Table of Content

15 July 2024, Volume 27 Issue 20

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Guidelines·Consensus

Chinese Guideline for Lipid Management (Primary Care Version 2024)

Joint Committee on the Chinese Guidelines for Lipid Management

2024, 27(20):  2429-2436.  DOI: 10.12114/j.issn.1007-9572.2024.0005

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Low-density lipoprotein cholesterol (LDL-C) is a pathogenic risk factor for atherosclerotic cardiovascular disease (ASCVD). In recent decades, the prevalence of dyslipidemia in the Chinese population increases continuously, it is urgent to improve blood lipid management in China. It is particularly important to carry out standardized blood lipid management at primary healthcare institutions. The Chinese Guideline for Lipid Management (Primary Care Version 2024) concisely recommends that LDL-C should be the preferred intervention target in lipid management, and the target values of LDL-C should be determined based on ASCVD risk stratification. The present guideline recommends to use moderate-intensity statins at the beginning of treatment on the basis of lifestyle intervention. If the LDL-C target level can not be reached, other lipid-lowering drugs like cholesterol absorption inhibitors or (and) proprotein convertase subtilisin/kexin type 9 inhibitors should be jointly used for the purpose of reaching the target value. The present guideline also provides blood lipid management strategies for special populations. We aim to provide guidance for primary healthcare professionals to carry out blood lipid management, and comprehensively improve their ability on blood lipid management, and thereby improve the primary and secondary prevention of ASCVD in China.

Original Research

Sleep Quality and Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease and Their Influencing Factors: a Multicenter Cross-sectional Study

LI Xingyang, SUN Wanqi, YIN Mengjie, DOU Tingting, LYU Yili, XU Wei, ZHA Zhenqiu

2024, 27(20):  2437-2444.  DOI: 10.12114/j.issn.1007-9572.2023.0794

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Background

Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies.

Objective

To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors.

Methods

Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression.

Results

A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P<0.05). Acute exacerbations ≥2 times (OR=2.220, 95%CI=1.093-4.510) and malnutrition risk (OR=1.961, 95%CI=1.044-3.683) were risk factors for anxiety and depression symptoms in COPD patients (P<0.04). In COPD patients, PSQI score was positively correlated with HADS-A (r_s=0.413) and HADS-D score (r_s=0.430), and there was a positive correlation between HADS-A score and HADS-D score (r_s=0.719, P<0.05) .

Conclusion

The incidence of poor sleep quality, anxiety and depression symptoms was high in COPD patients, and age, malnutrition risk, regular physical activity and number of acute exacerbations in the past year are important influencing factors. Medical staff, family members and patients themselves should improve the awareness of sleep quality, anxiety and depression, and actively carry out screening and intervention work for key patients to improve the sleep quality and mental health of patients.

Efficacy and Preliminary Mechanism of Precise Exercise Prescriptions for Anxiety, Depression, and Cognitive Function in Patients with Stroke: a Randomized Controlled Trial

QIAN Zhen, LU Tongbo, HE Jun, ZHU Haiying, WANG Jin, GONG Zunke

2024, 27(20):  2445-2450.  DOI: 10.12114/j.issn.1007-9572.2023.0738

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Background

In the current rehabilitation environment, emotional issues and cognitive dysfunctions in stroke patients are often overshadowed by physical, speech, and swallowing difficulties, leading to their underestimation in clinical rehabilitation. This oversight can result in adverse outcomes, impacting the overall success of rehabilitation. Currently, clinical treatments primarily rely on pharmacotherapy to alleviate symptoms, which has limited effectiveness and can cause a range of adverse reactions.

Objective

To observe the efficacy of precision exercise prescriptions on anxiety, depression, and cognitive functions in stroke patients and to preliminarily analyze the underlying mechanisms of action.

Methods

A total of 84 stroke patients hospitalized in the Rehabilitation Department of Changzhou Dean Hospital from January 2022 to March 2023 were selected. They were randomly divided into a control group (42 patients) and an experimental group (42 patients). The control group received standard rehabilitation treatment, while the experimental group received precision exercise prescriptions based on cardiopulmonary exercise testing (CPET) results in addition to standard rehabilitation, over 12 weeks. The Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Mini-mental State Examination (MMSE) scores, and Homocysteine (Hcy) levels were compared before and after rehabilitation training in both groups. A Pearson correlation analysis was conducted between pre-rehabilitation Hcy levels and SAS, SDS, MMSE scores.

Results

All 42 patients in the experimental group completed the CPET and the 12-week precision exercise prescription rehabilitation without any adverse events. Before rehabilitation training, there were no statistically significant differences in SAS, SDS, MMSE scores, and Hcy levels between the two groups (P>0.05). After rehabilitation training, the scores of SAS, SDS, and Hcy levels in the experimental group were significantly lower compared to pre-treatment values (P<0.05), and which were significantly lower than those of the control group (P<0.05). The MMSE score in experimental groups increased significantly after interventions compared to pre-treatment value (P<0.05), and it was significantly higher than that of the control group (P<0.05). There were no significant differences in SAS, SDS, MMSE scores, and Hcy levels before and after rehabilitation training in the control group (P>0.05). Pearson correlation analysis revealed a positive correlation between Hcy levels and SAS, SDS scores (r-values of 0.420 and 0.507, respectively, P<0.05) and no correlation with MMSE scores (r=0.079, P=0.473) .

Conclusion

Our findings suggest that precision exercise prescriptions significantly improve anxiety, depression, and cognitive functions in stroke patients, suggesting their potential as a novel therapeutic approach in clinical applications. Hcy may be one of the mechanisms through which precision exercise prescriptions improve anxiety and depression in stroke patients. Further research is needed to determine whether Hcy is related to the improvement of cognitive functions through this prescription.

A Randomized Controlled Trial of Myofascial Release Therapy in Patients with Chronic Nonspecific Lower Back Pain

RAN Qingzhi, LI Aoshuang, CHEN Hengwen, ZHANG Jianmei, HE Benxiang

2024, 27(20):  2451-2457.  DOI: 10.12114/j.issn.1007-9572.2023.0681

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Background

Chronic non-specific low back pain (CNLBP) has become one of the common causes of limited activity, which seriously threatens the physical and mental health and quality of life of patients. According to certain studies, sensitivity and tension in the myofascial tissue play an important role in chronic pain disorders. By releasing fascial tension, myofascial release theropy (MFR) is primarily used to relieve pain; however, there is a lack of high-quality clinical evidence to support this application.

