Loading...

Table of Content

    20 June 2024, Volume 27 Issue 18
    Guidelines Interpretation
    Interpretation of Key Points of 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease
    XUE Yanan, OU Minxing, ZHANG Xiujie, MENG Qingxue, LIU Ying
    2024, 27(18):  2173-2178.  DOI: 10.12114/j.issn.1007-9572.2023.0827
    Asbtract ( )   HTML ( )   PDF (1266KB) ( )  
    Figures and Tables | References | Related Articles | Metrics

    Chronic coronary disease (CCD) refers to chronic heart or vascular disease caused by insufficient blood flow into or out of the heart. The incidence and mortality rates of CCD are high, resulting in significant personal, economic, and societal burdens. In July 2023, the American Heart Association (AHA) and the American College of Cardiology (ACC), along with other academic organizations, jointly released the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease. This guideline provides a on the evidence-based and patient-centered approach to comprehensive management of patients with CCD. It covers the epidemiology of CCD, patient assessment, diagnosis, risk stratification, treatment, management of special populations, patient follow-up, and related considerations. The guideline emphasizes the importance of a healthy diet, regular physical exercise, and tobacco avoidance for cardiovascular health. It also updates the recommendations for the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) and provides the latest evidence-based recommendations for clinical practice. This article provides a key interpretation of the management strategies outlined in the guideline, aiming to provide a basis for the development and update of relevant guidelines in China. The goal is to standardize and improve the specialized diagnosis and care for patients with CCD, with the ultimate aim of providing evidence-based guidance for clinical practice and improving the prognosis of patients with CCD.

    Article
    Correlation between Insulin Resistance Metabolic Score and Poor Prognosis in Patients with Chronic Heart Failure
    YIN Qiuguo, QIN Xintong, ZHANG Yidan, JIANG Peng, GUO Ping, JIA Xingtai, JIAN Liguo
    2024, 27(18):  2179-2185.  DOI: 10.12114/j.issn.1007-9572.2023.0892
    Asbtract ( )   HTML ( )   PDF (1402KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Insulin resistance (IR) is closely related to the development and progression of cardiovascular disease, and several studies have now demonstrated that IR is highly prevalent in patients with heart failure (HF) and is associated with adverse cardiovascular outcomes, whereas the association between the Metabolic Score of Insulin Resistance (Mets-IR), an indicator reflecting IR, and the poor prognosis in patients with chronic heart failure (CHF) is currently unknown.

    Objective

    To analyse the correlation between Mets-IR and poor prognosis in patients with CHF.

    Methods

    This was a retrospective study, and 313 patients who were diagnosed with CHF in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2021 were selected as study subjects. The patients were divided into two groups according to whether all-cause mortality occurred: the all-cause mortality group (61 cases) and the control group (252 cases). Mets-IR was analysed as a categorical variable, and Mets-IR was classified into two categories by median: low level Mets-IR (Mets-IR<37.28) and high level Mets-IR (Mets-IR≥37.28). Patients' baseline data, which included Mets-IR and their age, serum biomarkers and echocardiographic indices, were collected and followed up until 2022-12-31, and patients' prognosis was collected through our electronic medical record system or telephone follow-up, with the primary endpoint event being all-cause mortality and the secondary endpoint event being readmission due to HF. Survival curves for all-cause mortality and readmission due to HF in patients with different levels of Mets-IR were analysed using Kaplan-Meier plots and Log-rank tests. Cox proportional hazards regression model was applied to analyse the correlation between Mets-IR and the risk of all-cause mortality and readmission due to HF. Receiver operating characteristic (ROC) curves were constructed to analyse the predictive value of Mets-IR for the risk of all-cause mortality and readmission due to HF in CHF patients.

    Results

    At a median follow-up of 25.0 (9.0, 28.5) months, 61 (19.5%) all-cause mortality and 121 (38.7%) readmissions due to HF occurred in 313 CHF patients. Patients in the all-cause mortality group had higher age, BMI, fasting glucose, Mets-IR, N-terminal B-type natriuretic peptide precursor, blood uric acid, neutrophil count, erythrocyte distribution width, atrial fibrillation, hypertension, diuretics, aldosterone receptor antagonist, and New York Heart Association classification than controls, and triacylglycerol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, albumin, haemoglobin, blood sodium, left ventricular ejection fraction, and angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist /angiotensin receptor-enkephalinase inhibitor were lower than those of the control group (P<0.05) .The results of the log-rank test showed that the all-cause mortality rate and the readmission rate due to HF were both higher in the patients with high-level Mets-IR than those with low-level Mets-IR (P<0.001). Cox proportional hazards regression analysis after adjusting for several confounders showed that compared with low-level Mets-IR patients, high-level Mets-IR patients had higher risks of all-cause mortality (HR=2.90, 95%CI=1.51-5.54, P=0.001) and readmission due to HF (HR=1.55, 95%CI=1.04-2.30, P=0.030). The area under the ROC curve for Mets-IR to predict the risk of all-cause mortality and the risk of readmission due to HF were 0.68 (95%CI=0.62-0.75) and 0.62 (95%CI=0.55-0.68) .

    Conclusion

    Elevated Mets-IR levels may increase the risk of all-cause mortality and readmission due to HF in patients with CHF, and can be used for risk stratification of CHF patients.

    Correlation of Systemic Immune Inflammatory Index and Systemic Inflammatory Response Index with Microalbuminuria in Middle-aged and Elderly People Undergoing Health Examination
    HUANG Ya, NI Wenji, ZHANG Rui, LI Dandan, ZHOU Ying, JIN Tao, ZHONG Yong
    2024, 27(18):  2186-2191.  DOI: 10.12114/j.issn.1007-9572.2023.0860
    Asbtract ( )   HTML ( )   PDF (1357KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Microalbuminuria is a sensitive indicator of early renal microvascular damage and an independent risk factor for cardiovascular diseases. Previous studies have shown that long-term chronic inflammation plays an important role in the occurrence and development of microalbuminuria. However, the correlation between blood inflammatory markers and microalbuminuria has been less frequently reported.

    Objective

    To investigate the correlation of systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) with microalbuminuria in a middle-aged and elderly physical examination population.

    Methods

    This was a cross-sectional study in which 2 105 medical examiners over the age of 40 years who underwent health check-ups from April to July 2023 at the Department of Health Medicine, General Hospital of the Eastern Theatre of Operations were selected as study subjects. The study subjects were divided into two groups based on the urinary microalbumin/urinary creatinine ratio (UACR) values: the non-microalbuminuric group (1 857 cases, UACR<30 mg/g) and the microalbuminuric group (248 cases, UACR=30-300 mg/g). SII was divided into T1 (0.09-0.27), T2 (0.28-0.40) and T3 (0.41-1.38) according to tertile grouping, and SIRI was divided into t1 (0.11-0.41), t2 (0.42-0.66) and t3 (0.67-3.52). The general information and laboratory test results of the two study groups were collected and compared, and linear regression analysis was used to explore the correlation between the levels of SII and SIRI and the log-transformed value of UACR (log UACR), and binary Logistic regression analysis was used to explore the correlation between the levels of SII and SIRI and the risk of microalbuminuria.

