Table of Content

15 August 2025, Volume 28 Issue 23

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Guidelines·Consensus

Expert Consensus on the Application Technology System Standard of Virtual Simulation for Clinical Practice Skills

Chinese Hospital Association, Committee for Healthcare Simulation

2025, 28(23):  2833-2840.  DOI: 10.12114/j.issn.1007-9572.2025.0076

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The rapid advancement of virtual simulation technology has catalyzed transformative changes in clinical practical skills training and assessment. In recent years, extensive research and practical applications leveraging this technology have been conducted both domestically and internationally. To unify, standardize, and promote virtual simulation training and assessment for clinical practice skills and evaluation systems, the Chinese Hospital Association, Committee for Healthcare Simulation has organized a multidisciplinary panel of experts spanning clinical practice, technical development, education, and administrative management. Draw lessons from comprehensive investigation of domestic and foreign technical standards, expert consensus, systematic evaluation, original research and other materials related to medical virtual simulation training and assessment, as well as disease diagnosis and treatment guidelines, management consensus and other literatures, which formulate the Expert Consensus on the Application Technology System Standard of Virtual Simulation for Clinical Practice Skills (hereafter referred to as the Consensus). The Consensus was first drafted and revised, and experts including clinical, technical and management in the field of practical skills training and assessment were invited to review the draft and solicit public opinion through email, virtual meeting and in-person ways. After three rounds of opinion solicitation and expert discussion, the draft was revised to improve the final draft of Consensus. The Consensus was composed of four parts: virtual simulation content design and modeling, management platform interface design, content quality evaluation, data transmission and security. This Consensus was made by fully learning related standards, guidelines, consensus, and clinical research for medical virtual simulation training, as well as comprehensive evaluation opinions from experts, which can provide potential reference for medical colleges, medical or training institutions to carry out virtual simulation training for clinical practice skills.

Article·Multimorbidity Section·Co-management of T2DM & MAFLD

Innovative Practices in Chronic Disease Management: a New Model for Generalist-Specialist Combination Management of Diabetes and Metabolic Dysfunction-associated Fatty Liver Disease

BAI Xue, CHEN Qianqian, LI Jie

2025, 28(23):  2841-2845.  DOI: 10.12114/j.issn.1007-9572.2025.0067

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The evolution of diagnostic term from non-alcoholic fatty liver disease (NAFLD) to the metabolic dysfunction-associated fatty liver disease (MAFLD) aims to highlight the critical role of "metabolic dysfunction" in the development and progression of fatty liver diseases. As one of the most common metabolic disorders globally, type 2 diabetes mellitus (T2DM) is now considered as the most common complication of MAFLD. The two diseases interact in ways that adversely affect various systems within the body. With regard to this situation, it is urgently to fully implement the "holistic medical approach" and explore a full-cycle and comprehensive management model for patients with both T2DM and MAFLD, which is of great significant for improving their prognosis. This article summarizes the epidemiology and pathogenesis of patients with MAFLD and T2DM, and shared the innovative practices of the new multidisciplinary management model, aiming to provide more support for the co-management of MAFLD and T2DM.

Advances in the Co-management of Metabolism Dysfunction-associated Fatty Liver Disease and Type 2 Diabetes Mellitus

WANG Peng, QIU Lixia, XU Shanshan, ZHANG Yang, ZHANG Jing, DU Xiaofei

2025, 28(23):  2846-2851.  DOI: 10.12114/j.issn.1007-9572.2024.0591

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Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) are the two most common metabolic diseases worldwide. The coexistence of MAFLD and T2DM has a high prevalence rate and accelerates disease progression, imposing a significant disease burden on patients and posing a major public health challenge. MAFLD and T2DM mutually influence each other, sharing common pathogenic mechanisms. Developing effective co-management strategies for MAFLD and T2DM is a critical clinical priority. This review elaborates on recent advances in the epidemiology, pathogenesis, screening, monitoring, and treatment of T2DM combined with MAFLD. It highlights that the co-existence of T2DM and MAFLD has become a common clinical phenomenon with each condition exacerbating the development and progression of the other. Screening for MAFLD should be implemented in T2DM patients. Non-invasive diagnostic tools such as the Fibrosis 4 Index and NAFLD Fbrosis Score can be used for routine screening, though their accuracy requires further validation. Additionally, medications like sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have been shown to improve outcomes in patients with T2DM and MAFLD, effectively preventing cardiovascular events. This review provides reference for the optimization of clinical diagnosis and treatment strategy of T2DM combined with MAFLD and the formulation of clinical "glycohepatic co-management" strategy.

