According to the "Regulations on clinical application management of medical technologies", physicians intending to carry out restricted technologies must undergo standardized training and pass assessments in accordance with the clinical application management standards for the respective technology. As ventricular assist technology is classified as a nationally restricted technology, standardized training is one of the essential conditions for its application. This paper primarily explores the standardized training for the clinical application of ventricular assist technology in Shanghai, in light of its background, clinical application, and current training status. It proposes the training requirements for ventricular assist technology, animal training assessment standards, and clinical practice assessment standards in Shanghai, aiming to promote the standardized development and high-quality advancement of ventricular assist technology in Shanghai.

Objective:To assess the trends in case-fatality rates for acute myocardial infarction (AMI) in China from 2015 to 2019.Methods:This study employed a population-based surveillance. Data from the China Registry of Acute Cardiovascular Event (China RACE) were utilized, including AMI cases reported by Grade Ⅱ and Grade Ⅲ hospitals at the disease surveillance sites across China from January 1 st 2015 to December 31 st 2019. The 28-day mortality outcome for reported AMI events was obtained by linking to the national death certificate registry system. The study analyzed the overall and age-standardized case-fatality rates, as well as their annual percent change (APC), during the study period, stratified by gender, age, and region. Results:The overall 28-day case fatality rate for AMI was 28.97% (22 532/77 764) from 2015 to 2019. The age-standardized case-fatality rate for AMI declined significantly from 37.53% in 2015 to 18.58% in 2019, with an APC of -14.33% ( P=0.018). We observed a significant downward trend in case-fatality rates of AMI in both genders (both P<0.05). Among males, the case-fatality rate decreased more steeply in younger males compared to elder counterparts. The most marked decreases were seen in males aged<35 years and 35 to 44 years, with APC of -27.63% ( P=0.007) and -22.65% ( P=0.004), respectively. In females, we observed a relatively stable decrease in case-fatality across age groups. The age-standardized case-fatality rate of AMI in eastern and central China decreased significantly from 2015 to 2019, with the APC of -19.22% ( P=0.006) and -15.62% ( P=0.032) respectively. However, the age-standardized case-fatality rate of AMI in western China remained stable ( P=0.227). Conclusions:The prognosis of AMI has considerably improved from 2015 to 2019 in China, regardless of ages and gender. Inequality in case-fatality rates among geographic regions highlights the need for targeted strategies in AMI prevention in western regions.

Recent trends suggest that Chinese herbal medicine formulas(CHM formulas)are promising treatments for complex diseases.To characterize the precise syndromes,precise diseases and precise targets of the precise targets between complex diseases and CHM formulas,we developed an artificial intelligence-based quantitative predictive algorithm(DeepTCM).DeepTCM has gone through multilevel model cali-bration and validation against a comprehensive set of herb and disease data so that it accurately captures the complex cellular signaling,molecular and theoretical levels of traditional Chinese medicine(TCM).As an example,our model simulated the optimal CHM formulas for the treatment of coronary heart disease(CHD)with depression,and through model sensitivity analysis,we calculated the balanced scoring of the formulas.Furthermore,we constructed a biological knowledge graph representing interactions by associating herb-target and gene-disease interactions.Finally,we experimentally confirmed the thera-peutic effect and pharmacological mechanism of a novel model-predicted intervention in humans and mice.This novel multiscale model opened up a new avenue to combine"disease syndrome"and"macro micro"system modeling to facilitate translational research in CHM formulas.

