Table of Content

15 February 2023, Volume 26 Issue 05

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Guide Interpretation

Interpretation of the Management of Nephrolithiasis in Pregnancy: Multi-disciplinary Guidelines from an Academic Medical Center: Improving the Diagnostic and Therapeutic Capacity, and Strengthening Multi-disciplinary Collaborative Management

LIANG Puzhao, TIAN Zhentao, WU Yuyi

2023, 26(05):  519-524.  DOI: 10.12114/j.issn.1007-9572.2022.0569

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Nephrolithiasis in pregnancy is a common non-obstetric indication for hospital admission in obstetric patients, which is often associated with pain, nausea, vomiting, decreased renal function, urinary infection and other symptoms, and improper treatment for which will lead to abortion, premature delivery and other adverse pregnancy outcomes. In response, a multi-disciplinary team from a single academic medical center in the United States was assembled to create the management of nephrolithiasis in pregnancy: multi-disciplinary guidelines from an academic medical center to standardize the care for obstetric patients presenting with suspected nephrolithiasis. A total of 10 guideline statements were constructed, including four for guiding diagnosis and imaging, and six for guiding clinical treatment. It is noteworthy that compared with relevant Chinese guidelines, the guidelines provide practice-based evidence that proves the safety and effectiveness of low-dose non-contrast CT scan preferably used when condition changes and diagnostic uncertainty exists. This paper offers an in-depth interpretation of the above-mentioned contents in the guidelines.

Approaches to Improving General Practice: Building Primary Care Capability

Discussion on the Difficulties and Bottlenecks in the Management of Remote ECG-based Screening for Cardiovascular Disease Risk in Hierarchical Diagnosis and Treatment

ZHANG Haicheng, YU Xinyan, WANG Hongyu, XUE Tao, LIAO Xiaoyang, FAN Yongmei, ZHANG Qinghong

2023, 26(05):  525-531.  DOI: 10.12114/j.issn.1007-9572.2022.L0002

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In China, the overall prevalence and incidence of cardiovascular disease (CVD) continues to increase, and the mortality rate from CVD in rural areas has exceeded that in urban areas recently. Remote ECG-based screening for CVD risk is a beneficial supplement for CVD risk screening in primary hospitals, but there are many difficulties during its implementation, which mainly include the following aspects: how to improve the awareness and credibility of remote ECG-based screening for CVD risk and sense of gain in residents? How to incentivize primary physicians to actively participate in the screening? How to improve insufficient management ability and experience of primary physicians who can only provide single screening and communication services? How to build a collaborative mechanism between primary and higher level hospitals involved in delivering referral services, and to provide continuous services by establishing multiple teams consisting of screening team, diagnosis team, evaluation team, treatment team and follow-up management team? To address these issues, we invited a group of experts to attend discussions, in which the following recommended solutions were put forward: using various resources rationally and efficiently; strengthening the division of labor and cooperation between team members to improve hierarchical diagnosis and treatment; giving full play to the capacities of nursing and public health teams to develop different screening programmes; strengthening the technical support of experts from higher level medical institutions for primary doctors, and increasing the social benefits of primary hospitals; carrying out workplace training to improve the professional level of primary care workers; integrating Internet technologies into primary care to enable referrals; building a big data database of cases; constructing medical and health groups with clear defined division of labor and cooperation.

Attaching Importance to the Application of Lung Function Examination Technology in Grassroots Medical and Health Institutions——Expert Answers to Key Questions

HU Yiqing, FANG Jiwei, LIU Huanbing

2023, 26(05):  532-540.  DOI: 10.12114/j.issn.1007-9572.2022.0669

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The prevalence of chronic respiratory diseases is increasing, seriously threatening the health and life safety of Chinese residents. Lung function tests are important screening and diagnostic means for chronic respiratory diseases, but have been insufficiently valued for a long time, especially in primary care. Great emphasis should be placed on the use of these tests in primary care, mainly due to the following two aspects: (1) The incidence of chronic obstructive pulmonary disease (COPD) remains high in China, and it is estimated that more than 5.40 million people will die of COPD and its related diseases per year by 2060. Chronic respiratory diseases have become a public health issue that seriously impairs the health of Chinese residents. (2) Lung function tests are the gold standard for diagnosing chronic respiratory diseases. Carrying out these tests in primary care is contributive to early detection and timely intensive treatment of chronic respiratory diseases, thereby delaying the decrease in lung functions. As the major healthcare providers, general practitioner (GP) teams have many advantages to implement lung function tests, and they can perform many tasks related to the tests: (1) Working in primary care is favorable for GP teams to implement long-term follow-up management for chronic diseases, and the biopsychosocial model used by them is beneficial to improving the quality of care for the patients. (2) GPs may carry out various types of heath education to enhance residents' awareness of chronic respiratory disease prevention and control to improve their adherence to lung function tests. (3) GPs may proactively perform early lung function tests for residents in their service area, especially those at high risk for chronic respiratory diseases, by which the optimal treatment time will be determined, then the disease burden will be reduced. (4) GP teams can provide contracted care services and creating a respiratory health file for chronic respiratory disease patients, and offer tiered management services to COPD patients according to the severity of their disease. In general, GPs should provide chronic respiratory disease patients with continuous and standardized services using a scientific and effective process, and timely and appropriate follow-up services. In view of the unsatisfactory implementation status of lung function tests in primary care, we invited a group of experts to give their opinions on some key questions. Professor CHEN Yan put forward recommendations on the target population to be screened: COPD patients with dyspnea, a history of chronic cough / expectoration, recurrent lower respiratory tract infection, a family history of COPD /childhood factors (such as low birth weight, childhood respiratory tract infection) , a history of exposure to any COPD risk factors (including tobacco smoke, fumes from burning fuel and inhalable dust) , or age>40 years; asthma patients with allergic rhinitis, gastroesophageal reflux disease, COPD, bronchiectasis, smoking, a history of exposure to allergens and other environmental triggers, or obesity. And bronchiectasis and idiopathic pulmonary interstitial fibrosis patients should also be concerned population for implementing lung function tests. In terms of assessing and improving the quality control in performing lung function tests, Professor SONG Yuanlin and Professor GAI Xiaoyan proposed that during the implementation of such tests, the respiratory rate, respiratory amplitude and respiratory gas flow rate associated with lung ventilation function of the examinees are easily influenced by the performance of instruments and equipment, and operating skills of technicians as well as individual physiological and pathological factors of examinees. And they put forward recommendations, for example, using smart spirometers with built-in calibration and quality control standards in lung function tests, to reduce the operational complexity, so that primary care workers can quickly grasp the essentials of performing lung function tests. During the discussion of a community COPD department playing a demonstration role in the construction of early screening and intervention of respiratory disease project in primary care, Professor CHEN Yahong pointed out the standardized respiratory disease prevention, diagnosis and management system and capacity building program in primary care, and capabilities improvement program for early screening and intervention for respiratory diseases in primary care, have greatly promoted the levels of standardized prevention, treatment and nursing care of respiratory diseases, and the determination of number and quality of spirometers equipped in primary care settings. It is hoped that this article will provide insights into the promotion of lung function tests in primary care.

