Table of Content

15 December 2022, Volume 25 Issue 35

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Guide Interpretation

Global Strategy for Asthma Management and Prevention: Interpretation of the Updates in 2022

CHANG Chun, SUN Yongchang

2022, 25(35):  4355-4362.  DOI: 10.12114/j.issn.1007-9572.2022.0554

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Asthma is a serious health problem affecting people of all ages worldwide. To address asthma, the Global Initiative for Asthma Expert Group published the Global Strategy for Asthma Management and Prevention in 1995, and an updated version (GINA 2022) with new evidence being incorporated, on the World Asthma Day, May 3, 2022. Asthma prevalence is increasing but is unsatisfactorily controlled generally in China. We mainly interpreted the update points in the GINA 2022, discussed the management of asthma during the COVID-19 pandemic, and assessed the significance of the GINA 2022 for the diagnosis and treatment of asthma in China.

Monographic Research·Comorbidity

Multimorbidity in Elderly Population: Challenges and Coping Strategies

ZHANG Yili, HUANG Xinyi, QI Baoyu, SUN Chuanrui, WANG Xiaoyang, WEI Xu, XIE Yanming

2022, 25(35):  4363-4368.  DOI: 10.12114/j.issn.1007-9572.2022.0514

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Multimorbidity has become a prominent public health problem in older people in China as the country reached an aging society. Summarizing the studies in multimorbidity in elderly population and analyzing and discussing the coping strategies are of great significance for comprehensive management of this group of people. Herein, we reviewed the latest studies about multimorbidity in older people involving management practice, diagnosis and treatment model, medication strategy, and the building of medical and nursing team and health management system. Besides that, we summarized the following coping strategies: establishing a patient-centered multimorbidity management research program, promoting the application of geriatric multimorbidity assessment tools, conduct research on the common etiology and pathogenesis of comorbidity, developing standardized guidelines/consensuses on multimorbidity management, formulating treatment schemes using the TCM ideas of "treating diseases according to syndrome" and "holistic treatment", Internet technologies and smart wearable devices, and conducting early risk assessment and management of multimorbidity. In addition, we provided a comprehensive outlook on future research directions. All this is aimed at providing a reference for further in-depth research in this field.

Comorbidities of Osteoporosis: Recent Advances and Early Screening

WEI Xu, LIU Ning, ZHANG Yili, HAN Tao, SUN Kai, QI Baoyu, CHEN Xin, QIN Xiaokuan, GAO Jinghua, XIE Yanming, ZHU Liguo

2022, 25(35):  4369-4374.  DOI: 10.12114/j.issn.1007-9572.2022.0425

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Comorbidities are highly prevalent in osteoporosis patients, including endocrine, circulatory, respiratory, urinary, immune, musculoskeletal, and neurological diseases, which may aggravate osteoporosis, increase the risk of osteoporotic fracture, and seriously affect the quality of patient's life, bringing more challenges to associated clinical management, and imposing a heavy burden on the families and society. There is still a lack of studies on comorbidities of osteoporosis, and the existing research strategies are inadequate to support clinicians to carry out comorbidity management in terms of understanding the causes of osteoporosis and associated comorbidities, and delivering interventions for prevention and treatment of both of them. In view of this, it is suggested to use multidisciplinary integrated treatment, and strengthen the understanding of osteoporosis related comorbidities and their pathogenesis. Moreover, the screening for osteoporosis in people with possible osteoporosis risk should be performed as early as possible, and actions should be taken actively to reduce the risk of fracture in those who are found with osteopenia or osteoporosis. Early screening, diagnosis and treatment are necessary to realize the prevention and treatment of osteoporosis and associated comorbidities.

Prevalence and Associated Factors of Lumbar Disc Herniation in Osteoporosis: a Cross-sectional Survey

HAN Tao, SUN Kai, SUN Chuanrui, ZHANG Yili, XIE Yanming, SHEN Hao, WANG Xu, QI Baoyu, ZHU Liguo, WEI Xu

2022, 25(35):  4375-4380.  DOI: 10.12114/j.issn.1007-9572.2022.0584

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Background

Osteoporosis (OP) and lumbar disc herniation (LDH) are two common orthopedic diseases encountered clinically, which are closely related and often coexisted, causing great suffering to middle-aged and elderly people along with the accelerated process of population aging.

Objective

To perform a cross-sectional survey on the prevalence and associated factors of LDH in OP in community-dwelling middle-aged and elderly people in Beijing, providing a reference for clinical prevention and treatment of this disease.

Methods

From November 2017 to July 2018, 1 540 residents with complete demographics and bone mass measurement data who lived in 10 communities in Chaoyang District and Fengtai District of Beijing were selected. A survey was conducted with the residents for understanding their data collected on-site, including demographics, fracture history, fall history, history of hereditary disease, bone mineral density, EuroQol Health Utility score, then those with OP were further selected and divided into two groups by the prevalence of LDH. Multivariate Logistic regression analysis was used to explore the influencing factors of LDH in OP.

Results

A total of 521 cases of OP attended the survey, except for one with missing information of LDH, the other 520 cases (80 with LDH, and 440 without LDH) were included for final analysis. Multivariate Logistic regression analysis indicated that after controlling for age and BMI, falls〔OR=1.96, 95%CI (1.02, 3.78) , P=0.044〕, fracture〔OR=1.80, 95%CI (1.04, 3.12) , P=0.035〕and pain/discomfort〔OR=2.43, 95%CI (1.41, 4.18) , P=0.001〕were independently associated with LDH in OP.

