Table of Content

15 April 2022, Volume 25 Issue 11

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Guide·Consensus

Chinese Consensus on Diagnosis and Assessment of Sleep Apnea Syndrome in Older Adults

Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society

2022, 25(11):  1283-1293.  DOI: 10.12114/j.issn.1007-9572.2022.0014

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It is a necessary trend to improve the quality of life of rapidly increasing number of older adults. Sleep disorders are significantly associated with the quality of life in older adults, among which sleep apnea syndrome (SAS) is second only to insomnia, which is an inducer of multiple diseases, and directly associated with many chronic diseases, such as cardiovascular and cerebrovascular diseases, Alzheimer's disease, metabolic abnormalities, respiratory diseases, even leads to sudden death. So SAS in older adults should be given great attention by the whole society. With this in mind, the Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society invited Chinese sleep medicine experts to develop a consensus on the classification, risk factors, clinical symptoms, diagnosis and assessment methods, diagnostic procedures as well as complications of SAS in older adults based on a review of relevant clinical studies, aiming to provide a reference for the standardization of SAS diagnosis and assessment in China.

Interpretation of Global Strategy for the Diagnosis，Treatment，Management and Prevention of Chronic Obstructive Pulmonary Disease 2022 Report

CHEN Yahong

2022, 25(11):  1294-1304.  DOI: 10.12114/j.issn.1007-9572.2022.01.302

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Global initiative for chronic obstructive lung disease (GOLD) 2022 report was released on November 15, 2021. In general, chronic obstructive pulmonary disease (COPD) diagnosis, assessment and individualized therapy are the same as GOLD 2021, with corresponding content added in ten aspects. The article introduces and interprets the new content.

Clinical Decision Support

Blood Pressure Control Goals in Elderly Patients with Hypertension：Evidence from Latest Clinical Studies

LIU Kaixuan, GUO Yifang

2022, 25(11):  1305-1308.  DOI: 10.12114/j.issn.1007-9572.2022.01.303

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Due to the lack of relevant research evidence, the optimal blood pressure target in elderly hypertensive patients has been controversial for a long time. Many scholars believe that the elderly have poor tolerance to antihypertensive treatment, so their blood pressure control goal should bemore relaxed. However, the latest research evidence published in recent years shows that there may be more benefits from controlling systolic blood pressure in older adults to <130 mmHg. It is expected that these new research conclusions will have an important impact on the revision of guidelines in the future.

The Incubation Period of COVID-19 Caused by Different SARS-CoV-2 Variants

WU Yu, LIU Min

2022, 25(11):  1309-1313.  DOI: 10.12114/j.issn.1007-9572.2022.0078

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Since the beginning of the COVID-19 epidemic, the pathogen of COVID-19, SARS-CoV-2, has evolved and mutated continuously, producing variants with different enhanced transmission and virulence, such as Alpha (B.1.1.7) , Beta (B.1.351) , Gamma (P.1) , Delta (B.1.617.2) and Omicron (B.1.1.529) . An intensive study of the incubation period of COVID-19 caused by different SARS-CoV-2 variants will contribute to tracing the origin of COVID-19, determining the detention, quarantine and isolation time of close contacts, and timely improving measures for containing COVID-19. We reviewed the major studies on the incubation period of COVID-19 caused by wild-type strains and different variants of SARS-CoV-2, which estimated that the incubation period of COVID-19 caused by wild-type SARS-CoV-2 strains was 4-8 (median 5.5) days. And that for COVID-19 caused by Beta or Gamma variant was generally similar to that by wild-type strains, about 5 days. The incubation period of COVID-19 caused by Alpha, Delta and Omicron variants was shorter than that of other strains, which was 4, 4 and 3 days, respectively.

Research Status and Thinking of Minimal Clinically Important Difference in Patient-reported Outcome Assessment Tool for Allergic Rhinitis

ZHANG Peng, REN Jiaming, GUAN Jiarui, XIE Yang

2022, 25(11):  1314-1319.  DOI: 10.12114/j.issn.1007-9572.2021.01.502

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As the patient-reported outcome (PRO) assessment tool has been increasingly used in the clinical efficacy evaluation of patients with allergic rhinitis (AR) , the judgment and interpretation of changes in measurement results of assessment tools have become increasingly important. For the judgment of clinical research results, not only the statistical differences, but also the minimum clinically important difference (MCID) must be paid attention to. This paper systematically sorts out the MCID of the AR-PRO assessment tool, in order to provide a reference for AR-related clinical diagnosis and treatment decision-making and the objectification of the PRO assessment tool.

Article

Analysis of the Prevalence and Influencing Factors of Chronic Obstructive Pulmonary Disease in Elderly Hospitalized Patients：a Study Based on a Comprehensive Geriatric Assessment System in Yunnan Province

DAI Jingrong, LI Jie, HE Xu, LI Yang, LI Yan

2022, 25(11):  1320-1326.  DOI: 10.12114/j.issn.1007-9572.2021.01.054

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Current studies on chronic obstructive pulmonary disease (hereinafter referred to as COPD) mostly focus on the lung itself, while studies on the extrapulmonary manifestations of COPD are still lacking. Many studies in China and at abroad have shown that COPD is closely related to geriatric syndrome, but it has not been further confirmed.

To investigate the prevalence of COPD in senile inpatients in several hospitals in Yunnan Province in the past three years, and to explore the influencing factors of elderly COPD from the aspect of geriatric syndrome.