    Results

    Comparison of gender, waist-to-hip ratio, total cholesterol, low density lipoprotein cholesterol, and uric acid levels between the two groups showed no statistically significant difference (P>0.05) ; age, BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, 2 h blood glucose, glycosylated hemoglobin, triglycerides, homocysteine, glomerular filtration rate erythrocyte sedimentation rate, SII, and SIRI levels were higher in the microalbuminuria group than those in the non-microalbuminuria group, and high density lipoprotein cholesterol level was lower than that in the non-microalbuminuria group (P<0.05). Linear regression analysis showed that the levels of SII and SIRI were positively correlated with log UACR (P<0.05). The results of binary Logistic regression analysis showed that, after correcting for each control variable, elevated SII levels was a risk factor for microalbuminuria (OR=1.17, 95%CI=1.01-1.35, P=0.031), and T3 was positively correlated with the risk of microalbuminuria when compared to T1 (OR=1.43, 95%CI=1.01-2.03, P=0.046), and the risk of microalbuminuria tended to increase with increasing SII (Ptrend=0.038). After correcting for each control variable, elevated SIRI levels was a risk factor for microalbuminuria (OR=1.18, 95%CI=1.03-1.35, P=0.019) ; t3 was positively correlated with the risk of microalbuminuria compared to t1 (OR=1.45, 95%CI=1.01-2.09, P=0.046) and the risk tended to increase with increasing SIRI (Ptrend=0.032) .

    Conclusion

    SII and SIRI levels correlated positively with both log UACR and risk of microalbuminuria in middle-aged and elderly subjects who received health examination.

    Risk Factors and Predictive Model of Long-term Bedridden Risk of Falls in Super-aged Population Based on Competing Risk Model Analysis
    XU Yunjia, SHU Biyun, ZHENG Yongtao, CHEN Ting, LAI Fenhua, NI Mengjiao, LUO Xiulan, WU Hengjing
    2024, 27(18):  2192-2197.  DOI: 10.12114/j.issn.1007-9572.2023.0757
    Asbtract ( )   HTML ( )   PDF (1459KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    With the aging trend intensifying in China, the number of super-aged population (≥80 years old) is also increasing. This demographic faces a notable decline in balance and reaction capabilities, resulting in an elevated risk of falls than that of other age groups of the elderly. Falls leading to long-term bedridden risk of falls often pose a serious disease burden to families and society. Exploring the potential risk factors for falls in the super-aged people may provide reference for the fall prevention in this population.

    Objective

    To identify long-term bedridden risk of falls in super-aged population and develop a risk predictive model.

    Methods

    A prospective cohort study was conducted to collect relevant information based on the China Health and Retirement Longitudinal Study questionnaire among the super-aged people who regularly participate in annual physical examination in five districts and counties of Shanghai and Hangzhou from March to November 2015, and to follow up and observe long-term bedridden caused by falls (endpoint events) and death (competing events), a competing risk model was constructed to analyze the influencing factors of long-term bedridden caused by falls. Independent risk factors identified by the competing risk model were used to construct a risk predictive model and nomogram of long-term bedridden risk of falls in super-aged population, and receiver operating characteristic (ROC) curve was plotted to evaluate the accuracy of the model.

    Results

    A total of 986 super-aged individuals were included in this study, including 431 (43.7%) males and 555 (56.3%) females, with an average age of (89.8±5.2) years. After 8 years of follow-up, 96 people were lost to follow-up, with a loss rate of 9.7%; endpoint events occurred in 165 people with an incidence rate of 16.7%; 134 people had competing events, with an incidence rate of 13.6%. Competing risk model analysis showed an increase in muscle strength (HR=1.071, 95%CI=1.049-1.091), age>85 years (HR=1.954, 95%CI=1.255-3.042), rural household location (HR=1.946, 95%CI=1.385-2.731), poor sleep quality (HR=5.756, 95%CI=3.904-8.491), cataract (HR=1.832, 95%CI=1.201-2.794), diabetes (HR=1.549, 95%CI=1.121-2.143), cognitive impairment (HR=1.717, 95%CI=1.258-2.344) were independent risk factors for long-term bedridden caused by falls in elderly population under the influence of competing events, and the difference was statistically significant (P<0.05). The area under the ROC curve of the predictive model for the risk of falls resulting in long-term bedridden in the super-aged people was 0.798 (95%CI=0.608-0.988), with a sensitivity of 0.841 and a specificity of 0.677.

    Conclusion

    The incidence of long-term bedridden caused by falls in elderly population was 16.7%. A nomogram predictive model can be constructed based on factors such as muscle strength, age, household location, sleep quality, cataracts and diabetes status, cognitive function, to regularly assess the risk of falls in super-aged population. It is recommended to strengthen health education and social support, and reduce the incidence of falls and the risk of long-term bedridden caused by falls.

    Analysis of Clinical Characteristics and Influencing Factors of Gastrointestinal Dysfunction Associated with Peritoneal Dialysis in Uremia
    LI Jing, MA Leilei, WANG Guanran, JIANG Chen, XING Haitao, YANG Hongtao
    2024, 27(18):  2198-2204.  DOI: 10.12114/j.issn.1007-9572.2023.0658
    Asbtract ( )   HTML ( )   PDF (1494KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Gastrointestinal dysfunction is a very common complication in peritoneal dialysis patients, which not only seriously affects the appetite and mood of patients, but also induces malnutrition, dehydration, electrolyte disorders, or systemic inflammatory reactions, and even leads to a decrease in the effectiveness of peritoneal dialysis, thus increasing the difficulty of medical treatment and lowering the patients' standard of living.

    Objective

    To analyse the clinical characteristics and influencing factors of patients with peritoneal dialysis-associated gastrointestinal dysfunction, and provide reference for the clinical diagnosis and treatment of peritoneal dialysis-associated gastrointestinal dysfunction.

    Methods

    A retrospective study was conducted to select 304 uremic patients who underwent continuous ambulatory peritoneal dialysis in the Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from 2019-09-01 to 2021-09-01. The patients were divided into the gastrointestinal dysfunction group and non-gastrointestinal dysfunction according to the combination of gastrointestinal dysfunction. General data, comorbidities, laboratory test indexes, and dialysis adequacy-related indexes of the two groups of patients were collected and compared. SPSS 23.0 software was used to statistically analyze the clinical data, the clinical characteristics of peritoneal dialysis-associated gastrointestinal dysfunction, and multivariate Logistic regression analysis was used to explore the factors influencing the occurrence of peritoneal dialysis-associated gastrointestinal dysfunction in patients with uremia.

