Table of Content

20 October 2025, Volume 28 Issue 30

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Guidelines·Consensus

Guidelines on the Diagnosis and Treatment of Cancer Pain by Integrated Traditional Chinese and Western Medicine

LI Hao, LI Peijin, LIU Tingting, CUI Yiyuan, LI Sicong, LIU Lixing, FENG Li, Working Group on Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment Guidelines for Cancer Pain

2025, 28(30):  3729-3740.  DOI: 10.12114/j.issn.1007-9572.2025.0146

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Cancer pain refered to the pain experienced by cancer patients, including chronic cancer pain and cancer outbreak pain. The study showed that 59% of patients receiving antitumor therapy and 64% of patients with advanced tumors experienced cancer pain, and the incidence was related to the tumor site. The incidence of pain in patients with pancreatic cancer was approximately 95%, and that in patients with advanced lung cancer was about 80%. Cancer pain was associated with survival time and quality of life. Traditional Chinese medicine (TCM) treatment could effectively alleviate cancer pain and reduced the adverse reactions caused by Western medicine in treating cancer pain. The combination of traditional Chinese and Western medicine would help patients improve their quality of life and prolong their survival period. Therefore, the diagnosis of cancer pain and the standardized treatment of traditional Chinese and Western medicine were of great significance. This guide was led by Cancer Hospital of Chinese Academy of Medical Sciences, together with experts from 22 hospitals in China, including China-Japan Friendship Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Guang 'anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing Hospital of Chinese Medicine Affiliated to Capital Medical University, based on the current diagnosis and treatment practice of cancer pain combined with traditional Chinese and Western medicine at home and abroad, through a review of literature evidence, and formed after extensive discussion. This guideline summarized and concluded the definitions, causes, diagnostic and assessment methods, as well as treatment approaches of cancer pain from the perspective of integrating traditional Chinese and Western medicine, provided decision-making basis for the diagnosis of cancer pain and the treatment plan of integrated Chinese and Western medicine, so as to guide clinical practice.

Guidelines·Interpretation

Assessment and Treatment of Early-onset Hypertension: Position Statement of the British and Irish Hypertension Association and Its Implications for Clinical Management of Early-onset Hypertension in China

BAI Jiaxin, CHEN Yu, ZHOU Yiheng, LIU Lidi, YANG Rong, YAO Yi, YUAN Bo, ZHANG Yonggang, LEI Yi, ZENG Rui, JIA Yu, LIAO Xiaoyang

2025, 28(30):  3741-3746.  DOI: 10.12114/j.issn.1007-9572.2024.0406

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Hypertension is a global health issue that is increasingly manifesting in younger populations. Early-onset hypertension (≤40 years old) presents with complex underlying pathological mechanisms, challenging diagnoses of secondary causes, ambiguous timing for treatment initiation, and unclear management paradigms throughout the entire process. To address these issues, the British and Irish Hypertension Society (BIHS) issued a position statement in 2024 titled Assessment and Management of Early-onset Hypertension which provides guidance for standardizing the clinical management process of early-onset hypertension. Given the current absence of management documents suitable for early-onset hypertension in our country, this article organizes a team of clinicians from general practice and cardiovascular medicine to interpret the statement. The aim is to provide a reference for the management of early-onset hypertension in our country and to lay the groundwork for the development of documents tailored to our national conditions.

Interpretation and Clinical Implications of the 2024 Italian Guidelines for the Management of Adult Individuals with Overweight and Obesity and Metabolic Comorbidities That are Resistant to Behavioral Treatment

ZHANG Peng, LIU Lidi, ZHANG Ying, YANG Ziyu, LIU Changming, TANG Yijun, LIAO Xiaoyang, JIA Yu

2025, 28(30):  3747-3752.  DOI: 10.12114/j.issn.1007-9572.2025.0131

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Obesity is frequently accompanied by metabolism-related diseases, serving as a critical etiological factor or risk factor and being associated with adverse clinical outcomes. Effective weight reduction has been demonstrated to ameliorate or even alleviate these comorbidities. However, lifestyle interventions alone often yield suboptimal efficacy, and behavioral resistance is often observed. In China, there are currently no specific guidelines targeting patients with behavioral resistance. In 2024, the Italian Association of Clinical Endocrinologists released the Guidelines for the Management of Adult Individuals with Overweight and Obesity and Metabolic Comorbidities that are Resistant to Behavioral Treatment, grounded in the latest evidence-based research. The guidelines primarily focus on pharmacological and surgical interventions in this patient population. This paper, in conjunction with Chinese guidelines, delves into the obesity evaluation and treatment strategies from the Italian guidelines, aiming to offer a reference for managing Chinese overweight or obese patients with behavioral resistance.

