Table of Content

20 November 2024, Volume 27 Issue 33

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Guidelines Interpretation

Interpretation of the Screening Tool of Older Person's Potentially Inappropriate Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) Criteria (Version 3)

ZHU Suyan, ZHENG Xiaomeng, FAN Miao, CHEN Chunyan

2024, 27(33):  4097-4104.  DOI: 10.12114/j.issn.1007-9572.2024.0037

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The Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) were initially developed by a panel of experts from Cork University Hospital, Ireland in 2008, and underwent a second update in 2015. Since their inception, these criteria have played a pivotal role in identifying potentially inappropriate medication use in the elderly, enhancing oversight of medication misuse in older individuals, and reducing adverse drug events among the elderly. In 2023, the third edition of the STOPP/START criteria was released, providing updated and more practical evidence-based guidance. Building upon the second edition, this iteration includes the addition, revision, and removal of certain criteria, resulting in a total of 190 new standards for potentially inappropriate medication use. This latest version incorporates the most recent research findings and clinical evidence related to appropriate medication use in older adults. We provide a detailed analysis of the STOPP/START criteria (version 3), offering valuable insights for the updating and refinement of potentially inappropriate medication criteria in our country. Furthermore, it presents recommendations for future research in this field.

General Practice Tools Development

Study on Patients' Preferences for Anti-diabetic Drugs and the Development of an Evidence-based Decision Aid

XIE Tongling, YAN Feifei, ZHANG Yi, SONG Dongmei, CHEN Tianyong, MENG Jingyi, GENG Jinsong

2024, 27(33):  4105-4111.  DOI: 10.12114/j.issn.1007-9572.2023.0841

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Background

Diabetes is an important health problem due to its high prevalence and associated disability and mortality. Research evidence provides effective information for improving patient health outcomes. Decision aids can help patients obtain evidence and increase physician-patient interaction.

Objective

To obtain patients' preferences for anti-diabetic drugs and develop an evidence-based decision aid to achieve the integration of evidence, patient values, and decision settings, thus facilitating patient-centered evidence-based decision making.

Methods

Several literature databases, like PubMed, Web of Science Core Collection, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), VIP Chinese Science Journals Database, and Wanfang Data were searched to determine the value assessment dimensions and attributes of anti-diabetic drugs. The time limit for literature search is from the establishment of the database to December 31, 2022. The questionnaires for investigating patients' preferences for anti-diabetic drugs were designed using the best-worst scaling method. Then, the empirical study to explore preferences was carried out in five hospitals in Jiangsu Province. Based on the analysis of patients' preferences, an evidence-based decision aid was developed using techniques including Vue + Element UI, Spring Boot, Spring Security, Java, etc.

Results

The most important five attributes in patient decisions were incidence of macrovascular complications, length of extended life years, change of health-related quality of life, incidence of microvascular complications, and control of HbA_1c. The evidence-based decision aid provides a structured summary of evidence on the comparative effectiveness, comparative safety, convenience, and affordability of new anti-diabetic drugs. The multi-attribute value assessment module of new anti-diabetic drugs is the core element of the decision aid, supporting patients' evidence-based assessment of the drugs' value.

Conclusion

Evidence-based decision aid integrates research evidence of new anti-diabetic drugs, patients' preferences and values, and helps realize shared decision-making between physicians and patients.

Original Research

A New Exploration for Evaluating the Stability of Warfarin Anticoagulation Therapy: Based on Modified SAMe-T-PDW2-LAD2 Score

ZHOU Qibao, LUO Xiao, CHEN Ling, HE Huabin, YUAN Mingqing

2024, 27(33):  4112-4118.  DOI: 10.12114/j.issn.1007-9572.2023.0750

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Background

At present, there are few studies on the stability of warfarin anticoagulation therapy. The main evaluation method is SAMe-TT2R2 score, but it has obvious limitations and is not applicable to non-white population. Previous studies have shown that platelet distribution width (PDW) and left atrial diameter (LAD) are closely related to time within therapeutic range (TTR). Whether they can be incorporated into the existing scoring system and improved is worthy of clinical reflection.

Objective

To explore the predictive value of modified SAMe-T-PDW2-LAD2 score for the percentage of TTR of common international normalized ratio (INR) for the stability of warfarin anticoagulation therapy.

Methods

A total of 164 patients with persistent nonvalvular atrial fibrillation who were treated with warfarin anticoagulation in Jiujiang NO.1 People's Hospital from January 2021 to June 2023 were selected as the research objects. TTR≥65% was defined as high quality anticoagulation. TTR<65% was defined as substandard, that is, the stability of warfarin anticoagulation therapy was not high-quality. According to the above criteria, the patients were divided into two groups: TTR≥65% group (TTR≥65%, 46 cases) and TTR<65% group (TTR<65%, 118 cases). The modified SAMe-T-PDW2-LAD2 score retained the four parameters of gender, age, comorbidities and combined medication in the previous SAMe-TT2R2 score, and the two parameters of race and smoking were deleted. "Increased PDW" and "increased LAD" were replaced by 2 points respectively. The above parameters were collected and compared between the two groups. Binary Logistic regression analysis was used to explore the influencing factors of stable TTR target in warfarin anticoagulation therapy. Receiver operating characteristic (ROC) curves of SAMe-TT2R2 score and modified SAMe-T-PDW2-LAD2 score were plotted to evaluate the TTR target stability of warfarin anticoagulation therapy.

Results

Single factor analysis showed that there were significant differences in age, combined with heart failure, combined with hyperlipidemia, smoking, increased PDW and increased LAD between the two groups (P<0.05). Binary Logistic regression analysis showed that age (OR=0.882, 95%CI=0.812-0.958, P=0.003), increased PDW (OR=0.443, 95%CI=0.282-0.697, P<0.001), and increased LAD (OR=0.031, 95%CI=0.001-0.853, P=0.040) were the influencing factors of achieving stable TTR target on warfarin anticoagulation therapy. There were significant differences in TTR and TTR reaching the target rate between groups with different scores of SAMe-TT2R2 score (P<0.05). The TTR of scores 6 and 7 groups was higher than that of scores 2, 3, 4 and 5 groups (P<0.05). The TTR target rate in the score 7 group was higher than that in the score 2, 3, 4, 5, and 6 groups (P<0.05). There were significant differences in TTR and TTR reaching the target rate among different score groups of modified SAMe-T-PDW2-LAD2 score (P<0.05). The TTR of scores 3, 4, 5, 6, and 7 groups was lower than that of scores 0, 1, and 2 groups (P<0.05). The TTR target rate in the integral 2 group was higher than that in the integral 0, 1, 3, 4, 5, 6, and 7 groups (P<0.05). ROC curve results showed that the area under the ROC curve (AUC) of SAMe-TT2R2 score for evaluating the stability of warfarin anticoagulation therapy TTR target was 0.803 (95%CI=0.737-0.868), the best cut-off value was 5.5, the sensitivity was 1, and the specificity was 0.508. The AUC of modified SAMe-T-PDW2-LAD2 score was 0.814 (95%CI=0.751-0.877), the best cut-off value was 2.5, the sensitivity was 0.848, and the specificity was 0.737.

