[Treatment strategy of congenital tracheal stenosis associated with non-vascular ring cardiac malformations].

Objective: To examine the treatment strategy of congenital tracheal stenosis associated with non-vascular ring cardiac malformations. Methods: This is a retrospective case series. Clinic data from 24 children with tracheal stenosis who underwent surgical treatment in the Department of Cardiac Surgery, Children's Hospital Affiliated to Shandong University from February 2017 to March 2023 were retrospectively collected. There were 16 males and 8 females, aged (M(IQR)) 6.5 (19.6) months (range: 2.2 to 66.3 months) and weighted 5.95 (4.76) kg (range: 3.2 to 20.0 kg). All patients had obvious respiratory symptoms. Eighteen patients underwent cardiac malformation correction and tracheoplasty at the same time (simultaneous group). Six patients in the staged operation group were treated with cardiac malformation correction in the first stage operation and tracheoplasty in the second stage operation due to missed diagnosis or delayed diagnosis of tracheal stenosis or no condition for tracheoplasty. Slide tracheoplasty was used to correct tracheal stenosis in both groups. The recovery of the children was followed. Wilcoxon sign rank test was used for comparison between the two groups. Results: There was no death during the perioperative period and hospitalization. In the simultaneous group, 1 case with delayed chest closure underwent bedside chest closure after 52 hours, 2 cases were intubated again after operation, and 1 case was implanted with an endotracheal stent. The duration of mechanical ventilation was 40.5 (39.6) hours (range: 19.0 to 438.8 hours). In the staged group, there was 1 case of re-intubation after operation, combined with left vocal cord paralysis and respiratory multidrug-resistant bacterial infection (Acinetobacter baumanii). One patient underwent 3 times of bronchoscopic balloon dilatation of the right middle bronchus, and heart rate returned to normal range. The duration of mechanical ventilation was 19.0 (21.4) hours (range: 17.1 to 96.7 hours). During follow-up, a patient in the simultaneous group was prone to respiratory infection and had good exercise tolerance, 1 patient in the staged group still had sputum stridor in the throat 3 months after the operation, and symptoms improved significantly 6 months after the operation. The other children didn't have obvious respiratory symptoms. Conclusions: The diagnosis of tracheal stenosis may be delayed or missed when tracheal stenosis is complicated by non-vascular ring cardiac malformations. One-stage correction of tracheal stenosis and cardiac malformation can achieve a good outcome.

[The characteristics and citation analysis of the publications in the National Medical Journal of China from 2017 to 2019].

Objective: To analyze the characteristics and citation of National Medical Journal of China (NMJC) from 2017 to 2019, and provide reference for the development of the journal. Methods: All the literature published in NMJC during the period 2017 to 2019 was selected as the research objects, and the citation frequency data in Chinese core periodicals of science and technology from January 2018 to December 2021 were obtained through Institute of Scientific and Technical Information of China. The main indicators included the citation rate of published articles, average citation frequency of articles, citation status of individual papers, high citation authors and their affiliations from 2017 to 2019. Results: A total of 2 694 articles were published in 21 columns of NMJC from 2017 to 2019. The total number of published pages was 11 689, and the average number of articles was 4.34 pages. The total number of cited papers was 1 849, accounting for 68.63%. Among them, 845 papers were not cited, accounting for 31.37%. The total citation times was 6 578, with an average citation of 2.44 times. The highest citation frequency of a single paper was 217 times. A total of 54.27% articles obtained fund support, and the cited rate (72.78%) was slightly higher than that of articles without fund support (63.72%). Standard and specification articles were cited 1 817 times, with a citation rate of 96.67%, and 66 articles were cited more than 10 times. The columns with more than 30 articles but all cited less than 1 time included case report and difficult case analysis. The first author was from 31 provinces (autonomous regions, municipalities directly under the Central Government) in China. There were 21 corresponding authors whose papers have been cited more than 30 times, and 18 of them were from major hospitals and science academies in Beijing. Conclusions: NMJC has a wide coverage of contributions and strong academic influence during the period 2017 to 2019. The cited frequency of standard and specification articles is high, while case report and difficult case analysis evaluation column articles have very low cited frequencies. Therefore, NMJC should further adjust column setting, improve the academic quality, reduce the number of zero cited papers, and thus enhance the influence of the magazine.

[Surgical treatment strategy of pulmonary artery sling: a series of 110 cases].

