Table of Content

20 April 2022, Volume 25 Issue 12

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Editorial

Recent Advances in Chinese and Western Medicine Treatments for Diabetic Kidney Disease

Ying WANG, Jingwei ZHOU, Zhen WANG, Yingxia YANG, Yaoxian WANG

2022, 25(12):  1411-1417.  DOI: 10.12114/j.issn.1007-9572.2021.02.117

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Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease in China, which greatly negatively impacts public health and patients' quality of life. Recently, multiple guidelines have updated their recommendations to optimize the treatment and management of individuals with DKD. New antihyperglycemic drugs offer new options for DKD. Traditional Chinese medicine (TCM) has a long history in treating DKD, and relevant theories have been continuously enriched and developed. Along with the increasing application of evidence-based medicine in TCM research, the benefits of TCM treatments in DKD have been gradually recognized and valued, such as relieving fatigue, edema, backache and other symptoms, lowering protein in the urine, protecting kidney function, enhancing treatment efficiency, reducing the risk of end-stage renal disease, and improving the long-term prognosis. This article gave a summary and strengths analysis of the latest advances in TCM and Western medicine treatments for DKD.

Original Research

Correlation of Glycemic Variability and Time in Range with Early Neurological Deterioration in Patients with Acute Ischemic Stroke and Diabetes

Ming WANG, Zhi XI, Qizhe MENG, Xiaopeng YANG

2022, 25(12):  1418-1423.  DOI: 10.12114/j.issn.1007-9572.2021.02.133

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Background

Early neurological deterioration (END) in acute ischemic stroke is associated with permanent neurological deficits and dysfunction, and considered to be an unstable condition requiring comprehensive medical treatment. Moreover, the relationship between END and glycemic variability (GV) remains unclear.

Objective

To explore the relationship of GV, time in range (TIR) with END in patients with acute ischemic stroke and diabetes, and based on this, to develop a predictive model.

Methods

One hundred and twenty patients with acute ischemic stroke and diabetes (34 with END and 86 without) were selected from the Second Affiliated Hospital of Zhengzhou University from July 2019 to May 2021. Clinical data, GV indices 〔coefficient of variation (CV) , standard deviation (SD) , mean amplitude of glycemic excursion (MAGE) , mean of daily differences (MODD) 〕 and TIR measured by the 72-hour ambulatory continuous glucose monitoring were collected. Factors associated with END were explored by multivariate Logistic regression, and used to develop a nomogram for the prediction of END. ROC analysis was conducted to assess the predictive value of nomogram for END.

Results

Patients with END had higher mean glycosylated hemoglobin (HbA_1c) , admission NIH Stroke Scale score, CV, SD, MAGE, and MODD, and lower mean TIR than did those without (P<0.05) . Multivariate Logistic regression analysis indicated that increased CV〔OR=1.194, 95%CI (1.027, 1.388) , P=0.021〕, SD〔OR=11.040, 95%CI (1.189, 102.473) , P=0.035〕, MAGE〔OR=3.063, 95%CI (1.062, 8.837) , P=0.038〕, and MODD〔OR=20.990, 95%CI (1.420, 201.206) , P=0.027〕 were associated with elevated risk of END, and prolonged TIR〔OR=0.877, 95%CI (0.789, 0.974) , P=0.014〕 was associated with decreased risk of END. Internal validation of the predictive value of nomogram incorporating CV, SD, MAGE, MODD and TIR for END using bootstrapping showed that its predicted value was basically consistent with the actual value, demonstrating good predictive ability. For estimating END in acute ischemic stroke combined with diabetes, the AUC of CV, SD, MAGE, MODD and TIR was 0.847〔95%CI (0.765, 0.929) , P<0.01〕, 0.812〔95%CI (0.723, 0.901) , P<0.01〕, 0.850〔95%CI (0.772, 0.928) , P<0.01〕, 0.803〔95%CI (0.710, 0.896) , P<0.01〕, and 0.825〔95%CI (0.747, 0.903) , P<0.01〕, respectively.

Conclusion

CV, SD, MAGE, MODD and TIR may be influential factors for END in acute ischemic stroke with diabetes, which could partially predict END. It is of clinical significance to take measures to reduce GV and prolong TIR to prevent END.

The Effect of a Mobile APP-based Pelvic Floor Muscle Training during Pregnancy on the Occurrence of Postpartum Urinary Incontinence: Exploratory Analysis of a Randomized Controlled Trial

Ling CHEN, Tiantian LI, Wenzhi CAI

2022, 25(12):  1424-1428,1434.  DOI: 10.12114/j.issn.1007-9572.2022.0042

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Background

The prevalence of urinary incontinence (UI) is high, which greatly affects the quality of life of women. Studies have shown that pelvic floor muscle training (PFMT) is an effective prevention and treatment method. A randomized controlled trial was conducted previously with a result showing absence of a positive effect, when comparing a mobile APP-based pelvic floor muscle training programme with usual care, and the reasons need to be further explored.

Objective

This study intends to conduct an exploratory analysis of the negative result of a pelvic floor muscle training program during pregnancy based on a mobile APP, aiming to explore the factors affecting the preventive effect of postpartum UI and the subgroups that benefited.

Methods

The data comes from a randomized controlled trial carried out in the obstetrics clinic of a hospital in Shenzhen from June to October 2020. Convenience sampling technique was adopted to recruit pregnant women. A total of 126 participants were recruited, of which 63 were randomly assigned to intervention group, 63 to control group using a random numbers table. The control group received routine nursing care. The intervention group received the usual care plus "UIW" (Urinary Incontinence for Women) APP-based self management of UI. During the 42-day postpartum follow-up, the postpartum related data of the two groups were collected, including the occurrence of UI on the 42nd postpartum day. The subjects were divided into case group and the control group according to the present of postpartum UI. Logistic regression analysis was used to explore the confounding factors and their interaction with intervention methods on the present of postpartum UI. Subgroup analysis based on the results of Logistic regression analysis was performed to explore whether there are subgroups who can benefit from APP intervention.

