Zhonghua yi xue za zhi最新文献

In China, stroke is characterized by high incidence, high disability rate, and high recurrence rate. Coupled with population decline and deep aging, it poses challenges to public health and the economy. The "Million Disability Reduction Project" has made progress in stroke prevention and treatment, yet shortcomings remain, such as inadequate hypertension management and disconnection between screening and prevention. Drawing on relevant experiences from the United States, Japan, and the United Kingdom, Haian City in Jiangsu Province has established a county-township-village three-level grid-based system, realizing full-process intervention covering prevention, screening, diagnosis, treatment, management, and rehabilitation. This study puts forward suggestions including strengthening top-level policy coordination, implementing prevention-oriented strategies, and improving long-term support mechanisms, which aims to build a new grid-based system for chronic disease prevention and treatment, and provide support for the Healthy China Initiative and Chinese modernization.

Objective: To assess the impact of the Jilin Province Stroke Emergency Map (JSEM) initiative on the efficiency of emergency care for acute ischemic stroke. Methods: This study utilized data from the Jilin Stroke Center Construction Management Information System to describe the contruction of the regional stroke emergency network in Jilin Province since the JSEM initiative launched. Comparisons were made regarding the number and proportion of acute ischemic stroke patients receiving intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), as well as the Emergency Medical Services (EMS) response times, during the following periods: the 1-year pre-JSEM period (August 2016-July 2017), and the 1-year periods following the release of JSEM Version 1 (August 2017-July 2018), Version 2 (August 2018-July 2019), Version 4 (December 2021-November 2022), and Version 5 (August 2023-July 2024). Results: As JSEM evolved from Version 1 (August 2017) to Version 6 (September 2024), the number of hospitals in Jilin Province with IVT capability increased from 19 to 71, and those with MT capability increased from 10 to 30. With the increase in IVT-capable hospitals within the JSEM network, the number of acute ischemic stroke patients receiving IVT in Jilin Province has increased continuously, from 2 585 cases in the year pre-Version 1 to 9 464 cases within the year following Version 5 release. The IVT rate among the patients entering the"green channel"of stroke also increased from 3.3% (2 585/78 063)to 5.5%(9 464/172 951). The median door-to-needle time decreased from 62 (54, 71) minutes pre-Version 1 to 51 (43, 60) minutes post-Version 5. Meanwhile, the number of patients receiving emergency MT in Jilin Province rose from 457 cases pre-Version 1 to 1 337 cases post-Version 5; the MT rate among patients entering the"green channel"of stroke increased from 0.6% (457/78 063) to 0.8% (1 337/172 951). Treatment timeliness for MT also improved: the door-to-puncture time shortened from 136 (104, 157) minutes pre-Version 1 to 112 (94, 143) minutes post-Version 5. Conclusions: The launch and promotion of JSEM effectively reduces stroke-induced death and disability rates by optimizing the provincial stroke emergency network, reducing pre-and post admission delays, and enhancing treatment efficiency, which contributes to achieving the goals of the national"One Million Disability Reduction Project".

Objective: To investigate the trends in the quality of reperfusion therapy for acute ischemic stroke in Beijing from 2018 to 2024. Methods: Data of acute ischemic stroke patients who underwent reperfusion therapy between 2018 and 2024 was retrospectively collected using stroke emergency quality control data from the Beijing Center for Stroke Quality Control and Improvement. The Mann-Whitney U test was used to compare door-to-needle time (DNT) and door-to-puncture time (DPT) between hospital tiers and regions. Trends in DNT and DPT were assessed using Joinpoint Regression (version 4.8.0.1), and the average annual percentage change (AAPC) was calculated. Results: From 2018 to 2024, the number of institutions capable of performing intravenous thrombolysis increased from 76 to 86, and those capable of performing mechanical thrombectomy increased from 50 to 58. During this period, a total of 41 860 intravenous thrombolysis procedures were performed. The annual number of intravenous thrombolysis cases increased from 3 913 in 2018 to 8 702 in 2024. The median DNT [M(Q₁, Q₃)]decreased significantly from 51 (36, 72) minutes in 2018 to 37 (28, 49) minutes in 2024 (AAPC=-5.13%, P<0.001). A total of 10 383 mechanical thrombectomy procedures were performed from 2018 to 2024. The annual number of mechanical thrombectomy cases increased from 841 in 2018 to 2 614 in 2024. The median DPT showed a non-significant decrease from 119 (85, 169) minutes to 117 (80, 178) minutes (AAPC=-0.95%, P=0.504). In tertiary hospitals, DNT decreased from 51 (36, 73) minutes to 37 (29, 50) minutes (AAPC=-5.15%, P<0.001), while in secondary hospitals, it decreased from 50 (40, 66) minutes to 30 (25, 40) minutes (AAPC=-7.73%, P<0.001). The DPT trend showed no statistically significant difference both in tertiary hospitals (AAPC=-1.94%, P=0.154) and secondary hospitals (AAPC=2.64%, P=0.251). In urban areas of Beijing, DNT decreased from 47 (32, 66) minutes to 36 (27, 50) minutes (AAPC=-4.50%, P<0.001), while DPT showed a non-significant decrease from 115 (83, 165) minutes to 112 (76, 175) minutes (AAPC=-1.56%, P=0.410). In suburban areas of Beijing, DNT decreased significantly from 58 (45, 81) minutes to 37 (30, 48) minutes (AAPC=-6.05%, P=0.010), while DPT showed a non-significant decrease from 136 (95, 181) minutes to 128 (90, 183) minutes (AAPC=-0.76%, P=0.459). Conclusion: From 2018 to 2024, the number of reperfusion therapy cases for acute ischemic stroke in Beijing increased, accompanied by a significant reduction in DNT.