Original Research

Clinical Characteristics and Treatment of Atrial Fibrillation and Heart Failure: a Multicenter Survey

HU Huachao, CHEN Xianya, XIE Siyuan, XIA Zhen, XIAO Hua

2023, 26(05):  541-549.  DOI: 10.12114/j.issn.1007-9572.2022.0549

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Background

Atrial fibrillation (AF) is a common clinical tachyarrhythmia with high prevalence, and a predisposing factor of stroke. In addition, it has a causal relationship with heart failure (HF) . Treatment options for AF have changed recently owing to the emergence of new drugs. Many investigations are focused on anticoagulant therapies for AF, but relevant multicenter investigations on AF and HF are rare.

Objective

To investigate the clinical characteristics and treatment of patients with AF combined with HF in Chongqing, China.

Methods

A total of 4 011 patients with AF and HF who were discharged from 21 hospitals in Chongqing in 2018 were included. Data were collected through the electronic medical record system of the hospitals, including sex, age, basic comorbid conditions, type of AF, NYHA class, thromboembolism history, bleeding history, Color Doppler echocardiography results, HF type and use of drugs (including antithrombotic drugs, rhythm/ventricular rate-control drugs, ACEIs/ARBs, cardiotonic drugs) . The risk of thromboembolism and bleeding were assessed using admission CHA₂DS₂-VASc score and HAS-BLED score. Sex, basic comorbid conditions, AF type, NYHA class, admission CHA₂DS₂-VASc score and HAS-BLED score, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, endpoint events (thromboembolism and bleeding) , HF type, and treatment options were compared across three age groups (<65, 65-75, >75) and across patients by the level of hospitalized hospital (secondary and tertiary) .

Results

In terms of clinical characteristics, the patients had an average age of (74.0±10.6) years, 2 279 (56.8%) were female. The top three prevalent basic comorbid conditions were coronary heart disease (65.1%) , hypertension (51.0%) , and diabetes (17.5%) . 3 346 (83.4%) patients with nonvalvular atrial fibrillation (NVAF) . NYHA class was Ⅲ and Ⅳ in 3 059 patients (76.3%) , thromboembolism events occurred in 531 patients (13.2%) , and bleeding events occurred in 176 patients (4.4%) . In Color Doppler echocardiography results, The average left atrial diameter was (44.12±9.21) mm. The average left ventricular end-diastolic diameter was (48.45±10.06) mm. The average left ventricular ejection fraction was (54.23±11.94) mm. The main type of HF was HF with preserved ejection fraction, accounting for 66.2%. The average CHA₂DS₂-VASc score was (3.9±1.5) points, and the admission CHA₂DS₂-VASc score was positively correlated with age (r=0.589, P<0.001) . The average HAS-BLED score was (1.7±1.0) points. 3 641 (90.8%) patients were at high risk of thromboembolism and 723 (18.0%) patients were at high risk of bleeding. In terms of antithrombotic treatment, the overall prevalence of anticoagulation treatment was 47.1%, warfarin was the main anticoagulant (37.8%) , the prevalence of use of the new oral anticoagulant was only 9.3%. The overall prevalence of antiplatelet treatment was 44.6%, most of them were monoclonal antiplatelet agents (13.2%) . The prevalence of anticoagulation treatment decreased with age (χ²_trend=136.502, P<0.001) , but that of antiplatelet treatment increased with age (χ²_trend=135.730, P<0.001) . The prevalence of anticoagulation treatment, and use of warfarin and new oral anticoagulants in secondary hospitals was significantly lower than that in tertiary hospitals (P<0.001) . A total of 3 162 (78.8%) patients with atrial fibrillation received ventricular rate control. The prevalence of use of beta-blockers, digoxin and ACEIs/ARBs was 61.6%, 17.6%, and 59.7%, respectively.

Conclusion

The majority of patients with AF complicated with HF in Chongqing are elderly, and the proportion of women is relatively high. HFpEF is the main type of atrial fibrillation, and the NYHA classification is mainly classⅢandⅣ. Most were at high risk for thromboembolism, but less than 1/4 were at high risk of bleeding. The prevalence of antithrombotic treatmentin all ages and levels of hospitals was unsatisfactory, and there was a large gap between current treatment and guideline recommendations in improving HF. In view of this, hospitalphysicians should increase their awareness and capability of standardized diagnosis and treatmentregarding AF with HF.

