Objective The purpose of this article is to summarize and review the current status of the construction of clinical research evaluation systems in domestic public hospitals,identify existing problems in the evaluation system,and propose development strategies and suggestions.Methods Retrieved relevant articles,dissertations and policies from the past five years(2018-2022),screened the titles,viewed the full texts of 52 selected papers and their references,and summarized them.Results The"five-only"indicators have long been an important indicator for evaluating clinical research in public hospitals,but in today's scientific research environment and policy environment,the"five-only"evaluation system has revealed its utilitarian draw-backs and gradually evolved into a hindrance to scientific research.It is urgent to break through the"five-only"orientation and establish a clinical research evaluation system oriented towards"transforming and applying transformation of scientific research achievements".Conclusion The evaluation system for clinical research should break the previous"five-only"evaluation model based on quantity-oriented scientific research evaluation.We can draw on the framework of the research output,influence,and environment indicators in the UK's REF Excellence Framework model,combine the American APT system and the Chinese STEM indicator dimensions,explore multi-outcome evaluation,integrate developmental indicators,and continuously improve the indica-tor system and application methods in practice to promote the development of clinical research in public hospitals.

The pre-research of medical device standards is of great significance for the enactment and amendment of standards.This study discusses four aspects and explores how to promote more scientific and reasonable pre-research.Based on the pre-research practice of medical device standards project,this study puts forward relevant work ideas and suggestions.

Objective:To analyze the correlation between homocysteine (Hcy), ferritin and gestational anemia in advanced age pregnant women, and the effect on adverse pregnancy outcomes.Methods:The clinical data of 344 advanced age pregnant women in Handan City Maternal and Child Health Hospital from March 2021 to June 2022 were retrospectively analyzed. The adverse pregnancy outcomes were followed up and recorded. The pregnant women were divided into anemia group (114 cases) and control group (230 cases) according to the diagnostic criteria for anemia. The levels of Hcy and ferritin, etc. were compared between two groups, different degrees of anemia and different pregnancy outcomes. Pearson method was used to analyze the correlation between Hcy, ferritin and hemoglobin. Multivariate Logistic regression was used to analyze the independent risk factors of adverse pregnancy outcomes in advanced age pregnant women with gestational anemia.Results:The Hcy in anemia group was significantly higher than that in control group: (31.39 ± 3.34) mol/L vs. (9.28 ± 1.44) mol/L, the ferritin was significantly lower than that in control group: (69.81 ± 5.08) μg/L vs. (96.43 ± 7.52) μg/L, and there were statistical differences ( P<0.01). Among 114 advanced age pregnant women with gestational anemia, 64 cases were mild anemia (mild anemia group), 35 cases were moderate anemia (moderate anemia group), and 15 cases were severe anemia (severe anemia group). The levels of Hcy in the control group, mild anemia group, moderate anemia group and severe anemia group were gradually increased: (9.28 ± 1.44), (24.79 ± 3.25), (37.63 ± 5.51) and (45.01 ± 7.23) mol/L, the levels of ferritin were gradually decreased: (96.43 ± 7.52), (81.19 ± 5.14), (64.82 ± 4.47) and (32.96 ± 2.01) μg/L, and the difference between pairwise comparisons were statistically significant ( P<0.05). Pearson correlation analysis result showed that Hcy was negatively correlated with hemoglobin ( r = - 0.596, P<0.01), and ferritin was positively correlated with hemoglobin ( r = 0.685, P<0.01). Among 114 advanced age pregnant women with gestational anemia, 35 cases had adverse pregnancy outcomes, and 79 cases had normal pregnancy outcomes. The age, gestational reproductive tract infection rate and Hcy in advanced age pregnant women with adverse pregnancy outcomes were significantly higher than those in advanced age pregnant women with normal pregnancy outcomes: (41.17 ± 3.74) years old vs. (38.25 ± 4.28) years old, 28.57% (10/35) vs. 10.13% (8/79) and (49.56 ± 4.12) mol/L vs. (23.34 ± 2.63) mol/L, the ferritin was significantly lower than that in advanced age pregnant women with normal pregnancy outcomes: (38.36 ± 3.08) μg/L vs. (83.74 ± 6.25) μg/L, and the degree of gestational anemia was more serious than that in advanced age pregnant women with normal pregnancy outcomes, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that age, gestational reproductive tract infection, Hcy, ferritin and the degree of gestational anemia were the independent risk factors of adverse pregnancy outcomes in advanced age pregnant women with gestational anemia ( OR = 1.570, 1.758, 1.865, 1.556 and 1.652; 95% CI 1.154 to 2.136, 1.181 to 2.617, 1.223 to 2.842, 1.100 to 2.201 and 1.175 to 2.323; P<0.01). Conclusions:The level of Hcy in advanced age pregnant women with gestational anemia is relatively higher, and the level of ferritin is relatively lower. The ferritin and Hcy levels are risk factors for adverse pregnancy outcomes in advanced age pregnant women with gestational anemia, and may be involved in the occurrence and development of gestational anemia in advanced age pregnant women.

