Table of Content

15 February 2025, Volume 28 Issue 05

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Guidelines·Consensus

Clinical Practice Guideline for the Prevention and Treatment of Stroke with Integrated Traditional Chinese and Western Medicine (2023 Edition)

NI Xiaojia, LIN Hao, LUO Xufei, KUANG Zhuoran, LIU Yunlan, GUO Jianwen, CHEN Yaolong, CAI Yefeng, Working Group of Clinical Practice Guideline for the Prevention and Treatment of Stroke with Integrated Traditional Chinese and Western Medicine

2025, 28(05):  521-533.  DOI: 10.12114/j.issn.1007-9572.2024.0485

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Recently，the burden of stroke in China is currently increasing，and the clinical evidences have emerged in the field of integrative medicine for stroke. To standardize the prevention and treatment of integrative medicine for stroke，twelve research questions were identified after evaluating the necessity of updating guideline and selecting research questions，which were based on "Evidence-based Practice Guideline on Integrative Medicine for Stroke 2019". The guideline project was set up to China Association of Chinese Medicine as "Clinical Practice Guideline for the Prevention and Treatment of Stroke with Integrated Traditional Chinese and Western Medicin". Eighteen recommendations regarding integrative medicine for ischaemic stroke，haemorrhagic stroke，and complications of stroke were proposed following the latest clinical practice guidelines，systematic retrieval and objective evaluation of clinical evidence，experience of clinical experts of Chinese and Western medicine，discussion in working group，and solicited opinion. This guideline provided scientific and specific guidance for medical practitioners at all levels，and promoted the standardized application of integrative medicine for stroke，to reduce the death，recurrence and disability of stroke.

Stroke Section

Construction of Conceptual Framework of Proactive Health Behavior in Stroke Patients

ZHOU Chenxi, LIN Beilei, TANG Shangfeng, ZHANG Zhenxiang, WANG Xiaoxuan, JIANG Hu, ZHANG Dudu, LIU Bowen, LI Xin

2025, 28(05):  534-540.  DOI: 10.12114/j.issn.1007-9572.2024.0381

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Background

The incidence of stroke is increasing year by year, and behavioral control is a direct and effective intervention means to prevent stroke. Proactive health medical model improves the initiative and accessibility of chronic disease prevention and control, while the concept of proactive health behavior in stroke patients remains to be explored.

Objective

To explore the level of proactive health cognition and behavior in stroke patients, and construct the conceptual framework of proactive health behavior in stroke patients.

Methods

From August to October 2023, a total of 26 inpatients with stroke in the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University were selected as the study objects by means of purposive sampling method. Following the grounded theory methodology of interpretivism, 26 patients with stroke were interviewed by semi-structured method, and the data were analyzed by coding and persistence comparison methods.

Results

The 10 main categories and 4 core categories of the theme "proactive health behavior of stroke patients" were separated out, including 3 intrinsic behaviors of "health motivation, health responsibility and mental health", 1 habitual behavior of "lifestyle management", 3 social behaviors of "active compliance with doctors, social relations and information seeking", and 3 intervention conditions of "consciousness awakenings, self-control and resource availability". And establish the conceptual framework.

Conclusion

The conceptual framework of proactive health behavior in stroke patients includes intrinsic behavior, habitual behavior, social behavior and intervention conditions. This framework may be helpful for the further development of assessment tools and the formulation of personalized intervention measures, and has guiding significance for promoting the research and practice of proactive health behavior in stroke patients.

Correlation between the Systemic Inflammatory Response Index and Risk of Ischemic Stroke Recurrence

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

2025, 28(05):  541-547.  DOI: 10.12114/j.issn.1007-9572.2024.0011

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Background

Systemic inflammatory response index (SIRI) is an emerging biomarker associated with ischemic stroke (IS) , but its correlation with recurrent IS remains unclear.

Objective

To investigate the correlation between SIRI and one-year recurrence of IS.

Methods

Patients diagnosed with 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 between March 2019 and March 2021 were enrolled into the cohort. All patients were followed up for one year. Relevant clinical information within 48 hours of admission was collected. The recurrence of IS was recorded during the 1-year follow-up. The correlation between SIRI and one-year recurrence of IS was examined using Cox regression model, restricted cubic splines (RCS) , and subgroup analysis.

Results

A total of 1 023 eligible patients were enrolled in the cohort, including 107 (10.46%) experiencing a recurrence of IS during the one-year follow-up period. After adjusting for confounders, multivariable Cox regression analysis showed that an elevated SIRI was a risk factor for IS recurrence (HR=1.06, 95%CI=1.01-1.10, P<0.05) . Categorized into quartiles, patients in the highest quartile (fourth quartile, Q4 subgroup, n=256) of SIRI exhibited a significantly higher risk of IS recurrence compared to those in the lowest quartile (first quartile, Q1 subgroup, n=256) (HR=1.80, 95%CI=1.08-3.00, P<0.05) . RCS analysis demonstrated a J-shaped dose-response relationship between SIRI and the risk of IS recurrence (P_Nonlinear=0.025) . Subgroup analyses stratified by gender, age, history of stroke, and the National Institutes of Health Stroke Scale (NIHSS) score at admission were performed. A significant correlation was identified between SIRI and NIHSS score (P<0.001) . Specifically, for patients with an NIHSS score of 0-1 point, an elevated SIRI was significantly correlated with an increased risk of IS recurrence (HR=1.25, 95%CI=1.04-1.51, P=0.020) . For those with an NIHSS score of 5-15 points, an elevated SIRI was significantly correlated with a higher recurrence risk (HR=1.20, 95%CI=1.12-1.28, P<0.001) . It was indicated that a higher SIRI was significantly correlated with an increased risk of IS recurrence within these score ranges.

