Table of Content

15 November 2023, Volume 26 Issue 32

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Cardiovascular Research Development Report

Interpretation of Report on Cardiovascular Health and Diseases in China 2022

MA Liyuan, WANG Zengwu, FAN Jing, HU Shengshou

2023, 26(32):  3975-3994.  DOI: 10.12114/j.issn.1007-9572.2023.0408

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Due to the acceleration of population aging and the prevalence of unhealthy lifestyles, the huge population with cardiovascular disease (CVD) risk factors, the burden of CVD continues to increase in China. CVD is still the leading cause of death among urban and rural residents in China. In 2020, CVD accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively, and two out of every five deaths were due to CVD. It is estimated that the number of current CVD patients in China is 330 million, including 13 million cases of stroke, 11.39 million cases of coronary heart disease, 8.9 million cases of heart failure, 5 million cases of pulmonary heart disease, 4.87 million cases of atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of peripheral artery disease, and 245 million cases of hypertension. The total hospitalization costs were 270.901 billion yuan for CVD in China in 2020. The prevention and treatment of CVD in China still has a long way to go. In general, we should not only do a good job in secondary prevention and treatment of CVD, but also further strengthen the upstream treatment of modifiable risk factors such as hypertension, hyperglycemia and hyperlipidemia starting with both preventive treatment and treatment diseases. In addition, attention should be paid to the allocation and prioritization of health care and public health resources, so as to reach the inflection point of CVD prevention and treatment as early as possible.

Guidelines·Consensus

Interpretation of Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST) : Consensus Guidance from the American Society of Pain and Neuroscience (ASPN) in 2022

LU Guangqi, ZHUANG Minghui, ZHU Liguo, GAO Jinghua, WEI Xu, LI Luguang, YU Jie

2023, 26(32):  3995-4000.  DOI: 10.12114/j.issn.1007-9572.2023.0335

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Lumbar spinal stenosis (LSS) is a common disease in orthopedics. The American Society of Pain and Neuroscience (ASPN) published a new version of minimally invasive treatment practice guidelines in 2022 to improve the clinical efficacy of LSS. A total of seven treatments for LSS were included in the guidelines, including percutaneous image-guided lumbar decompression (PILD), interspinous spacers (ISP), interspinous fusion (ISF), intrathecal drug delivery systems (IDDS), spinal cord stimulation (SCS), epidural steroid injections (ESI) and open decompression. Based on the guidelines, this paper summarizes and discusses the research progress of minimally invasive treatment of LSS in the context of the clinical situation, aiming to provide a reference for clinicians and further related researches.

Article

A Prospective Cohort Study of Solid Fuels Use and Risk of Hypertension in Chinese Older Adults

ZHANG Shuai, LI Qin, LI Dongfeng, XIAO Jinping, LI Yunpeng

2023, 26(32):  4001-4006.  DOI: 10.12114/j.issn.1007-9572.2023.0268

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Background

The prevalence of hypertension in population is still increasing by year, and the significant increase in the prevalence of chronic diseases caused by aging of the population results in a serious medical burden. There are still about 450 million people in China who use solid fuels for cooking or heating, causing indoor air pollution as an important public health problem in China. At present, the relationship between solid fuels use and the risk of hypertension in Chinese older adults still remains unclear.

Objective

To analyze the association between solid fuels use and the risk of hypertension in older adults in urban and rural areas of China through a prospective cohort study, so as to provide a theoretical basis for the prevention and treatment of hypertension in the elderly.

Methods

This study is a prospective cohort study. Data were obtained from 2011 to 2018 China Longitudinal Healthy Longevity Survey (CLHLS) by using baseline questionnaire and physical examination. A total of 1 453 non-hypertensive older adults aged 65 years and above from 2011 to 2012 cohort were included in the study, and the occurrence of hypertension during follow-up was considered as the outcome indicator, follow-up as of 2018-12-31. The included subjects were divided into the clean fuel (electrical appliances such as induction cooker, pipeline natural gas, solar energy) group (n=654) and solid fuel (charcoal, kerosene, coal, firewood) group (n=799). Multivariate Cox proportional hazard regression model was used to analyze the association between cooking with solid fuels and the risk of hypertension.

Results

A total of 1 453 non-hypertensive older adults at baseline with an average age of (77.6±8.8) years and a median follow-up of 7 years, and a total of 838 people developed hypertension at the outcome. The results of this study showed that the proportion of cooking with solid fuels in rural areas was significantly higher than that in urban areas (70.3% vs. 1.1%, P<0.05). Multivariate Cox proportional hazard regression model showed that cooking with solid fuels significantly increased the risk of hypertension〔HR=1.20, 95%CI (1.05, 1.38), P=0.01〕, and the adjustment for covariates still indicated that it increased the risk of hypertension〔HR=1.21, 95%CI (1.04, 1.41), P=0.01〕. In addition, cooking with solid fuels was positively associated with abnormal mean arterial pressure (MAP) 〔HR=1.26, 95%CI (1.02, 1.55), P=0.03〕; and the adjustment for covariates still showed positive association of it with abnormal MAP〔HR=1.28, 95%CI (1.02, 1.60), P=0.03〕.

Conclusion

Cooking with solid fuels in urban and rural areas of China significantly increases the risk of hypertension in the elderly, as well as affects MAP. Reducing the use of solid fuels for cooking and promoting the use of clean fuels is a simple and effective measure in the prevention and control of hypertension.

