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漫漫肠路,点点星光

北京协和医学院临床医学(八年制)2018级  韩炳泰

 十分荣幸作为封面创作团队的一员,我参与了《协和医学杂志》2022年9月刊“肠道菌群与疾病治疗”这一重点选题的封面设计。肠道菌群与人体疾病的联系十分广泛,其在消化系统、免疫系统、心血管系统、孤独症谱系障碍等疾病中均可发挥潜在而重要的治疗作用。如何用小小封面体现二者之间的联系?这不仅是对我绘画功底的严峻考验,同时对我的想象力也提出了挑战。

 为了坚持手绘风格,我在创作初期并没有急于确定方向,而是收集素材并完成了许多草稿。而最后在众多疾病中选择孤独症作为题材,一方面是为了呼吁全社会能够对孤独症群体多一些关注,同时也是为给封面创作留下艺术空间。人们常说孤独症患儿是来自星星的孩子,因此我尝试将星河、月亮、肠道、菌群这些元素以童话风格融合在一起,而这一风格更适合用我最擅长的水彩来表现。

  这次创作中遇到的最大难题是“抽象”与“具体”之间的权衡。尤其是肠道的设计,过于具体则缺乏美感,过于抽象则难以理解。设计的过程是坎坷的,若没有专家组集思广益提供灵感,没有美术指导戴申倩老师的帮助,我的创作将会举步维艰。经过不断修改和完善,终于呈现了理想的画面:迂回的肠道延伸向远方,近处化为倒映着星河的道路,孤独的小女孩驾着月亮船,被圆滚滚的肠道杆菌合力托举,驶向远方;而肠道杆菌则借鉴了宫崎骏的电影《千与千寻》中煤球的形象,希望能体现与孩子之间可爱的互动。

 孤独症儿童的世界不应是孤独的,他们需要更多的爱与关注。相信随着医学研究的不断进步,肠道菌群治疗作为这些孩子们的“星光”,一定能给他们带来更多温暖和希望!

Vol. 13, No. 5 30 09 2022
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: 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: Clinical practice guidelines can facilitate the standardization of the diagnosis and treatment and improve health care quality. However, barriers exist to guideline dissemination and implementation, impeding the standardization of clinical practice and improvement of patient outcomes. One major barrier is that the unstructured text-based guidelines are difficult for doctors to read, understand, and apply in real clinical practice. This paper introduces the design of decision trees based on clinical practice guidelines, advantages, challenges, and solutions of this approach and provides a reference for promoting the transformation of textual clinical practice guidelines. more>
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Abstract: Objective To establish a fungal image-assisted classification model using deep learning technology. Methods The microscope images of people infected with Aspergillus, Saccharomyces and Cryptococcus neoformans were retrospectively collected from the Eighth Medical Center of PLA General Hospital from September 2020 to April 2021. The images were randomly divided into training set, validation set and test set according to the ratio of 7:1.5:1.5. The improved MobileNetV2 network structure was trained using the training set, a convolutional neural network (CNN) fungal image 11 classification model based on multi-scale attention mechanism was constructed and the parameters were debugged based on the validation set. Machine identification results were taken as the gold standard, the performance of the model on 11 fungal image classification tasks was evaluated, and the results were shown by precision, recall and F1 value. In addition, the performance of the proposed model with 5 classicCNN models were compared, and the results were measured in terms of model parameters, memory usage, frames per second (FPS), accuracy, and area under the curve (AUC) of receiver operating characteristic curve. Results A total of 7666 fungal microscope images were collected, including 2,781, 4,115, and 770 images of Aspergillus, Saccharomyces, and Cryptococcus neoformans, respectively. Among them, there were 5366 training images, 1150 validation images, and 1150 test images. The improved MobileNetV2 model had high performance for the classification of 11 fungal images in the test set. The precision rate was distributed between 96.36% and 100%, the recall rate was distributed between 96.53% and 100%, and the F1 value was distributed between 97.01% and 100%. The parameters, memory usage, FPS, accuracy, and AUC of the improved MobileNetV2 model were 4.22 M, 356.89 M, 573,(99.09 ±0.18)%, and 0.9944±0.0018, respectively, and the comprehensive performance was better than 5 kinds of classical networks. Conclusion The proposed fungal image classification model based on the improved MobileNetV2 can obtain higher fungal image recognition ability while maintaining low computational cost, with an overall performance better than classical CNN model. more>
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Abstract: Objective To construct a pathological image diagnostic model of cervical adenocarcinoma in situ (CAIS) based on deep learning algorithm. Methods Pathological tissue sections of CAIS and normal cervical canal and gland sections of chronic cervicitis stored in the Pathology Department of Shengjing Hospital, China Medical University from January 2019 to December 2021 were retrospectively collected. After image collection, they were randomly divided into training set, validation set and test set with a ratio of 4:3:3. The data of training set and validation set were used to conduct transfer learning training and parameter debugging for 6 network models, and the convolutional neural network binary classification model that could recognize pathological images of CAIS was constructed. The models were combined to build the ensemble learning model. Based on the test set data, the performance of pathological image recognition of single model and ensemble learning model was evaluated. The results were expressed by operation time, accuracy, precision, recall, F1 score and area under the curve (AUC) of receiver operating characteristic. Results A total of 104 pathological sections of CAIS and 90 pathological sections of normal cervical duct and gland with chronic