Table of Content

15 May 2025, Volume 28 Issue 14

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Guidelines Interpretation

Interpretation of the Key Updates in the Latest Version of 2024 NCCN Clinical Practice Guidelines for Gastric Cancer

MA Guifen, ZHANG Qian, SUN Jing

2025, 28(14):  1681-1688.  DOI: 10.12114/j.issn.1007-9572.2024.0405

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In 2024, the National Comprehensive Cancer Network (NCCN) has updated three editions of the Clinical Practice Guidelines for Gastric Cancer. These updates encompass multiple crucial areas of diagnosis, treatment, and follow-up monitoring for gastric cancer. It elevates the significance of next-generation sequencing in precision therapy for gastric cancer, refines the limitations for Epstein-Barr virus (EBV) testing and first-line immunotherapy in advanced stages. Adjustments have been made to the preoperative medication cycle for neoadjuvant immunotherapy, a new NTRK-targeted therapy drug was added in the second-line therapy, and a more detailed approach to postoperative monitoring and supplementation for nutritional deficiencies has been introduced. Notably, this version marks the first inclusion of endoscopic treatment pathways for early-stage gastric cancer and diagnostic and treatment pathways for single peritoneal metastasis in advanced gastric cancer. Additionally, it provides a comprehensive elaboration on the application principles of several emerging surgical techniques combined with intraperitoneal treatments. The updated content fully embodies the trend towards precision, personalized, and multidisciplinary treatment. This article will focus on the diagnosis, surgical treatment, systemic treatment, follow-up monitoring and other aspects of the guideline, in order to provide guidance and help for clinical practice.

Interpretation of the Updated NCCN Clinical Practice Guidelines for Colon Cancer (2024.V4)

XIA Yuhan, ZHUO Xiao, CAO Qinhan, LIAO Xingyu, LUO Guoliang, TANG Taichun, CHEN Min

2025, 28(14):  1689-1693.  DOI: 10.12114/j.issn.1007-9572.2024.0379

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The 2024.V4 of the NCCN Clinical Practice Guidelines for Colon Cancer provides important updates on pathological testing of systemic therapy for colon cancer, dose of chemoradiotherapy, and treatment and management of metastatic colon cancer. Firstly, the guidelines emphasize the importance of genomic testing in the systemic treatment of metastatic colon cancer. Secondly, the dose of chemoradiotherapy and targeted therapeutic targets of locally advanced colon cancer were modified. Finally, the new drug repitinib for the second-line treatment of metastatic colon cancer provides a new option for patients with positive neurotrophic tyrosine receptor kinase (NTRK) gene fusion. In terms of patient management, the importance of general practice to patients' quality of life and psychological support was emphasized. Through the interpretation of the above content, this paper is expected to provide references for the diagnosis, treatment and prognosis of colon cancer, ensure that patients receive timely specialized treatment, and provide references for the precision treatment of colon cancer.

Frontiers of Medicine

Medical Clinical Science Research in the Context of Internet Medicine

SHI Yifan, LI Bo, YU Miao, MA Yinhao, LIU Qian, HU Jing, WANG Hong, ZHANG Huina, WANG Tianyuan

2025, 28(14):  1694-1701.  DOI: 10.12114/j.issn.1007-9572.2023.0854

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Internet medical care has great potential for development, and the scientific research carried out under the background of internet medical care needs to be explored. This study starts from the application scenarios of internet medical care, and explores the selection of clinical scientific research topics under different application scenarios. Analyze the challenges faced by the application of internet medical care in clinical scientific research, and provide rational suggestions for the development of internet medical application in clinical scientific research. The results show that internet medical care has been applied in clinical diagnosis and treatment, pharmaceutical services, scientific research process management, rehabilitation care, health science popularization, etc. in clinical scientific research, highlighting the characteristics of convenience and accuracy, innovating diagnosis and treatment models, and improving service efficiency. The study specifically explores the challenges faced by clinical scientific research in the context of internet medical care in five aspects of scientific research elements, including the transformation of clinical evidence, the exchange and sharing of medical and health information, the development of clinical research methodologies, the training and supervision of scientific researchers, and internet traditional Chinese medicine. The development ideas of clinical scientific research and other aspects provide suggestions for the application of internet medical care in clinical scientific research, with a view to providing theoretical reference for the development of clinical scientific research related to internet medical care.

Clinical Research Progress and Challenges of Digital Therapeutics from Screening to Intervention in Autism Spectrum Disorder

ZENG Yongtian, CHEN Riling, NONG Xueyan, LIU Zhou, LIANG Lizhong, ZHU Zijian

2025, 28(14):  1702-1708.  DOI: 10.12114/j.issn.1007-9572.2024.0131

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In children, autism spectrum disorder (ASD) is primarily characterized by social (communication) impairments and repetitive, stereotyped behaviors and restricted interests, affecting children's social interaction, communication abilities, and behavioral patterns. In recent years, with technological advancements, digital therapeutics has played a significant role in managing ASD. For instance, multimodal data integration and machine learning algorithms have been used for the early identification of ASD, while virtual reality, augmented reality, and gamified learning platforms have been widely applied to enhance the social skills and cognitive functions of children with ASD. Although digital therapy has shown great potential and benefits in the field of autism, it also faces challenges, including individual differences in treatment response, uncertainty of long-term effectiveness, and data privacy protection. Overall, digital therapeutics has opened up a new path for the management of autism, and also points out important directions for future research and applications.

