1.Incidence of postoperative complications in Chinese patients with gastric or colorectal cancer based on a national, multicenter, prospective, cohort study
Shuqin ZHANG ; Zhouqiao WU ; Bowen HUO ; Huining XU ; Kang ZHAO ; Changqing JING ; Fenglin LIU ; Jiang YU ; Zhengrong LI ; Jian ZHANG ; Lu ZANG ; Hankun HAO ; Chaohui ZHENG ; Yong LI ; Lin FAN ; Hua HUANG ; Pin LIANG ; Bin WU ; Jiaming ZHU ; Zhaojian NIU ; Linghua ZHU ; Wu SONG ; Jun YOU ; Su YAN ; Ziyu LI
Chinese Journal of Gastrointestinal Surgery 2024;27(3):247-260
Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.
2.Pathogenesis of Respiratory Syncytial Virus Infection-Induced Asthma and Progress in Its Prevention and Treatment with Traditional Chinese Medicine
Ziyu ZHU ; Xia ZHAO ; Jianjian JI ; Jiabao WU ; Yiwen SHAN ; Hua YAN
Journal of Nanjing University of Traditional Chinese Medicine 2024;40(8):855-863
Respiratory syncytial virus(RSV)infection is a potential susceptibility factor for recurrent wheezing,which can affect the occurrence and development of asthma through immune damage,airway epithelial barrier damage,airway inflammatory infiltration,airway hyperresponsiveness,and high expression of induced susceptibility genes.Traditional Chinese medicine believes that asthma caused by RSV infection is mostly caused by the imbalance of the body's qi after infection and the retention of evil qi.By combing the mechanism of RSV infection in the occurrence and development of asthma and the research on traditional Chinese medicine intervention in recent years,it is hoped to provide ideas for the future application of combined Chinese and Western medicine to prevent and treat asthma.
3.Practice of a pediatric education model based on formative assessment
Feng CHEN ; Gengsheng YU ; Zhiyong ZHANG ; Ziyu HUA
Chinese Journal of Medical Education Research 2024;23(5):618-622
Formative assessment emphasizes timely feedback to guide and improve the learning process, benefiting both students and teachers through the evaluation–feedback–improvement–reevaluation mechanism. The Pediatric College of Chongqing Medical University has widely applied formative assessment to standardized residency training, and at the same time, has actively researched this method in undergraduate education to employ various formative assessment tools to establish a formative assessment-based pediatric education model that has specialized characteristics and can be popularized. We have demonstrated that the formative assessment-based education model can improve the teaching quality of pediatric medical education, and better meet the requirements of higher education and the new situation of medical education in the age of new medicine.
4.Application of clinical problem-centered integrated teaching in Pediatrics curriculum
Zhiyong ZHANG ; Ying DOU ; Yi GUO ; Ziyu HUA
Chinese Journal of Medical Education Research 2024;23(5):623-626
In view of the education and teaching problems in the course of Pediatrics about the construction of students' knowledge system and the cultivation of high-order abilities, on the basis of integrated organ and system courses, with the learner-centered and goal-oriented teaching concept seeking continuous improvement, we have developed a clinical problem-centered integrated teaching model in line with the learning law of medical students, innovatively integrating theoretical learning and clinical practice, and featuring the normalization of hybrid teaching and diversified teaching activities and evaluations. The curriculum innovation efforts substantially improve student satisfaction with teaching, and achieve good teaching effects. It has been actively promoted in the western pediatrics alliance of China, receiving extensive attention and positive feedback.
5.Progress on neonatal hypoglycemia and related brain injury
International Journal of Pediatrics 2024;51(10):685-688
Neonatal hypoglycemia is one of the most common metabolic conditions in newborns.A considerable proportion of newborns are evaluated to be at risk of hypoglycemia,and transitional hypoglycemia is common in healthy newborns.A correlation between severe and prolonged hypoglycemia and neonatal hypoglycemic brain damage(HBD)in newborns has been proven.Factors such as hypoglycemia,glucose reperfusion,and blood glucose fluctuations are all involved in the damage process of HBD to a certain extent.This article reviews the relevant definitions of neonatal hypoglycemia,the characteristics of neonatal blood glucose metabolism,the related mechanisms of HBD,and possible treatment strategies to improve its prognosis.
