Table of Content

15 July 2025, Volume 28 Issue 20

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Special Research Report

Exploring Relation between Primary Care and Inpatient Care Supply and Utilization

YANG Hui

2025, 28(20):  2449-2456.  DOI: 10.12114/j.issn.1007-9572.2025.0065

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Inpatient care and ambulatory care constitute the national and regional health care system. The relationship between the two subsystems is a significant topic that needs to be studied. Using publicly released data of China and international agencies, this paper preliminarily analyses the status and trends of hospital inpatient service provision and utilization and potential influencing factors, as well as the relationship between primary care and inpatient care. The results show that hospital admission rates in China are positively correlated with the degree of population aging and the availability of hospital beds, with synchronous growth observed in bed availability, utilization rates, and general practitioner resources. Hospital admission rates vary significantly across provinces. The hospitalization rate cannot be satisfactorily explained with commonly used indicators such as socioeconomic, population structure, and health resource allocation, but geographic density of hospital beds is related to socioeconomic and population indicators and other resource structures. Internationally, the supply of hospital beds is decreasing in high-income countries, increasing in middle-income countries, and remaining at a low level in low-income countries; the hospitalization rate is related to population aging, economic development, and hospital governance policies. It has been widely realized that excessive provision of expensive inpatient care will make the health system unsustainable. The healthcare system reforms are focusing on early disease prevention, consolidating and strengthening primary health care and basic medical care, and changing the traditional role of hospitals. High-income countries have reduced the supply and utilization of hospitalization services through various measures, middle-income countries are exploring the governance of hospitalization services, and low-income countries are exploring how to increase supply and utilization of inpatient care. Strengthening basic medical services does not necessarily lead to a reduction in inpatient services, but to improve the cost-effectiveness and fairness of regional medical services and optimize the use of inpatient resources. Effective governance of inpatient care and primary care, establishment and development of large-scale and competent basic medical services, implementation of shared care across the subsystems and apply gatekeeper systems, and measures to reduce avoidable hospitalizations for specific diseases and specific populations can help primary care contribute more rational inpatient care.

Quantitative Analysis of Chronic Disease Prevention and Treatment Policy Texts in China: Three-dimensional Framework Based on Policy Tools, Policy Evolution and Policy Subjects

LONG Chunxiao, LI Chenglu, FAN Yangdong, SHI Lei

2025, 28(20):  2457-2463.  DOI: 10.12114/j.issn.1007-9572.2024.0480

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Background

China is increasingly emphasizing the prevention and control of chronic diseases, with the number and variety of related policies showing a growing trend. With the intensification of population aging, multimorbidity has become a critical challenge in the field of public health, necessitating the urgent optimization of relevant policies.

Objective

This study aims to reveal the characteristics and priority areas of chronic disease policies and identify potential directions for policy improvement.

Methods

Based on a three-dimensional framework of policy tools, policy evolution, and policy actors, content analysis was conducted using NVivo 20.0 software to encode and classify relevant policy documents issued from January 2009 to January 2024. Social network analysis was applied using Ucinet 6.0 software to examine the collaboration network among policy actors, and statistical analyses were performed using Excel 2021.

Results

Analysis of the 68 included policy documents identified a total of 279 references to policy tool usage, comprising 135 instances of supply-side tools, 27 instances of demand-side tools, and 117 instances of environmental tools. The General Office of the State Council accounted for the highest proportion of policy tool references (35.48%, 99/279), while the National People's Congress (NPC) and its Standing Committee accounted for the lowest (2.87%, 8/279). In the social network analysis, the collaboration network density among policy actors was 0.631, with the National Health Commission exhibiting the highest centrality. Further analysis of the 68 policies revealed an increasing trend in both the number and variety of policy tools as policies evolved, though supply-side tools remained predominant (35 policies). The NPC and its Standing Committee were involved in relatively few policies (3 policies). Moreover, only 10 out of the 68 policies addressed multimorbidity.

Conclusion

The results indicate structural imbalances in the use of policy tools and insufficient collaboration among policy actors. The number of policies addressing multimorbidity is limited, and specialized policies in this area are lacking. To address the challenges of chronic disease prevention and control, it is recommended to optimize the allocation of policy tools, enhance coordination among policy actors, and promote the development of specialized policies for multimorbidity. Expanding policy coverage and transitioning from a single-disease management model to an integrated multimorbidity management approach are essential to comprehensively strengthen the capacity for chronic disease prevention and control.

