Table of Content

20 May 2026, Volume 29 Issue 15

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Guidelines·Consensus

Diagnosis and Treatment Guideline of Integrated Traditional Chinese and Western Medicine for Idiopathic Membranous Nephropathy (2025)

Nephrology Branch of China Association of Chinese Medicine, Nephrology Committee of Guangdong Provincial Association of Chinese Medicine, SU Peiling, YANG Lihong, BAO Kun

2026, 29(15):  1953-1970.  DOI: 10.12114/j.issn.1007-9572.2025.0482

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In China, idiopathic membranous nephropathy (IMN) accounts for 24.9% of glomerular diseases, the second highest share, and is increasing year by year. Combined therapy of Chinese and Western medicine has been widely used in the clinical practice of IMN. However, there are no evidence-based practice guidelines for the treatment of IMN with integrated traditional Chinese and Western medicine. This guideline followed the methods and steps of the guideline development manual. The level of the body of the evidence was assessed by the GRADE. An outline of the clinical questions was formulated through interviews with leading Chinese medicine experts and a review of relevant clinical guidelines. Based on the results of a systematic review of authoritative textbooks and clinical research literature, a clinical question list, a clinical outcome assessment index for IMN, and a list of types of Chinese medicine syndromes were developed, and a national expert survey was conducted to identify the clinical questions included in this guideline. A systematic retrieval of evidence was conducted for the clinical questions included in the guideline, and its quality was assessed. Through an expert consensus meeting, 8 recommendations on the integrated traditional Chinese and Western medicine diagnosis and treatment for IMN were finalized. This guideline focuses on the clinical practice of integrated traditional Chinese and Western medicine in the diagnosis and treatment of IMN, and is applicable to healthcare workers who provide Chinese and Western medicine services.

Hot Topic Research

Application and Implications of the Effect-oriented Comprehensive Evaluation Indicator System for the Retrospective Evaluation of National Essential Public Health Services in Shenzhen

ZHANG Siqi, CHEN Ying, CHEN Xuehui, WANG Yijing, LI Mengyu, LIU Lu, LIU Gang, YOU Lili

2026, 29(15):  1971-1977.  DOI: 10.12114/j.issn.1007-9572.2023.0805

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Background

In order to promote the change from process to result in the assessment and evaluation of National Essential Public Health Services, the group has theoretically constructed an "effect-oriented comprehensive evaluation index system of essential public health services", but the practical application of this index system is still insufficient.

Objective

In order to improve the pratical application of this indicator system, this study uses the index system to retrospectively evaluate the implementation effect of basic public health services in Shenzhen from 2017 to 2022.

Methods

From 2022 to 2023, indicator data were collected through the literature method and the correspondence method, and the comprehensive index method was used to calculate the comprehensive index of basic public health services in Shenzhen and the index of each dimension from 2017 to 2022.

Results

Of the 54 indicators in the indicator system, 49 were collected, with a completion rate of 91.8%. From 2017 to 2022, the comprehensive index of essential public health services in Shenzhen increased from 46.62 to 51.37, and the investment index increased from 3.75 to 10.40, and the execution index increased from 11.23 to 19.36, and the effect index decreased from 31.65 to 21.61. Looking at the effectiveness indices of the sub-projects alone, there was a large increase in the effectiveness index of health education, from 0.067 in 2017 to 4.079 in 2022; the effectiveness index of health management of patients with chronic diseases decreased from 13.469 in 2017 to 3.571 in 2022, with a minimum of 3.223 (2021) and a maximum of 14.970 (2019), the lowest values of child health management, knowledge and satisfaction effectiveness index were 3.374 and 1.987 respectively, both occurring in 2019. The lowest value of maternal health management effect index was 4.052 in 2022.

Conclusion

The application of the effect-oriented basic public health comprehensive evaluation index system to evaluate the basic public health services at the municipal level has certain feasibility and scientificity, but some of the indicators reflecting the population's health risk factors and health status still have the problem of low availability. The information-based full-quantity appraisal can solve the problem of data misreporting and improve the efficiency of project supervision. However, with service coverage nearing saturation, its facilitating effect is limited. In the future, the essential public health services should aim to improve service quality and enhance the health benefits of the population, with a particular focus on awareness and satisfaction, to continually improve the sense of access for residents.

Study on the Coupling, Coordination and Driving Force between the Health Service Capacity of Primary Medical Institutions and Regional Economic Development in Ningxia from 2015 to 2020

SHAO Lina, SUN Xiaotong, WU Jing, SUO Zhonghua, LANG Ying

2026, 29(15):  1978-1985.  DOI: 10.12114/j.issn.1007-9572.2023.0332

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Background

China's economy and health synergy has gradually come to the fore with development. The rural economy of Ningxia in the period 2015-2020 has maintained a rapid growth trend, and investment in primary health care organizations has been increasing. However, the effectiveness of such investment warrants further study, and few scholars have explored the coupling coordination between the health service sector and regional economic development.

Objective

To study the coupling coordination and spatial distribution of grassroots medical service capacity and regional economic development in Ningxia, and explore its driving forces.

Methods

By constructing an evaluation index system for grassroots medical service capacity and regional economic development in Ningxia, entropy method, coupled coordination model, geographic detector, etc. were used to study the coordination between the service capacity of 203 township health centers in 22 counties (districts) of Ningxia and regional economic development from 2015 to 2020.

Results

The comprehensive evaluation index of regional economy in Ningxia was higher than the comprehensive evaluation index of grassroots medical service capacity. The coupling coordination degree of the two subsystems shows an upward trend in time series, and a gradually decreasing distribution pattern in spatial layout from south to north. Factors such as health resources and medical service volume have become important factors driving the coordinated development of the two systems, while regional economic factors are gradually weakening.

Conclusion

There is significant room for improvement in the coupling and coordination between the grassroots medical service capacity and regional economy in Ningxia, with significant regional differences. It is necessary to continuously improve the grassroots medical service capacity by increasing health investment and strengthening medical prevention integration. Focusing on the high-quality development of regional economy, we will gradually strengthen the level of grassroots medical services and promote the coordinated development of the two systems.

Original Research

Association between Serum Bilirubin Within the Normal Range and Carotid Plaques in Elderly Patients with Type 2 Diabetes Mellitus

JIN Chunhua, ZHANG Yawen, LI Lianxi

2026, 29(15):  1986-1991.  DOI: 10.12114/j.issn.1007-9572.2025.0276

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Background

The relationship between serum bilirubin and carotid plaque in elderly patients with type 2 diabetes mellitus (T2DM) remains unclear.

Objective

To investigate the association between serum bilirubin levels within the normal range and the risk of carotid plaque in elderly patients with T2DM, and to explore the potential underlying mechanisms.