Conclusion

Age, increased PDW and increased LAD are the influencing factors of achieving stable TTR target in warfarin anticoagulation therapy. There are many limitations of SAMe-TT2R2 score in evaluating the stability of warfarin anticoagulation therapy. The modified SAMe-T-PDW2-LAD2 score has better clinical application value in evaluating the stability of warfarin anticoagulation therapy.

Predictive Value of the Oxygen Desaturation Induced by the 30-second Sit-to-stand-test combined with COPD Patient Self-assessment Test in Exercise-induced Hypoxemia and Its Clinical Application

YANG Tianyi, SITU Xuanming, QUMU Shiwei, WANG Siyuan, JIANG Shan, YANG Ting

2024, 27(33):  4119-4124.  DOI: 10.12114/j.issn.1007-9572.2023.0830

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Background

Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases in elderly patients, and a decrease in oxygen saturation during activity is a common phenomenon correlated with the prognosis. Current assessment of exercise-induced hypoxia (EID) has yielded controversial results.

Objective

To explore methods suitable for inducing EID in community and home-based COPD patients.

Methods

This was a retrospective study involving 76 patients with stable COPD admitted to China-Japan Friendship Hospital from January 2021 to August 2023. Resting oxygen saturation and the lowest oxygen saturation during exercise (ΔSpO₂) in the six-minute walk test 6MWT) were recorded. Based on the criterion of ΔSpO₂ ≥4% for the diagnosis of EID, patients were assigned into non-EID group and EID group. Pulmonary function indicators, ΔSpO₂ during 30-second sit-to-stand-test (30s STST), and COPD Assessment Test (CAT) were compared between the two groups. The correlation of EID with ΔSpO₂ of 30s STST and CAT scores was identified. The predictive value of ΔSpO₂ of 30s STST, CAT score, andΔSpO₂ of 30s STST combined with CAT score in predicting EID was analyzed using the receiver operating characteristic (ROC) curves.

Results

There were significant differences in the ΔSpO₂ of 30s STST and CAT score between non-EID group and EID group. The cut-off value of ΔSpO₂ of 30s STST in predicting EID was 2%, with the sensitivity, specificity and area under the curve (AUC) of 59.6%, 82.8%, 0.730 (95%CI=0.614-0.846, P<0.05), respectively. The cut-off value of CAT scores in predicting EID was 13, with the sensitivity, specificity and AUC of 48.9%, 79.3%, 0.712 (95%CI=0.596-0.828, P<0.05), respectively. The cut-off value of ΔSpO₂ of 30s STST combined with CAT scores in predicting EID was 0.593, with the sensitivity, specificity and AUC of 70.2%, 72.4% and 0.765 (95%CI= 0.659-0.871, P<0.001), respectively.

Conclusion

ΔSpO₂ of 30s STST ≥ 2% and CAT score ≥13 points alarm the development of EID. The 30s STST and CAT can be used as community and home-based measures to predict the induction of EID in patients with stable COPD.

Effectiveness and Safety of Drug-coated Balloons in Treating De Novo Lesions in Large Coronary Vessels of Elderly Patients: a Cohort Study

JIA Gaopeng, QU Ze, LI Guimei, HUANGFU Weizhong, ZHAO Zihao, YAN Shuang, CHEN Qiuyu, ZHANG Yue

2024, 27(33):  4125-4131.  DOI: 10.12114/j.issn.1007-9572.2024.0071

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Background

In recent years, with the aging of the population, the incidence of coronary artery large vessel disease in elderly patients has significantly increased. Drug-coated balloons (DCB), as an emerging treatment method, have attracted considerable attention due to their ability to effectively reduce the rate of restenosis. However, existing studies have largely focused on small vessel lesions, with limited data on the effectiveness in de novo large vessel lesions.

Objective

To explore the effectiveness of DCBs in treating de novo large coronary artery vessel lesions in elderly patients.

Methods

A retrospective selection of 128 elderly patients (>60 years) with coronary heart disease (CHD) who underwent percutaneous coronary intervention (PCI) at the Affiliated Hospital of Inner Mongolia Medical University in 2022 was conducted. Preoperative examinations and laboratory tests were completed. The patients were divided into DCB group (n=30), Drug-eluting stent (DES) group (n=64), and bioresorbable vascular scaffold (BVS) group (n=34) according to the PCI treatment plan. Coronary angiography (CAG) was performed preoperatively, immediately postoperatively, and during the 1-year follow-up to observe the reference vessel diameter (RVD), minimum lumen diameter (MLD), and further calculate the preoperative diameter stenosis (DS), immediate postoperative lumen gain (AG), residual diameter stenosis (RDS) at immediate postoperative and 1-year follow-up, and late lumen loss (LLL). During the follow-up period, patients were regularly followed up in outpatient clinics or by telephone, recording major adverse cardiovascular events (MACE) within the hospital and within one year after discharge. LASSO regression analysis was used to screen relevant variables, followed by multifactorial Logistic regression analysis to explore the influencing factors of MACE. The Kaplan-Meier method was used to draw the survival curve of patients with MACE, and the comparison of survival curves was made using the Log-rank test.

Results

There was no statistically significant difference in the baseline data of patients in the DCB, DES, and BVS groups (P>0.05). Immediately postoperatively, the MLD and AG in the BVS group were higher than those in the DCB and DES groups, and the RDS was lower than those in the DCB and DES groups (P<0.05). At 1-year postoperatively, the RDS in the DES group was lower than that in the DCB group (P<0.05). No MACE occurred in the hospital in all three groups. The median follow-up time was 478 (425, 538) days, with a total of 38 MACE. No myocardial infarction or cardiac death occurred during the follow-up period. Bleeding events: there were 0 cases in the DCB group, 3 cases in the DES group, and 3 cases in the BVS group, manifested as gum bleeding, assessed as mild bleeding. The Log-rank test showed no statistically significant difference in the survival rate of patients without MACE events among the three groups (P=0.580). LASSO regression analysis included low-density lipoprotein cholesterol (LDL-C) and history of interventional treatment in the analysis, and the results of multifactorial Logistic regression analysis showed that LDL-C (OR=12.204, 95%CI=3.403-43.768) and history of interventional treatment (OR=0.041, 95%CI=0.010-0.162) were influencing factors for the occurrence of MACE.

