Table of Content

20 March 2024, Volume 27 Issue 09

Previous Issue    Next Issue

Editorial

Discussion on Palliative Care and End of Life Care

YANG Hui

2024, 27(09):  0-C2.  DOI: 10.12114/j.issn.1007-9572.2024.A0009

Asbtract ( )   HTML ( )   PDF (977KB) ( )  

Related Articles | Metrics

Frontiers of Medicine

Benefits of Community-based Treatment for Patients with Schizophrenia: Based on Long-acting Injectable Antipsychotic Agents

Schizophrenia Coordination Group, Chinese Society of Psychiatry, Chinese Society of General Practice, LI Qian, SI Tianmei

2024, 27(09):  1021-1027.  DOI: 10.12114/j.issn.1007-9572.2023.0525

Asbtract ( )   HTML ( )   PDF (1200KB) ( )  

References | Related Articles | Metrics

Schizophrenia could affect the social and occupational functions of patients in the long term. Community-based mental health services and management models promote mental health by improving accessibility, acceptability, affordability, practicality and scalability. In the community management model, long-acting injectable antipsychotic agents are one of the main strategies for the treatment of schizophrenia, but there is a lack of relevant evidence. This paper systematically and comprehensively discussed the benefits of long-acting injectable antipsychotic agents in patients with schizophrenia, including effectiveness and safety, compliance, attitude to use, social function recovery and community rehabilitation. The results of this study showed that long-acting injectable antipsychotic agents can exert superior efficacy than oral drugs in the community rehabilitation of schizophrenia patients under different community management modes, not only reflected in the disease recurrence rate and readmission rate, but also in the recovery of social functioning and the reduction of accident rate and other aspects of excellent performance. However, the overall prescription rate of long-acting injectable antipsychotic agents is still low in China. The main reasons include insufficient information sharing between medical institutions and communities in primary level, low community medical services and treatment rate, low follow-up rate of patients, and less community psychiatric rehabilitation. This study can provide some references for the community treatment of schizophrenia patients in China, explore more community treatment programs, and improve the treatment effect and quality of life of schizophrenia patients in China.

Assessment and Treatment of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents

WANG Qingyu, LIN Zheng, LEI Yang, SUN Caiyun, WANG Mi, GU Junyi, ZHU Zhanhui, TANG Lichen

2024, 27(09):  1028-1033.  DOI: 10.12114/j.issn.1007-9572.2023.0422

Asbtract ( )   HTML ( )   PDF (1254KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Food intake disorders are costly to treat, with an increasing prevalence over the years, and a higher risk of mortality compared to other psychiatric disorders. Avoidant/restrictive food intake disorder (ARFID) , as a relatively new type of food intake disorder, is more prevalent in children and adolescents than in other age groups, affecting their normal growth and development, as well as psychosocial functioning. Currently, there are more foreign studies, while domestic studies are still in the initial stage. Therefore, this paper reviews assessment tools, influencing factors and treatment approaches for ARFID in children and adolescents, with the aim of providing a reference for related research in China.

Effects of Pre-hospital Metformin Use on Clinical Outcomes in Patients with Diabetes and Sepsis

HE Yufu, TONG Wenying, WANG Fang, LI Lixia, HE Junbing, SHAO Yiming

2024, 27(09):  1034-1041.  DOI: 10.12114/j.issn.1007-9572.2023.0347

Asbtract ( )   HTML ( )   PDF (1635KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

There is growing evidence that pre-hospital use of metformin reduces mortality in patients with diabetes and sepsis; however, the effect of metformin on clinical outcomes in patients with diabetes and sepsis remains controversial. Therefore, there is a need for a systematic review and Meta-analysis of existing studies to further evaluate whether metformin can improve mortality and other clinical outcomes in patients with diabetes and sepsis.

Objective

To systematically evaluate the effects of pre-hospital metformin use on mortality, initial plasma lactate level and organ dysfunction in patients with diabetes and sepsis.

Methods

PubMed, Embase, Cochrane Library, Web of Science, Scopus, China Biomedical Literature Service System, Wanfang Data, CNKI and other databases were searched by computer for Chinese and English literature on the effects of pre-hospital metformin use on clinical outcomes in patients with sepsis and diabetes from inception to March 15, 2023. The test group (MET group) involved adult patients with diabetes and sepsis received pre-hospital metformin use, and the control group (NM group) involved adult patients with diabetes and sepsis who did not receive pre-hospital metformin use. After screening, data extraction and literature quality evaluation were conducted by two researchers, Meta-analysis was performed using RevMan 5.3 software.

Results

A total of 12 papers were included in this study, involving 12 320 patients with diabetes and sepsis, with Newcastle-Ottawa Scale (NOS) scores of 7-8. The results of Meta-analysis showed that the mortality rate (OR=0.61, 95%CI=0.46 to 0.80, P<0.001) and the use rate of vasopressors (OR=0.83, 95%CI=0.69 to 0.98, P=0.03) in MET group were lower than those in NM group; there was no significant difference in initial plasma lactate level (MD=0.31, 95%CI=-0.12 to 0.75, P=0.16) , serum creatinine level (MD=-0.81, 95%CI=-0.48 to 0.13, P=0.25) , initial blood glucose level (MD=32.94, 95%CI=-10.12 to 76.01, P=0.13) and mechanical ventilation (OR=0.90, 95%CI=0.77 to 1.06, P=0.23) between the MET group and NM group.

Conclusion

The pre-hospital use of metformin can reduce the mortality of patients with diabetes and sepsis, and reduce the use rate of vasoppressors in corresponding patients, providing updated evidence that metformin can reduce the mortality of patients with diabetes and sepsis. However, whether it can reduce the sepsis severity score and reduce the maximum dose of norepinephrine in patients with diabetes and sepsis remains to be further studied.

Original Research

Study on the Influencing Factors of Gastric Cancer Based on Opportunistic Screening of Upper Gastrointestinal Cancer in Coastal Area of Northern Jiangsu

WEN Jing, ZHANG Yue, LIANG Xuyang, LYU Shengxiang

2024, 27(09):  1042-1047.  DOI: 10.12114/j.issn.1007-9572.2023.0252

Asbtract ( )   HTML ( )   PDF (1417KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

In recent years, screening, early diagnosis and early treatment of upper gastrointestinal cancer have been successively carried out in various provinces and cities in China. At present, there are few studies on the screening results of upper gastrointestinal cancer and influencing factors of gastric cancer in coastal area of northern Jiangsu.

Objective

To analyze the influencing factors of gastric cancer based on the results of opportunistic screening for upper gastrointestinal cancer in rural population in coastal areas of northern Jiangsu, so as to provide a reference for the development of relevant prevention and control strategies.