Results

There were statistically significant differences in the history of vaginal delivery, the presence of UI at the time of recruitment, and the Broome Pelvic Floor Muscle Self-efficacy Scale (BPMSES) score between the case group and the control group (P<0.05) . Logistic regression analysis showed that the presence of UI at the time of recruitment was a significant risk factor for postpartum UI〔OR=15.897, 95%CI (4.724, 53.495) , P<0.001〕. The interaction between BPMSES score and intervention method could affect the occurrence of postpartum UI〔OR=1.034, 95%CI (1.017, 1.051) , P<0.001〕. Further subgroup analysis found that for pregnant women with UI symptoms at the time of enrollment, APP-based intervention showed a better effect of preventing postpartum UI (χ²=4.18, P=0.041) , while for pregnant women without UI symptoms at the time of enrollment, the effect did not been observed (χ²=1.89, P=0.284) .

Conclusion

It is recommended that pregnant women with UI symptoms use "UIW" APP to prevent postpartum UI. However, there is insufficient evidence to prevent postpartum UI in people without UI symptoms during pregnancy. In addition, regardless of UI symptoms, pregnant women with high PFMT self-efficacy are expected to benefit from "UIW" APP.

Predictive Value of C-reactive Protein to Albumin Ratio for Microvascular Invasion in Single Small Hepatocellular Carcinoma

Gang YAO, Xinling CAO, Tao LI

2022, 25(12):  1429-1434.  DOI: 10.12114/j.issn.1007-9572.2021.02.131

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Background

The microvascular invasion pathologically diagnosed in hepatocellular carcinoma (HCC) has not been valued enough in previous studies. And there are no unified pathological diagnostic criteria for microvascular invasion in HCC. Besides that, microvascular invasion is not included as a routine pathological indicator for HCC. C-reactive protein to albumin ratio (CAR) is a new systemic inflammatory factor that is closely related to the proliferation, invasion, metastasis and other malignant biological behaviors of HCC.

Objective

To investigate the value of CAR in predicting microvascular invasion in single small HCC.

Methods

Participants (n=346) who were pathologically diagnosed with HCC following the resection of single liver tumor (diameter≤5 cm) were selected from the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2021. Demographic data and calculated CAR were collected. ROC analysis was performed to estimate the predictive value and optimal cut-off value of CAR for microvascular invasion in single small HCC. All patients were divided into two groups according to the optimal cut-off value of CAR (≥0.03 or <0.03) , and those with similar propensity scores estimated by Logistic model were matched by 1∶1 nearest neighbor matching, yielding two comparison groups with highly similar clinical characteristics, and the microvascular invasion rate between them was compared. Logistic regression was used in the sensitivity analysis of the predictive value of CAR for microvascular invasion in single small HCC before and after the aforementioned matching.

Results

One hundred and thirty-one (37.9%) cases were found with microvascular invasion and other 125 without (62.1%) . ROC analysis revealed that the AUC of CAR in predicting microvascular invasion in single small HCC was 0.787〔95%CI (0.697, 0.877) 〕, with 82.9% sensitivity and specificity 76.4% when the optimal cut-off point was determined as 0.03. Ninety-two of 145 cases with CAR<0.03 and 92 of 201 cases with CAR≥0.03 were successful matched, and the prevalence of microvascular invasion was found to be lower in the former group〔13.0% (12/92) vs 43.5% (40/92) 〕 (χ²=6.314, P=0.013) . Three Logistic models showed that CAR was an independent predictor of microvascular invasion in single small HCC, regardless of whether the participants were matched or not (P<0.05) .

Conclusion

CAR could be used as a predictor for microvascular invasion in single small HCC. CAR≥0.03 may indicate a very high probability of microvascular invasion.

Expression Levels and Clinical Significance of Serum NCAM1 and TTR in Tuberculous Meningitis

Yunhong WU, Shaolong ZHOU, Jing WANG, Yiqiu CAI, Yaming LIN

2022, 25(12):  1435-1440.  DOI: 10.12114/j.issn.1007-9572.2021.02.110

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Background

Tuberculous meningitis (TBM) is the most serious type of tuberculosis, usually yielding a high mortality. Antigen detection test in cerebrospinal fluid is the gold standard for etiological diagnosis of TBM, but it may easily lead to delayed treatment due to long culture time (42 days) and high cost. Non-invasive monitoring technologies have demonstrated a wide application prospect, and exploring relevant indicators will help to guide clinical treatment.

Objective

To investigate the expression levels of serum neural cell adhesion molecule 1 (NCAM1) and transthyretin (TTR) , and their associations with the condition and prognosis of TBM patients.

Methods

A total of 114 TBM patients〔TBM group, including 31 stage Ⅰ, 45 stage Ⅱ, and 38 stage Ⅲ by the British Medical Research Council (BMRC) staging system〕 were recruited from Sanya People's Hospital and Sanya Central Hospital from March 2017 to December 2020. All of them were treated with anti-tuberculosis therapy and followed up for 1 year after treatment, and their prognosis were classified as good (0-2 points, 63 cases) and poor (≥3 points, 51 cases) by the Modified Rankin Scale. TBM patients were compared to 46 healthy physical examines selected from the two hospitals during the same period in terms of baseline serum NCAM1 and TTR levels. NCAM1 and TTR levels measured at 6 time points (baseline, 7, 14 days after admission, and 1, 6 and 12 months after follow-up) were analyzed, and their associations with as well as predictive values for prognosis in TBM patients were assessed.

Results

TBM patients had much lower baseline serum NCAM1 and TTR levels than the controls (P<0.05) . Sage Ⅲ TBM patients had notably lower baseline serum NCAM1 and TTR levels than stage Ⅰ and ⅡTBM patients (P<0.05) . TBM patients with poor prognosis had significantly lower serum NCAM1 and TTR levels (measured at each of the aforementioned six time points) than those with good prognosis (P<0.05) . BMRC stage Ⅲ was associated with increased risk of poor prognosis (P<0.05) , while higher baseline levels of serum NCAM1 and TTR were associated with decreased risk of poor prognosis in TBM patients (P<0.05) . For predicting poor prognosis in TBM, the area under the ROC curve of the combination of baseline NCAM1 and TTR was greater than that of baseline NCAM1 (0.879 vs 0.665) or baseline TTR (0.879 vs 0.689) alone (Z=4.428, 3.941, P<0.05) .

Conclusion

TBM patients were found with decreased serum NCAM1 and TTR levels, which may be associated with their condition and prognosis. BMRC stage Ⅲ may be a risk factor for poor prognosis in TBM.