Objective:To evaluate the clinical effect of the position pillows for neuraxial anesthesia.Methods:This was a prospective randomized controlled trial. Four hundred and twelve patients regardless of gender, aged ≥18 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, who underwent elective surgery under neuraxial anesthesia at Peking University Third Hospital from February to October 2023, were selected and divided into 2 groups ( n=206 each) using a random number table method: pillow group (P group) and control group (C group). Group C underwent the conventional procedure for neuraxial anesthesia. The patients were placed in a position using the position pillow on the basis of oral education before routine anesthesia in group P. The success rate of puncture at first attempt, puncture time and position placement time were recorded. The adjustment of position, body movement and occurrence of discomfort during the puncture were also recorded. The visual analogue scale score was used to evaluate the level of anxiety before positioning, after positioning and after anesthesia. The visual analogue scale score was used to evaluate the patient′s comfort and the operator′s satisfaction with position after the anesthesia was completed. Results:Compared with group C, the time for positioning was significantly shortened, the anxiety level was decreased after positioning and after anesthesia, the rate of improvement in anxiety was increased, the scores for the patient′s comfort and the operator′s satisfaction with position were increased ( P<0.05), and no significant changes were found in the success rate of puncture at first attempt, puncture time and incidence of body movement during the puncture and incidence of the adjustment of position ( P>0.05). No discomfort was observed in either group during the puncture. Conclusions:This new type of position pillows for the neuraxial anesthesia can not only optimize the effect of position placement, but also improve the patients′ comfort.

Objective:To study the basic situation of Yunnan Province Suncus murinus carrying plague phage and to explore its epidemiological significance. Methods:From 2015 to 2018, a survey of plague host animals was carried out in 10 investigation sites in the historical plague foci, new plague foci (after 1982) and stubborn plague foci of domestric mouse in Yunnan Province. The plague phage was isolated and cultured from the intestinal specimens of Suncus murinus. The growth of plaque was observed by double-layer plate method, and the morphology and structure of plague phage were observed under electron microscope. At the same time, intestinal samples were taken to detect the structural gene caf1 of F1 antigen of Yersinia pestis. Results:In this study, a total of 157 Suncus murinus were captured and 16 strains of plague phage were isolated, with a total isolation rate of 10.19%. There was no difference in plague phage isolation rate between historical plague foci (10.00%, 1/10) and stubborn plague foci (16.22%, 12/74), new plague foci (4.11%, 3/73, χ 2 = 0.00, P = 0.965; Fisher test, P = 1.000). However, there was a difference in plague phage isolation rate between stubborn plague foci and new plague foci (χ 2 = 5.88, P = 0.015). There was no significant difference in the isolation rate of plague phage among different sex, growth period and habitat ( P > 0.05). The plaque morphology of the isolated plague phage was diverse, of which four strains were myotavirus phages; and all samples were negative for F1 antigen structural gene caf1. Conclusions:Suncus murinus is widely distributed in the domestic mouse plague foci in Yunnan Province, and the animals carry a certain number of plague phage. Regular surveillance of Suncus murinus and their plague phage has a certain guiding significance for the surveillance and early warning of plague in Yunnan Province.

