Table of Content

15 January 2023, Volume 26 Issue 02

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Guide·Evidence

Interpretation of the Lancet Commission on Towards the Elimination of Chronic Obstructive Pulmonary Disease: New Definition and Recommendations for Clinical Management of Chronic Obstructive Pulmonary Disease

WU Jiankang, CHEN Yan

2023, 26(02):  127-133.  DOI: 10.12114/j.issn.1007-9572.2022.0757

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Chronic obstructive pulmonary disease (COPD) is a common, chronic heterogeneous airway disease. Although recent years have witnessed growing advances in both COPD research and management, there are still many difficulties need to be solved urgently. In view of this, the Lancet published Towards the Elimination of Chronic Obstructive Pulmonary Disease in September 2022, a document in which new ideas on the recognition, diagnosis, assessment and individualized treatment of COPD and relevant clinical guidance were proposed. This article focuses on the introduction and interpretation of the classification, diagnostic criteria and diagnostic recommendations of COPD in this document, the acute exacerbation of COPD and the move towards elimination of COPD, hoping to provide insights into COPD research and management conducted by Chinese clinical workers.

Evaluation of the Guidelines and Consensuses on Enuresis in Children Using the AGREEⅡand RIGHT Checklists

SUN Xiangjuan, XIAO Xiang, WU Xuanyu, ZHANG Fenghua

2023, 26(02):  134-141.  DOI: 10.12114/j.issn.1007-9572.2022.0424

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Background

Enuresis in children is a common pediatric disease that can significantly reduce the quality of life of children and their families. High-quality guidelines on enuresis in children contribute to the standardization of control and improvement of clinical symptoms. So developing relevant high-quality clinical practice guidelines is a critical way to improve the diagnosis and treatment of enuresis in children.

Objective

To evaluate the quality of guidelines and expert consensuses on enuresis in children issued since 2010 using the AGREE Ⅱ and RIGHT checklists, aiming at providing a reference for clinical practice and future development of relevant guidelines.

Methods

Guidelines and expert consensuses related to enuresis in children published from January 1, 2010 to January 31, 2022 were searched in databases of CNKI, Wanfang Data, VIP, CBM, and PubMed (with searching databases of MedLive, WHO and NICE as a supplement) . The AGREE Ⅱ and RIGHT checklists were used to evaluate the methodological and reporting quality of included studies. According to the AGREEⅡ, the recommended grade of each guideline/consensus was rated as "recommended (A) ", "recommended after update (B) ", and "not recommended (C) ". The intra-class correlation coefficient (ICC) was used for the consistency test.

Results

Altogether, eight guidelines and five consensuses were included, which provide 185 recommendations, including 44 for diagnosis and evaluation, 140 for treatment, and one for follow-up. By the AGREEⅡchecklist, these 13 studies were assessed with average scores of (66.99%±16.73%) , (46.26%±21.56%) , (34.42%±26.73%) , (60.36% ±32.13%) , (39.82%±20.14%) and (45.35%±37.93%) for scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence, respectively. None of the studies were with recommendation grade A, eight were with recommendation grade B, and five were with grade C. The reporting rates of the studies in accordance with seven domains of basic information, background, evidence, recommendations, review and quality assurance, funding and declaration and management of interests and other information were (60.58%±12.19%) , (50.72%±20.18%) , (30.77%±26.88%) , (32.97%±27.53%) , 25.00% (40.63%) , (25.96%±24.00%) and 16.67% (33.33%) , respectively. The guidelines had higher score in terms of the scope and purpose domain of AGREEⅡ than consensuses (P<0.05) . The guidelines and consensuses had no significant differences in assessment results by each of the seven domains of RIGHT (P>0.05) . The ICC for the reliability of each of the domains of the AGREEⅡchecklist in assessment was greater than 0.750, showing a high consistency. The ICC for the reliability of each of the domains of the RIGHT checklist was 0.736, which showed a good consistency.

Conclusion

The overall methodological and reporting quality of the included guidelines and consensuses needs to be improved. The recommended grades of the included literature consist of B and C without A, suggesting that high-quality guidelines should be referred first when making clinical decisions. Currently, there is no guideline for the diagnosis and treatment of enuresis in children in primary care in China, and the quality of existing guideline on Traditional Chinese Medicine management of enuresis in children needs to be improved. It is suggested to develop relevant guidelines according to the AGREE Ⅱ and RIGHT checklists to guide the clinical management of enuresis in children.

Complete Revascularization for Acute Myocardial Infarction and Multivessel Disease: an Overview of Systematic Reviews

WANG Zhe, ZHAO Haibin, WANG Guoliang, MA Xiaojuan, YIN Huijun

2023, 26(02):  142-153.  DOI: 10.12114/j.issn.1007-9572.2022.0428

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Background

Culprit-only revascularization and complete revascularization are two major treatments for acute myocardial infarction (AMI) with multivessel disease. Many systematic reviews have compared the efficacy and safety of the two treatments, but the review results are inconsistent and cannot be directly applied to clinical practice.

Objective

To perform an overview of the systematic reviews of the efficacy and safety of complete revascularization versus culprit-only revascularization for AMI with multivessel disease.

Methods

PubMed, Cochrane Library, Embase and PROSPERO databases were searched from inception to February, 2022 for systematic reviews/meta-analyses about complete revascularization versus culprit-only revascularization for AMI with multivessel disease regardless of the language and status of publication. Two researchers independently evaluated the methodological quality and evidence quality of included studies using the AMSTAR 2 and GRADE, respectively.

Results

A total of 25 systematic reviews or meta-analyses were included. The methodological quality of the included studies was generally low, with one being of high quality, two being of moderate quality, and 22 being of critical low quality. Eight outcomes and 135 evidence bodies (eight were of high quality, 17 were of moderate quality, and the rest were of low or very low quality according to the GRADE classification) were identified in the studies in total.

