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.
Objective:To conduct a scoping review of health behavior-related assessment tools for pregnant women with gestational diabetes mellitus (GDM).Methods:A total of 6 Chinese and English databases, including CNKI, Wanfang Database, China Biomedical Literature Database, PubMed, Web of Science Core set and Embase, were systematically searched by the terms of “gestational diabetes mellitus”，“health behavior”，“assessment”. The relevant contents of GDM health behavior-related assessment tools were retrieved for systematic analysis, and the results were normalized reported. The search period was from the establishment of the databases to February 1, 2023.Results:A total of 2 657 literatures were retrieved, and 41 literatures were finally included after screening, including 16 literatures on the development and verification of assessment tools, 2 literatures on localization of assessment tools, and 23 literatures on the application of the assessment tools. A comprehensive analysis was conducted on 18 assessment tools, including 16 original assessment tools and 2 localized assessment tools, spanning the years 1987 to 2020. The assessment content covered dietary behavior, physical activity behavior, medication adherence, blood glucose monitoring behavior, treatment adherence, self-management behavior, and health-promoting lifestyles. Among them, 7 assessment tools were validated for reliability and/or validity in pregnant women with GDM. Among the 23 studies that covered the implication of the assessment tools, the Pregnancy Physical Activity Questionnaire and Health-Promoting Lifestyle Ⅱ were the most commonly utilized tools for assessing health behaviors in pregnant women with GDM.Conclusions:There is a wide variety of assessment tools related to health behaviors in pregnant women with GDM, and the assessment content is relatively rich. However, most of the assessment tools have not been validated for their reliability and validity within the GDM population, limiting their clinical application and promotion.
Objective:To explore the hotspots and development trend of research in the field of traditional Chinese medicine (TCM) health management in China based on bibliometrics.Methods:With the subject term of “TCM health management” “traditional Chinese medicine”“TCM” “health management”, the relevant literatures on TCM health management were retrieved in databases of CNKI, Wanfang Data, VIP, Web of Science, PubMed, Embase database from the establishment of the databases to December 31st, 2022. After screening and data processing, CiteSpace software was used for visual analysis of the included literature, including network maps of author and institutional collaborations, co-occurrence maps of keywords, burst analysis, timeline cluster maps, and keyword cluster views. This analysis aimed to identify research hotspots and trends in the field of TCM health management in China.Results:A total of 1 294 literatures were eventually included, and since 2013, the number of publications in the field of TCM health management in China had entered a period of rapid growth with the introduction of relevant policies, and it reached a peak in 2019. Li Candong (44 articles) et al. were the core authors in this field, and the research institutions and author groups were mainly concentrated in universities and TCM hospitals. The keywords were mainly “preventive treatment of disease” “TCM physical identification” “community” “hypertension” “elderly” “diabetes”, and the research hotspots were prominent. Among them,“physique”had the longest duration of emergence (2008-2014),“application” had the highest intensity of emergence (10.22), and the emergent words such as “big data” had surged in recent years. The keyword clustering mainly categorized into 3 types: (1) application of TCM health management in terms of hot social needs; (2) research on basic theories of TCM health management; (3) modern technology-enabled TCM health management. The representative keywords of this field in 2016-2022 were“healthcare integration” “application” “artificial intelligence” “Internet+” “intelligent Chinese medicine”and so on.Conclusion:Research in the field of TCM health management in China is heavily influenced by policy factors, resulting in a concentrated effort and uneven development. The research focuses on TCM theory, chronic disease prevention and treatment, combination of medical and nursing care and community application. Intelligent TCM health management modes technologies are emerging as a new research trend.