Guidelines·Consensus

Guideline on Treating Adult Community-acquired Pneumonia with Chinese Patent Medicines (2025 Edition)

YANG Jiang, LI Jiansheng, CHEN Yaolong, LIU Huiguo, WANG Jianxin, YU Jiajie, LI Huiru, XIAO Qionghua, XIE Yang, LI Suyun, WANG Minghang

2025, 28(20):  2464-2480.  DOI: 10.12114/j.issn.1007-9572.2025.0080

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Community-acquired pneumonia (CAP), one of the common infectious diseases, exhibits increasing morbidity and mortality with age, posing significant clinical challenges. Although Chinese patent medicines (CPMs) demonstrate efficacy in adult CAP treatment, high-quality evidence-based guidelines have been lacking. To address this gap, we organized a multidisciplinary expert panel to develop the Guideline on Treating Community-acquired Pneumonia with Chinese Patent Medicines, adhering to the principles of evidence-based, consensus-supplemented, and experience-referred and following standardized clinical practice guideline development procedures. Through literature review and Delphi questionnaires, six clinical questions were identified. Systematic evidence retrieval and synthesis of the best available evidence were conducted, integrating factors such as evidence quality, patient preferences, value orientations, and resource allocation. After two rounds of Delphi surveys and expert consensus meetings, the guideline was finalized and published in 2023 in Pharmacological Research. This updated edition systematically incorporates recent evidence, adds pharmacoeconomic evaluations and recommendation rationales, and presents 14 recommendations covering nine CPMs, covers 9 kinds of traditional Chinese patent medicines. The guideline has been restructured according to the first edition of reporting checklist for Chinese patent medicine guidelines (RIGHT for CPM) to enhance clinical applicability, accessibility, and operationalizability, thereby promoting the rational use of CPMs in adult CAP treatment.

Original Research

The Impact of Circadian Syndrome and Metabolic Syndrome on Subjective and Objective Cognitive Functions: a Cross-sectional Analysis from the Pingyin Cohort

ZHANG Luyi, YU Ruihong, WANG Qi, ZHANG Xiaoyu, LI Xiang, WANG Zhongxuan, ZHU Dongshan

2025, 28(20):  2481-2490.  DOI: 10.12114/j.issn.1007-9572.2024.0669

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Background

Current studies on the association between metabolic syndrome (MetS) and cognitive function remain inconsistent, and research exploring circadian rhythm syndrome (CircS) and subjective cognitive function are lacking.

Objective

To analyze the effects of CircS and MetS on both subjective and objective cognitive functions, providing theoretical support for the early prevention and intervention of cognitive decline and dementia.

Methods

This study conducted a cross-sectional study based on the Pingyin cohort data. Launched in July 2023 in Pingyin County, Shandong Province, the Pingyin Cohort Study employed a multi-stage cluster random sampling method, selecting permanent residents aged 45-70 years from seven villages of three towns as the research population. MetS was defined by harmonized criteria, while CircS included MetS components combined with short sleep duration and depression. Multivariate linear regression models were used to analyze the associations of CircS and MetS with subjective and objective cognitive scores, while multivariate Logistic regression analysis was employed to investigate their effects on abnormalities in these scores.

Results

A total of 2 187 people were surveyed at baseline and 2 165 valid samples were obtained. This study utilized baseline survey data, excluding individuals with missing CircS diagnostic data and covariates, resulting in a final inclusion of 1 939 participants. The prevalence of MetS and CircS was 48.2% (934/1 939) and 31.5% (611/1 939), respectively. Specifically, 356 (18.4%) had MetS alone, 33 (1.7%) had CircS alone, and 578 (29.8%) had both. Multivariate linear regression analysis revealed that, compared with healthy individuals, women with MetS alone had lower SCD-Q9 scores (β=-0.487, 95%CI=-0.875 to -0.099), whereas men with MetS alone had higher MoCA-B scores (β=1.097, 95%CI=0.261-1.934). In contrast, the overall population with CircS alone had elevated SCD-Q9 scores (β=1.643, 95%CI=0.765-2.521), and men with CircS alone displayed markedly reduced MoCA-B scores (β=-3.644, 95%CI=-6.323 to -0.965). Multivariable Logistic regression analysis demonstrated that, compared to healthy individuals, men and women with CircS alone exhibited 10.46-fold (95%CI=1.87-196.20) and 5.11-fold (95%CI=1.85-18.03) higher odds of abnormal SCD-Q9 scores, respectively, whereas those with MetS alone showed lower risks (men: OR=0.62, 95%CI=0.40-0.97; women: OR=0.65, 95%CI=0.47-0.91). Short sleep duration was associated with abnormal SCD-Q9 scores (OR=1.79, 95%CI=1.44-2.22), while depressive symptoms were linked to both abnormal SCD-Q9 scores (OR=4.75, 95%CI=3.41-6.72) and MoCA-B scores (OR=1.48, 95%CI=1.06-2.08) .

Conclusion

Patients with CircS demonstrate significant cognitive impairment, while MetS patients without short sleep or depression exhibit better cognitive function. CircS may serve as a robust predictor of subjective cognitive decline in middle-aged and elderly Chinese populations.

