Table of Content

20 January 2025, Volume 28 Issue 03

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Editorial

Should We Label Everyone as Patients with Diseases?

2025, 28(03):  0-B.  DOI: 10.12114/j.issn.1007-9572.2024.A0023

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Review & Perspectives

Clinical Research of Obstructive Sleep Apnea and Acute Coronary Syndrome: Current Status and Future Direction

ZHANG Ming, WANG Wenjuan, HAO Wen, CHEN Jibin, XIA Wei, SHAO Yibing, WANG Bin

2025, 28(03):  257-261.  DOI: 10.12114/j.issn.1007-9572.2024.0238

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Obstructive sleep apnea (OSA) is one of the most common sleep disorders, which is closely related to a variety of cardiovascular diseases, and has become one of the key directions for the control and prevention of cardiovascular disease risk factors. In recent years, many clinical studies have confirmed that OSA is closely related to the initiation and evolution of acute coronary syndrome (ACS). Therefore, this article summarized the status quo of clinical studies on OSA and ACS, the shortcomings of current studies, and prospects for future research directions.

Domestic and International Advances and Challenges in Early Diagnosis of Prediabetes with Integrated Chinese and Western Medicine

PENG Hongye, JING Yanan, LIU Dianchun, WANG Ying, XUE Xue, LU Chunli

2025, 28(03):  262-272.  DOI: 10.12114/j.issn.1007-9572.2024.0328

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Prediabetes is a condition characterized by impaired fasting glucose, impaired glucose tolerance, or a combination of both, which is classified under the category of "Pi Dan" in Traditional Chinese Medicine (TCM). With the changes in modern lifestyles, the prevalence of prediabetes is continuously rising, carrying a risk comparable to diabetes prognosis. Therefore, timely diagnosis and early intervention are crucial. This article reviewed the origins and definitions of prediabetes from both TCM and modern medical perspectives, revealing that TCM had already recognized "Pi Dan" as early as the composition of the "SuWen". With the development of evidence-based medicine and the implementation of standardized clinical research, China has gradually established the standardized clinical practice guidelines for prediabetes with TCM characteristics. Regarding diagnosis, diagnostic indicators and thresholds for monitoring blood glucose levels, various non-invasive integrated TCM and modern medical diagnostic methods, including TCM syndrome diagnosis, integrated TCM and Western medicine diagnostic models, disease risk scoring models, biomarkers, and wearable devices, have been continuously improved. However, its primary focus lies in diabetes prevention rather than the early detection and screening of prediabetes. Besides, 1-hour plasma glucose may be a new outcome for prediabetes diagnosis or identifying high-risk diabetes populations in the future. However, further research is required to validate its broader application. Addressing the challenges of dynamic diagnostic standards, complex screening processes, atypical clinical symptoms, and low disease awareness during early prediabetes diagnosis, it is imperative to continuously update and refine diagnostic standards. The integration of digital health management and wearable devices should be promoted to fully capitalize on TCM strengths in constructingt disease diagnostic models that combine TCM macro manifestations and omics microdata for prediabetes. Simplified and expedited integrated TCM and modern medical screening methods can facilitate early screening, early diagnosis, early intervention, and early recovery for prediabetes.

Guidelines Interpretation

Interpretation of the Clinical Practice Statement by the Obesity Medicine Association on the Obesity and Hypertension

LYU Yao, ZHOU Yiheng, LIU Lidi, YANG Rong, ZHANG Peng, ZHU Yawen, DAI Hua, LIAO Xiaoyang, LEI Yi, YANG Ziyu

2025, 28(03):  272-279.  DOI: 10.12114/j.issn.1007-9572.2024.0228

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Obesity and hypertension are global public health problems that place a huge burden on individual health and social economy. There is a close correlation between obesity and hypertension, both are major risk factors for cardiovascular diseases. In 2023, the Obesity Medicine Association (OMA) conducted a deep investigation into the mechanisms of obesity-related hypertension and published the Clinical Practice Statement on Obesity and Hypertension in the Obesity Pillars. This statement presents new recommendations for the prevention and treatment of obesity and hypertension. It also identifies ten important considerations for managing these disorders. The goal of this article's interpretation of the OMA statement is to help primary care physicians treat patients with obesity and hypertension more effectively by furthering the updating of China's clinical guidelines for these illnesses.

Article

Epidemic Characteristics and Influencing Factors of Bone and Joint Diseases among the Elderly Population

GAO Yan, YANG Shuxian, FAN Lei, CHANG Liang, GAO Li, ZHANG Hanxue, LI Hui, KANG Kai

2025, 28(03):  280-284.  DOI: 10.12114/j.issn.1007-9572.2024.0208

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Background

Given the increasing prevalence of the high incidence of bone and joint diseases in the elderly population, and significantly associated with higher mortality, more disability, decline in functional status and lower quality of life, this creates a large disease burden. There is currently no research on the prevalence and influencing factors of this disease in Henan Province.

Objective

To provide scientific basis for understanding the epidemic characteristics and influencing factors of bone and joint diseases in the elderly population in Henan Province and implementing precise prevention and control.

Methods

The multi-stage random cluster sampling method was used to obtain the demographic characteristics, past disease history, physical activity and physical indicators of permanent residents aged≥18 years old in Henan Province in 2018 through questionnaires, medical physical examination, laboratory testing and other methods. 1 055 people aged ≥60 years old were included in this study. Multivariate Logistic regression was used to analyze the characteristics and influencing factors of bone and joint diseases in the elderly population with different characteristics in Henan Province.

