Table of Content

20 February 2022, Volume 25 Issue 06

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Editorial

Actively Managing Obesity to Reduce the Risk of Cardiovascular Disease

GUO Yuyang, ZENG Qingchun

2022, 25(06):  643-650.  DOI: 10.12114/j.issn.1007-9572.2021.02.116

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Obesity and Cardiovascular Disease, a statement released by the American Heart Association on April 22, 2021, gives a summary of the impact of obesity on the diagnosis, clinical management and prognosis of atherosclerotic cardiovascular disease, heart failure, sudden cardiac death and atrial fibrillation. In view of the present clinical management of cardiovascular diseases in China, this paper interprets the content of the statement in detail, aiming to provide guidance relevant to domestic cardiovascular management practices.

Hot Research：Bowel Disease

Summary of the Essentials for the Diagnosis and Treatment of Sexually Transmitted Proctitis，Proctocolitis and Enteritis from CDC's Sexually Transmitted Infections Treatment Guidelines，2021

LENG Xinying, ZOU Huachun, FU Leiwen, KE Wujian

2022, 25(06):  651-655.  DOI: 10.12114/j.issn.1007-9572.2021.02.112

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Sexually transmitted infections (STIs) may cause symptomatic proctitis, proctocolitis and enteritis. Given that there are still many questions in the management of proctitis, proctocolitis and enteritis caused by STIs. On July 23, 2021, CDC released the latest guidelines on the diagnosis and treatment of STIs. Combining the latest literature and clinical experience, we focused on the interpretation of the differences between the new version and the previous version. We also compared part of the 2021 European Guideline on the Management of Proctitis, Proctocolitis and Enteritis Caused by Sexually Transmissible Pathogens with the essentials for the management of sexually transmitted proctitis, proctocolitis and enteritis in the CDC's Sexually Transmitted Infections Treatment Guidelines, 2021, aiming to assist clinicians in the management of proctitis, proctocolitis and enteritis caused by STIs.

Latent Profile Analysis of Benefit Finding in Patients with Inflammatory Bowel Diseases

SUN Caiyun, LIN Zheng, ZHOU Meijing, GU Zijun, LUO Dan, WANG Mi, GU Junyi, ZHU Zhanhui

2022, 25(06):  656-662.  DOI: 10.12114/j.issn.1007-9572.2021.02.085

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Patients with inflammatory bowel disease (IBD) are vulnerable to a variety of negative emotions due to recurrence of disease symptoms and prolonged unhealing. With the rise of positive psychology, scholars have discovered that in addition to the perceived negative emotions in the process of illness, individuals also conduct cognitive reappraisal on stressful events and explore the positive meaning brought by the disease, that is, benefit finding.

To explore the potential categories and influencing factors of benefit finding in patients with IBD.

A cross-sectional investigation was conducted among outpatients and inpatients with IBD selected by convenient sampling from the First Affiliated Hospital with Nanjing Medical University from September 2020 to April 2021. The General Demographic Information questionnaire, Revised Chinese Version of Benefit Finding Scale (BFS-RC), Chinese Version of Berkeley Expressivity Questionnaire (BEQ), and Social Support Rating Scale (SSRS) were administered to the participants. We applied ordinal and multinomial Logistic regression analyses to identify the factors associated with the potential categories of benefit finding.

A total of 226 of the 230 returned questionnaires were valid, resulting an effective response rate of 98.3%. According to the results of latent profile analysis, we classified the respondents into three categories by benefit finding, namely low benefit finding-coping disability group (n=115), moderate benefit finding group (n=64) and high benefit finding-perceived loved group (n=47), accounting for 50.9%, 28.3%, and 20.8% of the total respondents, respectively. Three groups showed statistically significant differences in employment status, annual household income, disease activity, total score and dimension scores of Chinese Version of BEQ and SSRS (P<0.05). Ordinal and multinomial Logistic regression analyses showed that positive emotion expression score 〔OR=1.246, 95%CI (1.040, 1.492) 〕, negative emotion expression score 〔OR=1.206, 95%CI (1.038, 1.402) 〕, and perceived support score〔OR=2.746, 95%CI (2.114, 3.565) 〕were associated with benefit finding in patients with IBD (P<0.05) .

Patients with IBD had obvious differences in characteristics by benefit finding. Low benefit finding-coping disability group accounted for a relatively larger proportion (50.9%). The influencing factors involved positive emotion expression, negative emotion expression and perceived support. To improve benefit finding of these patients, medical workers should pay more attention to those with low benefit finding-coping disability, encourage them to express disease related feelings and promote their perception of social support.

Prevalence and Associated Factors of Kinds of Dietary Restrictions in Patients with Inflammatory Bowel Disease：a Multicenter Study

WANG Yu, TU Wenjing, ZHANG Ping, FANG Jian, SHI Yi, LIU Xiaowen, JIN Hongcheng

2022, 25(06):  663-668.  DOI: 10.12114/j.issn.1007-9572.2021.02.065

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Diet has been proven to be an important factor affecting the occurrence, development and outcome of inflammatory bowel disease (IBD), but there are few studies in China on dietary restriction, a common diet management problem in patients with IBD.

To investigate the prevalence and associated factors of kinds of dietary restrictions in patients with IBD.

From January to October in 2020, a field survey was conducted with a convenience sample of IBD patient volunteers who were selected from gastroenterology and anorectal departments in four general hospitals in Nanjing, including Jiangsu Province Hospital of Chinese Medicine/Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Hospital of Chinese Medicine/Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing Drum Tower Hospital and Zhongda Hospital, Southeast University. A self-made questionnaire was used to collect general demographic information, disease-related conditions, dietary restriction behaviors and prevalence of receiving dietary guidance in these patients. Multiple linear regression analysis was used to analyze the associated factors of kinds of dietary restrictions.