Comorbidity of Diabetes and Depression in Middle-aged and Elderly People: the Impact of Sleep, Exercise, and Social Activities

FU Rong, SHI Lei, HE Feiying

2025, 28(20):  2491-2500.  DOI: 10.12114/j.issn.1007-9572.2024.0474

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Background

Diabetes and depression are global public health issues. There is a significant correlation between diabetes and depression. Therefore, monitoring and intervening in diabetes, depression, and their comorbidity among middle-aged and elderly people is crucial.

Objective

To explores the prevalence of diabetes and depression, as well as their comorbidity, among the elderly population, and the impact of sleep, exercise, and social activities on these conditions.

Methods

Based on the 2018 China Health and Retirement Longitudinal Study, 11 177 participants who met the research criteria were included as subjects. A multifactorial Logistic regression analysis model was employed to investigate the association between sleep, exercise, and social activities with the comorbidity of diabetes and depression. Subsequently, the product of nap duration and nighttime sleep duration was incorporated into the regression model for interaction analysis.

Results

A total of 11 177 subjects were included in the study, with a prevalence of diabetes of 13.95% (1 559/11 177), a prevalence of depressive status of 24.85% (2 777/11 177), and a comorbidity prevalence of both diabetes and depressive status of 14.64% (1 636/11 177). The results of the multinomial Logistic regression analysis indicated that a nighttime sleep duration of 7 to 9 hours (OR=0.337, 95%CI=0.296-0.384), a nighttime sleep duration greater than 9 hours (OR=0.509, 95%CI=0.374-0.692), and a nap duration greater than 90 minutes (OR=0.792, 95%CI=0.666-0.941) were all protective factors for the comorbidity of diabetes and depressive status. High levels of social interaction were also found to reduce the risk of comorbidity (OR=0.778, 95%CI=0.686-0.882, P<0.05). The interaction analysis results showed that maintaining a nighttime sleep duration of 7 to 9 hours, regardless of nap duration, was effective in preventing the comorbidity of diabetes and depressive status (P<0.001). If the nighttime sleep duration is less than 7 hours, a nap duration of 60 to 90 minutes can also reduce the risk of comorbidity (OR=0.740, 95%CI=0.577-0.950, P<0.05). In the case of a nighttime sleep duration greater than 9 hours, not taking a nap (OR=0.270, 95%CI=0.125-0.581) or maintaining a nap duration of 60 to 90 minutes (OR=0.165, 95%CI=0.040-0.674) can also reduce the risk of comorbidity.

Conclusion

The comorbidity prevalence of diabetes and depressive status among middle-aged and elderly people in China is relatively high (14.64%). Nighttime sleep duration of more than 7 hours, nap duration of more than 90 minutes, and a high level of social interaction can all effectively reduce the risk of comorbidity of diabetes and depressive status. Moderate levels of physical activity can reduce the risks of diabetes and depressive status respectively. Napping serves as a compensatory mechanism, helping to make up for insufficient nighttime sleep. If nighttime sleep is less than 7 hours, controlling the nap duration to 60 to 90 minutes can also reduce the risk of comorbidity of diabetes and depressive status.

Influence of Screen Time on Sleep Quality among Patients with Multimorbidity Aged 35 and Above

FANG Yingying, LIN Weiquan, SUN Minying, LI Yaohui, LIU Lan, YANG Yunou, CHEN Jiamin, LUO Liying, SHI Lei, LIU Hui

2025, 28(20):  2501-2507.  DOI: 10.12114/j.issn.1007-9572.2024.0567

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Background

With the popularization of digital media, screen-based electronics not only add convenience to life but also have adverse effects on sleep. Sleep is closely related to health, but there is a lack of research on the impact of screen time on sleep quality among patients with multimorbidity.

Objective

To explore the effect of screen time on sleep quality among patients with multimorbidity and seek measures to improve their sleep quality.

Methods

Using the data from the Fourth Adult Chronic Disease and Risk Factor Surveillance in Guangzhou in 2018, 6 177 patients with multimorbidity aged 35 and above were selected as study subjects. The Pittsburgh Sleep Quality Index scale was used to assess sleep quality. Calculated the average daily usage time of television, computers, and mobile phones among survey respondents. The average daily screen time of the respondents in this study was 4 h. Propensity score matching was used to match patients with multimorbidity who had ≤4 hours of daily screen time and >4 hours of daily screen time, and the matched data were analyzed by univariate and multivariate Logistic regression analyses to explore the relationship between screen time and sleep quality among patients with multimorbidity.

