Table of Content

15 September 2024, Volume 27 Issue 26

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Guidelines Interpretation

Interpretation of the Position Paper on Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-related Cardiovascular Diseases by the Italian Society of Arterial Hypertension (SIIA) in 2023

YANG Rong, YANG Ziyu, LIAO Xiaoyang, LIU Lidi, ZHANG Peng, TIAN Chenyu, YANG Hanfei, YAO Yi, JIA Yu, CHENG Yonglang, SHEN Can, JIANG Lihua, DAI Hua

2024, 27(26):  3197-3203.  DOI: 10.12114/j.issn.1007-9572.2024.0096

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High prevalence and low control rate of hypertension have brought a significant disease burden globally. In order to improve the level of hypertension prevention and treatment, remote healthcare and digital medicine have been rapidly developed and widely used worldwide. Currently, there are no relevant regulations in China for these technologies. In 2023, the Italian Society of Arterial Hypertension issued a position statement to guide the development, validation, and clinical use of remote medicine and digital healthcare. This article will interpret this position paper, focusing on the forms of application of telemedicine and digital healthcare in managing hypertension and its related cardiovascular diseases, key research evidence, existing advantages, as well as current opportunities and challenges. The aim is to guide general practitioners in China on how to utilize these technologies in managing hypertension and related cardiovascular conditions.

Hot Topics

Research Progress of Digital Therapy in Hypertension Disease Management

HE Qing, LI Lin, WANG Zihan, DAI Tiangu, ZHANG Gaoyu, FAN Jiarong, XIAO Xiang

2024, 27(26):  3204-3211.  DOI: 10.12114/j.issn.1007-9572.2023.0767

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Although medicine is developing rapidly, many chronic diseases are still extremely challenging to manage and control at the moment. In China, the prevalence rates of hypertension are still on the rise, making early identification, therapy, and prevention of the condition crucial. Digital therapy makes use of the Internet to assist patients with hypertension in strengthening their understanding of hypertension, encouraging the proper administration of hypertension medication, and improving their ability to manage their own health. This paper aims to provide an overview of the current state of digital therapy application in the medical field, investigate the viability and suitability of these therapies for the treatment of hypertension, and anticipate the advancement of digital therapy-based hypertension management and treatment in the future. Future developments in digital therapy involve bringing together the knowledge of Chinese medicine health management, optimizing the benefits of digitizing both Chinese and western medicine for the diagnosis and treatment of hypertension, forming a professional team for digital therapy, safeguarding patient privacy and data security, and offering patients more convenient, effective, and secure preventive and treatment options.

Application Progress of Electronic Health Technology in Home Management of Patients with Heart Failure

CHEN Kejun, YANG Yifei, GONG Jing, YANG Binxu, ZHOU Jing

2024, 27(26):  3212-3217.  DOI: 10.12114/j.issn.1007-9572.2023.0927

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Heart failure is a cardiovascular disease that poses a serious health risk to the global population and is characterised by a chronic and prolonged disease course. Effective management centered on home care is essential for controlling symptoms and improving patient prognosis. Electronic health (e-health) technology is one of the hotspots in the research field of home management of heart failure, with the advantage of overcoming temporal and spatial barriers, and can achieve continuous monitoring, intelligent assessment, and dynamic management of the health status of patients at home. This paper systematically sorts out the related research on e-health in home management of patients with heart failure, and discusses its application value in drug management, exercise rehabilitation, symptom management, risk profile, and other aspects of patients with heart failure. It also analyzes and prospects the limitations of the e-health system such as poor digital inclusion, imperfect operation system, and risk of data security. The purpose of this study is to provide reference for the innovation of home management model for patients with heart failure.

The Hotspots and Frontier Trends of Artificial Intelligence in the Clinical Diagnosis and Treatment of Alzheimer's Disease: Bibliometric Analysis of the Past 20 Years

YU Ruxia, JIANG Jing, WANG Qiucheng, WANG Yue, ZHAO Xiaoyue

2024, 27(26):  3218-3226.  DOI: 10.12114/j.issn.1007-9572.2023.0704

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Background

Currently, the number of research papers on the application of artificial intelligence to the field of Alzheimer's disease (AD) has increased significantly. It is important to clarify the latest research hotspots and future development trends in this field.

Objective

To summarize the relevant research on the application of artificial intelligence to AD through bibliometric analysis, and clarify the research hotspots and trends from 2004 to 2023.

Methods

Literature on the application of artificial intelligence to AD from January 2004 to June 2023 was searched for in the Web of Science core database, and Microsoft Office Excel, CiteSpace, and VOSviewer software were used to visually analyze the number of publications, countries, authors, institutions, keywords, and co-citation networks of the literature.

