Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective:To design and evaluate the application value of intracavitary-interstitial brachytherapy (IC-ISBT) applicator template for locally advanced cervical cancer.Methods:MRI data of 100 patients with ⅡB-ⅣA stage cervical cancer (International Federation of Gynecology and Obstetrics 2018 staging system) before and after external beam radiation therapy (EBRT) admitted to Sun Yat-sen University Cancer Center from March 2019 to September 2020 were collected. The range of primary cervical lesions was retrospectively analyzed and compared. Based on the residual mass of patients, the corresponding high-risk clinical target volume (HR-CTV) was delineated, and the IC-ISBT applicator template was designed and initially applied to cervical cancer patients. Dosimetry analysis and efficacy evaluation were compared between the applicator template-guided ( n=37) and free-hand implantation groups ( n=63). Chi-square test or Fisher exact test was performed for categorical variables, and t-test or U-test for continuous variables. Results:The median distance between the residual tumor margin (clockwise 3, 6, 9, 12 o'clock) and the center of 100 patients with ⅡB-ⅣA stage cervical cancer after EBRT was 16.5, 14.0, 17.0 and 13.0 mm, respectively. The corresponding HR-CTV was superimposed to reconstruct the three-dimensional diagram, and the cylindrical IC-ISBT applicator template with mushroom-like head was designed and manufactured: the longest and shortest diameter of the head was 35 and 20 mm, respectively; the central channel was adapted to the uterine tube, the C1-C12 channels was arranged in inner circle, and the peripheral B1-B5 and A1-A4 pin channels were expanded bilaterally. In terms of dose coverage, there was no significant difference between the HR-CTV D 90% [(635.12±22.65) vs. (635.80±25.84) cGy], bladder D 2 cm3 [(473.79±44.78) vs. (463.55±66.43) cGy)], rectum D 2 cm3 [(396.99±73.54) vs. (408.00±73.94) cGy] and sigmoid colon D 2 cm3 [(293.07±152.72) vs. (311.31±135.77) cGy] between the template-guided and free-hand implantation groups (all P>0.05), but the HR-CTV D 98% was significantly higher [(544.78±32.07) vs. (536.78±32.04) cGy, P=0.007] and the rectum D 1 cm3 and D 0.1 cm3 were significantly lower [(438.62±69.65) vs. (453.97±67.89) cGy, P=0.016; (519.46±70.67) vs. (543.82±81.24) cGy, P=0.001] in the template-guided implantation group. In addition, there was no significant difference in the complete response rate between two groups (86% vs. 83%, P>0.05). Conclusions:This IC-ISBT applicator template is reasonably designed, and the therapeutic efficacy of the template-guided implantation is equivalent to that of free-hand implantation. The dose coverage of the target area meets the clinical demand with a better protection of the organs at risk. The applicator template has the potential to be widely used as a conventional template in clinical practice as the applicator-guided implantation is convenient to operate and repeat.

Remote teaching consultation is an online continuing medical education mode which combines medical practice with teaching and superimposes teaching functions on the basis of remote consultation. Based on the pilot experiences of collaboration between Zhongshan Hospital and Xidu Community Health Service Center, this article analyzes the strengths, weaknesses, opportunities and threats (SWOT)of the remote teaching consultation for general practitioners, and discusses strategies to improve the further implementation plan. The analysis showed that as a novel educational method, the remote teaching consultation should take the advantages of online education, make good use of the remote consultation platform, improve its teaching connotation, and form standardized implementation norms to meet the diversified needs of general practitioners for continuing medical education.

Objective:To investigate the intention of medical students to be vaccinated against COVID-19 and to analyze the influencing factors.Methods:A self-filled electronic questionnaire survey was conducted among medical students from a medical school in Shanghai randomly selected from June 21 to 29, 2021. The questionnaire contained items of basic information, intention for COVID-19 vaccination, awareness of COVID-19 prevention measures and awareness of COVID-19 vaccine. Logistic regression was used to analyze the influencing factors.Results:The average age of the 966 respondents was (20.4±2.9) years, and 63.6% (614/966) of them were female;23.7% (229/966) of them had family members or relatives who had participated in anti-pandemic work or volunteer service;90.6% (875/966) of the respondents expressed they were very willing or willing to be vaccinated against COVID-19. The majority of the respondents thought that “COVID-19 infection is very serious” (94.3%, 911/966), “good protection can effectively prevent COVID-19 infection” (92.4%, 893/966), and “they can fully implement all kinds of protection measures” (73.5%, 710/966). About half of the respondents (51.8%, 501/966) knew about the adverse reactions and contraindications of COVID-19 vaccine. The low protected capability (47.4%, 458/966), short duration of protection (50.6%, 489/966), and many side effects (48.7%, 470/966) were the major concerns about COVID-19 vaccine. Logistic regression analysis showed that people thought that “COVID-19 infection is very serious” ( OR=5.30, 95 %CI:2.60-10.81, P<0.001), thought that “good protection can effectively prevent COVID-19 infection” ( OR=2.46, 95 %CI:1.26-4.81, P=0.009), thought that “they can fully implement all kinds of protection measures” ( OR=2.55, 95 %CI:1.53-4.25, P<0.001) were more willing to receive COVID-19 vaccination. While those concerned about vaccine quality did the opposite ( OR=0.29, 95 %CI:0.13-0.65, P=0.003). Conclusions:Medical students have a high intention of vaccination against COVID-19. The vaccine-related knowledge quality should be emphasized in future publicity to further enhance the intention of COVID-19 vaccination.

