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Table of Content

    15 January 2024, Volume 27 Issue 02
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    Editorial
    Removed from Taught in Hospitals but Close to Human Health and Happiness - Reflections of Lancet's Iconic Texts at Its Millstone of 200 Anniversary (1) : Henry Dicks's Education for General Practice
    YANG Hui
    2024, 27(02):  0-C1.  DOI: 10.12114/j.issn.1007-9572.2024.A0001
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    Guidelines·Consensus
    Chinese Expert Consensus on Diagnosis and Treatment of Psychiatric Dizziness
    Holistic Health Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association
    2024, 27(02):  125-131.  DOI: 10.12114/j.issn.1007-9572.2023.0577
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    The incidence of psychiatric dizziness is high. If clinicians do not have enough knowledge about it, they are prone to misdiagnose psychiatric dizziness as posterior circulation ischemic attack, cervical dizziness, vestibular peripheral vertigo or other diseases, thus leading to inappropriate examinations and treatments. With the increasing emphasis on psychosomatic diseases, the Holistic Health Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association formulated the Chinese Expert Consensus on Diagnosis and Treatment of Psychiatric Dizziness in combination with the latest evidence in relevant fields at home and abroad, as well as the opinions of experts in psychosomatic health, mental disorders, vertigo and other fields. This consensus elaborated the concept, etiology and pathogenesis, clinical characteristics, diagnosis and evaluation, and various treatment approaches of psychiatric dizziness, and formulated the final expert consensus after multidisciplinary expert communication, aiming to provide a reference basis for standardized diagnosis and treatment of psychiatric dizziness.

    Commentary
    Identification of COVID-19 Infection in Vulnerable Population and Its Prevention and Treatment Perspectives
    ZHENG Jinping, XUE Wujun, JU Chunrong, MA Jun, ZENG Xiaofeng
    2024, 27(02):  132-137.  DOI: 10.12114/j.issn.1007-9572.2023.0230
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    The COVID-19 pandemic has devastated human health and global economy. Diminished immune function of health-related vulnerable populations leads to insufficient protective effect of the vaccine with a higher risk of severe illness and death following infection, and there is a lack of adequate targeted drugs for the prevention and treatment of COVID-19. In the context that COVID-19 treated as a Category B disease in China, vulnerable populations have become the priority populations for epidemic prevention and control. Therefore, the strategies of individual immunization and prevention should be further optimized for vulnerable populations. In addition to vaccines, other prevention strategies should be supplemented, such as long-acting neutralizing antibodies. Based on this, this paper reviews the identification, immune function characteristics and prevention strategies of COVID-19 in vulnerable populations, to provide a reference for the prevention and control strategies for health-related vulnerable populations in China, expecting that more suitable preventive drugs for vulnerable populations can be developed in the future to reduce the risk of COVID-19 in vulnerable populations.

    Current Status and Prospects of General Practitioners in Community-based Prevention and Control of Communicable Diseases
    MA Yundi, REN Jingjing, QIU Yan
    2024, 27(02):  138-143.  DOI: 10.12114/j.issn.1007-9572.2023.0216
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    The prevention and control of communicable diseases is a major concern for the livelihood of the people.General practitioners play an irreplaceable role in the community-based prevention and control of communicable diseases as one of the key providers of primary care. This study discusses the shortcomings of general practitioners and the role they should play in the community-based prevention and control of communicable diseases based on their current situation by reviewing relevant domestic and foreign literature, and proposes that the laws and regulation system for the prevention and control of communicable diseases should be improved, a hierarchical medical system should be implemented, a robust information platform of prevention and control system should be enhanced, an efficient incentive and development mechanism should be established, and the financial and material investment in primary care, continuing medical education and regular drills should be enhanced, aiming to enhance the job attraction of general practitioners and the capabilities of community-based comprehensive prevention and control of communicable diseases.

    Original Research
    Detection Rate of Non-alcoholic Fatty Liver Disease and Its Influencing Factors: Analysis Based on the Data of 320 000 Beijing Population
    DOU Ziyan, QIAN Wenhong, KONG Linrun, CHEN Ye, LI Mingliang, ZHANG Jingbo
    2024, 27(02):  144-149.  DOI: 10.12114/j.issn.1007-9572.2023.0465
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    Background

    Non-alcoholic fatty liver disease has showed a high prevalence and a increasing trend especially towards younger age. It is of great public health significance to reduce damage through early detection of NAFLD in physical examination and intervention in time.

    Objective

    To investigate the detection rate of NAFLD in the Beijing physical examination population from 2018 to 2021, and analyze its related influencing factors.

    Methods

    People who received physical examinations at the Beijing Physical Examination Center from 2018-01-01 to 2021-12-31 were selected based on the inclusion criteria, the results of physical examination, laboratory examination, and liver ultrasonography were collected for analysis. Univariate analysis was performed using t-test, Mann-Whitney U test and Chi-square test. Multivariate Logistic regression was used to explore the influencing factors of NAFLD.

