Remarkable Research Achievements in Traditional Chinese Medicine During New Era （2012—2022） / 中国实验方剂学杂志

Since the 18th National Congress of the Communist Party of China （CPC）， a continuous stream of scientific and technological innovations has unfolded in the realm of traditional Chinese medicine （TCM）. With the aim of implementing the spirit of the 20th National Congress of the CPC， and the Opinions on Promoting the Inheritance， Innovation and Development of TCM， and to underscore the exemplary role of significant scientific and technological achievements， the China Association of Chinese Medicine， in alignment with relevant requirements and under the guidance of authoritative experts， has organized a comprehensive review of the important scientific and technological achievements in the field of TCM since the 18th National Congress of the CPC. Through rigorous procedures， including collecting and reviewing achievements， writing achievement reports， organizing expert reviews， and seeking public opinions， remarkable research achievements in TCM during 2012—2022 were compiled.

Adjustment of X-ray angle intraoperation based on the anatomic shape of femoral neck section / 解剖学报

[Abstract] Objective To investigate the appropriate X-ray angle which image can represent total proximal of femur according to the anatomic shape of the femoral neck section. Methods The anatomic parameter of the femoral neck section was observed and measured. Found the femoral neck was contained with three main surfaces of anterior surface, posterosuperior surface and posteroinferior surface. A model of surface fluoroscopy has been made by covering aluminum foil papers on the three surfaces of femoral neck. Taking the midpoint of the femoral neck as the fluoroscopy center, the C-arm was rotated at an interval of 10° between 0° and 170°, and the three aluminum foil paper models were taken for X-ray projection respectively. The X-ray angle with the smallest image of aluminum foil paper was taken as the appropriate X-ray angle of the surface. A penetrating model of the femoral neck internal fixation was made of three Kirschner wires penetrating through the anterior, posterosuperior and posteroinferior surfaces of femoral neck. The images of the penetrating Kirschner wires were observed through the traditional anteroposterior, lateral view and the three appropriate X-ray angle views obtained from the above test. Results The length of the three main surfaces accounts for 80. 95% of the circumference of the femoral neck. The anterior surface coronal angle was 18°, the posterosuperior surface coronal angle was 65°, and the posteroinferior surface coronal angle was 165°. The Appropriate X-ray angle of the three surfaces were 20°, 70° and 170° respectively. In the images of the three appropriate X-ray angles, the penetrating Kirschner wires of anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be clearly observed respectively, while the penetrating Kirschner wire could not be completely found in the traditional anteroposterior and lateral images. Conclusion Traditional anteroposterior and lateral fluoroscopy can not accurately display the three-dimensional structure of femoral neck. By increasing the appropriate X-ray angle of 20°, 70° and 170°, the reduction quality and bony violation from internal fixation implants on the anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck could be observed respectively.

Perceived exercise benefits and barriers and their association with physical activity time in Chinese Han children and adolescents aged 9 to 18 years / 中华流行病学杂志

Objective: To analyze the perceived exercise benefits and barriers and their association with physical activity time in Chinese Han children and adolescents aged 9-18 years. Methods: Data were extracted from the 2019 Chinese National Survey on Students' Constitution and Health and a total of 163 656 children and adolescents aged 9-18 years in Han ethnic group were included in the analysis. Mann-Whitney U test and Kruskal-Wallis test were used to compare the perceived exercise benefits score, perceived exercise barriers score and perceived exercise benefits to barriers ratio in the children and adolescents with different demographic characteristics and physical activity time. The differences in physical activity time in subgroups were compared with χ2 tests. log-binomial regression model was used to evaluate the association between physical activity time and perceived exercise benefits and barriers. Results: The M (Q1,Q3) of the perceived exercise benefits score, perceived exercise barriers score, and perceived exercise benefits to barriers ratio in the children and adolescents were 4.11 (3.78, 4.78), 2.70 (2.10, 3.20) and 1.55 (1.22, 2.07), respectively. Children and adolescents living in urban area, boys, those at younger age and those with physical activity time ≥1 hour had higher perceived exercise benefits score and perceived exercise benefits to barriers ratio, but lower perceived exercise barriers score (all P<0.001). The prevalence of physical activity time ≥1 hour was 41.4% in the children and adolescents. In the log-binomial model with two variables of perceived exercise benefits score and perceived exercise barriers score, for each 1-point increase in the perceived exercise benefits, the possibility of physical activity time ≥1 hour increased by 11% (OR=1.11, 95%CI: 1.10-1.12), and for each 1-point increase in the perceived exercise barriers, the possibility of physical activity time ≥1 hour decreased by 15% (OR=0.85, 95%CI: 0.84-0.85). In the log-binomial model with variable of perceived exercise benefits to barriers ratio, for each 1-point increase in the perceived exercise benefits to barriers ratio, the possibility of physical activity time ≥1 hour increased by 12% (OR=1.12, 95%CI: 1.11-1.12). Conclusion: The perceived exercise benefits and barriers are significantly associated with physical activity time in children and adolescents in China.

