Table of Content

15 March 2024, Volume 27 Issue 08

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Editorial

General Practice in Medicine—Reflections of Lancet's Iconic Texts at Its Milestone of 200 Anniversary (6) : Mackintosh's View on General Practice Research

YANG Hui

2024, 27(08):  0-C2.  DOI: 10.12114/j.issn.1007-9572.2024.A0008

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Review & Perspectives

Advances in Epidemiology and Related Mechanisms of Cardiovascular Diseases and Mental Illness

ZHANG Jinyi, ZHANG Shizhong

2024, 27(08):  893-899.  DOI: 10.12114/j.issn.1007-9572.2023.0655

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According to the latest statistics released by the World Health Organization, cardiovascular disease ranks as the leading cause of death worldwide. The number of deaths caused by cardiovascular disease exceeds that of any other diseases, that needs to be tackled by global public health. At the same time, according to statistics released by the World Health Organization in 2022, the prevalence of mental illness in China is as high as 17%. In the past 20 years, the incidence of depression in the Chinese population has increased 120 times. The correlation between cardiovascular disease and mental illness has been found to be significant with an underlying mechanism. This article aims to elucidate advances in the correlation between cardiovascular disease and mental illness, as well as their underlying mechanisms, showing that anxiety and depression are important drivers of cardiovascular disease by causing damage to the heart through the autonomic nervous system and the hypothalamic-pituitary-adrenal axis, while ischemic cardiomyopathy and myocardial infarction can induce adverse mood and cognitive impairment by mediating ischemic damage and inflammatory responses in the brain. This article can provide additional preventive ideas for patients at high risk of cardiovascular disease, as well as for the diagnosis and treatment of patients with mental illness, and provide a reference for the psycho-cardiology interdiscipline.

Advance in Epidemiologic Studies of Dietary Patterns Associated with Cerebrovascular Diseases

CHEN Wenjin, CHEN Piaoying, YANG Xiaohua, CHEN Yifan, CAI Yefeng, NI Xiaojia

2024, 27(08):  900-907.  DOI: 10.12114/j.issn.1007-9572.2023.0565

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Stroke has become the leading cause of death in China, and rational diet is an important primary prevention strategy, but the optimal dietary pattern remains to be studied. Based on this, this paper reviews the progress of epidemiological studies on the correlation of Mediterranean Diet (MD) , Dietary Approaches to Stop Hypertension (DASH) pattern, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, Japanese dietary pattern and Chinese diet pattern with cerebrovascular diseases, and suggests that MD pattern, DASH pattern and Japanese dietary pattern have protective effects on cerebrovascular disease; however, the relationship between MIND pattern and cerebrovascular disease remains uncertain. There is a lack of large-scale randomized controlled trials to examine the effect of traditional Chinese dietary pattern on cerebrovascular diseases. In the future, active efforts in exploring the healthy dietary patterns in line with local dietary habits are needed for providing a Chinese strategy for primary stroke prevention.

Original Research

Effects of Health Coaching Combined with Wearable Devices on Glucose and Lipid Metabolism and Self-management Behavior in Patients with Type 2 Diabetes Mellitus

GAO Yuan, ZHOU Min, QIN Manfen, XU Xuan, YANG Liping, FU Yahong, HUANG Ying, WANG Wei

2024, 27(08):  908-914.  DOI: 10.12114/j.issn.1007-9572.2023.0631

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Background

Type 2 diabetes mellitus (T2DM) has become a public health burden facing the whole world, with the rapid development of Internet and digital technology, intelligent service model plays an important role in the management of patients with T2DM.

Objective

To explore the effectiveness of wearable devices combined with health coaching in patients with T2DM.

Methods

A total of 315 patients with T2DM who were hospitalized in the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were selected as the study subjects, and divided into the control group, the intervention A group and the intervention B group based on the method of randomized numerical table, the control group implemented the routine management measures based on capillary blood glucose monitoring, the intervention A group adopted the wearable devices for routine management, the intervention B group was managed by wearable devices combined with health coaching. The differences in glycemic and lipid control status and self-management behaviors among the three groups before and 3, 6, 9 and 12 months after intervention were compared.

Results

A total of 15 lost visits were made during the implementation of the study, and 300 study subjects were finally included in the analysis, with 100 in each of the three groups. There was an interaction between intervention method and time in the three groups on 2-hour postprandial blood glucose (2 hPG) , glycated hemoglobin (HbA_1c) , number of hypoglycemic episodes, low-density lipoprotein cholesterol (LDL-C) , self-management behaviors of diabetes mellitus (2-DSCS) , and self-management behaviors of diabetic patients (SDSCA) scores (P<0.05) . There was a significant main effect of intervention method on the number of hypoglycemic episodes, total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , 2-DSCS and DSCS scores (P<0.05) . The main effect of time was significant on all indicators except the number of hypoglycemic episodes (P<0.05) . The levels of HbA_1c, FBG, 2 hPG, TC at 3, 6, 9, and 12 months after the intervention in each group were lower than those before the intervention in the same group, and the level of 2-DSCS and SDSCA scores of T2DM patients were higher than those before the intervention in the same group. After 3 months of intervention, the number of hypoglycemic episodes were lower in the intervention B group than in the intervention A group and control group (P<0.05) ; after 6 months of intervention, the 2 hPG level and the TC level in the intervention B group were lower than those in the control group (P<0.05) , HDL-C level, 2-DSCS score, SDSCA score in the intervention A and intervention B groups were higher than the control group (P<0.05) , SDSCA score in the intervention B group was higher than the intervention A group (P<0.05) ; after 9 months of intervention, FBG level, 2 hPG level, and TC level in the intervention B group were lower than those in the control group (P<0.05) , FBG level and 2 hPG level in intervention B group were lower than those in intervention A group, HDL-C level, 2-DSCS score, and SDSCA score in the intervention B group were higher than those in the control group (P<0.05) , 2-DSCS score and SDSCA score in the intervention B group were higher than those of the intervention A group (P<0.05) ; after 12 months of intervention, FBG level, 2 hPG level, HbA_1c level, TC level, LDL-C level in the intervention B group were lower than those in the control group (P<0.05) , FBG level, 2 hPG level, HbA_1c level in the intervention B group were lower than those in the intervention A group, HDL-C level, 2-DSCS score, and SDSCA score in the intervention B group were higher than those in the control and intervention groups (P<0.05) .

Conclusion

Wearable devices combined with health coaching has short-term and long-term effects in improving the comprehensive control of glucose and lipids, as well as improving self-management ability of them in patients with T2DM.

