Table of Content

20 December 2025, Volume 28 Issue 36

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Guidelines·Consensus

Expert Consensus on Sarcopenia Screening in Community-dwelling Older Adults

China Rehabilitation Science Institute, Community-Based Rehabilitation Committee of the China Association of Rehabilitation of Disabled Persons, Geriatric Rehabilitation Committee of Chinese Association of Geriatric Research, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) /Southern Medical University, Guangzhou Association of Rehabilitation Medicine

2025, 28(36):  4517-4534.  DOI: 10.12114/j.issn.1007-9572.2025.0150

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Sarcopenia is an age-related geriatric syndrome characterized by decreased muscle mass, reduced muscle strength, and/or impaired physical function. It is closely associated with adverse health outcomes such as frailty, falls, fractures, disability, and even death. In community-dwelling populations, sarcopenia often presents in early or subclinical stages, making it easy to overlook and resulting in missed opportunities for timely intervention. Standardized screening for sarcopenia among older adults in the community is of great significance for early detection, targeted intervention, delaying functional decline, preventing and mitigating disability, reducing healthcare costs, and responding to the challenges of an aging society. However, there is currently a lack of evidence-based expert consensus on community-based sarcopenia screening for older adults in China. To bridge the gap, the China Rehabilitation Science Institute, Community-Based Rehabilitation Committee of the China Association of Rehabilitation of Disabled Persons, Geriatric Rehabilitation Committee of Chinese Association of Geriatric Research, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) /Southern Medical University and the Guangzhou Association of Rehabilitation Medicine led the development of this consensus. Using the Delphi method to form a list of key questions and recommendations, the GRADE system to assess the quality of evidence and strength of recommendations, and the RIGHT checklist to standardize reporting, a total of 14 evidence-based recommendations were established. This expert consensus on community-based sarcopenia screening in older adults provides a scientific and feasible screening pathway, supports the construction of an early detection, early identification, and early intervention system for sarcopenia prevention and control in the community, and ultimately aims to improve the health and quality of life of the older population.

Guidelines Interpretation

Key Points Interpretation of Chinese Expert Consensus on Early Screening and Management of Homozygous Familial Hypercholesterolemia (2024)

WU Hui, WANG Luya, LI Jialu, ZHANG Jun

2025, 28(36):  4535-4540.  DOI: 10.12114/j.issn.1007-9572.2025.0074

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Familial hypercholesterolemia (FH) is a severe inherited metabolic disorder. Early diagnosis and early treatment can greatly improve the prognosis of patients, but the recognition and management of homozygous familial hypercholesterolemia (HoFH) remain severely inadequate globally. In recent years, a number of international guidelines and expert consensus documents on FH have been issued, but there are relatively few expert consensuses specifically on HoFH. Recently, the Chinese Society of Laboratory Medicine and a multidisciplinary expert panel have developed and published the Chinese Expert Consensus on Early Screening and Management of Homozygous Familial Hypercholesterolemia (2024) , which clarifies the early identification and diagnosis process of HoFH and updates and optimizes the therapeutic protocols. This article provides a detailed interpretation of the five key points of this consensus based on our team's HoFH family screening practice, including: (1) Introducing artificial intelligence for multidimensional optimization of HoFH early screening strategies; (2) Refining clinical diagnostic criteria for HoFH and emphasizing the importance of gene diagnosis collaboration; (3) Highlighting the significance of prenatal diagnosis and newborn screening; (4) Focusing on the differential diagnosis between sterolemia and HoFH; (5) Updating and optimizing HoFH treatment strategies with stratified low-density lipoprotein cholesterol treatment target values. Additionally, combining HoFH screening practices, this article proposes driving clinical practice and focusing on long-term HoFH management, aiming to provide references for early screening and clinical management of HoFH in China.

Interpretation of the 2024 International Society of Hypertension Position Paper on Innovations in Blood Pressure Measurement and Reporting Technology and Its Implications for China

ZHANG Ying, LIAO Xiaoyang, YANG Hanfei, YU Yongjun, LIU Lidi, JIA Yu, SHEN Can, LI Xiao, HUANG Chuanying, YANG Rong

2025, 28(36):  4541-4549.  DOI: 10.12114/j.issn.1007-9572.2025.0077

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Hypertension, as the leading modifiable risk factor for cardiovascular disease morbidity and mortality, requires accurate blood pressure measurement as a cornerstone of its management. Conventional blood pressure monitoring is limited by its intermittent and static nature, and inability to capture readings during daily activities. Emerging blood pressure measurement technologies are rapidly being integrated into clinical practice; however, their adoption is hindered by the lack of international consensus regarding validation criteria for accuracy, usability, acceptability, and reliability. In response, this article convenes expert interpretation of the latest International Society of Hypertension Position Paper on Innovations in Blood Pressure Measurement and Reporting Technology, aiming to inform evidence-based recommendations for community-based hypertension prevention and control strategies in China.

