the onset of CA. After treatment with CPR, 152 patients had ROSC, of whom 42 survived and were discharged. Univariate logistic regression analysis showed that coronary artery disease, nondefibrillation rhythm, no defibrillation rhythm during resuscitation, no electric defibrillation, no emergency endotracheal intubation were the possible factors to reduce the incidence of ROSC.Young age, CPR duration ≤ 30 min, and small cumulative dose of epinephrine were the possible factors to increase the incidence of ROSC. Non-cardiogenic etiology, nondefibrillable rhythm, no electric defibrillation, and no defibrillable rhythm during resuscitation decreased the likelihood of survival discharge, and CPR duration ≤ 30 min and a small cumulative dose of epinephrine increased the likelihood of survival and discharge. Multivariate logistic regression analysis showed that CPR duration ≥ 30 min was an independent risk factor for ROSC. And younger age, absence of emergency tracheal intubation, and small cumulative epinephrine dose were independent protective factors for ROSC. CPR duration ≥ 30 min was an independent risk factor for survival and discharge. Cardiogenic etiology and presence of defibrillable rhythm during resuscitation were independent protective factors for survival and discharge. Conclusion CPR duration, cumulative epinephrine dose, CA initial rhythm, electric defibrillation, and emergence of defibrillable rhythm during resuscitation were associated factors for ROSC and survival and discharge, and CPR duration >30 min was an independent risk factor. Clinical attention should be paid to these factors in order to improve the outcome of cardiopulmonary resuscitation. more>
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Abstract: Objective To analyze the clinical phenotype and immunological characteristics of a patient with heterozygous mutation of PTEN and enrich the clinical phenotypes related to PTEN mutation. Methods A retrospective analysis of the clinical data of a patient with PTEN heterozygous mutation admitted to the Children's Hospital of Chongqing Medical University was conducted. Peripheral venous blood was extracted for medical whole-exome comprehensive detection, and the PTEN mutation was confirmed by Sanger sequencing. Flow cytometry was applied to detect the lymphocyte subsets and immunophenotype of the patient. The expression level of PTEN protein in peripheral blood mononuclear cells was detected by Western blot, and the healthy control was the patient's father. Results The patient was a boy of 1 year and 4 months, with macrocephaly (head circumference > P99), verrucous epidermal nevus, delayed psychomotor development and delayed language learning as the main manifestations. Gene sequencing revealed a de novo heterozygous mutation of PTEN c.388C>T (p.R130X). Reduced expression of PTEN protein was observed in peripheral blood mononuclear cells of the patient. For immunological characteristics, the IgA level mildly decreased(0.177g/L), with increased counts of terminally differentiated memory CD4+ T cells, terminally differentiated memory CD8+ T cells, transitional B cells, but phosphorylation of PI3K/Akt/mTOR pathway in T cells was normal. The patient mainly manifested as PTEN hamartoma tumor syndrome related phenotype, without any classic activated phosphatidylinositol 3-kinase δ syndrome-like phenotype. Conclusion This patient has a de novo heterozygous mutation of PTEN c.388C>T (p.R130X), which has not been previously reported in China. This article could enrich clinicians' understanding of the disease and assist clinical diagnosis and treatment. more>
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Abstract: Ovarian sclerosing stromal tumor(OSST) is a benign ovarian sex cord stromal tumor. There are about 100 cases reported in literature. OSST usually occurs in women of childbearing age from 20 to 30 years old. The clinical manifestations are abdominal pain and adnexal mass. The tumor may have endocrine function, causing menstrual disorder and infertility, and a few patients even appear masculine. OSST is rare in prepubertal girls. Half of the patients go to see a doctor due to the accidental discovery of pelvic tumors during physical examination or the clinical manifestations caused by the increase of sex hormones. It usually occurs in one side of the ovary. Only 3 cases reported tumors in bilateral ovaries. For young women with bilateral OSST, bilateral ovarian tumor resection or operation with normal ovarian tissue on one side can be performed to preserve the fertility of the patients. In this paper, we report a rare case of bilateral OSST of the ovaries in a premenstrual girl and review the literature. more>
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Abstract: In 2018, the concept of "resuscitation center" was officially introduced in China. The "resuscitation center" refers to a special system established by medical institutions for cardiac arrest patients, which covers the entire process from prevention to emergency care, monitoring, treatment, and rehabilitation of cardiac arrest.Integrating various medical resources and optimizing the whole process helps provide high-quality care for patients, with the best possible resuscitation outcome. The construction of the resuscitation center is an indispensable need for high-quality emergency medical services, an important initiative for hospitals to promote multidisciplinary development, especially emergency medicine, and an important grasp for hospitals to improve their management capabilities. It aims to deepen and upgrade the traditional emergency medical system, and explore higher quality treatment models and processes for the most urgent emergencies. The construction of a resuscitation center first requires a consensus and active voice from the emergency medicine community before it gradually expands from a regional pilot to a nationwide program with the support of the health administration. more>
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Abstract: Irritable bowel syndrome (IBS) is a common digestive psychosomatic diseases, mainly manifested as recurrent abdominal pain and abnormal bowel movements. The intestinal dysfunction is often comorbidized with anxiety, depression and other emotional problems, resulting in increased intestinal burden and even a decrease in the quality of life. The etiology and pathogenesis of IBS are unclear, but it is currently believed that IBS involves abnormal gut-brain interaction caused by a combination of various factors, including visceral hypersensitivity, intestinal immune activation, intestinal infection, intestinal dysbacteriosis, and psychosocial stress. Recent studies have observed the disorders of gut microbiota-regulated kynurinaine metabolism in IBS patients, and found that the metabolite kynurenic acid (KA) has important correlations with inflammatory responses, pain stimuli and mood changes. KA may play a protective role in IBS such as anti-inflammatory and pain relief and thus has the potential to become a new approach for the diagnosis and treatment of IBS. In this work, studies related to KA and IBS are reviewed. 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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Juvenile Idiopathic Arthritis (JIA) is a common chronic rheumatologic disease in childhood. JIA-associated uveitis (JIA-U), an important extra-articular complication of JIA, is one of the major causes of childhood disability and blindness. It is predominantly anterior, nongranulomatous inflammation affecting the iris and ciliary body (iridocyclitis) of insidious onset. Recently, American College of Rheumatology (ACR) and the Single Hub and Access point for pediatric rheumatology in Europe (SHARE) have published clinical guidelines for JIA-U. There is no guideline of diagnosis and treatment of JIA-U in China. To promote the standardization of clinical understanding and treatment, the Subspecialty Group of Immunology of the Society of Pediatrics of Chinese Medical Association, Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases, and National Clinical Research Center for Child Health and Disorders organized experts and scholars in related fields to discuss the issue and finally formed this consensus for clinicians' reference.