Trend of the detection rate of myopia among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the trend of the detection rate of myopia among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019. Methods: Data from the Chinese National Survey on Students' Constitution and Health in 2010, 2014 and 2019 were used, and about 213 833, 212 742 and 209 942 Han students aged 7-18 years were included in this study. The χ² test was used to compare the differences in the prevalence of myopia among the subgroups in the survey year, and logistic regression was used to compare the differences in the prevalence of myopia between different years. A curve-fitting method was used to obtain the growth rate of myopia among Han Chinese students from 2010 to 2019, and the differences in the change of myopia between different age groups were analyzed. Results: In 2019, the overall detection rate of myopia among Chinese Han children and adolescents aged 7-18 was 60.1%. The detection rate of urban students (62.7%) was higher than that of rural students (57.4%) and the detection rate of girls (63.5%) was higher than that of boys (56.7%). In 2019, the regional disparities were large in the detection rate of myopia in various provinces, with the lowest in Guizhou (49.6%) and the highest in Zhejiang (71.3%). The detection rate of myopia showed an upward trend from 2010 to 2019, from 55.5% in 2010 to 57.1% in 2014, and finally to 60.1% in 2019. The gap in the detection rate of myopia between urban and rural children and adolescents gradually shrank. The average annual growth rate of myopia detection rate from 2014 to 2019 was 0.6 percentage points per year, higher than that from 2010 to 2014 about 0.4 percentage points per year. The peak age of the growth rate of myopia detection rate decreased from 12 years in 2010 to 10 years in 2014, and finally to 7 years in 2019. Conclusions: The detection rate of myopia among Chinese Han children and adolescents is still at a high level, and the peak age of the growth rate of myopia detection rate continues to advance.

Correct the imbalance of growth and development and prevent important comorbidities of children and adolescents / 中华预防医学杂志

There are certain stages and continuities in the growth and development of children and adolescents. Under the induction of some factors, their growth and development may deviate from the normal pattern and trajectory, which may lead to an imbalance of various systems, and even result in the occurrence of significant comorbidities. The imbalance of children's growth and development might be an internal factor leading to the occurrence of important comorbidities such as obesity, myopia and psychological problems in children and adolescents, while the mismatch between environmental changes and growth and development might be an external factor. Therefore, it is necessary to find the influencing factors of imbalance regarding growth and development based on regular monitoring of the growth and development indicators of children and adolescents, improve the pathogenic environment, reveal the behind mechanism, and fundamentally prevent the important comorbidities.