Methods

A total of 2 885 elderly T2DM patients (aged≥65 years) with complete clinical data hospitalized in the Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2003 to December 2012 were recruited in this retrospective study. According to the quintiles of serum unconjugated bilirubin (UCB) levels, the patients were divided into five groups: Q1 (UCB<6.0 μmol/L, n=446), Q2 (UCB: 6.0-7.5 μmol/L, n=717), Q3 (UCB: 7.6-8.9 μmol/L, n=533), Q4 (UCB: 9.0-10.1 μmol/L, n=607), and Q5 (UCB>10.1 μmol/L, n=582). The detailed clinical data, physical examination findings, carotid ultrasound measurements, and laboratory test results were collected. The prevalence of carotid plaque was compared among the five groups. Partial correlation analysis was performed to examine the associations between serum C-reactive protein (CRP) and bilirubin levels. Binary Logistic regression was used to analyze the association of serum bilirubin including total bilirubin (TB), UCB, and conjugated bilirubin (CB) with the presence of carotid plaque.

Results

Among 2 885 elderly hospitalized patients with T2DM, 1 296 were men (44.9%) and 1 589 were women (55.1%), with a mean age of 72.6±5.3 years. Significant differences were observed among the five groups with respect to age, sex, diabetes duration, smoking status, use of lipid-lowering medications, insulin or insulin analog therapy, diastolic blood pressure, and lipoprotein (a) levels (P<0.05). After adjustment for age, sex, and diabetes duration, the prevalence of carotid plaque in elderly T2DM patients across Q1 to Q5 was 76.9%, 71.8%, 68.5%, 65.9%, and 62.2%, respectively, showing a significant decreasing trend (χ²=30.900, P<0.001). Partial correlation analysis further demonstrated that serum TB (R=-0.090, P<0.001) and UCB (R=-0.100, P<0.001) were inversely correlated with CRP levels after adjustment for age, sex, and diabetes duration. After adjusting for multiple confounders, binary logistic regression analyses showed that serum TB (OR=0.833, 95%CI=0.721-0.963, P=0.013) and UCB (OR=0.831, 95%CI=0.725-0.952, P=0.008) were independently associated with a lower risk of carotid plaque in elderly patients with T2DM.

Conclusion

Higher serum bilirubin levels within the normal range are associated with a decreased risk of carotid plaque in elderly patients with T2DM. Lower levels of serum TB and UCB levels are independent risk factors for carotid plaque, which may be related to inflammatory status.

To Explore the Necessity of Bronchodilation Test in Children with Normal FEV₁, FVC and FEV₁/FVC but Decreased Small Airway Function

XIONG Xiaoman, LI Aijun, ZHENG Yuehong, YANG Qiuyan, ZHANG Yanli

2026, 29(15):  1992-1997.  DOI: 10.12114/j.issn.1007-9572.2025.0120

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Background

In clinical practice, children with asthmatic-related symptoms such as wheezing, cough, and chest tightness should first undergo pulmonary ventilation function examination. When forced expiratory volume in one second (FEV₁) <70%, which indicates obvious airflow restriction or airway obstruction, and bronchodilation test should be performed. However, some children with normal FEV₁ but decreased small airway function may have mild airflow restriction or airway obstruction. In addition, the bronchial stimulation test is complicated, expensive, risky, and more primary hospitals do not have the equipment and personnel conditions to carry out, but the bronchial diastole test for these children can also be positive, which has certain significance for the diagnosis of asthma.

Objective

To investigate the necessity of bronchial diastole test in children with normal FEV₁, forced vital capacity (FVC) and FEV₁/FVC but decreased small airway function.

Methods

A case-control study was conducted on 180 children with asthma aged 5 to 14 years who had symptoms such as wheezing, coughing and chest tightness and visited the outpatient department of the Third Affiliated Hospital of Zhengzhou University from May 29, 2019 to September 20, 2024. All subjects underwent routine pulmonary ventilation function examination and bronchodilation test, and the results of routine pulmonary ventilation function examination showed that FEV₁, FVC and FEV₁/FVC were normal, but the small airway function was decreased. Subjects were divided into positive group (n=33) and negative group (n=147) with FEV₁ improvement rate≥12% as the positive criterion of bronchodilation test, and the basic data and pulmonary ventilation function indexes of the two groups were compared. The correlation between small airway function index and bronchodilation test was analyzed by Pearson. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of small airway function indicators in predicting positive results of bronchodilation tests.

Results

The forced expiratory flow 50% of vital capacity as a percentage of the predicted value (FEF₅₀%pred), forced expiratory flow 75% of vital capacity as a percentage of the predicted value (FEF₇₅%pred) and maximum mid-expiratory flow as a percentage of the predicted value (MMEF%pred) in positive group were significantly lower than those in negative group (P<0.05). FEF₅₀%pred, FEF₇₅%pred and MMEF%pred were correlated with the results of bronchodilation test (P<0.001). The area under curve (AUC) of FEF₅₀%pred, FEF₇₅%pred and MMEF%pred in predicting positive results of bronchial diastolic tests were 0.733 (95%CI=0.644-0.822) 、0.827 (95%CI=0.756-0.898) 、0.849 (95%CI=0.789-0.909), respectively, and the cut-off values were 66.85%, 50.00% and 63.35%, respectively. The AUC of FEF₅₀%pred combined with FEF₇₅%pred, FEF₅₀%pred combined with MMEF%pred, FEF₇₅%pred combined with MMEF%pred and the combination of the three indexes were 0.859, 0.855, 0.865, 0.865, respectively. The AUC value of positive bronchial diastole test predicted by the combination of the three factors was greater than that predicted by FEF₅₀%pred and FEF₇₅%pred alone (Z=-2.801, -1.994; P=0.005, 0.046).

Conclusion

For children with asthma-related symptoms such as wheezing, chest tightness, and cough, small airway function indicators should be paid attention to even if FEV₁, FVC, and FEV₁/FVC are normal. When FEF₅₀%pred≤66.85% or FEF₇₅%pred≤50.00% or MMEF%pred≤63.35%, the positive result of bronchial diastole test can be predicted to a certain extent, and bronchial diastole test should be actively performed to assist the diagnosis of asthma.

Development and Validation of a Nighttime Hypertension Screening Model for Subclinical High-risk Populations: a Single-center Cohort Study

LIU Fan, CHEN Qiuyu, LI Jing

2026, 29(15):  1998-2005.  DOI: 10.12114/j.issn.1007-9572.2025.0236

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Background

Nocturnal hypertension (NH) is a significant contributor to multi-organ damage (cardiovascular, cerebral, and renal) and serves as a predictor of all-cause mortality. Its predictive value surpasses that of daytime blood pressure and office blood pressure. Classified as a form of masked hypertension due to its occult nature during nocturnal sleep, early screening and individualized treatment can mitigate the risk of cardiovascular, cerebral, and renal diseases.

Objective

To investigate risk factors associated with NH by leveraging routine health checkup parameters and personal health data, and to develop a clinical predictive nomogram model for NH.

