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疼痛综合管理:展望无痛诊疗的未来

北京协和医学院临床医学(八年制)2016级 浦军

作为第五大生命体征的疼痛,不仅会引起患者躯体不适和心理变化,影响康复进程,同时也给社会带来了巨大医疗负担。如何减轻患者疼痛已成为临床及大众共同关注的热点话题。本期《协和医学杂志》重点选题方向为"疼痛综合管理",旨在探讨近年来我国在术后急性疼痛、无痛舒适化诊疗、疑难慢性疼痛、多模式疼痛管理等方面取得的主要进展。

如何通过艺术手段展现疼痛综合管理理念是本期封面创作的重点和难点。通过翻阅大量资料,决定推翻最初欲采用疼痛评分量表来展现主题的设想,转而借鉴墨西哥弗里达卡罗画作中对疼痛的表现手法来展现这一主题。最终,画面主体以荆棘交织成网遮住夜空寓意疼痛,红色荆棘指代疼痛缠扰下患者的焦灼难安;而医生帮助患者拨开荆棘现出月光寓意镇痛,月色清冷喻示消除疼痛后的清凉宁静。整个画面以患者的第一视角穿破荆棘沐浴月光,共情长久困扰于疼痛后获得的无痛舒适体验,同时刻画医患双方并力向前,为无痛未来并肩探索的美好现状。

相信随着"舒适无痛诊疗"理念的深入传播,医疗机构和医护人员的疼痛综合管理服务意识与服务能力也将不断提升,可帮助患者在就医过程中收获更强烈的幸福感和安全感。

Vol. 15, No. 2 30 03 2024
Chinese Bimonthly CN 11-5882/R ISSN 1674-9081
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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Abstract: Objective The objective of this study was to construct phylogenetic trees based on HPV53 full length sequences, as well as to predict the physical and chemical parameters, secondary structure, B and T cell epitopes of HPV53 proteins (E1, E2, E4, E6, E7, L1, and L2). Method Full length of HPV53 variants were Obtained from the GenBank and a phylogenetic tree was constructed to define variant lineages. The physical and chemical parameters of HPV53 proteins were analyzed by ProtParam. The secondary structure of proteins was analyzed using PSIPRED and SOPMA. The B and T cell epitopes for HPV53 proteins were predicted by the IEDB analysis server and the ABCpred server, respectively. Then, to select the potential dominant B and T cell epitopes, more parameters including flexibility, hydrophilicity, surface accessibility, antigenicity of predicted B and T cell epitopes were further predicted by bioinformatic methods (e.g., DNASTAR-Protean, VaxiJen, etc.). Finally, for homology analysis, the potential dominant B and T cell epitopes were compared with the 13 high-risk HPV subtypes using NCBI BLAST tool. Results Phylogenetic analyses clustered HPV53 variants into 3 lineages designated A, B, and C. The physicochemical properties of three different HPV53 variants (representing A, B, and C lineages, respectively) were similar, while slight differences in secondary structure were observed. There were 6 potential dominant B cell epitopes and 9 potential dominant T cell epitopes were predicted for HPV53 proteins. Among these epitopes, B cell epitopes TTPIRPPPPPRPWAPT in E4 region and CYRCQHPLTPEEKQLH in E6 region, and T cell epitopes SGVHSYEEIPMQ in L2 region showed high homologous to HPV56 (all>90%). Conclusions Using bioinformatic tools, B and T cell epitopes for all proteins of HPV53 were predicted, which provides the basis for further research on epitope vaccines against HPV53. more>
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Abstract: Gestational trophoblastic neoplasia (GTN) can be classified into low-risk and high-risk patients based on the FIGO staging and scoring system. High-risk patients have a higher risk of resistance to single-agent chemotherapy and require combination chemotherapy. However, there are still some high-risk patients who develop resistance to combination chemotherapy or experience recurrence after cure. These patients exhibit strong heterogeneity, and subsequent treatment poses significant challenges, attracting considerable attention in recent years. Therefore, this article provides a review of the risk factors and treatment strategies for high-risk resistant and recurrent GTN patients, aiming to provide a basis for early identification of high-risk patients and their precise treatment. more>
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Abstract: As the revised Medical Regulations of Shenzhen Special Economic Zone was officially promulgated in 2022, China recognized the legal effect of living wills for the first time in legislation, which also triggered widespread concern and discussion in the whole society. Due to the influence of traditional culture, legal system and medical service supply, there are many challenges in the practice of living wills. Now, the improvement of the system of living wills should start with the problems encountered in practice, focus on creating a good system implementation environment, further improve the specific operating procedures of living wills, and improve the social supply capacity of hospice care, so as to better safeguard and protect the fundamental rights and interests of patients at the end of their lives. more>
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Abstract: Objective To construct a quality control indicators system for Chinese Plastic and Aesthetic Major and offer basics for medical quality control works. Methods National quality control center of Plastic and Aesthetic major established a working group. The working group guided by the "structure-process-outcome" theory, learned from other majors' relevant indicators, reviewed literatures, discussed in meetings, combined with opinions from quality control experts, and formulated medical quality control indicators for Plastic and Aesthetic major. The quality control indicators system was finally established by Delphi expert consultation. Results Delphi survey was 100% of 2 rounds. The authorities of 2 rounds of expert consultation were 0.854 and 0.857. The harmonious coefficients were 0.387 of primary indicators and 0.425 of secondary indicators (P<0.01). The finalized indicators system includes 3 primary indicators and 9 secondary indicators. Conclusion The quality control indicators system established in this study for Plastic and Aesthetic major in China has a certain degree of scientificity and rationality, which offered references for medical quality control works of Plastic and Aesthetic major in China. However, this system should be improved and ameliorated in practical application. more>