Prevalence trend of malnutrition among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the prevalence trend of malnutrition among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019. Methods: Based on the data from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019, about 215 102, 214 268 and 212 713 Han students aged 7-18 years were included in this study. According to the National Screening Standard for Malnutrition of School-age Children and Adolescents, the detection rate of malnutrition among Chinese Han children and adolescents aged 7-18 was calculated, and the prevalence trend of malnutrition from 2010 to 2019 was analyzed. Results: In 2019, the detection rate of malnutrition among Chinese Han students aged 7-18 years was 8.64% (18 381/212 713), of which the rate of growth retardation, moderate-to-severe wasting and mild wasting was 0.50% (1 062/212 713), 3.25% (6 914/212 713) and 4.89% (10 405/212 713), respectively. In 2019, the detection rate of malnutrition in these boys was higher than that of girls (9.97% vs. 7.31%), and the detection rate in rural areas was higher than that in cities (9.30% vs. 7.98%). The detection rates were 9.74% (5 252/53 916), 8.17% (4 408/53 937), 7.29% (3 885/53 310), and 9.38% (4 836/51 550) in 7-9, 10-12, 13-15, and 16-18 years groups, and 8.14% (6 563/80 618), 7.61% (4 237/55 694) and 9.92% (7 581/76 401) in the eastern, central, and western regions. Malnutrition among students in China was mainly caused by mild wasting, and the detection rate of growth retardation accounted for only 5.78% (1 062/18 381). Malnutrition was mostly concentrated in the southwest region, and the rate was relatively low in eastern provinces. In three surveys from 2010 to 2019, the detection rate of malnutrition among Han students aged 7-18 in China decreased gradually, and the differences were statistically significant (P<0.05). Among them, the detection rates in western rural areas decreased significantly, as well as the gap between urban and rural areas. Compared with that in 2014, the detection rate of malnutrition in Shandong, Hunan, Qinghai and Hainan provinces in 2019 decreased significantly (P<0.05). Conclusion: In 2019, the malnutrition of Chinese children and adolescents aged 7-18 years is dominated by wasting malnutrition. The detection rate shows a downward trend from 2010 to 2019, with regional differences.

Epidemiology and prediction of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019 / 中华预防医学杂志

Objective: To analyze and predict the epidemic trend of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019. Methods: Data were collected from the Chinese National Survey on Students Constitution and Health in 1985, 1995, 2000, 2005, 2010, 2014, and 2019 with the sample size of 409 945, 204 931, 209 209, 234 420, 215 317, 214 353, and 212 711, respectively. Overweight and obesity were evaluated according to the "classification standard of the weight index value of overweight and obesity screening for Chinese school-age children and adolescents" of the Working Group on Obesity in China (WGOC). The detection rate and average annual growth rate of overweight and obesity, and single obesity among children and adolescents aged 7-18 years were calculated, and ArcGis10.6 software was used to analyze the difference in the prevalence of overweight and obesity among children and adolescents in different regions in 2019. Polynomial regression function was used to fit the prevalence and average annual growth rate of overweight and obesity, and single obesity among children and adolescents from 1985 to 2019, and to predict the prevalence of overweight and obesity and single obesity among children and adolescents in China. Results: In 2019, the total prevalence of overweight and obesity among children and adolescents aged 7-18 years in China was 23.4%, and the prevalence of single obesity was 9.6%. The prevalence of overweight and obesity among urban children and adolescents was higher than that in rural areas (25.4% vs. 21.5%), and the prevalence in boys was higher than that in girls (28.4% vs. 18.4%) (both P values<0.001). In 2019, there was a large regional disparity in the prevalence of overweight and obesity in different provinces, with the lowest in Guangdong (12.2%) and the highest in Shandong (38.9%), and the high epidemic areas were mainly concentrated in North China and Northeast China. From 1985 to 2019, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China increased from 1.2% to 23.4%, with an increase of 18.1 times, while the prevalence of obesity alone increased from 0.1% to 9.6%, with an increase of 75.6 times. The prevalence of overweight and obesity in urban boys, urban girls, rural boys and rural girls increased from 1.3%, 1.5%, 0.5%, and 1.6% in 1985 to 31.2%, 19.4%, 25.6%, and 17.4% in 2019, with an increase of 22.3, 11.7, 54.2, and 10.1 times, respectively. According to the prediction model, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China will increase from 23.4% in 2019 to 32.7% in 2030, and the prevalence of obesity alone will increase from 9.6% in 2019 to 15.1% in 2030. The growth of rural children and adolescents is obvious. By 2025, the prevalence of overweight and obesity among rural children and adolescents in China will comprehensively exceed that of urban, and there will be an "urban-rural reversal" phenomenon. At the same time, the prevalence of children's obesity in China's low, medium and high epidemic areas will also continue to increase. By 2035, the prevalence of overweight and obesity among children and adolescents in medium epidemic areas will exceed that in high epidemic areas, and there will be a "provincial reversal" phenomenon. Conclusion: From 1985 to 2019, the overweight and obesity of children and adolescents in China will continue to grow rapidly with large regional differences.