Methods

A total of 8 564 rural subjects at high risk for upper gastrointestinal cancer admitted to the outpatient department of gastroenterology of the Affiliated Lianyungang Hospital of Xuzhou Medical University and received gastroscopy screening from January 2021 to December 2022 were selected, and divided into the gastric cancer group (n=183) and benign gastric disease group (n=366) after matching according to age (±2 years) and gender (1∶2) based on the screening results. The baseline data of the subjects were collected, the cancer detection rate and cancer early diagnosis rate were calculated. Multivariate Logistic regression analysis was used to explore the influencing factors of gastric cancer in rural population in coastal area of northern Jiangsu.

Results

A total of 521 patients with upper gastrointestinal neoplastic lesions were detected, including 183 patients with gastric (including cardia) cancer, with a detection rate of 2.14% (183/8 564) ; and 46 patients with early gastric (including cardia) cancer, with the early diagnosis rate of 25.14% (46/183) . There was no significant difference in the distribution of different categories of gastric neoplastic lesions in different genders and ages (P>0.05) . The detection rate of gastric (including cardia) neoplastic lesions in males (5.14%, 195/3 795) was higher than females (2.05%, 98/4 769) , and the difference was statistically significant (χ²=60.807, P<0.001) . There were significant differences in the detection rate of gastric (including cardia) neoplastic lesions among different age groups (χ²=163.216, P<0.001) and early diagnosis rate of gastric cancer among different age groups (χ²=69.349, P<0.001) , among which the early diagnosis rate was the highest in the group of 40-49 years (37.50%) and the lowest in the group over 80 years (10.53%) . Multivariate Logistic regression analysis showed that junior high school education or below (OR=4.001, 95%CI=2.029-7.890, P<0.001) , smoking (OR=3.710, 95%CI=2.127-6.470, P<0.001) , salty taste (OR=1.777, 95%CI=1.067-2.957, P=0.027) , frequent spicy diet (OR=2.147, 95%CI=1.297-3.556, P=0.003) , preference for red meat (OR=1.787, 95%CI=1.018-3.139, P=0.043) , frequent consumption of leftovers (OR=2.452, 95%CI=1.538-3.912, P<0.001) , irregular diet (OR=2.420, 95%CI=1.420-4.124, P=0.001) and helicobacter pylori (H. pylori) positive/previously positive (OR=3.785, 95%CI=2.394-5.984, P<0.001) were risk factors for gastric cancer in rural population, while regular physical exercise (OR=0.598, 95%CI=0.359-0.996, P=0.048) and frequent consumption of fresh fruits (OR=0.531, 95%CI=0.328-0.860, P=0.010) were protective factors for gastric cancer in rural population.

Conclusion

Opportunistic screening of upper gastrointestinal cancer is beneficial for the detection of upper gastrointestinal cancer in Coastal Area of Northern Jiangsu. Junior high school education and below, smoking, multiple unhealthy food habits and H. pylori positive/previously positive are risk factors for gastric cancer in rural population. Future efforts should focus on improving the awareness of gastric cancer prevention among rural males and elderly population in the region.

Investigation on the Incidence and Influencing Factors of Proteinuria and Renal Dysfunction in Community-dwelling Elderly Population

FAN Jing, WEI Shan, LI Liqiu, ZHENG Xiuli, LI Yan, NIU Jianying, WANG Ling, XU Chengyan

2024, 27(09):  1048-1053.  DOI: 10.12114/j.issn.1007-9572.2023.0330

Asbtract ( )   HTML ( )   PDF (1402KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The elderly tend to coexist with multiple chronic diseases (such as diabetes and hypertension) , while diabetes and hypertension can lead to chronic kidney damage, and fewer studies have been conducted on chronic kidney disease in older adults.

Objective

To investigate the proteinuria and renal dysfunction in the elderly population and provide guidance for the management of chronic kidney disease in the community-dwelling older adults by collecting the clinical data of physical examination of the elderly residents in community.

Methods

A total of 13 080 elderly residents who underwent physical examination in Zhuanqiao Community Health Service Center of Minhang District, Shanghai from 2020 to 2021 were included as the study objects. General information, physical examination results and laboratory examination data of study objects were collected. Subjects with estimated glomerular filtration rate (eGFR) <60 mL·min^-1· (1.73 m²) ^-1 were included in the abnormal renal function group (n=713) , and subjects with eGFR≥60 mL·min^-1· (1.73 m²) ^-1 were included in the normal renal function group (n=12 367) . The subjects with positive urine protein were included in the proteinuria group (n=1 690) , and the subjects with negative urine protein were included in the non-proteinuria group (n=11 390) . At the same time, the subjects were divided into 60 to 69 years old group (n=6 901) , 70 to 79 years old group (n=4 867) , 80 to 89 years old group (n=1 128) and ≥90 years old group (n=184) according to the age interval of 10 years. Multivariate Logistic regression analysis was used to explore the influencing factors of renal dysfunction and proteinuria in the study population.

Results

There were significant differences in the detection rates of urine protein positive and renal dysfunction in 60 to 69 years old, 70 to 79 years old, 80 to 89 years old and ≥90 years old groups (P<0.05) . The detection rate of urinary protein positive in males aged 60 to 69 years and 70 to 79 years was higher than that in females, the detection rate of renal dysfunction in males aged 60 to 69 years was higher than females, and the detection rate of renal dysfunction in males aged 80 to 89 years was lower than females, the difference was statistically significant (P<0.05) . Age, the proportion of diabetes and hypertension, blood urea nitrogen (BUN) , serum creatinine (Scr) and triglyceride (TG) in the abnormal renal function group were higher than those in the normal renal function group, while total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and hemoglobin (Hb) in the abnormal renal function group were lower than those in the normal renal function group. There was significant difference in urinary, albumin/creatinine ratio (ACR) between the two groups (P<0.05) . Multivariate Logistic regression analysis showed that age, hypertension, diabetes, proteinuria and anemia were the influencing factors of renal dysfunction (P<0.05) , while male, diabetes, obesity, hypertriglyceridemia, Scr and BNU were the influencing factors of proteinuria (P<0.05) .

Conclusion

The detection rates of proteinuria and renal dysfunction in the elderly aged 60 years and above are high, which increase with age. Age, hypertension, diabetes, anemia, hypertriglyceridemia and low HDL-C level are risk factors for renal dysfunction in community-dwelling elderly population (P<0.05) ; male, diabetes, obesity, hypertriglyceridemia, Scr and BUN are risk factors for proteinuria in community-dwelling elderly population.

A Nomogram Prediction Model and Validation Study on the Risk of Complicated Diabetic Nephropathy in Type 2 Diabetes Patients

HAN Junjie, WU Di, CHEN Zhisheng, XIAO Yang, SEN Gan

2024, 27(09):  1054-1061.  DOI: 10.12114/j.issn.1007-9572.2023.0571

Asbtract ( )   HTML ( )   PDF (1686KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Diabetes nephropathy (DN) is a common complication of diabetes patients. The prediction and validation of its risk will help identify high-risk patients in advance and take intervention measures to avoid or delay the progress of nephropathy.

