Objective:To analyze the current employment status and the reasons for not engaging in general practice among general practice residents who completed training during 2018-2020.Methods:This study was a cross-sectional study. A questionnaire survey on the current employment was conducted among general practice residents who completed redidency training from 2018 to 2020, participants were selected by stratified random sampling in 57 training centers from each 5 provinces(municipalities) of the eastern, middle and western regions in China. The reasons for not engaging in general practice were investigated through telephone contact.Results:Of the 1 037 general practice residents who responded to the questionnaire, 677 residents(65.3%, 677/1 037) were engaged in general practice after training, while 360 residents(34.7%, 360/1 037) left general practice career or were awaiting employment. The three provinces with the highest proportion of residents leaving general practice career were Hubei(76.5%, 26/360), Sichuan(74.4%, 29/360) and Shandong provinces(59.6%, 28/360). There were significant differences in proportion of residents leaving general practice career after completing the training among eastern, middle and western regions(χ 2=42.911, P<0.001). A total of 261 participants(25.2%, 261/1 037) were engaged in non-general practice clinical career like internal medicine, surgery, gynecology, pediatrics or medical imaging; and the proportion in the eastern(27.3%, 67/245) and middle(33.3%, 106/318) regions was significantly higher thant that in the western region(18.6%, 88/474)(χ 2=6.855, P<0.05; χ 2=21.651, P<0.05). Among 259(71.9%, 259/360) participants who left general practice career, the main reasons were personal choice(63.3%, 164/259) or employers′ arrangement(22.4%, 58/259); the three provinces with the highest percentage of personal choice were Hubei(92.0%, 23/25), Sichuan(85.2%, 23/27) and Henan provinces(80.0%, 20/25). The proportion of personal choice in the middle region(82.4%, 84/102) was significantly higher than that in the eastern(52.1%, 37/71) and western(50.0%, 43/86) regions(χ 2=16.799, P<0.05; χ 2=20.830, P<0.05). The three provinces with the highest proportion of employers′ arrangement were Xinjiang Uygur Autonomous Region(66.7%, 22/33), Zhejiang province(9/13), and Inner Mongolia Autonomous Region(38.5%, 10/26). The proportion of employers′ arrangement in the western region(41.9%,36/86) was significantly higher than that in the eastern(18.3%, 13/71) and middle(8.8%, 9/102) regions(χ 2=8.980, P<0.05; χ 2=26.186, P<0.05). Conclusions:The majority of general practice residents are engaged in general practice after training. The proportion of residents who left the general practice career and the related reasons in different regions are not the same.

Objective:To survey the post competency of general practitioners who had completed residency training in China.Methods:This study was a cross-sectional survey. An online questionnaire survey was conducted among general practitioners, institution leaders and patients from January to February 2021. The participants were selected from 45 general practice residential training bases in the eastern, central and western regions of China by a combination of stratified sampling and proportional random sampling methods. The post competency self-assessment questionnaire was used for the general practitioners, and the competency evaluation questionnaire was used for institution leaders and the patients.Results:A total of 677 valid self-assessment questionnaires were returned from general practitioners, 600 from institution leaders, and 2 579 from patients. The professionalism and humanistic literacy of the self-assessment questionnaire had the highest score (4.41±0.60),and the teaching, learning and research abilities had the lowest score(3.57±0.84). There was no significant difference in the post competency score of general practitioners among different regions ( P>0.05). The highest score of general practitioners′ post competency evaluated by leaders was the professionalism and humanistic literacy (4.64±0.57), and the lowest one was the basic public health service ability (4.31±0.95). The score of professionalism and humanistic ability in the eastern region was significantly higher than that in the central and western regions ( P<0.05). The highest score of general practitioners′ post competency evaluated by patients was the professionalism and humanistic literacy (4.73±0.55), and the lowest score was the basic medical service ability (4.11±1.35). There were significant differences in scores of the ability for basic medical service, ability for basic public health service, ability for interpersonal communication and ability for professionalism and humanistic literacy among different regions ( P<0.05). For institution leaders, 68.2% (409/600) believed that the general practitioners were fully competent for their current jobs, 28.7% (172/600) believed that the general practitioners were basically competent for their current jobs. For patients, 70.5% (1 817/2 579) were very satisfied with the general practitioners′ service, and 27.1% (700/2 579) were basically satisfied with the general practitioners′ service. Conclusions:The competency of general practitioners who had received training in some provinces is basically up to standard, but the basic public health service ability and teaching, learning and research ability need to be improved.

