ObjectiveThis paper used the AGREE Ⅱ guideline evaluation tool to evaluate the quality of 14 clinical guidelines for acute myocardial infarction，aiming to provide reference for the formulation and improvement of the guidelines. MethodsClinical guidelines and expert consensus related to acute myocardial infarction were searched by web search. The search period ranges from January 1，2019 to November 1，2024 in CNKI，VIP，Wanfang Data，SinoMed，Web of Science，OVID， the International Guidelines Collaboration Network （GIN），the UK National Institute for Health and Clinical Excellence （NICE），Yimaitong， and other platforms. Three researchers independently screened the literature and used AGREE Ⅱ to score the screening results. After ensuring that the researchers have a consistent understanding of each guideline，the quality of the guidelines was evaluated. After that，the ratings were analyzed by layer according to the issuing agency，category，method of formulation，and funding situation and compared longitudinally by rating time. The clinical guidelines and expert consensus were compared in terms of content and evidence. ResultsA total of 14 guidelines and consensus were included. The results of AGREE Ⅱ in the six areas in descending order were scope and purpose （62.82%±10.43%），rigor （62.40%±12.77%），editorial independence （62.11%±22.26%），participants （61.42%±11.65%），clarity of expression （59.98%±9.62%），and application （52.94%±16.90%） . Eleven of the guidelines were at level B， and three were at level A. In the stratified analysis，the score of the guideline formulated by the Chinese Medical Doctor Association was lower. There was little difference between the scores of Chinese/Western and Western medicine guidelines. The average score of the guidelines was higher than the consensus. Funded guidelines and consensus scores were higher. In the longitudinal comparison，the highest number of guidelines were developed in 2020 and 2021，while those developed in 2023 scored the highest. In the differential comparison analysis，the content of the guidelines was more comprehensive， and the evidence level was higher，while the content of the consensus was more novel， and the evidence was less. ConclusionThe AGREE Ⅱ score of the clinical guidelines for acute myocardial infarction is generally moderate，and there is room for improvement in terms of applicability. At the same time，the content quality of expert consensus should be improved，and more efforts should be made to develop and apply Chinese medicine guidelines for complications such as heart failure and microcirculatory obstruction after acute myocardial infarction.

Background and purpose:Preoperative risk categorization of thymoma is useful for treatment decisions but remains challenging.This study focused on training radiomics models using contrast-enhanced computed tomography(CECT)images for thymoma risk categorization and validating the model's performance,reliability and generalizability in a relatively large cohort.Methods:This retrospective cohort study analyzed the clinical data of thymoma patients(Masaoka Koga Ⅰ-Ⅲ)who underwent thymectomy surgery at the Affiliated Chest Hospital of Shanghai Jiao Tong University School of Medicine from January 2008 to December 2017.The cohort was divided into a training group(80%)and a test group(20%)using stratified random selection.The gold standard for histologic types was based on surgically resected specimens.Low-risk histologic types included A,AB and B1.High-risk histologic types included B2 and B3.Radiomics features were extracted from manually segmented regions of interest on preoperative CECT images.Interobserver correlation and least absolute shrinkage and selection operator(LASSO)regression were used for feature selection.Model performance metrics included area under the curve(AUC)of receiver operating characteristic(ROC)curve,sensitivity and specificity.Clinical characteristics were added to the combined model.Results:A total of 478 patients(mean age 51.3±12.3 years,48.1%was male)were included.The AUC of the clinical model,the CECT-based model,and the model using both clinical and CECT features on the test set were 0.666,0.831 and 0.850,respectively.The best performing model had a sensitivity of 0.829 and a specificity of 0.764.Conclusion:CECT-based radiomics models showed good performance in risk categorization of thymomas.

Under the background of "Internet+Healthcare", the iterative development and large-scale application of new technologies have brought great impact on doctor-patient relationship, and promoted the harmonious development of doctor-patient relationship to a certain extent. By analyzing the impact of "Internet+Healthcare" on doctor-patient relationship, this paper proposed to deepen the patient-centered doctor-patient relationship model, enhance the efficiency of doctor-patient communication and improve communication channels between doctors and patients, strengthen the supervision of internet medical information, and call on new media to actively promote the development of doctor-patient relationship.