Application of Artificial Intelligence in Nutritional Management of Patients with Inflammatory Bowel Disease: a Scoping Review

LI Yiting, TU Wenjing, YIN Tingting, MEI Ziqi, ZHANG Sumin, WANG Meng, XU Guihua

2025, 28(14):  1709-1716.  DOI: 10.12114/j.issn.1007-9572.2024.0276

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Background

Diet plays a critical role in the development, progression and prognosis of inflammatory bowel disease (IBD) . Given that specific nutritional guidelines are limited, nutritional management for patients with IBD remains challenging and fraught with uncertainty. Although previous studies have demonstrated that artificial intelligence (AI) shows promising applications in the nutritional management of patients with chronic diseases, research specifically focused on its application in the nutritional management of patients with IBD remains limited.

Objective

To conduct a scoping review of studies on AI in nutrition management of patients with IBD.

Methods

Following the methodology of scoping reviews, the databases of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, IEEE Xplore, Association for Computing Machinery Digital Library, SinoMed, CNKI, Wanfang Data, and VIP were systematically searched from inception to March 2024 for studies on the application of AI in the nutritional management of patients with IBD. According to the established inclusion and exclusion criteria, two investigators independently screened the literature, and the basic characteristics of the selected studies were extracted.

Results

A total of 15 studies were included. The applications of AI in this field include exploring the relationship between diet and IBD, assisting in nutritional assessment, and aiding nutritional interventions. The majority of utilization AI technologies in the included studies are machine learning, with some also employing additional techniques such as natural language processing and deep neural networks.

Conclusion

AI is beneficial for exploring healthy dietary patterns for patients with IBD and providing personalized nutritional guidance. However, its application in the field of nutritional management in patients with IBD is still in its infancy. Future efforts should focus on strengthening multidisciplinary collaboration, emphasizing the integration of clinical guidelines, and assessing the effectiveness of AI applications in clinical settings to enhance the rigor and accuracy of the results.

Original Research

Analysis of the Influencing Factors for Depression of Female Caregivers of Left-behind Children in Rural Area in China

XIA Yuwen, SHI Huifeng, LI Mengshi, ZHANG Jingxu, WANG Xiaoli

2025, 28(14):  1717-1722.  DOI: 10.12114/j.issn.1007-9572.2024.0113

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Background

The majority of caregivers of left-behind children in rural China are their mothers and grandmothers. The mental health of children's caregivers is one of the significant factors affecting the early development of children. Currently, there is a lack of research and comparison on the factors influencing depression among mothers and grandmothers of left-behind children in rural China.

Objective

To investigate the determinants of depression among female caregivers of left-behind children in rural China.

Methods

Data were collected from the baseline survey of the Home Visit Intervention Evaluation Segment of the Health and Development Promotion Program for Left-behind Children, conducted by UNICEF from April to July in 2018. The villages were selected through multi-stage stratified sampling. 1 or 2 towns were chosen as program towns in each of the 5 impoverished counties in 5 provinces. Villages in program towns were stratified by number of under-3-year-old children except Pingshan, where all villages from the program town were included. Three villages were randomly selected in each stratum as intervention villages, matched with control villages of similar number of under-3-year-old children, socioeconomic status and the distance from county. Ultimately 113 villages in 27 towns were included in the survey. This study focused on the mothers and grandmothers of left-behind children under 3. Questionnaire was used to collect the data of left-behind children under 3 years old and their main caregivers participating in the survey, and Zung Self-rating Depression Scale (ZSDS) was used to assess the depression status of caregivers. Multivariate Logistic regression was used to analyze the determinants of depression in the main caregivers of left-behind children.

Results

A total of 728 subjects were included in this study, including 282 mothers and 446 grandmothers. The overall incidence of depressive symptoms was 32.8% (239/728) . The prevalence of depression among mothers and grandmothers of left-behind children was 29.8% (84/282) and 34.8% (115/446) respectively, with no statistical significance between two groups (P>0.05) . Multivariate Logistic analysis revealed that for mothers, caring for 1-year-old children (OR=2.041, 95%CI=1.065-3.913) , 2-3-year-old children (OR=2.128, 95%CI=1.023-4.425) , and experiencing caregiving stress (OR=4.043, 95%CI=2.152-7.594) were risk factors for depression (P<0.05) . A mean communication time ≥10 minutes per time with absent fathers (OR=0.396, 95%CI=0.175-0.898) was a protective factor against maternal depression (P<0.05) . For grandmothers, looking after girls rather than boys (OR=0.506, 95%CI=0.331-0.772) was a protective factor for depression (P<0.05) . Conversely, being 60 years or older (OR=1.879, 95%CI=1.082-3.261) , self-rated health status affecting caregiving (OR=2.402, 95%CI=1.364-4.231) and children's mothers cumulative longer absence from home (OR=2.468, 95%CI=1.059-5.751) were the risk factors for depression (P<0.05) .

Conclusion

The incidence of depression among female caregivers of left-behind children in rural China is high. Mothers and grandmothers, as the primary caregivers of most left-behind children, experience different factors affecting depression. Older children, high caregiving stress are risk factors for maternal depression, whereas greater communication with the children's fathers is protective factor for maternal depression. Grandmothers face a higher risk of depression when advanced age, self-report health status affacts caregiving, and children's mothers are absent from home for extended period, while caring for a granddaughter is a protective factor against grandmother's depression.