Results

The incidence rate of bone and joint diseases among the elderly population in Henan Province in 2018 was 28.13% (95%CI=28.10%-28.15%). Among them, women, urban areas, those with overweight or obesity, central obesity, dyslipidemia or hyperlipidemia, snoring history, moderate intensity activity, and non-smoking history have higher incidence rates, and the differences are statistically significant (P<0.05). Multivariate Logistic regression analysis showed that males (OR=0.717, 95%CI=0.550~0.933, P=0.013) were protective factors for bone and joint diseases in the elderly population, while overweight or obesity (OR=1.329, 95%CI=1.050-1.684, P=0.018) and central obesity (OR=1.305, 95%CI=1.047-1.626, P=0.018) were risk factors for bone and joint diseases in the elderly population.

Conclusion

Bone and joint diseases in the elderly population in Henan Province are related to gender, BMI, and central obesity. Targeted health education and comprehensive intervention should be carried out for women, overweight or obese individuals, and central obesity in the elderly population.

Aerobic Exercise Improves Physique and Quality of Life in Breast Cancer Patients During Anthracycline-based Chemotherapy: a Randomized Controlled Trial

LI Hongmei, ZHANG Yimin, WANG Yong, ZHANG Yurong, JIA Xiao, YU Jingjing, SANG Die

2025, 28(03):  285-292.  DOI: 10.12114/j.issn.1007-9572.2023.0654

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Background

Anthracyclines are fundamental in the chemotherapy treatment of breast cancer, but these treatments often lead to changes in physique, such as increased body fat and decreased cardiopulmonary function, alongside gastrointestinal reactions and bone marrow suppression, thereby impacting the patients' quality of life. Current studies on the ameliorative effects of exercise on these side effects yield inconsistent results, necessitating further research. Clinically, the efficacy and safety of exercise prescriptions in mitigating these chemotherapy side effects in breast cancer patients warrant further exploration.

Objective

This study aims to investigate the effectiveness and safety of aerobic exercise in improving the physique and quality of life of breast cancer patients during anthracycline-based chemotherapy.

Methods

This study is a randomized controlled trial involving 44 adult female breast cancer patients who received anthracycline-based chemotherapy at Beijing Chaoyang Sanhuan Cancer Hospital, from March 2022 to January 2023. They were randomly assigned to an exercise group (23 participants) and a control group (21 participants). The control group was informed about personalized exercise guidance after chemotherapy. The exercise group, under the supervision of rehabilitation therapists, engaged in workouts during their hospital stay and continued personalized exercise interventions at home with self-monitoring and remote supervision by researchers. Key outcome measures, including physique and quality of life, were collected before and after chemotherapy, along with the incidence and severity of gastrointestinal reactions, bone marrow suppression, and exercise-related adverse events. Covariance analysis, using pre-chemotherapy data as covariates, compared the physique and quality of life between the two groups.

Results

Four participants were lost during the intervention and follow-up, leaving 40 participants (21 in the exercise group, 19 in the control group). No severe adverse events were observed during the exercise intervention. The average compliance with the exercise intervention was 81.8%; average compliance per exercise session was 91.9%, and average compliance with exercise intensity was 92.5%. Post-chemotherapy, the exercise group showed lower body fat weight, body fat percentage, visceral fat area, waist circumference, waist-to-hip ratio, and significantly higher grip strength of the dominant hand and relative peak oxygen uptake (VO₂peak) compared to the control group (P<0.05). The incidence of functional impairments post-chemotherapy in the exercise group (7/20) was significantly lower than in the control group (12/16) (χ²=5.707, P=0.017). Post-chemotherapy, the exercise group reported significantly lower scores in physical condition, emotional condition, and additional scores, and higher functional condition scores than the control group (P<0.05). Post-chemotherapy, the control group's physical condition scores (P<0.001) and the exercise group's functional condition scores (P=0.017) were higher than pre-chemotherapy. The control and exercise groups underwent 84 and 94 anthracycline chemotherapy sessions, respectively, with the control group experiencing 84 gastrointestinal reactions and 71 bone marrow suppressions, and the exercise group experiencing 54 gastrointestinal reactions and 45 bone marrow suppressions, showing statistically significant differences between the groups (P<0.05) .

Conclusion

Aerobic exercise during anthracycline chemotherapy can improve the physique and quality of life of breast cancer patients and is safe when supervised.

Expression and Prognostic Value of Serum SAA, IL-6, TNF-α and microRNAs in Children with Sepsis Complicated with Acute Kidney Injury

WANG Linna, ZHANG Jinghui

2025, 28(03):  293-298.  DOI: 10.12114/j.issn.1007-9572.2023.0763

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Background

Acute kidney injury (AKI) is a common complication of sepsis. Immune-inflammatory markers are commonly used to assess the prognosis of these patients. However, studies evaluating microRNAs (miR) in this context are scarce, indicating a need for further clinical investigation.

Objective

To investigate the expression of serum amyloid A (SAA), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and miR in pediatric patients with sepsis-induced AKI and analyze their prognostic assessment value.

Methods

This study included 100 pediatric patients with sepsis-induced AKI admitted to the First People's Hospital of Pingdingshan from March 2020 to March 2023 as the observation group, and 80 pediatric patients with sepsis alone as the control group. General patient data were collected, and serum levels of SAA, IL-6, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). The relative expression of miR-21-3p, miR-182-5p, and miR-128-3p was quantified using real-time quantitative PCR. The Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology and Chronic Health EvaluationⅡ (APACHE Ⅱ) score were compared between the groups. Pearson correlation analysis was used to evaluate the relationship between the levels of serum SAA, IL-6, TNF-α, and miRs and the SOFA and APACHEⅡ scores. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of these markers for mortality in pediatric patients with sepsis-induced AKI and to calculate the area under the ROC curve (AUC) .