Interpretation of a Position Statement from an Italian Scientific Consortium: Medication Review and Deprescribing

SUN Jiaying, ZHOU Pengxiang, XIA Yu, YAN Ming, ZHOU Xinmei, WU Lingyan, TONG Yuling, ZHAO Yang, XU Zhijie

2025, 28(36):  4550-4557.  DOI: 10.12114/j.issn.1007-9572.2025.0046

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Multimorbidity often leads to polypharmacy, increasing the risk of drug interactions and adverse drug reactions. Medication review and deprescribing are crucial strategies for improving therapeutic regimens, aiming to enhance patients' overall health and quality of life through reviewing and reducing inappropriate medication use. In March 2024, the Italian Scientific Consortium issued a position statement on medication review and deprescribing, outlining their key elements, methods, available tools, and clinical value. Based on an analysis of this statement, this article introduces the concepts and objectives of medication review and deprescribing. It elaborates on the main processes from four aspects: comprehensive medication history review, medication therapy assessment, multidisciplinary medication therapy planning, and follow-up. The article reviews implementation outcomes across different healthcare settings, analyzes challenges and coping strategies in China, and aims to provide theoretical support for promoting medication review and deprescribing by clinicians for their patients.

Article

The Impact of Cumulative Plasma Atherogenic Index Exposure on Incident Cardiovascular Disease in Non-Diabetic Individuals: a Cohort Study

ZHANG Shu, CHENG Yu, WU Shouling, CHEN Shuohua, WU Yuntao

2025, 28(36):  4558-4565.  DOI: 10.12114/j.issn.1007-9572.2024.0504

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Background

The plasma atherogenic index (AIP) is a well-established risk factor for cardiovascular disease (CVD) . However, most existing studies have focused on single AIP measurements and primarily investigated general or diabetic populations. To date, limited research has examined the association between cumulative exposure to the cumulative atherogenic index of plasma (cumAIP) and incident CVD in non-diabetic individuals, both domestically and internationally.

Objective

This study aimed to investigate the relationship between cumAIP and the risk of incident CVD in non-diabetic individuals.

Methods

This prospective cohort study included 65 921 non-diabetic employees of the Kailuan Group who participated in and completed health check-ups in 2006, as well as at least two of the subsequent check-ups in 2008 and 2010. Participant data were collected and followed up to calculate cumAIP, which was categorized into quartiles. The cumulative incidence of CVD was calculated using the Kaplan-Meier method and compared across groups using the Log-rank test. The Cox proportional hazards model was employed to assess the association between cumAIP levels and CVD risk. Additionally, restricted cubic spline plots were used to explore the dose-response relationship between cumAIP and CVD risk.

Results

The study population was divided into four quartiles based on cumAIP: Q1 (cumAIP <-0.93, n=16 480) , Q2 (-0.93≤cumAIP <-0.29, n=16 481) , Q3 (-0.29≤cumAIP <0.39, n=16 480) , and Q4 (cumAIP≥0.39, n=16 480) . Significant differences were observed in baseline characteristics, including gender, age, blood pressure, BMI, fasting glucose, lipid profiles, high-sensitivity C-reactive protein, smoking, alcohol consumption, physical activity, and medication use (all P<0.05) . During a mean follow-up of (10.32±2.07) years, 4 137 incident CVD events were recorded. The number of CVD events in Q1, Q2, Q3, and Q4 was 867, 947, 1 095, and 1 228, respectively. The Log-rank test revealed significant differences in cumulative CVD incidence across quartiles (χ²=73.33, P<0.05) . Multivariable Cox proportional hazards analysis showed that compared to Q1, individuals in Q3 (HR=1.11, 95%CI=1.00-1.24) and Q4 (HR=1.16, 95%CI=1.02-1.33) had a higher risk of CVD (P<0.05) . Restricted cubic spline analysis, adjusted for age, gender, and other confounders, indicated a linear association between cumAIP and CVD risk (overall trend P<0.05, non-linear P=0.97) . Sensitivity analyses excluding individuals on antihypertensive medications (n=12 785) , lipid-lowering medications (n=871) , and those with CVD events within the first two years of follow-up (n=546) confirmed that Q4 remained a significant risk factor for incident CVD (HR=1.18, 95%CI=1.03-1.35, P<0.05; HR=1.16, 95%CI=1.00-1.34, P<0.05) .

Conclusion

Higher levels of cumAIP are independently associated with an increased risk of incident CVD in non-diabetic individuals.

The Impact of the Ratio of High-sensitivity C-reactive Protein to Albumin on Incident Cardiovascular Disease in Different Age Groups: a Cohort Study

LIU Ruiyue, YANG Xuemei, ZHAO Naihui, WEN Xinran, CAI Xi, LIANG Yajing, MA Jiajia, WU Shouling, CUI Liufu

2025, 28(36):  4566-4577.  DOI: 10.12114/j.issn.1007-9572.2024.0521

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Background

Cardiovascular disease (CVD) is the most common chronic non-communicable disease, with an increasing prevalence worldwide and is also the leading cause of death globally. The ratio of high-sensitivity C-reactive protein (hs-CRP) to albumin (ALB) , known as the C-reactive protein to albumin ratio (CAR) , is a novel inflammatory marker. Our research team has previously investigated its association with CVD and found that a high CAR is closely related to an increased risk of CVD onset. Existing studies have reported that the risk of CVD associated with high levels of hs-CRP decreases gradually from middle-aged populations (51-64 years) to elderly populations (≥65 years) . However, it remains unclear whether the impact of CAR, as a novel marker for assessing CVD risk, on incident CVD differs among different age groups.