Altogether, 622 cases attended the survey, and 608 of them gave an effective response, with a response rate of 97.7% (608/622). Of the responders, 92.4% (562/608) had at least one kind of dietary restrictions, with 6.9 kinds of dietary restrictions on average. The kinds of dietary restrictions differed significantly by gender, body mass index, living status (living alone or with others), economic burden, type of IBD, course of IBD, prevalence of surgical treatment, incidence of complications, prevalence of receiving dietary guidance, and receiving dietary guidance from dietitian or gastroenterologist in IBD patients (P<0.05). Multiple linear regression analysis results showed that, gender (β=0.697), body mass index (β=0.777), living status (β=1.141), and incidence of complications (β=0.884) were associated with the kinds of dietary restrictions in IBD patients (P<0.05) .

Dietary restrictions are common and serious in IBD patients, whose kinds may be related to patients' gender, body mass index, living status and incidence of complications.

Article

Risk Factors of Dysphagia in Parkinson's Disease

SHI Xiaoxue, ZHENG Jinhua, MA Jianjun, WANG Zhidong, SUN Wenhua, LI Mingjian, HUANG Shen, HU Shiyu, LI Dongsheng

2022, 25(06):  669-674.  DOI: 10.12114/j.issn.1007-9572.2021.02.066

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Dysphagia is a common non-motor symptom of Parkinson's disease (PD), which may cause pneumonia, malnutrition, and declined quality of life. However, risk factors of dysphagia in PD are still unclear.

To explore the risk factors of dysphagiain PD.

One hundred and seven consecutive PD patients were recruited in Henan Provincial People's Hospital from June 2018 to December 2019, and general demographic data, incidence of dysphagia and sialorrhea, disease stage and illness severity, severity of anxiety and depression, cognitive function, as well as uric acid and homocsteine were retrospectively analyzed. Risk factors of dysphagia in PD were explored using multivariate Logistic regression analysis. ROC curve analysis was used for evaluating the predictive value of independent risk factors for dysphagia in PD.

Of the 107 PD patients, 45 with dysphagia and 62 without were assigned to an observation group and a control group, respectively, with an incidence of dysphagia of 42.1% (45/107). There were significant difference in terms of age, Hoehn-Yahr classification, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅰ, Ⅱ and Ⅲ scores, incidence of sialorrhea, the 14-item Hamilton Anxiety Scale (HAMA-14) score, the 24-item Hamilton Depression Scale (HAMD-24) score, Mini-mental State Examination (MMSE) score and uric acid between these two groups (P≤0.05). Multivariate Logistic regression analysis showed that, UPDRSⅢ score≥35〔OR=7.639, 95%CI (2.750, 21.219) 〕, sialorrhea〔OR=3.336, 95%CI (1.178, 9.447) 〕, HAMA-14 score≥13〔OR=2.847, 95%CI (1.027, 7.894) 〕and uric acid <251 μmol/L〔OR=0.354, 95%CI (0.129, 0.971) 〕were independent risk factors of dysphagia in PD (P<0.05). ROC curve analysis showed that, AUC of UPDRS Ⅲ score, sialorrhea, HAMA-14 score and uric acid was 0.750, 0.682, 0.638 and 0.670 in predicting dysphagia in PD, with sensitivity of 69.4%, 56.5%, 59.7% and 64.5%, specificity of 80.0%, 80.0%, 71.1% and 66.7%, Youden index of 0.494, 0.365, 0.308 and 0.312, respectively.

UPDRSⅢ score≥35, HAMA-14 score≥13, sialorrhea and uric acid <251 μmol/L are independent risk factors of dysphagia in PD, and the above four risk factors has certain predictive value for dysphagia in PD.

A Predictive Nomogram for the Risk of Peripheral Neuropathy in Type 2 Diabetes

LI Yongsheng, ZHANG Xueliang, LI Cheng, FENG Zhiwei, WANG Kai

2022, 25(06):  675-681.  DOI: 10.12114/j.issn.1007-9572.2021.02.118

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Effective treatment has not been worked out so far for diabetic peripheral neuropathy (DPN) in type 2 diabetes which is regarded as highly prevalent and quite harmful.

To screen the risk factors of DPN in type 2 diabetes, and used them to develop a predictive nomogram as a visualization tool assisting clinical diagnosis of this disease.

Participants (n=15 020) were type 2 diabetics who were retrospectively selected from the First Affiliated Hospital of Xinjiang Medical University from 2010 to 2019, and 75% of them were randomly assigned to a training group (n=11 265) and other 25% to a verification group (n=3 755). Patients' basic personal information and biochemical data were collected. Independent predictors of DPN were screened by Lasso regression analysis, and further analyzed using multivariate Logistic regression analysis, then the finally determined ones were used to develop a predictive nomogram. The performance of the nomogram was verified in the verification group. Finally, the area under the ROC curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the identification ability, accuracy and clinical applicability of the nomogram.

Among the 15 020 cases, 6 133 had DPN, and other 8 887 did not. The findings of Lasso regression with multivariate Logistic regression analyses showed that age〔OR=1.034, 95%CI (1.031, 1.039) 〕, diabetic retinopathy〔OR=11.881, 95%CI (10.756, 13.135) 〕, duration of diabetes〔OR=1.070, 95%CI (1.061, 1.078) 〕, glycosylated hemoglobin〔OR=1.237, 95%CI (1.209, 1.266) 〕 and high-density lipoprotein〔OR=0.894, 95%CI (0.877, 0.901) 〕were associated with DPN. The predictive nomogram was established by employing the above-mentioned variables. The AUC of the nomogram for identifying DPN in the training group was 0.858〔95%CI (0.851, 0.865) 〕, and in the validation group was 0.852〔95%CI (0.840, 0.865) 〕. The nomogram was found with a high goodness of fit by the Hosmer-Lemeshow test (P>0.05). DCA showed that when the threshold probability of patients was 0 to 0.9, using the nomogram resulted in higher net benefit of predicting the risk of DPN.

We successfully established and verified a nomogram (with above-mentioned five variables included) with a high accuracy, which may be used as a tool facilitating the improvement in early identification or screening of DPN in high-risk type 2 diabetics.