    Results

    A total of 304 peritoneal dialysis patients were included, of which 189 (62.2%) were in the gastrointestinal dysfunction group, with the median age of 62 (52, 67) years. The differences in age, proportions of primary diabetic nephropathy and combined hypertension and coronary artery disease between the two groups were statistically significant (P<0.05) ; the levels of blood calcium, cholesterol, creatine kinase, C-reactive protein, total bilirubin, blood glucose, glycosylated hemoglobin, procalcitonin, and triglyceride were compared between the two groups, and the differences were statistically significant (P<0.05) ; standardized comparison of the levels of blood urea nitrogen, residual renal urea clearance index (Kt/V), peritoneal Kt/V, total creatinine clearance (Ccr), residual kidney Ccr, and total Ccr between the two groups showed statistically significant (P<0.05). The results of multivariate Logistic regression analysis showed that primary diabetic nephropathy (OR=7.471, 95%CI=1.161-48.061, P=0.034), elevated glycosylated hemoglobin (OR=1.367, 95%CI=1.080-1.731, P=0.009) were the independent risk factors for the occurrence of peritoneal dialysis-associated gastrointestinal function in uremic patients, and elevated residual kidney Ccr (OR=0.952, 95%CI=0.908-0.997, P=0.038) was an independent protective factor for the occurrence of peritoneal dialysis-associated gastrointestinal disorders in uremic patients.

    Conclusion

    The incidence of peritoneal dialysis-related gastrointestinal dysfunction was relatively high, with a clinical prevalence in the elderly. Diabetic nephropathy and elevated glycosylated hemoglobin may be independent risk factors for peritoneal dialysis-associated gastrointestinal dysfunction in patients with uremia. Elevated residual kidney Ccr may be an independent protective factor for peritoneal dialysis-associated gastrointestinal dysfunction in uremic patients.

    A Retrospective Analysis on the Cesarean Section of Multiparous Women under the New Childbearing Policy Based on the Revised Robson Classification System
    XIANG Yuting, ZENG Daidi, OU Yijing, HUANG Lishan, CHEN Wenting, WU Wanhua, XIAO Lijuan, LI Zhongjun
    2024, 27(18):  2205-2211.  DOI: 10.12114/j.issn.1007-9572.2023.0285
    Asbtract ( )   HTML ( )   PDF (1513KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Since the implementation of the "universal two-child" policy, multiparous women has become the main labor and delivery population. Problems such as advanced maternal age, chronic comorbidities, obstetric complications and pregnancy after cesarean section have become increasingly prominent, bringing new challenges to obstetricians.

    Objective

    To analyze the current status of cesarean section in multiparous women under the new childbearing policy based on the revised Robson classification system, in order to provide data support for rational control of cesarean section rate, improvement of obstetric care.

    Methods

    A total of 19 170 women who delivered by cesarean section in the Tenth Affiliated Hospital, Southern Medical University from 2017 to 2020 were included and divided into the primipara group (n=5 630) and multiparous group (n=13 540). Maternal information including age, gravity, parity, previous deliveries, fetal position, pregnancy comorbidities and complications, maternal and fetal outcomes, was collected through the electronic medical records. The general information and maternal and neonatal outcomes of the two groups were compared. The revised Robson classification system was used to classify the parturients according to their obstetric characteristics (parity, fetal position, number of fetuses and gestational weeks of delivery). The distribution of parturients in the revised Robson classification system and the change of the proportion of parturients in each group with year were compared.

    Results

    The proportion of pregnancy after cesarean section was as high as 81.4% (11 026/13 540). The age, gravity, parity, proportion of age ≥35 years and gestational diabetes mellitus of the multiparous group were higher than the primipara group (P<0.05). Based on the revised Robson classification system, R3 class (singleton cephalic position at ≥37 weeks' gestation with a history of at least 1 cesarean delivery) accounted for the highest proportion (50.4%, 9 668/19 170) in all cesarean section, followed by R1 class (singleton cephalic primiparous labor at≥37 weeks' gestation, spontaneous labor, induced labor, or cesarean section before labor) (20.8%, 3 993/19 170). In multiparous women, R3 class accounted for 71.4% (9 668/13 540). Analysis of the population characteristics of multiparous women found that the proportion of R3 class, which had the highest proportion, decreased from 73.5% to 67.1%, while the proportion of R2 class [transplants with singleton cephalic position at ≥37 weeks' gestation (without history of cesarean section), spontaneous labor, induced labor, or cesarean section before labor], and R8 class [all singleton cephalic positions at <37 weeks' gestation (including history of cesarean section) ] all increased. The 24-h postpartum hemorrhage and the proportion of blood transfusions were higher in the multiparous group than the primipara group, while length of hospital stay after surgery was lower than that in the primipara group (P<0.05). A total of 20 026 newborns were delivered by 19 170 women, including 6 077 primipara women and 13 949 multiparous women; the birth weight and 1-minute Apgar score of neonates in the multiparous group were higher than the primipara group, while the proportions of 1-minute ≤7 and neonatal transfers were lower than those in the primipara group (P<0.05). There was no significant difference in 5-minute Apgar score between the two groups (P>0.05) .

    Conclusion

    Advanced age and pregnancy after cesarean section are prominent features of multiparous women. Although the proportion of R3 class decreased by year, it is still the main population of cesarean section. In order to reduce cesarean section rate, it is necessary to effectively control the cesarean section of primipara women, and actively promote the vaginal trial of labor for women in R3 class. Meanwhile, the proportion of R2 and R8 in the multiparous women, which put forward new requirements for clinical practice of obstetrics.

    Effectiveness Analysis of Two Incontinence Care Plans Based on Guidelines for Elderly COVID-19 Patients with Incontinence
    JIANG Qixia, XIE Haoting, WANG Huajun, LI Xiuyun, ZHU Yuling, WANG Yaling, MIN Yan, WANG Ke
    2024, 27(18):  2212-2217.  DOI: 10.12114/j.issn.1007-9572.2023.0477
    Asbtract ( )   HTML ( )   PDF (1489KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The elderly are at high risk for COVID-19 and incontinence, as well as a vulnerable population for incontinence-associated dermatitis (IAD). There has been a continuous exploration of how to provide good incontinence care to improve the effectiveness of preventing and treating IAD.

    Objective

    To investigate the effectiveness of two incontinence care plans based on guidelines for elderly COVID-19 patients with incontinence, in order to provide a reference basis for good incontinence care and prevention of IAD in such patients.

    Methods

    Using an exploratory intervention study design, 60 eligible patients with COVID-19 were selected as the study subjects from the surgical and internal medicine departments of Eastern Theater General Hospital, PLA, Daping Hospital, Amy Medical University, PLA, and Sir Run Run Hospital, Nanjing Medical University from December 26, 2022 to March 30, 2023. The study subjects were nonrandomly divided into the intervention group and control group, with 30 patients from the Eastern Theater Command General Hospital of PLA included in the intervention group and 30 patients from the other two hospitals included in the control group. Patients with IAD in both groups were also included in the intervention and control subgroups. The characteristics and types of incontinence in elderly COVID-19 patients were analyzed, the "AIMS Four Step Improved Incontinence" care plan (AIMS care plan) for the assessing incontinence and skin (A), identifying and managing risk (I), managing incontinence (M), and skin care (S) was modified based on the recommendations of the guidelines. The intervention group adopted the modified AIMS care plan, while the control group adopted a structured skin care plan, with continuous intervention for at least 14 days. The skin was inspected every shift and international standards were used to determine the occurrence of IAD and changes. The primary outcome indicator was the incidence of IAD in both groups of patients, and the secondary outcome indicators were the healing rate and healing time of IAD. The relevant clinical data of the two groups before and after intervention was collected and compared.