cervicitis were selected. A total of 500 pathological images of CAIS and normal cervical duct glands were collected, including 400 images of training set, 300 images of validation set and 300 images of test set, respectively. Among the 6 models, ResNet50 model, with the highest accuracy (87.33%), precision (90.00%), F1 score (86.90%) and AUC (0.87), second highest recall (84.00%) and shorter operation time (2062.04 s), demonstrated the best overall performance; VGG19 model was the second; and Inception V3 and Xception model had the worst performance. Among the 6 kinds of ensemble learning models, ResNet50 and DenseNet201 showed the best overall performance, and their accuracy, precision, recall, F1 score and AUC were 89.67%, 84.67%, 94.07%, 89.12% and 0.90, respectively. VGG19 and ResNet50 ensemble model followed. Conclusion It is feasible to construct CAIS pathological image recognition models by deep learning algorithm, among which ResNet50 models has higher overall performance. Ensemble learning can improve the recognition effect on pathological images by single model. more>
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Abstract: Assistive technology is a subset of health technology. The resolution on improving access to assistive technology adopted by the 71st World Health Assembly illustrates that it is extremely important to integrate assistive technologies into the health system, which will help to achieve the sustainable development goal including universal health coverage. This paper introduces the history of the development of assistive technology, expounds that assistive technology plays an increasingly important role in health protection/care, rehabilitation treatment/training, functional compensation, environmental health and other health fields. and puts forward suggestions and opinions on strengthening the understanding of assistive technology, improving relevant policies and systems, strengthening the construction of assistive technology service system, promoting R & D and production development, and building professional technical teams, so as to better achieve Universal health coverage. more>
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Abstract: The information on the two early postcards sent from Peking Union Medical College was studied. Henry E. Meleney and H.F. Hsü, the parasitologists and medical educator of Peking Union Medical College were introduced. Their experience of scientific research and achievements was reviewed. The professional ethics of serving patients and scientific spirit with rigorous scholarship of the medical scientists provide educational significance at present. more>
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Abstract: Objective: To explore the current situation and characteristics of clinical trials of 121 rare diseases in Chinese First List of Rare Diseases over the past 10 years and to provide reference for promoting the research and development of orphan drugs in China. Methods: A total of 121 rare diseases covered in Chinese First List of Rare Diseases and Guidelines for Diagnosis and Treatment of Rare Diseases published in 2019 were retrieved as keywords on the China Food and Drug Administration Registration and Information Disclosure Platform for Drug Clinical Studies (chinadrugtrials.org.cn) from November 1st, 2012 (Platform registration open time) to November 28th, 2021. The current status and characteristics of rare disease clinical trials were analyzed from the perspectives of the number of registrations, geographical distribution, research fields, research design, and sample size. Results : A total of 235 clinical trials The Drug Clinical Trial Registration and Information Publication Platform has registered from November 1st, 2012 to November 28th, 2021, including 41 items of phase I, 22 tiems of phase II, 74 items of phase III, 15 items of phase IV, 77 items of bioequivalence clinical trials, and the other 6 clinical trials. During the ten years, the number of rare diseases clinical trials in China showed an increasing trend year by year, with an annual average growth rate of about 54%. A total of 16 kinds of rare diseases were involved in the Chinese First List of Rare Diseases in early phase (phase I and phase II) clinical trials, mainly focusing on hemophilia, idiopathic pulmonary fibrosis, multiple sclerosis, and neuromyelitis optica. The main researchers of rare disease clinical trials were mainly in Beijing, Tianjin, Shanghai, and so on; In phase I clinical trials of rare diseases listed in Chinese First List of Rare Diseases in China, there were mainly Single-center parallel control studies (46%, 19/41), Phase II clinical trials were mainly multi-center paralleled studies (65%, 13/22), and phase III clinical trials were mainly multi-center (99%, 73/74) single-arm trials (64%, 47/74); The sample size in clinical trials increases with study stage. The sample size of phase I clinical trials was mainly restricted in 11 ~ 50 cases (85%, 34/41).59% (13/22) of phase II clinical trials were more than 50 cases, and 52% (13/22) of phase III clinical trials were in the range of 51~500. Conclusions: The research and development of orphan drugs in China is still at an early stage. There are few rare diseases involved in the Chinese First List of Rare Diseases in China, but it has shown a rapid growth trend in recent years. At present, the development of rare disease drugs is still based on traditional clinical trial design. It is necessary to explore more new clinical research strategies according to the disease and drug mechanism of action to promote the development of rare disease drugs. more>