Results

The observation group showed significantly higher SOFA scores, APACHE Ⅱ scores, and levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to the control group (P<0.05). After 28 days of hospitalization, 74 patients in the observation group survived, while 26 died. Surviving patients had lower levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p compared to those who died (P<0.05). Levels of serum SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, and miR-128-3p were positively correlated with SOFA and APACHEⅡ scores (P<0.05). ROC curve results showed a combined predictive AUC of 0.926 (95%CI=0.856-0.969, P<0.05) .

Conclusion

The serum levels of SAA, IL-6, TNF-α, miR-21-3p, miR-182-5p, miR-128-3p are abnormally high in children with sepsis complicated with AKI. Clinical detection of these indicators has a high value and early warning effect on the prognosis of children.

Association of Residual Cholesterol with Vulnerable Plaques in Non-culprit Lesions Progressing to Major Adverse Cardiovascular Events

YANG Hong, LIU Cheng, LIU Sen, SHAO Qiqi, YAO Yuanhao, FU Zhenyan

2025, 28(03):  299-304.  DOI: 10.12114/j.issn.1007-9572.2024.0186

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Background

Remnant cholesterol (RC) is considered a significant risk factor for atherosclerotic cardiovascular diseases, and the progression of non-culprit coronary lesions (NCCLs) is also a prominent issue affecting the prognosis of patients with coronary artery disease. However, the relationship between residual cholesterol and vulnerable plaques in NCCLs that progress to major adverse cardiovascular events (MACE) is not well understood.

Objective

To explore the predictive value of RC for vulnerable plaques in NCCLs that develop MACE and its correlation with long-term prognosis.

Methods

A total of 488 patients with coronary artery disease admitted to the Cardiac Center of the First Affiliated Hospital of Xinjiang Medical University from February 2015 to February 2022 were selected as the study subjects. Baseline data of the patients were collected through the electronic medical record system, and coronary angiography and optical coherence tomography (OCT) were performed. Enrolled patients received scheduled follow-up at 1, 3, 6, and 12 months after discharge. Spearman's rank correlation test was used to explore the correlation between RC and the characteristics of thin-cap fibroatheroma (TCFA) plaques in NCCLs. Multiple Logistic regression analysis was used to explore the influencing factors of MACE in TCFA of NCCLs. The receiver operating characteristic curve (ROC curve) was plotted, and the area under the ROC curve (AUC) was calculated to explore the predictive value of RC for MACE in TCFA of NCCLs.

Results

A total of 488 coronary artery disease patients were included, and patients were divided into MACE group (n=38) and non-MACE group (n=450) based on whether NCCLs developed MACE. Plaque characteristics of NCCLs were identified by OCT, and a total of 749 NCCL plaques were analyzed, with 304 NCCL plaques having a minimum lumen area (MLA) <3.5 mm². During the follow-up period, 38 patients (7.8%) experienced 41 MACE events caused by NCCL plaques, 18 patients (3.7%) developed in-stent restenosis, and 15 patients (3.1%) had deaths due to uncertain factors. The proportion of patients with hypertension, diabetes, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), RC, glycated hemoglobin (HbA_1c), TCFA, and MLA <3.5 mm² in the MACE group was higher than that in the non-MACE group (P<0.05). TCFA was detected in 105 patients, of which 22 cases developed MACE (TCFA MACE group), and 83 cases did not develop MACE (non-TCFA MACE group). The proportion of diabetes and RC in the TCFA MACE group was higher than that in the non-TCFA MACE group (P<0.05). The results of Spearman's rank correlation analysis showed that RC was negatively correlated with the thinnest fibrous cap thickness and MLA (r_s=-0.665、-0.771, P<0.05), and positively correlated with the maximum lipid arc and macrophage infiltration (r_s=0.806、0.481, P<0.05). The results of Multiple Logistic regression analysis showed that diabetes (OR=3.410, 95%CI=1.165~9.988, P=0.025) and high level of RC (OR=5.879, 95%CI=1.436-24.073, P=0.014) was a risk factor for MACE in TCFA of NCCLs. The ROC curve for predicting MACE in TCFA of NCCLs by RC showed an AUC of 0.695 (95%CI=0.571-0.819, P=0.005), with the optimal cutoff value of 0.606 mmol/L, and sensitivity and specificity of 0.818 and 0.518, respectively.

Conclusion

Elevated levels of RC may be a risk factor for the development of MACE in vulnerable plaques of NCCLs in patients with coronary artery disease, and it has certain predictive value for MACE in TCFA of NCCLs.

Trend and Prediction of Changes in the Disease Burden of Diet-related Ischemic Heart Disease in China, 1990-2021

WU Xia, ZHANG Yiyun, YAO Chengzhi, ZHAO Xiangling, XIONG Wenjing, RANG Weiqing

2025, 28(03):  305-312.  DOI: 10.12114/j.issn.1007-9572.2024.0253

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Background

Ischemic heart disease (IHD) is the second leading cause of disease burden in the Chinese population, and dietary factors are considered as effective and feasible approaches to reduce the disease burden.

Objective

To analyze the trends in the disease burden of IHD attributable to dietary factors from 1990 to 2021 and future trends in China, aiming to provide a reference basis for dietary prevention and treatment of IHD in China.

Methods

Data related to the disease burden of IHD attributable to dietary factors in China, worldwide, and regions with varied socio-demographic index (SDI) from 1990 to 2021 were extracted from the Global Burden of Disease 2021 (GBD 2021) database. Using the Joinpoint model, the annual percent change (APC) and average annual percent change (AAPC) were calculated to analyze the disease burden of IHD attributable to dietary factors in China, worldwide, and regions with varied SDI. Furthermore, the model evaluated the diet-ralated disease burden by gender and age groups in China, as well as the burden of disease attributable to specific dietary factors within the Chinese population from 1990 to 2021. Additionally, the Bayesian age-period-cohort (BAPC) model was used to predict the standardized mortality rate and the standardized disability-adjusted life year (DALY) rate of IHD attributable to dietary factors from 2022 to 2031.

