Table of Content

15 August 2024, Volume 27 Issue 23

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Editorial

General Practice: the Integrating Discipline

YANG Hui

2024, 27(23):  0-C2.  DOI: 10.12114/j.issn.1007-9572.2024.A0016

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Review & Perspectives

Integrated Care Models for Cancer Survivorships: Conceptual Framework, Characteristics and Implications to China

ZHAO Miaomiao, GAO Yuexia, XU Yanfei, ZONG Li, WU Qunhong

2024, 27(23):  2813-2821.  DOI: 10.12114/j.issn.1007-9572.2023.0803

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Cancer is a significant global public health issue. With the continuous increase in cancer incidence rates and the prolonged survival time of cancer patients, the number of cancer survivors is also steadily rising. Cancer survivors face complex challenges in terms of physical, psychological, and social care, and their care services require effective coordination and integration across disciplines, sectors, and domains. Establishing integrated care model for cancer survivors has become an important strategy for addressing the challenges of survivorship care globally. However, the development of cancer survivorship care in China has been relatively lagging. This article synthesizes and summarizes the conceptual frameworks, characteristics and practical application of several representative integrated care models for survivorships. Based on China's healthcare service system, recommendations for designing and implementing integrated care strategies for cancer survivorships in China are proposed from five aspects: establishing consensus, pilot testing and exploration, workforce development, strengthening primary care, and policy support.

Advances in Life Goal Adjustment Ability of Cancer Patients and Its Effect on Physical and Mental Health

RAN Zhuorui, SUN Ruixin, JIA Jingyi, CHE Zhaoyu, LI Ruixi, HE Yaping, CHU Qiao

2024, 27(23):  2822-2828.  DOI: 10.12114/j.issn.1007-9572.2023.0613

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Cancer is a major traumatic event that causes serious interference in the pursuit of individual's life goals and leads to a variety of emotional disorders. Rational adjustment of life goals is beneficial to rebuild life direction, improve physical and mental health of patients. This paper reviews the current research of domestic and international studies on cancer affecting patients' pursuit of life goals, and summarizes the advances in the existing literature on the goal-adjustment behaviors of cancer patients and the effects on their physical and mental health by literature review. Literature review shows that the impact of cancer diagnosis on patients' pursuit of life goals is mainly manifested in the impact on self-efficacy, goal pursuit ability and goal prioritization. Reasonable goal-adjustment behaviors can help improve patients' physical and mental health, which includes promoting positive emotions, alleviating negative emotions, reducing physical discomfort, and improving quality of life. Therefore, future psychosocial intervention design for the emotional health of cancer patients can be based on guiding patients to replan and regulate their goals, so as to improve patients' emotional health and disease prognosis.

Original Research·Stroke Rehabilitation Section

Incidence and Related Factors of Post-stroke Cognitive Impairment: a Multicenter Cross-sectional Study Based on Full-cycle Rehabilitation in Stroke

TU Shuting, LIN Jiaying, ZHUANG Jinyang, XIANG Jingnan, WEI Dongshuai, XIE Yong, JIA Jie

2024, 27(23):  2829-2837.  DOI: 10.12114/j.issn.1007-9572.2023.0784

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Background

Post-stroke cognitive impairment (PSCI) can significantly limit the recovery of stroke patients at all stages and lead to a decline in activity participation and quality of life.

Objective

Based on the concept of full-cycle rehabilitation in stroke, by investigating the incidence of PSCI, to analyzed the differences of PSCI in different age and disease period and its potential influencing factors.

Methods

Stroke patients were hospitalized in the rehabilitation departments of 27 hospitals in different regions of China from October 2022 to July 2023 using simple random sampling method for cross-sectional analysis. A total of 402 patients were finally included according to the study criteria, and categorized into the young and middle-aged group (18-64 years old, n=234) and the elderly group (≥65 years old, n=168) according to the criteria of the National Bureau of Statistics of China, and the patients were also categorized into the acute-phase group (1-7 d, n=25), subacute-phase group (8-180 d, n=338), and the chronic-phase group (>180 d, n=39) according to the International Stroke Rehabilitation Alliance. Baseline information on patients was collected through interviews, assessments, and an electronic case system. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and subscores and total scores were calculated for each cognitive domain. Using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Hospital Anxiety Scale (HADS-A), and the Hospital Depression Scale (HADS-D) were used to assess the disease conditions and physical functioning of the patients. Spearman's rank correlation analysis was used to investigate the correlation between cognitive function levels and other clinical indicators at different ages and different stages of disease.