Conclusion

Compared with DES and BVS, there is no significant difference in the treatment of large vessel lesions in elderly CHD patients with DCB, and its effectiveness and safety are comparable to that of DES and BVS. DCB is a safe and effective method for treating large coronary artery vessel lesions in elderly patients, and increased LDL-C and a history of interventional treatment are influencing factors for the occurrence of MACE.

Clinical Study on the Predictive Value of Monocyte Count to High-Density Lipoprotein Cholesterol Ratio and Thyroid-stimulating Hormone for Acute Coronary Syndrome in Postmenopausal Women and Their Correlation with Coronary Artery Lesions

DAI Chengye, DENG Yifan, HE Shenghu, ZHANG Jing

2024, 27(33):  4132-4138.  DOI: 10.12114/j.issn.1007-9572.2024.0094

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Background

Previous studies have found associations between monocyte count, high-density lipoprotein cholesterol (HDL-C), and thyroid-stimulating hormone (TSH) with acute coronary syndrome (ACS). However, research on the correlation between the monocyte count to high-density lipoprotein cholesterol ratio (MHR) and the onset of ACS is limited. The association between MHR, TSH, and the onset of ACS in postmenopausal women remains unclear.

Objective

To explore the predictive value of MHR and TSH for the onset of ACS in postmenopausal women and to investigate the correlation between these indicators and the degree of coronary artery stenosis in patients.

Methods

A total of 325 postmenopausal women hospitalized in the Department of Cardiology at Northern Jiangsu People's Hospital, from 2020 to 2021 and who underwent coronary angiography were selected as the study subjects. Patient general information was collected through the electronic medical record system. Venous blood was collected upon admission to measure monocyte count, total cholesterol (TC), triglycerides (TG), HDL-C, low-density lipoprotein cholesterol (LDL-C), and TSH. Left ventricular ejection fraction (LVEF) was measured using the biplane Simpson method, and coronary artery lesions were observed through coronary angiography. The Gensini scoring system was used to uniformly measure the extent of coronary artery lesions. Patients meeting the diagnostic criteria for ACS were classified as the ACS group (n=184), and non-ACS patients as the control group (n=141). The ACS group was further divided into subgroups based on the tertiles of the Gensini score: ≤36.5 as the low-risk subgroup (n=59), 36.6-66.5 as the moderate-risk subgroup (n=64), and >66.5 as the high-risk subgroup (n=61). Univariate and multivariate Logistic regression analyses were used to explore the influencing factors of ACS. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of TSH, MHR, and combined detection for ACS and to calculate the area under the curve (AUC). Spearman's rank correlation analysis was used to explore the correlation between TSH, MHR, and combined detection indicators with the Gensini score.

Results

The baseline data of patients in the ACS and control groups showed that BMI, smoking rate, hypertension, diabetes, LDL-C, monocytes, TSH, and MHR in the ACS group were higher than in the control group, while LVEF and HDL-C were lower (P<0.05). Multivariate Logistic regression analysis showed that smoking, hypertension, BMI≥24.0 kg/m², LDL-C≥3.30 mmol/L, TSH≥2.1 mU/L, and MHR≥0.25 were risk factors for the occurrence of ACS in postmenopausal elderly women, and HDL-C≥1.2 mmol/L was a protective factor (P<0.05). The ROC curve analysis demonstrated that the AUC for MHR, TSH, and the combined predictive index in diagnosing ACS in postmenopausal women were 0.777 (95%CI=0.725-0.830, P<0.001), 0.747 (95%CI=0.694-0.800, P<0.001), and 0.810 (95%CI=0.764-0.857, P<0.001), respectively. In the moderate and high-risk subgroups, MHR and TSH were higher than in the low-risk subgroup, and the high-risk subgroup had higher MHR and TSH than the moderate-risk subgroup (P<0.05). Spearman's rank correlation analysis showed that in the ACS group, MHR (r_s=0.497, P<0.01), TSH (r_s=0.498, P<0.01), and the combined predictive indicators were positively correlated with the Gensini score (r_s=0.600, P<0.001) .

Conclusion

Elevated TSH and MHR are independent risk factors for the occurrence of ACS in postmenopausal women. Both indicators and their combination have certain sensitivity and specificity for disease prediction and are correlated with the extent of coronary artery lesions in patients, which has certain clinical application value for the early identification and risk assessment of ACS in postmenopausal women.

Study on Nomogram Prediction Model for Risk Factors of Muscle Mass Loss in Non-obese Patients with Type 2 Diabetes

ZHANG Bingqing, HU Xinyun, OUYANG Yuqin, XIANG Xinyue, TANG Wenjuan, FENG Wenhuan

2024, 27(33):  4139-4146.  DOI: 10.12114/j.issn.1007-9572.2024.0055

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Background

Muscle mass loss increases the risk of hyperglycaemia and sarcopenia in patients with type 2 diabetes mellitus (T2DM), and Chinese adults with T2DM are predominantly non-obese, who are more likely to be associated with muscle mass loss than the obese.

Objective

To establish an individualized Nomogram prediction model for the risk factors of muscle mass loss in non-obese patients with T2DM.

Methods

A retrospective study was conducted to select 905 non-obese patients with T2DM admitted to the Department of Endocrinology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2018 to September 2023. The patients were divided into a training set (n=633) and a validation set (n=272) using simple random sampling at a ratio of 7∶3, and the general data and clinical indexes of the two groups of patients were collected and compared. Multivariate Logistic regression analysis was performed to determine risk factors for muscle mass loss in the training set and a Nomogram prediction model was constructed. The predictive value and clinical utility of the Nomogram prediction model were evaluated using receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA), respectively.