    Results

    A total 325 726 people were included in the study, of which 108 512 cases of NAFLD were detected, with a detection rate of 33.31%. The results of liver ultrasonography revealed that the number of mild, moderate and severe NAFLD detections were 74 062, 33 281 and 1 169 cases, accounting for 68.25%, 30.67% and 1.08% of the detection population, respectively. The detection rate of NAFLD was higher in males than females (χ2=17 518.893, P<0.05). Chi-square test for trend revealed an age-dependent increase detection rate of NAFLD before 70 years old, and a subsequent decline after reaching 70 years old (χ2trend=14 397.61, P<0.001). Higher detection rate was revealed in males than females among people aged 18-59 years (P<0.05), while lower detection rate in males than females among people aged ≥70 years old (P<0.05). Multivariate Logistic regression results showed that gender (male: OR=1.173), aging (30-39: OR=1.604, 40-49: OR=1.948, 50-59: OR=2.486, 60-69: OR=2.663, 70-79: OR=2.079, ≥80: OR=1.149), BMI (18.5-23.9 kg/m2: OR=2.997, 24.0-27.9 kg/m2: OR=3.911, ≥28.0 kg/m2: OR=11.780), systolic blood pressure (SBP) (≥140 mmHg: OR=1.200), diastolic blood pressure (DBP) (≥90 mmHg: OR=1.177), fasting blood glucose (FBG) (≥6.10 mmol/L: OR=1.934), triacylglycerol (TG) (≥1.70 mmol/L: OR=2.946), total cholesterol (TC) (≥5.20 mmol/L: OR=1.050), high-density lipoprotein cholesterol (HDL-C) (<1.0 mmol/L: OR=1.645), low-density lipoprotein cholesterol (LDL-C) (≥3.4 mmol/L: OR=1.499), serum uric acid (SUA) (SUAmale>420 μmol/L, SUAfemale>360 μmol/L: OR=2.067) were influencing factors for NAFLD (P<0.05) .

    Conclusion

    The detection rate of NAFLD in physical examination population in Beijing was 33.31%, the highest incidence showed in people aged 50 to 69 years. Males, overweight and obese people are the high-risk groups, and abnormalities in blood lipids, blood pressure and blood glucose are also risk factors for NAFLD.

    Association of Different Metabolic Obesity Phenotypes with Breast Cancer Risk in Women: a Prospective Cohort Study
    ZHOU Jing, JIA Jianguo, LIN Yixin, WU Shuang, DAI Shilong, WANG Mingjun, ZHANG Qingsong
    2024, 27(02):  150-155.  DOI: 10.12114/j.issn.1007-9572.2023.0507
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    Background

    Earlier studies have investigated the association between overweight/obesity and an elevated risk of breast cancer in women. However, some studies have found that it may not be scientifically accurate to solely analyze the association between overweight/obesity and breast cancer in women for overweight/obesity can be classified into different metabolic phenotypes. The current findings on the association of different metabolic phenotypes with breast cancer remain inconsistent.

    Objective

    To prospectively analyze the associations of different metabolic obesity phenotypes with the risk of breast cancer in women.

    Methods

    In this prospective cohort study, female employees (n=23 406) of Kailuan Group who participated in physical examinations for the first time in Kailuan General Hospital and its 11 affiliated hospitals from 2006 to 2008 were selected as the study subjects and received questionnaire investigation, physical examination and laboratory tests. The study subjects were divided into the four groups based on the types of metabolic syndrome and BMI, including metabolically healthy normal weight (MHNW) group (n=12 739), metabolically unhealthy normal weight (MUNW) group (n=1 060), metabolically healthy overweight/obese (MHO) group (n=6 394), and metabolically unhealthy overweight/obese (MUO) group (n=3 213). The subjects were followed up, with the first physical examination attended as the starting point, and new onset breast cancer, death, or the end of follow-up time (2020-12-31) as the endpoints. Multivariate Cox proportional hazard regression model was used to estimate the association of the four groups with the risk of breast cancer.

    Results

    During an average follow-up of (13.26±1.85) years, with 353 new cases of breast cancer and an incidence density of 11.38 cases per 10 000 person-years in the total population. The incidence cases in the MHNW, MUNW, MHO, and MUO groups were 154, 21, 113, and 65, respectively, with the incidence density of 9.08, 15.37, 13.27, and 15.49 per 10 000 person-years, and the cumulative incidence of 1.22%, 2.01%, 1.67%, and 1.93%, respectively. Multivariate Cox proportional hazard regression model analysis, after adjusting for confounders, showed that compared with the MHNW group, the risk of breast cancer was increased by 42% (HR=1.42, 95%CI=1.11-1.82) and 59% (HR=1.59, 95%CI=1.17-2.17) in the MHO group and MUO group, respectively. Stratified analysis by menopausal status showed that compared to the MHNW group, the MUO group was associated with a 69% increase in risk of premenopausal breast cancer (HR=1.69, 95%CI=1.01-2.83). The risk of postmenopausal breast cancer was increased by 85% (HR=1.85, 95%CI=1.09-3.14), 50% (HR=1.50, 95%CI=1.06-2.13), and 55% (HR=1.55, 95%CI=1.05-2.28) for the MUNW, MHO, and MUO groups, respectively, compared to the MHNW group.

    Conclusion

    Overweight/obesity is a risk factor for female breast cancer, and overweight/obesity with metabolic abnormalities further increases the risk of breast cancer. Additionally, normal weight postmenopausal women who are metabolically unhealthy may be at an increased risk of postmenopausal breast cancer.

    Association of Gut Microbiota with Hypertensive Disorders in Patients with Gestational Diabetes Mellitus
    DAI Yuheng, GAO Chang, LIANG Xinxiu, LU Sha, HUA Wen, ZHENG Jusheng, HU Wensheng
    2024, 27(02):  156-162.  DOI: 10.12114/j.issn.1007-9572.2023.0321
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    Background

    Pregnant women with gestational diabetes mellitus (GDM) are often comorbid with hypertensive disorders of pregnancy (HDP), which can severely impact pregnancy health and delivery outcomes. The relationship between gut microbiota and pregnancy health has received increasing attention, but its association with concurrent HDP in GDM remains to be investigated.

    Objective

    To explore the association between gut microbiota characteristics and concurrent HDP in GDM patients.