Results

The prevalence of PSCI in stroke patients was 76.4% (307/402), including 81.0% (136/168) in elderly patients and 73.1% (171/234) in young and middle-aged patients; the prevalence of PSCI in stroke patients was 56.0% (14/25) in the acute phase, 78.4% (265/338) in the subacute phase, and 71.8% (28/39) in the chronic phase. The results of grouping by age and disease period showed that the elderly group had lower visuospatial and executive function, attention, numeracy, delayed recall scores and total MoCA scores than those in the young and middle-aged group (P<0.05). Patients in the subacute-phase group had lower visuospatial and executive function, language, delayed recall scores and total MoCA scores than those in the acute-phase group (P<0.05). Correlation analysis showed that the total MoCA score was positively correlated (P<0.001) with educational level (r_s=0.314), stroke type (r_s=0.114), FMA-UE (r_s=0.245), FMA-LE (r_s=0.242), BBS (r_s=0.265), MBI (r_s=0.293), and was negatively correlated (P<0.05) with gender (r_s=-0.107), age (r_s=-0.103), history of hypertension (r_s=-0.112), hemiplegic side (r_s=-0.139), disease duration (r_s=-0.135), NIHSS (r_s=-0.107), HADS-A (r_s=-0.239), HADS-D (r_s=-0.280). Further stratified analyses showed that the young and middle-aged and elderly groups were correlated with the total MoCA score in terms of the educational level, NIHSS and physical function indicators such as FMA-UE, FMA-LE, BBS, MBI, HADS-A, and HADS-D (P<0.05). In the acute-phase group, disease duration, FMA-UE, and HADS-A were related to total MoCA score (P<0.05). In the subacute-phase group, age, education level, hypertension, history of alcohol consumption, type of stroke, hemiplegic side, disease duration, NIHSS, and physical function indicators such as FMA-UE, FMA-LE, BBS, MBI, HADS-A, HADS-D were correlated with the total MoCA score (P<0.05), and only educational level, hypertension, and HADS-D were correlated with the total MoCA score in the chronic-phase group (P<0.05) .

Conclusion

PSCI is closely related to age, disease development period, education level, physical function, balance, activities of daily living, anxiety and depression levels in stroke patients, and individualised preventive strategies and interventions should be developed for patients based on different stratified cognitive potential influencing factors, as well as increased screening and attention to cognition in the early stages of the disease to the later stages of rehabilitation.

Correlation between Somatosensory and Motor Function in Stroke Patients of Different Age Groups and Thoughts on Full-cycle Rehabilitation: a Multicenter Cross-sectional Study

LIN Jiaying, TU Shuting, LIN Jiali, ZHOU Yuxin, HE Xinyuan, JIA Jie

2024, 27(23):  2838-2845.  DOI: 10.12114/j.issn.1007-9572.2023.0791

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Background

Somatosensory and motor dysfunctions are common after stroke, both lead to limitations in activities of daily living and social participation, there is still a lack of research evidence to analyze the relationship between the two from multiple perspectives.

Objective

To investigate the relationship between somatosensory and motor function among overall, upper and lower extremities in different-age-group patients within one year after stroke.

Methods

This prospective study enrolled the poststroke patients within one year from several hospitals in Fujian Province from October 2022 to April 2023. The sensory subscale of the Fugl-Meyer assessment (FMA-S) and the sensory subitem of National Institute of Health Stroke Scale (NIHSS) were used to evaluate the patient's somatosensory function. The motor subscale of the Fugl-Meyer assessment (FMA-M), Brunnstrom assessment, Berg Balance Scale (BBS) and the motor subitem of NIHSS were used to evaluate the patient's motor function. Modified Barthel Index (MBI) was used to evaluate the patient's activities of daily living (ADL). Hospital Anxiety and Depression Scale (HADS) was used to evaluate the patient's psychosomatic function. They were divided into two groups (the elderly group/the young and middle-aged group) according to their age, we compared the differences in general information and rehabilitation assessments between the two groups. And we analyzed the correlation between somatosensory function and motor function/ADL/psycho-psychological function.

Results

A total of 254 patients were included, with an average age of (61.0±12.3) years and an average disease course of 30.0 (17.0, 65.5) days. There were 112 cases (44.1%) in the elderly group and 142 cases (55.9%) in the young and middle-aged group. FMA-S and FMA-M scores were positively correlated in both groups (r_s values were 0.313 and 0.171, both P<0.05), NIHSS sensory items were all negatively correlated with FMA-M scores (r_s values were -0.199 and -0.177, both P<0.05). In the elderly group, FMA-S-UE related scores were positively correlated with FMA-M-UE, Brunnstrom-UE, and Brunnstrom-HAND scores; they were negatively correlated with NIHSS-UE score (all P<0.05). In the young and middle-aged group, FMA-S-UE total and light-touch scores were positively correlated with FMA-M-UE and Brunnstrom-HAND scores; FMA-S-UE proprioception score was positively correlated with FMA-M-UE, Brunnstrom-UE scores (all P<0.05). In the older group, FMA-S-LE related scores were positively correlated with FMA-M-LE, Brunnstrom-LE, and BBS scores; FMA-S-LE total and light touch scores were negatively correlated with NIHSS-LE scores (all P<0.01). In the young and middle-aged group, FMA-S-LE total and proprioception scores were positively correlated with FMA-M-LE, Brunnstrom-LE, and BBS scores; FMA-S-LE light touch score was positively correlated with Brunnstrom-LE and BBS scores; FMA-S-LE total and proprioception scores were each negatively correlated with NIHSS-LE score (all P<0.05). In the elderly group, FMA-S was positively correlated with MBI (r_s=0.270, P<0.05), FMA-S score was negatively correlated with HADS-A and HADS-D scores (r_s were respectively -0.300 and -0.374, P<0.01), NIHSS sensory item was positively correlated with HADS-D score (r_s=0.235, P<0.01) .

Conclusion

There is a positive correlation between somatosensory and motor function in different-age-group patients within one year after stroke, and age may affect the correlation between somatosensory function and motor function/ADL/psychosocial function.

Effect of Repeated Peripheral Magnetic Stimulations at Different Sites of Upper Limbs on Wrist Motor Function in Subacute Stroke Patients: a Randomized Controlled Trial

XIE Yong, LIN Jiali, LIU Yanping, CAI Yangfan, LIAN Xiaowen, DING Ling, JIA Jie

2024, 27(23):  2846-2852.  DOI: 10.12114/j.issn.1007-9572.2024.0081

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Background

Wrist motor dysfunction is a common sequela at post-stroke, and the wrist has an important role in improving hand practicality. Therefore, improving the range of motion of the wrist can effectively promote the activities of daily life in post-stroke patients. Although repetitive peripheral magnetic stimulations (rPMS) have been shown to have a significant effect on improving the range of motion of the wrist, the therapeutic effect of different stimulation sites still needs to be further explored.