Correlation of Visceral Fat with Bone Mineral Density and Osteoporotic Fracture Risk in Patients with Type 2 Diabetes

XIONG Dan, LIU Lijun, HE Peixiang, PENG Weixia, PENG Ke, ZHONG Yaqin, LI Juxiang, XU Xuehui, DING Ting

2022, 25(06):  682-688.  DOI: 10.12114/j.issn.1007-9572.2021.02.120

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Obesity is strongly associated with type 2 diabetes mellitus (T2DM). But the relationship of obesity with bone mineral density (BMD) and osteoporotic fractures in T2DM patients is not very clear.

To explore the relationship of visceral fat with BMD and osteoporotic fracture risk in T2DM patients.

Participants were selected during July to December 2019, including 202 T2DM inpatients from Endocrine Department, Yiyang Central Hospital, and 202 non-diabetics from three towns (Mahekou, Nanzhou, and Maocaojie) and one township (Wuzui) of Nan County, Yiyang, using multistage stratified random sampling. All the assessment examinations were conducted in Yiyang Central Hospital, specifically, BMD at lumbar spine, femoral neck and total hip was measured by dual-energy X-ray absorptiometry, subcutaneous and visceral fat areas were measured by DUALSCAN HDS-2000 visceral fat analyzer (Omron, Japan), and 10-year major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) or 10-year hip osteoporotic fracture risk was assessed by FRAX questionnaire. T2DM inpatients who completed a FRAX questionnaire in which the item of rheumatoid arthritis was substituted by diabetes, namely, diabetes was considered as a risk factor for osteoporotic fractures, whose assessment results were expressed by FRAX2, otherwise, their assessment results were expressed by FRAX1.

Type 2 diabetic men had higher average weight and BMI, and greater average areas of visceral and subcutaneous fat, and lower average FRAX1 (major osteoporotic fracture) than non-diabetic men (P<0.05). Type 2 diabetic women had greater average age and visceral fat area, lower femoral neck and total hip BMD, and higher average FRAX1 (hip osteoporotic fracture) and FRAX2 (major osteoporotic fracture) and FRAX2 (hip osteoporotic fracture) than non-diabetic women (P<0.05). After adjusting for age and weight, total hip BMD in type 2 diabetic women were lower than those in non-diabetic women (P<0.05). Pearson correlation analysis results showed that visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, BMD at lumbar spine, femoral neck and total hip in non-diabetic men and postmenopausal women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in non-diabetic women (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area, lumbar spine BMD and total hip BMD in T2DM men (P<0.05). Visceral fat area was positively correlated with weight, BMI, subcutaneous fat area and total hip BMD in women or postmenopausal women with T2DM (P<0.05). Partial correlation analysis results showed that after adjusting for age and weight, visceral fat area was negatively correlated with femoral neck BMD, and total hip BMD in T2DM women (P<0.05). Visceral fat area was negatively correlated with femoral neck BMD, but positively correlated with FRAX1 (hip osteoporotic fracture) or FRAX2 (hip osteoporotic fracture) in T2DM postmenopausal women (P<0.05) .

T2DM patients had higher weight, BMI and visceral fat area than those without diabetes. T2DM women had lower femoral neck BMD and hip BMD, and may be at higher risk of 10-year hip osteoporotic fracture. Visceral fat area was negatively correlated with femoral neck BMD and total hip BMD in T2DM women. The risk of 10-year hip osteoporotic fracture may increase as visceral fat area increases in postmenopausal women with or without T2DM.

Predictive Value of Age Shock Index for Adverse Outcomes in Patients with Acute Gastrointestinal Bleeding

GAN Junying, XU Heping, WU Kaifang, CHEN Yunmei, YE Xiaojuan

2022, 25(06):  689-692.  DOI: 10.12114/j.issn.1007-9572.2021.02.089

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Acute gastrointestinal bleeding (AGB) is one of the common emergencies for patients of emergency department. How to quickly and accurately stratify the risk of AGB is essential to improving the prognosis. Therefore, a simple, fast and easy-to-operate method is needed to early detect emergency patients at high-risk of AGB.

To compare the predictive value of shock index (SI), age shock index (ASI) and modified shock index (MSI) in the stratification of adverse outcomes in patients with AGB.

A retrospective design was used. Participants with AGB were selected from Department of Emergency, Hainan General Hospital from 2019 to 2020. Vital signs and calculated SI, ASI and MSI of patients were collected by the triage nurse, and their predictive values for the admission to the ICU, blood transfusion, endoscopic/colonoscopy (E/C) intervention and death were comparatively analyzed.

Altogether, 302 cases were enrolled. Among them, 158 (52.32%) had at least one adverse outcome, 38 (12.58%) were admitted to the ICU, 136 (45.03%) received blood transfusion, 54 (17.88%) received E/C intervention, and 12 (3.97%) died. The average SI, ASI and MSI of patients with adverse outcomes were all higher than those without (P<0.05). SI, ASI and MSI were all of statistical significance in predicting the adverse outcomes (P<0.05). Specifically, ASI had a larger AUC than SI (P=0.013) and MSI (P=0.024) for predicting adverse outcomes in AGB, but the AUC of SI was similar to that of MSI (P=0.985). Both SI and ASI were of statistical significance in predicting theadmission to the ICU (P<0.05). SI, ASI and MSI were all of statistical significance in predicting the requirement for blood transfusion (P<0.05). SI was of statistical significance in predicting the requirement for E/C intervention (P<0.05). The cut-off point of ASI predicting adverse outcomes in AGB was 45.12. Spearman correlation analysis indicated that the number of adverse outcomes in AGB had a positive relation with SI (r_s=0.255, P=0.002), ASI (r_s=0.360, P<0.001) and MSI (r_s=0.246, P=0.002) .

ASI is easy to be calculated during the triage phase, and it may be superior to both SI and MSI in terms of predicting adverse outcomes in AGB.

Predictive Value of Hemoglobin Glycation Index for Hyperuricemia in Type 2 Diabetes

LI Hang, LIU Yiying, LIU Yao, LIN Jie, WAN Qin

2022, 25(06):  693-698.  DOI: 10.12114/j.issn.1007-9572.2021.02.126

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Hemoglobin glycation index (HGI) is a simple marker of hemoglobin glycation, which is closely related to various chronic complications, such as diabetic microvasculopathy and macroavasculopathy. However, there are few studies on the relationship between HGI and hyperuricemia (HUA) in type 2 diabetes mellitus (T2DM) .