Efficacy and Safety of Risperidone Microspheres for Injection (Ⅱ) in the Treatment of Patients with Acute Schizophrenia

LI Qian, ZHANG Yunshu, YAN Baoping, WANG Jian, MA Yanjuan, WANG Yuan, QIN Yingjie, NA Long, REN Zhiyong, SUN Junwei, DENG Huaili, MA Hongjun, QU Xuehui, ZHOU Nan, SI Tianmei

2023, 26(32):  4007-4012.  DOI: 10.12114/j.issn.1007-9572.2023.0224

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Background

Long-acting antipsychotics are currently important therapeutic options for the long-term treatment of schizophrenia. Risperidone microspheres for injection (Ⅱ) has been modified in dosage form to ensure fast acting without oral antipsychotic supplementation during treatment, however, there is a lack of studies on the efficacy and safety of it.

Objective

To evaluate the efficacy and safety of risperidone microspheres for injection (Ⅱ) in patients with acute schizophrenia.

Methods

This is a single-arm multicenter prospective study. The patients aged 18-55 years with acute schizophrenia from August 2021 to April 2022 at five study centers including Peking University Sixth Hospital, Hebei Provincial Mental Health Center, the Fourth People's Hospital in Urumqi, Taiyuan Psychiatric Hospital and Tianjin Anding Hospital were included and given variable dose of risperidone microspheres for injection (Ⅱ) of 25.0 mg/2 weeks, 37.5 mg/2 weeks or 50.0 mg/2 weeks and followed up for 8 weeks. The Positive and Negative Symptom Scale (PANSS), Clinical Global Impression Scale (CGI-S) and the Udvalg for Kliniske Undersogelser (UKU) Side Effects Rating Scale were used for evaluation at baseline and the end of week 2, 4, 6 and 8. In addition, Personal and Social Performance (PSP) Scale were evaluated and laboratory tests were collected at baseline and the end of week 8.

Results

A total of 58 patients were included in the study. PANSS total score, PANSS-positive score, PANSS-negative score, PANSS-general psychopathology score and CGI-S score were significantly reduced at the end of week 2, 4, 6 and 8 compared to baseline (P<0.001). The effective rates of PANSS total score reduction were 37.9% (22/58), 70.7% (41/58), 89.7% (52/58) and 89.7% (52/58) at the end of week 2, 4, 6 and 8, respectively. The PSP score at the end of week 8 (71.00±14.99) was higher than at baseline (46.28±15.43) (P<0.001). The average plasma concentration was (12.94±8.47), (13.23±10.86), (21.09±13.04), (23.64±14.23) and (29.08±19.51) μg/L at the end of week 1, 2, 4, 6 and 8, respectively. Common adverse reactions included tremor, dystonia, and constipation, all of which ranged from mild to moderate, with no serious adverse reactions or discontinuations due to no adverse reactions. Plasma prolactin (PRL) level was increased at the end of week 8 compared with baseline (P<0.05) .

Conclusion

Risperidone microspheres for injection (Ⅱ) can act fast without oral antipsychotic supplementation and effectively improve the multi-dimensional symptoms of acute schizophrenia with acceptable tolerance.

Construction of Recurrence Risk Prediction Model for Diabetic Foot Ulcer on the Basis of Logistic Regression, Support Vector Machine and BP Neural Network Model

ZHANG Juan, LI Haifen, LI Xiaoman, YAO Miao, MA Huizhen, MA Qiang

2023, 26(32):  4013-4019.  DOI: 10.12114/j.issn.1007-9572.2023.0175

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Background

The rates of first and multiple recurrence of diabetic foot ulcers (DFUs) are increasing annually worldwide, and the risk of early recurrence is higher than the distant recurrence. There are numerous risk factors for DFUs recurrence, and there is a lack of systematic screening. Therefore, there is a need to explore the risk factors for DFUs recurrence in order to identify high-risk population of recurrence at an early stage.

Objective

To explore the predictive value of Logistic regression (LR), support vector machine (SVM), BP neural network model (BPNN) in the recurrence risk of DFUs.

Methods

From January 2020 to October 2021, a total of patients with DFUs attending the Department of Burn Plastic Surgery, Endocrinology and Wound Ostomy Outpatient Department in General Hospital of Ningxia Medical University were selected as the research objects and divided into the recurrence group (n=116, 29.7%) and non-recurrence group (n=274, 70.3%) according to the recurrence of DFUs within 1 year after discharge. General information was collected and compared between the two groups of patients, including sociodemographic characteristics, medical history assessment and clinical case information. The Diabetes Foot Self-care Behavior Scale (DFSBS) was used to assess the self-management behavior of diabetes foot in patients and chronic diseases risk perception questionnaire was used to assess the risk perception level of DFUs among patients. Multivariable Logistic regression analysis was used to explore the influencing factors of DFUs recurrence in patients within 1 year after discharge. The patients were divided into training and test sets according to the ratio of 7 to 3, the LR, SVM and BPNN recurrence risk prediction models were developed based on Logistic regression variable screening strategy. The receiver operating characteristic (ROC) curves of each model were plotted to predict the recurrence risk of DFUs.

