北京大学学报（医学版）最新文献

Trauma is recognized globally as a great public health challenge. It stands as the predominant cause of mortality among those under the age of 45 and is also ranked among the top five causes of death for both urban and rural populations within China. This stark reality underscores the critical urgency in establishing an efficient system for trauma care, which is pivotal for substantially enhancing the survival rates of patients. An optimally developed system for trauma care not only guarantees that patients promptly receive professional medical assistance but also facilitates significant improvements in the outcomes of trauma care through the strategic establishment of trauma centers. At present, a considerable variation exists in the quality of trauma care provided across various regions within China. The adoption of comprehensive quality management strategies for the medical processes involved in trauma care, alongside the standardized management of on-site rescue operations, pre-hospital emergency care, and in-hospital treatment protocols, stands as a fundamental approach to boost the capabilities of trauma care and, consequently, the survival rates of trauma patients. Serving as the cornerstone of comprehensive medical quality management, key quality control indicators possess the capacity to steer the development direction of trauma centers. In a concerted effort to further augment the medical quality management of trauma care, standardize clinical diagnosis and treatment methodologies, and advocate for the standardization and ho-mogenization of medical services, the Medical Quality Control Professional Committee of the National Center for Trauma Medicine has undertaken a detailed refinement and update of the 16 key quality control indicators for trauma centers. These were initially put forward in the "Notice on Further Enhancing Trauma Care Capabilities" disseminated by the National Health Commission in 2018.Consequent to this endeavor, a revised set of 19 quality control indicators has been devised. This comprehensive set, inclusive of the indicators' names, definitions, calculation methodologies, significance, and the subjects for quality control, is designed for utilization within the quality management and control operations of trauma centers across various levels. This initiative aims to furnish a concrete and executable roadmap for the quality control endeavors of trauma centers. Through the enactment of these quality control indicators, medical institutions are empowered to conduct more stringent monitoring and evaluative measures across all facets of trauma care. This not only facilitates the prompt identification and rectification of existing challenges but also substantially boosts the efficiency of internal collaboration. It enhances the synergy between different departments, thereby markedly improving the efficiency and quality of trauma care.

Objective: To explore the association between polymorphisms of transforming growth factor-β (TGF-β) signaling pathway and non-syndromic cleft lip with or without cleft palate (NSCL/P) among Asian populations, while considering gene-gene interaction and gene-environment interaction.

Methods: A total of 1 038 Asian NSCL/P case-parent trios were ascertained from an international consortium, which conducted a genome-wide association study using a case-parent trio design to investigate the genes affec-ting risk to NSCL/P. After stringent quality control measures, 343 single nucleotide polymorphism (SNP) spanning across 10 pivotal genes in the TGF-β signaling pathway were selected from the original genome-wide association study(GWAS) dataset for further analysis. The transmission disequilibrium test (TDT) was used to test for SNP effects. The conditional Logistic regression models were used to test for gene-gene interaction and gene-environment interaction. Environmental factors collected for the study included smoking during pregnancy, passive smoking during pregnancy, alcohol intake during pregnancy, and vitamin use during pregnancy. Due to the low rates of exposure to smoking during pregnancy and alcohol consumption during pregnancy (<3%), only the interaction between maternal smoking during pregnancy and multivitamin supplementation during pregnancy was analyzed. The threshold for statistical significance was rigorously set at P =1.46×10^-4, applying Bonferroni correction to account for multiple testing.

Results: A total of 23 SNPs in 4 genes yielded nominal association with NSCL/P (P<0.05), but none of these associations was statistically significant after Bonferroni' s multiple test correction. However, there were 6 pairs of SNPs rs4939874 (SMAD2) and rs1864615 (TGFBR2), rs2796813 (TGFB2) and rs2132298 (TGFBR2), rs4147358 (SMAD3) and rs1346907 (TGFBR2), rs4939874 (SMAD2) and rs1019855 (TGFBR2), rs4939874 (SMAD2) and rs12490466 (TGFBR2), rs2009112 (TGFB2) and rs4075748 (TGFBR2) showed statistically significant SNP-SNP interaction (P<1.46×10^-4). In contrast, the analysis of gene-environment interactions did not yield any significant results after being corrected by multiple testing.