Objective

To explore the impact of CAR on incident CVD in different age groups.

Methods

A total of 54 951 participants who attended the third health examination in the Kailuan Cohort Study in 2010 were included. Demographic and clinical data, physical examination results, and laboratory test indicators of the participants were collected. The CAR was calculated and log-transformed (lgCAR) . Participants were divided into four quartile groups based on lgCAR: Q1 (lgCAR<-4.34, n=13 744) , Q2 (-4.34≤lgCAR<-3.67, n=13 731) , Q3 (-3.67≤lgCAR<-2.83, n=13 736) , and Q4 (lgCAR≥-2.83, n=13 740) . They were also stratified by age into <40 years (n=9 617) , 40-49 years (n=12 633) , 50-59 years (n=17 740) , and ≥60 years (n=14 691) . Follow-up began from the time of the 2010 health examination and ended at the occurrence of CVD, all-cause death, or the end of follow-up on 2021-12-31. The cumulative incidence of CVD in the total population and each age group was calculated using the Kaplan-Meier method, and comparisons between groups were made using the Log-rank test. Cox proportional hazards regression analysis was used to assess the risk of CVD in the total population at different CAR levels. The multiplicative interaction between age and CAR quartile groups was explored using the Cox regression model, and the analysis was repeated after stratifying by age. To eliminate the impact of medication use on the results, sensitivity analyses were conducted by excluding participants who took antihypertensive, antidiabetic, or lipid-lowering drugs at baseline or during follow-up. To eliminate the impact of reverse causality and short follow-up duration, sensitivity analyses were conducted by excluding participants with a follow-up duration of less than 1 year. Given the high mortality risk of CVD and the potential competition between CVD and patient death, a competing risk model for death was used to analyze the impact of different CAR levels on CVD in participants aged 60 years and older.

Results

A total of 54 951 participants were included in the final analysis, including 41 083 men (74.8%) and 13 868 women (25.2%) , with a mean age of 51.7±12.8 years. The mean lgCAR values in groups Q1 to Q4 were -5.6±1.5, -4.0±0.2, -3.3±0.2, and -2.2±0.6, respectively. There were statistically significant differences among the Q1 to Q4 groups in terms of age, gender, higher education, smoking, alcohol consumption, physical exercise, BMI, hs-CRP, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, diabetes, hypertension, antihypertensive medication use, antidiabetic medication use, lipid-lowering medication use, estimated glomerular filtration rate, alanine aminotransferase, ALB, and lgCAR (P<0.05) . The mean follow-up duration was 10.38±1.99 years, during which 3, 444 participants (6.27%) developed CVD. The number of incident CVD cases in groups Q1 to Q4 was 659, 809, 901, and 1 075, respectively, with cumulative incidences of 4.79%, 5.89%, 6.56%, and 7.82%. The Log-rank test showed that the differences in cumulative incidence of CVD among the Q1 to Q4 groups in the total population and different age groups were statistically significant (P<0.05) . The results of The Cox proportional hazards regression model indicated that after adjusting for confounding factors, the risk of incident CVD in group Q4 was 1.20 times that of group Q1 (HR=1.20, 95%CI=1.07-1.35) , and there was an interaction between age and CAR group with CVD (P_interaction=0.021) . In the <40 years, 40-49 years, 50-59 years, and ≥60 years age groups, the risk of incident CVD in group Q4 was 1.13 times (HR=1.13, 95%CI=0.55-2.33) , 1.44 times (HR=1.44, 95%CI=1.06-1.96) , 1.24 times (HR=1.24, 95%CI=1.02-1.50) , and 1.11 times (HR=1.11, 95%CI=0.93-1.33) that of group Q1, respectively. The results of the sensitivity analysis showed that after excluding participants who took lipid-lowering drugs at baseline or during follow-up, there was an interaction between age and CAR group with CVD (P_interaction=0.020) . After excluding participants who took antidiabetic drugs at baseline or during follow-up, there was an interaction between age and CAR group with CVD (P_interaction=0.015) . After excluding participants with a follow-up duration of less than 1 year, there was an interaction between age and CAR group with CVD (P_interaction=0.045) . The Cox proportional hazards regression model analysis found that the association between CAR group and incident CVD was consistent with the main results, and the association between CAR group and incident CVD still existed in the middle-aged population (40-59 years) , with the risk of CVD associated with elevated CAR decreasing with age. After excluding participants who took antihypertensive drugs at baseline or during follow-up, the interaction between age and CAR group with CVD was not significant (P_interaction=0.114) . The Cox proportional hazards regression model analysis found that compared with the main results, in the 50-59 years age group, the statistical association between CAR group and incident CVD was not significant (P>0.05) . The competing risk model for death was used to analyze the impact of different CAR levels on CVD in participants aged 60 years and older, and the results were consistent with the main results, showing no association between CAR and incident cardiovascular events.