Methods

A total of 406 patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) at the Affiliated Hospital of Inner Mongolia Medical University between January 1, 2021, and June 30, 2024, were included. Baseline clinical data, laboratory test results, and echocardiographic findings were collected. Patients were randomly divided into a training set (n=284) and a validation set (n=122) in a 7∶3 ratio. A risk prediction model for NH was constructed using LASSO regression analysis and multivariate Logistic regression analysis, followed by Nomogram development. The ROC curve was plotted, and the area under the ROC curve (AUC) was calculated to validate the model's accuracy. Calibration curves were generated to assess the model's predictive capability and consistency between predicted and observed risks.

Results

Based on 24-hour ABPM results, patients were categorized into an NH group (n=254) and a non-NH group (n=152). Four predictors identified via LASSO regression "body weight, total cholesterol (TC), hypertension, and stroke "were used as independent variables in multivariate Logistic regression analysis. The results indicated that increased body weight (OR=1.029, 95%CI=1.006-1.053), elevated TC (OR=1.496, 95%CI=1.136-1.972), hypertension (OR=2.372, 95%CI=1.214-4.632), and stroke (OR=7.850, 95%CI=4.157-14.824) were all risk factors for NH (P<0.05). The Nomogram revealed that stroke history (score: 0 or 62) and hypertension (score: 0 or 26) had a more pronounced impact on diagnostic rates compared to body weight and TC (scores varied linearly with variable values). The total model score was 240, with a 95%risk of NH when the score exceeded 176. ROC curve analysis demonstrated an AUC of 0.791 (95%CI=0.739-0.843) in the training set, with a sensitivity of 0.698 and specificity of 0.786. In the validation set, the AUC was 0.820 (95%CI=0.742-0.899), with a sensitivity of 0.817 and specificity of 0.725. The Hosmer-Lemeshow calibration curve indicated good model fit, and decision curve analysis showed that the validation set achieved high net benefit within a threshold probability range of 0.2-0.6, confirming optimal clinical utility.

Conclusion

This study established an NH risk prediction model incorporating four clinical indicators: body weight, TC, hypertension history, and stroke history. The model demonstrates robust calibration, discrimination, and clinical applicability for screening NH risk in suspected patients.

Weight Status and Metabolic Characteristics on the Longitudinal Trajectory of Systolic Blood Pressure: a Cohort Study

QIU Xinyu, ZHAO Qian, CHEN Yufei, JIAMULE· Maimaitiyiming, HAN Congcong, AIKEDAN· Aierken, LI Xiaomei, YANG Yining

2026, 29(15):  2006-2013.  DOI: 10.12114/j.issn.1007-9572.2025.0222

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Background

Weight significantly impacts blood pressure, yet the link between their combined metabolic status and systolic blood pressure (SBP) trajectories remains unclear.

Objective

The impact of different body weight statuses and metabolic characteristics on the trajectory changes of SBP was investigated.

Methods

A total of 2 051 subjects who participated in health check-ups in Urumqi City, Xinjiang Uygur Autonomous Region from July 2019 to September 2021 were selected as study subjects, with baseline information collected. The dynamic changes of SBP and new-onset hypertension status were collected every 12 months at the Health Management Center of the First Affiliated Hospital of Xinjiang Medical University. Group-based trajectory modeling (GBTM) was used to determine the optimal number of trajectories for SBP among the subjects, grouping them based on SBP change trajectories. Restricted cubic spline (RCS) analysis was conducted to examine the potential dose-response relationship between BMI and SBP trajectories under different weight statuses and metabolic features. Multivariate Logistic regression analysis was employed to explore the impact of weight status and its metabolic characteristics on SBP change trajectories.

Results

The average age of the subjects was (43.4±8.8) years old, including 883 males (43.1%) and 1 168 females. According to weight status and metabolic characteristics, participants were categorized into metabolically healthy normal weight (MHNW, n=915, 44.6%), metabolically healthy overweight/obese (MHO, n=608, 29.6%), metabolically unhealthy overweight/obese (MUO, n=379, 18.5%), and metabolically unhealthy normal weight (MUNW, n=149, 7.3%). During follow-up, a total of 362 (17.6%) new cases of hypertension were identified. GBTM categorized the subjects into three groups based on SBP trajectories: low-level group (n=870), mid-level group (n=1 067), and high-level group (n=114). There were statistically significant differences in gender, age, education below high school level, smoking and drinking proportions, BMI, SBP, diastolic blood pressure (DBP), fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol among the three groups (P<0.05). Within the low-, mid-, and high-level SBP trajectory groups, there were statistically significant differences in gender distribution across the four metabolic phenotypes (P<0.05). RCS results showed that BMI was linearly positively correlated with SBP trajectory risk in MHNW, MUNW, and MUO phenotype populations (P_non-linear>0.05, P<0.001), while in the MHO phenotype population, this correlation was nonlinear (P_non-linear<0.05, P<0.001). Multivariate Logistic regression analysis revealed that compared with MHNW, MHO (OR=2.29, 95%CI=1.84-2.87), MUNW (OR=5.32, 95%CI=3.62-7.83), and MUO (OR=5.20, 95%CI=3.90-6.95) were independent risk factors for increased SBP trajectory risk levels (P<0.05), and as weight status and metabolic characteristic types changed, so did the SBP trajectory risk level increase (P_trend<0.001). Further stratified analysis by gender showed that MHO, MUNW, and MUO remained independent risk factors for SBP trajectory risk levels in both genders (P<0.05).

Conclusion

The SBP trajectories of the subjects can be divided into three groups: low-level, mid-level, and high-level. MUNW, MHO, and MUO may influence the long-term trend of SBP, suggesting that personalized blood pressure management strategies should be developed targeting different body weight statuses and metabolic characteristics.

Correlation Analysis between Neurofilament Light Chain and the Risk of Left Ventricular Hypertrophy in Patients with Nocturnal Hypertension

LIU Tianyuan, SANG Wanyue, PENG Jiping, CHENG Siyi, HUANG Yiyi, LI Ouwen, JIANG Hong, ZHOU Xiaoya

2026, 29(15):  2014-2021.  DOI: 10.12114/j.issn.1007-9572.2025.0332

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Background

Neurofilament light chain (NfL), a sensitive biomarker of neuroal injury and neuroinflammation, has attracted increasing attention. Previous studies have demonstrated its associations with hypertension and adverse cardiovascular events;however, the potential relationship between NfL and left ventricular hypertrophy (LVH) in patients with nocturnal hypertension remains remains unclear.

Objective

To examine the association between serum NfL levels and the risk of LVH in patients with nocturnal hypertension.

