Table of Content

20 February 2026, Volume 29 Issue 06

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Guidelines·Consensus·Interpretation

Expert Consensus on Health Promotion Strategies for Adult Vaccination in China

Institute for Healthy China, Tsinghua University, School of Public Health, Peking University, College of General Practice, Southern University of Science and Technology, Public Health Security and Health Professional Committee, Public Safety Science and Technology Society

2026, 29(06):  681-687.  DOI: 10.12114/j.issn.1007-9572.2025.0303

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Vaccine-preventable diseases impose a significant health burden on adults in China, highlighting urgent needs to address gaps in the current adult immunization program. The Expert Consensus on Health Promotion Strategies for Adult Vaccination in China was developed through collaboration among experts from multiple institutions, led by the Institute for Healthy China, Tsinghua University, School of Public Health, Peking University, College of General Practice, Southern University of Science and Technology, and the Public Health Security and Health Professional Committee, Public Safety Science and Technology Society. Integrating evidence-based scientific research and practical insights from multidisciplinary experts in immunization promotion, this consensus addresses the necessity and health value of adult vaccination, the current status and challenges of adult vaccination services in China, and expert recommendations for advancing strategies such as integrating medical and preventive care, promoting vaccine prescriptions by general practitioners, and developing a national adult immunization strategy. The consensus aims to provide scientific, systematic, and actionable guidance for government policymakers, public health agencies, healthcare providers, and health promotion practitioners to facilitate vaccination efforts for key adult groups from a life-cycle perspective.

Implications for the Management of Chronic Obstructive Pulmonary Disease Patients Based on the Italian Consensus in 2024: Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease

CHEN Chuping, LIU Lidi, YANG Ziyu, ZHANG Peng, ZHANG Rui, YUAN Bo, SHEN Can, YANG Rong, LI Dongze, LIAO Xiaoyang, LEI Yi

2026, 29(06):  688-692.  DOI: 10.12114/j.issn.1007-9572.2024.0616

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In China, chronic obstructive pulmonary disease (COPD) is a prevalent chronic disorder. With high incidence and mortality, it burdens both individual health and socioeconomic systems. Pharmacological treatment is essential for COPD management, and personalized therapy is key. Triple therapy combining inhaled corticosteroids (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta-agonist (LABA) has become a focal point. In 2024 Italy has refined the management of COPD patients through the establishment of an expert panel focusing on the applicability of triple therapy in order to standardize the management of patients with COPD and published the "An Italian Delphi Consensus on the Triple Inhalation Therapy in Chronic Obstructive Pulmonary Disease". This article interprets the consensus' core points on triple therapy, analyzes its applications in diverse clinical scenarios, and provides evidence - based guidance for optimizing drug selection in Chinese COPD treatment. The goal is to improve treatment standardization and enhance patient outcomes.

Original Research

A Cross-sectional Study on the Relationship between the Chinese Visceral Adiposity Index and Cardiometabolic Multimorbidity in Individuals Aged 60 and Above

HAN Zheng, FU Fanglin, SUN Meng, PAN Yaojia, WANG Weiqiang

2026, 29(06):  693-698.  DOI: 10.12114/j.issn.1007-9572.2024.0391

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Background

With the aging of the population and the increasing prevalence of multimorbidity in China, the high-risk characteristics of cardio-metabolic multimorbidity (CMM) have become an important research field. The exact nature of the relationship between the Chinese visceral adiposity index (CVAI) and CMM remains to be elucidated.

Objective

This study aims to investigate the relationship between the CVAI and the high risk of CMM, and to evaluate the potential role of CVAI in the prevention and treatment of CMM in the elderly in China.

Methods

This study was based on the data of 60 029 subjects from the Early Screening and Comprehensive Intervention of High-risk Populations of Cardiovascular Disease in Anhui Province from 2017 to 2021. The demographic information, cardiovascular health status, physical examination and biochemical indicators were analyzed, and the CVAI index was calculated. The subjects were grouped according to the quartile of CVAI (male: T1-T4 group, female: F1-F4 group), and the differences in baseline characteristics were compared. Multtivariate Logistic regression analysis was used to explore the relationship between CVAI and the high risk of CMM. The nonlinear relationship between CVAI and CMM between different genders was assessed by restricted cubic spline (RCS) curves, and a threshold of OR=1 was determined.

Results

There were 60 029 subjects, including 27 203 males (45.32%) and 32 826 females (54.68%). There were statistically significant differences in age, smoking, drinking, rural area, high school education, BMI, mean arterial pressure (MAP), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), fasting plasma glucose (FPG), diabetes, stroke, hypertension, and ischemic heart disease in CVAI quartiles between different genders (P<0.05). There was no significant difference in the history of hypertension medication among males. In women, the difference in medication history of hypertension was statistically significant multivariate. Multtivariate Logistic regression analysis showed that compared with T1 (F1) group, the risk of CMM was significantly increased in T2 toT4 (F2 to F4 ) group. After fully adjusting for confounding factors, the T4 (F4) group showed the highest risk of CMM in both sexes, male (OR=2.335, 95%CI=1.741-3.180, P<0.001), and female (OR=2.735, 95%CI=1.778-2.686, P<0.001). There was no significant difference in the odds ratio between different genders. There was no significant difference in the risk of CMM between males in T4 group and females in F4 group (P>0.05). After controlling for different confounding factors, RCS curve suggested that there was a nonlinear relationship between CVAI index and CMM risk in men, and the threshold of OR=1 was 94.75. There was a linear relationship between CVAI index and CMM risk in women, and the threshold of OR=1 was 114.87.