Impact of COVID-19 Pandemic on the Frequency of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

SHI Weijuan, WANG Fengyan, YANG Yuqiong, XIE Qingxiu, LI Yuqi, LI Shiyue, CHEN Rongchang, ZHANG Dongying, ZHENG Jinping, LIANG Zhenyu

2023, 26(05):  550-556.  DOI: 10.12114/j.issn.1007-9572.2022.0583

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Background

Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However, there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations.

Objective

To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention.

Methods

The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University, which began recruiting patients in early 2016, with visits every 3 months to collect demographic and clinical data, including those who were followed up during June to August 2017 (group 1) , June to August 2018 (group 2) , June to August 2019 (group 3) , and June to August 2020 (group 4) . Basic clinical data (including the frequency of AECOPD, sex, age, symptom score and so on) were collected from group 1 from October 2016 to May 2017, group 2 from October 2017 to May 2018, group 3 from October 2018 to May 2019, and group 4 from October 2019 to May 2020 (during which the periods from October 2019 to January 2020, and from February to May 2020 were defined as pre-COVID-19 period, and post-COVID-19 period, respectively) . The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and post-COVID-19 periods were analyzed.

Results

There were 162 patients in group 1, 157 in group 2, 167 in group 3, and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year (P=0.013) , so did group 2 (P=0.016) . In contrast, group 4 had a higher frequency of AECOPD in October to January next year than in February to May (P=0.001) . The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups (P>0.05) . But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 (P<0.05) . There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3 (P>0.05) . The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3 (P>0.05) . but it from February to April in group 4 was lower than that in groups 1-3 (P<0.05) .

Conclusion

Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities, maintain social distance, wear masks when going out, and wash hands frequently even after the COVID-19.

Sex-specific Analysis of Influencing Factors for the Association between Baseline Serum Uric Acid and Two-year Outcome after First Acute Ischemic Stroke

YAO Huihui, SHU Lin, YAO Linli, LI Sha, YANG Xiaotong, LI Yunchun

2023, 26(05):  557-562.  DOI: 10.12114/j.issn.1007-9572.2022.0582

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Background

The level of serum uric acid (SUA) has recently been proven to be associated with outcomes in patients with acute ischemic stroke (AIS) , but whether the association is still controversial.

Objective

To explore the relationship of baseline SUA level with two-year recurrence and all-cause mortality after first AIS.

Methods

This retrospective study was conducted with a cohort of inpatients with first AIS treated in Department of Neurology, University of Hong Kong-Shenzhen Hospital from January 1, 2018 to December 31, 2019. The general information, biochemical indicators, and two-year adverse outcome (recurrence and all-cause mortality) after first AIS were collected and a follow up until December 31, 2021. Logistic regression analysis was used to explore the relationship of adverse outcome with quartile of baseline SUA levels〔Q1 group (n=129) , Q2 group (n=129) , Q3 group (n=128) , Q4 group (n=127) 〕 by sex.

Results

Univariate Logistic regression analysis showed that advanced age, history of diabetes, history of chronic renal insufficiency, high fasting blood glucose and triglyceride levels were risk factors for two-year recurrence and all-cause mortality after first AIS in male patients (P<0.05) . And advanced age and history of diabetes were risk factors for two-year recurrence and all-cause mortality after first AIS in female patients (P<0.05) . Multivariate Logistic regression analysis showed that the risk of two-year recurrence and all-cause mortality in males in Q4 group was lower than that of those in Q1 group〔OR=0.187, 95%CI (0.035, 0.990) , P<0.05〕 after adjusting for various confounding factors.

Conclusion

Higher baseline level of SUA was associated with lower two-year recurrence and all-cause mortality in male patients after first AIS compared to lower baseline level SUA. while intermediate baseline level of SUA was not associated with .

Effects of Complementary and Alternative Therapy of Mindfulness on Blood Sugar and Inflammatory Biomarkers and Adipokines in Pregnant Women with Gestational Diabetes Mellitus

SHU Ling, GONG Bo, WANG Jing, SU Yanlin

2023, 26(05):  563-568.  DOI: 10.12114/j.issn.1007-9572.2022.0496

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Background

The incidence of gestational diabetes mellitus (GDM) remains high, and it is prevalent all over the world. The incidence of GDM in China is up to 14.8%. Intrauterine hyperglycemia during pregnancy is a severe threat to maternal and neonatal health.

Objective

The aim of this study was to evaluate the effect of mindfulness-based complementary and alternative therapy for GDM.

Methods

This study selected 64 pregnant women with GDM undergoing routine outpatient prenatal examination in Changsha Central Hospital by using convenience sampling from March to December 2021. These patients were randomly assigned into the intervention group (n=31) and the control group (n=33) . The control group received routine psychologicalgcare, nutritional guidance and exercise guidance. The intervention group received 8 weeks of mindfulness-based complementary and alternative therapy on the basis of routine psychological care. This study collected the baseline characteristics and compared the blood sugar and inflammatory biomarkers and adipokines, followed-up neonatal outcomes (birth weight, random blood sugar) .

Results

The fasting blood sugar level, 1-hour blood sugar, 2-hour blood sugar and the expression of interleukin-6, interleukin-8, tumor necrosis factor-α and vaspin were lower than those of the control group (P<0.05) . After the intervention, the fasting blood sugar, 1-hour blood sugar, 2-hour blood sugar, and the expression of interleukin-6, interleukin-8, tumor necrosis factor-α and vaspin in the experiment group were lower than those before the intervention (P<0.05) . The pre-delivey weight, pre-delivery BMI, gestational weight gain, pre-delivey HbA_1c, birth weight of newborns of pregnant women with GDM in the intervention group were lower than those of the control group (P<0.05) , and the random blood sugar of the intervention group was higher than that of the control group (P<0.05) .