Objective

To investigates the effectiveness of MFR in CNLBP cases treated non-surgically.

Methods

From January to December 2022, 56 patients with CNLBP were recruited as study subjects by Chengdu Sports Institute Sports Hospital. The patients were then divided into two groups using a randomised number table. The MFR group received MFR intervention (lumbar-abdominal MFR intervention) and the patients in the control group (CG group) received pseudo-MFR intervention (pseudo-MFR intervention in the same area) for the duration of 4 weeks, once a week for 20 minutes each time. The following variables were measured: Visual Analogue Scale (VAS) scores, Activities of Daily Living (ADL) scores, Oswestry Dysfunction Index (ODI), lumbar joint mobility[including anterior lumbar flexion (ALF), posterior lumbar extension (LR) and lumbar spine rotation (LSR) on both sides], scores on the SAS, and changes in tumour necrosis factor α (TNF-α) .

Results

A total of 56 subjects were enrolled in this study. Of these, 8 cases were lost, 8 cases were automatically withdrawn and 40 cases -20 in the MFR group and 20 in the CG group eventually completed follow-up. There were no significant difference in VAS scores, ADL scores, ODI scores, ALF scores, SAS scores, SDS scores and TNF-α level between two groups before intervention (P>0.05). LR and LSR in MFR group were lower than those in CG group before intervention (P<0.05). After 4 weeks of intervention, VAS, ODI, SAS, SDS scores and TNF-α levels in MFR group were lower than those in CG group, ADL scores were higher than those in CG group, ALF, LR, LSR were higher than those in CG group (P<0.05). After 4 weeks of intervention, VAS, ODI, SAS, SDS scores and TNF-α levels in MFR group were lower than before intervention, ADL scores were higher than before intervention, ALF, LR, LSR were higher than before intervention (P<0.05) .

Conclusion

These results highlight the importance of MFR has been shown to have a better safety profile in patients with CNLBP, lowering the pain threshold, increasing lumbar joint mobility and improving negative psychological states such as anxiety and depression.

Association between Rainfall and Stroke Admissions: Based on Distributional Lag Nonlinear Modeling

ZENG Fanyan, YANG Xuezhi, LIU Xingyu, MO Jiali, LIU Zuting, LU Yi, YI Yingping, KUANG Jie

2024, 27(20):  2458-2465.  DOI: 10.12114/j.issn.1007-9572.2024.0010

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Background

Stroke is a chronic condition that seriously impairs human health. The correlation between rainfall and onset of stroke remains unclear.

Objective

To analyze the correlation between rainfall and stroke admissions in Nanchang City, and to provide scientific references for developing a comprehensive prevention and treatment strategy for stroke.

Methods

Stroke admission data from Nanchang City (2015-2019) from the digital-related group (DRG) system of the Jiangxi Provincial Health Commission Information Center were collected. In addition, atmospheric pollutant data from the national urban air quality real-time release platform and meteorological data from the Nanchang meteorological base station were collected. Basic characteristics of stroke admission patients, air pollutants, and meteorological factors were analyzed. Spearman rank correlation analysis was performed to identify the correlation of case number of stroke admissions with air pollutants and atmospheric factors. Distributional lag nonlinear model was used to explore the linkage between rainfall and stroke admissions. Stratified analysis was conducted based on gender and age (<65 years old and ≥65 years old), and lag represented the lagging days.

Results

From 2015 to 2019, there were 79 523 hospitalized patients with stroke in Nanchang City, of which 49 072 (61.71%) were males and 48 092 (60.48%) were ≥65 years old, accounting for a large proportion. The number of stroke admissions in winter (December to February) and spring (March to May) were 20 065 (25.23%) and 20 358 (25.60%), respectively. There was a nonlinear relationship between rainfall and stroke admission, and there was a certain lag effect. The RR values of lag1 and lag2 for the effect of rainfall on stroke admission was both 1.009, and 95%CI were 1.000-1.019 and 1.001-1.016, respectively. Stratified analysis showed that the main effect of higher rainfall on the number of male stroke admissions was lag6, RR value was 1.003; the main effect on the number of hospital admissions for female stroke was lag1 and lag2, with RR values of 1.018 (95%CI=1.004-1.031) and 1.020 (95%CI=1.009-1.031), respectively. The main effects on the number of hospitalizations for ischemic stroke under 65 years of age were lag1 (RR=1.016, 95%CI=1.003-1.030), and lag2 (RR=1.018, 95%CI=1.007-1.029) .

Conclusion

Short-term exposure to higher rainfall can increase the risk of stroke hospitalization, and women and people under 65 years of age are more sensitive to rainfall exposure, and protection should be strengthened for this group of people.

A Multicenter Randomized Controlled Clinical Trial Study on the Effect of Piwei Peiyuan Decoction Combined with Acupuncture in the Treatment of Chronic Atrophic Gastritis with Intestinal Metaplasia

WU Kairui, YE Yu, LI Jiaoyue, PEI Bei, LI Xuejun, CHENG Hongliang

2024, 27(20):  2466-2475.  DOI: 10.12114/j.issn.1007-9572.2023.0823

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Background

Chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) is an independent risk factor for gastric cancer. Long-term inflammation and oxidative stress response stimulate the physical and mental state of patients. Under the modern medical model, proton pump inhibitors and gastric mucosal protective agents are increasingly unable to meet the high drug resistance of patients. It is urgent to seek effective new Chinese medicine treatments and multiple methods to treat CAG and IM.

Objective

To evaluate the clinical efficacy and safety of modified Piwei Peiyuan Decoction combined with acupuncture in the treatment of CAG with IM.