Results

Ultimately 3 189 articles were included. The number of literature on the application of artificial intelligence to AD has steadily increased since 2004 and has grown rapidly since 2015, with a maximum of over 600 articles. A total of 94 countries, 3 930 institutions, 13 563 authors, and 52 019 cited authors participated in this study. Among them, the United States and China were in a leading position in this field; Republic of Korea universities ranked first in terms of the number of publications; In addition, ZHANG DAOQIANG, LIU MINGXIA, SUK HEUNG-IL, and CLIFFORD R. JACK Jr were not only prolific authors but also the authors with the most citations. The visualization analysis of keywords and literature citations revealed that regarding the application of artificial intelligence to AD, the diagnosis and disease course classification of AD, as well as the prediction of its risk factors, are current research hotspots and that task analysis are future research trends.

Conclusion

The application of artificial intelligence to AD has attracted widespread attention from researchers worldwide. The diagnosis and classification of AD, as well as the prediction of its risk factors, are current research hotspots. Developing adjunctive drugs in task analysis, personalized treatment and care, and improving the algorithm performance of artificial intelligence may be research trends in the future.

Original Research

Correlation between Remnant Cholesterol and the Risk of Ischemic Stroke Recurrence and Its Predictive Value

LIU Xingyu, DU Huijie, MO Jiali, XU Minghuan, LIU Zuting, YANG Xuezhi, ZHANG Huiqin, YI Yingping, KUANG Jie

2024, 27(26):  3227-3231.  DOI: 10.12114/j.issn.1007-9572.2024.0012

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Background

Serum remnant cholesterol (RC) is associated with the onset of ischemic stroke (IS). However, studies on the correlation between RC levels and recurrent IS are limited, and the predictive value of RC in recurrent IS has not been analyzed.

Objective

To investigate the correlation between serum RC and the recurrence of IS, and to evaluate the predictive value of RC levels in recurrent IS by detecting serum RC levels in patients with IS.

Methods

Patients diagnosed as IS and hospitalized in the First Affiliated Hospital of Nanchang University, the Second Affiliated Hospital of Nanchang University, the Second Hospital of Nanchang, and the Third Hospital of Nanchang from March 2019 to March 2021 were included in the study. Relevant clinical information within 48 hours of admission was collected. All patients were followed up for 12 months to record the cases of recurrent IS. Cox regression and Restricted Cubic Spline (RCS) were performed to identify the correlation between RC levels and recurrent IS. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of RC levels in recurrent IS.

Results

A total of 1 023 eligible patients were included in the study, and 107 (10.46%) of them experienced IS recurrence within 1 year. Multivariable Cox regression analysis showed that high RC was an independent risk factor for recurrent IS (HR=2.709, 95%CI=1.150-6.382; P<0.05). There was a nonlinear positive dose-response relationship between RC levels and the risk of recurrent IS (P-Nonlinear=0.019 3). The area under the curve (AUC) of RC in discriminating 1-year recurrence of IS was 0.687 (95%CI=0.631-0.743), with the optimal cutoff of 0.58 mmol/L. There was a significant difference in the AUC between the combination detection of RC and the Essen Stroke Risk Score (ESRS) versus ESRS alone in discriminating 1-year recurrence of IS (Z=2.356 2, P<0.05) .

Conclusion

High RC is an independent risk factor for recurrent IS, showing a predictive value in the recurrence of IS.

Establishment and Verification of Risk Prediction Model for Silent Brain Infarction in Maintenance Hemodialysis Patients: a Multicenter Study

LI Qiuling, TANG Wenwu, YU Yiwen, DENG Huan, YANG Xiaohua, CHEN Xiaoxia, JI Yifei

2024, 27(26):  3232-3239.  DOI: 10.12114/j.issn.1007-9572.2023.0762

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Background

Maintenance hemodialysis (MHD) patients have a high incidence of silent brain infarction (SBI) and are in the preclinical stage of symptomatic stroke and vascular dementia. Therefore, there is a great need to explore the risk of SBI in patients with MHD for early detection and reduction of poor prognosis.

Objective

To explore the risk factors for the occurrence of SBI in MHD patients, a predictive model was constructed and its performance was evaluated.

Methods

486 MHD patients from 4 centers (Nanchong Central Hospital Affiliated to North Sichuan Medical College, Guangyuan Central Hospital, Suining Central Hospital, and Pengan County People's Hospital) from January 2017 to October 2022 were included. Patients with MHD were divided into an SBI group (n=102) and a non-SBI group (n=384) using the presence or absence of SBI as the outcome event, and the baseline characteristics of the two study groups were compared. Patients were randomized in a 7∶3 ratio to the modeling set (n=340) and the validation set (n=146). The predictor variables were identified through LASSO regression and multifactorial Logistic regression analyses, and a risk prediction model for the occurrence of SBI in patients with MHD was constructed and presented as a nomographic chart. The predictive performance, accuracy, and clinical utility of the model were evaluated using area under the ROC curve, calibration curve, and decision curve analysis.