Conclusion

High level of CVAI may be closely related to the risk of CMM, and the predictive power is consistent in different genders. Special attention should be paid to men with CVAI over 94.75 and women with CVAI over 114.87 to reduce the risk of CMM.

The Relationship between Different Obesity Indicators and Frailty among the Elderly in Rural Regions

ZHANG Zhiwei, HE Panpan, YANG Qianwen, JIN Xueyi, MAO Xueqian, HU Ying, JING Lipeng

2026, 29(06):  699-709.  DOI: 10.12114/j.issn.1007-9572.2025.0093

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Background

Frailty was an age-related geriatric syndrome, with its prevalence among Chinese older adults being notably high and demonstrating a rising trend over time. Obesity was closely associated with the development of numerous diseases, but its relationship with frailty remained controversial. This uncertainty was potentially attributable to limitations of conventional obesity indicators in characterizing adipose tissue distribution. Therefore, investigating the associations between multiple adiposity metrics and frailty was important for to advance the understanding of frailty pathogenesis and developing preventive interventions.

Objective

This study investigates the relationship between various obesity indicators and frailty, providing a scientific basis for the early prevention and control of frailty in older adults.

Methods

In this study, a total of 1 429 elderly people aged 60 years and above were surveyed in six rural villages in Jingyuan County, Gansu Province, from March to May 2023. After further exclusions, a final sample of 1 153 participants was included in the analysis. The FRAIL scale was utilized to assess the frailty status of the elderly. Based on Chinese obesity criteria, waist circumference and BMI were categorized, and waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), and Chinese visceral adiposity index (CVAI) were grouped by quartiles. Multivariate Logistic regression, restricted cubic splines, and receiver operating characteristic (ROC) curve analysis were employed to explore the relationship between different obesity indicators and frailty.

Results

This study included 1 153 elderly participants aged≥60 years, comprising 474 males (41.11%) and 679 females (58.89%), with a mean age of 70.86±4.76 years. Based on FRAIL scale assessments, 226 participants were identified as frail and 927 as non-frail, resulting in a frailty prevalence of 19.60%. The adjusted multivariate Logistic regression analysis revealed that central obesity, moderate to severe obesity (reference: normal BMI), Q3 and Q4 (reference: Q1) levels of WHR, and Q4 (reference: Q1) levels of WHtR, BRI, and CVAI were significant risk factors for frailty in the elderly population (P<0.05), with progressively increasing risks of frailty associated with elevated levels of waist circumference, BMI, WHR, WHtR, BRI, and CVAI (P_trend<0.05). The restricted cubic spline (RCS) curve indicated that waist circumference, BMI, WHtR, BRI, and CVAI were linearly and positively correlated with the risk of frailty in the elderly (P_linear<0.05). The ROC curve analysis demonstrated that that the predictive capacity for frailty in the elderly was possessed by waist circumference, BMI, WHR, WHtR, BRI, and CVAI, with area under the curve (AUC) of 0.557 (95%CI=0.515-0.598), 0.570 (95%CI=0.528-0.612), 0.558 (95%CI=0.515-0.600), 0.610 (95%CI=0.568-0.652), 0.610 (95%CI=0.568-0.652), and 0.586 (95%CI=0.546-0.626), respectively (P<0.05). Additionally, WHtR, BRI, and CVAI demonstrated better predictive ability compared to waist circumference (Z=-5.443, P<0.001; Z=-5.443, P<0.001; Z=-2.595, P=0.009), and both WHtR and BRI showed better predictive ability compared to BMI (Z=-2.885, P=0.004; Z=-2.884, P=0.004).

Conclusion

In rural regions, among the elderly population aged 60 and above, obesity indicators such as waist circumference, BMI, WHR, WHtR, BRI, and CVAI were positively correlated with the risk of frailty in the elderly. Among these indicators, WHtR and BRI showed better predictive ability for frailty.

Analysis of Predictors for Immune-related Adverse Events and the Correlation with Efficacy in Progressive Esophageal Squamous Cell Carcinoma

YANG Haifei, SUN Wu, WU Cheng, REN Wei, LI Rutian

2026, 29(06):  710-717.  DOI: 10.12114/j.issn.1007-9572.2025.0208

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Background

Immunotherapy has become the standard regimen for progressive esophageal squamous cell carcinoma (ESCC), but there is a lack of clear biomarkers to predict immune-related adverse events (irAEs), and the relationship between irAEs and efficacy is also unclear.

Objective

To explore the predictive factors associated with the occurrence of irAEs in patients with progressive ESCC and the correlation between irAEs and prognosis.

Methods

A retrospective study was conducted on 118 patients diagnosed with progressive ESCC and treated with programmed death protein 1 (PD-1) inhibitors at Nanjing Drum Tower Hospital from 2020 to 2023. The enrolled patients were followed up through access to medical records, outpatient visits, re-admissions, phone calls. Clinical data and occurrence of irAEs were collected. Patients were divided into the irAEs-positive group and the irAEs-negative group based on the occurrence of irAEs during treatment. Univariate and multivariate Logistic analysis were conducted to analyze the factors influencing the occurrence of irAEs. The efficacy was evaluated as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Objective remission rate (ORR), disease control rate (DCR) were compared between the two groups. Kaplan-Meier survival curve were plotted, and Log-rank test was conducted to compare the progression free survival (PFS) and overall survival (OS) between the two groups.