Long-term trend of the age of spermarche and its association with nutritional status among Chinese Han boys aged 11-18 from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the long-term trend of the age of spermarche among Chinese Han boys aged 11 to 18 from 2010 to 2019 and its association with nutritional status. Methods: The data from Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019 were used. The age, residence and spermarche of the participants were collected by questionnaire, and their height and weight were measured. A total of 184 633 Han boys aged 11‒18 years with complete data on spermarche, height, and weight were included in this study. The probability regression method was used to calculate the median age (95%CI) at spermarche in different areas, and the trend of age at spermarche in different groups was compared. The multivariate logistic regression model was used to analyze the association between nutritional status and spermarche of Chinese Han boys aged 11‒18 years. Results: The median age of spermarche (95%CI) was 13.85 (13.45-14.22) years old among Chinese Han boys aged 11‒18 years in 2019, with 0.18 years earlier than that in 2010. The median age at spermarche in urban and rural boys was 13.89 and 13.81 years, respectively. Compared with that in 2010, the age at spermarche in urban and rural boys was 0.08 and 0.27 years earlier, respectively. After adjusting for age, province and urban/rural areas, compared with normal weight, spermarche was negatively associated with wasting and positively associated with overweight and obesity, with OR (95%CI) about 0.73 (0.67-0.80), 1.09 (1.02-1.17) and 1.09 (1.01-1.18), respectively. Conclusion: The age of spermarche generally shows an advanced trend among Chinese Han boys and is associated with nutritional status.

Prevalence trend of high normal blood pressure and elevated blood pressure in Chinese Han children and adolescents aged 7-17 years from 2010 to 2019 / 中华预防医学杂志

Objective: To investigate the prevalence trend of high normal blood pressure and elevated blood pressure in children and adolescents aged 7 to 17 years in China from 2010 to 2019. Methods: Students aged 7-17 years were selected from the Chinese National Survey on Students' Constitution and Health from 2010 to 2019. High normal blood pressure and elevated blood pressure were determined according to the "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" (WS/T 610-2018). The Chi-square test was performed to determine whether there was a difference in the prevalence of high normal blood pressure and elevated blood pressure by gender, residence and age group. Results: In 2019, the prevalence of high normal blood pressure in children and adolescents aged 7-17 years was 15.3% (29 855/195 625), which was higher in boys (20.2%, 19 779/97 847) and rural areas (15.4%, 15 066/97 567) than that in girls (10.3%, 10 076/97 778) and urban areas (15.1%, 14 789/98 058), respectively (all P<0.05). The prevalence of elevated blood pressure was 13.0% (25 377/195 625), which was higher in girls (13.2%, 12 925/97 778) and rural areas (14.1%, 13 753/97 567) than that in boys (12.7%, 12 452/97 847) and urban areas (11.9%, 11 624/98 058) (all P<0.05). From 2010 to 2019, the prevalence of high normal blood pressure showed an increasing trend, with an annual average growth rate from 1.14% to 3.18%. The overall prevalence of elevated blood pressure also showed an increasing trend from 2010 to 2019 but decreased in 2014. The annual average growth rate of elevated blood pressure was-1.07% from 2010 to 2014 and 9.33% from 2014 to 2019. About 17 provinces had an increasing trend in the prevalence of elevated blood pressure from 2010 to 2014, and 22 provinces with an increasing trend from 2014 to 2019. There were obvious regional differences in the annual average growth rate of the prevalence of high normal blood pressure and elevated blood pressure. The regions with the highest annual average growth rate of the prevalence of high normal blood pressure were the Northeast (5.47%) from 2010 to 2014 and the Western region (5.21%) from 2014 to 2019. For elevated blood pressure, the Northeast had the highest annual average growth rate from 2010 to 2014 (12.35%), while the Central (15.79%) and Western (12.87%) had the highest growth rate from 2014 to 2019. Conclusion: From 2010 to 2019, the prevalence of high normal blood pressure and elevated blood pressure in Chinese Han children and adolescents aged 7 to 17 shows an increasing trend, with regional disparities.

