Chinese medical service and medical education in urgent need of reform in the context of public welfare-based medical reform

After six years＇medical reform,about 7.8 billion person-times of medical service has been achieved by2014,and the number of persons covered by basic medical insurance for urban employees,basic medical insurance for urban residents,and new rural cooperative medical insurance exceeded 1.3 billion,of which the coverage ratio reached as high as over 95%,establishing the largest basic medical security network in the world.

Urgent need of vitamin D supplementation among Iranian elderly:a cross-sectional study

Dear Editor：Fortification programs are not established for nutrients like vitamin D among other nutrients in Iran.It is reported that approximately 80%of Iranians do not meet the estimated average requirement for calcium and vitamin D.The Iranian Multicenter Osteoporosis Study（IMOS）has shown that more than 80%of Iranians have vitamin D deficiency.However,currently,there is no data on vitamin D supplementation in elderly adults in Iran.We carried out a secondary analysis of a bigger population-based cross-sectional study,which was conducted among elderly men and women in the 6^th district of Tehran to determine the frequency of sarcopenia.

Medical Beauty Market Size Grows Rapidly in Urgent Need of Supervision

In recent years, China’s medical beauty market is growing rapidly. Up to now, the penetration rate of mature markets such as America, Brazil and the Public of Korea is around 10%. In China, however, the penetration rate is as low as 2% approximately which means that we have ample space for development.

Pulmonary rehabilitation protocols in urgent lung transplantation patients

BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe underlying diseases and complex conditions.The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.METHODS:A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation(IMV)and ECMO between January 2018 and January 2023.Data were retrieved from electronic medical records at our lung transplant center.RESULTS:Fourteen patients(mean age 57.43±10.97 years;12 males,2 females)underwent ULTx with bridging ECMO and IMV.The mean body mass index was 23.94±3.33 kg/m²,and the mean Acute Physiology and Chronic Health Evaluation(APACHE)II score was 21.50±3.96.The Nutritional Risk Screening 2002(NRS 2002)scores were≥3.ULTx was performed after an 8.5-day waiting period(interquartile interval[IQR]5.0-26.5 d).Following the surgeries,the average lengths of ECMO and IMV were 1.0(IQR 1.0-2.0)d and 5.0(IQR 3.0-7.3)d,respectively.The total length of hospital stay was 60.1±30.8 d,with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d.Two patients died within 30 d after ULTx,with a 30-day survival rate of 85.71%.CONCLUSION:Patients receiving ULTx showed an acceptable short-term survival rate,validating the practicality and safety of the treatment protocols implemented in our center.

Biliary leakage after urgent cholecystectomy: Optimization of endoscopic treatment

AIM: To investigate the results of endoscopic treatment of postoperative biliary leakage occurring after urgent cholecystectomy with a long-term follow-up.METHODS: This is an observational database study conducted in a tertiary care center. All consecutive patients who underwent endoscopic retrograde cholangiography(ERC) for presumed postoperative biliary leakage after urgent cholecystectomy in the period between April 2008 and April 2013 were considered for this study. Patients with bile duct transection and biliary strictures were excluded. Biliary leakage was suspected in the case of bile appearance from either percutaneous drainage of abdominal collection or abdominal drain placed at the time of cholecystectomy. Procedural and main clinical characteristics of all consecutive patients with postoperative biliary leakage after urgent cholecystectomy, such as indication for cholecystectomy, etiology and type of leakage, ERC findings and post-ERC complications, were collected from our electronic database. All patients in whom the leakage was successfully treated endoscopically were followed-up after they were discharged from the hospital and the main clinical characteristics, laboratory data and common bile duct diameter were electronically recorded. RESULTS: During a five-year period, biliary leakage was recognized in 2.2% of patients who underwent urgent cholecystectomy. The median time from cholecystectomy to ERC was 6 d(interquartile range, 4-11 d). Endoscopic interventions to manage biliary leakage included biliary stent insertion with or without biliary sphincterotomy. In 23(77%) patients after first endoscopic treatment bile flow through existing surgical drain ceased within 11 d following biliary therapeutic endoscopy(median, 4 d; interquartile range, 2-8 d). In those patients repeat ERC was not performed andthe biliary stent was removed on gastroscopy. In seven(23%) patients repeat ERC was done within one to fourth week after their first ERC, depending on the extent of the biliary leakage. In two of those patients common bile duct stone was recognized and removed. Three of those seven patients had more complicated clinical course and they were referred to surgery and were excluded from long-term follow-up. The median interval from endoscopic placement of biliary stent to demonstration of resolution of bile leakage for ERC treated patients was 32 d(interquartile range, 28-43 d). Among the patients included in the follow-up(median 30.5 mo, range 7-59 mo), four patients(14.8%) died of severe underlying comorbid illnesses.CONCLUSION: Our results demonstrate the great efficiency of the endoscopic therapy in the treatment of the patients with biliary leakage after urgent cholecystectomy.

Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Hemorrhage:A Retrospective Analysis

Objective:The role of urgent endoscopy in nonvariceal upper gastrointestinal hemorrhage(NVUGIH)remains controversial.We designed a retrospective study to compare the outcomes between urgent endoscopy(within 12 h)and non-urgent endoscopy for patients with NVUGIH.Methods:A total of 540 hospitalized patients with NVUGIH were included in our study.Patients who received endoscopy within 12 h or after 12 h were divided into two groups,the urgent and non-urgent endoscopy groups,respectively.The clinical outcomes including rebleeding,mortality,endoscopic re-intervention,need for emergency surgery and interventional radiotherapy were compared between the groups.Patients with Glasgow-Blatchford scores(GBS)<12 and>12 were defined as the lower-and high-risk groups,respectively,and the predictors of rebleeding and mortality in both groups were analyzed individually.Results:Patients with NVUGIH in the urgent endoscopy group had a higher rate of rebleeding(27.6%vs.16.9%,P=0.003)and blood transfusion(73.2%vs.55.5%,P<0.001)than those in the non-urgent endoscopy group,while the mortality and the length of hospitalization were not significantly different between the groups(P>0.05).For lower-risk patients,urgent endoscopy was independently associated with a higher likelihood of rebleeding(adjusted OR:1.73,95%CI:1.03-2.88),while it was not associated with in-hospital mortality.However,the urgent need for endoscopy was not associated with rebleeding and in-hospital mortality in high-risk patients.Conclusion:Endoscopy within 12 h did not provide any advantage in the outcomes of patients with NVUGIH,and may even lead to an increased rebleeding rate in lower-risk patients.

Forecasting patient demand at urgent care clinics using explainable machine learning

Urgent care clinics and emergency departments around the world periodically suffer from extended wait times beyond patient expectations due to surges in patient flows.The delays arising from inadequate staffing levels during these periods have been linked with adverse clinical outcomes.Previous research into forecasting patient flows has mostly used statistical techniques.These studies have also predominately focussed on short‐term forecasts,which have limited practicality for the resourcing of medical personnel.This study joins an emerging body of work which seeks to explore the potential of machine learning algorithms to generate accurate forecasts of patient presentations.Our research uses datasets covering 10 years from two large urgent care clinics to develop long‐term patient flow forecasts up to one quarter ahead using a range of state‐of‐the‐art algo-rithms.A distinctive feature of this study is the use of eXplainable Artificial Intelligence(XAI)tools like Shapely and LIME that enable an in‐depth analysis of the behaviour of the models,which would otherwise be uninterpretable.These analysis tools enabled us to explore the ability of the models to adapt to the volatility in patient demand during the COVID‐19 pandemic lockdowns and to identify the most impactful variables,resulting in valuable insights into their performance.The results showed that a novel combination of advanced univariate models like Prophet as well as gradient boosting,into an ensemble,delivered the most accurate and consistent solutions on average.This approach generated improvements in the range of 16%-30%over the existing in‐house methods for esti-mating the daily patient flows 90 days ahead.

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis:A multicenter retrospective cohort study

BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。

China’s Mobile Interent Needs Both Market and Innovation

China’s mobile Internet is growing rapidly and keeps generating new industrial patterns, business patterns, commercial modes and considerable economic benefits.

Urgent Urologic Surgery in Patients with Acute Coronary Syndrome

Urgent urologic interventions create a challenging scenario when they occur in patients suffering from concurrent acute coronary syndrome. Herewith we report two patients with this scenario. Case 1, a male patient was admitted with non-ST elevation myocardial infarction in which dual antiplatelet therapy was initiated. He developed symptomatic right obstructive uropathy. Case 2, a male patient developed non-ST elevation myocardial infarction and was commenced on dual antiplatelet therapy. Subsequently, he developed gross hematuria unresponsive to conservative measures. Urgent urological intervention was carried out while on aspirin in both cases with uneventful recovery. Upon coronary angiography, both cases were found to have multi-vessel disease requiring coronary artery by-pass graft later. Due to their concurrent urologic problems the patients described were not optimized fully to undergo coronary angiography. In close collaboration with cardiology, patients with acute coronary syndrome can be carefully selected to undergo urgent urologic interventions prior to coronary angiography/primary coronary intervention.