Objective

To analyze the risk factors affecting the complication of DN in patients with type 2 diabetes mellitus (T2DM) , construct a risk prediction model for the risk of DN in T2DM patients and validate it.

Methods

A total of 5 810 patients with T2DM admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2021 were selected as the study subjects and divided into the DN group (n=481) and non-DN group (n=5 329) according to the complication of DN. A 1∶1 case-control matching was performed on 481 of these DN patients and non-DN patients by gender and age (±2 years) , and the matched 962 T2DM patients were randomly divided into the training group (n=641) and validation group (n=321) based on a 2∶1 ratio. Basic data of patients, such as clinical characteristics, laboratory test results and other related data, were collected. LASSO regression was applied to optimize the screening variables, and a nomogram prediction model was developed using multivariate Logistic regression analysis. The discriminability, calibration and clinical validity of the prediction model were evaluated by using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA) , respectively.

Results

There were significant differences in gender, age, BMI, course of diabetes, white blood cell count, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, serum creatinine, hypertension, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, apolipoprotein B, 24-hour urinary micro total protein, qualitative urinary protein between the DN and non-DN group (P<0.05) . Five predictor variables associated with the risk of DN in patients with T2DM were screened using LASSO regression analysis, and the results combined with multivariate Logistic regression analysis showed that duration of diabetes, total cholesterol, serum creatinine, hypertension, and qualitative urinary protein were risk factors for the complication of DN in T2DM patients (P<0.05) . The area under the ROC curve (AUC) for the risk of DN in the training group of the model was 0.866 (95%CI=0.839-0.894) , and the AUC for predicting the risk of DN in the validation group was 0.849 (95%CI=0.804-0.889) based on the predictor variables. The Hosmer-Lemeshow calibration curve fit was good (P=0.748 for the training group; P=0.986 for the validation group) . DCA showed that the use of nomogram prediction model was more beneficial in predicting DN when the threshold probability of patients was 0.15 to 0.95.

Conclusion

The nomogram prediction model containing five predictor variables (diabetes duration, total cholesterol, serum creatinine, hypertension, qualitative urinary protein) developed in this study can be used to predict the risk of DN in patients with T2DM.

Analysis of the Predictive Value of 4-level Clinical Pretest Probability Score in Elderly Patients with Acute Pulmonary Embolism

ZENG Lingcong, ZHANG Longju, ZHOU Ling, ZHANG Wei, DAI Meng, HUANG Yin, HUANG Yi

2024, 27(09):  1062-1067.  DOI: 10.12114/j.issn.1007-9572.2023.0511

Asbtract ( )   HTML ( )   PDF (1528KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The elderly are at high risk for acute pulmonary embolism (APE) , and the difficulty of early identification and diagnosis of APE in the elderly has made the active search for an optimal prediction method for elderly patients with suspected APE a medical problem that must be faced.

Objective

To investigate the predictive value of the 4-level Clinical Pretest Probability Score (4PEPS) for pulmonary embolism (PE) in elderly patients with suspected APE.

Methods

Basic information and related clinical data were collected from elderly (age≥60 years) hospitalized patients who completed spiral CT pulmonary arteriography (CTPA) examinations in the Third Affiliated Hospital of Zunyi Medical University from 2017 to 2021. The study subjects were divided into the APE group and non-APE group according to the CTPA criteria for the diagnosis of PE in 2018 Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism. The 4PEPS, Standard algorithm, age-adjusted D-dimer (AADD) algorithm, YEARS algorithm and pulmonary embolism graduated D-dimer (PEGeD) algorithm were used to predict the APE of the study subjects, respectively, who were divided into the positive and negative groups, and the number of true positives, true negatives, false positives and false negatives of each prediction method was counted. The efficacy evaluation indexes of the five prediction method were calculated and their prediction values were compared.

Results

Among 1 193 elderly hospitalized patients who completed CTPA examination, 608 (50.96%) were male and 585 (49.04%) were female, with a median age of 74 (68, 81) years; 323 (27.07%) were APE patients and 870 (72.93%) were non-APE patients; there was no statistically significant difference between elderly APE patients and elderly non-APE patients in terms of gender and age (P>0.05) . 4PEPS, AADD algorithm, Standard algorithm, YEARS algorithm and PEGeD algorithm for elderly patients with suspected APE had a sensitivity of 95.05%, 97.83%, 98.76%, 97.21%, 97.83%, the specificity of 31.84%, 18.16%, 12.87%, 22.41%, 22.41%, the correctness of 48.95%, 39.73%, 36.13%, 42.67%, 42.83%, Youden index of 0.27, 0.16, 0.12, 0.20, 0.20. The net reclassification improvement (NRI) of 4PEPS, Standard algorithm, YEARS algorithm and PEGeD algorithm compared to AADD algorithm were 0.218, -0.087, 0.073, and 0.085, the difference of the NRI of 4PEPS compared to AADD algorithm was statistically significant (P<0.05) .

Conclusion

4PEPS predicts elderly patients with suspected APE with high specificity, correctness, and Youden index, and the overall predictive value is significantly better than the remaining four methods, which may be the optimal prediction method for elderly patients with APE.

Prediction of Severity and Length of Hospital Stay in Patients with Group 2 Pulmonary Hypertension Based on Serum Potassium Level

GUO Yunting, HOU Xiaomin, BAI Jianying, CHANG Mingyang, ZHAO Xu, SUN Lin, ZHENG Zhifa, SHI Yiwei, QIN Xiaojiang

2024, 27(09):  1068-1073.  DOI: 10.12114/j.issn.1007-9572.2023.0036

Asbtract ( )   HTML ( )   PDF (1519KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Pulmonary hypertension (PH) is often caused by left heart disease (group 2 PH) , which is difficult to diagnose early and with a high mortality rate. Potassium channel dysfunction is a marker of PH, however, the epidemiological data of the disease and the effect of potassium ions on PH still remain unclear.

Objective

To investigate the correlation of serum potassium level with myocardial markers, echocardiographic indicators and length of hospital stay in patients with group 2 PH, and evaluate the predictive value of serum potassium levels for the severity of group 2 PH, so as to provide the oretical basis for clinical diagnosis and treatment.

Methods

The clinical data of 400 adult inpatients diagnosed with group 2 PH in the First Hospital of Shanxi Medical University from January 2020 to December 2021 were retrospectively collected as follows: (1) general data: gender, age, BMI, length of hospital stay, smoking status, smoking index (SI) and drinking history; (2) underlying diseases (diabetes mellitus, hypertension) ; (3) laboratory data: serum potassium level, myocardial markers[procalcitonin, N-terminal pro-brain natriuretic peptide (NT-proBNP) , cardiac troponin I, cardiac troponin T, creatine kinase-MB], echocardiographic indicators (left atrial diameter, right ventricular diameter, right atrial area, left ventricular ejection fraction, shortening fraction, peak tricuspid regurgitation velocity, pulmonary artery systolic pressure) . The patients were divided into <3.5 mmol/L group (n=57) , 3.5-5.5 mmol/L group (n=340) and >5.5 mmol/L group (n=3) according to the serum potassium level. Spearman correlation analysis was used to explore the correlation of serum potassium level with myocardial markers and echocardiographic indicators. Log-rank (Mantel-Cox) test was used to compare the discharge rate of patients with different serum potassium levels. Receiver operating characteristic curve (ROC curve) was plotted to evaluate the predictive value of serum potassium level for the severity of group 2 PH.