Correlation of Fasting C-peptide to Diabetes Duration Ration and Type 2 Diabetes Mellitus Combined with Metabolism-related Fatty Liver Disease

LIU Yueying, WANG Xueli, LIU Yuqiu, WEI Limin

2025, 28(23):  2852-2860.  DOI: 10.12114/j.issn.1007-9572.2024.0566

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Background

Type 2 diabetes mellitus (T2DM) is the most common type of diabetes. The incidence of metabolic associated fatty liver disease (MAFLD) in T2DM patients is higher than that in non - diabetic patients. Therefore, it is of great significance to find effective indicators for predicting the occurrence of MAFLD in T2DM patients.

Objective

This study aims to explore the predictive value of the ratio of fasting C-peptide to diabetes duration (FCP/DD) for the occurrence of MAFLD in patients with T2DM, providing a potential indicator for the early prevention and management of MAFLD.

Methods

This study enrolled 532 patients diagnosed with T2DM at the Department of Endocrinology, Hebei General Hospital from September 2018 to December 2021. Demographic data were collected, and fasting blood samples were obtained to assess biochemical parameters. The FCP/DD was computed using a predefined formula. Participants were stratified into MAFLD (n=359) and non-MAFLD (n=173) groups based on the presence or absence of MAFLD. Further classification into low FCP/DD (n=266) and high FCP/DD (n=266) groups was performed according to the median FCP/DD ratio. The relationship between the FCP/DD ratio and MAFLD incidence in T2DM patients were examined using Spearman rank correlation and Logistic regression analyses. The predictive efficacy of the FCP/DD ratio for MAFLD was evaluated by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC) .

Results

The FCP/DD in the MAFLD group was higher than that in the non-MAFLD group (P<0.05). The incidence of MAFLD in the high FCP/DD group was higher than that in the low FCP/DD group (P<0.05). The Spearman rank correlation analysis results showed that in patients with T2DM and MAFLD, FCP/DD was negatively correlated with age and high-density lipoprotein cholesterol (HDL-C), and positively correlated with BMI, fasting blood glucose (FBG), glycated hemoglobin (HbA_1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and triglyceride-glucose index (TyG) (P<0.05). The results of multivariate Logistic regression analysis showed that after adjusting for confounding factors, a high level of FCP/DD was an independent risk factor for the occurrence of MAFLD in T2DM patients (P<0.05). The ROC curve results showed that the AUC of FCP/DD for predicting the occurrence of MAFLD in T2DM patients was 0.829 (95%CI=0.791-0.867), the AUC of FCP was 0.758 (95%CI=0.711-0.805), the AUC of HbA_1c was 0.525 (95%CI=0.471-0.578), and the AUC of TyG was 0.733 (95%CI=0.689-0.778) .

Conclusion

The level of FCP/DD was significantly increased. T2DM patients with high levels of FCP/DD had a higher risk of developing MAFLD. FCP/DD ratio has better predictive value than FCP, HbA_1c, TyG for combined MAFLD in T2DM patients.

Correlation Analysis and Model Construction of Metabolic Associated Fatty Liver Disease and Hyperglycemia Based on a Health Examination Cohort

WU Sha, ZHANG Daiyi, LI Jin, XUAN Qinkao, QIAN Xiaodong, ZHU Chuanwu, PU Jianhong, ZHU Li

2025, 28(23):  2861-2869.  DOI: 10.12114/j.issn.1007-9572.2024.0527

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Background

The global prevalence and incidence of metabolic associated fatty liver disease (MAFLD) co-occurring with type 2 diabetes mellitus (T2DM) are increasing, significantly elevating the risk of liver-related adverse outcomes. In clinical practice, early screening and diagnosis of high-risk MAFLD patients with hyperglycemia are crucial to slowing disease progression.