Trends of age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019 / 中华预防医学杂志

Objective: To analyze the trends of the age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019. Methods: Data were extracted from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019. A total of 253 037 Han girls aged 9 to 18 years with complete data on menarche were selected in this study. They were asked one-on-one about their menstrual status, age and residence information. The median age of menarche was estimated by probability regression. U tests were used to compare the difference in median age at menarche in different years. Results: The median age at menarche (95%CI) among Chinese Han girls was 12.47 (12.09-12.83) years in 2010, 12.17 (11.95-12.38) years in 2014 and 12.05 (10.82-13.08) years in 2019, respectively. Compared with that in 2010, the median age at menarche in 2019 decreased by 0.42 years (U=-77.27, P<0.001). The annual average changes were-0.076 years from 2010 to 2014 (U=-57.19, P<0.001) and-0.023 years from 2014 to 2019 (U=-21.41, P<0.001), respectively. The average annual changes in urban areas in the periods of 2010 to 2014 and 2014 to 2019 were-0.071 years and 0.006 years, respectively, while those in rural areas were-0.082 years and-0.053 years, respectively. The average annual changes in the regions of north, northeast, east, south central, southwest and northwest were-0.064, -0.099, -0.091, -0.080, -0.096 and-0.041 years in the period of 2010 to 2014 and 0.001, -0.040, -0.002, -0.005, -0.043 and-0.081 years in the period of 2014 to 2019. Conclusion: The age of menarche among Chinese Han girls aged 9 to 18 years shows an advanced trend from 2010 to 2019, and the trends in urban and rural areas and different regions have different characteristics.

Circulating Exosomal LncRNAs as Novel Diagnostic Predictors of Severity and Sites of White Matter Hyperintensities / 生物医学与环境科学（英文）

OBJECTIVE@#Exosomal long noncoding RNAs (lncRNAs) are the key to diagnosing and treating various diseases. This study aimed to investigate the diagnostic value of plasma exosomal lncRNAs in white matter hyperintensities (WMH).@*METHODS@#We used high-throughput sequencing to determine the differential expression (DE) profiles of lncRNAs in plasma exosomes from WMH patients and controls. The sequencing results were verified in a validation cohort using qRT-PCR. The diagnostic potential of candidate exosomal lncRNAs was proven by binary logistic analysis and receiver operating characteristic (ROC) curves. The diagnostic value of DE exo-lncRNAs was determined by the area under the curve (AUC). The WMH group was then divided into subgroups according to the Fazekas scale and white matter lesion site, and the correlation of DE exo-lncRNAs in the subgroup was evaluated.@*RESULTS@#In our results, four DE exo-lncRNAs were identified, and ROC curve analysis revealed that exo-lnc_011797 and exo-lnc_004326 exhibited diagnostic efficacy for WMH. Furthermore, WMH subgroup analysis showed exo-lnc_011797 expression was significantly increased in Fazekas 3 patients and was significantly elevated in patients with paraventricular matter hyperintensities.@*CONCLUSION@#Plasma exosomal lncRNAs have potential diagnostic value in WMH. Moreover, exo-lnc_011797 is considered to be a predictor of the severity and location of WMH.

Burden of multiple myeloma in China: an analysis of the Global Burden of Disease, Injuries, and Risk Factors Study 2019 / 中华医学杂志(英文版)

BACKGROUND@#There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma (MM) in China; therefore, this study determined the characteristics of the disease burden of MM at national and provincial levels in China.@*METHODS@#The burden of MM, including incidence, mortality, prevalence, and disability-adjusted life years (DALYs), with a 95% uncertainty interval (UI), was determined in China following the general analytical strategy used in the Global Burden of Disease, Injuries, and Risk Factors Study 2019. The trends in the burden of MM from 1990 to 2019 were also evaluated.@*RESULTS@#There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05 (95% UI, 12.31-20.77) per 100,000 in 2019. The estimated number of incident case and deaths of MM were 18,793 and 13,421, with age-standardized incidence and mortality rates of 0.93 (95% UI, 0.67-1.15) and 0.67 (95% UI, 0.50-0.82) per 100,000, respectively. The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak (93.82) in the 70 to 74 years age group. Males had a higher burden than females, with approximately 1.5- to 2.0-fold sex difference in age-specific DALY rates in all age groups. From 1990 to 2019, the DALYs of MM increased 134%, from 148,479 in 1990 to 347,453 in 2019.@*CONCLUSION@#The burden of MM has doubled over the last three decades, which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.