Results

There were significant differences in BMI, living alone, duration of diabetes, history of smoking, history of alcohol consumption, history of involved toe amputation, classification of diabetic foot ulcers, ankle-brachial index, glycated hemoglobin, sole ulcer, toe involvement, walking impairment, osteomyelitis, multidrug-resistant bacteria infection, diabetic peripheral neuropathy, lower limb atherosclerosis, self-management behavior of diabetes foot, level of risk perception in both groups of DFUs patients (P<0.05). Multivariable Logistic regression analysis showed that BMI〔OR=0.394, 95%CI (0.285, 0.546), P<0.001〕, duration of diabetes〔OR=1.635, 95%CI (1.303, 2.051), P<0.001〕, history of smoking〔OR=0.186, 95%CI (0.080, 0.434), P<0.001〕, classification of diabetic foot ulcers〔OR=2.139, 95%CI (1.133, 4.038), P=0.019〕, glycated hemoglobin〔OR=2.289, 95%CI (1.485, 3.528), P<0.001〕, sole ulcer〔OR=3.148, 95%CI (1.344, 7.373), P=0.008〕, self-management behavior of diabetes foot〔OR=0.744, 95%CI (0.673, 0.822), P<0.001〕and level of risk perception〔OR=0.892, 95%CI (0.845, 0.942), P<0.001〕were influencing factors of the recurrence of DFUs within 1 year (P<0.05). The accuracy rates of LR, SVM and BPNN models to predict the recurrence risk of DFUs in the test sets were 82.43%, 94.87% and 87.17%, with AUCs of 0.843, 0.937 and 0.820, respectively. There were significant differences in AUC of ROC curves of LR, SVM and BPNN recurrence risk prediction models of DFUs (Z=2.741, P<0.05) ; the AUC of ROC curve of SVM recurrence risk prediction model was higher than the LR and BPNN models (Z=5.937, P=0.013; Z=3.946, P<0.001) .

Conclusion

SVM model can predict the recurrence risk of DFUs patients within 1 year after discharge with good accuracy rate, sensitivity, specificity, AUC and other indicators, which is the relative optimal model. It is recommended to further promote and apply the prediction model to verify its effectiveness.

Value of an Dynamic Eye-tracking Task in Assessing Unilateral Spatial Neglect after Stroke

YANG Yuxuan, ZHANG Han, DU Juan, WANG Lingling, XIE Yulei, YIN Kaiming, ZHANG Bo

2023, 26(32):  4020-4025.  DOI: 10.12114/j.issn.1007-9572.2022.0791

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Background

Unilateral spatial neglect (USN) is a common post-stroke cognitive impairment that severely affects the functional recovery and quality of life of patients. Therefore, objective assessment of USN is essential to facilitate patients' functional recovery.

Objective

To investigate the feasibility of using adynamic eye-tracking task to assess USN in sub acute stroke patients.

Methods

Thirty inpatients in the sub acute phase after stroke in Department of Rehabilitation Medicine, Nanchong Central Hospital were recruited from September 2021 to July 2022. USN was assessed using the Behavioral Inattention Test-Conventional (BIT-C), Catherine Bergego Scale (CBS), and a two-minute dynamic eye-tracking task within one week of admission by two professional rehabilitation therapists, and adverse effects during the assessment were recorded. USN was diagnosed by a CBS score >0, a total BIT-C score <129, or gaze points distributed outside the four screen zones (gaze points distributed within the four screen zones were defined as non-USN). Correlation and consistency analyses were used to evaluate the results of the three assessments.

Results

In accordance with the performance assessment in conducting the dynamic eye-tracking task, 14 patients had left-sided neglect, and the other 16 had no USN. USN patients had a higher percentage of gaze points on the right side of the screen than non-USN patients (Z=-4.776, P<0.001). There was a significant difference in percentages of gaze points on the left and right side of the screen in USN patients (Z=-3.49, P<0.001). By BIT-C assessment, 15 patients were diagnosed with USN, and the remaining 15 patients had no USN. CBS assessment revealed that 16 patients had varying degrees of USN, and the remaining 14 were non-USN patients. The BIT-C and dynamic eye-tracking task were highly consistent in the assessment of USN (Kappa=0.933, P<0.001). Spearman's rank correlation analysis revealed a negative correlation between the percentage of gaze points on the right side of the screen and the total BIT-C score (r_s=-0.776, P<0.001). The CBS and dynamic eye-tracking task had good agreement on the assessment of USN (Kappa=0.867, P<0.001) .

Conclusion

It is feasible to use the dynamic eye-tracking task to assess USN, because it is less time-consuming, with high level of patient participation and motivation, and there is a good consistency between the results assessed by it and BIT-C or CBS. Therefore, it can be used as a supplement to the standard USN assessment.

Risk Factors for Endometrial Lesions Detected by Hysteroscopy in Breast Cancer Patients Taking Tamoxifen

LI Yujing, JIN Yichao, CHEN Xing, JI Mengying, DAI Huihua

2023, 26(32):  4026-4030.  DOI: 10.12114/j.issn.1007-9572.2023.0161

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Background

Breast cancer has become the most common malignant tumor threatening the health of Chinese women in recent years. The use of tamoxifen (TAM) has successfully reduced the recurrence and progression of estrogen receptor-positive breast cancer, however, it also increases the risk of endometrial lesions.

Objective

To explore the risk factors for endometrial lesions in breast cancer patients taking TAM, determine the optimal threshold value of endometrial thickness, and improve the positive detection rate of hysteroscopy.

Methods

Breast cancer patients taking TAM (20 mg/d) who underwent hysteroscopic endometrial biopsy admitted to the Department of Gynecology of the First Affiliated Hospital with Nanjing Medical University from January 2015 to January 2022 were retrospectively selected as the study objects and divided into the negative hysteroscopic endometrial biopsy group (normal endometrium) and positive hysteroscopic endometrial biopsy group (endometrial lesions including endometrial polyps, endometrial hyperplasia without atypia, endometrial atypical hyperplasia and endometrial carcinoma). Clinical data of the patients were collected, including age, BMI, history of hypertension and diabetes, delivery times, presence of menopause and abnormal uterine bleeding/postmenopausal bleeding (AUB/PMB), receiving of chemotherapy, duration of TAM treatment, use of gonadotropin-releasing hormone agonists (GnRH-a), endometrial thickness, echo features of intrauterine lesions. Multivariate Logistic regression analysis was used to explore the risk factors for endometrial lesions in breast cancer patients taking TAM. The receiver operating characteristic (ROC) curve of endometrial thickness for predicting endometrial lesions detected by hysteroscopy was plotted, and the area under the ROC curve (AUC) and its 95%CI were calculated to determine the optimal cut-off value of endometrial thickness for receiving hysteroscopic surgery.