Methods

From January 2022 to September 2023, 202 patients with CAG and IM diagnosed by gastroscopy and pathological examination in the Department of Spleen and Stomach, the Center for Preventive Treatment of Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were selected. The patients were divided into control group (n=67), treatment group A (n=68) and treatment group B (n=67) by random number table method. All patients participated in 6 weeks of treatment: (1) Control group: aluminum magnesium suspension combined with folic acid tablets (3 times/d) ; (2) Treatment group A: to add and subtract syndrome types of Piwei Peiyuan Decoction (2 times/d) ; (3) Treatment group B: Piwei Peiyuan Decoction (the same as group A) combined with acupuncture (1 time/d), with Zusanli, Liangqiu, Gongsun, Neiguan, Zhongwan as the main points, according to the syndrome type selection of acupoints. Before and 6 weeks after treatment, OLGA, OLGIM staging, gastric mucosal pathological efficacy, gastric mucosal pathological score, clinical symptom score, PRO scale score, drug-related adverse events (AE) and adverse drug reactions (ADR) were recorded.

Results

A total of 192 patients completed the 6-week course of treatment (62 in the control group, 66 in the treatment group A, and 64 in the treatment group B). The effective rate of the control group was 48.39% (30/62), the effective rate of the treatment group A was 69.70% (46/66), and the effective rate of the treatment group B was 71.88% (46/64). There was a statistically significant difference in the effective rate among the three groups (χ²=9.144, P=0.01). After treatment, the gastric mucosal pathological score, clinical symptom score and PRO scale score in the three groups were lower than those in the same group before treatment (P<0.05). Pathological score of gastric mucosa: the scores of chronic inflammation, atrophy and IM in treatment group A and treatment group B were lower than those in control group, and the scores of active inflammation and dysplasia were higher than those in control group (P<0.05). Clinical symptom score: the scores of epigastric fullness and epigastric pain in treatment group A and treatment group B were lower than those in control group (P<0.05). The PRO scale score: the treatment group A and the treatment group B were lower than the control group in acid reflux, dyspepsia, defecation, psychological state, systemic symptoms and total score (P<0.05). There was no significant difference in the incidence of AE and ADR among the three groups (P>0.05) .

Conclusion

The overall clinical efficacy of Piwei Peiyuan Decoction combined with acupuncture is better than that of aluminum magnesium suspension combined with folic acid tablets, which is better than that of traditional antacids and gastric mucosal protective agents.

Correlation between Serum Uric Acid/Creatinine Ratio and Metabolism-associated Fatty Liver Disease

HOU Nana, FENG Jinzhang, LIU Suohong, FENG Junfang, XUE Xiaoyan, YIN Na, CHI Gefu

2024, 27(20):  2476-2482.  DOI: 10.12114/j.issn.1007-9572.2023.0837

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Background

Metabolic associated fatty liver disease (MAFLD) is more prevalent than non-alcoholic fatty liver disease (NAFLD), leading to the identification of a variety of metabolically complex fatty liver diseases. The serum uric acid/creatinine ratio (SUA/Cr) is a new biomarker discovered after renal function-normalized SUA. At present, there have been few studies on the relationship between SUA/Cr and MAFLD.

Objective

To explore the correlation of SUA/Cr with MAFLD, and its predictive value for MAFLD.

Methods

We enrolled 2 288 individuals who visited the Physical examination Center of the Affiliated Hospital of Inner Mongolia Medical University in February to June 2023. Venous blood samples were collected for laboratory tests, and abdominal ultrasonography was used to examine the liver condition. Based on the results of abdominal ultrasonography and the diagnostic criteria for MAFLD, the subjects were divided into the MAFLD group (n=945) and non-MAFLD group (n=1 343). According to SUA/Cr quartiles, the subjects were divided into Q1 group (SUA/Cr≤4.13, n=574), Q2 group (4.13<SUA/Cr≤4.84, n=573), Q3 group (4.84<SUA/Cr≤5.72, n=570), Q4 group (SUA/Cr>5.72, n=571). Spearman rank correlation analysis was used to explore the correlation between SUA/Cr and clinical data. Binary Logistic regression analysis was used to gradually explore the influencing factors of MAFLD. Receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of SUA/Cr for MAFLD.

Results

Compared to the non-MAFLD group, the MAFLD group had higher levels of male proportion, age, waist circumference (WC), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), glycosylated hemoglobin (HbA_1c), homocysteine (Hcy), serum uric acid (SUA), serum creatinine (Scr), and SUA/Cr ratio (P<0.001). High-density lipoprotein cholesterol (HDL-C) in the MAFLD group was lower in the non-MAFLD group (P<0.001). In the Q4 group, the WC, BMI, ALT, GGT, SUA, TC and TG were higher than those in the Q1, Q2 and Q3 groups, the AST was higher than the Q1 and Q2 groups, the DBP, ALP and HbA_1c were higher than the Q1 group, the Scr, HDL-C were lower than those in the Q1, Q2 and Q3 groups, and the age was lower than those in the Q1 and Q2 groups (P<0.05). In the Q3 group, the ALT, AST, GGT, SUA, TC and TG were higher than those in the Q1 and Q2 groups, the WC and BMI were higher than those in the Q1 group, the Scr was lower than those in the Q1 and Q2 groups, and the age and HDL-C were lower than those in the Q1 group (P<0.05). In the Q2 group, the WC, BMI, ALT, GGT, SUA, and TG were higher than those in the Q1 group, and the age and HDL-C were lower than those in the Q1 group (P<0.05). Multivariate Logistic regression analysis showed that elevated WC (OR=1.034, 95%CI=1.016-1.053), BMI (OR=1.340, 95%CI=1.266-1.418), GGT (OR=1.006, 95%CI=1.003-1.010), SUA (OR=1.002, 95%CI=1.000-1.003), TG (OR=1.319, 95%CI=1.181-1.474), and HbA_1c (OR=1.348, 95%CI=1.184-1.536) were risk factors for MAFLD, while elevated HDL-C (OR=0.334, 95%CI=0.205-0.543) was a protective factor for MAFLD (P<0.05). After adjusting for confounding factors, the risk of MAFLD in Q4 group was 1.734 (95%CI=1.220-2.465, P=0.002) compared with Q1 group. SUA/Cr predicted that the area under the curve (AUC) of MAFLD was 0.607 (95%CI=0.584-0.630), with an optimal threshold value of 4.538.

Conclusion

The level of SUA/Cr in MAFLD group is higher compared to the non-MAFLD group. As the SUA/Cr level increased, the detection rate of MAFLD also increased. The SUA/Cr is a risk factor for MAFLD. The SUA/Cr can be used as a predictor to evaluate the risk of developing MAFLD.