Conclusion: The comprehensive evaluation of SNP associations and interactions within the TGF-β signaling pathway did not yield any direct associations with NSCL/P risk in Asian populations. However, the significant gene-gene interactions identified suggest that the genetic architecture influencing NSCL/P risk may involve interactions between genes within the TGF-β signaling pathway. These findings underscore the necessity for further investigations to unravel these results and further explore the underlying biological mechanisms.

Objective: To explore the relationship between puberty timing and cardiovascular metabolic risk factors among primary and secondary students with different genders in Beijing.

Methods: Using the method of stratified cluster sampling by urban and rural areas and school sections, 3 067 students from 16 primary and secondary schools in Fangshan District of Beijing were selected in October 2012, with questionnaire survey, physical examination and serum laboratory testing. In this study, we controlled for confounding factors such as school segments, current residence of the family, birth weight, feeding method, only child, highest educational level of parents, and monthly family income, and then the associations between cardiovascular metabolic risk factors and puberty timing among the primary and secondary students was analyzed by multivariate Logistic analysis. To ensure the reliability of the data, this study adopted strict quality control.

Results: A total of 3 067 primary and middle school students aged 7 to 16 years were included in this study, including 1 575 boys and 1 492 girls. The prevalence of premature puberty was 14.73% among the boys and 12.89% among the girls, respectively. The prevalence of delayed puberty was 9.49% among the boys and 10.99% among the girls, respectively. The detection rates of central obesity, hypertension, hyperglycemia, and dyslipidemia among the primary and secondary students were 35.87%, 19.95%, 2.54% and 26.31%, respectively. The detection rates of 1 risk factor clustering, 2 risk factors clustering and more than 3 risk factors clustering were 29.21%, 16.17% and 9.36%, respectively. The difference in the detection rate of cardiovascular and metabolic risk factors in different youth stages was insignificant (P>0.05), the detection rate of risk factor aggregation of 0 was lower than that of the timely group and delayed group, and the detection rate of risk factors aggregation of 2 was higher than that of the timely group (P < 0.05).After adjusting the effects of learning stage, region, birth weight, feeding patterns, one-child, family income and the parents' educational levels, multivariate Logistic regression analysis showed that, compared with the on-time puberty group, the risk of 1 risk factor clustering, 2 risk factors clustering and more than 3 risk factors clustering increased by 1.94 times (95% CI=1.29-2.91), 2.97 times (95% CI=1.89-4.67) and 2.02 times (95% CI= 1.13-3.63) among the girls; It had not been found that the relationship between puberty timing and cardiovascular risk factor clustering among the boys (P>0.05).

Conclusion: Premature puberty is an independent risk factor for the clustering of cardiometabolic risk factors in girls, and primary prevention strategies should be implemented to reduce the burden of cardiovascular metabolic diseases in the population.

Objective: Telemedicine, as an information-based tool, is widely recognized as an effective solution for compensating for the imbalanced allocation of medical resources in China. This study specifi-cally aimed to analyze the impact of telemedicine functions on the operational efficiency of public hospitals, with a particular focus on their heterogeneous effects on hospitals of different levels.

Methods: A cross-sectional research design was used based on the 2022 Health Informatization Statistical Survey data, and 8 944 public hospitals were used as research objects to analyze the impact of telemedicine on hospital revenues and business capacity. Multivariate linear model, propensity score matching (PSM), and grouped regression methods were employed to evaluate the impact of telemedicine on hospital revenues, number of consultations, and the number of discharges.