Conclusion

The 8 weeks of mindfulness-based complementary and alternative therapy reduced body mass index, effectively controlled blood sugar, reduced expression of inflammatory biomarkers and adipokines, and reduced the risk of neonatal hypoglycemia.

Efficacies of Tong-Xie-Yao-Fang Disassembled Recipes on Brain-gut Peptideina Rat Model of Diarrhea-predominant Irritable Bowel Syndrome

WANG Kekai, YANG Yanlin, ZHOU Yanni, XIAO Jin, XIE Xin, WU Qinping, CHEN Min

2023, 26(05):  569-575.  DOI: 10.12114/j.issn.1007-9572.2022.0510

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Background

Tong-Xie-Yao-Fang decoction has proven to be effective for irritable bowel syndrome (IBS) , a common intestinal disease. However, there are few studies on the main active ingredients in the decoction.

Objective

To examine the effects of Tong-Xie-Yao-Fang disassembled recipes on the expression levels of brain-derived neurotrophic factor (BDNF) and substance P (SP) in colon and hippocampus in a rat model of diarrhea-predominant irritable bowel syndrome (IBS-D) .

Methods

On July 2020, a total of 32 6-week-old SPF male Wistar rats were selected and randomized into blank group, model group, baishao-fangfeng group (B-F group) and chenpi-baizhu group (C-B group) , with 8 rats in each. Except for the blank group, the other three groups were used to establish visceral sensitive IBS-D rat model by use of colorectal dilatation + chronic restraint stress. At the end of successful model creation, the B-F group received the solution extracted from both baishao and fangfeng using gavage administration (4 ml/kg) , C-B group received the solution extracted from both chenpi and baizhu using gavage administration (4 ml/kg) , and the other two groups received gavage administration of distilled water. This treatment period was 14 days for all groups. The weight and growth status of weight, stool classification according to the Bristol Stool Scale (BSS) , abdominal withdrawal reflex (AWR) under different pressure gradients, BDNF and SP expression levels in colon and hippocampus were compared between the four groups at the end of modeling and subsequent treatment.

Results

All rats survived when the IBS-D model was successfully created. Blank group had bigger average growth of weight after modeling period than both B-F and C-B groups (P<0.05) . B-F and C-B groups had bigger average growth of weight after the treatment than model group (P<0.05) . Compared with model group, blank group had lower average score of BSS after treatment, and so did both B-F and C-B groups (P<0.05) . After the treatment, the AWR score under 60 mm Hg of cuff pressure in the model group was higher than that in the blank group (P<0.05) , and under both 60 mm Hg or 80 mm Hg of cuff pressure, the AWR score in the B-F group was lower than that in model group or C-B group (P<0.05) . Model group had higher average post-treatment expression levels of BDNF and SP in colon tissue than both blank group and B-F group, and so did C-B group (P<0.05) . Model group had lower average post-treatment expression level of BDNF in hippocampus than blank group (P<0.05) . B-F group had higher average post-treatment expression level of BDNF in hippocampus than both model group (P<0.05) . Model group had higher average post-treatment expression level of SP in hippocampus than both blank group and B-F group (P<0.05) . C-B group had higher expression level of SP in hippocampus than blank group (P<0.05) .

Conclusion

Both Tong-Xie-Yao-Fang disassembled recipes could significantly improve weight and diarrhea in rat model of IBS-D. Compared with chenpi and baizhu, baishao and fangfeng could better alleviate intestinal hypersensitivity, and down-regulate SP expression level in colon and hippocampus, and BDNF expression level in colon, up-regulate the BDNF expression level in colon, and regulate the balance of related brain-gut peptides.

Role of Calcium-sensing Receptors in Myocardial Remodeling and Retinal Vasculopathy in Rat Models of Hypertension

ZHAO Jiaqi, LIU Wei, TANG Na, WANG Lamei, QU Yuanyuan, XI Dongmei, ZHONG Hua, HE Fang

2023, 26(05):  576-582.  DOI: 10.12114/j.issn.1007-9572.2022.0520

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Background

Clinical treatment of target organ damage in hypertension is mainly based on systemic hypotension supplemented by topical medication, but the treatment is unsatisfactory due to different or even mutually exclusive responses of tissues to the drugs. The relationship between calcium-sensing receptors (CaSR) and hypertension has been investigated, however, studies on their role and mechanisms in hypertensive retinal disease are still lacking.

Objective

To investigate the expression level of CaSR in hypertensive retina and its relationship with myocardial remodeling and retinal vascular changes in hypertension.

Methods

Ten 8-week-old healthy wistar-kyoto rats (WKY) were selected as the WKY group, and 20 homologous spontaneous hypertensive rats (SHR) of the same age were randomly divided into SHR group and inhibitor (SHR+NPS2143) group from May to December 2021. During a 16-week intervention, the SHR+NPS2143 group received intraperitoneal injection of CaSR inhibitor NPS2143, while WKY and SHR groups were intraperitoneally injected with the equal volume of normal saline. At baseline and the end of intervention, blood pressure was measured by non-invasive blood pressure monitor in all rats, and from each group, five rats were selected and executed, and myocardial and retinal tissues were taken out for testing. Masson's Trichrome staining was used to measure the collagen deposition in the myocardium. H & E staining was used to detect the pathological changes in retinal tissues. The distribution and expression of CaSR and vascular endothelial growth factor A (VEGFA) in retinal tissues were detected using immunohistochemical staining and qRT-PCR.