Objective:To explore the relationship between thyroid parenchymal echogenicity abnormalities and thyroid function evolution in health examination population.Methods:It was a cohort study. According to the inclusion and exclusion criteria, participants were selected from individuals who underwent thyroid color ultrasound and thyroid function tests at the Health Management Center of Tianjin Medical University General Hospital from January to December 2017. Data including age, gender, smoking history, alcohol consumption history, personal medical history, and thyroid function re-examination information were collected. Follow-up was conducted until the occurrence of thyroid function abnormalities or until the end of the follow-up period. The cumulative incidence rate and incidence density of thyroid function abnormalities were evaluated. Cox regression analysis was used to analyze the relationship between thyroid parenchymal echogenicity abnormalities and thyroid function evolution.Results:A total of 6 754 participants were included in this study, with an average age of (45.80±12.12) years, and females accounted for 42.7%. The mean follow-up time was 1.82 years, with a cumulative follow-up duration of 12 263 person-years. During the follow-up period, 154 new cases of thyroid function abnormalities occurred, with a cumulative incidence rate of 2.28% (95% CI: 1.94%-2.66%) and an incidence density of 12.56/1 000 person-years (95% CI: 10.66/1 000-14.69/1 000 person-years). The multivariate adjusted Cox regression analysis showed that individuals with thyroid parenchymal echogenicity abnormalities had a significantly increased risk of developing isolated thyroid stimulating hormone abnormalities and thyroid function abnormalities, with HR(95% CI) of 3.09 (2.02-4.73) and 2.92(1.96-4.33), respectively, both P<0.001. Stratified analysis showed that, except for body mass index <18.5 kg/m 2, current smoking, and current alcohol consumption, all other stratified factors showed a significant increase in the risk of thyroid function abnormalities in individuals with thyroid parenchymal echogenicity abnormalities. Conclusion:Thyroid parenchymal echogenicity abnormalities are important risk factors for the evolution of thyroid function abnormalities. Continuous monitoring of thyroid function should be given due attention.
Objective:To assess the effects of intervention measures on the quality control of health examination institutions in Dalian City.Methods:This cross-sectional study encompassed a comprehensive evaluation of 40 physical examination institutions in Dalian City. Interrupted time series analysis was employed to examine the changes in level and slope of processing rates for significant abnormal health examination results, chief inspection physician qualification rates, and completion rates of basic health examination items before (January 2020 to July 2021) and after (August 2021 to July 2022) intervention. An interrupted time series analysis diagram was generated.Results:After the implementation of intervention measures, the processing rate of significant abnormal results in public physical examination institutions reached 93.52%, while the qualification rate of chief inspection physicians was as high as 98.86%. And completion rate of basic health examination items was 93.86%. The rates of handling important abnormal results in health check-ups at private healthcare institutions before intervention, 1 month after intervention, and long-term intervention showed an upward trend of 1.374%, 0.229%, and 0.664%, respectively ( t=8.61, 12.21, and 108.61, all P<0.05). The qualification rate of chief inspection physicians in public physical examination institutions exhibited an increase of 0.227% and 0.155% before and after the intervention respectively ( t=6.74 and 617.67, all P<0.05). The completion rates of basic health check-up items in public healthcare institutions showed an upward trend before intervention, 1 month after intervention, and long-term intervention, with a rate of 0.446%, 0.067%, and 0.745%, respectively ( t=24.95, 3.25, 138.80, all P<0.05). Conclusions:The implementation of quality control intervention measures for health check-ups has significantly improved the quality control of health examination institutions in Dalian City.