Results: The descriptive results showed that telemedicine was available in 35.51% of public hospitals. The analysis also demonstrated that various factors, such as hospital level, academic category, area of the hospital, administrational level and number of beds all had a significant influence on the operation of the hospital. Moreover, the regression results showed that opening telemedicine could increase hospital revenues by 0.140 (P < 0.01), hospital consultations by 0.136 (P < 0.01), and the number of discharges by 0.316 (P < 0.01). After correcting for endogeneity using the propensity score matching, the results showed that the effect of opening telemedicine on hospital revenues, consultations, and the number of discharges was 0.191 (P < 0.01), 0.216 (P < 0.01), and 0.353 (P < 0.01), respectively. Further heterogeneity analysis was conducted to explore the differential effects of telemedicine on hospitals of different levels. Grouped regression showed that telemedicine had a positive impact on the income of secondary hospitals, with a coefficient of 0.088 (P < 0.05), and it had a more significant positive impact on hospital consultations in secondary hospitals, with a coefficient of 0.127 (P < 0.01). An even greater impact on the number of discharges in primary hospitals, with a coefficient of 1.203 (P < 0.01). Telemedicine, on the other hand, did not have a significant positive impact on the overall revenue and operational capacity of tertiary hospitals.

Conclusion: Telemedicine had a significant promoting effect on hospital revenues, hospital consultations and the number of discharges, and this effect was differentiated between hospitals of different levels. Through the construction of telemedicine, primary hospitals were able to significantly improve their business capacity and revenue, which played a positive role in improving the operation of primary public hospitals.

Objective: To understand the nutritional status and physical fitness of the Uygur, Kazak and Han ethnic college students, and to investigate the nonlinear relationship between BMI and physical fitness indexes in different ethnic groups.

Methods: A total of 3 600 Uygur, Kazakh and Han students majoring in non-sports in a university in Xinjiang Uygur Autonomous Region in 2021 were selected by stratified random cluster sampling method. Height, weight, vital capacity, 50 m running, standing long jump, sit-and-reach, sit-up/pull-up and endurance running were measured. Body mass index (BMI), standardized Z score of each test score and physical fitness index (PFI) were calculated. The data were analyzed by Chi-square test, single factor analysis of variance, and nonlinear quadratic regression.

Results: Prevalences of overweight (16.00%) and obesity (8.08%) of the Han college students were significantly higher than those of the Uygur (11.83% and 4.08%) and Kazakh (13.58% and 4.58%). Prevalence of low weight in the Uygur (11.92%) was the highest, and the lowest was the Kazakh (9.75%). There were significant differences in the prevalence of BMI classification among the three ethnic groups boys and girls (all P < 0.05). There were significant differences in PFI among college students of different BMI levels in the Uygur, Kazakh and Han ethnic college students (all P < 0.05), and the PFI of normal weight group was higher than the other weight groups in general, and the overweight group was higher than the obese group, but some ethnics showed the highest PFI in the low weight group. The non-linear quadratic regression results showed that the curves of the Uygur boys and girls and the Kazakh boys were inverted "J" shaped, and the PFI increased and then decreased with the increase of BMI, while the rest of the curves were arc-shaped, and the PFI decreased with the increase of BMI.

Conclusion: Overweight obesity in the Uygur, Kazakh and Han ethnic college students brings about a decrease in physical fitness, but Kazakh low weight male and female and Han low weight grils have better physical fitness than the normal weight groups. Focusing on improving the physical fitness of Uygur low-weight and high-weight boys and Han high-weight girls could effectively reduce the differences in physical fitness of college students in different weight levels and ethnic groups.

Objective: To explore the association between self-control and the co-occurrence of depressive symptoms and overweight or obesity from adolescence to early adulthood in the Chinese population, and to provide a scientific basis for personalized interventions targeting individuals with different risks in the future.