Objective

Based on the relationship between T2DM and MAFLD, this study evaluates the impact of hyperglycemia on hepatic steatosis and liver fibrosis in MAFLD using large-scale health examination data and aims to identify key factors influencing the development of MAFLD with hyperglycemia.

Methods

Data from 18 286 individuals who underwent health examinations at the First Affiliated Hospital of Soochow University from March to July 2024 were analyzed. The dataset included demographic information, medical history, abdominal ultrasound results, biochemical markers, and routine blood tests. Individuals meeting the MAFLD diagnostic criteria were classified into the MAFLD group, which was further stratified into three subgroups according to the Fibrosis-4 index (FIB-4) scores: T1 (FIB-4<1.30, n=4 275), T2 (1.30≤FIB-4≤2.67, n=924), and T3 (FIB-4>2.67, n=59). Clinical indicators among these subgroups were compared. Additionally, the MAFLD group was divided into two subgroups: MAFLD with hyperglycemia (n=752) and MAFLD without hyperglycemia (n=4 506), based on a history of diabetes, fasting blood glucose (FBG) ≥7.0 mmol/L, or glycated hemoglobin A1c (HbA_1c) ≥6.5% (meeting any one criterion). Differences in hepatic steatosis and liver fibrosis-related indicators between these subgroups were analyzed. Univariate and multivariate Logistic regression analyses were performed to identify key factors associated with MAFLD with hyperglycemia. The predictive performance of a combined model for MAFLD with hyperglycemia was evaluated using the receiver operating characteristic (ROC) curve analysis.

Results

Among the T1, T2, and T3 groups, significant differences (P<0.05) were observed in clinical indicators, including smoking, hypertension, diabetes, hyperlipidemia, hyperuricemia, coronary heart disease, age, BMI, FBG, HbA_1c, platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), red blood cell distribution width (RDW), neutrophil count (NEUT), lymphocyte count (LYM), monocyte count (MONO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), albumin (ALB), glutamyl transferase (GGT), uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), alkaline phosphatase (ALP), and estimated glucose processing rate (eGDR). Moreover, the fatty liver index (FLI), hepatic steatosis index (HSI), and ZJU index were significantly higher in the MAFLD with hyperglycemia group compared to the MAFLD without hyperglycemia group (P<0.05). Additionally, the FIB-4, AST/PLT ratio index (APRI), non-alcoholic fatty liver disease fibrosis score (NFS), and BMI, AST/ALT and diabetes score (BARD) were also higher in the MAFLD with hyperglycemia group (P<0.05). The samples of MAFLD with hyperglycemia and MAFLD without hyperglycemia groups were randomly divided into training and validation sets at 1∶1 ratio respectively. In the training set, univariate and multivariate Logistic regression analyses identified age, waist circumference (WC), hypertension, hyperlipidemia, TG, GGT, UA and BUN as key influencing factors associated with MAFLD with hyperglycemia (P<0.05). Further ROC analysis of these factors demonstrated moderate predictive accuracy for MAFLD with hyperglycemia (0.53≤AUC≤0.75). A predictive model incorporating these eight key factors achieved an AUC of 0.805 (95%CI=0.781-0.828), with a sensitivity of 75.8% and specificity of 72.6%. Validation of this combined model in the validation set yielded a positive predictive value of 70.5%, a negative predictive value of 73.1%, and an overall predictive accuracy of 72.7%.

Conclusion

Among MAFLD patients stratified by FIB-4, significant differences in hypertension, FBG, HbA_1c, PLT, WBC, RBC, LYM, AST, and eGDR were observed across the three subgroups. Hyperglycemia exacerbates hepatic steatosis and liver fibrosis in MAFLD. Furthermore, age, WC, hypertension, hyperlipidemia, TG, GGT, UA and BUN were identified as significant risk factors for the progression of MAFLD to MAFLD with hyperglycemia. The predictive model incorporating these eight indicators enhances the accuracy of assessing hyperglycemia risk in MAFLD, potentially providing a reference for the early differential diagnosis in clinical practice.

Article

Study on Nomogram Prediction Model for Risk of Gastric Cancer

ZHOU Qian, WU Xiaomin, WANG Baohua, YAN Ruohan, YU Miao, WU Jing

2025, 28(23):  2870-2877.  DOI: 10.12114/j.issn.1007-9572.2024.0525

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Background

Gastric cancer (GC) causes a heavy burden in China. Predicting individual GC risk can help to identify high-risk groups early, and then take targeted interventions to avoid or delay GC progression.

