Objective:Currently, there is a lack of targeted training programs for resident physicians in cardiopulmonary resuscitation (CPR) in China. This study aims to establish a stratified training indicator system for resident physicians in CPR that is in line with the medical realities in China.Methods:Expert consultation questionnaires were designed through literature review, group discussions, and surveys. Two rounds of expert consultation were conducted using the modified Delphi method to develop the stratified training indicator system for resident physicians in CPR. Statistical analysis was performed using SPSS 26.0 software and Kendall's coefficient of concordance was used to assess the consistency of expert opinions.Results:A total of 15 experts participated in two rounds of questionnaire consultation, with a positive coefficient of 100.00% and an authority coefficient of 0.91, indicating high expert engagement and authority, thus ensuring the credibility of the results. The coefficient of variation for expert ratings in the first round of questionnaire consultation ranged from 0 to 0.40, with a concordance coefficient of 0.22 ( P<0.001). In the second round of questionnaire consultation, the coefficient of variation for expert ratings ranged from 0 to 0.24, with a concordance coefficient of 0.25 ( P<0.001). The Kendall's coefficient of concordance for expert opinions showed statistically significant differences in both rounds of questionnaire consultation, indicating consensus among experts and reliable results. This system consisted of 6 primary indicators and 32 secondary indicators. Conclusions:Based on the modified Delphi method, this study established a stratified training indicator system for resident physicians in CPR. In the future, based on the research findings, CPR training programs adapted to the medical realities in China will be developed and promoted to validate their scientific and practical value.

Orthopedic diseases are a prevalent global health issue, with an increasing incidence year by year, imposing a significant burden on the society and the healthcare system. Research into their diagnosis and treatment faces unprecedented challenges. Based on a comprehensive review of cutting-edge literature from both domestic and international sources, as well as our own clinical and research experience, the authors identified six major international challenges in the diagnosis and treatment of orthopedic diseases over the next decade including osteonecrosis, bone infection, cartilage injury, refractory wound, spinal cord injury, and genetic developmental bone diseases. These diseases are generally characterized by high incidence rate, complex and unknown etiology, serious damage and limited treatment options. There is an urgent need for breakthroughs in both clinical diagnosis and treatment, as well as in basic research. In recent years, the emergence and transformation of new technologies such as organoid, artificial intelligence, brain computer interface, gene editing, and stem cell therapy are profoundly transforming the traditional approaches to the diagnosis, treatment and research of orthopedic diseases. To gain a deeper understanding and grasp of the challenges and opportunities in this field and to promote innovation and development, the authors elaborated on the difficulties, pain points as well as potential opportunities and countermeasures in the researches on the diagnosis and treatment of orthopedic diseases, aiming to provide references and inspirations for clinical and scientific researchers in related fields and contribute to solutions of the six major international challenges.

Objective:To analyze the characteristics of bone and joint injuries-related articles published in Chinese Journal of Trauma (hereinafter referred to as the "Journal") from 1985 to 2024. Methods:Using the VIP Chinese Journal Database and Wanfang Database as data sources, all the articles on bone and joint injuries published in the Journal from 1985 to 2024 were retrieved. Analysis covered publication volume, citation frequency, research hotspot distribution, institutional affiliations, author characteristics, and funding support over the 40-year period.Results:During the 40 years since the Journal′s establishment, a total of 3 696 articles on bone and joint injuries have been published, with a total of 34 568 citations and an average of 9.35 citations per article. In the first decade following its foundation (1985-1994), the Journal mainly focused on research hotspots such as internal fixation of fractures (20.59%, 77/374), fracture classification (14.71%, 55/374), and surgical instruments (12.57%, 47/374); In the second decade (1995-2004), the Journal mainly focused on open fractures (11.56%, 101/874), osteoarthritis (9.73%, 85/874), and biomechanics (9.50%, 83/874) and other research hotspots; Osteoporosis (25.84%, 362/1 401), minimally invasive surgery (17.63%, 247/1 401), and rehabilitation (13.63%, 191/1 401) prevailed in the third decade (2005-2014), while tissue engineering (18.62%, 195/1 047), 3D printing (16.43%, 172/1 047), and intelligent technology (13.18%, 138/1 047) emerged as focal points in the fourth decade (2015-2024). Most publications involved 1-5 institutions, though 21 articles had>10 collaborating institutions. The maximum number of collaborating institutions reached 52, all observed in consensus and guideline documents. The average number of collaborating authors per article ranged from 3 to 7, primarily from renowned medical universities and major Grade A tertiary hospitals. Funding support rates increased progressively over the years: 0.80% (1985-1994), 13.04% (1995-2004), 22.13% (2005-2014), and 53.01% (2015-2024).Conclusion:Over the 40-year period, the Journal′s bone and joint injuries-related articles have exhibited substantial growth in publication volume, shift alongside disciplinary advances, technological innovations, and clinical needs in research hotspots, changes of geographical distribution from concentration to broader expansion in institutional collaborations, significant academic influence in core authors, and consistent upward trend in funding support rates.