A total of 2 182 newly admitted elderly patients (≥60 years old) in several hospitals of Yunnan Province from September 2018 to June 2021 were selected as the research objects and divided into COPD group and non-COPD group according to whether the patients had COPD. The software platform of "Comprehensive Geriatric Assessment System" independently developed by the Geriatrics Department of the First People's Hospital of Yunnan Province was used to collect general data from the patients. At the same time, the scales in the system were used to conduct a comprehensive geriatric evaluation of the patients, including the assessment of anxiety and depression by 15-item geriatric depression scale (GDS-15) , the assessment of insomnia situation by athens insomnia scale (AIS) , the assessment of family support by PAGAR scale, the assessment of fall risk by Morse fall scale, the assessment of cognitive function by mini-mental state examination (MMSE) , the assessment of nutrition status by mini nutritional assessment scale, the assessment of the patients' daily living ability by the basic activities of daily living (BADL) scale, the assessment of frailty state by the Fried Scale, the assessment of swallowing (choking) by swallowing function assessment scale, the assessment of urinary incontinence by incontinence questionnaire simple form (ICI-Q-SF) , the assessment of constipation by Roma Ⅲ scale, the assessment of pain by visual analogue scale (VAS) . The influencing factors of COPD in the elderly hospitalized patients were analyzed by binary Logistic regression.

There were 1 558 cases (71.4%) in the non-COPD group and 624 cases (28.6%) in the COPD group. The results of binary Logistic regression analysis showed that age ≥75 and <85 years, age≥85 years old, male, anxiety and depression, potential malnutrition, malnutrition, pre-frailty, frailty were independent influencing factors of COPD (P<0.05) .

Elderly hospitalized patients aged ≥60 years have a higher prevalence of COPD and are closely associated with geriatric syndrome.

Effect of Sleep Time and Sleep Quality on the Risk of Low Back Pain among the Middle-aged and Elderly People in China

LI Qiaomei, WANG Yihui, YU Li, WANG Pengju, GAO Yinyan, ZHAO Honglin, DING Guowu

2022, 25(11):  1327-1333.  DOI: 10.12114/j.issn.1007-9572.2022.02.027

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As one of the disabling pains, low back pain seriously affects the quality of life of patients and causes a huge economic burden to them. Studies have shown that poor sleep quality has a certain effect on the occurrence of low back pain, but the dose-response relationship between sleep time and the risk of low back pain has been currently unclear, and there is a lack of relevant research in this area in China.

To explore the effect of sleep time and sleep quality on the risk of low back pain among the middle-aged and elderly people in China.

Using the longitudinal data of China Health and Retirement Longitudinal Study (CHARLS) between 2011 to 2015, all middle-aged and elderly people with a baseline age >45 year sat baseline from the three surveys in 2011, 2013, and 2015 were selected as the research subjects. The cut-off time of follow-up was 2015-12-31, and the self-reported low back and back pain was used as the outcome event, and follow-up was terminated upon the occurrence of the outcome event. Multivariate Cox proportional hazards regression analysis was used to assess the effect of sleep time and sleep quality on the risk of low back pain and the combined effect of them. Restricted cubic spline model was used to analyze the dose-response relationship between sleep time and the risk of low back pain.

A total of 4 459 subjects were included, with an average follow-up of (3.6±0.8) years; sleep duration: <7 h/d in 1 549 subjects (34.74%) , 7-8 h/d in 1 843 subjects (41.33%) , ≥9 h/d in 1 067 subjects (23.93%) ; 2 700 people (60.55%) with good sleep quality and 1 759 people (39.45%) with impaired sleep quality. A total of 643 people developed low back pain, the incidence rate was 14.42% (643/4 459) . The prevalence of low back pain in middle-aged and elderly people with sleep time <7 h/d was higher than that in middle-aged and elderly people with sleep time of 7-8 h/d and ≥9 h/d 〔the prevalence rates were 20.92% (324/1 549 ) , 10.91% (201/1 843) and 11.06% (118/1 067) 〕 (P<0.05) . The prevalence of low back pain among middle-aged and elderly people with impaired sleep quality was higher than that of middle-aged and elderly people with good sleep quality 〔21.38% (376/1 759) and 9.89% (267/2 700) 〕 (P<0.05) . The multivariate Cox proportional hazards regression analysis showed that, compared with sleep time of 7-8 h/d, sleep time <7 h/d was the influential factor of low back pain 〔HR=1.63, 95%CI (1.37, 1.95) , P<0.05〕; compared with better sleep quality, impaired sleep quality was an influential factor of low back pain 〔HR=1.85, 95%CI (1.58, 2.17) , P<0.05〕; compared with male and female sleeping for 7-8 h/d, the risk of low back pain in male and female sleeping <7 h/d was 1.47 times 〔95%CI (1.09, 1.98) , P<0.05〕 and 1.76 times 〔95%CI (1.41, 2.20) , P<0.05〕.The data changed to 2.09 times 〔95%CI (1.60, 2.74) , P<0.05〕 and 1.73 times 〔95%CI (1.41, 2.11) , P<0.05〕 when comparing happened between impaired and good sleep quality (P<0.05) . Restricted cubic spline model analysis showed a linear dose-response relationship between sleep time and the risk of low back pain (P_trend<0.05, P_non-linear=0.33) , and the risk of low back pain increased with the decrease of sleep time. There was a linear dose-response relationship between sleep time and the risk of low back pain in male and female (male: P_trend<0.05, P_non-linear=0.66; female: P_trend<0.05, P_non-linear=0.23) , and the risk of low back pain in male and female increased with the decrease of sleep time (<7 h/d) .The multivariate Cox proportional hazards regression analysis showed that, only sleep time ≥9 h/d with good sleep quality was not associated with the risk of low back pain compared to sleep time 7-8 h/d with good sleep quality (P>0.05) , sleep time<7 h/d with good sleep quality, sleep time<7 h/d with impaired sleep quality, sleep time 7-8 h/d with impaired sleep quality, sleep time≥ 9 h/d with impaired sleep quality all increased the risk of low back pain (P<0.05) .