Results

Among the 118 patients, 47 cases (39.83%) experienced irAEs. The irAEs with higher incidence were dermal toxicity 21 cases (17.80%), endocrine toxicity 16 cases (13.56%) and pulmonary toxicity16 cases (13.56%). The comparison of autoantibody profiles and antinuclear antibody (ANA) between the irAEs-positive group and the irAEs-negative group showed a statistically significant difference (P<0.05). Univariate Logistic analysis showed that autoantibody profile positivity (OR=3.375, 95%CI=1.527-7.456, P=0.003) and ANA positivity (OR=3.072, 95%CI=1.404-6.722, P=0.005) were risk factors for the development of irAEs (P<0.05). Multivariate Logistic analysis showed that autoantibody profile positivity (OR=2.367, 95%CI=0.841-6.663, P=0.103) and ANA positivity (OR=1.733, 95%CI=0.621-4.837, P=0.293) were not significantly associated with the occurrence of irAEs. However, the incidence of endocrine toxicity was higher in autoantibody-positive patients than in autoantibody-negative patients, and the incidence of endocrine toxicity and myotoxicity was higher in ANA-positive patients than in ANA-negative patients (P<0.05). Moreover, the DCR of irAEs-positive group was longer than that of irAEs-negative group (χ²=6.690, P=0.010). Comparing the ORR of the two groups, the difference was not statistically significant (χ²=2.628, P=0.105). Survival analysis results showed that the median PFS and median OS of the irAEs-positive group were longer than those of the irAEs-negative group, all differences were statistically significant (PFS: χ²=9.521, P=0.002; OS: χ²=4.254, P=0.039).

Conclusion

Autoantibody profiles or ANA positivity may be more likely to develop irAEs after immunotherapy in patients with ESCC, and the occurrence of irAEs is associated with better efficacy.

Clinical Characteristics and Influencing Factors of Primary Sjögren's Disease with Dryness and Blood-stasis Syndrome

LEI Chunxin, ZHANG Xiya, ZHANG Yan, CHEN Jiaqi, LIU Zihan, LUO Jing, TAO Qingwen

2026, 29(06):  718-725.  DOI: 10.12114/j.issn.1007-9572.2025.0254

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Background

Primary Sjögren's disease (pSjD) is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands, presenting mainly with xerostomia and xerophthalmia, and potentially involving multiple systems. Epidemiological studies indicate a prevalence of approximately 0.06%-0.08%, with an increasing trend over time. In recent years, expert consensus in traditional Chinese medicine (TCM) has recognized the dryness and blood-stasis pattern as one of the common syndromes; however, its clinical characteristics, influencing factors, and prognosis have not been systematically investigated.

Objective

To explore the integrative clinical features, influencing factors, and prognostic outcomes of patients with pSjD of dryness and blood-stasis syndrome.

Methods

A total of 970 patients with pSjD treated at the China-Japan Friendship Hospital from 2017 to 2022 were enrolled, including 185 with pSjD of dryness and blood-stasis syndrome and 785 without pSjD of dryness and blood-stasis syndrome. General information, clinical symptoms, laboratory indicators, and disease activity scores (EULAR Sjögren's Syndrome Disease Activity Index, ESSDAI) were compared between groups. Multivariate Logistic regression analysis was used to identify independent factors associated with pSjD of dryness and blood-stasis syndrome. Survival outcomes, including all-cause mortality, malignancy, and incident interstitial lung disease (ILD), were analyzed using Kaplan-Meier survival curves and compared by the Log-rank test.

Results

Compared with the non-dryness and blood-stasis syndrome group, patients with pSjD of dryness and blood-stasis syndrome were more frequently female, had longer disease duration, and were younger at disease onset and enrollment (P<0.05). The top five symptoms in the pSjD of dryness and blood-stasis syndrome group were xerostomia (75.1%), xerophthalmia (75.1%), arthralgia (54.6%), fatigue (43.2%), and rampant caries (33.5%). The proportions of xerostomia, arthralgia, Raynaud's phenomenon, lymphadenopathy, parotid gland enlargement, purpura-like rash, arthritis, and bleeding were significantly higher in the pSjD of dryness and blood-stasis syndrome group, whereas cough and dyspnea were less frequent (P<0.05). Multivariate Logistic regression analysis identified older age at enrollment (OR=0.979, 95%CI=0.965-0.993, P=0.004) and higher platelet counts (OR=0.997, 95%CI=0.994-0.999, P=0.007) as independent protective factors for pSjD of dryness and blood-stasis syndrome, while anti-RNP positivity (OR=2.352, 95%CI=1.305-4.238, P=0.004), anti-CENP-B positivity (OR=2.490, 95%CI=1.404-4.415, P=0.002), anti-β2GP1 positivity (OR=2.269, 95%CI=1.057-4.872, P=0.036), and higher ESSDAI scores (OR=1.037, 95%CI=1.011-1.064, P=0.006) were identified as independent risk factors. Kaplan-Meier survival analysis showed no significant differences between groups in all-cause mortality, malignancy, or incident ILD (P>0.05).

Conclusion

Nearly 20% of pSjD patients had dryness and blood-stasis syndrome, and these patients exhibited a more chronic disease course, higher ESSDAI scores, and more prominent hematological involvement, although with a lower proportion of ILD. Older age at enrollment and higher platelet counts may be the independent protective factors for pSjD of dryness and blood-stasis syndrome, while anti-RNP positivity, anti-CENP-B positivity, anti-β2GP1 positivity, and higher ESSDAI scores may be identified as independent risk factors. No significant differences were observed in all-cause mortality, malignancy, or incident ILD between the two groups.