    Methods

    The 204 patients with GDM who underwent prenatal examination at the Hangzhou Women's Hospital from August 2019 to January 2020 were selected as the study subjects. Pregnant women diagnosed with GDM only were categorized as the GDM group (n=181), while those concurrently diagnosed with GDM and HDP were categorized as the GDM with concurrent HDP group (n=23). Clinical data and inflammation detection markers of the enrolled pregnant women were collected, and fecal samples of the same period were retained for gut microbiota 16S rDNA amplicon sequencing analysis. LEfSe analysis was used to compare microbiota composition between the two groups at the phylum, family and genus levels, and to identify distinct bacterial enrichments. Logistic regression analysis was performed to identify gut microbiota characteristics associated with concurrent HDP in GDM. Spearman's rank correlation analysis was performed to explore the association between gut microbiota and inflammatory markers.

    Results

    No significant differences were found in overall gut microbiota composition and relative abundances of major phyla between the two groups (P>0.05). LEfSe analysis on family level showed that the Veillonellaceae family was enriched in the GDM with concurrent HDP group (P<0.05), while Mollicutes RF39 unclassified family and Lachnospiraceae were depleted (P<0.05). At the genus level, Dialister, Intestinibacter, Eubacterium and Parasutterella were enriched in the GDM with concurrent HDP group (P<0.05), whereas [Eubacterium] xylanophilum group, Ruminiclostridium 6, Mollicutes RF39 unclassified genus and Lachnospiraceae unclassified genus were enriched in the GDM group (P<0.05). Logistic regression analysis results showed increased abundances of Veillonellaceae (OR=1.06, 95%CI=1.01-1.11), Dialister (OR=1.26, 95%CI=1.10-1.45) and Intestinibacter (OR=2.07, 95%CI=1.12-3.84) were independent risk factors for concurrent HDP in GDM (P<0.05), while increased Lachnospiraceae was a protective factor (P<0.05). Spearman's rank correlation analysis results showed Veillonellaceae was positively correlated with the proportion of monocytes (rs=0.149, P<0.05) ; Dialister was positively correlated with leukocyte count, eosinophil leukocyte, and eosinophil count (rs=0.151, 0.163, 0.171, P<0.05) .

    Conclusion

    Increased abundances of Veillonellaceae, Dialister and Intestinibacter are independent risk factors for concurrent HDP in GDM pregnant women, while increased abundance of Lachnospiraceae unclassified genus is a protective factor. Veillonellaceae and Dialister are positively correlated with multiple inflammatory markers. Gut microbiota may be an important risk factor for concurrent HDP in GDM.

    Platelet Changes during Extracorporeal Membrane Oxygenation in Patients with Different Modes of Support: a Retrospective Cohort Study
    HE Youkuan, CAO Yong, LIN Fei, OU Yuanyuan, LI Kewen, DENG Li
    2024, 27(02):  163-167.  DOI: 10.12114/j.issn.1007-9572.2022.0903
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    Background

    Extracorporeal membrane oxygenation (ECMO) has been widely used in the treatment of various acute and critical heart and respiratory failure diseases. However, platelet (PLT) counts decrease significantly during the treatment, which increases the risk of bleeding and thus affecting the prognosis of patients. Therefore, the explore of changes in PLT counts during ECMO support can help prevent bleeding related risks caused by thrombocytopenia, thus improving the prognosis of patients.

    Objective

    To retrospectively analyse the changes of PLT counts during ECMO support under different support modes.

    Methods

    40 adult patients received veno-venous ECMO (V-V ECMO) or veno-arterial ECMO (V-A ECMO) support from January 2019 to October 2021 at the heart center of the People's Hospital of Gaozhou were included as study subjects and divided into the death group (n=22) and survival group (n=18) according to the occurrence of death after ECMO. PLT and platelet infusion were collected at baseline, before ECMO, and during the intervention.

    Results

    The average age of patients was (49.0±17.8) years, and the average duration of ECMO support was (6.0±3.2) days. There was statistically significant difference in the proportion of ECMO intervention reasons between the operation group and the non-operation group (P<0.05). The incidence of thrombocytopenia before ECMO support was 18% (7/40), among which three patients were treated with V-V ECMO, all of whom suffering from severe pneumonia, and four patients were treated with V-A ECMO. After 1 day of ECMO support, the incidence of thrombocytopenia was 56.0% (18/32), among which four patients were treated with V-V ECMO, fourteen patients were treated with V-A ECMO. Nine patients in the non-operation group and 13 patients in the operation group received platelet transfusion. The effective rate of initial platelet transfusion was 59.1% (13/22). The proportion of thrombocytopenia before ECMO support in the operation group was higher than that in the non-operation group, with statistically significant difference (P<0.05). The lowest PLT count was observed on day 4 of ECMO in the non-operation group and day 5 of ECMO support in the operation group. The age of patients in the death group was higher than that in the non-death group, and the ECMO support time, weaning rate and PLT count on the day 7 of ECMO support were lower than those in the non-death group, with statistically significant difference (P<0.05) .

    Conclusion

    PLT count reached the lowest value on the day 3-4 of ECMO support and correlated with the prognosis of patients. The initial infusion of allogeneic platelets can increase PLT count in patients, suggesting that the corresponding intervention preparations should be made according to the changes of PLT in clinical practice, so as to reduce bleeding and other complications caused by thrombocytopenia and improve the prognosis of patients receiving ECMO support.

    Development Trajectory and Predictors of Strength-duration Adherence to Home-based Exercise Rehabilitation among Patients with Atrial Fibrillation after Radiofrequency Catheter Ablation: a Longitudinal Study
    WANG Jie, SUN Guozhen, BAO Zhipeng, WANG Lin, GAO Min, LIU Shenxinyu, YU Tianxi, WANG Qin, GAO Rongrong
    2024, 27(02):  168-176.  DOI: 10.12114/j.issn.1007-9572.2023.0426
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    Background

    The prevalence of atrial fibrillation (AF) in China is increasing year by year, and the prognosis and quality of life of patients urgently need attention. Current studies have confirmed that exercise rehabilitation is a beneficial way to improve the prognosis and poor quality of life in patients with AF after radiofrequency catheter ablation (RFCA). Adherence is a key measure of whether the benefits of exercise rehabilitation persist, but its trajectory remains unknown.