Results

Procalcitonin and NT-proBNP levels of patients in the >5.5 mmol/L group were significantly higher than the <3.5 mmol/L group (P<0.05) . Correlation analysis showed that serum potassium level was positively correlated with NT-proBNP (r_s=0.133) , peak tricuspid regurgitation velocity (r_s=0.017) and pulmonary artery systolic pressure (PASP) (r_s=0.126) (P<0.05) . Serum potassium level was further classified as <3.5 mmol/L, 3.5-3.9 mmol/L, 4.0-4.9 mmol/L, 5.0-5.5 mmol/L, and >5.5 mmol/L to investigate its relationship with length of hospital stay in depth. Log-rank (Mantel-Cox) testresults showed that for group 2 PH patients greater than average hospitalization levels, there was a significant difference in cumulative hospitalization rates among patients with different serum potassium levels (<3.5 mmol/L, 3.5-3.9 mmol/L, 4.0-4.9 mmol/L, 5.0-5.5 mmol/L, >5.5 mmol/L) (P=0.022) . ROC analysis showed that the diagnostic value of serum potassium level for non-mild PH (AUC=0.577, cut-off value=3.91 mmol/L, sensitivity=64.7%, specificity=52.5%) was similar to that of NT-proBNP (AUC=0.585, cut-off value=1 070.69 pg/mL, sensitivity=78.1%, specificity=39.6%) , which can effectively predict the severity of group 2 PH.

Conclusion

Serum potassium level can predict the severity of group 2 PH and the length of hospital stay. Intervention of serum potassium levels may be one of the new approach to prevent and treat PH.

Correlation of Serum Uric Acid and Serum Uric Acid/Creatinine Ratio Levels with Adverse Pregnancy Outcomes in Late Pregnancy

ZHAO Ru, HAN Chen, HUANG Zeyu, WANG Qian, HU Jun, GE Zhijuan, BI Yan, SHEN Shanmei

2024, 27(09):  1074-1081.  DOI: 10.12114/j.issn.1007-9572.2023.0435

Asbtract ( )   HTML ( )   PDF (1602KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The disorder of serum uric acid metabolism during pregnancy is associated with adverse pregnancy outcomes, while few studies have analyzed and compared the correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes.

Objective

To explore the correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes in late pregnancy.

Methods

A total of 743 pregnant women with singleton live births who were routinely examined and delivered at Nanjing Drum Tower Hospital from 2015 to 2022 were selected . Based on the occurrence of adverse pregnancy outcomes, pregnant women were divided into normal group (344 cases) and adverse outcome group (399 cases) . Serum uric acid and serum uric acid/creatinine ratio were divided into three levels by quartiles, respectively, including Q1 (serum uric acid<257 μmol/L) , Q2 (serum uric acid 257-359 μmol/L) , Q3 (serum uric acid>359 μmol/L) and q1 (serum uric acid/creatinine ratio<5.88) , q2 (serum uric acid/creatinine ratio 5.88-7.94) , q3 (serum uric acid/creatinine ratio>7.94) . According to the median age of pregnant women, they were divided into the age subgroup<30 years old (341 cases) and age subgroup≥ 30 years old (402 cases) . Based on previous pregnancies and deliveries, they were divided into the primiparous subgroup (539 cases) and multiparous subgroup (194 cases) . The correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes was analyzed by using multivariate Logistic regression.

Results

Pregnant women in adverse outcomes group were older with higher levels of BMI, serum uric acid, serum uric acid/creatinine ratio and triglycerides than those in the normal group (P<0.05) . After adjustment for confounders, the multivariate Logistic regression results of the effect of serum uric acid and serum uric acid/creatinine ratio on adverse pregnancy outcomes showed that, compared to Q1 serum uric acid level, the risk of preeclampsia (AOR=4.41, 95%CI=2.16-8.99) and intrauterine growth restriction (AOR=3.59, 95%CI=1.08-11.96) increased at Q3 serum uric acid level (P<0.05) ; compared to q1 serum uric acid/creatinine ratio level, the risk of preeclampsia (AOR=2.33, 95%CI=1.13-4.79; AOR=3.56, 95%CI=1.68-7.56) increased at q2 and q3 serum uric acid/creatinine ratio levels. Compared to q1 serum uric acid/creatinine ratio level, the risk of preterm labor (AOR=2.76, 95%CI=1.33-5.71) and intrauterine growth restriction (AOR=5.15, 95%CI=1.39-19.14) increased, while the risk of macrosomia (AOR=0.43, 95%CI=0.19-0.98) and large for gestational age (AOR=0.38, 95%CI=0.15-0.96) decreased (P<0.05) . The results of the effect of serum uric acid and serum uric acid/creatinine ratio on preeclampsia and preterm labor in different age subgroups showed that, compared to Q1 serum uric acid level, the risk of preeclampsia increased in both age subgroups at Q3 serum uric acid level (P<0.05) ; compared to q1 serum uric acid/creatinine ratio level, the risk of preeclampsia increased among women aged≥30 years at q2 and q3 serum uric acid/creatinine ratio level (P<0.05) . The results of the effect of serum uric acid and serum uric acid/creatinine ratio on preeclampsia and preterm labor in different pregnancies and deliveries subgroups showed that compared to Q1 serum uric acid level, the risk of preeclampsia increased at Q3 serum uric acid level among primiparous women (P<0.05) ; compared to q1 serum uric acid/creatinine ratio level, the risk of preeclampsia increased at q2 and q3 serum uric acid/creatinine ratio level among primiparous women, as well as the risk of preterm birth at q3 serum uric acid/creatinine ratio level among primiparous women (P<0.05) .

Conclusion

Elevated levels of serum uric acid and serum uric acid/creatinine ratio were associated with the risk of preeclampsia and intrauterine growth restriction, in which preeclampsia mainly occurred in pregnant women aged≥30 years or primiparous women. The risk of preterm labor was increased at high levels of serum uric acid/creatinine ratio, primarily in primiparous women. Serum uric acid/creatinine ratio predicted more adverse pregnancy outcomes than serum uric acid.