Results

Among 6 177 study subjects, 20.64% had poor sleep quality (1 275/6 177), and 39.40% (2 434/6 177) had screen time >4 hours per day. After propensity score matching, a total of 2 123 pairs of patients with multimorbidity who had daily screen time≤4 hours and daily screen time >4 hours were matched, totaling 4 246 cases. The results of multivariate Logistic regression analysis showed that the risk of poor sleep quality was higher in patients with >4 hours of daily screen time (OR=1.233, 95%CI=1.057-1.438). At the same time, females (OR=1.648, 95%CI=1.352-2.014), 55-64 years old (OR=1.617, 95%CI=1.171-2.270), ≥65 years old (OR=1.979, 95%CI=1.412-2.815), married/cohabiting (OR=0.683, 95%CI=0.540-0.866), retirees or unemployed individuals (OR=1.205, 95%CI=1.005-1.446), alcohol consumption (OR=1.318, 95%CI=1.103-1.574), having 3-4 kinds of chronic diseases (OR=1.612, 95%CI=1.363-1.907), having ≥5 kinds of chronic diseases (OR=2.314, 95%CI=1.799-2.967) were also factors affecting the sleep quality of patients with multimorbidity (P<0.05) .

Conclusion

Daily screen time >4 hours is associated with poor sleep quality in patients with multimorbidity, and reducing daily screen time have a positive effect on their sleep quality.

A Real-world Study of MRI-guided Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

TAN Yi, ZHU Lihong, YIN Zengwei, HOU Shunan, YU Houming

2025, 28(20):  2508-2515.  DOI: 10.12114/j.issn.1007-9572.2024.0442

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Background

Ischemic stroke has a high rate of disability and mortality, and for some patients, the onset time is difficult to confirm, making treatment for these patients particularly important.

Objective

To explore the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke of unknown onset time, guided by the mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) on MRI, in primary hospitals lacking CT perfusion.

Methods

A retrospective analysis was performed on 460 patients with acute ischemic stroke treated in the First People's Hospital of Lin'an District, Hangzhou, from March 2020 to February 2024. Patients with acute ischemic stroke and unknown onset time, excluding large vessel occlusion, were selected if their last known normal time was >4.5 hours and the time from symptom onset to treatment initiation was <4.5 hours. Those with DWI/FLAIR mismatch on MRI who received intravenous thrombolysis were included in the thrombolysis group. The control group consisted of acute ischemic stroke patients, within a clear time window of 4.5 hours or with an unknown onset time had DWI/FLAIR mismatch present and were eligible for intravenous thrombolysis, but refused the treatment. Clinical outcome measures were collected, including early neurological improvement, NIHSS score at 24 hours, hemorrhagic transformation, symptomatic intracranial hemorrhage (sICH), 90-day Modified Rankin Scale (mRS) score, 90-day mortality, and recorded occurrences of alteplase allergic reactions and ICU admissions. The efficacy and safety of treatment between the two groups were compared. Univariate analysis and multivariable binary Logistic regression models were used to analyze the influencing factors of early neurological improvement.

Results

A total of 83 patients were included in the thrombolysis group, 51 (61.4%) were male, with a mean age of (70.1±12.4) years.The control group had 55 patients, with 32 (58.2%) male and a mean age of (70.6±13.4) years. The thrombolysis group had a higher baseline NIHSS score and longer symptom recognition-to-admission time than the control group (P<0.05). The early neurological improvement rate in the thrombolysis group [50.6% (42/83) ] was significantly higher than that in the control group [23.6% (13/55) ] (P<0.05). There were no significant differences between the two groups in NIHSS score at 24 hours, hemorrhagic transformation rate, or symptomatic intracranial hemorrhage rate (P>0.05). When comparing males and females in terms of early neurological improvement, no significant differences were found [thrombolysis group: males 26 (61.9%), females 16 (38.1%), χ²=0.008, P>0.05; control group: males 6 (46.2%), females 7 (53.8%), χ²=1.012, P>0.05]. Multivariate Logistic regression analysis showed that intravenous thrombolysis was an influencing factor for early neurological improvement (OR=2.891, 95%CI=1.319-6.337, P=0.008). After adjusting for variables, the result indicated that pre-hospital notification combined with intravenous thrombolysis was an influencing factor for early neurological improvement (OR=6.938, 95%CI=3.120-15.427, P<0.001) .

Conclusion

In case of mild to moderate ischemic stroke without large vessel occusion, primary stroke centers using MRI to guide intravenous thrombolysis can provide short-term benefits for ischemic stroke patients with unknown onset time. Additionally, implementing pre-hospital notification may be more beneficial for early neurological recovery in these patients.

Study on the Relationship between Respiratory Drive Index and Oxygenation after Sputum Aspiration in Patients with Noninvasive Mechanical Ventilation

JING Chenchen, WANG Yanru, WANG Shujuan, XU Huihui, XING Qing

2025, 28(20):  2516-2522.  DOI: 10.12114/j.issn.1007-9572.2024.0072

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Background

Non-invasive positive pressure ventilation (NIPPV) is one of the important methods to treat acute exacerbation of chronic obstructive pulmonary disease (AECOPD). NIPPV combined with airway clearance therapy can effectively avoid endotracheal intubation and reduced length of hospital stay. The pathological characteristics of AECOPD make the indication of routine evaluation of airway suction lose its guiding value, frequent or delayed airway sputum aspiration is not beneficial to the positive pressure ventilation treatment of patients with acute phase of disease.