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Abstract: Alzheimer's disease(AD) is the most common neurodegenerative disease, has shown a trend of younger, most patients once onset, cognitive function will show a progressive decline, to the society and the family brings a heavy burden. Studies have shown that fibroblast growth factor (FGF) can be involved in the pathogenesis of AD through multiple mechanisms.In recent years, the research of FGF in AD animal models has made a breakthrough. This article reviews the mechanism of FGF in AD, providing new ideas for elucidating the pathogenesis and early diagnosis of AD. more>
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Abstract: Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is a relatively rare disease, and ultrasound is the first screening method for the initial diagnosis of the disease. contrast-enhanced ultrasound (CEUS) has unique advantages in the follow-up of patients with TIPIC syndrome. This paper reports a patient with TIPIC syndrome who was treated with acute left neck pain. The inflammation was significantly relieved and subsided after treatment with non-steroidal anti-inflammatory drugs. The ultrasound changes of carotid artery lesions in this patient during follow-up were analyzed, and the application value of CEUS in follow-up diagnosis of this disease was summarized, with a view to providing clinical reference. more>
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Abstract: Objective To investigate the expression of CD117 and DOG1 in triple negative breast cancer (TNBC) and to explore their relationship with clinicopathologic features and prognosis. Methods The patients with TNBC in Peking Union Medical College Hospital from 2000 to 2011 were retrospectively collected and tissue microarrays were made. The expression of CD117 and DOG1 in tumor cells was detected by immunohistochemistry to analyze their relationship with the clinicopathological characteristics of the patients, such as age, tumor diameter, American Joint Committee on Cancer (AJCC) cancer stage, histological grade, P53, and Ki-67 proliferation index, and explore the effect of both on the survival of patients. Results A total of 185 TNBC patients meeting the inclusion and exclusion criteria were selected, of which 24 (12.97%) were CD117 positive and 22 (11.89%) were DOG1 positive, with a co-expression rate of 1.62%. Compared with CD117-negative patients, CD117-positive patients had higher Ki-67 proliferation index (87.50% vs. 67.70%, P=0.048), basal-like TNBC (95.83% vs. 74.53%, P=0.020), and P53 diffuse positive (33.33% vs. 13.66%, P=0.032). Compared with DOG1-negative patients, DOG1-positive patients had lower proportions of tumor diameter ≤ 2cm (22.73% vs. 45.40%, P=0.026) and basal-like TNBC (54.55% vs. 80.37%, P=0.015). The median follow-up was 71 months (range:2-170 months), 4 cases (2.16%) were lost to follow-up, 66 cases (35.68%) relapsed or had distant metastasis, and 34 cases (18.38%) died. Survival analysis showed that AJCC stage (HR=7.624, 95%CI:2.187-26.576, P=0.001) and CD117 positive with P53 diffuse strong positive (HR=3.942, 95%CI:1.366-11.379, P=0.011) were negatively correlated with the overall survival of TNBC patients. Conclusion The expression of CD117 and DOG1 were significantly related to basal-like TNBC, CD117 positive with P53 diffuse strong positive may be correlated with a shorter overall survival and a higher mortality risk. more>
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Abstract: Hypertension (HT) can induce aortic dissection (AD) by increasing the tension of the aortic wall and promoting tissue degradation. It is a significant prognostic factor for AD and the most important controllable factor. Research shows that blood pressure management after AD can reduce the incidence rate and mortality of AD, so controlling HT is an important goal and means of AD treatment. At present, blood pressure management mainly includes lifestyle adjustment, drug treatment, and surgical treatment. This article reviews the research progress on the impact of AD on blood pressure, the significance and methods of blood pressure management after AD, providing reference for the treatment of AD patients and benefiting them. more>
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Abstract: Objective To analyze international research trends and cutting-edge hot spots in the field of Geriatric Interdisciplinary Team (GIT) from 2000 to 2023. Methods A search was conducted on the Web of Science database, focusing on 'Article' or 'Review' document types, and including English documents related to GIT published between January 1, 2000, and December 31, 2023. The literature content was extracted using VOSviewer 1.6.18 software to create a cooperation network diagram of countries/regions and institutions, as well as a timeline diagram of keyword cooccurrence relationships. Co-occurrence and cluster analysis of authors, research institutions, countries/regions, and other information was carried out using CiteSpace 6.1.R6 software. Furthermore, the 'bibliometrix' package of R language was employed to analyze the evolutionary trend of keywords in the literature. Results A total of 965 documents related to the Geriatric Interdisciplinary Team (GIT) were collected, consisting of 921 Articles and 44 Reviews. The global publication output in this area has experienced significant growth since 2000. The United States leads in both the number of publications, accounting for 357 articles (37.0%), and total citations, totaling 8656. The University of Michigan in the United States has the highest number of publications, with 27 articles (2.59%), while Johan Flamaing from the University of Leuven in Belgium emerges as the most prolific author with 12 articles (2.8%). The Journal of The American Geriatrics Society holds the highest number of documents related to geriatric medicine, with 72 articles (7.5%). Key topics in this field encompass elderly, frailty, geriatric assessment, comprehensive geriatric assessment, and hip fracture. Conclusions Recent research on Geriatric Interdisciplinary Teams (GIT) has emphasized the importance of conducting thorough geriatric assessments and implementing targeted GIT interventions for elderly patients with frailty and hip fractures. Additionally, studies have explored GIT interventions in addressing inappropriate medication use, fall prevention, and managing conditions such as tumors, dementia, and delirium in the elderly population. Looking ahead, there is a growing need for high-quality qualitative research on GIT for elderly patients receiving longterm or home care, as well as on educational initiatives in geriatric medicine that incorporate GIT principles. more>