Objective

To investigate the effect of rPMS on wrist extensor muscle and radial nerve for the motor function of wrist of subacute stroke patients.

Methods

A total of 60 subacute stroke patients with wrist motor dysfunction admitted to Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine from October 2022 to October 2023 were selected as the study subjects. The included patients were randomly divided into control group (20 cases), muscle stimulation group (20 cases) and nerve stimulation group (20 cases) by simple randomized grouping method using a random number table. Patients in all the three groups received routine rehabilitation training, and those in the muscle stimulation group and nerve stimulation group were additionally managed by rPMS on the wrist extensor muscle and the radial nerve, respectively. Before and after the interventions for 10 times of rPMS, integrated electromyography (iEMG), root mean square (RMS) and median frequency (MF) on the surface of the wrist extensor muscle, the Fugl-Meyer Assessment for upper extremity (FMA-UE), the Action Research Arm Test (ARAT) and the modified Barthel Index (MBI) were measured to assess the upper limb function of the affected side.

Results

During the intervention period, there were 2 cases of data loss due to voluntary withdrawal or forced termination of the trial, and finally 20 cases were included in the control group, 19 cases in the muscle stimulation group, and 19 cases in the nerve stimulation group. There were no significant differences in iEMG, RMS and MF of wrist extensor muscle among three groups before treatment (P>0.05). After treatment, iEMG, RMS and MF of wrist extensor muscle in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P<0.05). The iEMG, RMS and MF of wrist extensor muscle in nerve stimulation group were significantly higher than those of muscle stimulation group (P<0.05). The iEMG, RMS and MF of the wrist extensor muscle after treatment were higher than those before treatment in the three groups (P<0.05). There were no significant differences in FMA-UE, ARAT and MBI scores among the three groups before treatment (P>0.05). After treatment, FMA-UE, ARAT and MBI scores in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P<0.05). The scores of FMA-UE, ARAT and MBI in nerve stimulation group were significantly higher than those in muscle stimulation group (P<0.05). The scores of FMA-UE, ARAT and MBI in three groups were significantly higher after treatment than before treatment (P<0.05) .

Conclusion

rPMS on the wrist extensor muscle and the radial nerve can improve the wrist motor dysfunction after stroke, and the effect on the radial nerve is more significant than that on the wrist extensor muscle.

Original Research·Hot Topics·Enteropathy

Advances in Energy Metabolism Regulation of Intestinal Stem Cell Function and the Therapeutic Advantages of Traditional Chinese Medicine

ZHU Yan, XIAO Jin, YANG Yang, TANG Taichun, WANG Shuting, CHEN Siqi, CHEN Min

2024, 27(23):  2853-2857.  DOI: 10.12114/j.issn.1007-9572.2023.0676

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Intestinal stem cells are an important part of maintaining the stability of intestinal barrier function, which is closely related to intestinal homeostasis, intestinal epithelial renewal, and repair of intestinal damage. Normal physiological activities of the human body cannot be separated from energy intake and metabolism, and the differentiation fate of stem cells is affected by energy metabolism, and impaired intestinal barrier is associated with the development of many intestinal diseases. Therefore, this paper focuses on intestinal stem cells, takes energy metabolism and metabolites as the background to investigate how energy metabolism and metabolites regulate the function and activity of stem cells, thus regulating the function of intestinal barrier and providing ideas for the treatment of various intestinal diseases; in addition, with the in-depth research of modern medical science in protecting intestinal barrier, the theory of traditional Chinese medicine (TCM) that cares for spleen and stomach is gradually showing its scientific validity, with the hope of providing ideas for the subsequent research.

Progress of Research on Mechanism of Intestinal Nervous System Regulating Intestinal Inflammation Based on Intestinal Stem Cells

CHEN Siqi, XIAO Jin, TIAN Siyu, ZHANG Jia, WANG Shuting, ZHANG Xindan, ZHU Yan, CHEN Min

2024, 27(23):  2858-2863.  DOI: 10.12114/j.issn.1007-9572.2023.0245

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Intestinal stem cells are regulated by the intestinal nervous system, and both of them are closely related to intestinal inflammation. Relevant studies have shown the existence of intestinal nerve dysfunction in intestinal inflammation. By summarizing the relationship among intestinal stem cells, intestinal nervous system and intestinal inflammation, this paper discusses that intestinal nervous system injury related to intestinal inflammation may be the basis for persistent alteration of intestinal function, while enteric neurons provide feasible targets for improving intestinal nerve dysfunction in inflammatory bowel diseases, so as to apply various types of stem cells to the improvement of intestinal nerve dysfunction in intestinal inflammation.