Objective: To examine the effect of surgical treatment in children with pulmonary artery sling and the surgical treatment strategy. Methods: Relevant data of 110 children with pulmonary artery sling admitted to the Department of Cardiac Surgery, Children's Hospital Affiliated to Shandong University from February 2017 to July 2022 were retrospectively analyzed. There were 55 males and 55 females, aging (M(IQR)) 9.0 (10.6) months (range: 1 to 96 months). The weight was 7.8 (3.5) kg (range: 2.5 to 25.0 kg). Of the 110 patients, 108 had different degrees of tracheal stenosis and 2 had normal trachea. Left pulmonary artery transplantation and tracheoplasty were performed in 78 patients. Left pulmonary artery transplantation was performed in 30 patients (11 in our hospital and 19 in other hospitals) due to the lack of an early tracheoplasty technique, in which 24 patients needed stage Ⅱ tracheoplasty due to obvious respiratory symptoms and limited activity endurance, and 6 cases did not intervene. Two children with normal trachea only underwent left pulmonary artery transplantation. Results: Among the 78 children who underwent surgery in the same period, 70 cases recovered smoothly after surgery, of whom respiratory symptoms were significantly reduced or disappeared during the 1 to 65 months follow-up, with similar activity endurance to normal children of the same age. Eight cases died, including 4 cases of postoperative multi-drug resistant bacteria infection, died from tracheal anastomotic opening or septic shock, 1 cases with severe congenital heart disease died from postoperative low cardiac output syndrome difficult to correct, 1 case died from blood pressure could not be maintained due to the compressed left pulmonary artery after transplantation, 2 cases of postoperative digestive system diseases (adhesive intestinal obstruction, gastrointestinal bleeding, etc.). The 24 patients in the staging group were followed for 1 to 84 months. All patients needed stage Ⅱ tracheoplasty due to respiratory symptoms and decreased endurance to activity. Eight cases of the non-intervention tracheal group were successfully separated from the ventilator, cured and discharged in a short period of time. Conclusions: Most children with pulmonary artery sling have tracheal stenosis. Children with low degree of tracheal stenosis and inconspicuous respiratory symptoms can only undergo left pulmonary artery transplantation by lateral thoracotomy. For patients combined with severe tracheal stenosis or obvious respiratory symptoms, a simultaneous left pulmonary artery transplantat and tracheoplasty is recommended.

[Evaluation of right ventricular function using two-dimensional speckle tracking echocardiography and analysis of the risk factors for right ventricular dysfunction in patients with silicosis].

Objective: To evaluate the right ventricular function using two-dimensional speckle tracking echocardiography (2-D STE) and analyze the associated risk factors of right ventricular dysfunction in patients with silicosis. Methods: All 104 patients with silicosis treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital, Capital Medical University from May 2021 to September 2022 were enrolled in this study in October 2022. The clinical information of patients such as general data, arterial blood gas analysis and pulmonary function test were collected. The right ventricular function of patients was evaluated by 2-D STE-derived right ventricular free wall longitudinal strain (RVFWLS) and conventional echocardiographic-derived parameters, including right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'), respectively. Based on their RVFWLS, the patients were divided into right ventricular dysfunction group and normal right ventricular function group. Risk factors for right ventricular dysfunction in patients with silicosis were analyzed using binary logistic regression analysis. Results: A total of 104 silicosis patients were enrolled, with aneverage age (65.52±11.18) years old, among whom including 57 cases diagnosed with stage Ⅰ/Ⅱ silicosis and 47 cases diagnosed with stage Ⅲ silicosis. 26 (25.00%) patients concurrent right ventricular dysfunction. The abnormal rates of RVFAC, TAPSE and S' in patients were 16.35% (17 cases), 21.15% (22 cases) and 6.73% (7 cases), respectively. The RVFAC and TAPSE in right ventricular dysfunction group were lower than those in normal right ventricular function group, and the incidence of pulmonary arterial systolic pressure ≥36 mmHg was higher than that in normal right ventricular function group (P<0.05). Logistic regression analysis showed that arterial partial pressure of oxygen (OR=0.932, 95%CI: 0.885-0.981, P=0.007) was the protective factor, and the forced expiratory volume in 1 second (FEV(1)) /forced vital capacity (FVC) ratio<70% (OR=5.484, 95%CI: 1.049-28.662, P=0.044) and stage Ⅲ silicosis (OR=6.343, 95%CI: 1.698-23.697, P=0.007) were the risk factors for silicosis patients concurrent right ventricular dysfunction. Conclusion: The incidence of right ventricular dysfunction is higher in patients with stage Ⅲ silicosis than that in patients with stage Ⅰ/Ⅱ silicosis. Using 2-D STE can help the early detection of silicosis with right ventricular dysfunction. Hypoxemia, airflow limitation and the stage Ⅲ silicosis are the risk factors for silicosis patients concurrent right ventricular dysfunction.