Correlation Analysis of Homocysteine and Stroke in People over 40 Years Old

LI Mei, JIANG Dongsheng, ZHAO Jingjing, CAO Yajing, ZHANG Fan, TANG Lijuan, LIU Xiaoli

2025, 28(14):  1723-1729.  DOI: 10.12114/j.issn.1007-9572.2024.0538

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Background

Homocysteine (Hcy) levels are strongly associated with vascular health problems like stroke, and early identification and screening for hyperhomocysteinemia (HHcy) is crucial for stroke prevention. However, lack of systematic epidemiological data on the relationship between Hcy and stroke in Hebei Province, China, and insufficient comprehensive studies on HHcy and other risk factors limit the development of effective prevention and control strategies.

Objective

To investigate the correlation between Hcy and stroke in people aged 40 years and over in Hebei Province, thus providing scientific basis for the development of accurate stroke prevention and control strategies.

Methods

On the basis of the China National Stroke Screening Survey from January 2018 to December 2020, 92 942 permanent residents aged 40 and above were sampled from 49 monitoring sites in 9 cities of Hebei Province by multi-stage cluster sampling method. The correlation between Hcy and stroke was investigated by unconditional Logistic regression analysis, and stratified analysis was performed based on age and sex. At the same time, the combined effects of Hcy and other factors on stroke were further studied.

Results

The prevalence of stroke among people aged 40 years and above in Hebei Province was 4.51% (4 196/92 942) , and the prevalence of high Hcy was 36.25% (33 692/92 942) . The prevalence of stroke in people with high Hcy levels was significantly higher than that in people with normal Hcy levels (P<0.05) . Stratified by Hcy quartiles, the prevalence of stroke tended to increase as Hcy levels gradually increased (χ² _trend=367.310, P<0.05) . The results of stratification analysis showed that in two age groups (40-59 years old and ≥60 years old) , the prevalence of stroke was significantly higher in people with high Hcy levels than in people with normal Hcy levels (P<0.05) . With the incremental increase of Hcy levels from Q1 to Q4, the prevalence of stroke in people with 40-59 and ≥60 years old showed an incremental trend (the trend χ² values were 109.213, and 75.653, respectively, P<0.05) . The prevalence of stroke was significantly higher in both males and females with high Hcy levels than normal Hcy levels (P<0.05) , and the prevalence of stroke in both males and females showed an increasing trend as the Hcy level increased from Q1 to Q4 (the trend χ² values were 197.115, and 117.406, respectively, P<0.05) . There was a positive additive interaction but no multiplicative interaction between high Hcy and hypertension (RERI=0.41, AP=0.08, SI=1.12, P<0.05) , and a negative additive (RERI=-0.30, AP=-0.25, SI=0.41, P<0.05) and negative multiplicative (OR=0.77, 95%CI=0.64-0.92, P<0.05) interactions. No interaction was found with diabetes or alcohol consumption.

Conclusion

The prevalence of high Hcy exceeded 36% in people over 40 years of age in Hebei province, and the prevalence of stroke increased with higher Hcy levels, especially across age and gender. The risk of stroke was increased when high Hcy coexisted with hypertension, whereas there was a negative interaction between high Hcy and smoking, with an antagonistic effect when the two exposure factors coexisted that altogether reduced the risk of stroke. However, it should be emphasized that the reduced risk does not mean that the harms of these two factors alone can be ignored, and that high Hcy and smoking are still important risk factors for stroke. Therefore, people at high risk of stroke should have their Hcy levels monitored regularly, and should take targeted measures to control their blood pressure, improve healthy lifestyles, and take folic acid and B vitamins supplements to reduce the overall risk of stroke.

Current Status and Influencing Factors of Motoric Cognitive Risk in Patients with Coronary Artery Disease in Frigid Zone

CHAI Yiyi, YE Qingfang, LIN Ping, LI Ling

2025, 28(14):  1730-1736.  DOI: 10.12114/j.issn.1007-9572.2024.0522

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Background

The motoric cognitive risk (MCR) is a new method for identifying the preclinical stage of dementia and represents the earliest stage of cognitive impairment. Cold is a common pathogenic factor for both coronary artery disease and cognitive impairment. Studying the key characteristics and influencing factors of MCR in hospitalized patients with coronary artery disease in the frigid zone can provide a scientific basis for preventing and controlling coronary artery disease combined with MCR in the frigid zone and formulating targeted intervention measures.

Objective

To clarify the occurrence of MCR in the population with coronary artery disease in the frigid zone and analyze its key influencing factors.

Methods

This study was a cross-sectional survey. Convenience sampling was used to select patients hospitalized in the Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University and diagnosed with coronary artery disease from September to December 2023. A self-designed questionnaire was used to investigate sociodemographic data and lifestyle, and handgrip strength was measured. Standardized electronic medical records were reviewed to obtain clinical data, and psychological scales were used to measure relevant psychological indicators of patients. MCR was identified based on subjective cognitive complaints, slow gait, no mobility impairment, and no diagnosis of dementia. Binary Logistic regression analysis was used to explore the influencing factors of MCR in patients with coronary artery disease in the frigid zone.

Results

A total of 413 patients were included in this study, and the incidence of MCR was 13.80% (57/413) . Binary Logistic regression analysis showed that polypharmacy (OR=2.142, 95%CI=1.151-3.987) , cardiometabolic co-morbidities (OR=3.730, 95%CI=1.059-13.143) , apathy (OR=2.305, 95%CI=1.239-4.287) , PCI (OR=2.861, 95%CI=1.461-5.602) , neutrophil count (OR=2.803, 95%CI=1.302-6.034) , and handgrip strength[Q2 (17.7-26.2 kg) : OR=0.362, 95%CI=0.160-0.814; Q3 (26.4-34.4 kg) : OR=0.349, 95%CI=0.156-0.831; Q4 (34.5-70.6 kg) : OR=0.259, 95%CI=0.105-0.639] were the influencing factors of MCR in patients with coronary artery disease (P<0.05) .