Objective

Establish and validate a nomogram model for predicting individual GC risk.

Methods

From January 2020 to July 2021, GC patients ≥40 years were diagnosed from the cancer registry system in 14 counties (districts) of Anhui province, Henan province, Shandong province and Jiangsu province were selected as the case group (684 cases). Match the general population with a frequency of 1∶2 based on gender, age, place of residence and health status matching people as a control group (1 368 cases). All subjects were randomly divided into training set (1 641 cases) and validation set (411 cases) according to a ratio of 8∶2. Multivariate Logistic regression analysis was used to screen variables and establish nomogram prediction model. The receiver operating characteristic (ROC) curve of the model predicting the risk of GC was drawn, the discrimination and calibration of the model were evaluated via the area under the ROC curve (AUC) and the Hosmer-Lemeshow test. The model was verified by Bootstrap method and the decision curve analysis (DCA) was used to evaluate the clinical practicability of the model.

Results

Multivariate Logistic regression analysis showed that salty tastes (OR=1.690, 95%CI=1.333-2.142), dry and hard diet (OR=1.596, 95%CI=1.145-2.225), spicy food tastes (OR=1.387, 95%CI=1.093-1.760), exposure to secondhand smoking (OR=1.880, 95%CI=1.473-2.399), frequent tantrums (OR=3.283, 95%CI=2.236-4.819), history of stomach disease (OR=4.008, 95%CI=3.046-5.273), the family history of cancer (OR=1.549, 95%CI=1.170-2.051), Helicobacter pylori (Hp) infection (OR=1.298, 95%CI=1.028-1.693), high-salt diet (OR=1.338, 95%CI=1.033-1.734) were independent risk factors for GC (P<0.05). Junior high school education (OR=0.616, 95%CI=0.468-0.811), high school education or above (OR=0.491, 95%CI=0.342-0.703), regular diet (OR=0.542, 95%CI=0.405-0.726), the garlic consumption (OR=0.501, 95%CI=0.394-0.636) were protective factors for GC (P<0.05). The AUC for predicting GC risk in the training and validation sets was 0.768 (95%CI=0.744-0.792) and 0.776 (95%CI=0.728-0.823), respectively. The verification results of Bootstrap method showed that the calibration curve was in good agreement with the actual curve (Brier score of training set=0.177; Brier score of verification set=0.176) ; Hosmer-Lemeshow results showed that the model had a good fit (training set: χ²=4.408, P=0.819; verification set: χ²=4.650, P=0.794). The DCA curve showed that when the threshold is between 0.05 and 0.79, patients can benefit clinically using the nomogram model to predict the risk of GC occurrence.

Conclusion

The nomogram model constructed in this study could predict individual GC risk, early identify high-risk groups and help to formulate targeted and individualized interventions.

The Impact of Early Microcirculation Perfusion after Percutaneous Coronary Intervention for Acute Myocardial Infarction on Left Ventricular Function

WANG Jiuge, ZHAN Wuyi, HE Anxia

2025, 28(23):  2878-2884.  DOI: 10.12114/j.issn.1007-9572.2025.0081

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Background

Although percutaneous coronary intervention (PCI) is capable of successfully reopening the occluded vessels beneath the epicardium in patients with acute myocardial infarction (AMI), a considerable proportion of patients experience coronary microvascular dysfunction (CMD) post-PCI, and this significantly affects the recovery of long-term cardiac function. Nevertheless, the dynamic change trends of early microcirculation perfusion after PCI therapy on cardiac function at different periods remain undefined.

Objective

To examine the influence of early coronary microcirculation perfusion following PCI on the left ventricular remodeling and functional changes at different postoperative time points in AMI patients.

Methods

A total of 98 AMI patients successfully treated with PCI in the Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine from June 2021 to June 2023 were divided into two groups based on myocardial contrast echocardiography (MCE) findings on 2-7 days postoperatively: the normal coronary microcirculation perfusion (NOR) group (n=41) and microvascular perfusion abnormalities (MPA) group (n=57). Echocardiographic assessments of left ventricular systolic and diastolic function were performed at 2-7 days, 2 months, and 12 months postoperatively. Clinical data from both groups were collected and subjected to statistical analysis.