Objective:To explore the effectiveness of digital management platform led by outpatient specialist nurses among patients with type 2 diabetes in outpatient settings.Methods:From March 2024 to March 2025, adult patients with type 2 diabetes who visited the Endocrinology Clinic at Peking Union Medical College Hospital were selected using convenience sampling. Patients were randomly assigned to the control group and intervention group using the random number table method. Patients in control group received routine education on type 2 diabetes during their clinic visits after enrollment. Intervention group was managed by nurses through a digital management platform, establishing long-term connections with patients. Based on the platform, nurses regularly provided patients with knowledge updates, promptly responded to patient inquiries, reviewed daily dietary records, monitored blood glucose data, conducted weekly telephone follow-ups, and scheduled regular clinic visits to precisely intervene in patients' lifestyles. The glycated hemoglobin (HbA1c) and self-management behavior scores were compared between two groups of patients before and after three months of intervention.Results:A total of 46 patients were enrolled and completed the 3-month follow-up, including 25 in control group and 21 in intervention group. There were no statistically significant differences in HbA1c or self-management behavior scores between the two groups of patients before intervention ( P>0.05). At three months of intervention, the HbA1c reduction in intervention group was greater than that in control group, with a statistically significant difference ( P<0.05). There was no statistically significant difference in Summary of Diabetes Self-Care Activities Scale scores between the two groups ( P>0.05). The difference in changes in diabetic foot self-screening scores between intervention group and control group was statistically significant ( P<0.05) . Conclusions:Specialist nurse-led precision health care management utilizing digital platforms can improve HbA1c and enhance self-management behaviors for diabetic foot in patients with type 2 diabetes, which is expected to be promoted and applied in the outpatient management of diabetes patients.

Objective:To explore the potential role of lipoprotein-associated phospholipase A2 (Lp-PLA2) and components of metabolic syndrome (MS) in the early progression of carotid arteriosclerosis.Methods:The study was a cross-sectional study. Urban participants undergoing routine health check-ups were enrolled from all 11 prefecture-level cities in Zhejiang Province between January and December 2022. General clinical information was obtained through interviews, and data on MS was collected from the clinical health examinations. Serum Lp-PLA? levels were measured in all participants. All participants were divided into 3 groups according to the results of the carotid ultrasound: the normal group, the intima thickening group with carotid intima thickening change and the plaque group. Multivariable logistic regression models were used to evaluate the associations of Lp-PLA2, MS, and the components of MS with early carotid atherosclerosis. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of combining Lp-PLA2 with MS and the cumulative number of MS components for early carotid atherosclerosis.Results:A total of 4 009 urban adults undergoing routine health check-ups were enrolled (mean age (48.9±8.46) years, 2 665(66.5 %)male). Of these, 1 398 were in the normal group, 1 650 in the intima thickening group, and 961 in the plaque group. Multivariable logistic regression demonstrated that Lp-PLA2 was independently associated with early carotid atherosclerosis ( OR=1.34, 95% CI: 1.11-1.63, P=0.003). Lp-PLA2 also showed independent positive associations with both carotid intima thickening and carotid plaque formation, with the latter being more pronounced (both P<0.05). MS was independently and positively associated with early carotid atherosclerosis ( OR=1.48, 95 % CI: 1.20-1.84, P<0.001), as well as with intima thickening and carotid plaque formation, with the association being stronger for the latter (both P<0.05). Furthermore, the strength of the association increased progressively with the number of MS components ( P<0.001), especially for carotid plaques formation (both P<0.001). Multivariable logistic regression revealed that, compared with individuals without MS and low Lp-PLA2 levels, the risk of early carotid atherosclerosis was increased in those with high Lp-PLA2 alone, MS alone, or both conditions concurrently, with the highest risk observed when both were present (all P<0.05). ROC analyses demonstrated that the combination of elevated Lp-PLA2 with 3, 4, or 5 MS components yielded good diagnostic performance for early carotid atherosclerosis ( AUC=0.869, 0.888, and 0.889, respectively), intima thickening ( AUC=0.844, 0.860, and 0.845, respectively), and carotid plaque formation ( AUC=0.899, 0.924, and 0.968, respectively) in urban health-screening participants. Conclusions:Lp-PLA2, MS, and the number of MS components were independently and positively associated with early carotid atherosclerosis in urban health chek-up populations. The combination of MS components and Lp-PLA2 provided favorable diagnostic performance for the detection of early carotid atherosclerosis.