Methods

A total of 351 patients with nocturnal hypertension who underwent 24-hour ambulatory blood pressure monitoring (ABPM) with complete clinical data at Renmin Hospital of Wuhan University from December 2022 to December 2024 were enrolled. Patients were divided into four groups according to NfL quartiles:Q1 (NfL≤62.82, n=88), Q2 (62.82<NfL≤92.00, n=88), Q3 (92.00<NfL≤136.40, n=87), and Q4 (NfL>136.40, n=88). Baseline characteristics, 24-hour ABPM data, laboratory results, and transthoracic echocardiographic parameters were collected. Left ventricular mass (LVM) and left ventricular mass index (LVMI) were calculated using the formula recommended by the American Society of Echocardiography. Spearman's rank correlation analysis was used to assess associations between NfL and echocardiographic parameters. Generalized linear models were applied to analyze the associations between NfL quartiles and LVMI. Logistic regression analysis was used to evaluate the relationship between NfL levels and the risk of LVH. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of NfL and autonomic function-related indicators for the risk of LVH in patients with nocturnal hypertension, and subgroup analyses were conducted.

Results

Significant differences were observed among the four groups in age, interventricular septal thickness in diastole (IVSd), left ventricular posterior wall thickness at end-diastole (LVPWd), LVM, and LVMI (P<0.05). Spearman correlation analysis showed that NfL levels were positively correlated with left ventricular internal diameter at end-diastole (LVIDd)(r_s=0.135, P=0.011), IVSd (r_s=0.128, P=0.016), LVPWd (r_s=0.146, P=0.006), LVM (r_s=0.162, P=0.002), and LVMI (r_s=0.277, P<0.001). After adjustment for confounding factors, the generalized linear model showed that, compared with Q1, NfL levels in Q3 (β=0.110, 95%CI=0.003-0.217, P=0.044) and Q4 (β=0.288, 95%CI=0.180-0.395, P<0.001) were significantly associated with LVMI. Logistic regression analysis showed that elevated NfL levels were an independent risk factor for LVH in patients with nocturnal hypertension (OR=1.012, 95%CI=1.007-1.016, P<0.001). Compared with Q1, NfL levels in Q3 (OR=3.328, 95%CI=1.152-9.611, P=0.026) and Q4 (OR=9.059, 95%CI=3.278-25.036, P<0.001) were associated with a significantly increased risk of LVH. ROC curve analysis showed that the areas under the ROC curve of NfL, norepinephrine (NE), acetylcholine (ACh), and the NE/ACh ratio for predicting LVH risk were 0.744, 0.618, 0.577, and 0.603, respectively, with sensitivities of 75.0%, 50.0%, 48.5%, and 48.5% and specificities of 63.3%, 69.3%, 51.5%, and 75.3%. Subgroup analyses indicated that NfL levels were positively associated with LVH risk in subgroups defined by age, male sex, BMI, and estimated glomerular filtration rate (P<0.05).

Conclusion

In patients with nocturnal hypertension, serum NfL levels are independently associated with the risk of LVH and may have clinical value in identifying individuals at high risk of LVH.

Effects of Intermittent Theta Burst Stimulation of the Cerebellum on Different Balance Abilities in Patients with Supratentorial Stroke: a Randomized Controlled Trial

JI Ying, GUO Chuan, ZHU Shizhe, JI Panpan, WANG Tong, KAN Chaojie, WANG Qinglei

2026, 29(15):  2022-2028.  DOI: 10.12114/j.issn.1007-9572.2025.0320

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Background

Balance dysfunction is one of the most common sequelae in patients with supratentorial stroke. The cerebellum, which plays a crucial role in balance, has been targeted with intermittent theta burst stimulation (iTBS) to improve balance function in these patients. However, the improvement of different types of balance abilities by this approach remains unclear.

Objective

To explore the influence of cerebellum iTBS intervention on the three types of balance abilities of static balance, dynamic balance and dual-task balance in supratentorial stroke patients.

Methods

Forty supratentorial stroke patients who were admitted to the Rehabilitation Medicine Center of Changzhou Dean Hospital from July 2023 to December 2024 were selected and divided into an experimental group (n=20) and a control group (n=20) by using a random number table. Both groups of subjects received conventional rehabilitation intervention. The experimental group received cerebellar iTBS intervention on this basis, while the control group received sham cerebellar iTBS intervention. The Berg Balance Scale (BBS) and Trunk Injury Scale (TIS) were used for assessment before the intervention and 2 weeks after the intervention. They were classified and statistically analyzed according to the static balance items and dynamic balance items. In addition, a balancing instrument was used to measure the overall stability index (OSI), anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI) of the patients in the stable platform, unstable platform and dual-task stable platform.

Results

One participant in each of the experimental and control groups dropped out during the treatment period; thus, 19 patients in each group were ultimately included in the analysis. After 2 weeks of intervention, the static balance subscore of the BBS increased significantly compared with baseline within both groups (P<0.05). After 2 weeks of intervention, the OSI, APSI, and MLSI under the stable surface condition were all significantly reduced compared with pre-intervention values within both groups (P<0.05). After 2 weeks of intervention, the dynamic balance subscores of the BBS and TIS were significantly increased compared with baseline within both groups (P<0.05). After 2 weeks of intervention, patients in the experimental group showed significant reductions in the OSI and APSI under the unstable surface condition compared with pre-intervention values (P<0.05). After 2 weeks of intervention, both groups exhibited significant reductions in the OSI and MLSI under the dual-task stable surface condition compared with baseline (P<0.05). Between-group comparisons demonstrated that improvements in the experimental group were significantly greater than those in the control group in terms of the total scores of the static and dynamic balance items of the BBS, the total scores of the dynamic balance items of the TIS, the OSI and APSI under the unstable surface condition, and the OSI under the dual-task stable surface condition (P<0.05).

Conclusion

Cerebellar iTBS can effectively improve the balance function of patients with supratentorial stroke, and has a positive impact on static balance, dynamic balance and dual-task balance.

The Correlation between Metabolic Dysfunction-associated Steatotic Liver Disease and Papillary Thyroid Carcinoma

ZHENG Renkuo, HUA Fei

2026, 29(15):  2029-2036.  DOI: 10.12114/j.issn.1007-9572.2024.0643

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Background

In recent years, the prevalence of papillary thyroid carcinoma (PTC) has been increasing in China. Literature suggests an association between non-alcoholic fatty liver disease (NAFLD) and PTC. However, there is limited research on the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD)-the latest definition incorporating metabolic criteria-and the occurrence of PTC.

Objective

To explore the influencing factors of PTC onset and evaluate the predictive value of MASLD for PTC development.

Methods

A total of 642 patients who underwent thyroid nodule resection at the Third Affiliated Hospital of Soochow University from May to September 2023 were included in the study. Among them, 323 PTC patients were assigned to the malignant group, and 319 patients with benign nodules were assigned to the benign group. General characteristics were compared between the benign and malignant groups, as well as between male and female patients. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing PTC. A nomogram prediction model was constructed to estimate the risk of PTC development. The predictive performance and discriminative ability of each factor and the model were assessed using ROC curve analysis.