Development and External Validation of an Evidence-based Risk Prediction Model for Multidrug-resistant Bacterial Infections in ICU Patients

Qian ZOU, Miaomiao GENG, Yanhong ZHU

2022, 25(12):  1441-1448.  DOI: 10.12114/j.issn.1007-9572.2021.02.137

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Background

Previous research has found that multi-drug resistant (MDR) bacteria can be transmitted between ICU patients, and the infections caused by MDR bacteria may negatively affect the efficacy of current treatment. As the speed of diagnostic testing to identify MDR bacteria is relatively slow in clinical practice, the research regarding the prediction of MDR bacteria infections has developed.

Objective

To develop an evidence-based risk prediction model for MDR bacterial infections in ICU patients, and to verify it using the real-world clinical data collected retrospectively.

Methods

Potential risk factors for MDR bacterial infections in ICU patients were identified by a meta-analysis of studies regarding MDR bacterial infections in ICU patients included in databases of PubMed, EMBase, the Cochrane Library, CNKI, Wanfang, China Science and Technology Journal Database, Ace Base of CMA during January 2012 to June 2020 using Stata/SE 12.0 software, and were used to develop a risk prediction model by transforming effect size to the standardized regression (β) coefficient. Next the model was fully established and externally verified using the clinical data of adult ICU patients (n=3 908) recruited from Shanghai General Hospital from January 2018 to June 2021. ROC analysis was used to describe the predictive accuracy of the prediction model.

Results

Seventeen potential risk factors of MDR bacterial infections in ICU patients were identified through the meta-analysis of 31 included studies. The MDR bacterial infection risk prediction model incorporating these 17 factors with corresponding β value as coefficient (derived from converting the risk effect size of each factor) was developed: Logit (P) =-2.476 3 +0.086X₁〔gender (male) 〕+0.191X₂ (history of hospitalization) +0.392X₃ (being transferred from another hospital) +1.723X₄ (length of ICU stay) +0.315X₅ (other infections) +0.385X₆ (chronic obstructive pulmonary disease) +0.131X₇ (diabetes) +0.536X₈ (renal disease) +0.285X₉ (renal failure) +0.565X₁₀ (dialysis) +0.148X₁₁ (mechanical ventilation) +0.742X₁₂ (central venous catheter) +0.336X₁₃ (urinary catheter) +3.483X₁₄ (types of used antimicrobial drugs) +0.174X₁₅ (history of antimicrobial use) +0.975X₁₆ (history of carbapenems use) +1.151X₁₇ (history of aminoglycosides use) . External verification of the model revealed that the model had 64.36% sensitivity, 80.39% specificity, and 0.447 4 Youden index, and an AUC of 0.724.

Conclusion

Our model has been proved to have good performance in predicting the MDR bacterial infection risk in ICU patients, as well as relatively good applicability, scientificity, and practicability. The development regimen may be used as a reference for developing a risk prediction model for other diseases.

Correlation between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Severity of Biliary Acute Pancreatitis and Concurrent Liver Injury

Guohao LIAO, Bin CHENG, Hongyu YU, Shang XIONG, Li XU, Lidong WU, Hua ZHANG, Hang DU

2022, 25(12):  1449-1454.  DOI: 10.12114/j.issn.1007-9572.2021.02.141

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Background

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have proved to have a certain significance in predicting the severity of pancreatitis, however, at present, there are few relevant studies on the diagnostic and predictive value of NLR and PLR for liver injury in biliary acute pancreatitis (BAP) .

Objective

To explore the correlation between NLR and PLR in the severity of BAP and the concurrent acute liver injury (ALI) .

Methods

A total of 142 patients with BAP admitted to Emergency Department of the Second Affiliated Hospital of Nanchang University from March 2019 to March 2021 were selected and divided into mild (MAP) /moderately (MSAP) group (n=98) and severe (SAP) group (n=44) according to Atlanta classification. According to whether the liver function is damaged or not, they were divided into ALI group (n=92) and non-ALI group (n=50) . The ALI group was further divided into hepatocyte type liver injury subgroup (n=1) , bile duct type liver injury subgroup (n=16) and mixed type liver injury subgroup (n=75) . The general condition and clinical data of patients were collected, and the predictive value of NLR and PLR on the severity of BAP and concurrent ALI was explored by the ROC curve and binary Logistic regression analysis.

Results

The NLR and PLR in MAP/MSAP group were lower than those in SAP group (P<0.05) . The NLR and PLR in ALI group were higher than those in non-ALI group (P<0.05) . There was no significant difference in NLR and PLR between bile duct type liver injury subgroup and mixed type liver injury subgroup (P>0.05) . The area under the ROC curve of NLR, PLR and their joint prediction of SAP was 0.809, 0.667, 0.809, respectively. The area under the ROC curve of NLR, PLR and their joint prediction of ALI in BAP was 0.774, 0.767, 0.806, respectively. The area under the ROC curve of NLR, PLR and their joint prediction of the occurrence of cholangiocytic liver injury in BAP was 0.813, 0.742, 0.861, respectively. The area under ROC curve of NLR, PLR and their joint prediction of mixed liver injury in BAP was 0.763, 0.770 and 0.794 respectively. The results of binary Logistic regression analysis showed that elevated NLR was a risk factor for SAP〔OR=1.184, 95%CI (1.102, 1.271) , P<0.001〕. Elevated NLR and PLR were the risk factors for ALI in BAP〔OR=1.140, 95%CI (1.050, 1.238) , P=0.002; OR=1.007, 95%CI (1.001, 1.013) , P=0.023〕; elevated NLR was a risk factor for bile duct cell liver injury in BAP〔OR=1.184, 95%CI (1.054, 1.331) , P=0.004〕. Elevated NLR and PLR were risk factors for mixed liver injury in BAP〔OR=1.120, 95%CI (1.120, 1.221) , P=0.011; OR=1.007, 95%CI (1.001, 1.013) , P=0.034〕.

Conclusion

Elevated NLR is a risk factor for SAP, elevated NLR and PLR are the risk factors for ALI in BAP. The predictive value of NLR on the severity of BAP and concurrent ALI is better than PLR, and the combined detection effect is better.

Study on the Relationship between the Levels of Trace Elements and Vitamins in Peripheral Blood of Patients with End-stage Liver Disease and the Etiology and Severity of Disease

Ming KONG, Manman XU, Yu CHEN

2022, 25(12):  1455-1459.  DOI: 10.12114/j.issn.1007-9572.2021.02.140

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Background

Patients with end-stage liver disease such as liver cirrhosis and acute-on-chronic liver failure (ACLF) often have abnormal intake or absorption of trace elements and vitamins, but the relevant tests have not been popularized in clinic, the exact level of vitamins and trace elements and their relationship with disease in end-stage liver disease have not been clear, and the clinical intervention of trace elements and vitamins lacks pertinence.