Conclusion

Compared with culprit-only revascularization, complete revascularization can partially improve clinical outcomes in patients with AMI with multivessel disease, but its safety needs to be further evaluated by high-quality, large-sample clinical studies.

Article

Prevalence and Associated Factors of Mild Cognitive Impairment in Young and Middle-aged Hospitalized Patients with Hypertension

YE Qingfang, WANG Yini, LI Ling, LIU Guojie, LIN Ping, LI Qiujie

2023, 26(02):  154-159.  DOI: 10.12114/j.issn.1007-9572.2022.0576

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Background

Mild cognitive impairment (MCI) is highly prevalent in hypertensive patients, but the current studies on MCI in hypertension mostly focus on the elderly group, while scarcely involve young and middle-aged patients.

Objective

To investigate the prevalence and associated factors of MCI in young and middle-aged hospitalized patients with hypertension.

Methods

A convenience sample of 213 young and middle-aged hypertensive inpatients were recruited from a tertiary grade A hospital in Harbin from May to December 2021. The General Demographic Questionnaire, Montreal Cognitive Assessment (MoCA) , and the Type-D Scale-14 (DS14) were used for understanding patients' demographics, cognitive impairment status, and D-type personality prevalence, respectively. Multiple Logistic regression was used to analyze associated factors of MCI.

Results

The prevalence of MCI was 37.56% (80/213) . Multiple Logistic regression analysis showed that age〔OR=1.073, 95%CI (1.033, 1.115) 〕, education level〔junior college education level: OR=0.278, 95%CI (0.084, 0.920) , smoking history〔OR=2.494, 95%CI (1.146, 5.426) 〕, stage of hypertension〔stage 2: OR=3.442, 95%CI (1.252, 9.468) ; stage 3: OR=3.934, 95%CI (1.518, 10.193) 〕, D-type personality〔OR=2.160, 95%CI (1.015, 4.598) , TG〔OR=1.596, 95%CI (1.125, 2.265) 〕, and HDL-C〔OR=0.185, 95%CI (0.049, 0.707) 〕were influential factors of MCI in hypertension (P<0.05) .

Conclusion

Young and middle-aged hospitalized patients with hypertension had a high prevalence of MCI. Older age, lower level of education, D-type personality, higher level of TG and lower level of HDL-C were related to increased risk of MCI in hypertension. In view of this, medical workers should screen MCI in these patients to identify those at high risk of MCI as early as possible, and deliver interventions to them timely.

Factors Associated with the Outcomes of Preimplantation Genetic Testing in Assisted Reproduction

WANG Boya, HE Yingming, XUE Yinshuang, XIANG Huifen

2023, 26(02):  160-167.  DOI: 10.12114/j.issn.1007-9572.2022.0397

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Background

Embryo anomaly is the most common cause of implantation failure and abortion in women of reproductive age. However, there is controversy about the cause of implantation failure or miscarriage that occurs after the transfer of a normal embryo screened by preimplantation genetic testing (PGT) .

Objective

To analyze the influencing factors affecting implantation failure and miscarriage after PGT assisted reproduction.

Methods

Three hundred and twenty-nine women who received PGT assisted reproduction in Reproductive Center, the First Affiliated Hospital of Anhui Medical University from December 2018 to February 2021 were enrolled, including 218 with clinical pregnancy〔175 of whom had a live birth (live birth subgroup) , and 43 had an abortion (abortion subgroup) 〕, and 111 with implantation failure. Clinical data, results of accessory examinations, ovulation induction and in vitro embryonic development were compared between women with clinical pregnancy and implantation failure, and between live birth and abortion subgroups. The influencing factors of implantation failure and abortion after PGT assisted reproduction were screened by multivariate logistic regression analysis, and predictive values of the determined factors for implantation failure and abortion were estimated using the receiver operating characteristic (ROC) analysis.

Results

Multivariate logistic regression analysis showed that, two or more previous abortions〔OR=4.032 0, 95%CI (2.423 0, 6.710 0) 〕 and low level of high-density lipoprotein cholesterol (HDL-C) 〔OR=3.890 0, 95%CI (1.455 0, 10.403 0) 〕were risk factors for implantation failure after PGT assisted reproduction (P<0.05) , while the low gonadotropin (Gn) dosage〔OR=0.999 5, 95%CI (0.999 2, 0.999 9) 〕 was associated with decreased risk of implantation failure after PGT assisted reproduction (P<0.05) . Two or more abortions〔OR=2.203 0, 95%CI (1.099 0, 4.417 0) 〕 and low normal rate of embryo biopsy〔OR=5.655 0, 95%CI (1.286 0, 24.865 0) 〕 were associated with increased risk of abortion after PGT assisted reproduction (P<0.05) , while low fasting insulin (FINS) level〔OR=0.912 0, 95%CI (0.835 0, 0.996 0) 〕 was associated with decreased risk of abortion after PGT assisted reproduction (P<0.05) . ROC analysis indicated that for predicting implantation failure after PGT assisted reproduction, the AUC of two or more previous abortions was 0.650 with 70.3% sensitivity, 59.6% specificity and Youden index of 0.299, the AUC of HDL-C level was 0.579 with 33.3% sensitivity, 80.3% specificity and Youden index of 0.136, and the AUC of the dosage of Gn was 0.561 with 60.4% sensitivity, 56.9% specificity and Youden index of 0.173. The AUC of two or more previous abortions for predicting the abortion after PGT assisted reproduction was 0.648 with 66.2% sensitivity, 63.4% specificity and Youden index of 0.296, and the AUC of fasting insulin level was 0.629 with 72.1% sensitivity, 52.6% specificity and Youden index of 0.247, and that of normal embryo biopsy rate was 0.641 with 65.1% sensitivity, 60.6% specificity and Youden index of 0.257.