Characteristics of Gender, Age, Spatial and Temporal Distribution of Stroke Hospitalization Cases Based on the Data of 190 000 Patients in Ningxia Region

ZHAO Yuan, LIU Shanghong, ZHANG Yanfang, MA Lixu, LI Hong, LI Xiaohua, TIAN Yuan, GUO Zhongqin, LIANG Peifeng

2024, 27(08):  915-920.  DOI: 10.12114/j.issn.1007-9572.2023.0695

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Background

Stroke is an acute cerebrovascular disease in which blood fails to flow into the brain, resulting in damage to brain tissue, with high rates of disability, death, and recurrence, and most of the related studies in Ningxia region are clinical analyses of strokes, which lack trend analysis of stroke hospitalization in Ningxia in recent years.

Objective

To analyze the disease prevalence characteristics and distribution of stroke hospitalized patients in Ningxia, and provide a basis for the development of comprehensive prevention and treatment measures for stroke.

Methods

The case home page data of 55 hospitals of traditional Chinese medicine (TCM) and western medicine in Ningxia region were collected, and the data discharged from 2013 to 2019 with a primary diagnosis of stroke [International Classification of Diseases (ICD) -10 coded as I60-I63] were screened and analyzed. SPSS 24.0 software was applied to analyze the differences in gender and age using the chi-square test, and a geographic information system (GIS) was applied to analyze the distribution of stroke hospitalization rate data across Ningxia from 2013 to 2019 using global spatial auto correlation analysis.

Results

A total of 190 634 stroke patients were finally included. The hospitalization rate of stroke in Ningxia region showed an increasing trend year by year from 2013 to 2019 (hospitalization rates of 24.302/10 000, 30.045/10 000, 34.949/10 000, 39.397/10 000, 44.049/10 000, 47.617/10 000, and 52.944/10 000, respectively, χ²_trend=5.982, P=0.014) , and the hospitalization rates were higher during the cold season of each year, with a significant peak in March and a slight decline thereafter. Among the stroke inpatients in Ningxia from 2013 to 2019, there were 167 194 cases of ischemic stroke and 23 440 cases of hemorrhagic stroke; there was significant difference between ischemic stroke and hemorrhagic stroke patients in gender and age (χ²=473.533, 7 518.543, P<0.05) ; and the proportion of male, ≥60 years old hospitalized patients in ischemic stroke and hemorrhagic stroke exceeded 50% from the data. The results of global auto correlation analysis showed spatial aggregation of stroke hospitalization rates in 2013, 2018 and 2019 (P<0.05) . The spatial distribution map showed that the hospitalized stroke patients in Ningxia were mainly concentrated in north-central Ningxia.

Conclusion

From 2013 to 2019, the hospitalization rate of stroke patients in Ningxia showed increasing and varying degrees of aggregation, and the areas with higher hospitalization rates were concentrated in north-central Ningxia.

Correlation of Platelet Distribution Width with Different Hypertension Subtypes in Elderly Males and Females

WANG Chang, QUAN Yawen, WANG Linfeng, LI Gang

2024, 27(08):  921-929.  DOI: 10.12114/j.issn.1007-9572.2023.0540

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Background

In recent years, the prevalence of hypertension among the elderly in China has been consistently increasing. Current studies have found some association between hypertension and platelets, and platelet distribution width serves as the most sensitive measure of platelet activation, therefore, this study was conducted to explore the relationship between platelet distribution width and hypertension in elderly males and females.

Objective

To investigate the correlation of platelet distribution width with various hypertension subtypes in the elderly males and females.

Methods

A total of 600 elderly hypertensive and elderly non-hypertensive patients aged 65 years and above who were hospitalized in the Department of Cardiovascular Medicine, Hebei Provincial People's Hospital between 1 January 2020 and 24 April 2023 were consecutively enrolled and classified into 150 cases in the simple systolic hypertension (ISH) group, 150 cases in the simple diastolic hypertension (IDH) group, 150 cases in the systolic-diastolic hypertension (SDH) group, 150 cases in the normotensive group based on hypertension measurements. Basic data of patients were collected, including age, gender, BMI, systolic blood pressure, diastolic blood pressure, creatinine, uric acid, total cholesterol, triacylglycerol, high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) , fasting blood glucose, and platelet distribution width. Binary Logistic regression models were used to analyze the correlation between platelet distribution width and different hypertension subtypes.

Results

Binary Logistic regression analysis showed that age, uric acid, and platelet distribution width were influencing factors in the occurrence of ISH in males (P<0.05) ; age, BMI, total cholesterol, triacylglycerol, HDL-C, LDL-C, and platelet distribution width were influencing factors in the occurrence of IDH in males (P<0.05) . Moreover, BMI, uric acid, total cholesterol, triacylglycerol, HDL-C, LDL-C, platelet distribution width, and fasting blood glucose were identified as influencing factors in the occurrence of SDH in males (P<0.05) . BMI, total cholesterol, triacylglycerol, and platelet distribution width were influencing factors in the occurrence of ISH females (P<0.05) . BMI, triacylglycerol, HDL-C, and platelet distribution width were influencing factors in the occurrence of IDH in women (P<0.05) . BMI, total cholesterol, HDL-C, LDL-C, and platelet distribution width were influencing factors for the occurrence of SDH in women (P<0.05) . The sex-stratified analysis showed that, after adjusting for confounders such as age, BMI, creatinine, uric acid, total cholesterol, triacylglycerol, HDL-C, LDL-C, and fasting blood glucose, in males, the quartile 3 of platelet distribution width (>12.1-12.9 fL) was a risk factor for ISH (OR=8.893, 95%CI=2.731-28.955) , IDH (OR=5.265, 95%CI=1.758-15.768) , and SDH (OR=4.674, 95%CI=1.549-14.102) , while the quartile 4 of platelet distribution width (>12.9 fL) was a risk factor in the occurrence of SDH (OR=3.316, 95%CI=1.177-9.345) compared to quartile 1 of platelet distribution width (≤10.7 fL) ; in females, compared to quartile 1 of platelet distribution width (≤11.0 fL) , the quartile 3 of platelet distribution width (>12.4-13.2 fL) was a risk factor for ISH (OR=3.494, 95%CI=1.218-10.021) and SDH (OR=4.949, 95%CI=1.283-19.089) , quartile 4 of platelet distribution width (>13.2 fL) was a risk factor for ISH (OR=5.283, 95%CI=1.786-15.633) , IDH (OR=5.837, 95%CI=1.544-22.068) and SDH (OR=4.966, 95%CI=1.373-17.963) .

Conclusion

Among elderly males, platelet distribution width ≥12.1 fL is a risk factor for IDH and SDH. Among elderly women, platelet distribution width ≥12.4 fL is a risk factor for ISH and SDH, when platelet distribution width>13.2 fL, it is a risk factor for IDH.