Results

The proportion of patients with AUB/PMB, duration of TAM treatment≥24 months, intrauterine hyperechoic lesions and endometrial thickness in the positive hysteroscopic endometrial biopsy group were higher than those in the negative hysteroscopic endometrial biopsy group (P<0.05). Multivariate Logistic regression analysis showed that AUB/PMB〔OR=7.731, 95%CI (1.949, 30.699), P=0.004〕, endometrial thickening〔OR=1.223, 95%CI (1.091, 1.371), P=0.001〕 and intrauterine hyperechoic lesions〔OR=13.383, 95%CI (2.751, 65.103), P=0.001〕were independent risk factors for endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM. The AUC of endometrial thickness for predicting endometrial lesions detected by hysteroscopy in breast cancer patients taking TAM was 0.753〔95%CI (0.638, 0.868), P<0.001〕, with the Youden index of 0.54, optimal cut-off value of 9.15 mm, sensitivity and specificity of 0.755 and 0.786, respectively.

Conclusion

The risk of endometrial lesions is increased in breast cancer patients taking TAM with AUB/PMB, endometrial thickness≥9.15 mm suggested by ultrasound and intrauterine hyperechoic lesions, when the hysteroscopy and endometrial biopsy should be actively considered.

Risk Factors for Loss of Skeletal Muscle Mass and Its Correlation with Complications after Major Hepatectomy for Liver Cancer

GAO Dekang, WEI Shaohua, MA Xiaoming, DU Peng, XING Chungen, CAO Chun

2023, 26(32):  4031-4037.  DOI: 10.12114/j.issn.1007-9572.2023.0127

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Background

Major hepatectomy for liver malignancies carries with large risks. Perioperative nutritional support plays a vital role for postoperative recovery. However, there are few studies focusing on predictions of postoperative complications and prognosis using postoperative loss of skeletal muscle mass (PLSMM) in acute stage after major hepatectomy.

Objective

To identify the change inskeletal muscle index (SMI), and to investigate risk factors for PLSMM, as well as its correlation with postoperative complications after major hepatectomy for liver cancer.

Methods

A total of 97 patients who received major hepatectomy for liver cancer from Department of General Surgery, the Second Affiliated Hospital of Soochow University between July 2018 and August 2022 were included. The preoperative and postoperative day 5 skeletal muscle area at the third lumbar vertebra level was measured, respectively, using computed tomographic images. The postoperative change rate of SMI was calculated. The PLSMM was defined as the lowest tertile of the percent change in SMI, according to which the patients were divided into PLSMM and Non-PLSMM group. Baseline data, surgical and postoperative indices were collected and analyzed.

Results

SMI was decreased in 54 patients postoperatively. Thirty-two and 65 patients were assigned to the PLSMM group (SMI≤-3.59%) and Non-PLSMM groups (SMI>-3.59%), respectively. Compared with Non-PLSMM group, PLSMM group had longer operation time, more intraoperative blood loss and higher ratio of microvascular invasion (MVI) (P<0.05). Moreover, PLSMM group had longer postoperative hospital stay, higher levels of white blood cell and international normalized ratio and lower level of fibrinogen on postoperative day 5 (P<0.05). PLSMM group showed a lower incidence of overall complications (P<0.05). Multivariate Logistic regression analysis indicated that MVI〔OR=2.751, 95%CI (1.173, 6.642) 〕 and operation time >210 min〔OR=1.973, 95%CI (1.286, 4.936) 〕were risk factors associated with PLSMM (P<0.05). PLSMM〔OR=2.591, 95%CI (1.173, 6.977) 〕, preoperative myopenia〔OR=1.798, 95%CI (1.133, 3.792) 〕, operation time >210 min〔OR=2.958, 95%CI (0.918, 9.529) 〕 and blood loss >500 mL〔OR=1.003, 95%CI (1.001, 1.007) 〕 were risk factors associated with postoperative complications (P<0.05) .

Conclusion

MVI and operation time >210 min were risk factors associated with PLSMM. PLSMM was the independent predictor of postoperative complications, which negatively affected postoperative outcomes after major hepatectomy.

Predictive Value of Tumor Budding and Tumor-infiltrating Lymphocytes on Lymph Node Metastasis of Esophageal Squamous Cell Carcinoma

ZHANG Jifang, CHEN Fang, TANG Jiawen, LI Hongliang

2023, 26(32):  4038-4042.  DOI: 10.12114/j.issn.1007-9572.2023.0112

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Background

The surgical protocols and prognosis of esophageal squamous cell carcinoma (ESCC) patients influenced by the status of lymph node metastasis. It is necessary to identify risk factors that can predict lymph node metastasis to assist in clinical treatment.

Objective

To investigate the predict value of tumor budding (TB) and tumor-infiltrating lymphocytes (TILs) on lymph node metastasis (LNM) in patients with ESCC.