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Abstract: Objective The prognosis of patients with brain metastases is poor and lacking in unified diagnosis and treatment standards. The demand for multidisciplinary team (MDT) diagnosis and treatment mode is extremely high. This study retrospectively summarizes the data of patients treated with MDT for brain metastases in order to provide clinical reference. Methods All patients undergoing MDT treatment for brain metastases at the Neurological Tumor Center of Peking Union Medical College Hospital from January 2019 to December 2021 were retrospectively included. The clinical characteristics, diagnosis and treatment decisions, treatment compliance, clinical prognosis, etc. at the time of enrollment were summarized, and the influencing factors of patients' prognosis were analyzed. Results A total of 159 patients who underwent MDT for brain metastases were included (13 cases with non-cerebral metastases). The most common source of tumor was lung cancer (61.6%), followed by breast cancer (11.3%). The vast majority of patients (87.4%) received only 1 MDT visit. The main characteristics of patients at the time of the initial MDT consultation for brain metastases were primary diagnosis of brain metastases (90.6%), good general condition (Karnofsky functional status score ≥ 70, 79.2%), age ≤ 65 years (78.6%), pathological findings of primary site or intracranial metastases (67.9%), tumor origin of lung cancer (61.6%), and single intracranial lesion (54.1%).76.7% (122/159) of the patients reaching specific treatment recommendations after MDT diagnosis and treatment, 9.4% (15/159) of the patients having changes in diagnosis, and 56.6% (90/159) of the patients exercising full compliance with MDT diagnosis and treatment recommendations at the time of 1-year follow-up. The 6-month survival rate of the 146 patients with brain metastases was 85.6% (125/146) and the 1-year survival rate was 78.8% (115/146). Kaplan-Meier survival curve showed that recursive partition analysis grading and grading prognosis evaluation score had guiding significance for prognosis stratification of patients with brain metastases. Multivariate Cox regression analysis showed that women (HR=0.437, 95% CI:0.231-0.828) and patients with brain metastases who fully complied with MDT diagnosis and treatment recommendations (HR=0.498, 95% CI:0.264-0.942) generally had a better prognosis. Conclusions It is necessary to set reasonable conditions for patients with brain metastases to be enrolled in order to improve the diagnosis and treatment efficiency of MDT. Most patients with brain metastases reached specific treatment recommendations after MDT diagnosis and treatment, and the patients had good treatment compliance. The diagnosis and treatment of MDT may help improve the overall survival rate of patients, but the exact benefits need to be evaluated individually. more>
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Rheumatic and immunologic diseases in children may involve multiple genes and interactions between genetic and environmental factors. There are no validated biomarkers that are predictive of treatment response. Treatment is largely based on symptoms, treatment guidelines, physician experience, and medicine accessibility. The application of precision medicine in pediatric rheumatic and immunologic diseases is in its infancy. This article focuses on the progress of precision medicine in juvenile idiopathic arthritis and pediatric systemic lupus erythematosus, in order to build a precision diagnosis and treatment system for pediatric rheumatic and immunologic diseases, and improve children's quality of life.

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Abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs or systems. The etiology of SLE is complex, involving molecular genetics, epigenetics, innate immunity, acquired immunity, race, hormone and environmental factors. Recent progress in fine immunophenotyping, GWAS, single cell sequencing and multiomics analysis has enabled a deeper understanding of the pathogenesis of SLE. Various monoclonal antibodies or small molecule drugs targeting immune cells, costimulatory molecules, cytokines or signal transduction pathways, and CART cell immunotherapy have been developed or even applied in clinical treatment. The approval of belizumab, telitacicept,anifrolumab and voclosporin for SLE has given clinicians, researchers and patients greater confidence and more treatment options for patients with moderate to severe SLE, especially those with refractory SLE. more>
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Abstract: With the rapid development of society, cardiac arrest has become a major public health problem worldwide. For cardiac arrest patients, the primary goal of CPR is to ensure oxygen supply to the brain and prevent brain hypoxia injury. Recently, near infrared spectroscopy (NIRS) and its application in cardiopulmonary resuscitation has attracted widespread attention because it can monitor local oxygen saturation of frontal cortex brain tissue, and reflect the balance of oxygen supply and demand in real time. NIRS technology can be used to evaluate the quality of cardiopulmonary resuscitation, detect repeat arrest early, predict prognosis of patients, evaluate the level of autonomous regulation of cerebral blood flow, as well as monitor target temperature management and the treatment effect of patients with extracorporeal cardiopulmonary resuscitation. Hence NIRS has good clinical application potential. This article mainly reviews the principle of NIRS and its application in cardiopulmonary resuscitation. more>