Results

Compared to the benign group, the malignant group had lower age, high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and thyroglobulin antibody (TgAb), but higher proportions of males, BMI, alanine aminotransferase (ALT), triglycerides (TG), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), MASLD, and systemic immune-inflammation index (SII) (P<0.05). Male patients had higher BMI, ALT, TG, TPOAb, neutrophil count, lymphocyte count, monocyte count, and MASLD prevalence, but lower HDL-C, TC, TgAb, platelet count, platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and SII than female patients (P<0.05). Multivariate Logistic regression analysis showed that male sex (OR=1.581, 95%CI=1.040-2.412, P=0.033), elevated BMI (OR=1.066, 95%CI=1.002-1.136, P=0.045) and elevated TSH (OR=1.662, 95%CI=1.401-1.997, P<0.001) were risk factors for PTC, while older age (OR=0.931, 95%CI=0.916-0.945, P<0.001) was a protective factor. Based on the regression equation Logit (P)=0.381+0.466×sex-0.070×age+0.503×TSH+0.086×BMI, a nomogram prediction model for PTC risk was established. The model achieved an AUC of 0.798 (95%CI=0.764-0.832) for predicting PTC, with an optimal cutoff value of 0.502, a sensitivity of 0.721, and a specificity of 0.752.

Conclusion

Male gender, increased BMI, and elevated TSH are independent risk factors for the development of PTC, while increasing age is a protective factor. MASLD is not an independent risk factor. The constructed combined prediction model has good clinical predictive value for the development of PTC.

Correlation Analysis between Serum TXNIP and Abnormal Lipid Metabolism

ZHENG Kunjie, RONG Yihua, WANG Xuejing, HOU Liping, GU Wei, LI Xiaolong, HOU Xiaoyu, SONG Guangyao

2026, 29(15):  2037-2042.  DOI: 10.12114/j.issn.1007-9572.2024.0593

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Background

There is a long-term link between elevated triglyceride (TG) levels and cardiovascular diseases. In patients receiving statin therapy and with low-density lipoprotein cholesterol (LDL-C) levels well controlled, those with elevated TG levels still have a higher risk of developing atherosclerotic cardiovascular disease than those with lower TG levels. Therefore, the early detection of factors related to the progression of hypertriglyceridemia (HTG) is essential for atherosclerotic cardiovascular disease prevention and treatment. And thioredoxin-interacting protein (TXNIP) plays a crucial role in lipid metabolism.

Objective

To evaluate the association of serum TXNIP levels with impaired fat tolerance (IFT) and hypertriglyceridemia (HTG).

Methods

A total of 235 volunteers with different fat tolerances were selected for the oral fat tolerance test (OFTT). According to the OFTT results, the subjects were divided into a normal fat tolerance group (NFT group, 75 cases), an IFT group (85 cases), and an HTG group (75 cases). The subjects were divided into Q1-Q4 groups according to the TG quartile. Measure fasting blood glucose (FBG), 2-hour postprandial blood glucose after oral glucose tolerance test (OGTT), fasting insulin (FINS), serum uric acid (SUA), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and total cholesterol (TC), TG, high-density lipoprotein cholesterol (HDL-C), LDL-C at fasting and 4 hours after high-fat meals. Calculate non-HDL-C and triglyceride-rich lipoprotein remnants (TRLRs). Evaluate the homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of beta-cell function (HOMA-β). Measure serum TXNIP with an enzyme-linked immunosorbent assay (ELISA) and analyze the correlation between TXNIP and each indicator.

Results

The serum TXNIP levels in the IFT group and the HTG group were higher than those in the NFT group, and the HTG group was higher than the IFT group(P<0.05). The levels of TXNIP in groups Q2, Q3 and Q4 were higher than those in group Q1, the levels of TXNIP in groups Q3 and Q4 were higher than those in group Q2, and the level of TXNIP in group Q4 was higher than that in group Q3(P<0.05). Serum TXNIP levels were positively correlated with SUA, FBG, FINS, HOMA-IR, HOMA-β, 0 h TC, 4 h TC, 0 h TG, 4 h TG, 0 h LDL-C, 4 h LDL-C, Non-HDL-C, TRLRs, and ApoB, and negatively correlated with 0 h HDL-C, 4 h HDL-C, and ApoA1/ApoB (P<0.05). After adjusting for major confounders, multiple linear regression analysis showed that IFT and HTG were significantly correlated with TXNIP levels (IFT: β=0.184, P=0.006; HTG: β=0.441, P<0.001).

Conclusion

Serum TXNIP levels were positively correlated with the degree of IFT, and decreasing serum TXNIP levels may delay the progression of HTG-related diseases.

Blood Pressure Variability in Conjunction with Coagulation Function Predicted Germinal Matrix-intraventricular Hemorrhage in Preterms with Gestational Age ≤32 Weeks

JIANG Lijun, YU Qian, WANG Fudong, GUO Wei

2026, 29(15):  2043-2049.  DOI: 10.12114/j.issn.1007-9572.2024.0693

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Background

Germinal matrix-intraventricular hemorrhage (GMH-IVH) represents the primary cause of neurological sequelae in preterm infants. Early prediction and integrated management of GMH-IVH are crucial for enhancing prognosis. Cerebral blood flow (CBF) disturbances induced by blood pressure fluctuations, along with the heightened bleeding risk attributed to immature coagulation function, constitute key pathogenic factors contributing to GMH-IVH.

Objective

To evaluate the predictive significance of coagulation function in conjunction with BPV for germinal matrix-intraventricular hemorrhage (GMH-IVH) in preterms with a gestational age of 32 weeks or less.

Methods

A total of 106 preterm infants with a gestational age of≤32 weeks who were admitted to the neonatal intensive care unit (NICU) of Affiliated Hospital of Yangzhou University and met the inclusion criteria between June 2022 and June 2024 were enrolled as research subjects. Based on the presence or absence of GMH-IVH, the preterm infants were categorized into the GMH-IVH group (n=51) and the non-GMH-IVH group (n=55). According to their short-term outcomes, they were further divided into the good outcome group (n=30) and the poor outcome group (n=21). Comprehensive data collection included general information and perinatal parameters of the enrolled preterm infants. Coagulation function, systolic blood pressure (SBP), diastolic blood pressure (DBP), and blood pressure variability (BPV) indices were monitored for each group, and the associations between these indices and GMH-IVH were analyzed. Binary Logistic regression analysis was conducted to identify risk factors for GMH-IVH and poor outcomes in preterm infants. Additionally, ROC curves were constructed to evaluate the predictive performance of identified risk factors for GMH-IVH and poor outcomes, with the area under the curve (AUC) calculated accordingly.

