Objective:To analyze the allocation of chief examining physicians in health examination (management) institutions in 2019.Methods:A current situation study. Using a census method, a questionnaire survey was conducted to collect basic information (such as institution name, address, nature, affiliation, category, and level) and the allocation of chief physicians (such as gender, year of birth, full-time or part-time, type of practice, level of professional title, and years of engagement in health examination and management work) of 5 428 health examination (management) institutions in 2019. The collected data were statistically analyzed using chi-square test.Results:In terms of the type of practice of chief physicians, the proportions of internal medicine physicians in public and privately-run institutions was 72.84% and 68.23%, respectively, with a statistically significant difference in distribution ( χ2=19.632, P<0.05); the proportions of surgeons was 27.16% and 31.77%, respectively. The proportions of internal medicine physicians in third-, second-, first-, and unclassified-level institutions was 75.76%, 69.14%, 68.60%, and 68.78%, respectively; the proportions of surgeons was 24.24%, 30.56%, 31.40%, and 31.22%, respectively; with a statistically significant difference in distribution ( χ2=47.682, P<0.05). In terms of the level of professional title of chief physicians, the proportions of associate senior physicians in public and privately-run institutions was 69.56% and 73.66%, respectively, and the proportions of senior physicians was 30.44% and 26.34%, respectively, with a statistically significant difference in distribution ( χ2=15.276, P<0.05); the proportions of associate senior physicians in third-, second-, first-, and unclassified-level institutions was 62.72%, 75.55%, 78.40%, and 74.51%, respectively, with the proportions of senior physicians being 37.28%, 24.45%, 21.60%, and 25.49%, respectively, with a statistically significant difference in distribution ( χ2=168.462, P<0.05). The average number of chief physicians per institution in China was 1.67, with the highest number in the North China (2.10) and the lowest number in the Southwest region (1.49). The compliance rate of chief physicians with qualifications was 33.37% nationwide, with only the North China (48.64%) and the East China (37.05%) surpassing the national average, and the lowest rate was in the Northeast region (24.01%). Conclusions:There are regional differences in the allocation of chief examining physicians in China, and the uneven and insufficient development of their skills and abilities remains a prominent contradiction.
保持脑认知健康是脑健康管理的重要内容，针对适宜人群开展脑认知健康筛查、风险评估及早期干预对认知障碍相关疾病防治有着重要的战略意义。本共识针对脑认知健康管理的适宜人群，通过量表、问卷以及各项临床生物标志物的筛查，评估为认知障碍不同风险的人群，并针对各人群推荐个体化的健康管理方案，开展生活方式干预、危险因素管理及认知数字疗法等，同时建立规范的随访制度，定期评估健康干预的效果，形成连续动态的脑认知健康管理模式。
Objective:To investigate the feasibility of active surveillance for low-risk papillary thyroid microcarcinoma.Methods:This is a cross-sectional study. From 2013 to 2017, 61 patients with pathologically confirmed papillary thyroid microcarcinoma were followed-up dynamically. The growth of nodules, newly-developed nodules and lymph node metastasis were recorded and were set as the criteria for disease progression. And the disease progression was the outcome event of survival analysis. The patients were divided into two groups based on the median age at diagnosis. Univariate analysis of factors influencing disease progression in different age groups was performed using Cox proportional hazards regression. The differences in disease progression between different age groups were compared using the Kaplan-Meier method and the log-rank test.Results:Of the 61 patients, there were 9 males and 52 females. The median age of disease onset was 43 years (ranged 23-74 years). The median follow-up time was 2 years (ranged 2-7 years), and 22 (36.1%) patients with tumor diameter increased by ≥3 mm, including 5 males and 17 females. A total of 22 cases (36.1%) showed an increase in tumor diameter of ≥3 mm, including 5 males and 17 females. Thirteen cases (21.3%) developed new malignancies, including 2 males and 11 females. Three cases (5%) had lymph node metastasis, all of which were females. In total, 24 cases (39.3%) showed disease progression, including 5 males and 19 females. Disease progression was more frequent in the <43 years age group compared to the ≥43 years age group.Conclusions:For patients with low-risk papillary thyroid microcarcinoma, strict adherence to the indications for active surveillance and consideration of patient preferences make active surveillance a feasible tumor management approach.
为探讨以时机理论为框架的家庭参与式照护对极低出生体重儿（VLBWI）病程及愈后的影响，本研究选取2020年11月至2022年10月入住徐州市中心医院新生儿科的70例VLBWI为研究对象（试验组38例、对照组32例）。试验组根据疾病分期进行家庭参与式照护：入院后予以皮肤接触1 h/d；病情稳定后探视2~3 h/d，护士指导家长参与床旁护理；出院前探视3 h/d，在护士督导下自主完成常规生活护理；出院后至患儿3月龄，用微信发布相关知识，解答疑问。对照组仅在出院过渡期进行家庭参与式照护2~3 h/d。比较两组患儿干预前后各项指标差异。试验组入院后72 h内动脉血氧分压（PaO 2）/吸入氧浓度（FiO 2）（P/F）值、出院后家长照护能力均高于对照组，无创辅助通气时间、呼吸支持总时间、达全胃肠内营养的时间及再住院率均低于对照组（均 P<0.05）；两组总住院时长差异无统计学意义（ P>0.05）。以时机理论为框架的家庭参与式照护可促进VLBWI的疾病恢复，提高家长照护能力，降低再住院率，对VLBWI病程及愈后有积极影响。
Objective:To investigate the correlation between the trajectory of triglyceride-glucose index multiplied by body mass index (TyG×BMI) and the incidence of new-onset non-alcoholic fatty liver disease (NAFLD).Methods:It was a retrospective cohort study. A total of 2 304 subjects who underwent health examinations at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from 2017 to 2019 were included as the study population. Based on the TyG×BMI values from the health examinations, a latent class modeling approach was used to determine four distinct TyG×BMI trajectory groups: low-stable, moderate-stable, high-stable, and extremely high-stable group. The incidence of NAFLD was followed-up during the 2020 and 2021 health examinations for each group. The differences in NAFLD incidence among different TyG×BMI trajectory groups were compared using the log-rank test, and the correlation between different TyG×BMI trajectories and the incidence of new-onset NAFLD was analyzed using Cox proportional hazards regression models.Results:The incidence of NAFLD increased with the elevation of TyG×BMI trajectories. The cumulative incidence rates of NAFLD for the low-stable, moderate-stable, high-stable, and extremely high-stable groups was 13.00%, 16.70%, 20.10% and 26.60%, respectively, with statistically significant differences ( χ2=35.155, P<0.01). Compared with the low-stable group, the high-stable and extremely high-stable groups had higher risks of NAFLD (HRs for high-stable group was 1.564, 1.428, 1.426, 1.289, respectively; HRs for extremely high-stable group was 2.121, 1.670, 1.659, 1.607, respectively; all P<0.05). After adjusting for various confounding factors such as gender, waist circumference, BMI, blood glucose, blood lipids and liver function in model 4, the risks of NAFLD for the high-stable and extremely high-stable groups were still 1.389 and 1.607 times higher than that in the low-stable group (95% CIs: 1.035-1.864, 1.207-2.140). Conclusion:The risk of NAFLD increases with the elevation of TyG×BMI trajectories, suggesting that TyG×BMI can serve as a predictive index for NAFLD.