Impact of Household Income Levels on Successful Aging of the Elderly

ZHANG Yafang, WEN Xuan, YANG Zhongting, DU Xingmei, DENG Chunyan, YE Qingyun, DENG Rui, HUANG Yuan

2024, 27(08):  930-935.  DOI: 10.12114/j.issn.1007-9572.2023.0430

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Background

Successful aging can help to alleviate the aging process, but may be affected by household income.

Objective

To explore the impact of household income on successful aging and provide fundamental data for improving health equity for the elderly in China.

Methods

Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used to select participants aged 60 and above. The older adults were categorized into the high-income (≤33.33%) , middle-income (33.34%-66.66%) , and low-income (≥66.67%) groups based on the annual household income levels within each province. Successful aging was measured based on the Rowe and Kahn models and the multivariate Logistic regression was conducted to identify the effects of different levels of household income on successful aging.

Results

A total of 7 741 subjects were finally included with 2 192 (28.32%) , 2 680 (34.62%) and 2 869 (37.06%) in the low-income group, middle-income group and high-income group, respectively. The proportion of successful aging was 15.55% (1 204/7 741) among Chinese older adults in 2018, with 21.02% (603/2 869) for high-income group, 13.62% (365/2 680) for middle-income group, and 10.77% (236/2 192) for low-income group (P<0.05) . Older adults in the low-income group performed worse than those in the middle-income and high-income groups in daily function loss, cognitive function, no depression, and active social participation (P<0.05) . However, there was no statistically significant difference in the prevalence of major chronic diseases among the three groups (P>0.05) . The results of multivariate Logistic regression analysis showed that after controlling for demographic characteristics (age, gender, ethnicity, education level, and region of residence) , the proportion of successful aging in the middle-income and high-income groups was 1.226 times (OR=1.226, 95%CI=1.028-1.463) and 1.721 times (OR=1.721, 95%CI=1.450-2.044) as high as those in the low-income group; after controlling for health status and behavioral factors (night sleep duration, accidental falls, hospitalization in the past year, hearing, and masticatory function) , the proportion of successful aging in the high-income group was 1.559 times higher than that in the low-income group (OR=1.559, 95%CI=1.300-1.882) ; after controlling for home living environment (bathing facilities, home hygiene) , the proportion of successful aging in the high-income group was 1.461 times higher than that in the low-income group (OR=1.461, 95%CI=1.207-1.770) (P<0.05) .

Conclusion

The proportion of successful aging in China is low, and the level of household income is an independent influencing factor for successful aging. Focus on the improvement of physical and mental health and function, increasing the social participation of older adults might be important measures to promote the construction of Healthy China and active responding to population aging.

Relationship between the Temperature-humidity Index of Twenty-four Solar Terms and Depression

ZHANG Wenjing, GE Xufeng, OU Xiwen, CAI Yuyang, YANG Ling, LIU Fang

2024, 27(08):  936-941.  DOI: 10.12114/j.issn.1007-9572.2023.0098

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Background

The number of depression patients has exceeded 300 million worldwide, and its high disability rate has attracted global attention. However, the relationship between temperature-humidity index (Humidex) and depression remains to be explored.

Objective

To explore the relationship between Humidex of the twenty-four solar terms and depression.

Methods

Outpatient data of depression patients (n=18 289) admitted to the Psychology Department, Mental Health Center of Jiading District from 2016-10-08 to 2019-10-07 were collected, including gender, age, time of treatment, number of outpatient visits and specialist visits. The data of daily mean temperature, relative humidity, rainfall, air pressure and mean wind speed in Jiading District from 2016-10-08 to 2019-10-07 published by Shanghai Meteorological Bureau were collected to calculate Humidex. The included patients were divided into the groups of ≤18 years (n=157) , 19-44 years (n=3 099) , 45-59 years (n=4 848) , 60-74 years (n=6 270) and≥75 years (n=3 915) according to different ages. The relationship between Humidex of twenty-four solar terms and depression was estimated by using the combination of nonhomogeneous Poisson distribution and distributed-lag nonlinear model. Correlation between Humidex and meteorological variables was calculated using Pearson correlation analysis. Relative risk rates (RR) of Humidex and depression were calculated of twenty-four solar terms using median Humidex as control.

Results

A total of 18 289 patients with depression were included from 2016-10-08 to 2019-10-07, including 6 900 males and 11 389 females. The Lesser Cold solar term corresponded to the lowest average Humidex and highest number of depression patients, the Great Heat solar term corresponded corresponded to the highest average Humidex and lowest number of depression patients from 2016-10-08 to 2017-10-07. The Great Cold solar term corresponded to the lowest average Humidex and highest number of depression patients, the Great Heat solar term corresponded to the highest average Humidex and lowest number of depression patients from 2017-10-08 to 2018-10-07. The Great Cold solar term corresponded to the lowest average Humidex and highest number of depression patients, the Great Heat corresponded to the highest average Humidex and lowest number of depression patients from 2018-10-08 to 2019-10-07. Humidex in 24 solar terms showed a nonlinear relationship with the overall population risk of depression. The top two solar terms corresponding to Humidex of depression risk distribution for total population, male, female, ≤18 years, 19-44 years, 45-59 years, 60-74 years, and ≥75 years were the Great Cold and Beginning of Spring solar terms, Great Heat solar term corresponded to the lowest depression risk distribution. The maximum lag effect was observed on the 10th day of the Great Cold and Beginning of Spring solar terms (RR=1.020, 95%CI=1.001-1.040) , and the lag effect was observed on the 8th day of Great Heat solar term and lasted to the 9th day. The lag effect was observed on the 7th day after the Great Cold and Beginning of Spring and the maximum lag effect was observed on the 9th day (RR=1.054, 95%CI=1.007-1.104) , which lasted until the 11th day in the 60-74 years group. The lag effect was observed on the 1st day and 8th day after the Great Heat, and lasted to the 2nd day and 10th day, respectively, with the maximum lag effect on the 10th day (RR=0.952, 95%CI=0.911-0.994) in male depression patients. The lag effect was observed on the 8th day after the Great Heat solar term and lasted to the 9th day in the 60-74 years group.

Conclusion

Humidex in the Great Cold and Beginning of Spring solar terms are risk factors for depression. Clinically, accurate diagnosis and treatment should be provided for different depression patients according to Humidex in different solar terms, and individualized intervention programs should be formulated.