Conclusion

A higher SIRI is significantly correlated with an increased risk of IS recurrence. A J-shaped association is observed between SIRI and IS recurrence risk. Notably, in IS patients with NIHSS scores of 0-1 and 5-15, elevated SIRI is significantly correlated with an increased risk of recurrence.

Study on Sleep Status and Prognostic Factors in Patients with Acute Posterior Circulation Ischemic Stroke

ZHANG Pingshu, XUE Jing, XING Aijun, WANG Lianhui, MA Qian, FU Yongshan, YUAN Xiaodong

2025, 28(05):  548-553.  DOI: 10.12114/j.issn.1007-9572.2024.0092

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Background

Patients with stroke often experience sleep disturbances and imbalances, which are easily overlooked in clinical treatment. Moreover, there is currently limited research on whether sleep status affects the prognosis of such diseases.

Objective

Exploration of factors influencing sleep state changes and prognosis in patients with acute posterior circulation ischemic stroke.

Methods

A total of 60 patients with acute posterior circulation ischemic stroke, admitted to Kailuan General Hospital Affiliated to North China University of Science and Technology, from December 2019 to December 2023, were selected as the case group. Based on the modified Rankin Scale (mRS) score at discharge, the case group was divided into a good prognosis subgroup (45 cases) and a poor prognosis subgroup (15 cases) . Additionally, 52 patients without cerebral vascular stenosis and acute ischemic stroke during the same period were selected as the control group. General and clinical data of the patients were collected to compare the circadian sleep-wake rhythms, daytime sleep-wake rhythms, nighttime sleep-wake rhythms, and the distribution of infarcted brain regions between the good prognosis subgroup and the poor prognosis subgroup. Multivariate Logistic regression analysis was used to identify the prognostic factors influencing the outcomes of patients with acute posterior circulation ischemic stroke.

Results

The apnea-hypopnea index (AHI) in the case group was higher than in the control group (P<0.05) . The proportions of patients in the case group with reversed sleep cycles, increased daytime sleep, and difficulty falling asleep were higher than those in the control group, with statistically significant differences (P<0.05) . The case group showed higher total daytime sleep time, wake time after sleep onset, light sleep duration, deep sleep duration, NREM sleep duration, REM sleep duration, REM sleep proportion, and deep sleep proportion compared to the control group, whereas the proportions of NREM sleep and light sleep were lower, all with statistically significant differences (P<0.05) . The case group also exhibited longer total nighttime sleep time, light sleep duration, and NREM sleep duration than the control group, with statistically significant differences (P<0.05) . The proportion of pontine infarction in the poor prognosis subgroup was higher than in the good prognosis subgroup, with a statistically significant difference (P<0.05) . Multivariate Logistic regression analysis showed that daytime deep sleep duration (OR=1.203, 95%CI=1.032-1.401) and pontine infarction (OR=16.497, 95%CI=1.142-238.391) were influencing factors for the prognosis of acute posterior circulation ischemic stroke (P<0.05) .

Conclusion

Patients with acute posterior circulation ischemic stroke exhibit an increased AHI and present with sleep characteristics such as reversed sleep cycles, increased daytime sleep, and difficulty falling asleep at night. Additionally, daytime deep sleep duration and pontine infarction are factors that adversely affect the prognosis of these patients.

Advances in the Prognostic Prediction of Acute Ischemic Stroke: Using Machine Learning Predictive Models as an Example

DU Huijie, LIU Xingyu, XU Minghuan, YANG Xuezhi, ZHANG Huiqin, MO Jiali, LU Yi, KUANG Jie

2025, 28(05):  554-560.  DOI: 10.12114/j.issn.1007-9572.2024.0090

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Acute ischemic stroke (AIS) is characterized by high rates of disability, mortality, and recurrence, posing a significant burden on patients and society. In the era of big data, predictive models are increasingly used in patient diagnosis, treatment decisions, prognosis management, and healthcare resource allocation, highlighting their growing importance. Machine learning methods have become a crucial tool for predicting the prognosis of AIS patients and have been widely applied. This review explores recent advancements in the study of AIS prognosis prediction, focusing on machine learning methods. It discusses current issues and challenges faced by machine learning models, aiming to provide new insights and references for methods of early assessment and prediction of prognosis outcomes in AIS patients.

Original Research

The Association between Nap Duration, Nighttime Sleep, and Depressive Symptoms among Elderly People in China: an Empirical Analysis based on 2020 CHARLS Data

ZHOU Mei, YANG Aiqiong, XING Ying, WANG Yuling

2025, 28(05):  560-567.  DOI: 10.12114/j.issn.1007-9572.2024.0226

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Background

As China enters a moderately aging society, the mental health problems of the elderly are increasing year by year, and lifestyle habits are closely related to the mental health of the elderly.

Objective

Exploring the relationship between nap time, nighttime sleep, and depressive symptoms among elderly people in China, and determining recommended sleep time based on lifestyle habits, providing scientific basis for early prevention and control of depression in the elderly.

Methods

Based on the publicly released fifth round (2020) of the China Health and Retirement Longitudinal Study (CHARLS) on November 16, 2023, 8 233 eligible individuals were included as research subjects. The Depression Rating Scale (CSE-D10) was used to assess depressive symptoms in elderly individuals, with nap duration divided into 5 levels: no nap, <30 min, 30-59 min, 60-89 min, ≥90 min. Nighttime sleep was divided into 5 levels: ≥8 h, 7-<8 h, 6-<7 h, 5-<6 h, <5 h. Multivariate Logistic regression analysis was used to explore the factors that affect the occurrence of depression symptoms in elderly people. Random forest model was used to analyze the importance of nap duration and nighttime sleep in the occurrence of depression symptoms in elderly people. Restrictive cubic spline curves were used to further explore the dose-response relationship between nap duration, nighttime sleep duration, and the risk of depression symptoms.