Objective: To compare the diagnostic and therapeutic preferences for Graves' disease (GD) between Chinese and international endocrinologists. Methods: A secondary analysis was conducted on the results of a global questionnaire survey on the management preferences for GD from May 1 to August 31, 2023. The questionnaire consisted of 31 items covering the diagnosis and treatment of GD, as well as the management of patients under different clinical scenarios, including those with pregnancy plans or concurrent pregnancy, and those with recurrent GD. Differences in responses between endocrinologists in China and those in other countries were compared. Results: A total of 991 questionnaire responses from interviewed endocrinologists were deemed valid data, including 380 males, 604 females, and 7 physicians who declined to answer. Among them, there were 108 Chinese endocrinologists and 883 foreign endocrinologists. The age of Chinese endocrinologists was mainly concentrated in the 36-45 age group (43.5%, 47/108), while foreign endocrinologists were mostly over 45 years old (56.9%, 502/883). For the diagnosis of GD, both Chinese and foreign endocrinologists selected thyrotropin receptor antibody (TRAb), thyroid peroxidase antibody (TPOAb), free triiodothyronine (FT3), and thyroid-stimulating hormone re-examination as diagnostic indicators. The proportion of Chinese endocrinologists choosing TRAb [98.1% (106/108) vs 75.4% (666/883)], TPOAb [84.3% (91/108) vs 40.8% (360/883)], thyroglobulin antibody (TgAb) [82.4% (89/108) vs 24.7% (218/883)], and FT3 [58.3% (63/108) vs 28.1% (248/883)] was higher than that of foreign endocrinologists (all P<0.001). For GD treatment, antithyroid drugs (ATD) were selected as the preferred treatment method by both Chinese and foreign endocrinologists [95.4% (103/108) vs 94.2% (832/883), P=0.637]. When treating GD patients with pregnancy plans or concurrent pregnancy, Chinese endocrinologists were more likely to choose ATD or radioactive iodine therapy compared to foreign endocrinologists (both P<0.05). For patients with recurrent GD, Chinese endocrinologists had a significantly higher proportion of selecting long-term (≥24 months) ATD treatment compared to foreign endocrinologists (P<0.001). Conclusions: Chinese endocrinologists generally share similar core diagnostic and therapeutic strategy preferences (in terms of diagnostic items and first-choice medications) with their foreign counterparts for GD. However, they exhibit a higher selection rate for certain examination items and demonstrate differences from foreign endocrinologists in terms of treatment approaches and duration preferences for special GD patients.

Objective: To explore the correlation between obesity and ultrasonic malignant features of papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was conducted on 8 483 patients who underwent thyroid surgery and were postoperatively diagnosed with PTC at China-Japan Union Hospital of Jilin University between January 2008 and December 2017. The cohort included 1 580 males and 6 903 females, with the age [M(Q₁,Q₃)] of 42.0(36.0,49.0) years. Patients were divided into the non-obese group and the obese group based on whether their body mass index was≥28 kg/m². Propensity score matching (PSM) was employed to conduct 1∶1 matching for variables such as gender and history of diabetes. Core ultrasound features and thyroid imaging reporting and data system (TIRADS) scores were compared between the two groups. Subgroup analyses were performed based on gender. A multivariate logistic regression model was employed to analyze the correlation between obesity and malignant ultrasonic features of PTC. Results: After PSM, each group consisted of 1 762 patients, and there were no statistically significant differences between the two groups in terms of gender, diabetes history, family history of thyroid cancer, the maximum tumor diameter was>1 cm, multifocality, extraglandular invasion, lymph node metastasis, and Hashimoto's thyroiditis (all P>0.05). The proportion of punctate hyperechoic foci (microcalcifications) in the obese group was lower than that in the non-obese group [33.1% (584/1 762) vs 37.9% (668/1 762), P=0.009]. Subgroup analysis by gender revealed that among obese males, the proportions of markedly hypoechoic nodules [4.9% (34/692) vs 2.7% (19/694)] and coarse calcifications [25.0% (173/692) vs 19.3% (134/694)] were higher than those in the non-obese group, while the proportion of punctate hyperechoic foci was lower [35.6% (246/692) vs 42.4% (294/694)] (all P<0.05). Among females, there were no statistically significant differences in any ultrasound features between the obese and non-obese groups (all P>0.05). There was no statistically significant difference in the overall distribution of TIRADS risk categories in thyroid nodules between the obese and non-obese groups (P=0.054). The multivariate logistic regression analysis revealed that obesity was a significant factor associated with the presence of peripheral calcification or punctate hyperechoic foci in thyroid ultrasound findings (OR=0.80, 95%CI: 0.70-0.93). Conclusions: Obesity is associated with a decreased display rate of a key malignant ultrasound feature in PTC -- punctate hyperechoic foci. The incidence of this feature is lower in obese males compared to non-obese males.