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Abstract: Objective To analyze the correlation between preoperative hypoproteinemia and the risk of perioperative allogeneic erythrocyte transfusion in ovarian cancer patients undergoing cytoreductive surgery. Methods Ovarian cancer patients who underwent cytoreductive surgery at Peking Union Medical College Hospital from January 2014 to December 2018 were retrospectively included. Clinical data such as the patients' general information, preoperative plasma albumin, American Society of Anesthesiologists classification, intraoperative bleeding volume, operation time, perioperative (intraoperative and within 3 d postoperatively) allogeneic red blood cell transfusion were collected, and the correlation between preoperative hypoproteinemia (plasma albumin<35g/L) and the risk of allogeneic red blood cell infusion was analyzed by using multivariate Logistic regression. Results A total of 1001 ovarian cancer patients who met the inclusion and exclusion criteria were enrolled, of which 64 (6.4%) had preoperative hypoproteinemia and 481 (48.1%) received perioperative allogeneic red blood cell transfusion. The rate of perioperative allogeneic red blood cell transfusion was higher in the patients with hypoproteinemia than in those without hypoproteinemia [84.4% (54/64) vs. 45.6% (427/937), P<0.001]. Multivariate Logistic regression analysis corrected for confounders such as American Society of Anesthesiologists classification, intraoperative bleeding volume, and operative time found that preoperative hypoproteinemia was significantly associated with the risk of perioperative allogeneic red blood cell transfusion (OR=5.68, 95% CI: 2.56-13.57, P<0.001). Conclusion : Preoperative hypoalbuminemia could be associated with the increased risk of perioperative transfusion in patients undergoing cytoreductive surgery for ovarian cancer. more>
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Abstract: Objective: To establish a teacher competency model and evaluate its application value in medical imaging group teaching for undergraduates. Methods: Based on literature review, a competency model for teachers in medical colleges and universities was established. This study collected the self-evaluation scores and student evaluation scores of the competency model for teachers from Radiology Department of Peking Union Medical College Hospital who participated in the undergraduate medical imaging group teaching from September 2020 to November 2021, and compared the differences of various competencies before and after training, between different professional titles and between different length of teaching. Results: A total of 18 teachers were included in the teaching of undergraduate medical imaging group, with 11 having short teaching experience (≤ 5 years) and 7 having long teaching experience (>5 years). Altogether 200 undergraduate students participated in the course (95 in the class of 2016 and 105 in the class of 2017). There were 8 teachers with a junior professional title, 5 with an intermediate professional title, and 5 with a senior professional title. The teacher competency model covered a total of 5 first-level indicators, including medical education knowledge, teaching competency, scientific research competency, organizational competency, and others, which corresponded to 13 second-level indicators. The teachers' self-evaluation scores of two first-level indicators, scientific research competency and organizational competency, as well as three second-level indicators, teaching skills, academic research on teaching and research, and communication abilities, showed significant improvements (P<0.05) after the training, compared to those before training. Compared to the teachers with intermediate to senior professional titles/long teaching years, the teachers with junior professional titles/short teaching years had lower self-evaluation scores for multiple first-level and second-level indicators before the teacher training. After the training, these teachers showed more significant improvements in multiple indicators of self-evaluation scores (P<0.05). Additionally, students' evaluation changes for the teachers with junior professional titles before and after the training were consistent with this trend. Conclusion: The competency model of undergraduate medical imaging teachers based on teacher competency can be preliminarily applied for the evaluation of medical imaging teachers, as it reflects the change of competency of the teachers with different professional titles and teaching years in the process of group teaching. more>