Objective:To survey and update the epidemiological data of chronic obstructive pulmonary disease (COPD) in people≥40 years old in Yinchuan City in the last 10 years.Methods:This was a cross-sectional study in which questionnaires and physical measurements were taken from April 2019 to December 2022 using multi-stage stratified whole population sampling of residents≥40 years in three districts, two counties, and one city in Yinchuan City. In this survey, 14 666 cases were extracted, and finally 11 547 cases with qualified lung function measurements and complete questionnaires were included in the analysis to obtain the basic information of the respondents, exposure to disease-related factors, symptoms related to COPD, disease awareness and lung function test rate, and logistic regression was used to analyze the risk factors of COPD.Results:A total of 11 547 cases were included in the study, and 1 841 patients with COPD were detected, giving an overall prevalence of COPD of 15.9%. The prevalence was higher in men (18.6%) than in women (12.9%); it was higher in urban areas (17.3%) than in rural areas (14.7%); and it was statistically significant that the prevalence of current smokers (24.4%) and ex-smokers (24.6%) was higher than the prevalence of non-smokers (13.0%) (all P<0.001) in those COPD patients. The prevalence rates of COPD in people aged 40-49, 50-59, 60-69, and ≥70 years were 11.7%, 12.9%, 16.9%, and 24.6%, respectively, which tended to increase gradually with age ( P<0.001). 10.5% of patients with COPD said they were aware of the disease and 17.4% received a pulmonary function test. The results of logistic regression analyses showed that the risk factors for COPD included male, advanced age, living in an urban area, low literacy, current smoking, former smoking, history of secondhand smoke exposure, low body weight, history of biomass fuel use, and family history of respiratory disease. Conclusions:The prevalence of COPD among people≥40 years in Yinchuan City is significantly higher than 10 years ago and is higher than the national data. However, the disease awareness rate is low, and active intervention of risk factors and enhancement of publicity are important measures to prevent and control the disease.
Objective:To explore the correlation between lean nonalcoholic fatty liver disease (NAFLD) and metabolic indicators in a young and middle-aged population undergoing physical examination.Methods:It was a cross-sectional study. A total of 8 250 individuals who underwent routine physical examinations at the Health Medical Center of the Second Affiliated Hospital of Chongqing Medical University from January to December 2021 and met the inclusion and exclusion criteria were selected as the research subbjects. The general examination, fasting blood glucose, blood lipids, liver function, renal function, and fasting color ultrasound examination results were analyzed retrospectively to assess the correlation between lean NAFLD and major metabolic indicators using independent sample t-test, chi-square test, and multivariable logistic regression. Results:The prevalence of lean NAFLD was higher in men than in women (50.7% vs. 49.3%, χ2=97.261, P<0.001). After stratifying the age of onset of lean NAFLD, the peak age of onset was found to be between 45 and 59 years, with the prevalence gradually increasing with age. When stratified by body mass index (BMI), the peak incidence of lean NAFLD was observed in individuals with a BMI of ≥20 and <23 kg/m 2, with the prevalence showing a significant upward trend as BMI increased. The systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein, fasting blood glucose, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, and serum uric acid in lean NAFLD groupwere all significantly higher than those in lean non-NAFLD group (all P<0.01), and the level of high density lipoprotein was significantly lower than that of lean non-NAFLD group ( t=23.755, P<0.001). The logistic analysis showed that systolic blood pressure ( OR=1.258, 95% CI: 1.081-1.465), diastolic blood pressure ( OR=1.282, 95% CI: 1.056-1.557), total cholesterol ( OR=1.712, 95% CI: 1.525-1.923), triglyceride ( OR=4.115, 95% CI: 3.621-4.676), alanine aminotransferase ( OR=1.467, 95% CI: 1.104-1.950), γ-glutamyltransferase ( OR=1.482, 95% CI: 1.242-1.769), fasting blood glucose ( OR=2.479, 95% CI: 2.092-2.939) and serum uric acid ( OR=1.390, 95% CI: 1.236-1.563) were independent metabolic risk factors for lean NAFLD (all P<0.05). Conclusions:The levels of various metabolic markers in young and middle-aged patients with lean NAFLD increase, and the risk of lean NAFLD increases. Metabolic markers are helpful to screen people at risk of lean NAFLD.