[Scoping review of progress in cohort studies of autism spectrum disorder].

Objective: To understand the status of autism spectrum disorder (ASD) cohort studies and explore the feasibility of constructing ASD disease-specific cohorts based on real-world data (RWD). Methods: ASD cohort studies published by December 2022 were collected by literature retrieval from major Chinese and English databases. And the characteristics of the cohort were summarized. Results: A total of 1 702 ASD cohort studies were included, and only 60 (3.53%) were from China. A total of 163 ASD-related cohorts were screened, of which 55.83% were birth cohorts, 28.22% were ASD-specific cohorts, and 4.91% were ASD high-risk cohorts. Most cohorts used RWD such as hospital registries or conducted community-based field surveys to obtain participant information and identified patients with ASD by scales or clinical diagnoses. The contents of the studies included ASD incidence and prognostic risk factors, ASD comorbidity patterns and the impact of ASD on self-health and their offspring's health. Conclusions: ASD cohort studies in developed countries have been in the advanced stage, while the Chinese studies are still in their infancy. RWD provides the data basis for ASD-specific cohort construction and offers new opportunities for research, but work such as case validation is still needed to ensure the scientific nature of cohort construction.

[Development of a Ranking Tool for Scientificity, Transparency and Applicability of Clinical Practice Guidelines].

Objective: To address the limitations of existing methods and tools for evaluating clinical practice guidelines, we aimed to develop a comprehensive instrument focusing on the three main dimensions of guideline development: scientificity, transparency, applicability. We will use it to rank the guidelines according to the scores. We abbreviated it as STAR, and its reliability, validity and usability were also tested. Methods: A multidisciplinary expert working group was set up, including methodologists, statisticians, journal editors, medical professionals, and others. Scoping review, Delphi methods and hierarchical analysis were used to determine the final checklist of STAR. Results: The new instrument contained 11 domains and 39 items. Intrinsic reliability of each domain was indicated by Cronbach's α coefficient, with a average value of 0.646. The Cohen's kappa coefficients for methodological evaluators and clinical evaluators were 0.783 and 0.618. The overall content validity index was 0.905. The R2 for the criterion validity analysis was 0.76. The average score for usability of the items was 4.6, and the mean time spent to evaluate each guideline was 20 minutes. Conclusion: The instrument has good reliability, validity and evaluating efficiency, and can be used for evaluating and ranking guidelines more comprehensively.

[Surgical tracheoplasty for children with congenital tracheal stenosis undergoing previous balloon dilatation or tracheal metal stent placement: a series of 9 cases].

Objective: To examine the outcomes of Slide tracheoplasty for the children with severe congenital tracheal stenosis received previous repeated balloon dilatation or metal stent placement under endoscopy. Methods: A retrospective study was conducted in 9 children with congenital tracheal stenosis undergoing previous interventional therapy under tracheoscopy and later received Slide tracheoplasty due to obvious respiratory symptoms at Department of Cardiac Surgery, Qilu Children's Hospital of Shandong University between February 2017 and July 2021. There were 7 males and 2 females with a median age at operation of 72.4 months (range: 13.3 to 98.9 months), and the median weight was 19.0 kg (range: 9.0 to 33.0 kg). Among the 9 patients, 2 patients began to receive repeated balloon dilatation (more than 3 times) 17.8 and 51.8 months ago respectively. One patient received metal stents placement into the trachea for 4 days and the other 6 children for median 56.8 months (range: 21.6 to 74.2 months). Complete tracheal cartilage rings and long segmental stenosis were present. in all 9 children. Operative details and outcome measures, including the need for endoscopic airway intervention and mortality, were collected. Results: Slide tracheoplasty was performed in all cases. Two patients with repeated balloon dilatation had different thickness of tracheal wall, local scar hyperplasia and irregular lumen. Among them, 1 case had obvious local calcification of tracheal wall, which was difficult to suture. The metal stent in one patient with short time of placement was completely removed. However, only part of the metal stents could be removed due to the long placement time in the other 6 cases. There was no operative death in the 9 children. The median postoperative tracheal intubation time was 25.3 hours (range: 17.4 to 74.5 hours). A silicone stent was placed in the trachea of 1 child due to obvious respiratory symptoms. Follow-up of median 11 months (range: 1 to 23 months) showed that no death occurred after discharge and all children had basically normal activity tolerance with no obvious respiratory symptoms. Conclusions: Slide tracheoplasty is feasible for children undergoing prior balloon dilatation or metal stents placement. Previously repeated balloon dilatation or metal stent placement under endoscopy increased the difficulty of slide tracheoplasty, the metal stent could not be completely removed after a long time.