To investigate the predictive value of HGI for HUA in T2DM.

Eligible participants were T2DM patients (n=1 194) who received treatment and personal health record creation services from Department of Endocrinology, the Affiliated Hospital of Southwest Medical University between January 2017 and January 2021. Demographics, physical examination information, laboratory test markers and calculated HGI were collected. HUA prevalence was compared across tertile groups of HGI〔low HGI (<-0.94%), moderate HGI (-0.94%≤HGI<0.27%), and high HGI (HGI≥0.27%) 〕. Multivariate Logistic regression analysis was used to explore the factors affecting the development of HUA in T2DM. The receiver operating characteristic (ROC) curve was plotted for HGI with clinical markers in predicting HUA in T2DM.

Low HGI group had much lower prevalence of HUA than did moderate HGI group 〔17.09% (68/398) vs 27.14% (108/398), χ²=11.672, P<0.01〕 and high HGI group 〔17.09% (68/398) vs 31.66% (126/398), χ²=22.928, P<0.01〕. Multivariate Logistic regression analysis found that age〔OR=1.048, 95%CI (1.029, 1.067) 〕, subcutaneous fat area (SFA) 〔OR=1.006, 95%CI (1.001, 1.010) 〕, triglyceride (TG) 〔OR=1.096, 95%CI (1.034, 1.161) 〕, high density lipid-cholesterol (HDL-C) 〔OR=0.560, 95%CI (0.326, 0.961) 〕, and HGI 〔OR=1.360, 95%CI (1.208, 1.531) 〕 independently influenced the development of HUA in T2DM (P<0.05). After adjusting for age, SFA, TG, and HDL-C, it was found that the risk of HUA was 1.855 times higher in moderate HGI group 〔95%CI (1.283, 2.681), P<0.001〕, and 2.192 times higher in high HGI group 〔95%CI (1.530, 3.141), P<0.001〕 compared to that of low HGI group. The AUC for HGI with clinical markers〔Logit (P) =-4.549+0.618×moderate HGI+0.785×high HGI+0.039×age+0.008×SFA+0.088×TG-0.750×HDL-C〕 to diagnose HUA in T2DM was 0.71〔95%CI (0.68, 0.75) 〕, with sensitivity of 78.7%, specificity of 53.5%, Youden index of 0.322, and optimal cut-off value of 0.208.

T2DM patients with elevated HGI may be more prone to HUA. HGI could be used as a clinical predictor of HUA in T2DM.

Effects of Different Exercise Modalities on Metabolic Indices and Pregnancy Outcomes in Patients with Gestational Diabetes Mellitus

ZHONG Xin, HUANG Qiuhong, QIN Yin, ZENG Yachang, QIN Guirong, CHEN Qingyun, XU Ming, WEI Xiao, MA Cui, HUANG Yanfeng, DAI Xia

2022, 25(06):  699-705.  DOI: 10.12114/j.issn.1007-9572.2021.02.072

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Gestational diabetes mellitus (GDM) is a common pregnancy disease, which can cause complications such as preterm delivery, macrosomia and cesarean section, seriously affecting maternal and infant health.

To investigate the effects of different exercise modalities on metabolic indices and pregnancy outcomes in GDM patients, providing a reference for choosing an appropriate exercise modality for GDM patients.

Two hundred and ten GDM patients were recruited from the First Affiliated Hospital of Guangxi Medical University and the Second Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020. By use of a random number sequence generated in Excel, they were equally divided into aerobic training (AT) group (moderate-intensity walking), resistance training (RT) group (lifting dumbbell while sitting) and RT+AT group (moderate-intensity walking plus lifting dumbbell while sitting). Metabolic indices were measured at baseline, 1 and 3 months after the intervention, and at delivery, respectively, including fasting blood glucose (FBG), two-hour postprandial blood glucose (2 hPBG), glycosylated hemoglobin (HbA_1c), body weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Pregnancy outcomes were also observed.

AT group, RT group and RT+AT group finally completed the test in 65 cases, 64 cases and 62 cases. (1) Significant decreases were found in average levels of FBG, 2 hPBG, SBP, and DBP in all groups at 1 and 3 months post-intervention (P<0.05). The average level of HbA_1c in RT and RT+AT groups showed a successive decrease over the period from baseline to 1, and 3 months post-intervention (P<0.05). The average level of DBP also demonstrated a successive decrease in these two groupsover the period from baseline to 1, and 3 months post-intervention (P<0.05). The average levels of 2 hPBG and HbA_1c in RT+AT group were lower than those of other two groups at 3 months post-intervention (P<0.05). (2) The average gestational age, incidence of preterm delivery and pregnancy-induced hypertension, number of insulin users, and average weight gain in late pregnancy showed no significant intergroup differences (P>0.05). The incidence of cesarean delivery in RT+AT group was lower than that of other two groups, the average amount of postpartum bleeding in RT and RT+AT groups were lower than that of AT group (P<0.05). (3) The average neonatal birth weight and length, and 1-minute Apgar score had no significant intergroup differences (P>0.05). The incidence of macrosomia varied significantly accross the groups (P<0.05). In particular, RT+AT group had a lower incidence of macrosomia than AT group (P<0.05) .

All of AT, RT and RT plus AT could improve the metabolic indices of GDM patients, but RT plus AT may be more effective. Furthermore, RT plus AT may also be more effective in improving maternal and infant outcomes of GDM patients.

Value of Multimodal Ultrasound for the Quantitative Assessment of Early Postpartum Pelvic Floor Structure and Function Changes as Well as Stress Urinary Incontinence in Parturients of Advanced Maternal Age

LI Ning, KAN Yanmin, WANG Yihua, LI Jie, SHI Chaohui, ZHANG Man, ZHANG Shuhua

2022, 25(06):  706-713.  DOI: 10.12114/j.issn.1007-9572.2021.02.104

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China is seeing an increase in the ratio of parturients of advanced maternal age, a population at high risk of stress urinary incontinence (SUI) .

