Table of Content

20 April 2025, Volume 28 Issue 12

Previous Issue   

Special Report

Advocating Qualitative Studies in Territory of General Practice

YANG Hui

2025, 28(12):  1421-1426.  DOI: 10.12114/j.issn.1007-957.2024.A0027

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Background

General practice research in China needs to further explore the path for breaking through the bottleneck of the discipline development from the perspective of philosophy and methodology.

Objective

By comparing and analyzing qualitative research articles published in benchmark journals, strategies for further advocating qualitative research in general practice medicine in China are proposed.

Methods

Based on a brief analysis of the categories and topics research articles published in the British Journal of General Practice, the author reflects on the current relevant publications and challenges of qualitative research in medical discipline and proposes strategies to promote qualitative research in general practice.

Results

Qualitative research in the British Journal of General Practice accounts for 38% (41/107) of research articles in 2024. The people-centred orientation of general practice encourages researchers to explore experiences, views, perceptions and opinions of patients, laypersons, doctors, nurses, and stakeholders, to plan and provide primary care that with humanity, responsiveness, and participatory. Social science methodologists and academic general practitioners who are interested in sociological research methods are the main driving force for the application of qualitative research in the field of general practice. The tradition of biomedicine philosophy with positivism is a disciplinary barrier that medical-trained need to overcome when conducting qualitative research. Academic general practitioners must understand the difference between ontology and epistemology, and acknowledge and try the interpretivist way of thinking. Different from qualitative data collection and coding techniques that are relatively easy to learn, during the training and learning process of qualitative research, special attention should be paid to breaking through the inertia of thinking and using interpretivism as another window to understand the world and primary care.

Conclusion

Qualitative research is an important area for the development of general practice disciplines. Better quality qualitative research first depends on the enrichment of philosophical thoughts and then use the tools and tactics to realize another understanding of the world.

Guidelines Interpretation

Interpretation of the Clinical Statement for Management of Female Cardiac Emergencies in 2024

HUANG Chuanying, LIAO Xiaoyang, YANG Rong, LI Dongze, ZHANG Peng, JIA Yu, LIU Lidi

2025, 28(12):  1427-1432.  DOI: 10.12114/j.issn.1007-9572.2024.0314

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Cardiac emergencies occur rapidly and pose a serious threat to the health and lives of patients. Female cardiac emergencies have been under-researched, under-diagnosed and under-treated due to gender bias and atypical symptoms for a long time. There are clear gender differences in the pathophysiological mechanisms, risk factors, management and outcomes of female cardiac emergencies. In China, the prevalence of female cardiac emergencies is notably high, and research on it has commenced relatively late. There is no authoritative guideline for female cardiac emergencies, so it is urgent to enhance the management strategies for these conditions. To standardize the management of cardiac emergencies in women and enhance health outcomes, clinicians from general medicine, cardiology and emergency medicine were convened to interpret the clinical statement titled Management of Female Cardiac Emergencies published in 2024 by the Association for Acute Cardiovascular Care and other organizations.

Original Research

Correlation between Lipid Accumulation Product and the Incidence of Hypertension in Adults: a Prospective Cohort Study

WANG Jiangtao, DU Yu, ZHU Ling, ZHAO Fouxi, HU Yuandong, LIU Tao

2025, 28(12):  1433-1438.  DOI: 10.12114/j.issn.1007-9572.2024.0219

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Background

Hypertension is a common disease among residents, characterized by insidious onset, high incidence, high disability rate, low control rate, and low awareness rate, posing a significant threat to residents' health. In recent years, medical research has discovered a certain association between the lipid accumulation index (LAP) and hypertension. However, current cohort studies on the risk of hypertension incidence related to adult LAP are still limited. This research aims to explore the association between adult LAP and the incidence of hypertension through long-term follow-up observation, providing reliable scientific evidence for the prevention and control of hypertension in the population.

Objective

To investigate the relationship between lipid accumulation index in adults and the incidence of hypertension.

Methods

A baseline survey was conducted in 2010 among 9 280 individuals from 48 townships in 12 counties (districts) in Guizhou Province. Baseline information, physical examination results, and laboratory test results were collected from the participants. Follow-up surveys were conducted in 2016 and 2020. Multivariable Cox proportional hazards regression analysis was used to assess the correlation between LAP and the incidence of hypertension in the population. The Schoenfeld residual method was employed to test the proportional hazards assumption.

Results

Ultimately, 3 774 individuals were included in this study, with 806 new cases of hypertension (21.36%) and 2 968 individuals without hypertension (78.64%). Statistically significant differences were observed between the two groups in terms of LAP, LAP distribution, gender, age, residence, occupation type, current smoking, harmful alcohol consumption, excessive oil intake, waist circumference, and triglyceride (TG) levels (P<0.05). Participants were divided into four groups based on LAP quartiles: Q1 (198 cases), Q2 (238 cases), Q3 (297 cases), and Q4 (394 cases). Multivariable Cox proportional hazards regression analysis revealed that the risk of hypertension in the Q4 group was 1.43 times that of the Q1 group (P<0.05). A non-linear dose-response relationship was observed between LAP levels and the risk of hypertension in the overall population (P_non-linear=0.004). Subgroup analyses showed that, among males, the risk of hypertension increased in the Q3 (HR=1.67, 95%CI=1.24-2.25) and Q4 (HR=1.62, 95%CI=1.20-2.16) groups compared to the Q1 group (P<0.05). In the 18-45 and 46-60 age groups, the risk of hypertension increased in the Q4 group compared to the Q1 group (HR=1.58, 95%CI=1.20-2.09, P<0.001; HR=1.51, 95%CI=1.07-2.11, P=0.018). Among individuals primarily engaged in physical labor, the risk of hypertension increased in the Q4 group compared to the Q1 group (HR=1.28, 95%CI=1.02-1.59, P=0.030). Among individuals primarily engaged in mental labor, the risk of hypertension gradually increased with elevated LAP levels compared to the Q1 group (P<0.05) .