Objective To standardize the selection of clinical research outcome indicators,which can objectively evaluate the clinical efficacy or effect of traditional Chinese medicine in the treatment of myasthenia gravis.This study aims to standardize the construction of the core outcome set of clinical research of traditional Chinese medicine in the treatment of myasthenia gravis.Methods We followed the core outcome set development specification(COS-STAD)to carry out research,established a research working group,which set up a Delphi-method advisory group.Two graduate students of working group conducted a document research and meetings of patients to establishe an outcome set item pool of myasthenia gravis in clinical trials of Chinese medicine under the instruction of other members.With the questionnaire based on the content of item pool,we then carried out Delphi-method expert consultations and a consensus meeting.Results The core outcome set of clinical research on myasthenia gravis treated with traditional Chinese medicine included five outcome domains:endpoint outcome,myasthenia gravis symptom evaluation,medication evaluation,quality of life evaluation and safety outcome;Nine outcome measures:recurrence rate,incidence of hormone complications,incidence of crisis,QMGS scale(MGFA quantitative myasthenia gravis score),daily activity scale of MG patients(ADL),analysis of immunosuppressant dosage,analysis of glucocorticoid dosage,analysis of cholinesterase inhibitor dosage,and incidence of adverse events.Conclusion The five outcome domains and nine outcome measures included in the core outcome set can be used as outcome options for the efficacy evaluation of myasthenia gravis clinical research.

Objective To assess the value of 18 F-FDG PET/CT, contrast-enhanced ultrasound, and their combination in the differential diagnosis of benign and malignant pancreatic lesions. Methods A retrospective analysis was performed on patients with pancreatic lesions who underwent 18 F-FDG PET/CT and contrast-enhanced ultrasound who were admitted to Tangshan Gongren Hospital from January 2015 to December 2020. The imaging results were confirmed by pathology examination to evaluate diagnostic sensitivity, specificity, accuracy, positive and negative predictive value. The t -test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. Results There were 83 malignant lesions and 25 benign lesions in 108 patients. The sensitivity, specificity, accuracy, positive and negative predictive value were 86.75%, 80.00%, 85.19%, 93.51% and 64.52% for 18 F-FDG PET/CT; and 69.88%, 76.00%, 71.30%, 90.63% and 43.18% for contrast-enhanced ultrasound, respectively. The two methods differed significantly in sensitivity and accuracy (all P < 0.05), but not in specificity, negative and positive predictive value (all P > 0.05). When combined with the contrast-enhanced ultrasound, 18 F-FDG PET/CT had an increased sensitivity, specificity, accuracy, positive and negative predictive value of 90.36%, 84.00%, 88.89%, 94.94% and 72.41%, respectively, though this was not statistically significant due to the increased signal of blood supply in the lesions. Conclusion 18 F-FDG PET/CT has a better performance than contrast-enhanced ultrasound in the differential diagnosis of benign and malignant pancreatic lesions, and their combination can improve the diagnostic value.