Application Value of Optical Coherence Tomography to Detect Neuronal Damage in Hypertensive Retinopathy

ZHAO Runze, SUN Xiaojia, Hernandez MELBA Marquez, DOU Guorui

2024, 27(09):  1082-1087.  DOI: 10.12114/j.issn.1007-9572.2023.0351

Asbtract ( )   HTML ( )   PDF (1543KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The current prevalence of hypertension is increasing year by year, and its ocular complication, hypertensive retinopathy, is also receiving increasing attention. However, little attention has been paid to neuronal damage in hypertensive retinopathy.

Objective

To investigate the application and value of optical coherence tomography as a screening tool in the evaluation of neuronal damage in hypertensive retinopathy.

Methods

A total of 102 patients with hypertension who were admitted to Hospital Clínico Quirúrgico "Hermanos Ameijeiras" (HHA Hospital) from March 2019 to July 2020 were included as study subjects, as well as 45 healthy subjects as the control group to monitor 24-h ambulatory blood pressure. The average arterial blood pressure of 24-h diastolic and systolic blood pressure were taken, intraocular pressure (IOP) was measured and ocular perfusion pressure was calculated. The thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GCC) in macular region were measured. The patients were divided into the control group (n=51) and uncontrolled group (n=51) according to their blood pressure control, with 45 healthy subjects as the control group. Pearson correlation analysis or Spearman rank correlation analysis were used to explore the correlation of blood pressure, ocular perfusion pressure, retinopathy and GCC thickness with blood pressure, as well as ocular perfusion pressure with retinopathy, and mediation analysis was performed using R 3.5.3 software.

Results

There were significant differences in race, systolic blood pressure, diastolic blood pressure, average arterial pressure, IOP, ocular perfusion pressure and retinopathy among the three groups (P<0.05) . The average RNFL thickness in the uncontrolled blood pressure group was lower than that in the control group (P<0.05) , the average GCC thickness in the control group and uncontrolled blood pressure group was lower than that in the control group, and the minimum GCC thickness in the uncontrolled blood pressure group was lower than that in the control group (P<0.05) . Correlation analysis results showed that average GCC thickness, superior temporal GCC thickness and inferior temporal CCG thickness were negatively correlated with systolic blood pressure, diastolic blood pressure, ocular perfusion pressure and retinopathy (P<0.05) , while superior temporal GCC thickness was negatively correlated with systolic blood pressure, diastolic blood pressure and ocular perfusion pressure (P<0.05) ; inferior temporal CCG thickness was negatively correlated with diastolic blood pressure (P<0.05) , retinopathy was positively correlated with systolic blood pressure, diastolic blood pressure and ocular perfusion pressure (P<0.05) . The mediating effect showed a significant effect of "systolic blood pressure→average GCC thickness→hypertensive retinopathy" , with systolic blood pressure positively correlated with average GCC thickness, average GCC thickness positively correlated with hypertensive retinopathy (P<0.05) . Systolic blood pressure had a direct effect on the risk of hypertensive retinopathy (β=0.013, 95%CI=0.007-0.020, P<0.001) , and the average GCC thickness partially mediated the effect of systolic blood pressure on the risk of hypertensive retinopathy (β=0.117, 95%CI=0.014-0.360, P=0.04) , the mediating effect accounted for 11.7% of the total effect.

Conclusion

Optical coherence tomography is a non-invasive ophthalmological test that can detect hypertensive retinal neuronal damage superior to normal fundus examination, provide early prevention and warning of irreversible blindness and hypertensive target organ damage in hypertension-induced optic neuronal damage.

A Qualitative Study on the Social Isolation Experience of Young and Middle-aged Patients with Schizophrenia in Remission

XU Yanan, LI Wenjuan, ZHAO Shuqin, TANG Yuji, YUAN Fuqiang, ZHAO Kunpeng

2024, 27(09):  1088-1094.  DOI: 10.12114/j.issn.1007-9572.2023.0416

Asbtract ( )   HTML ( )   PDF (1583KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Schizophrenia often experience severe social discrimination throughout their entire survival period, resulting in self isolation or social isolation. Limited studies have been conducted on social isolation in young and middle-aged patients with schizophrenia in remission.

Objective

To describe the social isolation experience of young and middle-aged patients with schizophrenia in remission, aiming to provide reference for developing supportive intervention plans to alleviate the social isolation experience of this population.

Methods

A purposive sampling method was used to select young and middle-aged schizophrenia patients aged 18-59 who had been hospitalized at the Second Affiliated Hospital of Xinxiang Medical University and were willing to continue follow-up after discharge as the research subjects. From May to December 2022, a semi-structured in-depth interview was conducted face-to-face with the respondents, and the themes were summarized and extracted using content analysis method.

Results

A total of 18 young and middle-aged patients with schizophrenia in remission were included. By analyzing the interview data, a total of 3 themes and 8 sub themes were extracted, including the performance of social isolation in young and middle-aged patients with schizophrenia in remission (containing 2 subthemes of negative emotional experience and withdrawal between expectation and behavior) ; subjective reasons for social isolation in young and middle-aged patients with schizophrenia in remission (containing 2 subthemes of self isolation and self discrimination) , and the objective reasons for social isolation in young and middle-aged patients with schizophrenia in remission (containing 4 subthemes of social discrimination and passive containing, effects of adverse drug reactions, increased burden of living and care caused by mental illness, and the lack of social support) .

Conclusion

Young and middle-aged patients with schizophrenia in remission may experience social isolation due to impaired physical health, poor psychological status, and insufficient social support. Healthcare professionals should strengthen symptom management and psychological counseling for this population. The government and all sectors of society should actively guide positive perception of mental illness and provide certain social support; family support should be strengthened to help young and middle-aged patients with schizophrenia in remission reintegrate and adapt to society.

Prevalence of Hyperuricemia and Its Correlation with Cardiometabolic Index in Xinjiang Region

LI Xing, YANG Yining

2024, 27(09):  1095-1101.  DOI: 10.12114/j.issn.1007-9572.2023.0586

Asbtract ( )   HTML ( )   PDF (1691KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The prevalence of hyperuricemia (HUA) is increasing year by year, and fewer studies have been conducted for the Xinjiang region. Because the population in Xinjiang has special regional and dietary characteristics, regional studies are necessary.

Objective

To investigate the current status of HUA among people aged≥35 years in Xinjiang Uygur Autonomous Region, and explore the correlation of cardiometabolic index (CMI) with HUA among healthy population undergoing health examinations of different ethnicities and genders, so as to provide a reference basis for the development of personalized preventive measures for HUA patients in the region.