Results

During the 2020 survey period, the incidence of depressive symptoms among elderly people in China was 24.84% (2 045/8 233) . The results of multivariate Logistic regression analysis showed that a nap duration of 30-59 minutes was a protective factor for depression symptoms in the elderly (OR=0.814, 95%CI=0.673-0.985, P=0.034) , and a nighttime sleep duration of less than 5 hours was a risk factor for depression symptoms in the elderly (OR=1.705, 95%CI=1.435-2.027, P<0.001) . Women, unmarried/separated/divorced/widowed, disabled, physically painful, physically active, self-rated health status decreased, life satisfaction decreased, stroke, and Parkinson's disease increased the risk of depression symptoms in the elderly (P<0.05) . The random forest model showed that the duration of nap time and nighttime sleep time had a significant impact on depressive symptoms. There was a non-linear relationship between the duration of nap time and the occurrence of depressive symptoms (P_nonlinear<0.05) . The risk of depression in elderly people continued to decrease with increasing time after nap time of 30 minutes, with the lowest level being about 50 minutes. The risk of depression symptoms increased after nap time exceeded 75 minutes. The risk of depression in elderly people decreased continuously with time after 6 hours of sleep at night, with a minimum level of about 7 hours. The risk of depression increased after more than 9 hours of sleep (P_overall<0.05) .

Conclusion

The incidence of depression (24.84%) is higher in the elderly population in China, and there is a J-shaped relationship between the duration of nap time and nighttime sleep and depression. It is recommended that elderly people nap for 30-75 minutes every day, and moderate nap time can effectively reduce the risk of depression symptoms in the elderly. At the same time, sleeping for 6-9 hours at night can reduce the risk of depression symptoms, which has certain significance for early prevention and control of depression in the elderly population.

Association of Prognostic Nutritional Index with Cardiovascular Mortality in Patients with Peritoneal Dialysis: a Multicenter Retrospective Cohort Study

ZHU Lu, AI Jun, LIAO Shengwu, HUANG Shuting, GONG Nirong, KONG Yaozhong, LIU Dehui, DOU Xianrui, ZHANG Guangqing

2025, 28(05):  568-574.  DOI: 10.12114/j.issn.1007-9572.2024.0340

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Background

Cardiovascular disease (CVD) is the primary cause of death in patients undergoing peritoneal dialysis (PD) , with malnutrition being one of the significant risk factors for both CVD and mortality. The prognostic nutritional index (PNI) serves as a comprehensive indicator of a patient's immune, inflammatory, and nutritional status. Due to its convenience and reliability, PNI has been widely used in prognostic assessments across various diseases, including cancer. Recent studies have indicated that PNI not only reflects the prognosis of PD patients but is also closely related to their cardiovascular health. However, the relationship between nutritional status at different time points and the prognosis of PD patients requires further exploration.

Objective

To explore the relationship between first-year PNI and CVD mortality in PD patients.

Methods

This multicenter, retrospective observational cohort study included 1 640 PD patients who initiated treatment between January 1, 2000, and July 1, 2019, at four medical centers: Nanfang Hospital, Southern Medical University, Shunde Hospital of Southern Medical University, the First People's Hospital of Foshan, and Ganzhou People's Hospital. Patients were followed up until July 1, 2021, with the primary endpoint being CVD mortality. A restricted cubic spline (RCS) was used to further examine the non-linear association between PNI and the risk of CVD mortality. Survival curves were generated using the Kaplan-Meier method, and receiver operating characteristic (ROC) curves for predicting CVD mortality based on PNI were analyzed, with an optimal cut-off of 40.46 dividing patients into low PNI (703 patients) and high PNI (937 patients) groups. The impact of PNI on CVD mortality was assessed using Log-rank tests and Cox regression analysis.

Results

The median follow-up period was 30 months, during which 148 patients died, 73 of whom from CVD (49.32%) . RCS results indicated a linear association between PNI and CVD mortality events (P for Nonlinear=0.655) . The area under the ROC curve (AUC) for PNI predicting CVD mortality was 0.717 (95%CI=0.659-0.775, P<0.001) , with a sensitivity of 74.0% and a specificity of 58.6%. Kaplan-Meier analysis showed statistically significant differences in CVD survival curves between the low and high PNI groups (χ²=26.685, P<0.001) . Multivariable Cox regression analysis, adjusted for gender, age, and history of CVD, indicated that a low PNI remains an independent predictor of CVD mortality (HR=7.76, 95%CI=1.72-35.06, P=0.008) . Subgroup analysis confirmed the robustness of these findings without significant interaction effects.

Conclusion

A reduced PNI is an independent factor influencing CVD mortality in PD patients, making the first-year PNI score a valuable tool for prognostic assessment in PD management.

The Effect of Cerebellar Vermal rTMS with TBS Paradigm on Negative Symptoms, Cognitive Function and Serum Inflammatory Factors in Elderly Patients with Chronic Schizophrenia: a Randomized Controlled Trial

DONG Xiaomei, ZHAO Hongyan, GENG Zhongli, XU Tianchao, WANG Qi

2025, 28(05):  575-580.  DOI: 10.12114/j.issn.1007-9572.2024.0161

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Background

The cerebellar vermis is closely related to emotional regulation and cognitive function. There have been few reports on whether repeated transcranial magnetic stimulation (rTMS) of the cerebellar vermis can improve clinical symptoms in elderly patients with chronic schizophrenia (CSZ) .