[Systematic review on the reform of disease prevention and control system in China].

Objective: To systematically understand the reform progress of disease prevention and control system in China. Methods: The literature regarding the reform of China's disease prevention and control system was searched by using the keywords including disease prevention and control, center for disease prevention and control (CDC), disease control, reform, and system from 2003 to 2020 in China CNKI, Wanfang Data knowledge service platform, VIP information and China biomedical literature database. The language is limited to Chinese. A total of 25 studies were included to analyze the information about the organizational structure, functional orientation, financing mechanism and personnel system of China's disease prevention and control system. Results: The 25 studies described the specific changes and reform suggestions of China's disease prevention and control system, including key policies (7 studies), organizational structure transformation (4 studies), institutional function transformation (7 studies), financing mechanism transformation (5 studies), personnel system reform (2 studies), and performance-based salary system reform (4 studies). Meanwhile, the reform suggestions were concluded at the top-level design system reform (two aspects), organization structure (three aspects), functioning (four aspects), and personnel guarantee mechanism (three aspects). Conclusions: This study indicates that there is a lack of empirical evidence regarding specific reform effects and content analysis at the micro level of disease prevention and control system in China. Future study should strengthen the rigorousness of study design and focus on the quantitative impacts of reform implementation in China.

[The characteristics and citation analysis of the publications in National Medical Journal of China during 2016].

Objective: To analyze the characteristics and citations of articles in National Medical Journal of China (NMJC) during 2016, and to discuss the academic level and quality of the journal. Methods: All the literature published in NMJC during 2016 were retrieved through the Chinese Medical Citation index, and the citation frequency data in China's core journals of science and technology from January 2017 to December 2018 was obtained through Institute of Scientific and Technical Information of China. The citation status of articles published in NMJC was statistically analyzed by the method of literature metrology. The main indicators included the citation rate of articles published in each year, the citation frequency of all articles, the citation status of individual papers and authors, the regional and high-yield institution distribution of cited authors, and the main citation journals. Results: In 2016, a total of 962 articles were published in 22 columns of NMJC. The total number of published pages was 3 940, and the average number of articles was 4.09 pages. A total of 28 key topics have been published. The total citation was 2 077 times, with 2.16 times per paper. Among them, 322 papers were not cited, accounting for 33.47%. The maximum citation frequency of a single paper was 66 times. There were good citations in the columns of Guidelines, Epidemiology, New technology and methods, Clinical research and Editorial. Oncology, neurology/psychiatry, imaging/ultrasound/radiology, respiratory medicine and orthopedics accounted for a large part [40.43% (389 articles)]. Articles in neurosurgery, respiratory medicine, preventive medicine and gastrointestinal surgery were all cited with high frequency (all ≥2.75 times/article). A total of 483(50.21%) articles had obtained fund support, and the rate (68.12%) of them cited was slightly higher than that of articles without fund support (64.93%). A total of 23 articles were cited ≥10 times, and 16 first authors were cited ≥10 times. In addation, 26 corresponding authors were cited ≥10 times and 10 institutions were cited more than 15 times. The authors of the cited papers were distributed in 29 provinces (autonomous regions, municipalities directly under the central government), and there were more articles and higher total citation frequency in Beijing, Shanghai, Jiangsu and Tianjin. From 2017 to 2018, papers published in NMJC were cited 2 077 times by a total of 490 journals. Conclusions: The guidelines published in NMJC is highly cited. The editorial department should adjust the column setting timely, strengthen the planning of key topic selection and the solicitation and publicity of excellent papers, and further improve the influence of the magazine.

[The citation analysis of the publications in Chinese Journal of Preventive Medicine from 2014 to 2017].

