Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective:To compare the clinical efficacy between a single palmar lateral transverse approach and the modified Henry approach in the locking plate fixation for distal radius fractures.Methods:A retrospective study was conducted to analyze the data of 82 patients with distal radius fracture who had undergone locking plate fixation through either a single palmar lateral approach or the modified Henry approach between January 2016 and December 2022 at Department of Traumatic Orthopaedics, Taihe Hospital, Affiliated to Hubei University of Medicine. There were 25 males and 57 females, with an age of (53.8±12.7) years. Based on the difference in surgical approach, the patients were divided into a single transverse approach group ( n=42) and a modified Henry approach group ( n=40). The 2 groups were compared in terms of injury cause, injury location, time from injury to surgery, AO fracture classification, tourniquet time during surgery, incision length, fracture reduction, Patient and Observer Scar Assessment Scale (PSAS & OSAS) and Disability of the Arm, Shoulder, and Hand (DASH) score at the last follow-up, and complications after surgery. Results:There were no statistically significant differences in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (8.2±3.5) months. Follow-ups revealed one case of injury to the palmar cutaneous branch of the median nerve but no other complications like infection, non-union, internal fixation failure, or tendon injury in the single transverse approach group. The single transverse approach group was significantly superior over the modified Henry approach group in incision length [(2.4±0.9) cm versus (5.3±1.6) cm], OSAS (8.1±4.2 versus 10.3±5.7), and PSAS (10.1±5.8 versus 14.7±6.4) ( P<0.05). There were no significant differences between the 2 groups in tourniquet time, fracture reduction quality, and DASH score at the last follow-up ( P>0.05). Conclusion:In locking plate fixation for distal radius fractures, in comparison with the modified Henry approach, a single palmar lateral approach is more minimally invasive so that more aesthetically pleasing outcomes can be achieved to facilitate patients' rapid return to work and society.

Iron (Fe) deficiency and excess cadmium (Cd) in rice grain are important problems to be solved in agricultural production. Previous studies have shown that OsVIT1 and OsVIT2 are vacuolar iron transporters. In this study, wild-type ZH11 was selected as the background material and OsVIT1 and OsVIT2 were overexpressed in endosperm by using endosperm specific promoter Glb-1. Field experiments were conducted to study the effect of OsVIT1 and OsVIT2 overexpression on Fe and Cd accumulation in different parts of rice. The results showed that OsVIT1 overexpression in endosperm significantly reduced Fe content in grain by about 50%, while significantly increased zinc (Zn) and copper (Cu) contents in straw and Cu content in grain. OsVIT2 overexpression in endosperm significantly decreased Fe and Cd contents in grain by about 50%, and significantly increased Fe content in straw by 45%-120%. Overexpression of OsVIT1 and OsVIT2 in endosperm did not affect the agronomic traits of rice. In conclusion, OsVIT1 and OsVIT2 overexpression in endosperm reduced Fe accumulation in rice grain, which did not achieve the expected effect. OsVIT2 overexpression in endosperm also decreased Cd accumulation in grain and increased Fe accumulation in straw, which provided reference for iron biofortification and cadmium reduction in rice.
Cadmium ; Endosperm/chemistry* ; Oryza/genetics* ; Iron ; Zinc ; Edible Grain ; Soil Pollutants

Objective    To evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation. Methods    From May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups. Results    After PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05). Conclusion    The mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.

Objective:To understand and predict the situation of occupational diseases in Changsha, and to provide theoretical basis for the scientific formulation of occupational diseases prevention, control strategies and measures.Methods:In April 2019, the data of occupational diseases incidences from 2010 to 2018 were collected. The original GM (1, 1) grey model and buffer operator improved model were established, and compared their prediction effect. The model with the smallest average relative error was selected to predict the incidence of occupational diseases during 2019-2023.Results:The relative accuracy of the original GM (1, 1) grey model and the first-order and second-order buffer operator improved model were 80.92%, 97.71%, 99.64%, respectively. And the c values were 0.74, 0.28, 0.09, and the P values were 0.67, 1.00, 1.00, respectively. It was predicted that the incidence number of occupational diseases in Changsha during 2019-2023 would be 40, 39, 39, 38, 37, respectively. Conclusion:The buffer operator improved model is suitable for the prediction of the original data series with high volatility, and it can fit the incidence of occupational diseases in Changsha.