Conclusion

Two or more previous abortions, dosage of Gn and serum HDL-C were influencing factors and partial predictors of implantation failure after PGT assisted reproduction. And two or more previous abortions, fasting insulin level, and normal embryo biopsy rate were influencing factors and partial predictors of abortion after PGT assisted reproduction.

A Randomized Controlled Study of Multisensory Interventions in Promoting Brain Function Development in Premature Infants

TENG Xiaoyun, LIANG Jie, TAN Jilei, SUN Jianfeng, LIANG Hua, QIN Shanshan, LU Caina, WEI Qin

2023, 26(02):  168-174.  DOI: 10.12114/j.issn.1007-9572.2022.0447

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Background

The prevalence of neurodevelopmental disorders in premature infants is high, and there is an urgent need to improve neurodevelopmental outcomes of them. There are few reports on amplitude-integrated electroencephalography (aEEG) -assessed effect of multisensory (MS) interventions on brain function of premature infants by aEEG.

Objective

To evaluate the effect of MS interventions on improving brain function of premature infants.

Methods

A single-center, randomized controlled trial was conducted. One hundred and twenty-six premature infants who were admitted to Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University from October 2020 to September 2021 were selected and randomly divided into control group (n=63) and intervention group (n=63) by random numbers according Excel. Both groups received routine treatment and nursing care, the intervention group additionally received MS interventions developed by our team (including auditory, tactile, visual and vestibular interventions) , twice a day, 15 minutes each time. The time of intervention lasted for at least 7 days for both groups. Before and 7 days after the intervention, the lower boundary voltage, bandwidth, and aEEG score during the quiet sleep (QS) period and active sleep (AS) period, average time and total time of QS period were monitored by AEEG. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavior. The Gesell Developmental Schedules (GDS) was used to evaluate the development quotient at the corrected age of one month.

Results

119 premature infants completed the study, including 59 cases in the control group and 60 cases in the intervention group. Seven days after intervention, intervention group had higher lower boundary voltage〔 (5.47±0.92) μV vs (5.10±0.87) μV〕and narrower bandwidth〔 (18.90±1.90) μV vs (19.78±2.50) μV〕 during QS period than the control group (P<0.05) . Moreover, intervention group also demonstrated higher lower boundary voltage〔 (7.63±0.97) μV vs (7.21±1.00) μV〕 and narrower bandwidth〔 (13.93±2.61) μV vs (14.94±2.58) μV〕 during AS period (P<0.05) . After 7 days of intervention, intervention group had higher total score of aEEG 〔 (10.45±2.18) vs (9.53±1.91) 〕, and higher item score of sleep-awakening cycle〔 (4.17±0.85) vs (3.80±0.85) 〕, and broadband score 〔 (2.90±0.75) vs (2.59±0.72) 〕 than control group (P<0.05) . However, there was no significant difference in item continuity and lower boundary score between two groups in aEEG score (P>0.05) . Moreover, intervention group had longer average time of QS period 〔 (25.67±6.95) min vs (23.29±4.87) min〕 and longer total time of QS period 〔 (62.80±18.89) min vs (55.27±20.65) min〕 than control group (P< 0.05) . Intervention group also had higher total score of NBNA 〔 (34.82±2.97) vs (33.12±3.49) 〕 (P< 0.05) . At the corrected age of one month, intervention group had higher developmental quotient scores in terms of gross motor 〔 (52.83±10.93) vs (48.83±10.11) 〕, fine motor〔 (51.67±11.05) vs (47.71±9.15) 〕, adaptive development 〔 (55.28±11.65) vs (50.31±10.14) 〕, language 〔 (53.40±11.29) vs (49.41±9.82) 〕 and personal-social〔 (53.57±10.57) vs (49.51±9.35) 〕 than the control group (P<0.05) .

Conclusion

MS intervention could facilitate the rise of lower boundary voltage, narrow the bandwidth and improve aEEG scores of preterm infants in QS period and AS period, thus promoting the maturation of aEEG background activity and improving brain development. MS intervention could also prolong the time of QS period and promote the development of brain function, improve the total scores of NBNA and GDS, suggesting that the intervention could improve neurobehavioral development of preterm infants.

Prevalence and Influenceing Factors of Diabetes in Ichemic Stroke Patients

LIU Fengdong, ZHANG Boqiang, YAN Han, JING Li, YU Xiaochen, WANG Li, LIU Yunfei, XING Liying, TIAN Yuanmeng

2023, 26(02):  175-183.  DOI: 10.12114/j.issn.1007-9572.2022.0623

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Background

Diabetes mellitus is an important risk factor for the onset, recurrence, disability and lethality of ischemic stroke. Assessing the prevalence of diabetes in patients with ischemic stroke, and carrying out targeted comprehensive prevention and control can effectively improve the prognosis of patients.

Objective

To understand the current situation of ischemic stroke patients complicated with diabetes in Liaoning Province, and to provide a theoretical basis for targeted intervention.

Methods

From 2017 to 2018, a cross-sectional survey of ischemic stroke patients (≥40 years old) in 28 villages/communities in 6 counties and districts in Liaoning Province was conducted by a combination of stratified sampling, cluster sampling, and random sampling. Multivariate logistic regression was used to analyze the influencing factors of diabetes prevalence, awareness, treatment and control of ischemic stroke patients.