Conclusion

The incidence of MCR in patients with coronary artery disease in the frigid zone is higher than that in the community population, at 13.80%. The risk factors associated with MCR suggest that medical staff should conduct early screening and follow-up for patients who have undergone PCI treatment, have apathy, have diabetes, and have a history of stroke, and provide long-term standardized drug management. Further exploration of the correlation mechanism between MCR and coronary artery disease, with a focus on the inflammatory pathway characterized by elevated neutrophil counts and the muscle and neural regulatory mechanisms, is expected to open up new avenues for in-depth research in this field.

Construction and Application of Comorbidity Follow-up Model for Patients with Coronary Heart Disease Complicated with Diabetes after PCI

SONG Hongna, XU Hongmei, LIU Yuhuan, WANG Qinglong, TANG Yunzhao, YU Xiang

2025, 28(14):  1737-1743.  DOI: 10.12114/j.issn.1007-9572.2023.0675

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Background

The lack of disease self-management awareness in patients after percutaneous coronary intervention (PCI) affects the prognosis, and the prognosis of patients with diabetes is worse. The establishment of chronic disease follow-up system and the collaborative management of the two diseases become the key to the rehabilitation of patients.

Objective

To construct a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI based on the theory of chronic disease self-management and CICARE communication model, and to explore the application effect.

Methods

From January to April 2022, literature review, semi-structured interviews and expert correspondence were used to constructed a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI. Patients with coronary heart disease complicated with diabetes who received PCI in the Department of Cardiology of Chu Hsien-I Memorial Hospital, Tianjin Medical University from May to December 2022 were selected as research subjects. They were divided into two groups by using the random number table method. The control group (77 cases) received routine follow-up, and the test group (78 cases) received comorbidity follow-up model. The scores of Coronary Heart Disease Self-management Scale (CSMS) and other outcome indicators were compared between the two groups before discharge, 3 months and 6 months after discharge.

Results

The positive coefficients of experts in the two rounds of expert correspondence were both 100%, the authority coefficient was 0.87, and the coordination coefficient was 0.310 and 0.334, respectively (all P<0.001) . The comorbidity follow-up model included three dimensions, 11 modules and 30 contents. Finally, 64 patients in each group completed the follow-up. There was an interaction between group and time on the scores of CSMS (F=150.504, P<0.001) . The scores of CSMS at 3 months and 6 months after discharge were higher than those before discharge (P<0.001) , and the scores of the test group were higher than those of the control group (P<0.05) . After 6 months, the BMI of the test group was lower than that of the control group (P<0.05) .

Conclusion

The constructed comorbidity follow-up model after PCI was scientific and effective, which can improve the self-management behavior of patients after PCI and reduce BMI.

Latent Profiles Analysis and Its Influencing Factors of Disease Burden in Patients with Inflammatory Bowel Disease

XU Jun, GAO Yanan, XU Yaxin, YAO Ting, CHEN Yamei

2025, 28(14):  1744-1750.  DOI: 10.12114/j.issn.1007-9572.2024.0207

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Background

Inflammatory bowel disease (IBD) patients suffer from recurrent and prolonged disease episodes, resulting in a high disease burden, which seriously affects patients' quality of life. Different types of disease burden have different impacts on the health status of patients, however, the current distribution of disease burden types in IBD patients and their influencing factors are not clear and need to be further explored.

Objective

To explore the potential profiles of disease burden in patients with IBD, and to analyze the influencing factors of different potential profiles.

Methods

Convenience sampling method was used to select 241 IBD patients from Tenth People's Hospital, Tongji University from June to October 2023. General information questionnaire, Chinese version of the Inflammatory Bowel Disease Disk Scale, and Psychological Resilience Scale were used to conduct the survey. Potential profile analysis was categorized the burden of disease for IBD patients, and multiple Logistic regression was explored the differences in the characteristics of different categories of patients.

Results

A total of 250 questionnaires were distributed in this study and 241 valid questionnaires were recovered, with a valid questionnaire recovery rate of 96.4%. The disease burden characteristics of IBD patients could be categorized into 3 potential profiles: high burden-disease coping difficulties type (n=147, 61.0%) , medium burden-perceived pain and image type (n=75, 31.1%) , and low burden-psycho-emotional type (n=19, 7.9%) . The results of multiple Logistic regression analysis showed that the high burden-disease coping difficulties type was compared with the low burden-psycho-emotional type, patients with unstable jobs and high education level were easily categorized into high burden-disease coping difficulties type, while patients with high annual income, long disease duration, no complications and favorable psychological resilience were easily categorized into low burden-psycho-emotional type. Comparing the medium burden-perceived pain and image type with the low burden-psycho-emotional type, the older the patients, the higher the literacy level, the higher the number of follow-ups, and the lack of surgical experience were easily categorized into the medium burden-perceived pain and image type, and the patients with high annual income, long disease duration, no complications, and favorable psychological resilience were easily categorized into the low burden-psycho-emotional type. Comparing the medium burden-perceived pain and image type with the high burden-disease coping difficulties type patients who were married, had no regular job, and had long disease duration were likely to be categorized in the high burden-disease coping difficulties type, whereas patients who had a high number of follow-ups and no surgical treatment were likely to be categorized in the medium burden-perceived pain and image type (P<0.05) .