Original Research

Relationship between Non-high-density Lipoprotein Cholesterol to High-density Lipoprotein Cholesterol Ratio and Left Ventricular Hypertrophy in a Community-based Hypertensive Population

QIN Bangguo, SUN Jin, LI Man, QIU Jiaojiao, CHENG Bokai, ZHU Ping, WANG Shuxia

2025, 28(30):  3753-3760.  DOI: 10.12114/j.issn.1007-9572.2024.0647

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Background

Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR), a novel composite lipid index, is a potential biomarker for assessing cardiovascular disease risk. Still, its relationship with left ventricular hypertrophy (LVH) is unclear.

Objectives

To explore the correlation between NHHR and LVH in hypertensive patients.

Methods

This is a cross-sectional study based on rural areas, and a stratified whole cluster sampling method was adopted in 2004-2005, in which 7 out of 22 townships in a county in Henan Province were selected using the simple random number method, and 63 out of the 180 villages under its jurisdiction were chosen randomly, and screening was performed among the long-staying rural residents aged 40-75 years, and finally 4 551 patients with hypertension were integrated. Patients were categorized into Q1 (NHHR≤2.05), Q2 (2.06≤NHHR≤2.58), Q3 (2.59≤NHHR≤3.20) and Q4 (NHHR≥3.21) groups according to NHHR quartiles. The clinical data of the patients in the four groups were compared. Logistic regression analysis was used to explore the association between NHHR and LVH. The consistency of the associations was confirmed using subgroup analyses.

Results

The differences were statistically significant in the comparison of BMI, diastolic blood pressure (DBP), alanine aminotransferase (ALT), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), HDL-C, low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), serum creatinine (Scr), stroke history, coronary heart disease history and diabetes history indicators in the four groups (P<0.05). In the fully adjusted model, NHHR was associated with the risk of LVH, with the probability of LVH risk in groups Q3, and Q4 compared with group Q1 being 1.346 (95%CI=1.102 to 1.644, P=0.004) and 1.344 (95%CI=1.053 to 1.717, P=0.018) ; after controlling for all covariates except grouping variables, this relationship remained significant in subgroup analyses in the subgroups of females, <60 years of age, ≥60 years of age, no history of coronary artery disease, no history of stroke, and history of diabetes mellitus (P<0.05) .

Conclusion

This study, based on hypertensive patients in rural areas and using cross-sectional studies, revealed that high levels of NHHR were independently associated with LVH in hypertensive patients. The association was stronger in women and older subgroups, suggesting that NHHR can be used to identify patients at high risk of LVH in hypertensive populations and provide a basis for stratified management of those at high risk of LVH.

Clinical Study on the Diagnostic Value of Circadian Variability of Systolic Blood Pressure Combined with SDNN in Coronary Heart Disease

ZHOU Qibao, LUO Xiao, CHEN Ling, CAO Junda, LI Juxiang, XU Jinsong, SU Hai

2025, 28(30):  3760-3765.  DOI: 10.12114/j.issn.1007-9572.2023.0622

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Background

At present, the main methods for diagnosing coronary heart disease are coronary contrast-enhanced computed tomography and angiography, of which coronary contrast-enhanced computed tomography is limited in clinical application due to its poor accuracy and some patients inability to perform because of rapid heart rate. While coronary angiography, which is the "gold standard", is also hampered in its promotion due to its invasive nature and the difficulty in popularizing in primary care institutions. It is particularly important to use some simple and easily accessible indicators to participate in the diagnosis of coronary heart disease. This study explores the diagnostic value of circadian variability of systolic blood pressure combined with standard deviation of NN intervals (SDNN) in coronary heart disease, with the aim of proposing a simple and practical new predictive method.

Objective

To explore the diagnostic and predictive value of circadian variability of systolic blood pressure combined with SDNN for coronary heart disease, in order to provide non-invasive methodological reference for evaluating and predicting the diagnosis of coronary heart disease.

Methods

From 2018 to 2022, 246 patients who were definitely diagnosed as coronary heart disease by coronary angiography and had Holter monitor examination results and blood pressure monitoring records before coronary angiography were selected as the research objects, and the general baseline data of coronary heart disease and non coronary heart disease were compared. Using the diagnosis of coronary heart disease as the observation endpoint, the correlation between various parameters included in the observation and endpoint events was analyzed, as well as the possible influencing factors related to endpoint events. The predictive value of circadian variability of systolic blood pressure combined with SDNN for the diagnosis of disease was further analyzed.

Results

The baseline data comparison between the coronary heart disease group and non coronary heart disease group showed statistically significant differences in age, SDNN, and circadian variability of systolic blood pressure (P<0.05). Correlation analysis showed that age and circadian variability of systolic blood pressure were positively correlated with the diagnosis of coronary heart disease (P<0.05), left ventricular diastolic dimension (LVD) and SDNN were negatively correlated with the diagnosis of coronary heart disease (P<0.05). Binary Logistic regression analysis showed that age, LVD, end-diastolic volume (EDV), cardiac output (CO), SDNN, and circadian variability of systolic blood pressure were influential factors in the diagnosis of coronary heart disease (P<0.05). The AUC of SDNN for diagnosing coronary heart disease was 0.690 (95%CI=0.620-0.760), with sensitivity and specificity of 0.753 and 0.615, the corresponding optimal cutoff value was 128.5. The AUC of circadian variability of systolic blood pressure for diagnosing coronary heart disease was 0.908 (95%CI=0.869-0.948), with sensitivity and specificity of 0.847 and 0.896, and the corresponding optimal cutoff value was 14.61%. The AUC of circadian variability of systolic blood pressure combined with SDNN for diagnosing coronary heart disease was 0.914 (95%CI=0.875-0.953), with sensitivity and specificity of 0.827 and 0.917, and the corresponding optimal cutoff value was 0.721.