Conclusion

The coexistence of LDH and OP was common in this population. Falls, fractures, and pain/discomfort may be influencing factors of LDH in OP.

Article

Prevalence and Influencing Factors of Sarcopenia in Essential Hypertension

YANG Chen, HE Huajuan, LI Jianpu, CHEN Jun

2022, 25(35):  4381-4388.  DOI: 10.12114/j.issn.1007-9572.2022.0494

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Background

The prevalence of sarcopenia is rising along with global population aging, and it is estimated that there will be about 200 million sarcopenia patients worldwide by the mid-21st century. Both essential hypertension and sarcopenia are common in the elderly, but the correlation between them has been rarely studied in China.

Objective

To examine the prevalence and risk factors of sarcopenia in middle-aged and elderly patients with essential hypertension, providing a reference for secondary prevention and early delivery of intervention of sarcopenia in this group.

Methods

A total of 107 patients with essential hypertension aged ≥50 years who were hospitalized in Geriatric Department, the First People's Hospital of Yunnan Province from December 2020 to December 2021 were enrolled. Sarcopenia was diagnosed by the recommendation from Asian Working Group for Sarcopenia in 2019. Nutrition status was assessed using the Mini-Nutritional Assessment Scale-Short Form (MNA-SF) . The general demographics, sarcopenia diagnostic indicators, laboratory indicators and MNA-SF assessment results were collected. Binary Logistic regression analysis was used to explore the influencing factors of sarcopenia in essential hypertension. The receiver operating characteristic (ROC) analysis was performed to explore the predictive value of body mass index (BMI) for sarcopenia in essential hypertension.

Results

Among the 107 patients, 53 (49.5%) were diagnosed with sarcopenia, and other 54 (50.5%) cases had no sarcopenia. The prevalence of sarcopenia in slightly underweight, normal weight, overweight or obesity patients was 83.3% (5/6) , 64.2% (34/53) , 30.0% (12/40) , 25.0% (2/8) , respectively. The prevalence rate of sarcopenia decreased with the increase of BMI (χ²_trend=15.027, P=0.001) . Logistic regression analysis showed that female〔OR=0.175, 95%CI (0.059, 0.518) 〕, overweight〔OR=0.039, 95%CI (0.003, 0.513) 〕, obesity〔OR=0.019, 95%CI (0.001, 0.459) 〕, higher 25- (OH) D〔OR=0.914, 95%CI (0.843, 0.991) 〕, and higher MNA-SF score〔OR=0.832, 95%CI (0.697, 0.992) 〕 were associated with decreased risk of sarcopenia (P<0.05) , while older age〔OR=1.139, 95%CI (1.073, 1.209) 〕, increased systolic blood pressure〔OR=1.038, 95%CI (1.001, 1.076) 〕 and increased diastolic blood pressure〔OR=1.095, 95%CI (1.035, 1.159) 〕 were associated with increased risk of sarcopenia (P<0.05) . The area under the ROC curve of BMI in predicting sarcopenia was 0.749〔95%CI (0.656, 0.843) 〕, with 52.8% sensitivity and 88.9% specificity when 22.0 kg/m² was determined as the optimal cut-off value.

Conclusion

The prevalence of sarcopenia was high in middle-aged and elderly patients with essential hypertension, the risk of which was increased with advanced age, higher systolic blood pressure and diastolic blood pressure, and declined with being female, overweight, obesity, higher vitamin D and good nutrition. BMI may be a good predictor of sarcopenia in essential hypertension.

Effect of Periodic Limb Movements in Sleep on Sleep Structure in Stroke Patients

HU Yaya, ZHU Ning, XUE Mengzhou

2022, 25(35):  4389-4393.  DOI: 10.12114/j.issn.1007-9572.2022.0468

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Background

Sleep disorder is a common complication of stroke with various clinical manifestations. Among them, periodic limb movements in sleep (PLMS) are characterized by repetitive and stereotyped limb movements during sleep. Due to limited clinical date, the pathogenesis of PLMS and their impact on prognosis of stroke are still in the exploratory stage. Studies about the effect of PLMS on sleep in stroke patients are few in worldwide.

Objective

To explore the sleep structure of stroke patients with PLMS.

Methods

From December 2020 to February 2022, a total of 81 stroke patients with sleep disorders were selected from the Second Affiliated Hospital of Zhengzhou University, in which polysomnography (PSG) was performed. The clinical information and PSG sleep monitoring data of patients were collected. According to the Periodic Limb Movement Index (PLMI) , the patients were divided into non-PLMS patients (control group, PLMI<15 times/h) and PLMS patients (experimental group, PLMI≥15 times/h) . The parameters between two groups were compared. These parameters include awake PLMI, sleep efficiency, proportion of stage N1 sleep in total sleep time, proportion of stage N2 sleep in total sleep time, proportion of stage N3 sleep in total sleep time, REM sleep in total sleep time, sleep apnea hypopnea index (AHI) , sleep latency, arousal index, and periodic limb movement arousal index (PLMAI) . Moreover, the correlation between PLMS and sleep structure and related parameters was analyzed.