Advances in Exploring the Interaction between Paneth Cells and Intestinal Stem Cells and Possible Targets for Traditional Chinese Medicine Based on Mitochondrial Function and Energy Metabolism

LUO Guoliang, ZHANG Xindan, TANG Taichun, ZHU Yan, WANG Shuting, CHEN Min

2024, 27(23):  2864-2868.  DOI: 10.12114/j.issn.1007-9572.2023.0574

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Intestinal stem cells and Paneth cells interact with each other to maintain intestinal homeostasis and function, the interaction between intestinal stem cells and Paneth cells is regulated by mitochondria-related functions and energy conversion. The unique advantages of traditional Chinese medicine (TCM) in the treatment of intestinal diseases are also reflected in its effects on mitochondria and energy metabolism. This paper explores the influence of mitochondrial function and energy metabolism on the interaction between intestinal stem cells and Paneth cells, as well as the possible targets related to mitochondria in the treatment of intestinal diseases by TCM, summarizes the regulatory effects of TCM on mitochondria and energy metabolism, thereby restoring intestinal homeostasis and alleviating disease, with an aim to provide reference and theoretical basis for the research related to the TCM treatment of intestinal stem cells and Paneth cells based on mitochondria.

Original Research

Study on the Independent and Joint Effects of Physical Activity and Sleep on Low Back Pain in Middle-aged and Elderly Adults

LI Mingzhe, TIAN Yichuan, WANG Chenglong, WANG Jingjing

2024, 27(23):  2869-2874.  DOI: 10.12114/j.issn.1007-9572.2023.0639

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Background Low back pain (LBP) in middle-aged and elderly adults has become a significant public health issue worldwide. Physical activity and sleep are two core components of the 24-hour lifecycle, and maintaining adequate physical activity and good sleep are crucial for health, both of which are associated with LBP.Objective To investigate the prevalence of LBP in middle-aged and elderly adults in China, analyze the independent and combined effects of physical activity and sleep on its occurrence, and provide scientific evidence for behavioral health.Methods Based on the 2018 China Health and Retirement Longitudinal Study, participants without demographic, physical activity, sleep, and LBP data were excluded. A total of 13 496 eligible individuals aged 45 to 69 were included, and their demographic and behavioral information was collected. Binary logistic regression and multiple linear regression were used to examine the relationship between physical activity, sleep duration, and LBP, and a mediation model was constructed to analyze the mediating effect of sleep duration on the association between physical activity and LBP.Results The prevalence of LBP among the 13 496 participants was 39.0% (n=5 269). Inadequate sleep (<7 hours) was reported by 57.1% (n=7 704) of middle-aged and elderly adults in China, with 11.6% (n=1 561) engaging in mild physical activity and 88.4% (n=11 935) engaging in moderate to high-intensity physical activity. The multicollinearity diagnosis results for confounding variables (gender, age, alcohol consumption, and smoking) showed that all variance inflation factors were less than 5, indicating no collinearity. Regression analysis revealed a positive correlation between physical activity and LBP (β=0.120, P<0.05), a negative correlation between sleep duration and LBP (β=-0.220, P<0.01), and a negative correlation between physical activity and sleep duration (β=-0.081, P<0.05). The mediation analysis of categorical variables indicated Z=2.223>1.96, and the path from physical activity to LBP was not significant (β=0.105, P>0.05), suggesting a complete mediating effect of sleep duration on the association between physical activity and LBP.Conclusion Over one-third of middle-aged and elderly adults in China suffer from LBP. Higher levels of physical activity or shorter sleep duration are associated with increased risk of LBP. Sleep duration plays a complete mediating role in the association between physical activity and LBP, where the increased risk of LBP associated with high-intensity physical activity is completely transmitted through reduced sleep duration. Adequate sleep duration plays an important role in reducing the risk of LBP associated with high-intensity physical activity. This study suggests that older adults should adjust their exercise intensity according to their own conditions and maintain adequate sleep duration to reduce the risk of LBP.

Effects of Menopausal Hormone Therapy Combined with Pelvic Floor Muscle Training on Pelvic Floor Structure in Patients with Stress Urinary Incontinence

GAO Shuaiying, YANG Mukun, SUN Mingli, BAI Wenpei

2024, 27(23):  2875-2882.  DOI: 10.12114/j.issn.1007-9572.2023.0715

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Background

The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasing, leading to a significant impact on both physical and mental well-being due to stress urinary incontinence (SUI) .

Objective

To investigate the impact of menopausal hormone therapy (MHT) in conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate SUI.

Methods

A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital, Capital Medical University in 2022 were selected. They were allocated into the MHT group and the control group in a 2∶1 ratio using a random number table method, and the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen combined with progestogen therapy (EPT) in a 1∶1 ratio. Both the control group and the MHT group underwent pelvic floor muscle training (PFMT), commonly referred to as Kegel exercises, for 15-30 minutes per session, 2-3 times daily, and 2-3 d per weekly, over a continuous period of 12 months. The control group received Kuntai capsules orally in combination with PFMT, with 4 capsules taken per dose, 3 times a day, for 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy (1 mg estradiol valerate + 10 mg dydrogesterone, once daily), continuous sequential estrogen-progestin therapy (femoston 12 courses), and the Tibolone subgroup takes tibolone orally, all of which were administered continuously for 12 months. The study examined serum estradiol (E2) and follicle-stimulating hormone (FSH) levels within and between groups and subgroups before and after treatment. In addition, measurements were obtained for urethral rotation angle (URA), bladder detrusor thickness (BDT), posterior vesicourethral angle (PVUA), levator hiatus area (LHA), urinary incontinence quantification, ICI-Q-SF score, clinical efficacy, as well as changes in the modified Kupperman Menopausal Index (KMI) score, and the modified oxford staging (MOS) .

