ObjectiveTo understand the development stages and use of policy tools of general practitioner policies in China since it was first proposed, to summarize the experience and explore the shortcomings, so as to provide references for the adjustment and optimization of China’s general practitioner policies. MethodsContent analysis and mathematical statistics analysis were used to conduct a quantitative research on 111 policy documents with 422 policy items involving general practitioners at the national level from 1997 to 2023, through a three-dimensional analysis framework integrating policy tools, human capital process and policy development stages. ResultsCapacity‑building policy tools were most frequently used in general practitioner policies, and the policy tools gradually shifted from mandate to inducement. The general practitioner policies paid less attention to the career selection link, but paid full attention to every segment of human capital links, with a comprehensive application of policy tools observed in the integrated development stage, despite the existence of unbalanced internal distribution. ConclusionIt is suggested to promote the use of incentive policy tools and to explore multiple approaches based on incentive theory; pay attention to the career selection link for guiding the employment of general practitioners; take the appropriateness between the policy tools and human capital process into comprehensive consideration, striking a dynamic balance of the internal structure of general practitioner policies.

ObjectiveTo analyze the characteristics of policy texts related to the physician periodic assessment system in China, providing references for the improvement of the system. MethodsContent analysis was employed, examining 116 policy documents from three dimensions: policy process, policy themes, and policy tools. ResultsA total of 298 codes were obtained. The number of policies related to the periodic assessment of physicians showed an overall trend of increasing first and then decreasing, with the peak annual issuance period between 2011 and 2021, and the average number of policy texts showing a downward trend. Policy documents were summarized into 3 levels: physician periodic assessment work, individual behavior, and institutional systems, encompassing a total of 8 categories of themes. The proportion of supply-oriented, environmental-oriented, and demand-oriented policy tools were 4.03%, 60.40%, and 35.57%, respectively. Moreover, environmental-oriented tools continued to dominate over time, followed by demand-oriented tools, with supply-oriented tools being the least. ConclusionThe policy themes are relatively broad and difficult to implement, focusing on establishing regulations while neglecting resource provision, and failing to continuously improve the construction of the system. It is recommended to clearly define the scope of the periodic assessment management, improve supporting systems, increase resource supply, and continuously promote the execution of assessments and policy revisions.

Objective:To investigate the application effects of self-developed rapid tracheotomy apparatus for acute tracheotomy.Methods:A total of 120 patients who underwent an acute tracheotomy in the Weihai Branch of The 970 Hospital of PLA Joint Logistics Support Force from January 2019 to December 2020 were included in this study. These patients were randomly divided into a rapid group and a conventional group, with 60 patients in each group. Patients in the rapid group underwent tracheotomy with a self-developed rapid tracheotomy apparatus. Patients in the conventional group underwent the standard steps of traditional tracheostomy. The operation time, incision length, amount of bleeding, and incidence of postoperative complications were compared between the two groups.Results:The operation time in the rapid group was significantly shorter than that in the conventional group [(4.5 ± 0.9) minutes vs. (19.3 ± 4.7) minutes, t = 23.86, P < 0.001]. The length of incision in the rapid group was significantly shorter than that in the conventional group [(2.8 ± 0.3) cm vs. (4.2 ± 1.3) cm, t = 8.68, P < 0.001]. The amount of bleeding during the surgery in the rapid group was significantly less than that in the conventional group [(4.4 ± 1.6) mL vs. (11.8 ± 4.1) mL, t = 12.99, P < 0.001]. The incidence of postoperative complications in the rapid group was significantly lower than that in the conventional group ( χ2 = 4.66, P = 0.031). Conclusion:The self-developed rapid tracheotomy apparatus for acute tracheotomy can be used to establish an artificial airway quickly and minimally invasively by simplifying the operational steps. It is remarkably innovative to increase safety with open-view operations and decrease the incidence of complications. It can be repeatedly sterilized and reused, which is worthy of clinical application and popularization.