Results

SHR group had significantly higher levels of systolic blood pressure (SBP) , diastolic blood pressure (DBP) and mean arterial pressure (MAP) than WKY group either at baseline or the end of intervention (P<0.05) . SHR group had much lower levels of SBP, DBP and MAP levels than SHR+NPS2143 group at the end of intervention (P<0.05) . At the end of the intervention, a significant growth was found in SBP, DBP and MAP levels in both SHR and SHR+NPS2143 groups (P<0.05) . Compared with SHR group, heart weight/body weight ratio (HW/BW%) , left ventricle weight/body weight ratio (LVW/BW%) , and myocardial collagen volume fraction (CVF) were significantly decreased in WKY group but increased significantly in SHR+NPS2143 group (P<0.05) . A significant growth was found in HW/BW%, LVW/BW% and CVF in both SHR and SHR+NPS2143 groups (P<0.05) . The total retinal thickness and inner plexiform layer thickness were higher in SHR group than in WKY group at baseline and 16 weeks of intervention (P<0.05) . The total retinal thickness and inner plexiform layer thickness were lower in the SHR group than in the SHR+NPS2143 group at 16 weeks of intervention (P<0.05) . Compared with SHR group, the inner plexiform layer thickness at 16 weeks of intervention was decreased in WKY group and increased in SHR+NPS2143 group (P<0.05) . CaSR in the retina of SHR group was lower than that of WKY group but higher than that of SHR+NPS2143 group (P<0.05) at 16 weeks of intervention. VEGFA in the retina of SHR group was higher than that of WKY group but lower than that of SHR+NPS2143 group (P<0.05) at 16 weeks of intervention.

Conclusion

The use of CaSR inhibitor could reduce the activation of CaSR, increase the expression of VEGFA in the retina, exacerbate hypertension-induced myocardial remodeling and the development of retinal vasculopathy.

Influencing Factors of the Incidence of Pulmonary Tuberculosis in China: an Analysis Using the Geographically and Temporally Weighted Regression Model

ZHAO Mingyang, ZHOU Qianyu, WANG Rongrong, WANG Zongxi, HE Wenqian, ZHANG Wensen, ZHANG Hengzhen, TIAN Zhuoyang, WU Ke, WANG Biyao, SUN Changqing

2023, 26(05):  583-590.  DOI: 10.12114/j.issn.1007-9572.2022.0552

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Background

Most of the existing studies on the influencing factors of pulmonary tuberculosis incidence are based on temporal or spatial regression models, and the results are limited.

Objective

To explore the temporal and spatial heterogeneity of pulmonary tuberculosis in China, and to analyze the temporal and spatial correlations between the incidence of pulmonary tuberculosis and meteorological and air quality factors, offering a scientific reference for the development of measures containing tuberculosis.

Methods

Monthly statistical data of pulmonary tuberculosis in China from 2016 to 2018 were collected. After being tested with multicollinearity and spatial-autocorrelation between incidence of pulmonary tuberculosis and meteorological and air quality factors, the incidence of pulmonary tuberculosis was used as the dependent variable, and meteorological and air quality factors as independent variables to construct OLS, GWR and GTWR models, respectively. Then the goodness of the three models was evaluated, and the optimal model was selected to describe the incidence of pulmonary tuberculosis. Kernel density plot and spatio-temporal graph were used to describe the spatio-temporal specificity of the fitting coefficients of each variable.

Results

The overall incidence of pulmonary tuberculosis in China during 2016-2018 decreased annually, with clustered spatial distribution. The GTWR model had higher R² value and lower AICc value compared to other two models, indicating that it had better performance in explaining the influence of meteorological and air quality factors on the incidence of pulmonary tuberculosis. The kernel density plot of each variable showed that the increase of wind speed was associated with decreased pulmonary tuberculosis incidence in most cities. But the increase of humidity and air pollutant concentration was associated with increased incidence of pulmonary tuberculosis, and the strength of association varied across cities.

Conclusion

Meteorological and air quality factors may significantly influence the incidence of pulmonary tuberculosis, and the influence had spatio-temporal specificity. So prevention methods for pulmonary tuberculosis should be developed according to region-specific factors influencing the disease.

Protein-energy Malnutrition Incidence in China: Trend in 1990-2019 and Future Trend in 2020-2029

WANG Hongxin, FAN Wenlong, YANG Xiaoyu, CHEN Dongyu, HUANG Qiao, PAN Suyue, WANG Pu, HU Min, HE Yuqing

2023, 26(05):  591-597.  DOI: 10.12114/j.issn.1007-9572.2022.0556

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Background

Protein-energy malnutrition (PEM) is a common nutritional deficiency. With the change of lifestyle and eating habits, people pay increasing attention to nutritional health problems, and PEM may have different effects on the health of different age groups.

Objective

To analyze the overall and age-specific trends of PEM incidence in 1990-2019 and to predict its incidence in 2020-2029 in China.

Methods

The data of this study were derived from the Global Burden of Disease Study 2019, involving mortality indicators, and incidence indicators in 18 age groups (ranged from 0 to over 85 years grouped by an interval of 5 years) of PEM in China from 1990 to 2019. The age-standardized rates were calculated using the world standard population. Joinpoint regression analysis was used to calculate the annual percentage change (APC) and annual average percentage change (AAPC) of the incidence rate and 95% confidence interval, and to describe the temporal trend. The autoregressive integrated moving average (ARIMA) model was used to predict the incidence of PEM in China from 2020 to 2029.