Methods: From a prospective cohort study that lasted for 10 years: The China family panel studies (CFPS), a total of 608 children and adolescents meeting the following inclusion and exclusion criteria were included as study subjects: (1) Aged 10 to 19 years, at normal weight according to Chinese standards, and without depressive symptom in 2010; (2) Had self-control scores, and with at least two measurements of depressive symptoms and body mass index (BMI) between 2010 and 2020; (3) The only one or the youngest child and adolescent from each family. The co-occurrence of depressive symptoms and overweight or obesity was defined in three ways: Both of the average level of standardized scores of depressive symptoms and BMI Z-scores across multiple measurements over time were at a high level, or both of the trajectories of depressive symptoms and BMI over time based on the latent classification trajectory model (LCTM) belonging to the "risk-type", or individuals had depressive symptoms and overweight/obesity at the last follow-up survey. The multinomial Logistic regression model was used to examine the association between standardized scores of self-control and the co-occurrence of depressive symptoms and overweight or obesity.

Results: The score of self-control was associated with the co-occurrence of depressive symptoms and overweight or obesity when using healthy individuals as the reference group after adjusting for age (years), gender (male/female), area (urban/rural), weekly physical activity duration (high/low), parental education level (college or above/high school or below), parental weight status (overweight or obese or not), and parental depressive symptoms (with depressive symptoms or not), regardless of the definition of the risk population. Specifically, the risk of co-occurrence of depressive symptoms and overweight or obesity was reduced by 33% (95%CI: 14% to 48%, based on the average level across multiple measurements over time) to 78% (95%CI: 6% to 95%, based on the joint trajectories of depressive symptoms and BMI over time) per 1-standard deviation (1-SD) increase in self-control score. In addition, the risk of depressive-symptom-dominant and overweight-or-obesity-dominant was reduced by 25% (95%CI: 4% to 42%, only based on the average level across multiple measurements over time) and 21% (95%CI: 1% to 37%, only based on the joint trajectories of depressive symptoms and BMI over time) per 1-SD increase in self-control score, respectively. The results from sensitivity analysis that defined individuals' weight status according to

Objective: To evaluate the outcome of Augmented reality technology in the recognizing of oral and maxillofacial anatomy.

Methods: This study was conducted on the undergraduate students in Peking University School of Stomatology who were learning oral and maxillofacial anatomy. The image data were selected according to the experiment content, and the important blood vessels and bone tissue structures, such as upper and lower jaws, neck arteries and veins were reconstructed in 3D(3-dimensional) by digital software to generate experiment models, and the reconstructed models were encrypted and stored in the cloud. The QR (quick response) code corresponding to the 3D model was scanned by a networked mobile device to obtain augmented reality images to assist experimenters in teaching and subjects in recognizing. Augmented reality technology was applied in both the theoretical explanation and cadaveric dissection respectively. Subjects' feedback was collected in the form of a post-class questionnaire to evaluate the effectiveness of augmented reality technology-assisted recognizing.

Results: In the study, 83 undergraduate students were included as subjects in this study. Augmented reality technology could be successfully applied in the recognizing of oral and maxillofacial anatomy. All the subjects could scan the QR code through a connected mobile device to get the 3D anatomy model from the cloud, and zoom in/out/rotate the model on the mobile. Augmented reality technology could provide personalized 3D model, based on learners' needs and abilities. The results of likert scale showed that augmented reality technology was highly recognized by the students (9.19 points), and got high scores in terms of forming a three-dimensional sense and stimulating the enthusiasm for learning (9.01 and 8.85 points respectively).

Conclusion: Augmented reality technology can realize the three-dimensional visualization of important structures of oral and maxillofacial anatomy and stimulate students' enthusiasm for learning. Besides, it can assist students in building three-dimensional space imagination of the anatomy of oral and maxillofacial area. The application of augmented reality technology achieves favorable effect in the recognizing of oral and maxillofacial anatomy.

Objective: To explore the current status of cognitive function of the older adults in Beijing, and to analyze the factors affecting their cognitive function.