Conclusion

Age, LVD, EDV, CO, SDNN, and the diurnal variation rate of systolic blood pressure are influencing factors for the diagnosis of coronary heart disease. Circadian variability of systolic blood pressure combined with SDNN has good clinical application value in predicting and diagnosing coronary heart disease.

Reasons for Seeking Medical Treatment in Endocrinology Department and the Need for Non-medical Intervention in Children with Normal Height: a Qualitative Study

LYU Juan, LI Yuchuan, CAI Siyu, WANG Chen

2025, 28(30):  3766-3772.  DOI: 10.12114/j.issn.1007-9572.2025.0011

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Background

The increasing concern about height among normal children and their families aggravates the burden on medical resources and the potential for growth hormone abuse.

Objective

This study aims to explore the reasons for seeking medical attention in endocrine clinics among families with children of normal height who feel short stature and their demand for non-medical interventions, which can provide insights for developing targeted intervention measures for families with children of normal height.

Methods

Purposive sampling method was used in this study, and the sample size was determined based on the principle of information saturation. From April to July 2024, parents who were admitted to Beijing Children's Hospital, with a complaint of "perceived short stature" and seeking growth hormone therapy but whose children were medically diagnosed with normal height, were collected for semi-structured in-depth personal interviews. The interview outline focused on the reasons, goals and non-medical interventions of children with normal height in endocrinology department, and the data were analyzed by the thematic framework analysis.

Results

This study ultimately included 24 families, comprising 28 individuals. The age range of the interviewees was 30 to 53 years, with 10 males and 18 females. The main reasons for parents bringing their children to seek medical attention are as follows: socio-cultural factors (social pressures and expectations, educational competitive pressures, media influences, relationships and social comparisons, cultural values, etc.), knowledge and information factors (misunderstanding of the role of growth hormone, recommendations of medical institutions and doctors, pollyanna attitude towards medicine), parental factors (personal emotions and pressures of parents, herd mentality, parental responsibility), and children's factors (occupation planning, consideration of genetic factors, marriage and childbearing considerations, children's mental health, etc.). The goals of parents include their children's height reach or exceed the average level. Parents often attempt self-interventions such as diet, sleep, and exercise, but adherence issues arise during implementation. The primary channels for parents to obtain medical information include healthcare professionals, friends and family, as well as online media. Parents have a great need for information regarding professional knowledge on growth and development, selection of nutritional supplements, and non-pharmacological therapies.

Conclusion

This study uncovers the multifaceted reasons why parents of children with normal height seek medical attention in endocrine clinics to improve their children's height, includes socio-cultural factors, knowledge and information factors, parental and children factors. Moreover, it is not enough for such families to seek information on non-medical interventions themselves, which reminds us that it is significant to develop personalized non-medical interventions for them.

Research on Influencing Factors and Risk Prediction of Cognitive Function in Community-dwelling Middle-aged and Elderly People

LI Ling, LI Yaping, QIAN Shixing, NIE Jing, LU Chunhua, LI Xia

2025, 28(30):  3773-3778.  DOI: 10.12114/j.issn.1007-9572.2025.0111

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Background

The incidence of cognitive impairment is rising year by year among middle-aged and elderly individuals, yet its pathogenesis remains unclear and effective treatments are lacking. Integrating multidimensional factors to construct a predictive model can enhance the early identification and intervention of high-risk populations for cognitive impairment.

Objective

To explore and construct a risk prediction model for cognitive impairment in community-dwelling middle-aged and elderly adults based on a biomarkers-genetic-environment multidimensional perspective.

Methods

A total of 2 243 middle-aged and elderly people in the community who underwent health examinations at Songjiang District Sijing Community Health Center of Shanghai from April to September 2021 were included as the research subjects. Their sociodemographic data, lifestyle, personal disease history and physical examination indicators were collected. The homocysteine (Hcy) concentration was measured by fully automatic biochemical analyzer to determine whether it was hyperhomocysteinemia (HHcy), and single nucleotide polymorphism (SNP) gene sites rs429358 and rs7412 were detected by ligase detection reaction technology to determine the Apolipoprotein E (APOE) genotype. Cognitive function was assessed using Two-tiered Cognitive Self-Assessment (TCSA), and the subjects were divided into normal cognitive group and cognitive impairment risk group according to the assessment results. The general data and physical examination indicators of the two groups were compared. The multivariate logistic stepwise regression method was used to screen independent predictors, and a nomogram prediction model for the risk of cognitive impairment in middle-aged and elderly people was constructed. The Bootstrap self-sampling method was used for internal validation to determine the accuracy of the prediction model.