Internet-based group cognitive behavioral therapy for depression and anxiety symptoms / 四川精神卫生

This paper presents a systematic review of extant research investigating the effectiveness of Internet-based group cognitive behavioral therapy （IGCBT） for depression and anxiety symptoms with an emphasis on the treatment modalities， treatment protocols， efficacy and mechanism， together with a summary of research limitations and suggestions for future research. Cognitive behavioral therapy （CBT） is a structured， short-term and present-oriented psychotherapeutic treatment， its Internet- and group-delivered modalities have led to its wider application， and has proven to be clinically effective in alleviating depression and anxiety symptoms caused by different diseases， whereas some drawbacks have been reported. Thus this paper elaborates the clinical application， therapeutic effect and underlying mechanisms of IGCBT intervention for depression and anxiety symptoms， so as to provide references for its future application. ［Funded by the Natural Science Foundation of the Inner Mongolia Autonomous Region （number， 2019MS03038）

Sex Estimation of Medial Aspect of the Ischiopubic Ramus in Adults Based on Deep Learning / 法医学杂志

OBJECTIVES@#To investigate the reliability and accuracy of deep learning technology in automatic sex estimation using the 3D reconstructed images of the computed tomography (CT) from the Chinese Han population.@*METHODS@#The pelvic CT images of 700 individuals (350 males and 350 females) of the Chinese Han population aged 20 to 85 years were collected and reconstructed into 3D virtual skeletal models. The feature region images of the medial aspect of the ischiopubic ramus (MIPR) were intercepted. The Inception v4 was adopted as the image recognition model, and two methods of initial learning and transfer learning were used for training. Eighty percent of the individuals' images were randomly selected as the training and validation dataset, and the remaining were used as the test dataset. The left and right sides of the MIPR images were trained separately and combinedly. Subsequently, the models' performance was evaluated by overall accuracy, female accuracy, male accuracy, etc.@*RESULTS@#When both sides of the MIPR images were trained separately with initial learning, the overall accuracy of the right model was 95.7%, the female accuracy and male accuracy were both 95.7%; the overall accuracy of the left model was 92.1%, the female accuracy was 88.6% and the male accuracy was 95.7%. When the left and right MIPR images were combined to train with initial learning, the overall accuracy of the model was 94.6%, the female accuracy was 92.1% and the male accuracy was 97.1%. When the left and right MIPR images were combined to train with transfer learning, the model achieved an overall accuracy of 95.7%, and the female and male accuracies were both 95.7%.@*CONCLUSIONS@#The use of deep learning model of Inception v4 and transfer learning algorithm to construct a sex estimation model for pelvic MIPR images of Chinese Han population has high accuracy and well generalizability in human remains, which can effectively estimate the sex in adults.

Genetic analysis of a child with Pitt-Hopkins syndrome due to a novel variant of TCF4 gene derived from low percentage maternal mosaicism / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic etiology of a child with Pitt-Hopkins syndrome.@*METHODS@#A child who had presented at the Medical Genetics Center of Gansu Provincial Maternal and Child Health Care Hospital on February 24, 2021 and his parents were selected as the study subjects. Clinical data of the child was collected. Genomic DNA was extracted from peripheral blood samples of the child and his parents and subjected to trio-whole exome sequencing (trio-WES). Candidate variant was verified by Sanger sequencing. Karyotype analysis was also carried out for the child, and her mother was subjected to ultra-deep sequencing and prenatal diagnosis upon her subsequent pregnancy.@*RESULTS@#The clinical manifestations of the proband included facial dysmorphism, Simian crease, and mental retardation. Genetic testing revealed that he has carried a heterozygous c.1762C>T (p.Arg588Cys) variant of the TCF4 gene, for which both parents had a wild-type. The variant was unreported previously and was rated as likely pathogenic based on the guidelines of the American College of Medical Genetics and Genomics (ACMG). Ultra-deep sequencing indicated that the variant has a proportion of 2.63% in the mother, suggesting the presence of low percentage mosaicism. Prenatal diagnosis of amniotic fluid sample suggested that the fetus did not carry the same variant.@*CONCLUSION@#The heterozygous c.1762C>T variant of the TCF4 gene probably underlay the disease in this child and has derived from the low percentage mosaicism in his mother.