Objective:To investigate the awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai on the extended prescription policy of the family doctor contract service, and to analyze the influencing factors.Methods:From March to May, 2021, the cluster random sampling method was used to select one community health service center in Fengxian district, Shanghai, and a smart voice telephone assistant survey was conducted among the contracted residents aged 18 and above in the area, to understand their awareness of the extended prescription policy. χ2 Test was used for single factor analysis on the influence of different factors on the policy awareness of the contracted residents, while a multivariate analysis was performed by binary logistic regression, presenting P<0.05 as statistically significant. Results:A total of 13 495 " 1+ 1+ 1" contracted residents were surveyed via phone calls. Their awareness rate of extended prescription policy was 67.5% (9 115/13 495), while those with higher awareness rates were patients with ≥2 chronic diseases (92.3%), patients with 1 chronic disease (88.5%) and those aged 81 and above (88.4%). Logistic regression analysis showed that age, marital status, the number of chronic diseases and signing duration were all independent factors influencing the awareness of extended prescription policy (all P<0.05), while whether the residents were key population groups presented no significant influence on the awareness of extended prescription policy ( P=0.431). Conclusions:The awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai to the extended prescription policy needs to be further improved and publicity should also be strengthened to extend the policy benefit coverage.

Background::To date, there is no effective medicine to treat coronavirus disease 2019 (COVID-19), and the antiviral efficacy of arbidol in the treatment for COVID-19 remained equivocal and controversial. The purpose of this study was to evaluate the efficacy and safety of arbidol tablets in the treatment of COVID-19.Methods::This was a prospective, open-label, controlled and multicenter investigator-initiated trial involving adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients were stratified 1:2 to either standard-of-care (SOC) or SOC plus arbidol tablets (oral administration of 200 mg per time, three times a day for 14 days). The primary endpoint was negative conversion of SARS-CoV-2 within the first week. The rates and 95% confidential intervals were calculated for each variable.Results::A total of 99 patients with laboratory-confirmed SARS-CoV-2 infection were enrolled; 66 were assigned to the SOC plus arbidol tablets group, and 33 to the SOC group. The negative conversion rate of SARS-CoV-2 within the first week in patients receiving arbidol tablets was significantly higher than that of the SOC group (70.3% [45/64] vs. 42.4% [14/33]; difference of conversion rate 27.9%; 95% confidence interval [CI], 7.7%-48.1%; P = 0.008). Compared to those in the SOC group, patients receiving arbidol tablets had a shorter duration of clinical recovery (median 7.0 days vs. 12.0 days; hazard ratio [HR]: 1.877, 95% CI: 1.151-3.060, P = 0.006), symptom of fever (median 3.0 days vs. 12.0 days; HR: 18.990, 95% CI: 5.350-67.410, P < 0.001), as well as hospitalization (median 12.5 days vs. 20.0 days; P < 0.001). Moreover, the addition of arbidol tablets to SOC led to more rapid normalization of declined blood lymphocytes (median 10.0 days vs. 14.5 days; P > 0.05). The most common adverse event in the arbidol tablets group was the elevation of transaminase (5/200, 2.5%), and no one withdrew from the study due to adverse events or disease progression. Conclusions::SOC plus arbidol tablets significantly increase the negative conversion rate of SARS-CoV-2 within the first week and accelerate the recovery of COVID-19 patients. During the treatment with arbidol tablets, we find no significant serious adverse events.Trial registration::Chinese Clinical Trial Registry, NCT04260594, www.clinicaltrials.gov/ct2/show/NCT04260594?term= NCT04260594&draw=2&rank=1

The Xidu Community Health Service Center has become the first general practice outskirt teaching site of Shanghai Zhongshan Hospital since May 2015; the Fudan University Shanghai Medical College Xidu General Practice Clinical Teaching and Training Base was formally established in May 2018. For last 6 years, with the cooperation with Zhongshan Hospital the Xidu Community Health Service Center has participated in teaching and training of general practice residents and general practitioners, which also greatly promoted the development of clinical service, disease prevention and scientific research of the center itself. This article introduces the "Fudan-Xidu" integrated model and its experiences in general practice teaching, focusing on the background, the organization, teaching implementation, achievements and future prospects, to provide a reference for talent training of general practice in grassroots institutions.

