With the rapid development of medical big data and artificial intelligence,Clinical Prediction Models(CPMs)have become pivotal tools for disease prevention,diagnosis,and treatment.Current research predominantly focuses on the economic analysis of pharmacological or public health interventions,yet a comprehensive methodological framework for the economic evaluation of CPMs has been notably absent.The Guidelines for Economic Evaluation of Clinical Prediction Models(hereafter the Guidelines),jointly initiated by the Chinese Research Hospital Association and Peking University,Tsinghua University,and Capital Medical University,adheres to the WHO Handbook for Guideline Development and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards.A multidisciplinary collaboration,including a steering committee,expert panel,secretariat,and external review group,was established to develop the guideline following evidence-based principles and procedures.Consensus recommendations were formulated through the Delphi method.It describes the background,objectives,target group,and the development methodology and process,ensuring the entire compilation process of the Guidelines is transparent and standardized.Through comprehensive evidence retrieval,systematic evidence appraisal,and a scientific approach to forming recommendations,the scientific rigor and validity of the Guidelines were further enhanced.

With the rapid development of medical big data and artificial intelligence,Clinical Prediction Models(CPMs)have become pivotal tools for disease prevention,diagnosis,and treatment.Current research predominantly focuses on the economic analysis of pharmacological or public health interventions,yet a comprehensive methodological framework for the economic evaluation of CPMs has been notably absent.The Guidelines for Economic Evaluation of Clinical Prediction Models(hereafter the Guidelines),jointly initiated by the Chinese Research Hospital Association and Peking University,Tsinghua University,and Capital Medical University,adheres to the WHO Handbook for Guideline Development and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards.A multidisciplinary collaboration,including a steering committee,expert panel,secretariat,and external review group,was established to develop the guideline following evidence-based principles and procedures.Consensus recommendations were formulated through the Delphi method.It describes the background,objectives,target group,and the development methodology and process,ensuring the entire compilation process of the Guidelines is transparent and standardized.Through comprehensive evidence retrieval,systematic evidence appraisal,and a scientific approach to forming recommendations,the scientific rigor and validity of the Guidelines were further enhanced.

The COVID-19 epidemic has spread to the whole world for three years and has had a serious impact on human life, health and economic activities. China's epidemic prevention and control has gone through the following stages: emergency unconventional stage, emergency normalization stage, and the transitional stage from the emergency normalization to the "Category B infectious disease treated as Category B" normalization, and achieved a major and decisive victory. The designated hospitals for prevention and control of COVID-19 epidemic in Tianjin has successfully completed its tasks in all stages of epidemic prevention and control, and has accumulated valuable experience. This article summarizes the experience of constructing a hospital infection prevention and control system during the "Category B infectious disease treated as Category A" period in designated hospital. The experience is summarized as the "Cluster" hospital infection prevention and control system, namely "three rings" outside, middle and inside, "three districts" of green, orange and red, "three things" before, during and after the event, "two-day pre-purification" and "two-director system", and "one zone" management. In emergency situations, we adopt a simplified version of the cluster hospital infection prevention and control system. In emergency situations, a simplified version of the "Cluster" hospital infection prevention and control system can be adopted. This system has the following characteristics: firstly, the system emphasizes the characteristics of "cluster" and the overall management of key measures to avoid any shortcomings. The second, it emphasizes the transformation of infection control concepts to maximize the safety of medical services through infection control. The third, it emphasizes the optimization of the process. The prevention and control measures should be comprehensive and focused, while also preventing excessive use. The measures emphasize the use of the least resources to achieve the best infection control effect. The fourth, it emphasizes the quality control work of infection control, pays attention to the importance of the process, and advocates the concept of "system slimming, process fattening". Fifthly, it emphasizes that the future development depends on artificial intelligence, in order to improve the quality and efficiency of prevention and control to the greatest extent. Sixth, hospitals need to strengthen continuous training and retraining. We utilize diverse training methods, including artificial intelligence, to ensure that infection control policies and procedures are simple. We have established an evaluation and feedback mechanism to ensure that medical personnel are in an emergency state at all times.