Objective:To compare oxytocin combined with ergometrine with oxytocin alone in terms of primary prophylaxis for postpartum hemorrhage (PPH) at the time of cesarean section (CS).Methods:This was a multicenter double-blind randomized controlled interventional study comparing ergometrine combined with oxytocin and oxytocin alone administered at CS. From December 2018 to November 2019, a total of 298 parturients were enrolled in 16 hospitals nationwide. They were randomly divided into experimental group (ergometrine intra-myometrial injection following oxytocin intravenously; 148 cases) and control group (oxytocin intra-myometrial injection following oxytocin intravenously; 150 cases) according to 1∶1 random allocation. The following indexes were compared between the two groups: (1) main index: blood loss 2 hours (h) after delivery; (2) secondary indicators: postpartum blood loss at 6 h and 24 h, placental retention time, incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution; (3) safety indicators: nausea, vomiting, dizziness and other adverse reactions, and blood pressure at each time point of administration.Results:(1) The blood loss at 2 h after delivery in the experimental group [(402±18) ml] was less than that in the control group [(505±18) ml], and the difference was statistically significant ( P<0.05). (2) The blood loss at 6 h and 24 h after delivery in the experimental group were less than those in the control group, and the differences were statistically significant (all P<0.05). There were no significant differences between the two groups in the incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution (all P>0.05). (3) Adverse reactions occurred in 2 cases (1.4%, 2/148) in the experimental group and 1 case (0.7%, 1/150) in the control group. There was no significant difference between the two groups ( P>0.05). The systolic blood pressure within 2.0 h and diastolic blood pressure within 1.5 h of drug administration in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05), but the blood pressure of the two groups were in the normal range. Conclusion:The use of ergometrine injection in CS could reduce the amount of PPH, which is safe and feasible.

Vaccination is the most effective and feasible way to contain the Coronavirus disease 2019 (COVID-19) pandemic. The rapid development of effective COVID-19 vaccines is an extraordinary achievement. This study reviewed the efficacy/effectiveness, immunogenicity, and safety profile of the 12 most progressed COVID-19 vaccines and discussed the challenges and prospects of the vaccine-based approaches in a global crisis. Overall, most of the current vaccines have shown safety and efficacy/effectiveness during actual clinical trials or in the real-world studies, indicating a development of pandemic control. However, many challenges are faced by pandemic control in terms of maximizing the effect of vaccines, such as rapid vaccine coverage, strategies to address variants with immune escape capability, and surveillance of vaccine safety in the medium- and long-terms.
COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; Humans ; Pandemics/prevention & control* ; SARS-CoV-2 ; Vaccination

Objective:Recently,the effects of Baduanjin (a traditional Chinese mind-body exercise) on diabetes have attracted increasing attention,and relevant systematic reviews (SRs) have emerged.However,the qualities of these SRs vary markedly,and their conclusions are inconsistent,which is not conducive to guiding decision-making.We sought to assess the quality of these SRs and provide more evidence for diabetes treatment.Methods:A literature search was conducted in 7 databases from inception to December 1st,2021.SRs of randomized controlled trials investigating the effects of Baduanjin were identified.A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) checklist,Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement,and Grading of Recommendations Assessment,Development and Evaluation (GRADE) system were applied to evaluate the quality of the SRs.Results:Ten SRs were identified.All SRs were judged as critically low methodological quality by the AMSTAR-2 checklist.The total PRISMA score of the included SRs ranged from 15 to 21,and the mean score was 18.60 (1.90),indicating that all SRs had partial reporting deficits.Sixty outcomes were reported in the included studies,of which 25 (41.67％) were judged as low quality,and 34 (56.67％) as very low quality according to the GRADE system,indicating that the overall evidence quality of outcomes was not high.Conclusion:Baduanjin seems to be an effective therapy for diabetes in improving glucose and lipid metabolism,mental health,quality of life,and waist-hip ratio (WHR).The overall quality of the SRs was less than optimal.This conclusion should be treated with caution,and researchers should conduct higher-quality clinical studies following AMSTAR-2checklist,PRISMA statement,and GRADE system in the future.

Chronic hepatitis B (CHB) is often treated with drugs such as interferons and nucleoside (acid)/nucleotide (acid) analogs. While these drugs are effective in controlling the viral loads, they are not able to eliminate hepatitis B virus (HBV) from the body completely. Besides, side effects and drug resistance may by caused by the long-term use of these drugs. Several monoclonal antibodies (McAbs) against HBV, mostly against hepatitis B surface antigen (HBsAg), have been demonstrated with viral neutralization capability and with effective inhibition of HBV replication in relevant animal models. The use of a McAb individually or in combination with another therapy has the potentials to achieve functional cure of CHB. In this review, we summarized the encouraging results from the research and development of anti-HBV McAbs in clinical or pre-clinical development stage, aiming to provide new idea for the treatment of CHB.