Prognosis and Influencing Factors of Patients with Malignant Melanoma

WU Shuqin, WANG Yuanhan, ZHENG Kaiyuan, HAN Hongjuan, KANG Jinxiu, YU Hongmei

2024, 27(08):  942-947.  DOI: 10.12114/j.issn.1007-9572.2023.0307

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Background

Malignant melanoma (MM) is caused by the malignant transformation of epidermal melanocytes with extremely high malignant degree, and its prevention and treatment is a key issue in the field of dermatology.

Objective

To investigate the prognosis of patients with MM, and influencing factors of the prognosis of patients with MM.

Methods

A total of 205 patients with malignant melanoma from the First Affiliated Hospital of Shanxi Medical University from January 2006 to December 2021 were selected as the subjects. The clinical data were obtained by collecting information from electronic medical records of patients, the overall survival (OS) was confirmed by telephone follow-up, and the last follow-up visit until 2022-12-31. The survival curve was plotted by the Kaplan-Meier method, and Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox proportional hazard regression model was used to analyze the influencing factors of survival outcome in MM patients.

Results

The 1-year overall survival, 3-year overall survival, and 5-year overall survival rates of MM patients were 94.6% (194/205) , 81.9% (168/205) and 72.6% (149/205) , respectively, the mean OS was 71.77 months and the median OS was 66.83 months. The results of survival curve analysis showed statistically significant differences when comparing the OS of MM patients with different genders, ages, tumor thicknesses, tumor ulcers, lymph node metastases, and neutrophil-to-lymphocyte ratios (NLR) (P<0.05) . Multivariate Cox regression analysis showed that male (HR=1.644, 95%CI=1.148-2.498) , tumor thickness >1.94 mm (HR=2.466, 95%CI=1.419-4.284) , tumor ulcer (HR=1.821, 95%CI=1.225-2.708) , lymph node metastasis (HR=1.999, 95%CI=1.305-2.892) , and NLR≥3 (HR=1.873, 95%CI=1.108-3.166) were the influencing factors of survival outcome in MM patients (P<0.05) .

Conclusion

Male, tumor thickness >1.94 mm, tumor ulcer, lymph node metastasis and NLR≥3 are poor prognostic factors for MM patients. Medical workers can focus on MM patients with the above poor prognostic factors and enhance care to improve their survival rate, thus better guiding the clinic treatment.

Risk Factors of Prone Position Ventilation-related Facial Pressure Injuries and the Selection of Best Modeling Method

YUAN Yuan, ZHANG Yarong, LI Zhengang, ZHANG Li

2024, 27(08):  948-954.  DOI: 10.12114/j.issn.1007-9572.2023.0278

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Background

Facial pressure injury is a common complication in patients with prone position ventilation. Local exposure of the trauma can increase the risk of systemic infection, and affect the therapeutic effect of prone position ventilation, and even cause permanent functional damage to local tissues. Exploring the risk factors and constructing a prediction model are of great clinical significance for the prevention of prone position ventilation related facial pressure injuries.

Objective

To investigate the risk factors for prone position ventilation-related facial pressure injuries and its optimal modeling methods.

Methods

A total of 159 patients who were admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Xinjiang Medical University from June 2020 to March 2023 and received prone position ventilation were selected and divided into the pressure injury group (n=22) and non-pressure injury group (n=137) according to whether facial pressure injuries occurred or not. General information, disease diagnosis, therapeutic measures, and laboratory test results were collected. Stepwise Logistic regression, multivariate Logistic regression, and Lasso-Logistic regression were used to screen risk factors for facial pressure injuries and develop predictive models, respectively. The area under receiver operating characteristic curve (AUC) was plotted to evaluate the model discrimination. The Akaike Information Criterion (AIC) , Bayesian Information Criterion (BIC) , and calibration curve were applied to evaluate the calibration of the model. Decision curves were applied to evaluate the clinical application value of the models. The optimal modeling method was selected by comparing the predictive efficacy and clinical application differences of the three logistic regression models.

Results

The results of stepwise Logistic regression model showed that the influencing factors of facial pressure injuries were age (OR=39.041) , diabetes mellitus (OR=7.256) , and duration of a single-prone ventilation session (OR=6.705) . The results of the multivariate Logistic regression model showed that the factors influencing facial pressure injuries were age (OR=26.882) , diabetes mellitus (OR=1.770) , length of stay in the ICU (OR=2.610) , and duration of a single-prone ventilation session (OR=5.340) . The results of Lasso-Logistic regression showed that the factors influencing facial pressure injuries were age (OR=38.256) , diabetes mellitus (OR=1.094) , duration of single prone ventilation (OR=5.738) , and RASS score (OR=1.179) . The AUC, sensitivity and specificity of the Lasso-Logistic regression model for predicting prone position ventilation-related facial pressure injuries were 0.855, 0.959 and 0.750, respectively, which were better than those of the stepwise and multivariate Logistic regression models. The AIC and BIC were 44.634 and 55.745, respectively, which were lower than the stepwise and multivariate Logistic regression models. The calibration curves showed that the Lasso-Logistic regression model predicted probabilities fitted the actual probabilities best. The decision curve showed that the Lasso-Logistic regression model obtained clinical benefits corresponding to risk thresholds of 0.01 to 0.98, which was better than the stepwise and multivariate Logistic regression models.

Conclusion

Age, diabetes mellitus, length of a single prone ventilation session, and Richmond Agitation Sedation Score are risk factors for ventilation-related facial pressure injuries. The Lasso-Logistic regression model has better predictive efficacy and clinical application value than stepwise and multivariate Logistic regression models, making it the best modeling method.

Research on the Relationship between Well-being and Personality Traits in the Elderly Based on Canonical Correlation Analysis

ZHOU Yujie, LIU Huanting, WAN Chonghua, GAN Qihui, XIAO Junhui, LIU Yuxi

2024, 27(08):  955-960.  DOI: 10.12114/j.issn.1007-9572.2023.0221

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Background

With the population ages, the mental health of the elderly has become a hot topic of concern for the whole society. Previous studies have shown that mental health problems in the elderly are closely related to well-being, while personality traits have a greater impact on subjective well-being. However, the internal relationship between the two in the elderly population is still unclear.

Objective

To explore the relationship between subjective well-being and personality traits of the elderly.

Methods

From July to August 2022, 511 elderly people in Lincun, Tangxia Town, Dongguan City, Guangdong Province were selected as the subjects by using cluster sampling method, conduct a site survey by using the questionnaire survey. The subjective well-being and personality traits of the elderly were evaluated by the Memorial University of Newfoundland Scale of Happiness (MUNSH) and the China Big Five Personality Scale (CBF-PI-15) respectively. Pearson correlation analysis was used to analyze the correlation between subjective well-being and personality traits of the elderly, canonical correlation analysis was used to construct a standardized canonical correlation model, canonical structure analysis, and canonical redundancy analysis.