A retrospective study was conducted on the patients with hematological disease who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between February 2023 and July 2024. The patients were divided into the luspatercept group and the control group according to whether luspatercept was administered after allo-HSCT. The luspatercept group was further subdivided into the matched group and the mismatched group according to ABO blood group compatibility between the donor and recipient, to compare the recovery of hematopoietic function before and after treatment in each group.The luspatercept group included 39 patients [18 males and 21 females; aged (47±13) years], and the control group included 94 patients [53 males and 41 females; aged (44±13) years]. In the luspatercept group, the hemoglobin (Hb) rose from (54.0±10.2) g/L at baseline to (95.8±19.7) g/L 21 days later, with 84.6% (33/39) of patients achieving an erythroid response (Hb increase≥20 g/L). Among luspatercept-treated patients, 17 were ABO-matched and 22 were ABO-mismatched. The baseline and day-21 Hb levels did not differ significantly between both groups (both P>0.05). Although the baseline Hb level was higher in the control group than that in the luspatercept group [(75.2±13.4) vs (54.0±10.2) g/L, P<0.001], there was no statistically significant difference in Hb levels between the two groups after 21 days of treatment (P=0.392). One-year overall survival and disease-free survival in the luspatercept group were 84.1% and 81.5%, respectively, while those in the control group were 92.9% and 88.6%. The differences in one-year overall survival and disease-free survival were not statistically significant (both P>0.05). Adverse events in the luspatercept group were predominantly grade 1-2, inclued diarrhea, nausea, and hypertension. Early administration of luspatercept after allo-HSCT can safely accelerate erythroid recovery.

Objective: To determinate the effective axial compression yield loads of different types of femoral fracture fixed by bridge system with mixed-rod and double-rod to select the internal fixation method. Methods: A total of 32 polyformaldehyde mixed-rod and double-rod models of long oblique, long spiral, wedge-shaped with large fragment and supracondylar fractures were made. Among them, there were 4 mixed-rod models and 4 double-rod models for each type of fractures. Axial compression test was conducted on all fracture models using the microcomputer-controlled electronic universal testing machine. When the compression displacement was 2.0 mm, the axial compression yield loads, which were the maximum effective loads, and the average load was calculated and compared with the reference value of 2 475 N. When the compression displacement was less than 2.0 mm, if there was an obvious break point in the load-displacement curve, the maximum load was invalid. Results: The average loads of models for different types of femoral fractures were as follows: the load of long oblique fracture with mixed-rod and double-rod models was (7 603.5±471.7) N and (4 117.5±29.2) N, respectively; the load of long spiral fractures was (2 890.1±139.4) N and(2 500.6±74.5)N, respectively; the load of wedge-shaped fracture with larger fragment was (5 110.2±489.0) N and(4 234.3±256.0)N, respectively; and the load of supracondylar fracture was (9 071.3±1 444.3) N and(9 403.1±1 649.6)N, respectively. The average loads of all the mixed-rod and double-rod models of femoral fractures were greater than the reference value. Conclusion: For long oblique, long spiral, wedge-shaped with large fragment and supracondylar fractures of the femur, the double-rod of bridge system can meet the fixation requirements, and it is recommended to use the double-rod of bridge system in terms of open reduction and internal fixation.

Central neck compartment metastases are most commonly found in papillary thyroid cancer(PTC) patients. Central neck dissection (CND), encompassing lymph node levels Ⅵ and Ⅶ, remains controversial when performed prophylactically CND (pCND) in clinically node-negative (cN0) PTC patients. Current guidelines, consensus statements, and literatures lack a unified, objective criterion for determining cN0 status. The reasons for the controversy surrounding pCND lie in the varying oncological benefits and complication rates of pCND reported in different studies for cN0 PTC patients, as well as the inconsistent research conclusions drawn by scholars from China and the West. Currently, there is insufficient evidence from large-sample, long-term follow-up randomized controlled trials to support the oncologic benefits of pCND. Therefore, the application of non-long-term follow-up study results regarding pCND in cN0 PTC should be interpreted and approached with caution. Furthermore, there is no established quality control indicators for CND. Anatomic landmark-guided standardized CND is crucial for ensuring the quality control of pCND.