Table of Content

20 June 2026, Volume 29 Issue 18

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Guidelines·Consensus·Standards

Expert Consensus on the Diagnosis, Treatment, and Management of Numbness (2025)

General Practice Branch of Cross-straits Medicine Exchange Association, General Practice Branch of Zhejiang Medical Association, General Undifferentiated Disease Professional Committee of Zhejiang Society of Mathematical Medicine, Chinese Geriatrics Society

2026, 29(18):  2433-2449.  DOI: 10.12114/j.issn.1007-9572.2025.0522

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Numbness is a common clinical problem with complex etiology and a lack of systematic clinical research data, affecting patients' physical and mental health and imposing an economic burden on society. This consensus was written by multidisciplinary experts including general practice, neurology, and geriatrics. By reviewing and integrating the cutting-edge domestic and international evidence-based medical research results in the field of numbness in recent years, it elaborates in detail on the definition, classification, epidemiology, etiology and pathogenesis, comprehensively summarizes the diagnostic methods of numbness, including detailed consultation, systematic physical examination, and auxiliary examination, and specifically expounds the individualized treatment principles and measures for numbness. The consensus also emphasizes the comprehensive community management of numbness, including screening, follow-up, comprehensive interventions, health education, multidisciplinary diagnostic support, and graded referral systems. Furthermore, it proposes future directions for the diagnosis, treatment, and management of numbness from the perspectives of clinical practice, education and training, and scientific research innovation. The ultimate aim is to provide guidance and support for the standardized diagnosis, treatment, and whole-process care of patients with numbness.

Interpretation and Discussion of Guidelines for Preventive Activities in General Practice: Bladder Cancer

FAN Meixiang, YAN Yunyun, HUANG Yanyan

2026, 29(18):  2450-2453.  DOI: 10.12114/j.issn.1007-9572.2025.0518

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As the world's tenth most prevalent cancer, bladder cancer imposes a substantial burden in China, exacerbated by rapid demographic aging and high rates of smoking and occupational exposure. The 10th edition of the Australian Guidelines for Preventive Activities in General Practice does not recommend bladder cancer screening for asymptomatic adults. Primary care practitioners are uniquely positioned to spearhead this transition by prioritizing primary prevention and lifestyle counseling. By focusing on high-risk cohorts and integrating early detection with standardized management, China can more effectively utilize healthcare resources and mitigate the long-term impact of the disease.

General Practice/Community Health Service

Factors Influencing Work-related Flow among "3+2" Order-oriented Assistant General Practitioners in Jiangsu Province

LIU Fang, LIU Weinan, XIANG Yuanyue, LU Cheng, ZHU Binhai

2026, 29(18):  2454-2460.  DOI: 10.12114/j.issn.1007-9572.2025.0132

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Background

The "3+2" order-oriented assistant general practitioners in Jiangsu Province play an important role in primary medical care, but face problems such as low fulfillment rates and a lack of professional identity, and urgently need to improve their work-related flow (WOLF).

Objective

To investigate the current situation of WOLF of "3+2" order-oriented assistant general practitioners in Jiangsu Province, and to analyze its influencing factors.

Methods

An online questionnaire survey of "3+2" order-oriented assistant general practitioners in Jiangsu Province was conducted in November 2024 using random sampling method. The general information of the questionnaire included gender, age, marriage, year of entry into training, assistant practitioner qualification or not, monthly income level, daily sleep hours, weekly work hours, and physical exercise; career calling (CC), career reshaping (CR), and WOLF were scored using relevant scales. Multiple linear regression was used to analyze the influencing factors of WOLF of order-oriented assistant general practitioners.

Results

Of the 299 questionnaires distributed, 282 were valid, resulting in a recovery rate of 94.31%. Among these order-oriented assistant general practitioners, 98 (34.75%) were male and 184 (65.25%) were female, with an average age of (22.5±1.4) years. The Jiangsu order-oriented assistant general practitioners' total CC score was 4.23±0.75, their total CR scale score was (4.32±0.75), and their total WOLF scale score was (5.57±1.40). All of these scores were above the intermediate level of the scale. Male order-oriented assistant general practitioners had higher CC, CR, and WOLF scale scores than females (P<0.05). A comparison of the WOLF scale scores of order-oriented assistant general practitioners according to sex, age, year of admission to training, assistant practitioner qualification, daily sleep hours, and physical activity revealed statistically significant differences (P<0.05). Multiple linear regression analysis revealed that gender, age, assistant medical practitioner qualification, and physical activity influenced order-oriented assistant general practitioners' sense of WOLF (P<0.05), with an adjusted R² value of 0.104. The CC score significantly positively affected the sense of WOLF (β=0.855, P<0.05), with an adjusted R² value of 0.735. However, CR had a non-significant effect on WOLF (β=0.038, P>0.05).

Conclusion

The overall level of WOLF among "3+2" order-oriented assistant general practitioners is relatively high, and CC is the core influencing factor that can significantly improve WOLF. To further enhance WOLF, it is recommended that the sense of CC among order-oriented assistant general practitioners be strengthened, that physical exercise be encouraged, that training bases be strengthened, and that the level of monthly income be raised, with a special focus on the career development of female order-oriented assistant general practitioners.

Autonomous Motivation and Its Change among Primary Healthcare Workers in Shandong Province: a Survey Based on Self-determination Theory

ZHAO Shichao, HE Jing, LI Zhiying, CHANG Huichen, WANG Ying

2026, 29(18):  2461-2471.  DOI: 10.12114/j.issn.1007-9572.2025.0403

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Background

Primary healthcare workers' work motivation is closely related to the quality and accessibility of health services. Autonomous motivation represents a higher-quality form of motivation, yet it is not fixed and may change with factors such as career experience and the institutional context, thereby exerting potential effects on work-related outcomes.

Objective

Drawing on Self-determination Theory (SDT), this study compared primary healthcare workers' initial (entry) motivation for practicing medicine with their current work motivation to describe changes in autonomous motivation (i.e., engaging in an activity based on full willingness and autonomous choice) and to examine the reasons for such changes and their associations with key work outcomes.