Objective:To investigate the effect of follicular size on the clinical outcomes of frozen-thawed embryo transfer induced by human chorionic gonadotropin (hCG) of natural cycles on ovulation.Methods:Clinical data of 427 cycles of frozen-thawed single blastocyst transfer in Nanjing Drum Tower Hospital from January 2016 to December 2019 were retrospectively analyzed. The patients were divided into 15-16 mm group (15≤diameter≤16 mm, n=66), 16-17 mm group (1620 mm group (diameter>20 mm, n=26), according to the maximum follicle diameter on the induction day of hCG ovulation induction. The estradiol and luteinizing hormone (LH) levels, and clinical pregnancy rate, abortion rate and live birth rate were compared in five groups. Results:There were statistically significant differences in estradiol and LH levels among the five groups on the day of hCG induction (all P<0.05). Estradiol levels in 15-16 mm group to >20 mm group gradually increased on the day of hCG induction, and estradiol level in 15-16 mm group was significantly lower than those in 17-18 mm group, 18-20 mm group and >20 mm group (median: 1 002.3 vs 1 103.3 vs 1 171.2 vs 1 539.0 pmol/L), with statistical significances ( P=0.034, P<0.001, P=0.002). On the day of hCG induction, LH levels in 15-16 mm group to >20 mm group showed a decreasing trend, and LH level in 15-16 mm group was significantly higher than those in 17-18 mm group and >20 mm group (median: 37.73 vs 28.24 vs 24.11 U/L), with statistically significant differences ( P=0.007, P=0.006). There were no significant differences in clinical pregnancy rate, abortion rate and live birth rate in 15-16 mm group to >20 mm group (all P>0.05). Conclusion:In the natural cycle protocol of hCG induced ovulation, the small follicle group could achieve similar clinical outcomes compared with normal sized follicles in the single blastocyst transfer of frozen-thawed embryos.

Objective To develop and validate a nomogram model to predict the risk of post-stroke cognitive impairment(PSCI) in patients with mild acute ischemic stroke(AIS). Methods We included 315 patients with mild AIS(181 in the PSCI group and 134 in the non-PSCI group) who were admitted to the Department of Neurology of the First Hospital of Jilin University from April 2019 to January 2021.Fifteen potential predictors associated with vascular cognitive impairment(VCI) were selected. The selection of predictors for the PSCI nomogram model was optimized by least absolute shrinkage and selection operator regression. The number of predictors with high effects on PSCI was finally reduced to 10.Based on the 10 predictors,we performed multivariable logistic regression analysis and construct the nomogram model. The accuracy,discriminatory ability,and clinical utility of the prediction model were assessed by using the C-index,calibration curve,and decision curve analysis(DCA). The Bootstrapping validation method was used for internal validation of the model. Results The nomogram model for PSCI risk prediction included five predictors:age,sex,education level,past stroke history,and the diameter of maximum transverse section(DMTS). The C-index of the nomogram model was 0.708(95% confidence interval:0.651-0.765),with good discriminatory ability. The C-index by internal validation was 0.682.The calibration curves showed good consistency. DCA indicated a higher net benefit by using this nomogram model for predicting the risk of PSCI when the probability threshold of PSCI was greater than 27%. Conclusion This PSCI risk nomogram model is based on age,sex,education level,past stroke history,and DMTS,which can help clinicians predict the risk of PSCI for patients with mild AIS. It is worthy of clinical promotion and application.

Objective:To investigate the methylation status of SDC2, PPP2R5C and ADHFE1 genes in stool and their values in the screening of colorectal cancer and precancerous lesions.Methods:From August 2020 to March 2021, 64 patients with colorectal cancer, 72 patients with adenoma, 33 patients with hyperplastic polyps and 59 healthy people were recruited from Qingdao Central Hospital Affiliated to Qingdao University, and the morning stool samples were collected from the research subjects. The genomic DNA was extracted and modified with sulfite. The methylation status of SDC2, PPP2R5C and ADHFE1 genes were detected by methylation specific polymerase chain reaction (MSP), and the fecal occult blood test (FOBT) was performed. Taking the pathological results as the gold standard, receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to compare the effect of combined detection of methylation of three genes and FOBT in predicting colorectal cancer and precancerous lesions. R-Studio software was used to construct a nomogram for the prediction of colorectal cancer with combined detection of gene methylation in stool and other clinical features, and the calibration and validation were performed.Results:The positive rates of combined detection of methylation of SDC2, PPP2R5C and ADHFE1 genes in stool were higher than those of FOBT in colorectal cancer+adenoma [74.3% (101/136) vs. 47.1% (64/136), χ2 = 23.20, P = 0.001], colorectal cancer [90.6% (58/64) vs. 70.3% (45/64), χ2 = 8.91, P = 0.003] and adenoma [59.7% (43/72) vs. 26.4% (19/72), χ2 = 14.43, P = 0.002]. There was no significant difference in the positive rates in hyperplastic polyps [21.2% (7/33) vs. 6.1% (2/33), χ2 = 0.12, P = 0.125] and healthy controls [10.2% (6/59) vs. 8.5% (5/59), χ2 = 4.01, P = 1.000]. The combined detection of gene methylation was better than FOBT in the prediction of colorectal cancer + adenoma [AUC: 0.85 (95% CI 0.80-0.91) vs. 0.71 (95% CI 0.64-0.78), P < 0.05], especially in the prediction of adenoma [AUC: 0.82 (95% CI 0.74-0.89) vs 0.64 (95% CI 0.57-0.69), P < 0.001]. The sensitivity and specificity of ADHFE1 gene methylation status in predicting colorectal cancer were high (90.6% and 96.6%). In colorectal cancer patients over 50 years old, the positive rate of combined detection of gene methylation was higher than that of FOBT [90.2% (55/61) vs. 68.9% (42/61), P < 0.05]. The nomogram calibration curve for predicting colorectal cancer constructed based on the combined detection of gene methylation and each clinical feature showed a high degree of concordance between the predicted and observed diagnostic performance of colorectal cancer. Conclusions:The methylation levels of SDC2, PPP2R5C AND ADHFE1 genes in stool are increased in patients with colorectal cancer or adenoma. The combined detection of gene methylation is expected to be a non-invasive method for the screening of colorectal cancer and precancerous lesions.