Results

The incidence rate of cognitive impairment risk in the community-dwelling middle-aged and elderly people was 16.72%. Multivariate Logistic regression analysis revealed that advanced age (OR=1.064, 95%CI=1.040-1.088, P<0.001), smoking (OR=1.746, 95%CI=1.277-2.386, P<0.001), hypertension (OR=2.584, 95%CI=1.761-3.793, P<0.001), stroke (OR=1.451, 95%CI=1.048-2.008, P=0.025), HHcy (OR=2.421, 95%CI=1.827-3.207, P<0.001) and E4 carrier (OR=2.034, 95%CI=1.473-2.808, P<0.001) were risk factors for cognitive impairment in middle-aged and elderly people in the community, while long years of education (OR=0.922, 95%CI=0.893-0.952, P<0.001) and appropriate sleep duration (OR=0.614, 95%CI=0.470-0.802, P<0.001) were protective factors for cognitive impairment. The nomogram prediction model was constructed based on the influencing factors in the multivariate Logistic regression analysis. The consistency index of the model was 0.743 (95%CI=0.712-0.771) .

Conclusion

Years of education, smoking, adequate sleep, history of hypertension and stroke, hyperhomocysteinemia (HHcy), and E4 carrier are influencing factors for cognitive impairment in middle-aged and elderly people. A risk prediction model based on multi-dimensional prediction of "biomarkers-genetics-environment" can provide guidance for screening the risk of cognitive impairment in community-dwelling middle-aged and elderly people.

Construction and Validation of a Risk Prediction Model for Recurrent Angina after Percutaneous Coronary Intervention in Elderly Patients with Acute ST-segment Elevation Myocardial Infarction: Based on CYP2C19-related Genetic Testing

JIA Gaopeng, CHEN Qiuyu

2025, 28(30):  3779-3786.  DOI: 10.12114/j.issn.1007-9572.2025.0027

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Background

Acute ST-segment elevation myocardial infarction (STEMI) has a high mortality and disability rate. Percutaneous coronary intervention (PCI) is an important revascularization method that can improve prognosis. However, some patients experience recurrent angina after PCI, which affects their quality of life and long-term prognosis. Drug-metabolizing enzyme gene polymorphisms influence drug efficacy and adverse reactions. Cytochrome P450 2C19 (CYP2C19) is involved in the metabolism of multiple drugs, and its gene polymorphisms can alter enzyme activity and affect drug metabolism. The correlation between different CYP2C19 metabolic levels and recurrent angina after PCI in STEMI patients is worth exploring.

Objective

To investigate the correlation between different CYP2C19 metabolic levels and recurrent angina after PCI in STEMI patients.

Methods

A total of 128 patients who underwent emergency PCI for acute coronary occlusion at the Chest Pain Center of the First Affiliated Hospital of Inner Mongolia Medical University in 2022 were selected as the study subjects. The patients' medical records and CYP2C19 gene test results were collected. Follow-up was conducted via telephone or outpatient visits at 1, 3, 6, and 12 months after PCI, with the follow-up ending on December 31, 2023. The endpoint event was angina attack. Lasso regression analysis was used to screen variables related to angina attacks, followed by the construction of a predictive model using multivariate Logistic regression analysis and the development of a nomogram. Bootstrap resampling was used for internal model validation. The training and validation sets were evaluated using receiver operating characteristic (ROC) curves, goodness-of-fit tests, calibration curves, and decision curve analysis (DCA) to construct a risk prediction model for recurrent angina after PCI in elderly STEMI patients.

Results

A total of 128 patients were included, with 92 males (71.9%) and 36 females (28.1%), and a median age of 63.5 (61.0, 66.0) years. During follow-up, 45 patients (35.2%) experienced recurrent angina, while 83 patients (64.8%) did not. There were statistically significant differences in gender, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and CYP2C19 genotype between patients with and without recurrent angina (P<0.05). Lasso regression analysis identified 7 independent predictive variables, including gender, LDL-C, HDL-C, homocysteine (Hcy), apolipoprotein B (ApoB), D-dimer, and CYP2C19 genotype. Multivariate Logistic regression analysis showed that female gender (OR=3.492 9, 95%CI=1.288 8-10.010 1), elevated LDL-C (OR=3.123 7, 95%CI=1.685 9-6.348 4), and elevated Hcy (OR=1.061 4, 95%CI=1.028 8-1.103 6) were risk factors for recurrent angina after STEMI intervention, while elevated HDL-C (OR=0.016 7, 95%CI=0.000 9-0.209 1), intermediate CYP2C19 metabolism (OR=0.273 4, 95%CI=0.0747-0.923 7), and normal CYP2C19 metabolism (OR=0.086 7, 95%CI=0.025 5-0.256 1) were protective factors against recurrent angina after PCI in STEMI patients (P<0.05). The model was internally validated using Bootstrap resampling with 1 000 replications, and the Hosmer-Lemeshow calibration curve showed good model fit. ROC curves were plotted for the training and validation sets, with areas under the ROC curve (AUC) of 0.869 (95%CI=0.796-0.943) and 0.789 (95%CI=0.701-0.877), respectively, indicating good discrimination in both the modeling and validation populations. Further DCA showed that the model had good clinical utility.