Results

The prevalence of muscle mass loss in non-obese patients with T2DM was 42.3% (383/905). Comparison of the clinical indicators of the patients in the training and validation sets showed no statistically significant differences (P>0.05). Multivariate Logistic regression analysis showed that age (OR=1.039, 95%CI=1.010-1.070, P=0.009), male (OR=3.425, 95%CI=2.133-5.499, P<0.001), BMI<23.5 kg/m² (OR=19.678, 95%CI=11.319-34.210, P<0.001), elevated HbA_1c (OR=1.196, 95%CI=1.081-1.323, P<0.001), increased visceral fat area (OR=1.021, 95%CI=1.010-1.032, P<0.001) were independent risk factors for muscle mass loss in non-obese patients with T2DM. The area under curve (AUC) of the ROC for the Nomogram prediction model to predict the risk of muscle mass loss occurring in patients in the training and validation sets was 0.825 (95%CI=0.793-0.856, P<0.001) and 0.806 (95%CI=0.753-0.859, P<0.001), respectively. The Hosmer-Lemeshow test showed that the model had a good fit (training set: χ²=11.822, P=0.159; validation set: χ²=8.189, P=0.415). Bootstrap method of plotting the calibration of the model showed that the calibration curves fitted well to the standard curves. The DCA curves showed that it was more beneficial to use the Nomogram prediction model to predict the incidence risk of muscle mass loss in patients with T2DM when the threshold probability of the patient was 0.06 to 0.94.

Conclusion

Age, male, BMI<23.5 kg/m², elevated HbA_1c, and increased visceral fat area are independent risk factors for muscle mass loss in non-obese patients with T2DM. The Nomogram prediction model established in this study can individually predict the risk of muscle mass loss in non-obese patients with T2DM, which facilitates the early identification of high-risk groups and the development of individualised interventions.

Construction and Validation of a Screening Model for Early Atherosclerosis Risk in the Aorta

ZHOU Zhensen, HUANG Yan, CHENG Siwei, ZHANG Xiaoyu, ZHANG Xiaoyu, SUN Ting, YANG Xianjun, XIE Hui, MA Zuchang

2024, 27(33):  4147-4154.  DOI: 10.12114/j.issn.1007-9572.2024.0032

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Background

In the field of cardiovascular risk assessment, aortic stiffness is considered a key predictive indicator, and carotid-femoral pulse wave velocity (cfPWV) is recognized as the gold standard for non-invasive assessment of atherosclerotic risk in the aorta. Due to challenges such as technical difficulty, cfPWV testing has not been widely implemented in China.

Objective

This study aimed to develop and validate a screening model for early atherosclerotic risk in the aorta based on cardiovascular risk factors, with the intention of replacing the complex measurement process of cfPWV and reducing reliance on traditional measurement methods.

Methods

A total of 878 participants recruited from the Health Checkup Center of the First Affiliated Hospital of Anhui Medical University between May and November 2023 were selected as research subjects, randomly divided into a model-building group (n=703) and a validation group (n=175) in an 8∶2 ratio. Patient general information, laboratory test results, and cfPWV were collected. Based on the cfPWV examination results and relevant guidelines, participants in the model-building group were divided into those without atherosclerotic risk in the aorta (n=503) and those with atherosclerotic risk in the aorta (n=200). Multifactorial Logistic regression analysis was used to screen variables and establish a nomogram assessment model. The receiver operating characteristic curve (ROC curve) for predicting the risk of atherosclerosis in the aorta was plotted for the model, and the model's discriminative ability and calibration were assessed using the area under the ROC curve (AUC) and the Hosmer-Lemeshow test, respectively. The Delong test was used to compare the AUCs of different models, and decision curve analysis (DCA) was used to assess the clinical utility of the model. Internal validation of the model was performed using the bootstrap method with 1 000 resampling iterations.

Results

Participants with atherosclerotic risk in the model-building group were older, had higher BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), urea, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hemoglobin (Hb), and a higher proportion of alcohol consumption, dyslipidemia, and diabetes than those without atherosclerotic risk in the aorta. The glomerular filtration rate (GFR) and platelet count (PLT) were lower in those with atherosclerotic risk (P<0.05). Multifactorial Logistic regression analysis showed that age (OR=1.112, 95%CI=1.082-1.143), MAP (OR=1.146, 95%CI=1.107-1.188), Hb (OR=1.026, 95%CI=1.004-1.049), and FBG (OR=1.353, 95%CI=1.076-1.701) were independent risk factors for atherosclerosis in the aorta (P<0.05). A predictive modelⅠ was constructed using statistically significant indicators from the multifactorial logistic regression analysis (age, MAP, Hb, FBG), and models Ⅱ, Ⅲ, and Ⅳ were constructed by additionally including smoking, gender, and dyslipidemia, respectively. The AUCs for models Ⅰ to Ⅳ were 0.941 (95%CI=0.923-0.964, P<0.05), 0.941 (95%CI=0.922-0.962, P<0.05), 0.941 (95%CI=0.922-0.963, P<0.05), and 0.939 (95%CI=0.919-0.962, P<0.05), respectively. The Delong test showed no statistically significant difference in AUCs among models Ⅰ, Ⅱ, Ⅲ, and Ⅳ (P>0.05). A nomogram model was constructed using age, MAP, FBG, and Hb as predictive factors, with an AUC of 0.941 (95%CI=0.920-0.962) for the training set, sensitivity of 0.832, and specificity of 0.917. The AUC for the validation set was 0.961 (95%CI=0.914-1.000), with sensitivity of 0.872 and specificity of 0.964. DCA results indicated that the use of the early atherosclerosis screening model could benefit participants in clinical practice.

Conclusion

Based on four simple indexes of age, mean arterial pressure, hemoglobin and fasting blood glucose, a screening model for early aortic sclerosis risk was established, which provides a convenient and efficient method for early vascular function screening.

Barriers and Facilitators of Implementation of Benefit Finding Promotion Program in Maintenance Hemodialysis Patients Based on the i-PARIHS Framework

LI Yongqi, CHEN Jing, LIU Lingling, YANG Jie, GONG Yanlin, CHU Jing

2024, 27(33):  4155-4161.  DOI: 10.12114/j.issn.1007-9572.2023.0877

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Background

Improving the level of benefit finding can help alleviate the high prevalence of negative emotional problems and promote mental health in maintenance hemodialysis (MHD) patients, so the research group has constructed a benefit finding promotion program for MHD patients based on the PERMA flourish model in the earlier stage, which is urgently needed to be applied in clinical practice.

Objective

To explore the barriers and facilitators to the implementation of benefit finding promotion program for MHD patients, and provide reference for psychological intervention of them.