Results

In the modeling set, 70 cases (20.6%) of MHD patients experienced SBI, while in the validation set, 32 cases (21.9%) of patients experienced SBI. The results of LASSO regression combined with multifactor logistic regression analysis showed that age (OR=1.027, 95%CI=1.005-1.050), history of alcohol consumption (OR=4.487, 95%CI=2.075-9.706), BMI (OR=1.082, 95%CI=1.011-1.156), insufficient sleep or excessive sleep (OR=6.286, 95%CI=3.560-11.282), history of chronic disease (chronic obstructive pulmonary disease, diabetes, chronic hepatitis B) (OR=1.873, 95%CI=1.067-3.347), serum lactate level (OR=1.452, 95%CI=1.152-1.897), urea reduction ratio (URR) (OR=0.922, 95%CI=0.875-0.970), and history of antiplatelet medication (OR=0.149, 95%CI=0.030-0.490) were independent influences on the occurrence of SBI in MHD patients (P<0.05). A predictive model incorporating the aforementioned 8 influencing factors was constructed, and a nomographic chart was developed. The area under the ROC curve of the predictive model in the modeling set and validation set were 0.816 (95%CI=0.759-0.873) and 0.808 (95%CI=0.723-0.893), respectively, and the calibration curves show good consistency. DCA curve suggested that this model could provide maximum clinical benefit to patients.

Conclusion

A prediction model for the risk of SBI in MHD patients based on age, history of alcohol consumption, BMI, insufficient sleep or excessive sleep, history of chronic disease (chronic obstructive pulmonary disease, diabetes, chronic hepatitis B), serum lactate level, URR, and history of antiplatelet medication demonstrated good predictive performance and clinical utility. It is expected to accurately and individually assess the risk of SBI in MHD patients and implement early interventions to reduce the incidence rate.

Investigation on Risk Factors and Main Symptoms of Long COVID and Their Influences on the Follow-up Research

LI Songjiao, LEI Kangchen, HUANG Hongwen, SONG Jiali, CHANG Yinghui, FAN Xiaonong, LI Li, DU Yuzheng, LIU Jian, CAI Xinru, BIAN Lina, MENG Lina, SONG Qian, SHEN Yan, GE Wenyi, LIU Wei, LI Yibing, JIA Hongbo, GAO Ying, MA Congcong

2024, 27(26):  3240-3248.  DOI: 10.12114/j.issn.1007-9572.2023.0920

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Background

Long COVID is a common problem in the recovery period of coronavirus disease (COVID-19). The prevention and treatment of long COVID has become the focus of the medical fields of COVID-19. It is important to clarify the situation of long COVID in China and find out the follow-up research route, thus providing evidence-based evidence for clinical practice.

Objective

To explore the characteristics of long COVID in China, aiming to provide references for the follow-up research.

Methods

From January 2023 to August 2023, a self-made survey questionnaire was used to investigate the current situation of long COVID in China. The questionnaire included general information, such as gender and age, treatment expectations, symptoms and signs in acute and recovery period, etc.

Results

A total of 1 001 questionnaires were collected, including 901 people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and 585 (64.9%) people with long COVID. Binary Logistic regression analysis showed that female (OR=2.000, 95%CI=1.477-2.705, P<0.05), history of cancer (OR=4.424, 95%CI=1.316-14.868, P<0.05), and retirement (OR=1.527, 95%CI=1.048-2.224, P<0.05) were risk factors for long COVID. Among the 19 symptoms and signs of long COVID, the top three were fatigue (341 people), decrease of memory, comprehension and attention (274 people), and insomnia (217 people). Low back pain was the leading pain symptom (201 people). Hair loss was the number one sign to be difficult to self-healing (58.57%). Acupuncture (55.73%) was the top 1 willingness of treatment, followed by Chinese herbal decoction (53.68%), Chinese traditional patent medicine (47.01%), Western medicine (24.79%), intravenous drip (12.14%), and hospitalization (11.97%) .

Conclusion

The incidence of long COVID is relatively high in China. Acupuncture therapy enjoys a widespread favor among patients. It is recommended to carry out targeted research to enhance the clinical evidence for the prevention and treatment of acupuncture therapy. Women, cancer patients, and retired individuals (elderly people) are high-risk groups for long COVID, and low immune function is a common feature among them. It is suggested to establish a database incorporating these populations and conduct cohort studies on the prevention of long COVID through acupuncture. Fatigue, insomnia, and low back pain are more representative symptoms of long COVID, and randomized controlled studies on acupuncture treatment for these three symptoms at first are recommended.

Study on the Efficacy and Safety of Kuhuang Injection and Kuhuang Granules in the Sequential Treatment of Drug-induced Liver Injury: a Non-inferiority Randomized Controlled Trial

ZHANG Jiateng, KONG Ming, CHEN Yu, DUAN Zhongping

2024, 27(26):  3249-3254.  DOI: 10.12114/j.issn.1007-9572.2024.0025

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Background

Drug-induced liver injury is the third major liver disease, following viral hepatitis and fatty liver disease. Timely diagnosis and effective treatment are crucial in halting disease progression and improving cure rates. Kuhuang preparation has been widely used in treating acute and chronic hepatitis stemming from various causes, particularly in patients manifesting jaundice, demonstrating clear clinical efficacy and safety. Nonetheless, there remains a dearth of evidence-based medical data concerning the efficacy and safety of hepatoprotective measures in patients with acute drug-induced liver injury.