Objective

Observing the effects of cerebellar vermis rTMS with theta burst stimulation (TBS) paradigm on negative symptoms, cognitive function, and serum inflammatory cytokine levels in elderly CSZ patients.

Methods

This study was a single blind randomized controlled trial. Fifty elderly CSZ patients in stable condition admitted to Shenyang Mental Health Center were selected between October 2022 and August 2023 as the subjects. Using a random number table method, CSZ patients were divided into an observation group and a control group, with 25 cases in each group. The patients in observation group were treated with rTMS with TBS paradigm, the stimulation site was the vermis of the cerebellum. The treatment was conducted 5 days a week, once a day, for 4 consecutive weeks. The patients in control group were intervention with pseudo stimulation, and the treatment time and parameters were the same as those in the observation group. Use the Positive and Negative Symptom Scale (PANSS) to evaluate overall psychiatric symptoms, and use the SANS to evaluate negative symptoms. Evaluate cognitive function using the MATRICS Consensus Cognitive Battery (MCCB) . Detecting serum interleukin-1β (IL-1β) , Interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) .

Results

Compared with the control group, the observation group had lower PANSS negative symptom scores [ (17.11±2.00) scores vs (19.21±2.76) scores], general psychopathological symptom scores [ (26.34±2.07) scores vs (29.33±4.27) scores], total scores after treatment [ (53.10±3.61) scores vs (58.99±5.53) scores], and lower SANS scale scores [ (54.00±3.78) scores vs (57.83±4.15) scores] (P<0.05) . Compared with the control group, the observation group had higher post-treatment information processing speed scores [ (39.78±2.45) scores vs (37.24±1.10) scores], attention alertness scores [ (47.07±4.27) scores vs (40.01±2.17) scores], working memory scores [ (45.12±3.20) scores vs (41.89±4.11) scores], and social cognitive scores [ (46.40±4.29) scores vs (41.42±7.45) scores] (P<0.05) . Compared with the control group, the observation group had lower levels of IL-1β [ (41.09±7.34) μg/L vs (47.03±12.45) μg/L], IL-6 [ (41.28±7.32) μg/L vs (47.03±9.45) μg/L], and TNF-α [ (53.28±14.15) μg/L vs (61.35±12.79) μg/L] after treatment (P<0.05) . During the rTMS treatment process, only 4 cases in the observation group experienced dizziness and headache symptoms during the first treatment, which gradually became tolerable with prolonged treatment time. All other patients have no complaints of discomfort.

Conclusion

The rTMS with TBS paradigm can improve negative symptoms, cognitive function, and serum inflammatory factor levels in elderly patients with CSZ.

Clinical Efficacy of Repetitive Transcranial Magnetic Stimulation Combined with Entacapone-Levodopa-Carbidopa on Motor and Non-motor Symptoms in Parkinson's Disease: a Randomized Controlled Trial

ZHANG Xiang, LIN Xiaoguang, CHEN Jing, YANG Dandan, ZHANG Xueling

2025, 28(05):  581-586.  DOI: 10.12114/j.issn.1007-9572.2024.0411

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Background

Parkinson's disease (PD) is one of the most common movement disorders, primarily affecting middle-aged and elderly individuals. With the increasing aging population, the incidence of PD is rising, placing a heavy burden on patients' families and society.

Objective

To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with entacapone-levodopa-carbidopa (LCE) on motor and non-motor symptoms in PD patients.

Methods

The study employed a randomized, double-blind design. A total of 110 PD patients who visited the Nanjing Drum Tower Hospital Group Suqian Hospital from August 2022 to May 2024 were selected and randomly divided into a control group (n=32) , a LCE group (n=40) , and an observation group (n=38) . The control group received Madopar treatment (0.5 tablet per dose, 3 doses per day) and sham stimulation, the LCE group received LCE treatment (1 tablet per dose, 3 doses per day) and sham stimulation, and the observation group received LCE (1 tablet per dose, 3 doses per day) combined with rTMS treatment (40 sequences per day, once daily, 5 times per week) for 4 weeks. The Unified Parkinson's Disease Rating Scale PartⅢ (UPDRSⅢ) , Hamilton Depression Rating Scale (HAMD) , Hamilton Anxiety Rating Scale (HAMA) , Parkinson's Disease Sleep Scale (PDSS) , Mini-Mental State Examination (MMSE) , Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) , and Activities of Daily Living (ADL) were used to assess improvements in motor and non-motor symptoms before and after treatment.

Results

In the control group, UPDRSⅢ scores decreased and ADL scores increased after treatment compared to pre-treatment (P<0.05) . In the LCE and observation groups, UPDRSⅢ, HAMD, HAMA, and SCOPA-AUT scores decreased, while MMSE, PDSS, and ADL scores increased after treatment compared to pre-treatment (P<0.05) . Post-treatment UPDRSⅢ, HAMD, HAMA, and SCOPA-AUT scores were lower, and PDSS, MMSE, and ADL scores were higher in the LCE and observation groups compared to the control group (P<0.05) . The observation group had lower UPDRSⅢ, HAMD, HAMA, and SCOPA-AUT scores and higher PDSS, MMSE, and ADL scores than the LCE group after treatment (P<0.05) . There was no significant difference in the total incidence of adverse reactions among the three groups after treatment (P>0.05) .