Methods

Using purposive sampling method, 12 healthcare workers and 9 MHD patients in the hemodialysis unit of the Second Affiliated Hospital of the Naval Medical University were selected as the study subjects from March to May 2023, and semi-structured interviews were conducted with them using the phenomenological research method, and the results of the interviews were analyzed in terms of the three dimensions of change, change recipients, and the organizational environment based on the i-PARIHS framework, and the responses to the obstacle factors were developed.

Results

Barriers to the application of the program at the change level include lack of detail, high professionalism, and cultural differences in the program content; at the recipient level include cognitive differences in the team, lack of psychosocial training for healthcare workers, low motivation of patients to participate, and inconsistent acceptance; at the organizational environment level, the lack of incentives in the ward, and the lack of a suitable place for the intervention. Factors facilitating the implementation of the program include, on the change side, interventions derived from high-quality research, richness and variety of program content, etc., on the receiver side, strong support from the ward leadership, positive cooperation from team members, etc., and on the organizational environment side, the ward has a certain base of psychological interventions, and changes are in line with national and health policies.

Conclusion

The application of benifit finding promotion program for MHD patients is affected by a variety of factors, the need to comprehensively analyze the barriers and facilitators, and to take specific action strategies to promote the program to the ground, so that it is orderly and efficient in the clinical implementation of the application.

Analysis of the Current Status of Atrial Fibrillation Epidemiological Survey in Shihezi Area of Xinjiang Corps

ZHANG Qiang, TANG Min, GUANG Yajie, LIU Dan, ZHAO Xueyan, ZHAO Yuanyuan, ZHANG Lin, NUERBAHETI

2024, 27(33):  4162-4167.  DOI: 10.12114/j.issn.1007-9572.2024.0050

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Background

Atrial fibrillation (AF) is a common clinical arrhythmia characterized by high prevalence, high disability rate, and high treatment costs, severely affecting patients' quality of life. Currently, there is no large-scale epidemiological survey on the prevalence of AF in the Xinjiang Corps region.

Objective

To further understand the prevalence, associated risk factors, and standardized treatment status of AF in the Shihezi area of the Xinjiang Corps, this study aims to provide reliable data support for the prevention, management, and treatment of AF in this region.

Methods

A cross-sectional age-stratified random sampling survey was conducted from May 2021 to June 2023 among 63 079 permanent residents aged 18 years and above in 18 pastoral and agricultural groups and urban areas of the Shihezi area of the Xinjiang Corps. A questionnaire was used to collect baseline data, epidemiological information, awareness, and treatment status of AF. Patients were divided into an AF group (n=737) and a non-AF group (n=62 342). Multifactorial Logistic regression analysis was used to explore the influencing factors of AF occurrence.

Results

A total of 63 079 residents from the Shihezi area of the Eighth Division of the Xinjiang Corps were included, with an average age of (54.9±15.3) years. A total of 737 AF patients were identified, with a prevalence rate of 1.17%, and an age-adjusted prevalence rate of 1.12%. The awareness rate of AF in the screened population was only 1.62% (1 021/63 079), of which the awareness rate among diagnosed AF patients was 52.78% (389/737). The prevalence rates of AF in the 18-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years age groups were 0.05% (5/9 964), 0.32% (29/9 076), 0.62% (135/21 686), 1.28% (151/11 810), 3.05% (207/6 776), and 5.57% (210/3 767), respectively. The prevalence rates of AF in males and females were 1.60% (441/27 591) and 0.83% (296/35 488), respectively. The prevalence rates of AF among Han, Hui, Uyghur, Kazakh, and other ethnic groups were 1.20% (720/60 014), 0.70% (7/1 007), 0.62% (7/1 130), 1.67% (2/120), and 1.41% (1/171), respectively. The prevalence rates of AF in urban and pastoral and agricultural areas were 0.79% (350/44 504) and 2.08% (387/18 575), respectively. There were statistically significant differences in age, gender, age group distribution, residential area, and education level between the AF and non-AF groups (P<0.05). The prevalence of smoking, alcohol consumption, hypertension, coronary heart disease, type 2 diabetes, hyperlipidemia, chronic heart failure, cerebrovascular diseases, valvular heart disease, chronic pulmonary disease, sleep apnea syndrome, thyroid dysfunction, peripheral vascular disease, and tumors was higher in the AF group than in the non-AF group (P<0.05). Multifactorial Logistic regression analysis showed that age, gender, alcohol consumption, hypertension, valvular heart disease, chronic heart failure, thyroid dysfunction, sleep apnea syndrome, and tumors were influencing factors for the occurrence of AF (P<0.05). There were 85 newly diagnosed cases of AF (11.53%), 257 paroxysmal AF cases (34.87%), 178 persistent AF cases (21.16%), and 217 permanent AF cases (29.44%) ; 360 cases received oral anticoagulant therapy, and 23 cases underwent radiofrequency ablation or one-stop treatment for AF, with a treatment rate of 51.96% in this region. Among AF patients, the rates of standardized treatment, non-standardized treatment, and no treatment were 360 cases (48.85%), 21 cases (2.85%), and 356 cases (48.30%), respectively. The standardized treatment rates for newly diagnosed AF, paroxysmal AF, persistent AF, and permanent AF were 11.11%, 28.89%, 24.72%, and 35.28%, respectively. There was a statistically significant difference in the standardized treatment rates among different types of AF (χ²=18.918, P=0.004) .

Conclusion

The prevalence rate of atrial fibrillation in Shihezi area of Xinjiang Corps is basically the same as that of the whole country, and the risk factors are similar to domestic and foreign studies. However, the awareness rate of atrial fibrillation and the standardized treatment rate of atrial fibrillation in the population are obviously low, and the situation is not optimistic.

Original Research·Prevention and Control of Obesity in Children and Adolescents

Analysis of Trend in the Prevalence of Central Obesity among Children and Adolescents Aged 7-18 in Putuo District, Shanghai from 2018 to 2023

ZHANG Yu, YU Shuo, WANG Bingqing, RAN Qingqing, ZHANG Xiayun

2024, 27(33):  4168-4175.  DOI: 10.12114/j.issn.1007-9572.2024.0172

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Background

With the improvement of economic level and changes in lifestyle of residents, the obesity among children and adolescents has become increasingly severe, threatening the healthy growth of children and adolescents. BMI was used as an evaluation index of obesity in most previous studies, which may underestimate the prevalence of central obesity. Therefore, it is urgent to evaluate the waist circumference (WC) and trend of the prevalence of central obesity among children and adolescents in Putuo District, in order to provide scientific basis for targeted proposed intervention.