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Abstract: Although the shock has long been treated routinely, right heart and pulmonary circulation were forgotten corners in clinical management. My colleagues and I published the paper of "right ventricular function of patients with septic shock" and proposed the strategy of "Right heart priority", taking right heart as a starting point, completing whole circulation pathway of blood flow clinically with hemodynamic indicators, and performing treatment based on the hemodynamic changes at real locations, degrees and responses to therapeutic interventions. Over the past 20 years, this strategy has been confirmed by many others and practiced in many hospitals worldwide. The current treatment of shock has been a continuous and dynamic, target directed quantitative hemodynamic therapy and is moving from individualized treatment towards organ targeted treatment. more>
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Abstract: In order to improve the prognosis of children with juvenile idiopathic arthritis (JIA), following the treatment guideline issued in 2019, the American College of Rheumatology (ACR) published new guidelines for the treatment of JIA in March 2022, including both recommendations for pharmacologic and nonpharmacologic therapies. Among them, the pharmacologic management focuses on treatment of oligoarthritis, temporomandibular joint arthritis, and systemic JIA. This article provides Chinese physicians with detailed interpretation of this guideline, for the purpose of better application in their clinical practice. more>
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Abstract: Objective To study a new conservative treatment of idiopathic scoliosis(IS) during growth and to validate the new classification. Methods 899 cases of conservative treated IS during growth with comprehensive data were reviewed. The standing X-ray (A-P and lateral) and clinical appearance (bending and standing) were analyzed. The purposed classification was tested for inter-and intra-observer reliability by 6 physical therapists individually. Results Four major types and 7 subtypes (9 totally) in PUMCH Scoliosis Specific Exercise classification system were identified. PUMCH Scoliosis Specific Exercise classification Type 0 accounted for 13.34%, TypeⅠ accounted for 48.94%, Type Ⅱ 33.82% and Type Ⅲ 3.89%. The inter-observer reliability testing was 88.22% (Kappa coefficient 0.862), while intra-observer reproducibility was 92.78% (0.908). Each type had its related conservative treatment. A prospective study of 90 subjects was conservative-treated according to PUMCH Scoliosis Specific Exercise classification system. After one year treatment, the Cobb angle in specific exercise group was decreased, and the satisfaction was increased. Conclusion PUMCH Scoliosis Specific Exercise classification is the first conservative system in China to combine the X-ray and clinical appearance, and have high inter-observer reliability and intra-observer reproducibility. more>
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Abstract: Objective To analyze the influencing factors of hospitalization expenses of patients treated in the KC19 group by the neurosurgery department of a tertiary hospital in Beijing, and to provide reference for the refinement of DRG grouping. Methods The medical records of 3809 patients from January 1, 2017 to November 30, 2021 were reviewed, and relevant influencing factors were found using descriptive statistics, univariate analysis, and multivariate linear regression. Results Among the 3809 patients included in this study, the average total hospitalization cost was 36,166.82 yuan, and the average hospital stay was 9.42 days. Neuroendoscopy accounted for 35.2%, and there were major complications or comorbidities. MCC) or complications or comorbidity (CC) accounted for 40%. Univariate analysis found that hospitalization costs were associated with gender, length of hospital stay, number of other diagnoses, number of surgical procedures, use of neuroendoscopy, and presence of MCC or CC. Through multivariate analysis, it was found that the main influencing factors were the length of hospital stay, followed by the number of other diagnoses, the number of surgical operations, whether neuroendoscopy was used, whether there was MCC or CC, and gender. Conclusion In the follow-up fine grouping of KC19, the above influencing factors should be considered, and the use of neuroendoscopy and the presence of MCC or CC should be included in the grouping criteria. more>