Objectives:To present the epidemiological characteristics of stroke incidence and stroke-related mortality among the whole population in national cardiovascular disease surveillance areas from 2015 to 2019. Methods:Data of stroke incidence and stroke-related mortality from 2015 to 2019 were collected from the China Registry of Cardiovascular Events(China RACE),which was established in 2014,covering 100 counties(cities,districts)in 31 provinces in China.The Joinpoint model was used to analyze the annual percentage changes(APC)and trends of stroke incidence rate.The age-standardized incidence rate(ASIR)was calculated using the Seventh National Census data as the standard population.With annual reported stroke events and stroke-related deaths,the mortality to incidence ratio(M/I)were examined. Results:From 2015 to 2019,an increase of 9.41%(APC=2.12%,95%CI:1.43%-2.82%,Ptrend<0.01)resulted in the overall stroke crude incidence rate(CIR)of 468.48/100 000 in 2019 among the whole population,with relatively higher in male and in rural area.The more sharply elevating of CIR appeared in males(11.26%[APC=2.53%,95%CI:1.83%-3.24%,Ptrend<0.01])rather than in females(7.26%[APC=1.63%,95%CI:0.81%-2.46%,Ptrend<0.01]).Meanwhile,the general ASIR decreased 7.47%(APC=-1.72%,95%CI:-3.23%--0.20%,Ptrend<0.05),reaching 523.82/100 000 in 2019.The females generally showed significant descending trend(9.56%[APC=-2.27%,95%CI:-3.99%--0.52%,Ptrend<0.05]),as well as more reduction than that in the males(15.82%vs.11.40%)in urban area.The crude incidence rate of stroke increased with age.From 2015 to 2019,the CIR in 45-49 age group increased 12.48%(APC=3.18%,95%CI:1.67%-4.72%,Ptrend<0.01),compared with an reduction of 15.76%(APC=-4.39%,95%CI:-7.63%--1.04%,Ptrend<0.05)in 80-84 age group.Over the monitoring years,the overall M/I was 0.19,with an age-specific U-shaped distribution.The lowest of M/I(0.10)appeared in those aged 50-54 and 55-59,while the highest(0.45)detected in those aged 85 and over.The M/I of all age in urban areas were consistently lower than that in rural areas. Conclusions:Stroke incidence burden increased from 2015-2019 in the national surveillance areas in China,along with the unfavorable geographic diversity and age-specific divergence.Further efforts are required to improve health care covering all ages and regions in China to reduce the incidence of stroke and stroke-related mortality.

Objectives:The present study aims to investigate the incidence and mortality feature of acute myocardial infarction(AMI)from 2015 to 2019 in China by utilizing national registry data. Methods:Data of AMI incidence and mortality in the surveillance area during 2015 to 2019 were abstracted from China Registry of Acute Cardiovascular Event(China RACE),which was established in 100 counties from 31 provincial regions in China.Incidence rate,age standardized incidence rate(ASIR)and mortality to incidence ratio(M/I)was estimated in AMI cases.A Joinpoint regression was executed and annual percent change(APC)was examined to identify trends in incidence. Results:From 2015 to 2019,a total of 257 686 acute myocardial infarction incidence and 149 169 deaths were registered.The annual incidence rate of AMI in 2019 was 82.76 per 100 000.Over the study period,the incidence rate of AMI increased by 6.05%for men(APC=1.30%,95%CI:0.56%to 2.02%)but decreased by 11.80%for women(APC=-3.10%,95%CI:-4.54%to-1.68%),resulting a steady trend for AMI crude incidence rate for the overall population.The overall ASIR of AMI declined by 16.59%(APC=-4.32%,95%CI:-5.32%to-3.34%)from 113.68 per 100 000 in 2015 to 94.82 per 100 000 in 2019.The ASIR of AMI declined by 11.04%(APC=-2.72%,95%CI:-3.78%to-1.67%)for men,23.96%(APC=-6.56%,95%CI:-8.57%to-4.58%)for women,12.57%(APC=-3.08%,95%CI:-6.01%to-0.08%)for the urban areas,and 19.24%(APC=-5.18%,95%CI:-10.19%to 0.03%)for rural areas respectively.The incidence rate of AMI increases gradually with age in both men and women.The incidence of AMI in urban men of 35-44 and 45-54 year age groups increased by 77.16%(APC=13.52%,95%CI:3.29%to 24.57%)and 26.36%(APC=5.71%,95%CI:-0.95%to 12.68%)over time.However,the incidence of AMI fell in the population above 65 year old,by 26.58%(APC=-6.68%,95%CI:-11.98%to-1.01%),19.85%(APC=-5.64%,95%CI:-11.57%to 0.65%)and 14.53%(APC=-4.44%,95%CI:-7.75%to-1.04%)in the 65-74 year age,75-84 year age and≥85year age groups respectively from 2015 to 2019.The mortality to incidence ratio of AMI was 0.58 over time,higher in women than in men,and higher in rural areas than in urban areas.The M/I ratio of AMI decreased from 0.62 in 2015 to 0.52 in 2019(APC=-4.28%,95%CI:-5.75%to-2.83%).There was a declined trends in M/I of AMI in urban residents of both male and female,and in the rural male residents(all P<0.05),while a steady trend in the rural female residents(P>0.05). Conclusions:The overall incidence of AMI remains steady during 2015 to 2019 in the national surveillance areas in China.Yet,downward trends in elder and female residents and increased trend in middle-aged urban males in AMI incidence are observed.The mortality of AMI in these period are age,sex and urban-rural dependent.Targeted mitigation strategies on AMI prevention and treatment need to be strengthened to reduce its incidence and mortality.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.