Conclusion

The disease burden of IBD patients has a distinct categorical profile and is divided into three potential profiles: high burden-disease coping difficulties type, medium burden-perceived pain and image type, and low burden-psycho-emotional type, which are influenced by age, marital status, job status, education level, annual income, disease duration, frequency of follow-up, surgical experience, complications, and level of psychological resilience. Healthcare professionals should pay attention to identifying the disease burden levels of different patients, focusing on high-burden patients, strengthening IBD symptom management and psychological interventions, and improving patients' disease coping ability and psychological resilience levels to reduce their disease burden.

Association of Blood Pressure Variability and Systemic Immune-inflammation Index with Intracranial Arterial Negative Remodeling in Patients with Cerebral Small Vessel Disease

LI Bing, XI Zhi, WANG Yang, XIU Jiaqi, GUO Qiancheng, YU Chenchen, SUN Siyu, YANG Xiaopeng

2025, 28(14):  1751-1757.  DOI: 10.12114/j.issn.1007-9572.2024.0315

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Background

Intracranial arterial negative remodeling refers to stenotic changes in the large intracranial arteries and is a potential indicator of accelerated atherosclerosis in the vessel wall. If left untreated, this condition can lead to serious cardiovascular and cerebrovascular diseases such as stroke and myocardial infarction. However, research on the influencing factors of intracranial arterial negative remodeling is still limited.

Objective

To explore the relationship between blood pressure variability (BPV) , the systemic immune-inflammation index (SII) , and intracranial arterial negative remodeling in patients with cerebral small vessel disease (CSVD) , and to establish a predictive model.

Methods

A total of 110 patients with CSVD admitted to the Second Affiliated Hospital of Zhengzhou University between September 2022 and March 2024 were enrolled in the study. Based on imaging examinations, the brain arterial remodeling (BAR) score was calculated, and the patients were divided into two groups: the intracranial arterial negative remodeling group (BAR score <-1 standard deviation, 17 cases) and the non-negative remodeling group (BAR score ≥-1 standard deviation, 93 cases) . Clinical data were collected, and dynamic blood pressure monitoring was conducted. Multivariate Logistic regression analysis was performed to identify factors that may contribute to intracranial arterial negative remodeling in CSVD patients. The predictive value of these factors for intracranial arterial negative remodeling was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, a nomogram predictive model was constructed and its clinical utility was assessed.

Results

There were statistically significant differences between the intracranial arterial negative remodeling group and the non-negative remodeling group in terms of history of hypertension, SII, 24-hour systolic blood pressure standard deviation (24 hSSD) , and 24-hour systolic blood pressure coefficient of variation (24 hSCV) (P<0.05) . Multivariate Logistic regression analysis revealed that a history of hypertension (OR=23.192, 95%CI=1.029-522.644, P=0.048) , SII elevated (OR=1.005, 95%CI=1.000-1.010, P=0.041) , and 24 hSSD elevated (OR=3.510, 95%CI=1.155-10.671, P=0.027) were risk factors for intracranial arterial negative remodeling in CSVD patients. The area under the ROC curve (AUC) for SII and 24 hSSD in predicting intracranial arterial negative remodeling was 0.797 (95%CI=0.670-0.924, P<0.001) and 0.933 (95%CI=0.885-0.980, P<0.001) , respectively. Based on SII and 24 hSSD, a nomogram predictive model was developed to predict the occurrence of intracranial arterial negative remodeling in CSVD patients. Internal validation showed that the ideal curve closely matched the predictive curve.

Conclusion

Elevated SII and 24 hSSD are risk factors for intracranial arterial negative remodeling in CSVD patients and have a certain predictive value for its occurrence. Reducing SII and 24 hSSD may have clinical value in preventing the onset of intracranial arterial negative remodeling.

Comparative Study on the Clinicopathological Features and Prognostic between HPV-related and Non-HPV-related Cervical Adenocarcinoma

ZHANG Shujing, SUN Lixin, CAO Yuqing

2025, 28(14):  1758-1764.  DOI: 10.12114/j.issn.1007-9572.2023.0882

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Background

The majority of cervical adenocarcinomas are caused by human papilloma virus (HPV) infection, and only about 10%-15% are unrelated to HPV infection. However, there are few comparative studies of HPV-related and non-HPV-related cervical adenocarcinomas, and few studies have investigated the prognostic risk factors of cervical adenocarcinoma.

Objective

To investigate the clinicopathological features and prognostic factors of human papillomavirus-associated (HPVA) and human papillomavirus-independent adenocarcinoma (HPVI) .

Methods

A total of 227 cases of cervical adenocarcinoma diagnosed and treated by the Department of Female Tumor, Shanxi Provincial Cancer Hospital from January 2017 to September 2021 were selected, including 47 cases (20.7%) of HPVI and 180 cases (79.3%) of HPVA. The clinicopathological characteristics of the patients were collected, and the patients were followed up until September 30, 2020. Records of the patient's overall survival (OS) and time progression-free surial (PFS) .

