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Background The clinical thinking of general medicine is based on the characteristics of the general medicine profession and has its uniqueness, requiring general practitioners to have "patient-centered" clinical diagnosis and treatment skills. In order to better reflect the clinical thinking ability of clinical residents in general practice, it is necessary to establish a set of effective evaluation criteria that can reflect all aspects of their ability. At present, there is no suitable method to evaluate the clinical thinking ability of residents in general practice. Objective To construct a post competency oriented clinical thinking ability evaluation system for general practice residents by Delphi method. Methods From December 2021 to February 2022, based on literature research, we preliminarily constructed the evaluation system framework of clinical thinking ability of general residents. Delphi method was used to conduct two rounds of in-depth communication with 12 experts to give objective evaluation on the importance of the indicators in the framework. Futher, we use analytic hierarchy process to determine the weight of each indicator. Results Through two rounds of expert consultations, we developed a comprehensive evaluation system consisting of 5 first-level indicators (clinical knowledge learning and extension, data collection and utilization, diagnostic analysis and utilization, treatment decision making ability, communication and collaboration ability) and 30 second-level indicators. The effective response rate of the two rounds of questionnaire was 100.0%, the expert authority coefficient was 0.85, and the expert coordination coefficient of the first and second indexes were 0.299 and 0.189 respectively (P

Objective To dectect six-minute walking distance (6MWD) of patients with multimorbidity by an intelligent six-minute walking test (6MWT) device, and to investigate the correlation of 6MWD with lung function, quality of life, and clinical indicators. Methods A total of 138 patients with multimorbidity who were hospitalized in the General Practice Department of Peking University Third Hospital from January to December 2022 were selected. 6MWT was conducted in patients, and pulmonary function before and after the test was measured, and the general data, height, weight, blood routine ［white blood cell (WBC) count, hemoglobin (Hb), platelet (PLT) count］, liver function ［albumin (ALB), aspartate aminotransferase (AST), alanine aminotransferase (ALT)］, renal function ［creatine (Cr), blood urea nitrogen (BUN), uric acid (UA)］, carbohydrate metabolism indicators ［fasting blood glucose (FPG), glycated hemoglobin (HbA1c)］, blood lipids ［total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)］, echocardiographic indicators ［left ventricular end diastolic diameter (LAD), E peak, A peak, left ventricular ejection fraction］ and SF-36 scores were collected. The correlations between 6MWD and the above indicators were analyzed. Results Among the 138 patients, 58, 47, 23, and 10 patients coexisted with 2, 3, 4, 5 diseases respectively. 6MWD was positively correlated with height, pre- and post-test pulmonary function ［forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC］, physical function, role-physical, Hb, ALT, LDL-C (P＜0.05), and negatively correlated with age, FPG, HbA1c, and A-peak (P＜0.05). Conclusion 6MWD is correlated with cardiovascular function and quality of life in patients with multimorbidity, and can play an important role in evaluating and monitoring the overall function of patients with multimorbidity.

Introduction: This study aimed to investigate the prospective role of serum irisin – a novel adipo-myokine – in all-cause mortality and cardiovascular (CV) mortality in patients on peritoneal dialysis (PD). Methods: A prospectively observational study was conducted with 154 PD patients. Baseline clinical data were collected from the medical records. Serum irisin concentrations were determined using enzyme-linked immunosorbent assay. Patients were divided into the high irisin group (serum irisin ≥113.5 ng/mL) and the low irisin group (serum irisin <113.5 ng/mL) based on the median value of serum irisin. A body composition monitor was used to monitor body composition. Cox regression analysis was utilized to find the independent risk factors of all-cause and CV mortality in PD patients. Results: The median serum irisin concentration was 113.5 ng/mL (interquartile range, 106.2–119.8 ng/mL). Patients in the high irisin group had significantly higher muscle mass and carbon dioxide combining power (CO2CP) than those in the low irisin group (p < 0.05). Serum irisin was positively correlated with pulse pressure, CO2CP, and muscle mass, while negatively correlated with body fat percentage (p < 0.05). During a median of follow-up for 60.0 months, there were 55 all-cause deaths and 26 CV deaths. Patients in the high irisin group demonstrated a higher CV survival rate than those in the low irisin group (p = 0.016). Multivariate Cox regression analysis showed that high irisin level (hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.135–0.858; p = 0.022), age, and diabetic mellitus were independently associated with CV mortality in PD patients. However, serum irisin level failed to demonstrate a statistically significant relationship with all-cause mortality. Conclusion: Low serum irisin levels at baseline were independently predictive of CV mortality but not all-cause mortality in PD patients. Therefore, serum irisin could be a potential target for monitoring CV outcomes in PD patients. [ABSTRACT FROM AUTHOR]