    Objective

    To examine the development trajectory and predictors of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA using five-period follow-up data based on prospective longitudinal observation.

    Methods

    Convenience sampling method was used to select 246 patients with AF who attended the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University for RFCA from May to November 2020 for follow-up. The baseline survey was conducted 1 week after enrollment, and the follow-up survey was conducted at 3, 6, 9 and 12 months after enrollment. The general and clinical data of patients were collected. The strength-duration adherence was monitored and recorded using smart devices or fitness log to assess exercise adherence in terms of strength-duration adherence; Self-efficacy for Exercise Scale (SEE), Fear of Activity in Patients with Chronic Heart Failure (Fact-CHF), Perceived Social Support Scale (PSSS), Patient Activation Measure 13 (PAM13) were used for assessing self-efficacy of exercise, fear of activity, social support and motivation level. Mplus tool was used to construct latent class growth model (LCGM), and the optimal fitting model was selected to determine the development trajectory of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA. Logistic regression analysis was used to identify the predictors of trajectory categories.

    Results

    A total of 202 patients were included in the final analysis with 44 patients lost to follow-up. The number of patients at baseline, 3 months, 6 months, 9 months, and 12 months after exercise were 202, 201, 185, 174 and 159, respectively, and the strength-duration adherence were (0.83±0.55), (1.07±0.54), (0.99±0.57), (0.91±0.55) and (0.89±0.60). The LCGM results showed group heterogeneity in the process of change in strength-duration adherence to exercise rehabilitation in patients, which was divided into 3 latent classes based on their development trajectories, including 69 in slow decline-low level group (34.2%), 14 in rapid increase-high level group (6.9%), and 119 in sustained adherence group (58.9%). Multinomial unordered Logistic regression showed higher levels of intensity-time adherence in the rapid increase-high level group and sustained adherence group using the slow decline-low level group as the reference group (P<0.001). The patients in the rapid increase-high level group and sustained adherence group were older, with higher level of exercise self-efficacy (P<0.05). The level of fear of activity was lower in the rapid increase-high level group, and the level of activation was higher in the sustained adherence group (P<0.05) .

    Conclusion

    The strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA showed a multi-class curve growth trajectory. In the future, intensive interventions can be conducted periodically according to the time-varying characteristics and predictors, to improve and stabilize the adherence to home-based exercise rehabilitation.

    Modulation of Iron Death by Poric Acid through Nrf2/SLC7A11/GPX4 Signal Pathway in the Improvement of Cognitive Impairment of Alzheimer's Disease Rats
    FAN Yun, DOU Runpeng, HU Jiulue, HOU Zijun, ZHOU Chunxiang
    2024, 27(02):  177-183.  DOI: 10.12114/j.issn.1007-9572.2023.0326
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    Background

    Alzheimer's disease (AD) is a common and irreversible neurodegenerative brain disease that severely affects the quality of life and survival of patients, while there is still a lack of effective treatments to delay or stop disease progression. Traditional Chinese medicine (TCM) and its active ingredients have important potential in the prevention and treatment of AD.

    Objective

    To investigate the effects of poric acid (PA) on cognitive impairment and nuclear factor E2-related factor 2 (Nrf2) /solute carrier family 7A11 (SLC7A11) /glutathione peroxidase 4 (GPX4) signaling pathway in AD rats.

    Methods

    Seventy-five male SPF grade SD rats aged 6 to 8 weeks were divided into the control group (Control group), AD Model group (Model group), PA treatment group (PA group) and PA+Nrf2 inhibitor group (PA+ML385 group) by random number table method to prepare AD rat model from January to September, 2022. After successful modeling 50 mg/kg PA was intraperitoneally injected into the PA group, 50 mg/kg PA and 30 mg/kg ML385 was intraperitoneally injected into the PA+ML385 group, and 0.9% sodium chloride solution was intraperitoneally injected into the Control group and Model group. The Morris water maze experiment was performed 24 h after the last dose, and the positioning navigation experiment was carried out on days 2, 4 and 6 to record the time when the rats arrived at the platform (escape latency). The platform was removed on day 7, and the duration of the rats staying on the platform and the number of times they crossed the platform within 120 s were recorded. The pathological changes of hippocampal neurons in each group were observed after Nissl staining. Iron deposition was detected by Prussian blue staining, GPX4 expression and GSH, MDA and Fe2+ contents were detected by immunofluorescence staining. The protein expression levels of Nrf2, SLC7A11 and GPX4 in rat hippocampus were detected by Western blotting.