    Results

    The general data of the both groups of patients showed no statistically significant differences, which included gender, age, types of incontinence, frequency of incontinence, chronic comorbidities, serum albumin, hemoglobin, blood glucose, pulse oxygen concentration, and Braden scores (P>0.05). The incidence of IAD in 60 elderly COVID-19 patients with incontinence was 33.3% (20/60), of which the incidence of IAD was 43.3% (13/30) in the control group and 23.3% (7/30) in the intervention group; There was no statistically significant difference in the incidence of IAD between the two groups of patients (P>0.05). There was no statistically significant difference in the grading, and healing rate of IAD between the two subgroups of patients (P>0.05). Patients in the intervention subgroup had a delayed time to IAD occurrence (t=3.225, P=0.005), shorter time to IAD healing (t=2.644, P=0.020), and shorter hospitalization time (t=4.364, P<0.001) than those in the control subgroup.

    Conclusion

    Both incontinence care plans based on guidelines can effectively prevent IAD and promote healing in elderly incontinent patients. However, the modified AIMS care plan is more effective and can be referred to and used in clinical care.

    Reasons for Refusal of Exercise Rehabilitation in Patients after Radiofrequency Ablation of Atrial Fibrillation in the Context Digital Medical Care: a Qualitative Research
    TANG Zhijie, SUN Guozhen, GAO Min, WANG Jie, BAO Zhipeng, YANG Gang, WANG Lin, WANG Qin
    2024, 27(18):  2218-2224.  DOI: 10.12114/j.issn.1007-9572.2023.0478
    Asbtract ( )   HTML ( )   PDF (1446KB) ( )  
    References | Related Articles | Metrics
    Background

    Telerehabilitation based on digital medical care can efficiently improve the health status of patients after radiofrequency ablation of atrial fibrillation. However, the current participation rate in telerehabilitation is low.

    Objective

    To analyse the reasons for refusal of exercise rehabilitation in patients after radiofrequency ablation of atrial fibrillation in the context digital medical care based on the theory of leisure constraints.

    Methods

    Patients after radiofrequency ablation of atrial fibrillation in the inpatient department or outpatient clinic of Department of Cardiology, at the First Affiliated Hospital of Nanjing Medical University from July to September 2022 were selected as the study subjects by using the purposive sampling method. The phenomenological approach was adopted to collect data from patients who refused exercise telerehabilitation after radiofrequency ablation through semi-structured interviews, and Colaizzi analysis was used to summarize the reasons.

    Results

    A total of 14 patients were finally included in this study. Three themes including self-limiting factors, interpersonal limiting factors, and structural limiting factors, and twelve sub-themes were extracted, namely, low level of digital literacy, negative illness perception, psychological distress caused by disease, digital medical trust crisis, deep-rooted personal exercise habits, alienation sense from rehabilitation team, insufficient social network establishment, economic burden related to equipment acquisition, harsh climate, low rehabilitation service capacity in primary care, constraints of available time by role pressure, and poor applicability of wearable devices.

    Conclusion

    The reasons for refusal to exercise telerehabilitation include lack of literacy and trust in digital medical care, high level of illness perception and psychological distress, poor exercise habits, rehabilitation team and peer alienation, economic burden, harsh climate, lack of capacity and personal time for rehabilitation service capacity in primary care, and inadequate applicability of existing wearable devices.

    Effects of Irrigation of Porphyromonas Gingivalis on Colonic Mechanical and Immune Barriers in Type 2 Diabetic Mice
    LI Xiaowen, YAN Fuhua, CHEN Wenwen, HUANG Mingkun, MO Chaolun, ZHANG Junmei
    2024, 27(18):  2225-2232.  DOI: 10.12114/j.issn.1007-9572.2023.0386
    Asbtract ( )   HTML ( )   PDF (1725KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Porphyromonas gingivalis (Pg.) is the main pathogen of periodontitis. Studies have found that Pg. can affect systemic diseases including type 2 diabetes mellitus (T2DM) through oral-intestinal pathway, but its specific mechanism remains unclear.

    Objective

    To explore whether Pg. has an effect on T2DM by changing intestinal mechanical and immune barriers.

    Methods

    A total of 24 among 40 SPF mice were randomly selected to construct T2DM models, among the successful models, 16 mice were selected to be divided into the model group (DM group, n=8) and model+Pg. group (PD group, n=8), and the other 16 mice were divided into the control group (N group, n=8) and Pg. group (n=8). After modeling, body mass and fasting plasma glucose (FPG) of mice were observed, and oral glucose tolerance test (OGTT) was performed at the 5th week, OGTT curve was plotted and the area under the curve (AUC) was calculated. Pg. group and PD group were gavaged with Pg. bacterial solution from the 7th week for 5 consecutive weeks. Lipopolysaccharide (LPS) was determined by enzyme-related immunosorbent assay (ELISA), colonic tight-junction protein and inflammatory factors were detected by real-time fluorescence quantitative PCR, and colonic tissue lesions were observed by hematoxylin-eosin (HE) staining. Pearson correlation or Spearman correlation analysis was used to investigate the relationship of FPG with colonic tight junction protein mRNA expression and serum LPS levels in mice.

    Results

    Body weight of DM group was higher than that of N group and Pg. group at 2nd to 6th weeks before irrigation (P<0.05), and body weight of PD group was higher than that of N group and body weight of PD group was higher than that of Pg. group at 3rd to 6th weeks before irrigation (P<0.05). The body weight of N group and Pg group was higher than that of DM group and PD group at 9th to 11th weeks, and the body weight of PD group was lower than that of DM group at 11th week (P<0.05). FPG in PD group was higher than that in the N and Pg. groups at 3rd to 6th weeks, and FPG in the DM group at 4th to 6th weeks was higher than that in N and Pg. groups. FPG of Pg. group was lower than that of the DM group and PD group at 7th to 11th weeks, PD group was higher than that of the N group, and PD group at week 10 and 11 was higher than the Pg. group (P<0.05). AUC in the DM group was higher than that in the N group and Pg. group, and PD group was higher than that in the N group, DM group and Pg. group (P<0.05). LPS of PD group was higher than that of N group and DM group (P<0.05). Tight junction protein 1 (ZO-1) in the PD group was lower than that in the N group, occludin in the DM group was lower than that in the N group, occludin in the PD group was lower than that in the N group, DM group and Pg. group (P<0.05). The interleukin (IL) -17A in the PD group was lower than that in the N group and Pg. group, and IL-10 in the N group was higher than that in the DM group and Pg. group (P<0.05). Tumor necrosis factor α in the PD group was higher than that in the N group, DM group and Pg. group (P<0.05). Toll-like receptor 4 in the Pg. group and PD group was higher than that in N group (P<0.05). Correlation analysis showed that FPG was positively correlated with LPS, and negatively correlated with occludin, ZO-1 (P<0.05). The pathological results showed connective tissue hyperplasia with focal lymphocyte infiltration in the lamina propria in the Pg. and DM groups, and the lamina propria with focal lymphocyte infiltration in the PD group.