Results

Upon completion of the study, 7 participants from the MHT group were lost to follow-up (5 in the Tibolone subgroup and 2 in the EPT subgroup), with 3 participants from the control group also lost to follow-up. In the end, a total of 65 participants were included. After 1 year of treatment, there were no statistically significant differences in FSH, E2, and MOS between the MHT group and the control group (P>0.05). After 1 year of treatment, there were no statistically significant differences in PUVA, BDT, and URA between the MHT group and the control group (P>0.05). However, the LHA of the MHT group was significantly lower than that of the control group (P=0.028). After 1 year of treatment, there were no statistically significant differences in PUVA, BDT, URA, and LHA between the EPT and Tibolone subgroups (P>0.05). Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT group (P=0.005). Conversely, no statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroups (P=0.727). After 1 year of treatment, the MHT group showed lower urinary incontinence quantity, ICI-Q-SF score, and KMI score compared to the control group (P<0.05). Before and after the treatment, there were no statistically significant differences in urinary incontinence quantity, ICI-Q-SF score, and KMI score between the EPT and Tibolone subgroups (P>0.05) .

Conclusion

The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Nevertheless, there is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.

Application of Artificial Intelligence-assisted Chromosome Karyotyping Analysis in Prenatal Diagnosis

GUO Caiqin, WANG Junfeng, YANG Lan, SHI Jinping, TANG Ye, ZHAO Di, WU Xiao

2024, 27(23):  2883-2887.  DOI: 10.12114/j.issn.1007-9572.2023.0549

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Background

Chromosomal abnormalities are one of the common causes of birth defects, and karyotype analysis is still an important method for prenatal diagnosis of chromosomal abnormalities as well as an effective way to prevent and control birth defects. However, karyotype analysis, especially chromosomal image segmentation and classification mainly depends on manual work at present, which is laborious and time-consuming. As an emerging approach to karyotype analysis, it is of great significance to investigate the application value of artificial intelligence (AI) in prenatal chromosomal karyotype diagnosis.

Objective

To investigate the application effect and clinical value of AI in prenatal karyotype diagnosis.

Methods

A total of 1 000 pregnant women who received interventional prenatal diagnosis and karyotype analysis of amniotic fluid cells in the department of medical genetics and prenatal diagnosis of Wuxi Maternity and Child Health Care Hospital between 2020 and 2022 were selected as the study subjects. The karyotype analysis of all cases was performed using two-line mode, the results of the AI reading were reviewed by one geneticist in the first line, and another geneticist analyzed the karyotypes by Ikaros karyotype analysis workstation in the second line, the diagnostic results and time were recorded respectively. The final diagnosis of the samples were based on the manual review of the first line and the manual reading of the second line.

Results

Among the 1 000 amniotic fluid samples, 735 cases were diagnosed as normal karyotype, 233 cases as aneuploidy, 0 case as structural abnormality and 32 cases as mosaicism by AI. The numbers of normal karyotype, aneuploidy, structural abnormality and mosaicism assessed by AI-assisted geneticist were 689, 233, 45 and 33, which were completely consistent with those evaluated by geneticist using Ikaros system. Compared with AI-assisted geneticist, AI-based diagnosis had strong consistency (Kappa=0.895, 95%CI=0.866-0.924, P<0.01). The diagnostic accuracy, sensitivity and positive predictive value of AI-based diagnosis was 95.4%, 95.4% and 100.0%, respectively, among which the normal karyotype, aneuploidy, structural abnormality and mosaicism were detected with a sensitivity of 100.0%, 100.0%, 0 and 97.0%, and the positive predictive value of 100.0%, 100.0%, 0 and 100.0%. The average diagnostic time of AI was shorter than that of AI-assisted geneticist and Ikaros-assisted geneticist (P<0.001), and AI-assisted geneticist took less time on average to diagnose than the Ikaros-assisted geneticist (P<0.001) .

Conclusion

AI-assisted karyotype analysis of amniotic fluid cells has a high degree of automation, but its ability to recognize chromosomal structural abnormalities needs to be improved. It is suggested that AI be combined with the geneticist for karyotype analysis in clinical application to ensure the quality of prenatal diagnosis and improve efficiency.

Levels of Endothelial Cell Microparticles miR-126, Mitochondrial Components and Adhesion Molecules in Peripheral Blood of Patients with Acute Myocardial Infarction and Their Clinical Significance

MA Yiping, YUAN Yujuan, NIGERE Alimu, ABULAJIANG Aihemaiti, MA Qingyu, PALIDA Yushanjiang, MUYESAI Nijiati

2024, 27(23):  2888-2896.  DOI: 10.12114/j.issn.1007-9572.2024.0004

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Background

Acute myocardial infarction (AMI) is one of the common cardiovascular diseases, and despite the widespread use of biomarkers for myocardial necrosis, morbidity and mortality of AMI remain high.

Objective

To investigate the expression levels and clinical significance of miR-126, mitochondrial components and adhesion molecules in endothelial microparticles (EMPs) .

Methods

A total of 50 patients with AMI (AMI group), 50 patients with stable coronary artery disease (SCAD) (SCAD group) and 50 healthy subjects (control group) were enrolled in the People's Hospital of Xinjiang Uygur Autonomous Region from September 2021 to September 2022. AMI patients and SCAD patients were hospitalized in our hospital and received percutaneous coronary intervention (PCI), and all healthy subjects were evaluated by the physical examination center of our hospital. Peripheral blood samples and general data of three groups were collected. The morphology of the microparticles (MPs) was observed by transmission electron microscopy (TEM), the level of EMPs was identified by flow cytometry, and the expression of miR-126 in EMPs was detected by fluorescence quantitative PCR. ELISA was used to detect the levels of mitochondrial reactive oxygen species (ROS) and intracellular adhesion molecules [vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), E-selectin, and P-selectin] in EMPs.