Conclusion

Intermediate and normal CYP2C19 metabolic types are protective factors against recurrent angina after STEMI intervention. This study established a risk prediction model for recurrent angina after PCI in STEMI patients that includes five clinical indicators: female gender, LDL-C, Hcy, HDL-C, and CYP2C19. The model can be used to predict the risk of recurrent angina in patients for early screening and has good fit, discrimination, and clinical application value.

Original Research·Research Trends of Traditional Chinese Medicine

Regularity of Prescriptions for Coronary Heart Disease with Hypertension Based on Latent Structure and Association Rules

WU Wenjun, WEI Jingjing, LI Xue, REN Hongjie, YU Rui, PENG Guangcao, ZHU Mingjun

2025, 28(30):  3787-3795.  DOI: 10.12114/j.issn.1007-9572.2024.0348

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Background

The incidence and mortality rates of coronary heart disease combined with hypertension in China have been steadily rising, posing a significant threat to public health security. Consequently, it is essential to standardize and synthesize the treatment protocols for coronary heart disease combined with hypertension within the framework of traditional Chinese medicine (TCM), thereby providing a robust data foundation for clinical differential diagnosis and management as well as for the development of consensus guidelines.

Objective

This study aims to investigate the formulation and compatibility rules of coronary heart disease combined with hypertension utilizing latent structure modeling in conjunction with association rule mining.

Methods

The search period for this research extends from the establishment of the database until May 31, 2024, a systematic search was conducted in CNKI, VIP, Wanfang Data and SinoMed databases, the literature on TCM decoction for coronary heart disease complicated with hypertension was screened using EndNote software. Standardized data were imported into Microsoft Excel 2019 to establish a TCM database, lantern 5.0 and Rstudio were used for analyzing the hidden structure model and association rules of high-frequency TCM.

Results

In the end, a total of 122 TCM prescriptions were included, involving 104 medicinals with cumulative use frequency of 1 390, the high-frequency Chinese medicines identified were salvia miltiorrhizomes, Chuanxiong, achyranthus rhizome, red peony root and Yujin, which primarily exerted tonifying effects on deficiencies and promoting blood circulation. Through hidden structure analysis, a total of 19 latent variables, 38 latent categories, 5 comprehensive cluster models and 16 core formulas were obtained, decoctions deduced syndrome types for coronary heart disease complicated with hypertension, common witnessed types included Qi deficiency and blood stasis, Yin deficiency and blood stasis as well as phlegm dampness blocking. Association rule analysis yielded 43 strong association rules with the highest support degree observed between Achyrantha-Chuanxiong and the highest confidence degree between Yujin-Salvia miltiorrhiza.

Conclusion

Coronary heart disease combined with hypertension is a syndrome characterized by deficiency in nature and excess in superficiality, the core pathological mechanism is dominated by blood stasis, followed by deficiency and phlegm, it is closely related to liver, heart and spleen, treatment principles should focus on activating blood circulation while supplementing Qi, clearing phlegm while dispelling dampness, nourishing Yin while strengthening spleen, regulating Qi while soothing liver.

Research on the Mechanism of Action of Simiao Yongan Decoction in the Treatment of Diabetic Foot Based on Metabolomics

ZHANG Kexing, ZHANG Bo, WU Qiong, ZHU Shanshan, WANG Di, ZHANG Chunnan

2025, 28(30):  3796-3805.  DOI: 10.12114/j.issn.1007-9572.2024.0676

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Background

In recent years, diabetic foot has become an important cause of disability and death among diabetic patients. With the advancement of the times and technology, modern medicine and traditional Chinese medicine have gradually deepened their understanding and research on diabetic foot, further improving the treatment methods for diabetic foot. To a certain extent, this can relieve the pain of patients and improve their quality of life.

Objective

The mechanism of action of Simiao Yongan Decoction in the treatment of diabetic foot was explored by combining metabolomics with network pharmacology.

Methods

Diabetic foot patients who were hospitalized in the Burn Department, Vascular Surgery Department of Heilongjiang Provincial Hospital and the Vascular Surgery Department of Nangang Campus from July 2023 to August 2024 were selected as the research subjects. A total of 60 patients with heat-toxin intense diabetic foot who met the criteria were included in this study. They were randomly divided into debridement group, Western medicine group, traditional Chinese medicine group and combined Chinese and Western medicine group, with 15 cases in each group. Another 15 normal people were included as the control group. Firstly, databases and software such as TCMSP, GeneCards, OMIM, and TTD were used to search for the pharmacodynamic basis, target sites and metabolic pathways of Simiao Yongan Decoction on diabetic foot. The serum metabolomics and network pharmacology of Simiao Yongan Decoction were integrated for research to verify the possible active ingredients and metabolic pathways of Simiao Yongan Decoction in the intervention of diabetic foot.