Methods

A mixed-methods design was adopted. Using multistage cluster sampling, we selected three cities in Shandong Province, China (Yantai in the east, Zibo in the central region, and Liaocheng in the west). In each city, three districts/counties were selected, and four primary healthcare institutions were sampled within each district/county, yielding 36 survey sites. On the survey day, all on-duty healthcare workers (including physicians, nurses, public health workers, and medical technicians) were invited to complete a questionnaire. Of 1 271 questionnaires distributed, 1 113 were valid (effective response rate: 87.6%). In addition, 107 participants were purposively sampled for in-depth interviews. Initial motivation for practicing medicine was measured using a self-developed questionnaire, while current work motivation was assessed with a revised Work Motivation Scale. Based on SDT, both initial and current motivations were classified into two types: autonomous motivation and non-autonomous motivation. By comparing the dominant type of initial and current motivation, a "motivation change" variable was constructed, yielding four categories. Four key indicators of work attitudes and behaviors were assessed: turnover intention, job burnout, job satisfaction, and job performance. Questionnaire data were analyzed using descriptive statistics, analysis of variance (ANOVA), and multiple linear regression. Interview data were analyzed using the thematic framework approach.

Results

For initial motivation, 545 (49.0%) participants were classified as having autonomous motivation and 568 (51.0%) as having non-autonomous motivation. For current work motivation, 713 (64.0%) participants had autonomous motivation and 400 (36.0%) had non-autonomous motivation. The 2×2 "motivation change" variable produced four categories: stable autonomous motivation (n=403, 36.2%), stable non-autonomous motivation (n=258, 23.2%), autonomization (n=310, 27.8%), and de-autonomization (n=142, 12.8%). Scores for turnover intention, job burnout, job satisfaction, and job performance differed significantly across the four categories (all P<0.05). Specifically, compared with the stable autonomous motivation group and the autonomization group, the stable non-autonomous motivation group and the de-autonomization group reported higher turnover intention and job burnout (P<0.05) and lower job satisfaction and job performance (P<0.05). In addition, the autonomization group had higher turnover intention and job burnout (P<0.05) and lower job satisfaction and job performance (P<0.05) than the stable autonomous motivation group. Multiple linear regression indicated that, relative to the stable autonomous motivation group, the other three groups had higher regression coefficients in the models for turnover intention and job burnout (P<0.05) and lower regression coefficients in the models for job satisfaction and job performance (P<0.05). Interview findings suggested that changes in motivation were mainly influenced by the needs for meaning, competence, and relatedness.

Conclusion

Autonomous motivation is associated with better work performance among primary healthcare workers. Greater resource investment and institutional improvements are needed to foster a more supportive organizational context—such as strengthening health information systems, improving training mechanisms, and innovating doctor-patient communication-to satisfy primary healthcare workers' basic psychological needs and thereby enhance autonomous motivation.

Investigation on the Cognition and Current Status of General Practitioners in the Multidisciplinary Diagnosis and Treatment of Medically Unexplained Symptoms

AN Xian, HUANG Peng, REN Jingjing

2026, 29(18):  2472-2481.  DOI: 10.12114/j.issn.1007-9572.2024.0708

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Background

The trend towards specialization in general hospitals has promoted the development of professional and refined medical technology. However, it also brings problems: patients with complex conditions need to seek medical advice across multiple specialties, increasing the difficulty of accessing healthcare and potentially leading to incomplete treatment plans. Therefore, when dealing with undifferentiated diseases, general practitioners (GPs) must take on the responsibility of providing multidisciplinary comprehensive support.

Objective

To analyze GPs' understanding and practice regarding multidisciplinary undifferentiated disease treatment (MUD-MDT).

Methods

A survey questionnaire targeting MUD-MDT was developed, and distributed to GPs from multiple hospitals nationwide via the General Practice Alliance platform affiliated with the First Affiliated Hospital of Zhejiang University School of Medicine, collecting basic information of GPs, their awareness and practice of undifferentiated diseases (MUD), and multidisciplinary diagnosis and treatment (MDT).

Results

A total of 303 questionnaires were included, with an average age of (38.8±9.2) years; 194 females (64.03%) and 109 males (35.97%). Regarding MUD, 88.78% (269/303) knew about MUD, but only 23.79% (64/269) had participated in related work; the main reason for lack of knowledge was "lack of relevant training" at 76.47% (26/34). For MDT, 91.42% (277/303) were aware of it, 77.26% (214/277) merely knew the basic concept, and only 22.74% (63/277) had participated in related work. In terms of practical implementation, 32.67% (99/303) had implemented MUD, 49.83% (151/303) had implemented MDT, and 20.46% (62/303) had implemented MUD-MDT. There was a high recognition of MUD-MDT among GPs. Differences in MUD awareness among GPs with different professional titles were statistically significant (P<0.05); differences in MDT awareness between genders and education levels were statistically significant (P<0.05); differences in the implementation of MUD-MDT among different genders, working years, and types of affiliated medical institutions were statistically significant (P<0.05). Analyzing the cognitive scores of three groups of GPs who had implemented, not implemented, or were unclear if MUD-MDT was implemented at their units showed no significant difference in all cognitive items (P>0.05).

Conclusion

Although GPs have a certain level of understanding of MUD-MDT, the implementation rate is not high. Despite its application in outpatient clinics, wards, and teaching activities, more efforts are needed to address issues such as inadequate organizational management, lack of standardized procedures, and uneven professional competence among doctors.

Article

Association between the Chinese Visceral Adiposity Index and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus

LI Yachan, YANG Yang, XU Qianting, KE Tingyu

2026, 29(18):  2482-2488.  DOI: 10.12114/j.issn.1007-9572.2025.0394

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Background

The incidence of type 2 diabetes mellitus (T2DM) has risen steadily in recent years. Cardiovascular disease is a common complication of T2DM, with left ventricular diastolic dysfunction (LVDD) often occurring at an early stage. Central (visceral) obesity is closely linked to cardiovascular risk; however, the performance of visceral-fat-focused indices in identifying LVDD among patients with T2DM remains under-studied.