To quantitatively assess pelvic floor structure and function changes and SUI, and to determine the ultrasonic diagnostic indices and threshold values for SUI in the early postpartum period in parturients of advanced maternal age using 2D and 3D ultrasound and real-time shear wave elastography (SWE) of the pelvic floor.

Participants were 194 puerperants who received ambulatory services in the early postpartum period (within the first 6-8 weeks after childbirth) from North China University of Science and Technology Affiliated Hospital from August 2016 to February 2021, including 105 of advanced maternal age (≥35 years old) and 89 of proper maternal age (<35 years old). SUI was determined by medical history, physical examination, urination diary and urodynamic test results and clinical diagnosis. Intergroup comparisons were conducted in terms of the detection rate of SUI, and parameters of 2D and 3D ultrasound and real-time SWE of the pelvic floor〔bladder neck position at rest (h_1BL) and tension (h_2BL), degree of mobility of bladder neck (Δh_BL), urethral inclination angle at rest (UIA₁) and tension (UIA₂), and urethral rotation angle (URA), posterior vesicourethral angle at rest (PVUA₁) and tension (PVUA₂), levator ani hiatus area at rest (LHA₁) and tension (LHA₂), elastic modulus of puborectal muscle in resting (E₁) and anal constriction state (E₂), and the difference between E₁ and E₂ (ΔE) 〕. The above-mentioned multimodal ultrasound parameters were also compared between those with SUI (n=51) and without (n=54) in the advanced maternal age group. The performance of multimodal ultrasound parameters in predicting early postpartum SUI was analyzed using the analysis of the area under the receiver operating characteristic curve (AUC), and was estimated with the accuracy of clinical diagnosis as the gold standard.

Compared to parturients of proper maternal age, those of advanced maternal age had higher h_1BL, h_2BL, Δh_BL, PVUA₁, and LHA₂, and lower bilateral E₁, E₂, and ΔE (P<0.05). Moreover, they had higher detection rate of SUI〔48.6% (51/105) vs 32.6% (29/89) 〕 (χ²=5.081, P=0.028). Parturients of advanced maternal age with SUI had greater h_1BL, h_2BL, Δh_BL, UIA₂, URA, PVUA₁, PVUA₂, LHA₁, LHA₂, and less bilateral E₁, E₂, and ΔE than those without (P<0.05). For parturients of advanced maternal age, the analysis of the receiver operating characteristic curve of multimodal ultrasound parameters predicting early postpartum SUI revealed that the AUC for h_1BL, h_2BL, Δh_BL, PVUA₁, PVUA₂, LHA₁, LHA₂, bilateral E₂, or bilateral ΔE was greater than 0.700. In particular, the AUC was greater than 0.850 for h_1BL (-2.28 cm optimal cutoff, 82.4% sensitivity, 90.2% specificity), h_2BL (-0.50 cm optimal cutoff, 83.3% sensitivity, 85.2% specificity), LHA₁ (16.79 cm² optimal cutoff, 94.1% sensitivity, 90.2% specificity), or bilateral ΔE (16.85 kPa optimal cutoff, 88.9% sensitivity, 87.0% specificity). Binary Logistic regression analysis of PRESUI=-3.691×h_2BL-0.952×LHA₁+0.675×bilateral ΔE, an algorithm with three ultrasound parameters incorporated for predicting SUI in parturients of advanced maternal age, indicated that the AUC of h_2BL in combination with LHA₁ and bilateral ΔE was 0.992〔95%CI (0.982, 0.999) 〕, with 0.571 optimal cutoff, 96.1% sensitivity and 96.3% specificity.

The early postpartum pelvic floor structure of parturients of advanced maternal age, especially those with SUI, was more relaxed than that of those of proper maternal age. Multimodal ultrasound can quantitatively evaluate the changes of early postpartum pelvic floor structure and function in parturients of advanced maternal age. h_1BL, h_2BL, LHA₁, bilateral ΔE or the combination of h_2BL, LHA₁ and bilateral ΔE could be used as an ultrasonic predictor of early postpartum SUI in this group, and the latter has higher diagnostic value.

Overall and Sex-specific Associations between Ratio of Monocyte to High-density Lipoprotein Cholesterol and Hyperuricemia Prevalence

WANG Yanping, WU Meihua, YANG Sheng, CHEN Zhong

2022, 25(06):  714-718.  DOI: 10.12114/j.issn.1007-9572.2021.02.091

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Hyperuricemia (HUA) is a common metabolic disease, which may cause damage to multiple target organs. Studies have showed that HUA is strongly related to inflammatory markers. It is of great importance to study the relationship of HUA with monocyte to high-density lipoprotein cholesterol ratio (MHR), a new inflammatory marker that could be obtained easily in the community, for community-based prevention and treatment of HUA.

To examine the overall and sex-specific associations between MHR and HUA, to assess the predictive value of HUA for HUA.

The demographic and 2020 physical examination data of 12 305 subjects over 50 years old〔5 498 men (44.7%) and 6 807 women (55.3%) 〕 from Laogang community of Shanghai's Pudong New Area were analyzed retrospectively. HUA was defined as serum uric acid level > 360 μmol/L in women, and >420 μmol/L in men. Multivariate Logistic regression was used to examine the association between MHR and HUA in all participants, and in men and women, respectively.

The prevalence of HUA in all participants, men and women was 15.8% (1 948/12 305), 17.7% (974/5 498), and 14.3% (974/6 807), respectively. After adjusting for confounding factors, monocyte〔male, OR=2.010, 95%CI (1.265, 3.194) ; female, OR=5.427, 95%CI (3.059, 9.627) 〕 and MHR〔male, OR=1.918, 95%CI (1.111, 3.313) ; female, OR=6.073, 95%CI (2.984, 12.358) 〕 were independently associated with HUA in both men and women (P<0.05) .

MHR was independently associated with HUA in men and women, and the association was stronger in women.