Conclusion

As a simple indicator for assessing abdominal obesity, LAP has a certain predictive effect on the risk of hypertension. Its predictive efficacy varies among different populations, with better performance in males and middle-aged and young adults. LAP can serve as a screening indicator for classifying individuals at risk of hypertension in primary healthcare or medical examination settings during health management services.

Analysis of Age-related Changes of Characteristics and High Frequency Symptoms in Pre-elderly and Elderly Inpatients

YUE Xiao, WANG Mei

2025, 28(12):  1439-1445.  DOI: 10.12114/j.issn.1007-9572.2024.0194

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Background

Subjective symptoms are the main reason for visiting and readmissions in elderly patients, and symptoms of elderly patients are closely related to ageing. At present, few studies have focused on the age-related changes of symptoms in elderly patients, thus reducing the targete, dynamic and prospective management of symptoms in elderly patients.

Objective

To analyze the characteristics of hospitalization, incidence of high-frequency symptoms and age-related changes for pre-elderly and elderly inpatients in recent 10 years, and to provide reference and direction for symptoms management, functional improvement in pre-elderly and elderly inpatients.

Methods

We conducted a retrospective study. Pre-elderly and elderly inpatients of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2014 to 2023 were included. The medical data retrieval and application platform of the hospital "IDu Cloud" was used for retrieval, and statistical data of the departments receiving treatment, the top 5 patients diagnosed with diseases and the symptoms of patients were extracted through the platform result analysis interface. The frequency of symptoms was defined as ≥5%. The high frequency symptoms of elderly hospitalized patients were divided into 6 categories: common, respiratory system, digestive system, nervous system, circulatory system, urinary system symptoms. Cases (%) were used to describe the distribution of hospitalization departments, disease diagnoses, and symptoms of elderly inpatients. To analyze the differences in high frequency symptoms among inpatients aged 50-<60 years (pre-elderly), 60-<70 years (younger elderly), 70-<80 years (middle-senior elderly), and≥80 years (senior elderly). Origin was used to plot scatter plots and graphs to describe the pattern of change in the incidence of inpatient symptoms with age.

Results

A total of 1 214 387 pre-elderly and elderly inpatients were included in the study, including 465 488 (38.33%) pre-elderly inpatients, 422 935 (34.83%) younger elderly inpatients, 235 364 (19.38%) middle-senior elderly inpatients, and 90 600 (7.46%) senior elderly inpatients. The first inpatient department was cardiovascular medicine, the first disease diagnosis was malignant tumor chemotherapy in presenium, hypertension in the young and middle aged elderly, and coronary heart disease in advanced age. There were 12, 14, 19 and 23 kinds of high frequency symptoms in 50-<60 years old, 60-<70 years old, 70-<80 years old, and≥80 years old inpatients, respectively. The most prominent symptoms were physical decline, weight loss, cough, chest tightness, and poor appetite. Respiratory symptoms showed a "high increase" trend with aging, the age-related changes of digestive symptoms showed heterogeneity, and neurological, circulatory and urinary symptoms showed a relatively "low increase" trend with aging.

Conclusion

The incidence of symptoms in pre-elderly and elderly inpatients shows an overall increasing trend with age, and the rate of age-related changes varies for different symptoms. The diagnosis, the number and incidence of high-frequency symptoms in elderly inpatients after 70 years old changed significantly compared with those of the younger elderly, and the role of age-related changes became prominent. The age of 70 years may become an important turning point in the decline of the overall condition of elderly inpatients.

The Immune-inflammatory Characteristics of Primary Sjögren's Syndrome with Different Levels of Rheumatoid Factors

YANG Jianying, ZHANG Yan, CHEN Jiaqi, WU Zihua, HUANG Ziwei, LEI Chunxin, ZHANG Xiya, LUO Jing, TAO Qingwen

2025, 28(12):  1446-1452.  DOI: 10.12114/j.issn.1007-9572.2024.0078

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Background

Rheumatoid factor (RF) is a common autoantibody found in patients with primary Sjögren's syndrome (pSS), but its specific role in the disease is not fully understood.

Objective

To explore the immune-inflammatory characteristics of pSS patients with different levels of RF.

Methods

This study included 262 pSS patients who visited the Department of Rheumatology of Traditional Chinese Medicine at China-Japan Friendship Hospital from December 2018 to September 2022. Patients were divided into three groups based on RF levels: negative group (RF<20 U/mL, n=137), low-titer positive group (RF: 20-60 U/mL, n=47), and high-titer positive group (RF>60 U/mL, n=78). Clinical data, including general information, clinical manifestations, symptom scores, and haematological indexes, were collected and compared among groups.

Results

The RF positivity rate in 262 pSS patients was 47.7% (125/262), including 14 males (5.3%) and 248 females (94.7%), with a median age of 57.0 (49.0, 63.0) years, an average age of onset of (48.7±11.6) years, and a median disease duration of 60.0 (24.0, 120.0) months. There were no significant differences in gender, age, age of onset, or disease duration among the three groups (P>0.05). The top three common clinical manifestations in pSS patients were dry mouth (257 cases), dry eyes (247 cases), and fatigue (235 cases). The incidence of haematological involvement and arthritis was higher in the high-titer positive group than in the negative group (P<0.05). With the increase in RF titer, the incidence of haematological involvement (χ²_trend=6.992, P_trend=0.008) and arthritis (χ²_trend=10.918, P_trend=0.001) showed an upward trend. As RF titer increased, the proportions of pSS patients with antinuclear antibody≥1∶160 (χ²_trend=40.691, P_trend<0.001), anti-SSA antibody positivity (χ²_trend=26.138, P_trend<0.001), anti-Ro52 antibody positivity (χ²_trend=31.426, P_trend<0.001), anti-SSB antibody positivity (χ²_trend=23.682, P_trend<0.001), elevated erythrocyte sedimentation rate (χ²_trend=40.132, P_trend<0.001), elevated immunoglobulin (Ig) A (χ²_trend=7.508, P_trend=0.006), elevated IgG (χ²_trend=71.570, P_trend<0.001), decreased complement 3 (χ²_trend=7.452, P_trend=0.006), decreased neutrophil count (χ²_trend=8.364, P_trend=0.004), and decreased hemoglobin (χ²_trend=6.390, P_trend=0.011) all showed an upward trend.