Objective

To detect and analyze the levels of trace elements and vitamins in peripheral blood of patients with liver cirrhosis and ACLF and their relationship with the cause (alcoholic or non-alcoholic liver disease) and severity of the disease, providing basis for clinical targeted intervention in patients with end-stage liver disease.

Methods

From September 2020 to May 2021, 21 patients with ACLF hospitalized in the Fourth Department of Liver Disease, Beijing You'an Hospital, Capital Medical University were enrolled as the ACLF group by continuous fixed-point sampling. Nine patients with compensated liver cirrhosis who were hospitalized at the same time for elective endoscopic treatment or reexamination were enrolled as the liver cirrhosis group, and the patients were all in the compensatory period. Five healthy controls were enrolled as healthy control group. ACLF patients and liver cirrhosis patients were divided into alcoholic liver disease subgroup and non-alcoholic liver disease subgroup according to the cause of disease. The mass spectrometry was used to detect the levels of vitamin B₁, vitamin B₆, 25-hydroxyvitamin D, 25-hydroxyvitamin D₃ and trace elements (zinc, manganese, selenium ) in peripheral blood, in order to analyze the relationship between the levels of vitamins and trace elements in patients with liver cirrhosis and liver failure and the cause and severity of the disease〔total bilirubin (TBiL) , serum albumin (ALB) , international normalized ratio (INR) , Child-Pugh and MELD scores〕.

Results

The levels of TBiL, INR, scores of Child-Pugh and MELD in ACLF group were significantly higher than those in liver cirrhosis group, ALB was significantly lower than that in liver cirrhosis group (P<0.05) . The levels of 25-hydroxyvitamin D, 25-hydroxyvitamin D₃ and blood selenium in ACLF group were significantly lower than those in healthy control group and liver cirrhosis group (P<0.05) , the difference in the above indicators between liver cirrhosis groupand healthy control groupwas not statistically significant. The blood manganese in ACLF group and liver cirrhosis group was significantly higher than that in control group (P<0.05) . There was no significant difference in vitamin B₁, vitamin B₆, 25-hydroxyvitamin D, 25-hydroxyvitamin D₃, blood manganese and blood zinc between alcoholic liver disease subgroup and nonalcoholic liver disease subgroup (P>0.05) ; the blood selenium in alcoholic liver disease subgroup was significantly lower than that in nonalcoholic liver disease subgroup (P<0.05) . The levels of 25-hydroxyvitamin D, 25-hydroxyvitamin D₃ were positively correlated with TBiL, INR, Child-Pugh score and MELD score, and positively correlated with ALB level (P<0.05) . The levels of 25-hydroxyvitamin D and 25-hydroxyvitamin D₃ in Child-Pugh grade C patients were lower than those in Child-Pugh grade A patients (P<0.05) .

Conclusion

In patients with liver cirrhosis and ACLF, 25-hydroxyvitamin D and 25-hydroxyvitamin D₃ are reduced, which is obviously related to the severity of the disease; patients with liver cirrhosis and ACLF, especially those with alcoholic disease, have a significant decrease in blood selenium, which can be supplemented as appropriate in clinical treatment.

Original Research·Diabetic Complications

Awareness of Diabetic Foot, Level and Associated Factors of Foot Self-management Behavior in Wagner Grade 0 Diabetic Foot Patients in the Community

Daping HE, Qin ZHU, Huirong ZHANG

2022, 25(12):  1460-1463,1469.  DOI: 10.12114/j.issn.1007-9572.2021.02.095

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Background

Diabetic foot is a common diabetic complication and a major cause of diabetes-related disability, but there are few reports about awareness of diabetic foot and foot self-management behavior in Wagner grade 0 diabetic foot patients.

Objective

To analyze the awareness of diabetic foot, level and associated factors of foot self-management behavior in Wagner grade 0 diabetic foot patients in the community.

Methods

A total of 500 outpatients with Wagner grade 0 diabetic foot were selected from Changning District Xinhua Subdistrict Community Health Center from January to June 2021, to attend an on-site survey using a questionnaire developed by us, for understanding their knowledge of diabetic foot and approaches used to acquire the knowledge, as well as foot self-management behavior. Multiple linear regression analysis was used to analyze the associated factors of foot self-management behavior.

Results

The response rate was 100.0% (500/500) . The awareness rate of diabetic foot and average foot self-management behavior score of the respondents were 53.2% (266/500) , and (20.1±6.2) , respectively. The awareness of diabetic foot in the respondents differed by age, educational level, course of diabetes, and prevalence of receiving diabetes health education (P<0.05) . The foot self-management behavior score in the respondents differed by age, educational level, marital status, monthly per capita household income, course of diabetes, and prevalence of receiving diabetes health education (P<0.05) . Multiple linear regression analysis results demonstrated that, age (β=0.242) , educational level (β=0.417) , marital status (β=-0.175) , monthly per capita household income (β=-0.075) , course of diabetes (β=0.175) , and diabetes health education (β=-0.173) were associated with foot self-management behavior score (P<0.05) . The major approaches to acquiring knowledge of diabetic foot were guidance from the family doctor or community nurse (62.2%) , searching the Internet (33.2%) , and watching television/listening to the radio (30.6%) .

Conclusion

In Wagner grade 0 diabetic foot patients in the community, the awareness rate of diabetic foot is relatively low. Moreover, the level of foot self-management behavior is also relatively low, which may be associated with many factors, such as age, educational level, marital status, monthly per capita household income, course of diabetes, and diabetes health education.

Influencing Factors of Anemia in Patients with Diabetic Kidney Disease

Shili SHANG, Zijuan SUN, Lina BI, Wenjing ZHOU, Daiyu SHEN, Jingshan CHEN, Sha LUO, Yuerong FENG, Qian YANG, Jun LI

2022, 25(12):  1464-1469.  DOI: 10.12114/j.issn.1007-9572.2021.02.108

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Background

Patients with diabetic kidney disease (DKD) are more prone to anemia than those with non-diabetic kidney disease. Anemia quickens the progression of DKD, and is closely associated with cardiovascular disease and other complications. So studying the influencing factors of anemia in DKD is of great importance to the reduction of anemia incidence and the delaying of DKD progression.