Conclusion

Treatment with rTMS combined with LCE can significantly improve motor and non-motor symptoms in PD patients, with better efficacy than monotherapy.

A Predictive Nomogram for the Risk of Frailty/Pre-frailty on Inflammatory Biomarkers in the Elderly

SHI Xiaotian, WANG Shan, YANG Huayu, YANG Yifan, LI Xu, DOU Guoze, MA Qing

2025, 28(05):  587-593.  DOI: 10.12114/j.issn.1007-9572.2023.0924

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Background

Frailty is a common geriatric syndrome linked to negative clinical outcomes. Current assessments of frailty predominantly depend on various scales, lacking a standardized gold standard. Chronic inflammation is a key pathophysiological mechanism of frailty, and examination of inflammatory markers in routine blood tests is easy and simple-to-use. Nevertheless, the correlation between these inflammatory markers and frailty has not been fully elucidated.

Objective

To explore the correlation between inflammatory markers in routine blood tests and frailty in the elderly, analyze the influencing factors of frailty and construct a risk prediction model for the risk of frailty or pre-frailty.

Methods

Elderly individuals receiving physical examinations in the Healthcare Center, Beijing Friendship Hospital, Capital Medical University from August 2020 to September 2022 were recruited. Baseline characteristics and laboratory test results were collected. The frailty was assessed using the Simple Frailty Questionnaire (FRAIL) . Univariate and multivariate Logistic regression analyses were applied to identify risk factors for frailty/pre-frailty in the elderly. A nomogram was then created, followed by an internal validation of its performance via Bootstrap. Finally, the receiver operating characteristic (ROC) curves, calibration curve and decision curve analysis (DCA) were used to evaluate the identification ability, accuracy and clinical applicability of the nomogram.

Results

A total of 554 elderly individuals were included in the study, of whom 213 (38.4%) were identified as frail or pre-frail. Multivariate Logistic regression analysis showed that age-adjusted Charlson Comorbidity Index (ACCI, OR=1.42, 95%CI=1.21-1.66) , Mini-nutritional Assessment-short Form (MNA-SF, OR=0.71, 95%CI=0.61-0.83) , hemoglobin/red cell distribution width ratio (HRR, OR=0.44, 95%CI=0.23-0.86) , and medication of multiple drugs (OR=0.54, 95%CI=0.36-0.81) were independent influencing factors of frailty or pre-frailty in the elderly (P<0.05) . The predictive nomogram was established by employing the above-mentioned variables. The area under the curve (AUC) of the nomogram for identifying frailty or pre-frailty in the elderly was 0.719 (95%CI=0.675-0.764) . The nomogram had a high goodness-of-fit after internal validation using the Bootstrap resampling method. The nomogram was found with a high goodness-of-fit by the Hosmer-Lemeshow test (P>0.05) . DCA showed that when the threshold probability of patients ranging from 0.15 to 0.95, the nomogram resulted in higher net benefit of predicting the risk of frailty or pre-frailty.

Conclusion

Comorbidities, medication of multiple drugs, malnutrition, and HRR are influencing factors of frailty or pre-frailty in the elderly. The constructed predictive nomogram shows strong discrimination, consistency, and clinical utility, offering valuable guidance for the early screening of frailty or pre-frailty.

Identification of Sepsis Subphenotypes and Risk Stratification Using the Procalcitonin Trajectory

ZHANG Shaotong, WANG Bo, ZHANG Mingrui, MA Guiyan, LIU Shaoguang

2025, 28(05):  594-600.  DOI: 10.12114/j.issn.1007-9572.2023.0923

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Background

Sepsis is a heterogeneous disease and identifying sepsis subphenotypes can help optimize sepsis management.

Objective

To identify sepsis subphenotypes and risk stratification using procalcitonin trajectories.

Methods

Retrospective analysis of 800 cases admitted to the General Hospital of Ningxia Medical University and 202 adult patients with sepsis (age >18 years) in Gansu Provincial Hospital from January 1, 2021 to August 1, 2023 was performed. 597 patients from the General Hospital of Ningxia Medical University were randomized into the development cohort (60%) , and another 202 and 203 from Gansu Provincial Hospital, totaling 405 patients, were included in the validation cohort (40%) . Firstly, the development cohort was divided into survival and death groups to analyze the prognostic value of procalcitonin measurements for sepsis at different times, and ROC curves were plotted to assess predictive efficacy. Then, Group-based trajectory modeling (GBTM) based on repeated measurements of procalcitonin was performed to identify sepsis subphenotypes, which were characterized based on trends in procalcitonin changes and clinical features, and survival analysis and risk stratification were performed, and, Finally, the predictive model was validated.

Results

In the development cohort, 512 patients survived and 85 died, and the overall 28-day mortality was 14.2%. In the validation cohort, 341 patients survived and 64 died, with an overall 28-day mortality of 16.3%. The death group had significantly higher PCT d3, PCT d5, and PCT d7 than the survival group (P<0.01) , and PCT d7 had the highest predictive efficacy with an area under the ROC curve of 0.833. The "Middle Start Rapid Rise" was characterized by respiratory dysfunction; the "Low Start Slow Decline" had the lowest comorbidity and critical care scores and was considered to be the baseline group; the "High Start Rapid Decline" was characterized by higher comorbidity and critical care scores; and the "High Start Slow Decline" was characterized by multiple organ dysfunction and had the highest value of critical care scores and was considered to be the most severe group on admission. Survival analyses of the four subphenotypes showed that "Middle Start Rapid Rise" had the highest mortality rate and was defined as the high-risk group, followed by "High Start Slow Decline" and was defined as the intermediate-risk group, "Low Start Slow Decline" and "High Start Rapid Decline" had the lowest mortality rate and were defined as the low-risk group. The relative distributions of calcitonin trajectories and comorbidities in the validation and development cohorts were generally consistent.