Objective:This study aimed to investigate the correlation between the ingested dose of amlodipine and the severity of shock in affected patients by analyzing clinical data from documented cases.Methods:This study respectively included adult patients treated for amlodipine poisoning-induced shock at the emergency department of Peking University Third Hospital between January 2018 and December 2022. Additionally, cases reported in the literature from January 1997 to December 2022 were also included. Patients were categorized into two groups: non-refractory shock and refractory shock. Statistical analysis was conducted on the data between the two groups.Results:This study included a total of 80 patients, with 37 experiencing non-refractory shock patients and 43 presenting with refractory shock patients. Significant differences were observed between the two groups in terms of sex distribution ( P=0.037) and the ingested amlodipine dose ( P=0.001). Through binary logistic regression analysis, the amlodipine dose was identified as an independent predictor of shock severity ( OR=1.43, 95% CI: 1.12-1.84, P=0.005). A subgroup analysis was performed on patients who were poisoned by ingesting amlodipine alone, further confirming the significant dose difference ( P=0.003) between the non-refractory shock and refractory shock categories. The area under the receiver operating characteristic curve (AUC) for predicting refractory shock in patients with amlodipine poisoning was 0.723 (95% CI: 0.613-0.833). The optimal cutoff dose for predicting refractory shock was 347.5 mg, with a sensitivity of 0.651 and a specificity of 0.784. Sensitivity analyses, excluding cases of mixed poisoning, yielded a higher AUC of 0.795 (95% CI: 0.634-0.956), with a slightly adjusted cutoff dose of 350 mg, a sensitivity of 0.867, and a specificity of 0.737. The dose-response relationship table between medication dosage and incidence of refractory shock shows that as the dosage increases, the proportion of refractory shock also increases. Conclusions:In adult patients with amlodipine poisoning, the severity of shock was correlated with the ingested dose of the drug. When the ingested amlodipine dose exceeds 347.5 mg, it is crucial to be cautious of the development of refractory shock.

Objective:To analyze the electrocardiogram (ECG) data of congenital long QT syndrome (LQTS) patients, and to identify the ECG parameters for prediction of life-threatening arrhythmic events (LAEs).Methods:This cohort study enrolled patients diagnosed with congenital LQTS at the Department of Cardiology, Beijing Tsinghua Changgung Hospital from September 2014 to May 2023. Baseline clinical and ECG data were collected. Patients were followed with LAEs as the primary endpoint. Based on the occurrence of LAEs, patients were divided into two groups: the event group and the event-free group. Cox regression analysis was used to identify independent predictors of LAEs in LQTS patients.Results:A total of 293 patients diagnosed with congenital LQTS were included, aged 32.5 (19.0, 41.8) years, including 201 females (68.6%). Sixty-six patients experienced LAEs and 227 patients did not. Compared to the event-free group, the event group had a younger onset age (13.0 (5.5, 20.5) years vs. 26.0 (13.0, 35.0) years), a slower heart rate (69.0 (59.5, 76.5) beats/min vs. 77.0 (67.0, 88.0) beats/min), a higher proportion with family history of sudden cardiac death (30.3% vs. 14.5%), as well as longer QT intervals (500.0 (467.0, 594.0) ms vs. 428.0 (402.0, 470.0) ms) and QTc intervals (544.0 (502.5, 589.0) ms vs. 489.0 (480.0, 504.0) ms). Additionally, the event group had higher peak T-wave alternans value (65.0 (42.5, 85.3) μV vs. 44.0 (36.0, 54.0) μV), a higher proportion of patients with documented torsades de pointes (TdP) or ventricular fibrillation (VF) on 24-hour Holter monitoring (39.3% vs. 4.9%), and higher rates of pharmacological treatment (100.0% vs. 9.7%) and device therapy or left cardiac sympathetic denervation (45.5% vs. 2.2%) (all P<0.05). Multivariate Cox regression analysis identified that the heart rate<60 beats/min ( HR=2.0, 95% CI: 1.0-3.7) and QTc interval ≥500 ms ( HR=2.9, 95% CI: 1.5-5.6) on 12-lead ECG, as well as peak T-wave alternans value ≥55.5 μV ( HR=3.2, 95% CI: 1.3-7.8) and documented TdP or VF ( HR=2.0, 95% CI: 1.1-3.7) on 24-hour Holter monitoring were independent predictors of LAEs in LQTS patients (all P<0.05). Conclusion:Heart rate <60 beats/min and QTc interval ≥500 ms on 12-lead ECG, along with peak T-wave alternans value ≥55.5 μV and documented TdP or VF on 24-hour Holter monitoring, have been identified as independent predictors of LAEs in patients with LQTS. These ECG parameters may serve as valuable early indicators of sudden cardiac death in LQTS patients.