Development and Validation of a Prediction Model for Prostate Cancer Early Screening

LI Hongji, ZHAO Xiaolong, HU Wei, HAN Donghui, WANG Anhui, QIN Weijun

2024, 27(20):  2483-2490.  DOI: 10.12114/j.issn.1007-9572.2023.0862

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Background

As a common malignant tumor, prostate cancer (PCa) poses a significant threat to the well-being of men worldwide. The prognosis of PCa is intricately linked to the grade and stage of the tumor at the time of initial detection. Prostate specific antigen (PSA) is a key biomarker for evaluating prostate health, yet lacks specificity for prostate cancer tumors. Elevated PSA levels can also be caused by benign prostate diseases. And the indiscriminate use of biopsy resulting in overdiagnosis. Hence, the development of a prostate cancer risk prediction model based on pre-biopsy clinical indicators in patients can serve as a valuable tool for early screening of individuals with suspicious findings warranting biopsy.

Objective

To examine the individual risk factors associated with positive prostate biopsy outcomes and develop a risk assessment model for predicting positive biopsy results in PCa screening.

Methods

A total of 1 138 patients who underwent prostate biopsy in the Department of Urology, the First Affiliated Hospital of Air Force Medical University from January 2011 to June 2023 were gathered and organized. Following the exclusion of 351 cases with inadequate clinical data, the remaining 787 cases were randomly allocated into a training set and validation set in a 7∶3 ratio by R software. Patient demographics and routine biochemical test results prior to biopsy were compiled, with PCa diagnosis determined based on the outcomes of the biopsy. LASSO regression analysis in the R software was utilized to identify independent risk factors associated with the development of PCa based on biochemical indicators. Subsequently, multivariate logistic regression analysis in SPSS software was employed to construct an early screening and predictive model for PCa, with a Nomogram being generated. The model was validated according to the data of training set and validation set.

Results

The study utilized LASSO regression analysis to identify 6 independent risk factors associated with positive prostate biopsy results, including age, total PSA (tPSA), alkaline phosphatase, serum protein level, Ca²⁺, and urea. Multivariate Logistic regression analysis revealed that individuals aged 60 years or older (OR=3.769, 95%CI=2.393-5.937), with tPSA levels of 10 μg/L or higher (OR=2.259, 95%CI=1.419-3.596), and alkaline phosphatase levels exceeding 45 U/L (45-<125 U/L, OR=20.136, 95%CI=4.419-91.752; ≥125 U/L, OR=45.691, 95%CI=9.199-226.951) were at increased risk for positive prostate biopsy outcomes (P<0.05). Conversely, higher levels of serum total protein (≥65 g/L, OR=0.086, 95%CI=0.031-0.236), Ca²⁺ (≥2.11 mmol/L, OR=0.148, 95%CI=0.054-0.403), and urea (≥9.5 mmol/L, OR=0.069, 95%CI=0.019-0.252) were found to be protective factors against positive prostate biopsy results (P<0.05). Based on the identification of 6 independent risk factors exhibiting statistically significant differences, a nomogram was constructed and a predictive model was developed. The predictive model yielded an Area under the receiver operating characteristic (ROC) curve (AUC) of 0.778 (95%CI=0.740-0.816) for PCa in the training set, with a sensitivity of 53.2% and a specificity of 85.5%. In the validation cohort, the AUC for PCa was 0.770 (95%CI=0.708-0.832), with a sensitivity of 61.2% and a specificity of 80.0%. The goodness of fit test indicated P=0.543 in the training set and P=0.372 in the validation set, demonstrating a satisfactory level of fit. The discriminant analysis (DCA) demonstrated that the high-risk threshold in the training set was below 10%, while in the validation set it was approximately 15%, indicating valuable implications for clinical practice.

Conclusion

This study developed a PCa nomogram risk prediction model incorporating 6 biochemical indicators, namely age, tPSA, alkaline phosphatase, serum total protein, Ca²⁺, and urea, prior to prostate biopsy, to effectively forecast PCa risk in patients with favorable early screening outcomes.

The Relationship between Fibrinogen and International Study of Kidney Disease in Children Pathologic Grading and Microscopic Lesions of Renal Units with Henoch Schonlein Purpura Nephritis in Children

GAO Min, DING Ying, WU Ruihong, DAI Yanlin, XU Yan, HAN Shanshan, HUANG Yanjie, YANG Xiaoqing

2024, 27(20):  2491-2497.  DOI: 10.12114/j.issn.1007-9572.2023.0734

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Background

Fibrinogen (FIB) is often elevated in children with Henoch Schonlein purpuric nephritis (HSPN), but the correlation between FIB and renal lesions has been less studied.

Objective

To explore the correlation between FIB in children with HSPN and the International Study Group on Pediatric Kidney Disease (ISKDC) pathology grading and micropathological changes in parts of renal units, and to clarify whether FIB can assess the severity of renal injury in children with HSPN.

Methods

In total, 922 children with HSPN who were hospitalized in the First Affiliated Hospital of Henan University of Chinese Medicine in the pediatric nephrology ward and underwent kidney biopsy at the same time from December 2017 to December 2022 were collected, and the clinical information, FIB and renal pathological information during renal biopsy were summarized, and based on the FIB level, the children were categorized into group A (low) <2.38 g/L, group B (standard) 2.38-4.98 g/L, and group C (high) >4.98 g/L. The correlation between FIB and ISKDC pathological grades, glomerular mesangial hyperplasia ratio, the crescentic bodies ratio and the nature of the glomerular lesions from acute to chronic was investigated by Spearman rank correlation analysis, and the prediction of FIB on the micropathological changes of renal units was analyzed by the subject's work characteristic (ROC) curve.