Results

(1) In 2019, the standardized incidence ratio (SIR) of PEM in the whole population of China was 1 996.5/100 000, and that in males (2 444.7/100 000) was higher than that in females (1 536.0/100 000) . The SIR of PEM in the whole population in China was lower than that of the world standard population (2 099.4/100 000) , and that of PEM in Chinese males was higher than that in the world standard male population (2 304.0/100 000) . The incidence of PEM was highest in <5 years old group (4 402.5/100 000) , followed by 80-84 years old group (2 417.7/100 000) . After 5 years old, the incidence of PEM in both males and females increased with age, but that was still higher in males. (2) The SIR of PEM in China from 1999 to 2019 generally showed six inflection points, which were in 1995, 2006, 2010, 2014, 2017 and 2019, respectively. The SIR of PEM in China showed a downward trend in periods from 1990 to 1995 (APC=-1.3%) and from 2010 to 2014 (APC=-2.3%) (P<0.05) . But from 1995 to 2006 and 2006 to 2010, it showed an upward trend, with APC of 0.9% in 1995, and of 2.5% in 2010, respectively (P<0.05) . The growth trend of the SIR of PEM was the most obvious in 2017-2019, with an APC of 8.9% (P<0.05) . The SIR of PEM in China increased at an average annual rate of 0.7% from 1999 to 2019 (AAPC=0.7%, P<0.05) . (3) The age-specific incidence of PEM in China from 1999 to 2019 showed that the incidence of PEM decreased at an average annual rate of 2.1% in the population under 5 years old, but showed a steady upward trend in other 17 groups (P<0.05) . In age groups of 75-79 and 80-84, the incidence of PEM increased at each time interval from 1999 to 2019 (P<0.05) . (4) The ARIMA model-based prediction showed that the incidence of PEM in China might continue to rise from 2020 to 2029, reaching 7 280.06/100 000 in 2029.

Conclusion

In 2019, the SIR of PEM in the whole population in China (1 996.5/100 000) was lower than that in the world standard population (2 099.4/100 000) , but that of PEM in Chinese males was higher than that in the world standard male population (2 304.0/100 000) . The SIR of PEM in China increased at an average annual rate of 0.7% from 1999 to 2019, and it might continue to rise until 2029.

Original Research·Evidence-based Medicine

Efficacy and Safety of Anti-tuberculosis Drugs for the Treatment of Multidrug Resistance-tuberculosis: a Network Meta-analysis

CHEN Tao, FAN Qingze, SUN Xuemei, YU Yongqi, LUO Hongli

2023, 26(05):  598-606.  DOI: 10.12114/j.issn.1007-9572.2022.0530

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Background

Second-line anti-tuberculosis drugs are widely used in clinic for multi-drug resistant tuberculosis (MDR-TB) . At present, there are several reticulated meta-analyses investigating them, but the effect is not very satisfactory.

Objective

To systematically evaluate the efficacy and safety of five anti-tuberculosis chemotherapy regimens in the treatment of MDR-TB.

Methods

Randomized controlled trials (RCTs) on anti-tuberculosis drug for MDR-TB were retrieved from PubMed, Medline, Web of Science, VIP, and Wanfang data from January 2010 to March 2022. The experimental group was treated with individualized treatment combined with moxifloxacin (Mfx) , levofloxacin (Lfx) , linezolid (Lzd) , clofazimine (Cfz) and bedaquiline (Bdq) . The control group was treated with individualized treatment combined with placebo or Lfx. After literature screening and data extraction, quality assessment was performed using the risk of bias assessment tool provided by the Cochrane system evaluator handbook 5.1.0. Bayesian network Meta-analysis on the rate of sputum culture conversion, clinical efficacy rate and incidence of adverse reactions was conducted using GeMTC 0.14.3 software and Stata SE 15.0 software.

Results

A total of 39 RCTs and 3 860 patients were included. Results of Meta-analysis showed that the rate of sputum culture conversion of Bdq, Cfz, Lfx, Lzd, Mfx, were higher than those of placebo〔OR=3.49, 95%CI (2.11, 5.73) ; OR=2.85, 95%CI (1.93, 4.23) ; OR=2.93, 95%CI (1.45, 6.94) ; OR=6.37, 95%CI (3.67, 11.31) ; OR=8.15, 95%CI (3.97, 18.47) 〕 (P<0.05) . The rate of sputum culture conversion of Cfz and Lfx was lower than Mfx〔OR=0.34, 95%CI (0.14, 0.80) ; OR=0.36, 95%CI (0.24, 0.55) 〕 (P<0.05) , and Cfz was lower than Lzd〔OR=0.44, 95%CI (0.23, 0.91) 〕 (P<0.05) in rate of sputum culture conversion. The surface under the cumulative ranking curve area (SUCRA) ranking showed the following: Mfx (94.3%) >Lzd (82.1%) >Bdq (50.2%) >Lfx (37.5%) >Cfz (35.9%) >placebo (0.1%) . The clinical response rates for Bdq, Cfz, Lfx, Lzd and Mfx were all higher than that of placebo〔OR=2.80, 95%CI (1.74, 4.46) ; OR=2.02, 95%CI (1.33, 3.08) ; OR=4. 93, 95%CI (2.13, 11.50) ; OR=5.72, 95%CI (3.44, 10.08) ; OR=3.20, 95%CI (1.16, 9.21) 〕 (P<0.05) , and Bdq, Cfz, and Lfx had lower clinical response rates than Mfx〔OR=0.27, 95%CI (0.08, 0.77) ; OR=0.19, 95%CI (0.07, 0.53) ; OR=0.47, 95%CI (0.29, 0.74) 〕 (P<0.05) , and lower clinical response rates for Bdq and Cfz than Lzd〔OR=0.49, 95%CI (0.23, 0.97) ; OR=0.35, 95%CI (0.17, 0.68) 〕 (P<0.05) , and the SUCRA ranking showed the following: Mfx (87.4%) >Lzd (86.2%) >Lfx (54.6%) >Bdq (47.3%) >Cfz (24.3%) >placebo (0.1%) . There were no significant differences both in the incidence of adverse reactions among the 5 anti-tuberculosis drugs and placebo (P>0.05) and in the incidence of adverse reactions of each anti-tuberculosis drugs between groups (P>0.05) .

Conclusion

Current evidence suggests that Mfx and Lzd are more effective than other drugs in the treatment of MDR-TB. The results of the study need to be further verified due to the small number clinical studies and sample size.