    Conclusion

    Pg. may aggravate the glucose metabolism disorders of T2DM mice by disrupting the intestinal mechanical barrier and immune barrier leading to LPS entry into the bloodstream.

    Article·Adolescent Health Study
    Research on the Situation Characteristics of Health Literacy and Sedentary Time of High School Students on Both Sides of the "Hu Line"
    JING Tao, DAI Yongmei, LUO Jianying, LUO Wei, JI Yelinfan, PENG Chi, ZHANG Cuijun, CAO Yanjun, ZHENG Qing, HUANG Yu, SHEN Hejun
    2024, 27(18):  2233-2242.  DOI: 10.12114/j.issn.1007-9572.2023.0648
    Asbtract ( )   HTML ( )   PDF (2092KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    The academic value of the "Hu Line" has been extended to other related disciplines. Considering China's large population and obvious differences in distribution, this study draws on the research results of population geography to explore the population density and distribution criteria of the "Hu Line".

    Objective

    To investigate and analyze the current situation of health literacy and sedentary time among urban and rural high school students in the southeast and northwest halves of the "Hu Line", and to provide a basis for improving the physical and mental health of high school students in China.

    Methods

    A stratified cluster random sampling method was used to study the health literacy and sedentary time of freshmen and sophomores in 62 schools in 31 provinces (municipalities directly under the central government and autonomous regions) of China from January to March 2019 (12 400 questionnaires on health literacy and 12 400 questionnaires on sedentary time each were uniformly mailed and distributed in advance). Multiple linear regression models were used to analyze the coefficient of variance expansion, and after correcting for confounding factors, we analyzed the factors affecting the length of meditation time of high school students in the southeastern and northwestern halves of both sides of the "Hu Line".

    Results

    Finally, 9 057 health literacy questionnaires were included, of which 7 489 (82.7%) were from the southeast half of China and 1 568 (17.3%) from the northwest half of China, and 8 031 questionnaires on sedentary time were included, of which 6 614 (82.4%) were from the southeast half of China and 1 417 (17.6%) from the northwest half of China. Health literacy scores and sedentary time of high school students in the southeast half of China were higher than those in the northwest half of China (Z=-4.009, -9.198; P<0.001). The health literacy scores of high school students in the southeastern half of China aged 17 and 18, female, urban and rural, with father's education of less than college and college, mother's education of college and bachelor's degree, annual family income of 10 000-, 50 000-, 80 000-, and >100 000 yuan, and family size of 1, 3, 7, 9, and ≥10 were higher than those of the northwestern half of China (P<0.05) ; Those high school students in the southeastern half of China aged 15, 16, 18, and male and female, urban and rural, father's education less than college, college, mother's education less than college, annual family income <10 000, 25 000-, 50 000-, 80 000-, and >100 000 yuan, and the number of people in the family of 3, 4, 5, and 6 people were higher than those in the northwestern half of China in terms of the number of hours spent in meditation (P<0.05). The results of the multiple linear regression model analysis showed that after correcting for confounders, the length of time high school students in the southeastern half of China spent sedentary still was positively correlated with annual family income (β=0.324) and mother's educational attainment (β=0.644) but negatively correlated (P<0.05) with both the health literacy scores (β=-0.015) and the father's educational attainment (β=-0.212) were negatively correlated (P<0.05) ; standardized regression coefficients β were compared with annual family income (0.164) > mother's educational attainment (0.131) > father's educational attainment (-0.056) > health literacy score (-0.050). The length of sedentary time of high school students in the northwestern half of China was positively correlated with health literacy score (β=0.017), father's education (β=0.789), and mother's education (β=0.540) (P<0.05) ; standardized regression coefficients β were compared with father's education (0.163) > mother's education (0.111) > health literacy score (0.056) .

    Conclusion

    Health literacy scores and meditation hours of high school students in the southeastern half of China were higher than those in the northwestern half of China. Meditation duration of high school students in the southeastern half of China was positively correlated with annual family income and mother's education, but negatively correlated with health literacy scores and father's education, while meditation duration of high school students in the northwestern half of China was positively correlated with health literacy scores parent's education. Annual family income had the highest weight on the effect of meditation duration for high school students in the southeast half of China, and father's education had the highest weight on the effect of meditation duration for high school students in the northwest half of China.

    Investigative Study on the Physical Fitness Testing Status of First and Second Year High School Students in Urban and Rural Areas in China
    JING Tao, DAI Yongmei, LUO Jianying, CAO Yanjun, LUO Wei, PENG Chi, JI Yelinfan, ZHANG Cuijun, HUANG Yu, ZHENG Qing, SHEN Hejun
    2024, 27(18):  2243-2252.  DOI: 10.12114/j.issn.1007-9572.2023.0871
    Asbtract ( )   HTML ( )   PDF (2011KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Current research on the physical fitness test scores of high school students is more localized within provinces and cities, with few multicenter, large-sample-size, domain-wide research results. The prevalence of blended online and offline teaching in schools of all types has inevitably prolonged the already long sedentary time of high school students. Whether this trend has some impact on the physical health of high school students is an urgent need for a region-wide study.

    Objective

    To investigate and analyze the levels of physical fitness test scores and related influencing factors of urban and rural high school first- and second-year students in seven regions of China, and to explore the empowering paths for the balanced improvement of physical fitness levels of first- and second-year high school students.

    Methods

    Stratified randomized cluster sampling method was used to conduct stratified sampling according to urban counties and townships and villages in high school schools in seven regions (East China, South China, North China, Central China, Northwest China, Southwest China, Northeast China) of 31 provinces (municipalities directly under the central government and autonomous regions) of China from January to March 2019, and then randomized clusters of 1 high school school in urban counties and 1 high school school in townships and villages in total of 62 schools were selected respectively. A total of 42 523 freshmen and sophomores in high schools were randomly selected to conduct the research, and the data on students' physical fitness test scores were collected at the same time (BMI reflects the level of physical development; lung capacity reflects the level of physical function; sit-and-reach reflects the level of flexibility; pull-up, 50 m run, standing long jump reflects the level of explosive strength of upper and lower limbs; 1 min sit-up reflects the level of core strength of the torso; 800 m run, 1 000 m run reflects the level of cardiorespiratory endurance), and non-parametric tests and multiple linear regression analysis were used to explore the influencing factors of the level of physical fitness test scores.