Objective

To evaluate the association between the Chinese visceral adiposity index (CVAI) and LVDD in patients with T2DM and to assess CVAI's diagnostic utility.

Methods

This retrospective study enrolled 1 028 T2DM patients who attended the Second Affiliated Hospital of Kunming Medical University (Metabolic Management Center) from January 2019 to August 2024 (647 males, 381 females). Patients were classified as a T2DM group (n=257) or an LVDD group (n=771) based on the presence of LVDD. We assessed correlations between CVAI and other visceral-type obesity measures and echocardiographic structural and functional parameters. Multivariable Logistic regression evaluated the independent association of CVAI with LVDD. Diagnostic performance was assessed by receiver operating characteristic (ROC) curves. Subgroup analyses were conducted by sex, age, and BMI.

Results

Compared with the T2DM group, the LVDD group had higher BMI, neck circumference, waist circumference (WC), hip circumference, visceral fat area (VFA), and CVAI (P<0.05 for all). When stratified by CVAI quartiles, LVDD prevalence increased across quartiles: Q1 64.2%, Q2 71.2%, Q3 79.4%, Q4 85.2% (χ²_trend=34.715, P<0.05). Correlation analyses demonstrated that WC, BMI, VFA, and CVAI were positively correlated with left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular end-diastolic diameter (LVDd), and negatively correlated with left ventricular ejection fraction (LVEF) (P<0.05). After adjustment for confounders, patients in the CVAI Q4 group had a 2.361-fold increased risk of LVDD compared with Q1 (95%CI=1.349-4.133, P=0.003). ROC analysis yielded an area under the curve (AUC) of 0.621 for CVAI in diagnosing LVDD, outperforming VFA (0.557), BMI (0.589), and WC (0.599). A combined predictive model achieved an AUC of 0.727 (95%CI=0.692-0.763, P<0.001), with sensitivity 0.726 and specificity 0.638. Subgroup analyses indicated that CVAI Q4 was a significant risk factor for LVDD in both male and female subgroups (OR=1.948 and 8.617, respectively; P<0.05). In participants aged<60 years, CVAI Q3 and Q4 were associated with increased LVDD risk (OR=2.387 and 4.371, respectively; P<0.05). In the normal-BMI subgroup, CVAI Q3 was associated with higher LVDD risk (OR=3.997, P<0.05).

Conclusion

CVAI is an independent risk factor for LVDD among patients with T2DM and demonstrates superior discriminative ability compared with conventional obesity indices. Its predictive value is particularly notable in women and in individuals under 60 years of age.

Elevated Neutrophil Percentage to Albumin Ratio is Associated with In-hospital Outcomes in Patients with Acute Myocardial Infarction

YUAN Yujuan, TAO Jing, WANG Ying, PENG Hui, YANG Yining

2026, 29(18):  2489-2497.  DOI: 10.12114/j.issn.1007-9572.2024.0481

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Background

The Neutrophil percentage to albumin ratio (NPAR) is considered a novel inflammatory marker. Previous studies have confirmed that admission NPAR is an independent predictor of clinical outcomes in various diseases such as sepsis, acute kidney injury, cardiogenic shock, chronic obstructive pulmonary disease, and cerebral hemorrhage.

Objective

The aim of this study is to investigate the potential role of Neutrophil Percentage to Albumin Ratio (NPAR) in predicting the in-hospital adverse events among patients with acute myocardial infarction (AMI).

Methods

This retrospective study included AMI patients (n=6 768) admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from August 1, 2011, to January 10, 2022. Baseline data and laboratory results were collected, and NPAR was calculated. Endpoint events were identified from discharge diagnoses in the electronic medical record system. Patients were divided into quartiles based on NPAR: Q1 (NPAR<1.67, n=1 753), Q2 (1.67≤NPAR≤2.02, n=1 694), Q3 (2.03≤NPAR≤2.34, n=1 624), and Q4 (NPAR>2.34, n=1 697). Multivariate Logistic regression was used to analyze the association between admission NPAR and endpoint events. Restricted cubic spline regression was employed to examine the dose-response relationship between NPAR and endpoint events.

Results

A total of 6 768 patients were included. There were 765 cases (11.3%) of all-cause mortality, 709 cases (10.5%) of cardiogenic shock, 380 cases (5.6%) of ventricular tachycardia/ventricular fibrillation (VT/VF), and 119 cases (1.8%) of new-onset stroke. Multivariate logistic regression analysis with admission NPAR as a continuous variable and all-cause mortality as the dependent variable showed that for each standard deviation increase in NPAR, the risk of all-cause mortality increased by 18% (OR=1.18, 95%CI=1.08-1.29, P<0.001). When NPAR was treated as a categorical variable, the Q4 group (OR=1.48, 95%CI=1.11-1.97, P=0.008) was identified as a risk factor for all-cause mortality, with increasing risk across higher NPAR quartiles (P_trend=0.007). Restricted cubic spline regression revealed a linear relationship between NPAR and all-cause mortality risk (P_nonlinearity=0.171). Multivariate Logistic regression analysis with cardiogenic shock, VT/VF, atrioventricular block, and new-onset stroke as dependent variables showed that for each standard deviation increase in NPAR, the risk of cardiogenic shock increased by 20% (OR=1.20, 95%CI=1.09-1.32, P<0.001). When NPAR was treated as a categorical variable, the Q2 (OR=1.41, 95%CI=1.01-1.97, P=0.044), Q3 (OR=1.85, 95%CI=1.36-2.54, P<0.001), and Q4 (OR=2.09, 95%CI=1.53-2.89, P<0.001) groups were risk factors for cardiogenic shock, with a trend of increasing risk across higher quartiles (P_trend<0.001). Restricted cubic spline regression indicated a nonlinear relationship between NPAR and cardiogenic shock risk (P_nonlinearity=0.026). NPAR as a continuous variable was not a risk factor for VT/VF, atrioventricular block (P>0.05). When treated as a categorical variable, Q3 was a risk factor for VT/VF (OR=1.43, 95%CI=1.01-2.03, P=0.045) and atrioventricular block (OR=1.85, 95%CI=1.11-3.15, P=0.020), while Q4 was a risk factor for VT/VF (OR=1.56, 95%CI=1.09-2.26, P=0.017), atrioventricular block (OR=1.87, 95%CI=1.08-3.31, P=0.028), and new-onset stroke (OR=2.26, 95%CI=1.16-4.58, P=0.019). The risks of VT/VF, atrioventricular block, and new-onset stroke increased with higher NPAR quartiles (P_trend=0.009, 0.005, and 0.017, respectively). Stratified and interaction analyses showed that age, sex, hypertension, type 2 diabetes, smoking, and AMI type did not alter the association between NPAR and in-hospital adverse outcomes (P>0.05).