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Abstract: Objective To apply electrical impedance tomography (EIT) technology to assess the lung regional ventilation distribution in patients admitted to the intensive care unit (ICU) after a cardiac surgery, and to analyze its value of predicting patients’ short-term prognosis. Methods Data from 46 patients admitted to ICU after a cardiac surgery from January to November 2023 were retrospectively collected. Using EIT, we assessed the lung regional ventilation of four regions of interest (ROI) and analyze its influence on patients’ length of stay in ICU, mechanical ventilation duration and tracheal intubation duration. Results Patients who received a cardiac surgery equal to or over 5 hours had worse ventilation in the dorsal region (ROI 4) (P = 0.022). Patients with worse dorsal region ventilation (ROI4 < 9%) had lower oxygenation index (P = 0.025), longer mechanical ventilation duration (P = 0.004), longer tracheal intubation duration (P = 0.010), and longer ICU stay (P = 0.018). A larger ROI 4 percent is a protective factor for patients’ prognosis (OR = 0.743, 95%CI: 0.587~0.941, P = 0.014) after controlling for the impact of age, gender, length of surgery and acute physiology and chronic health evaluation (APACHE) score at the admission. Using a cutoff value of 9.5%, ROI 4 has 85.7% sensitivity and 56.2% specificity to predict worse patients’ prognosis. The area under the curve (AUC) is 0.752 (95% CI: 0.599~0.905, P = 0.007). Conclusion The length of a cardiac surgery influences patients’ lung ventilation, which further impacts patients’ prognosis. EIT can be used as a bedside tool to assess patients’ lung ventilation and to inform corresponding clinical interventions to improve patients’ prognosis. more>
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Abstract: Pain is one of the most common symptoms in cancer patients. Apart from causing patients to suffer from unpleasant feelings and emotional experiences, uncontrolled pain may also influence patients' function and quality of life, and may be associated with poorer prognosis. Difficulties in management of chronic cancer-related pain may be related to its complicated mechanisms, limitations of current clinical treatment and insufficient cognition of clinicians and patients. This review summarizes the definitions, classifications, evaluation and treatment principles of chronic cancer-related pain,, aiming to provide clinicians with the overall idea of pain management in adult cancer patients, emphasizing the importance of multidisciplinary management and patient education in cancer pain management. more>
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Abstract: Objective To explore the incidence and related factors of subacute and chronic pain in patients returning to the ICU after surgery, provide diagnostic and therapeutic insights for the evaluation and management of such patients, and improve the prognosis of this population. Methods Patients who underwent surgical treatment and returned to the ICU from November 29, 2021 to December 31, 2021 at Peking Union Medical College Hospital were prospectively recruited. Subacute and chronic pain incidence and characteristics were assessed by telephone at 1 and 3 months after surgery and the influencing factors were further explored. Results A total of 117 patients were enrolled, with an average age of 60.85 ± 16.03 years. The incidence of subacute postoperative pain in patients returning to the ICU after surgery was 45.7%(53/116), and the incidence of chronic postoperative pain in patients returning to the ICU after surgery was 32.7% (36/110) . The mean NRS for moderate to severe subacute pain and chronic pain after surgery were (4.9±1.2) and (5.2±1.1), respectively. Multivariable logistic regression analysis showed that coronary artery disease (OR=5.263 , 95%CI : 1.436~19.292) was risk factor for chronic postoperative pain in patients returning to the ICU after surgery. Conclusions Cardiac surgery and coronary artery disease were the risk factors for postoperative chronic pain in patients returning to the ICU, a relatively common surgical complication. Perioperative multimodal pain management can be used to improve the pain experience of patients during ICU hospitalization and the shortterm and long-term prognosis of patients. more>
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Objective    To investigate the risk factors for early relapse after curative resection of Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) and to construct a visual predictive model.     Methods    A retrospective analysis was conducted on the clinicopathological data of patients diagnosed with Siewert type II/III AEG who underwent curative resection at the Second Hospital of Lanzhou University from January 2016 to March 2021. The samples were randomly divided into a training group and a validation group in a 7:3 ratio. The LASSO-logistic regression method was used to select variables predictive of early recurrence of Siewert type II/III AEG and to construct a predictive model for early recurrence. The model was validated through 1000 bootstrap resampling. Receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the model's stability.     Results    According to the inclusion and exclusion criteria of this study, a total of 320 Siewert type II/III AEG patients were included, with 122 experiencing recurrence within two years and 198 without recurrence within the same timeframe. Lasso-logistic regression analysis revealed AJCC staging, degree of differentiation, CA199, CEA, NLR, and tumor maximum diameter as independent predictive factors for early recurrence of Siewert type II/III AEG. A predictive model was constructed with these factors and depicted as a nomogram. The AUC of the ROC curve for the training group was 0.836, 95%CI (0.785–0.887), with a sensitivity of 81.4% and a specificity of 85.6%; for the validation group, the AUC was 0.812, 95%CI (0.711–0.912), with a sensitivity of 80.6% and a specificity of 87.7%. Calibration curves for both the training and validation groups displayed curves close to the reference line, indicating high model stability. The DCA curve showed the model provided a good net benefit with threshold probabilities between 0.05 and 0.75.     Conclusions    A multivariate model to predict early relapse in patients with Siewert type II/III AEG was developed using LASSO-logistic regression, which may be instrumental in assessing patient prognoses and in guiding postoperative surveillance and management for patients with Siewert type II/III AEG.

