Clinical practice guidelines represent the best recommendations for patient care. They are developed through systematically reviewing currently available clinical evidence and weighing the relative benefits and risks of various interventions. However, clinical practice guidelines have to go through a long translation cycle from development and revision to clinical promotion and application, facing problems such as scattered distribution, high duplication rate, and low actual utilization. At present, the clinical practice guideline information platform can directly or indirectly solve the problems related to the lengthy revision cycles, decentralized dissemination and limited application of clinical practice guidelines. Therefore, this paper systematically examines different types of clinical practice guideline information platforms and investigates their corresponding challenges and emerging trends in platform design, data integration, and practical implementation, with the aim of clarifying the current status of this field and providing valuable reference for future research on clinical practice guideline information platforms.

Objective To clarify the risk factors of diaphragmatic dysfunction (DD) after cardiac surgery with extracorporeal circulation. Methods A retrospective analysis was conducted on the data of patients who underwent cardiac surgery with extracorporeal circulation in the Department of Cardiovascular Surgery of Peking University People's Hospital from January 2023 to March 2024. Patients were divided into two groups according to the results of bedside diaphragm ultrasound: a DD group and a control group. The preoperative, intraoperative, and postoperative indicators of the patients were compared and analyzed, and independent risk factors for DD were screened using multivariate logistic regression analysis. Results A total of 281 patients were included, with 32 patients in the DD group, including 23 males and 9 females, with an average age of (64.0±13.5) years. There were 249 patients in the control group, including 189 males and 60 females, with an average age of (58.0±11.2) years. The body mass index of the DD group was lower than that of the control group [(18.4±1.5) kg/m2 vs. (21.9±1.8) kg/m2, P=0.004], and the prevalence of hypertension, chronic obstructive pulmonary disease, heart failure, and renal insufficiency was higher in the DD group (P<0.05). There was no statistical difference in intraoperative indicators (operation method, extracorporeal circulation time, aortic clamping time, and intraoperative nasopharyngeal temperature) between the two groups (P>0.05). In terms of postoperative aspects, the peak postoperative blood glucose in the DD group was significantly higher than that in the control group (P=0.001), and the proportion of patients requiring continuous renal replacement therapy was significantly higher than that in the control group (P=0.001). The postoperative reintubation rate, tracheotomy rate, mechanical ventilation time, and intensive care unit stay time in the DD group were higher or longer than those in the control group (P<0.05). Multivariate logistic regression analysis showed that low body mass index [OR=0.72, 95%CI (0.41, 0.88), P=0.011], preoperative dialysis [OR=2.51, 95%CI (1.89, 4.14), P=0.027], low left ventricular ejection fraction [OR=0.88, 95%CI (0.71, 0.93), P=0.046], and postoperative hyperglycemia [OR=3.27, 95%CI (2.58, 5.32), P=0.009] were independent risk factors for DD. Conclusion The incidence of DD is relatively high after cardiac surgery, and low body mass index, preoperative renal insufficiency requiring dialysis, low left ventricular ejection fraction, and postoperative hyperglycemia are risk factors for DD.

Iodine is an essential micronutrient for the synthesis of thyroid hormones and for growth and development in the human body. Recent studies have revealed that iodine can exert biological functions beyond the thyroid. By modulating oxidative stress and gut microbiota abundance, it influences systemic metabolic homeostasis. Imbalance in iodine nutrition during pregnancy is closely associated with the onset and progression of gestational metabolic diseases. Based on studies pertaining to the relationship between iodine nutrition during pregnancy and gestational metabolic diseases from 1980 to 2025, this review summarized the relationship of iodine nutrition during pregnancy with gestational metabolic diseases, including gestational diabetes mellitus, gestational hypertension and preeclampsia, gestational overweight or obesity, and gestational dyslipidemia, and described the underlying biological mechanisms, so as to provide the evidence for formulating prevention and control strategies for gestational metabolic diseases.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Abstract Long noncoding RNA (lncRNA) is closely related to the pathogenesis of cancer,representing a burgeoning field in tumor research in recent years. MAGI2-AS3, a tumor-associated lncRNA, exerts pivotal roles in epigenetics, transcription and post-transcriptional regulation. Studies have suggested that MAGI2-AS3 may be involved in multiple stages of tumor development, and has potential applications for tumor diagnosis, therapy and prognosis. This review summarizes the expression, regulatory mechanism and clinical application value of MAGI2-AS3 in common malignant tumrs, providing the reference for tumor prevention and treatment.