Results

As observed by TEM, the membrane structure of the isolated MPs was intact and its diameter ranged from 100 to 400 nm. Compared with the control group, the expression of miR-126 in plasma EMPs in the AMI group was significantly decreased (P<0.001), the expression of ROS was significantly increased (P<0.001), the expression of VCAM-1 was increased (P=0.019), and the expression of ICAM-1 (P<0.001), E-selectin (P=0.019) and P-selectin (P<0.001) were increased. Multivariate Logistic regression analysis showed that the decreased expression of miR-126 (OR=0.026, 95%CI=0.003-0.210, P=0.001) was a protective factor for AMI, increased expression of ROS (OR=1.009, 95%CI=1.005-1.013, P<0.001) and P-selectin (OR=1.063, 95%CI=1.022-1.105, P=0.002) were risk factors for AMI. The receiver operator characteristic curve (ROC) showed that the area under the curve of miR-126 for the diagnosis of AMI was 0.816, the area under the curve of ROS for the diagnosis of AMI was 0.892, the area under the curve of P-selectin for the diagnosis of AMI was 0.728, and the area under the curve of miR-126, ROS and P-selectin combined diagnosis was 0.950.

Conclusion

In EMPs, miR-126, ROS, P-selectin and their combined indicators all have diagnostic value for AMI, and the combined indicators of the three have the highest diagnostic value, indicating that they may be potential diagnostic indicators for AMI patients.

Comparative Analysis of Cervical Cancer Screening Results from 2019 to 2021 in Shihezi City, Xinjiang Uyghur Autonomous Region

QIAO Hui, WEI Yan, LIU Yu, BAI Rui, YANG Ping

2024, 27(23):  2897-2903.  DOI: 10.12114/j.issn.1007-9572.2023.0756

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Background

Cervical cancer (CC) is one of the common malignant tumors that poses a threat to female health. The screening and prevention strategies of CC vary in different regions. The economic and cultural levels in the Xinjiang region differ significantly from those in other areas. It is of practical significance to identify CC screening efficacy in this region, thus favoring the modification of CC screening program.

Objective

To compare and analyze the CC screening results in Shihezi city, Xinjiang Uyghur Autonomous Region from 2019 to 2021, and to understand the distribution of high-risk human papillomavirus (hrHPV) infection and the changes in cervical lesion detection in this region.

Methods

CC screening in Shihezi city was conducted in a three-year interval. We retrospectively collected the screening data of 68 300 women from 2019 to 2021, who underwent hrHPV-based screening in the First Affiliated Hospital of Shihezi University, Shihezi City People's Hospital, and Shihezi Maternal and Child Health Hospital. The distribution of hrHPV infection and the changes in cervical lesion detection from 2019 to 2021 were compared and analyzed.

Results

A total of 18 378, 28 616 and 21 306 individuals were screened for CC in 2019, 2020 and 2021, respectively. The hrHPV-positive rate in 2021 and 2022 was significantly lower than that in 2019 [9.90% (2 109/21 306) vs 9.13% (2 612/28 616) vs 15.32% (2 816/18 378), P<0.017]. The hrHPV 52 type and hrHPV 16 type had the highest positive rates for three consecutive years in Shihezi city. The rate of thin-layer cytology (TCT) examination for non-HPV 16/18 types in 2021 and 2020 was significantly higher than that in 2019 [88.61% (1 502/1 695) vs 74.70% (1 559/2 087) vs 48.90% (1 090/2 229), P<0.017]. Among women who underwent vaginal colposcopy, the positive pathology rate of LSIL (low-grade squamous intraepithelial lesion) and above was the highest in 2021 [52.80% (217/411) ], followed by that in 2020 [41.42% (239/577) ] and the lowest in 2019 [28.53% (107/375) ] (P<0.017) .

Conclusion

The hrHPV-positive rate in Shihezi city, Xinjiang Uyghur Autonomous Region showed certain decline from 2019 to 2021, but hrHPV 52 type and hrHPV 16 type remained the main infection types. Since the initiation of CC screening in 2019, the hrHPV-positive rate has decreased from 15.32% to 9.90%, the TCT examination rate has increased from 48.90% to 88.61%, and the positive rate of cervical lesion detection of LSIL and above has increased from 28.53% to 52.80% from 2019 to 2021. There have been significant improvements in the completion rate of CC screening and the detection rate of cervical lesions.

Clinical Efficacy and Mechanism of Action of Tongnao Decoction Treating Acute Cerebral Infarction: a Study Based on Network Pharmacology and Molecular Docking

ZHANG Lin, GAO Jin, WU Minghua, WANG Guangmei

2024, 27(23):  2904-2912.  DOI: 10.12114/j.issn.1007-9572.2023.0594

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Background

Cerebral infarction is a disorder of blood supply to the local brain tissue area caused by various causes. Tongnao Decoction is approved and used in Jiangsu Province Hospital of Chinese Medicine for the treatment of cerebral infarction. However, the specific mechanisms underlying its action remain unclear.

Objective

To explain the mechanism of Tongnao Decoction in the treatment of cerebral infarction through network pharmacology and clinical trails.