Results

There were 42 cases in the control group and 39 cases in the experimental group. The awake PLMI, proportion of stage N1 sleep in total sleep time, proportion of stage N2 sleep in total sleep time, arousal index and PLMAI in experimental group were higher than those in control group (P<0.05) . However, the sleep efficiency and proportion of stage N3 sleep in total sleep time of experimental group were lower than those of control group (P<0.05) . There was no significant difference between two groups in sleep latency, AHI and REM stage sleep in total sleep time (P>0.05) . The results of Spearman rank correlation analysis showed that PLMS was positively correlated with awake PLMI, proportion of stage N2 sleep in total sleep time, sleep latency, arousal index, and PLMAI (r_s values were 0.619, 0.250, 0.271, 0.312, 0.828, respectively; P values were <0.001, 0.024, 0.014, 0.005, <0.001) , which were negatively correlated with sleep efficiency (r_s=-0.345, P=0.002) .

Conclusion

Stroke patients with PLMS have objective sleep disturbance and reduced sleep efficiency, and PLMS may be one of the signs of poor prognosis of stroke.

Correlation between Serum Thyroid Hormone and Hyperuricemia in Euthyroid Hypertensive Patients

ZHAO Wei, YANG Shanshan, TANG Rongjie, YANG Fang, SUN Feng, LIAN Qiufang

2022, 25(35):  4394-4398.  DOI: 10.12114/j.issn.1007-9572.2022.0557

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Background

Hypertension is closely related to serum uric acid (SUA) level, and often accompanied by thyroid function changes. However, there are few reports on the relationship between thyroid hormone level and hyperuricemia (HUA) in euthyroid hypertensive patients.

Objective

To explore the correlation between serum thyroid hormone level and HUA in euthyroid individuals with essential hypertension (EH) .

Methods

Two hundred and sixty-seven euthyroid patients with EH were retrospectively selected from Department of Cardiology, Xianyang Hospital of Yan'an University from January 2019 to December 2020, including 101 with HUA (combined HUA group) and 166 without HUA (non-HUA group) . The general demographic data and laboratory examination indices of the two groups were compared, including gender, age, body mass index (BMI) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , smoking history, drinking history, total cholesterol (TC) , triacylglycerol (TG) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) , serum creatinine (Scr) , SUA, thyroid-stimulating hormone (TSH) , free triiodothyronine (FT₃) , and free thyroxine (FT₄) . Multivariate Logistic regression analysis was used to explore factors associated with HUA. Pearson correlation was used to examine the correlation between thyroid hormone level and SUA level.

Results

There were significant intergroup differences in gender ratio, mean age, BMI, and DBP, as well as prevalence of smoking history and drinking history (P<0.05) . Moreover, the mean levels of TC, TG, LDL-C, Scr and SUA were also significantly different in the two groups (P<0.05) . In particular, the mean level of FT₃ in combined HUA group was significantly higher (t=-5.066, P<0.05) . Multivariate Logistic regression analysis demonstrated that male〔OR=2.843, 95%CI (1.121, 7.215) , P=0.028〕, higher BMI〔OR=1.126, 95%CI (1.020, 1.234) , P=0.018〕, TG〔OR=1.824, 95%CI (1.300, 2.560) , P=0.001〕, LDL-C〔OR=2.804, 95%CI (1.157, 6.795) , P=0.022〕, Scr〔OR=1.071, 95%CI (1.041, 1.102) , P<0.001〕and FT₃〔OR=2.297, 95%CI (1.326, 3.977) , P=0.003〕were associated with increased risk of HUA. Advanced age〔OR=0.959, 95%CI (0.931, 0.989) , P=0.007〕was decreased risk of HUA. Pearson correlation analysis revealed that the level of FT₃ was positively correlated with SUA (r=0.327, P<0.001) .

Conclusion

Being male, high BMI, elevated TG, LDL-C, Scr and FT₃ levels may be risk factors for HUA in euthyroid patients with EH. Advanced age may be protective factor for HUA in euthyroid patients with EH. As FT₃ level is positively correlated with SUA in these patients, those with elevated serum FT₃ level are prone to HUA, which should be paid attention by clinicians.

Comparative Study of Cognitive Function in Inpatients with Generalized Anxiety Disorder and Healthy Controls

TANG Chong, ZENG Shufei, LIANG Hanwen, WANG Jiajia, ZOU Hui, CAI Lidan, ZHANG Bin

2022, 25(35):  4399-4405.  DOI: 10.12114/j.issn.1007-9572.2022.0481

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Background

Generalized anxiety disorder is a common chronic psychiatric disorder, which leads to cognitive impairment and seriously affects the quality of life and social function of patients.

Objective

To compare the differences in cognitive function between GAD inpatients and healthy controls.

Methods

From August 2018 to January 2020, GAD patients hospitalized in Nanfang Hospital, Southern Medical University were selected as the GAD group (n=30) . At the same time, age- and gender-matched healthy volunteers were recruited from the escorts of inpatients in Nanfang Hospital, Southern Medical University as the healthy control group (n=30) . The Hamilton Anxiety Scale (HAMA) , Hamilton Depression Scale (HAMD) and Beck scale for suicide ideation-Chinese Version (BSI-CV) were used for psychological evaluation. Psychomotor vigilance task (PVT) , Go/No-go association task and N-back task were used to evaluate the cognitive function of attention, inhibition and working memory separately. The differences in general conditions, psychological characteristics, and cognitive function between two groups were compared. Multivariate Logistic regression analysis was further used to compare the differences in cognitive function between GAD inpatients and healthy controls.