Objective

To analyze WC and the trend in the prevalence of central obesity among children and adolescents aged 7-18 years in Putuo District, Shanghai, from 2018 to 2023.

Methods

Data on medical examinations of primary and secondary school students in Putuo District in 2018 and 2020 to 2023 were used to analyze the WC, the prevalence of central obesity and the trends. The 90th percentile (P₉₀) age-specific children and adolescents of different genders was used as the cut-off point of high WC, and WC exceeding the P₉₀ value was defined as central obesity. SPSS 22.0 and SAS 13.1 were used for statistical analysis and Excel 2021 was used for graphic plotting.

Results

A total of 280 648 primary and secondary school students participated in the medical examination in Putuo District, Shanghai, from 2018 to 2023, of which 146 334 (52.1%) were male students and 134 314 (47.9%) were female students, with an median age of 10.5 (8.7, 12.6) years. WC of male and female students from 2018 to 2023 showed fluctuating downward trends with a statistically significant difference (H_male=209.785, H_female=373.076; P<0.001). WC of male students decreased from 65.2 (58.0, 74.0) cm in 2018 to 64.8 (56.9, 74.0) cm in 2023 and female students decreased from 60.5 (55.0, 67.0) cm to 59.8 (53.8, 66.2) cm. Comparison of the prevalence of central obesity among male and female students in each year showed statistically significant differences (χ²_male=264.123, χ²_female=448.289; P<0.001). The results of Cochran-Armitage trend test showed decreasing trends in prevalences of central obesity among male and female groups from 2018 to 2023 (Z_{trend male}=-10.974, Z_{trend female}=-15.218; P_trend<0.001). The prevalence of central obesity among male students decreased from 28.8% (6 714/23 286) to 24.6% (7 935/32 227), while that among female students decreased from 21.9% (4 604/21 062) to 15.5% (4 604/29 695). The WC and prevalence of central obesity among male students were higher than that among female students (U=7 128 257 114.500、χ²=2 928.075, P<0.001). Prevalence of central obesity showed increasing trends with age for both sexes (Z_{trend male}=35.167, Z_{trend female}=6.533; P_trend<0.001) .

Conclusion

This study suggests that WC and the prevalence of central obesity among children and adolescents aged 7-18 in Putuo District are fluctuating and decreasing. WC and the prevalence of central obesity of male students are high than those of female students of the same age. The prevalence of central obesity is increasing with age. Results of this study provide theoretical support for the targeted intervention of central obesity in children and adolescents.

Asset Assessment for Obesity Control among Middle School Students: a Qualitative Study

LIN Yixi, PAN Shasha, ZHANG Youjie

2024, 27(33):  4176-4181.  DOI: 10.12114/j.issn.1007-9572.2024.0143

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Background

Adolescence is a high-risk period for obesity, and it is crucial and urgent to implement obesity control among adolescents. However, existing interventions commonly face challenges in sustainability and scalability. Asset assessment to identify and leverage existing community assets and strengths is essential to facilitate and maintain the implementation of these programs.

Objective

To assess assets for obesity control among middle school students, and to identify the advantages and deficiencies in the current policy, physical, social, and information environments, along with suggestions for improvements.

Methods

From 2023 to January 2024, purposive sampling method was adopted, face-to-face one-by-one interviews were conducted with 11 staff members involved in obesity control for middle school students from the Center for Disease Control and Prevention, Education Bureau, and three middle schools in a major city in East China. Additionally, eight parents and their children from each of the three schools were invited to participate in focus group discussions, with 6 groups and 8 participants per group. Thematic analysis was applied to analyze the interview data.

Results

This study found that the advantages in obesity control for middle school students primarily included policies and conditions ensured for obesity surveillance, nutritional school lunch and physical activity, along with media for health communication. The main deficiencies were the lack of specific policies for efficient obesity control, insufficient physical and social assets to support healthy eating and physical activity, and the quality and intensity of information assets supporting to facilitate changes in knowledge, attitude, and behaviors. In response to these challenges, participants suggested the implementation of both rigid regulations and flexible incentives, improvement of asset accessibility, encouragement of multi-stakeholder cooperation, and strengthening of health communication. Integrating existing assets and suggestions for improvement has formed an asset assessment checklist, corresponding to 10 assets from the policy environment, 8 from the physical environment, 20 from the social environment, and 12 from the information environment.

Conclusion

Several assets exist for obesity control among middle school students and identifies areas for improvement. Subsequent efforts in obesity control for middle school students should be made on promoting intervention strategies to better align with the context based on the asset assessment checklist to diagnose the current status of assets, thus enhancing the efficacy and sustainability of the program.

Intestinal Flora: an Important Participant in Childhood Obesity

LUO Yu, LUO Dan, TANG Binzhi

2024, 27(33):  4182-4189.  DOI: 10.12114/j.issn.1007-9572.2023.0809

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The increasing incidence of childhood obesity has emerged as a novel challenge in the realm of global public health. Studies have demonstrated that alterations in the composition of intestinal flora during the early stages of life contribute to the development of obesity by influencing nutrient absorption and metabolism, triggering inflammatory responses, and regulating the communication between the gut and brain. Currently, Bifidobacterium and Akkermansia muciniphila have been found to reduce body fat content, exhibit anti-inflammatory properties, and enhance intestinal barrier function, whereas Prevotella is strongly associated with improvements in individual glucose metabolism induced by dietary fiber. Translational application of specific intestinal flora benefits to body glycolipid metabolism is helpful for the early prevention and therapy of pediatric obesity. This review elucidates the impact of early-life changes in intestinal flora composition on childhood obesity explores the mechanisms by which intestinal flora contributes to obesity pathogenesis, and specifically focuses on recent advances in utilizing short-chain fatty acids for the regulation of intestinal flora and the amelioration of obesity, aiming to provide a theoretical foundation for the intervention of childhood obesity from the perspective of intestinal flora.

Original Research·Combination of Chinese and Western Medicine

Research on Disability Weights of Wasting Thirst Disorder Based on ICD-11 Traditional Medicine Chapter

ZHAO Lanhui, GAO Jing, ZHOU Shangcheng

2024, 27(33):  4190-4195.  DOI: 10.12114/j.issn.1007-9572.2023.0418

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Background

The approval of the International Classification of Diseases 11th Revision (ICD-11) has for the first time included a chapter about traditional medicines that includes TCM. Disease weight (DW) is a weight coefficient that quantifies the health loss caused by non-fatal diseases and injuries, and is an important parameter to measure the burden of disease.