Methods

This was a cross-sectional study, and 9 429 medical examiners aged≥35 years who participated in health checkups at the First Affiliated Hospital of Xinjiang Medical University from October 2021 to October 2022 were selected as the study subjects and divided into the HUA group (n=527) and the non-HUA group (n=8 902) according to the combination of HUA; and the study subjects were stratified into Q1 (CMI≤0.34) , Q2 (0.34<CMI≤0.56) , Q3 (0.56<CMI≤0.99) and Q4 (CMI>0.99) according to the CMI. General demographic information (gender, age, ethnicity) , past medical history (coronary heart disease, hypertension, diabetes mellitus, stroke) , physical examination and laboratory test indices of the study subjects were collected and compared by reviewing the medical record system. A multivariate Logistic regression model was used to analyze the effect of CMI on the risk of HUA (model Ⅰ adjusted for age, gender, gender and BMI; model Ⅱ adjusted for age, gender, past history, urea nitrogen, etc.) , and the correlation between CMI and HUA was analyzed bystratification according to gender (male/female) and ethnicity (Han/Uyghur/Kazak) .

Results

There were 527 (5.58%) HUA patients among 9 429 medical examiners, with an average age of (54.3±12.9) years; 434 (82.4%) were male and 93 (17.6%) were female; 402 (76.3%) of them were Han nationality, 82 (15.5%) were Uyghurs, and 43 (8.2%) were Kazakhs. In the comparison between the HUA group and non-HUA group, there was no statistically significant difference in stroke history and HDL-C levels (P>0.05) ; the differences in gender, age, ethnicity, history of coronary heart disease, hypertension and diabetes, diastolic blood pressure (DBP) , systolic blood pressure (SBP) , urea nitrogen (UN) , blood uric acid (SUA) , creatinine, fasting plasma glucose (FPG) , triacylglycerol (TG) , total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , BMI, waist-to-height ratio (WHtR) , and CMI were statistically significant (P<0.05) . Multivariate Logistic regression analysis showed that after adjusting for relevant confounders, the risk of HUA was increased when CMI was Q2, Q3, and Q4 compared to Q1 (OR=1.874, 4.201, 6.053; P<0.05) , and CMI was positively associated with the risk of HUA (P_trend<0.001) . Stratified by gender after adjusting for relevant confounders, the results showed that compared with Q1, a CMI of Q3, Q4 increased the risk of HUA in men (OR=3.168, 4.273; P<0.05) , and a CMI of Q2, Q3, and Q4 increased the risk of HUA in women (OR=3.144, 8.805, 10.938; P<0.05) , and CMI was positively associated with the risk of HUA (P_trend<0.001) . The results after adjusting for relevant confounders stratified by different ethnic groups showed that compared with Q1, the risk of HUA was increased at CMIs of Q2, Q3, and Q4 in Han nationality (OR=1.924, 4.522, 6.681; P<0.05) , and at CMIs of Q2, Q3, and Q4 in Kazakhs (OR=4.004, 9.461, 14.291; P<0.05) , and CMI was positively associated with the risk of HUA development in all cases (P_trend<0.001) .

Conclusion

The prevalence of HUA among medical examiners aged≥35 years in Xinjiang Uygur Autonomous Region was 5.58%, and HUA patients were predominantly male and Han nationality. Elevated CMI increases the risk of HUA, which is more pronounced in Han and Kazakh populations.

Predictive Value of Machine Learning Based on Retinal Structural Changes for Early Parkinson's Disease Diagnosis

LIANG Keke, GUO Qingge, LI Xiaohuan, MA Jianjun, YANG Hongqi, SHI Xiaoxue, FAN Yongyan, YANG Dawei, GUO Dashuai, DONG Linrui, GU Qi, LI Dongsheng

2024, 27(09):  1102-1108.  DOI: 10.12114/j.issn.1007-9572.2023.0450

Asbtract ( )   HTML ( )   PDF (1874KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The diagnosis of Parkinson disease (PD) is mainly based on clinical symptoms, and there is a lack of objective methods for correct diagnosis. At present, there have been studies on retinal structural changes as a biomark for early diagnosis of PD, but machine learning based on retinal structural changes for predicting early PD has not yet been studied.

Objective

To construct a machine learning model based on the characteristics of retinal structural changes, explore its value in early PD diagnosis, and the accuracy of different machine learning algorithms for early PD diagnosis.

Methods

From October 2021 to September 2022, 49 PD patients aged 40 to 70 years old (PD group) who attended outpatient clinics and were hospitalized in the department of neurology of Henan Provincial People's Hospital (PD group) and 39 healthy people with matching age and sex (healthy control group) who came to the hospital for physical examination were collected. All study subjects underwent swept-source optical coherence tomography and swept-source optical coherence tomography angiography, the thickness and vessel density of the macular retina were also quantitatively analyzed. The 88 subjects were randomly divided into the 62 training sets and 26 validation set according to the ratio of 7∶3. Variables with significant differences between the PD group and healthy control group were selected as the characteristic variables for inclusion in the machine learning model, and Logistic regression (LR) , K-nearest neighbor algorithm (KNN) , decision tree (DT) , random forest (RF) and extreme gradient boosting (XGboost) models were constructed in the training set. The area under the curve (AUC) , accuracy, sensitivity and specificity of the receiver operating characteristic (ROC) curve were used to evaluate the predictive value of the machine learning model based on retinal structural changes for early PD.

Results

Compared with the healthy control group, the density of the upper outer ring (A6) , the outer temporal outer ring (A7) , the lower outer ring (A8) and the outer nasal ring (A9) of the superficial capillaries in the PD group were reduced, the thickness of the upper inner ring (A2) , the inner temporal inner ring (A3) , the inferior inner ring (A4) , the inner ring of the nasal side (A5) of the retinal layer, A6, A7, A8 and A9, the thickness of A6 of the ganglion cell complex layer, the thickness of A7 of the nerve fiber layer, A2 and A4, A5, A6, A7, A8, A9 became thinner (P<0.05) . The reductions in A2 thickness of the retinal layer (OR=0.781, 95%CI=0.659-0.926) , A3 thickness of the retinal layer (OR=1.190, 95%CI=1.019-1.390) , A2 thickness of the outer retina (OR=0.748, 95%CI=0.603-0.929) , A6 thickness of the outer retina (OR=2.264, 95%CI=1.469-3.490) , A8 thickness of the outer retina (OR=0.723, 95%CI=0.576-0.906) , and A7 thickness of the nerve fiber layer (OR=0.592, 95%CI=0.454-0.773) , and the decrease in A7 density of the superficial capillaries (OR=1.966, 95%CI=1.399-2.765) were independent risk factors for the occurrence of early PD (P<0.05) . The above variables were involved to construct the machine learning model, the results showed that among the five models constructed, the LR model had the highest overall performance, with an AUC of 0.841, while the DT model has the highest accuracy at 0.846.

Conclusion

Machine learning model based on retinal features can accurately predict early PD, among which the DT model has high accuracy for early PD diagnosis.