Objective

To establish the relationship between the oxygenation dropped dramatically after suction and respiratory effort index (ROX index and VOX index) in patients with AECOPD treated with NIPPV, and the predictive value of respiratory drive index on the time of suction.

Methods

Convenience sampling method was used, to investigate 140 AECOPD patients with NIPPV treated in the emergency intensive care unit of Qingdao Municipal Hospital from October 2022 to November 2023, the ROX index and VOX index were monitored and calculated within 24 h of non-invasive positive pressure ventilation and during sputum aspiration, the frequency and duration of a dramatic drop in SpO₂ (>10%) after sputum aspiration were assessed. Then analyzed the correlation between ROX index, VOX index and SpO₂ sharp drop after sputum aspiration, and ROX index and VOX index were plotted to predict the receiver operating characteristic (ROC) curve of SpO₂ sharp drop after sputum aspiration.

Results

One hundred and forty patients within 24 hours a total of 861 sputum aspiration, SpO₂ decreased sharply after sputum aspiration in 98 patients (70.0%) ; in 96 patients (68.6%), the incidence of SpO₂ decrease was more than 60%; in 75 patients (53.6%), SpO₂ decreased dramatically for 16-30 seconds, and in 10 patients (7.1%), SpO₂ decreased more than 30 seconds. The baseline ROX index and the ROX index 1 hour before sputum aspiration were negatively correlated with the incidence and duration of SpO₂ decrease after sputum aspiration (P<0.05), baseline VOX index and VOX index 1 hour before sputum aspiration were positively correlated with the incidence and duration of SpO₂ sharp decline after sputum aspiration (P<0.05). The area under the ROC curve of the baseline VOX index was 0.970 (95%CI=0.939-0.967), the best threshold was 0.007 4; the area under the ROC curve of the VOX index 1 hour before sputum aspiration was 0.893 (95%CI=0.826-0.959), the best threshold was 0.008 7.

Conclusion

When VOX index ≥0.007 4 after 1 h of NIPPV and VOX index ≥0.008 7 within 1 h before sputum aspiration, we should be alert to the occurrence of dramatic SpO₂ reduction after sputum aspiration.

Current Status and Characteristics of Novel Cancer Drugs Approved in China with Clinical Response Rate as a Surrogate Endpoint

ZHU Ting, ZHONG Jinjia, WU Hao, HUANG Yafang

2025, 28(20):  2523-2529.  DOI: 10.12114/j.issn.1007-9572.2024.0475

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Background

Cancer is a leading cause of death among residents in China, accounting for 23.1% of all disease-related deaths. To address the urgent needs of patients with severely life-threatening diseases, the National Medical Products Administration (NMPA) allows the use of clinical response rates (RRs) as a surrogate endpoint to support conditional approval of new drugs.

Objective

To analyze the current situation and characteristics of new anticancer drugs approved in China based on clinical RRs as a surrogate endpoint.

Methods

This study systematically collected data on anticancer drugs approved by the NMPA from 2017 to 2023, focusing on anticancer drugs and their indications that were approved based on RRs as surrogate endpoint. The study analyzed the initial approval types of these drugs (including regular approval and conditional approval), the types of efficacy endpoints used for subsequent conversion to regular approval, clinical treatment lines, trial designs for initial drug approval and post-marketing confirmation, drug mechanism classifications, and cancer types. Additionally, the study compared the differences in RRs among anticancer drugs with different NMPA approval types.

Results

From 2017 to 2023, NMPA approved 95 indications for 68 new anticancer drugs based on RRs as surrogate endpoint for advanced or metastatic cancers. Among these, 21 (22.1%) were granted regular approval, while 74 (77.9%) were conditionally approved. Of the 74 conditionally approved indications, 13 (17.6%) were subsequently converted to regular approval. The median RRs for all 95 indications was 59.0% (35.8%, 75.8%). Specifically, 47 (49.5%) indications had RRs higher than or equal to 60%, while 16 (16.8%) had RRs lower than 30% [with 15 (93.8%) of these being for second-line or higher treatment]. There was no statistically significant difference in RRs between conditionally approved and regularly approved anticancer drugs (P=0.076) .

Conclusion

The standards for conditional approval of novel anticancer drugs in China based on RRs are strict and show no significant difference compared to regular approval. The RRs of the majority of novel anticancer drugs exceed internationally recommended standards.

Construction of a Medical Transition Intervention Model for Multiple Chronic Diseases in Children Based on the E-Coach Management Model

GUO Yi, HAN Xuanye, LIU Zhaojun, JIANG Yaoyao, FU Yang, SHI Lei, ZHAO Shihong

2025, 28(20):  2530-2537.  DOI: 10.12114/j.issn.1007-9572.2024.0479

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Background

With adva nces in medical technology, more than 90 percent of children with chronic diseases need to be transitioned from pediatric to adult care, and the greater number of chronic diseases a child has, the higher risk of morbidity and mortality. However, until now, research in China focused mainly on multiple chronic diseases in adults, and there are no systematic and comprehensive interventions for the transition of children with multiple chronic diseases.