Results

Among 922 children with HSPN who had undergone renal biopsy, the FIB was (3.48±1.01) g/L. 113 cases in group A had a low FIB rate of 12.26%; 734 cases in group B had a standardized FIB rate of 79.61%; and 75 cases in group C had a high FIB rate of 8.13%. The ISKDC pathology classification was type Ⅱa in 173 cases (18.76%), type Ⅱb in 29 cases (3.15%), 466 cases (50.54%) of type Ⅲa, 232 cases (25.16%) of type Ⅲb, and 22 cases (2.39%) of type Ⅳ and above (including 2 cases of type Ⅳa, 18 cases of type Ⅳb, and 2 cases of type Ⅴ). The results of the Spearman's rank correlation analysis showed that the FIB and the grouping of the FIB of the children with HSPN were positively related to the renal pathology ISKDC grading (r_s=0.146, P<0.001; r_s=0.129, P<0.001). 911 (98.80%) of 922 children with HSPN were mesangial proliferative, and 655 (71.04%) had crescentic hyperplasia. Spearman rank correlation analysis showed a weak positive correlation between FIB and FIB subgroups and the rate of mesangial hyperplasia (r_s=0.092, P=0.005; r_s=0.096, P=0.003), and a positive correlation with the rate of crescentic bodies (r_s=0.132, P<0.001; r_s=0.830, P=0.012). 922 children with HSPN had glomerular acute lesions in 763 cases (82.75%), acute chronic lesions in 97 cases (10.52%), and chronic lesions in 62 cases (6.73%). In addition, FIB gradually increased with the nature of the glomerular lesions from acute to chronic (r_s=0.145, P<0.001). At the same time, comparison of some renal biopsy indexes FIB in HSPN children showed statistically significant difference (P<0.05). The ROC curves showed that the FIB had the highest sensitivity for glomerulosclerosis (sensitivity=0.900, specificity=0.303), and the optimal cutoff value for FIB was 2.835 mg/L; the area under the ROC curve (AUC) of FIB for the positive prediction of tubulointerstitial fibrosis=0.623, and that of FIB for the reverse prediction of tubulointerstitial cellular granulomatous degeneration=0.641.

Conclusion

FIB can be used as a laboratory index reflecting the severity of renal pathological changes in patients with HSPN, can reflect the severity of renal pathological grading, is closely related to irreversible lesions according to renal microscopic indicators such as glomerular sclerosis and balloon adhesion, and can assist clinical diagnosis and treatment.

Original Research·Multimorbidity Section

Complex Pattern of Multiple Chronic Physical Conditions and Its Effect on Healthcare Utilization among Older Adults in China

ZHAO Ziyin, ZHANG Jiajun, SUN Wenjun, LI Huining, XING Xing, ZHU He

2024, 27(20):  2498-2504.  DOI: 10.12114/j.issn.1007-9572.2023.0902

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Background

The prevalence of multiple chronic conditions (MCCs) is continuously increasing among older adults in China, but few studies have explored complex pattern of MCCs from perspectives of patient demand and disease management.

Objective

This study aims to investigate the pattern distributions, correlates, and treatment burdens of MCCs.

Methods

Data were obtained from the 2018 and 2020 China Health and Retirement Longitudinal Study (CHARLS) waves, and the study sample included older adults aged≥60 years old (n=15 349). The generalized ordered logit model and the generalized linear model were used to examine correlates of MCCs complex pattern and its associations with outpatient/inpatient utilization and expenditure, respectively. All statistical analyses were weighted except for sample size.

Results

Among the total sample of 15 349 older adults, there were 7 147 in 2018 and 8 202 in 2020; 2 054 participants[13.0%, defined as the relatively healthy group (RH group) ] had none of 12 chronic conditions defined in this study, 5 228 participants [33.7%, defined as the simple chronic illness group (SCI group) ] had 1-5 non-complex chronic conditions, 6 737 participants [44.7%, defined as the minor complex chronic illness group (MiCCI group) ] had 1-2 complex chronic conditions, and <6 non-complex chronic conditions, and 1 330 participants[8.6%, defined as the major complex chronic illness group (MaCCI group) ] had ≥3 complex chronic conditions or ≥6 non-complex chronic conditions. The proportion of MiCCI and MaCCI groups had an increase of 2.1% and 1.9% between 2018 and 2020, respectively. Among the SCI and MiCCI groups, the most prevalent chronic conditions were hypertension (49.2% and 56.1%) and arthritis/rheumatism (51.9% and 47.4%), respectively. Among MaCCI group, 82.0% had heart disease, and 67.9% had chronic lung diseases. There were statistically significant differences in the prevalence of chronic conditions among the three groups (P<0.05). Age, sex, education level, annual household expenditure per capita, medical insurance, depression status, and survey year were associated with being in SCI, MiCCI, and MaCCI groups (P<0.05) ; age, education level, urban-rural location, region, annual per capita household expenditure, and survey year were associated with being in MiCCI and MaCCI groups (P<0.05) ; age, region, annual per capita household expenditure, depression status, and survey year were associated with being in MaCCI group (P<0.05). In 2018, compared to the RH group, the MiCCI and MaCCI group had more outpatient numbers, and the SCI, MiCCI, and MaCCI groups had higher outpatient expenses, inpatient numbers and expenses (P<0.05). In 2020, compared to the RH group, the SCI, MiCCI, MaCCI groups utilized more outpatient and inpatient services (P<0.05) .

Conclusion

According to the most recent CHARLS data, over half of older adults in China suffers from complex chronic comorbidities, with 44.7% for the MiCCI group and 8.6% for MaCCI group. The heart disease and chronic lung disease was the most prevalent in the MaCCI group. Furthermore, as the complexity of multimorbidity increases, there is a noticeable increase in outpatient and inpatient utilization as well as medical expenditures. Therefore, it is recommended to explore effective MCC management models based on healthcare demands to improve health outcomes and reduce disease burdens.

Patient Delay and Associated Factors in Older Adults with Multimorbidity

WANG Xiaoran, GUAN Xinyue, ZHANG Dan

2024, 27(20):  2505-2511.  DOI: 10.12114/j.issn.1007-9572.2023.0614

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Background

With the aggravation of population aging in China, the disease spectrum of the population has changed and the coexistence of multiple chronic diseases has become the norm for the health status of the older population in China. Patient delay refers to the behaviour of an individual who fails to seek medical care in a timely manner after becoming unwell for a variety of subjective or objective reasons, resulting in a decrease in the treatment effectiveness and a decrease in the quality of the patient's survival. At present, there are few researches on patient delay and the associated factors for elderly adults with multimorbidity in China.

Objective

To explore the patient delay and the associated factors for older adults with multimorbidity, so as to provide references to further reduce the incidence of patient delay.