Objective

To evaluate the efficacy and safety of Kuhuang injection sequential Kuhuang granules in the treatment of drug-induced liver injury.

Methods

Using a randomized, positive-controlled, non-inferiority trial design, 93 patients diagnosed with acute drug-induced liver injury at Beijing Youan Hospital, Capital Medical University, between November 2021 and September 2023 were selected. These patients were allocated through single-center randomization, with 49 cases assigned to the experimental group and 44 cases to the control group. After receiving conventional hepatoprotective therapy for 4 weeks, the experimental group and the control group were treated with Kuhuang injection/ adenosylmethionine butanedisulfonate for injection for 2 weeks, followed by Kuhuang granules/enteric-coated tablets of adenosylmethionine butanedisulfonate for another 2 weeks. The efficacy rates of jaundice regression, as well as changes in key liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), total bile acid (TBA) ] at baseline, 2 weeks, and 4 weeks of treatment, along with their normalization rates, were compared between the two groups.

Results

A total of 4 patients fell off during treatment, including 3 patients in the experimental group and 1 patient in the control group. Following 2 and 4 weeks of treatment, there was no significant difference observed in the efficient rate of jaundice regression between the two groups (P>0.05). Similarly, no significant differences were detected in the levels of ALT, AST, ALP, GGT, TBIL, and TBA between the two groups at the 2-week and 4-week marks of treatment (P>0.05). Additionally, there were no notable variations in the recurrence rates of ALT, AST, ALP, GGT, TBIL, and TBA between the two groups following 2 and 4 weeks of treatment (P>0.05) .

Conclusion

Kuhuang Injection Sequential Kuhuang Granules has definite efficacy and good safety in the treatment of drug-induced liver injury, and is not inferior to adenosylmethionine butyldisulfonate for injection sequential enteric-coated tablets of adenosylmethionine butanedisulfonate.

The Correlation between Red Blood Cell Distribution Width Level and Hypertension in Patients with Obstructive Sleep Apnea

CHANG Yuan, LIU Shuang, GAO Yinghui, ZHANG Wei, HAN Fang

2024, 27(26):  3255-3263.  DOI: 10.12114/j.issn.1007-9572.2023.0828

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Background

Hypertension and obstructive sleep apnea (OSA) often coexist, posing challenges in the management of blood pressure in these patients. A reliable and objective predictor is needed to anticipate the occurrence of hypertension and assess the status of blood pressure control in OSA patients, which would facilitate their blood pressure management.

Objective

To explore the correlation between red blood cell distribution width (RDW) and hypertension in patients with OSA.

Methods

A retrospective study was conducted at the Sleep Center of Peking University International Hospital, involving 510 patients who were diagnosed with OSA using polysomnography between January 2019 and September 2022. The derivation cohort comprised of 370 enrolled patients between January 2019 and December 2021, while the validation cohort included the remaining 140 patients enrolled between January and September 2022. Within the derivation cohort, patients were categorized into two groups based on their adherence to the definition of hypertension: hypertension group (n=211) and non-hypertension group (n=159). Subsequently, the hypertension group was further divided into two subgroups: blood pressure control subgroup (n=107) and blood pressure uncontrolled subgroup (n=104). The clinical characteristics and laboratory examination results of patients in the hypertension group and non-hypertension group, as well as those in the blood pressure control subgroup and blood pressure uncontrolled subgroup, were analyzed. Univariate and multivariate Logistic regression analyses were employed to investigate the predictors of hypertension in OSA patients and the status of blood pressure control in OSA patients with combined hypertension. The receiver operating characteristic (ROC) curve was plotted to evaluate the sensitivity and specificity of RDW in predicting the occurrence of hypertension among OSA patients, with its validity confirmed in the validation cohort.

Results

The multivariate Logistic regression analysis revealed that an increased BMI (OR=1.087, 95%CI=1.007-1.174, P=0.032), diabetes (OR=3.310, 95%CI=1.484-7.380, P=0.003), and a decreased RDW (OR=0.598, 95%CI=0.507-0.704, P<0.001) were independent predictors of hypertension in OSA patients. Furthermore, an increased hemoglobin level (OR=1.027, 95%CI=1.005-1.050, P=0.016) and a decreased RDW (OR=0.804, 95%CI=0.669-0.965, P=0.019) were identified as independent predictors of poor blood pressure control status in OSA patients with combined hypertension. The results of ROC curve analysis for RDW in predicting hypertension in OSA patients showed that the area under the ROC curve was 0.779 (95%CI=0.732-0.826, P<0.001), with an optimal cut-off value identified at 39.9 fL. Considering the clinical usability, when using an RDW≤40 fL as the threshold value, the sensitivity and specificity for predicting hypertension in OSA patients were 70.14% and 81.76%, respectively. The validation cohort, utilizing an RDW cutoff value of ≤40 fL, demonstrated that RDW predicted the hypertension in OSA patients with a sensitivity of 63.64% and a specificity of 80.95%. The area under the ROC curve was 0.757 (95%CI=0.678-0.835, P<0.001) .

