Objective: To systematically evaluate risk factors for cardiometabolic multimorbidity (CMM), so as to provide the evidence for formulating CMM prevention and control strategies. Methods: Publications pertaining to the risk factors for CMM were retrieved from databases, including SinoMed, CNKI, Wanfang Data, VIP, PubMed and Cochrane Library from inception to March 31, 2023. Meta-analysis was performed using the software RevMan 5.4 and Stata 16.0, and sensitivity analysis was performed using the leave-one-out method. The publication bias was evaluated using Egger's test. Results: Totally 494 publications were screened, and 20 publications were included in the final analysis, including 13 cohort studies (covering 1 940 000 participants) and 7 cross-sectional studies (covering 13 000 000 participants). Meta-analysis revealed that female (OR=1.54, 95%CI: 1.40-1.71), middle age (OR=3.80, 95%CI: 3.33-4.34), elderly (OR=2.82, 95%CI: 1.48-5.37), urban resident (OR=1.41, 95%CI: 1.27-1.57), higher education level (OR=2.01, 95%CI: 1.35-3.01), higher economic level (OR=1.21, 95%CI: 1.16-1.25), overweight (OR=1.92, 95%CI: 1.64-2.26), obesity (OR=3.01, 95%CI: 2.30-3.93), central obesity (OR=1.70, 95%CI: 1.12-2.56), smoking (OR=1.27, 95%CI: 1.07-1.51), alcohol consumption (OR=1.27, 95%CI: 1.01-1.59), irregular diet (OR=1.10, 95%CI: 1.02-1.18), insufficient intake of vegetables and fruits (OR=1.12, 95%CI: 1.07-1.17), lack of sleep at night (OR=1.17, 95%CI: 1.08-1.27), and depression (OR=1.50, 95%CI: 1.33-1.69) were risk factors for CMM. Sensitivity analysis of effects of central obesity and alcohol consumption were not robust. No publication bias was examined by Egger's test. Conclusions Female, middle age, elderly, urban resident, higher education level, higher economic level, overweight, obesity, central obesity, smoking, alcohol consumption, irregular diet, insufficient intake of vegetables and fruits, lack of sleep at night and depression are risk factors for CMM.

Objective To study the volume of lateral cerebral ventricle in neonates with threedimensional ultrasonography(3F-US),and to investigate the influence of sex,body weight(BW),head circumference(HC)and gestational age(GA) on it. Methods A total of 255 healthy neonates (GA 28~40 weeks) were examined with 3D cranial ultrasound. The ultrasonography was performed with anterior fontanel as the acoustic window,and the data were aquired at the deck of third ventricle on coronal section.The 3D image on the screen was constructed automatically and the volume of lateral cerebral ventricle was (P=0.809),and there was negative correlation between the volume of lateral cerebral ventricle and GA(r=-0.971). The correlation between the volume of lateral cerebral ventricle and HC was positive(r≥According to the relationships among HC(X 1),GA(X 2)and volume of lateral cerebral ventricle(Y),a linear regression equation Y=2.298-0.011 X1-0.04 X2 was obtained(the determinate coefficient R2 was accurately,which would be helpful to the evaluation on the cerebral maturity and the diagnosis of cerebral desease in neonates without wound.

Objective: To conduct a scoping review on prognostic prediction models for patients with comorbidity of chronic diseases, and understand modeling methods, predictive factors and predictive effect of the models, so as to provide the reference for prognostic evaluation on patients with comorbidity of chronic diseases. Methods: Literature on prognostic prediction models for patients with comorbidity of chronic diseases was collected through SinoMed, CNKI, Wanfang Data, VIP, PubMed, Embase, Cochrane Library and Web of Science published from the time of their establishment to November 1, 2023. The quality of literature was assessed using prediction model risk of bias assessment tool (PROBAST), then modeling methods, predictive factors and predictive effects were reviewed. Results: Totally 2 130 publications were retrieved, and nine publications were finally enrolled, with an overall high risk of bias. Thirteen models were involved, with three established using machine learning methods and ten established using logistic regression. The prediction results of four models were death, with main predictive factors being age, gender, body mass index (BMI), Barthel index and pressure ulcers; the prediction results of nine models were rehospitalization, with main predictive factors being age, BMI, hospitalization frequency, duration of hospital stay and hospitalization costs. Eleven models reported the area under the receiver operating characteristic curve (AUC), ranging from 0.663 to 0.991 6; two models reported the C-index, ranging from 0.64 to 0.70. Eight models performed internal validation, one model performed external validation, and four models did not reported verification methods. Conclusions The prognostic prediction models for patients with comorbidity of chronic diseases are established by logistic regression and machine learning methods with common nursing evaluation indicators, and perform well. Laboratory indicators should be considered to add in the models to further improve the predictive effects.