Results

Log-rank analysis showed that patients with age of onset≥50 years, maximum tumor diameter ≥4 cm, HPVI, FIGO stageⅡ-Ⅳ, cervical invasion depth ≥1/2, lymph node metastasis, vascular tumor thrombus, nerve invasion, uterine body invasion and ovarian metastasis had higher recurrence and metastasis rates and death rates (P<0.05) . Cox multivariate regression analysis showed that age of onset (HR=1.056, 95%CI=1.021-1.091) , tumor size (HR=1.266, 95%CI=1.006-1.594) , pathological type (HR=2.060, 95%CI=1.073-3.956) , vascular invasion (HR=4.986, 95%CI=2.478-10.032) , nerve invasion (HR=5.632, 95%CI=2.159-14.687) were influencing factors for progression-free survival. Age of onset (HR=1.056, 95%CI=1.021-1.093) , tumor size (HR=4.147, 95%CI=1.384-12.424) , pathological type (HR=4.371, 95%CI=1.602-11.925) , FIGO stage (HR=1.748, 95%CI=1.057-2.889) , vascular invasion (HR=8.054, 95%CI=3.905-16.608) and nerve invasion (HR=3.842, 95%CI=1.147-12.872) were independent poor prognostic factors for overall survival of cervical adenocarcinoma (P<0.05) .

Conclusion

Compared with HPV-related cervical adenocarcinoma, non-HPV-related cervical adenocarcinoma has worse clinicopathological features and prognosis. More attention should be paid to cervical adenocarcinoma, especially non-human papillomavirus associated adenocarcinoma.

Joint-modeling of Estradiol Levels and Survival Data of Breast Cancer Patients in the Case-cohort Design

WU Mengjuan, ZHANG Tao, GAO Chunjie, ZHAO Ting, WANG Lei

2025, 28(14):  1765-1772.  DOI: 10.12114/j.issn.1007-9572.2023.0918

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Background

Breast cancer is a hormone receptor-dependent malignant tumor, and the dynamical changes of estradiol (E2) play a critical role in the development of breast cancer. The classical case-cohort design completely ignores the information of non-selected samples, which could easily lead to biased estimating.

Objective

To explore the effect of dynamical changes of E2 levels on the survival prognosis in breast cancer patients, and evaluate the superiority of improved case-cohort design.

Methods

In this study, we selected 8 226 patients who were diagnosed as breast cancer by pathological examination at the Affiliated Cancer Hospital of Xinjiang Medical University from 2015 to 2019, by using the time of patient diagnosis as the follow-up start date, and defining the death of patients due to breast cancer as the outcome event. The follow-up end date was December 31, 2021. The demographic characteristics, immunohistochemical indicators, clinicopathological characteristics and survival status of patients were gathered, and their serum E2 levels were longitudinally monitored. Based on the classical case-cohort design, the improved case-cohort design was achieved by incorporating survival data from patients outside of the case-cohort sample. Under the classical and improved case-cohort designs, linear mixed effects model and Cox proportional risk model were used to fit the longitudinal data (longitudinal submodel) and survival data (survival submodel) of breast cancer patients, respectively, and two joint models for longitudinal and time-to-event data were further established. Moreover, Markov Chain Monte Carlo algorithm was used to estimate the parameters of two joint models. The area under the receiver operating characteristic curves (AUC) and prediction errors (PE) were further applied to compare the discrimination and calibration of two joint models under the classical and improved case-cohort designs.

Results

Based on the inclusion and exclusion criteria, a total of 895 breast cancer patients were included in the full cohort, of which 53 patients died of breast cancer. The median follow-up time for patients was approximately 28 months. The samples of classical case-cohort design were concluded two parts: one was one quarter of the patients selected from the full cohort as a random subcohort, the other was patients who died during the follow-up period outside the random subcohort, of which included survival data from 236 patients and 1 062 measurements of E2 levels. Moreover, on the basis of the classical case-cohort design, the survival data of breast cancer patients who were outside of the classical case-cohort samples and survived during the follow-up period (G₄) were included as the samples of the improved case-cohort design that included survival data from 895 patients, 1 062 measurements of E2 levels from 236 patients (in which it was assumed that there were 2 958 longitudinally missing measurements of E2 levels) . The results of two joint models under classical and improved case-cohort designs both revealed that dynamical change of E2 levels was identified as the influencing prognostic factors for breast cancer patients. For one-unit longitudinal increment of lg (E2) , the mortality risks for patients would increase by about 23% (HR=1.23, =1.015) and 8% (HR=1.08, =1.020) , respectively. Moreover, the joint model under the improved case-cohort design showed better discrimination and calibration (AUC=0.706-0.962, PE=0.001 2-0.010 8) .

Conclusion

The longitudinal increment of E2 levels could cause a decrease of the survival probability for breast cancer patients. The joint model under case-cohort design could both analyze longitudinal and survival data, and the improved case-cohort design would be superior to that of the classical case-cohort design.

Original Research·Research on the Management of Specifical Population

Application and Evaluation of the Mobile Platform for Perinatal Depression Screening and Intervention

WU Dadong, LIU Huimin, ZHANG Jiayi, LIU Siyuan, ZHAO Guanglin, JIN Shuyan, JIANG Lei

2025, 28(14):  1773-1780.  DOI: 10.12114/j.issn.1007-9572.2024.0290

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Background

Perinatal depression, which affects both maternal and child health, is a significant public health issue that requires urgent and effective management. Since 2021, Shenzhen has been promoting city-wide perinatal depression screening and intervention using a mobile healthcare platform.

Objective

This study utilises routine data from the Shenzhen perinatal depression screening and intervention programme to assess the impact of the mobile platform on programme implementation and identify the most prominent implementation bottlenecks.

Methods

This retrospective study included pregnant and postpartum women who delivered in one of Shenzhen's 82 midwifery institutions across 10 districts between June 2020 and May 2022. Eligible participants were divided into two groups: the routine service group (delivered between June 2020 and May 2021) and the mobile platform group (delivered between June 2021 and May 2022) . Depression screening rates, screening positive rates, referral rates, and intervention rates during early pregnancy, mid-pregnancy, late pregnancy, and postpartum were observe.