Objective:To explore the influencing factors of severe pneumonia in children with respiratory syncytial virus (RSV) infection.Methods:A retrospective case-control study was used to collect 210 children with RSV infected pneumonia admitted to Hebei Children′s Hospital from October 2017 to October 2020. Among them, 70 children with severe pneumonia were included in the severe pneumonia group, and 140 children with common pneumonia were included in the common pneumonia group; the baseline data and relevant laboratory indicators of the two groups were compared; Logistic regression was used to analyze the influencing factors of severe pneumonia in children infected with RSV.Results:The proportions of wheezing, congenital heart disease, respiratory failure, heart failure and pleural effusion of children in severe pneumonia group were higher than those in common pneumonia group, and the forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1) were lower than those in common pneumonia group (all P<0.05); the levels of C-reactive protein (CRP), CD8 + cells, RSV load and Beclin-1 in severe pneumonia group were higher than those in common pneumonia group, and the levels of CD4 + cells and 1, 25-dihydroxyvitamin D [1, 25-(OH) 2D] were lower than those in common pneumonia group (all P<0.05). After treatment, the levels of CRP, CD8 + cells and Beclin-1 in children with severe pneumonia were lower than those before treatment, and the levels of CD4 + cells and 1, 25-(OH) 2D were higher than those before treatment (all P<0.05). Multiple regression model analysis was established. The results showed that congenital heart disease, high CRP level, high CD8 + cells, high RSV load and high Beclin-1 level were risk factors for severe pneumonia in children with RSV infected pneumonia (all OR>1, P<0.05), and high CD4 + cells and 1, 25-(OH) 2D level were protective factors (all OR<1, P<0.05). Conclusions:Severe pneumonia in children with RSV infected pneumonia may be affected by congenital heart disease, CRP, CD4 + cells, CD8 + cells, 1, 25-(OH) 2D, RSV load and Beclin-1.

Objective:To evaluate the clinical value of Xing's ureteroileal anastomosis technique in radical cystectomy.Methods:The data of 38 patients who underwent radical cystectomy with Xing's ureteroileal anastomosis technique at Cancer Hospital, Chinese Academy of Medical Sciences and Beijing Chaoyang Hospital from July 2013 to June 2021 were retrospectively reviewed. There were 30 males and 8 females. The mean age was 61.6±15.1 years old. The mean body mass index (BMI) was 25.1±2.7 kg/m 2. The American Society of Anesthesiology (ASA) graded 25 cases as grade 1, 10 cases as grade 2 and 3 cases as grade 3. There were 35 cases with stage cT 2N 0M 0 and 3 cases with cT 3N 0M 0. All patients underwent radical cystectomy and ileal conduit, and the ureteroileal anastomosis was performed using the Xing's ureteroileal anastomosis technique. Afferent loop entry was divided equally into two lumens. After 1.5 cm-long lengthwise incisions, each ureter was directly and end-to-end anastomosed to the aforementioned lumens. Postoperative information was recorded, including ureteric stricture, ureteric reflux, hydronephrosis, anastomotic leakage, renal calculus, urinary tract infection, and pyelonephritis. Results:Ureteroileal anastomosis was performed successfully in 38 cases with 76 units. The median follow-up time was 35.6 (17.0, 46.3) months. Three patients developed unilateral anastomotic stenosis after operation. Five patients had unilateral ureteral reflux. Two patients had unilateral hydronephrosis. No anastomotic leakage, urinary tract infection, or pyelonephritis occurred after the operation. Renal calculus appeared in 3 cases, all on the left unit.Conclusions:Xing's ureteroileal anastomosis technique is a simple method with few postoperative and good functional outcomes.