Results

In 2021, the standardized mortality rate and standardized DALY rate of IHD attributable to dietary factors in China were 44.26/100 000 and 820.87/100 000, respectively, which were close to the global levels, but higher than those of high SDI regions and lower than the remaining four categories of SDI regions. From 1990 to 2021, the standardized mortality rate (AAPC=-0.17%, P<0.001) and the standardized DALY rate (AAPC=-0.50%, P<0.001) of IHD attributable to dietary factors in China showed a decreased trend, which were consistent with the global trend and those in the five categories of SDI regions. The global decrease was significantly higher than that in China, with the fastest decrease in the high SDI regions. Disease burden of IHD attributable to dietary factors was significantly higher in Chinese males than in females in 1990 and 2021. The standardized mortality rate (AAPC=0.25%, P<0.001) of IHD attributable to dietary factors in Chinese males showed an increasing trend from 1990 to 2021. The standardized mortality rate (AAPC=-0.71%, P<0.001) and standardized DALY rate (AAPC=-1.23%, P<0.001) in Chinese females both showed a decreased trend. Disease burden of IHD attributable to dietary factors showed an increased trend with age in China in 1990 and 2021, and the highest mortality and DALY rate were detected in people ≥70 years old. The mortality and DALY rate of IHD attributable to dietary factors for the residents aged 50-69 years showed a decreased trend from 1990 to 2021, while those in the 15-49 years and ≥70 years showed an increased trend (P<0.001). Among the 13 dietary factors attributed to the standardized mortality and standardized DALY rate of IHD in 1990 and 2021, the top were excessive sodium intake and insufficient intake of whole grains. Dietary factors attributed to the most significant increased trends in the standardized mortality and standardized DALY rate of IHD from 1990 to 2021 were excessive intake of sugar-sweetened beverages, excessive intake of processed meats, and red meat intake. The BAPC model showed that the standardized mortality rate and standardized DALY rate of IHD attributable to dietary factors in China will decline over the next 10 years.

Conclusion

From 1990 to 2021, the standardized mortality and standardized DALY rate of IHD attributable to dietary factors decreased in China, but the decline is slower compared to high SDI regions. Disease burden of IHD attributable to dietary factors is heavier among men and the elderly. Therefore, it is essential to focus on dietary prevention and control strategies for IHD. Efforts should be made to promote healthy dietary patterns, increase the intake of whole grains, and reduce the consumption of sodium, sugar-sweetened beverages, processed meats, and red meats. Targeted measures and effective interventions are needed to further reduce the disease burden.

Analysis and Prediction of Incidence and Mortality Trends of Three Enteric Infectious Diseases in China from 1990 to 2019

LAI Fengxia, WANG Shihong, ZHAO Le, HUANG Ruixian, YANG Zihua, ZHANG Zhiyi, KONG Danli, DING Yuanlin

2025, 28(03):  313-319.  DOI: 10.12114/j.issn.1007-9572.2024.0077

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Background

Intestinal infectious diseases are one of the common infectious diseases. Analysis and prediction of their epidemic status can provide certain reference for the prevention and treatment of intestinal infectious diseases.

Objective

To understand the incidence and mortality of three enteric infectious diseases, including diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections in China from 1990 to 2019, and to predict their morbidity and mortality from 2020 to 2030, so as to provide reference for the prevention and control of intestinal infectious diseases.

Methods

Based on the 2019 Global Burden of Disease Database (GBD), the incidence and mortality data of three enteric infectious diseases, including diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections in China from 1990 to 2019 were collected. The change rate (%) and estimated annual percentage change (EAPC) were used to describe the changing trends of the above three intestinal infectious diseases. The autoregressive integrated moving average model (ARIMA) was used to predict the morbidity and mortality of the above three enteric infectious diseases in China from 2020 to 2030.

Results

There was no statistically significant change in the incidence of diarrheal diseases from 1990 to 2019 (EAPC=0.09, P>0.05), while the incidence of typhoid fever, paratyphoid fever and invasive non-typhoid salmonella intestinal infections showed a downward trend (EAPC were -4.0% and -0.64% respectively, P<0.05). The mortality rates of diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections all showed a downward trend from 1990 to 2019 (EAPC were -8.39%, -3.38%, and -1.87%, respectively, P<0.05). Among all age groups, the incidence of diarrheal disease among people aged ≥70 years in 2019 was the highest among all age groups, and it was on the rise (EAPC=0.27, P<0.05). The mortality rates of the above three intestinal infectious diseases in all age groups from 1990 to 2019 showed a downward trend (P<0.05). The ARIMA model prediction results show that the incidence of diarrheal diseases in China will be on an upward trend from 2020 to 2030, while the incidence of typhoid and paratyphoid fever and invasive non-typhoid Salmonella will be on a downward trend. The estimated incidence of the above three diseases was 58 793.04/10⁵, 5.26/10⁵, 0.447/10⁵, respectively. In addition, the mortality rates of diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoid Salmonella in our country will all show a downward trend from 2020 to 2030. The mortality rates of the above three diseases in 2030 were expected to be 0.214/10⁵ and 0.039/10⁵, 0.026/10⁵, respectively.

Conclusion

The mortality rates of diarrheal diseases, typhoid fever and paratyphoid fever, and invasive non-typhoidal Salmonella intestinal infections in China will show a downward trend in 2030. Except for the incidence of diarrheal diseases, which will show an upward trend, the incidence of the other two diseases will show a downward trend. It reminds the government and relevant health departments to pay attention to diarrheal diseases and adopt different prevention and control measures for different groups of people.