Objective This study aimed to analyze the impact of genetic factors on the clinical presentation of tic disorder and investigate the pathogenesis of tic disorder considering different sources of genetic influence and generations,along with the distribution characteristics of evidence from Chinese medicine.Methods Inclusion of 474 cases of tic disorder was assembled(from October,2020 to October,2023),and clinical data on the children,including gender,age of onset,disease duration,initial symptoms,severity,comorbidities,and family history,and TCM patterns were collected.Firstly,the children were divided into genetic and nongenetic groups based on family history,and their clinical manifestations were observed.Secondly,the age of peak incidence of tic disorder in China(6 or 9 years)was used as the age segmentation point to explore the influence of heredity on clinical manifestations at different ages and the distribution of TCM patterns.Finally,children with genetically-related tic disorder were selected as probands to carry out family studies.The morbidity of the first-degree,second-degree and third-degree relatives of the probands were investigated to analyze the morbidity characteristics and distribution of TCM patterns of children with tic disorder under different genetic types.Results Out of 474 children,226 cases(47.7％)belonged to the genetic group,and 248 cases(52.3％)to the nongenetic group.Compared with the non-genetic group,the genetic group had a younger age of onset(P=0.013),a longer duration of illness(P=0.011),a higher degree of severity(P＜0.01),and more comorbid conditions(P=0.016).Children in the genetic group with an age of onset under 6 years accounted for a larger proportion of the liver-hyperactive and wind-driven pattern(26.5％)and a smaller proportion of the qi depression transforming into fire pattern(17.1％),which were significantly different from those in the non-genetic group(P=0.016).In the genetic group,146 cases(64.6％)were inherited from the father,80 cases(35.4％)from the mother,and there was no significant difference in the developmental characteristics of children with tic disorder from different sources of genetic influence.Furthermore,183 cases(81.0％)were inherited from the parent-child generation,26 cases(11.5％)from the second generation,and 17 cases(7.5％)from the third generation;the difference in initial symptoms between different genetic generations was statistically significant(P=0.042).Conclusion Children with genetically related tic disorder have a younger age of onset,their condition is more severe,and they are more likely to be comorbid with other psychiatric disorders.The variation in the distribution of Chinese medicine patterns among children with tic disorder of different ages of onset.

Objective To identify clinical risk factors for early major adverse cardiovascular events (MACEs) following surgical correction of supravalvar aortic stenosis (SVAS). Methods Patients who underwent SVAS surgical correction between 2002 and 2019 in Beijing and Yunnan Fuwai Cardiovascular Hospitals were included. The patients were divided into a MACEs group and a non-MACEs group based on whether MACEs concurring during postoperative hospitalization or within 30 days following surgical correction for SVAS. Their preoperative, intraoperative, and postoperative clinical data were collected for multivariate logistic regression. Results This study included 302 patients. There were 199 males and 103 females, with a median age of 63.0 (29.2, 131.2) months. The incidence of early postoperative MACEs was 7.0% (21/302). The multivariate logistic regression model identified independent risk factors for early postoperative MACEs, including ICU duration (OR=1.01, 95%CI 1.00-1.01, P=0.032), intraoperative cardiopulmonary bypass (CPB) time (OR=1.02, 95%CI 1.01-1.04, P=0.014), aortic annulus diameter (OR=0.65, 95%CI 0.43-0.97, P=0.035), aortic sinus inner diameter (OR=0.75, 95%CI 0.57-0.98, P=0.037), and diameter of the stenosis (OR=0.56, 95%CI 0.35-0.90, P=0.016). Conclusion The independent risk factors for early postoperative MACEs include ICU duration, intraoperative CPB time, aortic annulus diameter, aortic sinus inner diameter, and diameter of the stenosis. Early identification of high-risk populations for MACEs is beneficial for the development of clinical treatment strategies.

Objective:To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021.Methods:A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children.Results:The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M ( Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 ( χ 2trend=111.427, P<0.001). The median of urinary iodine concentration M ( Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [ M ( Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [ M ( Q1, Q3): 173.00 (113.00, 250.30) μg/L] ( P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95% CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95% CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95% CI: 2.64%-3.10%), 588/20 530] ( P=0.001). Conclusion:From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.

Objective To observe effect of reconstructing physiological fulcrum in the treatment of elderly patients with intertrochanteric fracture of the femur. Methods Clinical materials of 40 elderly patients with osteoporotic intertrochanteric fracture of femur in the Tongling City People's Hospital from October 2020 to October 2022 were retrospectively analyzed. Among them, 20 patients treated with proximal femoral nail anti-rotation (PFNA) were assigned to the PFNA group, and 20 patients treated with proximal femoral bionic nail (PFBN) were assigned to the PFBN group. The operation time, intraoperative blood loss, length of hospital stay, postoperative rehabilitation, and incidence of complications were compared between the two groups. Results The postoperative weight-bearing time in the PFBN group was (8.50±1.99) days, which was significantly shorter than (20.15±4.87) days in the PFNA group (P<0.05). There were no significant differences in operation time, intraoperative blood loss, length of hospital stay, fracture healing time, excellent and good rate of fracture reduction quality, and excellent and good rate of Harris score between the PFBN group and the PFNA group (P>0.05). During the follow-up period of 10 to 14 months, no patients had complications such as wound infection, bone nonunion, implant failure, or deep venous thrombosis. Conclusion Both PFBN and PFNA can effectively treat elderly patients with osteoporotic intertrochanteric fracture of femur. However, patients treated with PFBN can take bed-off activities earlier, which is beneficial for postoperative rehabilitation, and the reason may be related to the double triangular stable structure reconstructed by PFBN.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.