Methods

A total of 124 patients with ESCC who underwent radical resection and retained paraffin-embedded specimens in the Affiliated People's Hospital of Ningbo University from January 2013 to March 2022 were selected as the research subjects. The light microscopy and CK5/6 immunohistochemical staining were used to evaluate the amount of TB and density of TILs. Multivariate Logistic regression analysis was used to explore the influencing factors of lymph node metastasis in patients with ESCC and the receiver operating characteristic (ROC) curve was plotted to investigate the predictive value of TB and TILs for lymph node metastasis in patients with ESCC.

Results

Multivariate Logistic regression analysis showed that TB〔OR=20.078, 95%CI (6.043, 66.713), P<0.001〕, TILs〔OR=0.218, 95%CI (0.071, 0.666), P=0.008〕and intravascular tumor thrombus〔OR=28.609, 95%CI (7.512, 108.946), P<0.001〕 were influencing factors for lymph node metastasis. The area under ROC curve (AUC) for TB and TILs to predict lymph node metastasis in patients with ESCC was 0.835〔95%CI (0.763, 0.907) 〕 and 0.656〔95%CI (0.558, 0.753) 〕, respectively.

Conclusion

High-grade TB and low-density TILs were influencing factors for lymph node metastasis, TB grade and density of TILs has good diagnostic efficacy in predicting lymph node metastasis in patients with ESCC.

Health-related Quality of Life and Its Influencing Factors in Patients with Prevention of Disease in Traditionnal Chinese Medicine based on EQ-5D-5L Scale

GAO Jing, ZHOU Shangcheng, GAO Sande, ZOU Guanyang, CHEN Yingyao

2023, 26(32):  4043-4050.  DOI: 10.12114/j.issn.1007-9572.2023.0154

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Background

Prevention of disease in Traditionnal Chinese Medicine (TCM) is a distinguishing advantage of TCM health management services, however, the holistic health state of the patients remains to be elucidated and evaluated.

Objective

To evaluate the health-related quality of life (HRQoL) and its influencing factors in patients with prevention of disease in TCM.

Methods

From May to June 2022, a stratified cluster sampling method was used to randomly select a district-level TCM hospital from each of the four administrative regions of Guangzhou (Liwan District, Tianhe District, Baiyun District, Huadu District) as the research site. The EQ-5D-5L scale was used to investigate the patients with prevention of disease in TCM by questionnaire in primary care, and the health utility value was calculated according to the Chinese EQ-5D utility score system. The influencing factors of health utility value and EQ-VAS score were analyzed by using optimal scale regression analysis.

Results

A total of 660 questionnaires were completed in this survey, including 630 valid questionnaires, with a effective recovery rate of 95.45%. Among the 630 investigated patients with prevention of disease in TCM, 185 patients (29.4%) visited for daily health care, 242 patients (38.4%) visited at the initial stage of disease for discomfort, 218 patients (34.6%) visited for avoiding exacerbation of current illness, 67 patients (10.6%) visited for post-illness rehabilitation physiotherapy. The top three conditions for prevention of disease in TCM were insomnia disorder, epigastric pain and arthralgia. The EQ-5D-5L health utility value for the investigated patients was 0.942 (0.893, 1.000), and the EQ-VAS score was 80 (70, 90). All five dimensions based on the ranking of difficulties frequency were pain/discomfort (50.2%), anxiety/depression (46.9%), daily activities (14.4%), mobility (9.9%) and self-care (6.0%). The influencing factors of health utility value based on the ranking of importance were the main causes of most recent prevention of disease in TCM (0.366), age (0.281), comorbidities of TCM conditions (0.145), occupation (0.111) and education level (0.098). The influencing factors of EQ-VAS score based on the ranking of importance were marital status (0.378), understanding of prevention of disease in TCM (0.353), age (0.176) and monthly income (0.092) .

Conclusion

The HRQoL of patients with prevention of disease in TCM in primary care in Guangzhou is at a medium level. The health utility values were relatively low in patients suffered from TCM conditions such as lung cancer, stroke, chronic obstructive pulmonary disease, osteoporosis and breast cancer, aged 60 and above, comorbid with 2 or more TCM conditions, with manual labour and lower education level. The self-rated health status was relatively poor in patients absence from marriage, unaware of prevention of disease in TCM, aged 60 and above, with higher monthly income. HRQoL should be applied reasonably as an important outcome indicator. Attention should be paid to the population with poor HRQoL among patients with prevention of disease in TCM, the promotion and dissemination of the concept and connotation of prevention of disease in TCM should be strengthened.

Progress in Methods for the Assessment of Allostatic Load and Its Impact on Health

LI Yiru, LI Yuhong

2023, 26(32):  4051-4056.  DOI: 10.12114/j.issn.1007-9572.2023.0362

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Stress is considered to be an important factor leading to diseases. Continuous stress can cause serious disorders in the physiological system of the body. Allostatic load, as a comprehensive index to assess the physiological disorders of multiple systems in the body under chronic stress, can predict a range of health problems. This paper systematically and comprehensively reviews the related concepts and assessment methods of allostatic load and its impact on health, and reveals a significant correlation between allostatic load and health. However, there is no standardized criteria for the selection and algorithm of biomarkers for allostatic load in domestic and foreign studies, which is still a future research direction.

Status and Influencing Factors of Allostatic Load in Pregnant Women at Different Trimesters

YUAN Dehui, LI Yuhong, XIONG Min, YU Min, MA Ruiliang, YANG Fangfang, YU Qiaozhi, WANG Minghuan

2023, 26(32):  4057-4063.  DOI: 10.12114/j.issn.1007-9572.2023.0158

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Background

As an objective index to evaluate chronic stress, allostatic load (AL) is associated with adverse pregnancy outcomes. At present, there are few longitudinal studies to analyze the influencing factors of AL among pregnant women.