Methods

Eligible elderly patients attending 27 community health centers in Guangdong Province from September to December 2022 were selected for the study using multi-stage stratified whole cluster random sampling method. A self-designed questionnaire was used to collect patients' general information, disease-related information and delays in seeking medical care. Multivariate Logistic regression analysis and a decision tree model based on the CHAID algorithm were used to analyse the influencing factors of patient delay in older adults with multimorbidity.

Results

A total of 998 patients were included in the study, of which 243 (24.35%) showed delays in seeking medical care. The multivariate Logistic regression results showed that gender (OR=0.701, 95%CI=0.504-0.977, P=0.036), type of household registration (OR=0.590, 95%CI=0.358-0.973, P=0.039), type of health insurance (OR=2.660, 95%CI=1.764-4.010, P<0.001), disease-related self-efficacy (OR=4.378, 95%CI=2.079-9.217, P<0.001), family doctor contract (OR=2.277, 95%CI=1.618-3.206, P<0.001) and self-reported health (OR=1.554, 95%CI=1.073-2.250, P=0.020) were the main factors influencing patient delay in older adults with multimorbidity (P<0.05). The decision tree model has 3 levels and 13 nodes, and a total of 5 influencing factors were screened, including type of health insurance, family doctor contract, gender, self-reported health and age. The results of the two models for predicting patient delay in older adults with multimorbidity showed that the area under receiver operating characteristic curve (AUC) was 0.729 for the multivariate Logistic regression model and 0.721 for the decision tree model. There was no significant difference in AUC between the two models for predicting patients delay in elderly patients with multimorbidity (Z=0.539, P=0.590) .

Conclusion

The incidence of patient delay in older adults with multimorbidity is 24.35% in Guangdong province, and the type of health insurance, the contracting rate of family doctors, gender, and self-reported health status are the main factors influencing patient delay in older adults with multimorbidity. The medical insurance system should be further improved to increase the contracting rate and utilization rate of family doctors in order to reduce the incidence of patient delay.

Influencing Factors for the Effectiveness of Family Doctor Contract Services for Elderly Patients with Multimorbidity in Communities

XIE Kexin, DU Fang, ZHANG Dan

2024, 27(20):  2512-2519.  DOI: 10.12114/j.issn.1007-9572.2023.0703

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Background

With the aging of the population and changes in the disease spectrum, the incidence of multimorbidity among the elderly remained high, and have become the focus of the family doctor contracting service at the primary level. At present, there are many studies promoting the signing of family doctors from the perspective of increasing "quantity", but there is still a lack of studies on the factors affecting the effectiveness of family doctor contract services for elderly multimorbidity patients after signing from the perspective of improving "quality".

Objective

To explore the important influencing factors of satisfaction and usefulness evaluation of elderly multimorbidity patients with family doctor contract services in urban communities of guangdong province, and to provide a basis for future improvement of multimorbidity management services at the grassroots level.

Methods

From September to December 2022, elderly patients with multiple chronic conditions in the community of Guangdong Province (Shenzhen, Zhanjiang and Meizhou) were selected by multi-stage stratified whole cluster random sampling method and surveyed by self-administered questionnaire. Multifactorial Logistic regression analysis was used to explore the influencing factors of satisfaction and usefulness evaluation of family doctor contracting services for elderly multimorbidity patients.

Results

A total of 636 valid questionnaires were collected, with effective recovery rate of 99.69% (636/638). There were 624 family doctors who were relatively satisfied/very satisfied, accounting for 98.11%; The service usefulness evaluation of family doctors was slightly helpful/greatly helpful to 625 people, accounting for 98.27%. The results of multivariate Logistic regression analysis showed that patients with general satisfaction of family doctor contract service were taken as reference. Patients with hyperlipidemia (OR=15.203), disease duration <3 years (OR=48 703 577.681), 4 chronic diseases (OR=135.131), and severe dependence on self-care ability (OR=668 738.913) were more likely to make satisfactory evaluations than patients with complete self-care. Patients with annual personal income of ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), >50 000-100 000 yuan (OR<0.001) were less likely to make a satisfactory evaluation than patients with income >100 000-200 000 yuan (P<0.05). Patients aged 65-69 years (OR=12.573) were more likely to be very satisfied than those aged ≥70 years, and those with 4 chronic diseases (OR=135.131) were more likely to be very satisfied than those with 5 or more chronic diseases. The average annual income of individuals was ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), and some understanding of the disease (OR=0.013) or more understanding (OR=0.035) patients were less likely to give a very satisfactory evaluation (P<0.05). Multivariate Logistic regression analysis of the evaluation of the effectiveness of family doctor contract services by elderly patients with comorbidity of chronic diseases showed that taking the family doctor contract service as not very useful as the dependent variable, patients aged 65-69 years old (OR=28.710) were more likely to make a slightly helpful evaluation than patients aged ≥70 years old. Working patients (OR=0.091) were less likely to give a slightly helpful evaluation than unemployed patients (P<0.05). Patients aged 65 to 69 years (OR=56.795) were more likely to make helpful evaluations than those aged ≥70 years, and patients with chronic heart failure (OR=0.023) were less likely to make helpful evaluations than those without the disease (P<0.05) .

Conclusion

The overall level of satisfaction and usefulness evaluation of family doctors contracted services of elderly multimorbidity patients in urban communities of Guangdong province is relatively high, both above 95%, which is influenced by a combination of factors, including changing the type of chronic disease, annual income, knowledge of the condition, and self-care ability. In the future, we should continue to standardize and improve the connotation of family doctor contracted services, optimize the management mode of key populations such as elderly multimorbidity, improve the satisfaction and sense of gain of patients, so as to ultimately enhance the effectiveness of family doctor contracted services.

Study of Medication Adherence and Its Influencing Factors among Elderly Patients with Multimorbidity

GUAN Xinyue, WANG Xiaoran, ZHANG Dan

2024, 27(20):  2520-2526.  DOI: 10.12114/j.issn.1007-9572.2023.0674

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Background

As the aging population continues to increase, there has been a rise in the prevalence of multimorbidity in the elderly. The adherence to medication regimens by elderly patients with multimorbidity significantly impacts the effectiveness of chronic disease management.