Results

The total scores of HAMA and HAMD, the total scores of BSI-CV at the most severe condition and the proportion of the patients with suicidal ideation at the most severe condition in GAD group were higher than those in control group (P<0.05) . N-back task: the percentage of hitting targets at 1-back (NBACK1a) and 2-back (NBACK2a) in GAD group were both significantly lower than that in control group (P<0.05) ; the average reaction time of hitting targets at 1-back (NBACK1b) in GAD group was significantly longer than that in control group (P<0.05) . Multivariate Logistic regression analysis showed that NBACK1a〔OR=0.946, 95%CI (0.898, 0.997) , P=0.038〕and NBACK1b〔OR=1.007, 95%CI (1.000, 1.014) , P=0.042〕 were the influencing factors of GAD.

Conclusion

GAD inpatients perform worse than healthy controls mainly in working memory, which deserves more clinical attention.

Clinical Diagnostic Value of Gastroscopy, High-resolution Esophageal Manometry and Upper Gastrointestinal Contrast Examination for Hiatal Hernia in Metabolic Syndrome: a Comparative Analysis

LI Xin, AIKEBAIER· Aili, ALIMUJIANG· Maisiyiti, WANG Zhi, JIANG Yuan, YIBITIHAER· Maimaitiaili, KELIMU· Abudureyimu

2022, 25(35):  4406-4411.  DOI: 10.12114/j.issn.1007-9572.2022.0476

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Background

There is no a gold standard examination method for the diagnosis of hiatal hernia in patients with metabolic syndrome. Improving the preoperative detection rate of hiatal hernia is of great significance for formulating an appropriate surgical approach and avoiding severe postoperative complications.

Objective

To examine the diagnostic value of gastroscopy, high-resolution esophageal manometry and upper gastrointestinal contrast examination for hiatal hernia in metabolic syndrome.

Methods

Fifty-five patients with metabolic syndrome complicated with gastroesophageal reflux who were surgically treated in Department of Minimally Invasive, Hernia and Abdominal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region from September 2021 to April 2022 were retrospectively selected, including 17 with hiatal hernia found intraoperatively (complex group) and 38 without (simple group) . The results of gastroscopy, high-resolution esophageal manometry, acid measurement, upper gastrointestinal contrast tests performed after admission and GERD-Q score were collected. Receiver operating characteristic (ROC) curves of these examination methods were plotted and the area under the ROC curve (AUC) was compared for estimating their diagnostic performance.

Results

Compared with simple group, complex group had higher diagnostic rates of gastroscopy, high-resolution esophageal manometry, greater manometric hiatal hernia diameter and upper gastrointestinal contrast examination, and higher Gerd-Q score (P<0.05) . Complex group also had lower mean resting pressure of lower esophageal sphincter (LESP) and Demeester score (P<0.05) . Multivariate Logistic regression analysis showed that Demeester score and findings upper gastrointestinal angiography were associated with the diagnosis of hiatus hernia in metabolic syndrome (P<0.05) . ROC analysis indicated that all of gastroscopy (AUC=0.728, P=0.007) , LESP (AUC=0.789, P=0.001) , Demeester score (AUC=0.772, P=0.001) , upper gastrointestinal contrast examination (AUC=0.774, P=0.007) , Gerd-Q score (AUC=0.746, P=0.004) had an AUC greater than 0.7, indicating high clinical diagnostic value.

Conclusion

Gastroscopy, LESP, Demeester score, upper gastrointestinal contrast examination, and Gerd-Q score all had high diagnostic value for hiatus hernia in metabolic syndrome.

Therapeutic Effect of Huazhi Suppository Combined with Cap-assisted Endoscopic Sclerotherapy on Internal Hemorrhoids

ZENG Zhigang, ZHENG Shimin, CHEN Xiaofen, MA Juan

2022, 25(35):  4412-4417.  DOI: 10.12114/j.issn.1007-9572.2022.0366

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Background

The incidence of internal hemorrhoids is high. Internal hemorrhoids often cause hematochezia. Medication and minimally invasive surgery are effective therapies for internal hemorrhoids, but these two treatments have high rates of recurrence.

Objective

To evaluate the efficacy of a Chinese medicine, Huazhi suppository, combined with cap assisted endoscopic sclerotherapy (CAES) for symptomatic internal hemorrhoids and its long-term recurrence rate.

Methods

This study selected 104 patients (older than 18 years) with grade Ⅰ-Ⅲ internal hemorrhoids admitted to Guangdong Provincial People's Hospital from January 2018 to June 2020. These patients were randomly assigned into 3 groups by using the single-blind envelope method: medication group (n=31) , CAES group (n=38) and combined group (n=35) . Patients in the medication group received one Huazhi Suppository per time, twice daily for 7 days. Patients in the CAES group received sclerosing agent injection into the hemorrhoidal vein or hemorrhoids exposed by a short transparent cap under the direct vision of flexible endoscope. Patients in the combination group received one Huazhi Suppositoryper time, twice daily for 7 days after the CAES treatment. This study collected the data about clinical efficacy, complications and the satisfaction degree of these three groups, and followed up the recurrence of internal hemorrhoids at one year after treatment.