Methods

From January 2019 to June 2020, a total of 199 patients with cerebral infarction admitted to Jiangsu Province Hospital of Chinese Medicine were included in the clinical study. and divided into the control group (97 cases) and experimental group (102 cases) according to the method of random number table. Both groups received standardized treatment for stable cerebral infarction, and the experimental group was treated with Tongnao Decoction. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of functional impairment caused by stroke, and the modified Rankin Scale (mRS) was used to assess the recovery of neurological function for both groups before treatment and at 2 weeks of treatment. The chemical compounds of Tongnao Decoction were screened from TCMSP and literature, and those with bioavailability (OB) ≥30% and drug-like properties (DL) ≥0.18 requirements were selected to find the active ingredient of the prescription. OMIM and GeneCards databases were used to analyze the molecular targets of Tongnao Decoction for the treatment of cerebral infarction. After screening the common targets, Cytoscape software, String database were used to plot the network of compounds and target proteins, construct protein-protein interaction (PPI) network, gene ontology (GO) function, and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis, respectively. Molecular docking experiments were finally performed to identify the main active ingredients of Tongnao Decoction for the treatment of cerebral infarction.

Results

After treatment, the scores of NIHSS and mRS in the experimental group were lower than those in the control group (P<0.05). Finally, 60 active ingredients of Tongnao Decoction were obtained, including 147 potential targets, 5 167 disease-related targets, and 121 intersection targets of drugs and diseases. The enrichment analysis of KEGG signaling pathway obtained prostate cancer, neuroactive ligand-receptor interaction, IL-17 signaling pathway, prolactin signaling pathway, PI3K-Akt signaling pathway, calcium signaling pathway, etc. Molecular docking showed that β-sitosterol, kastricol and carotene, the main active ingredients of Tongnao Decoction in the treatment of stroke, had good binding properties to the core protein androgen receptor (AR) .

Conclusion

Tongnao Decoction may play a role in treating cerebral infarction by activating AR. IL-17 signaling pathway, PI3K-Akt signaling pathway and prolactin signaling pathway are potential mechanisms as well.

Evidence-based Medicine

Effect of Chronic Atrophic Gastritis Treated with Different Acupuncture and Moxibustion Therapies: a Network Meta-analysis

WANG Ting, WANG Haiyan, FU Wenjun

2024, 27(23):  2913-2920.  DOI: 10.12114/j.issn.1007-9572.2023.0660

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Background

Chronic atrophic gastritis is a common clinical precancerous lesion, which is prone to recurrent attacks and seriously affects the quality of life of patients. At present, Western medicine has limited effect in the treatment of chronic atrophic gastritis, while acupuncture has good results in the treatment of chronic atrophic gastritis, but which acupuncture therapy is the best still inconclusive.

Objective

To compare the clinical efficacy among different acupuncture and moxibustion therapies on chronic atrophic gastritis by network meta-analysis.

Methods

The articals of randomized controlled trials for chronic atrophic gastritis treated with acupuncture and moxibustion therapies were searched from CNKI, Wanfang Data, VIP, CBM, PubMed, Embase and Web of Science until April 30, 2023 according to the inclusion exclusion criteria. Literature quality assessment was based on ROB2 bias assessment tool, network meta-analysis was performed using RStudio software, and funnel plotting was used Stata software for publication bias risk assessment.

Results

26 articles involving 10 interventions with a sample size of 2 068 cases were included. The results of network meta-analysis showed that in clinical efficacy, there were five acupuncture therapies were superior to conventional western medicines, including western medicine combined with acupoint injection, catgut embedment in acupoint therapy, western medicine combined with acupuncture, needle warming therapy and acupuncture (P<0.05). The SUCRA ranking result was western medicine combined with acupoint injection (0.86) >catgut embedment in acupoint therapy (0.80) >western medicine combined with acupuncture (0.67) >needle warming therapy and acupuncture (0.59) >western medicine combined with fire dragon moxibustion (0.58) >acupuncture (0.48) >western medicine combined with ginger separated moxibustion (0.40) >thunder-fire moxibustion (0.31) >western medicine combined with electroacupuncture (0.24) >conventional western medicine (0.06). In improving the efficacy of gastroscopy, five acupuncture therapies were superior to conventional western medicines, including catgut embedment in acupoint therapy, needle warming therapy, western medicine combined with acupuncture, acupuncture and western medicine combined with acupoint injection (P<0.05). The SUCRA ranking results show: catgut embedment in acupoint therapy (0.80) >needle warming therapy and acupuncture (0.72) >western medicine combined with acupuncture (0.58) >acupuncture (0.47) >western medicine combined with acupoint injection (0.41) >conventional western medicine (0.01). In terms of pathological efficacy, there were five acupuncture therapies that were superior to conventional western medicines, such as catgut embedment in acupoint therapy and needle warming therapy and acupuncture (P<0.05). The SUCRA ranking results show: catgut embedment in acupoint therapy (0.79) >western medicine combined with acupuncture (0.59) >needle warming therapy and acupuncture (0.53) >acupuncture (0.52) >western medicine combined with acupoint injection (0.51) >conventional western medicine (0.06) .

Conclusion

Western medicine combined with acupoint injection is preferred for patients with obvious clinical symptoms, while catgut embedment in acupoint therapy is preferred for patients with no obvious symptoms. Catgut embedment in acupoint therapy can not only improve the clinical efficacy, but also improve the efficacy of gastroscopy and pathological than other acupuncture treatments.

The Effectiveness of Non-pharmacological Treatment for Post-stroke Shoulder-hand Syndrome: a Network Meta-analysis

HUANG Tengjia, CAO Xi, CHEN Lei, LI Ziying, QIN Lihua

2024, 27(23):  2921-2930.  DOI: 10.12114/j.issn.1007-9572.2023.0727

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Background

Shoulder-hand syndrome is one of the major disabling factors for stroke patients, which seriously affects their physical and psychological health as well as their quality of life. Currently, there are many non-pharmacologic treatments used to treat post-stroke shoulder-hand syndrome, but there is still some confusion about which non-pharmacologic treatment modality is more effective in clinical practice.