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Abstract: Objective To investigate the expression and clinical significance of GATA-3 and H3K27me3 in Tibet with bladder urothelial carcinoma (BUC). Methods BUC and normal bladder tissues were collected retrospectively from January 2016 to December 2021 in the People's Hospital of Tibet Autonomous Region. The expression of GATA-3 and H3K27me3 in both tissues was detected by immunohistochemical method, and the clinical and pathological characteristics were statistically analyzed. Results A total of 70 patients with BUC were selected, including 51 males and 19 females, with an average age of (60.5± 12.0) years. At the same time, 20 normal bladder tissue samples were collected during the same period. All cases were Tibetan patients. Immunohistochemistry results showed that the high expression rate of GATA-3 in BUC and normal bladder tissue was 70% (49/70) and 100% (20/20), respectively. High expression of GATA-3 was associated with male, low pathological grade, and non invasive tissue (P<0.05). The high expression rate of H3K27me3 in BUC and normal bladder tissue was 45.7% (32/70) and 20% (4/20), respectively. High expression of H3K27me3 was only associated with male (P<0.05). Conclusions The expression of GATA-3 is down regulated in patients with BUC in Tibet, and significantly down regulated with the increase of tumor grade, suggesting that GATA-3 may be involved in the occurrence and development of BUC and related to its malignancy, providing a reference for clinical diagnosis and treatment and judging disease prognosis. The expression of H3K27me3 in BUC in Tibet is higher than that in normal bladder tissue, suggesting that H3K27me3 may be a new immune marker for diagnosis of bladder urothelial carcinoma. more>
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Abstract: Carcinoembryonic antigen-related cell adhesion molecule 1(CEACAM1) is a transmembrane protein of the immunoglobulin superfamily,which is involved in mediating cell adhesion,tissue metastasis,control of immune response,and metabolic homeostasis.Studies have shown that CEACAM1 plays a protective role in the liver by promoting insulin clearance and preventing fat deposition.The down-regulation of the CEACAM1 expression level leads to a vicious cycle of insulin resistance and aggravates metabolic disorders.Because CEACAM1 is critical in controlling metabolic dysfunction-associated steatotic liver disease (MASLD),stimulating its pathway or regulating its expression level is expected to be a new therapeutic approach for MASLD.In this paper,we summarize the research progress of CEACAM1 in MASLD. more>
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Abstract: Antisense oligonucleotides (ASOs) are a novel class of small molecule gene-targeted drugs that can bind to target mRNA. Through complementary base pairing with the target sequence, antisense oligonucleotides achieve targeted regulation of genes. With the continuous development of gene sequencing technology and molecular synthesis techniques, research and applications of ASOs in the musculoskeletal system are further advancing. This article reviews the mechanisms of ASOs in gene silencing and expression regulation, as well as their prospects in gene therapy. In addition, we evaluate the research progress and applications of ASOs in musculoskeletal diseases, while analyzing the urgent issues currently faced by this class of drugs. This comprehensive study aims to deepen our understanding of ASOs and provide valuable references for their widespread application in biomedical research and clinical settings. more>
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Abstract: Purpose To develop and connotation and framework of Clinical Teaching Management (CTM)positions competency, and to conduct preliminary application of competency framework. Methods Key groups of clinical teaching coordinators, clinical trainees, teaching administrators and educational reform practice and research group at Peking Union Medical College Hospital(PUMCH) were selected as the research samples. The Nominal Group Technique (NGT) was used to generate, integrate, form framework and provide descriptions of CTM competencies, and rankings of competency importance were collected. Further, the competency framework was used to conduct a self-assessment of CTM using questionnaire survey. The self-assessment was scored with the Likert method (with a maximum of 5 points and a minimum of 1 point), and the self-assessment results were analyzed. Results Through the first round of NGT discussions of key groups, consensus was achieved on the primary framework of CTM competency, including professionalism, coordinating ability, teaching ability, and teaching innovation. However, different opinions were held regarding the connotations and importance rankings of each dimension. Based on the second round of NGT discussion conducted by educational reform practice and research group, a self-assessment was conducted using the CTM framework of competency. Through the second round of NGT discussions, educational reform practice and research group has developed a competency framework for clinical teaching management positions covering seven dimensions (medical knowledge and skills, learner centeredness, communication and cooperation, professionalism and role modelling, reflection and improvement, teaching theory and methods, teaching coordination and management) based on the results of the first round of discussions. The self-assessment results show that except for the two dimensions of "teaching coordination and management" and "teaching theory and methods", the scores of the other five dimensions are above 4 points. Conclusion A preliminary competency framework of CTM has been developed and applied, specific items require further validation and improvement in practice. more>
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Abstract: Objective To explore the effect of esketamine on working memory impairment in neuropathic mice and its underlying mechanism. Methods Fifty clean grade male C57BL/6J mice (2 months) were divided into 5 groups by random number table method: sham + saline (SN group), CCI + saline (CN group), CCI+(S)-ketamine(CE group), CCI + ANA-12 (CA group), CCI + ANA-12+(S)-ketamine (CAE group), with 10 mice in each group. Chronic constriction injury (CCI) was employed to establish a neuropathic pain model. On the 16th day after modeling, CE group and CAE group were administered ketamine (10 mg/kg), CAE group received ANA-12 (0.5 mg/kg) half an hour before ketamine injection, CA group was only given ANA-12, and SN group and CN group received an equivalent volume of saline. The administration was done through intraperitoneal injection for 5 consecutive days. The open-field test (OFT), paw withdrawal threshold (PWT), paw withdrawal latency (PWL) and Y-maze test were performed from day 21 after surgery. Bromo-2- deoxyUridine (BrdU) was dissolved in saline and intraperitoneally injected into the mice on days 21 to 23 after the surgery. Western blot was performed to determine the expression of Brain-derived neurotrophic factor(BDNF) in hippocampus, the immunofluorescence was performed to determine the number of bromodeoxyuridine nucleoside (BrdU) and doublecortxin (DCX) positive cells in the dentate gyrus (DG) area of hippocampal. Results Compared with SN group, the other four groups showed significant reductions in both PWT and PWL on day 21 after surgery (all P<0.05); There was no significant difference in the total distance travelled by the 5 groups of mice (P=0.142) ; In the Y maze test, compared to SN group, the accurate percentage of spontaneous alternation in CN group showed significant reductions (P<0.001), which was reversed by esketamine administration (P<0.001); compared with CE group, there was a significant reduction of the accurate percentage of spontaneous alternation in CAE group (P=0.004). The expression of BDNF protein in CN group was lower than that in SN group(P=0.021) and CE group (P=0.03), and compared with CE group, the expression of BDNF was significant decreased in CEA group (P=0.043). The number of BrdU positive and DCX positive cells significantly reduced in the DG area of the hippocampus in CN group compared to SN group(P=0.025) and CE group (P=0.003). The number of BrdU positive and DCX positive cells in CAE group significantly reduced in the DG region of the hippocampus compared to CE group(P=0.014). Conclusion Esketamine improves working memory impairment in neuropathic mice and the neurogenesis in dentate gyrus area of hippocampal through the BDNF-TrkB pathway. more>