Maternal and Neonatal Outcome for Singleton and Twin Pregnancies in Emergency Cesarean Section vs.Urgent Cesarean Section in a Retrospective Evaluation from 2003-2012

Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.

Biological Diversity VS. Urgent Protection

Not long ago, an international symposium was held in Lhasa to discuss ways and means of protecting and managing the region’s biological diversity. Wangdui took the advantage of the occasion to interview Mr. Li Bosheng, research fellow with the Beijing Plant Research Institute and Director of the Beijing Botanical Garden. Mr. Li is one of the few who discovered the U-turn canyon on the Yarlung Zangbo River. The following is his view on the symposium theme.

Urgent reoperation early after coronary artery bypass graft

Objective To explore the cause of acute myocardial ischemia early after coronary artery bapass graft (CABG) and surgical management on it. Methods From 2001 to 2009,28 patients underwent urgent reoperation early after CABG due to acute myocardial ischemia. The incidence of reoperation is about 0. 02% . The cause of reoperation inclouded early

Textile Machinery Sector Takes on Economic Crisis,but Requests Urgent Measures

Preliminary year-end 2008 figures for Italy’s textile machinery industry register a 18% drop in production compared to the previous year,with a total production value estimated at 2,285 billion Euros.This decline affects both Italy’s domestic market and export sales.

Transforming agri-food systems for multiple wins in nutrition,inclusion and environment

The call for agri-food system transformation is urgent in many global development agendas(UN 2023).Food systems have contributed to economic prosperity and feeding the world,but they are also associated with numerous challenges,including climate change,continued hunger,poor diets and malnutrition,and increasing disparities(Webb et al.2020;Fanzo et al.2021).

A Special Issue:“Energy Transition Technology for Emission Peak and Carbon Neutrality”for Global Energy Interconnection

In 2020,China made a solemn commitment to the world:striving to achieve carbon peak before 2030 and carbon neutrality before 2060.The energy industry is the main source of carbon emissions and the key path to achieving the“dual carbon”goals.The revolution in energy production and consumption has already sparked a wave.However,the energy transition still faces challenges such as a high proportion of fossil fuel usage,multiple constraints on clean energy supply,urgent request to improve the carrying capacity and flexible regulation capability of the power system,and rising energy costs for the entire society.To cope with these difficulties and challenges,it is necessary to balance safety and stability,economic efficiency,and clean and low-carbon development three aspects;strengthen energy technology innovation;and deepen institutional and market reform and innovation.Therefore,the editorial department of Global Energy Interconnection has planned the special issue of“Energy Transition Technology for Emission Peak and Carbon Neutrality”.

全球数字治理赤字:表现、成因与中国的应对

Global digital governance is an emerging field of global governance.As digital technology progresses and becomes a key driver of globalization,the booming digital economy has revealed many cyber risks and areas of concern that can trigger crises.The potential downside risks have captured wide attention,making global digital governance all the more urgent on the global governance agenda.

U.S.Silence,Regional Chaos:The Unseen Hand in Syria's Crisis

In just 12days beginning on November 27,the Syrian Government,led by Bashar al-Assad,was overthrown by insurgent groups supported by a coalition of countries,a process rooted in the Syrian Civil War.This long-running conflict,which has been characterized by many political analysts as a U.S.-led proxy war,started in 2011 as an uprising against Assad's rule,which quickly escalated into a violent and protracted civil war involving multiple factions and foreign powers.

黑龙江省对俄合作紧缺人才培养的路径

在全球化时代,国与国之间的合作越来越密切。对于中国和俄罗斯两个邻国来说,相互的合作关系非常重要。在中国黑龙江省与俄罗斯的合作中,存在着紧缺人才的问题。黑龙江省对俄合作中紧缺人才的培养应以文化为核心,以语言为内涵,以合作为手段,以政策为导向,形成培养体系。

新型电力系统的紧急需求响应机制研究

随着电力行业的快速发展,新型电力系统对高效、可靠的运行需求日益迫切。紧急需求响应机制作为优化电力资源配置、提升电力系统运行灵活性的有效工具,对电力系统的稳定性、经济性及可持续发展具有重大意义。基于此,概述了新型电力系统中紧急需求响应的重要性,针对新型电力系统紧急需求响应机制的现状进行了分析,并提出了新型电力系统紧急需求响应机制的发展路径,以期对促进电力系统转型以及提升紧急需求响应效率提供一定的参考价值。