Conclusion

With the increase in RF titer, the proportion of pSS patients with serum immunological abnormalities and extra-glandular involvement increases. High RF titers have predictive value for arthritis and hematologic involvement.

Analysis of Influencing Factors of Pastoral Dietary Behaviors among Metabolically Healthy Obese Patients: a Qualitative Study

WANG Xinyu, ZHANG Jiaming, GUO Zeyuan, WU Yuting, SUN Xiaofang

2025, 28(12):  1453-1458.  DOI: 10.12114/j.issn.1007-9572.2024.0319

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Background

In the context of rising obesity rates, metabolically healthy obesity (MHO) can achieve favorable outcomes through early intervention. However, grazing behavior in this population poses a significant barrier to weight management. Understanding the factors influencing grazing behavior is essential to improve dietary compliance in obesity management. Currently, there is a lack of qualitative research on this topic.

Objective

To explore the influencing factors of grazing behavior in metabolically healthy obese individuals.

Methods

Based on the capacity opportunity motivation-behavior (COM-B) model and the theoretical domains framework (TDF), the interview guide was developed. 17 cases of metabolically healthy obese were selected from the Department of Endocrinology, Northern Jiangsu People's Hospital for semi-structured interviews via purpose sampling method. The interview data were coded using the COM-B and TDF frameworks and analyzed through both inductive thematic analysis and deductive framework methods.

Results

Six core themes were identified, including lack of dietary management knowledge, insufficient cognitive resources, perceptual and practical influences, maladaptive coping strategies, absence of reflection/self-motivation, environmental and social influences.

Conclusion

Grazing behavior in individuals with MHO are shaped by a multifaceted interplay of personal, healthcare-related and societal factors. Appropriate intervention measures should be taken according to the multidimensional needs of patients and help them establish healthy eating habits and behaviors.

Predictive Value of Abdominal CT Based-skeletal Muscle Mass Combined with Critical Illness Score for Prognosis in Older Patients with Intra-abdominal Sepsis

LI Qiujing, SHANG Na, GAO Qian, YANG Li, GUO Shubin

2025, 28(12):  1459-1464.  DOI: 10.12114/j.issn.1007-9572.2024.0118

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Background

Intra-abdominal infection is a common etiology of sepsis, and older patients with intra-abdominal sepsis have a high mortality rate. Therefore, it is significant to evaluate the prognosis accurately. Currently, the measurement of skeletal muscle mass derived from computed tomography (CT) has become a research hotspot. Whereas the prognostic value of skeletal muscle mass in older patients with abdominal sepsis is rarely reported.

Objective

To investigate the prognostic value of the skeletal muscle index (SMI) at the midpoint of the third lumbar vertebra (L3) along with Sequential Organ Failure Assessment (SOFA) score or Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score in older patients diagnosed with intra-abdominal sepsis.

Methods

This study was conducted at the Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University from January 1 to July 31, 2022. A total of 335 older patients with intra-abdominal sepsis were recruited. The participants were divided into survival group (250 cases) and non-survival group (85 cases) based on their survival status during hospitalization. Clinical characteristics and L3 SMI derived from abdominal CT were compared between survival and non-survival groups. Multivariable Logistic regression analysis was used to identify the risk factors of in-hospital mortality in older patients with intra-abdominal sepsis. The receiver operating characteristic (ROC) curves of L3 SMI, SOFA score, APACHEⅡ score, and combined variables for predicting in-hospital mortality were drawn, and the area under the curve (AUC) were calculated and subsequently compared.

Results

335 older patients with intra-abdominal sepsis were included, of whom 85 (25.4%) died. There were statistically significant differences in age, BMI, albumin, creatinine, procalcitonin, L3 SMI, Nutritional Risk Screening 2002 (NRS2002), sepsis shock proportion, SOFA score, APACHE Ⅱ score between the two groups (P<0.05). Multivariable Logistic regression analysis revealed that decreased L3 SMI (OR=0.924, 95%CI=0.886-0.964, P<0.001), increased NRS2002 score (OR=1.312, 95%CI=1.086-1.585, P=0.005), increased SOFA score (OR=1.170, 95%CI=1.053-1.300, P=0.004), and increased APACHEⅡ score (OR=1.052, 95%CI=1.003-1.103, P=0.038) were independent risk factors for in-hospital mortality in older patients with intra-abdominal sepsis. The AUCs of L3 SMI, SOFA score, and APACHEⅡ score for predicting the risk of in-hospital mortality were 0.711, 0.740, and 0.742, respectively. L3 SMI combined with SOFA score, or APACHEⅡ score could improve their predictive ability, with AUCs of 0.795 and 0.792, respectively.

Conclusion

Decreased L3 SMI was an independent risk factor for in-hospital mortality in older patients with intra-abdominal sepsis, The skeletal muscle mass based on abdominal CT combined with critical illness scoring systems could effectively evaluate the prognosis of these patients.