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Abstract: Diabetes is the most common metabolic condition worldwide. Regional anaesthesia has benefits in promoting the restoration of function and may avoid the worse outcomes related to general anesthesia and intravertebral anesthesia. However, patients with diabetes are susceptible to peripheral neuropathy. The incidence of complications of regional anaesthesia in patients with diabetes is supposed to be higher. The aim of this review is to explore the strategies of regional anesthesia implementation, the selection of adjuvant, and the way to reduce the risk of complication. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes. 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: The Folin-Wu method is one of the classic methods for blood glucose determination. It is the representative scientific research achievement of Hsien Wu, one of the most celebrated biochemists in China. This study focus on the invention process of the Folin-Wu method by referring to the original papers of Folin, Hsien Wu, etc. and relevant second-hand historical materials. The implication of competition and cooperation in scientific community on further improvement of the Folin-Wu method was also discussed. The purpose is to evaluate the influence of the Folin-Wu method based on historical data, and to further clarify the academic contribution of Hsien Wu in the research process of this method. more>
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Abstract: With the development of information technology in the medicine, medical data mainly based on unstructured data has increased dramatically. These massive data can be processed by big data technology to generate databases with different themes and create huge additional value. At the same time, with the rapid development of artificial intelligence technology centered on deep learning, artificial intelligence assisted diagnosis and treatment has ushered in a huge development space, which is helpful to guide medical activities and improve the efficiency of medical processes. The combination of big data, artificial intelligence and medical industry will become an important development direction in the future. This paper summarizes the application of big data and artificial intelligence in the medicine. 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>
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Abstract: With the wide spread of quality improvement (QI) methodology, the application of QI in healthcare field is increasing recently. QI in healthcare field is to use the methodology of continuous and cyclic interventions to transform existing knowledge into clinical practice with the specific aim, and to measure whether the interventions are effective through monitoring of quantifiable indicators, finally to improve the medical process and outcomes. We introduce the structures of QI projects and reporting elements, including the example and exploration of title and abstract, introduction, results and discussion section, hope to help medical staffs to better understand QI in healthcare field. 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: Here we report a case that a young man had early onset myocardial infarction. Coronary angiography showed coronary aneurysm-like dilation and thromboembolism. Stents were implanted but complicated with repeated stent restenosis. Polycystic kidney, nephrotic syndrome and antiphospholipid antibody syndrome were also present. Antiphospholipid antibody syndrome is a risk factor for recurrent coronary thrombosis and can lead to nephrotic syndrome.Polycystic kidney can be characterized by nephrotic syndrome and may be combined with aneurysmal lesions due to genetic abnormalities. According to the multidisciplinary discussion and follow-up results, the patient was diagnosed as connective tissue diseases and secondary antiphospholipid antibody syndrome, nephrotic syndrome, and coronary artery lesions. the patient's symptoms improved after treatment for the original disease. The management of this patient broadened our understanding of the etiology of coronary artery disease in young patients and demonstrated the importance of clinical thinking. more>
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Abstract: With the advent of the era of medical big data, new changes have occurred to the development of evidence-based medicine. Data-driven evidence-based medicine was defined, and the changes it brings to evidence-based medicine were explained. The intelligent evidence acquisition and utilization process of evidence-based medicine was 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 come from data integration, data quality, technical deviation, data security and ethics, talent team and so on. 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: Objective: To analyze the artificial intelligence (AI) randomized controlled trial (RCT) researches published in PubMed, and explore the current situation of AI RCT researches and provide a reference for researchers to carry out related researches. Methods: AI RCTs researches were obtained by searching PubMed database, the Web of Science was used to obtain the publication year, journals, authors, organizations, and countries of included AI RCTs researches. The VOSviewer 1. 6. 