Objective:To analyze the clinical characteristics of pulmonary mucormycosis (PM) in children with leukemia, and explore its diagnosis and treatment strategies and prognosis.Methods:In this case-series study, the clinical data of 19 children who were diagnosed with leukemia complicated by PM at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2024 were retrospectively analyzed.Their gender, age, type of leukemia, clinical manifestations, chest CT findings, bronchoscopy results, etiology, treatment regimens, and prognosis were summarized.The patients were divided into a survival group and a death group.The clinical data were compared between the 2 groups.Categorical variables were compared using the Fisher′s exact test, and continuous variables were compared using the Wilcoxon rank-sum test.Results:A total of 19 children aged 2 to 17 years with leukemia complicated by PM were involved, including 9 boys and 10 girls, with most cases (15 cases) occurring in the autumn and winter.The median time from the first leukemia chemotherapy to infection with mucor was 1 month.Clinical manifestations mainly included fever (100%), cough (94.7%), hemoptysis (42.1%), and pneumothorax (21.1%).Chest CT findings primarily showed extensive lung consolidation (84.2%), pleural effusion (84.2%), pulmonary nodules (78.9%), halo signs (73.7%), cavitation (36.8%), crescent signs (26.3%), and reverse halo signs (21.1%).Fourteen children underwent bronchoscopy, which primarily revealed tracheal obstruction, pale or congested mucosa, mucosal edema, mucosal necrosis, bronchial stenosis, and bronchial cavitary fistulas.Mucor was detected using various methods including metagenomic next-generation sequencing (mNGS), cultures, and lung tissue microscopy.Patients were mainly treated with intravenous administration of Amphotericin B in different formulations combined with oral Posaconazole.Three patients also underwent surgical resection of the affected lung lobe in addition to medical treatment.After treatment, 14 patients had a good prognosis, while 5 patients died.The causes of death were massive hemoptysis in 2 cases, severe respiratory failure in 1 case, and treatment withdrawn due to critical condition in 2 cases.There were no statistically significant differences in age, gender, type of leukemia, whether to undergo bronchoscopy and surgery, time from the first chemotherapy to onset of infection, presence of comorbid infection, chest CT characteristics, and time to start treatment between survival and death groups(all P>0.05). Conclusions:There is no specificity in clinical manifestations of leukemia complicated by PM, which, however, still exhibits some characteristics.mNGS plays a crucial role in early diagnosis.Intravenous administration of Amphotericin B combined with oral Posaconazole and surgical intervention are an effective treatment regimen.

Objective To explore the potential causal relationship between childhood obesity and the risk of inflammatory bowel disease(IBD)based on Mendel randomization(MR).Methods The genome-wide association study(GWAS)data for childhood obesity included 5 530 cases and 8 318 controls.The GWAS data for IBD included 5 673 cases and 213 119 controls.The GWAS data for ulcerative colitis included 4 320 cases and 210 300 controls.The GWAS data of Crohn's disease included 2 056 cases and 210 300 controls.The risk association between obesity and the occurrence of IBD was analyzed using the inverse variance weighted meth-od(IVW),general model,weighted model,weighted median,and MR-Egger.Results Fourteen independent single nucleotide polymorphisms(SNP)significantly associated with childhood obesity were screened out as instrumental variables.IVW analysis results showed that no potential causal association was found between childhood obesity and IBD(OR=1.048,95%CI:0.976-1.125),ulcerative colitis(OR=1.026,95%CI:0.946-1.113),and Crohn's disease(OR=1.123,95%CI:0.993-1.269,P>0.05).Conclusion There was no causal relationship between childhood obesity and the risk of IBD.