Results

The rates of overall symptom remission in medication group, CAES group and combined group were 71.0% (22/31) , 100.0% (38/38) and 100.0% (35/35) , respectively. The CAES group and combined group had significant higher rates of overall symptom remission compared with medication group (P<0.001) . The remission rates of hematochezia, perianal discomfort and defecation difficulty were significantly higher in the CAES group and combined group compared with the medication group (P<0.01) . There were no severe adverse events among these three groups. One year after treatment, the recurrence rates of internal hemorrhoids in the medication group, CAES group (n=38) and combined group were 36.4% (8/22) , 15.8% (6/38) and 8.6% (3/35) , respectively. The combined group had lower recurrence rate compared with medication groups (P=0.015) . The satisfactory rates in medication group, CAES group and combined group were 48.4% (15/31) , 78.9% (30/38) , 88.6% (31/35) , respectively. The CAES group and combined group had higher rates of satisfaction compared with the medication group (P<0.05) .

Conclusion

The short-term efficacy of CAES combined with Huazhi Suppository equals to that of CAES group, but better than that of medication group. The long-term recurrence rate of combination group was lower than that of CAES group. We may recommend using CAES combined with Huazhi Suppository.

Article·Research Methodology

Development and Evaluation of Three Risk Assessment Models for Hearing Loss: a Comparative Study

LI Chao, YANG Yongzhong, WANG Hui, WANG Xuelin, MENG Rui, SI Zhikang, ZHENG Ziwei, CHEN Yuanyu, WU Jianhui

2022, 25(35):  4418-4424.  DOI: 10.12114/j.issn.1007-9572.2022.0375

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Background

Hearing loss is highly prevalent in occupational populations, but it could be effectively prevented through early monitoring. There is still a lack of studies on the risk assessment of hearing loss.

Objective

To construct three risk assessment models for hearing loss in oil workers, and evaluate their performance to obtain the optimal one.

Methods

A cross-sectional study was conducted. Participants were 1 423 workers of an oil company who received the occupational health examination from 2018 to 2019 in the Jingxia Hospital of North China Petroleum Administration. Their general demographic data, audiometric test and laboratory test results were collected. Unconditional multivariable Logistic regression was used to explore the factors influencing hearing loss. Python was used to build the random forest, XG Boost, and BP neural network models with factors potentially associated with hearing loss determined based on a literature review and expert opinions incorporated. The discriminative ability of the models were evaluated using the receiver operating characteristic curve (ROC) , and the calibration ability of the model was tested using the calibration curve.

Results

The prevalence of hearing loss changed significantly according to age, gender, monthly household income, history of diabetes, labor intensity, physical exercise, ototoxic chemical exposure, sleep disturbance, shift, and high temperature exposure (P<0.05) . The prevalence of hearing loss rose with the increase in years of work and cumulative noise exposure (P<0.05) . The results of unconditional multivariate Logistic regression analysis showed that 50- years old, diabetes, ototoxic, chemical exposure, insomnia, shift, 30-years of work and cumulative noise exposure≥90 dB (A) ·year were risk factors for hearing loss in oil workers (P<0.05) , monthly household income≥11 000 and moderate labor intensity were protective factors for hearing loss in oil workers (P<0.05) . The AUC of the random forest in assessing hearing loss risk in oil workers was 0.95, with 95.99% accuracy, 91.43% sensitivity, 97.69% specificity, a Youden index of 0.89 and a F1 score of 0.74, the AUC of the XG Boost model in assessing hearing loss risk in oil workers was 0.93, with 95.22% accuracy, 89.09% sensitivity, 97.50% specificity, a Youden index of 0.87 and a F1 score of 0.73, and that of the BP neural network model in assessing hearing loss risk in oil workers was 0.83, with 88.62% accuracy, 70.13% sensitivity, 95.47% specificity, a Youden index of 0.66 and a F1 score of 0.73. The Brier score of the random forest was 0.04, with an observation-to-expectation (O/E) ratio of 1.02 and a calibration-in-the-large of 0.029. The Brier score, O/E ratio and calibration-in-the-large of the XG Boost model were 0.04, 1.04 and 0.032, respectively. The Brier score of the BP neural network model was 0.11, with an O/E ratio of 1.21 and a calibration-in-the-large of 0.097. The calibration efficiency of the random forest model was the best.

Conclusion

The random forest model outperformed the XG Boost model and the BP neural network model, which could be adopted to assess the risk of hearing loss in oil workers more accurately.

Risk Prediction Questionnaire and Item Screening for Acute Exacerbation of Asthma Based on the Modified Delphi Technique

YANG Jiang, WANG Minghang, LI Jiansheng, LIN Xiaohong, LIU Yuanyuan, XIE Yang, LI Suyun

2022, 25(35):  4425-4432.  DOI: 10.12114/j.issn.1007-9572.2022.0489

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Background

China owns a huge number of asthma patients and an increasing incidence of asthma, but low rate of overall control and high rate of acute asthma exacerbation. Moreover, there is a lack of methods for systematically screening the risks of acute exacerbation of asthma.

Objective

To develop a risk prediction questionnaire for acute exacerbation of asthma after screening the associated risk factors using the modified Delphi technique, providing a reference for building a multidimensional risk prediction model of asthma acute exacerbation.