Article·Obesity Prevention and Control Section

Predictors for Overweight/Obesity of Chinese Healthcare Workers

GUO Xinyue, GONG Shaoqing, HOU Xiaohui, SUN Tong, WEN Jianqiang, WANG Zhiyao, HE Jingyang, SUN Xuezhu, WANG Sufang, TIAN Xiangyang, FENG Xue

2025, 28(03):  320-329.  DOI: 10.12114/j.issn.1007-9572.2023.0582

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Background

Healthcare workers have played a crucial role in preventing and controlling the COVID-19 pandemic. However, the heightened risk of infection and intense work schedules have not only induced occupational burnout among them but also significantly impacted their mental health and lifestyles. A large number of foreign studies have shown that the COVID-19 pandemic has led to unreasonable diet, reduced exercise, irregular work and rest, and decreased sleep quality among HCWs, increasing the risk of overweight and obesity. Despite this, research on weight and lifestyle changes among Chinese healthcare workers during the pandemic is limited, and the key lifestyle factors contributing to these weight changes remain unclear.

Objective

To analyze the predictors of overweight and obesity in Chinese healthcare workers by constructing a Bayesian network model, and to provide a scientific basis for the prevention and control of overweight and obesity.

Methods

In August 2022, Chinese healthcare workers in 100 medical institutions from five provinces/autonomous regions/municipalities were randomly sampled, and the questionnaire (Cronbach's α=0.820, AVCR=63.55%) was prepared by the researchers to collect data. All respondents were required to scan QR code generated by the "Wenjuanxing" to answer the e-questionnaire and submit. The "bnlearn" package of R 4.3.0 software was used to construct a Bayesian network model, and Netica 6.09 software was used for Bayesian network risk prediction.

Results

The study surveyed a total of 20 261 healthcare workers, of whom females accounted for 67.57% (13 690/20 261) ; The average age was (40.2±9.2) years old; 73.28% (14 848/20 261) had a college or undergraduate education level. In 2019 and 2022, the overweight/obesity rates were 43.06% (8 726/20 261) and 45.71% (9 262/20 261), respectively. From 2019 to 2022, 12.64% (1 458/11 535) of survey respondents' BMI changed from underweight/normal to overweight/obese. The Bayesian network model included a total of 15 nodes, and the amount of consumption of vegetables and fruits, breakfast frequency, alcohol drinking, and appetite were the parent nodes of BMI changing from underweight/normal to overweight/obesity, and when there were "a reduction" in the consumption of vegetables and fruits, "no change" in frequency of eating breakfast, alcohol drinking consumption "no change", and "a great increase" in the appetite the risk of BMI changing from underweight/normal to overweight/obese was the highest (75.00%). And when there were "a great increase" in consumption of vegetables and fruits, "an increase" in the frequency of eating breakfast, "never or rarely" in alcohol drinking and "a reduction" in appetite, the risk of becoming overweight/obese was the lowest (2.04%) .

Conclusion

Consumption of vegetables and fruits, eating breakfast frequently, drinking alcohol and appetite are the direct predictors of overweight/obesity of Chinese healthcare workers. During the epidemic of major infectious diseases such as the COVID-19, on the premise of ensuring the normal operation of medical and health institutions, a reasonable rotation system is implemented to provide psychological support and lifestyle behavior intervention services, which is conducive to the prevention and control of obesity of healthcare workers.

Reference Equations for the 6-Minute Walk Test Distance in Outpatient Obese Patients Aged 17 to 45 Years

ZHANG Jiaming, WANG Xinyu, WANG Daorong, SUN Xiaofang

2025, 28(03):  330-334.  DOI: 10.12114/j.issn.1007-9572.2023.0846

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Background

The 6-minute walk test (6MWT) is extensively used to assess the exercise capacity of obese populations and offers a reference for devising intervention measures. While reference equations for the 6MWT distance for various populations have been proposed internationally, there is a scarcity of studies on reference equations for the 6MWT distance among Chinese obese subjects aged 17 to 45 years with a BMI ≥ 30 kg/m².

Objective

To develop reference equations for the 6MWT distance for outpatient obese subjects aged 17 to 45 years and to assess its influencing factors.

Methods

Following the American Thoracic Society guidelines, from June 2022 to September 2023, 143 adults aged 17 to 45 years with a BMI ≥30 kg/m² (71 males and 72 females) who visitied the Department of Endocrinology, Northern Jiangsu People's Hospital, were prospectively selected for anthropometric measurements and the 6MWT. A stepwise multiple regression model was employed to establish reference equations for the 6MWT distance, and the newly developed equations were compared with existing prediction equations.

Results

The average 6MWT distance for the 143 subjects was (506.1±49.8) m, with males averaging (515.7±50.14) m, which was greater than the females' average of (496.6±47.9) m (P<0.05). Across age groups 17-23, 24-30, 31-37, and 38-45 years, differences in 6MWT distances between males and females were statistically significant (P<0.05). In males, weight, BMI, HR_max, resting heart rate difference (ΔHR), waist circumference, diastolic blood pressure difference (ΔDBP), and Borg scale score difference (ΔBorg) were related to 6MWT distance (P<0.05), whereas in females, weight, BMI, and waist circumference were related to 6MWT distance (P<0.05). Incorporating potential influencing factors into a stepwise multiple linear regression equation, the final reference formulas were established as follows: for males, y=494.463+1.414×ΔHR-3.903×BMI+0.874×HR_max, R²=0.429; for females, y=670.448+0.299×ΔHR-4.342×BMI-0.195×HR_max, R²=0.312.