Construction of the Predictive Model for Lymph Node Metastasis in Patients with Epithelial Ovarian Cancer: Based on ¹⁸F-FDG PET/CT Radiomics Technology

YUAN Xiaorui, TAN Yanlin, FU Chun

2025, 28(12):  1465-1472.  DOI: 10.12114/j.issn.1007-9572.2023.0484

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Background

Accurate preoperative assessment of lymph node metastasis in patients with epithelial ovarian cancer is of great significance for formulating treatment plans and assessing prognosis. Radiomics technology has been used as a non-invasive means to predict lymph node metastasis in various cancers before surgery, but there are few research reports on its application effects in the field of gynecological cancer.

Objective

To construct a predictive model for lymph node metastasis in patients with epithelial ovarian cancer using radiomics technology based on ¹⁸F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (¹⁸F-FDG PET/CT) .

Methods

A total of 98 patients with epithelial ovarian cancer admitted to the Department of Gynecology, the Second Xiangya Hospital of Central South University from September 2020 to December 2022 were selected, according to the lymph node metastasis status, they were divided into lymph node metastasis group (n=65) and non-lymph node metastasis group (n=33), into training set of 68 cases and validation set of 30 cases in a 7∶3 ratio at the same time. All patients' clinical characteristics were analyzed, and the lymph node metastasis status was used as the result label for model construction.

Results

The lymph node metastasis rate in patients with epithelial ovarian cancer was 66.3% (65/98) in this study. There was a statistically significant difference in the level of human epididymal protein 4 (HE4) and location of the primary lesion between lymph node metastasis group and non-lymph node metastasis group (P<0.05). Multivariate Logistic regression analysis showed that, HE4 level, location of the primary lesion, and Radscore were predictive factors for lymph node metastasis in patients with epithelial ovarian cancer (P<0.05). The clinical predictive model was constructed using HE4 level and location of the primary lesion, the combined predictive model was constructed using HE4 levels, location of the primary lesion, and Radscore. Delong's test showed that, the combined predictive model had an AUC of 0.80 (95%CI=0.70-0.90) for predicting lymph node metastasis in the training set of patients with epithelial ovarian cancer, which was higher than that of the clinical predictive model (AUC=0.73, 95%CI=0.61-0.85) (P=0.042). The calibration curve showed that, the combined predictive model passed the calibration test (P=0.990), had good discrimination ability. Decision curve (DCA) analysis showed that, both the clinical and combined predictive models had good predictive performance, but the net benefit of the combined predictive model was higher.

Conclusion

We successfully constructed the combined predictive model for lymph node metastasis in patients with epithelial ovarian cancer using radiomics technology based on ¹⁸F-FDG PET/CT, with high robustness, good discrimination ability, and relatively high net benefit, which can be used for clinical doctors to formulate individualized treatment plans for patients and assess patients' prognosis.

Bibliometric Analysis of RNA-seq Technology in Liver Cancer Research

GE Qiong, HU Jiakang, YU Yuqi, LAI Wenwen, LUO Shiwen, LU Quqin

2025, 28(12):  1473-1478.  DOI: 10.12114/j.issn.1007-9572.2023.0466

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Background

In recent years, the extensive application of transcriptome sequencing technology in the field of liver cancer has provided assistance in genomic and biological studies of liver cancer. Summarizing and analyzing the literature on RNA-seq applied to liver cancer research in the last two decades can help to provide researchers with a comprehensive understanding of the research hotspots and latest progress in this field, and provide reference for subsequent research.

Objective

To evaluate the application of RNA-seq in various aspects of liver cancer research, such as treatment, diagnosis, and pathogenesis as a whole by bibliometric analysis, so as to reveal the global distribution of research hotspots in the field of RNA-seq applied to liver cancer, and predict the development trend of this field in the future.

Methods

Web of Science database was searched for English literature related to the application of RNA-seq to liver cancer research from 2001 to 2022, and the number of publications was analyzed using Microsoft Excel 2016 software. CiteSpace software was used for visualization of authors, countries, institutions, and keywords.

Results

A total of 1 397 documents on the application of RNA-seq to liver cancer research were retrieved in the database, and the analysis results showed that the core group of authors in this field had been formed; China has the largest number of publications, but the research depth is slightly lacking, the United States has the second largest number of publications after China, but with the highest centrality (0.44) ; most of the institutions with a high publication volume are located in China, and most of the institutions with greater influence are located in the United States; the keyword analysis showed that the research hotspots in the field include the molecular mechanism, gene expression and molecular markers related to the occurrence and development of liver cancer.

Conclusion

The molecular mechanism of liver cancer development, biomarkers and therapeutic targets of the disease are the current research hotspots in this field, and clinical precision medicine may be a key research direction in the future.

Original Research·Atrial Fibrillation Management Section

Research Progress of Perioperative Symptoms and Management Strategies in Patients Undergoing Catheter Ablation for Atrial Fibrillation

BAO Zhipeng, LI Yunxia, WANG Jie, TANG Zhijie, YOU Zhanhong, HE Ying, SUN Guozhen

2025, 28(12):  1479-1485.  DOI: 10.12114/j.issn.1007-9572.2024.0337

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The burden of atrial fibrillation (AF) in China is increasing, and catheter ablation has become a first-line treatment. The perioperative symptom clusters of AF patients undergoing catheter ablation are complex and diverse, closely related to patients´ quality of life, disease prognosis, and healthcare resource utilization, and therefore, warrant significant attention. This paper systematically reviews the research related to the perioperative symptom clusters of AF patients undergoing catheter ablation. It introduces the types and current status of these symptom clusters, summarizes the influencing factors of perioperative symptom clusters, organizes the assessment tools for AF symptom clusters, and finally elucidates the management strategies for perioperative symptom clusters in AF patients. The goal is to provide insights for developing innovative comprehensive management models for perioperative symptom clusters in AF patients.