Non-comatose Hyperglycemic Crisis：Low-dose Insulin Therapy by Two Routes

LAI Weihua, LUO Sichan, CHEN Guangshu, HAN Dunzheng, TANG Muhan

2022, 25(06):  719-723.  DOI: 10.12114/j.issn.1007-9572.2021.02.102

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Hyperglycemic crisis is a critical emergency related to uncontrolled diabetes, and the treatment of which is individualized. Studies have showed that low-dose subcutaneous and insulin infusion with a pump have similar hypoglycemic effects in hyperglycemic crisis, but the former is simpler and more convenient.

To explore hypoglycemic effectsof low-dose subcutaneous versus insulin infusion with a pumpin the treatment of non-comatose hyperglycemic crisis.

One hundred and fifteen hyperglycemic crisis inpatients〔72 with diabetic ketoacidosis (DKA), and 43 with hyperosmolar hyperglycemic syndrome (HHS) 〕 were selected from Guangzhou Red Cross Hospital from March 2017 to March 2020, and divided into low-dose subcutaneous insulin infusion with a pump (n=58) and low-dose intravenous insulin infusion with a pump (n=57) using random number table, treated with recombinant human insulin, and insulin aspart, respectively. Both groups were treated by a continuous low-dose insulin infusion of 0.10-0.15 U·kg^-1·h^-1 before meeting the glycemic targets. The speed of blood glucose reduction, time to reach the glycemic targets, average blood glucose and frequency of hypoglycemia were observed in both groups.

The speed of blood glucose reduction, time to reach the glycemic targets, average blood glucose and frequency of hypoglycemia demonstrated no significant differences in both groups (P>0.05). These four indicators also showed no notable differences in DKA patients in both groups (P>0.05). Furthermore, theyhad no obvious differences in HHS patients in both groups (P>0.05) .

In patients with non-comatose hyperglycemic crisis, eitherlow-dose subcutaneous or insulin infusion with a pump could effectively lower the blood glucose, and the former could be used as an alternative for hyperglycemic crisis.

Clinical Analysis of Peptic Ulcer Bleeding in Tibet

XU Ying, Cirenyangjin

2022, 25(06):  724-728.  DOI: 10.12114/j.issn.1007-9572.2021.02.059

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Tibet is located on the plateau with a high incidence of peptic ulcer bleeding, but there are few reports about the clinical characteristics of peptic ulcer bleeding, as well as the risk factors of bleeding and rebleeding associated with peptic ulcer in Tibet.

To explore the clinical characteristics of peptic ulcer bleeding, and the potential risk factors of bleeding and rebleeding associated with high-risk peptic ulcer in Tibet.

A total of 212 hospitalized patients who visited the Tibet Autonomous Region People's Hospital for upper gastrointestinal bleeding and were clearly diagnosed as peptic ulcer bleeding by gastroscopy from 2017 to 2020 were selected. Patients were divided into two groups according to the Forrest classification under endoscopy: high-risk group (Ⅰa-Ⅱb) and low-risk group (Ⅱc and Ⅲ). The high-risk group was further divided into rebleeding subgroup and non-rebleeding subgroup according to the occurrence of rebleeding. The general data and clinical characteristics of the patients were analyzed, and multivariate Logistic regression analysis was used to explore the influencing factors of the high risk of peptic ulcer bleeding.

Among 212 patients with peptic ulcer bleeding, the male-to-female ratio was 5.42∶1; including 125 cases (59.0%) with gastric ulcer bleeding, 87 cases (41.0%) with duodenal ulcer bleeding; 86 (40.6%) patients in the high-risk group, and 126 (59.4%) in the low-risk group. There were 12 (14.0%) patients in the rebleeding subgroup, and 74 (86.0%) in the non-rebleeding subgroup. The hemoglobin level (HGB), urea nitrogen (BUN), the rebleeding rate and the length of hospital stay in high-risk group were higher than low-risk group (P<0.05). Multivariate Logistic regression analysis showed that HGB〔OR=1.007, 95%CI (1.001, 1.014), P=0.028〕 and BUN〔OR=1.061, 95%CI (1.003, 1.121), P=0.037〕 were the independent influencing factors for the high-risk peptic ulcer bleeding. The platelet count (PLT) and the albumin level (ALB) in the rebleeding subgroup were lower than non-rebleeding subgroup (P<0.05) .

The incidence of peptic ulcer bleeding in men was higher than women, and the incidence of peptic ulcer bleeding of gastric ulcer was higher than duodenal ulcer in Tibet. HGB and BUN level at admission were the independent influencing factors of high-risk peptic ulcer bleeding. PLT and ALB level at admission might be the risk factors of high-risk peptic ulcer rebleeding.

Big Data·Population Health Research

Analysis of the Spatial Epidemiological Characteristics of the Probability of Diabetes Death and Premature Death among Residents in Pudong New Area of Shanghai from 2010 to 2020

CHEN Yichen, CHEN Hua, SUN Lianghong, QU Xiaobin, LI Xiaopan, CHEN Hanyi, YANG Chen, ZHOU Yi, XU Wanghong

2022, 25(06):  729-734.  DOI: 10.12114/j.issn.1007-9572.2021.02.076

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With the development of society and economy, the rapid growth of diabetes incidence has become an important public health problem, but there are still few studies on the urban and rural distribution of diabetes.

To explore the spatial epidemiological characteristics of mortality and probability of premature death caused by diabetes among residents in Pudong New Area of Shanghai from 2010 to 2020, so as to provide the reference for the development of the regional strategy for diabetes control and prevention.

The diabetes death data reported from 2010 to 2020 were screened for analysis based on the death surveillance system in Pudong New Area in May 2021. The Crude mortality, age-standardized mortality, probability of premature death caused by diabetes and the annual percentage change (APC) of the residents from diabetes in each subdistricts and towns of Pudong New Area, so as to analyze the status and trend of diabetes death in Pudong New Area. The geographical information system (GIS) was used to plot the spatial distribution map of diabetes deaths and carry out trend surface analysis and spatial autocorrelation analysis respectively.