Methods

Based on literature reports and our clinical pre-investigation results, an expert consultation questionnaire on risk predictors of acute exacerbation of asthma was developed, and was distributed through E-mail to 30 experts for review through two rounds of online consultation survey using the modified Delphi technique conducted from April to October 2021. SPSS 25.0 was used to assign weight and analyze the risk predictors. Then according to the screening criteria developed by the experts, the risk predictors were finally determined.

Results

Both two rounds of consultation achieved a 100% response rate. The familiarity, judgment, and authority coefficients as well as Kendall's W were 0.894, 0.963, 0.929, and 0.331, respectively, for the first round of expert consultation (P<0.001) , and were 0.920, 0.976, 0.948, and 0.437, respectively, for the second round of expert consultation (P<0.001) . The determined risk predictors of acute exacerbation of asthma include six domains (clinical symptoms and signs, conditions, quality of life, biological information, traditional Chinese medicine syndromes and basic demographics) , and 29 indices including severity of asthma, Asthma Control Test, wheezing, chest tightness, allergy history, hormone therapy, work and living environment, eosinophils, number of exacerbations in the past year, treatment compliance, climate and seasonal changes, and so on.

Conclusion

The based on the modified Delphi method, the risk predictors of acute exacerbation of asthma determined using expert consultation with the modified Delphi technique include the aforementioned six domains and 29 indices, which is relatively concise, and can provide a reference for follow-up studies.

A Comparative Study of Outcomes and Measurements Used in Randomized Controlled Trials for Low Back Pain Treated by Western Medicine and Traditional Chinese Medicine

WU Yining, WAN Ying, HU Chaoyue, SUN Yanan, YU Changhe

2022, 25(35):  4433-4442.  DOI: 10.12114/j.issn.1007-9572.2022.0412

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Background

Low back pain (LBP) is the leading cause of hypokinesia globally. Currently, the reporting of outcomes in clinical trials for LBP lacks consistency, utility, and standardization, and the results of studies in the same field cannot be combined for comparison. Thus, the homogeneity and utility of outcomes need to be enhanced.

Objective

To assess the quality of randomized controlled trials (RCTs) for LBP and their outcome reports, then to analyze the variations of reported outcomes and measurements among different interventions for LBP, and to explore homogeneous and practical outcome indices for LBP.

Methods

Four clinical trials registry platforms (Complementary Medicine Field Trials Register, Back and Neck Review Group Trials Register, ClinicalTrials.gov, WHO ICTRP) and seven databases (Cochrane Library, PubMed, Web of Science, CNKI, Wanfang Data, SinoMed, VIP) were searched for RCTs about LBP treated by traditional Chinese medicine (TCM) , western medicine (WM) and integrated traditional Chinese and western medicine (TCM-WM) published during 2017 to 2021. Information was extracted and analyzed descriptively.

Results

In total, 1 014 RCTs of LBP with WM treatment, 624 RCTs of LBP with TCM treatment, and 392 RCTs of LBP with integrated TCM-WM treatment were included. Overall, the quality of RCTs was low and the reporting of outcome in different interventions was deficient. Through our assessment, the total Jadad score was 2 (2, 4) for RCTs of LBP with WM treatment, 2 (2, 3) for RCTs of LBP with TCM treatment, and 2 (2, 2) for those of LBP with integrated TCM-WM treatment, with more than 50% of the RCTs having a total Jadad score of 2, and more than 10% having a Jadad score of 3. More than 80% of the RCTs had an outcome score of 1. The number of indices reported in RCTs about WM for LBP ranged from 1 to 8 (with a median value of 2) , and the top five outcome domains reported with frequency were pain level (28.2%) , physical function (28.0%) , hospital-related outcomes (8.0%) , economic indices (8.0%) , and adverse events/effects (8.0%) , and the top three scales used to evaluate outcomes were the Visual Analogue Scale (VAS) /Verbal Rating Scale (VRS) , the Oswestry Disability Index (ODI) , and Japanese Orthopaedic Association Score (JOA) . The number of indices reported in RCTs about TCM for LBP ranged from 1 to 6 (with a median value of 2) , and the top five outcome domains reported with frequency were pain level (45%) , physical function (27%) , others (14%) , overall quality of life (5%) , and musculoskeletal and connective tissue outcomes (2%) , and the main scales used included VAS/VRS, ODI, short-form McGill Pain Questionnaire (SF-MPQ) , the Numerical Rating Scale/ Numeric Pain Rating Scale (NRS/NPRS) , Roland-Morris Disability Questionnaire (RMDQ/RMD) , and 12-Item Short Form Health Survey/ 36-Item Short Form Health Survey (SF-12/SF-36) . The number of indices reported in RCTs for LBP with integrated TCM-WM treatment was 1-12 (with a median value of 2) , and the top five outcome domains reported with high frequency were physical function (39%) , pain level (34%) , others (9%) , overall quality of life (5%) , and musculoskeletal and connective tissue outcomes (4%) , and the scales used with high frequency were VAS/VRS, ODI, JOA, SF-12/SF-36, RMDQ, and NRS/NPRS. The evaluation dimensions of outcomes for three interventions were all mainly based on pain level and physical function, and the measurements were focused on the VAS/VRS scale (WM: 22.16%, TCM: 32.97%, integrated TCM-WM: 30.94%) and the ODI/CODI scale (WM: 15.88%, TCM: 18.74%, integrated TCM-WM: 20.07%) , and the common outcome indices with corresponding measurements were pain level (VAS/VRS) , physical function (ODI/RMD) , overall quality of life (SF-12/SF-36) and imaging results (X-ray/CT/MRI) .