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Abstract: Autoinflammatory diseases (AIDs) were defined over 20 years ago, and since then, 56 monogenic AIDs have been discovered. Due to the overlapping symptoms, AIDs are prone to misdiagnosis and mistreatment. Different AIDs are characterized by distinct genetic variants, and some AIDs have shown unique genetic characteristics in the Chinese population. Currently, there is no evidence-based guideline for the genetic diagnosis of AIDs in China. To further standardize the early recognition and precision diagnosis of AIDs, it is urgently needed to develop evidencebased clinical practice guidelines on the genetic diagnosis of AIDs to provide scientific guidance for the clinical management of AIDs. The Chinese Pharmacists Association Rare Diseases Medication Working Committee and the Subspecialty Group of Immunology from the Society of Pediatrics of the Chinese Medical Association have jointly launched a protocol for the development of the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, which was registered and written following WHO Handbook for Guideline Development with the help of nationwide multidisciplinary experts organized by the Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. A formal document of the guidelines will be devised and published following the workflow of evidencebased guideline development. This paper introduces the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, including its background, significance, objectives, target population, guideline users, guideline working group members, and the workflow of guideline development. more>
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Objective We aim to compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA)patients and osteonecrosis of the femoral head (ONFH) patients underwent unilateral total hip arthroplasty ( THA) under multimodal blood management measures. Methods: 26 patients with HA who underwent unilateral THA from January 1, 2010, to June 15, 2022, and met the criteria, with a mean age of (30.46±6.78) years and BMI of (23.90±4.53) kg/m2, were retrospectively included; 76 patients with ONFH who underwent unilateral THA were matched according to 1:3. All were male, mean age (34.41±7.398) years, BMI (24.61±4.11) kg/m2; demographic data, median operative time, median hospital stay, preoperative and postoperative day 1 and 3 hemoglobin and hematocrit, postoperative hemoglobin and hematocrit decline values, total blood loss, transfusion ratio, and complications were compared between the two groups. Results: There was significantly more total blood loss ((1927.08±956.60) mL vs. (1475.88±924.43) mL, P=0.036) and hidden blood loss (1526.70±835.82 mL vs. (1147.94±930.10) mL, P=0.069), higher rate of major bleeding (38.46% vs. 15.38%, P=0.002); higher transfusion risk (15.38% vs. 9.89%, P=0.012); longer median operative time (98min vs. 77min, P=0.015); and longer median hospital stay (20 days vs. 12 days, P=0.000) in HA-THA group than in ONFH-THA group. Conclusion: The risk of perioperative blood loss and allogeneic transfusion is still high in unilateral HA-THA compared to ONFH-THA patients. Further research is needed on prophylactic and effective methods to reduce the risk of blood loss in HA-THA.

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Abstract: Objective To evaluate the clinical value of ultrawide-field scanning laser ophthalmology (UWF-SLO) in tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartoma (RAH) by comparing the detection rate of RAH lesions between UWF-SLO and traditional color fundus photography (CFP). Methods The clinical data of patients with established TSC-associated RAH diagnosis by the Department of Internal Medicine and Ophthalmology of Peking Union Medical College Hospital from October 2018 to March 2021 were retrospectively reviewed.The detection rate of TSC-associated RAH lesions between 9-fixation-point CFP and UWF-SLO was compared with funduscopic recordings as the reference standard.Related factors that may affect the detection of lesions were analyzed. Results 24 patients with TSC-associated RAH were involved in this study.UWF-SLO (composed pseudocolor dual-channel images) performed better than 9-fixation-point CFP in the identification of TSC-associated RAH lesions[98.6%(138/140)vs.65.7%(92/140),P<0.001],especially for RAH lesions located in the mid and far peripheral retina (P<0.001).In UWF-SLO,red-channel (633nm) images showed significant lower detection rate than green-channel (532nm)[52.1%(73/140) vs.98.6%(138/140),P<0.001]or composed dual-channel images[52.1%(73/140) vs.98.6%(138/140),P<0.001].Undetected RAH lesions in red-channel UWF-SLO images were all type 1 RAH,and type 1 RAH with greater maximal thickness on OCT was more easily detected by red-channel UWF-SLO (389.7±76.6μm vs.527.3±134.7μm,P<0.001),while the location and retinal involving depth of type 1 RAH were not significantly related (P=0.812,P=1.000). Conclusion Compared to CFP,UWF-SLO may be associated with higher detection rate of TSC-associated RAH and could be considered for the evaluation of TSC-associated RAH. more>
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Abstract:

Under the new era background of hospital pharmaceutical service transformation, higher standards and requirements are constantly put forward for clinical pharmacists to participate in patient-centered pharmaceutical professional technical services. The formulation of competency standards has become an international trend. However, research on pharmacist competency is still lacking in China, there is a lack of core competency framework for clinical pharmacist. In order to improve the construction of pharmacist competency, Peking Union Medical College Hospital, China Medical Boar and Chinese Hospital Association Pharmaceutical Specialized Committee organized multidisciplinary experts in pharmacy, clinical medicine, education and administrators et al to formulate Expert Consensus on the Core Competency Framework of Chinese Clinical Pharmacist ( 2023) , which based on domestic and foreign research results and clinical pharmacy practice experience in China. This specialist consensus adopts the modified Delphi method to formulate the core competency framework of Chinese clinical pharmacist, and determines six first-level item of core competencies that clinical pharmacist should have, including professionalism, knowledge and skill, patient care, communication and collaboration, teaching and lifelong learning. The six first-level item has twenty-three multiple second-level items, which are explained in detail. This consensus can provide an important basis and exploration direction for the training and ability enhancement of clinical pharmacist in China.