Research on international cooperation of academic papers of Peking University First Hospital / 中华医学科研管理杂志

Objective:Based on the academic papers published by Peking University First Hospital in the past 11 years, this paper analyzes the international cooperation in scientific research and aims to provide reference for the formulation of future scientific research programs.Methods:Bibliometric analysis was used to analyze the current status and trend of international cooperation, the journal distribution and preferences, as well as the subject distribution and participation.Results:It is found that the international cooperation has made some progress in recent years, however, the international cooperation rate is basically the same, while the level of cooperation should be improved. The level of international cooperation varies among different disciplines, the more strong disciplines are higher than others. Most research are concentrated in clinical medicine, basic research and other interdisciplinary research need to be strengthened.Conclusions:For the next step, we should improve the top-level design of international cooperation, strengthen the international cooperation in basic research and interdisciplinary research, and promote the development of discipline construction.

Construction of an evaluation scale for post competence of family doctors based on knowledge-skill-management model / 中华全科医师杂志

Objective:To construct an evaluation scale for post competence of family doctors based on knowledge-skill-management model.Methods:The evaluation dimensions and indicators for post competency of family doctors were preliminarily developed through literature review, internal group meeting and brainstorming, and in-depth interviews of experts. And 16 experts in the fields of general practice and health management were invited for 2 rounds of Delphi consultation from December 2020 to April 2021. A competency evaluation scale for family doctors based on the dimensions of knowledge, skills and management was finally constructed.Results:The age of the experts was (47.9±7.3) years with a working experience of (24.6±7.8) years. The Cronbach′s α of the questionnaires was 0.891 and the KMO was 0.844. The positive coefficients for 2 rounds of expert consultation were 100%; the familiarity level of experts was 0.86 and authority level was 0.89 in the first round consultation, and those were 0.84 and 0.90 in the second round consultation. After 2 rounds of consultation, the coordination coefficient of expert opinions in the knowledge and skill dimensions was>0.5, and that in the management dimension and overall evaluation system was>0.3. After discussion 2 indicators were deleted in the first round of consultation. The finally constructed family doctor post competency evaluation scale included 3 dimensions, 8 secondary indicators and 61 tertiary indicators. Conclusion:Through the Delphi consultation, we have successfully constructed an evaluation scale for post competence of family doctors based on the three dimensions of knowledge, skills and management.

Investigation on clinical knowledge and training needs of general practitioners: a perspective of subjective perception and objective assessment / 中华全科医师杂志

Objective:To analyze the clinical knowledge and training needs of general practitioners from subjective perception and objective assessment, and to analyze their relationship.Methods:A survey was conducted among general practitioners from community health service centers in Shanghai Changning district from September to December 2020. Based on the general practitioner competency indicator system designed by the project team, 17 clinical knowledge competency evaluation indicators were developed through expert consultation, and used for subjective perception and objective assessment of clinical knowledge and learning needs among general practitioners. The influencing factors of objective assessment scores were analyzed, and the relationship between subjective perception and objective assessment scores was analyzed using the four quadrant method.Results:A total of 136 general practitioners participated in the study with the mean age of (39.25±5.90) years, most of whom were attending physician (67.65%, 92/136) and had undergraduate education (88.20%, 122/136). The average daily application frequency score was (1.55±0.21), and the training needs score was (1.65±0.09) for 17 clinical knowledge items; the average objective evaluation score was (74.21±14.0) points. The older the age ( OR=1.25, 95% CI:1.14-1.37), the higher the educational level ( OR=2.11, 95% CI:1.57-2.83), and the longer the working years ( OR=1.16, 95% CI:1.04-1.30) were significantly correlated with the higher objective evaluation scores (all P<0.05). The objective evaluation scores of endocrine diseases such as diabetes, cerebrovascular diseases and respiratory diseases are the highest, and the daily application frequency and learning needs are high (the first quadrant); The objective evaluation scores of common orthopedic diseases, common psychological diseases, and planned immunity indicators were relatively low, but their daily application frequency and learning needs were relatively high (second quadrant). The objective evaluation scores of indicators such as common malignant tumors, common dermatology diseases and health problems, and common ENT diseases were low, and the daily application frequency and learning needs were also low (the third quadrant). The objective evaluation scores of indicators such as hospice and palliative care are relatively high, but their daily application frequency and training needs are relatively low (listed in the fourth quadrant). Conclusions:The clinical knowledge levels of general practitioners are correlated with age, education level, and years of practice. There is a certain overlap between the objective evaluation results of clinical knowledge and the frequency of knowledge usage and training needs of general practitioners, and a targeted training mechanism should be established.