Latent Profile Analysis and Its Influencing Factors of Physical Activity in Patients with Atrial Fibrillation

YOU Zhanhong, SUN Guozhen, LU Jing, TANG Zhijie, WANG Jie, WANG Qin, WANG Lin

2025, 28(12):  1486-1493.  DOI: 10.12114/j.issn.1007-9572.2024.0236

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Background

Physical activity is the focus of disease management in patients with atrial fibrillation (AF), and different types and intensities of physical activity have different impacts on the health status of patients; however, the current distribution of physical activity types in patients with AF is not clearly characterized.

Objective

To explore differences in the distribution of the daily physical activity energy expenditure in patients with AF and the influencing factors.

Methods

A total of 300 AF patients newly admitted to the Department of Cardiology Medicine at the First Affiliated Hospital with Nanjing Medical University for elective catheter ablation from July to December 2023 were enrolled. General patient information was collected. The International Physical Activity Questionnaire-Long Form (IPAQ-L) was used to assess the level of physical activity, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) to evaluate fear of disease progression, the Cancer Acceptance Scale-Revised (CAS-R) to assess perceived control, and the Family Apathy Index (FAI) to gauge family care. A latent profile analysis was conducted on energy expenditure from various types of physical activity among AF patients. Starting from a one-class model, the number of classes was incrementally increased to determine the best-fitting model. Multivariate Logistic regression analysis was employed to investigate the impact of various factors on different latent profiles.

Results

Based on IPAQ-L scores, 80 patients (26.7%) had low, 63 (21.0%) had moderate, and 157 (52.3%) had high levels of physical activity. The latent profile analysis of patients' physical activity energy expenditure categorized them into two profiles: low energy expenditure-primarily sedentary (n=198) and high energy expenditure-primarily occupational physical activity (n=102). Univariate analysis revealed statistically significant differences in age, education level, occupation, family monthly income per capita, and scores on the FoP-Q-SF, CAS-R, and FAI between the two profiles (P<0.05). Multivariate Logistic regression analysis indicated that age 40-59 years (OR=0.280, 95%CI=0.087-0.899, P=0.017), bachelor's degree or higher (OR=0.331, 95%CI=0.124-0.883, P=0.027), mental labor (OR=0.315, 95%CI=0.121-0.817, P=0.032), retirement (OR=0.151, 95%CI=0.050-0.452, P<0.001), FoP-Q-SF score (OR=1.086, 95%CI=1.036-1.139, P<0.001), CAS-R score (OR=0.899, 95%CI=0.820-0.985, P=0.022), and FAI score (OR=0.828, 95%CI=0.707-0.969, P=0.018) were influencing factors of the latent profiles of physical activity (PA) energy expenditure (P<0.05) .

Conclusion

There are different latent profiles of physical activity energy expenditure among AF patients, with heterogeneous distribution characteristics across profiles. Patients aged 40-59, with bachelor's degree or higher, engaged in mental labor, retired, possessing strong perceived control, and receiving high family care are more likely to be classified as low energy expenditure-primarily sedentary. Interventions can be tailored based on the characteristics of different physical activity energy expenditure profiles and influencing factors to promote appropriate and scientific physical activity.

The Impact of Home-based Exercise Rehabilitation Compliance on the Recurrence of Atrial Fibrillation after Radiofrequency Ablation

WANG Jie, SUN Guozhen, WANG Qin, BAO Zhipeng, GAO Min, WANG Lin

2025, 28(12):  1494-1499.  DOI: 10.12114/j.issn.1007-9572.2024.0067

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Background

Although exercise rehabilitation has been proven to be safe and effective for cardiovascular patients, compliance remains suboptimal. The sustained benefits of exercise are closely related to compliance, yet current research has failed to delineate the relationship between exercise compliance and the recurrence of atrial fibrillation (AF) in patients undergoing radiofrequency ablation.

Objective

To investigate the impact of adherence to home-based exercise rehabilitation programs and other relevant factors on the recurrence of atrial fibrillation in patients following radiofrequency ablation.

Methods

Convenience sampling was used to select patients with AF who underwent radiofrequency ablation surgery in the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University from May to November 2020. Patients routinely underwent a 6-minute walk test, balance and flexibility assessments, and cardiopulmonary exercise testing, and individualized exercise prescriptions were formulated based on the assessment results. General patient data were collected, and exercise rehabilitation compliance was assessed using the Cardiac Rehabilitation Inventory (CRI) to evaluate the cardiac rehabilitation needs and willingness of patients with cardiovascular diseases, and the Patient Activation Measure (PAM13) was used to measure the level of knowledge, skills, behaviors, and confidence in participating in their own health management and health care during the disease diagnosis and treatment process. Compliance data on intensity-time and frequency were followed up at the 1st week, 3rd month, 6th month, 9th month, and 12th month. The generalized estimating equations (GEE) model was used to explore the influencing factors of the recurrence of AF in patients after radiofrequency ablation surgery.

Results

A total of 151 patients aged 29 to 84 years, with an average age of (61.7±11.0) years, and 23 patients experienced a recurrence of AF. The changes in intensity-time compliance and frequency compliance of AF patients after radiofrequency ablation surgery at different follow-up stages were statistically significant (P<0.05). After controlling for time, BMI, smoking, type of AF, activation, process anxiety, and outcome anxiety, the GEE analysis showed that intensity-time compliance≥100% was a protective factor for the recurrence of AF after radiofrequency ablation surgery (P<0.05) .

Conclusion

The compliance with home-based exercise rehabilitation in AF patients after radiofrequency ablation surgery changes over time, and it is recommended that clinical medical staff pay attention to the guidance and supervision of exercise intensity, take targeted measures to reduce process and outcome anxiety, in order to more effectively improve patient outcomes through exercise rehabilitation.