Objective

To form healthcare transition intervention models for multiple chronic diseases in children based on the E-Coach management model.

Methods

In April 2024, a systematic search was conducted for domestic and international literature on the medical transition of children with multiple chronic diseases. Two researchers independently screened the literature, evaluated the methodological quality of the included literature, extracted and summarized the evidence, and initially formed an intervention model for the medical transition of children with multiple chronic diseases based on the E-Coach management model after discussion in the research group. From May to June 2024, two rounds of correspondence were conducted with experts using the expert correspondence method, and the medical transition intervention model was finalized by calculating the coefficient of expert positivity, the coefficient of expert authority, the coefficient of expert coordination, and the coefficient of variation for each level of entries.

Results

A total of 1 734 documents were searched, and 11 documents were finally included, summarizing 36 pieces of evidence involving four aspects: intervention goals, intervention forms, intervention targets, and intervention measures. The E-Coach management model-based multiple chronic disease medical transition intervention model for children, which was initially constructed after discussion by the research group, contains 4 primary indicators, 13 secondary indicators, and 21 tertiary indicators. The recovery rates of the two rounds of expert questionnaires were 100.0%, the expert authority coefficients were 0.813 and 0.830, the Kendall's W coefficients of the importance of the indicators were 0.270 (χ²=149.866, P<0.001) and 0.321 (χ²=154.058, P<0.001), and the Kendall's W coefficients of the feasibility of the indicators were 0.266 (χ²=147.396, P<0.001), 0.362 (χ²=173.605, P<0.001), respectively. The finalized medical transition intervention model for children with multiple chronic diseases based on the E-Coach management model included four primary indicators (intervention target, intervention team, intervention form, and intervention measures), 10 secondary indicators, and 19 tertiary indicators.

Conclusion

The medical transition intervention model for children with multiple chronic diseases based on the E-Coach management model has strong reliability and operability, and can provide guidance for clinical healthcare professionals to carry out medical transition interventions for children with multiple chronic diseases.

Effect of Semaglutide in Hepatic Lipid Metabolism of Rats in a Methionine-choline Deficient Diet-induced Non-alcoholic Fatty Liver Disease Model

ZHANG Quanai, LI Sha, WANG Kaiti, DONG Huicong, LU Xiaofei, GUO Yongze

2025, 28(20):  2538-2545.  DOI: 10.12114/j.issn.1007-9572.2023.0534

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Background

Semaglutide, as one of the glucagon-like peptide-1 (GLP-1) receptor agonists, has significant potential for alleviating the progression of non-alcoholic fatty liver disease (NAFLD). However, its mechanism of action remains unclear.

Objective

To investigate the effect of semaglutide on hepatic lipid metabolism, further explore the pathogenesis of NAFLD and help clinical diagnosis and treatment.

Methods

Between September and November 2022, 30 SPF-grade male SD rats, aged 5-8 weeks with a body weight of (180±20) g, were acclimatized for one week and then randomly divided into three groups of control, model, and intervention, with 10 rats in each. The NAFLD rat model was prepared, and the intervention group received semaglutide at 40 μg/kg dissolved in 0.9% saline solution subcutaneously. The control and model groups received an equivalent volume of 0.9% saline subcutaneously. The general condition of the rats was observed, with hematoxylin-eosin (HE) staining and Oil Red O staining to examine liver tissue lesions. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and liver tissue triglyceride (TG) levels were measured. Real-time polymerase chain reaction (RT-PCR) was used to detect mRNA expression of fatty acid synthase (FAS), acetyl-CoA carboxylase 1 (ACC1), carnitine palmitoyltransferase 1α (CPT1α), acyl-CoA oxidase (AOX), fatty acid transport protein 36 (FAT/CD36), liver fatty acid-binding protein (LFABP), apolipoprotein B (ApoB), and microsomal triglyceride transfer protein (MTTP). Western blotting assay was used to detect FAT/CD36 protein levels.

Results

There was no death of animals in all groups during the experimental period, and the rats in the control group exhibited smooth and glossy fur with good spirit, while the rats in the model group and intervention group showed a significant reduction in body weight, disorganized and lusterless hair, reduced activity and depressed spirit with the increase in feeding time. The body weight of the model group was lower than that of the control group at the end of the intervention, and the intervention group was higher than that of the model group (P<0.05). The liver weight of the model group was higher than the control group, and lower in the intervention group (P<0.05). The levels of ALT, AST, and TG were higher than those in the model group than in the control group, and lower in the intervention group (P<0.05). The levels of CPT1α, AOX, LFABP, ApoB, and MTTP were lower in the model group than in the control group, and the level of FAT/CD36 was lower in the intervention group (P<0.05). The model group had higher levels of FAT/CD36 than the control group, and the intervention group had lower levels than the model group (P<0.05) .