Conclusion

Procalcitonin trajectories can be used to identify sepsis subphenotypes, and the combination of procalcitonin values and trajectories can be used to achieve risk stratification for sepsis, providing a theoretical basis for clinicians to assess the prognosis of patients using procalcitonin trajectories.

Mechanism of Liraglutide in Oxidized Low-density Lipoprotein Induced Endothelial Cell Injury Based on NOD-like Receptor 3 Inflammasome Pathway

CHEN Ling, XU Rui, CHENG Xinchun, ZHANG Zhanying, XU Hong

2025, 28(05):  601-606.  DOI: 10.12114/j.issn.1007-9572.2023.0531

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Background

Atherosclerosis is the primary cause of cardiovascular and cerebrovascular diseases worldwide, and inflammation is a current research focus, with NOD-like receptor 3 (NLRP3) being the most intensively studied inflammasome. GLP-1 receptor agonists have shown anti-atherosclerotic effects, but the underlying mechanisms remain unclear.

Objective

To investigates the mechanism of liraglutide in antagonizing oxidized low-density lipoprotein (ox-LDL) induced endothelial cell injury.

Methods

From March 25 to May 19, 2022, Human umbilical vein endothelial cells (HUVEC) were cultured, and HUVEC with blank serum was served as the control group, 100 μg/mL ox-LDL treated HUVEC for 48 hours was served as the model group. Liraglutide was added in concentrations of 100 nmol/L, 200 nmol/L, and 400 nmol/L to the HUVECs treated with ox-LDL for 24 hours, forming low, medium, and high concentration liraglutide groups, respectively. Cell proliferation rates were calculated using the CCK-8 method. Pyroptotic cell morphology was observed by using scanning electron microscopy. Lactate dehydrogenase (LDH) activity was measured. The expression levels of interleukin (IL) -1β and IL-18 were detected using enzyme-linked immunosorbent assay (ELISA) . Western blot was used to assess the expression levels of NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC) , caspase-1, gasdermin D (GSDMD) , and N-terminal GSDMD (N-GSDMD) .

Results

Cell proliferation rate in the model group and both low and medium concentration liraglutide groups were lower than the control group, while the rate in all liraglutide-treated groups were higher than the model group (P<0.05) . Scanning electron microscopy showed obvious pyroptosis in the model group cells, which was significantly reduced in all liraglutide-treated groups. LDH activity in the model group and the low concentration liraglutide group was higher than the control group, while it was lower in all liraglutide-treated groups compared to the model group (P<0.05) . IL-1β level in the model group and the low concentration liraglutide group was higher than the control group, whereas IL-1β levels in the medium and high concentration liraglutide groups was lower than the model group (P<0.05) . IL-18 level in the model group was higher than the control group, while level in all liraglutide-treated groups was lower than the model group (P<0.05) . The expression levels of NLRP3, ASC, Caspase-1, GSDMD, and N-GSDMD in the model group were higher than the control group. In the low concentration liraglutide group, ASC and Caspase-1 levels were higher than the control group, whereas in the medium concentration group, NLRP3 and ASC levels were lower than the model group. In the high concentration group, NLRP3, ASC, and Caspase-1 levels were lower than the model group (P<0.05) .

Conclusion

Liraglutide significantly inhibits NLRP3 inflammasome activation in endothelial cells induced by ox-LDL, and can inhibit endothelial cell pyroptosis, with anti-atherosclerotic effects.

Original Research·Research of Specific Population·Adolescents Health

The Developmental Trajectory of Obsessive-compulsive Symptoms in College Students: an Analysis of a Latent Growth Model

GUO Zexi, YILIZHATI· Maimaiti, GULIGENA· Aitahong

2025, 28(05):  607-611.  DOI: 10.12114/j.issn.1007-9572.2024.0174

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Background

Obsessive-compulsive symptoms is a common psychological phenomenon among college students. There is a wealth of cross-sectional research examining the overall development trend of obsessive-compulsive symptoms among college students, but there is a lack of research on the development trajectory of obsessive-compulsive symptoms among college students.

Objective

To investigate the development trajectory and influencing factors of compulsive symptoms among college students through longitudinal tracking.

Methods

The study employed a cluster random sampling method to select freshman students from Xinjiang Normal University as the research subjects, and conducted three follow-up tests using the obsessive-symptom and anxiety subscales in the Symptom Checklist 90 (SCL-90) over a period of 3 years. The first test was initiated in November 2020 (T1) , followed by the second test in March 2022 (T2) , and the third test in March 2023 (T3) . The survey results were analyzed using latent variable growth modeling.