Conclusion

In outpatient obese patients aged 17 to 45 years, males had a longer average 6MWT distance than females, with significant differences across different age groups. Factors such as weight, BMI, HR_max, ΔHR, wait cirumference ΔDBP, and ΔBorg were associated with 6MWT distance in males, while weight, BMI, waist cirumference and ΔSBP were related to 6MWT distance in females. Through multiple linear regression analysis, reference equations predicting 6MWT distance were established for males and females, providing valuable references for assessing individual physical fitness levels.

The Improvement of Maximal Fat Oxidation Intensity on Body Composition, Cardiopulmonary Function, and Lipid Metabolism in Overweight or Obese Individuals: a Meta-analysis

LU Donglei, TAN Sijie, YANG Fengying

2025, 28(03):  335-345.  DOI: 10.12114/j.issn.1007-9572.2024.0108

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Background

Research has linked the physical constitution of overweight/obese individuals to obesity, with a potential bidirectional association. Although FATmax exercise can boost their fitness, the exact magnitude of this benefit needs further study.

Objective

Systematic evaluation is needed to assess the impact of FATmax exercise on physical fitness indicators among overweight or obese populations.

Methods

Retrieve RCTs from PubMed, Web of Science, EBSCO, CNKI, VIP, Wanfang Data (January 2001 to January 2024) on FATmax exercise effects on body composition, cardiovascular endurance, lipid metabolism in overweight/obese patients. Evaluate quality with Cochrane tool, Meta-analysis with RevMan 5.4.

Results

A total of 16 randomized controlled trials were included, including 568 overweight or obese patients. The Meta-analysis results showed that compared with the control group, the FATmax exercise intervention group significantly improved body composition (BMI: WMD=-1.82, P<0.01; BFR: WMD=-2.86, P<0.01; WHR: WMD=-0.04, P<0.01), cardiovascular endurance (VO_2max: WMD=3.34, P<0.01), and lipid metabolism except for TC (TG: WMD=-0.24, P<0.01; HDL-C: WMD=0.14, P<0.01; LDL-C: WMD=-0.27, P<0.01). Optimal results vary: ≥12 weeks, 3-5 times/week, 60-minute running for body composition; ≥12 weeks, 5 times/week, <60 minutes combined for VO_2max; ≥12 weeks, 3 times/week, 60-minute running for TG; <12 weeks, 4 times/week, 60-minute combined for HDL-C; <12 weeks, 4 times/week, >60-minute combined for LDL-C.

Conclusion

FATmax exercise benefits body composition, cardiovascular endurance, and lipid metabolism (except TC) in overweight/obese patients.

Article·Children's Health Section

Clinical Effect of Vitamin D on Children with Global Developmental Delay

NIU Guohui, XIE Jiayang, ZHU Dengna, CUI Bo, ZHAO Huiling, WANG Mingmei, FENG Huanhuan, ZHANG Mengmeng, LI Tingting

2025, 28(03):  346-351.  DOI: 10.12114/j.issn.1007-9572.2023.0730

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Background

Except for global developmental delay (GDD) caused by certain metabolic diseases with clear causes, rehabilitation treatment is the main treatment for GDD. Vitamin D plays an important neuroprotective role in regulating the development and differentiation of nerve cells by affecting neurotrophic factors; however, there is no study on the clinical effect of vitamin D supplementation on children with GDD.

Objective

To explore the clinical effects of vitamin D supplementation at different doses on the rehabilitation of children with GDD.

Methods

A total of 110 children with GDD who were hospitalized for the first time in the Department of Rehabilitation of the Third Affiliated Hospital of Zhengzhou University from September 2020 to June 2022 were selected as the study subjects and divided into the conventional group (n=38), 400 U group (n=37) and 1 200 U group (n=35) using a randomized block grouping method. The conventional group only received conventional rehabilitation; 400 U/d of vitamin D was given orally on the basis of conventional rehabilitation to the 400 U group; 1 200 U/d of vitamin D was given orally on the basis of conventional rehabilitation to the 1 200 U group. Basic data such as sex and age at consultation were collected from the children in the 3 groups; serum 25-hydroxyvitamin D [25 (OH) D] level and the score of Gesell scale for developmental quotient (DQ) in 5 functional areas of adaptive ability, gross motor ability, fine motor ability, linguistic competence, and social competence were measured at the time of admission and at the end of 3 courses of rehabilitation. The number of adverse events during the hospitalization of the children and the incidence of adverse events were recorded, and the above data were analyzed and compared.

Results

The comparison of the 3 groups of children in sex, place of residence, season of birth, mode of delivery, age of consultation, birth body mass, birth gestational age, and main reason for consultation showed no statistically significant difference (P>0.05). Before treatment, there was no statistically significant difference in 25 (OH) D level and DQ value of each functional area of Gesell scale among the 3 groups of children (P>0.05). After treatment, children in the 1 200 U group had higher blood 25 (OH) D levels, Gesell scale DQ values for gross motor ability, fine motor ability, and linguistic competence than those in the conventional group (P<0.05). During the first and second course of rehabilitation, the incidence of adverse events in the 3 groups of children showed no statistically significant difference (P>0.05) ; in the third course of rehabilitation, the incidence of adverse events in the 1 200 U group was significantly lower than that in the conventional group.

Conclusion

Supplementation with 1 200 U of vitamin D is beneficial to the rehabilitation outcome of children with GDD and reduces the incidence of adverse events during rehabilitation.