6.Incidence of postoperative complications in Chinese patients with gastric or colorectal cancer based on a national, multicenter, prospective, cohort study
Shuqin ZHANG ; Zhouqiao WU ; Bowen HUO ; Huining XU ; Kang ZHAO ; Changqing JING ; Fenglin LIU ; Jiang YU ; Zhengrong LI ; Jian ZHANG ; Lu ZANG ; Hankun HAO ; Chaohui ZHENG ; Yong LI ; Lin FAN ; Hua HUANG ; Pin LIANG ; Bin WU ; Jiaming ZHU ; Zhaojian NIU ; Linghua ZHU ; Wu SONG ; Jun YOU ; Su YAN ; Ziyu LI
Chinese Journal of Gastrointestinal Surgery 2024;27(3):247-260
Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.
7.Mental health service utilization of patients with five mental disorders in Inner Mongolia communities
Yinxia BAI ; Lu TONG ; Zhaorui LIU ; Jie YAN ; Ruiqi WANG ; Tingting ZHANG ; Hua DING ; Lixia CHEN ; Jiahui YAO ; Xiaojuan GAO ; Dongsheng LYU ; Zhijian BAI ; Ziyu LI ; Xiaojie SUI ; Yueqin HUANG
Chinese Mental Health Journal 2024;38(5):419-425
Objective:To describe the current situation of mental health service utilization of community pa-tients with five mental disorders in Inner Mongolia Autonomous Region and provide reference for health education and formulating relevant policies.Methods:The multistage stratified sampling method with unequal probability was used to select a total of 12 315 community residents aged 18 and over in Inner Mongolia Autonomous Region.Using Composite International Diagnostic Interview,mood disorders,anxiety disorders,substance use disorders,intermit-tent explosive disorders,and eating disorders,and health service utilization were investigated.Descriptive statistics was completed by single factor analysis method.Results:The lifetime rates of consultation and treatment of any mental disorder were 18.7%and 10.2%,respectively.The highest proportion of patients received treatment by non-medical professionals was 31.4%,followed by psychiatrists in psychiatric hospital or psychologists in general hospitals.Among the patients,1.1%of them received medication,and 2.5%received psychotherapy.Conclusion:The utilization rate of mental health services in community patients with five mental disorders is relatively low.It is necessary to conduct health education for medical help seeking properly.
8.A consensus on the management of allergy in kindergartens and primary schools
Chinese Journal of School Health 2023;44(2):167-172
Abstract
Allergic diseases can occur in all systems of the body, covering the whole life cycle, from children to adults and to old age, can be lifelong onset and even fatal in severe cases. Children account for the largest proportion of the victims of allergic disease, Children s allergies start from scratch, ranging from mild to severe, from less to more, from single to multiple systems and systemic performance, so the prevention and treatment of allergic diseases in children is of great importance, which can not only prevent high risk allergic conditions from developing into allergic diseases, but also further block the process of allergy. At present, there is no consensus on the management system of allergic children in kindergartens and primary schools. The "Consensus on Allergy Management and Prevention in Kindergartens and Primary Schools", which includes the organizational structure, system construction and management of allergic children, provides evidence informed recommendations for the long term comprehensive management of allergic children in kindergartens and primary schools, and provides a basis for the establishment of the prevention system for allergic children.