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Abstract: Hypertrophic cardiomyopathy is one of the most common hereditary cardiomyopathy, the most serious outcome of which is sudden cardiac death(SCD) . Early recognition and prevention may delay or avoid the onset of cardiac arrest. Therefore, it is important to identify the high-risk factors of SCD in patients with hypertrophic cardiomyopathy and prevent cardiac arrest. At present, the recognized high risk factors mainly include family history of sudden death, unexplained syncope, non-sustained ventricular tachycardia, severe left ventricular hypertrophy, left ventricular dysfunction, left ventricular systolic dysfunction, etc. The main preventive measures involve medical treatment, surgical septal myectomy, alcohol septal ablation, and implantable cardiac defibrillator. This article mainly focuses on the identification of high-risk factors and prevention strategies of SCD caused by hypertrophic cardiomyopathy, and reviews the latest progress of prevention, diagnosis and treatment of hypertrophic cardiomyopathy, to provide guidance for prevention of SCD caused by hypertrophic cardiomyopathy. more>
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Abstract: With the development of the technology of artificial intelligence,hardware of the computer and big data,more and more artificial intelligent device and algorithm are springing up. Based on the analysis of these data,artificial intelligent device make great achievements to predict the risk of the cardiac arrest,identify the early period of the cardiac arrest,instruct the process to improve the quality of cardiopulmonary resuscitation as well as make the prediction of resuscitation. Meanwhile these tools not only provide new insight for the clinical research,but play significant roles in the clinical decision making and medical resources distribution. This paper will focus on the application of artificial intelligence in cardiopulmonary resuscitation,in order to provide reference for clinical practice. more>
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Abstract: Interleukin-1 mediated autoinflammatory diseases, a large class of autoinflammatory diseases characterized by increased release of interleukin-1 or activation of the interleukin-1 pathway, mainly include familial Mediterranean fever, cryopyrin-associated periodic syndrome, tumor necrosis factor receptor associated periodic syndrome, mevalonate kinase deficiency syndrome and deficiency of the interleukin-1 receptor antagonist. These diseases present in early childhood and affect multiple systems, which, if untreated, may result in progressive organ damage, morbidity and mortality. In 2016, European Alliance of Associations for Rheumatology (EULAR) published recommendations for familial Mediterranean fever. For the latter four types of diseases, EULAR and the American College of Rheumatology developed several points in terms of diagnosis, management and monitoring in 2022. This article aims to introduce the application of these points. more>
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Abstract: Objective To study the epidemiology of mold infectionsin China. Methods Based on the surveillance data of hospitals participating in theChina Hospital Invasive Fungal Surveillance Netfrom Jan 2019 to Jun 2022, the general information of patients and the epidemiological characteristics such as the proportion of strains were analyzed by WHONET software. Results A total of 16285 mold infections were included in the analysis, with the median age of 60 years old, of which 49.3% were patients aged 61 and over. The proportion ofmales was significantly higher than females (62.1% vs 37.9%). The patients were mainly from the internal medicine and ICU wards. Most strains were isolated fromlowerrespiratory tract, accounting for 81.7%, followed by pus and secretions (7.8%). About the species distribution, Aspergillus spp. accounted for the highest proportion (84.8%), with Penicillium spp., Fusarium spp.,order Mucorales and Sedosporium spp. accounting for 5.1%, 3.0%, 1.3% and 0.4%, respectively. For species distribution among different mold infection, 88.7% of lower respiratory tract mold infections were caused by Aspergillus spp., and Aspergillus fumigatus(47.8%) was the most common species. Theotomycosis was mainly caused by Aspergillus spp. (98.7%), of which Aspergillus terreus accounted for 39.7%. Fusarium spp.(54.6%) was the most common species among ophthalmomycosis. Conclusion By the retrospective analysis of mold isolation from multicenter in China, it was found that Aspergillus fumigatus, Aspergillus terreus, and Fusarium spp. were the most common species causing pneumonomycosis,otomycosis,and ophthalmomycosis, respectively. It is necessary to pay attention to the difference in the species distribution among different mold infections in clinical empirical treatment of fungal infections. more>
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Abstract: With the adjustment of China's epidemic prevention and control guidelines regarding coronavirus disease of 2019 (COVID-19), the preoperative evaluation and timing of surgery for patients after COVID-19 infection have become the focus of attention for both healthcare workers and patients. Based on the latest study and related clinical experience, Peking Union Medical College Hospital (PUMCH) has therefore compiled this multidisciplinary, evidence-based recommendation for concise, individualized, and practical preoperative evaluation and timing of surgery for patients after COVID-19 infection. The recommendations emphasize patients COVID-19 infection history, the severity of symptoms, and medical/physiologic recovery status during preoperative evaluation. The determination of appropriate length of time between recovery from COVID-19 and surgery/procedure should take into account of patients underlying health conditions, the severity of the COVID-19 infection course, and the types of surgery and anesthesia scheduled, to minimize postoperative complications. The recommendations are intended to aid healthcare workers in evaluating these patients, scheduling them for the optimal timing of surgery, and optimizing perioperative management and postoperative recovery. more>
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Abstract:

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of central nervous system, characterized by optic neuritis and longitudinally extensive transverse myelitis, together with neuropathic pain. Limited by the lack of mature animal models, the mechanism of neuropathic pain in NMOSD is still unclear. Although some studies have reported neuropathic pain in NMOSD models, it is necessary to build a reliable and feasible animal model of NMOSD related neuropathic pain, which could provide scientific support for the mechanism and he mining of therapeutic targets. This article reviews research progress on the animal models of NMOSD related neuropathic pain. The prospects of ideal animal models and development tendencies are also described.