Results

A total of 106 preterm infants were enrolled in the study, comprising 43 males (40.6%) and 63 females (59.4%). Binary Logistic regression analysis revealed that the international normalized ratio (INR) (OR=5.608, 95%CI=2.858-8.587, P=0.003) and standard deviation (SD) of DBP (OR=1.455, 95%CI=1.003-2.111, P=0.038) were significant independent risk factors for GMH-IVH in preterm infants. The AUC for the combined prediction of GMH-IVH using INR SD and DBP SD was 0.803, with a sensitivity of 82.4% and specificity of 79.7%. Furthermore, binary Logistic regression analysis indicated that INR SD (OR=3.942, 95%CI=1.509-6.680, P=0.025) and DBP SD (OR=2.334, 95%CI=1.013-5.378, P=0.047) were associated with poor outcomes of GMH-IVH. The AUC for predicting poor outcomes using INR SD and DBP SD was 0.864, with a sensitivity of 76.2% and specificity of 90.0%.

Conclusion

Increased INR and DBP SD are independent risk factors for occurrence and poor short-term prognosis of GMH-IVH. Combined monitoring of INR and DBP SD has certain reference value for early identification and prognosis evaluation of GMH-IVH.

Defining Clinical Questions and Outcome Indicators in Guidelines for Diagnosis and Treatment of Nocturnal Enuresis in Children with Integrated Traditional Chinese and Western Medicine Based on Modified Delphi Method

LIU Xiaoyu, ZHU Rongxin, ZHANG Bo, SU Hang, REN Xianqing

2026, 29(15):  2050-2055.  DOI: 10.12114/j.issn.1007-9572.2024.0674

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Background

Nocturnal enuresis in children is one of the common renal diseases in clinic, the recurrence rate after stopping the first-line treatment of Western medicine is high and the compliance is poor, the effect of Chinese medicine treatment is slow and the treatment plan is not uniform, therefore, it is important to integrate the Chinese and Western medicines in order to give full play to the advantages of their respective treatments.

Objective

This study aims to construct a system of clinical queries and outcome indiators for the Guidelines for Diagnosis and Treatment of Nocturnal Enuresis in Children with Integrated Traditional Chinese and Western Medicine.

Methods

Through literature research, expert interviews, and clinical research, an initial list was formed. The modified Delphi method was then employed to conduct 2 rounds of expert questionnaire surveys and 1 round of expert discussions from July to November 2024. The SPSS 26.0 software was employed in statistical analysis of the results, including positivity coefficient, mean, statistics, coefficient of variation, and Cronbach's α for quality control.

Results

The first round of questionnaires involved 26 experts and professionals, with a positivity coefficient of 100% and a Cronbach's α of 0.907. The second and third rounds involved 7 experts, maintaining a positivity coefficient of 100% and a Cronbach's α of 0.724. Ultimately, 13 clinical questions and 9 outcome indicators were included, covering key areas such as characteristics of traditional Chinese medicine (TCM), intervention methods (decoctions, patent medicines, acupuncture, moxibustion, Chinese massage, etc.), relapse treatment, early intervention, and preventive care; 8 efficacy indicators were number of episodes of enuresis, degree of nocturnal awakening, indicators of negative mood, quality of life, quality of sleep, TCM evidence scores, relapse rate, and bladder capacity; and 1 safety indicator was the rate of adverse reactions.

Conclusion

Clinical questions and outcome indicators were identified through the Modified Delphi method, and the structural system of the guidelines was initially formed, laying a working foundation for the subsequent development of the guidelines.

Acupotomy Inhibits Knee Osteoarthritis Through Activating A3AR to Suppress Chondrocyte Pyroptosis Via the Wnt/β-catenin Signaling Pathway

HE Linqin, LI Xiaodong, LIU Hongpeng, CHEN Qipeng, TANG Zonghan, REN Xaingqian, SONG Hanbing

2026, 29(15):  2056-2066.  DOI: 10.12114/j.issn.1007-9572.2024.0265

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Background

Acupotomy can delay the progression of knee osteoarthritis (KOA), but its therapeutic mechanism is still unclear.

Objective

To investigate the therapeutic effect of acupotomy on KOA and related mechanism.

Methods

From May 2023 to February 2024, 40 healthy specific pathogen-free (SPF) New Zealand rabbits were randomly divided into blank group, model group, acupotomy group, acupotomy combined with A3 adenosine receptor (A3AR) antagonist group and acupotomy combined with β-catenin activator group by SPSS 26.0 software, with eight rabbits in each group. The rabbits in the blank group did not receive any intervention, and the rabbits in the other groups were injected with papain into the joint cavity, combined with forced flexion of the knee joint, to construct KOA models. The rabbits in the model group were not given any intervention after the model was established; rabbits in the acupotomy group were treated with acupotomy; rabbits in the acupotomy combined with A3AR antagonist group were treated with acupotomy and injection of A3AR antagonist MRS1220 (5 mg/kg) via the auricular vein; rabbits in the acupotomy combined with β-catenin activator group were treated with acupotomy and combined with injection of Wnt/β-catenin signaling pathway activator SKL2001 (5 mg/kg) through the auricular vein, once a week for 4 weeks. Before and after the intervention, the behaviors of rabbits in each group were observed. After the intervention, the knee joint of rabbits in each group was imaged, and then the gross morphological changes in the knee joint cartilage were observed. The pathological changes in the cartilage tissue were observed by hematoxylin-eosin (HE) staining. The Lequesne MG score, Kellgren-Lawrence (K-L) grade, Pelletier score and Mankin score were used for quantitative evaluation. The content of pro-inflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-18 (IL-18), and matrix metalloproteinase-13 (MMP-13) in knee cartilage tissue and joint fluid were detected by enzyme-linked immunosorbent assay (ELISA). The mRNA levels of A3AR, Wnt3a, β-catenin, Nod-like receptor protein 3 (NLRP3), Caspase-1 and Gasdermin-D (GSDMD) in knee cartilage tissue were detected by real-time polymerase chain reaction (Real-time PCR), and the relative protein expression levels of A3AR, Wnt3a, β-catenin, NLRP3, Caspase-1 and GSDMD in knee cartilage tissue were detected by Western Blotting.

Results

Compared with the blank group, the model group showed obvious knee joint degeneration, and higher the Lequesne MG score, K-L grade, Pelletier score and Mankin score (P<0.05), contents of TNF-α, IL-1β, IL-18, and MMP-13 in knee cartilage tissue and joint fluid (P<0.05), lower mRNA levels and protein relative expressions in A3AR of knee cartilage tissue (P<0.05), and higher mRNA levels and protein relative expressions of Wnt3a, β-catenin, NLRP3, Caspase-1 and GSDMD in knee cartilage tissue (P<0.05). Compared with the model group, the above changes in the acupotomy group were reversed, and tended to return to the normal range (P<0.05). Compared with the acupotomy group, both the acupotomy combined with A3AR antagonist group and the acupotomy combined with β-catenin activator group showed less improvement in knee joint degeneration, higher Lequesne MG score, K-L grade, Pelletier score and Mankin score (P<0.05), higher contents of TNF-α, IL-1β, IL-18, and MMP-13 in knee cartilage tissue and joint fluid (P<0.05), lower mRNA levels and protein relative expressions of A3AR in knee cartilage tissue (P<0.05), higher mRNA levels and protein relative expressions of Wnt3a, β-catenin, NLRP3, Caspase-1 and GSDMD in knee cartilage tissue (P<0.05).