    Results

    The escape latency of the Model group was higher than that of the Control group and PA group, and escape latency of the PA+ML385 group was higher than that of the PA group at 2, 4 and 6 days after the last administration. The platform residence time and platform crossing times in the Model group were lower than those in the Control group and PA group, and those in the PA+ML385 group were lower than those in PA group, and the difference was statistically significant (P<0.05). The results of Nissl staining showed severe neuronal necrosis, nucleus shrinkage and decreased number of Nissl bodies in the Model group, decreased neuronal necrosis with tight arrangement and increased number of Nissl bodies in the PA group, significantly increased neuronal damage and decreased the number of Nissl bodies in the PA+ML385 group. The Prussian blue staining results showed that iron deposition in the Model group was higher than that in the Control group, iron deposition in the PA group was lower than that in the Model group, and iron deposition in the PA+ML385 was higher than that in the PA group. The results of immunofluorescence staining showed that green fluorescence was weakened and GPX4 positive cells were reduced in the Model group, green fluorescence was enhanced and GPX4 positive cells were increased in the PA group compared with the Model group, and GPX4 positive cells were decreased in the PA+ML385 group compared with the PA group. GSH in the Model group was lower than that in the Control group and PA group, GSH in the PA+ML385 group was lower than that in the PA group. MDA and Fe2+ in the Model group were higher than those in the Control group and PA group, and those in the PA+ML385 group were higher that the PA group, and the differences were statistically significant (P<0.05). The relative expression levels of Nrf2, SLC7A11 and GPX4 in the Model group were lower than those in the Control group and PA group, and those in the PA+ML385 group were lower than those in the PA group, and the differences were statistically significant (P<0.05) .

    Conclusion

    PA can improve the cognitive impairment of AD rats, and its mechanism may be related to the inhibition of iron death by activating Nrf2/SLC7A11/GPX4 signal pathway.

    Research Progress of International and Domestic Integrated Health Care of Multimorbidity
    LI Chanjiao, HE Anning, HUANG Xianhong, NI Ziling
    2024, 27(02):  184-191.  DOI: 10.12114/j.issn.1007-9572.2023.0502
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    With the gradual shift in the disease spectrum, chronic non-communicable diseases (hereafter referred to as "chronic diseases") have become a serious threat to health and economic development in China and globally. Due to various pathogenic factors and a long course of disease, patients with chronic diseases often have a chronic disease accumulation state of individuals suffering from two or more chronic diseases at the same time, referred to as multimorbidity. The problem of multimorbidity is becoming increasingly prominent with a younger trend. The effective integration of fragmented and discontinuous health services, which are disease-centered and treatment-based, is of great significance in addressing this problem. This paper reviewed the current research status and development trends of multimorbidity health service integration at home and abroad, and analyzed the shortcomings of the current researches and practices of integrated health care of multimorbidity. It is proposed that constructing a personalized integrated service model centered on patients with multimorbidity and exploring the quantitative evaluation practice of integrated health care of multimorbidity in the real world are the development direction of future research on multimorbidity integrated services, providing reference for realizing the efficient and sustainable integration mechanism of multimorbidity services among medical institutions in China.

    Construction of an Integrated Management Model for Geriatric Comorbidities under Medical Association Based on PDSA Theory
    ZHOU Xuan, ZHANG Dan
    2024, 27(02):  192-200.  DOI: 10.12114/j.issn.1007-9572.2023.0374
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    The continuous increase in the prevalence of comorbidities has severe challenges to population health management, and the World Health Organization (WHO) recommends the development of integrated medical care models to cope with the pressure of health management of patients with comorbidities. In this paper, we constructed an integrated management model for geriatric comorbidities under medical association based on PDSA theory, in order to continuously improve the management ability and effect in the reciprocal cycle of "plan-execute-research-act". The model consists of four key elements, including management team, management process, management tools and management effect. Based on previous intervention research, the model integrates patient-centered care, multidisciplinary team, patient self-management and other intervention methods, and relies on big data technology to establish a decision support platform, thus realizing the whole life cycle health management of patients with comorbidities.

    Analysis of the Current Status of Ischemic Stroke Co-morbidity and Co-morbidity Patterns in Middle-aged Based on Data from Tertiary Hospitals in Henan Province
    HU Qianqian, ZHOU Tong, LIU Zhihui, PAN Ye, WANG Liuyi
    2024, 27(02):  201-207.  DOI: 10.12114/j.issn.1007-9572.2023.0459
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    Background

    Middle-aged and elderly ischemic stroke patients suffer from multiple co-morbid chronic diseases, and this co-morbidity status has a great impact on the patients' healthy living standard. Currently, there are few studies on the current status of ischemic stroke co-morbidities and the analysis of co-morbidity patterns.

    Objective

    To understand the current status of ischemic stroke co-morbidities in middle-aged and elderly people in Henan Province, and explore the association between ischemic stroke co-morbidities, so as to provide a reference basis for the management of ischemic stroke co-morbidities, as well as the preventive and control measures.

    Methods

    Ischemic stroke patients over 45 years of age attending Henan Provincial People's Hospital from January 2021 to December 2022 were selected for the study, with their chronic disease prevalence counted, the status of ischemic stroke co-morbidities was compared by different demographic characteristics, and the co-morbidity patterns of ischemic stroke in the middle-aged and elderly population were investigated using cluster analysis.

    Results

    A total of 1 685 middle-aged and elderly ischemic stroke patients were enrolled in this study, of whom 90.0% (1 516/1 685) had at least 1 co-morbid chronic disease; 13.6% (230/1 685) had 2 co-morbid chronic diseases, 26.9% (454/1 685) had 3 co-morbid chronic diseases, and 49.4% (832/1 685) had 4 or more co-morbid chronic diseases. The chronic diseases with high prevalence were hypertension in 1 047 cases (62.1%) and dyslipidemia in 755 cases (44.8%). Among ischemic stroke patients, the prevalence of co-morbidities was higher in females compared with males (χ2=14.516, P<0.05) ; the prevalence of co-morbidities tended to increase with age (χ2trend=148.889, P<0.001) ; and the prevalence of co-morbidities tended to decrease with higher education (χ2trend=30.890, P<0.001). Cluster analysis showed four patterns of co-morbidity, which were cardiovascular-metabolic patterns (hypertension, dyslipidemia, heart attack, and diabetes mellitus), patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders (chronic lung disease, renal disease, hepatic disease, gastrointestinal disorders, and urinary disorders), psychiatric-degenerative patterns (neurological or psychiatric problems, arthritis or rheumatism, disorders related to memory), and cancer.