Objective

To investigate the influencing factors of anemia in DKD.

Methods

Two hundred and fifty-four inpatients with DKD were selected from Department of Nephrology, First Affiliated Hospital of Kunming Medical University from January 2019 to September 2020. Data of them were retrospectively collected, including demographic information 〔gender, age, height, weight, blood pressure, duration of diabetes, calculated body mass index (BMI) , and smoke prevalence〕, and laboratory test indices 〔red blood cells (RBC) , serum hemoglobin (Hb) , total protein (TP) , albumin (ALB) , globulin (GLB) , alkaline phosphatase (ALP) , cholinesterase (CHE) , uric acid (SUA) , blood urea nitrogen (BUN) , creatinine (Scr) , cystatin C (Cys C) , retinol binding protein (RBP) , fasting plasma glucose (FPG) , calcium (Ca) , phosphorus (P) , magnesium (Mg) , zinc (Zn) , iron, unsaturatediron binding capacity (UIBC) , total iron binding capacity (TIBC) , ferritin, transferrin (TRF) , C-reactive protein (CRP) , and erythrocyte sedimentation rate (ESR) , glycated hemoglobin (HbA_1c) , UALB/CRE, 24-hour urine for microalbumin (24 h-mALB) , 24-hour urine for total protein (24 h-MTP) 〕 and estimated glomerular filtration rate (eGFR) . One hundred and sixteen cases were diagnosed with anemia, and 138 without (anemia was defined as serum Hb≤130 g/L for men, and ≤120 g/L for women) . Spearman rank correlation analysis and multiple linear regression analysis were used to explore the factors associated with anemia in DKD.

Results

Compared with patients without anemia, those with anemia had higher systolic blood pressure, and longer duration of diabetes (P<0.05) . Moreover, anemia patients had lower levels of RBC, Hb, TP, ALB, GLB, CHE, eGFR, serum Ca, Zn, iron, UIBC, TIBC, ferritin, and TRF, and higher levels of BUN, Scr, Cys C, RBP, FPG, serum P, Mg, CRP, ESR, and HbA_1c, UALB/CRE, 24 h-mALB, as well as 24 h-MTP (P<0.05) . Spearman rank correlation analysis showed that Hb was positively correlated with TP, ALB, CHE, eGFR, FPG, serum Zn, and iron, UIBC, TIBC, and ESR (P<0.05) and negatively correlated with SBP, duration of diabetes, BUN, Scr, serum Cys C, P, CRP, HbA_1c, UALB/CRE, 24 h-mALB, and 24 h-MTP (P<0.05) . Multiple linear regression analysis showed that duration of diabetes (β=-0.060) , ALB (β=0.755) , CHE (β=1.512) , Zn (β=1.173) , and HbA_1c (β=-5.766) in serum, and eGFR (β=0.341) were independently associated with serum Hb in DKD (P<0.05) .

Conclusion

Anemia in DKD may be associated with the duration of diabetes, serum levels of ALB, CHE, Zn and HbA_1c, as well as eGFR. The above-mentioned influencing factors should be actively corrected to reduce the incidence of anemia and to improve the quality of life in DKD patients.

Influencing Factors of Delayed Healthcare-seeking and Visiting Time in Patients with Diabetic Retinopathy

Hailin CHU, Yongxia REN

2022, 25(12):  1470-1474.  DOI: 10.12114/j.issn.1007-9572.2021.02.078

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Background

Diabetic retinopathy (DR) may cause vision loss, visual field defects, vitreous hemorrhage, and even blindness. However, there are few reports about delayed healthcare-seeking in patients with DR.

Objective

To analyze the influencing factors of delayed healthcare-seeking and visiting time in DR patients.

Methods

DR patients were recruited from Tianjin Eye Hospital from January to May 2018, to attend an anonymous questionnaire survey for understanding their healthcare-seeking status, and delay in healthcare-seeking (taking visiting time over 5 years as delayed healthcare-seeking) . Influencing factors of delayed healthcare-seeking were explored using multinomial ordinal Logistic regression analysis with the stepwise method.

Results

The survey achieved a response rate of 94.5% (120/127) . Among the 120 respondents, the visiting time was less than 1 year in 9 cases, 1 to 2 years in 11 cases, 3 to 5 years in 17 cases, and over 5 years in 83 cases; the prevalence of delayed healthcare-seeking was 69.1% (83/120) . The visiting time differed significantly by educational level, monthly income, place of residence, course of diabetes, vision, classification of diabetic macular edema, status of blood glucose monitoring, and prevalence of hypertension (P<0.05) . Multinomial ordinal Logistic regression analysis with the stepwise method showed that, place of residence〔OR=3.395, 95%CI (1.362, 7.053) 〕, vision〔OR=1.526, 95%CI (1.086, 2.775) 〕, prevalence of hypertension〔OR=1.307, 95%CI (1.002, 5.376) 〕, classification of diabetic macular edema〔OR=5.537, 95%CI (1.897, 9.534) 〕and status of blood glucose monitoring〔OR=2.582, 95%CI (1.271, 6.882) 〕were associated with the visiting time (P<0.05) .

Conclusion

The prevalence of delayed healthcare-seeking is high in patients with DR, which may be influenced by place of residence, vision, prevalence of hypertension, classification of diabetic macular edema and status of blood glucose monitoring.

Original Research·Characteristic Therapy of TCM

Efficacy and Mechanism of Action of Wuyintiaoshen Therapy in Patients with Post-stroke Insomnia

Chenchen GUO, Haifeng LU, He ZHUANG, Li LI, Congan WANG, Yi DING

2022, 25(12):  1475-1481.  DOI: 10.12114/j.issn.1007-9572.2021.02.101

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Background

Insomnia is a common post-stroke complication, which may greatly influence patients' recovery progress, and even induce the recurrence of cerebrovascular diseases. It has been reported that the traditional Wuyintiaoshen therapy has good efficacy in post-stroke insomnia, and can decrease the harm of adverse reactions often produced by western medicine treatment via reducing the intake of such medicines.

Objective

To explore the clinical effect and possible mechanism of action of Wuyintiaoshen therapy on post-stroke insomnia.