Conclusion

Semaglutide alleviated hepatic lipid deposition in NAFLD rats, potentially related to the downregulation of FAT/CD36 expression.

Original Research·Evidence-based Medicine

Risk Factors for Severe Acute Pancreatitis Complicated with Acute Lung Injury: a Meta-analysis

GUO Shengteng, ZHANG Fenfen, WAN Di, YU Dongmei, WANG Qinghua

2025, 28(20):  2546-2554.  DOI: 10.12114/j.issn.1007-9572.2024.0380

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Background

Acute lung injury represents the most probable organ injury in the context of severe acute pancreatitis, with the exception of the pancreas, which is primarily distinguished by respiratory insufficiency, manifested as shortness of breath, cyanosis, and diminished lung compliance. Nevertheless, the precise pathogenesis remains incompletely elucidated. Despite the administration of protective measures, the quality of life of patients with severe acute pancreatitis complicated by acute lung injury remains adversely affected.

Objective

To systematically evaluate the risk factors of severe acute pancreatitis complicated with acute lung injury.

Methods

Computer searches were conducted on CNKI, Wanfang database, VIP, PubMed, Web of Science and EBSCO databases to search relevant studies on the risk factors of severe acute pancreatitis complicated with lung injury from the establishment of the database to October 2023. Two researchers independently screened literature, extracted data, evaluated literature quality and evidence level, and conducted meta-analysis using RevMan 5.3 software. Begg's test in Stata17.0 was used for publication bias analysis.

Results

A total of 10 studies were included, all of which were case-control studies, including 1 053 patients with severe acute pancreatitis. The results of meta-analysis showed that increased age (SMD=0.58, 95%CI=0.03-1.14, P=0.04), elevated fasting blood glucose (SMD=0.45, 95%CI=0.27-0.64, P<0.000 01), and an elevated respiratory rate (>30 breaths/min) (OR=6.18, 95%CI=3.20-11.94, P<0.000 01), the occurrence of fever (OR=12.92, 95%CI=4.41-37.84, P<0.000 01), the occurrence of pleural effusion (OR=7.19, 95%CI=3.25-15.91, P<0.000 01), decreased albumin (SMD=-0.77, 95%CI=-0.98 to -0.56, P<0.000 01), combined with obesity (OR=3.11, 95%CI=1.94-4.98, P<0.000 01), decreased calcium ion (SMD=-0.63, 95%CI=-0.85 to -0.42, P<0.000 01), combined with acidosis (OR=2.15, 95%CI=1.03-4.49, P=0.04), elevated C-reactive protein (SMD=0.79, 95%CI=0.56-1.03, P<0.000 01), decreased hemoglobin (SMD=-0.77, 95%CI=-1.10 to -0.43, P<0.000 01), elevated blood amylase (SMD=0.21, 95%CI=0.01-0.42, P=0.04), increased urinary amylase (SMD=0.40, 95%CI=0.03-0.77, P=0.03), elevated Ranson score (SMD=0.87, 95%CI=0.66-1.08, P<0.000 01), a rise in APACHE Ⅱ score (SMD=0.77, 95%CI=0.58-0.96, P<0.000 01), increased CT severity index score (SMD=0.39, 95%CI=0.19-0.59, P<0.000 01), elevated BISAP (SMD=0.62, 95%CI=0.37-0.88, P<0.000 01), severe acute pancreatitis with hyperlipidemia (OR=1.68, 95%CI=1.05-2.67, P=0.03), combined with SIRS (OR=9.57, 95%CI=4.03-22.72, P<0.000 01), number of organ injury (≥2) (OR=6.94, 95%CI=3.34-12.59, P<0.000 01), the occurrence of infection (OR=4.59, 95%CI=2.42-8.71, P<0.000 01) were risk factors for severe acute pancreatitis complicated with acute lung injury. The results of the publication bias analysis demonstrated that no significant publication bias was observed for the 14 factors (age, obesity, glucose, albumin, calcium ions, C-reactive protein, serum amylase, respiratory rate, Ranson score, APACHE Ⅱ score, CT severity index score, BISAP, hyperlipidemicity and pleural effusion) for which the analyses were conducted (P>0.05). The GRADE evidence evaluation demonstrated that a total of 11 risk factors (age, respiratory rate, pleural effusion, obesity, hemoglobin, serum amylase, urinary amylase, Ranson score, BISAP, hyperlipidemicity and organ damage) exhibited moderate quality, while 10 (fasting blood glucose, fever, albumin, calcium ions, acidosis, C-reactive protein, APACHE Ⅱ score, CT severity Index score, SIRS and infection) demonstrated low quality.