Conclusion

The reduction of RDW is associated with the occurrence of hypertension and poor blood pressure control status in patients with OSA. OSA patients exhibiting decreased RDW level are at an elevated risk for hypertension.

Warm Qi Arrives after Tuina: Dose-effect Association between Number of Tuina and Warming Effect Measured Using Infrared Thermal Imaging

HUANG Fan, ZHENG Beisi, HUANG Jiaying, HUANG Qianying, LI Tao, WU Shan, LIN Yanzhao, FAN Zhiyong

2024, 27(26):  3264-3272.  DOI: 10.12114/j.issn.1007-9572.2022.0858

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Background

An increasing number of objective measurements are used to explore the dose-effect relationship of Tuina, but infrared thermal imaging has been rarely used.

Objective

To compare the temperature, muscle tone and pain threshold in the lesion area yielded by different times (3, 5 and 7) of Tuina with cross-palm pressing manipulation using infrared thermal imaging, providing a basis for the use of infrared thermal imaging to study the dose-effect of Tuina.

Methods

Eighteen patients with thoracic facet joint disorder (T3-T4) who visited Tuina Department, Guangdong Provincial Hospital of Chinese Medicine (Dade Road Main Hospital) from 17th June, 2021 to 24th December, 2021 were recruited and randomized into three groups by the number of Tuina with cross-palm pressing manipulation: 7-time group (n=6), 5-time group (n=6) and 3-time group (n=6). The infrared thermal imager was utilized to obtain a full body infrared thermogram, and extract the average temperature in the lesion area. The muscle tone of the erector spinae muscle adjacent to the affected thoracic vertebrae was measured by the tissue tension test. The pain pressure threshold of the site adjacent to paraspinal process of the affected thoracic vertebra was measured by the pain-threshold analyzer.

Results

After intervention, the temperature on the site 0.5 inch to the right spinous process of T3 (T3 R) or T4 (T4 R) in 3-time group decreased significantly (P<0.05). After intervention, there were statistically significant differences among the three groups in muscle tension on the site 0.5 inch to the left spinous process of T3 (T3 L) at 0.2 kg, T3 R at 0.2 kg, on the site 0.5 inch to the left spinous process of T4 (T4 L) at 0.2 kg, T4 L at 0.5 kg, T4 L at 0.8 kg, T4 R at 0.2 kg, or T4 R at 0.5 kg (P<0.05). The muscle tnsion of T3 R at 0.2 and 0.5 kg was higher significantly in 7-time group after intervention (P<0.05). The pain pressure threshold of T3 L, T3 R, T4 L, and T4 R was lowered significantly in 3-time group after intervention (P<0.05). The pain pressure threshold of T3 L and T3 R was lowered significantly in 7-time group after intervention (P<0.05). No adverse events were reported.

Conclusion

Fewer number of Tuina with cross-palm pressing manipulation may generate better improvement in clinical outcomes. Further research is required to explore the dose-effect of Tuina using the infrared thermal imaging, and our study may provide useful ideas for reference.

Original Research·Research on Geriatric·Cognitive Impairment

Advances in Cognitive Function Health Management Strategies for Individuals with Mild Cognitive Impairment in Community

WANG Chenyu, ZHANG Chen, SHI Lulu, ZHU Mengna, WANG Lina

2024, 27(26):  3273-3280.  DOI: 10.12114/j.issn.1007-9572.2023.0880

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As the primary place of treatment for mild cognitive impairment (MCI), community primary medical institutions need to carry out cognitive function health management for the MCI population. At present, the community still lacks the specific process and program of MCI cognitive function health management. Based on the "Structure-Process-Results" three-dimensional quality structure theoretical model, this study reviewed the community MCI cognitive function health management strategies from three dimensions of functional departments and organizational structure (Structure), health management program (Process) and effect evaluation system and methods (Results), aiming to provide support and reference for the standardized and process-oriented MCI cognitive function health management practice in Chinese communities.

Research of Influencing Factors for Physical Impairment Combined with Cognitive Impairment in the Elderly

LIU Xin, WEI Yanan, LIU Jie, WANG Jingtong

2024, 27(26):  3281-3288.  DOI: 10.12114/j.issn.1007-9572.2023.0844

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Background

In recent years, physical impairment (PI) combined with cognitive impairment (CI) is a common comorbidity in the elderly. An early detection of PI combined with CI in the elderly and timely interventions may help to improve the quality of life of the elderly and reduce the burden on their families and society. However, relevant studies on the comorbidity of PI and CI in the elderly and its influencing factors have been rarely reported.