    Conclusion

    The prevalence of co-morbidities of ischemic stroke in middle-aged and elderly people in Henan province is high, and their co-morbidity patterns include cardiovascular-metabolic patterns, patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders, psychiatric-degenerative patterns, and cancers, among which cardiovascular-metabolic patterns are more associated with ischemic stroke, and the screening and prevention of which should be better controlled.

    Study on the Factors Affecting the Number of Chronic Diseases among Elderly Comorbidity Patients in Guangdong Province Based on the Model of Ecological Health
    LI Linjin, XIAO Liqin, ZHANG Dan
    2024, 27(02):  208-216.  DOI: 10.12114/j.issn.1007-9572.2023.0396
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    Background

    The number of elderly comorbidity patients in our country is continuously increasing. With the accumulation of chronic diseases, older adults experience varying degrees of health loss. Currently, there is a lack of research analyzing the multi-level factors influencing the number of chronic conditions in elderly comorbidity patients.

    Objective

    To explore the factors influencing the number of chronic conditions in elderly patients from different levels combining with the etiology and characteristics of chronic diseases based on the health ecology model, so as to provide evidence for the management and prevention of chronic diseases in community-dwelling elderly comorbidity patients in our country.

    Methods

    In February 2023, a multi-stage stratified cluster random sampling method was used to select community-dwelling elderly (≥60 years old) comorbidity patients in Guangdong province as the survey subjects. A face-to-face interview was conducted using the "Survey Questionnaire on the Status and Influencing Factors of Elderly Patients with Multiple Chronic Conditions", which was based on the health ecology model and included five levels of individual trait, behavioral characteristic, interpersonal relationship, living and working conditions, and policy environment. The number of chronic conditions in elderly comorbidity patients was considered as the dependent variable, and an unordered multivariate Logistic regression analysis was conducted by incorporating independent variables according to the five levels.

    Results

    A total of 1 000 questionnaires were distributed, and 987 valid questionnaires were collected, with a recovery rate of 98.7%. Among the 987 elderly comorbidity patients, 346 (35.1%) had two concurrent chronic diseases, 456 (46.2%) had three concurrent chronic diseases, and 185 (18.7%) had more than three concurrent chronic diseases. The results of unordered multivariate logistic regression analysis showed that, compared to elderly patients with two concurrent chronic diseases, disease duration less than 6 years and 6-10 years, local urban household were risk factors for elderly patients with three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 2.100 (1.284-3.435), 1.948 (1.201-3.158), and 4.103 (1.496-11.250), respectively. Having at least 6 hours of sleep daily, self-rating good health status, taking 1-3 types of medication daily, regularly participating in social activities, level of junior high school or below and high school/secondary school, and having urban employee medical insurance/rural resident medical insurance were protective factors for elderly patients with three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 0.528 (0.322-0.867), 0.570 (0.325-0.998), 0.385 (0.261-0.569), 0.348 (0.208-0.582), 0.412 (0.175-0.972), 0.486 (0.298-0.790), and 0.392 (0.242-0.634), respectively. Being male, exercising less than 3 times a week were risk factors for elderly patients with more than three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 2.563 (1.634-4.021), 2.990 (1.429-6.256), respectively. Having at least 6 hours of sleep daily, self-rating good and fair health status, taking 1-3 types of medication daily, having an annual average income below ≤30 000 and >30 000-50 000 yuan, and having urban employee medical insurance/rural resident medical insurance were protective factors for elderly patients with more than three concurrent chronic diseases (P<0.05), with OR (95%CI) values of 0.300 (0.159-0.565), 0.247 (0.125-0.487), 0.448 (0.240-0.837), 0.288 (0.178-0.467), 0.318 (0.155-0.654), 0.489 (0.293-0.816), and 0.416 (0.229-0.755), respectively.

    Conclusion

    The proportion of elderly comorbidity patients having 2-3 types of chronic diseases is relatively high in Guangdong province, accounting for over 80%. The factors influencing the number of chronic conditions in elderly comorbidity patients are complex, including gender, duration of disease, physical activity, sleep quality, self-rated health status, medication adherence, household registration type, supervision by children or family members in medication adherence or exercise, income level, educational level, and type of medical insurance. Moreover, there are significant differences in the risk factors across different comorbidity counts. Therefore, corresponding intervention measures should be implemented at different levels to reduce the number of chronic conditions in elderly comorbidity patients and improve their overall health level.

    Application Analysis of the Outcome Measures in Randomized Controlled Trials of Traditional Chinese Medicine in the Treatment of Coronary Microvascular Disease
    WANG Aolong, ZHU Mingjun
    2024, 27(02):  217-225.  DOI: 10.12114/j.issn.1007-9572.2023.0402
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    Background

    Coronary microvascular disease (CMVD) is currently a research hotspot in the field of cardiovascular disease, traditional Chinese medicine (TCM) has unique advantages and significant efficacy in the treatment of CMVD, but there are problems in relevant clinical trials, such as inconsistencies in the diagnostic and efficacy criteria, exploring the core outcome set of TCM in the treatment of CMVD is conducive to the development of high-quality evidence in the future.

    Objective

    To analyze the application of outcomes measures in randomized controlled trials (RCTs) of CMVD treated with TCM, and propose corresponding questions and recommendations.

    Methods

    CNKI, SinoMed, VIP, Wanfang, PubMed, Embase and Cochrane Library were systematically searched for RCTs of CMVD treated with TCM from inception to February 09, 2023. The basic information, interventions and outcome measures in RCTs of CMVD treated with TCM were extracted, the Cochrane systematic review manual bias risk assessment tool was used to evaluate the bias risk of the included literature and the Excel software was used to statistically analyze the outcome measures.