Methods: It was a cross-sectional study. A questionnaire survy was conducted in 2023 among the older adults in Beijing. The cognitive function of the older adults was assessed with the Hong Kong brief cognitive test (HKBC) scale, a simple cognitive assessment tool. Using SPSS 27.0 to perform the descriptive analysis and multiple linear regression analysis of factors, which affect cognitive function among the older adults.

Results: Totally 349 older adults were recruited, with the highest percentage of respondents aged 60-69 years (41.3%), of whom 58.7% were female, 88.0% of the respondents had a junior high school or above education level. Most of the older adults (68.8%) worked 35-48 h/week before they retired, and 14.0% of the older adults had a family history of dementia. After controlling age and gender, the linear regression analysis showed that marital status married (β=0.501, 95%CI: 0.144-0.859) and 3-4 times physical activity per week (β=0.617, 95%CI: 0.087-1.148) were protective factors of cognitive function in the older adults, and depressive symptoms were a risk factor (β= -0.723, 95%CI: -1.198 to -0.247) of cognitive function for the older adults.

Conclusion: In this study, the factors influencing cognitive function among the older adults was analyzed based on a life-cycle perspective. Lack of physical activity and depressive symptoms were risk factors for cognitive function among the older adults. It was suggested that strengthening physical activity, improving mental health of the older adults, as well as conducting preventive intervention in early stages of the life-cycle will be benefit for preventing and slowing cognitive decline in the older adults.

Objective: To assess the safety of sitagliptin added to metformin on cardiovascular adverse events in real world patients with type 2 diabetes mellitus (T2DM).

Methods: Real world data from Yinzhou Regional Health Care Database were used to select T2DM patients with diagnosis and treatment records in the platform from January 1, 2017 to December 31, 2022. According to drug prescription records, the patients were divided into metformin plus sitagliptin group (combination group) and metformin monotherapy group(monotherapy group). A series of retrospective cohorts were constructed according to the index date.Finally, full retrospective cohorts were constructed according to propensity score model, including baseline covariates that might be related to outcomes, to match the subjects in the combination group and monotherapy group for the purpose of increasing the comparability of baseline characteristics. The participants were followed up from the index date until the first occurrence of the following events: Diagnosis of outcomes, death, or the end of the study period (December 31, 2022). Cox proportional risk model was used to estimate the hazard ratio(HR)and 95% confidence interval (CI) of sitagliptin added to metformin on 3-point major adverse cardiovascular events (3P-MACE) combination outcome and secondary cardiovascular outcomes.

Results: Before propensity score matching, the proportion of the patients in combination group using insulin, α glucosidase inhibitors, sodium-glucose transporter 2 inhibitors (SGLT-2I) and glienides at baseline was higher than that in monotherapy group, and the baseline fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels in combination group were higher than those in monotherapy group. After propensity score matching, 5 416 subjects were included in the combination group and the monotherapy group, and baseline characteristics were effectively balanced between the groups. The incidence densities of 3P-MACE were 6.41/100 person years and 6.35/100 person years, respectively. Sitagliptin added to metformin did not increase or decrease the risk of 3P-MACE compared with the metformin monotherapy (HR=1.00, 95% CI: 0.91-1.10). In secondary outcomes analysis, the incidence of cardiovascular death was lower in the combination group than in the monotherapy group (HR=0.59, 95% CI: 0.41-0.85), and no association was found between sitagliptin and the risk of myocardial infarction and stroke (HR=1.12, 95% CI: 0.89-1.41; HR=0.99, 95% CI: 0.91-1.12).

Conclusion: In T2DM patients in Yinzhou district of Ningbo, compared with metformin alone, sitagliptin added to metformin may reduce the risk of cardiovascular death, and do not increase the incidence of overall cardiovascular events. The results of this study can provide real-world evidence for post-marketing cardiovascul