Results

Compared with the NOR group, patients in the MPA group exhibited higher brain natriuretic peptide (BNP) levels (P<0.001), lower proportion of preoperative standardized medication use (P=0.025), higher proportion of ST-segment elevation myocardial infarction (STEMI) (P=0.032). Compared with the NOR group, patients in the MPA group exhibited lower left ventricular ejection fraction (LVEF) and absolute values of global longitudinal strain (GLS) at 2-7 days, 2 months, and 12 months postoperatively. Additionally, the left ventricular internal diameter at end-diastole (LVIDd), left ventricular internal diameter at end-systole (LVIDs), left ventricular end-diastolic volumetric capacity (LVEDV) and left ventricular end-systolic volumetric capacity (LVESV), and anteroposterior diameter of the left atrium (LAD') were larger in the MPA group than the NOR group (P<0.05). Furthermore, the ratio of early mitral inflow velocity to early diastolic velocity of the mitral annulus (E/e') at 12 months postoperatively was significantly higher than that in the NOR group (P<0.05). Compared with the 2-7 days postoperative period, patients in both groups exhibited significant improvements in LVEF and absolute values of GLS at 2 months and 12 months after PCI. Additionally, LVEDV and LVESV were significantly reduced during these follow-up periods (P<0.05). Spearman correlation analysis revealed that early microcirculation perfusion after PCI was negatively correlated with LVEF changes from 2-7 days to 12 months postoperatively (r_s=-0.305, P=0.019) and from 2 months to 12 months postoperatively (r_s=-0.279, P=0.034). In contrast, it was positively correlated with LVEF changes from 2-7 days to 2 months postoperatively (r_s=0.276, P=0.019). Multivariate Logistic regression analysis showed that LVEF (2-7 days after PCI) (OR=0.151, 95%CI=0.040-0.568, P=0.005) and myocardial perfusion (OR=0.098, 95%CI=0.026-0.366, P<0.001) were independent risk factors for recover in left ventricular function at 12 months after PCI in AMI patients.

Conclusion

The early microcirculation perfusion level following PCI in AMI patients is associated with subsequent left ventricular functional alterations. Patients with poor early microcirculation perfusion exhibit poorer left ventricular systolic function. Even if there is a marked improvement in the short term, the long-term recovery remains unsatisfactory.

Cognitive Impairment in Patients on Maintenance Hemodialysis and Its Influencing Factors: a Multicenter Cross-sectional Study

DING Zijun, ZHOU Nannan, LUO Xing, LUO Jieyu, HAO Wenjuan, ZHANG Chunjiang, JIN Xin, ZHAO Dan

2025, 28(23):  2885-2893.  DOI: 10.12114/j.issn.1007-9572.2024.0425

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Background

Understanding the condition and influencing factors of cognitive impairment in maintenance hemodialysis (MHD) patients could signficantly enhance their quality of life while alleviating the burden on their families and society.

Objective

TO investigate the status of cognitive impairment in MHD patients and explore the possible influencing factors.

Methods

Using convenience sampling, we selected MHD patients from three hemodialysis centers (including the Department of Nephrology at the First Affiliated Hospital of Shihezi University, the Department of Nephrology at Shihezi People's Hospital, and the Langshen Hemodialysis Center) in Shihezi City between April 2023 and April 2024. We collected data on demographic characteristics, cognitive impairment levels, sleep quality, independent living abilities, serum levels of α-Klotho, β-Klotho, FGF-23, and other common laboratory indicators. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), sleep quality was evaluated with the Athens Insomnia Scale (AIS-8), and independent living ability was assessed using the Functional Activities Questionnaire (FAQ). Serum levels of α-Klotho, β-Klotho, and FGF-23 were measured by the ELISA method. Univariate and multivariate Logistic regression analyses were performed to identify influencing factors, which were validated for their predictive value on cognitive impairment using the receiver operating characteristic (ROC) curve. A nomogram was subsequently plotted.