新生儿早发B族链球菌感染是造成新生儿不良结局的重要原因，产时抗生素应用已被证明对其有显著预防效果。目前国际上针对该疾病主要有两种预防策略——筛查策略和危险因素策略。孕妇B族链球菌定植和新生儿早发B族链球菌感染的流行病学分布呈明显区域特点，全球范围内北美和非洲水平较高，而包括中国的东亚地区较低。研究表明，两种预防策略的效果在高发病率区域相较低发病率区域更加显著，且多以筛查策略更优。卫生经济学评价结果也存在差异，美国的评价结果推荐采取筛查策略，英国的研究则显示危险因素策略更具成本效果，这可能与流行病学差异及公共卫生成本等因素相关。因此，预防策略的选择应依据区域流行病学特点和卫生经济学评价进行综合考量。
Objective:To investigate the effect of lifestyle intervention on the clinical outcomes of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in overweight or obese patients with polycystic ovary syndrome (PCOS).Methods:This study was a non-randomized controlled trial. A total of 126 overweight or obese PCOS patients who received IVF/ICSI treatment for infertility in Shaoguan Maternal and Child Health Hospital from January 2021 to December 2022 were selected by semi-random sampling method. The patients were divided into the experimental group (39 cases) and the control group (87 cases) according to whether they received the comprehensive lifestyle intervention. The experimental group maintained a healthy lifestyle and emotional control, accepted balanced diet, performed aerobic exercise and resistance exercise regularly and quantitatively, the data changes related to body mass index were collected regularly. The control group implemented a weight loss regimen on their own, following a low-calorie diet and exercise interventions. After 2 to 3 months, both groups of patients entered the test tube cycle (the intervention duration for each patient was up to the effect and their willingness to weight loss). The baseline data, cycle characteristics and pregnancy outcomes were compared between the two groups with t test and Chi-square. And the effects of lifestyle interventions on the clinical outcomes of IVF/ICSI in overweight or obese PCOS patients were also analyzed. Results:Before the intervention, the serum level of anti-muller hormone (AMH) in the experimental group was significantly higher than that in the control group [(5.62±2.98) vs (4.47±2.64) μg/L]( P<0.05). But there were no significant differences in age, infertility years, basal follicle maturation hormone (FSH), antral follicle count (AFC), primary infertility ratio, ICSI ratio, body mass index, proportion of obese patients, abdominal circumference, waist-to-hip ratio, visceral fat area and body fat percentage between the two groups (all P>0.05). After intervention, the body mass index, proportion of obese patients, abdominal circumference, visceral fat area and body fat percentage in experimental group were all significantly lower than those before intervention [(26.56±2.92) vs (29.21±3.37) kg/m2, 25.64% vs 64.10%, (89.92±7.16) vs (95.27±7.38) cm, (78.46±15.92) vs (95.46±17.21) cm2, 33.71%±2.46% vs 36.27%±3.02%] (all P<0.05). After intervention, the visceral fat area in the control group was significantly lower than that before the intervention [(92.08±19.38) vs (98.84±19.65) cm2] ( P<0.05), and there was no significant differences in the other indexes (all P>0.05). After intervention, the total amount of gonadotropin (Gn) in experimental group was significantly lower than that in control group [(2 488.23±711.30) vs (2 935.67±854.78) U] ( t=2.301, P<0.05). Conclusion:A 2-3 month lifestyle intervention can significantly reduce the body mass index, waist circumference, visceral fat area, and body fat percentage of overweight or obese PCOS patients, as well as decrease the total amount of Gn used for ovulation induction. However, it does not show a significant improvement in clinical outcomes.