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Abstract: We reported a case of an elderly female patient with multi-organ involvement of the ear, eye, nose and heart, with elevated serum inflammatory markers and IgG4, and negative anti-neutrophil cytoplasmic antibodies. The patient was suspected to have granulomatosis with polyangiitis (GPA) combined with IgG4-related disease (IgG4-RD), because both GPA and IgG4-RD can lead to multi-organ involvement, with similar clinical manifestations and consistency in treatment. After treatment with high-dose glucocorticoid combined with cyclophosphamide, the clinical symptoms were relieved. The patient also had a high degree of atrioventricular block (AVB), which is rare in both GPA and IgG4-RD. In this paper we discuss the characteristics of the overlap syndrome, the diagnosis and treatment of this patient and the possible pathological mechanism of AVB, in order to provide reference for clinical treatment. more>
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Abstract: Isocitrate dehydrogenase (IDH), a key enzyme in the tricarboxylic acid cycle, plays an important role in cellular energy metabolism. When the IDH gene is mutated, the enzyme activity is altered, resulting in an accumulation of a large amount of the tumor metabolite 2-hydroxyglutaric acid (2-HG), causing severe epigenetic deregulation and dysregulation of gene expression, and promoting tumorigenesis. Recent studies have shown that IDH1 and IDH2 mutations are closely related to the occurrence and development of a variety of tumors such as glioma, AML and iCCA as well as their clinical treatment. It is of great significance to use IDH gene mutations as molecular indicators for detecting glioma, AML and iCCA tumorigenesis, and developing targeted drugs. This review is focused on the mechanism of IDH mutation, the relationship between mutant IDH and the development of multiple tumors, and the progress of treatment of IDH mutation in basic research and drug clinical trials. more>
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Abstract: Objective The purpose of the present study is to analyze the effect of introducing the mixed teaching mode for audiology course in otorhinolaryngology clinical teaching. Methods A total of 26 clinical postgraduates and residents studying in the department of otorhinolaryngology at Peking Union Medical College Hospital from 2019 to 2021 were enrolled into this study. The audiology course, designed according to the results of the preliminary questionnaires, combined theory teaching with practice. Feedback was collected by questionnaires before and after the course, and statistical analysis was conducted. Results All students finished the audiology course through mixed teaching mode, and completed questionnaires before and after the course. The results of questionnaires collected before the course showed that the students recognized the importance of audiology and had a high willingness to join the course. They showed more interest in the clinical application than in basic principles and practical operation. All students showed better comprehension for audiology knowledge after the course (P< 0.001), and they were satisfied with all parts of the course (the average score was greater than 5 points, out of a full score of satisfaction of 7 points). Conclusions The mixed teaching mode for the audiology course achieved preliminary results among postgraduates of the department of otorhinolaryngology, which is worthy promoting in clinical teaching. more>
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Abstract:

Bone is the most common metastatic site of advanced breast cancer. Bone related events caused by bone metastasis seriously affect the quality of life and survival time of patients. Therefore, in order to improve the quality of life and prolong the survival time of breast cancer patients with bone metastases, it is of great clinical value to deeply explore the occurrence and development mechanism of bone metastases, explore early diagnosis methods, and find abundant and effective treatment methods and drugs for bone metastases. This article mainly reviews the new research progress of bone metastasis of breast cancer from the aspects of molecular mechanism, imaging and biological diagnosis methods, systematic treatment, in order to provide more reference for clinical diagnosis and treatment.

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Abstract:

With the increasing morbidity of gastric neuroendocrine neoplasms (G-NENs), the understanding of clinicians about G-NENs is also deepening. However, there are still have many controversies regarding the diagnosis and treatment of GNENs. Therefore, this article reviews the current status of diagnosis and treatment of G-NENs, and discusses the existing controversies, aiming to provide reference for clinicians in standardized diagnosis and treatment.

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Abstract: As an emerging international research hotspot, the development of guidelines with patient participation has great differences in related methodological research at China and abroad. This paper advocates the establishment of patient panel, and discusses the working methods of patient panel, the source and selection of patient representatives, participation phases, management, and support, etc. Methodological optimization suggestions will be proposed, such as the sustainability of patients, structuring and two-way communication mode made by experts with common sense between patient’ s values and preferences, in order to provide a reference for the development of China patient participation guidelines. more>
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Abstract:

Objective  The aim of this study was to evaluate the association between rs3797053 and rs10040443 polymorphisms of SPRY4 gene and idiopathic scoliosis in Chinese Han adolescents through a retrospective case-control study, so as to explore the risk factors or etiology of the disease.   Methods  A total of 197 subjects were included according to the adolescent idiopathic scoliosis diagnostic criteria, including 97 patients and 100 normal healthy subjects. Whole genome sequencing was used to detect the polymorphism of rs3797053 and rs10040443 in SPRY4 gene, and Logistic regression model was used to analyze the distribution of genotype, allele and carrier frequency (SPSS 25.0).   Results  There was no significant difference in the allele and genotype of SPRY4 rs3797053 in Chinese Han adolescent idiopathic scoliosis group compared with the healthy group (P=0.245, P=0.499). The frequency of SPRY4 rs10040443 C allele in AIS group was significantly higher than that in healthy group (17.5% vs 8.0%, P=0.005), and there was a significant difference between CC genotype and healthy group (P=0.014). The genotype distribution of this locus in AIS group was correlated with PUMC typing (P=0.001), and its genotype C/T+T/T was correlated with PUMC typeⅡ.   Conclusions  SPRY4 gene rs10040443 is associated with adolescent idiopathic scoliosis in Chinese Han population, and C allele may be a risk factor for this disease.

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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: Type Ⅰ autoimmune pancreatitis (AIP) is a type of pancreatitis with a predominantly inflammatory and fibrotic nature and is an IgG4-related disease. The pathogenesis of type Ⅰ AIP is still poorly understood, and it is generally believed that its pathogenesis is the result of a combination of genetic, environmental, and immune factors. In recent years, many advances have been made in the cellular and molecular mechanisms of the pathogenesis of type Ⅰ AIP, and this article mainly reviews the understanding and research progress of the pathogenesis of this disease from the immunological perspective in recent years. more>