9.Association of peripheral axial length, retinal curvature with refraction in school-aged children
Xi HE ; Ziyu HUA ; Shiming LI ; Xin YAN ; Yan JIANG ; Zhining CAI ; Nufei LIU ; Yuting KANG ; Shuang MA ; Lingyun HUANG ; Hanyue LI
Chinese Journal of Experimental Ophthalmology 2023;41(2):140-145
Objective:To investigate the association of peripheral axial lengths and retinal curvatures with refractive status.Methods:A cross-sectional study was conducted out.Two hundred and eighty-seven eyes of 287 consecutive children aged 6-15 years old who recieved eye examinations at Beijing Tongren Hospital from July to October 2021 were enrolled, including 154 males and 133 females.Uncorrected and best corrected visual acuity were tested with a standard logarithmic visual acuity chart.Spherical equivalent (SE) was measured via an auto refractometer after cycloplegia with tropicamide.The hyperopic, emmetropic and myopic groups were defined with a SE >+ 0.5 D, SE >-0.5 D to ≤+ 0.5 D and SE≤-0.5 D, respectively.Central and 30° peripheral eye lengths (nasal, temporal, superior, inferior) were obtained using the Lenstar LS900.Retinal coordinates were derived from partial coherence interferometry modeling and converted to retinal curvatures.According to the median horizontal peripheral eye length differences (absolute difference between nasal and temporal), participants were assigned to H1 group (absolute difference <0.35 mm) or H2 group (absolute difference ≥0.35 mm). According to the median vertical peripheral eye length differences (absolute difference between superior and inferior), participants were assigned to V1 group (absolute difference <0.32 mm) or V2 group (absolute difference ≥0.32 mm). Four groups of V1H1, V1H2, V2H1 and V2H2 were constructed according to the grouping methods in both directions above.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2021-162). Written informed consent was obtained from guardians of each subject prior to any medical examination.Results:The central axial length was 23.53(22.93, 24.10)mm.Peripheral eye lengths of temporal, nasal, superior and inferior were 22.75(22.11, 23.22)mm, 22.99(22.32, 23.45)mm, 23.24(22.58, 23.75)mm and 23.12(22.52, 23.56)mm, respectively.Temporal eye length was shorter than nasal, showing a statistically significant difference ( Z=-3.58, P<0.01). Compared with H2 group, H1 group had shorter central, nasal, superior and inferior eye lengths, showing statistically significant differences (all at P<0.05). Compared with V2 group, V1 group had shorter central, nasal and superior eye lengths, showing statistically significant differences (all at P<0.05). SE of H1 group was + 0.06 (-1.06, + 0.75) D, which was significantly greater than -0.32 (-1.64, + 0.56) D of H2 group ( Z=-2.10, P=0.04). SE of V1 group was + 0.13 (-0.81, + 0.80) D, which was significantly greater than -0.56 (-1.83, + 0.48) D of H2 group ( Z=-3.39, P<0.01). The myopia ratio of V1 group was 33.5% (58/173), which was significantly lower than 50.5% (53/105) of V2 group ( χ2=7.83, P<0.01). There was a significant overall difference in SE among VIH1, V1H2, V2H1 and V2H2 groups ( H=24.79, P<0.01). SE was greater in V1H1 group than V1H2, V2H1 and V2H2 groups (all at P<0.01). There was a significant difference in both horizontal and vertical retinal curvatures among different refractive groups ( H=22.34, 19.30; both at P<0.01). The retical curvature in both directions of hyperopic and emmetropic groups were significantly larger than those of myopic group (both at P<0.01). Conclusions:Peripheral eye lengths are asymmetric in school-aged children.Higher asymmetry is associated with myopic shifts.Myopic children have a steeper retina than the hyperopic and emmetropic children.
10.Exploration and practice of hierarchical training model for improving professional ability of primary pediatricians
Jing ZHU ; Ying HE ; Hong ZHANG ; Jing GAO ; Hongmei DENG ; Ziyu HUA ; Qian CHENG ; Hongmei XU ; Ping LIANG ; Qiu LI
Chinese Journal of Medical Education Research 2023;22(4):602-605
At present, the routine specialized training for primary pediatricians (focusing on theoretical learning of public subjects) cannot meet the needs of primary pediatricians. In order to promote the development of children's medical care at the grassroots level and improve the quality, medical and clinical research abilities of regional pediatric medical personnel, the Children's Hospital of Chongqing Medical University has designed and built a "hierarchical training model for improving the professional ability of pediatricians" from the aspects of training objectives, training contents, training methods, construction and evaluation of training programs, and quality control. In addition, the 8-month "Pediatric Professional Basic Training" and the 9-month "Pediatric Professional Ability Improvement Training" were respectively carried out in Xianyang Children's Hospital. In the "Professional Basic Training", 88 trainees were comprehensively evaluated after training, 53 of whom were qualified or above. In the "Ability Improvement Training", 26 of the 29 students actually participated in the evaluation and reached the qualified level or above. Learners provided feedbacks that they have effectively improved their own knowledge structure, expanded their clinical diagnosis and treatment thinking and clinical research ideas, and provided some guidance for clinical work.


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