Results

A total of 276 MHD patients were surveyed, revealing a cognitive impairment incidence rate of 76.4% (211/276). Among these, 145 patients had mild cognitive impairment and 66 patients had moderate cognitive impairment. Nearly half of the patients exhibited suspected insomnia (21.4%) or confirmed insomnia (25.4%). Among the patients studied, 14.9% (41 out of 276) lacked the ability to live independently. The multivariate Logistic regression analysis indicated that age (OR=1.038, 95%CI=1.004-1.072) and sleep disorders (OR=1.179, 95%CI=1.051-1.322) were risk factors for cognitive impairment in MHD patients (P<0.05). High serum α-Klotho levels (OR=0.996, 95%CI=0.994-0.998), high serum β-Klotho levels (OR=0.750, 95%CI=0.661-0.852), and higher years of education (OR=0.800, 95%CI=0.699-0.915) were protective factors (P<0.05). The area under the ROC curve (AUC) showed that age (AUC=0.732, 95%CI=0.667-0.797), sleep disorder (AUC=0.710, 95%CI=0.638-0.783), α-Klotho (AUC=0.774, 95%CI=0.709-0.839), β-Klotho (AUC=0.741, 95%CI=0.663-0.819) and years of education (AUC=0.718, 95%CI=0.647-0.789) had predictive value for cognitive impairment in MHD patients. The combination of age, sleep disorder, serum α-Klotho, serum β-Klotho and years of education (P=-0.004×α-Klotho-0.287×β-Klotho+0.370×age-0.223×years of education +0.165×AIS-8 score+6.658) predicted the occurrence of MHD. The AUC of cognitive impairment was 0.894 (95%CI=0.851-0.937, P<0.001), the sensitivity was 82.9%, and the specificity was 78.5%.

Conclusion

The prevalence of cognitive impairment among MHD patients is substantially high, estimated at approximately 76%. Age, sleep disorders, years of education, and levels of α-Klotho and β-Klotho are important influencing factors. Medical staff and patients' families should raise awareness of cognitive impairment, actively screen and intervene in key patients to improve their quality of life and reduce the burden on their families and society.

Spatiotemporal Distribution Patterns and Influencing Factors of Pulmonary Tuberculosis in Xinjiang: Based on Hierarchical Bayesian Model

LI Feifei, ZHOU Peiyao, LU Yaoqin, ZHENG Yanling, ZHANG Liping

2025, 28(23):  2894-2899.  DOI: 10.12114/j.issn.1007-9572.2024.0524

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Background

China ranks third globally in tuberculosis burden and is classified as one of the highest tuberculosis (TB) burden countries. Xinjiang, a multi-ethnic region in northwestern China, has consistently reported one of the highest TB incidence rates nationwide, posing significant challenges to Chinese TB prevention and control efforts. Therefore, investigating region-specific epidemiological characteristics, quantifying the effects of covariates on pulmonary tuberculosis (PTB) risk, and deriving robust conclusions aligned with Xinjiang's sociodemographic and environmental contexts is critical to formulating targeted, evidence-based strategies for pulmonary tuberculosis control, thereby providing actionable scientific recommendations to mitigate the disease burden in this region.

Objective

A hierarchical Bayesian spatiotemporal model integrated with the Integrated Nested Laplace Approximations-Stochastic Partial Differential Equations (INLA-SPDE) acceleration algorithm was employed to analyze the spatiotemporal distribution patterns and associated influencing factors of PTB in Xinjiang.

Methods

Data on PTB reported incidence counts and population demographics across 14 prefectures in Xinjiang from 2010 to 2019 were retrieved from the China Disease Prevention and Control Information System (CDCIS). An exploratory statistical analysis was conducted to characterize the spatiotemporal distribution of PTB incidence. Subsequently, a hierarchical Bayesian spatiotemporal model integrated with the INLA-SPDE acceleration algorithm was developed to assess the epidemiological trends and quantify the impact of associated risk factors on PTB transmission dynamics during the study period.