Predictive Value of Muscle-to-Fat Ratio in Type 2 Diabetes Mellitus among Non-overweight/Obese People

LI Jixin, QIU Linjie, REN Yan, WANG Wenru, LI Meijie, LI Wenjie, ZOU Chacha, WU Zijing, ZHANG Jin

2026, 29(06):  726-732.  DOI: 10.12114/j.issn.1007-9572.2024.0624

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Background

Type 2 diabetes mellitus (T2DM) onset is insidious in non-overweight/obese individuals, making early identification of risk factors for T2DM critically important. Muscle-to-fat ratio (MFR) is widely used in predicting metabolic diseases, but less analyzed in T2DM, especially in non-overweight/obese people with T2DM.

Objective:

To investigate the correlation of MFR with T2DM in non-overweight/obese individuals, and its predictive value.

Methods

This study enrolled non-overweight/obese adults who underwent health examinations in Xiyuan Hospital of China Academy of Chinese Medical Sciences from 2021 to 2024. Participants were stratified based on the T2DM status, and baseline levels were compared. Logistic regression and linear regression were used to analyze the correlation of MFR with T2DM risk and fasting plasma glucose (FPG) levels in non-overweight/obese individuals. To assess the robustness of findings, subgroup analyses were conducted based on gender, age, smoking status, alcohol consumption, and hypertension status. A receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of MFR in T2DM risk among non-overweight/obese individuals.

Results

A total of 1 021 non-overweight/obese participants were enrolled, including 113 T2DM patients. Logistic regression and linear regression results showed that in Model 1 (unadjusted for covariates), each 1-unit increase in MFR among non-overweight/obese individuals was associated with a 36% reduction in T2DM risk (OR=0.36, 95%CI=0.22 to 0.60, P<0.001), and a 0.26-unit decrease in FPG (β=-0.26, 95%CI=-0.39 to -0.14, P<0.001). In Model 3 with adjustments for all covariates, each 1-unit increase in MFR was associated with a 29% reduction in T2DM risk (OR=0.29, 95%CI=0.12 to 0.69, P=0.005) and a 0.28-unit decrease in FPG (β=-0.28, 95%CI=-0.49 to -0.08, P=0.007). When MFR was treated as a categorical variable in Model 3, the risk of T2DM in the MFR Q4 group was 0.34 times that in the MFR Q1 group (OR=0.34, 95%CI=0.12 to 0.93, P=0.036), and FPG levels decreased by 0.36 units (β=-0.36, 95%CI=-0.63 to -0.09, P=0.009). Subgroup analysis revealed the correlation between MFR and FPG levels was more pronounced among smokers and individuals with hypertension. The area under the curve (AUC) of MFR in predicting T2DM risk among non-overweight/obese individuals was 0.635 4 (95%CI=0.578 6 to 0.687 4), with an optimal cutoff of 1.080 1, a sensitivity of 46.90% and a specificity of 75.44%.

Conclusion

Among non-overweight/obese individuals, MFR exhibits a nonlinear negative correlation with T2DM risk and FPG levels. MFR demonstrates good predictive efficacy and can be used for early prediction of T2DM risk in non-overweight/obese populations.

Clinical Characteristics of Growth Hormone Deficiency and Analysis of the Efficacy of Recombinant Human Growth Hormone: a Ten-year Longitudinal Cohort Study

ZHAO Qianqian, ZHANG Mei, LI Yanying, ZHANG Yanhong, YAN Wenhua, PAN Hui, BAN Bo

2026, 29(06):  733-740.  DOI: 10.12114/j.issn.1007-9572.2024.0709

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Background

Growth hormone deficiency (GHD) can lead to growth and development disorders in children. Its clinical features are complex and diverse, and diagnosis and treatment are difficult. Recombinant human growth hormone (rhGH) is the first - choice drug for treating GHD, but there are significant individual differences in treatment efficacy, and the influencing factors are not yet clear.

Objective

Based on a ten-year longitudinal cohort study, to investigate the clinical characteristics of children with GHD and the efficacy of rhGH therapy.

Methods

A total of 1 050 children who were hospitalized in the Department of Endocrinology, Genetics and Metabolism, Affiliated Hospital of Jining Medical University from 2013 to 2022 and diagnosed with GHD were selected as the study subjects. The general clinical characteristics of children with GHD and the treatment effects of rhGH were analyzed. Multivariate logistic regression analyzed factors affecting first-year rhGH treatment effects.

Results

Among the 1 050 children with GHD, there were 737 (70.19%) boys and 313 (29.81%) girls. The average age was (10.3±3.5) years, the average bone age was (8.4±3.6) years, the average height standard deviation score (SDS) was (-2.64±0.63), the median insulin-like growth factor 1 (IGF-1) SDS was -1.06 (-1.79 to -0.28), the median peak growth hormone level was 5.51 (3.64 to 7.28) ng/mL, and most (72.76%, 764 cases) of the children were prepubertal. Compared with children who had not received rhGH treatment, children who received rhGH treatment had a younger average age, a higher average height SDS, and a lower average genetic target height, and the differences were statistically significant (P<0.05). rhGH treatment can significantly improve the height SDS in children with GHD. After 0.5 years of rhGH treatment, there was a significant improvement in the height SDS of the children (β=0.34, 95%CI=0.29 to 0.39, P<0.001). As the treatment duration increased, the maximum improvement was achieved after 8 years of rhGH treatment (β=2.28, 95%CI=1.84 to 2.72, P<0.001). Age (OR=0.84, 95%CI=0.78 to 0.91, P<0.001), bone age (OR=0.87, 95%CI=0.81 to 0.94, P<0.001), height SDS (OR=0.24, 95%CI=0.12 to 0.49, P<0.001), insulin - like growth factor binding protein 3 (OR=0.73, 95%CI=0.60 to 0.89, P<0.001), and peak growth hormone level (OR=0.98, 95%CI=0.95 to 0.99, P=0.004) had a negative impact on the efficacy of rhGH treatment. Genetic target height SDS (OR=1.22, 95%CI=1.02 to 1.46, P=0.032), genetic target height SDS - height SDS (OR=1.34, 95%CI=1.13 to 1.59, P=0.001), and IGF-1 (OR=1.01, 95%CI=1.01 to 1.22, P=0.019) had a positive impact on the efficacy of rhGH treatment.