Results

The prevalence, awareness, treatment, and control rates of diabetes among ischemic stroke patients in Liaoning Province were 29.5% (289/980) , 63.3% (183/289) , 56.4% (163/289) , and 47.2% (77/163) , respectively. Multivariate logistic regression suggested that urban residence〔OR=1.818, 95%CI (1.317, 2.508) , P<0.001〕, family history of diabetes〔OR=2.790, 95%CI (1.922, 4.050) , P<0.001〕, hypertension 〔OR=1.813, 95%CI (1.160, 2.834) , P=0.009〕, high triglycerides〔OR=2.312, 95%CI (1.631, 3.277) , P<0.001〕, high-low density lipoprotein cholesterol 〔OR=2.241, 95%CI (1.300, 3.865) , P=0.004〕, and being overweight or obese〔OR=1.562, 95%CI (1.136, 2.146) , P=0.006〕 were the risk factors to diabetes mellitus in ischemic stroke patients; Having an urban residence〔OR=1.865, 95%CI (1.086, 3.203) , P=0.024〕, and having a family history of diabetes〔OR=2.402, 95%CI (1.306, 4.416) , P=0.005〕 favored diabetes awareness, and high cholesterol〔OR=0.389, 95%CI (0.215, 0.705) , P=0.002〕 disfavored diabetes awareness; 60-69 years old〔OR=3.052, 95%CI (1.523, 6.115) , P=0.002〕, urban residence〔OR=1.866, 95%CI (1.104, 3.155) , P=0.020〕, family history of diabetes〔OR=2.303, 95%CI (1.275, 4.161) , P=0.006〕 favored the treatment of diabetes, and high cholesterol〔OR=0.387, 95%CI (0.210, 0.713) , P=0.002〕disfavored the treatment of diabetes; Urban residence〔OR=1.916, 95%CI (1.021, 3.595) , P=0.043〕 favored blood glucose control in patients with ischemic stroke and diabetes.

Conclusions

The prevalence of diabetes in patients with ischemic stroke in Liaoning Province is relatively high, while the awareness, treatment and control of the disease are still at a low level. Factors such as place of residence, having a family history of diabetes are beneficial for improving the knowledge, treatment, and control of diabetes in patients with ischemic stroke, and comprehensive prevention and control are urgently needed

Prevalence and Predictive Value of Elevated Hemoglobin in OSAHS Patients

ZHAO Binji, GUO Jingyu, ZHOU Jiajin, MOU Lanxue, MU Taojuan, ZHANG Kaiyan, LYU Yunhui

2023, 26(02):  184-191.  DOI: 10.12114/j.issn.1007-9572.2022.0216

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Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) can cause secondary polycythemia and elevated hemoglobin, but the prevalence and predictive value of elevated hemoglobin in OSAHS patients remain unclear.

Objective

To explore the prevalence and associated factors of elevated hemoglobin (HGB) and its potential role in predicating pulmonary hypertension and type Ⅱ respiratory failure in OSAHS patients.

Methods

We conducted a retrospective analysis of 1 035 patients with OSAHS diagnosed by polysomnography who were hospitalized at Sleep Medical Center, First People's Hospital of Yunnan Province from 2018 to 2020. Data of polysomnography, clinical parameters, and comorbidity were compared between 145 cases with polycythemia and 145 cases with normal HGB. The propensity score matching (PSM) was used to balance the baseline variables of the age, sex and BMI. Spearman correlation and multiple regression analysis were used to explore the associated factors of HGB level. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of elevated HGB for pulmonary hypertension and type Ⅱ respiratory failure in OSAHS.

Results

The overall prevalence of polycythemia was 16.8% (174/1 035) in OSAHS patients. Males (25.7%, 157/610) had higher prevalence of polycythemia than females (4.0%, 17/425) (P<0.05) . Patients with a high apnea-hypopnea index (AHI) had higher mean HGB level and prevalence of polycythemia than those with a mild or moderate AHI (P<0.05) . In comparison to patients with normal HGB, those with elevated HGB had higher AHI, longer maximum apnea time (maxAT) and sleep time spent at SpO₂<90% (TS90%) , higher values in laboratory and clinical parameters including red blood cell count, HGB, hematocrit, mean corpuscular hemcglobin concentration, aspartate aminotransferase, alanine aminotransferase, uric acid (UA) , total cholesterol, triglyceride, T₄, T₃, partial pressure of carbon dioxide (PaCO₂) , tetraiodothyronine and triiodothyronine, but mean oxygen saturation (MSpO₂) , the lowest oxygen saturation (LSpO₂) and partial pressure of oxygen (PaO₂) (P<0.05) . Higher prevalence of hyperuricemia, proteinuria, and hypercapnia and lower prevalence of hypothyroidism were also seen in those with elevated HGB (P<0.05) . Spearman correlation showed that in patients with elevated HGB, HGB level increased with the increase of BMI, AHI, maxAT, TS90%, PaCO₂ and UA, but decreased with the increase of MSpO₂, LSpO₂ and PaO₂ (P<0.05) . Age, BMI, maxAT, MSpO₂, LSpO₂, PaCO₂, creatinine and UA were the factors affecting the level of HGB in multiple regression analysis. ROC curve analysis showed that in male patients, the AUC of HBG in predicting the risk of pulmonary hypertension was 0.699〔95%CI (0.504, 0.893) , P=0.033〕with a cutoff value of 169.5 g/L, and its AUC was 0.836〔95%CI (0.682, 0.989) , P=0.005〕in predicting the risk of type Ⅱrespiratory failure with a cutoff value of 181.5 g/L.

Conclusion

The prevalence of elevated HGB was high in patients with OSAHS in Kunming, which may be associated with the severity of hypoxemia and lung ventilation during sleep. Patients with elevated HGB had severer conditions and higher prevalence of comorbidities. Elevated HGB may be a predictor of higher risk of pulmonary hypertension and type Ⅱrespiratory failure in male patients.

Population Health Research·Screening

Diagnostic Accuracies of Three Schemes for Arrhythmia Screening Using a Wearable Single-lead ECG Monitoring System: a Real-world Community-based Study

YU Xinyan, ZHAO Xudong, ZHAO Xiaoye, LIU Haipeng, JIANG Qingru, ZHANG Haicheng

2023, 26(02):  192-200.  DOI: 10.12114/j.issn.1007-9572.2022.0511

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Background

Arrhythmia has a high incidence, and is a serious threat to human health. However, due to concealed symptoms and unpredictability of onset, it is difficult for traditional ECG equipment to capture the ECG data at the onset of the arrhythmic events, so it could be misdiagnosed and under-treated. Fortunately, the diagnosis rate of arrhythmia could be greatly enhanced by analyzing the uploaded real-time ECG data of individuals measured at home using the wearable single-lead ECG monitoring system under the guidance of community doctors, but there is a lack of relevant evidence from real-world studies.