Insufficient sleep time and impaired sleep quality are closely related to the occurrence of low back pain, and the risk of low back pain is significantly increased when insufficient sleep time and impaired sleep quality coexist.

Comparison of Three Risk Prediction Models for Carotid Atherosclerosis in Steelworkers

WANG Jiaojiao, CHEN Yuanyu, ZHENG Ziwei, YANG Yongzhong, CHEN Zhe, LI Chao, WANG Haidong, WU Jianhui, WANG Guoli

2022, 25(11):  1334-1339.  DOI: 10.12114/j.issn.1007-9572.2022.0125

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As a leading cause of ischemic cerebrovascular disease, carotid atherosclerosis (CAS) lowers the productivity of steelworkers. An increasing number of scholars have used machine learning to identify readily available factors to predict the risk of diseases. But there is still a lack of research on risk prediction models for CAS.

To compare the performance of support vector machine (SVM) -, BP neural network (BPNN) - and random forest (RF) -based models in predicting the risk of CAS in steelworkers.

4 568 steelworkers who underwent physical examination and health monitoring in Tangshan Hongci Hospital from March to June 2017 were selected for a survey using the Health Assessment Checklist developed by us for understanding their information about demographic characteristics (sex, age, BMI, education level, marital status) , personal behavior and lifestyle (smoking and drinking) , medical history (hypertension, diabetes, family history of CAS) , occupation history (current work in shifts, working under high temperature or in noisy environments) . Levels of serum cholesterol, triglyceride, homocysteine and uric acid were also collected. Variables for building SVM-, BPNN- and RF-based models for predicting the risk of CAS were determined using unconditioned multivariate Logistic regression analysis and literature review.

In predicting the risk of CAS in participants in the training set, the accuracy, sensitivity and specificity were 83.81%, 80.10%, 87.32%, respectively, for the SVM-based model, 79.27%, 66.19%, 91.62%, respectively, for the BPNN-based model, and 86.60%, 73.62%, and 98.90%, respectively, for the RF-based model. And the AUC for SVM-, BPNN- and RF-based models was 0.84, 0.79 and 0.86, respectively. The SVM-based model had the highest sensitivity, while the RF-based model had the highest accuracy and specificity (P<0.05) . In predicting the risk of CAS in participants in the test set, the accuracy, sensitivity and specificity were 85.70%, 81.63%, 90.29%, respectively, for the SVM-based model, 75.46%, 64.65%, 87.66%, respectively, for the BPNN-based model, and 73.37%, 60.00%, and 88.45%, respectively, for the RF-based model. And the AUC for SVM-, BPNN- and RF-based models was 0.86, 0.76, and 0.74, respectively. The SVM-based model had the greatest accuracy, sensitivity and AUC. The sensitivity, accuracy and AUC of the SVM-based model were significantly different from those of the BPNN- or RF-based model in predicting the CAS risk (P<0.05) .

The SVM-based model may be better than other two models in predicting the risk of CAS in steelworkers.

Relationship of Cognitive Function with Emotion and Sleep Architecture in Patients with OSAHS

LIU Yishu, TAN Huiwen, ZENG Yin, XIAO Li

2022, 25(11):  1340-1345.  DOI: 10.12114/j.issn.1007-9572.2022.01.603

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Background　Obstructive sleep apnea-hypopnea syndrome （OSAHS） is a sleep-related breathing
disease，which influences patients' sleep quality and emotion regulation due to long-term intermittent hypoxemia and sleep fragmentation. It has a close relationship with cognitive function. Objective　To explore the relationship of cognitive function
with emotion and sleep architecture in patients with OSAHS. Methods　A retrospective analysis was conducted. Participants
were 116 cases of OSAHS diagnosed by polysomnography（PSG） recruited from Sleep Medical Center，Shengjing Hospital of
China Medical University from September 2019 to December 2020. Clinical data were collected，including results of PSG and
questionnaires before PSG〔including Generalized Anxiety Disorder（GAD-7），Patient Health Questionnaire-9（PHQ-9），
Montreal Cognitive Assessment（MoCA），Mean Memory and Executive Screening（MES），Insomnia Severity Index（ISI），
Epworth Sleepiness Scale（ESS）〕. According to the total score of MoCA，participants were divided into normal cognition group
（≥ 26 points， n=79） and abnormal cognition group （<26 points， n=37）. Pearson and Spearman correlation analyses were
used to study the correlation of cognitive function with PSG indicators. Multiple linear regression analysisi was used to explore the
factors associated with cognitive function. Results　There were no significant differences in emotion functions between normal
cognition group and abnormal cognition group. Both groups had significant differences in mean age，sex ratio，MES score，total
arousals，arousals in non-rapid eye movement（NREM），arousals in rapid eye movement（REM），total sleep time（TST），
wake after sleep onset（WASO），sleep efficiency，percentage of stage N3 sleep（N3/TST%） and percentage of REM（REM/
TST%） （P<0.05）. Correlation analyses showed that MoCA score was negatively correlated with age，apnea hypopnea index
（AHI），and WASO（P<0.05），and positively correlated with TST，sleep efficiency，REM/TST%，total arousals and
arousals in REM（P<0.05）. The score of delayed recall in the MoCA scale was negatively correlated with age and WASO
（P<0.05），and positively correlated with sleep efficiency，REM/TST%，total arousals and arousals in REM（P<0.05）.The
total score of MES was negatively correlated with age（P<0.05），and positively correlated with REM/TST%，total arousals，
and arousals in NREM and REM（P<0.05）. Multiple linear regression analysis showed that age，AHI and REM/TST% were
associated with MoCA score（P<0.05），and age was associated with delayed recall score and MES score（P<0.05）. The final
regression model established using stepwise regression revealed that the MoCA score had a stronger correlation with age and REM/
TST%，and MoCA score was negatively correlated with age（P<0.05），and positively correlated with REM/TST%（P<0.05）.
Conclusion　The decline of cognitive function in OSAHS patients was significantly correlated with the reduction of REM. No
obvious abnormality in emotion was found in these patients with cognitive dysfunction. The relationship between cognitive function
and sleep architecture in OSAHS patients can be further clarified in future research.