Introduction: Lipid disturbances are common in ESRD patients. In peritoneal dialysis (PD) patients, dyslipidemia is even more common. This study aimed to examine whether serum lipids were associated with prognosis of PD patients. Methods: Patients from a multicenter retrospective cohort were used for the present study. The primary endpoint was all-cause mortality. Cox regression was used to analyze the association between serum lipids including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, and triglycerides and the prognosis. Results: The results showed that lower total cholesterol and LDL levels at the initiation of PD predicted higher all-cause mortality in PD patients. Multivariate analysis reveal that the association disappeared after adjusting for age, gender, albumin, prealbumin, protein catabolic rate normalized to body weight, C-reactive protein, and residual renal function. Further analysis showed that patients with lower total cholesterol/LDL had a higher mortality only during the first 24 months of follow-up. In the patients who survived >2 years after PD, lower total cholesterol/LDL was not associated with higher long-term all-cause mortality any more. Conclusion: Lower total cholesterol/LDL levels at the initiation of PD were associated with overall mortality in PD patients. The association could be potentially modified by malnutrition, inflammation, and residual renal function or disappeared after 24 months. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non-existent. In 2008, China's 2008 Anti-Drug Law encouraged the development and use of community-based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods: In 2015, we conducted semi-structured, in-depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community-based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community-based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results: We identified three challenges to community-based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take-home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions: To overcome barriers to effective community-based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health-based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community-based treatment centres as mediators. The preliminary success of the take-home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community- based treatment. Keywords: community-based treatment; drug use; policy; harm reduction; police; China., Introduction In the 1980s and 1990s, China experienced a surge in drug use, predominantly involving heroin, in which the number of registered drug users increased more than 15-fold between 1990 [...]

Introduction: Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non‐existent. In 2008, China's 2008 Anti‐Drug Law encouraged the development and use of community‐based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods: In 2015, we conducted semi‐structured, in‐depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community‐based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community‐based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results: We identified three challenges to community‐based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take‐home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions: To overcome barriers to effective community‐based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health‐based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community‐based treatment centres as mediators. The preliminary success of the take‐home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community‐based treatment., Introduction In the 1980s and 1990s, China experienced a surge in drug use, predominantly involving heroin, in which the number of registered drug users increased more than 15‐fold between 1990 [...]

Colorectal cancer remains the third most common cause of death from cancer worldwide. MicroRNA emerges as a good area of research for current cancer therapy. Here, we identified miR-135b to be a contributor to anti-apoptosis and chemoresistance in colorectal cancer. We observed high levels of miR-135b in colorectal cancer cell lines and clinical tissues, compared to colorectal epithelium cell line and noncancerous tissues. Furthermore, enforced expression of miR-135b attenuated doxorubicin-induced apoptosis in colorectal cells. (Doxorubicin alone can trigger significant apoptosis). In elucidating the molecular mechanism by which miR-135b participate in the regulation of apoptosis and chemoresistance in colorectal cancer, we discovered that large tumor suppressor kinase 2 (LATS2) is a direct target of miR-135b. The role of miR-135b was confirmed in colorectal tumor xenograft models. The growth of established tumors was suppressed by an inhibition of miR-135b expression and enhanced apoptosis was further assessed by TUNEL assay. Taken together, our results reveal that miR-135b and LATS2 axis may be a novel therapeutic target for colorectal cancer.

Objective: To investigate the impact of nutritional status, inflammation and cardiovascular disease on the mortality of 90 patients with continuous ambulatory peritoneal dialysis (CAPD)., Methods: A cross-sectional study was performed in 90 clinically stable CAPD patients. Patients' nutritional status (by SGA), chronic inflammation (by CRP), cardiovascular disease (CVD) were evaluated. All patients were followed for 24 months., Results: Thirty-three of the 90 (36.67%) patients died during the follow-up, five patients transferred to hemodialysis and 3 patients received transplantation. The causes of death were CVD in 12, infection in 13 and other causes in 7. Seventeen patients who died were malnourished. Malnourished patients had significantly higher mortality than well nourished patients (P<0.05). Patients with high serum CRP had higher mortality (P<0.01). CVD patients had also significantly higher mortality (P<0.01). The patients with malnutrition-inflammation-CVD (MIA) syndrome had significantly lower survival rate as compared with those with one or two components of MIA (P<0.01)., Conclusion: During 2-year follow up, 45 percent of 90 CAPD patients left the program. The most common causes of death were CVD and infection. Half of the patients who died were malnourished. Inflammation, malnutrition and CVD may have aggravated each other, and contributed to the poor outcome of this patient population.