Results

The main active ingredients of Simiao Yongan Decoction for treating diabetic foot are luteolin, quercetin and acanthopanthin, etc. Diabetic foot may be treated by regulating pathways such as mitogen-activated protein kinase signaling pathway, tumor necrosis factor signaling pathway, phosphatidyacyl alcohol signaling pathway, HIF-1 signaling pathway, and Toll-like receptor signaling pathway through targets such as AKT1, TNF, HSP90AA1, MAPK8, and STAT3. Among them, the phospholipacyl alcohol signaling pathway is consistent with the research results of the serum metabolomics of Simiao Yongan Decoction.

Conclusion

The main active ingredients of Simiao Yongan Decoction for treating diabetic foot are luteolin, quercetin and acanthopanthin, etc. The phosphatidylinositol signaling pathway may be the one through which Simiao Yongan Decoction interferes with the metabolism of diabetic foot.

Original Research·Drug Use Guide

Study on the Efficacy and Safety of Carfilzomib in the Treatment of Multiple Myeloma

ZHENG Boyue, FU Jiyi, WU Jiafei, WANG Jun, LI Hui

2025, 28(30):  3806-3814.  DOI: 10.12114/j.issn.1007-9572.2024.0477

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Background

Since its introduction in China in 2022, carfilzomib has been widely used in patients with relapsed and refractory multiple myeloma (RRMM), but there is a lack of research on its clinical efficacy and safety in the Chinese population with multiple myeloma (MM) .

Objective

To explore the efficacy and safety of carfilzomib in the treatment of MM.

Methods

This study included 53 cases MM patients who received at least two courses of carfilzomib treatment from March 2022 to September 2023 at Sichuan Provincial People's Hospital. Baseline data were collected, and all patients were treated with carfilzomib-based regimens. The starting point for follow-up was the first use of carfilzomib, and the endpoint was death, disease recurrence, or the end of follow-up. Patients were followed up through outpatient visits, hospital re-examinations, or phone calls every two months. The number of patients with stringent complete remission (sCR), complete remission (CR), very good partial remission (VGPR), partial remission (PR) and adverse reactions were recorded. The overall response rate (ORR), ≥VGPR rate, best ORR and best ≥VGPR rate were calculated to evaluate the clinical efficacy. The efficacy was analyzed in subgroups according to the number of treatment lines, extramedullary disease, Durie-Salmon (DS) staging, international staging system (ISS), renal function, and cardiovascular disease. The survival curves of progression-free survival (PFS) and overall survival (OS) were drawn by Kaplan-Meier method for survival analysis, and the survival curves were compared by Log-rank test.

Results

After 2 courses of treatment, the PR was 17 cases (32.1%), VGPR was 11 cases (20.8%), CR was 4 cases (7.5%), sCR was 8 cases (15.1%), ORR was 75.5% (40/53). The overall efficacy evaluation showed that the best ORR was 84.9% (45/53) and the best ≥VGPR rate was 71.7% (38/53). There was no significant difference in the overall clinical efficacy between the first-line treatment group, the first recurrence treatment group and the third-line and above treatment group (P>0.05). There was statistically significant difference in PFS survival curve among the three groups (P<0.05). There was no significant difference in OS survival curve among the three groups (P>0.05). There were no significant differences in clinical efficacy, PFS and OS survival curves between mSMART standard risk group and high-risk group, DS stage Ⅰ-Ⅲ group, ISS stage Ⅰ-Ⅲ group, extramedullary disease group and non-extramedullary disease group, cardiovascular disease group and non-cardiovascular disease group, normal renal function group and abnormal renal function group (P>0.05). Among 53 patients, 8 cases (15.1%) had infection, 7 cases (1.2%) had adverse reactions such as hypertension, arrhythmia and heart failure, 3 cases (5.7%) had gastrointestinal adverse reactions such as nausea and vomiting, 1 case (1.9%) had liver function damage, and 1 case (1.9%) had renal function damage. The incidence of adverse reactions was 37.7% (20/53) .

Conclusion

Carfilzomib-based chemotherapy regimens have good clinical efficacy and high safety profiles, can serve as a preferred treatment option for MM patients.

Prevalence of Potentially Inappropriate Medication in Older Adults with Cancer: a Meta-analysis

XU Jialan, YAN Hong, WEN Jun, ZHOU Zitong, WANG Siyu

2025, 28(30):  3815-3822.  DOI: 10.12114/j.issn.1007-9572.2024.0557

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Background

The increasing phenomena of multimorbidity and polypharmacy in older adults with cancer predisposes them to potentially inappropriate medication (PIM), which adversely affects patient prognosis.