Objective To investigate the efficacy and safety of warfarin anticoagulation in Chinese elderly patients based on vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) genetic polymorphisms.Methods Clinical data of 41 elderly patients with initial anticoagulation therapy in our emergency department and respiratory department were collected.Patients were divided into observation group (n=20,patients treated with warfarin based on genetic polymorphisms) and control group (n =21,patients treated based on clinical experience).The international normalized ratio (INR),the time of INR stabilized within target range (2.0-3.0) and the incidence of bleeding episodes in 6-month follow up were compared between groups.Results INR within target range at day 3,4,5 and 7 were 0.0％,42.1％,52.6％,68.4％ in observation group and 0.0％,10.0％,25.0％,35.0％ in control group,respectively.There were significant differences in INR within target range at day 4,7 between the two groups (both P＜0.05),while no significant difference was found in INR within target range at day 5 (P＞0.05).The time of INR stabilized within target range was shorter in observation group than in control group [(9.5±2.4) d vs.(12.3± 4.8) d,P＜0.05].Bleeding complication occurred in 3 patients in observation group and 5 patients in control group,and there was no significant difference between the two groups.Conclusions Warfarin therapy based on VKORC1 and CYP2C9 gene polymorphisms may shorten the time of first INR reaching the target value and INR within target range in elderly patients.However,the risk of bleeding complications should be alerted.

Objective: To systematically evaluate the influencing factors for medication compliance in patients with comorbidities of chronic diseases, so as to provide the evidence for improving medication compliance. Methods: Literature on influencing factors for medication compliance in patients with comorbidities of chronic diseases were retrived from CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of Science, Cochrane Library and Embase from inception to January 20, 2024. After independent literature screening, data extraction, and quality assessment by two researchers, a meta-analysis was performed using RevMan 5.4 and Stata 16.0 softwares. Literature were excluded one by one for sensitivity analysis. Publication bias was assessed using Egger's test. Results: Initially, 7 365 relevant articles were retrieved, and 35 of them were finally included, with a total sample size of about 150 000 individuals. There were 30 cross-sectional studies and 5 cohort studies; and 11 high-quality studies and 24 medium-quality studies. The meta-analysis showed that the demographic factors of lower level of education (OR=2.148, 95%CI: 1.711-2.696), lower economic income (OR=1.897, 95%CI: 1.589-2.264), male (OR=0.877, 95%CI: 0.782-0.985), living alone (OR=2.833, 95%CI: 1.756-4.569) and unmarried (OR=2.784, 95%CI: 1.251-6.196); the medication treatment factors of polypharmacy (OR=1.794, 95%CI: 1.190-2.706), potentially inappropriate medication (OR=2.988, 95%CI: 1.527-5.847), low frequency of daily medication (OR=0.533, 95%CI: 0.376-0.754) and adverse drug reactions (OR=3.319, 95%CI: 1.967-5.602); the disease factors of long course of disease (OR=2.118, 95%CI: 1.643-2.730), more comorbidities (OR=1.667, 95%CI: 1.143-2.431) and cognitive impairment (OR=2.007, 95%CI: 1.401-2.874); and the psychosocial factors of poor belief in taking medication (OR=1.251, 95%CI: 1.011-1.547), poor self-rated health (OR=1.990, 95%CI: 1.571-2.522) and being guided by healthcare professionals (OR=0.151, 95%CI: 0.062-0.368) were the influencing factors for medication compliance in patients with chronic comorbidities. Conclusion The medication compliance in patients with comorbidities of chronic diseases is associated with demographic factors, pharmacological factors, disease factors and psychosocial factors, mainly including living alone, adverse drug reactions, course of disease, number of comorbidities and medication beliefs.

Objective: To understand the association between childhood abuse experience and health risk behaviors among college students, providing references for childhood abuse and health risk behavior prevention. Methods: During Mar. to Apr. of 2016, 918 college students from 2 universities in Nanchong city were selected through cluster sampling, the survey included general demographic characteristics, childhood abuse experiences and health risk behaviors. Chi square test was used for univariate analysis, and Logistic regression was used for multivariate analysis. Results: A total of 720(78.43%) of participants reported at least one type of health risk behaviors, overeating was the most common type[595(64.81%)]. The number of adolescent reporting smoking, drinking 5 or more beers at a time, fighting and suicidal ideation was 146(15.90%), 271(29.52%), 224(24.40%), 205( 22.33 %), respectively. Multivariate Logistic regression analysis showed that a significant positive association between experiencing at least one kind of childhood abuse and the behaviors of fighting, suicidal ideation, and overeating; between childhood emotional neglect with smoking and suicidal ideation; between childhood emotional abuse with fighting, suicidal ideation, and overeating; and between childhood sexual abuse with smoking( P <0.05). Conclusion Health risk behavior in college students is popular. Childhood abuse can increase the risk of health risk behaviors of college students.