Objective:To analyze the correlation between sleep midpoint and sleep quality in insomnia patients with type 2 diabetes mellitus (T2DM).Methods:By adopting current situation investigation research, total of 150 T2DM patients hospitalized in the Department of Endocrinology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from November 2021 to July 2022 were selected as the research objects. The general information questionnaire, Pittsburgh Sleep Quality Index (PSQI), anxiety scale (SAS) and Depression Scale (SDS) were used to investigate, and then analysis the datum.Results:Among 150 T2DM insomnia patients, 41 cases (27.33%) were in the early midpoint sleep group, 37 cases (24.67%) were in the middle midpoint sleep group, and 72 cases (48.00%) were in the late midpoint sleep group. There were significant differences in the distribution of sex, age and BMI level among different sleep midpoint groups ( χ2=7.24, 13.36, 15.93, all P<0.05). The scores of time to fall asleep at the midpoint of sleep in the 3 groups were (2.12 ± 1.25), (2.65 ± 0.79), (2.33 ± 1.02), the difference was significant ( F=2.14, P<0.05); the daytime disability scores in the 3 groups were (1.39 ± 1.36), (2.16 ± 1.12), (1.85 ± 1.32), the difference was significant ( F=3.17, P<0.05). Logistic regression analysis of disorder showed that the time to fall asleep ( OR=4.922, P<0.05) and daytime disability ( OR=4.043, P<0.05) had significant influence to the middle midpoint of sleep group when the early midpoint of sleep group as the control, while the male ( OR=2.182, P<0.05), 50 - 70 years old ( OR=5.005, P<0.05) and BMI over fat side ( OR=3.488, P<0.05) had significant influence to the late midpoint of sleep group. Conclusions:Medical staff should pay attention to the sleep quality of T2DM patients, pay attention to the sleep midpoint of patients, and improve patients′cognition of healthy sleep patterns.

Objective To investigate the influencing factors of opioid analgesics need within 48 hours after arthroscopic rotator cuff repair.Methods Clinical data of 90 consecutive arthroscopic rotator cuff repairs by the same operator from March 2017 to July 2022 were retrospectively analyzed.The patients were divided into opioid group(62 patients)and control group(28 patients)according to whether they used opioid analgesics within 48 hours after surgery.The control group consisted of patients who did not use analgesics or who had good analgesic effects with conventional analgesic regimens(non-steroidal anti-inflammatory drugs or non-opioid central analgesics)after surgery,and the opioid group consisted of patients who required opioid analgesics as assessed by the surgeon or who need opioid analgesics because of inefficacy of conventional analgesic regimens.The following factors were selected as independent variables:gender,age(whether≥65 years old),duration of disease(whether≥4 weeks),body mass index(BMI)(whether≥25),occupation(whether employed),with or without a history of smoking and alcohol consumption,hypertension,diabetes,heart disease,and trauma,duration of surgery(whether≤180 min),number of torn tendons(whether≥2),number of screws(whether≥2),large nodular osteophyte,and whether there was moderate-to-severe impingement.Single factor analysis was used to screen the factors influencing the need for opioid analgesics within 48 hours after arthroscopic rotator cuff repair.Results The results of univariate analysis showed that among the above independent variables,only the number of torn tendons≥2 was the factor affecting the need for opioid analgesics within 48 hours after arthroscopic rotator cuff repair(OR = 5.263,P = 0.007).Conclusions Patients with rotator cuff tears with≥2 tendons had more severe pain within 48 hours after rotator cuff repair,requiring opioid analgesics.Focus should be placed on postoperative pain in such patients,and a diverse analgesic regimen should be used early.

Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Logistic Models ; Phenotype ; Risk Factors