Diagnostic Value of LH/FSH Ratio in Rapidly Progressing Central Precocious Puberty Girls

YUAN Shuxian, LIN Yifan, ZHAO Yixuan, WEI Yi, LU Shuai, WEI Haiyan

2025, 28(03):  352-357.  DOI: 10.12114/j.issn.1007-9572.2023.0885

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Background

Central precocious puberty (CPP) is a common endocrine disease in children, which shows an increasing trend year by year in recent years. It can be divided into fast-progressing central precocious puberty (RP-CPP) and slow-progressing central precocious puberty (SP-CPP) through pubertal development. RP-CPP has great harm, but it is difficult to distinguish it from SP-CPP in early clinical stage, mainly relying on the progress of adolescent development and bone age during follow-up. At present, there is a lack of effective laboratory indicators to predict RP-CPP.

Objective

To investigate the relationship between luteinizing hormone (LH) /follicle-stimulating hormone (FSH) ratio and pubertal development.

Methods

CPP girls aged 4-10 years old (n=380) admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2020 to May 2022 were regression selected and divided into RP-CPP group (n=130) and SP-CPP group (n=250 cases) according to indicators such as puberal development process. Clinical characteristics of the two groups were compared and analyzed. Univariate and multivariate Logistic regression analysis of the influencing factors of RP-CPP was performed, and ROC curve of LH/FSH ratio on the predictive value of RP-CPP was drawn.

Results

The height, weight, BMI, IGF-1, difference between bone age and actual age, bilateral ovarian volume, LH base value, estradiol level, LH base value /FSH base value, and LH peak /FSH peak value of girls in RP-CPP group were all higher than those in SP-CPP group, with statistical significance (P<0.05). Regression analysis showed that CPP patients progressed to RP-CPP related serological indexes when LH base value and LH peak /FSH peak were detected. LH base /FSH base value and LH peak /FSH peak were positively correlated with height, IGF-1, LH base value, estradiol level, LH peak, ovarian volume and bone age (P<0.05). ROC curve showed that the LH base /FSH base value and LH peak /FSH peak value were more sensitive and specific than other indexes to the predictive value of RP-CPP. When the LH base /FSH base value was 0.63, the Yoden index reached a maximum of 0.258 (sensitivity 43.1%, specificity 82.7%, AUC=0.644). When the LH peak /FSH peak was 1.39, the maximum Jorden index was 0.276 (sensitivity 74.6%, specificity 53.0%, AUC=0.655). The combined prediction model is better than the single index prediction model (AUC=0.668). The basal gonadotropin levels of children without clinical intervention were analyzed after 6 months of follow-up. It was found that the height increase, ΔLH, ΔFSH, bone age increase and ovarian volume increase in RP-CPP group were significantly higher than those in SP-CPP group after 6 months of follow-up, and the difference was statistically significant (P<0.05) .

Conclusion

LH base /FSH base value and LH peak /FSH peak are early predictors of RP-CPP. When LH/FSH base value ≥0.63 or LH peak/FSH peak ≥1.39, the possibility of RP-CPP should be considered, and the combined predictive value of the two indicators is better than that of a single indicator. It can be used as an auxiliary reference index for clinical application of gonadotropin-releasing hormone analogue therapy.

Progress in the Study of the Association between Adverse Childhood Experiences and the Prevalence of Hypertension in Adulthood

JIANG Shen, WU Jing, ZHOU Jiali, JIANG Denan, SUN Weidi, CHENG Siqing, ZHU Siyu, HOU Leying, SONG Peige

2025, 28(03):  358-364.  DOI: 10.12114/j.issn.1007-9572.2024.0193

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Adverse childhood experiences (ACEs) are traumatic events or situations that individuals may experience during their childhood. Children living with prolonged and persistent adverse experiences may have lifelong effects on their physical and mental health. Most studies in Europe and the United States confirm that ACEs increase the risk of hypertension in adulthood. However, the association between different types of ACEs and hypertension in adulthood remains controversial. This study provides a comprehensive review of studies on the association between different types of ACEs and hypertension, which explores the effects of ACEs on hypertension in adulthood and potential mechanisms. This study also summarizes the current status of studies on ACEs and hypertension. It presents a prospective view of providing a basis for improving the early childhood developmental environment and preventing hypertension in adulthood.

Precision Medication

Study on the Medication Status and Influencing Factors of Hypertensive Patients in the Rural Areas: Based on Family Doctor Contract Services

MA Xiaoyan, CUI Enci, XUE Qun, LIU Rong, ZHANG Xuewu, WANG Qian, WANG Debin, SHEN Xingrong

2025, 28(03):  365-371.  DOI: 10.12114/j.issn.1007-9572.2024.0008

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Background

Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currently, there is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services.

Objective

To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou City, Anhui Province, to describe the association between patient medication behavior and patient characteristics, to explore the influencing factors of medication adjustment, and to analyze the rationality of medication use in primary hypertensive patients.

Methods

Using cluster sampling, from July to August 2021, 48 administrative villages were randomly selected from Jieshou City, Anhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level (2020 Edition) ", the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories: category A includes angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), category B includes beta-blockers, category C includes calcium channel blockers (CCBs), category D includes diuretics, and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study, "combination medication" refers to taking a combination drug or two or more antihypertensive drugs, and "medication adjustment" refers to patients previously taking other antihypertensive drugs.

Results

A total of 3, 005 hypertensive patients were included in this study, including 1 291 males (43.0%) and 1 714 females (57.0%), with an average age of (65.5±9.8) years. The medication rate of hypertension was 79.1%, and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs, the rates of different types of antihypertensive drugs from high to low were (some patients had combination medication) : category E (39.6%), category C (35.1%), category D (20.3%), category A (20.1%), and category B (3.7%) ; the most frequently taken antihypertensive drug was compound lisinopril (33.7%). For patients with an average annual blood pressure ≥160/100 mmHg, 12.2% and 4.9% still did not take antihypertensive drugs. Patients' combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure≥100 mmHg" and "with complications", the rates of adjusted category A and C antihypertensive drugs increased relatively more; for patients with an average annual "systolic pressure ≥160 mmHg" and "without complications", the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication (OR=1.042, 95%CI=1.031-1.053, P<0.001), education level above junior high school (OR=1.488, 95%CI=1.195-1.853, P<0.001), combined hyperlipidemia (OR=1.267, 95%CI=1.052-1.525, P=0.013), combined cardiovascular diseases (OR=1.394, 95%CI=1.166-1.667, P<0.001), and combined cerebrovascular diseases (OR=1.258, 95%CI=1.040-1.522, P=0.018) were promoting factors for medication adjustment in patients, while advanced age (OR=0.980, 95%CI=0.971-0.990, P<0.001) was an inhibiting factor for medication adjustment.