Conclusion

Age increase, fasting blood glucose, amylase, C-reactive protein, urinary amylase increase, albumin, hemoglobin, calcium ion concentration decrease, respiratory rate (>30 breaths/min), Ranson score, APACHE Ⅱ score, CT severity index score, BISAP score high, SAP subtype - hyperlipidemia, fever, acidosis, obesity, pleural effusion, SIRS, organ involvement (≥2) and infection were the risk factors for ALI in SAP patients. In the future, it is necessary to carry out further high-level research to prove the above research results.

A Systematic Review of the Assessment Tools for Maternal Psychological Birth Trauma

WEN Yongxia, SUN Hai, CHEN Xiaoju, CAI Wanjing, LI Shuni, GUO Honghua

2025, 28(20):  2555-2561.  DOI: 10.12114/j.issn.1007-9572.2024.0291

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Background

Psychological birth trauma is closely related to maternal mental health, so identifying and evaluating the effectiveness of interventions are extremely important. There are many assessment tools for psychological birth trauma, but there is a lack of research evaluating the quality for them.

Objective

To systematically review the methodological quality and measurement properties of assessment tools of psychological birth trauma, so as to provide a reference for subsequent research.

Methods

PubMed, Web of Science, CINAHL, APA psycArticles, Embase, CNKI, Wanfang, VIP and CBM databases were searched on assessment tools of psychological birth trauma from the date of library construction to November 6, 2023. Literature screening, extraction and evaluation were conducted independently by 2 researchers and cross-checked.

Results

Six literature involving six assessment tools for psychological birth trauma were included: the Birth Trauma Perception Assessment Scale (BTPS), the Maternal Childbirth Trauma Scale (MCTS), the Chinese version of the Traumatic Childbirth Perception Scale (TCPS-C), the Birth Trauma Scale (BTS), the Traumatic Childbirth Perception Scale (TCPS), and the Childbirth Trauma Index (CTI). None of assessment tools reported measurement error, cross-cultural validity, hypothesis testing, and responsiveness; In terms of content validity was "adequate" for the MCTS, TCPS-C, BTS, and TCPS, "uncertain" for the BTPS, and not reported for the "CTI"; In terms of structural validity, TCPS-C was "adequate", the remaining scales were "uncertain"; In terms of internal consistency, MCTS was "inadequate", the remaining scales were "adequate"; In terms of stability, BTPS, MCTS, and TCPS-C were "adequate", the remaining scales were "not mentioned". Ultimately, the recommendation grade for TCPS-C, BTS, and TCPS were A, and for BTPS, MCTS, and CTI were B.

Conclusion

TCPS-C, BTS and TCPS are valid assessment tools and can be provisionally recommended. However, their measurement properties and methodological quality are still inadequate, and this aspect can be further studied and continuously optimized in the future to improve the scientific and accuracy of the assessment tools and promote the development of related fields.

Review & Perspectives

Exploration of the Association and Mechanism between Abnormal Lipid Metabolism and Depressive Development

LI Xinyue, WU Minmin, ZHU Luwen

2025, 28(20):  2562-2569.  DOI: 10.12114/j.issn.1007-9572.2024.0233

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Lipid metabolism is a key physiological process in the human body, and its disruption is closely omected with the onset and development of depression. Nevertheless, a systematic collation of these associations is currently inadequate. This article comprehensively explored the changes in lipid metabolism in patients with depression and elaborates on disorders in which disorders of lipid metabolism were co-morbidly associated with depression, such as overweight, obesity and metabolic syndrome. In addition, the article summarised five intrinsic mechanisms by which abnormalities in lipid metabolism were associated with the development of depression: overexpression of SNCA genes and abnormal accumulation of α-Syn, iron death, dysbiosis of gut microbiota, impairment of mitochondrial quality control systems, and chronic stress. Finally, this article suggested future research directions aimed at providing a new perspective and research basis for the early diagnosis and treatment of depression.

Research Progress on the Mechanism of Exercise Rehabilitation in Improving Coronary Microcirculation Disorder

GAO Guiying, HU Yang, ZHANG Shiyi, MENG Yi, DENG Jie

2025, 28(20):  2570-2576.  DOI: 10.12114/j.issn.1007-9572.2024.0286

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Coronary microcirculation disorder refers to the clinical syndrome caused by the abnormal structure and/or function of the precoronary arterioles and arterioles, which is closely related to the prognosis of cardiovascular diseases such as acute coronary syndrome, coronary offender vascular revascularization and heart failure. As a non-drug intervention for the prevention and treatment of cardiovascular diseases, exercise rehabilitation improves endothelial function and oxidative inflammation stimulation in patients with coronary microcirculation disorders through signaling molecules, restores mitochondrial autophagy level, and induces functional recovery of perivascular adipose tissue. This article reviewed the research progress of exercise rehabilitation intervention in coronary microcirculation disorder, aiming to provide more ideas and references for exercise rehabilitation treatment of coronary microcirculation disorder.