Objective To survey on training for general practice backbone mentors in tertiary hospitals of Hebei province.Methods A questionnaire survey on training status was conducted among general practice backbone mentors in tertiary hospitals of Hebei Province.The survey items included the basic information,knowledge of general practice and its training,suggestions for mentors training and general practice discipline construction in tertiary hospitals.Results Total 208 questionnaires were distributed and 208 were retrieved with a recovery rate of 100％.Among 208 participants,all of them were over the age of 30;202 (97.1％) had bachelor degree or above;202 (97.1％) were attending doctors or above;165 (79.3％) had worked for more than 10 years;169 (81.3％) had no or little knowledge of general practice;159 (76.4％)had not received general practice training before;124 (59.6％) thought that general practitioners were not qualified as "gatekeeper" at present;and 192 (92.3％) worked in the hospitals providing standardized residency training.The training contents in general section were prioritized as clinical skills,community health service development and policy,rules for general practice standardized training,theoretical training,the present situation and countermeasure of general teaching,the doctor-patient relationship and medical ethics.The contents in training method section were prioritized as lecture series of clinical medicine,case discussion,seminar,distance education with classroom teaching.The suggestions for mentors training included:the exploration of standardized training model,perfecting continuing education system for general practice mentors,more attention to the training at community health service centers and the consummation of general practice system.The suggestions for general practice discipline construction were that more attentions should be paid by the government and the hospitals leaders,the general practice departments in tertiary hospitals should closely cooperate with community health service centers in training ofqualified general practitioners.Conclusions The specialists in tertiary hospitals of Hebei province do not have enough knowledge about general practice and do not quite understand the necessity of establishment of general practice department,so the training for general practice mentors should be strengthened and improved.Properly policy and more social resources from the government and the hospitals leaders will be helpful for construction of general practice discipline in general hospital.

Objective: To investigate the refractive status of children and adolescents aged 4-18 years in Chengdu, and to analyze the epidemiological characteristics of refractive parameters. Methods: A cross sectional survey was conducted among 82 024 children and adolescents aged 4-18 years in Gaoxin District of Chengdu from August to September 2021. The prevalence of screening myopia, low vision rate, high myopia rate, refractive status and axial development were analyzed. Results: The prevalence of screening myopia in students aged 4-18 years was 40.42%(33 158/82 024). Low myopia was 24.51%(20 108/82 024), moderate myopia was 13.05%(10 703/82 024) and high myopia was 2.86%(2 347/82 024). The prevalence of screening myopia was 1.81% (233/12 848) in kindergarten, 34.44%(17 095/49 644) in primary school, 79.73%(9 738/12 214) in junior high school and 83.25% (6 092/7 318) in senior high school. The rate of visual impairment increased by year from the age of 4, and the rate of myopia increased most rapidly from 6 to 15 years old, the prevalenct of high myopia was compared between adjacent age groups: there were statistical differences between 9-15 years old were more likely to be nearsighted than boys( P <0.035 7). Significant differences in screening myopia between 5- and 7-17 year old groups,and in boys and girls.The median total diopter was 0.40 D at the age of 4 and developed to -2.90 D at the age of 18 . The diopter of girls aged 8-15 years was higher than that of boys, and there was statistical significance( Z=-2.53, -4.09, -5.67, -8.64, -5.56, -4.97, -2.52, -2.14, P <0.05). The axial length gradually increased with age, with the mean value of (22.31±0.59) mm at 4 years old and (24.91±1.00) mm at 18 years old. The mean corneal curvature did not change with age (43.19±1.47)D. Conclusion 6-15 years old is a especially critical period for myopia development. More efforts need to be taken to decrease the prevalence of myopia before 6 years old. Prevention of the development of high myopia should start before the age of 10. The prevalence of myopia in girls is higher than that in boys, more prevention and control of myopia should focus on girls.

Objective:To explore the related factors affecting the prognosis of patients with tardive dyskinesia, in order to find the risk factors of poor prognosis.Methods:A retrospective cohort study was implemented to collect the data of 113 patients with tardive dyskinesia from the movement disorders clinic of the Department of Neurology, Peking Union Medical College Hospital by telephone follow-up. The main variables studied included gender, age, educational level, living environment, job, cigarette smoking, alcohol drinking, hypertension, diabetes, medication type, interval from taking medicine to dyskinesia, course of dyskinesia and intervention measures. The data were analyzed by the statistical software SPSS 25.0. The quantitative data analysis was done by normality test and descriptive statistics, and the qualitative data analysis was done by χ 2 test or Fisher exact probability test. The variables with P≤0.01 in univariate analysis were included in multivariate Logistic regression analysis. Results:Among the 113 patients, 16 patients (14.16%) were cured, 27 patients (23.89%) had obvious improvement, 25 patients (22.12%) had slight improvement, 26 patients (23.01%) had no obvious change, 15 patients (13.27%) had slight deterioration, and 4 patients (3.54%) had obvious deterioration. The good prognosis rate was 60.18%, and the poor prognosis rate was 39.82%. In single factor analysis, the related factors for poor prognosis included age>52 years (χ 2=15.07, P<0.001), educational level in secondary schools and below (χ 2=8.58, P=0.003), physical labor (χ 2=4.66, P=0.031), hypertension (χ 2 = 16.38, P<0.001), diabetes mellitus (χ 2=6.06, P=0.011), dyskinesia caused by first-generation antipsychotics, calcium channel blocker or flupentixol/melitracen tablets ( P<0.001), and the duration of dyskinesia more than 2 years (χ 2 =7.05, P=0.008). Multivariate Logistic regression analysis showed that the independent risk factors for poor prognosis of tardive dyskinesia included hypertension ( OR=3.60, 95% CI 1.17-11.05, P=0.025) and dyskinesia caused by first-generation antipsychotics, calcium channel blocker or flupentixol/melitracen tablets ( OR=3.14, 95% CI 1.21-8.16, P=0.019). Conclusions:Most patients with tardive dyskinesia have a good prognosis. Hypertension and dyskinesia caused by first-generation antipsychotics, calcium channel blocker or flupentixol/melitracen tablets are independent risk factors for poor prognosis.