    Results

    The age distribution of 42 523 high school students was 16.0 (16.0, 17.0) years; 20 074 (47.2%) boys and 22 449 (52.8%) girls, 21 725 (51.1%) in cities, counties and districts, and 20 798 (48.9%) in towns and villages. Comparison of the gender and urban-rural distribution of high school students in the seven regions showed statistically significant differences (P<0.05). Comparison of male high school students' scores on various physical fitness tests in the seven regions showed statistically significant differences (P<0.05) ; the top three regions in terms of scores on various physical fitness tests were as follows: height (North China>Northeast China>Central China), body mass (Northeast China>North China>Central China), BMI (Central China>Northeast China>North China), lung capacity (Northeast China>Central China>South China), 50 m run (South China>Central China>East China), standing long jump (South China>North China>Northwest China), sit-and-reach (South China>Southwest China>Central China), pull-up (South China>Southwest China>Northwest China), and 1 000 m run (South China>Central China>Southwest China). High school boys in the city, county and districts had higher lung capacity scores than those in the town and country, and lower scores than those in the town and country in the 50 m run, standing long jump, sit-and-reach, pull-up, and 1 000 m run (P<0.001). The differences in height, weight and BMI between high school boys in cities, counties and towns and villages were not statistically significant (P>0.05). The differences in the scores of high school girls in each physical fitness test in the seven regions are statistically significant (P<0.05) ; the top three regions in the scores of each physical fitness test are as follows: height (North China>Northeast China>Northwest China), body mass (Northeast China>North China>Northwest China), BMI (Northeast China>North China>Northwest China), lung capacity (Northeast China>South China>Central China), 50 m run (South China>Central China>East China), standing long jump (South China>North China>Central China), sit-and-reach (Northeast China>Central China>South China), 1 min sit-up (North China>Central China>East China=Southwest China), 800 m run (Northeast>Central China>South China). High school girls in the city and county districts had higher height, body mass, and BMI scores than those in the town and country, and lower scores than those in the town and country in lung capacity, 50 m run, standing long jump, sit-and-reach, 1 min sit-up, and 800 m run (P<0.001). The results of the multiple linear regression analysis showed that boys' pull-up scores were negatively correlated with BMI and the 1 000 m run scores, and positively correlated with the 50 m run, standing long jump and sit-and-reach scores (P<0.05), with sit-and-reach being the most important influence factor, followed by 1 000 m run; 1 000 m run scores were negatively correlated with BMI, lung capacity, and pull-up scores, and positively correlated with 50 m run, standing long jump and sit-and-reach scores (P<0.05), with pull-up being the most important influence factor, followed by sit-and-reach. The girls' 1 min sit-up scores were positively correlated with BMI, lung capacity, standing long jump, and 800 m run scores, and negatively correlated with 50 m run and sit-and-reach scores (P<0.05), with BMI being the most important influence factor, followed by sit-and-reach; the 800 m run scores were negatively correlated with BMI, 50 m run, and sit-and-reach scores, and positively correlated with standing long jump and 1 min sit-up scores (P<0.05), with sit-and-reach being the most important influence factor, followed by BMI.

    Conclusion

    The physical development levels of first and second year high school boys in Chinese city, county and districts were comparable to those of town and country, but the physical development levels of first and second year high school girls in the city, county and districts were higher than those of town and country. Upper and lower extremity explosive strength, trunk core strength, and cardiorespiratory endurance levels of first and second year high school students in city, county and districts were significantly lower than those of town and country. In addition to the level of physical development, the dominance of the performance levels of first and second year male high school students on all tests of physical fitness and health was evident in South China.

    Reliability and Validity of the Chinese Version of Type 1 Diabetes Stigma Assessment Scale for Adolescents
    YANG Cuicui, WANG Yubing, XU Jingjing, LUO Dan
    2024, 27(18):  2253-2259.  DOI: 10.12114/j.issn.1007-9572.2023.0382
    Asbtract ( )   HTML ( )   PDF (1797KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Stigma in adolescents with type 1 diabetes mellitus (T1DM) is closely associated with their health outcomes. Currently, there is a lack of stigma assessment tools for this population.

    Objective

    To translate the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) and test its reliability and validity in Chinese adolescents with T1DM.

    Methods

    A total of 194 patients with T1DM admitted to the First Affiliated Hospital with Nanjing Medical University and Children's Hospital of Nanjing Medical University were selected as the study subjects by using the convenient sampling method from March 2022 to March 2023. The English version of DSAS-1 was directly translated, back-translated and culturally adapted by using Brislin's classical back translation model to form a Chinese version. The Self-designed General Information Questionnaire, the Chinese version of the DSAS-1, the Diabetes Strengths and Resilience Measure for Adolescents, the Parent-child Relationship Scale, and the Quality of Life Scale was used to conduct investigation. Exploratory factor analysis and confirmatory factor analysis were used to test the structural validity of the scale, and the internal consistency of the version was evaluated by calculating the Cronbach's α coefficients. Correlation analyses with the Diabetes Strengths and Resilience Measure for Adolescents, the Parent-child Relationship Scale, and the Quality of Life Scale were conducted to confirm the effect of the Chinese version of DSAS-1 in detecting stigma among adolescents.

    Results

    A total of 194 valid questionnaires were recovered. The exploratory factor analysis and confirmatory factor analysis results showed that the Chinese version of DSAS-1 for adolescents was categorized into three dimensions of differential treatment, complaints and comments and identity concerns, with good structural validity (all factor load>0.55, cumulative variance=67.98%), convergent validity (AVE>0.5), and discriminant validity (correlation coefficients of each dimension less than the square root of AVE). The reliability test results showed good internal consistency of the scale (Cronbach's α coefficient of 0.930). The total score of the Chinese version of DSAS-1 for adolescents was negatively correlated with the total scores of the Diabetes Strengths and Resilience Measure for Adolescents (r=-0.425, P<0.001), the Parent-child Relationship Scale (r=-0.302, P<0.001), and the Quality of Life Scale (r=-0.408, P<0.001) .

    Conclusion

    The Chinese version of DSAS-1 for adolescents has good reliability and validity and is simple and easy to conduct, which can provide a reliable quantitative assessment tool for the stigma of adolescents with T1DM in China.

    Article·Epidemiological Study
    Trend Analysis and Prediction of Cardiovascular Disease Mortality in China from 2009 to 2021
    MIAO Lipeng, REN Kehao, LI Mengdie, LYU Juncheng
    2024, 27(18):  2260-2264.  DOI: 10.12114/j.issn.1007-9572.2023.0773
    Asbtract ( )   HTML ( )   PDF (1777KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    With the prevalence of unhealthy lifestyles and the accelerated trend of population aging, the mortality rate of cardiovascular diseases remains high in China. A timely understanding of the current and future trends of cardiovascular disease mortality in China, as well as exploring potential influencing factors and solutions, can provide a reference for formulating cardiovascular disease prevention and control measures.