Results

The total score of MUNSH in the elderly was (39.72±7.74) , and the scores of MUNSH in each dimension were positive experience (9.48±3.24) , positive emotion (8.61±2.24) , negative experience (1.44±2.31) , and negative emotion (0.93±1.80) from high to low. The scores of CBF-PI-15 in each dimension of the elderly were agreeableness (14.04±2.60) , extroversion (11.77±4.05) , conscientiousness (10.75±3.57) , openness (7.20±3.90) and neuroticism (6.34±3.22) . Pearson correlation analysis showed that subjective well-being was positively correlated with conscientiousness (r=0.334) and openness (r=0.219) (P<0.05) and negatively correlated with neuroticism (r=-0.223, P<0.05) . Canonical correlation analysis showed that the correlation coefficients of the first and second pairs of canonical correlation variables were 0.476 and 0.331 (P<0.001) . The results of the standardized canonical correlation model construction showed that the correlation between the first canonical correlation coefficient of subjective well-being (U₁) of the elderly and the first canonical correlation coefficient of personality traits (V₁) mainly manifested negative correlation between positive experience and neuroticism, and positive correlation between positive experience and conscientiousness. The correlation between the standardized canonical correlation coefficient of the second canonical variable of subjective well-being (U₂) and the standardized canonical correlation coefficient of the second canonical variable of personality traits (V₂) of the elderly mainly manifested positive correlation of positive emotion and negative emotion with neuroticism. The results of canonical structure analysis showed that U₁ was strongly correlated with positive emotion, negative emotion, positive experience, and negative experience, while U₂ was strongly correlated with negative emotion and negative experience. V₁ was strongly correlated with positive experience, conscientiousness, and openness. V₂ was strongly correlated with neuroticism and openness. Canonical redundancy analysis showed that U₁ explained 5.4% variation in personality traits and V₁ explained 12.2% variation in subjective well-being, indicating that personality traits had a greater influence on subjective well-being than subjective well-being.

Conclusion

On the whole, the elderly from Lincun Tangxia Town, Dongguan City, Guangdong Province hold a positive and optimistic attitude, with a high level of subjective well-being, which is closely related to neuroticism and conscientious personality. In the future, corresponding intervention strategies should be adopted according to different personality characteristics to improve subjective well-being, maintain the mental health of the elderly.

Prediction of Type 2 Diabetic Nephropathy Based on BP Neural Network Optimized by Sparrow Search Algorithm

ZOU Qiong, WU Xi, ZHANG Yang, WAN Yi, CHEN Changsheng

2024, 27(08):  961-970.  DOI: 10.12114/j.issn.1007-9572.2023.0360

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Background

Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes, which is highly prevalent and harmful. Early detection of DN is an important task in preventing related diseases. Currently, most of the researches are based on traditional statistical prediction methods, and data need to meet the prerequisites it requires. It is necessary to try to apply new methods such as machine learning in the area of DN prediction for its failing to meet the needs in the field of DN prediction in recent years.

Objective

To construct DN prediction model using the LASSO regression and BP neural network optimized by sparrow search algorithm (SSA-BP) .

Methods

This study was conducted from April 2023 to August 2023, and the data was obtained from publicly available data on complications of 133 patients with diabetes mellitus in Iran. Univariate analysis was conducted using SPSS 26.0 software, and variables were screened using LASSO regression. Using the presence of DN as the dependent variable, the training and testing sets were divided into 8∶2 and 7∶3 ratios, respectively. The SSA-BP neural network was used for modeling and analysis, and the prediction performance was compared with classical machine learning models to analyze the better DN model. Model evaluation was performed based on accuracy, precision, sensitivity, specificity, F1-score and AUC indicators.

Results

Excluding 9 patients with type 1 diabetes, the effective sample size included in this study was 124 patients with type 2 diabetes mellitus (T2DM) , of which 73 (58.9%) were diagnosed with DN. Univariate analysis of risk factors for type 2 DN showed statistically significant for age, BMI, duration of diabetes, fasting blood glucose (FBG) , glycosylated hemoglobin (HbA_1c) , low-density lipoprotein (LDL) , high-density lipoprotein (HDL) , triacylglycerol (TG) , systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05) . When the ratio of the training set to the test set was 8∶2, there were 59 DN patients in the training set (n=100) and 14 DN patients in the test set (n=24) . Five influencing factors of age, diabetes duration, HbA_1c, LDL, and SBP were obtained by LASSO regression screening. The accuracy rates of Logistic regression (LR) , K-nearest neighbor (KNN) , support vector machine (SVM) and SSA-BP models in the test set were 83.33%, 79.17%, 79.17%, 87.50%, and 95.83%, with F1-score as 0.846 2, 0.800 0, 0.800 0, 0.888 9, and 0.960 0, respectively. When the ratio of the training set to the test set was 7∶3, there were 52 DN patients in the training set (n=88) and 21 DN patients in the test set (n=36) . Seven influencing factors obtained by LASSO regression screening included age, BMI, diabetes duration, LDL, HDL, SBP, and DBP. The accuracy rates of LR, KNN, SVM, BP, and SSA-BP models in the test set were 86.11%, 86.11%, 86.11%, 72.22%, and 91.67%, with F1-score as 0.871 8, 0.871 8, 0.864 9, 0.705 9, and 0.909 1, respectively.

Conclusion

LR, KNN, and SVM perform better when the training set to the test set is 7∶3, while BP and SSA-BP perform better when the training set to the test set is 8∶2. Compared with the BP neural network and traditional machine learning models, SSA-BP model has the best prediction performance and can timely and accurately identify type 2 DN patients, realize early detection and treatment of DN, thus preventing and mitigating the harm to their bodies.

Survival and Prognosis Analysis of Bortezomib Based Regimen in Newly Diagnosed Super-aged Multiple Myeloma Patients

ZHAO Fengyi, LI Xin, ZHAN Xiaokai, ZHANG Jiajia, SHEN Man, TANG Ran, FAN Sibin, HUANG Zhongxia

2024, 27(08):  971-977.  DOI: 10.12114/j.issn.1007-9572.2023.0313

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Background

Multiple myeloma is a highly heterogeneous disease. Super-aged patients with multiple myeloma are a special group. There is a lack of evidence-based medical basis in the treatment decision and general evaluation of them, and there is also some controversy in the assessment of frailty.

Objective

To explore the clinical features and the influencing factors of survival and prognosis in newly diagnosed super-aged multiple myeloma (MM) patients with the bortezomib based regimen and to evaluate the best assessment model for the general status of patients with MM.