Conclusion

Acupotomy can significantly relieve the symptoms of KOA and delay the course of KOA, and its mechanism may be related to activation of A3AR in knee cartilage tissue to inhibit the transduction of Wnt/β-catenin signaling pathway, thereby interfering with chondrocyte pyroptosis, reducing joint inflammation and further alleviating cartilage matrix degradation.

Epidemiological Study

Disease Burden of Obesity among Individuals Aged 60 and above Globally and in China from 1990 to 2021: Trend Analysis and Model-based Projection

LI Jiali, LIU Fan, KE Lixin, LI Huijuan, WANG Haibo, ZHAO Xiaoxiao, ZHAO Xinke, LU Cuncun

2026, 29(15):  2067-2076.  DOI: 10.12114/j.issn.1007-9572.2025.0140

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Background

Obesity and aging have emerged as significant global public health concerns. Notably, the issue of aging is especially pronounced in China. However, there is relatively little research evidence regarding the disease burden of obesity in the elderly population, which needs to be addressed urgently.

Objective

To analyze the disease burden of elderly obesity population globally and in China from 1990 to 2021, and to predict future trends aiming to provide scientific evidence for the formulation of relevant public health prevention and control policies and healthcare decision-making.

Methods

Data on "high body-mass index" related to mortality and disability-adjusted life years (DALYs) for populations aged ≥60 in the global, China, and five sociodemographic index (SDI) regions were obtained from the Global Burden of Disease 2021 database. Joinpoint regression analysis was conducted to evaluate the trends of age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) over time, and results were reported as average annual percent change (AAPC) and corresponding 95%CI. A three-factor decomposition analysis was used to evaluate the relative impact of aging, population growth, and epidemiological changes on the disease burden. Additionally, a Bayesian age-period-cohort (BAPC) model was utilized to forecast mortality and DALYs trends from 2022 to 2035.

Results

In 2021, the number of obesity-related deaths among elderly populations was 2 880 400 globally and 467 000 cases in China, representing increases of 161.26% and 359.19%, respectively, compared to 1990. Corresponding DALYs number reached 71 193 400 person-years globally and 11 763 600 person-years in China, with increases of 171.50% and 344.80%. Globally, the ASMR for obesity in the total elderly population and elderly males showed an overall upward trend from 1990 to 2021, with AAPC of 0.22% (95%CI=0.08%-0.36%, P=0.002) and 0.43% (95%CI=0.31%-0.55%, P<0.001), respectively. In China, the ASMR for obesity in the total elderly population, elderly females, and elderly males also showed an overall upward trend from 1990 to 2021, with AAPC of 1.19% (95%CI=0.97%-1.40%, P<0.001), 1.01% (95%CI=0.80%-1.23%, P<0.001), and 1.47% (95%CI=1.16%-1.77%, P<0.001), respectively. From 1990 to 2021, the global ASDR for obesity in the total elderly population, elderly females, and elderly males showed an overall upward trend, with AAPC of 0.53% (95%CI=0.44%-0.62%, P<0.001), 0.43% (95%CI=0.33%-0.54%, P<0.001), and 0.69% (95%CI=0.60%-0.79%, P<0.001), respectively. In China, the ASDR for obesity in the total elderly population, elderly females, and elderly males also showed an overall upward trend from 1990 to 2021, with AAPC of 1.45% (95%CI=1.32%-1.58%, P<0.001), 1.34% (95%CI=1.21%-1.47%, P<0.001), and 1.60% (95%CI=1.41%-1.79%, P<0.001), respectively. Furthermore, in 2021, the numbers of obesity-related mortality and DALYs among the elderly in the five SDI regions also rose to varying degrees compared to 1990. The 60-64 years age group accounted for the highest DALYs burden globally (16 500 500 person-years, 23.18%), while in China, the highest DALYs burden was observed in the 65-69 age group (2 930 200 person-years, 24.91%). Decomposition analysis identified population growth as the primary driver of the increased obesity-related disease burden across all regions. Forecasting models suggested that by 2035, the numbers of obesity-related deaths and DALYs among the global elderly population will increase by 66.33% and 71.93%, respectively, while in China, they are projected to rise by 151.17% and 135.03%.

Conclusion

The disease burden of obesity among the elderly remains substantial both globally and in China, and is expected to escalate in the future. Targeted efforts to enhance public health awareness, promote healthy aging and lifestyles, and appropriately utilize medical and surgical interventions can be necessary to mitigate the growing burden of obesity in elderly population.

Burden of Cardiovascular Diseases Attributable to Metabolic Risk Factors in China 1990—2021 and Projected Trends from 2022 to 2035

ZHEN Rui, GU Xufang, GAO Shengwei, ZHANG Bowen, REN Zhenjuan, YANG Ruixuan

2026, 29(15):  2077-2083.  DOI: 10.12114/j.issn.1007-9572.2025.0299

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Background

Metabolic risk factors have become a primary driver of the increasing burden of cardiovascular diseases (CVD) in China.

Objective

To assess the temporal trends of CVD burden attributable to metabolic risk factors in China from 1990 to 2021 and project the future burden through 2035 using the Bayesian age-period-cohort (BAPC) model.

Methods

Based on data from the Global Burden of Disease Study 2021 (GBD 2021), we quantified the contributions of level 1 and major level 2 risk factors (e.g., high blood pressure, air pollution, smoking, high LDL cholesterol, and dietary risks) to CVD mortality and disability-adjusted life years (DALYs) using the population attributable fraction (PAF) method. Joinpoint regression was applied to estimate the average annual percent change (AAPC) of CVD burden attributable to metabolic factors from 1990 to 2021. A BAPC model was used to project future burden trends from 2022 to 2035.

Results

From 1990 to 2021, the age-standardized DALYs rate of CVD attributable to metabolic factors declined, while the age-standardized mortality rate increased. In 2021, metabolic factors accounted for 68.6% of CVD-related DALYs and 70.1% of CVD deaths. Elevated systolic blood pressure remained the leading risk factor, contributing 53.3% and 55.4% to DALYs and deaths, respectively. Among the four main metabolic risks, high BMI showed the most significant increase, with the attributable age-standardized DALYs rate rising from 281.04 per 100 000 to 396.09 per 100 000 (AAPC=1.08%, P<0.000 1), and the age-standardized mortality rate increasing from 13.73 per 100 000 to 18.80 per 100 000 (AAPC=1.00%, P<0.000 1). In contrast, the burden associated with high fasting plasma glucose and high LDL cholesterol changed minimally, with most AAPC showing no statistical significance. Age-and sex-stratified analyses indicated the heaviest burden among older males, with widening gender differences at older ages. Projections based on the BAPC model suggest a continued decline in CVD burden by 2035: for males, the mortality rate is projected to decrease from 291.97 per 100 000 to 183.33 per 100 000 and the DALY rate from 5 296.99 per 100 000 to 3 274.07 per 100 000; for females, age-standardized mortality rate is projected to decline from 149.26 per 100 000 to 103.00 per 100 000 and age-standardized DALYs rate from 2 863.17 per 100 000 to 1 814.15 per 100 000. A clear downward inflection point is expected around 2030 in males, while a steady decline is projected for females. All model predictions had mean absolute percentage errors below 2%, indicating high predictive accuracy.