The path and effect of regional medical centers and community centers in post-training of general practitioners with "integrated dual-drives" model / 中华全科医师杂志

The integration of regional medical centers and community health service centers is an effective way to improve the professional ability of general practitioners in post-practice training. Its major advantage lies in the establishment of a regional general practitioner ability improvement system integrating assessment, practice and teaching under the unified health administrative department. This article introduces the path of general practitioner post-training developed by Shanghai Tongren Hospital in forms of a regional medical center combined with the community health service center under the "integrated dual-drives" model, which was carried out in Shanghai Changning District; and its preliminary accomplishment is also discussed. It may provide reference for regional medical centers to improve the ability of general practitioners through practice-driven and teaching-driven.

Comparison of invasive and non-invasive blood pressure in perioperative elderly hypertensive patients with atherosclerosis of the extremities / 中华老年医学杂志

Objective:To compare the correlation and differences between invasive blood pressure(IBP)and noninvasive blood pressure(NBP)monitoring at three different levels of systolic blood pressure(SBP), diastolic blood pressure(DBP)and mean arterial pressure(MAP)in elderly hypertensive patients with atherosclerosis of the extremities during perioperative anesthesia.Methods:156 elderly patients were prospectively admitted to the Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, for peripheral vascular stenosis interventions between December 2018 and December 2021.Their IBP and NBP were measured simultaneously during the perioperative anesthesia period.Then the correlation and consistency between IBP and NBP were analyzed via the Pearson correlation coefficient, Bland-Altman plots, and the receiver operating characteristic curve(ROC curve).Results:A total of 156 elderly patients were enrolled, including 108 men(69.2%)and 48 women(30.8%), with a mean age of 72.2±7.6.Pearson correlation analysis revealed that there was a significant positive correlation between IBP and NBP.The correlation coefficient was 0.993 for invasive systolic blood pressure(ISBP)and non-invasive systolic blood pressure(NSBP), 0.808 for invasive diastolic blood pressure(IDBP)and non-invasive diastolic blood pressure(NDBP), and 0.853 for invasive mean arterial pressure(IMAP)and non-invasive mean arterial pressure(NMAP)( P<0.001 for all). Bland-Altman analysis showed that the mean deviation of ISBP and NSBP was(20.3±6.5)mmHg(95% CI: 19.18-21.38)(1 mmHg=0.133 kPa), the mean deviation of IDBP and NDBP was(3.8±9.7)mmHg(95% CI: 2.13-5.41), and the mean deviation of IMAP and NMAP was(12.7±11.0)mmHg(95% CI: 10.83-14.55). The correlation coefficient of ISBP-NSBP deviation with ISBP was 0.856, the correlation coefficient of IDBP-NDBP deviation with IDBP was 0.206, and the correlation coefficient of IMAP-NMAP deviation with IMAP was 0.583( P<0.05 for all). When ISBP≥137 mmHg, the sensitivity of an ISBP-NSBP deviation ≥20 mmHg was 96.3%, the specificity was 96.4%, and the area under the ROC curve was 0.970(95% CI: 0.934-1.000). When ISBP≥158 mmHg, the sensitivity and specificity of a predicted ISBP-NSBP deviation≥25 mmHg were 97.4% and 78.8%, respectively, and the area under the ROC curve was 0.876(95% CI: 0.820-0.933); When ISBP≥208 mmHg, the sensitivity and specificity of a predicted ISBP-NSBP deviation≥30 mmHg were 100% and 98.5%, respectively, and the area under the ROC curve was 0.985(95% CI: 0.964-1.000). Conclusions:There is a good agreement between IBP and NBP in elderly hypertensive patients with peripheral atherosclerosis during perioperative anesthesia.The magnitude of the deviation between the two is significantly and positively correlated with the level of blood pressure, suggesting that we should appropriately choose the method of blood pressure measurement in the perioperative period to correctly evaluate the blood pressure of these elderly patients.