Conclusion

This study confirms that elevated NPAR is associated with an increased risk of in-hospital all-cause mortality and cardiogenic shock in AMI patients, exhibiting a dose-response relationship. These findings suggest that NPAR, as a simple and accessible composite marker of inflammation and nutritional status, may help identify high-risk patients early during admission and provide valuable reference for clinical risk stratification and prognostic assessment.

Accuracy of Artificial Intelligence in Remote Electrocardiography Diagnosis

HU Min, LYU Xiangdong

2026, 29(18):  2498-2503.  DOI: 10.12114/j.issn.1007-9572.2025.0021

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Background

Artificial intelligence (AI) technologies have shortcomings like vulnerability to adversarial attacks and overfitting, which make AI far less perfect in practical applications than experimental data. Considering factors such as the cost and timeliness of remote electrocardiography (ECG) consultation, primary medical staff will directly use AI diagnosis results, which may pose medical risks.

Objective

To analyze the accuracy and the influence factor of AI technology in ECG diagnosis based on the 3-year consultation data of Huangshan Regional Remote ECG Diagnostic Center.

Methods

A retrospective collection of 18 164 ECGs from primary care institutions was conducted at the Huangshan City Regional Remote ECG Diagnosis Center between September 2020 and September 2023. Both AI and physicians categorized the ECG diagnostic conclusions into four types: normal, positive, critical, and poor acquisition. Patient identity information was linked to the inpatient electronic medical record system of Huangshan City People's Hospital to extract discharge diagnosis information from tertiary hospitals. Patients were classified into two groups based on discharge diagnosis: cardiovascular disease (CVD) hospitalization and non-CVD hospitalization. A paired-design McNemar χ² test was used to compare the classification differences between the AI and physician groups. A Pearson χ² test was used to compare the differences between the classification results of both groups and CVD hospitalization status. After excluding cases with poor acquisition, a univariate logistic regression analysis was performed to analyze the correlation between different classifications and CVD hospitalization, using the normal category as a reference. Furthermore, 17 ECG indicators from the physician group (excluding poor acquisition cases) were converted into binary variables. Using the consistency of classification between the AI and physician groups as the dependent variable, receiver operating characteristic (ROC) curves were plotted for stratified analysis of the physician group's critical and positive categories to evaluate the impact of each ECG indicator on the inconsistency between the two groups.

Results

A total of 18 164 remote routine ECGs were included in the study. The median patient age was 69 (65, 74) years, with 8 731 males and 9 433 females. The physician group classified ECGs as normal in 5 873 cases (32.3%), positive in 11 678 (64.3%), critical in 393 (2.2%), and poor acquisition in 220 (1.2%). The corresponding figures for the AI group were 4 723 (26.0%), 12 861 (70.8%), 390 (2.1%), and 190 (1.0%), respectively. During the study period, 553 related patients were transferred to tertiary hospitals for inpatient care, of which 457 (82.6%) were for CVD. Univariate logistic regression analysis showed that, with normal ECG as a reference, the risk of CVD hospitalization for the physician group's positive and critical categories was 1.84 times (OR=1.84, 95%CI=1.11-3.04) and 2.80 times (OR=2.80, 95%CI=1.08-7.21) that of the normal category, respectively, with statistically significant differences (P<0.05). The AI group's positive (OR=1.54, 95%CI=0.88-2.67) and critical (OR=2.46, 95%CI=0.92-6.55) categories showed no statistically significant association with CVD hospitalization (P>0.05). The diagnostic classification was consistent between the AI and physician groups in 16 018 cases (88.2%) and inconsistent in 2 146 cases (11.8%), with a statistically significant difference between the two groups (χ²=680.931, P<0.001). Using the physician group as the standard, the AI group had a misdiagnosis rate of 27.7% and a missed diagnosis rate of 3.9%. ROC curve results indicated that for the physician group's critical ECGs, sinus rhythm, ST-segment abnormalities, and acute myocardial ischemia had discriminative value for the inconsistency between the two groups, with areas under the curve (AUC) of 0.74 (95%CI=0.65-0.82), 0.69 (95%CI=0.58-0.80), and 0.97 (95%CI=0.96-0.99), respectively. For the physician group's positive ECG, low voltage and T-wave abnormalities had discriminative value, with AUC of 0.58 (95%CI=0.55-0.61) and 0.61 (95%CI=0.58-0.63), respectively. For the physician group's normal ECG, bradycardia had discriminative value, with an AUC of 0.58 (95%CI=0.56-0.60).

Conclusion

The accuracy of current AI algorithm in ECG diagnosis is inferior to physician group, which still needs to be reviewed and confirmed by experienced physicians. We propose that AI technology applied in clinic should undergo extensive robustness verification.