Objective

This study analyses the factors that impact medication adherence among the elderly with multimorbidity in Guangdong province. This study aims to provide a foundation for the management of multimorbidity in this population.

Methods

A multi-stage stratified cluster random sampling method was used to survey a population of 998 multimorbid patients aged 60 years and above in Guangdong province from October 2022 to March 2023. Medication adherence was the dependent variable, while patient sex, age, marital status, living conditions, education level, personal annual income, family encouragement for medication adherence, family doctor support, number of diseases, disease awareness, medication awareness, BMI, smoking and alcohol consumption were considered as independent variables. Multivariate Logistic regression analysis was used to identify the factors influencing medication adherence among elderly patients with multimorbidity in Guangdong province.

Results

A total of 1 000 questionnaires were distributed and 998 valid questionnaires were collected, with a valid recovery rate of 99.8%. Among the 998 cases of elderly patients with multimorbidity in Guangdong province, there were 719 cases (72.0%) with good adherence to medication and 279 cases (28.0%) with poor medication adherence; there were 512 cases (51.3%) of males and 486 cases (48.7%) of females. The results of multivariate Logistic regression analysis showed that: education level (high school/secondary school: OR=0.298, 95%CI=0.117-0.762; college and above: OR=0.325, 95%CI=0.127-0.831), personal annual income (>30 000 to 50 000 yuan: OR=7.694, 95%CI=2.071-28.582; >50 000 to 100 000 yuan: OR=12.408, 95%CI=3.229-47.686; >100 000 to 200 000 yuan: OR=4.893, 95%CI=1.174-20.397), and frequency of family members' supervision of medication taking (occasionally: OR=1.842, 95%CI=1.222-2.779), family doctor's help (slightly helpful: OR=2.537, 95%CI=1.531-4.205), understanding of the condition (mostly understood: OR=3.015, 95%CI=1.948-4.667; better understood: OR=3.510, 95%CI=1.955-6.300; some/no understanding: OR=3.469, 95%CI=1.338-8.994), medication concern (mostly concerned: OR=4.928, 95%CI=3.336-7.278; more concerned: OR=3.670, 95%CI=1.915-7.033; somewhat concerned/unconcerned: OR=8.560, 95%CI=2.497-29.339), BMI (too low: OR=2.303, 95%CI=1.154-4.598; overweight/obese: OR=0.598, 95%CI=0.390-0.915), and alcohol consumption (OR=1.959, 95%CI=1.270-3.022) were the influencing factors of medication adherence among elderly patients with multimorbidity in Guangdong province (P<0.05) .

Conclusion

The elderly patients with multimorbidity in Guangdong province had better medication adherence, at 72.0%. Medication adherence was poorer among the elderly patients with multimorbidity in Guangdong province who were high-income earners, occasionally urged to take medication by their family members, slightly assisted by their family doctors, had a low understanding of their condition, paid little attention to the use of medication, had a low BMI, and drank alcohol. All parties in society should join hands to take multiple measures to improve the medication adherence of elderly patients with multimorbidity in all aspects, strengthen the integrated management of multimorbidity, and promote the health of elderly patients.

Evidence-based Medicine

Prevalence for Cerebral Microbleeds in China: a Meta-analysis

XIAN Lihong, LI Juan, XUE Chao, ZHAO Xuejiao, LU Ting, YAN Huan

2024, 27(20):  2527-2533.  DOI: 10.12114/j.issn.1007-9572.2023.0908

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Background

Cerebral microbleeds (CMBs) are important diseases that seriously endanger our national health, and their incidence is positively correlated with age. Meanwhile, CMBs are also an independent risk factor for stroke recurrence and induced hemorrhagic stroke. Understanding the current prevalence of CMBs is of great practical significance for promoting healthy aging and strengthening stroke prevention and treatment in China.

Objective

To systematically evaluate the current status of the occurrence of CMBs in China and to provide data support for promoting the process of healthy aging and strengthening the prevention and treatment of stroke in China.

Methods

Literature related to the occurrence of the disease of CMBs in our national population was systematically searched through Chinese and English databases such as CBM, CNKI, Wanfang Data, VIP, PubMed, Embase, and Web of Science, with a timeframe of the establishment of the database until November 2023 for all searches. Two researchers separately performed literature screening, data extraction, and evaluation of the risk of bias in the included literature, and meta-analysis was performed using Stata 16.0 software.

Results

A total of 39 studies were included, with a total of 25 877 study subjects. Meta-analysis showed that the overall incidence of CMBs in China was 25.0% (95%CI=21.0%-29.0%). The results of subgroup analysis showed that the prevalence was 27.0% (95%CI=12.0%-44.0%) for those aged 51-60 years, 23.0% (95%CI=16.0%-30.0%) for those aged 61-70 years, and 27.0% (95%CI=20.0%-35.0%) for those aged 71-80 years; the prevalence was 21.0% (95%CI=15.0%-28.0%) in North China, 26.0% (95%CI=21.0%-33.0%) in East China, 21.0% (95%CI=8.0%-39.0%) in South China, 21.0% (95%CI=16.0%-27.0%) in Central China, 24.0% (95%CI=21.0%-27.0%) in Southwest China and 46.0% (95%CI=41.0%-51.0%) in Northwest China by geographic area; the prevalence of CMBs with a history of hypertension was 19.0% (95%CI=13.0%-26.0%) and without a history of hypertension was 8.0% (95%CI=6.0%-11.0%) ; the prevalence of CMBs with a history of smoking was 9.0% (95%CI=5.0%-14.0%) and without a history of smoking was 16.0% (95%CI=12.0%-21.0%) .

Conclusion

The overall prevalence of CMBs in China is high, with significant differences between different age segments, regions, and provinces. Its prevalence was higher in people of advanced age, males, Northwest China, and nationals with a history of hypertension. Due to the limitations in both quantity and quality of the included studies, further confirmation of this conclusion through additional high-quality research is required.

Prevalence and Influencing Factors of Frailty in Maintenance Hemodialysis Patients in China: a Meta-analysis

WANG Xiaoxia, CAO Xuehua, LI Yan, XIONG Langyu, HU Wanqin, XIANG Feng, JIA Yu

2024, 27(20):  2534-2544.  DOI: 10.12114/j.issn.1007-9572.2023.0687

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Background

Chronic kidney disease has become a major global concern, and the prevalence of kidney disease in China is the highest in the world. About 89.5% of patients require hemodialysis. In recent years, the prevalence of frailty in maintenance hemodialysis (MHD) patients has risen significantly, seriously affecting the quality of life and prognosis of patients.