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Abstract: The Department of Obstetrics and Gynecology of Peking Union Medical College (PUMC) has practiced the Johns Hopkins model of combining education, clinical practice and scientific research. The elites of obstetrics and gynecology cultivated by this model have deeply internalized the concepts of medical science, they actively spread modern obstetrics and gynecology, which prompt the rooting of western obstetrics and gynecology and the professionalization and institutionalization of obstetrics and gynecology in China. This study combined archives, letters, memoirs, newspapers and other materials to investigate the educational, clinical and scientific research work of Obstetrics and Gynecology of PUMC, and on this basis, to explore the characteristics and influence of Obstetrics and Gynecology of PUMC, with a view to enrich the research of the history of obstetrics and gynecology in China. more>
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Abstract: Objective To analyze the feasibility to realizing hospitalized treatment of inpatients’ mental disorders in a general hospital by innovatively consultation-liaison psychiatric hospitalized treatment mode. Methods Retrospective study involved the patients in the department of physical diseases of Peking Union Medical College Hospital who received hospitalized treatment of the department of Psychological medicine from July 1, 2020 to June 30, 2021. Based on the concept of consultation-liaison psychiatry (CLP), this treatment mode integrated the three-level ward round and follow-up system to promote the diagnosis and treatment of inpatients with mental disorders. According to the consultation records, the consultation volume, follow-up volume, diagnosis results and intervention methods were extracted, and the consultation rate and follow-up rate were calculated. Results A total of 1647 consultation services were provided for 1196 patients. The consultation departments involved all the physical disease departments of the hospital. The total consultation rate was 1.21% (1196/98 496) and total follow-up rate was 23.08% (276/1196). The follow-up rate of liaison departments was 23.98% (158/659), and the follow-up rate of liaison departments was 21.97% (118/537). In 2019, the general consultation rate was 1.10% (1269/114 917), the total follow-up rate was 17.65% (224/1269), the follow-up rate of liaison departments was 19.0% (177/933), and the follow-up rate of non-liaison departments was 14.0 (47/336). The diagnosis results of consultation-liaison hospitalized treatment involved almost all mental disorders, among which anxiety disorder (18.76%, 309/1647), depressive disorder (17.1%, 282/1647) and brain organic mental disorder (16.45%, 271/1647) accounted for a high proportion. As for the intervention mode of patients, 30.66% (505/1647) only need psychological counseling or treatment, and almost all patients had non-drug treatment intervention. Conclusions It is feasible to apply the concept of CLP to realize the hospitalized treatment of mental disorders in general hospitals, which can improve the accessibility of mental medical services. more>
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Abstract: Atopic Dermatitis (AD) is a common chronic inflammatory skin disease characterized by recurrent eczematous lesions with dry skin and refractory pruritus.The pathogenesis of AD is complex,one of the reasons may be related to the skin microbial environment,and multiple studies have found that bathing may be related to skin barrier function.Different bathing method may affect the severity of AD.This paper spots on the bathing method of children with AD,the cleanser and reviews relevant guidelines and evidence-based medicine. more>
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Abstract: Clinical practice guidelines are an important basis for clinical decision-making, but there are still many factors that prevent physicians from following the guidelines, one of which is the limited external validity of the guidelines, which ultimately makes the guidelines unable to provide an adequate basis for clinical decision-making. This forms the distance between the guidelines and clinical decisions. Real-world research can enhance the external validity of the guidelines, provide a basis for clinical decision-making, offer localized evidence for the guidelines, demonstrate evidence of cost-effectiveness and other evidence for the guidelines. It can also monitor the implementation of the guidelines, help to make up for the lack of evidence in the formulation of traditional guidelines, thus help to span the distance between the guidelines and clinical decisions. High-quality real-world studies and real-world evidence may be considered for inclusion in the guideline development process to facilitate guideline optimization and serve as an aid to guideline quality improvement. more>
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Abstract: Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. The main clinical manifestations are recurrent fever and serous inflammation in various parts of the body. Some patients with FMF may also develop neurological manifestations such as epilepsy, demyelinating disease, aseptic meningitis and so on. Since neurological manifestations are rare in patients with FMF, the association between the two is often overlooked in clinical practice. We reviewed the neurological manifestations of FMF and their relationship with genotypes, so as to deepen the understanding of the clinical manifestations of FMF and provide help for the diagnosis and treatment of patients with neurological manifestations. 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>
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Abstract: In clinical diagnosis and treatment, informed consent to anesthesia is still the unique field of anesthesiologists. In patients with mental disorders, doctors attach importance to the signing of informed consent to anesthesia, while ignoring the process of informed consent of patients has become a weak link in their work. With the support of human primitive moral instinct and based on a kind of sympathetic moral care for patients with mental disorders, surrogate consent is considered to be beneficial to patients. However, various factors in reality restrict the informed consent of patients with mental disorders to different degrees. On the other hand, in the face of patients with mental disorders, considering the problems of intraoperative cooperation and anesthesia safety, the choice of anesthesia mode is particularly critical. The doctor led medical model can not ignore the right of informed consent of patients. It should do everything possible to let patients with mild mental disorders participate in the informed consent process. The depth and breadth of information provided will depend on the patient's self-knowledge. The path to truly obtain the informed consent of patients with mental disorders needs to be optimized. Through multi-disciplinary cooperation, the use of informed consent ability assessment tools, and the improvement of preoperative visits, we hope to achieve real informed consent and protect the rights of patients with mental disorders. more>
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Abstract: Although the incidence of rare diseases is extremely low, more than 7000 rare diseases affect 6% to 8% of the global population. Rare disease guidelines are playing an increasingly important role as guiding documents to improve the health outcomes of patients with rare diseases.We aim to systematically elaborate on the status quo, challenges and opportunities of rare disease guidelines at home and abroad, and put forward thoughts and suggestions on promoting the development of rare diseases guidelines in the future. more>