Article

Effects of Non-invasive Positive Pressure Ventilation on Sleep of Patients in Respiratory Intensive Care Unit Assessed by Overnight Polysomnography

LIU Yanan, WANG Xi, ZHANG Cheng, SHEN Yane, MA Jing, WANG Guangfa

2022, 25(11):  1346-1350.  DOI: 10.12114/j.issn.1007-9572.2022.0064

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Sleep disorders are commonin RICU patients, with mechanical ventilation as one of the important factors leading to sleep disorders in RICU patients. Previous studies have mainly focused on the effect of invasive positive pressure ventilation (IPPV) on sleep in RICU patients, but there is no study on the effect of polysomnography on sleep in RICU patients with non-invasive positive pressure ventilation (NIPPV) .

To evaluate patients' sleep disorders and the effect of NIPPV on sleep in patients in respiratory intensive care unitsby overnight polysomnography.

The clinical data of 31 patients who underwent overnight polysomnography in the Department of Respiratory and Critical Care Medicine of Peking University First Hospital from May 2012 to August 2021 were retrospectively analyzed. The clinical data〔sex, age, height, body mass index, APACHEⅡscore, underlying diseases, main diagnosis, white blood cell count, hemoglobin, serum albumin, high-sensitivity C-reactive protein (hs-CRP) , arterial blood gas analysis, respiratory failure classification, total length of hospital stay, length of stay in RICU, RICU stay in the past 6 months, death during hospitalization〕, sleep characteristics 〔respiratory events: apnea-hypopnea index (AHI) , respiratory disturbance index (RDI) , total detection time, total sleep time, sleep latency, sleep efficiency, sleep stage: time, latency and proportion of REM and NREM, pulse oxygen: minimum pulse oxygen, average pulse oxygen during sleep, heart rate: minimum heart rate, maximum heart rate〕 of patients were collected. The patients were divided into NIPPV group and control group (non-NIPPV group) according to whether NIPPV treatment was performed during overnight polysomnography, and the clinical data and sleep characteristics of the two groups were compared.

There were 15 cases in the NIPPV group and 16 cases in the control group. Compared with the control group, the total sleep time (P=0.028) , REM sleep time (P=0.034) , NREM time (P=0.003) and N2 sleep time (P=0.003) were shortened in the NIPPV group, while the sleep efficiency (P=0.038) decreased, and the average heart rate increased (P=0.028) .

Sleep disturbance is a common problem in RICU patients, and NIPPV patients are more likely to lead to decreased total sleep time, decreased REM sleep, and decreased sleep efficiency. It is recommended that RICU patients be routinely assessed with overnight polysomnography and given appropriate intervention to conduct appropriate interventions.

Iurnal Variability of Airway Hyperresponsiveness in Asthma Patients

YU Xinxin, ZHENG Jinping, GAO Yi, XIE Yanqing, AN Jiaying, LIU Wenting, ZHONG Liping, WU Zhongping, ZHU Zheng

2022, 25(11):  1351-1356.  DOI: 10.12114/j.issn.1007-9572.2022.01.001

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There are daytime variability in pulmonary function indexes such as peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV₁) in asthma patients. Studies evaluating the effects of drug therapy on lung function and airway hyperresponsiveness (AHR) in asthma patients all required patients to perform spirometry and bronchial challenge test in the same time point of the days. However, whether there is a daily diurnal AHR variability is still not clear.

To explore the characteristics and diurnal variability of AHR in asthma patients.

The data of 202 patients with asthma who consulted in respiratory department of the First Affiliated Hospital of Guangzhou Medical University from January 2018 to September 2020 were included for statistical analysis. All patients completed the methacholine bronchial provocation tests, they were divided into the morning detection group (morning group) with 81 cases and the afternoon detection group (afternoon group) with 121 cases; according to the disease course, 98 cases were divided into the initial diagnosis group if the disease course was ≤6 months, and 104 cases were divided into the follow-up group if the disease course was >6 months. The initial diagnosis group and the follow-up group were divided into the initial diagnosis morning group, the initial diagnosis afternoon group, the follow-up morning group, and the follow-up afternoon group according to the detection time; according to the AHR, the patients were divided into very mild, mild, moderate and severe groups. The characteristics of AHR and the main pulmonary function indexes including FVC%pred, FEV₁%pred, PEF%pred, MMEF%pred, MEF50%pred, MEF25%pred, PD20-FEV₁, PD20-PEF, PD20-MMEF, PD20-MEF25%, PD20-MEF50% of these groups were analyzed and compared.