Objective To evaluate the clinical effect of proximal femoral nail anti-rotation Ⅱ (PFNA Ⅱ) internal fixation in the treatment of intertrochanteric fracture.Methods From September 2012 to April 2016,the clinical data of 37 patients with intertrochanteric fracture who were treated by PFNA Ⅱ internal fixation in Yuehua Hospital were retrospectively analyzed.Results All 37 patients were successfully operated,and the operation time was 40 ～120 min,with an average of 66 min.The amount of blood loss was 30 ～ 110 mL,with an average of 50 mL.During operation and after operation,X ray showed a good position and steady internal fixation.Three days after operation,patients exercised diseased side hip joint.Seven days after operation,patients exercised sitting on the bed.Fourteen days after operation,suture was dismantled and patients could get out of bed and walk with no weight or some weight.Lower limb deep venous thrombosis (DVT) was not observed.Through operative multiple reexamination,the fracture was healed and hip joint function was good.Conclusion PFNA Ⅱ has advantages of convenient operation,less trauma,stronger internal fixation,rapid recovery.It is an ideal method to treat intertrochanteric fracture.

Objective To analyze the influencing factors of surgical management for Blalock-Taussig shunt during neonatal period,and to summarize the clinical experience,therefore,to improve the surgical outcome.Methods The clinical data between Jan 2011 and Dec 2016 were reviewed,42 neonates(26 males,16 females)with the mean age from 1 to 29 days,and weight from 2.3 to 4.1 kg,underwent a Blalock-Taussig shunt.The additional operation included PDA retention in 3 patients,right ventricular outflow tract retention in 12 patients,B-T conduit banding in 2 patients and PDA banding in 1 patient.Results The early mortality was 28.6％ (12/42).Univariate analysis revealed low birth weight,waiting time for surgery,preoperative acidosis or cardiac shock,dual pulmonary blood supply,conduit/weight,high IS (inotropic drugs score),unplanned intervention as risk factors for early death.In the multivariate analysis,preoperative acidosis or cardiac shock,conduit/weight,high IS were independent risk factors of early death.Conclusion The mortality rate after the neonatal modified Blalock-Taussig shunt remains high.It can be improved by proper perioperative treatment,immediate surgical treatment and choose suitable conduit size,maintain the stable circulation.

Objective To analyze the clinical characteristics of brucellosis cases with fever of unknown origin (FUO) as initial manifestation,and to further raise awareness of doctors in non-epidemic areas.Methods Clinical data of 19 brucellosis cases with FUO as initial manifestation in Huashan Hospital,Fudan University and Jing'an branch from June 2005 to July 2016 were collected.The epidemiological,clinical,assistant examination,imaging,treatment and prognosis data of these patients were retrospectively analyzed.Results The average age of the 19 cases was 48 years old,of whom 3 were female and 16 were male.Seventeen cases had the history of contact with sick livestock or epidemic areas.The main clinical manifestations were hepatomegaly or splenomegaly or lymphadenectasis (14 cases),bone,joint and spine involvement (9 cases),orchitis (3 cases),encephalopathy and peripheral neuropathy (1 case),infectious myelitis (1 case) and sequelae of infectious transverse myelitis (1 case).Brucella was detected in 7 patients by blood culture.The agglutination test of serum antibody were 100％ positive.All patients got improvement after anti-Brucella therapeutic regimen based on doxycycline.Conclusion Brucellosis should be considered for patients with FUO from non-epidemic areas according to clinical and epidemic features.

Objective To investigate the feasibility of inserting and detaining nasointestinal feeding tube in small bowl guided by bedside ultrasound(US)in critically ill elderly patients.Methods This was a retrospective study.Sixty four aged patients(≥ 60 years)in general ICU,the Second Affiliated Hospital of Jiaxing College,received the US-guided nasointestinal feeding tubes inserting and detaining.Feeding tubes passed through nasal and went into the stomach by manual blind method.Under US-guiding condition,the tube passed through the pyloric sphincter and further into the duodenum or jejunum.Finally the correct position of the tube head was assessed by bedside X-ray examination.Results The US-guided nasointestinal feeding tube-detaining technique was successfully operated in 57 patients(89.1％).The feeding tube heads were in the duodenum in thirty four cases(53.1 ％),and in proximal jejunum in twenty-three cases(35.9％).The untoward reaction included the bleeding of nasal cavity in 1 case,and hypotension in another case.Conclusions Bedside US-guided nasointestinal feeding tube placement is safe and feasible in aged critical patients.