The crude mortality, age-standardized mortality and probability of premature death caused by diabetes among residents in Pudong New Area between 2010 and 2020 were 37.90/100 000, 16.90/100 000 and 0.52%, respectively. The crude mortality rate, the age-standardized mortality rate and the probability of premature death caused by diabetes had been on the rise in Pudong New Area between 2010 and 2020 (APC for crude mortality rate=5.59%, Z=13.887, P=0.001, APC for age-standardized mortality rate=2.06%, Z=4.547, P=0.001, APC for the probability of premature death=1.50%, Z=2.476, P=0.035). The trend surface analysis showed that the crude and standardized mortality of diabetes in Pudong New Area gradually decreased from north to south, the probability of premature death was high in the middle and low in the north and south, the APC of crude death rate, standardized death rate and premature death probability was gradually decreasing from north to south. In the east-west direction, the crude death rate of diabetes, the standardized death rate and the probability of premature death all showed a trend of high at both ends, and the rate of crude death, standardized death rate and APC showed a trend of high at the middle and low at the two ends. The results of global spatial autocorrelation analysis showed that the crude death rate of diabetes, standardized death rate and premature death probability of residents in Pudong New Area were spatially positively correlated (P_{crude death rate}<0.001, P_{standardized death rate}<0.001, P_{premature death probability}=0.003). The results of local spatial autocorrelation analysis showed that the high-high clustering area of the crude death rate of diabetes and the standardized death rate was located in the west of Pudong New Area, both of which contained 6 streets and 1 town, and there were partial geographic overlaps. The standardized low mortality rate-the low agglomeration areas were Chuansha New Town and Xuanqiao Town in the middle of Pudong New Area. The area in the west of Pudong New Area with three streets and two towns was a high-high concentration area with a high probability of early death.

The status of diabetes death in Pudong New Area during 2010 to 2020 was at a high level and showed an upward trend over the years. The crude and standardized mortality of diabetes in the western urban area of Pudong New Area were relatively high, and the mortality among residents living in the urban fringe rose at a relatively high speed in Pudong New Area. More attention should be paid to the status of diabetes in these subgroups.

Spatiotemporal Analysis of Cervical Cancer Prevalence in Guangdong Province，2015—2019

XU Bixia, LIN Xiaodan, YAO Weiguang

2022, 25(06):  735-741.  DOI: 10.12114/j.issn.1007-9572.2021.02.084

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Cervical cancer is the most common cancer threatening women's health that calls for strengthened dynamic monitoring and early warning.

To perform a spatiotemporal analysis of cervical cancer prevalence in Guangdong from 2015 to 2019, providing a decision-making basis for relevant government departments to take targeted prevention and treatment measures for cervical cancer.

In May 2021, data of 5-year (2015—2019) cervical cancer prevalence in 20-64-year-old female Guangdongers living in Guangdong's 21 cities were collected for analysis at the provincial and municipal levels. Average annual growth rate for descriptive analysis. ArcGIS 10.6 was used for spatial visualization, spatial autocorrelation analysis and hot spot analysis (Getis-Ord Gi) .

During 2015—2019, cervical cancer prevalence in Guangdong declined from 50.28/100 000 to 49.84/100 000. The highest average annual growth rate of cervical cancer prevalence was in Meizhou (76.05%), and the lowest was in Chaozhou (-52.81%). In 2019, Jieyang (210.40/100 000) was found to have the highest cervical cancer prevalence, followed by Maoming (127.34/100 000) and Yangjiang (108.05/100 000). In 2018, global spatial correlation (Global Moran's I value=0.364, P<0.05) appeared in the prevalence of cervical cancer in 21 cities in Guangdong, showing the characteristic of aggregated distribution. The results of local spatial autocorrelation indicated that Guangzhou consistently showed the local characteristics of "low-value to low-value agglomeration" from 2015 to 2019, with an expanded scope with the local characteristics overall. Jieyang and Chaozhou were cervical cancer "hot spots" in 2015, 2018 and 2019.

From 2015 to 2019, although Guangdong saw a decrease in cervical cancer prevalence on the whole, it had a higher cervical cancer prevalence in 2019 (43.3/100 000) than the national level. Comparatively speaking, the overall cervical cancer prevalence in Pearl River Delta region was lower than that of eastern, western and northern Guangdong. And cervical cancer "hot spots" were mainly in eastern Guangdong.

Geriatric Health Problems

Developmental Trajectory of Frailty in Chinese Elderly People：an Analysis Based on the Latent Growth Model

GUO Kailin, WANG Shiqiang, LI Dan, WANG Yijie, WANG Shaokun, XU Zhihan

2022, 25(06):  742-749.  DOI: 10.12114/j.issn.1007-9572.2021.02.119

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Frailty is a prominent manifestation of aging. Frailty in Chinese older people has been studied mostly using cross-sectional designs, but its developmental trajectory has been rarely studied using longitudinal designs.

To examine the developmental trajectory and associated factors of frailty in Chinese older people using the data of four national waves of China Health and Retirement Longitudinal Study (CHARLS) .

The data of this study obtained from four national waves〔2011 (the baseline survey), and 2013, 2015 and 2018 (follow-up surveys) 〕 of CHARLS, which was initially conducted in 2011, and was followed by tracking once every 2 to 3 years with multi-stage PPS sampling for middle-aged and elderly groups in 28 provincial administrative regions of China, covering 150 counties and 450 villages. The surveyees were coded, and matched, then 2 267 cases (≥60 years old) involved in the four waves of surveys were selected as the sample. Frailty was assessed by the frailty index (FI). Mplus was used to construct three types of unconditional latent growth models, and the optimal fitting model was selected to determine the developmental trajectory of frailty of Chinese older people, and was used to develop the conditional latent growth model. The effects of time-invariant factors (gender, education level) and time-varying factors (physical activity, smoking, alcohol consumption, sleep) on frailty were examined.