Objective

To systematically evaluate the prevalence of PIM in older adults with cancer.

Methods

The Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, Wanfang Data, and CBM databases were searched to collect studies related to the prevalence of PIM in older adults with cancer, and the search period was from the inception of the databases to September 2024. The examined literature was independently screened, data extracted, and evaluated, and Stata 17.0 software was used to perform meta-analysis.

Results

A total of 36 studies with 54 prevalence estimates were analyzed, including 95 290 patients. Meta-analysis indicated that the prevalence of PIM in older adults with cancer was 44.5% (95%CI=39.2%-49.8%). The results of subgroup analysis showed that the prevalence of PIM in older adults with cancer aged 60-70 and >70 years was 44.4% and 46.1%, respectively; the prevalence of PIM in elderly male and female patients was 40.9% and 42.5%, respectively; the prevalence of PIM in patients with ≤5 and >5 diseases was 34.4% and 47.1%, respectively; the prevalence of PIM in patients with≥5 and <5 medications was 39.9% and 30.4%, respectively; the prevalence of PIM in patients with lung cancer, gastrointestinal cancer, hematologic malignancies, breast cancer, and prostate cancer was 45.6%, 39.4%, 42.0%, 39.4%, and 42.6%, respectively; the prevalence of PIM among older adults with cancer in Asia, Europe, North America, and South America was 50.2%, 45.8%, 35.7%, and 51.4%, respectively; the prevalence of PIM in patients from hospitals, databases, Dana-Farber Cancer Institute, and cancer centers was 47.6%, 43.0%, 34.6%, and 34.5%, respectively; the prevalence of PIM screened by the Beers criteria, DAE, STOPP/START criteria, EU (7) -PIM list, and the 2017 Chinese criteria was 46.6%, 16.5%, 44.6%, 60.0%, and 39.3%, respectively; the prevalence of PIM published in 2020 and before and after 2020 was 36.1% and 52.5%, respectively.

Conclusion

The prevalence of PIM is relatively high in older adults with cancer, at 44.5%. The prevention, screening, and intervention of potential inappropriate medication among relevant populations should be emphasized to lay a solid foundation for the health in older adults with cancer.

Timing of Administration and Combination Therapy of Non-steroidal Anti-inflammatory Drugs for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

WU Xiangpeng, LI Enjun, LI Xiongwei, WANG Haihong, CUI Wei, WU Xiangli, QI Weihua, HOU Senlin

2025, 28(30):  3823-3830.  DOI: 10.12114/j.issn.1007-9572.2024.0716

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Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a standard method for the diagnosis and treatment of biliary and pancreatic diseases, but post-ERCP pancreatitis (PEP) is one of the serious complication. Non steroidal anti-inflammatory drugs (NSAIDs) may play a role in the prevention of PEP due to their anti-inflammatory and analgesic effects. To explore the appropriate timing of medication and the effect of combined medication can help reduce the risk of PEP occurrence.

Objective

This study aimed to evaluate the administration timing and influencing factors of NSAIDs in PEP prevention, in order to determine the best application in clinical practice.

Methods

A total of 866 patients who underwent ERCP in the Department of General Surgery and Oncology of Handan Central Hospital from December 2021 to December 2023 were included as the research objects. According to the random number table method, they were divided into preoperative medication group (431 cases) and postoperative medication group (435 cases). Among them, the preoperative medication group was divided into the preoperative medication alone subgroup (210 cases) and the preoperative combined medication subgroup (221 cases), and the postoperative medication group was divided into the postoperative medication alone subgroup (247 cases) and the postoperative combined medication subgroup (188 cases). In the preoperative medication alone subgroup, 75 mg diclofenac sodium was intramuscularly injected 30 min before ERCP, and in the preoperative medication combination subgroup, 100 mg indomethacin suppository was added to the anal plug at the same time; The single drug group was given 75 mg diclofenac sodium intramuscularly immediately after ERCP, and the combined drug group was given 75 mg diclofenac sodium intramuscularly and 100 mg indomethacin suppository anal plug simultaneously after ERCP. All interventions were single dose. The main outcome measures included the incidence and severity of PEP, the incidence of postoperative perforation, bleeding, and cholangitis. Multivariate Logistic regression was used to analyze the influencing factors of PEP.

Results

There was a statistically significant difference in the incidence of PEP among the four subgroups (P<0.05). The incidence of PEP in the preoperative medication alone subgroup was lower than that in the postoperative medication alone subgroup and the postoperative combination subgroup (P<0.05), and the incidence of PEP in the preoperative combination subgroup was lower than that in the postoperative medication alone subgroup and the postoperative combination subgroup (P<0.05) ; There was no significant difference in the severity of PEP and the incidence of adverse reactions among the four subgroups (P>0.05). The results of multivariate Logistic regression analysis showed that, BMI≥24 kg/m² (OR=3.751, 95%CI=2.293-6.136), alcohol abuse (OR=2.624, 95% CI=1.520-4.529), diabetes mellitus (OR =2.687, 95%CI=1.559-4.634), intubation time >10 min (OR=4.229, 95%CI=2.531-7.066) and the use of double guide wire technology (OR=3.542, 95%CI=2.159-5.809) were the independent risk factors of PEP (P<0.05), B-ultrasound showed that extrahepatic bile duct dilatation was a protective factor for PEP (OR=0.573, 95%CI=0.347-0.947, P<0.05) .