Objective: To analyze the childhood blood pressure (BP) trajectory and its relationship with overweight and obesity, to provide evidence regarding prevention and control of childhood elevated BP. Methods: A total of 1 177 children who participated in five surveys of Zigong school based cardiometabolic risks survey. Elevated BP was defined by using National BP reference for Chinese children. Groupbased trajectory model was used to identify distinct BP trajectories. Logistic models were conducted to investigate the association of number of overweight/obesity across surveys with BP trajectory. Results: In the five consecutive waves, the corresponding prevalence of elevated BP was 1.9%, 6.6%, 7.0%, 12.5% and 11.2%. Childhood BP trajectory were classified into constant low and high increasing risk of elevated BP groups. The risk of elevated BP increased at a steady rate with age in constant low risk of elevated BP groups, while the risk of elevated BP increased dramatically with age in high increasing risk of elevated BP groups. Logistic regression analysis showed that those with increasing number of occurrence of overweight/obesity tended to be classified into high increasing risk of elevated BP group( OR=1.34, 95%CI=1.17-1.53, P <0.01). Conclusion Blood pressure trajectory during childhood varies. The risk of elevated BP increased dramatically with age in overweight and obese children. Attention should be paid to the BP trajectory of overweight and obese children to prevent elevated BP.

Objective:To describe the clinical characteristics and diagnosis and treatment process of a patient with primary pleural diffuse large B-cell lymphoma(DLBCL),in order to enhance the understanding of primary pleural DLBCL in clinical practice. Methods:The clinical characteristics and diagnosis and treatment process of a patient with primary pleural DLBCL was reported,and the related literatures were reviewed. Results:The patient complained of chest tightness and shortness of breath for over a year,and chest CT showed left pleural effusion and thickening of the left pleura.Thoracoscopic examination revealed extensive adhesions in the parietal pleura of the chest cavity,diffuse congestion of the parietal pleura,and multiple cauliflower-like new organisms.The pathological biopsy of the pleura diagnosed(left pleural mass)as DLBCL.After diagnosis,R-CHOP combined with Zebutinib treatment was performed for 4 cycles,and mid-term evaluation of chest CT showed significant regression of the tumor. Conclusion:Primary pleural DLBCL is a rare disease.It is easily to be misdiagnosed due to non-specific clinical and imaging manifestations.The final diagnosis depends ultimately on pathological biopsy,and thoracoscopy is the most effective method to confirm DLBCL.

Objective:To analyze students' learning behavior in the teaching practice of the presentation-assimilation-discussion (PAD) class based on Xuexitong platform.Methods:The PAD class based on Xuexitong platform was applied to the course of child and adolescent health in the specialty of preventive medicine. And the data were collected from the platform to analyze students' learning behavior, including the number of visits and its rules, the completion rate and duration of homework submission, the completion rate of task points, and the number of students participating in discussions. Questionnaires were used to investigate students' evaluation of the learning effect. SPSS 17.0 was used for Mann-Whitney U test, Kruskal Wallis H, and Chi-square test. Results:A total of 99 students visited the platform 40 322 times over 84 days, with a peak on the day of the discussion class, with the highest number of visits from 16:00 to 20:00, and 29.3% (29/99) of them visited the platform for less than 40 days. The completion rate of homework submission was 98.0% (582/594), with 31.1% (181/582) of the person-times less than 6 hours of homework submission duration. The completion rate of task points was 99.0% (3 919/3 960), and the number of students participating in discussions was 3 (2,7). In total, 86.9% to 90.9% of the students thought that the five aspects of learning effect were partly or basically achieved.Conclusion:Students' learning behavior is good on the whole, but their participation in discussion is few, and some of them learn passively, which needs to be further improved.

Objective The study explored the feasibility of PBL teaching approach and mini-CEX scores evaluation method in hematology probation teaching practice. Methods 54 medical students of eight-year program were selected in the study and they were in hematology department of Sun Yat-sen Memorial Hospital for clinical probation. The study compared PBL teaching approach with traditional training method, and used mini-CEX to evaluate the students' clinical competence. Results The performance of PBL teaching group is better than traditional teaching group in the aspect of inquiry skill, clinical diagnosis, therapy plan and humanistic care (P<0.05). There is no significant difference of basic knowledge, physical examination skill and clinical operational skills between these two groups. More than 85％of the students in PBL group are satisfied with the teacher in the aspect of participation, feedback, guidance, correction and assistance. Conclusion Through this teaching practice, the study provides new methods for improving the teaching of pre-internal clinical practice in hematology department.