Conclusion

This study revealed that children with GHD exhibited delayed bone age and low levels of IGF-1. rhGH significantly improves height in children with GHD, with more favorable outcomes observed in longer the treatment duration, younger the chronological age and bone age, the lower the baseline height SDS, the lower the insulin-like growth factor binding protein 3 level with lower peak growth hormone levels and higher genetic target heights. Early diagnosis, timely intervention, and appropriate treatment are essential for children with severe GHD to enhance their height and overall quality of life.

Original Research·Proactive Health

Effects of Different Exercise Types on Fall Efficacy in the Elderly: a Network Meta-analysis

ZHANG Ling, HUANG Shuangying, XU Hui, MEI Huiting, HONG Yongping

2026, 29(06):  741-751.  DOI: 10.12114/j.issn.1007-9572.2025.0224

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Background

Fall is one of the most common and serious problems in the elderly, and fall efficiency is an important influencing factor. There are various exercise ways to improve fall efficiency in the elderly, and the merits and demerits of various exercise intervention effects are still uncertain.

Objective

To compare the effects of different exercise modes on fall efficacy in the older people, aiming to provide a reference for patients to choose the best exercise mode.

Methods

A literature search was conducted in databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, SinoMed, PubMed, CINAHL, Web of Science, Embase, Cochrane Library, and FMRS to identify relevant studies on the effectiveness of exercise in reducing falls among the elderly. The search period was from the establishment of the databases to August 15, 2025. The outcome measures were the Falls Efficacy Scale-International (FES-I), Berg Balance Scale (BBS), and Timed Up and Go Test (TUGT). The Cochrane bias assessment tool was used to evaluate the quality of the literature. Stata 18 software was used to perform a network meta-analysis, and the surface under the cumulative ranking curve (SUCRA) was used to rank the effectiveness of different treatment regimens.

Results

A total of 35 studies were included in this study, involving 2, 627 subjects and 13 types of exercise. In terms of fall efficacy, Otago (MD=8.94, 95%CI=3.51-14.38), Tai Chi (MD=9.24, 95%CI=4.96-13.51), step marching exercise (MD=8.60, 95%CI=2.56-14.64) and pilates (MD=6.86, 95%CI=1.19-12.53) were more effective than the usual care group (P<0.05), with Tai Chi having the highest likelihood of being the most effective intervention (SUCRA=81.2). In terms of balance function, Otago (MD=3.87, 95%CI=2.71-5.02), Tai Chi (MD=3.87, 95%CI=1.71-6.03), and resisted + balance training (MD=3.26, 95%CI=0.53-6.00) were more effective than the usual care group (P<0.05), with Otago having the highest likelihood of being the most effective intervention (SUCRA=68.1). In terms of mobility, Otago (MD=3.90, 95%CI=2.77-5.04), Tai Chi (MD=4.44, 95%CI=3.50-5.39), Baduanjin (MD=2.25, 95%CI=1.47-3.02), Baguazhang (MD=2.35, 95%CI=1.26-3.43), Gait balancing enercises (MD=3.60, 95%CI=2.15-5.05) were more effective than the usual care group (P<0.05), with Tai Chi having the highest likelihood of being the most effective intervention (SUCRA=95.0).

Conclusion

This study indicates that Tai Chi and Otago exercises are effective in improving fall efficacy, balance function, and mobility in older adults. Clinical healthcare professionals should select appropriate exercise methods based on the health status and needs of older adults to enhance fall efficacy, effectively prevent falls, and promote patient health. Meanwhile, further high-quality researches are needed to validate these findings.

Efficacy Assessment of Exercise Prescription Intervention Based on the New Version of Eyesight Improving Qigong for Visual Fatigue in College Students

JING Tao, QIU Xiaorong, LI Shensen, LIU Jiawei, ZHU Jingyou, WANG Xueqian, SUN Xinyuan, WANG Kan, CAO Yanjun, JI Yelinfan, BAI Yujie

2026, 29(06):  752-759.  DOI: 10.12114/j.issn.1007-9572.2023.0778

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Background

In the current digital era, the unprecedented abundance of mobile video content has led to a high prevalence of visual fatigue among individuals who engage in prolonged screen exposure. This issue is particularly prominent among adolescents and university students, who often face heavy academic demands. Existing studies have confirmed that the prevalence of visual fatigue among Chinese university students is 53.3%, and this figure continues to rise. Therefore, there is a need to explore proactive health management approaches to promote recovery and implement preventive strategies.

Objective

This study investigates the rehabilitative effects of a new eyesight improving Qigong exercise prescription on visual fatigue symptoms among university students with prolonged screen exposure. It aims to provide empirical evidence supporting the use of traditional Chinese exercise therapy as an innovative approach for alleviating visual fatigue in this population.