Results

Data analysis was conducted using 3 289 valid samples who participated in all three measurements. Among the 3 289 college students, there were 1 966 females (59.8%) , 2 352 Han nationality (71.5%) , with an average age at the first survey of (21.0±0.7) years old. The scores of anxiety subscales in the SCL-90 were (1.48±0.51) scores at T1, (1.38±0.45) scores at T2 and (1.33±0.43) scores at T3; The scores of obsessive-symptom subscales in the SCL-90 were (1.75±0.58) scores at T1, (1.66±0.55) scores at T2 and (1.53±0.53) scores at T3. Pearson correlation analysis showed that there was a positive correlation between obsessive-compulsive symptoms and anxiety in college students at each time point (P<0.05) . The unconditional linear model showed a good fit, with a significant positive intercept (P<0.001) and a significant negative slope (P<0.001) , and a negative correlation between the intercept and slope (r=-0.033, P<0.001) , indicating that the scores of compulsive symptoms among college students showed a downward trend, with a higher starting level leading to a faster rate of decline. Inclusion of gender covariates (male=0, female=1) , it was found that gender had a positive predictive effect on intercept (β=0.105, P<0.001) , but had no significant predictive effect on slope (β<0.001, P>0.05) , indicating that female college students had a higher initial level of obsessive-compulsive symptoms than male students, and there was no significant difference in decline rate. After including anxiety as a covariate, it was found that anxiety positively affected obsessive-compulsive symptoms at each time point (P<0.001) . It was also found that gender had a positive predictive effect on the slope (β=0.017, P<0.05) , but had no significant predictive effect on the intercept (β=0.012, P>0.05) , indicating that after controlling for the influence of anxiety, the decline rate of obsessive symptoms in female college students was significantly lower than that in male college students.

Conclusion

Obsessive-compulsive symptoms among college students decrease with the increase of grade, and a high starting level does not necessarily lead to long-term distress. Anxiety hinders the alleviation of obsessive-compulsive symptoms and influences the emergence of obsessive-compulsive symptoms in female college students and the decline rate of obsessive-compulsive symptoms in male college students to a greater extent.

Correlation of Non-suicidal Self-injury with 25-Hydroxyvitamin D₃ and Blood Lipid Levels in Adolescents with Major Depressive Disorder

FAN Haojie, LIU Lewei, XIA Lei, TIAN Yinghan, YANG Cheng, HAO Mingru, ZHAO Xin, SHEN Qingqing, MO Daming, GENG Feng, LIU Huanzhong

2025, 28(05):  612-618.  DOI: 10.12114/j.issn.1007-9572.2024.0127

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Background

The incidence of major depressive disorder (MDD) in adolescents is annually elevated. Non-suicidal self-injury (NSSI) is a common clinical manifestation of MDD. Evidence suggested that vitamin D and lipid levels are associated with MDD, but whether they are related to NSSI is unclear.

Objective

To compare the levels of 25 (OH) D₃ and blood lipids in MDD adolescents with or without NSSI behavior, and to explore their diagnostic value for NSSI.

Methods

A total of 129 MDD adolescents who received treatment in the Department of Psychiatry, Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei from October 2020 to March 2022 were recruited. They were assigned into NSSI group (n=77) and non-NSSI group (n=52) based on the diagnostic criteria of NSSI in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) . The Positive and Negative Suicide Ideation (PANSI) , Insomnia Severity Index (ISI) , and Center for Epidemiological Survey, Depression Scale (CES-D) were used to evaluate the clinical symptoms. Fasting venous blood samples were collected to measure the levels of 25 (OH) D₃ and blood lipids, and compared between groups. In addition, multivariate Logistic regression analysis was performed to identify influencing factors for NSSI behavior in MDD adolescents. The diagnostic value of 25 (OH) D₃ and lipid levels in NSSI behaviors was assessed by plotting the receiver operating characteristic (ROC) curves.

Results

The age of the NSSI group was significantly lower than that of the non-NSSI group, whereas the total scores of PANSI, ISI, and CES-D were significantly higher than those of the non-NSSI group (P<0.05) . The level of 25 (OH) D₃ in the NSSI group was significantly lower than that in the non-NSSI group, whereas the levels of total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , and low-density lipoprotein cholesterol (LDL-C) were significantly higher than those in the non-NSSI group (P<0.05) . Multivariate Logistic regression analysis showed that both LDL-C (OR=5.695, 95%CI=2.422-13.388, P<0.001) and 25 (OH) D₃ (OR=0.871, 95%CI=0.768-0.987, P<0.05) were the influencing factors of MDD adolescents with NSSI. The area under curve (AUC) of LDL-C and 25 (OH) D₃ levels in assessing the risk of developing NSSI behavior in MDD adolescents was 0.73 (95%CI=0.65-0.82, P<0.001) and 0.62 (95%CI=0.52-0.72, P=0.023) , respectively. Their optimal cut-off value was 1.89 mmol/L and 19.15 μg/L, respectively. The AUC of 25 (OH) D₃ combined with LDL-C levels [ln (p/1-p) =1.364X1-0.143X2-0.161, where X1 and X2 was LDL-C and 25 (OH) D₃, respectively] in diagnosing NSSI behavior in MDD adolescents was 0.77 (95%CI=0.69-0.85, P<0.001) , with 77.92% of sensitivity and 67.31% of specificity.

Conclusion

25 (OH) D₃ and lipid levels are out of normal ranges in MDD adolescents with NSSI. Measurement of LDL-C combined with 25 (OH) D₃ levels may provide information to predict the occurrence of NSSI behaviors in MDD adolescents. A regular measurement of LDL-C and 25 (OH) D₃ and a dynamic monitor is valuable to provide symptomatic supports.

Original Research·Health Management·WITMED

Design of an Intelligent Health Management Platform

CHEN Penggang, SUN Guoqiang, ZHANG Xi, LI Xiaoze, QIN Panpan, GAO Xing, HU Hongpu

2025, 28(05):  619-623.  DOI: 10.12114/j.issn.1007-9572.2024.0338

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Intelligent health management is a crucial countermeasure to solving public health problems. By utilizing high-quality medical resources from a Third-Grade First Class Hospital, this study is able to solve prominent health problems in China, and it also creates medical knowledge bases and model bases. By taking advantage of intelligent additional features including self-testing health, risk estimation, health education, assessment, intelligent consultation, comprehensive intervention, and contracted doctor services, 40 statutory infectious diseases are monitored and warned early, and 260 common diseases are managed intelligently. The insured population can access health assessment, intelligent consultation, comprehensive intervention, and contracted doctor services through this research platform. The service management process is completed by these functions, which include health assessments, health classification management, personalized health plans, and health intervention to improve health status, decrease disease incidence rates, and improve health levels.