Methods

The clinical data of newly diagnosed super-aged patients with MM in Beijing Chao-yang Hospital, Capital Medical University from November 2013 to January 2023 were retrospectively analyzed. Survival follow-up was conducted through the medical record system of Beijing Chao-Yang Hospital, Capital Medical University until April 1, 2023, with the end points of this study of overall survival (OS) and progression-free survival (PFS) . The patients were divided into the two-drug treatment group (n=18) and three-drug treatment group (n=11) , and the clinical and genetic characteristics of the two groups were compared. The Geriatric Assessment System (GA) score, UK Myeloma Research Alliance Risk Profie (MRP) score, and Mayo score were used to evaluate the frailty status and treatment efficacy. Survival curves of OS and PFS in MM patients were plotted using the Kaplan-Meier method. Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox hazard risk regression analysis was used to explore the influencing factors of OS and PFS in MM patients.

Results

The median PFS was 8.70 (1.90-43.87) months and the median OS was 17.23 (2.00-72.83) months. A total of 21 (72.41%) patients experienced disease progression (PD) or relapse, and 12 (41.38%) patients died by the final follow-up. The objective remission rate (ORR) for first-line treatment was 82.76% (24/29) , the partial remission (PR) rate was 51.72% (15/29) , the very good partial remission (VGPR) rate was 24.14% (7/29) , and the complete remission (CR) rate was 6.90% (2/29) . There was no significant difference in CR rate, VGPR rate, PR rate and ORR between the two groups of newly diagnosed super-aged MM patients (P>0.05) . Multivariate Cox hazard risk regression analysis showed that MRP debilitation (HR=0.213, 95%CI=0.049-0.924, P=0.039) , elevated serum corrected calcium (HR=0.153, 95%CI=0.041-0.570, P=0.005) and maintenance therapy (HR=4.301, 95%CI=1.219-15.169, P=0.023) were independent influencing factors of PFS in newly diagnosed super-aged MM patients, while maintenance treatment (HR=4.372, 95%CI=1.049-18.221, P=0.043) was an independent influencing factor for OS in newly diagnosed super-aged MM patients.

Conclusion

There is no significant difference in the efficacy and prognostic impact of two-drug or three-drug Bortezomib based treatment. Serum corrected calcium elevation and maintenance therapy are independent prognostic factors for survival. MRP score can be used to assess the prognosis of newly diagnosed super-aged MM patients.

Study on the Mechanisms of Multiple Myeloma Cells Promoting M2 Macrophage Polarization through PI3K/AKT Signaling Pathway

PENG Yilun, LI Yang, WANG Xiaotao

2024, 27(08):  978-984.  DOI: 10.12114/j.issn.1007-9572.2023.0322

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Background

The incidence of multiple myeloma has long been high, however, there are fewer studies on phosphatidylinositol 3-kinase (PI3K) /serine-threonine kinase (AKT) signaling pathway and M2 macrophage polarization promoting the progression of multiple myeloma.

Objective

To investigate the expression of M2 macrophages in patients with multiple myeloma and the mechanism of PI3K/AKT signaling pathway promoting M2 macrophage polarization.

Methods

Forty-eight multiple myeloma patients diagnosed in the Department of Hematology of the Affiliated Hospital of Guilin Medical University from October 2021 to April 2022 were selected as the test group, and thirty healthy volunteers (healthy donors of blood marrow transplantation) in the same period were selected as the control group. Peripheral blood was taken from the 2 group and mononuclear cells were isolated, the proportion of M2 macrophages was determined by flow cytometry. RPMI8226 cells were subcultured by cell passage, and mononuclear macrophages THP-1 cells were cultured as macrophages by phorbol ester differentiation. According to the experimental requirements, tumor cells were cultured and transfected with siRNA to silence phosphatase and tensin homolog (PTEN) and divided into three groups, including blank group, siRNA-PTEN experimental group, and siRNA control group; the supernatants of the above three groups were collected and added to the macrophage co-culture system and then divided into four groups including M0 macrophage group, tumor cell supernatant group, siRNA-PTEN supernatant group, and siRNA supernatant group. The protein expression levels of AKT, p-AKT, PI3K-p85, and p-PI3K-p85 in the blank group, siRNA-PTEN experimental group, and siRNA control group of multiple myeloma cell culture were determined by Western blot assay. The mRNA expression levels of MMP2 and MMP9 in the blank group, siRNA-PTEN experimental group and siRNA control group were determined by fluorescence quantitative polymerase chain reaction (PCR) . The expression levels of specific antibodies CD163, CD206, and F4/80 in M2 macrophages in M0 macrophage group, tumor cell supernatant group, siRNA-PTEN supernatant group, and siRNA supernatant group were determined by flow cytometry. The mRNA expression levels of arginase 1 (ARG-1) and interleukin 10 (IL-10) in M0 macrophage group, tumor cell supernatant group, siRNA-PTEN supernatant group, and siRNA supernatant group were determined by fluorescence quantitative PCR.

Results

The expression level of M2 macrophages was higher in the test group than that in the control group (t=0.855, P<0.001) . The protein expression levels of p-AKT/AKT and p-PI3K-p85/PI3K-p85 in the siRNA-PTEN experimental group were higher than the blank group and siRNA control group (P<0.05) . The mRNA expression levels of MMP2 and MMP9 in the siRNA-PTEN experimental group were higher than the blank group and siRNA control group (P<0.05) . M2 macrophage specific antibody CD163+F4/80 and CD206+F4/80 in the siRNA-PTEN supernatant group were higher than the tumor cell supernatant and siRNA-PTEN supernatant group (P<0.05) . The mRNA expression levels of ARG-1 and IL-10 in the siRNA-PTEN supernatant group were higher than the tumor cell supernatant group and siRNA supernatant group (P<0.05) .

Conclusion

M2 macrophages are upregulated in multiple myeloma patients, and multiple myeloma cells can promote M2 macrophage polarization through activation of the PI3K/AKT signaling pathway, thereby regulating the myeloma cell microenvironment.

Efficacy and Safety of Dual-targeted Chimeric Antigen Receptor-T Cell Therapy in Patients with Refractory-relapsed Multiple Myeloma: a Meta-analysis

YU Haibo, ZHANG Tianyu, LI Xin, ZHANG Jiajia, SHEN Man, ZHAN Xiaokai, TANG Ran, FAN Sibin, ZHAO Fengyi, HUANG Zhongxia

2024, 27(08):  985-994.  DOI: 10.12114/j.issn.1007-9572.2023.0454

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Background

Chimeric antigen receptor (CAR) -T cell immunotherapy has achieved good therapeutic effect in multiple myeloma (MM) , and the most common target is B cell maturation antigen (BCMA) . The disadvantage of single target CAR-T cell immunotherapy is that it can lead to disease resistance and recurrence, which may be related to antigen escape. Therefore, the dual-targeted CAR-T cell therapy for refractory-relapsed multiple myeloma (RRMM) has been improved and developed, but there is still a lack of systematic clinical analysis in this field.