Methods

From September 2021 to January 2024, a total of 101 university students with visual fatigue were recruited from 3 universities (including 30 students majoring in Optometry from Nanjing University of Chinese Medicine, 18 students majoring in Sports Medicine from Beijing Sport University, and 53 students from majors including Rehabilitation Therapy from Nanjing Sport Institute). Participants were randomly divided into an experimental group (new edition eyesight improving Qigong exercise prescription) and a control group (outdoor walking). After 30 days, the following parameters were assessed in both groups: refractive diopters of the left and right eyes, uncorrected visual acuity of the left and right eyes, attention level, total score on the Convergence Insufficiency Symptom Survey (CISS) scale, average heart rate, total sleep duration, rapid eye movement (REM) sleep duration, light sleep duration, and deep sleep duration.

Results

After treatment, compared with before treatment, the uncorrected visual acuity of both eyes in the experimental group showed statistically significant differences (P<0.05), and the refractive diopter of the right eye in the experimental group showed a statistically significant difference compared with before treatment (P<0.05). After treatment, the time spent on attention reading tests (6×6 and 7×7 grids) in the experimental group was lower than in the control group (P<0.05); the time spent on the 7×7 grid attention reading test in the experimental group after treatment was lower than before treatment (P<0.05). After treatment, the total CISS scale score in the experimental group was lower than in the control group (P<0.05), and the total CISS scale score in the experimental group after treatment was lower than before treatment (P<0.05). After treatment, the total sleep duration and deep sleep duration in the experimental group were higher than in the control group (P<0.05); the total sleep duration and deep sleep duration in the experimental group after treatment were higher than before treatment (P<0.05). After treatment, all five items of visual dysfunction symptom scores in the experimental group were lower than in the control group (P<0.05). After treatment, all three items of periocular discomfort symptom scores in the experimental group were lower than in the control group (P<0.05). After treatment, both items of psychological and physical discomfort symptom scores in the experimental group were lower than in the control group (P<0.05).

Conclusion

The new version of eyesight improving Qigong exercise prescription effectively alleviates visual fatigue symptoms across three dimensions, visual disturbances, periocular discomfort, and physical and mental discomfort, while significantly improving sleep quality and duration, as well as enhancing attention levels. It also leads to mild improvements in uncorrected visual acuity in both eyes, thereby promoting recovery from visual fatigue in a safe and effective manner.

Research Progress on Assessment Methods of 24-hour Movement Behaviors in Children

XIANG Tianle, ZHOU Na, LI Fang, CAO Meijuan

2026, 29(06):  760-766.  DOI: 10.12114/j.issn.1007-9572.2024.0431

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Children's 24-hour movement behaviors refer to the physical activity, sedentary and sleep behaviors that children experience during a 24-hour day. Many studies have shown that the combination of the above 3 different movement behaviors and their time allocation have a significant impact on children's physical and mental health. How to effectively and completely measure all of children's movement behaviors over a 24-hour period has positive implications for further epidemiological research investigations of children's time-use and the establishment of health behavioral interventions and guidelines for children. China's research on the 24-hour movement behaviors assessment tools for children is still at an exploratory stage. This paper reviews the specific content, application, advantages and disadvantages of foreign children's 24-hour movement behaviors assessment methods, aiming to draw on foreign experience and combine with China's cultural background and children's growing environment to develop assessment methods suitable for China's children's 24-hour movement behaviors, and to provide scientific and effective assessment tools for understanding China's children's 24-hour movement behaviors.

Original Research·Drug Use Guide

Drug-induced Cardiotoxicity in the Chinese Population: Current Analysis and Considerations

ZHONG Lanfang, YU Xinyu, PI Zheyu, LI Bin

2026, 29(06):  767-776.  DOI: 10.12114/j.issn.1007-9572.2024.0701

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Pharmacogenetic cardiotoxicity is one of the most common and serious clinical adverse drug reactions and an important risk factor for cardiovascular disease. At present, highly specific and sensitive early predictive indicators and effective preventive and curative drugs are still lacking. It is of great significance to understand the current situation of the occurrence of drug-induced cardiotoxicity in China, to explore the clinical evaluation indices for early detection, and to summarize the measures to reduce toxicity and increase efficacy in order to improve cardiac injury and enhance drug safety. The purpose of this paper is to systematically summarize the clinical status of drug-induced cardiotoxicity in China, list in detail the drugs with definite or potential cardiotoxicity, and explore the mechanisms of their toxicity. At the same time, it focuses on the early monitoring and warning of drug-induced cardiotoxicity, and summarizes the prevention and treatment measures in Chinese and Western medicine, which provide valuable references for its early detection and early intervention.

Study on the Clinical Value of a Risk Prediction Model for Venlafaxine Plasma Concentration Exceeding the Safety Threshold

ZHANG Yanjing, ZHOU Chunhua, LI Xiaodong, LIU Yan, WANG Jing, YU Jing

2026, 29(06):  777-782.  DOI: 10.12114/j.issn.1007-9572.2024.0715

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Background

Venlafaxine is a 5-hydroxytryptamine-adrenergic reuptake inhibitor (SNRI) antidepressant widely used in the treatment of major depression, generalized anxiety disorder, and depressive co-morbidities, and China's Expert Consensus on Clinical Application of Psychiatric Therapeutic Drug Monitoring (2022 edition) suggests that venlafaxine can be feasibly monitored for blood concentration during treatment to avoid the use of over-alert concentrations, which can lead to the occurrence of adverse reactions or unsatisfactory therapeutic effects. However, the influence of patient physiology, genetic polymorphisms and other factors on the over-alert value of blood concentration is controversial.