Objective:To investigate the frailty state transition in the community-dwelling elderly undergoing health check-up, and related influencing factors.Methods:From September to October 2016, 3 833 residents aged ≥ 60 years undergoing health check-up in Xidu Community Health Center were enrolled in this prospective cohort study by multistage random sampling. All participants completed a questionnaire survey, health examinations, and frailty assessments as measured with the Fried frailty phenotype. A second assessment of frailty status was conducted from June to July 2020, the frailty state transition was analyzed by comparison between two assessments of frailty states. Logistic regression was used to analyze the influencing factors related to frailty progression.Results:The final cohort consisted of 3 061 participants. At the entering of the study, the median age of participants was 71.0 years, 41.0% were male, 1 563 (51.1%) were prefrail, and 156 (5.1%) were frail. At the follow-up, the frailty status of 1 304 (42.6%) participants was progressed and that of 395 (12.9%) participants was improved from their baseline levels, respectively. Logistic regression showed that age ( OR=1.170,95% CI:1.147-1.194), marital status (married: OR=0.377,95% CI:0.292-0.486), physical exercise (never vs. every day: OR=18.610,95% CI:14.461-23.950; sometimes vs. every day: OR=4.210,95% CI:2.186-8.107), baseline frailty state (robust vs. frail: OR=20.464,95% CI:11.779-35.553;prefrail vs. frail: OR=2.147,95% CI:1.270-3.632), stroke ( OR=2.195,95% CI:1.454-3.313) and diabetes ( OR=1.811,95% CI:1.346-2.437) were identified as independent factors influencing frailty progression (all P<0.05). Conclusions:Frailty state progression is common among older adults, and its related factors include age, unmarried status, physical exercise, baseline frailty state, stroke and diabetes. It is necessary to identify elderly at high risk for frailty progression and implement medical interventions.

【Objective】 To investigate the role of thromboelastography (TEG) in the diagnosis and treatment of PICC related venous thrombosis in tumor patients, and provide basis for predicting PIC related venous thrombosis. 【Methods】 148 tumor patients who underwent PICC catheterization in our hospital from January to July 2019 were enrolled. The patients were subjected to TEG examination and ultrasound examination of limb blood vessels on catheterization side regularly one day before catheterization and 4 successive weeks after catheterization(once a week), respectively. The patients with venous thrombosis were subjected to TEG examination and vascular ultrasound regularly for 3 successive weeks(once a week) after anticoagulant therapy. The relationship between the occurrence and time of venous thrombosis and the changes of TEG parameters was analyzed. 【Results】 The pre-/post-catheterization TEG parameter of 81 patients without venous thrombosis indicated that coagulation state was normal (R value F=0.198, K value F=0.047, α value F=0.442, MAvalue F=0.079, CIvalue F=0.026, P>0.05). The TEG parameter of 67 patients, who developed asymptomatic venous thrombosis 1 to 3 weeks after catheterization(38 cases in 1 week, 16 in 2 weeks and 13 in 3 weeks), indicated the blood was hypercoagulable and the TEG parameter was statistically different from the pre-catheterization value(P<0.01). But after anticoagulant treatment, the coagulation state gradually returned to normal as the TEG parameter reached pre-catheterization value for 3 successive weeks (P>0.05). 【Conclusion】 TEG can reflect the status of PICC related venous thrombosis in tumor patients.Strengthening TEG monitor in tumor patients 1 to 3 weeks after PICC catheterization is conducive to early detection, diagnosis and treatment for PICCrelated thrombosis, thus reducing the harm of venous thrombosis to patients.

A pilot mixed assessment method was used to evaluate the clinical and teaching ability of general practitioners (GPs) in a suburban district of Shanghai. In December 2018, 29 GPs from 20 community health centers in a suburban district of Shanghai were assessed by a mixed method consisting of 3 domains and 8 stations for one day. The average age of GPs was (37.8±4.7) years and 22 were females (75.9%). In 3 domains, the average score (66.8±9.7) and qualified rate (75.9%) of clinical thinking abilities were the lowest. In 8 stations, the average score [(53.8+13.4) points] and qualified rate (34.5%) of adult SOAP medical record writing station were the lowest. The average score of pediatric outpatients consult station of GPs with<15 years of community work experience was higher than that of GPs with >15 years of work experience [(68.6+10.2) vs. (58.5+9.4), t=2.787, P<0.05]. There was no significant difference in the scores among GPs with different teaching years and titles. The average scores of clinical thinking ability domain ( t=2.115) and adult outpatient consult station ( t=3.410); in the clinical operation ability domain the ophthalmoscopy and readings ( t=3.816) and otoscopy and reporting station ( t=2.286); clinical teaching abilities ( t=2.618) and simulated educational situation station ( t=2.452) and mini lectures station ( t=2.802) of GPs in the community teaching base were higher than those in non-community teaching base (all P<0.05). Mixed assessment method can be used as one of the important means for GPs′ ability assessment. The community teaching bases have effectively improved the clinical and teaching abilities of GPs in suburban areas, however, the clinical thinking abilities of them are still weak.