Objective To explore CT manifestations of perivascular epithelioid cell tumor(PEComa)of liver and kidney.Methods Totally 18 hepatic PEComa and 5 renal PEComa confirmed by surgical pathology were retrospectively enrolled,and the preoperative CT manifestations were explored.Results Single lesion of liver or kidney was found in all 23 cases,and the main CT manifestations included low or slightly low density lesion(23/23,100％),with irregular morphology(16/23,69.57％),clear boundaries(17/23,73.91％),non-envelope(21/23,91.30％)and enhancement after administration of contrast agents(21/23,91.30％).Among 18 cases of liver PEComa,most lesions(13/18,72.22％)presented as uniform density,while some(5/18,27.88％)presented as non-uniform density lesions often contained with fat components(5/5,100％)and thickened blood vessels(4/5,80.00％)but rare hemorrhagic necrosis(1/5,20.00％)nor calcification(0/5,0).Fast in and fast out of contrast agents were observed in 16(16/18,88.89％)lesions.Uneven density and internal fat components were found in all 5(5/5,100％)renal PEComa,which rarely with hemorrhagic necrosis(1/5,20.00％),blood vessels orientation(1/5,20.00％)and calcification(0/5,0).After enhancement,fast in and fast out,progressive enhancement and non-enhancement was observed in 2(2/5,40.00％),1(1/5,20.00％)and 2(2/5,40.00％)cases,respectively.Conclusion CT manifestations of PEComa in liver and kidney had certain characteristics.

Objective To explore CT manifestations of perivascular epithelioid cell tumor(PEComa)of liver and kidney.Methods Totally 18 hepatic PEComa and 5 renal PEComa confirmed by surgical pathology were retrospectively enrolled,and the preoperative CT manifestations were explored.Results Single lesion of liver or kidney was found in all 23 cases,and the main CT manifestations included low or slightly low density lesion(23/23,100％),with irregular morphology(16/23,69.57％),clear boundaries(17/23,73.91％),non-envelope(21/23,91.30％)and enhancement after administration of contrast agents(21/23,91.30％).Among 18 cases of liver PEComa,most lesions(13/18,72.22％)presented as uniform density,while some(5/18,27.88％)presented as non-uniform density lesions often contained with fat components(5/5,100％)and thickened blood vessels(4/5,80.00％)but rare hemorrhagic necrosis(1/5,20.00％)nor calcification(0/5,0).Fast in and fast out of contrast agents were observed in 16(16/18,88.89％)lesions.Uneven density and internal fat components were found in all 5(5/5,100％)renal PEComa,which rarely with hemorrhagic necrosis(1/5,20.00％),blood vessels orientation(1/5,20.00％)and calcification(0/5,0).After enhancement,fast in and fast out,progressive enhancement and non-enhancement was observed in 2(2/5,40.00％),1(1/5,20.00％)and 2(2/5,40.00％)cases,respectively.Conclusion CT manifestations of PEComa in liver and kidney had certain characteristics.

