To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To analyze the exposure level and changes in severe respiratory infection among Chinese residents aged ≥40 years in China and to provide essential data for preventing and controlling chronic respiratory diseases.Methods:The data came from chronic obstructive pulmonary disease surveillance of Chinese residents in 2014-2015 and 2019-2020. The surveillance covers 31 provinces (autonomous regions and municipalities) in China. A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥40 years. Relevant information about exposure to severe respiratory infections during childhood was collected through investigation. Rigorous complex sampling and weighted analysis were applied to estimate the exposure rate of severe respiratory infections among children with different characteristics among residents aged ≥40 years in China from 2019 to 2020. Additionally, changes in severe respiratory infections during childhood were analyzed over 2014-2015 and 2019-2020.Results:In 2019-2020, the exposure rate of severe respiratory infection before 18 for residents aged ≥40 years in China was 21.58‰ (95% CI: 17.57‰-25.59‰). The exposure rate of severe respiratory infection before the age of 14 was 19.40‰ (95% CI:15.25‰-23.55‰), the difference in the exposure rate between men and women was not statistically significant (both P>0.05), and the exposure rate of urban residents is higher than that of rural residents. The results of multivariate logistic regression analysis showed that in western rural areas, factors including being born by cesarean section, exposure to secondhand smoke before age 14 years old, and a family history of chronic respiratory diseases were associated with severe respiratory infections in childhood. Compared with 2014-2015, the proportion of residents aged 40 and older in China hospitalized for pneumonia or bronchitis before 14 from 2019 to 2020 was slightly lower than five years prior. Conclusions:Among residents in China aged ≥40 years, 21.58‰ experienced severe respiratory infection exposure during childhood, varying exposure levels across different demographic groups. The burden of chronic respiratory diseases in adulthood cannot be ignored. Efforts should be made to expand the coverage of planned immunization and to focus on early-life interventions during childhood to reduce the incidence of severe respiratory infections.

Objective To evaluate the efficacy of cold preservation solution containing desferrioxamine (DFO) in protecting the rat hearts.Methods Pathogen-free male Sprague-Dawley rats,weighing 300-350 g,were used in the study.Thirty-two isolated rat hearts were equally and randomly divided into control group (C group) and DFO group using a random number table.Hearts of rats were stored for 6 h in 4 ℃ histidine-tryptophan-ketoglutarate (HTK) solution in group C.DFO was added to HTK solution (DFO concentration 100 μmol/L),and hearts of rats were stored for 6 h in 4 ℃ HTK solution in group DFO.At 6 h of cold storage,creatine kinase and lactate dehydrogenase activities in the cold preservation solution were determined.Myocardial specimens were obtained from the apex,cut into sections which were stained with haematoxylin and eosin,and examined under a microscope.The pathological changes of myocardial tissues were scored.The content of malondialdehydc in myocardial tissues was determined using thiobarbitnric acid method,and hypoxia-inducible factor-1α protein and mRNA expression in myocardial tissues was detected by real-time reverse transcriptase polymerase chain reaction and Western blot.Results Compared with group C,the creatine kinase and lactate dehydrogenase activities in the cold preservation solution,malondialdehyde content in myocardial tissues,and pathological scores were significantly decreased,and the expression of hypoxia-inducible factor-1α protein and mRNA expression in myocardial tissues was significantly up-regulated in group DFO (P＜ 0.05).Conclusion Cold preservation solution containing DFO can protect the rat hearts effectively,and the mechanism is related to up-regulation of the expression of hypoxia-inducible factor-1α.

Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.
Stroke

Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.

Objective To observe the effectiveness of alprostedil in treatment of diabetic nephropathy and the mechanism of the renal protection of the drug. Methods One hundred patients with diabetic nephropathy due to diabetes mellitus were randomly divided into 2 groups ,50 in treatment group ,and 50 as controls, alprostadil was used intravenously in the Treatment Group for 12 day while routine management of diabetes such as food intake control,physical exercises and oral drugs or injection of insulin was conducted in both of the 2 groups. Urinary albumin were employed for evaluation as well as the side-effects. Results By the end of the trial, urinary albumin was decreased significantly compared with those before intravenous alprostadil treatment or with those in the control group (P<0.05). Conclusion Urinary albumin was decreased significantly after intravenous alprostadil. Therefore,it is a safe and effective drug in the treatment of diabetic nephropathy.