There were no significant differences of the math pulmonary function indexes and PD20 between morning and afternoon groups (P<0.05) . FEV₁%pred and PD20-PEF were significantly higher in initial diagnosed group than follow-up group (P<0.05) . There was no significant difference in FVC%pred, PEF%pred, MMEF%pred, MEF50%pred, MEF25%pred, PD20-FEV₁, PD20-MMEF, PD20-MEF25%, and PD20-MEF50% between the initial visit group and the follow-up visit group (P>0.05) . In follow-up group, MMEF%pred and MEF50%pred were higher in afternoon than in morning (P<0.05) . There were no differences of lung function and AHR between morning and afternoon in initial diagnosed group (P<0.05) . No obvious correlations were found between disease history and PD20. There were no significant differences of PD20-FEV₁ between the morning and afternoon, initial diagnosed and follow-up (P>0.05) .

The longer the duration of asthma, more serious impairment of lung function found in asthma, while the AHR had no significant difference between morning and afternoon.

Clinical Effect of Early Application of Self-prescribed Yiqihuoxue Decoction on Prevention and Treatment of Depressive Symptoms after Acute Myocardial Infarction

WANG Mengxi, LIU Qian, SHEN Le, CHEN Xiaohu

2022, 25(11):  1357-1362.  DOI: 10.12114/j.issn.1007-9572.2021.01.602

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Post-acute myocardial infarction (AMI) patients are prone to depression and other negative emotions. Current treatment for post-AMI patients with depression is anti-myocardial infarction treatment plus anti-depression treatment, in the circumstances that the patients have depression. In view of this, the therapeutic program could not be used early in most post-AMI patients.

To assess the effect of early application of self-prescribed Yiqihuoxue Decoction on the prevention and treatment of post-AMI depression.

Participants were eligible AMI inpatients (n=44) who were selected from Jiangsu Province Hospital of Chinese Medicine from May 2020 to March 2021 and equally randomized into a control group and an experimental group, receiving three-week standard Western treatment, and three-week standard Western treatment with self-prescribed Yiqihuoxue Decoction, respectively. The interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured at the end of one-week treatment. At the end of three-week treatment, depression prevalence was estimated using HAMD-17 score, angina pectoris was graded using angina score, and TCM syndrome score and improvement rate of TCM syndrome were measured.

The HAMD-17 score in the experimental group decreased significantly after treatment (P<0.05) . The IL-6 in both groups demonstrated a significant decrease after treatment (P<0.05) , and the decrease was much more obvious in the experimental group (P<0.05) . The IL-8 in the control group was lower after treatment than at baseline (P<0.05) . The post-treatment angina score in the experimental group was lower than that in control group (P<0.05) . The TCM syndrome score decreased significantly in both groups after treatment (P<0.05) . And it showed a much more obvious decrease in the experimental group (P<0.05) . The TCM syndrome improvement rate in the experimental group was higher than that in control group (P<0.05) .

For AMI patients, early use of self-prescribed Yiqihuoxue Decoction significantly reduced the serum IL-6 level, relieved angina pectoris symptoms and improved TCM syndrome, as well as slightly alleviated the incidence of depressive symptoms.

Application of Artificial Intelligence Technologies in a Cloud-based Platform for ECG Analysis to Support the Diagnosis of a Critical Electrocardiography in Primary Care

YU Xinyan, GU Zhile, ZHANG Xiaojuan, ZHAO Xiaoye, ZHANG Haicheng

2022, 25(11):  1363-1367.  DOI: 10.12114/j.issn.1007-9572.2021.01.411

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The cloud-based platform for electrocardiography (ECG) analysis plays a supporting role in the prevention and treatment of cardiovascular diseases. During the construction of a cloud-based platform for ECG analysis, problems that should be focused and addressed are exploring ways to better use artificial intelligence (AI) technologies supporting ECG analysis, and improving the process and effectiveness of AI-aided diagnosis of a critical ECG.

To explore the use of AI technologies in a cloud-based platform for ECG analysis to support the diagnosis of a critical ECG in primary care.

The 12-lead resting ECGs (n=20 808) uploaded to Nalong Cloud-based ECG Analysis Platform by primary healthcare institutions were selected from June 2019 to June 2021. After being interpreted by AI-based algorithms and physicians, respectively, ECG findings were classified into critical group (critical ECGs) , normal group (normal ECGs) , and positive group (abnormal but not critical ECGs) . The results interpreted by the AI-based algorithm were compared with those interpreted by physicians (defined as the gold standard) to assess the diagnostic agreement and coincidence rate between AI-based and physician-based interpretations, and to assess the diagnostic sensitivity, and positive predictive value of AI-based interpretation. And the mean time for making diagnoses of three groups of ECGs was calculated.

By the AI-based interpretation, 619, 15 634 and 45 55 ECGs were included in the critical, positive, and normal groups, respectively. And by the physician-based interpretation, 619, 15 759 and 4 430 ECGs were included in the critical, positive, and normal groups, respectively. There was high agreement between AI-based and physician-based interpretation results of ECGs〔Kappa=0.984, 95%CI (0.982, 0.987) , P<0.001〕, with a diagnostic coincidence rate of 99.4%. The diagnostic sensitivity and positive predictive value of AI-based interpretation for ECGs was 99.4%, and 100.0%, respectively. The mean time for making diagnoses of critical ECGs, abnormal but not critical ECGs, and normal ECGs was statistically different (P<0.001) , the mean time of critical critical ECGs was shorter than normal ECGs and abnormal but not critical ECGs (P<0.001) .