The latent growth model with undefined curve fit the data better, and was selected as the optimal model to determine the frailty development trajectory. The results of χ² (3) =36.16, CFI=0.992, TLI=0.984, RMSEA=0.070, SRMR=0.022, indicating that the frailty prevalence in older adults showed a trend of curvilinear increase. The values of intercept (initial level), slope (growth), and the variation of them of the model were significantly higher than 0 (P<0.01), indicating that there were significant individual differences in the initial level and growth rate of frailty. Gender and education level were negatively associated with the initial level of frailty (β=-0.113, -0.173, P<0.01). They were also negatively associated with the growth of frailty (β=-0.181, -0.151, P<0.01). Compared with men, women had higher initial level and faster growth rate of frailty (P<0.05). Compared to those with higher education level, those with lower education level had higher initial level and faster growth rate of frailty (P<0.05). Physical activity and sleep were negatively associated with frailty in all waves of surveys (P<0.05). Smoking was positively associated with frailty in 2011, 2015, 2018 waves of surveys (P<0.05). Alcohol consumption was positively associated with frailty in 2013 and 2015 waves of surveys (P<0.05) .

The frailty in Chinese older people showed a trajectory of curvilinear increase, and its initial level and growth rate had significant individual differences. Comparatively speaking, being female and having lower education level were associated with increased risk of having frailty. Moderate- and high-level physical activity and adequate sleep were associated with decreased risk of having frailty or alleviating frailty. Long-term smoking and drinking too much could exacerbate frailty.

Study on the Relationship between the Risk of Elderly Diabetes and Physical Activity

GU Yunjuan, WU Shangxi, LYU Jingyi, ZHOU Yang, CHEN Lunwen, LU Qingyun, LU Juying, ZHANG Xiaoyi, LIANG Yuanyuan, XIAO Jing

2022, 25(06):  750-755.  DOI: 10.12114/j.issn.1007-9572.2021.02.090

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The prevalence of elderly diabetes is increasing in China recently, with lower cure and control rates. Some epidemiology studies have shown that physical activity (PA) can alleviate the prevalence and the development of elderly diabetes. However, the effects of different types and intensities of PA and their metabolic equivalent on elderly diabetes have not been clarified, and there are few related studies.

To understand the size and trend of the relationship between the risk of elderly diabetes and PA, in order to provide a scientific basis for formulating strategies for the prevention and control of elderly diabetes.

Based on the stratified cluster random sampling, a total of 13 022 elderly people aged 60 and above who had registered residence actually lived continuously for more than 1 year in Gangzha District, Tongzhou District, Qidong City, Haimen City, Rugao City, and Haian City of Jiangsu Province were selected from October 2017 to June 2018, including 2 698 diabetic patients. 2 698 non-diabetes people in the control group were matched with a age 1∶1 propensity score. The general demographic characters, laboratory indicators were collected, behavioral lifestyles such as physical activity and sitting time were investigated refer to the International Physical Activity Scale. Multivariate conditional Logistic regression and spline regression models were used to analyze the association between PA and elderly diabetes.

Multivariate Logistic regression analysis showed that with the Leisure physical activity (LPA) and occupational physical activity (OPA) increased by one intensity level, the risk of elderly diabetes decreased by 18% and 24% (P<0.000 1). The higher the metabolic equivalent of LPA, OPA, commuting physical activity (CPA), and total PA, the lower the risk of elderly diabetes (P<0.000 1). Daily steps ≥6 000 were associated with a 66% lower risk of diabetes (P<0.000 1), compared with daily steps <6 000. The longer thesitting time per week, the higher the risk of elderly diabetes (P<0.05). The results of spline regression showed that with the increased metabolic equivalent of OPA, the risk of elderly diabetes decreased monotonously. With the increase of metabolic equivalent of CPA, LPA, and total PA, the risk of elderly diabetes decreased first and then leveled off. The risk of different genders was consistent with the total population.

Moderate and severe LPA and OPA can reduce the risk of elderly diabetes, the effect of reducing the risk of elderly diabetes is enhanced, and the increased range increases significantly at first and then tends to flatten. The recommended LPA, CPA and total PA of 28 MET-h/w, 18 MET-h/w and 45 MET-h/w are optimal, respectively.

Review

New Developments in Biotargeted Drug Therapies for Glucocorticoid-induced Osteoporosis

HU Zhonghui, ZHANG Qian, LI Mei

2022, 25(06):  756-759.  DOI: 10.12114/j.issn.1007-9572.2021.02.071

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Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, but its treatment is challenging, which may be due to lack of focus. Recent years have seen considerable developments in biotargeted therapies targeting two important pathophysiologic mechanisms for treating GIOP, including increased osteoclast activities induced by receptor activator of nuclear factor-κB ligand and decreased bone formation induced by inhibition of Wnt signaling pathway. We summarized the latest advances in three biotargeted drugs, denosumab, sclerostin monoclonal antibody and DKK-1 monoclonal antibody, in the treatment of GIOP, and found that denosumab can significantly increase bone mineral density of patients with GIOP, and sclerostin monoclonal antibody and DKK-1 monoclonal antibody are new promising therapies for GIOP. However, due to limited evidence, efficacies of these biotargeted drugs in GIOP need to be studied further.

New Advances in Post-tracheal Extubation Swallowing Dysfunction in Critically Ill Patients

HE Yueyue, LIU Huan, TIAN Yongming, DU Aiping, XU Yu, JING Wenwen

2022, 25(06):  760-765.  DOI: 10.12114/j.issn.1007-9572.2021.02.087

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Post-tracheal extubation swallowing dysfunction in critically ill patients may negatively affect patient prognosis, and cause significant increases in relevant medical and social burden as well as care burden. We reviewed the epidemiology, causes, associated factors and interventions regarding post-tracheal extubation swallowing dysfunction in critically ill patients, aiming at providing evidence for the management of post-tracheal extubation swallowing dysfunctionin this group.

Latest Research on Pregnancy of Unknown Location

SHI Juanjuan, CUI Xiujuan, ZHANG Dan, LIN Li

2022, 25(06):  766-770.  DOI: 10.12114/j.issn.1007-9572.2021.02.010

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Pregnancy of unknown location (PUL) is a descriptive term, and while most cases of PUL are subsequently diagnosed with a spontaneous abortion or viable intrauterine pregnancy, 7% to 20% develop to ectopic pregnancy. The potential risk of ectopic pregnancy-related morbidity and mortality suggests that clinical attention should be paid to PUL assessment and treatment. We reviewed the latest research on PUL, including its classification, follow-up tools and treatment-related issues, in order to provide more references for clinicians.