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Abstract: Objective To investigate the expression and significance of cell surface receptor signaling lymphocyte activation molecule receptor 7 (SLAMF7) in normal intestinal tissues and intestinal inflammatory tissues of mice. Methods Five C57BL/6J wild-type male mice aged 8-10 weeks were taken and fed normally. Lamina propria lymphocytes (LPLs) and intestinal epithelial cells (IECs) were extracted, and total cell RNA was extracted by Trizol reagent. The mRNA expression of SLAMF7 in cells was detected by reverse transcription polymerase chain reaction (RT-PCR) and real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). Ten C57BL/6J wild-type male mice aged 8-10 weeks were randomly divided into control group (n=5) and model group (n=5). The control group was fed with normal drinking water for 5 days, the model group was fed with 2.5% dextran sodium sulfate (DSS) drinking water for 5 days to establish a model of ulcerative colitis(UC), and the mice in both groups were killed on the 5th day. Flow cytometry was used to detect the expression of SLAMF7 in immune cell subpopulations in the control group and the model group. Results Compared with colonic IECs, the expression of SLAMF7 was higher in colonic LPLs (P=0.017). After DSS induced enteritis, the expression of SLAMF7 was up-regulated in neutrophils (P=0.001), but had no significant changes in CD4+T cells, CD8+T cells, B cells, macrophages and conventional dendritic cell (all P>0.05). Conclusion SLAMF7 may play a certain role in the occurrence and development of UC through neutrophilrelated pathways. more>
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Abstract: Adaptive design, with advantages such as dynamically adjusting trial plans, reducing resource waste, and improving trial efficiency, has broken through the competitive situation of new drug development and gradually met the needs of clinical research. In recent years, the use of adaptive design in platform trials as an innovative research model has added impetus to new drug development. This article briefly outlines the research progress , content and characteristics, common design types, statistical analysis, and case interpretation of adaptive design, introduces the concept, types, and applications of adaptive platform trials, in the hope to provide scientific references for further exploration of clinical trials and new drug development. more>
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Missing data commonly occur in clinical trials due to various reasons. The occurrence of missing data will cause information loss of the original data, and reduce the robustness and validity of the research results. Therefore, how to adequately deal with missing data should be considered with caution in clinical trials. This article introduces the causes and types of missing data, as well as several common methodological approaches to addressing missing data, aiming to promote researchers’ understanding and improve the quality of handling missing data in trials. Nevertheless, the best way to deal with missing data is to prevent or reduce the occurrence of data being missing in clinical trials, rather than relying on post hoc statistical analyses.

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Abstract: Systematic reviews are the basis of evidence-based medical research, and high-quality systematic reviews represent the highest level of evidence for evaluating treatment effects. Traditional systematic reviews are mainly done manually, especially the reading and screening of massive literature requires a lot of energy and time for clinicians, and the efficiency is low, which cannot meet the needs of rapid decision-making. This article systematically sorts out existing automated tools for systematic review literature screening, and analyzes their respective performance, characteristics, and usage to understand the current development status of this field and provide reference for related research and applications. more>
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Abstract: Objective To explore the clinical effect, safety and effectiveness of ultrasound-guided rhomboid intercostal and subserratus plane (RISS) block for postoperative analgesia after minimally invasive McKeown esophagectomy (MIE-McKeown), and provide new ideas for the selection of postoperative analgesia programs for minimally invasive esophageal cancer surgery patients. Methods: A prospective randomized controlled study design was used to collect 96 patients undergoing MIE-McKeown in the Department of cardiothoracic surgery of Fuling Hospital of Chongqing University from March 2022 to June 2023 were prospectively collected as research objects, They were divided into three groups by random number table method: Group A: continuous RISS plane block+patient controlled intravenous analgesia (PCIA), Group B: single RISS plane block+PCIA, Group C: control group, simple PCIA, with 32 cases in each group. The outcome indicators of each group were recorded and compared: ①Analgesic effect [visual analogue scale (VAS) pain score for rest and cough at 2, 6, 12, 24, and 48 hours after surgery], ②Postoperative use of analgesics [the amount of sufentanil used within 24 hours after surgery, the number of effective presses of the analgesia pump and the number of additional rescue analgesia], ③Adverse reactions during postoperative analgesia [dizziness, lethargy, postoperative nausea and vomiting(PONV), hypotension, respiratory depression, urinary retention, etc.], ④Intraoperative hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR) at different time points], ⑤Analgesia satisfaction. ①②③ were the primary outcome indicator, and ④⑤were the secondary outcome indicator. Results: Group A patients had lower resting and cough VAS scores at 2, 6, 12, 24, and 48 hours after surgery compared to Group C. Group A had lower resting VAS scores at 2, 24 hours after surgery and lower cough VAS scores at 12, 24 hours after surgery compared to Group B. Group B patients had lower resting VAS scores at 2, 6, 12 hours after surgery and lower cough VAS scores at 2, 6, 12, 24, and 48 hours after surgery compared to Group C, with statistically significant differences (P<0.05). The dosage of sufentanil, the number of effective compressions of the analgesic pump, and the additional number of remedial analgesia gradually increased between groups A, B, and C within 24 hours after surgery, with statistical differences (P<0.05). The incidence of dizziness and PONV in Group C was higher than that in Groups A and B, respectively (P<0.05). There were no statistically significant differences in MAP and HR among the three groups of patients before anesthesia induction (T0), immediately after skin incision (T1), 5 minutes after skin incision (T2), and 5 minutes after extubation (T3) (P>0.05). The satisfaction with pain relief in Group A, Group B, and Group C decreased sequentially. Conclusion: Ultrasound guided RISS block can provide good postoperative analgesia for MIE-McKeown surgery. As an active exploration of multimodal analgesia, continuous RISS has better analgesic effects, is safe and effective, and is worthy of further clinical promotion and use. more>