Objective

To observe the clinical characteristics of the comorbidity of PI and CI in the elderly and the influencing factors.

Methods

Elderly patients hospitalized in Peking University People's Hospital from September 2018 to November 2019 were selected. A total of eligible 244 subjects meeting the inclusion criteria were surveyed for the physical function and cognitive function using the Short Physical Performance Battery (SPPB) and the Mini-mental State Examination (MMSE), respectively. PI was diagnosed with lower than 10 points of the SPPB, and CI was diagnosed with lower than 27 points of the MMSE. Patients were divided into non-PI+non-CI, PI+non-CI, non-PI+CI, PI+CI. Social demographic, anthropometric, laboratory examination and other indicators of patients were collected, and Logistic regression analysis was used to explore the influencing factors for PI combined with CI in the elderly.

Results

Among the 244 patients, there were 102 (41.80%), 64 (26.23%), 26 (10.66%) and 52 (21.31%) cases of non-PI+non-CI, PI+non-CI, non-PI+CI and PI+CI, respectively. Multivariate binary Logistic regression analysis showed that compared with non-PI+non-CI cases, age (P<0.001, OR=1.216, 95%CI=1.217-1.312) and grip strength (P<0.001, OR=0.875, 95%CI=0.813-0.941) were independent influencing factors for PI+CI cases. Compared with PI+non-CI cases, fatty liver disease (P=0.007, OR=0.200, 95%CI=0.062-0.646), hypertension (P=0.007, OR=3.596, 95%CI=1.414-9.143), and grip strength (P=0.038, OR=0.943, 95%CI=0.891-0.997) were independent influencing factors for PI+CI cases. Compared with non-PI+CI cases, age (P=0.008, OR=1.104, 95%CI=1.026-1.189) and grip strength (P=0.004, OR=0.889, 95%CI=0.821-0.963) were independent influencing factors for PI+CI cases.

Conclusion

Grip strength is the independent influencing factor for PI combined with CI in the elderly. Among the elderly patients without PI and CI, age and grip strength were the influencing factors of PI and CI. In elderly patients with PI and no CI, fatty liver, hypertension and grip strength were the influencing factors of PI and CI.

Latent Class Analysis and Influence Factors Study of Cognitive Function among Older People with Chronic Diseases in Community

FENG Zihang, ZHU Yaning, SUN Ying, LUO Ruzhen, CHEN Hongbo, LIU Jingying, CHENG Ranran, LIU Yanhui

2024, 27(26):  3289-3296.  DOI: 10.12114/j.issn.1007-9572.2024.0014

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Background

Older people with chronic diseases in the community have a higher risk of impaired cognitive function, which seriously threatens their quality of life. Improving cognitive function is crucial for enhancing their quality of life. However, there is heterogeneity in the forms of individual cognitive impairment, and how to effectively improve their cognitive function needs to be further explored.

Objective

To explore the Latent class of cognitive function among older people with chronic diseases in the community, and analyze the influence factors of different categories, to provide a reference for formulating targeted cognitive function improvement strategies for older people with chronic diseases in the community.

Methods

Convenience sampling was used to recruit 502 older people with chronic diseases in the community who visited the Tianjin University of Traditional Chinese Medicine Affiliated Baokang Hospital from September to December 2022, using the General Information Questionnaire, Mini-mental State Examination (MMSE), Activity of Daily Living Scale (ADLS), Social Support Rating Scale (SSRS), and Cognitive Reserve Questionnaire (CR). Mplus 8.3 was used to conduct a latent class analysis of cognitive function among older people with chronic diseases in the community and establish a subgroup model. Univariate analysis and unordered multiple Logistic regression were used to analyze the influence factors of cognitive function among older people with chronic diseases in different categories.