Objective: To analyze the characteristics and citations of articles in Chinese Journal of Preventive Medicine from 2014 to 2017, and discuss the academic level and quality of the journal. Methods: All the literatures published in Chinese Journal of Preventive Medicine from 2014 to 2017 were retrieved through the Chinese Medical Citation index, and the citation frequency data in China's core journals of science and technology from 2014 to 2018 was obtained through Institute of Scientific and Technical Information of China. The citation status of articles published in Chinese Journal of Preventive Medicine was statistically analyzed by the scientometric method. The main indicators included the citation rate of articles published in each year, the citation frequency of all articles, the citation status of individual papers and authors, the regional and high-yield institution distribution of cited authors, and the main citation journals. Results: From 2014 to 2017, a total of 929 articles were published in 19 columns of Chinese Journal of Preventive Medicine, and the number of each year was 253 (27.23%), 231 (24.87%), 224 (24.11%) and 221 (23.79%), respectively. The total number of published pages was 3 564, and the average number of articles was 3.45 pages. A total of 28 key topics have been published. The total citation was 3 861 times, with 4.16 times per paper. Among them, 161 papers were not cited，accounting for 17.33%. The maximum citation frequency of a single paper was 49 times. There were good citations in the columns of original article and methodology introduction. There was no correlation between fund project support and paper citation. But the cited rate (93.67%) and cited frequency of special issue ï¼»M (P25, P75)=3 (1, 6)ï¼½ were higher compared with the cited rate (80.42%; χ2=16.08, P<0.001) and cited frequency ï¼»M (P25, P75)=2 (1, 6); Z=2.56, P=0.010] of free-lance articles. A total of 15 authors were cited more than 25 times, and 15 articles were cited more than 20 times. There were 213 institutions involved in the 768 cited papers, among which 12 institutions were cited more than 50 times. The authors of the cited papers were distributed in 28 provinces (autonomous regions, municipalities directly under the central government). From 2014 to 2018, a total of 281 journals cited the papers published in our journal, of which 12 journals cited more than 50 times. Conclusion: The quality of the literature in Chinese Journal of Preventive Medicine is high and the journal has a strong influence in the field of preventive medicine and public health in China. The editorial department should adjust the column setting timely, strengthen the planning of key topic selection and the solicitation and publicity of excellent papers, reduce the number of papers cited by zero, and further improve the influence of the magazine.

[Interpretation for the group standard of Health check-up guide for rural residents].

With the acceleration of the population aging in China, the health problems and the demands of health services such as health check-up for rural residents should attract the attention of the whole society. The group standard entitled Health check-up guide for rural residents (T/CHAA 005-2019), was written by experienced researchers from Chinese Center for Disease Control and Prevention and other professional institutes coordinated by Chinese Health Association. The standard aims to establish a service model that takes health information collection as a means, health risk assessment, health risk intervention and information services as the core, improving the health of rural residents as the target.

[Risk related to bias assessment: (4) Revised Cochrane Risk of Bias Tool for cluster-randomized control trials (RoB2.0)].

This paper introduced the Revised Cochrane Risk of Bias Tool RoB2.0 for cluster-randomized control trials (CRCT) and compared RoB2.0 of CRCT with individually randomized, parallel group trials, and illustrated the application of RoB2.0 for CRCT in a published CRCT. Special signal questions were designed for CRCT according to its specialty that different from individually randomized, parallel group trials in RoB2.0 and also providing information on risk of bias about CRCT in systematic reviews for the synthesis of evidence.

[Study on polymorphisms of genes with susceptibility to drug induced liver injury in a cohort receiving anti-tuberculosis treatment].

OBJECTIVE: To investigate the association between the polymorphisms of genes involving in drug metabolism and transport as well as immunological reaction and the risk of anti-tuberculosis drug-induced liver injury(ATLI)in Chinese. METHODS: This 1∶4 matched case-control study was conducted by using the data from a cohort study of Anti-tuberculosis Drugs Induced Adverse Reactions in National Tuberculosis Prevention and Control Progtam of China. Genes involving in three phase of drug metabolism and transport as well as related immunological reaction were chosen and single nucleotide polymorphisms(SNPs)were genotyped by TaqMan allele discrimination technology. Lasso regression and multivariate conditional logistic regression analysis were used to select susceptible genes. RESULTS: A total of 33 genes with 75 SNPs were tested. The combined results of Lasso and regression logistic regression analysis showed that genetic polymorphism of SLCO1B1 rs4149014, HSPA1L rs2227956, STAT3 rs1053023 and IL-6 rs2066992 were significantly associated with the risk of ATLI(P<0.05). CONCLUSION: SLCO1B1, HSPA1L, STAT3 and IL-6 might be the susceptibility genes of drug induced liver injury in patients receiving anti-tuberculosis treatment.