Objective

Based on the traditional medicine chapter of ICD-11, this study investigates the DW of wasting thirst disorder, which provides a reference for the measurement of TCM disease burden, and lays a foundation for establishing a statistical network that is consistent with international standards and reflects TCM health service information.

Methods

From June 1, 2020 to June 1, 2021, the Visual Analogue Scale (VAS) method was adopted to conduct a survey on the DW of each lower category of wasting thirst disorder among clinical Chinese medicine practitioners and healthy people. The EQ-5D-3L with VAS scale was adopted to conduct a DW survey among patients. In addition, the survey results were demonstrated with expert intentions.

Results

The survey on DW of wasting thirst disorder among TCM practitioners shows that the DWs were 0.300 (0.185, 0.380) for wasting thirst disorder involving the upper-jiao, 0.430 (0.368, 0.568) for wasting thirst disorder involving the middle-jiao, 0.585 (0.510, 0.738) for wasting thirst disorder involving the lower-jiao, and 0.725 (0.660, 0.908) for consciousness loss caused by wasting thirst disorder. The survey on DW of wasting thirst disorder among patients shows that the VAS conversion weights of patients were 0.310 (0.225, 0.373) for diabetes involving the upper-jiao, 0.395 (0.335, 0.453) for wasting thirst disorder involving the middle-jiao, 0.445 (0.360, 0.513) for wasting thirst disorder involving the lower-jiao, and 0.590 (0.550, 0.698) for consciousness loss caused by wasting thirst disorder;the investigator assigned weights are 0.152 (0, 0.311) for wasting thirst disorder involving the upper-jiao, 0.240 (0, 0.275) for wasting thirst disorder involving the middle-jiao, 0.380 (0.186, 0.622) for wasting thirst disorder involving the lower-jiao, and 0.484 (0.311, 0.814) for consciousness loss caused by wasting thirst disorder. The survey on DW of wasting thirst disorder among healthy people shows that the DWs were 0.210 (0.150, 0.390) for wasting thirst disorder involving the upper-jiao, 0.345 (0.260, 0.510) for wasting thirst disorder involving the middle-jiao, 0.425 (0.313, 0.748) for wasting thirst disorder involving the lower-jiao, and 0.640 (0.380, 0.898) for consciousness loss caused by wasting thirst disorder. There were significant differences between the DWs by different methods of wasting thirst disorder involving the upper-jiao, wasting thirst disorder involving the middle-jiao, wasting thirst disorder involving the lower-jiao, and consciousness loss caused by wasting thirst disorder (H=153.883, 76.561, 34.575, 74.014, P<0.001). There were significant differences between VAS DW for traditional Chinese medicine practitioner survey, patient VAS conversion DW, investigator assignment DW, and VAS DW for healthy population survey involved by three jiao of wasting thirst disorder and consciousness loss caused by wasting thirst disorder (H=10.543, 35.692, 19.924, 16.327, P<0.05). Through expert intention argumentation, the method of calculating DWs for wasting thirst disorder according to the classification of wasting thirst disorder involving the upper-jiao, wasting thirst disorder involving the middle-jiao, wasting thirst disorder involving the lower-jiao, and consciousness loss caused by wasting thirst disorder under the standardized framework was agreed upon. Experts qualitatively agreed that the DW of wasting thirst disorder involving the upper-jiao, wasting thirst disorder involving the middle-jiao, wasting thirst disorder involving the lower-jiao, and consciousness loss caused by wasting thirst disorder gradually increased. And they basically agreed with the DW in the investigation of traditional Chinese medicine practitioners.

Conclusion

A preliminary exploration was conducted to investigate the DW of wasting thirst disorder, using the VAS method and the EQ-5D-3L, based on the ICD-11 chapter on traditional medicine and the national standards of traditional Chinese medicine, providing a reference for calculating the burden of traditional Chinese medicine diseases. The research results have been supported by expert intention analysis. The DW of wasting thirst disorder in Guangzhou is relatively heavy, and attention should be paid to the loss of healthy life years caused by disability in wasting thirst disorder, to improve the quality of life of patients.

The Evaluation of Effective-component Compatibility of Bufei Yishen FormulaⅢ and Components Compatibility in Treating Airway Remodeling of COPD

QIN Yanqin, DONG Haoran, YANG Jingfan, LI Haibo, ZHAO Peng, LI Jiansheng

2024, 27(33):  4196-4203.  DOI: 10.12114/j.issn.1007-9572.2023.0868

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Background

Chronic obstructive pulmonary disease (COPD) is a major chronic disease, and airway remodeling is an important pathological mechanism. Bufei Yishen formula and effective-component compatibility of Bufei Yishen formula Ⅲ (ECC-BYF Ⅲ) are effective for COPD treatment. ECC-BYF Ⅲ significantly improves airway remodeling of COPD model rats, however, the components compatibility remains to be revealed.

Objective

To evaluate the effect of ECC-BYFⅢ and components compatibility in treating airway remodeling of COPD based on the COPD rat model.

Methods

The components of ECC-BYFⅢ were divided into four categories: Buqi, Bushen, Huatan, and Huoxue. The four categories were divide into different groups according to the method of mathematical permutation. The animal experiment were performed during May to September in 2018. 216 SD rats were randomly divided into normal, model, ECC-BYF Ⅲ, different components compatibility and aminophylline groups, and 12 rats in each model. From week 1 to week 8, rat model of COPD in stable phase was established by cigarette smoke exposure combined with repeated bacterial infections. The rats were orally gavaged with corresponding drugs from week 9 to week 16. Hematoxylin eosin (HE) staining technique was used to observe the changes of bronchial wall and airway smooth muscle. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of matrix metalloprotein 12 (MMP-12), basic fibroblast growth factor (bFGF) in serum and levels of collagen (COL) -1, COL-3, and MMP-12 in bronchoalveolar lavage fluid (BALF). Region (R) value comprehensive evaluation method was used to evaluate the effect of different component compatibility on airway remodeling in COPD rats.