Conclusion

High BMI and high blood pressure remain the predominant metabolic risk factors for CVDs in China. The projected burden attributable to these risks is expected to continue rising, with males and older adults experiencing a higher burden. Younger adults are increasingly affected by BMI-related risks, highlighting the need for targeted, stratified prevention strategies.

Review & Perspectives

Advances in the Study of Cardiac Macrophages in Heart Failure with Preserved Ejection Fraction

LI Shilong, WANG He, ZHOU Xiaoyu, FU Lei, ZHAO Zhuo, HUA Chengjun, SI Chunying

2026, 29(15):  2084-2091.  DOI: 10.12114/j.issn.1007-9572.2024.0627

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Heart failure with preserved ejection fraction (HFpEF) is a universal and highly fatal global disease, accounting for nearly 50% of patients with heart failure. Innovative methods are needed to protect cardiac function and prevent the progression of HFpEF. Cardiac macrophages (CMs) have emerged as key regulators of the pathophysiology of HFpEF. CMs are a heterogeneous population consisting of subpopulations with distinct lineage origins and gene expression profiles. Several key aspects of HFpEF progression have been shown to be regulated by CMs, including the recruitment of peripheral immune cells, myocardial inflammation, and cardiac electrical conduction. In addition, CMs play a critical role in regulating cardiac fibrosis, epicardial adipose tissue dysfunction, and ventricular diastolic dysfunction. Given the multifaceted roles of CMs in the pathophysiology of HFpEF, targeted regulation of CMs represents a promising therapeutic strategy. Therefore, this article will review the research progress between CMs and the pathophysiological mechanism of HFpEF from the aspects of cardiac inflammation and fibrosis, ventricular diastolic dysfunction, epicardial adipose tissue, cardiac electrical conduction, and clinical intervention.

Research Progress on Identifying Bipolar Ⅱ Disorder and Depressive Disorder in Primary Care

YAO Dingye, LUO Guiping, SUN Junsheng, LI Hui

2026, 29(15):  2092-2099.  DOI: 10.12114/j.issn.1007-9572.2024.0634

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The overlap in clinical presentation between bipolarⅡdisorder (BD-Ⅱ) and depressive disorders (DD) poses a significant challenge for differential diagnosis in primary care. Early and accurate diagnosis is critical to improve patient prognosis, and general practitioners (GPs), as frontline healthcare providers, play a pivotal role in initial screening, diagnosis, and treatment planning. However, GPs currently face challenges in accurately distinguishing BD-Ⅱ from DD. This paper summarises recent research advances in the differential diagnosis of BD-Ⅱ and DD, with a focus on clinical features, use of screening tools and follow-up strategies, and further evaluates the strengths and limitations of existing screening instruments in primary care settings. Additionally, emerging tools such as artificial intelligence, biomarkers and remote monitoring technologies are discussed for their potential to enhance diagnostic accuracy, offering valuable insights for follow-up research and clinical practice.

Research Methodology & Tools

Quality Evaluation of TCM Clinical Practice Guidelines/Consensus: Based on Two Guideline Evaluation Tools

GUO Jiao, ZHANG Gaojing, LIU Xincan

2026, 29(15):  2100-2106.  DOI: 10.12114/j.issn.1007-9572.2024.0661

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Background

Clinical practice guidelines are able to regulate the clinical behavior of clinicians and provide appropriate suggestions and references for patients. In recent years, the number of clinical practice guidelines in China has been on the rise. However, the quality of the guidelines, especially traditional Chinese medicine (TCM) is very uneven. At present, there have been some studies on the application of guideline evaluation tools, but studies on the evaluation of TCM guidelines are scant.

Objective

To evaluate the selected TCM clinical practice guidelines using two guideline evaluation tools, and to analyze the important dimensions influencing the quality of TCM clinical practice guidelines.

Methods

TCM clinical practice guidelines for common and frequently occurring diseases in the Gastroenterology, Pediatrics, Orthopedics and Gynecology were searched in China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP and SinoMed databases from November 1, 2023 to June 30, 2024. Two guidelines of each specialty were selected after a negotiation with 2 clinical doctors. Journals that published the guidelines, publishing institutions/groups, tools used for evidence grading and recommendation intensity, number of references, number of authors, number of experts formulated, whether to update the guidelines, the evaluation results of the AGREE-China evaluation, the evaluation results of the list of suggestions for quality evaluation of TCM clinical practice guidelines, and the evaluation time of the guidelines were collected.

Results

Among the 8 guidelines evaluated, 6 guidelines were strongly recommended after the AGREE-China evaluation, and only 3 guidelines had more than half of the reports after the evaluation of the list of suggestions for quality evaluation of TCM clinical practice guidelines. The median time required for AGREE-China evaluation was 22.0 min. The median time required for the list of suggestions for quality evaluation of TCM clinical practice guidelines was 18.8 min.

Conclusion

Although AGREE-China evaluates 6 high-quality guidelines, the tool lacks an evaluation of TCM content and takes a relatively long time. Although the list of suggestions for the quality evaluation of TCM clinical practice guidelines has increased the content of TCM evaluation and shortened the time consuming, only three guideline reports have reached more than half in the number, and the evaluation results are not quantitative and intuitive. Therefore, there are still some inconveniences in clinical use.

Interpretation for the Reporting of Surrogate Endpoints in Randomized Controlled Trial Protocols: Based on SPIRIT and CONSORT Extension Checklist

ZHOU Hui, TANG Yubo, CHEN Jie, TANG Kejing, YUAN Gang, YAO Mi

2026, 29(15):  2107-2112.  DOI: 10.12114/j.issn.1007-9572.2025.0082

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Surrogate endpoints are frequently used to substitute for primary outcomes in randomized controlled trials to shorter trial duration, reduce sample size and etc. But some surrogate endpoints would increase uncertainty of the intervention's true effect and unreliable in revealing intervention harms. We do need better reporting of trials that rely on surrogate endpoints. The SPIRIT-Surrogate and CONSORT-Surrogate provides the minimum reporting requirements for trials that use surrogate endpoints. Those extension checklists help to improve transparency, usefulness of trial findings, and ultimately reduce research waste. We interpreted these two guidelines with the aim of providing reference for practitioners and drawing their attention to surrogate endpoints.