Results

The study area encompassed 14 prefectures in Xinjiang, categorized into 10 estimation sites (Urumqi City, Changji Hui Autonomous Prefecture, Karamay City, Hami City, Ili Kazakh Autonomous Prefecture, Bayingolin Mongol Autonomous Prefecture, Kashgar Prefecture, Tacheng Prefecture, Aksu Prefecture and Altay Prefecture) and 4 validation sites (Turpan City, Bortala Mongol Autonomous Prefecture, Kizilsu Kirghiz Autonomous Prefecture and Hotan Prefecture). From 2010 to 2019, the incidence rate and reported case count of PTB in Xinjiang peaked in 2018 (304.945 per 100 000 population, 76 846 cases), followed by a declining trend thereafter. The Bayesian posterior estimates indicated that population size, mean temperature, PM_2.5 concentration, and longitude were positively associated with tuberculosis incidence, whereas GDP per capita, hospital bed availability, and latitude demonstrated protective effects against disease incidence. Spatial autocorrelation analysis revealed significant geographic clustering of PTB cases (σ²_ω=1.806), with a spatial correlation range of 946.053 km, indicating that spatial dependence diminished with increasing distance between sites. Furthermore, short-term temporal persistence of PTB infection rates was strongly supported (α=17.926), suggesting sustained transmission dynamics within localized regions.

Conclusion

Significant spatial autocorrelation of PTB incidence was observed in Xinjiang from 2010 to 2019, with a spatial correlation range of 946.053 km, indicating that spatial dependence diminished with increasing distance between geographic locations. Furthermore, population density, mean annual temperature, PM_2.5 concentration, and longitude exhibited positive associations with PTB incidence rates. In contrast, GDP per capita, healthcare bed availability, and latitude were identified as protective factors, demonstrating inverse associations with PTB risk.

Characterization of Intestinal Flora in Different Age Groups with Chronic Fatigue Syndrome

XU Yisha, LI Chunmei, WANG Chengcheng, GUO Wei, GAN Yunong, ZHANG Yu, ZHANG Wen, YU Congcong

2025, 28(23):  2900-2907.  DOI: 10.12114/j.issn.1007-9572.2024.0288

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Background

Chronic fatigue syndrome (CFS) is a chronic debilitating disease of unknown etiology associated with intestinal microecological dysregulation and disturbances in bacterial metabolism, and there are significant differences in the composition of the intestinal flora and intestinal permeability between patients with CFS and healthy populations, but the characteristics of the intestinal flora suggestive of CFS populations of different ages have rarely been reported.

Objective

To explore the characteristics of intestinal flora of CFS patients in different age groups, and to provide scientific basis for risk prevention and control of CFS in different age stages.

Methods

CFS patients from outpatient clinics of Sichuan Integrative Medicine Hospital between February 2021 and October 2021 were selected as the study subjects, and divided into three groups: 20 cases in the young group (18-34 years old), 20 cases in the middle-aged group (35-55 years old), and 20 cases in the old-aged group (56-80 years old). Basic information of the cases was collected, stool specimens were collected, and 16S rRNA high-throughput sequencing was used to detect the intestinal flora, and bioinformatics and statistical analysis were performed.

Results

Differences in species composition and relative abundance were observed in CFS patients of different ages, with higher Pielou_e index of intestinal flora in the old-aged group, with statistically significant differences compared to the middle-aged group (P<0.05), and significant separation of the aggregated flora in the middle-aged group from the other two groups (P<0.01). Coprococcus, Megamonas, Dialister, and Acinetobacter were the core flora of the young group, and Ruminococcus was the core flora of the old group. The relative abundance of Pseudomonadales, Moraxellaceae, and Acinetobacter in the young group was higher than the middle-aged and old-aged groups (P<0.05). The relative abundance of Erysipelatoclostridium and Sellimonas in the middle-aged group was higher than the young and old-aged groups (P<0.05). The relative abundance of Eggerthellaceae and Bilophila in the old-aged group was higher than the young and the middle-aged group (P<0.05) .

Conclusion

There are differences in the diversity and composition of the intestinal flora of CFS patients in different age groups, and it was initially found that Acinetobacter and Erysipelatoclostridium can be used as the key flora to differentiate the intestinal flora of old-aged, middle-aged and young CFS patients.

Evaluation of Vision-related Quality of Life in Myopic Macular Degeneration Patients with Low Vision and Associated Factors

WU Yue, WANG Xuetong, KE Bilian

2025, 28(23):  2908-2914.  DOI: 10.12114/j.issn.1007-9572.2024.0123

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Background

Myopic macular degeneration causes irreversible structural and functional damage to the fundus, which seriously affects elderly patients' lives. There are few reports on vision-related quality of life in myopic maculopathy patients with low vision, and the factors affecting it are inconclusive.