Objective

To assess the diagnostic accuracies of three schemes for screening arrhythmia in the community using a wearable single-lead ECG monitoring system.

Methods

A real-world, community-based study design was used for comparing three schemes for screening arrhythmia using a wearable single-lead ECG monitoring system: scheme 1 was used for collecting 24-hour ECG data on any three nonconsecutive days in two weeks, scheme 2 was used for collecting 24-hour ECG data on any day and at least three 1-hour ECG data in two weeks, and scheme 3 was adopted for collecting 72-hour ECG data on any three consecutive days and at least one 1-hour ECG data on any one day in two weeks. Subjects were 435 community-living residents, who were recruited from Yinchuan from September 2020 to September 2021. They were divided into male group (177 cases) , female group (258 cases) ; young group (135 cases) , middle-aged group (200 cases) and elderly group (100 cases) by age; primary school group (77 cases) , middle school group (165 cases) and university group (193 cases) by educational level; arrhythmia group (233 cases) and non-arrhythmia group (202 cases) by the history of arrhythmia. Subjects measured the ECG either at the onset time of perceived arrhythmia or not using any one of the three screening schemes chosen voluntarily with the wearable single-lead ECG monitoring system, then uploaded the measurement results to the cloud platform. The number of participants using each of the three screening schemes was counted. The correlation of age, education level or history of arrhythmia with scheme selection was analyzed. And detection rates of the three screening schemes were compared.

Results

The number of subjects who selected the three screening schemes was 321, 40 and 74, respectively. The average age of the subjects was significantly different (P=0.047) . There was no correlation between gender, education level, medical history and protocol selection (χ²=0.670, P=0.715; χ²=2.994, P=0.559; χ²=2.225, P=0.893) . There was a significant correlation between different age groups and protocol selection (χ²=9.939, P=0.041) . The arrhythmia detection rates of the three screening protocols were 85.67%, 82.50% and 85.14%, respectively, and the difference was not statistically significant (χ²=0.286, P=0.867) . There was no significant difference in the arrhythmia detection rate between the male group and the female group (χ²=0.966, P=0.707; χ²=0.917, P=0.678) . There was no significant difference in the detection rate of arrhythmia among young group, middle-aged group and elderly group (χ²=2.102, P=0.350; χ²=0.871, P=0.706; χ²=1.063, P=0.622) . There was no significant difference in the detection rate of arrhythmia among the three screening schemes in primary school group, middle school group and university group (χ²=2.421, P=0.271; χ²=1.115, P=0.633; χ²=2.181, P=0.353) . There was no significant difference in the arrhythmia detection rate between the three screening protocols in the history group and the no history group (χ²=1.442, P=0.507; χ²=0.548, P=0.818) . The frequency of 1-hour ECG data collection in protocol 2 was positively correlated with arrhythmia detection rate (r_s=0.912, P=0.011) . The frequency of 1-hour ECG data collection in protocol 3 was positively correlated with arrhythmia detection rate (r_s=0.852, P=0.026) . In protocol 2, the detection rate of arrhythmia in 24-hour ECG data was 72.5%, and that in 1-hour ECG data was 77.5%. There was a strong consistency between the two kinds of long-term ECG data (Kappa=0.601, P=0.001) . In protocol 3, the arrhythmia detection rate of 72-hour ECG data was 82.4%, and the arrhythmia detection rate of 1-hour ECG data was 63.5%. There was a medium consistency between the two kinds of long-term ECG data (Kappa=0.410, P<0.001) . In protocol 2, there was a strong consistency between the diagnosis results of 1-hour ECG data and the total protocol (Kappa=0.844, P<0.001) . There was a strong consistency between 24-hour ECG data diagnosis and total protocol diagnosis (Kappa=0.717, P<0.001) . In protocol 3, there was a moderate consistency between the 1-hour ECG data diagnosis and the total protocol diagnosis (Kappa=0.466, P<0.001) , and the consistency strength was general. The results of 72-hour diagnosis were strongly consistent with those of the total protocol (Kappa=0.901, P<0.001) .

Conclusion

There is no significant difference in the arrhythmia detection rate among the three arrhythmia screening schemes based on community mobile health care, which can be used regardless of whether there are symptoms or not. Subjects of different ages have different tendencies to choose the three screening schemes, and the frequency of 1-hour ECG data collection is positively correlated with the arrhythmia detection rate, which suggests that the community doctors should select the optimal compliance screening scheme according to patients' age, occupational characteristics, economic income and other factors, so as to truly enable the screening and management of arrhythmia in the community using mobile technologies.

Development and Validation of Hearing Loss Screening Software for the Elderly in the Community in the Context of Smart Medicine

GE Jianli, GENG Shasha, CHEN Xin, ZHU Yingqian, SUN Xiaoming, JIANG Hua

2023, 26(02):  201-209.  DOI: 10.12114/j.issn.1007-9572.2022.0380

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Background

There is currently insufficient effective treatment for hearing loss in the elderly since it is a hidden disease whose damage is irreversible. It is crucial to establish early warnings, screenings and interventions. As of now, there are few studies carried out on the assessment of hearing loss in the elderly based on risk factors at home and abroad. There are no standardized measurement tools or perfect scales.

Objective

Utilizing smart medicine and the WeChat platform, investigate high-risk factors of hearing loss in the elderly, develop screening software for hearing loss in the elderly, and explore the screening and management modes of hearing loss in the elderly.