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Abstract: Objective To analyze the clinical and immunological characteristics of first case of FOXN1 haploinsufficiency in China and summarize the clinical characteristics of previous reported cases in other countries. Methods The whole-exome sequencing(WES) and Sanger sequencing were conducted to verify the mutation of FOXN1.The T cell receptor rearrangement excision circles(TRECs) and κ -deleting recombination excision circles(κ RECs) copies, peripheral blood lymphocyte subsets and T cell receptor (TCR) Vβ repertoire were further detected。A literature search was conducted using PubMed, Wangfang Med Online and CNKI with search terms "FOXN1 deficiency", "FOXN1 haploinsufficiency". Results A 1-year-old girl manifested with recurrent autoimmune hemolytic anemia, hair loss and nail dystrophy. Genetic mutation of FOXN1 (c.1392_1401delTCCTGGACCC, p.P465Rfs*82) was confirmed by WES and Sanger sequencing. The TRECs were 0.35copies/μ L, κ RECs were normal. The TCR Vβ repertoire in this patient was markedly oligoclonal. Lymphocytes subsets revealed a predominate decrease of CD4+ T cell and NaïveCD4+ T, an increase of effector memory helper T cells. A total of 5 publications were included (5 English and 0 Chinese). Thus far, 41 cases have been reported in the worldwide who mostly manifested with the decrease of T cells in early child. Conclusion FOXN1 haploinsufficiency deficiency is a kind of combined immunodeficiency disease, which is mainly manifested by the decrease of T cells and repeated infection in infants and young children, and may also accompanied by hair loss, nail dystrophy and autoimmune disease, which cannot be cured by hematopoietic stem cell transplantation. more>
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Abstract: Lung cancer is a malignant tumor with high incidence rate and mortality worldwide. Nonsmall cell lung cancer (NSCLC) is the most common malignancy. The traditional treatment of NSCLC mainly depends on chemical drugs. In recent years, immunotherapy has become a hot spot in the treatment of NSCLC and made remarkable progress. The overall objective remission rate of immunotherapy for NSCLC patients is about 20%. A large number of new biological immune agents have been developed and applied in clinic. Among them, immune checkpoint inhibitors (ICI) have the widest development and the most positive effect on NSCLC. This paper summarizes the research status and progress of immunotherapy biomarkers of NSCLC in recent years, in order to improve the accuracy of immunotherapy and better guide the individualized treatment of NSCLC patients. more>
 doi: 10.12290/xhyxzz.2022-0240
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Abstract: Randomized controlled trials (RCTs) provide the most valid means of establishing the efficacy of clinical therapeutics. A good RCT should be based on topics with clinical significance and scientific value, and focus on the establishment of intervention and control, the method of randomization and the selection of primary endpoints. During the implementation process, details such as ethics application, research registration, data collection and regular review of the research are of great value to ensure the scientificity of the trial and the credibility of the results. more>
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Abstract: Helicobacter pylori (HP) -associated chronic atrophic gastritis (CAG) is known to be a precancerous lesion of gastric cancer, and can act on gastric carcinogenesis through a variety of factors, but the specific mechanism of action is not clear. In this paper, we review the research progress of the mechanism of HP-associated CAG in the development of gastric cancer for your reference. more>
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Abstract: Objective To evaluate the methodological quality of Systematic Review/Meta analysis (SR/MA) published in Chinese Science Citation Database (CSCD) Journal in 2020, with the aim of providing suggestions for researchers in China to develop SR/MA and reference for editors and reviewers to review SR/MA. Methods The list of journals was formed with a sample of journals published by the Chinese Medical Association Publishing House and included in CSCD. Four researchers worked in pairs conducted independently manual searches on the official websites of the journals to include SR/MA published in 2020, and one researcher conducted a supplementary search on China National Knowledge Infrastructure. After identifying the included literature,researchers worked in pairs extracted information independently, evaluated methodological quality by using AMSTAR 2(A measurement tool to assess systematic reviews 2) and performed statistical analysis of the result. Results A total of 79 journals from the Chinese Medical Association Publishing House were included in CSCD, 46 of which published SR/MA in 2020, and 126 SR/MA were included for analysis after screening according to inclusion and exclusion criteria. AMSTAR 2 evaluation results showed that the average score of SR/MA was 10.38±1.91. The scored proportion of 9 items was more than 70%. SR/MA met/partially met a minimum of 5 AMSTAR 2 items and a maximum of 12 items. Before the key items were adjusted, over 90% of SR/MA's credibility rating was critical low. After adjusting the key items according to Chinese actual situation, about 40% of SR/MA's credibility rating was medium and low respectively. The results of the stratified analysis showed that the use of GRADE, adherence to the PRISMA statement, the number of authors greater than 5, the language of publication, the type of included studies including RCTs, and the reporting of funding were not factors that influenced the methodological quality of SR/MA. Conclusion The methodological quality of SR/MA published on CSCD journal in 2020 was higher than that of previous. Meanwhile, attention should be paid to the registration, retrieval, inclusion and exclusion criteria of SR/MA as well as financial support, so as to effectively improve the quality of SR/MA. more>
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Abstract: Objective To explore whether the establishment of general surgical emergency team can evacuate emergency congestion, increase emergency surgery turnover rate and reduce the medical burden. Methods All patients attending our emergency surgery from August 1,2019 to July 31,2021 were retrospectively analysed. The disease severity grading, the ratio of the observation and flow, the number of surgery, preoperative preparation time, the ratio of transfering to ICU, the ratio of patients staying more than 30 days, and complication rate before and after the establishment were compared. Length of stay and hospitalization costs were compared by surgical grading and disease severity grading. Analyse the factors affecting hospitalization costs in emergency surgery patients using univariate and multiple linear regression. Results: After the establishment of the surgical team, the ratio of observation decreased from 11.6% to 7.3% (P=0.000), the operation number increased from 26 to 77 monthly, preoperative preparation time decreased from (1.5 ± 0.7) days to (0.7 ± 0.9) days (P=0.000), the ratio of transfering to ICU decreased from 37.9% to 23.7% (P=0.000), the ratio of patients staying more than 30 days decreased from 5.7% to 0.5% (P=0.000). There was no significant change in complication rate. The average length of stay and cost of the third and forth grade surgery were significantly reduced. The establishment emergency surgery team can reduce the hospitalization cost, while serious disease, long hospitalization time, transfering to ICU and high surgical grading can increase the hospitalization cost. Conclusion The establishment of emergency surgery team can solve the current problem of emergency in some degree, such as evacuating emergency congestion, increasing emergency surgery turnover rate and reducing the medical burden on the premise of ensuring medical safety, so as to improve the efficiency of emergency treatment and benefit both doctors and patients. more>
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Abstract: Crohn's disease( CD) is a kind of inflammatory bowel disease, and its incidence rate is increasing year by year. Mesenteric creeping fat is a special sign of CD, which is closely related to intestinal inflammation and stenosis of CD. It is a research hotspot in recent years. The formation mechanism of mesenteric creeping fat may be related to the migration of adipocytes and the translocation of intestinal microbiota. However, at present, there is no standard imaging method to evaluate mesenteric fat entrapment. MRI, CT and US are commonly used imaging evaluation methods for CD, which can show the sign of creeping fat, and evaluate the inflammation of intestinal wall and intestinal stenosis. However, the relationship between mesenteric creeping fat and inflammatory activity, stenosis and prognosis of CD remains to be further studied. The purpose of this review is to introduce the pathogenesis and clinical significance of mesenteric creeping fat, as well as the evaluation indicators of different imaging methods, and to further explore the relationship between mesenteric creeping fat and CD inflammatory activity and stenosis. more>