Results

In this study, a total of 526 questionnaires were distributed and 502 valid questionnaires were recovered, with an effective response rate of 95.44%. The cognitive function among 502 older people with chronic diseases in the community was classified into three categories: high cognition with memory impairment group (n=253), moderate cognition with attention impairment group (n=158), and low cognition with overall impairment group (n=91). Unordered multivariate Logistic regression analysis showed that the high cognition with memory impairment group compared to the low cognition with overall impairment group, older people aged 60-74 years (OR=2.315, 95%CI=1.163-4.608, P=0.017), with two chronic diseases (OR=4.105, 95%CI=1.807-9.327, P=0.001), normal blood pressure (OR=2.763, 95%CI=1.414-5.400, P=0.003), normal blood lipids (OR=2.016, 95%CI=1.014-4.008, P=0.046), higher CR scores (OR=1.031, 95%CI=1.005-1.057, P=0.018), and higher SSRS scores (OR=1.055, 95%CI=1.007-1.105, P=0.023) were more likely to belong to the high cognition with memory impairment group, while those with higher ADLS scores (OR=0.920, 95%CI=0.885-0.957, P<0.001) were more likely to belong to the low cognition with overall impairment group. Similarly, in the moderate cognition with attention impairment group compared to the low cognition with overall impairment group, older people with chronic diseases in the community with two chronic diseases (OR=2.862, 95%CI=1.254-6.529, P=0.012), normal blood pressure (OR=2.655, 95%CI=1.350-5.225, P=0.005), normal blood lipids (OR=2.310, 95%CI=1.147-4.652, P=0.019), and higher SSRS scores (OR=1.077, 95%CI=1.027-1.129, P=0.002) were more likely to belong to the moderate cognition with attention impairment group, while those with higher ADLS scores (OR=0.948, 95%CI=0.913-0.984, P=0.005) were more likely to belong to the low cognition with overall impairment group.

Conclusion

There are significant differences in the classification characteristics of cognitive function among older people with chronic diseases in the community. Age, number of chronic diseases, blood pressure, blood lipids, cognitive reserve, social support, and activities of daily living are the influencing factors of the latent classes of cognitive function. Medical staff should actively identify the cognitive function characteristics of different categories of older people with chronic diseases in the community, and provide timely and effective intervention measures to improve the cognitive function level of older people with chronic diseases in the community.

Cognitive Impairment in the Elderly: a Survey and Analysis of Influencing Factors

FENG Yuhui, LI Shanshan, TAO Jianwen, HUANG Yanyan

2024, 27(26):  3297-3303.  DOI: 10.12114/j.issn.1007-9572.2024.0087

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Background

With the intensifying trend of population aging, cognitive impairment has become one of China's significant public health challenges. The impact of lifestyle on cognitive impairment warrants further exploration.

Objective

This study aims to ascertain the prevalence of cognitive impairment among the elderly in the Baoshan District of Shanghai and analyze how educational level, economic status, lifestyle, and comorbidities affect cognitive impairment, providing a scientific basis for early prevention and control.

Methods

From July 2020 to August 2020, a stratified random sampling method was employed to survey 374 residents aged 65 and older in the Dachang Community of Baoshan District, using the Montreal Cognitive Assessment Basic Scale (MoCA-B) for cognitive evaluation. Multivariate Logistic regression analysis was used to explore the factors influencing cognitive impairment among the elderly.

Results

A total of 374 valid questionnaires were retrieved, with a response rate of 100.0%. The prevalence of cognitive impairment among the suburban elderly population over the age of 65 in Shanghai was 37.7% (141/374). The multivariate Logistic regression analysis indicated that socializing and chatting (OR=0.574, 95%CI=0.350-0.941) were protective factors against cognitive impairment (P<0.05), while aging (OR=1.568, 95%CI=1.207-2.307), living alone (OR=3.569, 95%CI=1.079-11.807), and daily sedentary time of ≥3 hours (OR=1.944, 95%CI=1.091-3.462) were risk factors (P<0.05) .

Conclusion

Over one-third of the elderly in the suburban areas of Shanghai suffer from cognitive impairment; advanced age, living alone, and prolonged daily sedentary behavior are significant risk factors that should be closely monitored.

Evidence-based Medicine

Alcohol Intake and Risk of Stroke: a Dose-response Meta-analysis

HAN Xuemei, ZHAO Chunshan, MEI Chunli, CHEN Dan

2024, 27(26):  3304-3311.  DOI: 10.12114/j.issn.1007-9572.2024.0043

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Background

Stroke, as a major chronic non-communicable disease, seriously affects the health of the nation and imposes a heavy burden on patients, families and society. Alcohol consumption is common in China, and there is a close relationship between alcohol intake and stroke incidence, but the relationship between alcohol intake and stroke incidence is still controversial.

Objective

To investigate the relationship between alcohol intake and risk of stroke.

Methods

PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang Data, and SinoMed were searched for prospective cohort studies on the relationship between alcohol intake and risk of stroke from inception to December 2023. Literature screening, data extraction, and literature quality evaluation were performed independently by 2 researchers. Stata/MP 17.0 was used for dose-response meta-analysis.