Objective

To investigate the status of AL and its influencing factors in pregnant women at different trimesters.

Methods

This study was designed as a prospective study. Questionnaire survey, physical examination and laboratory examination were administered to 152 women in the first (≤14 weeks), second (23-27 weeks) and third (30-34 weeks) trimesters of pregnancy collected in the obstetrics outpatient clinics of the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, Jin'an Maternal and Child Health Care Hospital from November 2021 to November 2022 by using convenience sampling method. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess the depression during pregnancy. Referring to previous studies, the relevant assessment indexes of metabolic system, cardiovascular system, and immune system were used to calculate the total score of AL, and AL≥3 score was used as a criterion for determining high AL level at different trimesters of pregnancy. Multivariate Logistic regression analysis was used to explore the influencing factors of AL in the first, second and third trimesters.

Results

Among 152 pregnant women, the mean total AL score was (2.06±1.68), (2.07±1.84) and (2.07±1.68) in the first, second and third trimesters; 52 (34.2%), 54 (35.5%) and 50 (32.9%) women were in high level of AL (total score of AL≥3) in the first, second and third trimesters. The results of multivariate Logistic regression analysis showed that occupations {business service employees〔OR=0.229, 95%CI (0.062, 0.845), P=0.027〕, office staff〔OR=0.164, 95%CI (0.051, 0.528), P=0.002〕, professional and technical personnel〔OR=0.278, 95%CI (0.099, 0.784), P=0.015〕}, unemployment〔OR=5.516, 95%CI (1.044, 29.144), P=0.044〕and depression〔OR=6.241, 95%CI (1.403, 27.757), P=0.016〕were the influencing factors of AL in the first trimester. Age〔OR=1.098, 95%CI (1.002, 1.202), P=0.045〕and AL in the first trimester〔OR=9.965, 95%CI (4.402, 22.561), P<0.001〕were the influencing factors of AL in the second trimester. Sleep duration in the third trimester〔≥9 h/d: OR=0.176, 95%CI (0.044, 0.703), P=0.014〕, AL in the first trimester〔OR=4.697, 95%CI (1.852, 11.908), P<0.001〕and AL in the second trimester〔OR=9.426, 95%CI (3.728, 23.834), P<0.001〕 were the influencing factors of AL in the third trimester.

Conclusion

More than 30% of women are at high levels of AL at different trimesters and the influencing factors of AL at different trimesters are different. Occupation, unemployment status, and depression are the influencing factors of AL in the first trimester; age and AL in the first trimester are the influencing factors of AL in the second trimester; sleep duration in the third trimester and AL in the first and second trimesters are the influencing factors of AL in the third trimester.

Effect of Allostatic Load on Adverse Pregnancy Outcomes of Women in Late Pregnancy

WANG Minghuan, LI Yuhong, YU Min, WANG Yougang, YU Qiaozhi, YANG Fangfang, YUAN Dehui, ZHANG Liu

2023, 26(32):  4064-4069.  DOI: 10.12114/j.issn.1007-9572.2023.0159

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Background

The incidence of adverse pregnancy outcomes has remained high in recent years, which poses a serious threat to maternal and neonatal life and health. Chronic stress is known to be a risk factor for adverse pregnancy outcomes, while the relationship between allostatic load (AL) as a composite physiological index of chronic stress, and adverse pregnancy outcomes has not been clarified.

Objective

To explore the effect of AL on adverse pregnancy outcomes in women in late pregnancy.

Methods

Women in late pregnancy who met the study requirements were recruited as study subjects by using the convenience sampling method from November 2021 to November 2022 in the obstetrics outpatient clinics of the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, Jin'an Maternal and Child Health Care Hospital. Basic information such as general and obstetric data were collected through questionnairs, biological indicators were collected through physical examination and laboratory tests, and AL scores of the study subjects were calculated by referring to AL-related literature; pregnancy outcome information was obtained by reviewing the hospital electronic medical record system. Multivariate Logistic regression analysis was used to explore the effect of AL on adverse pregnancy outcomes in women in late pregnancy.

Results

A total of 354 women in late pregnancy with an average age of (29.3±4.1) years and upper quartile of AL total score of 3 were included in this study. The upper quartile of the total AL score of the study subjects was used as the high-risk threshold, and they were divided into low-level AL (AL <3) and high-level AL (AL ≥3) according to their AL scores. High AL pregnant women accounted for 32.8% (116/354) and low AL pregnant women accounted for 67.2% (238/354). The prevalence of adverse pregnancy outcomes was 15.5% (55/354), including 9.9% (35/354) of macrosomia, followed by preterm birth〔5.4% (19/354) 〕and low birth weight〔2.3% (8/354) 〕. The incidence of adverse pregnancy outcomes was higher in women in late pregnancy with high AL (26.7%, 31/116) than in women in late pregnancy with low AL (10.1%, 24/238) (P<0.05) ; the incidence of preterm birth (10.3%, 12/116) and delivery of macrosomia (15.5%, 18/116) was higher in women in late pregnancy with high AL than in women in late pregnancy with low AL (2.9%, 7/238; 7.1%, 17/238) (P<0.05). Multivariate Logistic regression analysis showed that women in late pregnancy with high AL had a 2.465-fold increased risk of adverse pregnancy outcomes compared to women in late pregnancy with low AL〔95%CI (1.315, 4.622), P<0.05〕. High AL level was a risk factor for preterm birth〔OR=4.832, 95%CI (1.545, 15.114) 〕and delivery of macrosomia〔OR=2.868, 95%CI (1.392, 5.909) 〕in women in late pregnancy compared to low AL level (P<0.05) .