Objective

To investigate the factors influencing venlafaxine blood concentration exceeding the alert threshold in patients with depression and to develop a risk prediction model for elevated venlafaxine concentrations, providing a reference for individualized venlafaxine therapy.

Methods

A retrospective analysis was conducted on 590 hospitalized patients who received venlafaxine treatment and underwent TDM at the First Hospital of Hebei Medical University between January 2021 and August 2024. Patients were categorized into a target concentration group (100-400 ng/mL) and an above-alert group (>800 ng/mL) based on their venlafaxine plasma concentrations. Demographic and clinical variables, including sex, age, BMI, average daily dose, plasma albumin level, concomitant medications, liver and kidney function, were collected and compared between groups. Multivariate Logistic regression analysis was performed to identify independent risk factors associated with venlafaxine concentrations exceeding the alert threshold. A nomogram prediction model was constructed based on the identified factors and was subsequently validated.

Results

A total of 590 patients were included in this study, including 203 (34.4%) males and 387 (65.6%) females, with a mean age of (51.9±16.4) years. Among the 590 patients, there were 516 (87.5%) patientsin the target group, and 74 (12.5%) in the ultra-alert group. Multivariate Logistic regression analysis revealed that average daily dose≥225 mg (OR=26.628, 95%CI=12.912-54.916, P<0.001), renal impairment (OR=2.429, 95%CI=1.215-4.854, P=0.012), and concomitant use of CYP2D6 inhibitors (OR=5.232, 95%CI=2.781-9.844, P<0.001) were independent risk factors for venlafaxine concentrations exceeding the alert threshold. The model for predicting venlafaxine plasma concentrations exceeding alert threshold in patients with depression showed an area under the ROC curve of 0.899 (95%CI=0.864-0.935), sensitivity of 48.65%, specificity of 95.74%, positive predictive value of 62.07%, and negative predictive value of 92.86%. Bootstrap validation demonstrated good consistency (Brier score=0.072), and the Hosmer-Lemeshow test indicated good calibration (χ²=3.160, P=0.531). Decision curve analysis demonstrated clinical utility for threshold probabilities of 0.05-0.80.

Conclusion

Average daily dose≥225 mg, renal impairment, and concomitant use of CYP2D6 inhibitors are independent risk factors for venlafaxine plasma concentrations exceeding the alert threshold in patients with depression. The constructed nomogram model effectively predicts the risk of venlafaxine concentration exceeding the alert range and has significant clinical application value.

Retrospective Analysis of Therapeutic Drug Monitoring of Risperidone from 2022 to 2024

LIANG Lingjun, ZHANG Jun, CHEN Jianhui, GAO Yongshuang

2026, 29(06):  783-789.  DOI: 10.12114/j.issn.1007-9572.2025.0180

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Background

Risperidone, as an antipsychotic drug, is widely used in the treatment of schizophrenia and other mental disorders. Although the blood concentration of risperidone has been monitored through therapeutic drug surveillance (TDM) technology at home and abroad for many years, there is no consensus on the influence of gender and age differences on the results of its blood concentration.

Objective

To analyze the TDM results of risperidone, it provides medication reference for patients with mental disorders such as schizophrenia who are treated with risperidone, promoting the rationalization and individualization of clinical medication.

Methods

Based on the hospital information retrieval system, the basic information such as age, gender, blood drug concentration data, monitoring frequency, and the number of monitoring cases of outpatients and inpatients who underwent risperidone blood drug concentration monitoring in Zhongshan Third People's Hospital from 2022 to 2024 was collected. Classification and statistics were conducted based on the risperidone treatment window range recommended in the 2017 Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology by Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) (<20 ng/mL was below the treatment window, 20-60 ng/mL was within the treatment window, and >60 ng/mL was above the treatment window). Compare the distribution of risperidone (TDM) in patients of different years, types of visits, age groups, and genders at different treatment Windows and its influence on the blood concentration of risperidone. Data analysis was conducted using SPSS 29.0, and graph drawing was performed using Origin Pro 2021.

Results

A total of 2 583 patients were included in this study, and a total of 4 879 monitoring sessions were conducted, among which 1 738 were for females and 3 141 for males. The comparison of the number of risperidone TDM monitoring sessions from 2022 to 2024 showed that the number of monitoring sessions in 2023 increased by 28.61% compared with that in 2022, and in 2024 increased by 71.31% compared with that in 2022, showing a year-on-year increase. Among the 2 583 monitored patients, the proportion of outpatients who received one monitoring was higher than that of inpatients (χ²=115.48, P<0.001); The number of inpatients who received monitoring for more than 2 or 3 times was higher than that of outpatients (χ²=7.22, P=0.007; χ²=102.68, P<0.001). There was no statistically significant difference in risperidone blood concentration between outpatients and inpatients (Z=-1.254, P=0.210). The blood concentration of risperidone in male patients was lower than that in female patients (Z=-11.540, P<0.001). The comparison of risperidone blood concentrations among patients of different age groups showed statistically significant differences (H=36.560, P<0.001). From 2022 to 2024, risperidone TDM was monitored 3 445 times (70.61%) within the treatment window, which was lower than 471 times (9.65%) within the treatment window and higher than 963 times (19.74%) within the treatment window. The proportion of monitoring within the treatment window was higher than that of the other two treatment Windows. The difference was statistically significant (χ²=3 772.19, 2 548.73; P<0.001). The comparison of the monitored blood drug concentrations of risperidone TDM below the treatment window, within the treatment window, and above the treatment window from 2022 to 2024 showed statistically significant differences (H=1 465.03, P<0.001). There were statistically significant differences in the monitoring ratios of risperidone TDM below the treatment window, within the treatment window, and above the treatment window among patients of different years, age groups, and genders (P<0.001). The monitored blood drug concentrations of risperidone TDM in male, female and overall samples were 37.4 (26.7, 52.3) ng/mL, 45.3 (32.4, 60.9) ng/mL, and 40.2 (28.6, 55.6) ng/mL respectively, and the results were all within the range of 20-60 ng/mL. It is consistent with the risperidone treatment window (20-60 ng/mL) recommended by the AGNP consensus.