Conclusion

A high CAR level is an independent risk factor for incident CVD. The association between CAR and the risk of CVD onset is age-dependent in the middle-aged population, and the risk of CVD associated with elevated CAR decreases with increasing age.

Analysis of Correlation Factors and Predictive Value of Microvascular Complications in Patients with Type 2 Diabetes Mellitus Combined with Metabolic-associated Fatty Liver Disease

FAN Xueming, YANG Ningning, ZHENG Zheng, WU Yumei, WANG Qi

2025, 28(36):  4578-4585.  DOI: 10.12114/j.issn.1007-9572.2024.0434

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Background

Type 2 diabetes mellitus (T2DM) is often associated with metabolic fatty liver disease (MAFLD) , which significantly increases the risk of microanglopathy through the interaction of insulin resistance, abnormal lipid metabolism, chronic inflammation and other mechanisms. However, the quantitative analysis of related risk factors and the construction of predictive models are insufficient in existing studies. Identification of key biomarkers to guide early intervention‌ is urgently needed.

Objective

To investigate the correlation factors and predictive value of microangiopathy in T2DM patients with MAFLD.

Methods

A retrospective analysis was conducted on the clinical data of patients with T2DM combined with MAFLD admitted to the Lu'an Hospital Affiliated to Anhui Medical University from January 2021 to August 2023. According to the medical record system, 110 patients with microvascular complications and 110 patients without microvascular complications were selected as the modeling group at a 1∶1 ratio. Another 106 patients with T2DM combined with MAFLD during the same period were selected as the validation group. Patients with microvascular complications were assigned to the occurrence group (n=110) , and those without microvascular complications were assigned to the non-occurrence group (n=110) . General information and laboratory test results of the patients were collected through the medical record system. The non-alcoholic fatty liver fibrosis score (NFS) , liver fibrosis 4-factor index (FIB-4) , and triglyceride-glucose index (TyG) were calculated. Multivariate logistic regression analysis was performed on indicators with a variance inflation factor (VIF) <10 selected by collinearity analysis. The receiver operating characteristic (ROC) curve was constructed to evaluate the predictive effect of each indicator on the occurrence of microvascular complications in patients with T2DM combined with MAFLD.

Results

There were no significant differences in baseline data between the modeling cohort and the validation cohort (P>0.05) . Among the patients with T2DM combined with MAFLD who developed microvascular complications, 44 (40.0%) had diabetic nephropathy, 29 (26.4%) had diabetic retinopathy, and 37 (33.6%) had both diabetic nephropathy and diabetic retinopathy. Significant differences were observed in smoking history, duration of diabetes, C-reactive protein (CRP) , TyG, triglycerides (TG) , FIB-4, and NFS between the non-occurrence and occurrence groups (P<0.05) . Multivariate logistic regression analysis showed that smoking history (OR=8.298, 95%CI=1.957-35.175) , long duration of diabetes (OR=2.638, 95%CI=1.515-4.596) , elevated CRP (OR=7.918, 95%CI=4.013-15.624) , elevated TyG (OR=1.533, 95%CI=1.171-2.006) , elevated TG (OR=2.055, 95%CI=1.475-2.862) , elevated FIB-4 (OR=29.598, 95%CI=9.179-95.437) , and elevated NFS (OR=3.433, 95%CI=2.113-5.576) were risk factors for microvascular complications in patients with T2DM combined with MAFLD (P<0.05) . The areas under the ROC curve (AUC) for predicting microvascular complications in patients with T2DM combined with MAFLD based on CRP, TyG, duration of diabetes, smoking history, TG, NFS, and FIB-4 were 0.964 (95%CI=0.944-0.984, P<0.001) , 0.620 (95%CI=0.546-0.693, P=0.002) , 0.795 (95%CI=0.737-0.853, P=0.001) , 0.605 (95%CI=0.530-0.679, P=0.004) , 0.663 (95%CI=0.592-0.735, P<0.001) , 0.730 (95%CI=0.664-0.796, P<0.001) , and 0.743 (95%CI=0.678-0.808, P<0.001) , respectively. The AUC (95%CI) of the predictive model based on the above indicators in the modeling cohort was 0.990 (0.990-1.000) , indicating good predictive value.

Conclusion

Clinically, the occurrence of microvascular complications in patients with T2DM combined with MAFLD can be effectively predicted by observing CRP, TyG, duration of diabetes, smoking history, TG, NFS, and FIB-4. This approach is conducive to identifying high-risk patients with microvascular complications among patients with T2DM combined with MAFLD.

