Fellowship training of family medicine in the United States and its implications for China / 中华全科医师杂志

The study utilized a cross-sectional design. Data was retrieved from the American Academy of Family Physicians fellowship training directory, including program names, areas of focus, program length, and program descriptions. The collected data was categorized and analyzed based on areas of focus and training duration. The program descriptions were also analyzed qualitatively using Nvivo12 software. A total of 532 programs were included in the study:295 programs (55.5%) were ACGME-certified, while 237 programs (44.5%) were not. The majority of programs, 468 (87.9%), were clinically oriented, while 64 programs (12.1%) were non-clinical. Among ACGME-certified programs, the largest number of programs were in sports medicine (121 programs), followed by geriatrics (52 programs). Among non-certified programs, the largest number of programs was in obstetrics (66 programs), accounting for 27.8% of all non-certified programs. Qualitative research found that fellowship programs were diverse, reflecting the societal demands of healthcare service. Moreover, a significant emphasis was placed on empowering teaching and research abilities.The family medicine fellowship programs in the United States cover a wide range of disciplines and meet both the professional interests of doctors and the needs of patients. As China continues to implement its tiered medical system, it can learn from the experience of the United States and develop general practice subspecialty training programs, thereby improving the service capacity of general practitioners and improve the quality of healthcare.

Preliminary exploration of Internet-based practice of stomatology hospitals / 中华医院管理杂志

Internet-based practice of stomatology hospitals plays an important role in promoting hierarchical medical system and overcoming the social problems of " high costs and difficulties of medical services" . The authors introduced the practice of free online consultations at a tertiary stomatology hospital during this period. They also analyzed such characteristics of the practice as the doctors′ response rate, doctors′ response timeliness, as well as the specialties and timeframe distribution of patient consultations. The hospital provides online consultations on Guangdong cloud-based hospital platform in two modes. For example, the normal consultation mode operates in a many-many manner, with services provided by attendings and associate chief physicians appointed less than three years. In off hours, patients can also raise questions online. The expert consultation mode offers consultations during business hours in a one-to-one manner, with services provided by associate chief physicians appointed over three years and chief physicians. From February 10 to March 22 2020, 2 156 persons/times of consultations were served in the normal mode, and 1 043 persons/times received in the expert mode. The response timelines of the latter (16.19 min) was much better than the former (27.10 min). In terms of consultation workload of sub-specialties, oral medicine ranked the top (69.30%), while the consultations of the normal mode in work hours accounted for only 73.47% of total consultation workload. It is recommended to optimize resources deployment, introduce artificial intelligent inquiry service, explore an online-offline combined stomatological service, and improve performance management. These measures, when in place, can promote sustainable development of Internet-based stomatology hospitals.

Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the ‘beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification. MATERIALS AND METHODS: One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). CONCLUSION: In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.

Secular trends of overweight and obesity prevalence between 2007 and 2011 in children and adolescents in Guangzhou / 中华预防医学杂志

<p><b>OBJECTIVE</b>This study aimed to explore the secular trends of overweight and obesity prevalence between 2007 and 2011 in children and adolescents in Guangzhou.</p><p><b>METHODS</b>The data of physical examination was collected from the routine measurements carried out by the Health Care Facilities of Primary and Secondary schools between 2007 and 2011. Random stratified cluster sampling was conducted, all the students aged 5-18 years old form 19 primary and secondary schools from 4 districts (Tianhe district, Yuexiu district, Baiyun district and Haizhu district) were included in this survey, including 27 944 students in 2007 and 38 284 students in 2011. Body mass index reference norm established by Working Group on Obesity in China (WGOC) and the WHO cut-off criteria were employed for overweight and obesity screening, and the trend was analyzed.</p><p><b>RESULTS</b>Prevalence of obesity in children and adolescents (7-18 years old) significantly increased from 5.96% (1 553/26 055) in 2007 to 6.56% (2 339/35 664) in 2011, and the difference showed statistical significance (χ(2) = 9.195, P < 0.05). Overweight and obesity was more common in boys (overweight: 13.25% (1 766/13 329) in 2007 and 13.87% (2 559/18 451) in 2011; obesity: 7.82% (1 042/13 329) in 2007 and 8.63% (1 592/18 451) in 2011) than in girls (overweight: 7.43% (946/12 726) in 2007 and 8.17% (1 406/17 213) in 2011; obesity: 4.11% (523/12 726) in 2007 and 4.48% (771/17 213) in 2011), and the difference showed statistical significance (overweight:χ(2) = 236.123 in 2007 and χ(2) = 292.892 in 2011; obesity:χ(2) = 158.533 in 2007 and χ(2) = 247.794 in 2011. All P values < 0.05). Further analysis found that significant increases occurred in boys aged 16 and 17 years old and in girls aged 12 years old (boy: 16 years old,χ(2) = 6.820, P < 0.05. 17 years old, χ(2) = 4.893, P < 0.05. girl: 12 years old,χ(2) = 5.921, P < 0.05).</p><p><b>RESULTS</b>of Join-point regression showed that for boys less than 10 years old the prevalence increased with age increasing (in 2007, APC = 3.75; in 2011, APC = 1.76), while over 10 years old the prevalence decreased with age increasing (in 2007, 10-18 years old's APC = -18.58; in 2011, 10-18 years old's APC = -15.95). While for girls the prevalence of obesity increased with age increasing between 7-9 years old (APC = 12.16), decreased with age increasing through 9 to 18 years old (APC = -17.23) in 2007. The prevalence decreased with age increasing for girls in 2011 (APC = -4.66).</p><p><b>CONCLUSION</b>The prevalence of obesity is high and still increasing in children and adolescents in Guangzhou, and it is higher in boys than in girls. It is more likely to become obesity at 10 years for boys, and for girls the prevalence decrease with age increasing.</p>