17 software was used to extract the related information, and generate visual cooperation network maps for the country, organizations, citations, and authors, perform cluster analysis for keywords. The Cite Space 5. 8. R3 software was used to analyze the burst citation references and keywords. Results: A total of 1174 RCTs in AI field were included, and the number of articles increased rapidly after 2007; United States, Italy, and South Korea contributed the most publications; China ranks fifth in the number of publications and has formed good cooperative relations with the United States, Canada, and Italy; The three most contributed institutions are Harvard University of the United States, Yonsei University of Korea, and Northwestern University of the United States. Krebs, Calabro, and Picelli published the most literature; The main hot topics are the application of robot technology in treatment, the application of machine learning in disease diagnosis and management, and the application of AI in rehabilitation training. Combined with strongest citation burst, it can be seen that machine learning maybe the current research hot topic; The magazine International Journal of Neuroengineering and Rehabilitation (n=40, IF 2020=4.26) is the most productive journal; The paper with the highest number of citations and the strongest citations burst is RCT published in the New England Journal of medicine in 2010 by Albert et al, which analyzed the effect of robot-assisted treatment of long-term upper-limb injury after stroke. Conclusion: The authors, institutions, and countries of AI RCTs research should strengthen cooperation, and the research theme needs to be expanded. AI has great application prospects in the medical field, Chinese scholars should strengthen tracking the application trend of AI in the medical field, strengthen cooperation with foreign scientific research institutions, and provide more high-quality evidence for the clinical application of AI. more>
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Abstract: Recently,National Comprehensive Cancer Network(NCCN) released the latest version of clinical practice guidelines for gastric cancer in 2022. In this version, evaluation of peritoneal metastasis using laparoscopy with cytology was refined. Postoperative chemoradiation was recommended as an alternative option for patients who received less than a D2 lymph node dissection. The use of three cytotoxic drugs in a regimen should be reserved for medically fit patients with excellent performance status and easy access to frequent toxicity evaluation. More importantly, next generation sequencing (NGS) is recommended for the first time for the detection of MSI/MMR status. Also the recommendation for the detection of MSI/MMR status is extended to all newly diagnosed cases. Several recently developed targeted drugs and immuno-oncology therapy were involved in the recommendation for sequential treatment. Inevitably, presice treatment strategy based on biomarkers will become the future for gastic cancer. This article aims to interpret the updates, so as to provide reference for clinical practice. 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>
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Abstract: The specialty of critical care medicine in China has developed rapidly and plays an irreplaceable role in the treatment of critically ill patients, sudden disasters and public health events. The standardized training of specialists is not only an important part of medical education after graduation, but also a conventional way to train qualified specialized clinicians. As the second batch of national pilot specialties, the specialty of critical care medicine has established a national unified specialist training system, which has become an important way to cultivate the echelon of discipline professionals. This study compares and considers the similarities and differences of critical care medicine specialty training in foreign countries from different aspects of training system and platform construction, so as to provide reference for promoting the continuous improvement of critical care specialist training system in China. more>
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Abstract: Lynch syndrome (LS) is an autosomal dominant genetic disorder caused by mismatch repair gene defects, and the susceptibility to multi-system malignancies is the main feature. Ls associated endometrial cancer (LS-EC) is the most common extraintestinal sentinel cancer of LS. In the era of precision medicine, the early screening of LS-EC is of great significance to prevent the occurrence of other LS related malignant tumors. This paper reviewed the research progress on screening methods and prevention of LS-EC, in order to provide reference for precise diagnosis and prevention of LS-related tumor patient. more>