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Abstract: Objective This study aims to analyze the research trends and cutting-edge hot spots in the field of multimorbidity in older adults from 2000 to 2023. Methods We conducted a search in the Web of Science Core Collection database, specifically looking for articles or reviews in English literature on multimorbidity in older adults published between January 1, 2000, and October 24, 2023. VOSviewer 1.6.18 software was used to extract the content in the literature and to draw the cooperative network diagram of countries(regions) and institutions and the timeline diagram of keyword co-occurrence relationship. CiteSpace 6.1.R6 software was used to co-occur and cluster analyse the information of authors, research institutions and countries(regions). The "bibliometrix" package in R was used to analyse the evolution of keywords in the literature. Results A total of 2590 documents were obtained, consisting of 2230 Articles and 360 Reviews. The worldwide publication count has significantly increased since 2000. Among the countries(regions), the United States has the highest number of publications (907 articles, accounting for 35.02% of the total) and total citations (31,343 times) in this field. In terms of institutions, the University of Toronto stands out with 67 articles (2.59%) as the top contributor. McMaster University's author, Jenny Ploeg is recognized as the most prolific authors, having published 32 articles (1.24%). When it comes to journals, BMC Geriatrics has the highest amount of literature related to multimorbidity (99 articles). The key areas of research in this field include multimorbidity, older adults, frailty, aging, and polypharmacy. Notably, there is growing interest in studying the relationship between multimorbidity and aging in older adults, as well as the impact of frailty and polypharmacy on multimorbidities. Conclusions In recent years, research on multimorbidities in the elderly has primarily centered around examining the correlation between comorbidities and aging, as well as exploring the impact of frailty and polypharmacy on individuals with multimorbidities. Future research could potentially delve into the significance of primary health care and comprehensive geriatric assessment in effectively managing comorbidities among older adults, while also emphasizing the importance of maintaining their overall quality of life. more>
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Abstract: Objective To analyze the methodological and reporting quality of systematic reviews of prediction models published in Chinese journals, with the aim of providing references for enhancing the quality of Chinese systematic reviews of prediction models. Methods Chinese systematic reviews of prediction models were electronically searched in CNKI, WanFang Data, CBM, and VIP databases from inception to July 20, 2023. Two independent reviewers screened literature, extracted data, and used the AMSTAR and PRISMA 2020 tools to assess methodological and reporting quality of the included reviews. Results A total of 55 systematic reviews published between 2015 and 2023 were included, with 12 of them being meta-analyses. These reviews encompassed a range of topics, with a primary focus on cardiovascular diseases, stroke, and diabetes. The identified systematic reviews exhibited obvious deficiencies in some areas, including items 1, 4, 5, 6, and 10 of AMSTAR, as well as items 7, 10a, 12, 13a-f, 14, 15, 16a-b, 17, 20b-d, 21, 22, 23d, 24a-c, 25 and 26 of PRISMA 2020. Furthermore, a moderate positive correlation (r = 0.58, P < 0.001) was observed between the methodological and reporting quality. Multiple linear regression analyses revealed: greater number of pages, more recent publications, and funding support were associated with higher methodological quality (P < 0.05). Similarly, greater number of pages, more recent publications, qualitative systematic reviews, and funding support were associated with higher reporting quality, but the number of authors showed a negative association (P < 0.05). Conclusions The current systematic reviews of prediction models published in Chinese journals require enhancement in both methodological and reporting quality. more>
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Abstract: Artificial intelligence(AI) empowers the development of the medical industry, providing precise and intelligent assistance for clinical diagnosis, treatment, and rehabilitation.AI has the potential to facilitate shared decision making (SDM). AI interventions used for SDM are currently in their infancy, with new challenges and opportunities. Therefore, this paper describes the application of AI in SDM, explores the problems and challenges of AI-based decision aid used for SDM, and proposes possible solutions, aiming to provide a guide for the development and implementation of AI-based decision aid. more>
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Abstract: Objective This study explores the essential factors during the consensus process in guideline development, aiming to improve the quality of the consensus process by providing methodological suggestions for enhancing standardization. Methods Semi-structured qualitative interviews were used to interview guideline leaders, working groups and consensus groups to explore the relevant factors affecting the credibility of the consensus and their views on the composition and process of the consensus method. Results The researchers interviewed 26 individuals. After summarization, 212 codes were deepened into five areas:establishment of a consensus group, patient participation, meeting moderator, preparation of consensus and the influencing factors of consensus. Summarized the three basic steps of constructing a consensus group and the 17 basic principles of the application of the consensus method. Conclusion In the future guideline development, it is recommended to increase the methodological training before the consensus process and the full participation of methodologists, encourage experts to treat differences reasonably, pay attention to the methodology and evidence materials. The process should involve openly disclosing the selection of consensus group members, increasing patient participation, and managing and reporting conflicts of interest to reduce bias and enhance transparency, reliability, and scientific rigor of consensus outcomes. more>
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Abstract: The development of clinical practice guidelines involves a series of evidencebased decision-making processes, of which the formation of recommendations being a particularly challenging aspect. It demands decision-makers to have a thorough and precise understanding of the evidence, weigh the potential benefits and risks of interventions, and make value judgments and clinical choices. Compared to traditional approaches of presenting evidence information, the use of visualization tools can facilitate the communication and analysis of evidence, simplify information interpretation, and improve the efficiency of decision-making. Based on previous studies, this paper proposes a visualization tool, Vitruvian plot, for summarizing evidence and provides illustrative examples to demonstrate its usage and application effects, aiming to offer valuable guidance for researchers. more>
2024, 15(2): 237-238.