Objective

To provide evidence-based support for clinical decision-making, this network meta-analysis evaluates the efficacy of seven non-pharmacological treatments in improving outcomes for post-stroke shoulder-hand syndrome, pain as measured by the Visual Analogue Scale (VAS), and scores on the simplified Fugl-Meyer Assessment (FMA) .

Methods

A computerized search of databases including CNKI, Wanfang Data, VIP, China Biomedical Literature Service System, PubMed, Embase, and Cochrane Library was conducted for randomized controlled trials on non-pharmacological treatments for post-stroke shoulder-hand syndrome up to June 2023. Two researchers independently screened the literature and extracted data, performing the network meta-analysis using RevMan 5.3 and Stata 15.0.

Results

The analysis included 62 studies involving 5 090 patients, assessing interventions such as acupuncture, herbal fumigation, extracorporeal shockwave therapy, moxibustion, herbal hot compress, electrical stimulation, and herbal soak. Results showed that all seven non-pharmacological treatments were superior to the control group in improving overall effectiveness, and FMA scores (P<0.05). Except for moxibustion, the six non-pharmacological treatments were superior to the control group in improving VAS scores in patients with shoulder hand syndrome (P<0.05). In terms of improving overall effectiveness, the cumulative ranking probability area (SUCRA) scores for the treatments were: acupuncture (86.1%), herbal soak (77.1%), herbal fumigation (54.7%), extracorporeal shockwave (53.1%), hot compress (49.0%), electrical stimulation (48.4%), and moxibustion (31.1%), with conventional control treatment at (0.4%). For VAS score improvement, the SUCRA scores were: hot compress (81.3%), herbal soak (78.4%), acupuncture (76.7%), electrical stimulation (58.4%), herbal fumigation (52.7%), extracorporeal shockwave (32.9%), moxibustion (18.1%), and conventional control (1.5%). For FMA score improvement, the SUCRA scores were: herbal soak (90.6%), acupuncture (83.5%), herbal fumigation (59.9%), electrical stimulation (59.8%), extracorporeal shockwave (42.3%), moxibustion (39.7%), hot compress (24.1%), and conventional control (0.2%) .

Conclusion

Compared to conventional treatments, the use or combination of non-pharmacological treatments yields better therapeutic outcomes for treating post-stroke shoulder-hand syndrome. However, due to limitations in the original studies, these conclusions need to be substantiated by further clinical trials.

Research Methodology

Development of a Short Version of the Health Literacy Scale Based on Classical Test Theory and Item Response Theory

SUN Xiaonan, CHEN Ke, WU Yunchou, TANG Jingqi, WANG Fei, SUN Xinying, HE Miao, WU Yibo

2024, 27(23):  2931-2940.  DOI: 10.12114/j.issn.1007-9572.2023.0072

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Background

Health literacy is closely associated with health status, most domestic studies tend to use multidimensional and multi-item tools for assessing health literacy, lacking simple and effective assessment methods.

Objective

To simplify health literacy scale and conduct psychometric test within the Chinese population.

Methods

Adults aged 18 years and above were selected from the "China Family Health Index Survey (2021) " for this investigation. Based on inclusion and exclusion criteria, a total of 7 449 participants were selected and randomly divided into two sample sets, including 3 680 cases in sample set 1 and 3 769 cases in sample set 2. The general information questionnaire, Short-form Health Literacy Questionnaire (HLS-SF12), Perception Social Support Scale (PSSS), and Family Health Scale Short-form (FHS-SF) were administered to the respondents. Classical test theory (CTT) and the Mokken model in item response theory (IRT) were used to screen the original items, and validation analyses such as reliability and validity of the simplified scales were also conducted.

Results

A 9-item version (HLS-SF9) and a 4-item version (HLS-SF4) were simplified by using CTT and the Mokken model, respectively. Both the HLS-SF9 and the HLS-SF4 had no ceiling effect or floor effect, and the Cronbach's α coefficients for both were 0.913 and 0.842, with split-half reliabilities of 0.871 and 0.815, respectively. The exploratory factor analysis of HLS-SF4 revealed one common factor, accounting for 67.813% of the cumulative variance, with factor loadings exceeding 0.81 for each item. The confirmatory factor analysis of HLS-SF9 showed that χ²/df was 10.844, goodness of fit index (GFI) was 0.985, adjusted goodness of fit index (AGFI) was 0.971, normative fit index (NFI) was 0.986, comparative fit index (CFI) was 0.987, and root mean squared error of approximation (RMSEA) was 0.051. The correlation analysis demonstrated positive correlation of HLS-SF9 and HLS-SF4 with PSSS (r=0.367, 0.292, P<0.001), as well as FHS-SF (r=0.340, 0.237, P<0.001), respectively. The intraclass correlation coefficients (ICC) (95%CI) for the criterion validity of HLS-SF9 against HLS-SF12 was 0.989 (0.988-0.999), while for HLS-SF4 against HLS-SF12 was 0.892 (0.886-0.899) .

Conclusion

The simplified health literacy scales have good reliability and validity, which are reliable and effective tools for assessing the health literacy of the Chinese population. Researchers can choose the scale according to the needs of research precision (HLS-SF9) or assessment time (HLS-SF4) .