Objective:To compare the differences in lung function between sanitation workers and the general population undergoing routine physical examinations, and to analyze the risk factors for restricted airflow and severity of the condition in sanitation workers.Methods:This study is a large cross-sectional study called "Shanxin Respiratory Health Screening for Ten Thousand People". A total of 1 036 sanitation workers (sanitation group) and 6 701 individuals from the general population undergoing routine physical examinations (control group) were selected as the original study subjects from June 2021 to April 2022 (before matching). Both groups underwent pre-bronchodilator lung function tests, and the differences in lung function characteristics between the two groups were compared. The sanitation group also completed a questionnaire survey. Multivariate and ordinal multinomial logistic regression analysis were used to analyze the risk factors for airflow limitation and its severity.Results:A total of 1 027 individuals from the sanitation group and 999 individuals from the control group were included in the study. There were no significant differences in age, gender, height, weight, and body mass index (BMI) between the two groups (all P>0.05). The rate of airflow restriction was significantly higher in the sanitation group compared to the control group (22.88% vs 8.81%, P<0.001). In the sanitation group, there was no statistically significant difference in a self-assessment test for chronic obstructive pulmonary disease (CAT) scores between individuals with airflow restriction (235 cases) and those without airflow restriction (792 cases) [(1.50±2.50) vs (1.15±2.03) points, P=0.084]. There were no statistically significant differences in forced vital capacity (FVC) as a percentage of predicted value (FVC%pred) between the two groups. However, the sanitation group had significantly lower %pred for forced expiratory volume in one second (FEV 1%pred), FVC/FEV 1 ratio (FEV 1/FVC%pred), forced expiratory flow at 50% of FVC (FEF 50%%pred), forced expiratory flow at 75% of FVC (FEF 75%%pred), and maximal mid-expiratory flow (MMEF%pred) compared to the control group (all P<0.05). The rates of abnormal FEF 50%%pred, FEF 75%%pred, and MMEF%pred were significantly higher in the sanitation group compared to the control group (17.62% vs 10.31%, 17.04% vs 10.01%, 27.26% vs 18.41%, all P<0.001). Small airway parameters and the rate of airflow restriction were significantly higher in past and current smokers of the sanitation group compared to never smokers (all P<0.05). Multifactorial analysis showed that high BMI ( OR=0.929, 95% CI: 0.885-0.974) was a protective factor for airflow restriction, while high smoking index was a risk factor ( OR=1.020, 95% CI: 1.011-1.030). Ordered multinomial logistic regression analysis showed that high BMI ( OR=0.925, 95% CI: 0.882-0.971) was a protective factor for the severity of airflow restriction, while high smoking index ( OR=1.020, 95% CI: 1.011-1.029) was a risk factor for the severity of airflow restriction. Conclusions:The incidences of airflow limitation and small airway abnormalities in sanitation workers are higher than that in general physical examination population. High smoking index and low BMI are independent risk factors for airflow limitation and its severity.
《健康体检主检报告撰写专家共识》提出，为形成关于主检报告统一的标准和规范，需遵循八大书写原则，特别是“一元论”原则。当前主检报告体检结论碎片化现象比较普遍，大多为各种阳性检查结果的罗列，结果间缺乏相应的逻辑关系，不利于科学准确地健康评估与健康指导，迫切需要探索智能化主检报告一元化结论撰写系统。本研究针对主检报告的数据密集型与知识密集型特点，通过采集受检者的个人病史与检查结果等多源数据，根据疾病指南共识构建一元化结论知识库，生成一元化结论词与个体化建议。在此基础上，以甲状腺疾病为例，构建甲状腺疾病主检报告一元化结论智能化撰写系统，通过测试集评估取得了非常高的准确性和完整性，能够减轻主检医师工作量，提高工作效率，促进主检报告的统一性与规范性。
Objective:To analyze the efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with chronic heart failure (CHF) complicated by sarcopenia.Methods:In this randomized controlled trial, seventy CHF patients with sarcopenia, aged 80 years or older, who had received standard CHF medication treatment and had stable conditions with preserved ejection fraction (HFpEF) from June 2021 to October 2022 at the China-Japan Friendship Hospital outpatient clinic were continuously selected. The patients were randomly divided into a test group ( n=35) and a control group ( n=35) using a random number table. The test group continued the original heart failure medication treatment, and on the basis of daily