Objective:To explore the effectiveness of digital management platform led by outpatient specialist nurses among patients with type 2 diabetes in outpatient settings.Methods:From March 2024 to March 2025, adult patients with type 2 diabetes who visited the Endocrinology Clinic at Peking Union Medical College Hospital were selected using convenience sampling. Patients were randomly assigned to the control group and intervention group using the random number table method. Patients in control group received routine education on type 2 diabetes during their clinic visits after enrollment. Intervention group was managed by nurses through a digital management platform, establishing long-term connections with patients. Based on the platform, nurses regularly provided patients with knowledge updates, promptly responded to patient inquiries, reviewed daily dietary records, monitored blood glucose data, conducted weekly telephone follow-ups, and scheduled regular clinic visits to precisely intervene in patients' lifestyles. The glycated hemoglobin (HbA1c) and self-management behavior scores were compared between two groups of patients before and after three months of intervention.Results:A total of 46 patients were enrolled and completed the 3-month follow-up, including 25 in control group and 21 in intervention group. There were no statistically significant differences in HbA1c or self-management behavior scores between the two groups of patients before intervention ( P>0.05). At three months of intervention, the HbA1c reduction in intervention group was greater than that in control group, with a statistically significant difference ( P<0.05). There was no statistically significant difference in Summary of Diabetes Self-Care Activities Scale scores between the two groups ( P>0.05). The difference in changes in diabetic foot self-screening scores between intervention group and control group was statistically significant ( P<0.05) . Conclusions:Specialist nurse-led precision health care management utilizing digital platforms can improve HbA1c and enhance self-management behaviors for diabetic foot in patients with type 2 diabetes, which is expected to be promoted and applied in the outpatient management of diabetes patients.

Objective:To analyze the clinical characteristics of pulmonary mucormycosis (PM) in children with leukemia, and explore its diagnosis and treatment strategies and prognosis.Methods:In this case-series study, the clinical data of 19 children who were diagnosed with leukemia complicated by PM at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2024 were retrospectively analyzed.Their gender, age, type of leukemia, clinical manifestations, chest CT findings, bronchoscopy results, etiology, treatment regimens, and prognosis were summarized.The patients were divided into a survival group and a death group.The clinical data were compared between the 2 groups.Categorical variables were compared using the Fisher′s exact test, and continuous variables were compared using the Wilcoxon rank-sum test.Results:A total of 19 children aged 2 to 17 years with leukemia complicated by PM were involved, including 9 boys and 10 girls, with most cases (15 cases) occurring in the autumn and winter.The median time from the first leukemia chemotherapy to infection with mucor was 1 month.Clinical manifestations mainly included fever (100%), cough (94.7%), hemoptysis (42.1%), and pneumothorax (21.1%).Chest CT findings primarily showed extensive lung consolidation (84.2%), pleural effusion (84.2%), pulmonary nodules (78.9%), halo signs (73.7%), cavitation (36.8%), crescent signs (26.3%), and reverse halo signs (21.1%).Fourteen children underwent bronchoscopy, which primarily revealed tracheal obstruction, pale or congested mucosa, mucosal edema, mucosal necrosis, bronchial stenosis, and bronchial cavitary fistulas.Mucor was detected using various methods including metagenomic next-generation sequencing (mNGS), cultures, and lung tissue microscopy.Patients were mainly treated with intravenous administration of Amphotericin B in different formulations combined with oral Posaconazole.Three patients also underwent surgical resection of the affected lung lobe in addition to medical treatment.After treatment, 14 patients had a good prognosis, while 5 patients died.The causes of death were massive hemoptysis in 2 cases, severe respiratory failure in 1 case, and treatment withdrawn due to critical condition in 2 cases.There were no statistically significant differences in age, gender, type of leukemia, whether to undergo bronchoscopy and surgery, time from the first chemotherapy to onset of infection, presence of comorbid infection, chest CT characteristics, and time to start treatment between survival and death groups(all P>0.05). Conclusions:There is no specificity in clinical manifestations of leukemia complicated by PM, which, however, still exhibits some characteristics.mNGS plays a crucial role in early diagnosis.Intravenous administration of Amphotericin B combined with oral Posaconazole and surgical intervention are an effective treatment regimen.