Editorials
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Abstract: This study reviews the core methods and models that have emerged from the development of evidence-based medicine over the past 30 years, including the PICO question model, systematic reviews, grading of evidence quality and strength of recommendations, reporting guidelines, the 5S pyramid of evidence resources, and evidence ecosystem. The above methods and models constitute the theoretical system, promote the progress of evidence-based medicine and provide the internal impetus for its development. The clarification of the core methods and key models of evidence-based medicine will help scholars and researchers fully understand its scientific philosophy, explore its future direction in light of current development trends, achieve its renewal and iteration, and further promote the construction of evidence-based science and the development of multidisciplinary integration. more>
Editorials
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Abstract: Since the outbreak of COVID-19, SARS-CoV-2 has continued to evolve. As the fifth variants of concern (VOCs) announced by the World Health Organization, Omicron has significantly changed from previous VOCs in terms of genome, biological and epidemiological characteristics. Although the severe illness and mortality caused by Omicron infection are significantly lower than those caused by the previous VOCs, Omicron's strong transmission ability has continued to break through the epidemic prevention barrier and human immunity barrier established by prior infections and vaccines. Omicron has opened a new chapter in the COVID-19 pandemic. In this paper, we review the changes in genome and biological characteristics of Omicron and its subspecies as well as the differences in epidemiological characteristics between Omicron and influenza viruses in order to provide scientific basis for the optimization of epidemic prevention and control. more>
Editorials
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Abstract: There is a high prevalence of psychiatric comorbidity in general hospital inpatients of various physical departments. Psychiatric comorbidity may result in the difficulty in clinical communication, longer hospitalization, worse clinical outcomes and higher costs. However, psychiatric comorbidities are often neglected and left untreated. We believe this phenomenon is caused by complex problems including, but not limited to, insufficient recognition, insufficient invitation for consultation, clinical challenge of complex multiple-comorbidi-ties, and insufficient treatment. To address these problems, we developed consultation-liaison psychiatry system of resident-attending-professor rounds with fixed follow-ups to provide standardized care to general hospital inpatients with psychiatric comorbidity. more>
Specialist Forum
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Abstract: A comprehensive evaluation of clinical practice guidelines (CPGs) is essential to measure their quality. This study introduces the function and meaning of the systematic review of CPGs and combs the development and current status of guideline appraisal tools. On this basis, we expound the content and characteristics of the Scientific, Transparent, and Applicable Rankings Tool (STAR) for Guidelines in depth, with the hope of providing reference for the improvement of the compressive guideline assessment system and the development of high-quality guidelines in the future. more>
Specialist Forum
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Abstract: As an important guidance of medical practice, clinical practice guideline of integrative Chinese medicine (ICM-CPG) plays an extremely important role in showing the respective advantages of Chinese and Western medicine and in promoting the integrated Chinese and Western medicine. However, the research status on ICM-CPG is faced with the problem of emphasizing development but neglecting implementation. The establishment of ICM-CPG implementation model based on the theoretical framework of implementation science is conducive to promoting the implementation of ICM-CPG and advancing the integration and development of Chinese and Western medicine. In this paper, by sorting out and analyzing the knowledge to action (KTA) framework, we discuss the implementation framework development of ICM-CPG in order to provide reference for future research. more>
Specialist Forum
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Abstract: With the advent of the era of medical big data, new changes have occurred in the development of evidence-based medicine. This paper defines data-driven evidence-based medicine, and explains the changes it brings to evidence-based medicine. The intelligent evidence acquisition and utilization process of evidence-based medicine is discussed from more and more scientific original evidence sources, intelligent evidence-based medicine literature information extraction, AI-based real-world health and medical data analysis, innovative clinical research disease database, and AI-based clinical guidelines and other scenarios. The main factors affecting the evidence production of evidence-based medicine may involve data integration, data quality, technical deviation, data security and ethics, talent team and so on. more>
Specialist Forum
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Abstract: Based on the clinical trials and cohort studies in the Chinese population, this paper systematically summarized the association between weight/ body mass index (BMI) and their changes in preventing non-alcoholic fatty liver disease (NAFLD) and its adverse outcomes. The results showed that BMI was positively correlated with NAFLD risk, but for those with NAFLD, BMI was negatively related to the remission of NAFLD and there was a non-linear dose-response relationship between BMI and adverse outcomes. The lean NAFLD group had a higher risk of all-cause death, liver-related death, digestive system tumors, and obesity-related tumors than the overweight or obese NAFLD and lean non-NAFLD group. Additionally, the association between baseline BMI levels and adverse outcomes in NAFLD populations may be affected by other metabolic indicators. After controlling for baseline BMI, most studies suggested that weight loss could reduce the NAFLD risk. However, there is no consistent conclusion on how to control weight to prevent NAFLD because the methods and the time windows to assess BMI changes vary in different studies. Moreover, for those with NAFLD, limited evidence suggested the different relationship between weight loss and different outcomes. Therefore, we call for conducting multi-center cohort and experimental studies to verify the effect of weight control on NAFLD and its related adverse outcomes after considering the heterogeneity of NAFLD, so as to propose precision weight control recommendations. more>
Guideline and Consensus
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Abstract: With the adjustment of China's COVID-19 policies and measures, the treatment of infected patients, especially the severe and critically ill patients, has become the focus of all medical staff at this stage. Since the outbreak of the pandemic, Peking Union Medical College Hospital has accumulated rich experience in this field. Based on the updated international evidence-based knowledge, the multidisciplinary expert group of COVID-19 at Peking Union Medical College Hospital has compiled a set of operational recommendations. Adhering to the evidence-based, concise, and clinically operable principles, these recommendations for diagnosis and treatment integrate the latest research evidence. For clinical issues that lack evidence, certain recommendations are given based on the frontline clinical working experience and expert opinions. The purpose is to enhance medical staff's understanding of COVID-19 infection and its critical illness and improve patient care. more>