Risk Factors of In-hospital Death in COVID-19 Patients: a Meta-analysis

ZHANG Weizong, YUAN Hong, SUN Jindong, YU Huamin, SHI Mingjuan, HU Haiqiang, HE Haiying, YE Li, ZHANG Huihui, BAI Xinghua, SHEN Chaofeng, TU Sijia, WANG Yang, WANG Gang, ZHAO Xiaofeng, YU Tao, LI Cairong, ZHANG Zhi, ZHOU Donglai, CAI Mengyang, NING Le

2023, 26(05):  607-620.  DOI: 10.12114/j.issn.1007-9572.2022.0211

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Background

The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis, and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform.

Objective

To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis.

Methods

Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library, ScienceDirect, PubMed, Medline, Wanfang Data, CNKI and CQVIP from inception to October 1, 2021. Literature screening, data extraction and methodological quality assessment were conducted. Meta-analysis was performed using Stata 15.1. Meta-regression was used to explore the potential sources of heterogeneity.

Results

Eighty studies were included which involving 405 157 cases〔349 923 were survivors (86.37%) , and 55 234 deaths (13.63%) 〕, that were rated as being of high quality by the Newcastle-Ottawa Scale. Meta-analysis showed that being male〔OR=1.49, 95%CI (1.41, 1.57) , P<0.001) , older age〔WMD=10.44, 95%CI (9.79, 11.09) , P<0.001〕, dyspnoea〔OR=2.09, 95%CI (1.80, 2.43) , P<0.001〕, fatigue〔OR=1.49, 95%CI (1.31, 1.69) , P<0.001〕, obesity〔OR=1.46, 95%CI (1.43, 1.50) , P<0.001〕, smoking〔OR=1.18, 95%CI (1.14, 1.23) , P<0.001〕, stroke〔OR=2.26, 95%CI (1.41, 3.62) , P<0.001〕, kidney disease〔OR=3.62, 95%CI (3.26, 4.03) , P<0.001〕, cardiovascular disease〔OR=2.34, 95%CI (2.21, 2.47) , P<0.001〕, hypertension〔OR=2.23, 95%CI (2.10, 2.37) , P<0.001〕, diabetes〔OR=1.84, 95%CI (1.74, 1.94) , P<0.001〕, cancer〔OR=1.86, 95%CI (1.69, 2.05) , P<0.001〕, pulmonary disease〔OR=2.38, 95%CI (2.19, 2.58) , P<0.001〕, liver disease〔OR=1.65, 95%CI (1.36, 2.01) , P<0.001〕, elevated levels of white blood cell count〔WMD=2.03, 95%CI (1.74, 2.32) , P<0.001〕, neutrophil count〔WMD=1.77, 95%CI (1.49, 2.05) , P<0.001〕, total bilirubin〔WMD=3.19, 95%CI (1.96, 4.42) , P<0.001〕, aspartate transaminase〔WMD=13.02, 95%CI (11.70, 14.34) , P<0.001〕, alanine transaminase〔WMD=2.76, 95%CI (1.68, 3.85) , P<0.001〕, lactate dehydrogenase〔WMD=166.91, 95%CI (150.17, 183.64) , P<0.001〕, blood urea nitrogen〔WMD=3.11, 95%CI (2.61, 3.60) , P<0.001〕, serum creatinine〔WMD=22.06, 95%CI (19.41, 24.72) , P<0.001〕, C-reactive protein〔WMD=76.45, 95%CI (71.33, 81.56) , P<0.001〕, interleukin-6〔WMD=28.21, 95%CI (14.98, 41.44) , P<0.001〕, and erythrocyte sedimentation rate〔WMD=8.48, 95%CI (5.79, 11.17) , P<0.001〕 were associated with increased risk of in-hospital death for patients with COVID-19, while myalgia〔OR=0.73, 95%CI (0.62, 0.85) , P<0.001〕, cough〔OR=0.87, 95%CI (0.78, 0.97) , P=0.013〕, vomiting〔OR=0.73, 95%CI (0.54, 0.98) , P=0.030〕, diarrhoea〔OR=0.79, 95%CI (0.69, 0.92) , P=0.001〕, headache〔OR=0.55, 95%CI (0.45, 0.68) , P<0.001〕, asthma〔OR=0.73, 95%CI (0.69, 0.78) , P<0.001〕, low body mass index〔WMD=-0.58, 95%CI (-1.10, -0.06) , P=0.029〕, decreased lymphocyte count〔WMD=-0.36, 95%CI (-0.39, -0.32) , P<0.001〕, decreased platelet count〔WMD=-38.26, 95%CI (-44.37, -32.15) , P<0.001〕, increased D-dimer〔WMD=0.79, 95%CI (0.63, 0.95) , P<0.001〕, longer prothrombin time〔WMD=0.78, 95%CI (0.61, 0.94) , P<0.001〕, lower albumin〔WMD=-1.88, 95%CI (-2.35, -1.40) , P<0.001〕, increased procalcitonin〔WMD=0.27, 95%CI (0.24, 0.31) , P<0.001〕, and increased cardiac troponin〔WMD=0.04, 95%CI (0.03, 0.04) , P<0.001〕were associated with decreased risk of in-hospital death due to COVID-19. According to the meta-regression result, the heterogeneity in gender, renal disease, cardiovascular diseases, asthma, white blood cell count, neutrophil count, platelet count, hemoglobin, and urea nitrogen differed siangificnatly by country (P<0.05) .

Conclusion

The risk of in-hospital death due to COVID-19 may be increased by 25 factors (including being male, older age, dyspnoea, fatigue, obesity, smoking, stroke, kidney disease, cardiovascular disease, hypertension, diabetes, cancer, pulmonary disease, liver disease, elevated levels of white blood cells, neutrophil count, total bilirubin, aspartate transaminase, alanine transaminase, lactate dehydrogenase, blood urea nitrogen, serum creatinine, C-reactive protein, interleukin-6, and erythrocyte sedimentation rate) , and may be decreased by 13 factors (including myalgia, cough, vomiting, diarrhoea, headache, asthma, low body mass index, decreased lymphocyte count and platelet count, increased D-dimer, longer prothrombin time, lower albumin, increased procalcitonin and cardiac troponin) . The conclusion drawn from this study needs to be further confirmed by high-quality, multicenter, large-sample, real-world studies.