Results

ECC-BYFⅢ, different components compatibility and aminophylline weakened the thickness of airway wall, when compared to model group. ECC-BYFⅢ, Buqi Huatan, Fuzheng Huatan, Fuzheng Huoxue, Buqi Quxie and aminophylline significantly decreased the number of airway smooth muscle hyperplasia (P<0.05). When compared to model group, the level of bFGF in serum decreased in ECC-BYF Ⅲ, Bushen, Buqi Huatan, Buqi Huoxue, Bushen Huatan, and Bushen Huoxue groups. The level of MMP-12 in serum decreased ECC-BYFⅢ, Fuzheng groups. The levels of MMP-12, COL-1 in BALF decreased in ECC-BYFⅢ, different components compatibility and aminophylline groups. The level of COL-3 in BALF decreased in ECC-BYFⅢ, Bushen, Huatan, Huoxue, Fuzheng, Buqi Huatan, Buqi Huoxue, Bushen Huoxue, Fuzheng Huatan, Buqi Quxie, Bushen Quxie, and aminophylline groups (P<0.05). The results of R-value comprehensive evaluation about airway wall thickness, airway smooth muscle hyperplasia, indicators related to airway remodeling in serum and BALF in COPD rats showed that the components compatibility, except for Huatan, Quxie, ECC-BYFⅢ, other components compatibility and aminophylline improved the airway remodeling of COPD rats (P<0.05). Buqi Quxie, Fuzheng Huatan, and Buqi Huoxue showed better effects in improving airway remodeling in COPD rats.

Conclusion

ECC-BYFⅢ and its components compatibility showed different effects on airway remodeling in COPD rats. Buqi Quxie, Fuzheng Huatan, Buqi Huoxie (containing ginsenoside Rh1, astragaloside) showed better effects.

Review & Perspectives

Mechanism of Estrogen and Estrogen Receptors in Pathologic Pain

HE Bangjing, ZHOU Mingwang, ZHANG Pengwei

2024, 27(33):  4204-4209.  DOI: 10.12114/j.issn.1007-9572.2023.0377

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Pathologic pain is a serious chronic disease, including inflammatory pain, neuropathic pain and cancer pain. Previous studies have proved a close correlation of estrogen and its receptors with pathologic pain, which plays an important role in its occurrence and development, therefore, it has attracted the attention of many researchers at home and abroad. Combining the relevant literature at home and abroad in recent years, this paper reviews the relevant research progress of the mechanism of estrogen and its receptors in pathologic pain, in order to provide a theoretical basis for the prevention and treatment of pathologic pain, as well as the guidance for future research.

The Idea of Kidney Tonifying Therapy for Spermatogenesis Disorder in Type 2 Diabetes Mellitus Based on the Hypothalamic-pituitary-gonadal Axis

LU Wei, YANG Yunsong, LIN Lianmei, LIU Qiong, ZHAO Min, LI Jia, LIANG Fengxia, WU Song

2024, 27(33):  4210-4214.  DOI: 10.12114/j.issn.1007-9572.2023.0644

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Diabetic hyperglycemia in males is a significant contributing factor to the development of spermatogenesis disorder. The hypothalamic-pituitary-gonadal (HPG) axis serves as a crucial center for autonomic sexual function and the neuroendocrine network within the human body. It dominates physiological prominence in human reproduction, growth, and development, while also being susceptible to hyperglycemia, which is one of the key mechanisms in the development of spermatogenic disorder in type 2 diabetes mellitus (T2DM). This mechanism involves kidney deficiency, which is a common etiology and pathogenesis of both spermatogenesis disorder and T2DM. The kidney storing essence, which encompasses the functions of "dominating reproduction, manufacturing marrow to fill up the brain" bears similarities to the HPG axis. Kidney tonifying therapy can regulate and improve the function of HPG axis, thereby establishing a theoretical basis for the use of kidney tonification therapy in the treatment of spermatogenesis disorder in T2DM. The traditional formula of tonifying the kidney can serve as a complementary treatment for both DM and spermatogenesis disorder. This approach offers a conceptual framework and methodology for the prevention and treatment of T2DM-induced infertility through kidney tonification.

Bibliometric Analysis

The Application of Rapid Review in the Field of Medical Research: a Bibliometric Analysis

LI Miaomiao, WU Xue, JING Chengyang, ZHANG Le, ZHAO Hui, LIAO Xing

2024, 27(33):  4215-4224.  DOI: 10.12114/j.issn.1007-9572.2023.0358

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Background

In the face of the surge of primary studies within a certain period of time, the traditional time-consuming systematic review method is difficult to provide evidence-based basis for clinical practice. Rapid review (RR), as an extension of systematic review, can integrate existing research in a limited time to meet the need for rapid decision-making. Currently, RR has been widely used in the field of medical research, but its application status remains unclear.

Objective

To explore the current status and hotspot of RR research by using bibliometric analysis.

Method

CNKI and WOS databases were searched for the researches in the field of RR application from 2001 to 2023, a visualization analysis was performed on annual publication volume, countries, institutions, authors, journals, and keywords of Chinese and English literature by the bibliometrics software of VOSviewer and CiteSpace.

Results

A total of 151 articles in Chinese and 1197 in English were included. The publication volume of RR application increased gradually from 2001 to 2023, but the publication volume in foreign was higher than that in China, with more obvious increasing trend. The United Kingdom was the country with the highest publication volume (252), the University of Toronto in Canada was the institution with the highest publication volume (52), and Peking University Third Hospital ranked first in publication volume in China (23). The journal Evaluation and Analysis of Drug-use in Hospitals of China had the highest publication volume in China (22), and the journal BMJ Open had the highest publication volume abroad (42). In China, the author team mainly composed of MEN Peng, ZHAI Suodi and ZHAO Zinan published more research. In foreign, the authors of NUSSBAUMER-STREIT, GARTLEHNER and TRICCO published more studies. The most frequently cited literature in China was mainly about RR application and methodology, rapid assessments of drugs or technologies, and the impact of COVID-19, while the most frequently cited literature in foreign was mainly about the the impact, intervention, and epidemiological factors of COVID-19, or methodological studies of RR. Domestic research hotspots mainly focused on the field of rapid health technology assessment in the safety, efficacy, and cost effectiveness of intervention for chronic or serious diseases. Foreign research hotspots mainly focused on the etiology, intervention, diagnosis, prevention, and impact of COVID-19, and rapid evidence synthesis related to decision-making, such as the safety and effectiveness of the drug intervention in children, health care, cancer treatment or mortality risk in middle-aged and elderly populations.

Conclusion

At present, there is a great difference in the development of RR application in the medical field at home and abroad. The application of RR in foreign is gradually maturing, but in China, it is still in the preliminary stage. The experience of RR application in foreign can be learned to expand the development of domestic RR application.