AI technologies used in a cloud-based platform for ECG analysis could provide physicians with support for interpreting ECGs, which may contribute to improving the interpretation accuracy, optimizing the diagnostic process, shortening the time for diagnosing a critical ECG, and the treating of critical patients in primary care.

Study on the Moderating Effect of Body Mass Index in Correlation of Anxiety and Depression Disorders

TIAN Yangli, YANG Zhaoxi, ZHANG Jianzhao, ZOU Xiaowei, FENG Jigao, ZHU Bo, WAN Ailan

2022, 25(11):  1368-1372.  DOI: 10.12114/j.issn.1007-9572.2021.01.416

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As two different kinds of mental disorders, anxiety disorder and depressive disorder could probably coexist in one with the proceeding of the illness. However, there are few studies on how to prevent and treat the coexistence of anxiety and depressive disorders.

To discuss the relationship between anxiety and depressive disorders, and the moderating effect of body mass index (BMI) in their relationship.

By use of simple random sampling, 86 outpatients and inpatients with anxiety disorders were selected from the First Affiliated Hospital of Nanchang University during June 1st to August, 31st, 2021. A self-made demographic questionnaire was used to obtain the demographic information. The Hamilton Anxiety Rating Scale was used to assess the anxiety level. The Hamilton Rating Scale for Depression was used to assess the depression level. Pearson correlation analyses were performed to assess the relationship between anxiety and depression disorders, and that between BMI and anxiety or depression disorder. Hierarchical regression analysis was adopted to explore the moderating effect of BMI on the relationship between anxiety and depressive disorders.

Eighty eligible cases were also diagnosed with depression. The anxiety prevalence was significantly increased with depression prevalence (r=0.70, P<0.01) . BMI had no significant linear correlation with anxiety prevalence (r=0.03, P>0.05) . BMI also had no significant linear correlation with depression prevalence (r=0.14, P>0.05) . BMI moderated the relationship between anxiety and depression disorders significantly (β=-0.16, P<0.01) .

BMI can weaken the effect of anxiety disorder on depression, helping prevent them from developing into comorbid mental disorders, providing new ideas for developing new dietary standard or exercise patterns for mental health prevention and treatment in the future and expands the research field of nutritional psychiatry to a certain extent.

Development and Application Effect of Knowledge-to-action Framework-based Health Management in Adolescents with Depressive Disorder in Remote Counties

LU Heli, LIU Yun, HUANG Zewen, GUO Ming, HUANG Xiaoqin, XU Xi, WANG Biyi, DONG Xiangli, LI Guanhua, HU Feihu

2022, 25(11):  1373-1377.  DOI: 10.12114/j.issn.1007-9572.2021.01.417

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The prevalence of depressive disorder in adolescents is increasing. Adolescents with depressive disorder in remote counties and their families have a low awareness of the disease, and often are difficult to complete the whole treatment.

To explore the application effect of knowledge-to-action (KTA) framework-based health management in adolescents with depressive disorder in remote counties.

Ninety-four adolescents with depressive disorder coming from remote countries were recruited from the Second Affiliated Hospital of Nanchang University from June to December 2020. They were randomly divided into a routine group (receiving a 12-week routine health management) and a KTA group (receiving a 12-week KTA framework-based health management) . At the time of enrollment and 12 weeks after intervention, the status of non-suicidal self-injury was assessed by the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ) , mobile phone use was evaluated by the Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) , the anxiety was evaluated with the score of the Screen for Child Anxiety Related Emotional Disorders (SCARED) , and the depression was assessed by the Depression Self-Rating Scale for Childhood (DSRS) .

Two groups had no significant differences in mean total scores of ANSAQ, SQAPMPU, SCARED, and DSRS before receiving intervention (P>0.05) .Two groups had no significant differences in each dimension score of SQAPMPU before receiving intervention (P>0.05) .After the 12-week intervention, the mean total scores of ANSAQ, SQAPMPU, SCARED, and DSRS decreased significantly in both groups (P<0.05) , and they were lowered more significantly in the KTA group (P<0.05) , the each dimension score of SQAPMPU decreased significantly in both groups (P<0.05) , and they were lowered more significantly in the KTA group (P<0.05) .

KTA framework-based health management could effectively reduce the incidence of non-suicidal self-injury and the problematic use rate of mobile phones, relieve the anxiety and depression in adolescents with depressive disorder in remote counties, indicating that this type of health management may have good applicability as an outpatient management in this group.

Effect of Cognitive Behavioral Therapy with Virtual Reality in the Treatment of Insomnia in Adolescents

XU Ou, QI Pei, ZHU Qisha

2022, 25(11):  1378-1382.  DOI: 10.12114/j.issn.1007-9572.2021.01.412

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The number of adolescents with insomnia is increasing in recent years. Cognitive behavioral therapy (CBT) is traditional treatment for this disease, but has some limitations. Virtual reality technology (VRT) is a novel treatment, but there is a lack of research on its effect on this disease.

To explore the effect of CBT with VRT on adolescents with insomnia.

Adolescents with insomnia were selected from Hangzhou Seventh People's Hospital from April 2020 to June 2021, and randomized into a control group (treated with CBT) and a test group (treated with CBT and VRT) . Sleep quality was measured in both groups at admission and four weeks after admission using the Pittsburgh Sleep Quality Index (PSQI) .