Results

A total of 311 719 pregnant and postpartum women were included in the study, of which 166 832 were in the routine service group and 144 887 in the mobile platform group. Screening rates, referral rates, and intervention rates in all stages of pregnancy and postpartum were significantly higher in the mobile platform group than in the routine service group (P<0.05) . Screening positive rates in early and mid-pregnancy were higher in the mobile platform group (P<0.05) , while rates in late pregnancy and postpartum were lower than in the routine service group (P<0.05) .

Conclusion

The mobile platform offers an effective tool for routine perinatal depression management. However, the low intervention rate among screening-positive women represents the most prominent implementation bottleneck. Future research should focus on optimising platform functionality, identifying the most effective combination of intervention measures, enhancing health education, and developing innovative, sustainable, and widely applicable implementation strategies.

Construction of a Comprehensive Health Management Evaluation Indicator System for Menopausal Women

CHEN Yi, BAI Wenpei, LI Hongtian, WANG Yao, TIAN Zongmei, GU Bei, LIU Xiaohong, YANG Mukun

2025, 28(14):  1781-1787.  DOI: 10.12114/j.issn.1007-9572.2024.0138

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Background

China's aging population is expanding rapidly, highlighting the imperative of successful aging as a critical health management goal. Effective menopause management plays a crucial role.

Objective

To construct a comprehensive health management evaluation indicator system for menopausal women based on the modified Delphi method.

Methods

Between September 2023 and February 2024, a preliminary construction of the comprehensive health management evaluation indicator system for menopausal women was executed via literature review and group discussion. 25 experts in the realms of climacteric health and related fields were selected as conference participants and correspondence subjects. Two rounds of electronic questionnaires using modified Delphi method were conducted, and the survey results were statistically analyzed using SPSS 24.0 software.

Results

The positive coefficients of the two rounds of expert correspondence were 100%, with the authoritative degree of expert opinions were 0.932 and 0.949, respectively. In the initial round, the primary and secondary indicators were assigned mean importance scores ranging from 4.44 to 4.84 and 4.00 to 4.88, respectively, alongside Kendall's W coefficients of concordance at 0.194 (P=0.001) and 0.187 (P<0.001) . The second round yielded mean importance scores for the primary and secondary indicators within the ranges of 4.44 to 4.84 and 3.84 to 4.96, with corresponding Kendall's W coefficients of 0.146 (P=0.006) and 0.326 (P<0.001) , reflecting a notable enhancement in expert agreement for the secondary indicators. The tertiary indicators received mean rationality scores of 4.24 to 4.68 (4.47±0.10) in the first round and 4.08 to 4.72 (4.51±0.15) in the second, with Kendall's W coefficients of 0.063 (P=0.025) and 0.129 (P<0.001) , indicating a trend towards uniformity in expert opinions. The ultimate construction of the comprehensive health management evaluation indicator system for menopausal women encompasses five primary indicators: basic information, lifestyle, symptom assessment, laboratory tests, and key disease screenings. Additionally, it includes 34 secondary indicators such as age, duration since menopause, BMI, and waist circumference, and so on. Each of these secondary indicators is meticulously subdivided and quantified to establish tertiary indicators, thereby providing a granular framework for assessment.

Conclusion

The indicator system, constructed through the modified Delphi method, is endowed with substantial authority and scientific rigor. It offers a holistic assessment of the health status of menopausal women, with a detailed classification and valuation of specific indicators. This systematic approach is conducive to comprehensive and stratified patient management by clinical practitioners, providing a valuable framework for clinical guidance and reference. Nonetheless, the efficacy of its practical application merits ongoing validation through empirical research.

Original Research·Evidence-based Medicine·Traditional Chinese Medicine

Effect of Postoperative Upper Extremity Lymphedema after Breast Cancer Treated with Different Acupuncture and Moxibustion Therapies: a Network Meta-analysis

HE Yun, FAN Huanfang, MA Pan, XU Shaoqing, YANG Liu, JIN Mingzhe, ZHANG Mingrui, CHEN Jiaqi

2025, 28(14):  1788-1794.  DOI: 10.12114/j.issn.1007-9572.2024.0181

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Background

Postoperative upper extremity lymphedema is a common postoperative complication in breast cancer patients, which greatly affects patients' quality of life and confidence in treatment. Currently, western medicine has limited effect in treating postoperative upper extremity lymphedema after breast cancer, and acupuncture has better efficacy in treating this disease, however, there is no research on the choice of different acupuncture treatment modalities.

Objective

To compare the efficacy of different acupuncture modalities on upper extremity lymphedema after breast cancer surgery using reticulated meta-analysis, with a view to providing an evidence-based basis for the selection of clinical treatment options.

Methods

A computerized systematic search of the China national knowledge infrastructure, Wanfang Data, VIP, China Biomedical Literature Service, PubMed, Embase, Medline and Cochrane Library databases of randomized controlled trials (RCT) on the intervention of different acupuncture modalities in postoperative lymphedema after breast cancer was conducted from the time of database construction to October 31, 2023. The literature search was completed independently by two researchers, and the initial and re-screening were performed in strict accordance with the inclusion and exclusion criteria. After the final inclusion of the literature was categorized, the basic information and data were extracted and the risk of bias was assessed, and the data were analyzed using software such as R 3.6.2 and Stata 14.0.