Study on Medication Compliance and Influencing Factors in Patients after Percutaneous Coronary Intervention

CHEN Li, XIONG Weihong, LU Xiaoqin

2025, 28(36):  4586-4591.  DOI: 10.12114/j.issn.1007-9572.2024.0360

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Background

Because of the widespread use of percutaneous coronary intervention (PCI) , cardiac rehabilitation of patients after PCI has received much attention. With the social development trends and policy orientation, the community has gradually become a key area for the cardiac rehabilitation of patients after PCI, especially in terms of medication adherence, which has improved but still falls short of ideal results.

Objective

To investigate the current situation of medication adherence among patients after PCI in the community, explore its influencing factors, and propose countermeasures.

Methods

From May 2021 to August 2022, by convenient sampling, 200 eligible patients after PCI from 10 community health service centers in Beijing were recruited as the study subjects. Medication adherence of patients after PCI was evaluated using the Morisky Medication Adherence Scale. Those who scored 8 points on the Morisky Medication Adherence Scale were included in the excellent adherence group (n=45) , and those who scored less than 8 points were included in the general adherence group (n=136) , and multivariate Logistic regression analysis was used to explore the influencing factors of medication adherence in patients after PCI.

Results

A total of 181 valid questionnaires were collected, with a valid recovery rate of 90.5%. The 181 patients ranged in age from 41 to 90 years old, with an average age of (68.6±11.2) years. There were statistically significant differences in age, personal monthly income, burden of taking care of family members, diabetes or not, Medication Literacy Questionnaire scores, PHQ-9 scores and PCI duration between the general adherence group and the excellent adherence group (P<0.05) . Multivariate Logistic regression analysis showed that burden of taking care of family members (OR=0.092, 95%CI=0.031-0.276) , PCI duration (OR=0.882, 95%CI=0.794-0.979) , Medication Literacy Questionnaire scores (OR=3.044, 95%CI=1.881-4.927) and PHQ-9 scores (OR=0.067, 95%CI=0.021-0.210) were the factors that influence the medication adherence of patients after PCI (P<0.05) .

Conclusion

The drug utilization rate of patients after PCI decreased year by year, and the medication adherence was not ideal in general. Affected by factors such as burden of taking care of family members, PCI duration, medication literacy questionnaire scores and depressive state, targeted health management and follow-up should be provided to strengthen the establishment of long-term stable and good doctor-patient relationship which can effectively improve medication adherence among patients after PCI.

The Impact of Lactate Metabolism on the Prognosis of Patients with Multiple Myeloma and the Tumor Microenvironment Based on Bioinformatics Analysis

TAN Jiewen, CHEN Chang, ZHONG Jinman, HU Wanzhen, BAI Hai, XIONG Dan

2025, 28(36):  4592-4604.  DOI: 10.12114/j.issn.1007-9572.2024.0418

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Background

The significance of lactate and lactate metabolism in the development and progression of certain solid tumors has been reported. However, the role of lactate metabolism in the prognosis of multiple myeloma (MM) patients and in the tumor microenvironment (TME) remains unclear.

Objective

This study aimed to construct a prognostic risk-scoring model for MM patients based on lactate metabolism and to explore the impact of lactate metabolism on the TME.

Methods

Transcriptomic sequencing expression data and survival information of MM samples were obtained from the Gene Expression Omnibus (GEO) datasets GSE136324 and GSE4581. Lactate metabolism-related genes (LMRGs) for subsequent analysis were identified through the MSigDB and GeneCards databases. Consensus clustering and Cibersort were applied to explore the relationship between LMRGs and the TME. Differences in the TME among MM samples were analyzed using the Wilcoxon rank-sum test. A linear regression model was used to identify LMRGs associated with survival prognosis, and results were visualized using forest plots and Kaplan-Meier survival curves, with comparisons made by log-rank test. Least absolute shrinkage and selection operator (Lasso) regression was used for variable selection, and univariate and multivariate Cox regression analyses were performed to identify prognostic LMRGs for model construction. The predictive performance of the model was evaluated using Kaplan-Meier survival analysis and receiver operating characteristic (ROC) curves. Pearson correlation analysis was used to examine the relationship between the lactate metabolism-based risk score and immune score, stromal score, and tumor purity.