Effect of Abdominal Dynamic Moxibustion on Monoamine Neurotransmitters and Brain-gut Peptides in Perimenopausal Insomnia Rats

ZHANG Xiaoting, ZHANG Xuefeng, QIU Sigan, LIU Junchang, GULAISAER Aikebaier, LU Xusheng, FAN Sien, KANG Xia, LAN Yongli

2026, 29(18):  2504-2512.  DOI: 10.12114/j.issn.1007-9572.2025.0137

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Background

Perimenopausal insomnia adversely affects women's health. Western medicine primarily employs hormone replacement therapy (HRT) and sedative-hypnotic drugs for its treatment. However, HRT is associated with a high recurrence rate and carries increased risks of thrombosis and carcinogenesis, while sedative-hypnotics often lead to issues of dependence and addiction. Therefore, exploring safe and effective non-pharmacological treatments holds significant clinical importance.

Objective

To investigate the potential mechanism of action of dynamic moxibustion in treating perimenopausal insomnia.

Methods

Forty SPF-grade adult female SD rats were randomly divided into a sham-operated group, a model group, a dynamic moxibustion group, a suspended moxibustion group, and a positive control group using a block randomization method, with 8 rats per group. A rat model of perimenopausal insomnia was established. Rats in the sham-operated and model groups received intragastric administration of 0.9% NaCl solution (10 mL/kg). The dynamic moxibustion group received treatment with dynamic moxibustion. The suspended moxibustion group received intervention with circling moxibustion. The positive control group received intragastric administration of 0.1 mg/L estazolam solution (10 mL/kg), once daily. All interventions lasted for 15 consecutive days. One week after ovariectomy, vaginal exfoliated cells were collected for Giemsa staining. After the intervention period, a pentobarbital sodium cooperative sleep test was conducted to evaluate sleep duration. The Morris water maze test was used to assess learning and memory abilities in the perimenopausal rat model. After the completion of the Morris water maze and pentobarbital sodium tests, rats were anesthetized and sacrificed, and hypothalamic and colon tissues were collected. Hematoxylin-eosin (HE) staining was performed to observe pathological changes in colon tissue. Immunohistochemical staining was used to detect the protein expression of substance P (SP) and neuropeptide Y (NPY) in the hypothalamus and colon tissues. Western blot analysis was used to detect SP and NPY protein expression in thalamic tissue. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of SP, NPY, 5-hydroxytryptamine (5-HT), norepinephrine (NE) and estradiol (E2).

Results

Giemsa staining results showed that rats in the sham-operated group maintained a regular estrous cycle, while the modeling success rate, indicated by loss of the estrous cycle, was 100% in the model group, suggesting the rats entered a perimenopausal state. Compared with the sham-operated group, the model group exhibited prolonged sleep latency and shortened sleep duration. Compared with the model group, all treatment groups showed shortened sleep latency and prolonged sleep duration. Compared with the suspended moxibustion group, the dynamic moxibustion group demonstrated shortened sleep latency and significantly prolonged sleep duration (P<0.05). Morris water maze results indicated that compared with the sham-operated group, the model group showed decreased platform crossings, prolonged escape latency, and increased total path length. Compared with the model group, all intervention groups exhibited a shortened total path length, decreased escape latency, and increased platform crossings (P<0.05). HE staining revealed that the sham-operated group had regular, intact, and orderly arranged colonic tissue structure with abundant neurons. The model group showed irregular colonic tissue surfaces, structural changes, and a decreased number of neuronal cells. Compared with the model group, all intervention groups demonstrated more uniformly and orderly arranged colonic crypts and an increased number of neuronal cells, with the abdominal dynamic moxibustion group showing marked improvement. Immunohistochemical staining results showed that compared with the sham-operated group, the model group had decreased protein expression of SP and NPY in the colon and thalamic tissues (P<0.05). Compared with the model group, all intervention groups showed increased protein expression of SP and NPY in the colon and thalamic tissues (P<0.05). Compared with the suspended moxibustion group, the dynamic moxibustion and positive control groups exhibited increased protein expression of SP and NPY in the colon and thalamic tissues (P<0.05). Western blot results indicated that compared with the sham-operated group, the model group had increased protein expression of SP and NPY in the thalamic tissue (P<0.05). Compared with the model group, all intervention groups showed decreased protein expression of SP and NPY in the thalamic tissue (P<0.05). Compared with the suspended moxibustion group, the dynamic moxibustion and positive control groups exhibited increased SP protein expression (P<0.05). ELISA results demonstrated that compared with the sham-operated group, the model group had significantly decreased serum levels of SP, NPY, 5-HT, and E2, and significantly increased NE levels. Compared with the model group, all intervention groups showed significantly increased serum levels of SP, NPY, and 5-HT, and decreased NE levels. Compared with the suspended moxibustion group, the dynamic moxibustion group showed significantly increased serum SP and 5-HT levels, and decreased NE levels (P<0.05).

Conclusion

Abdominal dynamic moxibustion can improve sleep and spatial cognitive ability in a rat model of perimenopausal insomnia. Its mechanism of action may be associated with the regulation of brain-gut peptide and monoamine neurotransmitter expression.

Effects of Pressing Intervention on Myofascial Trigger Points in Rats Based on cAMP/PKA/P-RyR1 and Intracellular Ca²⁺ Content

JIANG Quanrui, FENG Xiang, LIU Dan, LI Tao, YANG Zhou, LI Jiangshan, LIU Xiaowei, LI Wu

2026, 29(18):  2513-2522.  DOI: 10.12114/j.issn.1007-9572.2024.0054

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Background

Pressure manipulation at trigger points is a recognized and effective therapeutic approach for pain relief, reflecting the muscle-relaxing and analgesic effects of traditional Chinese tuina. However, its underlying mechanism of action has not yet been fully elucidated.

Objective

To investigate whether the effect of pressure manipulation on myofascial trigger points is associated with the regulation of intracellular Ca²⁺ by the cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA)/ryanodine receptor 1 (RyR1) pathway.