Objective To investigate the association between microalbuminuria and cardiovascular risk factors in a general Chinese population.Methods A multi-stage cluster randomized sampling method was used to select 2400 residents (18-69 years old) in four counties in Shandong and Jiangsu provinces in October 2013 to March 2014.24-hour MAU were measured for each subject.The prevalence of MAU in different groups was analyzed.The relationship between the aggregation of risk factors and MAU was analyzed.Logistic regression analysis was used to evaluate the association between MAU and cardiovascular risk factors.Results A total of 2265 subjects were included in the analysis.The prevalence of MAU was 8.96％ (203/2265,95％ CI:7.82-10.21).The prevalence of MAU in obesity,hypertension,diabetes,hypertriglyceridemia,and low HDL-C group were 14.65％ (63/430),12.53％ (104/830),20.22％ (36/178),15.57％ (64/411),11.99％ (53/442) respectively,which were significantly higher than the corresponding healthy population (all P ＜ 0.01).Multivariate logistic regression analysis showed that obesity,hypertension,diabetes,and hypertriglyceridemia were risk factors for MAU.The OR(95％ CI) values were 1.491(1.016-2.265),1.660(1.190-2.314),2.291 (1.494-3.515) and 1.734(1.205-2.495) respectively.With the increase in the number of influencing factors,urinary albumin levels and the prevalence of MAU all showed an upward trend.Conclusion MAU was associated with cardiovascular risk factors such as obesity,hypertension,diabetes,and hypertriglyceridemia.

Objective: To analyze the association between 24 h urinary sodium excretion and microalbuminuria (MAU) among Chinese people aged from 18 to 69 years old. Methods: 2 400 subjects aged from 18 to 69 years old were selected form Gaomi and Fushan sites of Shandong Province and Xinyi and Ganyu sites of Jiangsu Province in 2013 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24 h urine collection were conducted. 2 262 subjects were finally included in the analysis. According to the quartile of 24 h urinary sodium, all subjects were divided into Q1-Q4 groups and the levels of urinary microalbumin and MAU among different groups were compared. The relationship between urinary sodium and MAU was analyzed by multivariate logistic regression analysis. Results: The age of subjects was (42.1±13.5) years old, including 1 124 males (49.7%). The 24 h urine volume, urinary sodium, urine albumin M (P₂₅, P₇₅) and MAU detection rate were (1 411±495) ml, (166.4±71.6) mmol/d, 12.5 (9.6, 17.4) mg/d and 9.0% (203 cases), respectively. With the increase of urinary sodium level, the level of urinary albumin increased (P_trend<0.001), and the prevalence of MAU also showed an upward trend (P_trend<0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, smoking, alcohol consumption, BMI, hypertension and diabetes, the risk of MAU in Q4 group increased by 174% compared with Q1 group, and OR (95%CI) value was 2.74 (1.80-4.16). Conclusion 24 h urinary sodium is associated with the prevalence of MAU and salt reduction can help reduce MAU.

Objective To analyze the association between 24 h urinary sodium excretion and microalbuminuria (MAU) among Chinese people aged from 18 to 69 years old. Methods 2 400 subjects aged from 18 to 69 years old were selected form Gaomi and Fushan sites of Shandong Province and Xinyi and Ganyu sites of Jiangsu Province in 2013 by using multi?stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24 h urine collection were conducted. 2 262 subjects were finally included in the analysis. According to the quartile of 24 h urinary sodium, all subjects were divided into Q1-Q4 groups and the levels of urinary microalbumin and MAU among different groups were compared. The relationship between urinary sodium and MAU was analyzed by multivariate logistic regression analysis. Results The age of subjects was (42.1 ± 13.5) years old, including 1 124 males (49.7%). The 24 h urine volume, urinary sodium, urine albumin M (P25, P75) and MAU detection rate were (1 411±495) ml, (166.4± 71.6) mmol/d, 12.5 (9.6, 17.4) mg/d and 9.0% (203 cases), respectively. With the increase of urinary sodium level, the level of urinary albumin increased (Ptrend<0.001), and the prevalence of MAU also showed an upward trend (Ptrend<0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, smoking, alcohol consumption, BMI, hypertension and diabetes, the risk of MAU in Q4 group increased by 174% compared with Q1 group, and OR (95%CI ) value was 2.74 (1.80-4.16). Conclusion 24 h urinary sodium is associated with the prevalence of MAU and salt reduction can help reduce MAU.