Methods

Post-stroke insomnia inpatients (n=90) were selected from Rehabilitation Department, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2019 to June 2020, and equally randomized into an experimental group and a control group. Besides usual rehabilitation training and basic medical treatment, experimental group received Wuyintiaoshen therapy〔listening to the music symbolizing the five elements (metal, wood, water, fire, and earth) in Chinese philosophy〕 plus acupuncture treatment with Baihui, Shenting, and Yintang acupoints, and the control group received oral alprazolam before sleeping. The treatment for all patients was 4 weeks. Clinical efficacy was evaluated by comparing pre- and post-treatment changes in sleep quality assessed using Pittsburgh Sleep Quality Index (PSQI) , quality of life assessed using Stroke-specific Quality of Life Scale (SS-QOL) , and sensorimotor impairment using Fugl-Meyer Assessment Scale (FMA) , as well as levels of serum 5-HT, melatonin and norepinephrine. Adverse reactions were observed during treatment.

Results

There was no significant difference in overall clinical efficacy between the two groups (P>0.05) . The incidence of adverse reactions was higher in the control group (P<0.05) . The PSQI, SS-QOL and FMA scores as well as serum levels of 5-HT, melatonin and norepinephrine were similar in both groups before and after treatment (P>0.05) . After treatment, the PSQI score and norepinephrine level decreased, and SS-QOL and FMA scores as well as serum levels of 5-HT and melatonin increased in both groups (P<0.05) , but were still similar in both groups (P>0.05) . Correlation analysis results showed that PSQI score was negatively correlated with SS-QOL or FMA score (r=-0.340, P=0.010; r=-0.350, P=0.008) .

Conclusion

Wuyintiaoshen therapy may produce good effects on post-stroke insomnia as an adjuvant therapy, which were similar to those of oral alprazolam, the mechanism may be related to the regulation of serum 5-HT, melatonin and norepinephrine, and sleep quality improvement had a direct linear relationship with motor function and life quality improvement.

Impact of Rational Emotive Behavior Therapy on Sleep and Mood in Patients with Post-stroke Depression

Ning ZHU, Yanyan DUAN, Na WANG, Mengzhou XUE

2022, 25(12):  1481-1486.  DOI: 10.12114/j.issn.1007-9572.2021.02.056

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Background

Depression is a common mood disorder that seriously affects the recovery of various functions in patients after stroke. Antidepressant drug therapy alone could not achieve satisfactory treatment responses.

Objective

To investigate the effects of rational emotive behavior therapy (REBT) on sleep and mood in patients with post-stroke depression.

Methods

Seventy-one patients with post-stroke depression were selected from Department of Neurological Rehabilitation, the Second Affiliated Hospital of Zhengzhou University from June 2019 to June 2020, and according to random number table, they were divided into the control group (n=35) or combined treatment group (n=36) . The control group received four consecutive weeks of treatment with oral sertraline hydrochloride tablets (25 mg per day within the first week, and 50 mg per day within other three weeks) . The combined treatment group received four consecutive weeks of treatment with REBT (three times per week, the treatment duration for each time lasting for 30 minutes) plus the same treatment for the control group. Pittsburgh Sleep Quality Index (PSQI) , Insomnia Severity Index (ISI) , 17-item Hamilton Depression Rating Scale (HAMD-17) , Hamilton Anxiety Rating Scale (HAMA) , and Modified Barthel Index (MBI) were used to assess pre- and post-treatment sleep quality, insomnia severity, depression prevalence, anxiety prevalence and ability to engage in basic activities of daily living, respectively.

Results

The mean scores of PSQI, ISI, HAMD-17, and HAMA showed a significant decrease and the mean score of MBI demonstrated a significant increase in both groups after treatment (P<0.05) . The mean post-treatment scores for PSQI and HAMA demonstrated no significant differences between two groups (P>0.05) . The combined treatment group had lower mean post-treatment scores of ISI and HAMD-17 and higher mean post-treatment score of MBI than the control group (P<0.05) . The improvement in depression was much better in the combined treatment group (P<0.05) . The improvement in anxiety was more obviously in the combined treatment group (P<0.05) .

Conclusion

REBT plus oral sertraline hydrochloride tablets could produce better effects on improving insomnia, mood, and ability to engage in basic activities of daily living in patients with post-stroke depression.

Moxibustion on Governor Vessel Acupoints Improves the Cognitive Function and TCM Symptoms in Patients with Post-stroke Mild Cognitive Impairment Due to Deficiency of Kidney Essence

Yan WANG, Yanjie BAI, Ming ZHANG, Xiaoxiao LI, Yongchuang ZHANG

2022, 25(12):  1487-1492,F01.  DOI: 10.12114/j.issn.1007-9572.2021.02.113

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Background

Post-stroke mild cognitive impairment (PSMCI) is a common complication after stroke, which negatively affects patients' full recovery from stroke and imposes financial and emotional pressure on their families.

Objective

To observe the clinical efficacy of moxibustion on Governor vessel on the cognitive function and TCM syndromes in PSMCI due to deficiency of kidney essence.

Methods

Eligible patients with PSMCI (n=60) who were treated in Rehabilitation Center, the First Affiliated Hospital of Henan University of CM from July 2020 to July 2021 were selected, and evenly randomized to a control group (routine basic treatment plus routine cognitive rehabilitation training) and a moxibustion group 〔routine basic treatment plus routine cognitive rehabilitation training and moxibustion on the Governor vessel acupoints (once daily, five times per week) 〕, received four consecutive weeks of treatment. The Mini-Mental State Examination (MMSE) , and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function. Symptoms of kidney essence deficiency was assessed by the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) . And quality of life was measured by the Specifications for Stroke-Quality of Life (SS-QOL) . The overall clinical efficacy and safety of the two treatments were evaluated.

Results

Pre- and post-treatment comparisons of scores of MMSE and MoCA, SDSVD, and SS-QOL revealed that moxibustion group patients group had greater improvements in cognitive function, symptoms of kidney essence deficiency, and quality of life than control group patients (P<0.05) . Moreover, moxibustion group patients had better clinical outcomes (P<0.05) . The safety of treatment showed no significant intergroup differences (P>0.05) .

Conclusion

Moxibustion of the Governor vessel helps to better improve the cognitive function and TCM symptoms of PSMCI patients due to deficiency of kidney essence with good clinical efficacy and safety.