Conclusion

The medication rate among rural hypertensive patients in Jieshou City is high, mainly involving category E and C antihypertensive drugs. Longer duration of medication, education level above junior high school, combined hyperlipidemia, combined cardiovascular and cerebrovascular diseases are promoting factors for medication adjustment in patients, while advanced age is an inhibiting factor for medication adjustment.

Comparison of Different Doses of Ticagrelor on the Efficacy and Safety in Patients with ST-segment Elevation Myocardial Infarction: Based on Propensity Score Matching

WANG Yanbo, SU Lifang, LIU Changchang, ZHOU Qing, TIAN Jia, ZHI Wei, FU Yang, GU Xinshun

2025, 28(03):  372-378.  DOI: 10.12114/j.issn.1007-9572.2024.0150

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Background

The dual antiplatelet therapy of aspirin combined with ticagrelor is the preferred antiplatelet therapy for patients with ST segment elevation myocardial infarction (STEMI) who receive primary percutaneous coronary intervention (PPCI). Compared with clopidogrel, ticagrelor can inhibit platelets faster and more effectively, and improve prognosis. However, there is still a lack of research on the application of reduced dose ticagrelor in STEMI patients receiving PPCI treatment.

Objective

To compare the different doses of ticagrelor on the efficacy and safety in patients with STEMI based on propensity score matching (PSM) .

Methods

The patients with STEMI who underwent PPCI and antiplatelet therapy with ticagrelor at the Fifth Department of Cardiology, Second Hospital of Hebei Medical University from June 2019 to May 2021 were selected consecutively. According to the different maintenance doses of ticagrelor, patients were divided into a reduced dose group (n=60) and a standard group (n=180), using ticagrelor 60 mg/time (2 times/day) and 90 mg/time (2 times/day), respectively. The PSM method was used to perform a 1∶1 match between two groups, with matching variables including gender, age, medical history, Killip grade at admission, and intervention related parameters. Finally, 54 patients were included in the each group. Follow-up was conducted on both groups at 1 month, 3 months, and 6 months after discharge, and platelet parameters as well as clinical events were recorded and compared between the two groups of patients.

Results

There was no statistically significant difference in baseline data, intervention parameters, and incidence of major adverse cardiovascular events (MACEs) during hospitalization between the two groups of patients after PSM (P>0.05). At baseline, there was no statistically significant difference in platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) between the two groups (P>0.05). The level of platelet aggregation rate (PAR) of patients in the reduced dose group was lower than that of the standard group (P<0.05). At discharge, the MPV of patients in the reduced dose group was higher than that in the standard group, and the PDW was lower than that in the standard group (P<0.05). At one month after discharge, there was no statistically significant difference in PLT, MPV, PDW, and PAR between the two groups (P>0.05). At 3 months after discharge, the PDW of patients in the reduced dose group was higher than that of the standard group (P<0.05). At 6 months after discharge, the MPV of patients in the reduced dose group was higher than that of the standard group (P<0.05). There was no statistically significant difference in PLT and PAR before and after discharge between patients in the reduced dose group and those in the standard group (P>0.05). Patients in the reduced dose group and standard group had higher MPV than baseline at discharge, lower PDW than baseline at discharge in the reducde dose group, and lower PAR than baseline at discharge in the standard group (P<0.05). The MPV of patients in the reduced dose group at 1, 3, and 6 months after discharge was lower than those at discharge, and the PDW was higher than that at discharge (P<0.05). The PAR of the standard group patients at 1, 3, and 6 months was lower than baseline and higher than that at discharge (P<0.05). There was no statistically significant difference in the incidence of MACEs and severe bleeding events between the two groups during follow-up (P>0.05) .

Conclusion

Reduced dose of ticagrelor treatment is safe and effective for STEMI patients undergoing PPCI.

Advances in Monitoring and Reversal Strategies for the Novel Anticoagulants Factor Ⅺ Inhibitors

CHEN Yuexiu, YAO Yuanyuan, SUN Dawei, WANG Ying, WU Chaomin, ZHAO Linqian, TANG Zhifeng, ZHANG Fengjiang

2025, 28(03):  379-384.  DOI: 10.12114/j.issn.1007-9572.2024.0046

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Factor Ⅺ (FⅪ) plays a major role in thrombus amplification and an ancillary role in hemostasis. This differential contribution is expected to provide new ideas for the prevention and treatment of thrombotic diseases by targeting FⅪ as a potentially safer anticoagulation strategy. Currently, an increasing number of FⅪ inhibitors are entering phaseⅢ clinical trials, and although these inhibitors showed promising clinical potential, the strategies for monitoring and reversing the effects of these inhibitors remain unclear, which poses new challenges for laboratory monitoring and clinical practice. This review, based on the physiological function of FⅪ and FⅪ inhibitors under study, systematically explored the laboratory evidence of coagulation activity linked to these inhibitors, summarized potential methods of reversal in combination with the treatment protocols of inherited FⅪ deficiency, which provided certain references for the development of clinical treatment protocols and reversal strategies.