    Results

    A total of 88 articles were included, involving 2 clinical trial registration protocols and 1 English literature. Cochrane systematic review manual bias risk assessment showed that the included literature were evaluated as unclear in terms of random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, and other bias; mostly low risk in terms of outcome data completeness and selective reporting. A total of 18 RCTs were analyzed for TCM syndromes of patients diagnosed with CMVD, involving 6 RCTs related to blood stasis due to qi deficiency, 3 RCTs related to intermingled phlegm and blood stasis. A total of 115 outcome measures were obtained by statistical analysis, the total frequency was 571 times, which can be divided into 7 categories, including clinical efficacy, physicochemical testing, signs and symptoms, TCM syndrome points, quality of life, long-term prognosis, and safety testing. The frequency of total clinical efficacy rate was the highest (46 times), 3 months was the most commonly used intervention node. and the highest frequency of composite outcome measures was the clinical efficacy combined with physicochemical testing.

    Conclusion

    It was found that the overall quality of RCTs of TCM in the treatment of CMVD was generally low, and there are some problems in the outcome measures, such as the lack of standardized TCM syndrome diagnosis criteria and efficacy criteria, and the lack of long-term prognosis monitoring. In the future, it is also necessary to conduct high-quality RCTs, combined with the characteristics of TCM treatment, to construct a standardized core outcome set of TCM in the treatment of CMVD.

    Literature Characteristics and Outcome Measures of Randomized Controlled Trials of Oral Traditional Chinese Medicine in Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease
    WANG Jing, WANG Hui, SONG Shiqun, JI Guanghe, GUO Yakun, YAO Danning, ZHAO Shuhan, LI Duoduo, XIA Ruyu, ZHANG Lishan
    2024, 27(02):  226-232.  DOI: 10.12114/j.issn.1007-9572.2023.0133
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    Background

    Oral traditional Chinese medicine (TCM) has been widely used in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but the outcome measures of relevant clinical trials have not been standardized and regulated.

    Objective

    To screen the published randomized controlled trials (RCTs) of oral TCM in the treatment of AECOPD, summarize the literature characteristics and outcome measures, so as to provide reference for the design of clinical trials and the selection of outcome measures for the treatment of AECOPD with TCM.

    Methods

    CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov and Chinese Clinical Trial Registry were systematically searched by computer to obtain RCTs and clinical trial registration protocols for the treatment of AECOPD with oral TCM from January 2018 to October 2022. After independent screening of the literature and extraction of data by 2 researchers, qualitative analysis was used to describe the selection of outcome measures in the enrolled studies.

    Results

    A total of 578 studies were enrolled, including 574 RCTs with reported trial results and 4 clinical trial registration protocols. A total of 51 508 patients were involved in 574 RCTs. In the inclusion criteria, 88 studies limited the classification of disease, and 361 studies limited the TCM syndrome type, 6 studies reported the blinding method, and 6 studies mentioned the follow-up. A total of 4 030 outcome measures were covered and the number of outcome measures in a single article ranged from 1 to 24. According to the functional attributes, the outcome measures were classified into 8 measure domains: TCM symptoms/syndromes, symptoms/signs, physical and chemical tests, quality of life, long-term prognosis, economic evaluation, safety evaluation and others. The measure domain with the highest reporting rate was physical and chemical tests, and the top 5 outcome measure items reported in terms of frequency were: response rate (11.5%), forced expiratory volume in 1 s (FEV1) (7.5%), TCM symptom/syndrome score (7.0%), FEV1/Forced Vital Capacity (FVC) (6.8%), FVC (4.6%). Four hundred and forty-five studies reported the composition of response rate, and the top 5 measures with reporting rate were symptoms (423), signs (281), TCM syndrome score (203), laboratory tests (89), and pulmonary function (71) .

    Conclusion

    The RCTs of oral TCM in the treatment of AECOPD involved a large number and a wide range of outcome measures. The included literature focused on the effects of oral TCM on the symptoms and signs, physical and chemical test indicators, quality of life, long-term prognosis, economic evaluation and safety outcomes of patients with AECOPD in varying degrees. However, the selection of outcome measures remains problematic in multiple ways: unclear prioritization of outcome measures; focusing on clinical endpoints with insufficient attention to clinical endpoints; insufficient attention to health economics indicators; different sources and judgment criterias of reference of response. In the future studies, researchers can design the rational outcome measures by refering to the published core outcome set (COS) to improve the quality of TCM clinical research.

    Epidemic Status, Disease Burden and Prediction of Cardiovascular Diseases in China, 1990-2019
    YANG Ji, ZHANG Yao, MA Teng, TIAN Xintong, ZHAO Yingqiang
    2024, 27(02):  233-244.  DOI: 10.12114/j.issn.1007-9572.2023.0470
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    Background

    Cardiovascular disease is a major chronic disease that seriously endangers human health, and remains a public health problem to be solved in China and even globally.

    Objective

    To explore the epidemic characteristics and disease burden of cardiovascular diseases in China from 1990 to 2019, forecast the incidence of cardiovascular diseases in China from 2020 to 2050, and provide a reference for the formulation of relevant prevention and treatment strategies of cardiovascular diseases.

    Methods

    The 2019 Global Burden of Disease Study (GBD 2019) database was searched to extract and analyze relevant data on cardiovascular disease burden and risk factors in China and globally from 1990 to 2019. The prevalence of cardiovascular diseases was quantified by using the publicly available incidence, prevalence, mortality, and corresponding age-standardized rate (referred to as standardized rate) based on GBD 2019 database, and the burden of diseases was quantified by years lived with disability (YLD), years of life lost (YLL) and disability adjusted life year (DALY), and the ARIMA model was constructed to predict the incidence of cardiovascular diseases in China from 2020 to 2050.