Effects of Combined Motion Intervention on Body Composition, Cardiovascular Risk Factors and Cardiopulmonary Fitness of Obese Female Adolescents

WANG Kai, XU Baichao, WANG Zhaoxin, SU Jianjiao

2024, 27(09):  1109-1117.  DOI: 10.12114/j.issn.1007-9572.2023.0483

Asbtract ( )   HTML ( )   PDF (2004KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

At present, there has been a dramatic increase in the number of obese children and adolescents globally, among which the prevalence of obesity in children aged 5 to 19 years has increased by about 8 times, and the prevalence of obesity in children aged 2 to 4 years has increased by about 1 times. Exercise intervention has an important effect on improving obesity and enhancing cardiorespiratory fitness. However, studies on the effects of combined motion intervention on obese female adolescents aged 14-16 years have not been addressed.

Objective

To investigate the effects of 12-week combined motion intervention on body composition, cardiovascular risk factors and cardiopulmonary fitness in obese female adolescents.

Methods

From May to July 2022, 48 obese female adolescents aged 14 to 16 years old in Qufu City, Shandong Province were selected as research objects, numbered and divided into the experimental group (n=24) and control group (n=24) using random numbers. The experimental group finally included 20 female adolescents based on the inclusion and exclusion criteria, and the whole intervention lasted for 12 weeks, including rope skipping intervention and taekwondo intervention; while the control group did not perform any exercise intervention and other dietary or pharmacological interventions throughout the 12 weeks. The indicators such as height, body mass, body fat rate (BFR) , waist circumference, BMI, blood pressure (BP) , fasting plasma glucose (FPG) , insulin, insulin resistance index (HOMA-IR) and maximal oxygen uptake (VO_2max) were detected before and after the 12-week combined motion intervention and compared between the two groups, as well as before and after the intervention. Pearson correlation analysis was used to explore the correlation of BFR and waist circumference with VO_2max in obese female adolescents.

Results

Before the intervention, there was no significant difference in age, height, body mass, BFR, waist circumference, BMI, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , pulse pressure difference, FPG, insulin, HOMA-IR, maximal number of completions (Laps) , maximal aerobic speed (MAS) , and VO_2max between the two groups (P>0.05) . After 12-week combined motion intervention, BFR, waist circumference, SBP, DBP, FPG, insulin and HOMA-IR in the experimental group were lower than the control group, while Laps, MAS, VO_2max was significantly higher than the control group (P<0.05) . Compared with pre-intervention, the BFR, waist circumference, SBP, DBP, FPG, insulin and HOMA-IR were decreased and Laps, MAS, VO_2max were increased after 12-week combined motion intervention (P<0.05) . The results of correlation analysis showed that body fat percentage and circumference were negatively correlated with VO_2max in obese female adolescents (r=-0.55, P<0.001; r=-0.41, P<0.001) .

Conclusion

The 12-week combined motion intervention can improve body composition and cardiovascular risk factors in obese female adolescents, and also enhance cardiopulmonary fitness by increasing VO_2max.

Disease Burden of Chronic Obstructive Pulmonary Disease in the BRICS Countries from 1990 to 2019

WANG Xueting, JIANG Yi

2024, 27(09):  1118-1125.  DOI: 10.12114/j.issn.1007-9572.2023.0564

Asbtract ( )   HTML ( )   PDF (2138KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

As emerging economies, the BRICS countries (Brazil, Russia, India, China and South Africa) face similar challenges of a significant increase in the burden of chronic obstructive pulmonary disease (COPD) .

Objective

To understand the current situation, past trends and attributable risk factors of the burden of disease caused by COPD in the BRICS countries, and provide a basis for evaluating and developing prevention and control strategies of COPD and strengthening health cooperation among the BRICS countries.

Methods

The trends in prevalence, mortality and disability life-adjusted year (DALY) rates of COPD in the BRICS countries from 1990 to 2019 was characterized by using the Global Burden of Disease 2019 Database (GBD 2019) . Annual percentage change (APC) and average annual percentage change (AAPC) were calculated using Joinpoint software, and population attributable fraction (PAF) was used to estimate the proportion of COPD disease burden attributable to different risk factors.

Results

The disease burden in the BRICS countries showed an increasing trend with age in 2019, and increased rapidly above 45 years of age with a certain gender difference. From 1990 to 2019, the prevalence of COPD was on the rise in all BRICS countries, while the mortality and DALY rates were on the decline in all BRICS countries except India. The standardized prevalence rate, standardized mortality rate and standardized DALY rate in the BRICS countries showed a decreasing trend, and the decrease was the largest in China, with the AAPC value of -1.14, -4.22 and -4.17, respectively (P<0.05) . Tobacco use was the top risk factor for COPD disease burden in Brazil, Russia, China and South Africa, with a PAF of more than 50%, while the top risk factor in India was air pollution.

Conclusion

The burden of COPD disease remains high in the BRICS countries, with differences within countries. Positive results have been achieved in the prevention and treatment of COPD in BRICS countries, but the overall improvement is less than that in the high-income countries in Asia-Pacific. The total burden of COPD in China has decreased significantly, but the prevention and control situation is still serious. The BRICS countries should pay more attention to the prevention and treatment of COPD in the middle-aged and elderly population, and continue to pay attention to the health effects caused by tobacco use and environmental pollution at the same time.

Analysis and Prediction of the Disease Burden of Type 2 Diabetes Attributable to High Body Mass Index in China from 1990 to 2019

LI Ziyue, FANG Jiawen, LIN Kaicheng

2024, 27(09):  1126-1133.  DOI: 10.12114/j.issn.1007-9572.2023.0504

Asbtract ( )   HTML ( )   PDF (2262KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

China ranks first in the world in terms of the number of diabetes patients. In recent years, the prevalence and mortality of diabetes have been rising, threatening people's health and placing a heavy burden on the people of China. As the prevalence of obesity continues to rise, the burden of diabetes is expected to continue to rise, and diabetes has become a public health problem that cannot be ignored in China.

Objective

To describe and analyze the disease burden of type 2 diabetes attributable to high BMI and its trend in China from 1990 to 2019, and predict the disease burden of type 2 diabetes attributable to high BMI in China from 2020 to 2024, so as to provide a basis for the scientific prevention and control of type 2 diabetes in China.

Methods

In May 2023, data on the burden of disease indicators of type 2 diabetes such as disability-adjusted life years (DALYs) , DALYs rate, standardized DALYs rate, death toll, mortality rate and standardized mortality rate of type 2 diabetes in China from 1990 to 2019 were extracted from the Global Burden of Disease 2019 (GBD 2019) , and the trend was analyzed by annual percentage change (APC) and average annual percentage change (AAPC) using the Joinpoint Regression Model. An autoregressive moving average (ARIMA) model of DALYs rate and mortality rate of type 2 diabetes attributable to high BMI was constructed based on the data from 1990 to 2016 (training set) , and evaluated using the data from 2017 to 2019 (test set) . The relative error between the predicted value and the actual value, the mean absolute error (MAE) , mean absolute percentage error (MAPE) , mean square error (MSE) and root mean square error (RMSE) of the model were used to determine the model prediction effect, and the optimal model was selected to predict the burden of type 2 diabetes attributable to high BMI in China from 2020 to 2024.