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Abstract: With the Law on Doctors of the People's Republic of China implemented on March 1, 2022, off-label use of drugs has been included into the legislation for the first time. The Law on Doctors of the People's Republic of China stipulates: "In the absence of effective or better treatment approaches and other special circumstances, after obtaining the informed consent of the patient/guardian/entrusted agent, the clinician can undertake a usage not specified in the drug instruction if supported with evidence. Medical institutions are suggested to establish a management system to review the suitability of prescriptions and medications , and strictly standardize the medication behavior of clinicians". In view of this, Peking Union Medical College Hospital established the management system for off-label drug use based on evidence-based methods with the aim to strengthen its management and rational use in our hospital. The measures for off-label drug use were formulated to safeguard doctor's legitimate rights, as well as to strictly standardize practicing behavior. Contingency plans were established for risk prevention and control to protect patients' rights and escort the off-label use of drugs. Hierarchical management based on the patients’ needs and the types of evidence sources for offlabel medication use was adopted to improve its feasibility. more>
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Abstract: The application of various bedside imaging monitoring techniques in critical care department make the necessity of imaging ward round increasingly prominent. In terms of medical treatment, it is beneficial to improve the accuracy of intervention, improve the consistency of team working mode, and improve the level of individualized and organ-targeted treatment. In terms of teaching, it helps to improve the understanding of the physiological mechanism of diseases, promote the cultivation of critical clinical thinking, and improve the use of the monitoring equipment. In the aspect of scientific research, it promotes the summary of image data and the development of scientific research ideas. At the same time, it is necessary to pay attention to data security, patient privacy and limitations of imaging data when conducting ward rounds. more>
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Abstract: This was a patient with a medical history of aspirin-aggravated respiratory disease present with eosinophilic enteritis and recurrent acute pancreatitis. Eosinophilic granulomatosis with polyangiitis was clinically suspected due to the clinical presentation of multiple systems involved and the histological appearance of eosinophilic infiltrate, while acute pancreatitis was rarely reported in this disease. In addition, the patient developed pancreatic pseudocyst, and delayed pseudoaneurysm hemorrhage occurred after drainage of the pseudocyst. The hemorrhage was successfully treated after angiographic embolization, and the patient remained stable after one year. Both the diagnosis and the management of this case were challenging and worth learning. more>
Editorials
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Abstract: The human microbiome, the second genome of the human body, can determine human health status. Microbiome research has prompted humans to re-understand the relationship between microbiota and individuals, as well as microbiota and the ecological environment. A comprehensive and systematic study of the structure and function of human gut microbiome and an analysis of the interaction and regulation mechanism of the relevant core bacteria will bring revolutionary theoretical innovations to solve the health problems of humans, and the resulting disruptive technological innovation has the potential to provide better solutions for microbiome research. more>
Editorials
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Abstract: Congenital scoliosis (CS) is a congenital spinal deformity that originates from abnormal spinal development in embryo. Characterized by rapid progression, severe deformity, and many complications, CS brings heavy economic and mental burden to patients and their families. At present, there is no good treatment for the etiology of spinal deformity. Due to the lack of early prediction methods, patients are often not detected until the appearance of malformation, and the treatment is mainly passive, conservative or traumatic treatment with braces or surgery to control the progression of the disease. Therefore, the exploration of early diagnosis methods and effective etiological intervention targets for spinal deformity is currently an international research hotspot. The orthopaedic team of Peking Union Medical College Hospital, focusing on the molecular genetics research and clinical application of CS, has built the world leading genetic research system of skeletal deformity. Through a multi-center large-scale cohort study, the team has found and demonstrated that compound inheritance of a rare null mutation and a hypomorphic allele of TBX6 led to CS. A set of genotype-phenotype integrated analysis method has been established, which successfully defined a new subtype of CS (TBX6-associated congenital scoliosis, TACS) and realized accurate clinical prediction of this unique subtype. With the establishment of the first genetics clinic of skeletal deformity in China, the clinical transformation of research results can thus be realized, providing a new paradigm for the etiology research and clinical application of skeletal deformity. more>