Results

Based on the expression profiles of LMRGs, consensus clustering via the ConsensusClusterPlus package identified two lactate metabolism-related subtypes: Lactate.cluster A and Lactate.cluster B. Patients in Lactate.cluster A had significantly worse prognosis than those in Lactate.cluster B (χ²=19.11, P<0.000 1) . Significant differences were observed between the two subtypes in the infiltration levels of naive B cells, memory B cells, plasma cells, CD₈⁺ T cells, resting memory CD₄⁺ T cells, activated memory CD₄⁺ T cells, follicular helper T cells, gamma delta T cells, resting natural killer (NK) cells, activated NK cells, monocytes, M0 macrophages, M2 macrophages, activated dendritic cells, resting mast cells, activated mast cells, eosinophils, and neutrophils (P<0.05) . Several LMRGs were significantly associated with prognosis: high expression of PC, POLG, FASN, FABP2, SLC7A5, BCAT2, SLC16A8, HAGH, PFKL, PGK2, PKLR, CA2, and SLC2A1 was associated with better prognosis, while high expression of PDP1, AGK, PEX12, and PFKFB2 was associated with poorer prognosis (P<0.05) . Eleven independent predictive variables—SLC2A1, CA2, PKLR, PFKL, PFKFB2, SLC16A8, SLC7A5, AGK, FABP2, POLG, and PC—were included in the multivariate Cox regression analysis to construct a predictive model. Based on the median risk score, patients were divided into high-risk and low-risk groups. In the training set, the high-risk group had significantly worse overall survival than the low-risk group (χ²=59.02, P<0.05) . The area under the ROC curve (AUC) for predicting 5-year survival was 0.781 (95%CI=0.664-0.886) . In the validation set, the high-risk group also had significantly poorer survival (χ²=9.24, P<0.05) , with an AUC of 0.64 (95%CI=0.542-0.737) for predicting 1-year survival. Analysis of immunotherapy response data from the training dataset showed a significant difference in outcomes between the high- and low-risk groups (Z=-2.469, P=0.014) , with high-risk score being an independent prognostic factor (P<0.05) . Comparisons of immune cell infiltration between the two groups revealed significant differences in plasma cells, CD₈⁺ T cells, resting memory CD₄⁺ T cells, activated memory CD₄⁺ T cells, follicular helper T cells, resting NK cells, activated NK cells, monocytes, M0 macrophages, resting dendritic cells, activated dendritic cells, resting mast cells, activated mast cells, and eosinophils (P<0.05) . Significant differences were also observed in the expression of immune-related genes including HAVCR2, CD₂₇₄, PVR, CD₈₀, CTLA4, PDCD₁, CD₂₀₀R1, CD₂₇₆, CD₂₀₀, BTLA, LGALS3, and VTCN1 (P<0.05) . Pearson correlation analysis between the lactate metabolism-based risk score and enrichment scores of 50 hallmark pathways revealed positive correlations with WNT beta-catenin signaling, androgen response, and UV response, and negative correlations with KRAS signaling, pancreas beta cells, and heme metabolism (P<0.05) . The risk score was positively correlated with stromal score (P<0.05) but not with tumor purity (P>0.05) .

Conclusion

This study constructed a risk score prognostic model for multiple myeloma patients based on lactate metabolism and validated it with independent datasets. The new prognostic model is robust and demonstrates better performance in predicting long-term survival. Furthermore, the analysis of lactate metabolism in relation to the TME suggests that lactate metabolism may influence immune cell populations within the TME of MM, thereby affecting tumor progression and the prognosis of MM patients.

Exploring the Causal Relationship between Circadian Rhythm Disorders and Lung Cancer and Potential Interventional Traditional Chinese Medicine

XIAO Junjie, HE Jiawei, ZENG Xiao, XIANG Hongxia, LEI Mao, ZHENG Ruyi, ZHENG Chuan, REN Yifeng, YOU Fengming, FU Xi, MA Qiong

2025, 28(36):  4605-4618.  DOI: 10.12114/j.issn.1007-9572.2024.0706

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Background

Lung cancer is a leading cause of morbidity and mortality, making its prevention and treatment a key focus of research. Circadian rhythm disruption (CRD) is considered an important risk factor for lung cancer, but the causal relationship between CRD and lung cancer remains unclear.

Objective

To investigate the causal relationship and potential mechanisms between circadian rhythm disruption and lung cancer risk, and to predict potential Traditional Chinese Medicine (TCM) interventions.

Methods

GWAS data on daytime napping, daytime sleepiness, short and long sleep duration, chronotype, insomnia, and early waking were obtained from UK Biobank and other sources, while lung cancer-related data, including overall lung cancer, lung adenocarcinoma (LUAD) , lung squamous cell carcinoma (LUSC) , and small cell lung cancer (SCLC) , were collected from the IEU Open GWAS database. Mendelian randomization (MR) analysis was conducted using the inverse-variance weighted (IVW) method to evaluate the causal relationship between circadian rhythm disruption and lung cancer, with supplementary methods used to confirm result robustness. Core genes were identified through SNPs localization and PPI network analysis, followed by functional enrichment and survival analysis. Core genes were then uploaded to the Coremine database to identify TCMs with potential intervention effects. The properties, flavors, meridian tropism, and efficacy of the TCMs were cataloged. Core TCMs were then selected, and their key components were obtained from the TCMSP and BATMAN-TCM databases. Molecular docking was used to validate the binding ability of the key components of the core TCMs to the core genes.