Regional cerebral blood flow in children with autism spectrum disorders: a quantitative ⁹⁹mTc-ECD brain SPECT study with statistical parametric mapping evaluation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Autism spectrum disorders (ASD), which include autism, asperger syndrome (AS) and pervasive developmental disorder-not otherwise specified (PDD-NOS), are devastating neurodevelopmental disorders of childhood resulting in deficits in social interaction, repetitive patterns of behaviors, and restricted interests and activities. Single photon emission computed tomography (SPECT) is a common technique used to measure regional cerebral blood flow (rCBF). Several studies have measured rCBF in children with ASD using SPECT, however, findings are discordant. In addition, the majority of subjects used in these studies were autistic. In this study, we aimed to investigate changes in rCBF in children with ASD using SPECT.</p><p><b>METHODS</b>A Technetium-99m-ethyl cysteinate dimmer (⁹⁹m)Tc-ECD) brain SPECT study was performed on an ASD group consisting of 23 children (3 girls and 20 boys; mean age (7.2 ± 3.0) years) who were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria and an age-matched control group with 8 children (1 girl and 7 boys, mean age (5.5 ± 2.4) years). Image data were evaluated with Statistical Parametric Mapping, 5th version (SPM5). A Student's t test for unpaired data was used to compare rCBF and asymmetry in the autism and corresponding control group. The covariance analysis, taking age as covariance, was performed between the ASD and control group.</p><p><b>RESULTS</b>There was a significant reduction in rCBF in the bilateral frontal lobe (frontal poles, arcula frontal gyrus) and the bilateral basal ganglia in the autism group, and a reduction in the bilateral frontal, temporal, parietal, legumina nucleus and cerebellum in the AS group compared to the control. In addition, asymmetry of hemispheric hypoperfusion in the ASD group was observed. Inner-group comparison analysis revealed that rCBF decreased significantly in the bilateral frontal lobe (42.7%), basal nucleus (24.9%) and temporal lobe (22.8%) in the autism group, and in the bilateral cerebellum (22.8%), basal nucleus (19.3%) and right thalamencephalon (16.6%) in the AS group (P < 0.05).</p><p><b>CONCLUSIONS</b>The decrease in rCBF in ASD is a global event, which involves the bilateral frontal, temporal, limbic system and basal ganglias. Asymmetry of hemispheric hypoperfusion was more obvious in the AS group than the autism group, which indicates a different neurobiological mechanism from that of autism.</p>

Research on the relation between ACE gene I/D polymorphisms and sensitivity to endurance training of Han nationality male / 中国应用生理学杂志

<p><b>AIM</b>In order to seek the marks of the genes, the relation between the influence of endurance training on aerobic ability and ACE Gene I/D Polymorphisms were studied.</p><p><b>METHODS</b>102 army recruits of Han nationality from North China for an 18 week en durance training of 5000m distance. Their VO2(max), VT and the left ventricular structure and function were measured before and after the training. We also tested their ACE Gene I/D Polymorphisms with PCR-AFLP method.</p><p><b>RESULTS</b>The compliance of VO2(max), VT and left ventricular structure and function had improved after the training; the deltaVO2(max) of ID and II type was obviously higher than that of DD type (P < 0.05); there was obviously diference of deltaVO2(VT) in different ACE genotype (P < 0.05), the deltaVO2(VT) of type II was obviously higher than that of DD type (P < 0.05).</p><p><b>CONCLUSION</b>I allele has obviously hereditary advantage on the sensitivity to aerobic training in VO2(max) and VT, and type II has relation on the sensitivity to aerobic training in VT; there is no relation between I/D polymorphism and the sensitivity to aerobic training on the structure and function of left ventricle.</p>