Objective:Currently, there is a lack of targeted training programs for resident physicians in cardiopulmonary resuscitation (CPR) in China. This study aims to establish a stratified training indicator system for resident physicians in CPR that is in line with the medical realities in China.Methods:Expert consultation questionnaires were designed through literature review, group discussions, and surveys. Two rounds of expert consultation were conducted using the modified Delphi method to develop the stratified training indicator system for resident physicians in CPR. Statistical analysis was performed using SPSS 26.0 software and Kendall's coefficient of concordance was used to assess the consistency of expert opinions.Results:A total of 15 experts participated in two rounds of questionnaire consultation, with a positive coefficient of 100.00% and an authority coefficient of 0.91, indicating high expert engagement and authority, thus ensuring the credibility of the results. The coefficient of variation for expert ratings in the first round of questionnaire consultation ranged from 0 to 0.40, with a concordance coefficient of 0.22 ( P<0.001). In the second round of questionnaire consultation, the coefficient of variation for expert ratings ranged from 0 to 0.24, with a concordance coefficient of 0.25 ( P<0.001). The Kendall's coefficient of concordance for expert opinions showed statistically significant differences in both rounds of questionnaire consultation, indicating consensus among experts and reliable results. This system consisted of 6 primary indicators and 32 secondary indicators. Conclusions:Based on the modified Delphi method, this study established a stratified training indicator system for resident physicians in CPR. In the future, based on the research findings, CPR training programs adapted to the medical realities in China will be developed and promoted to validate their scientific and practical value.

Orthopedic diseases are a prevalent global health issue, with an increasing incidence year by year, imposing a significant burden on the society and the healthcare system. Research into their diagnosis and treatment faces unprecedented challenges. Based on a comprehensive review of cutting-edge literature from both domestic and international sources, as well as our own clinical and research experience, the authors identified six major international challenges in the diagnosis and treatment of orthopedic diseases over the next decade including osteonecrosis, bone infection, cartilage injury, refractory wound, spinal cord injury, and genetic developmental bone diseases. These diseases are generally characterized by high incidence rate, complex and unknown etiology, serious damage and limited treatment options. There is an urgent need for breakthroughs in both clinical diagnosis and treatment, as well as in basic research. In recent years, the emergence and transformation of new technologies such as organoid, artificial intelligence, brain computer interface, gene editing, and stem cell therapy are profoundly transforming the traditional approaches to the diagnosis, treatment and research of orthopedic diseases. To gain a deeper understanding and grasp of the challenges and opportunities in this field and to promote innovation and development, the authors elaborated on the difficulties, pain points as well as potential opportunities and countermeasures in the researches on the diagnosis and treatment of orthopedic diseases, aiming to provide references and inspirations for clinical and scientific researchers in related fields and contribute to solutions of the six major international challenges.

Objective:To analyze the characteristics of bone and joint injuries-related articles published in Chinese Journal of Trauma (hereinafter referred to as the "Journal") from 1985 to 2024. Methods:Using the VIP Chinese Journal Database and Wanfang Database as data sources, all the articles on bone and joint injuries published in the Journal from 1985 to 2024 were retrieved. Analysis covered publication volume, citation frequency, research hotspot distribution, institutional affiliations, author characteristics, and funding support over the 40-year period.Results:During the 40 years since the Journal′s establishment, a total of 3 696 articles on bone and joint injuries have been published, with a total of 34 568 citations and an average of 9.35 citations per article. In the first decade following its foundation (1985-1994), the Journal mainly focused on research hotspots such as internal fixation of fractures (20.59%, 77/374), fracture classification (14.71%, 55/374), and surgical instruments (12.57%, 47/374); In the second decade (1995-2004), the Journal mainly focused on open fractures (11.56%, 101/874), osteoarthritis (9.73%, 85/874), and biomechanics (9.50%, 83/874) and other research hotspots; Osteoporosis (25.84%, 362/1 401), minimally invasive surgery (17.63%, 247/1 401), and rehabilitation (13.63%, 191/1 401) prevailed in the third decade (2005-2014), while tissue engineering (18.62%, 195/1 047), 3D printing (16.43%, 172/1 047), and intelligent technology (13.18%, 138/1 047) emerged as focal points in the fourth decade (2015-2024). Most publications involved 1-5 institutions, though 21 articles had>10 collaborating institutions. The maximum number of collaborating institutions reached 52, all observed in consensus and guideline documents. The average number of collaborating authors per article ranged from 3 to 7, primarily from renowned medical universities and major Grade A tertiary hospitals. Funding support rates increased progressively over the years: 0.80% (1985-1994), 13.04% (1995-2004), 22.13% (2005-2014), and 53.01% (2015-2024).Conclusion:Over the 40-year period, the Journal′s bone and joint injuries-related articles have exhibited substantial growth in publication volume, shift alongside disciplinary advances, technological innovations, and clinical needs in research hotspots, changes of geographical distribution from concentration to broader expansion in institutional collaborations, significant academic influence in core authors, and consistent upward trend in funding support rates.