Objective:To analyze the current employment status and the reasons for not engaging in general practice among general practice residents who completed training during 2018-2020.Methods:This study was a cross-sectional study. A questionnaire survey on the current employment was conducted among general practice residents who completed redidency training from 2018 to 2020, participants were selected by stratified random sampling in 57 training centers from each 5 provinces(municipalities) of the eastern, middle and western regions in China. The reasons for not engaging in general practice were investigated through telephone contact.Results:Of the 1 037 general practice residents who responded to the questionnaire, 677 residents(65.3%, 677/1 037) were engaged in general practice after training, while 360 residents(34.7%, 360/1 037) left general practice career or were awaiting employment. The three provinces with the highest proportion of residents leaving general practice career were Hubei(76.5%, 26/360), Sichuan(74.4%, 29/360) and Shandong provinces(59.6%, 28/360). There were significant differences in proportion of residents leaving general practice career after completing the training among eastern, middle and western regions(χ 2=42.911, P<0.001). A total of 261 participants(25.2%, 261/1 037) were engaged in non-general practice clinical career like internal medicine, surgery, gynecology, pediatrics or medical imaging; and the proportion in the eastern(27.3%, 67/245) and middle(33.3%, 106/318) regions was significantly higher thant that in the western region(18.6%, 88/474)(χ 2=6.855, P<0.05; χ 2=21.651, P<0.05). Among 259(71.9%, 259/360) participants who left general practice career, the main reasons were personal choice(63.3%, 164/259) or employers′ arrangement(22.4%, 58/259); the three provinces with the highest percentage of personal choice were Hubei(92.0%, 23/25), Sichuan(85.2%, 23/27) and Henan provinces(80.0%, 20/25). The proportion of personal choice in the middle region(82.4%, 84/102) was significantly higher than that in the eastern(52.1%, 37/71) and western(50.0%, 43/86) regions(χ 2=16.799, P<0.05; χ 2=20.830, P<0.05). The three provinces with the highest proportion of employers′ arrangement were Xinjiang Uygur Autonomous Region(66.7%, 22/33), Zhejiang province(9/13), and Inner Mongolia Autonomous Region(38.5%, 10/26). The proportion of employers′ arrangement in the western region(41.9%,36/86) was significantly higher than that in the eastern(18.3%, 13/71) and middle(8.8%, 9/102) regions(χ 2=8.980, P<0.05; χ 2=26.186, P<0.05). Conclusions:The majority of general practice residents are engaged in general practice after training. The proportion of residents who left the general practice career and the related reasons in different regions are not the same.

Objective:To explore the potential role of lipoprotein-associated phospholipase A2 (Lp-PLA2) and components of metabolic syndrome (MS) in the early progression of carotid arteriosclerosis.Methods:The study was a cross-sectional study. Urban participants undergoing routine health check-ups were enrolled from all 11 prefecture-level cities in Zhejiang Province between January and December 2022. General clinical information was obtained through interviews, and data on MS was collected from the clinical health examinations. Serum Lp-PLA? levels were measured in all participants. All participants were divided into 3 groups according to the results of the carotid ultrasound: the normal group, the intima thickening group with carotid intima thickening change and the plaque group. Multivariable logistic regression models were used to evaluate the associations of Lp-PLA2, MS, and the components of MS with early carotid atherosclerosis. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of combining Lp-PLA2 with MS and the cumulative number of MS components for early carotid atherosclerosis.Results:A total of 4 009 urban adults undergoing routine health check-ups were enrolled (mean age (48.9±8.46) years, 2 665(66.5 %)male). Of these, 1 398 were in the normal group, 1 650 in the intima thickening group, and 961 in the plaque group. Multivariable logistic regression demonstrated that Lp-PLA2 was independently associated with early carotid atherosclerosis ( OR=1.34, 95% CI: 1.11-1.63, P=0.003). Lp-PLA2 also showed independent positive associations with both carotid intima thickening and carotid plaque formation, with the latter being more pronounced (both P<0.05). MS was independently and positively associated with early carotid atherosclerosis ( OR=1.48, 95 % CI: 1.20-1.84, P<0.001), as well as with intima thickening and carotid plaque formation, with the association being stronger for the latter (both P<0.05). Furthermore, the strength of the association increased progressively with the number of MS components ( P<0.001), especially for carotid plaques formation (both P<0.001). Multivariable logistic regression revealed that, compared with individuals without MS and low Lp-PLA2 levels, the risk of early carotid atherosclerosis was increased in those with high Lp-PLA2 alone, MS alone, or both conditions concurrently, with the highest risk observed when both were present (all P<0.05). ROC analyses demonstrated that the combination of elevated Lp-PLA2 with 3, 4, or 5 MS components yielded good diagnostic performance for early carotid atherosclerosis ( AUC=0.869, 0.888, and 0.889, respectively), intima thickening ( AUC=0.844, 0.860, and 0.845, respectively), and carotid plaque formation ( AUC=0.899, 0.924, and 0.968, respectively) in urban health-screening participants. Conclusions:Lp-PLA2, MS, and the number of MS components were independently and positively associated with early carotid atherosclerosis in urban health chek-up populations. The combination of MS components and Lp-PLA2 provided favorable diagnostic performance for the detection of early carotid atherosclerosis.