Objective

To explore the prevalence of frailty and the influencing factors of maintenance hemodialysis patients in China through Meta-analysis.

Methods

Cross-sectional and cohort studies on the prevalence and influencing factors of frailty in Chinese MHD patients were systematically searched in CNKI, VIP, CBM, Wanfang Data, Web of Science, PubMed, Cochrane Library, Embase, and CINAHL databases. The search deadline was from the respective databases to July 2023. Literature screening, data extraction and quality assessment were performed independently by two researchers. Stata 15.0 was used for meta-analysis.

Results

Thirty-two papers were included, and including 6 746 patients, among which 2 566 experienced frailty, involving 37 influencing factors. Meta-analysis showed that the prevalence of frailty in MHD patients in China was 37.4% (95%CI=30.3%-44.5%). Age (OR=1.09, 95%CI=1.06-1.13), age>60 years (OR=3.81, 95%CI=2.31-6.30), female (OR=2.13, 95%CI=1.47-3.08), living alone (OR=2.42, 95%CI=1.22-4.80), sleep (OR=1.28, 95%CI=1.08-1.50), depression (OR=1.97, 95%CI=1.26-3.08), age on dialysis (OR=3.25, 95%CI=1.82-5.79), social support (low level) (OR=1.99, 95%CI=1.39-2.86), comorbidities (OR=1.79, 95%CI=1.40-2.30), malnutrition (OR=1.17, 95%CI=1.07-1.28), Charlson Comorbidity Index (CCI) (OR=1.32, 95%CI=1.01-1.71), C-reactive protein (CRP) (OR=1.15, 95%CI=1.09-1.21), hemoglobin (Hb<110 g/L) (OR=2.70, 95%CI=1.67-4.36), comorbid diabetes (OR=2.16, 95%CI=1.48-3.16), comorbid cerebrovascular disease (OR=2.66, 95%CI=1.85-3.82), comorbid coronary heart disease (OR=3.50, 95%CI=2.15-5.70) were risk factors for frailty MHD (P<0.05) ; economic income (OR=0.02, 95%CI=0.01-0.14), social support (high level) (OR=0.86, 95%CI=0.76-0.97), well nutrition (OR=0.47, 95%CI=0.26-0.85), ability to perform activities of daily living (ADL) (OR=0.80, 95%CI=0.70-0.91), serum albumin (ALB) (OR=0.84, 95%CI=0.77-0.91), Hb≥110 g/L (OR=0.70, 95%CI=0.54-0.90), 25-hydroxyvitamin D[25- (OH) VD] (OR=0.69, 95%CI=0.49-0.98) were protective factors for MHD frailty (P<0.05) .

Conclusion

The prevalence of frailty in MHD patients in China is at a high level, in which age, female, living alone, economic income, sleep, depression, age on dialysis, social support, comorbidities, nutritional risk scores, ADL, CCI, CRP, ALB, Hb, 25- (OH) VD, comorbid diabetes mellitus, comorbid cerebrovascular disease, and comorbid coronary heart disease are mainly factors influencing of MHD frailty patients in China, and in the future, there is a need for early screening and intervention to slow down or avoid the occurrence of hemodialysis frailty in patients.

Review & Perspectives

Hemorrhoidal Disease Classification Methods: Recent Advances and Value Analysis

NI Jiachun, CAI Zengjin, HOU Changcheng, JIANG Qiong, KANG Jian, YANG Xiangdong, FAN Wenbin

2024, 27(20):  2545-2550.  DOI: 10.12114/j.issn.1007-9572.2022.0704

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As a common anorectal disease, the high incidence and recurrence of hemorrhoidal disease impose pressure on both doctors and patients. Hemorrhoidal disease assessment is a necessary prerequisite for diagnosis and selection of appropriate treatment options. Objective assessment of hemorrhoidal disease and selection of an appropriate treatment are strong concerns of clinicians, and many hemorrhoidal disease classification methods have been developed recently. We reviewed these recently emerged hemorrhoidal disease classification methods, which mainly include prolapse-dominated classification methodologies (Goligher classification, Indian new classification algorithm of haemorrmoids, single pile classification, algorithm for grading prolapsing haemorrhoids), bleeding-dominated classification methodologies (Japanese endoscopic classification of internal hemorrhoids, PNR-bleeding classification), and comprehensive classification methodologies[Lunniss's classification of internal haemorrhoids, anatomical/clinical-therapeutic classification, BPRST classification, BPECT classification, four-factors (PBCE) hemorrhoids classification], then analyzed evaluation values, essential factors, principles of use and components of assessment indicators of the methods. Afterwards, we put forward optimization strategies targeting their limitations and predicted their possible future development directions. All these will provide a reference for the development regarding the assessment and classification of hemorrhoids and clinical diagnosis and management of hemorrhoids.

Research Progress of Astrocyte-derived Extracellular Vesicles in Post-stroke Cognitive Impairment

XIAO Yuqian, BAI Yanjie, WANG Yan, SUN Kexin, WAN Jun, CHEN Shuying, CHEN Limin

2024, 27(20):  2551-2556.  DOI: 10.12114/j.issn.1007-9572.2023.0412

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Post-stroke cognitive impairment, characterized by cognitive dysfunction, is a common complication of stroke and has a direct impact on the quality of life of ischemic stroke patients. Previous studies have found that astrocytes play an important role in the pathogenesis of PSCI. In addition, extracellular vesicles (EVs) have been recognized as an important medium for intercellular communication and are involved in various pathophysiological processes by carrying and transporting various cargoes. Astrocyte-derived extracellular vesicles (ADEVs) may communicate with other brain cells to improve PSCI by enhancing synaptic plasticity, modulating neuroinflammation, regulating angiogenesis and autophagy. This review clarifies the multiple effects of ADEVs on the development of PSCI, offers new strategies for studying the underlying mechanisms of PSCI, and further explores the potential uses of ADEVs as novel drugs and biomarkers in the diagnosis and treatment of PSCI.