Original Research·Research Trends of Traditional Chinese Medicine

Influences of Treatment Timing of the TCM prescription Qingfei Huayu Tongfu Formula on the Therapeutic Effect and Prognosis of Sepsis-related Acute Respiratory Distress Syndrome

WANG Dexiang, YUAN Jiawen, LU Qinyun, HANG Yuhao, LU Jun, CHENG Lu

2025, 28(12):  1500-1505.  DOI: 10.12114/j.issn.1007-9572.2024.0107

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Background

Grounded in the traditional Chinese medicine (TCM) theory of visceral outward manifestation describing the Lung and Large Intestine being Externally-Internally Related (Zang-Fu Xiang Guan), previous research has revealed that a self-formulated TCM prescription Qingfei Huayu Tongfu Formula positively treats sepsis-related acute respiratory distress syndrome (ARDS). However, the effect of the therapeutic timing of Qingfei Huayu Tongfu Formula on the clinical outcomes and prognosis of sepsis-related ARDS remains unclear.

Objective

To explore the optimal timing of the Qingfei Huayu Tongfu Formula in the treatment of sepsis-associated ARDS and its impact on the treatment efficacy and prognosis.

Methods

A total of 208 patients with sepsis-associated ARDS diagnosed in the Intensive Care Unit, Affiliated Hospital of Nanjing University of Chinese Medicine from 2021 to 2023, and treated with Qingfei Huayu Tongfu Formula were retrospectively recruited. According to the time of the first application of TCM decoction, those who took Qingfei Huayu Tongfu Formula within 48 hours of the diagnosis of sepsis-associated ARDS were included the early intervention group (n=109), and patients who took Qingfei Huayu Tongfu Formula after 48 hours were included in the late intervention group (n=85). Fourteen patients were lost to follow-up. Clinical outcomes and prognosis were compared between groups.

Results

The 28-day all-cause mortality rate in the early intervention group was significantly lower than that of the late intervention group (13.8% vs. 29.4%, P=0.001 4). The risk of death in the late intervention group was 2.11 times that of the early intervention group (HR=2.11, 95%CI=1.13-3.91, P=0.019). The median duration of mechanical ventilation was 12 (8, 23) days in the early intervention group, which was significantly shorter than 27 (13, 35) days in the late intervention group (P=0.035). Intra-group comparisons showed improvements in oxygen index for both groups post-treatment (P<0.001). C-reactive protein (CRP), procalcitonin (PCT), and white blood cell counts post-treatment were all significantly reduced in both groups compared to pre-treatment levels (P<0.05). After the intervention, the mean oxygen index in the early intervention group was significantly higher than that of the late intervention group[ (319.87±95.32) vs. (259.55±99.72), P<0.001]. After the intervention, the median CRP in the early intervention group was significantly lower than that of the late intervention group[19.39 (8.16, 44.47) mg/L vs. 38.01 (17.53, 86.05) mg/L, P<0.001]. Similarly, the median PCT concentration post-treatment in the early intervention group was significantly lower than that of the late intervention group[0.175 (0.089, 0.750) ng/mL vs. 0.460 (0.143, 1.850) ng/mL, P=0.004].

Conclusion

Early administration (within 48 hours after diagnosis) of the TCM formula Qingfei Huayu Tongfu Formula to treat sepsis-related ARDS can reduce the 28-day mortality and the length of mechanical ventilation, improve the oxygenation index, and reduce inflammatory responses.

A Retrospective Cohort Study of Chinese Herbal Medicine Reducing the Risk of Readmission of Rheumatoid Arthritis Complicated with Sjogren's Syndrome

CHEN Xiaolu, LIU Jian

2025, 28(12):  1506-1512.  DOI: 10.12114/j.issn.1007-9572.2023.0134

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Background

Many patients with rheumatism seek Chinese herbal medicine (CHM). Currently, CHM is effective in treating rheumatoid arthritis (RA) and Sjogren's syndrome (SS), but there are few studies on whether CHM reduces the risk of readmission for rheumatoid arthritis with Sjogren's syndrome (RA+SS) .

Objective

To determine whether CHM can reduce the readmission risk ratio of rheumatoid arthritis with Sjogren's syndrome (RA+SS) .

Methods

a retrospective cohort design was used in this study, and the data were collected from the First Affiliated Hospital of Anhui University of Chinese Medicine hospital information system (HIS) from 2012 to 2021. All subjects were followed up until January 2022. They were divided into RA+SS patients and RA patients according to their disease conditions. RA+SS patients were divided into CHM users and non-CHM users according to drug use. Cox regression model was used to investigate the factors affecting the readmission of patients with RA+SS. Kaplan-Meier (KM) curve was used to compare the readmission ratio between the CHM group and the non-CHM group.

Results

The incidence of liver dysfunction, chronic renal dysfunction, autoimmune hepatitis, the levelof rheumatoid factor (RF), and positive rates of anti-SS-A antibody (SSA) and anti-SS-B antibody (SSB) were higher in the RA+SS group than in the RA group, and the number of recurrent hospitalizations was higher in the RA group (P<0.05). Cox proportional risk model analysis showed that the adjusted HR for readmission risk of RA+SS in CHM patients was lower (0.45) (95%CI=0.28-0.71). Kaplan-Meier survival analysis showed that the readmission rate of RA + SS was higher than that of RA group (χ²=56.254, P<0.01). The readmission rate of CHM group was lower than that of non-CHM group (χ²=24.020, P=0.019), and the readmission rate of female patients in CHM group was reduced more significantly (χ²=20.577, P=0.002). The readmission rate of patients over 60 years of age in CHM group was reduced more significantly (χ²=6.583, P=0.006) .

Conclusion

The addition of CHM treatment to RA+SS patients on the basis of conventional treatment can reduce the need for readmission, especially for female patients or patients over 60 years old, and provide theoretical basis for clinical treatment of RA+SS patients.