Medication Analysis

Research Progress of Sodium-glucose Cotransporter 2 Inhibitor in the Treatment of T2DM Complicated with Coronary Heart Disease

Zikang FU, Haiying LI, Ping LI

2022, 25(12):  1493-1499.  DOI: 10.12114/j.issn.1007-9572.2022.02.024

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Diabetes is an independent risk factor for coronary heart disease, and the two are mutually causal in disease progression. Sodium-glucose cotransporter 2 inhibitor is a new oral medicine for the treatment of type 2 diabetes mellitus, which can play a hypoglycemic effect by blocking the reabsorption of glucose by the renal proximal convoluted tubules and increasing the excretion of urine glucose. A large number of studies have confirmed that in addition to hypoglycemic effects, SGLT2 inhibitors can also benefit in the treatment of coronary heart disease. This article mainly reviews the research progress and mechanism of SGLT2 inhibitors in the treatment of T2DM complicated with coronary heart disease.

Progress on Drug Therapy for Opioid-induced Constipation

Jiachun NI, Zengjin CAI, Qiong JIANG, Haibo LAN, Xiangdong YANG, Wenbin FAN

2022, 25(12):  1499-1505.  DOI: 10.12114/j.issn.1007-9572.2021.02.092

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Opioid-induced constipation (OIC) is one of the common adverse reactions of opioids, which may affect the quality of life and follow-up treatment compliance of patients. With the rise of number of cancer patients worldwide and the increase in the use of opioids in chronic non-cancerous pain, the number of OIC patients will increase accordingly. Therefore, how to achieve effective analgesia and balance the occurrence of analgesia and OIC is one of the clinical problems that need to be resolved urgently. At present, the main therapeutic drugs for OIC mainly include oral laxatives and peripheral μ-opioid receptor antagonists, secretagogues, traditional Chinese medicines, etc. This paper mainly analyzed the drug therapy of OIC, in order to provide a reference for the effective clinical prevention and treatment of OIC.

Investigations

Irritable Bowel Syndrome Prevalence and Influencing Factors in Senior High School Students

Mingxiu WANG, Junkai ZHANG, Wei XU, Xiaojie FAN, Fei LI, Guoying DENG

2022, 25(12):  1506-1511.  DOI: 10.12114/j.issn.1007-9572.2021.02.088

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Background

In recent years, with the increase of academic pressure, it is common for high school students to stay up late, eat and rest irregularly, leading to gradually increased yearly incidence of irritable bowel syndrome (IBS) in this population. IBS has a long course, long-term recurrent symptoms and unsatisfactory treatment effects, seriously affecting patients' quality of life, and causing socioeconomic burden of IBS.

Objective

To examine the prevalence, epidemiology, and risk factors of IBS in senior high school students, to provide a scientific basis for formulating practical and feasible IBS treatment plans for this group.

Methods

An epidemiological questionnaire survey was conducted with acluster random sample of senior high school students in Shanghai, Qinghai, Henan and Macao from July to August in 2020. The questionnaire includes demographic information, the prevalence of IBS, mental health, sleep habits, living habits and other relevant information. The Rome Ⅳ Criteria for IBS were used to diagnose IBS. The Symptom Checklist-90 (SCL-90) was used to assess mental problems and symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. SPSS 21.0 was used for the analysis of risk factors of IBS.

Results

A total of 5 046 cases attended the survey, 4 793 (95.00%) of them who returned effective questionnaires were included for final analysis. The prevalence of IBS was 4.50% (217/4 793) . It was found that higher grade, depression, anxiety, sensitive interpersonal relationships, eating spicy food, skipping meals, drinking alcohol, excessively bright and noisy sleep environment, poor and very poor sleep quality, sleeping latency≥ 15 min, sleeping time per night ≤7 h, taking hypnotic drugs, daytime disturbance and total PSQI score ≥7 points were associated with increased risks of IBS (P<0.05) .

Conclusion

IBS is a common and frequently-occurring disease among senior high school students. Regular diet, learning to relieve anxiety appropriately, and good sleep quality will contribute to lowering the probability of IBS.

Factors Associated with Compliance and Association between Compliance and Recurrence in Patients with Acute Pancreatitis

Liyanran YAN, Yaqian WANG, Rina WU, Tianran CHEN, Xueli ZHANG

2022, 25(12):  1512-1518.  DOI: 10.12114/j.issn.1007-9572.2022.02.015

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Background

Acute pancreatitis is one high-incidence acute abdominal condition, which is closely related to dietary habits and lifestyle. Patients' compliance with medical advice also directly affects treatment effect and prognosis. There are some studies on compliance in patients with acute pancreatitis, but little attention has been paid to its association with recurrence.

Objective

To investigate the factors associated with compliance with medical advice and the association between compliance and recurrence in patients with acute pancreatitis.

Methods

By use of convenience sampling, four grade A tertiary hospitals in Shijiazhuang City (The First Hospital of Hebei Medical University, the Second Hospital of Hebei Medical University, the Third Hospital of Hebei Medical University, and the Fourth Hospital of Hebei Medical University) were selected as survey settings, in which patients with acute pancreatitis treated from 2019 to 2021 were selected as the subjects. Then the patients were surveyed using a self-designed questionnaire for investigating their demographics, awareness level of acute pancreatitis, and health belief during the three days prior to discharge, and were followed up by telephone at 3, 6, and 12 months after the questionnaire survey for acquiring the recurrence. They also attended another survey using a self-designed questionnaire at the last telephone follow-up for understanding their compliance.

Results

In all, 100 cases attended the survey, 97 of them (97.0%) who effectively responded to the survey were included for final analysis. Among the 97 respondents, 62 (63.9%) were fully compliant, 27 (27.8%) partially compliant, and 8 (8.3%) non-compliant. Multivariate Logistic regression analysis showed that gender〔OR=9.393, 95%CI (1.909, 46.223) 〕, age〔OR=1.048, 95%CI (1.000, 1.099) 〕, education level 〔OR=0.572, 95%CI (0.333, 0.985) 〕, and awareness level of acute pancreatitis〔OR=0.902, 95%CI (0.834, 0.976) 〕 were associated with compliance in patients with acute pancreatitis (P<0.05) . During the 12 months of follow-up, 41 patients (42.3%) relapsed and 56 (57.7%) did not. There was a statistically significant difference in compliance of patients with and without recurrence (χ²=7.082, P=0.029) . Multivariate Logistic regression analysis showed that male 〔OR=10.798, 95%CI (1.034, 112.781) 〕, alcohol consumption〔OR=16.546, 95%CI (1.310, 209.049) 〕, cholelithiasis〔OR=8.502, 95%CI (1.694, 42.673) 〕, hyperlipidemia〔OR=5.287, 95%CI (1.098, 25.450) 〕, partial compliance〔OR=0.115, 95%CI (0.014, 0.947) 〕, and noncompliance〔OR=0.036, 95%CI (0.003, 0.513) 〕 were risk factors for the recurrence of acute pancreatitis (P<0.05) .