Results

Insomnia (OR=1.149, 95%CI=1.074-1.232, P=0.013) and short sleep duration (OR=1.462, 95%CI=1.033-2.061, P=0.031) showed a causal relationship with lung cancer. Insomnia (OR=1.181, 95%CI=1.061-1.322, P=0.001) , short sleep duration (OR=1.563, 95%CI=1.024-2.401, P=0.038) , and daytime sleepiness (OR=4.033, 95%CI=1.062-15.434, P=0.042) were causally linked to LUAD, while insomnia (OR=1.152, 95%CI=1.028-1.281, P=0.001) was linked to LUSC and short sleep duration (OR=1.952, 95%CI=1.120-3.383, P=0.017) to SCLC. A total of 139 core genes were identified, enriched in pathways such as GPCR, MAPK, and PI3K/Akt. The top five core genes included EP300, GAPDH, GNB1, GNG13, and TNF. EP300 expression correlated positively with survival in LUAD, LUSC, and SCLC patients (P<0.05) . GNB1 expression negatively correlated with survival in LUAD patients but positively with survival in SCLC patients (P<0.05) . GAPDH, GNG13, and TNF expressions negatively correlated with survival in LUAD patients (P<0.05) . Forty TCMs, including Shui Niu Jiao, Dan Shen, Yu Nao Shi, Huang Qin, Yu Jin, Huang Qi, Ling Zhi, and Ren Shen were predicted and screened, with sweet flavor being predominant, followed by bitter and pungent, and cold nature being dominant, followed by warm and neutral. The TCMs mainly targeted the liver, spleen, lungs, stomach, heart, and kidney meridians, with functions focused on tonifying qi, promoting blood circulation, and clearing heat and toxins. Eight key herbs (Shui Niu Jiao, Dan Shen, San Qi, Huang Qin, Yu Jin, Jiang Huang, Yu Mi Xu, Ling Zhi) showed excellent molecular docking affinity (binding energy<-4 kcal/mol) with core target genes.

Conclusion

The findings suggest a causal relationship between circadian rhythm disruption and lung cancer, with potential mechanisms involving pathways such as GPCR, MAPK, and PI3K/Akt. The predicted TCMs offer new insights for using Chinese medicine to regulate circadian rhythms and prevent lung cancer.

The Current Status and Analysis of Postgraduate Dissertations in General Practice in China

HUANG Danhua, GUAN Lan, YANG Xin, ZHANG Xiaofei, HU Bingjie

2025, 28(36):  4619-4626.  DOI: 10.12114/j.issn.1007-9572.2024.0420

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Background

Postgraduate education in general practice is an essential part of cultivating high-quality general practitioners. However, the postgraduate education in general practice in China started relatively late and has revealed some problems in practice. How to effectively implement the national guidelines for accelerating the innovation and development of medical education is an important issue for graduate education in general practice in the new era.

Objective

Using graduate theses in general practice as a starting point, this study analyzes the current status and issues of graduate education in general practice, and provides reflections and suggestions.

Methods

A literature search was conducted in the China National Knowledge Infrastructure (CNKI) database for theses related to "General Practice" published up to December 20, 2023. Descriptive analysis of the annual publication volume, as well as publication volume by region, province, and institution, was performed using SPSS 16.0. ArcGIS 10.8 was used to layer and display the number and regional distribution of theses on a map. CiteSpace 6.2.R4 software was employed to process the literature data, generating keyword cluster maps, keyword time series line charts, and keyword hotspot analysis. Prior to using CiteSpace 6.2.R4, a file containing bibliographic information for 1 834 theses was exported to NoteExpress software, then uniformly converted to Refworks-CiteSpace format for analysis of research directions, hot topics, and other aspects of the theses.

Results

A total of 1 834 graduate theses in general practice were retrieved (1 829 master's theses and 5 doctoral theses) , involving 821 supervisors. The highest number of publications was from East China (614 theses, 33.40%) . Among provinces, Anhui had the most publications (228 theses, 12.43%) . The number of theses showed a rapid growth trend, entering an explosive growth phase in 2015 with a sustained upward trend, with an average year-on-year growth rate of 51.5% (P < 0.05) . Among the supervisors, 445 (54.20%) supervised only one cohort of graduate students, while 227 (27.65%) supervised three or more cohorts. In terms of research direction, aside from general practice, health education, and health management, the main research topics included hypertension, heart failure, coronary heart disease, diabetes, and stroke. A total of 439 theses (23.94%) explicitly involved studies on micro-mechanisms.

Conclusion

Graduate education in general practice has shown positive results under policy support, with the scale of graduate training growing rapidly. The training objectives are relatively clear, but the discipline's characteristics still need to be further refined. The supervisor team is continuously expanding, but further improvement of team development are needed. The scale of graduate student enrollment also needs to be expanded.

Review & Perspectives

Exercise-based Cardiac Rehabilitation in Acute Myocardial Infarction Management: Global Perspectives, Multimodal Interventions, and Personalized Strategies

CEN Kaiyuan, FATIMAH Ahmedy, CHEN Hong, SHAO Mingchen, MEXMOLLEN Marcus, MOHD Fadzli Shukor

2025, 28(36):  4627-4639.  DOI: 10.12114/j.issn.1007-9572.2025.0028

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Acute myocardial infarction (AMI) remains one of the leading causes of mortality and disability worldwide, making the optimization of long-term post-procedural management a key focus in cardiovascular medicine. Exercise-based cardiac rehabilitation (EBCR) , as a core intervention recommended by evidence-based medicine, has demonstrated significant benefits in enhancing cardiopulmonary function, alleviating psychological stress, and improving overall quality of life by integrating diverse exercise modalities with personalized management strategies. The rapid advancement of precision medicine, smart technologies, and psychosocial interventions has provided new opportunities for the expansion of EBCR, particularly in resource-limited settings. However, the global implementation of EBCR still faces substantial challenges, including limited healthcare accessibility, economic constraints, and poor patient adherence, especially in regions with insufficient medical resources. This study systematically reviews the global landscape of EBCR implementation, regional disparities, and the efficacy of multidimensional interventions and personalized approaches. Furthermore, it explores future directions in the integration of intelligent technologies, policy frameworks, and interdisciplinary collaborations, aiming to provide targeted theoretical insights and practical guidance for optimizing AMI rehabilitation management.