Methods

Sixty Sprague-Dawley rats were assigned, according to a random number table, to a blank group not subjected to modeling (n=10) and a modeling cohort subjected to trigger-point modeling (n=50). Rats in the modeling cohort underwent blunt-strike modeling. After modeling, rats that met the model evaluation criteria were randomly allocated to the model group, pressure manipulation group, pressure manipulation+agonist group, and pressure manipulation+vehicle group. The pressure manipulation group received intervention using a pressure manipulation stimulation device. The pressure manipulation+agonist group received intraperitoneal injection of 8-Bromo-cAMP solution at 20 mg/kg, whereas the pressure manipulation+vehicle group received an equivalent volume of 0.9% sodium chloride solution. Mechanical pain threshold, soft-tissue tension, and electromyography were assessed in each group. After the final electromyographic assessment, the rats were anesthetized and euthanized. The taut bands or nodular regions of the left medial thigh muscle were collected. cAMP content was measured using enzyme-linked immunosorbent assay. Protein expression levels of PKA, phosphorylated RyR1 (P-RyR1), and 12-kDa FK506-binding protein (FKBP12) were determined by Western blotting. P-RyR1 was detected by immunohistochemistry, and intracellular Ca²⁺ concentration was assessed by fluorescence staining.

Results

A total of 40 successfully modeled rats were ultimately included, with 10 rats each in the model group, pressure manipulation group, pressure manipulation+agonist group, and pressure manipulation+vehicle group. Before intervention, the mechanical pain thresholds in the model group, pressure manipulation group, pressure manipulation+agonist group, and pressure manipulation+vehicle group were lower than those in the blank group (P<0.05). After intervention, the mechanical pain thresholds in the model group and pressure manipulation+agonist group remained lower than those in the blank group; the thresholds in the pressure manipulation group, pressure manipulation+agonist group, and pressure manipulation+vehicle group were higher than those in the model group; and the threshold in the pressure manipulation+agonist group was lower than those in the pressure manipulation group and pressure manipulation+vehicle group (P<0.05). Within-group comparisons before and after intervention showed that the mechanical pain thresholds in the pressure manipulation group, pressure manipulation+agonist group, and pressure manipulation+vehicle group were higher after intervention than before intervention (P<0.05).

Conclusion

Local manual stimulation of trigger points may alleviate pain through the downregulation of intracellular Ca²⁺ concentrations mediated by inhibition of the cAMP/PKA/P-RyR1 pathway, resulting in the relaxation of abnormally contracted muscle nodules.

Screening of Hub Genes and Immune Infiltration Analysis in Stanford Type A Aortic Dissection

FANG Binbin, SHAN Chunfang, LIU Fen, TIAN Ting, XIE Qian, JI Wei, LI Yanhong, YANG Yining, LI Xiaomei

2026, 29(18):  2523-2531.  DOI: 10.12114/j.issn.1007-9572.2025.0042

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Background

Stanford type A aortic dissection (TAAD) is a life-threatening cardiovascular condition with high morbidity and mortality, requiring emergency surgical intervention. Due to the similarity of its clinical manifestations with other diseases such as acute coronary syndrome, diagnosis is often delayed. Identifying potential pathogenic genes of TAAD is crucial for early diagnosis and improving prognosis.

Objective

This study aims to identify hub pathogenic genes in TAAD through integrated bioinformatics analysis and experimental validation, and to explore their association with immune cell infiltration.

Methods

The GSE153434 dataset was downloaded from the gene expression omnibus (GEO) database. Differential expression analysis was performed using the Limma package in R. gene ontology (GO), disease ontology (DO), and KEGG enrichment analyses were conducted to elucidate the underlying molecular mechanisms of TAAD. Hub genes were screened and validated for expression consistency using the GSE52093 dataset. Receiver operating characteristic (ROC) curves were plotted to evaluate diagnostic performance. A TAAD model was established in 18 C57BL/6 mice via subcutaneous implantation of an angiotensin Ⅱ micro-osmotic pump. Aortic tissues were collected, and pathological changes were examined by hematoxylin and eosin (HE) staining. Quantitative real-time PCR (qPCR) was performed for validation. Immune cell infiltration differences and correlations were analyzed using the CIBERSORT algorithm.

Results

A total of 1 672 differentially expressed genes were identified in TAAD patients, including 1 064 upregulated and 608 downregulated genes. Functional enrichment analysis revealed their involvement in biological processes such as vascular system development, inflammatory response, and cytokine activity regulation, as well as key pathways including the PI3K-Akt and calcium signaling pathways. The TAAD model was successfully established in 10 out of 12 mice, with 4 mice dying due to aortic dissection. The remaining 6 mice were used for subsequent experiments. HE staining showed normal aortic wall structure and intact elastic fibers in the control (Con) group, whereas the aortic dissection (AD) group exhibited significant structural disruption, medial layer separation, elastic fiber fragmentation, and formation of true and false lumens with intraluminal thrombus. Validation via the GSE52093 dataset and mouse aortic qPCR indicated that secreted phosphoprotein 1 (SPP1) may serve as a core gene in TAAD pathogenesis, with its expression correlated with infiltration of immune cells such as macrophages and T cells.

Conclusion

The pathogenesis of TAAD is closely associated with dysregulation of the PI3K-Akt and calcium signaling pathways, as well as immune microenvironment imbalance. SPP1 may serve as a potential biomarker and therapeutic target for TAAD, providing new research directions for early diagnosis and immunotherapy. Further multicenter clinical studies and molecular mechanism investigations are warranted to validate its clinical applicability.

Article·Hot Topic Research·Metablic Disorder

Association between the Ratio of Uric Acid to High-density Lipoprotein Cholesterol and Metabolic Syndrome in the Yi Ethnic Group of Yunnan Province

ZHANG Mei, LI Mengqi, LU Shuangyan, PU Huijie, LI Guitao, DIAO Yi, TAO Hui, FAN Luming, YE Aifang, MAO Yong

2026, 29(18):  2532-2537.  DOI: 10.12114/j.issn.1007-9572.2024.0618

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Background

Metabolic syndrome (MetS) is a global public health issue, with an increasing prevalence among the Yi ethnic group due to their unique lifestyle and genetic background. The uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) is closely related to various metabolic diseases and requires further investigation.

Objective

This study aims to explore the association between UHR and MetS in the Yi ethnic group of Yunnan Province, and to assess the predictive value of UHR for the risk of MetS.