Conclusion

By means of quality evaluation and data analysis, the result showed that all RCTs for LBP and their outcome reports had low-quality. The main outcome assessments among three interventions were pain level and physical function, and the main measurements were the VAS/VRS scale and the ODI/CODI scale. Pain level, physical function, quality of life, and imaging results were commonly reported through varied interventions. In brief, the results provide a basis for the future construction of Core Outcome Sets (COS) and Intervention-related Specific Outcome Sets (In-SOS) for LBP.

Evidence-based Medicine

Diagnostic Accuracy of Screening Tools for Chronic Obstructive Pulmonary Disease: a Network Meta-analysis

LIU Yue, YUAN Yuan

2022, 25(35):  4443-4452.  DOI: 10.12114/j.issn.1007-9572.2022.0413

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Background

Inexpensive and convenient early screening for chronic obstructive pulmonary disease (COPD) is of great significance to identify individuals at high risk of COPD. There are many kinds of COPD screening tools with various diagnostic accuracies, but which one is superior to others has not been identified by evidence-based studies.

Objective

To evaluate the diagnostic accuracies of common COPD screening tools using a network meta-analysis.

Methods

PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data and VIP databases were searched for diagnostic studies related to COPD screening and tools for early diagnosis COPD included from database establishment to December 31, 2021. Two researchers independently conducted literature screening, quality evaluation and data extraction. Meta-disc 1.4 and Stata 15.0 were used for network meta-analysis.

Results

A total of 46 studies were enrolled, involving seven screening tools: the Lung Function Questionnaire (IFQ) , COPD Diagnostic Questionnaire (CDQ) , COPD Screening Questionnaire (COPD-SQ) , Self-Scored COPD Population Screener Questionnaire (COPD-PS) , spirometer, peak flow meter, questionnaire+peak flow meter. The results of meta-analysis demonstrated combined sensitivity values of the aforementioned seven screening tools for COPD were as follows: 0.79〔95%CI (0.75, 0.83) 〕, 0.85〔95%CI (0.83, 0.86) 〕, 0.68〔95%CI (0.65, 0.70) 〕, 0.60〔95%CI (0.56, 0.63) 〕, 0.58〔95%CI (0.54, 0.61) 〕, 0.86〔95%CI (0.84, 0.88) 〕, and 0.68〔95%CI (0.65, 0.71) 〕. And combined specificity values of them were: 0.67〔95%CI (0.65, 0.68) 〕, 0.59〔95%CI (0.58, 0.59) 〕, 0.81〔95%CI (0.80, 0.82) 〕, 0.84〔95%CI (0.83, 0.85) 〕, 0.88〔95%CI (0.87, 0.89) 〕, 0.86〔95%CI (0.84, 0.88) 〕, and 0.85〔95%CI (0.84, 0.86) 〕. The surface under the cumulative ranking curve (SUCRA) values of the tools ranked in terms of combined sensitivity from highest to lowest were: peak flow meter (72.7%) >CDQ (70.1%) >LFQ (61.8%) >questionnaire+peak flow meter (45.3%) >COPD-SQ (28.5%) >COPD-PS (13.2%) >spirometer (9.1%) . And the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: spirometer (76.8%) >questionnaire+peak flow meter (66.7%) >COPD-SQ (46.7%) >peak flow meter (45.8%) >COPD-PS (39.2%) >LFQ (11.9%) >CDQ (8.2%) .

Conclusion

Among the seven commonly used tools, peak flow meter has higher sensitivity, and spirometer has higher specificity. But this conclusion still needs to be further confirmed by more multicenter, large-sample studies.

Psychometric Properties of the Pain Assessment Scales in Newborns: an Overview of Systematic Review

SHEN Qiao, TANG Yuman, LENG Hongyao, LEI Ruobing, ZHENG Xianlan

2022, 25(35):  4453-4461.  DOI: 10.12114/j.issn.1007-9572.2022.0478

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Background

Timely and accurate pain assessment is essential for safe and effective management of pain in neonates. Scholars at home and abroad have developed more than 40 pain assessment scales for different neonatal groups and types of pain. However, the reliability and stability of the outcomes vary significantly. In addition, existing single studies or systematic reviews (SRs) can only provide unsystematic evidence of a particular scale or specific psychometric properties, which is not conducive to clinical decision-making.

Objective

To overview the SRs of psychometric properties of neonatal pain assessment scales, providing clinical practitioners and researchers with evidence for the best pain assessment scale.

Methods

Databases including CNKI, SinoMed, Wanfang DATA, VIP, PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched for SRs about psychometric properties of neonatal pain assessment scales. By screening the references of the included SRs, their associated studies were found. Two researchers independently performed literature screening, and data extraction, then assessed the methodological quality using the JBI systematic review critical appraisal tool, risk of bias using the ROBIS, the reporting quality using the PRISMA statement, and the evidence quality using CERQual.