Objective

A meta-analysis was conducted on the efficacy and safety of dual-targeted CAR-T cell therapy for RRMM patients.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, and VIP were searched for single-group rate studies on dual-targeted CAR-T cell therapy in patients with RRMM from inception to 2023-02-06. The data were extracted for collection by 2 investigators using a self-designed form and the quality of literature was evaluated using the methodological index for non-randomized studies (MINORS) . The data analysis was conducted using RStudio software.

Results

A total of 9 clinical studies, involving 200 RRMM patients who had previously received multi-line therapy were included in the study. Dual-targeted CAR-T cell therapy can be mainly divided into four categories based on different targets of BCMA/CD₁₉, BCMA/CD₃₈, BCMA/TACI, and BCMA/CS1, of which the BCMA+CD₁₉ target is more studied. Dual-targeted CAR-T cell therapy also can be divided into four categories of bispecific categories, combined/sequential infusion of two different CAR-T cells, bicistronic or cotransduction according to the different forms of infusion. Meta-analysis showed that the overall response rate (ORR) of dual-targeted CAR-T cells for RRMM was 90.0% (95%CI=0.849-0.943) , and the complete response rate (CRR) was 54.6% (95%CI=0.416-0.673) , the negative rate of minimal residual disease (MRD) was 75.6% (95%CI=0.489-0.952) , the ORR of extramedullary diseases (EMD) was 55.1% (95%CI=0.234-0.851) , the recurrence rate at the last follow-up was 29.7% (95%CI=0.141-0.454) , and the survival rate was 75.6% (95%CI=0.554-0.915) . The incidence of grade 3 to 4 cytokine release syndrome (CRS) was 16.4% (95%CI=0.094-0.245) , and the incidence of immune effector cell-associated neurotoxicity syndrome (ICANS) was 4.0% (95%CI=0-0.120) . Sensitivity analysis suggested stable results. The results of Egger's test indicated a potential bias risk for ORR (P=0.03) and overall response rate of EMD (P=0.02) . Meanwhile, no publication bias was suggested for CRR (P=0.53) , MRD negative rate (P=0.79) , recurrence rate at the last follow-up (P=0.71) , survival rate (P=0.98) , incidence of grade 3-4 CRS (P=0.90) , and incidence of ICANS (P=0.30) .

Conclusion

Dual-targeted CAR-T cell therapy for RRMM has shown favorable efficacy and safety, and multicenter, large-sample, and longer follow-up studies are needed to further evaluate its efficacy and safety.

Analysis of Randomized Controlled Trials Outcome Indicators of Acupuncture for Knee Osteoarthritis

QIN Yuan, XIAO Lingyong, YANG Huan, ZHANG Xinyu, LIU Yi, DAI Xiaoyu

2024, 27(08):  995-1000.  DOI: 10.12114/j.issn.1007-9572.2023.0329

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Background

Traditional Chinese acupuncture has been widely applied for the treatment of knee osteoarthritis (KOA) with outstanding efficacy. However, recognized and unified outcome indicators remain to be absent, which impedes the translation of research into high-quality clinical evidence. Therefore, the establishment of core outcome indicators for acupuncture in KOA is conducive to enhance the scientific rigor, rationality, and feasibility of clinical research programs in traditional Chinese medicine (TCM) , provide higher quality evidence-based basis for clinical research.

Objective

To analyze the current status of the application of outcome indicators in randomized controlled trials (RCTs) of acupuncture for KOA, so as to provide a basis for the assessment method of clinical efficacy.

Methods

PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP and SinoMed were searched for clinical RCTs of acupuncture in the treatment of KOA from 2003 to 2022. Two researchers screened and extracted the characteristics of literature. The indicator domain, measurement tools and the time point of measurement of RCTs of acupuncture for KOA were analyzed.

Results

A total of 131 papers were included, with a sample size of 22 726 cases and 89 outcome indicators, which were classified into 40 (44.9%) items for symptoms and signs, 22 (24.7%) items for physical and chemical examinations, 5 (5.6%) items for quality of life, 5 (5.6%) items for psychological state, 3 (3.4%) items for satisfaction evaluation, 2 (2.2%) items for safety indicators, and 12 (13.5%) items for other indicators. Among the 131 articles, 23 measurement time points were included in the 131 articles, ranging from 1 hour to 3 years after treatment, 106 (80.9%) articles used "clinical efficacy" as the outcome indicator, 23 (17.6%) articles used safety evaluation and adverse event reports.

Conclusion

There are some problems in the use of outcome indicators in the RCTs of acupuncture for KOA, such as large variation in the use of outcome indicators, confounding of primary and secondary indicators, abuse of index combination, irregular use of composite indexes, inadequate safety evaluation, irregular measurement time points, insufficient evaluation of long-term prognosis, and failing to reflect the characteristics of TCM intervention of acupuncture. Future research should combine treatment based on syndrome differentiation characteristics of TCM, to evaluate the efficacy of acupuncture in the treatment of KOA by using scientific and reasonable outcome indicators. It is urgent to establish the core indicators set of TCM in the treatment of KOA, and to construct a standardized and recognized COS-TCM.

Evaluation Study of Traditional Chinese Medicine Syndrome Differentiation Therapy on the Quality of Life and Efficacy Satisfaction in Elderly Community-acquired Pneumonia Patients after Discharge

WANG Minghang, HAN Weihong, BI Lichan, YANG Jiang, LI Jiansheng

2024, 27(08):  1001-1007.  DOI: 10.12114/j.issn.1007-9572.2023.0446

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Background

Community-acquired pneumonia (CAP) is one of the common infectious diseases, especially in elderly patients, with atypical clinical symptoms, which is susceptibility to serious complications, lacks effective treatment measures, and often has a poor prognosis.

Objective

To investigate the effect of traditional Chinese medicine (TCM) syndrome differentiation therapy on the quality of life and efficacy satisfaction of elderly patients with CAP discharged from hospital (within 1 week) .