Methods

From May to November 2021, a stratified cluster sampling method was employed to select 1 100 Yi ethnic residents from 17 villages across 6 sample streets/towns in Anning City, Yunnan Province. After excluding 49 ineligible cases, a total of 1 051 subjects were ultimately included in the study. General demographic data and physical examination indicators were collected from all participants. The UHR was calculated, and Pearson correlation analysis along with Binary Logistic regression analysis were performed to examine the association between UHR and MetS. Additionally, the receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of UHR for the risk of MetS.

Results

Among the 1 051 participants, there were 335 (31.87%) males and 716 (68.13%) females, with a mean age of (70±7) years. The study identified 235 (22.36%) cases of MetS and 816 (77.64%) non-MetS cases. Significant differences were observed between MetS and non-MetS groups in age, BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), UA, fasting blood glucose (FBG) and UHR levels (P<0.05). The UHR was significantly higher in the MetS group (P<0.05). Participants were stratified into quartiles (Q1-Q4) based on UHR levels (7.94%, 10.57%, and 14.75% as cut-off points). Cochran-Armitage trend test revealed a significant dose-dependent increase in the prevalence of MetS and its components with ascending UHR quartiles (P<0.001). Pearson correlation analysis demonstrated positive associations of UHR with age, height, body weight, BMI, waist circumference (WC), SBP, DBP, creatinine (Cr), urea, TG, FBG, ALT, and UA (P<0.05), while negative correlations were observed with TC, HDL-C, LDL-C, AST, and direct bilirubin (DBIL) (P<0.05). Binary Logistic regression analysis showed that the risk of MetS in the Q4 group was 27.31 times that of the Q1 group (95%CI=11.39-65.47, P<0.01). After adjusting for confounding variables, each 1-unit increase in UHR was associated with a 29% elevated risk of MetS (OR=1.29, 95%CI=1.22-1.35, P<0.01). ROC curve analysis confirmed a strong predictive value of UHRfor MetS (AUC=0.805).

Conclusion

High UHR is a risk factor for MetS in Yi ethnic group and has a good predictive value for the risk of MetS.

Research Advances on the Effects of Intermittent Fasting on Cardiometabolic Diseases

MIAO Jingjie, ZHANG Jinwen, WU Qianhao, HAN Peipei

2026, 29(18):  2538-2545.  DOI: 10.12114/j.issn.1007-9572.2025.0158

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This review summarizes the effects of intermittent fasting on cardiometabolic diseases in humans and examines various fasting regimens-including alternate-day fasting, the 5∶2 diet, time-restricted eating, and the 16∶8 diet. These approaches may confer benefits for cardiometabolic health by reducing blood pressure, insulin resistance, and oxidative stress. Although large-scale randomized controlled trials investigating the relationship between intermittent fasting and cardiovascular outcomes are lacking, and some studies suggest a potential increase in cardiovascular risk, the majority of existing clinical evidence indicates that this dietary pattern may reduce the risk of cardiovascular disease by improving weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting is thought to exert its effects through multiple mechanisms, including reduced oxidative stress, optimized circadian rhythms, and ketogenesis. It is generally safe and is not associated with disruptions in energy levels or increased disordered eating behaviors, while also offering additional health benefits. In conclusion, intermittent fasting represents a relatively safe dietary intervention whose potential cardiovascular implications warrant further investigation.

Research Progress on Postprandial Hyperlipidemia and Its Therapeutic Approaches

LIU Daiyue, LIU Xincan, LAN Zhenzhen

2026, 29(18):  2546-2553.  DOI: 10.12114/j.issn.1007-9572.2025.0317

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Hyperlipidemia can be complicated by various cardiovascular and metabolic diseases, posing an increasingly serious threat to human health. Clinically, blood lipid levels are often defined based on fasting blood levels in the early morning. However, in the real world, the human body is not in a fasting state for most of the time, and simply detecting fasting blood lipid levels is difficult to reflect the full picture of lipid metabolism in the body. In recent years, multiple studies at home and abroad have focused on postprandial hyperlipidemia, exploring various aspects such as its diagnosis and treatment. This article reviews the latest research on the evaluation methods, inducing factors, complications, and treatment approaches of postprandial hyperlipidemia, aiming to provide reference and assistance for the clinical diagnosis and treatment of postprandial hyperlipidemia.

Research Methodology & Tools

Comparison, Analysis and Considerations of Methods for Determining Clinical Questions in Domestic and International Clinical Practice Guideline Development Manuals

HEI Moran, MA Hui'e, XU Zecheng, YAN Shiyan, LI Ziyan, YANG Yi, JIN Jun, CHEN Zelin, GUO Yi, ZHAO Xue, ZHAO Tianyi

2026, 29(18):  2554-2560.  DOI: 10.12114/j.issn.1007-9572.2025.0425

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Background

The formulation of clinical questions is a critical starting point in the development of Clinical Practice Guidelines (CPGs), directly influencing their scope and recommendations. Although various health organizations have issued numerous guideline development manuals, their guidance on the specific processes and operational methods for formulating clinical questions remains generally insufficiently detailed. This often leads to misunderstandings and operational difficulties for guideline developers in practice.

Objective

To compare the methodological content related to the formulation of clinical questions in authoritative guideline development manuals from both domestic and international sources, and to provide insights and references for constructing a more systematic and operational clinical question formulation process.

Methods

The system systematically retrieved guidelines and manual development documents published by authoritative domestic and international institutions, with a search period spanning from January 2010 to May 2025. Data were screened based on clearly defined inclusion and exclusion criteria. Using a directed content analysis approach, the study employed the seven-step framework of WHO manuals as an analytical framework to encode, extract, and conduct summary analyses of clinically relevant content identified in the 11 included manuals. Comparative analyses were performed on key elements and processes.

