Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective:To explore the construction of clinical competence index system for general practitioners based on CIPP(context evaluation, input evaluation, process evaluation, product evaluation) evaluation model.Methods:Based on the CIPP evaluation model, a research team was established to conduct a literature review. Research articles were retrieved, screened, and analyzed to formulate the primary clinical competence index system for general practitioners based on CIPP evaluation model and the expert consultation questionnaire. The Delphi method was employed to finalize the clinical competence index system for general practitioners based on CIPP evaluation model.Results:A total of 24 experts from grade A tertiary hospitals in several provinces and cities in China participated in two rounds of consultation. The effective recovery rate for both rounds was 100.00%. The authority coefficients were 0.905 and 0.912, respectively. After the consultations, the coefficients of variation of indexes at all levels were <0.25. The Kendall's W of all indexes ranged between 0.769 and 0.814 in the first round and between 0.867 and 0.905 in the second round of expert consultation ( P<0.001). The final clinical competence index system for general practitioners based on CIPP evaluation model included 4 first-level indexes, 12 second-level indexes, and 42 third-level indicators. Conclusions:The clinical competence index system for general practitioners based on CIPP evaluation model established in this study has reference significance for further research on the training assessment and evaluation index system of clinical competence for general practitioners in China, and has important practical significance for the evaluation tool of clinical work performance of general practitioners.

Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective:To explore the construction of clinical competence index system for general practitioners based on CIPP(context evaluation, input evaluation, process evaluation, product evaluation) evaluation model.Methods:Based on the CIPP evaluation model, a research team was established to conduct a literature review. Research articles were retrieved, screened, and analyzed to formulate the primary clinical competence index system for general practitioners based on CIPP evaluation model and the expert consultation questionnaire. The Delphi method was employed to finalize the clinical competence index system for general practitioners based on CIPP evaluation model.Results:A total of 24 experts from grade A tertiary hospitals in several provinces and cities in China participated in two rounds of consultation. The effective recovery rate for both rounds was 100.00%. The authority coefficients were 0.905 and 0.912, respectively. After the consultations, the coefficients of variation of indexes at all levels were <0.25. The Kendall's W of all indexes ranged between 0.769 and 0.814 in the first round and between 0.867 and 0.905 in the second round of expert consultation ( P<0.001). The final clinical competence index system for general practitioners based on CIPP evaluation model included 4 first-level indexes, 12 second-level indexes, and 42 third-level indicators. Conclusions:The clinical competence index system for general practitioners based on CIPP evaluation model established in this study has reference significance for further research on the training assessment and evaluation index system of clinical competence for general practitioners in China, and has important practical significance for the evaluation tool of clinical work performance of general practitioners.

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ²=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ²=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ²=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ²=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

Objective:To explore the pathogenic characteristics of incision wound infections after breast cancer surgery and related influencing factors.Methods:Clinical files of 200 middle-aged and elderly patients who underwent breast-conserving surgery for breast cancer in the Affiliated Three Gorges Hospital from May 2016 to April 2021 were retrospectively analyzed.The results of pathogenic bacteria and drug sensitivity tests were examined, and the influencing factors of postoperative incision infections after breast cancer surgery were analyzed.Results:Among 200 middle-aged and elderly patients aged 55-75 years who underwent breast-conserving surgery for breast cancer, 13 patients(4.64%)developed postoperative incision infections, with 40 strains of pathogenic bacteria isolated, including 14 strains of gram-positive bacteria, 25 strains of gram-negative bacteria and 1 fungal strain.Univariate and multivariate logistic regression analysis showed that age( OR=3.40), duration of surgery( OR=2.50), albumin level( OR=2.83), underlying diseases( OR=4.23), preventive use of antibiotics( OR=3.14)and length of hospital stay( OR=2.33)were independent risk factors for postoperative incision infections in breast cancer patients(all P<0.05). Conclusions:Common pathogens of incision infections after breast-conserving surgery are Gram-negative bacteria.There are many factors affecting postoperative incision infections.Clinical measures need to be taken to reduce or prevent postoperative incision infections.

ObjectiveTo understand the health-related life quality and its influencing factors in elderly community residents in Shanghai， and to provide reference for improving their life quality. MethodsDuring April to June 2021， a cross-sectional survey was conducted in five selected community health care centers， from Baoshan District， Minhang District， Songjiang District and Pudong New District of Shanghai， respectively. The elderly residents aged 65 and over who received physical examination were face-to-face interviewed using EQ-5D-5L scale. SPSS 26.0 and Stata 16 were used for statistical analysis. Binary logistic regression， multiple linear regression and Tobit regression were used to analyze influencing factors of each dimension in EQ-5D scale， EQ-VAS score and health utility value. ResultsA total of 1302 elderly residents were included in the study， and the proportions of problems in the five dimensions of EQ-5D-5L scale were pain/discomfort （13.9%）， mobility （9.1%）， daily activity （5.8%）， self-care ability （4.8%） and anxiety/depression （3.6%）， while age was a factor influencing problems in each dimension. The average score of EQ-VAS was 84.28±10.32， and the average health utility value based on Chinese population was 0.97±0.08， which was higher than the rest of the country. Tobit regression analysis showed that female （t=-3.96， P<0.001）， age group over 75 （t=-5.28， P<0.001）， high school education or above （t=-2.53， P=0.012）， chronic disease （t=-5.12， P<0.001） had poor quality of life （P<0.05）. ConclusionThe overall quality of life of the elderly in Shanghai community is good， but the quality of life in the elderly women and in the group suffering from chronic diseases is relatively poor. It is necessary to pay more attention to the key populations to improve their health status.

Objective To explore the association of CD22 gene T＞A locus (SNPrs2267574) with the development of systemic lupus erythematosus (SLE) and SLE phenotypes in Southern Chinese Han people.Methods Two hundreds fifteen cases and 216 normal controls were enrolled with the aim of case-control design,and the genotype was determined by PCR-RFLP.We calculated X2 and ORs for association study.Results In CD22 gene T＞A locus,there was significant difference of genotypes distribution between cases and controls (X2=6.086,P＜0.05).The frequency of AT genotype was higher in cases than in controls (OR=1.68,95%CI:1.08～2.60,P=0.021 ),and A allele had a higher proportion in cases (OR=1.58,95%CI:1.09～2.29,P=0.015).Meanwhile,the frequency of A allele in patients with positive anti-SSA was higher than in patients with negative anti-SSA (OR=3.69,95%CI:2.08～6.52,P＜0.01 ).Conclusion In Southern Chinese Han population,CD22 gene T＞A locus is associated with the development of SLE and the A allele has positive association with anti-SSA.