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Editorials
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Abstract: Postoperative pain seriously affects the recovery process of patients, resulting in prolonged hospital stay and increased care costs. Appropriate application of patient-controlled analgesia devices can effectively relieve perioperative acute pain. In 1994 patient-controlled analgesia began to be used in Peking Union Medical College Hospital, and the Acute Pain Service Working Group was established in 2004. With the cooperation of anesthesiologists and specialist nurses, the group jointly has implemented the whole process and standardized management based on patient-controlled analgesia, and constantly improved and innovated working methods, laying a solid foundation for the development of postoperative pain management. This paper systematically reviews and summarizes the work from the aspects of clinical focus, nursing management experience, promotion and dissemination of pain treatment concepts, and development of acute pain service model under the new situation, with the hope of providing valuable reference for comprehensively strengthening pain management in the process of diagnosis and treatment, and enhancing patients' satisfaction with perioperative analgesia services. more>
Editorials
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Abstract: Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals. more>
Specialist Forum
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Abstract: Pain management, listed as the fifth vital sign, has gained increasing attention from clinicians. Conventional analgesics have limited duration, leading to intense monitor and frequent dosing during the early phase in order to prevent the progression of chronic pain. Thus, prolonging the duration of analgesics has become one focus of the pain research. Several strategies, such as adding adjuvants, producing derivatives, and applying extended-release carriers, make it possible for super long-acting analgesics to come into reality. This review briefly introduces the strategies and development of the super long-acting analgesics, including the successful translation and commercialization of the present products of super long-acting analgesics. It also summarizes the application and translation of extended-release drug carriers, providing invaluable reference for the future research on the field of super long-acting analgesics. more>
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Abstract: The baroreceptor reflex is an essential mechanism for the autonomic nervous system in cardiovascular homeostasis and is closely related to pain regulation. Baroreflex sensitivity (BRS) is an indicator for quantitative evaluation of baroreflex reflex function. Pain sensitivity is negatively correlated with BRS, therefore, BRS has potential application prospects in pain risk prediction and therapeutic efficacy assessment. Vagus nerve stimulation, capable of activating the baroreceptor reflex, has been widely used in acute or chronic pain patients in recent years. This article reviews the mechanism and clinical application progress of the baroreceptor reflex in pain regulation, with the hope of providing reference for further exploring treatment to regulate baroreceptor reflex function in pain treatment. more>
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Abstract: Central post-stroke pain (CPSP), a neuropathic pain syndrome occurring after a cerebrovascular accident, is characterized by pain or paraesthesia in the part of the body dominated by the area of the brain where blood vessels are injured. CPSP patients are often accompanied by anxiety, depression and other emotional disorders, which have a serious negative impact on patients' quality of life. However, the pathogenesis of CPSP has not been fully elucidated, the clinical diagnosis rate is not high, and the commonly used treatment methods are not effective. This article reviews the clinical features, epidemiology, pathogenesis and treatment of CPSP in order to provide reference for the elucidation of CPSP mechanism and effective treatment. more>
Specialist Forum
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Abstract: Pain not only affects the physical and mental health of individuals, but also imposes a huge burden on society as a whole. Traditional pain management measures are diverse, but each has its limitations. Therefore, there is an urgent need for new tools. Digital therapies are booming, and virtual reality (VR) has been widely used, especially in the field of pain management. VR uses assistive tools, such as headsets, to build a three-dimensional virtual world with the participation of multiple senses, including vision, hearing, and smell, so that it can make user feel being there. This review aims to summarize the application and mechanism of VR in the field of pain management, with the hope of making VR a new choice for pain management. more>
Specialist Forum
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Abstract: In recent years, with the gradual and extensive application of digital medical treatment in the field of medica anesthesia, its role in the postoperative pain management of children has attracted increasing attention. It provides new ideas for the preoperative prediction, postoperative monitoring and evaluation, and treatment management of postoperative pain in children, as well as a new scheme for anesthesiologists to formulate the best postoperative pain management strategy for children. This article reviews digital medical treatment and its application in clinical anesthesia, and reviews the application prospects of this therapy in postoperative pain in children, in order to deepen clinicians' knowledge. more>