Results

A total of 16 papers with 548 595 study subjects were included. Meta-analysis results showed that alcohol intake was associated with the risk of stroke (RR=1.17, 95%CI=1.10-1.26, P<0.05). The results of the subgroup analysis showed that the risk of stroke was increased by 10% for alcohol intake <20 g per day (RR=0.90, 95%CI=0.85-0.95, P<0.05) ; alcohol intake >40 g increased the risk of stroke by 35% (RR=1.35, 95%CI=1.23-1.49, P<0.05) ; alcohol intake increased the risk of hemorrhagic stroke by 49% (RR=1.49, 95%CI=1.14-1.95, P<0.05), alcohol intake ischemic stroke risk increased by 20% (RR=1.20, 95%CI=1.00-1.43, P<0.05) ; alcohol intake in Asian populations increased the risk of stroke incidence by 27% (RR=1.27, 95%CI=1.14-1.40, P<0.05) ; intake alcohol in men increased the risk of stroke by 19% (RR=1.19, 95%CI=1.09-1.29, P<0.05). Dose-response Meta-analysis showed a J-shaped nonlinear relationship between alcohol intake and risk of stroke (P=0.018), and the relative risk ratios of stroke for alcohol intake in drinkers compared with never-drinkers were 1 g/d: RR=0.97, 95%CI=0.96-0.98; 2 g/d: RR=0.96, 95%CI=0.94-0.97; 3 g/d: RR=0.95, 95%CI=0.93-0.97; 4 g/d: RR=0.94, 95%CI=0.91-0.96; 5 g/d: RR=0.91, 95%CI=0.88-0.94; 6 g/d: RR=0.90, 95%CI=0.86-0.93; 7 g/d: RR=0.88, 95%CI=0.84-0.92; 8 g/d: RR=0.88, 95%CI=0.83-0.92; 9 g/d: RR=0.88, 95%CI=0.83-0.92; 10 g/d: RR=0.88, 95%CI=0.83-0.93; 11 g/d: RR=0.88, 95%CI=0.83-0.93; 12 g/d: RR=0.90, 95%CI=0.85-0.95; 13 g/d: RR=0.91, 95%CI=0.85-0.95; 14 g/d: RR=0.92, 95%CI=0.86-0.95; 15 g/d: RR=0.93, 95%CI=0.86-0.96; 16 g/d : RR=0.95, 95%CI=0.88-0.96; 17 g/d: RR=0.96, 95%CI=0.88-0.97; 18 g/d: RR=0.98, 95%CI=0.89-0.97; 19 g/d: RR=0.98, 95%CI=0.89-0.98; 20 g/d: RR=0.99, 95%CI=0.90-0.99, and drinkers with an average alcohol intake of <20 g per day showed a reduced risk of stroke (P<0.001) .

Conclusion

There is a J-shaped nonlinear dose-response relationship between alcohol intake and the stroke risk, with moderate alcohol intake negatively associated with stroke risk. The risk of stroke is lowest with an average alcohol intake of 7-11 grams per day.

The Incidence Rates of Sexual Dysfunction in Perimenopausal and Postmenopausal Women: a Meta-analysis

XIANG Feng, CAO Xuehua, HU Wanqin, JIA Yu, ZHOU Zitong, XIONG Langyu, WANG Xiaoxia

2024, 27(26):  3312-3313.  DOI: 10.12114/j.issn.1007-9572.2023.0684

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Review & Perspectives

Advances in Magnetic Resonance Imaging Technology Applied to Human Brain Glymphatic System

CHEN Zeran, HUANG Mengying, ZENG Lichuan, JIN Shuoguo, YIN Haiyan

2024, 27(26):  3314-3319.  DOI: 10.12114/j.issn.1007-9572.2023.0380

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The glial lymphatic system is a recently discovered anatomical structure in the field of neuroscience, with functions such as regulation of interstitial fluid movement, waste removal and potentially brain immunity, playing an important role in physiology and pathology of the central nervous system. With the development of imaging technology, more and more magnetic resonance imaging (MRI) techniques have been applied to the study of the glial lymphatic system of the human brain. Currently, the commonly used imaging techniques include dynamic contrast-enhanced MRI, diffusion tensor image analysis along the perivascular space, and novel multimodal ultra-fast magnetic resonance techniques, etc. This article summarizes and reviews the application of these techniques in the brain glymphatic system, in order to provide a reference for the imaging study of the glymphatic system.

Advances in the Impact of Microbial Dissemination in Metabolic Fatty Liver Disease through the Oral-gut-liver Axis Theory

HAO Qi, LU Chenxia, LI Xiaodong

2024, 27(26):  3320-3324.  DOI: 10.12114/j.issn.1007-9572.2023.0633

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Metabolic fatty liver disease (MAFLD) is one of the most common chronic liver diseases worldwide, with a prevalence of up to 30% in China, and still rising. The disease is associated with genetic factors, environmental factors and patients' lifestyle habits, and is easily combined with various metabolism-related diseases such as diabetes, cardiovascular and cerebral vascular diseases, as well as serious complications such as liver cirrhosis and liver cancer. An increasing number of basic experimental and clinical studies have demonstrated the relevance of oral and gut microbiota to MAFLD, and targeted treatment of oral and gut microbiota may play an important role in the prevention and treatment of MAFLD. In this paper, we summarize the oral and gut microbiota characteristics of MAFLD patients based on the theory of the oral-gut-liver axis and the mechanism of the role of oral and gut microbiota dysbiosis on the development of MAFLD, hoping to provide ideas for the diagnosis and treatment of MAFLD.