meal, supplemented with whey protein powder [37 g per serving (including 16.2 g of whey protein, 145 kcal), twice a day]; they were given resistance exercise primarily focused on resistance training (5 sets of exercises, progressively increasing to 3 days per week, twice a day, 5 sets per session, 20 repetitions per set). The control group maintained the original heart failure medication treatment plan and lifestyle. The body mass index, appendicular skeletal muscle mass index (ASMI), grip strength, Five-Times-Sit-to-Stand Test, 6-meter walking speed, 6-minute walk test, brain natriuretic peptide (BNP), left ventricular ejection fraction, ratio of early mitral flow peak velocity to early mitral annulus diastolic peak velocity (E/e′), serum albumin, hemoglobin, and serum creatinine were compared between the two groups before and after 3 months of intervention using t-tests and chi-square tests to analyze the efficacy of nutrition intervention combined with rehabilitation exercise in elderly patients with CHF complicated by sarcopenia. Results:Among the 70 patients, there were 42 males and 28 females. There was no significant difference in baseline data between the test group and the control group (all P>0.05). After 3 months of intervention, ASMI, grip strength and 6 min walking distance in the test group were all significantly higher than those in the control group [(6.43±1.07) vs (6.09±0.86) kg/m 2, (27.75±2.13) vs (23.45±0.47) kg, (361.51±58.71) vs (273.50±69.85) m], and significantly higher than those before intervention [(5.99±1.45) kg/m 2, (23.55±9.64) kg, (273.50±69.86) m]. The time of Five-Times-Sit-to-Stand Test, BNP and E/e′ in the test group were both significantly lower than those in the control group [(11.20±2.09) vs (15.36±0.46) s, (278.80±58.69) vs (400.80±87.86) ng/L, (11.10±0.81) vs (14.66±1.90)], and significantly lower than those before intervention [(18.51±2.90) s, (407.50±122.74) ng/L and (14.00±1.15)]. There was no significant difference in remaining indicators between the two groups (all P>0.05). Conclusion:Nutritional intervention combined with rehabilitation exercise primarily focused on whey protein supplementation and resistance training can significantly improve limb muscle mass, muscle strength, muscle function, and cardiac function in elderly patients with CHF complicated by sarcopenia on the basis of heart failure medication treatment.
Objective:To investigate and analyse the current status of screening and management of diabetic kidney disease (DKD) in six provinces and cities in China.Methods:The qualitative research method of focus group interview was adopted, based on the semi-structured interview outline, the clinical medical and disease control personnel in Tianjin, Chongqing, Gansu, Hubei, Heilongjiang, and Guangdong were interviewed. The interview transcripts were analyzed using thematic analysis, and MAXQDA analysis software was used for data management and analysis.Results:A total of 6 interviews were conducted with 49 interviewees. Forty respondents (81.6%) claimed that DKD screening was critical; 53.1% think that it was not easy for patients to obtain DKD screening services; 40.8%, 26.5% and 14.3% of the people believed that the technology of DKD screening services was moderate, simple or very simple, respectively. Of the respondents,16.3% thought that the cost of DKD screening service was relatively expensive, while 83.7% thought that the cost was inexpensive; 75.5% of the respondents believed that the patients could receive early DKD screening service. The factors of fully implementing medical reform policies, changing concepts and actively serving patients, and integrating external resources in medical and health institutions at all levels and of all types were conducive to the development of DKD screening and management services. The lack of technology and personnel for DKD screening services at the grassroots level, the lack of trust in the service capabilities of grassroots medical institutions by patients, the low level of patient awareness, and the novel coronavirus infection epidemic had an adverse impact on the development of DKD screening and management services.Conclusion:The screening and management services for DKD are relatively limited in China, and there is a significant fragmentation in the management and care of diabetes and DKD.