Results

A total of seven SRs were included. According to the JBI and ROBIS tools, four SRs were of high quality and had a low risk of bias, while three were of relatively low quality and had an increased risk of bias. With the PRISMA checklist, 5 SRs were fairly complete with over 60% of report completion rate (RCR) , 1 SR had certain reporting deficiencies with 45.95% of RCR, and 1 SR had serious information missing with 10.81% of RCR. The results of CERQual showed that there were 22 pieces of evidence in total, including two pieces of high quality (9.09%) , eight pieces of moderate quality (36.36%) , nine pieces of low quality (40.91%) , and three pieces of critically low quality (13.64%) . A synthesis of evidence showed that there were 25 scales with good internal consistency, inter-rater reliability, construct validity, and interpretability. Those scales could be used to measure acute pain, persistent pain, postoperative pain, or mechanically ventilated pain in preterm and/or term infants.

Conclusion

No single pain assessment scale is available to assess all types of pain in neonates. It is recommended that the selection of validated scales for periodic dynamic pain assessment in neonates should be based on clinical situations such as age and pain type. More high-quality, well-designed studies are needed to examine the reliability and stability of the existing scales for measuring different kinds of pain in neonates in China and to explore the feasibility of expanding their applications.

Review & Perspectives

Advances in the Use of Regional Homogeneity from Resting-state Functional MRI for the Diagnosis of Insomnia in Depressive Disorder

CHEN Pinqi, ZHANG Liqing, XIANG Ting, SUN Xizhe, PAN Jiyang

2022, 25(35):  4462-4467.  DOI: 10.12114/j.issn.1007-9572.2022.0443

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Insomnia is a common concomitant symptom in patients with depressive disorder. Early and effective assessment of insomnia symptoms in these patients is the key to preventing sleep problems and delaying the deterioration of depression disorder. Currently, the effectiveness of subjective and objective sleep assessment tools has often been expounded in relevant reviews, but the assessment indicators related to insomnia in depressive disorder, and rs-fMRI technique, an objective sleep assessment tool, have been rarely reviewed. We reviewed the latest advances in the use of regional homogeneity from resting-state functional MRI for the diagnosis of insomnia in major depressive disorder, and described its use in the differentiation between unipolar and bipolar disorders, with a view to providing theoretical and practical evidence for clinical diagnosis, differentiation, and treatment of unipolar and bipolar disorders, and for relevant studies.

Review & Perspectives

A Review on the Significance of Elevated 1-hour Post-load Plasma Glucose during the Oral Glucose Tolerance Test

HUANG Yucheng, DONG Aimei, HUANG Youyuan, FEI Xiuwen

2022, 25(35):  4468-4472.  DOI: 10.12114/j.issn.1007-9572.2022.0311

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Elevated 1-hour post-load plasma glucose (1 hPG) concentration during the oral glucose tolerance test (OGTT) may be associated with insulin resistance and pancreatic β-cell dysfunction, and higher risks of diabetes and cardiovascular disease. We reviewed the studies related to the significance of 1 hPG during the OGTT, in which 1 hPG during the OGTT has been reported to be prevalent in 10% to 40% of people with normal glucose tolerance, and the prevalence is higher in those with impaired glucose tolerance or impaired fasting glucose. Attention should be paid to the cutoff point of 1 hPG during the OGTT for the diagnosis of diabetes and pre-diabetes in Chinese population, which may be beneficial to early diagnosis and intervention of diabetes and pr-diabetes.

Recent Advances in Assessment Tools for HIV/AIDS-related Psychological Distress

MA Haiqi, ZHAI Huimin, BU Mengru

2022, 25(35):  4473-4478.  DOI: 10.12114/j.issn.1007-9572.2022.0285

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Psychological distress, a newly defined negative emotion in psychological research for HIV/AIDS patients, has increasingly attracted the attention of researchers. Scales are the most commonly used tools to assess the psychological status of these patients. We reviewed the widely used HIV/AIDS-related psychological distress assessment tools with good reliability and validity, and summarized that in foreign counties, relevant research is relatively mature, and there are many relatively sound assessment scales for a wide range of applications, but the research in this area is still in its infancy in China. HIV/AIDS-related psychological distress assessment tools suitable for China's national conditions and cultural background can be further developed based on drawing lessons from relevant scales and research abroad.

Research of Typical Cases

Gastrointestinal Bleeding Induced by Jejunal Dieulafoy's Disease: a Case Report and Review of the Literature

ZHAO Baoyin, LIANG Zhaojun, ZHANG Lixia, JIA Dong, CHEN Shun, JIANG Yaoyue, ZHU Xiangxiang, YANG Yonglin, YU Xiaohui

2022, 25(35):  4479-4482.  DOI: 10.12114/j.issn.1007-9572.2022.0516

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Due to the fact that the arteries supplying the gastrointestinal tract fail to branch out into capillaries after entering the mucosa, but instead maintain a constant vessel diameter, which lead to damage to the blood vessels under the influence of high pressure blood flow, causing Dieulafoy's disease. Dieulafoy's disease is a rare vascular malformation that primarily affects the stomach and can result in bleeding in the gastrointestinal tract, particularly in the upper part. Dieulafoy's disease in small intestine is extremely uncommon and has rarely been documented. We reported a case of jejunal Dieulafoy's lesion diagnosed by single-balloon enteroscopy, with detailed description of his diagnosis and treatment process, and carried out a literature review, with a view to increasing clinicians' understanding of the diagnosis of management of gastrointestinal tract bleeding of unknown origin.