Objective:To understand and predict the situation of occupational diseases in Changsha, and to provide theoretical basis for the scientific formulation of occupational diseases prevention, control strategies and measures.Methods:In April 2019, the data of occupational diseases incidences from 2010 to 2018 were collected. The original GM (1, 1) grey model and buffer operator improved model were established, and compared their prediction effect. The model with the smallest average relative error was selected to predict the incidence of occupational diseases during 2019-2023.Results:The relative accuracy of the original GM (1, 1) grey model and the first-order and second-order buffer operator improved model were 80.92%, 97.71%, 99.64%, respectively. And the c values were 0.74, 0.28, 0.09, and the P values were 0.67, 1.00, 1.00, respectively. It was predicted that the incidence number of occupational diseases in Changsha during 2019-2023 would be 40, 39, 39, 38, 37, respectively. Conclusion:The buffer operator improved model is suitable for the prediction of the original data series with high volatility, and it can fit the incidence of occupational diseases in Changsha.

Objective To investigate the clinical,imaging,intestinal pathological characteristics and prognosis of gluten ataxia (GA).Methods The clinical data,treatment and prognosis in a patient with GA that was confirmed by pathology and hospitalized in the Department of Neurology,China-Japan Friendship Hospital in July 2018,were analyzed retrospectively.The related literature was reviewed and the clinical feature was summarized.Results The patient is a 41-year old man.He suffered from progressive cerebellar ataxia,and the brain magnetic resonance imaging exhibited diffused cerebellar atrophy.Serum human leukocyte antigen (HLA) tests showed that the patient carried HLA-DQ2 genotype.IgA type anti-gliadin antibody was positive (39.39 RU/ml).Duodenoscopy biopsy revealed mild villus atrophy and lymphocytic infiltration,indicating celiac disease.The diagnosis of GA was established then and the patient was administered gluten-free diet combined with intravenous immunoglobulin,which markedly improved the cerebellar symptoms and signs of cerebellar speech,walk capability and daily living activities.He could do long distance driving independently two months later.Conclusions GA is one of immune-mediated reversible acquired cerebellar ataxia caused by gluten sensitivity.The genotype,serologic features,and clinical phenotype of GA in Chinese mainland population might be similar with those in European and American countries.

Objective To compare the clinical significance of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting prognosis of patients with hepatocellular carcinoma (HCC).Methods The clinical data of 661 patients with HCC were retrospectively analyzed.Routine peripheral blood test results were used to calculate the NLR and PLR,and the receiver operating characteristic (ROC) curves were drawn.Using the thresholds of NLR and PLR,the patients were divided into the low NLR group and the high NLR group,and the low PLR group and the high PLR group.Overall survival (OS) and disease free survival (DFS) were evaluated by the Kaplan-Meier method.Independent prognostic predictors were determined by the Cox proportional hazard model.Results The NLR and PLR thresholds were 2.790 and 99,respectively.Analysis of the ROC curves showed higher NLR and PLR were significantly associated with poorer OS and DFS (all P ＜ 0.05).Multivariate analysis showed that NLR was an independent risk factor of OS and DFS (both P ＜ 0.05).The results remained unchanged when the NLR was further analyzed by applying different cut-off values of 2.810 and 3.In subgroup analysis,NLR remained an independent factor of Barcelona Clinical Liver Cancer staging system (BCLC) 0/A/B (P ＜ 0.05 for all measurements).Conclusion An elevated preoperative NLR could be a better prognostic predictor for HCC patients in comparison with PLR,especially for BCLC 0/A/B patients.