    Objective

    To analyze the trend of cardiovascular disease mortality in China from 2009 to 2021 and predict the future trends from 2022 to 2030.

    Methods

    Cardiovascular disease mortality data were selected and analyzed based on gender, urban-rural areas, regions, and age groups from the "China Death Surveillance Data Set (2009-2021) " published by the Chinese Center for Disease Control and Prevention. The Joinpoint regression model was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to analyze the changing trends. Additionally, a GM (1, 1) model was established using R (4.3.1) software to predict the crude mortality rate of cardiovascular diseases in China from 2022 to 2030.

    Results

    From 2009 to 2021, the crude mortality rate of cardiovascular diseases in China increased from 235.83/100 000 in 2009 to 353.31/100 000 in 2021, with the AAPC of 3.3% (95%CI=2.8% to 3.8%, P<0.001). The age-standardized mortality rate decreased from 281.82/100 000 in 2009 to 221.24/100 000 in 2021, with the AAPC of -1.9% (95%CI=-2.6% to -1.2%, P<0.001). During this period, the standardized mortality rate for cardiovascular diseases in China showed a decreasing trend across different genders (AAPC for males=-2.0%, AAPC for females=-2.1%; P<0.05), urban and rural areas (AAPC for urban=-1.3%, AAPC for rural=-2.4%; P<0.05), and regions (AAPC for eastern region=-2.1%, AAPC for central region=-2.2%, AAPC for western region=-1.0%; P<0.05). Notably, the mortality rate decline was greater in females than males, in rural areas than urban areas, and the central region than the eastern and western regions. The results of the GM (1, 1) model showed that the crude mortality rate of cardiovascular diseases in China will continue to rise to 461.57/100 000 from 2022 to 2030.

    Conclusion

    From 2009 to 2021, the overall crude mortality rate of cardiovascular disease in China has shown a continuous upward trend, while the overall standardized mortality rate has shown a downward trend. The burden of cardiovascular disease mortality in China still faces severe challenges. The GM (1, 1) model predicts a continuous increase in the crude mortality rate of cardiovascular diseases in China from 2022 to 2030. Therefore, it is necessary to formulate and implement scientifically effective measures for the prevention and control of cardiovascular diseases, with a focus on male, elderly and rural residents.

    Analysis of Disease Burden and Annual Change Trends of Gastroesophageal Reflux Disease in China from 1990 to 2019
    MA Xuefeng, HUANG Jun, LI Na, SHAO Huijuan, LU Lixia, YU Xiaohui, ZHANG Jiucong
    2024, 27(18):  2265-2271.  DOI: 10.12114/j.issn.1007-9572.2023.0649
    Asbtract ( )   HTML ( )   PDF (2042KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Gastroesophageal reflux disease (GERD) has a high incidence and a heavy disease burden in recent years, but there is a lack of data to understand the burden of GERD in China. This study describes and analyzes the disease burden of GERD in order to better understand the prevalence of GERD in China.

    Objective

    To analyze the disease burden and prevalence trend of GERD in China from 1990 to 2019, and to provide a reference for the prevention and treatment of GERD in China.

    Methods

    Crude and standardized incidence, prevalence, and DALY rates of GERD in China from 1990 to 2019 were obtained from the Global Burden of Disease Database 2019 (GBD 2019) ; the rate of change was calculated, and Joinpoint regression model was used to analyze the standardized incidence, prevalence, and DALY rates of GERD, and the annual percentage change (APC) was calculated.

    Results

    In 2019, the crude rate and standardized rate of GERD incidence in China were 2 299.80 per 100 000 and 1 841.66 per 100 000, respectively. Compared with 1 761.59 per 100 000 and 1 849.31 per 100 000 in 1990, the crude rate increased by 30.55%, and the standardized rate decreased by 0.41%. In 2019, the crude rate and standardized rate of GERD prevalence in China were 5 739.55 per 100 000 and 4 509.32 per 100 000, respectively. Compared with 4 252.72 per 100 000 and 4 532.19 per 100 000 in 1990, the crude rate increased by 34.96%, and the standardized rate decreased by 0.51%. In 2019, the crude rate and standardized rate of GERD DALY rate in China were 44.37 per 100 000 and 34.94 per 100 000, respectively. Compared with 33.10 per 100 000 and 35.04 per 100 000 in 1990, the crude rate increased by 34.05%, and the standardized rate decreased by 0.29%. The standardized incidence, prevalence, and DALY rates were lower than crude rates after 1996. The standardized incidence, prevalence, and DALY rates of Chinese women were higher than those of men from 1990 to 2019. The results of Joinpoint regression analysis showed that the standardized incidence of GERD in China showed a downward trend from 1990 to 1994 (APC=-1.0%), a downward trend from 2005 to 2010 (APC=-1.4%), and an upward trend from 2014 to 2017 (APC=3.2%). The standardized prevalence of GERD in China showed a downward trend from 1990 to 1994 (APC=-1.2%), a downward trend from 2005 to 2009 (APC=-1.7%), and an upward trend from 2014 to 2017 (APC=3.7%). The standardized DALY rates of GERD in China showed a downward trend from 1990 to 1994 (APC=-1.1%), a downward trend from 2005 to 2009 (APC=-1.7%), and an upward trend from 2014 to 2017 (APC=3.6%). In 2019, the standardized incidence, prevalence, and DALY rates of GERD in China continued to increase with age, peaking at the age of 70 to 84 years. The number of new cases and cases of GERD in 2019 were respectively about 32.711 3 million and 81.636 5 million, and the populations were mainly concentrated in the age group of 45 to 59 years and 30 to 34 years.

    Conclusion

    From 1990 to 2019, the disease burden of GERD in China showed an upward trend in terms of crude rate and a slight decline in terms of standardized rate, indicating that aging had a great impact on the incidence, prevalence and DALY rate of GERD in China. In addition, it is important to pay attention to the middle-aged and young population, who account for a larger proportion of the population already suffering from GERD and may be closely related to overweight or obesity, alcohol consumption and dietary habits, etc.

    Article·Evidence-based Medicine
    A Systematic Review of Symptom Assessment Tools for Patients with Heart Failure
    LI Jingjing, ZHENG Gaigai, WANG Yu, LIU Yancun, ZHANG Shuangqi, YANG Qiaofang
    2024, 27(18):  2272-2278.  DOI: 10.12114/j.issn.1007-9572.2023.0786
    Asbtract ( )   HTML ( )   PDF (1914KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    There are many tools for symptom assessment of patients with heart failure, but there is a lack of standardized evaluation studies on the quality of such tools, which brings difficulties to the selection of tools.

    Objective

    To evaluate the measurement property and methodological quality of symptom assessment tools in patients with heart failure, and to provide reference for relevant personnel to choose symptom assessment tools.

    Methods

    The Chinese and English databases such as PubMed, Embase, and CNKI were searched for relevant studies from the date of library construction to July 30, 2023. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline was employed to evaluate the scale and form recommendations.