Methods

Based on cross-sectional survey, five community health service centers in Pudong New Area of Shanghai were obtained. The tudy was performed from April to December 2019 to investigate the distribution of risk factors for hearing loss in the elderly in the community, and conditional logic was applied, and receiver operation charateristic curve (ROC curve) were used for risk stratification. The screening software for hearing loss in the elderly has been developed using JavaScript language during the period January and June 2020. Verification and evaluation of the screening software were performed between July 2020 to March 2021.

Results

The study involved 401 elderly peoplein across-sectional design. Multivariate Logistic regression analysis revealed that aging〔OR=1.100, 95%CI (1.037, 1.166) 〕, noise history〔OR=3.886, 95%CI (1.077, 14.022) 〕, non-light diet〔OR=2.445, 95%CI (1.127, 5.305) 〕, hypertension〔OR=1.8393, 95%CI (1.015, 3.330) 〕, diabetes〔OR=4.310, 95%CI (1.817, 10.225) 〕and hyperuricemia〔OR=3.174, 95%CI (1.030, 9.779) 〕were independent risk factors (P<0.05) . A total of 18 factors (male, overweight/obesity, living alone, widowed/divorced, noise history, family history of deafness, non-light diet, no exercise habits, smoking, drinking, wearing headphones, hypertension, diabetes, hyperlipidemia, cardiovascular and cerebrovascular diseases, hyperuricemia, hypothyroidism, ototoxic drug use history) were included in the analysis as a result of the difference analysis and literature review. According to the ROC curve, combined scores of risk factors can predict hearing loss in the elderly with an area under the curve (AUC) of 0.777〔95%CI (0.721, 0.833) 〕, and the cut off value is 3.5. According to this study, a cumulative risk factor score of 4 defined the threshold for predicting hearing loss in the elderly. The elderly were then stratified into those with low risk of hearing loss (<4) and those with high risk of hearing loss (≥4) . The software for screening elderly hearing loss is developed on the WeChat platform. There are four parts in total: risk factors stratification assessment, screening version of the Hearing Impairment Scale (HHIE-s) for the elderly, general conclusions, and health education. From July to December 2020, a total of 78 elderly people were recruited to evaluatethe hearing loss screening software, with a completion rate of 55.1% (43/78) .A mode ratecor relation exists between cumulative risk factor scores and HHIE-s scale score (r_s=0.360, P=0.018) . From January to March, 2021, a suitability evaluation questionnaire with 8 single item questions was administered to 106 general practitioners to determine the suitability of hearing loss screening software for the elderly. According to the 5-level Likert scale, the proportion of respondents who answered "completely agree" to each question is 85.8% (91/106) , 81.1% (86/106) , 71.7% (76/106) , 68.9% (73/106) , 68.0% (72/106) , 59.4% (63/106) , 15.1% (16/106) and 14.2% (15/106) respectively.

Conclusion

There are 18 risk factors for hearing loss in the elderly. The screening software for hearing loss in the elderly based on WeChat platform has a good effect in early warning of hearing loss in the elderly, which provides a medical basis for screening for hearing loss in the elderly. Hearing loss screening software can support real-time data transmission, optimize, and integrate the hierarchical assessment system of risk factors, HHIE-s and WeChat platform for self-health management. The screening software of hearing loss for the elderly offers general practitioners a new way to manage and control hearing loss provides a new way of hearing loss management and control for general practitioners at the grassroots.It is appropriate and enforceable.

TCM Research·Technique Development

Comparative Study of the Royal TCM-based Tendon-regulation Manipulation and Joint Mobilization for Knee Osteoarthritis

HAN Siyu, LI Duoduo, CAI Meiling, YU Changhe

2023, 26(02):  210-219.  DOI: 10.12114/j.issn.1007-9572.2022.0431

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Background

Appropriate and effective prevention and treatment of knee osteoarthritis (KOA) has become a challenge faced by medical institutions. Clinical evidence shows that both the royal TCM-based tendon-regulation manipulation and joint mobilization are effective for KOA, but there are few comparative studies of them in KOA.

Objective

To compare the similarities and differences between the royal TCM-based tendon-regulation manipulation and joint mobilization in the treatment of KOA, promoting the normalization and standardization of manipulative medicine worldwide.

Methods

From October 2020 to June 2021, 67 KOA patients who met the requirements were recruited from the Massage Department of Dongzhimen Hospital, Beijing University of Chinese Medicine. They were randomly divided into royal TCM-based tendon-regulation manipulation (n=33) and joint mobilization (n=34) . The two groups of patients received 10 treatments for 4 weeks, 4 cases fell off midway, and 63 patients were finally included. A mixed method of quantitative and qualitative analysis was adopted. Quantitative data collected were pre- and post-treatment assessment of the clinical responses in two groups with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) . Qualitative data were collected using semi-structured individual interviews conducted in the participants based on topics of the efficacies and assessment of the two treatments for KOA, and understanding of the massage therapy. The similarities and differences between the two treatments were compared, and analyzed using thematic analysis. Parallel comparison and joint display were used for integrative analysis of the mixed data.

Results

Efficacy evaluation: there was no statistically significant difference in the total score of WOMAC between the two groups after 4 weeks of treatment (P>0.05) , the total scores of WOMAC in both groups were lower than those before treatment (P<0.05) . According to the interview, there were no significant differences in patient-assessed efficacies (positive, neutral or negative evaluation) between the two treatments. Besides that, patients' positive, neutral and negative perceptions of massage were basically the same before and after treatment, but after treatment, patients' perception of massage inclined to be positive. The results of quantitative analysis showed that the curative effect was not related to previous hospital treatment with massage therapy. The efficacy was also not related to the success of blinding. There was no significant correlation between the success of blinding and the type of treatment or previous massage treatment. Patients' perceptions of massage were not associated with the efficacy, and the type of treatment received by them. Manipulation evaluation: There were no significant differences in the two treatments assessed by patients in terms of strength, pain degree, manipulation characteristics, onset time of curative effect and number of times with the most obvious perceived curative effect after the first or fourth week of treatment.