Results

A total of 11 manuals were included, comprising those from the WHO, the National Institute for Health and Care Excellence (NICE) in the UK, the Scottish Interhospital Guidelines Network (SIGN), and the Manual on Acupuncture in Traditional Chinese Medicine [World Federation of Acupuncture Societies (WFAS), National Administration of Traditional Chinese Medicine (NATCM)]. Comparative analysis revealed that all manuals recommended the use of the PICO framework for problem formulation, but differences existed in the definition and application of core concepts such as "scope","issues"and "problems". Only a few manuals provided step-by-step procedural recommendations, while most offered only general guidelines. Regarding the sources of clinical questions, clinical surveys and literature reviews were included. In terms of outcome measure importance evaluation, manuals such as WHO explicitly adopted a 9-point scoring system.

Conclusion

Current guideline manuals provide insufficient guidance in terms of standardization and refinement for the clinical question formulation stage. Future efforts should focus on constructing a systematic, step-by-step operational framework that integrates multi-source clinical question collection, PICO-structured formulation, pre-assessment of evidence quality, and incorporation of patient values. Through systematic comparison, this study clarifies the key components and directions for building such a framework, offering direct methodological references for enhancing the scientific rigor, practicality, and efficiency of guideline development.

Application Status and Research Progress of Observer-reported Outcome

CHEN Qiulong, CHEN Jia, FANG Jing, DAI Wei, YANG Qing

2026, 29(18):  2561-2570.  DOI: 10.12114/j.issn.1007-9572.2025.0269

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Observer-reported outcome (ObsRO), which records patients' observable behavioral signs and symptoms from a third-party perspective, has become a key technical support for health management in special populations such as infants, young children, and individuals with cognitive impairments. This paper reviews the international development context and trends of ObsRO, as well as the progress and bottlenecks in domestic localization practices; it reveals the core value of ObsRO in primary healthcare and its role in supporting the "prevention-treatment-rehabilitation" full-cycle management; and it explicitly identifies three key pathways for future breakthroughs: developing localized tools adapted to the Chinese model, integrating cutting-edge digital technologies, and improving policy support and interdisciplinary collaboration mechanisms. It provides a theoretical basis for the standardized application of ObsRO under the "Healthy China" strategy, emphasizing its practical potential to enhance the quality of primary healthcare services and the effectiveness of health management for special populations through the integration of cutting-edge technologies.

Review & Perspectives

Research Progress of Exhaled Nitric Oxide and Alveolar Nitric Oxide in Interstitial Lung Diseases

ZHANG Mingyue, HOU Yan

2026, 29(18):  2571-2576.  DOI: 10.12114/j.issn.1007-9572.2025.0161

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Interstitial lung disease (ILD) is a group of heterogeneous lung diseases containing more than 200 different pathological types. Due to its insidious early symptoms and lack of specificity in clinical manifestations, diagnosis and treatment are challenging. Exhaled nitric oxide (eNO), as a biomarker in exhaled gas, has the advantages of being convenient, non-invasive and repeatable. This article starts from the biological role of nitric oxide and the pathogenesis of interstitial lung diseases, introduces the connection between NO and interstitial lung diseases, systematically and comprehensively summarizes the application of fractional exhaled nitric oxide (FeNO) and alveolar nitric oxide (CaNO) in various interstitial lung diseases in the past few years, including their value in the auxiliary diagnosis of diseases. The value in the assessment of disease severity and prognosis, as well as the value in the differentiation among various subtypes, provides new ideas for the diagnosis and treatment research of interstitial lung diseases.

Recent Advances in Mitochondrial Dysfunction in Chronic Metabolic Diseases

JIAN Yingchun, ZENG Yongqin, ZHANG Haiping, WANG Zhengdi, AN Ke, YAN Rui

2026, 29(18):  2577-2584.  DOI: 10.12114/j.issn.1007-9572.2024.0677

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Imbalance in energy metabolism is a common feature of chronic metabolic diseases such as diabetes, atherosclerosis, neurodegenerative disorders, and non-alcoholic fatty liver disease, with mitochondrial dysfunction recognized as one of the core mechanisms. Abnormal mitochondrial function leads to oxidative stress, metabolic disturbances, and exacerbated inflammation, thereby driving disease progression. This review systematically explores the specific mechanisms of mitochondrial dysfunction in chronic metabolic diseases and summarizes potential mitochondria-targeted therapeutic strategies. By screening and analyzing relevant literature on mitochondrial dysfunction and chronic metabolic diseases, this study focuses on mitochondrial structure, functional regulation, and pathological mechanisms in disease contexts. Mitochondrial dysfunction manifests distinct mechanisms across different diseases: excessive reactive oxygen species production and calcium homeostasis imbalance in diabetes contribute to microvascular complications, while impaired mitophagy in atherosclerosis aggravates endothelial injury. Additionally, aberrant mitochondrial dynamics significantly promote metabolic dysregulation in obesity and fatty liver disease. Therapeutic strategies targeting mitochondrial dysfunction, such as antioxidant therapy, mitophagy modulation, and emerging mitochondrial transplantation techniques, show promise but require further clinical validation. Future research should emphasize precision mitochondrial interventions and synergistic multi-mechanism therapies to provide novel insights for managing chronic metabolic diseases.

Advances in the Diagnosis and Treatment of Post-COVID-19 Condition of Myocardial Injury

CHEN Yiping, ZHANG Jianmei, LI Yanhu, LI Rui, ZHANG Ruiping, YANG Ping

2026, 29(18):  2585-2592.  DOI: 10.12114/j.issn.1007-9572.2024.0247

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Patients with post-COVID-19 condition (PCC) of myocardial injury may exhibit a variety of cardiac-related symptoms, such as palpitations, chest distress, chest pain, without objective evidence of cardiovascular disease. In recent years, PCC of myocardial injury, as a newly emerging condition, lacks evidence-based medical evidence to support its diagnosis and treatment. Insufficient clinical experience in the diagnosis and treatment can easily lead to prolonged illness and decreased quality of life in patients. Therefore, this article focuses on the latest research progress in the diagnosis, clinical treatment, and rehabilitation of PCC of myocardial injury and improves the knowledge of clinical workers about this disease.