Study on Metabolic Characteristics in Esophageal Squamous Cell Carcinoma Patients with TCM Differentiation of Deficiency of Fluid and Blood Based on Non Target Metabolomics

ZHANG Yushuang, WU Zhongbing, HUANG Ming, JIA Lei, GAO Shuang, ZHAO Weipeng, LI Jing

2025, 28(12):  1513-1519.  DOI: 10.12114/j.issn.1007-9572.2023.0542

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Background

Deficiency of fluid and blood is the main clinical manifestation of middle- and advanced-stage patients with esophageal cancer, but there are few reports about the metabolomic characteristics of esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood.

Objective

To investigate the metabolomic characteristics of esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood.

Methods

From April to December 2022, 35 esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood, were selected as the case group in the departments of TCM and Thoracic Surgery, the Fourth Hospital of Hebei Medical University, meanwhile 35 healthy volunteers were selected as the control group. Serum specimens were collected, and metabolomic characteristics was analyzed by ultra performance liquid chromatography-mass spectrometry, and then screened the differential metabolites metabolic pathways.

Results

A total of 88 differential metabolites with substance secondary matching names were screened out; 5 key metabolic pathways with significant difference and 11 related differential metabolites were further screened out. The 5 key metabolic pathways were β-Alanine metabolism pathway, Sphingolipid metabolism pathway, Linoleic acid metabolism pathway, Glycine, serine and threonine metabolism pathway, and Arachidonic acid metabolism pathway. Of the 11 related differential metabolites, β-Alanine, Phosphatidylcholine, L-homoserine, and L-allothreonine were significantly down-regulated, whereas Carnosine, Linoleic acid, 9, 10-DHOME, Hydroxypyruvic acid, Arachidonic acid, Heparin B3, and Thromboxane B2 were significantly up-regulated.

Conclusion

There are metabolic pathways with significant difference and related differential metabolites in esophageal squamous cell carcinoma patients with TCM differentiation of deficiency of fluid and blood, which mainly involved in metabolic abnormality of energy, such as amino acids and fatty acids.

Evidence-based Medicine

The Prevalence of Osteosarcopenia in Chinese Patients with Type 2 Diabetes Mellitus: a Meta-analysis

SUN Qing, WU Yuxiao, CUI Limin

2025, 28(12):  1520-1526.  DOI: 10.12114/j.issn.1007-9572.2024.0449

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Background

Type 2 diabetes mellitus (T2DM), as a chronic metabolic disorder, represents a significant health threat to middle-aged and elderly populations in China and is a major risk factor for osteosarcopenia. The presence of osteosarcopenia can markedly impact the health status and quality of life of individuals with T2DM. A comprehensive examination of the epidemiological characteristics of osteosarcopenia holds substantial significance in guiding the prevention and management of osteosarcopenia among T2DM patients in China.

Objective

To conduct a systematic evaluation of the prevalence of osteosarcopeniain patients with T2DM in China.

Methods

A comprehensive search was conducted for studies on the prevalence of osteosarcopenia in Chinese patients with T2DM across multiple databases, including CNKI, Wanfang Data, VIP, SinoMed, Cochrane Library, PubMed, Web of Science, EBSCO and Embase. The search period extended from the establishment of these databases to June 2024. Two researchers independently screened the literature, extracting relevant information such as the first author, publication year, survey period, geographical region, osteosarcopenia prevalence, diagnostic criteria, assessment tools and quality evaluation information. The methodological quality of the included studies was assessed using the AHRQ tool. Data were analyzed using Stata 15.0.

Results

A total of 18 cross-sectional studies were included, involving 3 724 T2DM patients, of whom 623 were diagnosed with osteosarcopenia. The meta-analysis revealed that the overall prevalence of osteosarcopenia in Chinese T2DM patients was 21% (95%CI=15%-26%). Subgroup analysis showed that the prevalence after 2020 (25%) was higher than that before 2020 (19%) ; the prevalence in the elderly group (27%) was higher than in the middle-aged group (13%) ; the prevalence using the AWGS diagnostic criteria (23%) was higher than with the AWGS2 criteria (14%) ; the detection rate by BIA (22%) was higher than by DXA (17%) ; males (38%) had a higher prevalence than females (36%) ; the prevalence in patients with a T2DM duration of ≤10years (25%) was higher than in those with a duration > 10 years (20%) ; the prevalence in the western region (27%) was higher than in the central (18%) and eastern regions (16%) (P<0.05). Meta-regression analysis revealed no statistically significant results (P>0.05), and no significant sources of heterogeneity were identified.

Conclusion

Existing evidence suggests a relatively high prevalence of osteosarcopenia among patients with T2DM in China, with significant disparities observed across factors such as survey period, age groups, diagnostic criteria, assessment tools, gender, duration of T2DM, and regional differences. Consequently, it is imperative to enhance early screening and intervention strategies for high-risk populations, in order to effectively prevent and mitigate the progression of the disease.

Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review

WANG Xiaoyu, FENG Zhenzhen, WANG Jun, GUO Xiaochuan, LI Jiansheng

2025, 28(12):  1527-1537.  DOI: 10.12114/j.issn.1007-9572.2024.0109

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Background

Acute kidney injury (AKI) is one of the most common complications of acute respiratory distress syndrome (ARDS) and significantly increases the mortality rate of ARDS patients. Currently, the clinical understanding of ARDS complicated with AKI, effective prevention and treatment measures are not enough. Exploring the possible predictors is significant for early evaluation and effective intervention measures to reduce the incidence and mortality of AKI in ARDS.

Objective

To systematically evaluate the risk factors of AKI in ARDS.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed were searched for literatures on risk factors of AKI in ARDS from inception to December 2023. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of included literatures. RevMan 5.3 software was used for Meta-analysis.