Conclusion

Quantitative and qualitative studies show that both the royal TCM-based tendon-regulation manipulation and joint mobilization are safe and effective for KOA, and they have no significant differences in patient-assessed efficacy and manipulation skills, as well as patients' perceptions of them.

A Qualitative Study on the Factors Influencing the Treatment of Musculoskeletal Pain by Tuina Manipulation

FAN Xiran, LI Duoduo, WANG Shuangshuang, GUO Ye, YU Changhe

2023, 26(02):  219-224.  DOI: 10.12114/j.issn.1007-9572.2022.0533

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Background

Musculoskeletal disorders are one of the most prevalent chronic diseases around the world. Additionally, they contribute significantly to the global burden of disease. Tuina manipulation played a crucial role in treating musculoskeletal diseases from ancient times to the present. However, there are no systematic investigations on the efficacy characteristics of Tuina manipulation for alleviating musculoskeletal pain.

Objective

To objective of the study was to investigate the factors that have an influence on the effectiveness of Tuina manipulation in treating musculoskeletal pain.

Methods

In October 2021, we interviewed physicians from Beijing's Tuina Department using the purpose sampling method and the snowball sampling strategy. Interviews were carried out following a semi-structured format to determine the factors influencing Tuina manipulation for musculoskeletal pain. In accordance with the study's aims, the interview outline was drafted and discussed with the research group, and the interview was ended when saturation of information had been reached. To develop a theoretical model, the interview content is organized into text using three-level coding and rooted theory using the qualitative analysis software NVivo 11.

Results

A total of 16 interviewees were interviewed effectively. The interviews were open coded to obtain 21 initial categories. And The 21 initial categories were summarized into five main categories: "health care providers" "patients" "medical environment" "regional divergence" and "advantages of disease" . In addition to selective coding, the factors of musculoskeletal pain are summarized as the intrinsic factors of "people" ( "health care provider" and "patients" ) , the external factors of "environment" ( "medical environment" and "regional divergence" ) , and the causative factors of "disease" ( "advantages of disease" ) . By combing these factors with Tuina manipulation, it becomes a tree-like model of influencing factors in the treatment of musculoskeletal pain.

Conclusion

The factors affecting the treatment of musculoskeletal pain by Tuina manipulation are composed of three factors: the internal factors of "people" , the external factors of "environment" and the causative factors of "diseases" . "Health care providers" constitute the most critical factors, as their diagnosis, treatment plan, and technical level significantly affect the final result of treatment. The patient's compliance is largely a secondary factor, while external factors indicate that good doctor-patient communication leads to success. From the causative factors of "disease" , it can be seen that Tuina has a more prominent effect in the treatment of musculoskeletal diseases.

Latest Advances in Central Analgesic Mechanism of Osteopathic Manipulative Treatment for Cervical Spondylosis

JIN Zikai, WANG Xu, SUN Kai, WANG Yanguo, SHI Bin, LUO Jie, ZHU Liguo, WEI Xu

2023, 26(02):  225-232.  DOI: 10.12114/j.issn.1007-9572.2022.0427

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Osteopathic manipulative treatment (OMT) is a popular treatment for cervical spondylosis, a common degenerative disease of the spine. It has proven to be effective in relieving the pain from cervical spondylosis, but the mechanism is not clear. The development of neuroimaging has made it possible to perform visualization analyses of the cerebral structure and function in patients with cervical spondylosis, made the theory of somatosensory cortical remodeling proposed from the central perspective a new hot spot in the research on pathogenesis of cervical spondylosis, and the exploration of different manipulation treatments for cervical spondylosis based on the central effect a new direction of research on OMT. We reviewed the latest advances in central analgesic mechanisms of OMT for cervical spondylosis, mainly involving modulating the activity of brain regions, changing the default mode network, and regulating sympathetic nerve function, and summarized that OMT may improve pain via the following paths: enhancing central gating and modulating sensory-motor integration processes, or enhancing the strength of connections between sensory cortex and prefrontal cortex (an important structure for performing executive functions) in the default mode network, accelerating local neural remodelling and weakening white matter fibre connections between negative memory and emotion-related areas, or modulating sympathetic function and restoring brain mechanisms in inhibiting pain and central sensitisation for analgesic effects. The brain regions, functional brain networks and various biomarkers and observable indicators related to pain activation summarised in this study provide directions for future research. Future applied and basic research is recommended to adopt a step-by-step design, pay attention to the diversity of the research population, use the multi-point observation technique to assess the mechanism of efficacy, and enrich the scientific essentials of OMT.

Medication Guide·Precision Medication

Effect of Two Commonly Used Doses of Tolvaptan on the Prognosis of Elderly Patients with Chronic Heart Failure

GAO Yan, LIANG Kun, LUAN Mingya, ZHANG Jianxin, XU Ning, LIU Nana, ZHANG Xiaoping, SHANG Gechu, LIU Kewei

2023, 26(02):  233-240.  DOI: 10.12114/j.issn.1007-9572.2022.0579

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Background

Tolvaptan is widely used in elderly patients with chronic heart failure (CHF) , but the effect of different doses of tolvaptan on the prognosis of elderly CHF patients is unclear.

Objective

To investigate the effect of two commonly used doses of tolvaptan, 7.5 mg/d and 15.0 mg/d, on the prognosis of elderly patients with CHF.

Methods

This is a retrospective cohort study. This study selected patients (age≥80 years) with CHF treated with tolvaptan in the health care ward of the 960th Hospital of PLA Joint Logistics Support Force of China from February 2016 to February 2022, and analyzed their clinical data. The patients were divided into 7.5 mg/d and 15.0 mg/d groups based on the dose of tolvaptan. The end point of follow-up was the occurrence of all-cause mortality or cardiovascular mortality or until the end of follow-up. This study used Kaplan-Meier method to perform survival curves analysis and used Cox proportional hazards regression models to analyze the effect of two doses of tolvaptan on all-cause mortality and cardiovascular mortality in elderly patients with CHF.