Conclusion

The factors affecting the compliance of patients with acute pancreatitis include gender, age, educational level, and awareness of acute pancreatitis, and compliance may be a key associated factor of the recurrence rate. Therefore, to reduce the development and recurrence of acute pancreatitis, it is suggested to take actions in accordance with the associated factors of compliance to promote relevant health education to improve patients' compliance with medical advice and ability of self-management. In addition, actions should be taken to reduce the influence of risk factors of recurrence of acute pancreatitis, such as improving unhealthy eating habits, quitting drinking, actively treating hyperlipidemia and other underlying diseases, and curing cholelithiasis and other predisposing factors as soon as possible.

Review

Latest Advances in the Associations of Early- and Mid-pregnancy Fasting Plasma Glucose with Pregnancy Outcome

Jinfeng GAO, Xiaoping YU, Ju ZHANG

2022, 25(12):  1519-1523.  DOI: 10.12114/j.issn.1007-9572.2021.02.094

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Gestational diabetes mellitus (GDM) , gestational hypertension, macrosomia, low birth weight, and premature delivery can directly affect short- and long-term maternal and infant health. Fasting plasma glucose can be obtained conveniently and rapidly during pregnancy. Numerous studies have verified that early- and mild-pregnancy fasting plasma glucose are associated with GDM, large for gestational age, and neonatal birth weight. But there is still some controversy about whether they associate with gestational hypertension and cesarean section. Furthermore, further studies are needed to examine their long-term influence on related diseases of pregnant women and their offspring in childhood and adulthood. This paper gives a summary of recent advances in the associations of early- and mid-pregnancy fasting plasma glucose with pregnancy outcome, providing a reference for future studies that profoundly explore relevant issues.

Novel Advances in Cognitive Impairmentin Amyotrophic Lateral Sclerosis

Shuanghui GUO, Yumei ZHANG

2022, 25(12):  1524-1528.  DOI: 10.12114/j.issn.1007-9572.2021.02.100

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Cognitive impairment is frequently found in patients with amyotrophic lateral sclerosis (ALS) , whose presence often suggests a poor prognosis.Recent years have seen some achievements in relevant research. We reviewed the clinical features, biomarkers, genetic features and latest therapeutic progress of cognitive impairment in ALS, aiming at providing new ideas for clinical management of this disease.

Research Progress on the Relationship between Mitochondrial Dysfunction and Post-stroke Depression

Zhimin DING, Kaiqi SU, Jing GAO, Tingyu CHEN, Yixuan FENG, Xiaodong FENG

2022, 25(12):  1528-1532.  DOI: 10.12114/j.issn.1007-9572.2021.02.099

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Post-stroke depression (PSD) is one of the most common emotional disorders that occurs after cerebrovascular diseases, with core symptoms mainly including low mood, loss of interest, and behavioral inhibition. A large amount of evidence indicates that mitochondrial dysfunction is one of the important pathophysiological factors in the occurrence and development of depression, so we put forward the hypothesis that mitochondrial dysfunction may be one of the pathogeneses of PSD. The article reviewed the relationship between mitochondrial dysfunction and PSD from the aspects of mitochondrial energy metabolism disorder, oxidative stress, deletions, damage or mutation of mitochondrial DNA, and apoptosis, so as to clarify the specific role of mitochondrial dysfunction in the pathogenesis of PSD and provide a new theoretical basis for the development of targeted antidepressants in the future.

Research Methodology

Development, Validity and Reliability of High-risk People's Intention to Use Stroke Screening Scale

Fengyin QIN, Yibing TAN, Xuqian HUANG, Qishan ZHANG, Xinglan SUN, Fen WANG, Xiting HUANG, Jun HUANG

2022, 25(12):  1533-1538.  DOI: 10.12114/j.issn.1007-9572.2021.02.115

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Background

The program of screening for stroke in high-risk populations is being carried out vigorously in Chinese communities, the implementation effectiveness of which is closely associated with residents' intention to use the program. However, there is no reliable scale for measuring high-risk residents' intention to use stroke screening.

Objective

To develop a scale for measuring high-risk people's intention to use stroke screening, and to assess its reliability and validity, providing a reliable tool for assessing high-risk residents' intention to use stroke screening.

Methods

The Theory of Planned Behavior, literature review, field survey and brainstorming were used to develop the item pool of the scale. Then the items were used to form an initial version of High-risk People's Intention to Use Stroke Screening Scale (three domains covering 28 items) after being revised in accordance with the assessment results of two rounds of expert survey with five experts (four stroke researchers and one with a good command of developing a scale) from July to August 2021. After that, the reliability and validity of the initial version of the scale was tested in August to September 2021 with a convenience sample of community residents from Hubei's Xiangyang, Wuhan, Jingmen, and Guangdong's Guangzhou, Huizhou, Shenzhen.

Results

Altogether, 535 residents attended the survey for testing the reliability and validity of the initial version of the scale, and 524 of them (98%) returned responsive questionnaires. The final revised version consists of four domains (positive attitude, negative attitude, subjective norms, perceived behavioral control) with 25 items. The Cronbach's α of the scale was 0.904. And its ICC for test-retest reliability was 0.810. The content validity index of each item (I-CVI) ranged from 0.80 to 1.00. The scale-level CVI/universal agreement (S-CVI/UA) and average scale-level CVI (S-CVI/Ave) were 0.93 and 0.99, respectively. By exploratory factor analysis, four common factors were extracted, and they explained 61.945% of the total variance. The loading for each factor was 0.482-0.828. Confirmatory factor analysis showed that the scale's fit indices were: χ²=361.040, df=267, χ²/df=1.352, RMSEA=0.038, GFI=0.897, CFI=0.958, AGFI=0.875, IFI=0.959, TLI=0.953, NFI=0.859.

Conclusion

The scale has proven to be highly reliable and valid, which could be used as a tool for measuring high-risk community-dwelling residents' intention to use stroke screening.