Conclusion

High level of AL in women in late pregnancy increase the risk of adverse pregnancy outcomes, especially the risk of preterm birth and delivery of macrosomia. Attention to AL in women during pregnancy should be enhanced to provide a theoretical basis for preventing adverse pregnancy outcomes.

Evidence-based Medicine

A Meta-analysis of the Prevalence and Influencing Factors of Post-stroke Cognitive Impairment in Chinese Elderly Patients

JIAN Qiufeng, XU Ronghua, YAO Qian, ZHOU Yuanyuan

2023, 26(32):  4070-4079.  DOI: 10.12114/j.issn.1007-9572.2023.0212

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Background

China has entered a comprehensive aging society, and stroke is the primary cause of death and disability among adults in China, post-stroke cognitive impairment has become an important cause for long-term disability and quality of life decline in stroke patients.

Objective

To analyse and clarify the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China by Meta-analysis.

Methods

CNKI, Wanfang Data, VIP, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched by computer to collect cohort, case-control, and cross-sectional studies on influencing factors of cognitive impairment in elderly stroke patients from inception to 2023-02-12. After independent screening of the literature and data extraction by two investigators, the quality of the literature was assessed and a Meta-analysis of the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China was performed using Stata 14.0 software.

Results

A total of 46 papers were included, with 3 281 cases of cognitive impairment and 27 influencing factors involved. The Meta-analysis results showed that the prevalence of cognitive impairment in elderly stroke patients in China was 42.4%〔95%CI (36.6%, 48.3%) 〕; female〔OR=4.167, 95%CI (1.937, 8.967), P<0.001〕, hypertension〔OR=2.824, 95%CI (2.292, 3.481), P<0.001〕, systolic blood pressure〔OR=1.572, 95%CI (1.444, 1.711), P<0.001〕, diabetes mellitus〔OR=3.344, 95%CI (2.611, 4.284), P<0.001〕, hyperlipidemia 〔OR=2.228, 95%CI (1.091, 4.547), P=0.028〕, carotid plaque 〔OR=2.544, 95%CI (1.076, 6.014), P=0.033〕, infarction location of frontal lobe〔OR=1.615, 95%CI (1.167, 2.235), P=0.004〕, infarction location of temporal lobe〔OR=1.739, 95%CI (1.246, 2.427), P=0.001〕, multiple cerebral infarction〔OR=2.583, 95%CI (2.009, 3.321), P<0.001〕, encephalanalosis 〔OR=2.943, 95%CI (1.938, 4.469), P<0.001〕, homocysteine (Hcy) 〔OR=2.209, 95%CI (1.656, 2.948), P<0.001〕, hyperhomocysteinemia〔OR=3.043, 95%CI (2.092, 4.426), P<0.001〕, high-sensitivity C-reactive protein (hs-CRP) 〔OR=4.331, 95%CI (1.756, 10.685), P=0.001〕, and National Institutes of Health Stroke Scale (NIHSS) score >10〔OR=1.977, 95%CI (1.320, 2.961), P=0.001〕 were influencing factors for cognitive impairment in elderly stroke patients in China.

Conclusion

The prevalence of cognitive impairment in elderly stroke patients in China was high (42.4%), and female, hypertension, systolic blood pressure, diabetes mellitus, hyperlipidemia, carotid plaque, infarction location of frontal lobe and temporal lobe, multiple cerebral infarction, encephalanalosis, Hcy, hyperhomocysteinemia, hs-CRP, and NIHSS score >10 were influencing factors for cognitive impairment in elderly stroke patients in China.

Incidence of Perimenopausal Syndrome in Chinese Women Aged 40 to 65 Years: a Meta-analysis

JIA Yu, ZHOU Zitong, CAO Xuehua, HU Wanqin, XIANG Feng, XIONG Langyu, WANG Xiaoxia

2023, 26(32):  4080-4088.  DOI: 10.12114/j.issn.1007-9572.2023.0303

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Background

With the rapid development of economy and society in China, the living standards and health care awareness have been improved significantly, the average life expectancy of our population is gradually prolonged, causing increasing population of perimenopausal women, therefore, the health management of perimenopausal women has become more important. Perimenopausal syndrome can be seen in women aged 40-65 years, which can seriously affect the physical and mental health and quality of life of patients.

Objective

To systematically review the incidence of perimenopausal syndrome in Chinese women aged 40-65 years.

Methods

PubMed, Embase, Web of Science, CNKI, Wanfang Data, CBM and VIP were searched by computer to collect cross-sectional studies on the occurrence of perimenopausal syndrome in Chinese women aged 40-65 years from inception to February 1, 2023. Two investigators independently screened the literature, extracted data and evaluated the quality of included literature. Meta-analysis was performed using Stata 17.0 software.

Results

A total of 62 cross-sectional studies were included, with a total sample size of 82 340 cases. Meta-analysis showed that the incidence of perimenopausal syndrome in Chinese women aged 40-65 years was 61.0%. The results of subgroup analysis showed that the incidence of perimenopausal syndrome in women aged 40-45 years, >45-50 years, >50-55 years, >55-60 years and >60 years was 42.6%, 53.8%, 64.6%, 59.7% and 56.1%, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with normal, disordered and postmenopausal menstrual status was 43.6%, 56.9% and 61.3%, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with and without chronic diseases was 85.9% and 68.3%, respectively. The incidence of perimenopausal syndrome was highest in women aged 40-65 years in Southwest China at 71.3%, and at 57.4%, 57.9%, 50.5%, 59.2%, 69.5%, and 68.6% in North, East, South, Northwest, Northeast, and Central China, respectively. The incidence of perimenopausal syndrome in women aged 40-65 years with education level of junior high school and below, high school or technical secondary school, university and above was 54.1%, 55.7% and 49.6%, respectively. The incidence of perimenopausal syndrome in Han Chinese and ethnic minority women aged 40-65 years was 62.1% and 64.7%, respectively.