    Results

    Compared with 1990, the incidence, prevalence and mortality of cardiovascular diseases in China showed an increasing trend by year up to 2019, in which the incidence, prevalence and mortality increased by 93.75%, 99.75% and 57.39%, respectively. The standardized incidence and prevalence of females were higher than those of males, while the standardized mortality was lower than that of males (P<0.05). According to the data in 2019, the overall incidence of cardiovascular diseases in China showed an increasing trend with age, reaching its highest value in the age group of 95 years and above. Incidence trends for both men and women were similar to the overall trend, with slight differences. The overall prevalence also increases with age and is higher in women than men. There is an increasing trend in cardiovascular disease mortality after the age of 45, with males having a higher mortality rate than females at all ages. Compared with 1990, the rates of YLL, YLD and DALY in Chinese men increased by 36.99%, 102.42% and 40.78%, respectively, and increased by 2.79%, 107.13% and 11.50% in women in 2019. According to the data in 2019, the YLL rate, YLD rate and DALY rate of cardiovascular diseases in Chinese population showed an upward trend with the increase of age, with no inflection point. YLL rate and DALY rate of males gradually increased with the progress of population aging and were much higher than females, YLD rate gradually increased in the age group of 55-59 years and was much higher than males. From 1990 to 2019, the global standardized incidence, standardized prevalence and standardized mortality of cardiovascular diseases showed a downward trend by year, while the standardized morbidity and standardized mortality still increased in China, the standardized incidence and prevalence decreased, but that was still higher than the global scale. From the global level, the standardized YLL rate and DALY rate of cardiovascular diseases in China showed a downward trend along with the global level, but the disease burden of cardiovascular diseases in China was higher than the global level after 2000, and the standardized YLD rate increased by year. Risk factors associated with death from cardiovascular diseases mainly included smoking, second-hand smoke, alcohol consumption, low physical activity, high fasting blood glucose, high systolic blood pressure, high BMI, high low density lipoprotein cholesterol and renal insufficiency. From the relevant data in China and globally, high systolic blood pressure (hypertension) was still the primary risk factor for death from cardiovascular diseases, and the number of deaths was increasing by year. High density lipoprotein cholesterol (hyperlipidemia) was the second cause of death from cardiovascular diseases globally and in China in recent years. From 2020 to 2050, the standardized incidence of cardiovascular diseases in China is still on the rise, and it is expected that the standardized incidence of cardiovascular diseases will reach 663.618 per 100 000 by 2050.

    Conclusion

    The incidence, prevalence and mortality of cardiovascular diseases in China from 1990 to 2019 have shown an increasing trend by year. The disease burden caused by cardiovascular diseases is more severely, and there is no inflection point in the next 50 years. The prevalence and burden of diseases are higher than those of the world. It is expected that the standardized incidence of cardiovascular diseases will reach 663.618 per 100 000 by 2050.

    Trend Analysis of Gout Burden in China from 1990 to 2019 and Prediction for the Next Ten Years
    FANG Jiawen, FENG Tianyuan, ZHOU Zhiheng, LI Ziyue, YAN Danhong, LIN Kaicheng
    2024, 27(02):  245-252.  DOI: 10.12114/j.issn.1007-9572.2023.0505
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    Background

    Gout is the most common inflammatory arthritis, which causes great harm to people's health, however, there are limited studies on the trend analysis and prediction of gout burden in China.

    Objective

    To analyze the changing trend of gout in China from 1990 to 2019, and predict the age-standardized disability-adjusted life years (DALYs) rate, incidence rate and prevalence rate of gout in the next 10 years.

    Methods

    The indicators of DALYs, incidence, and prevalence of gout in China were extracted from the Global Burden of Disease Study (GBD 2019), the annual percentage change (APC) and annual average percentage change (AAPC) of the age-standardized DALYs rate, age-standardized incidence rate and age-standardized prevalence rate were calculated using the Joinpoint regression model, autoregressive integrated moving average model (ARIMA model) was used to predict the age-standardized DALYs rate, age-standardized incidence rate and age-standardized prevalence rate in 2020-2029.

    Results

    In 1990-2019, the DALYs of gout in China increased from 187 436 to 510 485 person-years, with an increase of 172.35%, the number of cases increased from 1 181 969 to 3 041 329, with an increase of 157.31%, the number of patients increased from 5 864 143 to 16 161 325, with an increase of 175.60% (the corresponding standardized rates increased by 28.45%, 25.92% and 28.63%, respectively). Joinpoint regression results showed an overall increasing trend in the age-standardized DALYs rate, age-standardized incidence rate and age-standardized prevalence rate (AAPC was 0.9%, 0.8%, 0.9%, respectively, P<0.05) from 1990 to 2019. The gout burden had significant gender and age differences, with men having a higher burden than women, and the range of the male-to-female gender ratios for the standardized DALYs rate, age-standardized incidence rate, and age-standardized prevalence rate was 3.23 to 3.51, 3.14 to 3.40, and 3.17 to 3.42, respectively. The age peaks for each indicator were generally delayed in females compared to males, the burden began to increase in females after 45 years of age, and the burden increased again after 90 years of age for both males and females. The ARIMA model results showed that the age-standardized DALYs rate and age-standardized incidence rate due to gout are projected to decrease by 0.33% and 0.45%, respectively, and the age-standardized prevalence rate to increase by 0.71% by 2029.

    Conclusion

    From 1990 to 2019, the gout burden in China showed an obvious increasing trend, with significant gender and age differences, and a trend of younger age. The age-standardized prevalence rate due to gout is expected to increase slightly by 2029.

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