Objective:To investigate the value of visceral fat index (VAI) and lipid accumulation product (LAP) on predicting metabolic associated fatty liver disease (MAFLD) in the population without overweight/obesity.Methods:This study is a cross-sectional study. The physical examination data derived from International Physical Examination and Health Center of the Second Affiliated Hospital of Harbin Medical University from January to December 2021 were collected. According to the inclusion and exclusion criteria, a total of 4 304 subjects without overweight/obesity aged from 18-75 were included in this study. The subjects were divided into two groups with MAFLD or without MAFLD, according to the diagnostic criteria of MAFLD provided by The Asian Pacific Association for the Study of the liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Comparison of the clinical parameters (blood pressure, lipid, glucose) and obesity measurement indexes (BMI, VAI, LAP) between the two groups was analyzed. All subjects were respectively divided into four groups according to BMI, VAI and LAP quartile, which were defined as A, B, C, D. The prevalence of MAFLD in the population without overweight/obesity in quartile area groups of different obesity measurement indexes was calculated. Spearman′s rank correlation was used to evaluate the correlation between BMI, LAP, VAI and MAFLD in the population without overweight/obesity, respectively. Meanwhile, receiver operating characteristics (ROC) curves were used to calculate area under the curve (AUC) and evaluate the accuracy of BMI, VAI and LAP on predicting for MAFLD in the population without overweight/obesity.Results:The prevalence of MAFLD in the population without overweight/obesity was 10.87%. In the population without overweight/obesity, the clinical data blood pressure, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and fasting plasma glucose (FPG) in the group with MAFLD were significantly higher than those of the group without MAFLD (131/80 vs 113/70 mmHg, 5.29 vs 4.65 mmol/L, 3.21 vs 2.75 mmol/L, 1.87 vs 0.89 mmol/L, 5.60 vs 4.95 mmol/L; P<0.001), but high density lipoprotein cholesterol (HDL-C) of the group with MAFLD was significantly lower than that of the group without MAFLD (1.19 vs 1.49 mmol/L; P<0.001). The obesity measurement indexes (BMI, VAI, LAP) in the group with MAFLD were significantly higher than those of the group without MAFLD (22.10 vs 20.70 kg/m 2, 2.64 vs 1.00, 36.27 vs 12.48; all P<0.001). In the population without overweight/obesity, the prevalence of MAFLD was increased with the increase of BMI, VAI and LAP quartile area, and there was a linear correlation between MAFLD and obesity measurement indexes above. Spearman′s rank correlation analysis showed that correlation coefficient between obesity measurement indexes and MAFLD in the population without overweight/obesity was respectively LAP (0.427)>VAI (0.406)>BMI (0.282). ROC curve analysis showed that in the population without overweight/obesity, LAP had the highest accuracy on predicting MAFLD, with the AUC value of 0.896 (0.886-0.905), the optional cut-off value was 20.75, sensitivity and specificity was 85.9% and 79.0%, respectively. VAI (0.876) took the second place and BMI (0.761) located lastly. Conclusions:Both VAI and LAP have good prediction ability for MAFLD in the population without overweight/obesity. However, compared with VAI, LAP has higher accuracy on predicting MAFLD in the population without overweight/obesity.
Objective:To analyze the accuracy of a single-lead electrocardiogram (iECG) algorithm based on intelligent wristwatch in identifying sinus tachycardia and atrial fibrillation (AF) with rapid ventricular rate.Methods:In this non-randomized control trial, 642 patients aged ≥18 years were enrolled in the General Hospital of Chinese PLA between December 15, 2020 and May 30, 2022, with sinus tachycardia or rapid ventricular rate of AF (ranging from 111 to 145 beats/min for sinus tachycardia, from 110 to 150 beats/min for rapid ventricular rate of AF, respectively). The patients wore Huawei Watch GT2 Pro smartwatches on their left wrists, and the physiological signals detected by the smartwatches in a relaxed state were used as the measured data. The iECG algorithm developed by Huawei was used for identification. Simultaneously, 12-lead electrocardiograms (12L-ECG) were performed, and two cardiologists served as the gold standard for interpretation. Three participants who did not meet the inclusion criteria were excluded based on the detection results, and a total of 639 participants were included in the study. The accuracy of the algorithm in identifying sinus tachycardia and rapid ventricular rate AF was evaluated using metrics such as recall rate, precision rate, macro F1 score for multi-class classification.Results:Among 639 subjects, there were 469 males and 170 females. There were 389 cases of sinus tachycardia and 250 cases of rapid ventricular rate AF, with a mean age of (46.53±13.32) years. The recall rate, precision rate, and F1 value of iECG algorithm in identifying sinus tachycardia was 98.7%, 99.2% and 99.0%, respectively, while it was 98.8%, 98.0% and 98.4%, respectively for AF with rapid ventricular rate. The macro F1 of AF with rapid ventricular rate and sinus tachycardia was 98.7%. The iECG based on the intelligent wristwatch showed good consistency with the corresponding 12L-ECG waveforms.Conclusion:The intelligent wristwatch-based iECG algorithm can effectively identify sinus tachycardia and rapid ventricular rate AF, demonstrating good accuracy.