Results

Fourteen papers were finally included, containing a total of 915 patients with upper limb lymphedema after breast cancer surgery, including 459 cases in the treatment group and 456 cases in the control group. Eleven interventions were involved, including conventional treatment, ordinary acupuncture, warm acupuncture, millifire acupuncture, western medicine, acupuncture+moxa stick, conventional+abdominal acupuncture, conventional+warm acupuncture, conventional+acupuncture, conventional+guanxi, and conventional+forceful motion acupuncture. The results of the ranking of the cumulative probability plot area under the curve (SUCRA) of each intervention on the difference between the affected-patient side circumferential diameters showed that the results of routine + abdominal needling (100.0%) >milli-fire needling (66.4%) >routine + warm needling (58.2%) >regular needling (19.0%) >routine (6.5%) . The results of SUCRA ranking of each intervention on the total efficiency showed that milli-fire acupuncture (90.1%) >ordinary acupuncture (71.1%) >routine+force-activated acupuncture (67.7%) >warm acupuncture (62.1%) >routine + warm acupuncture (57.9%) >acupuncture+moxa sticks (50.7%) >routine +off-needling (48.2%) >routine+needling (47.7%) >routine + abdominal needling (38.6%) >western medicine (9.6%) >routine (6.3%) .

Conclusion

Among the 11 interventions, the combined total efficiency and the ranking of the difference between the affected-healthy side circumference showed that millipede acupuncture is the best choice for the treatment of upper extremity lymphedema after breast cancer surgery, but more high-quality RCTs are needed to confirm this.

Network Meta-analysis of Different Traditional Chinese Medicine Injections for the Treatment of Posterior Circulatory Ischemic Vertigo

ZHU Shengjie, DIAO Huaqiong, HANG Xiaoyi, SUN Wenjun

2025, 28(14):  1795-1808.  DOI: 10.12114/j.issn.1007-9572.2024.0384

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Background

Posterior circulation ischemic vertigo (PCIV) can often be used as a precursor symptom of cerebral infarction. It has the characteristics of recurrent attacks, lingering and non healing, which seriously affects the quality of life of patients. However, the clinical efficacy of conventional western medicine treatment is limited. At present, traditional Chinese patent medicines and simple preparations injection has significant efficacy in controlling and alleviating the onset of vertigo. However, in view of the wide variety of traditional Chinese patent medicines and simple preparations preparations, there is a lack of relevant evidence-based medical evidence to evaluate the advantages and disadvantages of various traditional Chinese patent medicines and simple preparations injections.

Objective

To evaluate the efficacy and safety of different Chinese herbal injections combined with conventional western drugs in the treatment of PCIV using reticulated Meta-analysis.

Methods

A comprehensive search was conducted on CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library up to May 7, 2024, for randomized controlled trials involving TCM injections for the treatment of PCIV. Randomized controlled trial (RCT) on the treatment of post-circulatory ischemic dizziness with herbal injections. The Cochrane risk of bias tool was used to evaluate the quality of the included literature, and RevMan 5.4 and Stata 17 software were used for data analysis.

Results

Forty-nine RCT with 4 556 patients were finally included, involving 13 types of traditional Chinese medicine injections, including Danshen Chuanxiongqin injection, Danhong injection, Shenxiong Putaotang injection, Shenmai injection, Tianmasu injection, Dengzhanhuasu injection, Shuxuetong injection, Honghuahuangsesu injection, Shuxuening injection, Kudiezi injection, Gegensu injection, Xingnaojing injection, Yinxingdamo injection. Net Meta-analysis showed that in terms of vertigo symptom improvement[i.e. Dizziness Disorder Inventory (DHI) score]: the top 3 SUCRA-ranked interventions were Xingnaojing injection (87.2%) , Shenmai injection (73.5%) , and Shuxuening injection (59.6%) in combination with conventional western medicine, respectively; In terms of total clinical effectiveness: the top 3 SUCRA-ranked interventions were Yinxingdamo injection (88.3%) , Tianmasu injection (63.3%) , and Gegensu injection (57.6%) in combination with conventional western medicines, respectively; In terms of improvement of blood flow velocity in left and right vertebral arteries: the top three interventions were Xingnaojing injection (96.2%, 99.2%) , Dengzhanhuasu injection (90.2%, 85.6%) , and Honghuahuangsesu injection (69.3%, 79.4%) in combination with conventional western medicines; In terms of improvement of blood flow velocity in basilar arteries: the top three interventions were Dengzhanhuasu injection (97.6%) , Honghuahuangsesu injection (85.8%) , and Xingnaojing injection (80.6%) in combination with conventional western medicine; In terms of the improvement of whole blood high cut viscosity, the top three interventions were Shenmai injection (85.6%) , Danhong injection (80.0%) , and Shuxuetong injection (77.5%) in combination with conventional western drugs, respectively; In terms of the improvement of whole blood low cut viscosity, the top three interventions were Shuxuetong injection (90.3%) , Tianmasu injection (77.5%) , and Shenmai injection (73.0%) in combination with conventional western drugs, respectively. In terms of safety: no serious adverse drug reactions occurred in all studies.

Conclusion

Xingnaojing injection combined with conventional western medicine showed excellent clinical efficacy in improving PCIV vertigo symptoms and vertebral basilar artery blood flow velocity, which provided a certain reference for clinical medication, and the combination of traditional Chinese patent medicines and simple preparations injection and conventional western medicine was superior to conventional western medicine alone, and had good drug safety. However, the available evidence is limited by the quality and quantity of the included literature, and the above conclusions need to be further validated by more high-quality prospective RCT.