Results

This study enrolled 212 elderly patients with CHF, and the follow-up was 374.5 (155.5, 940.5) days. 124 (58.5%) patients died from all-cause mortality and 54 (25.5%) patients died from cardiovascular mortality during the follow-up. Kaplan-Meier survival curve showed that 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with 7.5 mg/d group (P=0.004 3, P=0.001 2) . Multivariate Cox proportional hazards regression model analysis showed that after adjusting for age, NYHA cardiac functional class, chronic kidney disease, diabetes, hypertension, coronary artery disease, diuretics, albumin (ALB) , serum N-terminal brain natriuretic peptide precursor (NT-proBNP) and estimated glomerular filtration rate (eGFR) , 15.0 mg/d group had a 1.03-fold increased risk of all-cause mortality〔HR=2.03, 95%CI (1.34, 2.99) 〕and 1.51-fold increased risk of cardiovascular mortality〔HR=2.51, 95%CI (1.40, 4.50) 〕compared with 7.5 mg/d group. This study stratified analysis by eGFR, age, ALB, and NT-proBNP, the results showed that tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality.

Conclusion

Tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with tolvaptan 7.5 mg/d in elderly CHF patients (age≥80 years) . We may recommend using low-dose tolvaptan.

Efficacy and Safety of PD-1 Inhibitors Monotherapy for Elderly Patients with Advanced Non-small Cell Lung Cancer

SONG Pingan, CHEN Xiaoliang, YAO Yuan, GAO Jin, YANG Yang, CUI Hongchun, ZHANG Yi

2023, 26(02):  241-247.  DOI: 10.12114/j.issn.1007-9572.2022.0567

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Background

Immunotherapy represented by programmed death protein-1 (PD-1) inhibitors has gradually become the standard treatment of advanced non-small cell lung cancer (NSCLC) in recent years, changing the treatment landscape of advanced NSCLC. However, most PD-1-related studies excluded patients with NSCLC more than 70 or 75 years, resulting in relatively limited data about the efficacy and safety of PD-1 inhibitors in elderly patients.

Objective

This study aims to evaluate the efficacy and safety of PD-1 inhibitors in elderly patients with advanced NSCCL.

Methods

This study selected elderly patients with advanced NSCLC over 65 years who received PD-1 inhibitors monotherapy in Department of Thoracic Surgery and Oncology of the Fourth Affiliated Hospital of Gansu University of Traditional Chinese Medicine from October 2018 to November 2021. A total of 63 elderly patients with NSCLC were included. The PD-1 inhibitors of the study were approved in Chinese market, including camrelizumab, sintilimab and pembrolizumab. The data about efficacy and safety of PD-1 inhibitors were collected in the hospital electronic medical record system. All patients were followed up regularly to obtain the long-term prognostic data until 2022-03-15. The efficacy data of PD-1 inhibitors, the prognosis of elderly patients with advanced NSCLC and the toxicity and side effects of PD-1 inhibitors were collected. Cox comparative risk model was used to explore the influencing factors of the prognosis of elderly patients with advanced NSCLC.

Results

The median age of the 63 elderly patients with advanced NSCLC was 71 (65, 89) years. The best response assessment during PD-1 inhibitors therapy showed that no patients had complete response, 14 patients had partial responses, 21 patients had stable status, and 28 patients had progressive status. The objective response rate (ORR) of patients with advanced NSCLC treated with PD-1 inhibitors monotherapy was 22.2% (14/63) , and the disease control rate (DCR) was 66.7% (14/21) . Prognostic data showed that the median progression free survival (PFS) of the 63 patients with advanced NSCLC was 3.3 (2.0, 4.6) months and the median overall survival (OS) was 10.2 (6.1, 14.3) months. Among 63 elderly patients with NSCLC, 46 of them (73.0%) had treatment related adverse reaction during PD-1 inhibitors monotherapy, and the rate of grade 3 or above adverse reactions was 14.3%. The most common adverse reactions were fatigue, diarrhea, rash and abnormal liver function with the rates of 23.8% (15/63) , 19.1% (12/63) , 15.9% (10/63) and 14.3% (9/63) , respectively. Cox comparative risk model analysis suggested that ECOG performance status and number of metastatic lesions might be independent factors of PFS in patients with advanced NSCLC treated with PD-1 inhibittors.

Conclusion

PD-1 blockades monotherapy demonstrated potential efficacy and acceptable safety for elderly patients with NSCLC. ECOG performance status and number of metastatic lesions might be potential risk factors that predict the PFS of the patients.

The Use of β-blockers in the Management of Hypertension in Young and Middle-aged People

LI Hairui, PENG Wei, WU Shaorong

2023, 26(02):  248-254.  DOI: 10.12114/j.issn.1007-9572.2022.0527

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Hypertension in young and middle-aged populations has a prevalence of approximately 20% according to relevant epidemiological reports, and is increasing in the light of the annual update, which is probably related to sympathetic excitation induced by stressful workloads and nervousness, and mainly characterized by elevated diastolic hypertension. There is an evident correlation between hypertension and long-term risk of coronary heart disease or stroke in the populations, but the long-term risk for cardiovascular events and mortality could be significantly reduced by active and appropriate antihypertensive treatment. β-blockers are medications that reduce blood pressure via inhibiting sympathetic activity, which are more suitable for young and middle-aged people primarily with diastolic hypertension. We did a review of the latest advances in epidemiology and pathogenesis of hypertension and major antihypertensive efficacies of β-blockers as well as precautions during the use of β-blockers in young and middle-aged populations, providing clinicians with evidence on treating the disease.