Results

From 1990 to 2019, the burden of disease showed an overall upward trend (AAPC of standardized DALYs rate=2.85%, AAPC of standardized mortality=2.32%, both P<0.05) , the standardized DALYs rate increased from 80.21/100 000 to 181.54/100 000, and the standardized mortality rate increased from 1.25/100 000 to 2.39/100 000. The standardized DALYs rate and standardized mortality rate of both men and women showed a rapid upward trend, with standardized DALYs rate increasing by 173% for males and 89% for females compared to 2019, as well as the standardized mortality rate increasing by 146% for males and 58% for females. The DALYs rate and mortality rate increased significantly with age, with DALYs rates increasing rapidly after age 30 years, with peaks basically maintained in the 65-69 (337.47/100 000 in 1990, 711.09/100 000 in 2019) and 70-74 age groups (323.64/100 000 in 1990, 730.47/100 000 in 2019) , and the population mortality rate increased rapidly after the age of 45 years and the peak was maintained above the age of 95 years (12.78/100 000 in 1990 and 33.29/100 000 in 2019) . The DALYs and mortality rates of type 2 diabetes attributable to high BMI in China was increasing at a higher rate compared to the world. There were four inflection points in 1990-2019, the standardized DALYs rate and standardized mortality rate increased the fastest in 2000-2004 and 1996-2004, respectively. The ARIMA model predicted that the standardized DALYs rate and standardized mortality rate of type 2 diabetes attributable to high BMI in China would continue to increase from 2020 to 2024, reaching 205.142/100 000 (95%CI=189.775/100 000-220.508/100 000) and 2.621/100 000 (95%CI=2.343/100 000-2.900/100 000) by 2024, respectively.

Conclusion

The disease burden of type 2 diabetes attributable to high BMI in China is generally on the rise, manifested by an increase in the disease burden and number of deaths attributable to DALYs, and the growth rate is higher than globally. The disease burden of type 2 diabetes attributable to high BMI in men was progressively higher than that in women. The DALYs rate and mortality rate of type 2 diabetes attributable to high BMI were trending towards younger age groups. The ARIMA model indicated that the disease burden of type 2 diabetes attributable to high BMI was expected to continue to rise. In order to reduce the disease burden of type 2 diabetes, health education should be strengthened for the key populations (male, middle-aged and elderly people) to improve the awareness of diabetes prevention and control, and weight management can be strengthened by promoting healthy diet and lifestyle habits.

Meta-integration of Qualitative Research on Fatigue Experience in Patients with Post-stroke Fatigue

WANG Xiaoxuan, ZHANG Zhenxiang, ZHAO Zhixin, JIANG Hu, WANG Jiajia, LIN Beilei, WANG Wenna, CHEN Suyan

2024, 27(09):  1134-1141.  DOI: 10.12114/j.issn.1007-9572.2023.0497

Asbtract ( )   HTML ( )   PDF (2021KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Previous studies have found that 25%-85% of stroke patients develop post-stroke fatigue (PSF) , and continuous feeling of fatigue seriously affects patients' daily life and rehabilitation process. Therefore, it is urgent to understand the psychological experience and needs of such patients. However, the results of previous single qualitative studies may not be representative.

Objective

To systematically review and integrate qualitative studies on the fatigue experience of patients with PSF, so as to provide a reference for the construction of management strategies for PSF patients.

Methods

PsycINFO, PubMed, Web of Science, CINAHL, Cochrane Library, Scopus, Joanna Briggs Institute (JBI) Evidence-Based Health Care database, CNKI, Wanfang Data, VIP, CBM were searched by computer to screen qualitative studies on fatigue experience of patients with PSF from inception to July 5, 2023. JBI Critical Appraisal Tool for qualitative studies in Australia was used to evaluate the quality of included literature, and Meta-synthesis was performed to integrate results.

Results

A total of 10 papers were included, and 22 primary outcomes were distilled, grouped into 8 categories, and synthesized into 4 integrated outcomes, including significant lack of cognition of PSF; intricate negative physical and psychological experience; different self-regulation of PSF and multiple needs for PSF rehabilitation.

Conclusion

PSF patients have insufficient cognition of fatigue with significant negative physical and psychological experience. Therefore, PSF patients should be identified and screened at an early stage with strengthened fatigue education and personalized fatigue management strategies. Emphasis should also be placed on the role of community and family in the management of fatigue, so that they can work together with healthcare professionals to provide a favorable rehabilitation environment for PSF patients.

Short-term Effects of Opportunistic Salpingectomy on Ovarian Reserve: a Meta-analysis of Randomized Controlled Trials Based on GRADE Evidence Grading System

ZHAO Li, YANG Chunyan, ZUO Manyun, YANG Hongmei

2024, 27(09):  1142-1148.  DOI: 10.12114/j.issn.1007-9572.2023.0165

Asbtract ( )   HTML ( )   PDF (2020KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Opportunistic salpingectomy (OS) can be used as a primary prevention of ovarian cancer (OC) , but OS may cause impairment of ovarian function due to the homologous blood supply system shared by ovaries and fallopian tubes, thereby increasing the risk of ovarian aging and early menopause.

Objective

To evaluate the short-term effects of OS on ovarian reserve based on GRADE evidence grading system.

Methods

In September 2022, CNKI, Wanfang, VIP, PubMed, Web of Science, and Scopus were searched for literature assessing the short-term effects of OS on ovarian reserve from inception to 10 September 2022. Two investigators independently screened the literature and extracted the data. The Jadad scale was used to evaluate the quality of literature, Stata 17.0 software was used for data processing and meta-analysis, and GRADEpro 3.2 software was used to assess the evidence quality for the results of meta-analysis.

Results

A total of 9 randomized controlled trials (RCT) were included, involving 482 patients, including 238 cases in the OS group and 244 in the non-OS group. The results of the Jadad risk assessment scale showed that the included RCTs were all of high quality literature. The results of meta-analysis showed that the differences in changes of anti-mullerian hormone (AMH) (WMD=-0.07, 95%CI=-0.28-0.13, P=0.13) , follicle-stimulating hormone (FSH) (WMD=-0.03, 95%CI=-1.65-1.59, P=0.24) , luteinizing hormone (LH) (WMD=-0.39, 95%CI=-1.62-0.83, P=0.08) and estradiol (E2) (WMD=3.08, 95%CI=-4.26-10.43, P=0.35) before and after surgery between the OS and non-OS groups were not significant (P>0.05) . The results of the meta-analysis by GRADEpro software showed high quality evidence for AMH, moderate quality evidence for FSH, and low quality evidence for E2 and LH.

Conclusion

There is no significant difference in ovarian reserve indicators between the non-menopausal women who receive OS for benign disease in the short term and those who did not receive OS. It is reasonable for premenopausal women who have completed childbearing to prevent OC by OS, but this conclusion remains to be validated by a longer follow-up and more rigorous RCTs with a larger sample size.