    Results

    Eleven studies were included for quality assessment, including eight tools for assessing symptoms in patients with heart failure: Chinese version of Memorial Symptom Assessment Scale Heart Failure (MSAS-HF), Heart Failure Somatic Perception Scale (HF-SPS), M.D.Anderson Symptom Inventory Heart Failure (MDASI-HF), Symptom Status Questionnaire Heart Failure (SSQ-HF), Shortness of Breath in Heart Failure Instrument (SOB-HF), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Assessment Tool (CHAT) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Regarding the measurement property, scales such as Chinese version of MSAS-HF, MDASI-HF, MLHFQ, and KCCQ were demonstrated a "sufficient" level of content validity. Conversely, HF-SPS, SSQ-HF, and SOB-HF were exhibited an "uncertain" level of content validity, while CHAT was categorized as having "insufficient" content validity. Finally, Chinese version of MSAS-HF and MLHFQ were recommended as level A, and the other six scales were recommended as level B.

    Conclusion

    Certainly, both Chinese version of MSAS-HF and MLHFQ demonstrate a remarkable level of reliability. Considering the distinct attributes of assessment tools, it is highly advisable to utilize Chinese version of MSAS-HF for the purpose of symptom assessment in patients suffering from heart failure.

    Efficacy and Safety of Closed Reduction Percutaneous Pinning versus Open Reduction with Kirschner Wire Fixation for Paediatric Lateral Humeral Condyle Fractures: a Meta-analysis
    MENG Chao, MENG Zhen, HUANG Xin, YANG Qun, ZHAO Fenghua
    2024, 27(18):  2279-2286.  DOI: 10.12114/j.issn.1007-9572.2023.0391
    Asbtract ( )   HTML ( )   PDF (2136KB) ( )  
    Figures and Tables | References | Related Articles | Metrics
    Background

    Traditionally, open reduction with Kirschner wire fixation (ORKF) is used to treat paediatric patients with significantly displaced lateral humeral condyle fractures. However, in recent years, the use of closed reduction percutaneous pinning (CRPP) to treat lateral humeral condyle fractures in children has been increasingly reported. However, there is some controversy as to which surgical technique is more effective and safe.

    Objective

    To evaluate the efficacy and safety of CRPP and ORKF in paediatric patients with lateral humeral condyle fractures.

    Methods

    Chinese databases including CNKI, Wanfang Data, VIP and CBM and English databases including PubMed, Embase, Cochrane Library and Web of Science were searched from inception to 2023-01-01 for the case-control studies of CRPP and ORKF to treat the lateral humeral condyle fractures, the quality of the literature was evaluated and data were extracted. RevMan 5.3 software was performed to conduct a meta-analysis comparing the relevant efficacy and safety indexes of the two surgical techniques.

    Results

    A total of 16 studies involving 1 165 cases were included for this meta-analysis. The results of meta-analysis indicated that CRPP was superior in status of surgical time (MD=-11.81, 95%CI=-15.04 to -8.58, P<0.000 01), intraoperative bleeding (MD=-3.36, 95%CI=-4.37 to -2.36, P<0.000 01), postoperative fracture healing time (MD=-3.92, 95%CI=-6.80 to -1.03, P=0.008), Kirschner wire rtention time (MD=-3.35, 95%CI=-6.33 to -0.38, P=0.03), and postoperative functional recovery of elbow joint (OR=0.44, 95%CI=0.25 to 0.76, P=0.006). The incidence of overall postoperative complications (OR=0.33, 95%CI=0.19 to 0.56, P<0.000 1) and superficial infections (OR=0.39, 95%CI=0.21 to 0.73, P=0.003) was lower than that in the ORKF group. However, there is no statistically significant difference in the deep infections, poor fracture healing, and ischemic necrosis of the lateral condyle between the two groups (P>0.05) .

    Conclusion

    CRPP was superior to ORKF in the treatment of pediatric lateral humeral condyle fractures, both in terms of efficacy and overall complications, but more high-quality studies are needed to further validate CRPP in terms of specific complications.

    Review & Perspectives
    Advances in the Application of Antibody Drug Conjugate in Gastric Cancer with Low Expression of Human Epidermal Growth Factor Receptor 2
    KANG Yinnan, SHI Jiaqi, WANG Junke, LI Bin, LI Chuyi, MA Jun, YU Xiaohui
    2024, 27(18):  2287-2294.  DOI: 10.12114/j.issn.1007-9572.2023.0319
    Asbtract ( )   HTML ( )   PDF (2013KB) ( )  
    Figures and Tables | References | Related Articles | Metrics

    Gastric cancer (GC) is one of the most heterogeneous and aggressive malignant tumors of the digestive system. Traditional chemotherapy drugs and epidermal growth factor receptor 2 (HER2) targeted drugs such as Trastuzumab still have the disadvantages of high incidence of drug resistance, high toxic side effects and poor tolerance of patients. Therefore, it is imperative to develop more effective anti GC drugs. Novel targeted drugs against HER2 are currently available, but are ineffective or resistance in some cases, which is related to the low expression of HER2 (HER2 IHC1+ or IHC2+/ISH-) in certain GC cells, accounting for about 40%-60% of all types. However, in clinical practice, these patients are still reported as HER2-negative GC. Therefore, accurate detection of HER2 expression is crucial to identify patients who may benefit from trastuzumab therapy. The emergence of antibody drug conjugates (ADC) provides a new therapeutic option for HER2-positive GC and it is expected to replace traditional GC chemotherapy in the future by its precise and efficient anti-tumor effect. Recent studies have found that ADC may have potential anti-tumor activity in HER2 low-expression GC, and related clinical studies are evaluating its effectiveness and safety in HER2 low-expression GC treatment. This article reviews the application and the latest research progress of ADC in HER2 low-expression GC patients in the era of targeted therapy and discusses the challenges faced in the application and development of HER2-targeted ADCs.

    Recent Advances in Soluble Prorenin Receptor in Multisystem Diseases
    LI Mengye, JIANG Yinong
    2024, 27(18):  2295-2300.  DOI: 10.12114/j.issn.1007-9572.2022.0503
    Asbtract ( )   HTML ( )   PDF (1771KB) ( )  
    References | Related Articles | Metrics

    Previous studies on renin-angiotensin-aldosterone system (RAAS) mainly focus on renin, prorenin and prorenin receptor (PRR), which play an important role in cardiovascular, renal and other diseases. The physiological function of PRR has been widely studied. Soluble prorenin receptor (sPRR) is generated by cleavage of extracellular components of PRR by protease and secreted into extracellular space, therefore the change of sPRR level may reflect the change of RAAS in tissue. However, there are limited clinical researchs on sPRR. In recent years, increasing evidences show that sPRR has important biological functions in various pathophysiological processes. This article summarized the recent advances in sPRR in cardiovascular system, kidney diseases, respiratory diseases, endocrine and metabolic diseases, pregnancy complications and cancers, and considered that sPRR may be a new biomarker of multiple diseases, and has potential therapeutic effects on metabolic diseases.