Conclusion

Our fingdings suggest that in clinical practice, individualized treatment with risperidone should be implemented in combination with gender and age differences of patients to increase the proportion of blood drug concentration within the therapeutic window. At the same time, the importance of TDM of risperidone for both outpatients and inpatients should be enhanced, thereby providing a guarantee for the safety and effectiveness of clinical medication.

Review & Perspectives

Review on Inflammatory Response in Patients with Acute Myocardial Infarction

WANG Lina, LEI Jingshu, LI Kuibao, WANG Ruiying, LI Xinmiao, WANG Fangfang, GUO Xiaorong, NIU Ruihao, ZHAO Wei, ZHOU Fangfang, ZHAO Jingjing, LEE CHONGYOU

2026, 29(06):  790-801.  DOI: 10.12114/j.issn.1007-9572.2025.0176

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Inflammatory response plays a crucial role in the pathogenesis and prognosis of acute myocardial infarction (AMI) patients, even surpassing the influence of traditional risk factors on AMI. However, there is a lack of systematic summary of the pathophysiological mechanisms, clinical impaction, and current evidence-based medicine of inflammatory response in AMI patients. We reviewed the relevant literature and comprehensively explores the mechanism of inflammatory response in AMI patients, related inflammatory derived indicators, clinical significance, and a summary of current research evidence. We exposed that the initial stage of AMI is characterized by a rapid increase in inflammatory response, which is the most destructive stage. In the subsequent stage, multiple immune cells and cytokines work together to participate in myocardial repair and healing. Therefore, AMI patients have a complex inflammatory network mechanism, which may become a new breakthrough for AMI treatment. However, our current understanding of the role of immune mechanisms in cardiac remodeling is incomplete. The biggest challenge is that initially pro-inflammatory and harmful cells can also exhibit strong healing characteristics, leading to research even producing opposite results. Therefore, the current evidence-based medicine for anti-inflammatory treatment of AMI patients is not sufficient. Perhaps in the future, machine learning based on artificial intelligence assisted inflammation phenotype typing, combined with multidimensional inflammation indicators, can identify the specific roles of immune cells in individuals, achieving a breakthrough in inflammation regulation from theory to clinical practice and solving the dilemma of residual cardiovascular risk. This article can provide reference for the in-depth development of anti-inflammatory treatment for AMI patients.

Multi-omics Research Progress of IgA Vasculitis

QU Yaxue, DING Ying, HAN Shanshan, XU Shanshan

2026, 29(06):  802-809.  DOI: 10.12114/j.issn.1007-9572.2024.0655

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IgA vasculitis is a common systemic small vasculitis in childhood. Its pathogenesis is mainly caused by IgA immune complex deposition, manifested as skin purpura with or without digestive tract injury, joint injury and kidney involvement. The long-term prognosis is mainly related to the severity of kidney damage, and some may develop into end-stage renal disease. The etiology, pathogenesis and progression mechanism of IgA vasculitis are complex and have not been determined so far. As an effective tool for disease research, omics technology has been gradually applied to the search for biomarkers at different molecular levels of IgA vasculitis and the exploration of pathogenesis, progression and other mechanisms, and has achieved certain results. By reviewing the current literature on IgA vasculitis, this paper summarizes and analyzes the application status and progress of various omics techniques in IgA vasculitis, in order to provide ideas and directions for further research on IgA vasculitis in the future.

Consulting Room of General Practitioner

Case Analysis of General Practice Diagnosis and Treatment in a "Three High" Patient with Coexistence and Fatty Liver Disease

LI Jie, YANG Xinhui, CAO Li, ZHANG Jing, JIANG Yue

2026, 29(06):  810-816.  DOI: 10.12114/j.issn.1007-9572.2025.0129

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Background

Hypertension, diabetes, and dyslipidemia (abbreviated as "Three High") frequently coexist with metabolic dysfunction-associated fatty liver disease (FLD). These diseases interact synergistically, significantly elevating the risk of adverse cardiovascular and hepatic outcomes. The standardized diagnosis and treatment pathway for these patients by general practitioners in primary care is still being explored.

Objective

Through a typical case report, this paper intends to explore the general practice thinking and practice process of general practitioners in the general practice of patients with "Three High" and FLD.

Methods

Reporting the general practice process of screening, identification, risk assessment, two-way referral and comprehensive management of a patient with "Three High" and FLD, this article showed the individualized comprehensive management plan and general practice diagnosis and treatment pathway.

Results

After 8 months of full-course and comprehensive management by general practitioners, the patient's blood pressure and blood glucose reached the target, low-density lipoprotein cholesterol was reduced, the weight loss, waist circumference was reduced, the degree of liver steatosis and fibrosis was significantly improved, and the medication compliance and self-management ability were significantly improved.

Conclusion

The general practitioner-based comprehensive management of patients with "Three High" and FLD can significantly improve the metabolic indicators and liver status of patients, reflecting the central role of general practice in the management of multiple chronic diseases, and providing practical reference for optimizing the standardized management path of such patients at primary level.