Specialist Forum
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Abstract: In recent years, with the progress of multi-omics and next-generation sequencing technology, the association between gut microbiome and cardiovascular diseases has attracted great attention around the world. Gut microbiota, as a "microbial organ", directly regulates the host's health status through lipopolysaccharide, metabolites like trimethylamine oxide and short-chain fatty acids, and affects the host's immunity through bacteria and their products. "Gut-heart axis" may be a breakthrough in the prevention and treatment of cardiovascular diseases. The paper briefly discusses the relationship between gut microbiome and cardiovascular diseases, the possible ways in which gut microbes affect cardiovascular health, and the regulation of gut microbiota by various factors. more>
Specialist Forum
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Abstract: Gut microbiome regulates host metabolism and immunity via their metabolites, secretions, and cellular components, and protects the host from pathogen invasion. Low diversity and dysfunction of the gut microbiome caused by environmental changes, unhealthy dietary habits and lifestyles, and antibiotics abuse are closely related to disease pathogenesis. Gut microbiome can serve as diagnostic and therapeutic tools for diseases related to gut microbiome dysbiosis. In this article, we aim to review the latest study advances on gut microbiome in the pathogenesis and therapeutics of gastrointestinal diseases, such as Clostridium difficile infection, Helicobacter pylori infection, inflammatory bowel disease, and irritable bowel syndrome, so as to shed light on the prospect of gut microbiome modulations in disease therapies. more>
Specialist Forum
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Abstract: Gut microbiota is indispensable for the maintenance of human immune homeostasis. Dysbiosis and translocation of gut microbes as well as aberrance of microbiome metabolites, which are commonly seen in many autoimmune diseases, are suggested to participate in the breakdown of immune tolerance and the excessive inflammatory responses. The involved mechanisms include immune equilibrium skewing, molecular mimicry, bystander activation and epitope spreading, which contributes to the initiation and progression of autoimmune diseases. In addition, the microbial biotransformation of antirheumatic drugs help determine the bioactivity and toxicity of these drugs. Herein, gut microbiota-based intervention may shed light on developing novel strategies for prophylaxis and treatment of autoimmune diseases. In this review, recent advances in exploring the potential pathogenic role of gut microbiota in autoimmunity are summarized and the prospect of applying microbiota-based intervention in systemic autoimmune diseases is addressed. more>
Specialist Forum
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Abstract: The gut microbiota and their metabolites play a critical role in the maintenance of host immune homeostasis. The dysbiosis and gut microbiota-derived metabolites are closely associated with the initiation and development of multiple autoimmune diseases. Among the microbiota metabolites, short-chain fatty acids, tryptophan and its derivatives, and bile acids are the most widely studied. In this review, the metabolic pathway of the microbiota metabolites, their functions in the immune response and the current findings on their correlation with autoimmune diseases are summarized, with the hope of revealing the role of gut microbiota-derived metabolites on the pathogenesis of autoimmune diseases. more>
Specialist Forum
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Abstract: Autism spectrum disorder (ASD), a neurodevelopmental disorder during early childhood, currently has no effective treatment. The prevalence of ASD has been increasing, which brings a heavy burden to the family of the patients and the society. Children with ASD are accompanied by gastrointestinal symptoms and have an imbalance of intestinal microbiota. Fecal microbiota transplantation (FMT) can improve autism-related symptoms in children with ASD. This review aims to summarize the research progress of FMT for treating ASD to provide a novel strategy for this untreatable disease. more>
China Healthcare Big Data
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Abstract: Glioma, the most prevalent primary malignant tumor of the central nervous system, has a high degree of malignancy and poor prognosis for patients. At present, the researches of glioma mainly focus on the investigation of the mechanism of tumor occurrence and the discovery of new therapeutic methods and agents. In-depth researches have also been conducted on the optimization of molecular pathological typing of glioma, improvement of diagnostic imaging techniques and formulation of comprehensive treatment guidelines. In this review, we summarize the achievements and important progress made by Chinese medical scientists in the field of glioma in 2021, and propose possible future research directions with the aim of providing reference for clinical research. more>