Objective: To understand the changes of students nutritional status in the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES) of Henan Province, and to provide scientific basis for designating scientific nutritional intervention measures. Methods: About 20%-30% of primary schools and middle schools in the pilot counties in Henan Province were selected to monitor the nutritional status of students. Surveillance data from 2012 to 2019 were analyzed. Results: From 2012 to 2019(no surveillance data were available in 2018), the detection rates of mild thinness were 4.0%, 3.3%, 3.3%, 3.6%, 3.1%, 2.9%, 4.4%, respectively; the detection rates of moderate and severe thinness were 4.5%, 4.5%, 4.4%, 4.6%, 3.9%, 3.6%, 5.1%, respectively; the detection rates of overweight were 9.6%, 12.4%, 12.3%, 12.2%, 12.7%, 13.4%, 11.1%, respectively; and the detection rates of obesity were 3.9%, 6.8%, 6.7%, 6.2%, 7.6%, 7.2%, 5.8%, respectively. The differences were statistically significant (χ 2=1 032.29, 4 771.39, P<0.05). The detection rates of 2019 mild (5.0%, 3.7%) and moderate to severe thinness (5.9%, 4.3%) were the highest for both male and female students, and the highest for primary school students and junior middle school students were the highest for 2019 mild (4.1%, 6.0%) and moderate to severe thinness (5.1%, 4.9%), with statistical significance (χ 2=653.22, 486.46, 919.07, 306.27, P<0.05). The detection rate of overweight was the highest in both males and females (14.8%, 11.8%) in 2017, and the detection rate of obesity was the highest in 2016 (8.3%, 6.9%). The detection rates of overweight and obesity in primary school students were the highest in 2017 and 2016 (13.7%, 8.4%), and the detection rates in middle school students were the highest in 2017 (11.5%, 3.0%), with statistical significance (χ 2=2 391.65, 2 371.74, 4 827.75, 512.64, P<0.05). Conclusion In the early stage of the implementation of NNIPRCES in Henan Province, malnutrition among students has improved, however, the contem porary malnutrition shows increasing trend, and the co occurrence of malnutrition and obesity calls for targeted nutritional intervention measures.

Objective: To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China. Methods: Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ² test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method. Results: Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ²=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection. Conclusions It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.

Objective To investigate the differentially expressed genes of urine samples from renal fibrosis model and carry out bioinformatics analysis.Methods Rat renal fibrosis model was constructed with the method of unilateral ureteric obstruction.Urine were collected from the rats with unilateral obstructive nephropathy and sham group, respectively.Total RNA was extracted and sequencing library was established.Differential expression mRNA were analyzed by GO and KEGG pathway.Known pre-miRNA were detected and novel lncRNA family were classified.Results Compared with the sham group urine, 813 up-regulated mRNA/lncRNA and 213 down-regulated mRNA/lncRNA were collected from the urine of renal fibrosis rats.Conclusions There are significant differential expression profile in urine samples between renal fibrosis rat group and the shame group.With high-throughput transcriptome sequencing and bioinformatics analysis, the exciting possibility was raised for better understanding renal pathologies and development of new diagnostic biomarkers.

OBJECTIVES: The aim of this study was to investigate the feasibility and safety of percutaneous ¹²⁵I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome. METHODS: ¹²⁵I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate. RESULTS: In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of ¹²⁵I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1–31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events. CONCLUSION: This review shows relatively low toxicity for interstitial ¹²⁵I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control results suggest that ¹²⁵I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation.
Brachytherapy ; Drug Therapy ; Follow-Up Studies ; Humans ; Hypopharyngeal Neoplasms ; Neoplasm Metastasis ; Palliative Care* ; Pyriform Sinus ; Recurrence ; Survival Rate