Scoping Review of Telemedicine Application in Cardiac Rehabilitation for Coronary Heart Disease Patients

LIU Yan, YUAN Yanling, LING Rong, WANG Lanyun, SUN Li

2025, 28(36):  4640-4647.  DOI: 10.12114/j.issn.1007-9572.2024.0699

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Background

Coronary heart disease, a common cardiovascular disease, severely impacts patients' quality of life and survival rate globally. Cardiac rehabilitation, crucial for post-coronary heart disease recovery, significantly improves patient prognosis and quality of life. In recent years, with the development of information technology, telemedicine has emerged in cardiac rehabilitation for coronary heart disease patients, showing good prospects and providing more convenient rehabilitation support. However, differences in rehabilitation quality among centers affect the stability and accessibility of rehabilitation outcomes.

Objective

This scoping review aims to summarize existing research on telemedicine application in cardiac rehabilitation for coronary heart disease patients, providing a reference for healthcare professionals conducting remote cardiac rehabilitation.

Methods

Based on Arksey and O'Malley's scoping review framework, we searched multiple databases including Cochrane Library, PubMed, Web of Science, Embase, EBSCO, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Data, and VIP Network from their inception to August 20, 2024. We screened, summarized, and analyzed the included literature.

Results

We included 23 articles from 10 countries: 21 randomized controlled trials, 1 quasi-experimental study, and 1 qualitative study. Telemedicine carriers mainly included apps and remote monitoring systems. Telemedicine could guide rehabilitation exercise frequency and intensity, monitor arrhythmias, provide health education and social support. Most studies focused on coronary heart disease-related indicators, symptom assessment, quality of life, self-management, rehospitalization and mortality rates, resource costs, user experience (satisfaction and safety) , anxiety, depression, and physical activity levels.

Conclusion

Telemedicine enhances cardiac rehabilitation participation, exercise motivation, and medication adherence in coronary heart disease patients, improves sedentary behavior, and increases survival rate and quality of life. Although China's telemedicine is rapidly developing, it still faces challenges. Future improvements should involve optimizing remote cardiac rehabilitation platforms with AI technology, refining evaluation systems, and strengthening community service integration to enhance application effectiveness.

A Review of Discrete Choice Experiment in Treatment and Device Preferences for Chronic Obstructive Pulmonary Disease

SHAO Jiachen, LI Shunping, YANG Ting, ZHANG Chunyu, LU Liyong, YUAN Jiaqi

2025, 28(36):  4648-4654.  DOI: 10.12114/j.issn.1007-9572.2024.0585

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Background

Chronic obstructive pulmonary disease (COPD) is associated with a substantial disease burden. The attributes of different treatment options vary, which can affect patient adherence and, consequently, treatment outcomes. Discrete choice experiment (DCE) can identify the key factors (attributes) influencing patient choices, determine the most valued attributes, and quantify the trade-offs between attributes. DCEs have been widely applied in the healthcare field.

Objective

To review and evaluate the literature on DCE regarding treatment and device preferences among patients with COPD, with the aim of providing a reference for conducting health preference-related research on COPD patients in China.

Methods

Literature utilizing DCEs to measure health preferences among patients with COPD was retrieved from the Web of Science Core Collection, PubMed, CNKI, Wanfang Data, CBM, and VIP Database. The PREFS checklist was employed for quality evaluation. The attributes in the studies and their corresponding dimensions were analyzed and discussed.

Results

A total of 11 studies were included, all from developed countries. Significant differences were observed in the attributes due to variations in research objectives and subjects. Regarding treatment preferences, the proportions of attributes related to efficacy, convenience, treatment burden, risk, and patient characteristics were 29%, 29%, 20%, 11%, and 11%, respectively. Patients with COPD particularly preferred attributes related to efficacy and risk dimensions, followed by treatment burden and patient characteristics, with less emphasis on convenience. For device preferences, the proportions of attributes related to feature design, device usage, and drug-related features were 36%, 32%, and 32%. COPD patients showed a strong preference for attributes related to device design and drug related features, followed by device use. The overall quality of the literature was not relatively high.

Conclusion

There is a discrepancy between the frequency of attributes included in each dimension and the dimensions preferred by patients, particularly with the convenience dimension being the least preferred in treatments. To date, there is no application of DCEs among COPD patients in China. In the future, more relevant research should be carried out based on the actual situation in China to provide evidence for the improvement of COPD treatment.