Research on the Service Quality Evaluation System Construction of Future Community Health Scenario

WANG Wenting, WANG Jing, ZHOU Fengchen, LIU Kening, WANG Sheng

2025, 28(05):  624-630.  DOI: 10.12114/j.issn.1007-9572.2024.0400

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Background

Under the background of the promotions concept change from "disease-centered" to "health-centered", Zhejiang province takes the lead in building a future community health scenario for the whole population and the whole life cycle, providing a "Zhejiang model" for the comprehensive reform of grassroots health care. It is of great theoretical significance and practical value to construct a set of scientific and effective service quality evaluation index system for future community health scene.

Objective

The purpose of this study is to construct a service quality evaluation index system for future community health scenes in Zhejiang province, aiming to provide a reference for improving the capabilities and quality of community health services and advancing the achievement of public health objectives.

Methods

Employing the SERVQUAL theory model, an initial indicators pool was developed through policy analysis, literature review, and field research. From October to December 2023, a two-round Delphi expert consultation method was used to refine the indicators, and the Analytic Hierarchy Process (AHP) was applied to determine the weights and composite weights of each indicator.

Results

A total of 17 experts participated in both rounds of consultation, among which 12 (70.6%) hold senior titles; 15 (88.2%) have 10 or more years of work experience; and there are 5 (29.4%) managers and medical staff from future community. The positivity level of the experts in both rounds was consistently rated at 1.0, with authority coefficients of 0.862 and 0.842, respectively, and the degree of expert consensus increased round by round. The final constructed indicator system includes 5 primary indicators, 13 secondary indicators, and 36 tertiary indicators, and the weights for the primary indicators—tangibles, reliability, assurance, responsiveness, and empathy were 0.168, 0.180, 0.240, 0.174 and 0.238, respectively. For the secondary indicators, the weights for venue facilities, digital equipment, Service Provision, Health Monitoring, Service Efficiency, Service Accessibility, Crisis Prevention and Emergency Rescue Capability, Professional Skills, Activity Organization, Smart Platform Maintenance, Service Attitude and Emotional Support, Service Effectiveness and Personalized Services were 0.399, 0.601, 0.672, 0.328, 0.487, 0.171, 0.342, 0.410, 0.416, 0.174, 0.284, 0.323 and 0.393 respectively.

Conclusion

The indicator system constructed in this study, which is an effective tool for conducting evaluation of future community health scenario, is scientifically reliable and exhibits a degree of systematization, innovation, operability and practical value. It is hoped to provide a reference to fomulate relevant policies and targeted improvement strategies.

Review & Perspectives

Research Progress on Stigma of Cognitive Disorders

YUAN Yiqing, CHEN Honglin

2025, 28(05):  631-638.  DOI: 10.12114/j.issn.1007-9572.2023.0437

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Cognitive impairment is also known as cognitive disorders. With the rapid aging of the population, the number of people affected by cognitive disorders and the Alzheimer's disease is on the rise. The stigma associated with cognitive disorder is widely recognized in the international community, but related research in this field remains limited. This paper found that definition and measurement of stigma of cognitive disorders need to be standardized, there is a lack of research on economically underdeveloped areas and evidence to establish causal inference; and there is ample room for improvement in both the quantity and quality of intervention studies. The research on stigma of cognitive disorders provides an unique opportunity to break the binary subject perspective in the traditional field of stigma research. At the same time, the discussion on the mechanism of cognitive disorder stigma formation can also deepen the academic discussion on labeling theory and attribution theory.

Research Progress in the Study of Traditional Chinese Herbal Medicine Extracts Regulating Ferroptosis thus Improving the Symptom of Alzheimer's Disease

PEI Jinying, SONG Jinzhou, MA Daofeng, LUO Xiaoting, LIU Bin, DONG Xiaohong, CONG Shuyuan

2025, 28(05):  639-648.  DOI: 10.12114/j.issn.1007-9572.2024.0295

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Alzheimer's disease (AD) is a common neurodegenerative disease in the elderly population. It's typical clinical manifestation is progressive memory impairment. Ferroptosis, rising as a new research direction on AD biological mechanism in recent years, mainly studies on iron-dependent programmed cell death. A large amount of evidence has shown that AD is closely related to ferroptosis in the brain. However, the exact mechanism of the role ferroptosis has played in AD is still unclear. One of the most popular research results indicates that AD might be induced by iron metabolism disorders, lipid peroxidation, and amino acid metabolism, thereby affecting the deposition of iron ions in the brain. So far, some effective chemical components of traditional Chinese herbs as cures of AD have been studied in depth, such as rhodiola rosea, polygala root, ginkgo biloba, poria cocos, etc. These traditional Chinese herbs have shown remarkable effects in the treatment of AD by means of targeting ferroptosis. In this context, this review systematically elaborates on the metabolism of iron in the brain, the characteristics of ferroptosis, and focuses on the metabolic regulation mechanism of ferroptosis. Meanwhile, this review also discusses the connection between ferroptosis and AD. Furthermore, it lists the effective compositions in traditional Chinese herbs that can improve AD by inhibiting ferroptosis, so as to provide reference information for the development and research of ferroptosis inhibitors in the future.