Conclusion

The incidence of perimenopausal syndrome is high in women aged 40 to 65 years in China. Among them, women aged >50-55 years, menopausal, suffering from chronic diseases, living in southwest region, with education level of high school or below, and ethnic minorities are at high risk of perimenopausal syndrome. We should pay attention to the prevention, screening and intervention of perimenopausal syndrome in relevant population to lay the foundation of elderly health in women.

The Correlation of Dietary Inflammatory Index with Overweight, Obesity and Abdominal Obesity: a Meta-analysis

LI Jixin, QIU Linjie, REN Yan, WANG Wenru, LI Meijie, ZHANG Jin

2023, 26(32):  4089-4097.  DOI: 10.12114/j.issn.1007-9572.2023.0316

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Background

Dietary inflammatory index (DII), as a new index for quantitative evaluation of dietary inflammatory potential, has been widely used in various chronic disease studies, but the correlation between DII and different types of obesity has not been uniformly established.

Objective

To systematically evaluate the correlation of DII with overweight, obesity and abdominal obesity to provide reference for the prevention of different types of obesity.

Methods

CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Cochrane Library and Web of Science were searched by computer for cross-sectional studies of the association of DII with overweight, obesity and abdominal obesity from inception to January 10, 2023. Risk of Bias Rating Scale of AHRQ was used to evaluate the included studies. Meta-analysis was performed using RevMan 5.4.1 to calculate OR and 95%CI of the pooled data to assess the association of DII with overweight, obesity and abdominal obesity. Subgroup analyses were performed based on differences in gender, study geography, survey method, number of DII components, whether the sample population was healthy, diagnostic criteria, and type of DII grouping.

Results

A total of 20 studies from 9 countries with 214 808 subjects were included. Meta-analysis results showed that high levels of DII may be a possible risk factor for overweight 〔OR=1.12, 95%CI (1.03, 1.22), P=0.005〕, obesity 〔OR=1.56, 95%CI (1.34, 1.82), P<0.000 01〕, abdominal obesity 〔OR=1.42, 95%CI (1.14, 1.78), P=0.002〕. Subgroup analysis for differences in gender, study geography, survey method, number of DII components, whether the sample population was healthy, diagnostic criteria, and type of DII grouping in the original studies showed no significant between-group heterogeneity within each subgroup for the correlation between DII and overweight (P>0.05). Among the subgroups for the correlation between DII and obesity, the male population〔OR=1.79, 95%CI (1.13, 2.85) 〕 had a higher proportion of obesity than the other gender groups, the North American population 〔OR=1.57, 95%CI (1.27, 1.83) 〕 had a higher proportion of obesity compared to populations from other geographic regions, and the results of the 24-h recall 〔OR=1.83, 95%CI (1.39, 2.42) 〕 had a higher proportion of obesity compared to studies with other survey methods. Among the subgroups for the correlation between DII and abdominal obesity, the North American population 〔OR=1.87, 95%CI (1.44, 2.44) 〕 had a higher proportion of abdominal obesity compared to populations from other geographic regions, and no significant heterogeneity was found among other groups. The funnel plot distribution in this study had good symmetry, suggesting no significant publication bias.

Conclusion

DII diets may be a risk factor for overweight, obesity and abdominal obesity, and the association is more obvious in North American populations. The association between a high DII diet and obesity was more significant in men. Increasing the intake of anti-inflammatory dietary components is important for the prevention and treatment of overweight, obesity and abdominal obesity.

Review & Perspectives

Advances in the Prognostic Value of Diffusion Tensor Imaging with Motor Evoked Potential for Motor Function in Cerebral Infarction Patients with Hemiplegia

MENG Jiangtao, YANG Siyu, SUN Lei, LEI Ruining, ZHAO Xiaoxia

2023, 26(32):  4098-4102.  DOI: 10.12114/j.issn.1007-9572.2023.0152

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Limb paralysis is a common sequela of cerebral infarction, which leads to both physical disorders and heavy psychological burden. Recent years have witnessed growing studies on the prognosis of motor function in patients with cerebral infarction, and increasing well-known relevant medical evaluation tools, such as diffusion tensor imaging (DTI) and motor evoked potential induced by transcranial magnetic stimulation (TMS-MEP), which can microscopically assess the structural changes in white matter fiber bundles, and the combined use of them, that is, the combination of neuroanatomy, electrophysiology and neuroimaging, can more accurately assess the level of motor neuron impairment, thereby obtaining a motor function assessment surpassing the assessment based on clinical function indicators in terms of objectivity. We reviewed the prognostic value of DTI and TMS for motor function recovery via detecting and quantifying corticospinal tract degeneration in patients after cerebral infarction, and summarized the prognostic values of commonly used relevant measurement parameters for motor function recovery in hemiplegic patients. We concluded that DTI and TMS-MEP are powerful tools for noninvasively assessing complex structures of brain tissues, which can detect more subtle neural and tissue changes, and the combined use of them can effectively explore the damage pattern of white matter fiber bundles using different analysis methods, contributing to the development of neurological rehabilitation programs and maximum improvement of the long-term prognosis for patients.