Methods

This study was designed as a multicentre, randomized double-blind placebo clinical study. Elderly CAP post-discharge patients admitted to the respiratory departments of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Chest Hospital, Henan People's Hospital, Zhengzhou Hospital of Traditional Chinese Medicine and Zhengzhou People's Hospital from April 2018 to January 2020 were selected as the study subjects and divided into the experimental group and control group by using a central randomized group enrolment model. The patients in the experimental group were treated with corresponding TCM granules based on syndrome differentiation, and the lung-tonifying spleen-invigorating phlegm-reducing formula was given for syndrome of phlegm-dampness due to qi deficiency, and the qi-supplementing yin-nourishing lung-clearing formula was given for qi and yin deficiency and phlegm-heat syndrome. The control group was given a placebo with the same appearance, weight, color, and smell as the Chinese medicine granules. The treatment course was 2 months, and the follow-up was up to 6 months. The quality of life evaluated by the Chinese version of the Quality of Life Rating Scale (SF-36) and efficacy satisfaction evaluated by the Efficacy Satisfaction Questionnaire for CAP (ESQ-CAP) were compared between the two groups before the treatment, 1 month after the treatment, 2 months after the treatment, 3 months after the follow-up, and 6 months after the follow-up.

Results

Among the 120 subjects included, 8 were dislodged and 112 were finally included that met the protocol set, including 54 cases in the experimental group and 58 cases in the control group. There was no significant difference in gender, age, time after discharge, TCM syndrome differentiation, CUBR-65 score, and underlying diseases between the two groups before treatment (P>0.05) . The main effects of the group were significant on SF-36 physiological function domain score (F_group=5.057, P_group=0.027) , general health domain score (F_group=7.286, P_group=0.008) , and role limitations due to emotional problems domain score (F_group=6.858, P_group=0.010) . Comparison between the two groups showed that SF-36 physical function domain score of the experimental group was higher than that of the control group at 2 months of treatment, 3 months of follow-up, and 6 months of follow-up (P<0.05) ; SF-36 general health status domain and role limitations due to emotional problems domain scores of the experimental group were higher than those of the control group at 1 and 2 months of treatment, 3 and 6 months of follow-up (P<0.05) ; the SF-36 domain score for role limitations due to mental health was higher than that of the control group (P<0.05) at 3 and 6 months of follow-up. The main effect of group on ESQ-CAP daily living and ability domain score (F_group=16.218, P_group<0.001) , convenience domain score (F_group=25.013, P_group<0.001) , and ESQ-CAP total score (F_group=13.843, P_group<0.001) was significant. The ESQ-CAP daily living and ability domain scores were higher in the experimental group than the control group at 2 months of treatment, 3 and 6 months of follow-up (P<0.05) . At 1 and 2 months of treatment and 3 and 6 months of follow-up, ESQ-CAP convenience domain score and ESQ-CAP total score were higher in the experimental group than in the control group (P<0.05) . At 3 months of follow-up, the ESQ-CAP overall efficacy domain score was higher in the experimental group than the control group (P<0.05) .

Conclusion

The TCM syndrome differentiation therapy scheme can improve the quality of life and efficacy satisfaction of elderly patients with CAP after discharge.

Analysis of Hotspots and Frontiers of Allostatic Load Research: a Visualization Analysis Based on CiteSpace

DING Lixue, LI Yuhong, ZHANG Yudong

2024, 27(08):  1008-1014.  DOI: 10.12114/j.issn.1007-9572.2023.0341

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Background

Allostatic load (AL) is a multi-systematic physiological indicator to measure chronic stress in the body, reflecting the cumulative physiological burden of chronic stress exposure on the body, which is of great significance for prevention and treatment of chronic diseases. In recent years, studies related to AL are gradually increasing, however, the development of domestic AL related studies is slow. Reviewing the literature related to AL and comprehensively understanding the development trends and hotspots in this field will be beneficial to prompt domestic innovative development of AL research in China.

Objective

To understand the research hotspots and frontiers in the field of AL and provide reference for future research by analyzing the relevant literature on AL published in recent years.

Methods

Science Citation Index Expanded of Web of Science Core Collection database was searched for literature on the topic of AL from inception to 2022-12-01. Microsoft Excel 2019 and CiteSpace software were applied to perform a visualization analysis of collected articles regarding the publication volume, countries, authors, institutions and keywords.

Results

A total of 509 articles were included, with a slowly increasing trend in annual publication volume. The United States ranked first in annual publication volume (315 articles) and betweenness centrality (0.65) . The top three authors in terms of publication volume were JUSTER of Canada (23 articles) , SEEMAN of the United States (16 articles) and KARLAMANGLA of the United States (12 articles) . The top three institutions in terms of publication volume were the University of California, Los Angeles (39 articles) , the University of Montreal in Canada (21 articles) and the University of Michigan in the United States (20 articles) , respectively. High-frequency keywords included AL, stress, health, socio-economic status, cumulative biological risk. Blood pressure was the keyword with the strongest citation bursts, the strength was 5.8.

Conclusion

The research on AL is gradually becoming a new academic hotspot, which mainly focuses on the influencing factors of AL and its relationship with health outcomes, with rare intervention studies. The domestic development in this field still needs to be further explored. Expanding the scope of research participants, formulating AL measurement methods for different populations and forming norms, as well as performing relevant intervention research should be considered in future studies to promote human health.

Medical Safety

Legal Issues and Countermeasures of Transcranial Magnetic Stimulation for Mental Disorders from the Perspective of Brain Science

REN Jing, LI Xiaoyong, LIANG Hengyu, ZHAO Yifan, WU Jiaoyue

2024, 27(08):  1015-1020.  DOI: 10.12114/j.issn.1007-9572.2023.0473

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In the context of brain science research strategy in China, transcranial magnetic stimulation, as an input brain-computer interface technology, is able to improve the pathology of patients with mental disorders in a noninvasive way. However, new risks arising from the new technology have been ignored by the legislation, and there is a risk of privacy leaks of the neurological data presented by the patient's brain. The legal issues of physicians neglecting to inform patients of the risks of personality changes and the off-lable use of transcranial magnetic stimulation devices need to be explored. The legal issues of physicians neglecting to inform patients of the risks of personality changes and off-label use of transcranial magnetic stimulator devices need to be urgently explored. Multidisciplinary literature in the fields of trade-off between the right to health and privacy protection, principle of informed consent, data and application of off-label use for devices was searched and analyzed by using literature review and case analysis methods, to summarize the key points of the adjudication documents on off-label use for transcranial magnetic stimulation devices. It was found that the legal interpretations and value balances between the right to health and protection of privacy, physician's right of diagnosis and treatment and patient's right of informed consent, as well as the accessibility and safety of the devices, should be clarified and the adequate notification of new risks in the application of new technologies should be improved; it should be clarified that physicians and medical institutions should respect the privacy of the patients and the obligation to protect the security of neurological data, expand the scope of risk notification, clarify the risks of personality, prohibit the off-label use of the devices and establish a mechanism for risk analysis and dynamic monitoring of adverse reactions.