Objective:To investigate the value of the venous-to-arterial CO 2 gap (Δ CO 2 gap) before and after the fluid challenge (FC) in determining the fluid responsivenessin septic shock patients. Methods:A total of 104 septic shock patients admitted to the Medical Intensive Care Unit (MICU) of Peking Union Medical College Hospital were included in the retrospective study. All patients were monitored by Swan Ganz floating catheter during the FC. Hemodynamics and blood gas indices were collected before FC (T0) and immediately (T1), 10 min (T2), 30 min (T3) and 60 min (T4) after FC. Responders were defined as patients with a > 10% increase in cardiac output (CO) after FC. Spearman correlation analysis was used to evaluate the correlation between CO 2 gap and CO. The value of ΔCO2 gap were calculated by the area under the receiver operating characteristic (AUROC) curve in the whole population. Results:Among 104 patients, the effective rates of FC at T1, T2, T3 and T4 were 59% (61/104), 72% (75/104), 73% (76/104), and 77% (80/104), respectively. CO of patients in the reactive group was lower than that in the non-reactive group at T2 [6.0 (4.7, 7.5) vs. 7.2 (6.4, 8.5) L/min, P=0.019], and there was no significant difference in CO 2 gap between the two groups before FC. Spearman correlation analysis showed that CO 2 gap was negatively correlated with CO, and the correlations between CO 2 content gap and CO was -0.34, and -0.33 of CO 2 pressure gap and CO, respectively (both P <0.05). ROC curve analysis showed that the ΔCO 2 gap at T1 could weakly judge the reactivity at T2, T3 and T4, but could not judge the reactivity at T1. The AUROC at T2 was 0.669 of ΔCO 2 content gap and 0.684 of ΔCO 2 pressure gap (both P <0.05). Conclusions:The evaluate time judging the effect of FC should be appropriately extended. The change value of CO 2 gap before and immediately after volume expansion in septic shock patients can judge the fluid responsiveness within 10 min after FC.

Cardio-cerebrovascular disease (CCVD) is a major comorbidity of Coronavirus disease 2019 (COVID-19). However, the clinical characteristics and outcomes remain unclear. In this study, 102 cases of COVID-19 from January 22, 2020 to March 26, 2020 in Xixi Hospital of Hangzhou were included. Twenty cases had pre-existing CCVD. Results showed that compared with non-CCVD patients, those with CCVD are more likely to develop severe disease (15% versus 1%), and the proportion of pneumonia severity index grade IV was significantly higher (25% versus 3.6%). Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group (90% versus 63.4%). Compared with non-CCVD group, the levels of C-reactive protein, fibrinogen, D-dimer, and serum amyloid-A were higher, whereas the total protein and arterial partial PaO
COVID-19 ; Cerebrovascular Disorders/epidemiology* ; Comorbidity ; Humans ; SARS-CoV-2 ; Tomography, X-Ray Computed

The lung is one of the most common sites for cancer metastasis. Collagens in the lung provide a permissive microenvironment that supports the colonization and outgrowth of disseminated tumor cells. Therefore, down-regulating the production of collagens may contribute to the inhibition of lung metastasis. It has been suggested that miR-29 exhibits effective anti-fibrotic activity by negatively regulating the expression of collagens. Indeed, our clinical lung tumor data shows that miR-29a-3p expression negatively correlates with collagen I expression in lung tumors and positively correlates with patients' outcomes. However, suitable carriers need to be selected to deliver this therapeutic miRNA to the lungs. In this study, we found that the chemotherapy drug cisplatin facilitated miR-29a-3p accumulation in the exosomes of lung tumor cells, and this type of exosomes exhibited a specific lung-targeting effect and promising collagen down-regulation. To scale up the preparation and simplify the delivery system, we designed a lung-targeting liposomal nanovesicle (by adjusting the molar ratio of DOTAP/cholesterol-miRNAs to 4:1) to carry miR-29a-3p and mimic the exosomes. This liposomal nanovesicle delivery system significantly down-regulated collagen I secretion by lung fibroblasts in vivo, thus alleviating the establishment of a pro-metastatic environment for circulating lung tumor cells.