Malignant Transformation Rate in Chinese Patients with Oral Leukoplakia: a Meta-analysis

YANG Ling, HOU Lili, CHEN Weihong, WENG Ximei, LUO Shasha, XIA Jialin

2023, 26(05):  621-628.  DOI: 10.12114/j.issn.1007-9572.2022.0303

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Background

Oral cancer is highly prevalent, which is often caused by oral potentially malignant disorders, and oral leukoplakia is the most common. The malignant transformation of oral leukoplakia not only affects the physical and mental health of patients, but also imposesa heavy economic burden on the patient's families and society. Due to limited sample size, regional differences and other factors, the epidemiological characteristics of malignant transformation in Chinese patients with oral leukoplakia in China are various.

Objective

To perform a systematic review of the malignant transformation rate of oral leukoplakia in Chinese patients.

Methods

Databases of CNKI, SinoMed, CQVIP, Wanfang Data, PubMed, Web of Science, Embase and Cochrane Library were searched to identify cohort studies about malignant transformation rate of oral leukoplakia in Chinese patients included from inception to February 2022. Two researchers separately screened the cohort studies, evaluated the qualities and extracted data. Meta-analysis was conducted using Stata 15.0.

Results

Thirty cohort studies including 109 047 patients were finally included. Meta-analysis revealed that the malignant transformation rate of oral leukoplakia in Chinese patients was 9.0%〔95%CI (7.0%, 11.3%) 〕. The results of subgroup analysis revealed that the malignant transformation rate was 7.6% in male patients〔95%CI (5.1%, 10.6%) 〕, and was 13.2% in female patients〔95%CI (9.5%, 17.4%) 〕. The malignant transformation rate of oral leukoplakia in patients aged <60 years was 12.3%〔95%CI (9.2%, 15.7%) 〕, and was 17.9% in those aged ≥60 years 〔95%CI (13.8%, 22.5%) 〕. The malignant transformation rate of tongue leukoplakia was 16.2%〔95%CI (11.0%, 22.2%) 〕, and that of leukoplakia of other parts of the oral cavity was 6.1%〔95%CI (3.2%, 9.6%) 〕.

Conclusion

Current evidence shows that the malignant transformation rate of oral leukoplakia in Chinese patients is relatively high, female, age ≥ 60 years, tongue oral leukoplakia malignant rate is higher.

Review & Perspectives

Latest Advances in Exercise-induced Autophagy in Improving Cardiovascular Disease Prognosis

WU Changyong, BAO Suli, XU Fei, PENG Yunzhu

2023, 26(05):  629-634.  DOI: 10.12114/j.issn.1007-9572.2022.0524

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Cardiovascular disease is the leading cause of human mortality worldwide. Autophagy, a highly conserved metabolic pathway in which organelles and macromolecules are degraded by lysosomes and recycled, is essential for maintaining cardiovascular homeostasis and function, but excessive or insufficient autophagy could result in cardiovascular disease. A growing body of research has demonstrated that exercise is a critical component in preventing onset and improving the prognosis of cardiovascular disease. Exercise regulates autophagy bidirectional and dynamically. In cardiovascular disease caused by excessive or insufficient autophagy, exercise can restore autophagy level and function, delaying the progression of the disease, and improving ventricular remodeling. We reviewed the main mechanisms of autophagy and signaling pathways, as well as the beneficial effect of exercise-induced autophagy on prognosis of cardiovascular disease, and summarized that the mechanism of exercise regulating autophagy in cardiovascular diseases is beneficial to improving prognosis and reducing the incidence of cardiovascular events, but the mechanism for prognosis improvement is still not fully elaborated and needs further study.

Review & Perspectives

Recent Advances in Pathogenesis and Mechanism of Action of Exercise Regarding Frailty in Older Adults with Hypertension

LIU Yameng, YANG Xiaoli, ZHANG Caihong

2023, 26(05):  635-640.  DOI: 10.12114/j.issn.1007-9572.2022.0484

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Frailty is a common geriatric syndrome that has become a great public health concern in China with the acceleration of population aging. Hypertension and frailty often coexist in older adults, leading to multiple adverse health outcomes. We reviewed recent advances in epidemiology of frailty in older people with hypertension, and its pathogenesis involving inflammatory response, oxidative stress, insulin resistance and hormone metabolism, and the possible mechanisms of action of exercise in improving it, then summarized that relevant studies on mechanisms of action of exercise in enhancing frailty in older people with hypertension are still insufficient, and the mechanism of action varies by the type of exercise. Further research could explore the targets and effects of different types of exercise in improving frailty in older people with hypertension.

Research of Typical Cases

Hereditary Pancreatitis in Children: Report of One Case with Pedigree Analysis and Literature Review

HE Xiaoli, LIANG Shuheng, LI Miaoxia, KONG Jinliang, SHAN Qingwen

2023, 26(05):  641-646.  DOI: 10.12114/j.issn.1007-9572.2022.0338

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Hereditary pancreatitis (HP) is a rare autosomal genetic disease that is often manifested by recurrent pancreatitis and complicated type 3c diabetes mellitus (T3cDM) , and even leads to pancreatic cancer, impairing the quality of life and prognosis of patients. We reported a child with HP caused by p.Val39Ala (V39A) mutation of the PRSS1 gene with a pedigree analysis, which is the first case report in China, hoping to provide clinicians with evidence for the diagnosis and treatment of HP.