77 patients with adolescent insomnia were initially included, 15 cases of shedding were removed (12 in the control group and 3 in the test group) , and finally 62 cases were included, including 32 in the control group and 30 in the test group. After treatment, the test group had mean lower scores of four domains (overall sleep quality, sleep latency, duration of sleep, sleep efficiency) and mean total PSQI score than that of the control group (P<0.05) . But the mean scores of other three domains, sleep disturbance, need meds to sleep and day dysfunction due to sleepiness, were similar in the two groups (P>0.05) . The overall response rate of the test group was higher than that of the control group (P<0.05) . The patient treatment satisfaction rate of the test group was also higher than that of the control group (P<0.05) .The failure rate of the test group was lower than that of the control group (P<0.05) .

Adolescents with insomnia showed good response to and high satisfaction with CBT in combination with VRT. The therapy could notably improve the sleep quality of such patients, so its clinical application will be promising.

COVID-19 Containment

Analysis and Research on the Characteristics of COVID-19 Epidemic in Urban Village and Its Prevention and Control Strategies in Primary Care Institutions

ZHANG Dongying, YAO Mi, LIU Manling, GUO Fagang, WU Jiang, WANG Baoji, XIAO Baojun, XU Jing, LAI Yanmei, ZHENG Jinping

2022, 25(11):  1383-1386.  DOI: 10.12114/j.issn.1007-9572.2022.0098

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For a period of time, the outbreak of the COVID-19 outbreak in many urban villages in our country had caused concern. The dense and complex population structure of urban villages, with their inter-regional mobility, posed a challenge to the prevention and control of the epidemic.

Urban village areasare more prone to regional outbreaks of infectious diseases because of their spatial environment, demographic characteristics, cross-regional mobility and the characteristics of residents' medical treatment behavior. The purpose of this study was tounderstand the characteristics of the COVID-19 epidemic situation in urban villages and the current situation and difficulties of primary care institutions in carrying out COVID-19 epidemic prevention and control measures, in order to provide references for primary care institutions to deal with normalized prevention and control, social dynamic clearing work and future infectious disease prevention and control.

By using public opinion analysis, literature retrieval, online interviews with epidemic prevention and control personnel and experts in urban village, the epidemic situation, prevention and control status of urban village were summarized, and the existing weak links and important loopholes were analyzed.

Based on the relevant information, a total of six points of concern were extracted: (1) The number of mapping and screening objects was large, which was the focus and difficulty of epidemic prevention and control work in urban villages. (2) There was not strict closed-loop management lead to virus carriers who were not timely controlled, which caused a risk of spreading the epidemic. (3) The prevention and control of nosocomial infection in primary care institutions was not in place. (4) There were loopholes in the inspection of close contacts in the principle of territorial management; close contacts who did not live and work in the same administrative area but only screened in their living places, which may lead to the spread of the epidemic in workplaces where secondary close contacts may be at risk of infection were not screened in a timely manner. (5) Overload had become the norm, highlighting the large gap in primary health care manpower. (6) During the normalization of epidemic prevention and control, residents were paralyzed and careless, and the phenomenon of not wearing masks in public places and crowd gathering was common. Health education still needs to be strengthened and emphasized that residents were the first responsible for their own health.

Primary care providers played an important role in the prevention and control of COVID-19 in urban village by undertaking community management, outpatient treatment, public health services, health education, vaccination, quarantine hotel stationing, joint prevention and control, etc. It was recommended that additional fever sentinel clinics be set up for early detection and isolation to avoid further spread of the epidemic, rental houses be requisitioned to meet the demand for isolated medical observation, primary care institutions be strengthened for hospitalization and prevention, green relief channels be opened to protect special groups from medical treatment, volunteers be organized to reinforce primary care institutions, and health education emphasized that residents were the first to be responsible for maintaining their own health and raised personal awareness of the risk of COVID-19 prevention and control.

Rural Physicians' Duties and Responsibilities in COVID-19 Pandemic Containment：an Empirical Study from the Perspective of Governance in Primary Care

XU Ting, LIU Lanqiu, LI Jin

2022, 25(11):  1387-1392.  DOI: 10.12114/j.issn.1007-9572.2022.0100

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COVID-19 pandemic containment in rural areas is the frontline for containing COVID-19 and a key part of response system for public health emergencies in China, during which rural physicians play an important role as the "gatekeeper" of rural residents' health and rural pandemic prevention and control. However, rural physicians have demonstrated some work-related problems during the COVID-19 pandemic containment, which have affected the implementation effectiveness of their duties and responsibilities.

To investigate the duties and responsibilities of rural physicians during COVID-19 pandemic containment in rural areas, and to identify the problems, then put forward relevant suggestions.

An on-site semi-structured interview using non-participant observation approach was carried out in Beijing's Huairou District from April to July, 2021. Eighteen rural physicians were selected to attend the interview as stakeholders. The interview was guided by an outline developed based on a literature review and an expert consultation, including three parts: (1) demographic characteristics (practice location, sex, age) , (2) practicing qualifications (education level, starting time of practicing, professional qualifications) , (3) involvement in COVID-19 pandemic prevention and control (awareness of the 10 instructions for COVID-19 pandemic containment in village clinics, participation in COVID-19 pandemic containment, and personal protective equipment materials for COVID-19) . The interview was continued until data saturation.