Results

A total of 17 studies involving 6 160 patients were included. Meta-analysis demonstrated that: being older (OR=1.02, 95%CI=1.00-1.03, P=0.007), higher Sequential Organ Failure Assessment (SOFA) scores (OR=1.17, 95%CI=1.05-1.30, P=0.004), diabetes (OR=1.40, 95%CI=1.09-1.80, P=0.008), hypertension (OR=1.56, 95%CI=1.26-1.93, P<0.001), atrial fibrillation (OR=1.76, 95%CI=1.09-2.85, P=0.020), chronic kidney disease (OR=10.31, 95%CI=3.30-32.19, P<0.001), higher neutrophil to lymphocyte ratio (NLR) (OR=1.02, 95%CI=1.00-1.05, P=0.030), higher angiopoietin 2 (Ang-2) (OR=1.84, 95%CI=1.73-1.95, P<0.001), aspartate aminotransferase (AST) >40 U/L (OR=2.27, 95%CI=1.56-3.31, P<0.001), lower arterial blood pH (OR=0.83, 95%CI=0.75-0.92, P=0.000 6), lower glomerular filtration rate (GFR) (OR=0.92, 95%CI=0.75-0.99, P=0.020), mechanical ventilation (OR=2.53, 95%CI=1.96-3.26, P<0.001) and extracorporeal membrane oxygenation (ECMO) (OR=1.81, 95%CI=1.43-2.28, P<0.001) were risk factors for AKI in ARDS. However, gender (OR=1.17, 95%CI=0.82-1.67, P=0.390), BMI (OR=1.27, 95%CI=0.77-2.09, P=0.350), obesity (OR=5.88, 95%CI=0.51-68.28, P=0.160), Acute Physiology and Chronic Health Evaluation Ⅱ scores (OR=1.20, 95%CI=0.99-1.46, P=0.060), heart failure (OR=4.49, 95%CI=0.58-34.70, P=0.150), disturbance of consciousness (OR=1.83, 95%CI=0.88-3.84, P=0.110), pleural effusion (OR=1.16, 95%CI=0.81-1.65, P=0.410), oxygenation index (OR=4.30, 95%CI=0.69-26.77, P=0.120), procalcitonin (OR=1.08, 95%CI=0.95-1.23, P=0.230), white blood cell count (OR=1.56, 95%CI=0.51-4.80, P=0.440) and plasma albumin (OR=1.07, 95%CI=0.97-1.17, P=0.170) were not related to AKI in ARDS.

Conclusion

The risk factors of AKI in ARDS involve many aspects, including general factors (being older), overall assessment (high SOFA scores), disease factors (combined with diabetes, hypertension, atrial fibrillation and chronic kidney disease), laboratory indicators (higher NLR, higher Ang-2, AST>40 U/L, lower arterial blood pH and GFR), and treatment (mechanical ventilation, ECMO). Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by more high-quality studies in the future.

Review & Perspectives

Research Progress on the Relationship between Vitamin D and Type 1 Diabetes Mellitus and Its Complications

LYU Cheng, JIANG Sheng

2025, 28(12):  1538-1542.  DOI: 10.12114/j.issn.1007-9572.2024.0224

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Type 1 diabetes mellitus (T1DM) is currently considered to be a chronic autoimmune disease caused by destruction of pancreatic β-cells. It is mainly caused by a combination of genetic and environmental factors that lead to destruction of pancreatic β-cells, which results in an absolute lack of insulin secretion in the body and a lifelong dependence on extracorporeal insulin therapy. As the incidence of T1DM continues to increase globally, more attention has been paid to the prevention and treatment of T1DM. Numerous studies have demonstrated that vitamin D, in addition to its value in bone metabolism and calcium-phosphorus homeostasis, also plays an important role in the development and progression of chronic inflammatory and immune-related diseases. Therefore, on the basis of introducing the epidemiology of T1DM and the role of vitamin D, this article further elaborates the correlation between vitamin D and T1DM and its complications, with a view to providing a theoretical basis for clinicians to comprehensively diagnose and treat T1DM.

Study on Anti-inflammatory and Anti-oxidative Stress Mechanism of Sitagliptin: a Dipeptidyl Peptidase-4 Inhibitor

ZHU Jing, XIE Ji, HU Xiaoxia

2025, 28(12):  1543-1548.  DOI: 10.12114/j.issn.1007-9572.2024.0268

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The prevalence rate of type 2 diabetes is increasing year by year. It is known that oxidative stress and inflammation can participate in the occurrence and development of diabetes. Dipeptidyl peptidase-4 (DPP-4) inhibitors can enhance the incretin effect by inhibiting DPP-4, thus playing a hypoglycemic role, and have been widely used in the treatment of diabetes patients. Currently, studies have shown that DPP-4 expression is up-regulated in a variety of inflammatory diseases, suggesting that it may be involved in the occurrence of inflammation. However, there are few relevant reports on the mechanism of action of DPP-4 inhibitor in inflammation and oxidative stress. Therefore, this paper reviews the anti-inflammatory and antioxidant stress mechanism of sitagliptin, a DPP-4 inhibitor, and proposes that sitagliptin has certain application prospects in the treatment of other diseases, providing references for subsequent relevant studies.

Case Study in Public Health

Research on the Integrated Development of TCM and Primary Health Care under ROCCIPI Framework

LI Bingsong, LYU Yitong, LEI Tianchu, LIU Yuchen, ZHEN Xuemei, WANG Jian

2025, 28(12):  1549-1552.  DOI: 10.12114/j.issn.1007-9572.2024.0576

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Based on the case of the Central Health Center, the ROCCIPI framework was used to identify and analyze the problems of integrating traditional Chinese medicine (TCM) into grassroots township health centers from seven dimensions. On this basis, it puts forward the strategy of implementing precision strategy, building connotative ability, strengthening TCM awareness and promoting multi-platform communication, in order to better realize the integration of TCM into modern primary health.