Conclusion

BMI≥24 kg/m², alcohol abuse, diabetes, intubation time >10 min and the use of double guide wire technology are independent risk factors for the occurrence of PEP. Preoperative prophylactic use of indomethacin suppositories and diclofenac sodium before ERCP can effectively reduce the risk of PEP.

Review & Perspectives

Research Progress on Cardiac Energy Metabolic Changes in Heart Failure with Preserved Ejection Fraction

MA Shuangshuang, XING Yanjiang, ZHANG Jiawei, WANG Jing

2025, 28(30):  3831-3840.  DOI: 10.12114/j.issn.1007-9572.2024.0654

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Heart failure with preserved ejection fraction (HFpEF) refers to a clinical syndrome characterized by a left ventricular ejection fraction of ≥50% and the presence of symptoms and clinical signs of heart failure. Currently, approximately 50% of patients with heart failure in clinical practice have heart failure with preserved ejection fraction. An increasing body of evidence suggests that heart failure is a metabolic disease with significant changes in energy metabolism, and the complex energy metabolic network is not yet fully understood. This review will discuss the changes in energy metabolism in heart failure from four aspects: glucose metabolism, lipid metabolism, ketone body metabolism, and amino acid metabolism. By comparing HFpEF with heart failure with reduced ejection fraction (HFrEF), the study further demonstrates the changes and significance of different metabolisms in the energy metabolism of the heart with HFpEF, clarifies the relationship between heart failure and energy metabolism, and provides theoretical bases and new treatment concepts for the precise treatment of different types of heart failure from a metabolic perspective.

Research Progress on Exercise Intervention of Hyperuricemia

WANG Tingting, TANG Yong, ZHANG Wenke, LI Zhigang

2025, 28(30):  3841-3846.  DOI: 10.12114/j.issn.1007-9572.2024.0209

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With the change of human production and lifestyles, the incidence rate of hyperuricemia (HUA) is increasing year by year and the incidence is showing a younger trend, which seriously endangers human health and becomes a burden hindering the development of medical, economic and social development. Therefore, this paper reviews from the pathogenesis, comorbidity, and exercise intervention of HUA, and focuses on analyzing the effects of different exercise characteristics on HUA based on the perspective of integrating sports and medicine. It provides a basis for the formulation of exercise prescriptions for HUA patients, so as to provide a reference for the prevention and treatment of HUA, improve the quality of life of HUA and gout patients, and contribute to the construction of a healthy China.

Research Methods and Tools

Research and Analysis of Screening Tools for Chronic Obstructive Pulmonary Disease Comorbidity Lung Cancer

XU Baichuan, WANG Yan, ZHANG Peng, LI Yiting, LIU Feilai, XIE Yang

2025, 28(30):  3847-3852.  DOI: 10.12114/j.issn.1007-9572.2025.0110

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Chronic obstructive pulmonary disease (COPD) and lung cancer (LC) are high-incidence and high-mortality diseases of the respiratory system. COPD is an independent high-risk factor for LC, and the two conditions influence each other, posing challenges for clinical diagnosis and treatment. Early detection and early treatment are crucial for improving prognosis, making preliminary screening particularly important. This article starts from the current research status of COPD-LC, comprehensively introducing the existing screening tools, including low-dose computed tomography (LDCT), the COPD-LUCSS score and its improved version, the COPD-LUCSS-DLCO score, as well as other COPD-LC risk prediction models. By objectively analyzing the advantages and limitations of existing screening tools, this article proposes countermeasures and precautions for developing new screening tools and envisions future application prospects, aiming to provide support for future COPD-LC screening research.

Living Systematic Reviews: Methods and Processes for Development

TIAN Chen, LIU Jianing, TIAN Jinhui, GE Long

2025, 28(30):  3853-3860.  DOI: 10.12114/j.issn.1007-9572.2023.0772

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Living Systematic Reviews (LSRs) represent an evolving methodology for systematic review that is continuously updated to incorporate new evidence in a timely manner, ensuring that healthcare professionals and policymakers have access to the most last information to make optimal decisions. Compared to traditional systematic reviews, LSRs ensure the timeliness and accuracy of information by conducting regular searches, screenings, and analyses of new evidence, thereby better meeting the needs of rapidly changing clinical practices. This article aims to introduce the applicability, and production methods and processes of LSRs by comparing them with traditional systematic reviews and rapid reviews, discusses the challenges and opportunities faced during the implementation of LSRs, and illustrates the production process and key aspects of living updating with examples, in order to provide scholars with references and insights for conducting LSRs.