Among the 18 rural physicians, 14 (77.8%) were certified as rural physicians, 3 (16.7%) were certified as rural assistant general practitioners, 2 (11.1%) had a certificate of licensed physician and 1 (5.6%) had a certificate of licensed assistant physician. Except for one (5.6%) , the rural physicians〔17 (94.4%) 〕 indicated that they knew the 10 instructions for COVID-19 pandemic containment in the village clinic. The top three services about COVID-19 pandemic containment most frequently provided by the rural physicians were health education (94.4%) , information reporting (72.2%) and diagnosis and treatment (64.7%) , and the least provided was throat swab sampling〔only one case (5.6%) 〕. In addition, three rural physicians participated in providing other services, which included screening suspected COVID-19 cases in the village, guiding COVID-19 pandemic containment in the village, and purchasing food for villagers. Ten physicians (55.6%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 8 (44.4%) expressed that such materials were inadequate during the first response phase. During the regular COVID-19 pandemic containment phase, 16 physicians (88.9%) indicated that personal protective equipment materials for COVID-19 were adequate, but other 2 (11.1%) still indicated that such materials were inadequate. The top four personal protective equipment materials for COVID-19 owned by the physicians in regular COVID-19 pandemic containment phase were 84 Disinfectant (72.2%) , ordinary disposable medical masks (66.7%) , disposable gloves (66.7%) and medical surgical masks (61.1%) , and the least owned were medical protective clothing (38.9%) and goggles (11.1%) .

Rural physicians play a necessary role in COVID-19 pandemic containment in rural areas, but the effectiveness of their services has been affected by limited personal capabilities in delivering COVID-19 pandemic containment services (including pharyngeal swab sampling) , lack of a legal right to provide home-based isolation and monitoring services, and inadequate personal protective equipment materials. Therefore, it is recommended that relevant laws and regulations should be improved to provide a legal right for rural physicians to perform their duties and responsibilities in COVID-19 pandemic containment, recruit them to the public health team of the village committee, and ensure the provision of emergency materials for village physicians to help them to realize their potential in pandemic containment.

Review

Current Status of PD-1/PD-L1 Anti-tumor Therapy and Exploration of the Mechanism of Immune-related Adverse Events

YANG Leiyi, LIN Sang, XIE Qibing, YIN Geng

2022, 25(11):  1393-1398.  DOI: 10.12114/j.issn.1007-9572.2021.01.312

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Programmed cell death protein-1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors are a group of immune checkpoint inhibitors. Since May 2006, there have been 10 immune checkpoint inhibitors targeting PD-1 and PD-L1 for tumor treatment. Although PD-1/PD-L1 inhibitors show promising curative effects on certain tumors, serious immune-related adverse events limited the clinical application. Therefore, it is urgent to develop new drugs with the same efficacy but fewer side effects than PD-1/PD-L1 inhibitors. In addition, exploring the mechanisms of immune-related adverse events provides a scientific foundation for developing personalized intervention strategies, which is equally important in the research of PD-1/PD-L1 inhibitors. This review discusses the mechanism and immune-related adverse events of several anti-PD-1/PD-L1 monoclonal antibodies, aiming at reminding clinicians of the occurrence of related adverse events while performing anti-tumor therapy. Moreover, this review also points out the possible research direction of PD-1/PD-L1 inhibitors in the future.

Research Advances in Vestibular Rehabilitation Mechanism and Treatment

QI Xiaoyuan, SONG Ning, GU Ping, YANG Xu

2022, 25(11):  1399-1405.  DOI: 10.12114/j.issn.1007-9572.2021.01.104

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Recent years have seen rapid advances in clinical diagnosis and treatment of vestibular diseases, especially vestibular evaluation and rehabilitation technologies, greatly promoting the developments in individualization and precision of rehabilitation for peripheral and central vestibular diseases. The vestibular rehabilitation helps to correct inappropriate strategy of equilibrium and/or to accelerate a good but slow compensation phenomenon, effectively improve vestibular, visual, and proprioceptive inputs to balance coordination control ability, improve the compensatory function of central nervous system, so as to reduce or eliminate the symptoms of dizziness, vertigo, and balance instability, eventually restoring the normal vestibular status. Given this background, we reviewed the advances in mechanisms of rehabilitation, pre-rehabilitation evaluation, rehabilitation program formulation and treatment regarding vestibular diseases, offering insights into clinical implementation and research concerning vestibular rehabilitation in China.

Research Progress on the Relationship between Osteoporosis and Cognitive Impairment

REN Yun, TAO Liyuan, FAN Dongwei

2022, 25(11):  1406-1410.  DOI: 10.12114/j.issn.1007-9572.2021.01.314

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In recent years, studies have shown that among elderly comorbidities, the incidence of comorbidity between osteoporosis and cognitive impairment is increasing year by year, which is manifested as a high incidence of falls and an increased risk of fractures, which leads to disability, increased mortality, and serious harm to health and quality of life of patients with comorbidities also bring a heavy economic burden to the family and society, which has become a more difficult problem in the management of chronic diseases in the community. This article reviews the progress of the relationship between osteoporosis and cognitive impairment. The focus is on the co-morbidity mechanism, clinical risk factors and clinical features of co-morbidity between osteoporosis and cognitive impairment. It is found that osteoporosis is closely related to cognitive impairment and seriously endangers the health of the elderly. It is hoped that this article can provide ideas for exploring new risk factors for comorbidity of osteoporosis and cognitive impairment, and provide help for the effective prevention and management of patients with comorbidity of osteoporosis and cognitive impairment.