OBJECTIVE:To investigate the effect of total saponins of Man medicine Thladiantha dubia root(TSTR)on the ex-pressions of CD3+,CD4+and CD8+ in spleen tissue of rats with type Ⅱ collagen-induced arthritis (CIA),and explore its mecha-nism in the treatment of rheumatoid arthritis(RA). METHODS:8 rats were taken as normal control group(NC group),the others 72 rats were injected mixture of bovine type Ⅱ collagen and Freund's complete adjuvant in tail and back to induce CIA model. The 50 modeled rats were randomly divided into model group(MC group),tripterygium polyglycoside(TG)group(12 mg/kg,posi-tive control),TSTR low-dose,medium-dose,high-dose groups (20,40,80 mg/kg),10 in each group. Rats in medicine groups were intragastrically administrated for 35 d,once a day;rats in NC group and MC group were intragastrically administrated equal volume of distilled water. Ankle swelling degree of rats was determined,arthritis indexes were calculated,HE staining was used to observe the lesions in synovial tissue,and immunohistochemistry was used to detect the expressions of CD3+,CD4+,CD8+ in spleen tissue of rats. RESULTS:After 35 d of administration,ankle swelling degree,arthritis indexes,CD4+ expression in spleen tissue,and CD4+/CD8+ ratio in MC group were significantly higher than NC group (P<0.05 or P<0.01),expressions of CD3+, CD8+were significantly lower than NC group(P<0.05);and there was congestion and massive inflammatory cell infiltration in sy-novial tissue. The ankle swelling degree,arthritis indexes,expression of CD4+ in spleen tissue,and CD4+/CD8+ ratio in administra-tion groups were significantly lower than MC group(P<0.05);the expressions of CD3+,CD8+ in spleen tissue in administration groups were significantly higher than MC group (P<0.05);TG group,TSTR medium-dose and high-dose groups showed mild congestion and a small amount of inflammatory cell infiltration in synovial tissue of rats,and TSTR low-dose group showed no ob-vious congestion or inflammatory cell infiltration. CONCLUSIONS:Up-regulating the expressions of CD3+,CD8+ and down-regu-lating the expression of CD4+ may be one of the mechanisms of TSTR in the treatment of RA;and with best efficacy when the TSTR dose of 20 mg/kg.

Soft aid for health has become an important component of China's foreign aid. Soft aid for health with a focus on human resources development reflects the core spirit and the innovative mechanism of China's foreign aid. This paper examines three different types of aid for health human resources: medical assistance teams, govern-ment scholarships for students from developing countries, and health training courses for officials from developing countries. It also argues that China's foreign aid exposes problems, including insufficient strategic planning, non-in-volvement of civil society and NGOs, and lack of research on China's soft aid practices. In this paper, we suggests that to improve the effectiveness of foreign aid, the government should improve its strategic planning for aid, ensure the full public participation, strengthen the academic research, and improve knowledge sharing.

Objective To describe the clinical feature ,therapeutic approach and prognosis of histoplasmosis for improving clinicians’ awareness of this disease .Methods The clinical data of 7 cases of histoplasmosis treated in Shanghai Huashan Hospital from 2001 to 2014 were reviewed retrospectively .Relevant reports about histoplasmosis from 2001 to 2014 in Chinese mainland were comprehensively reviewed .Results The major clinical manifestations of progressive disseminated histoplasmosis included fever ,hepatosplenomegaly ,lymphadenopathy ,and pancytopenia .Skin lesions and pancytopenia were more common in the patients complicated with HIV/AIDS .The patients with local infection were lack of systemic symptoms or signs . Histological examination found Histoplasmacapsulatum in macrophages in bone marrow or biopsy tissues .Amphotericin B was used most frequently to treat histoplasmosis .Itraconazole was appropriate in mild patients .Conclusions Histoplasmosis is caused by H .capsulatum .The golden standard of diagnosis is any culture positive for H .capsulatum .Antifungal treatments such as amphotericin B and itraconazole are very important .