Objective

To assess the vision-related quality of life in myopic macular degeneration patients with low vision and to explore its association with visual function and disease characteristics.

Methods

Forty patients with myopic macular degeneration who attended the ophthalmology clinic of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine from September 2022 to January 2023 were included, and visual-related quality of life was assessed by the Low Vision Quality of Life Questionnaire (LVQOL). Best-corrected visual acuity (BCVA), contrast sensitivity (CS) were detected, ATN grading and choroidal thickness based on colored fundus photographs and optical correlation tomography were also recorded. Relationship of vision-related quality of life with ocular parameters and ATN grading was analyzed by Pearson and Spearman correlation, moderating effect of the worse eye on the impact of the better eye's visual function on quality of life was assessed by stratified regression, and generalized linear regression model was used to further confirm the associated factors of vision-related quality of life.

Results

Correlation analysis results showed, LVQOL scores were negatively correlated with BCVA logMAR (r=-0.921, P<0.001), positively correlated with logCS (r=0.943, P<0.001) in better eyes, and positively correlated with logCS in worse eyes (r=0.32, P=0.044). Hierarchical regression analysis showed that the BCVA interaction between worse eyes and better eyes had a statistically significant effect on the total score of LVQOL (β=8.25, P<0.001). LVQOL scores were negatively correlated with atrophic disease (r_s=-0.827, P<0.001) and neovascular disease (r_s=-0.802, P<0.001). Generalized linear regression analysis showed that LVQOL score was positively correlated with sex (β=3.93, P=0.011), logCS (β=18.92, P<0.001) and choroid thickness (β=0.08, P=0.007) in better eyes, and negtively correlated with logMAR (β=-9.93, P=0.016) in better eyes.

Conclusion

Gender, BCVA, CS, and choroidal thickness in the better eye were key factors affecting the quality of life. Future treatment strategies should focus on visual function improvement, disease monitoring and comprehensive management to improve patients' quality of life.

A Comparative Study on Chinese Residents' Attitudes and Behaviors towards Traditional Chinese Medicine: an Empirical Analysis Based on the Data from the Chinese General Social Survey in 2011 and 2021

XU Yutong, SU Wei, TANG Song, MA Shuang

2025, 28(23):  2915-2923.  DOI: 10.12114/j.issn.1007-9572.2024.0561

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Background

In recent years, China has emphasized the development of traditional Chinese medicine (TCM), yet there is a lack of longitudinal comparative studies on Chinese residents' attitudes and behaviors towards TCM and Western medicine based on national samples in the academic research field.

Objective

To comparatively analyze Chinese residents' attitudes and behaviors towards TCM and their influencing factors in 2011 and 2021, provide empirical evidence for improving residents' attitudes and behaviors towards TCM and promoting the construction of a quality TCM service system.

Methods

A total of 4 326 samples that effectively answered questions related to residents' attitudes and behaviors toward TCM in 2011 and 2021 were screened using data from the 2011 and 2021 Chinese General Social Surveys (CGSS), of which the samples in 2011 and 2021 were 2 879 and 1 447, respectively. Factors affecting residents' attitudes and behaviors toward TCM were analyzed from three dimensions: demographic characteristics, social environment and medical services. A multifactor multicategorical Logistic regression model was used for the analysis of factors influencing residents' attitudes and behaviors toward TCM.

Results

In terms of attitudes toward TCM, the proportion of people who agreed that "TCM is more effective" was the highest in 2011 (34.5%, 994/2 879), and the proportion of people who held a neutral attitude toward this view was the highest in 2021 (44.8%, 649/1 447). Compared with 2011, the proportion of people with a neutral attitude towards the statement that "Chinese medicine is more effective" increased significantly in 2021, while the proportion of people agreeing and disagreeing with the statement decreased. In terms of the frequency of consultation, the frequency of consultation for both TCM and Western medicine decreased between 2011 and 2021, with "sometimes consulting TCM practitioners" decreased by 7.3% and "sometimes consulting Western medicine practitioners" decreased by 16.1%, and "often consulting TCM practitioners" decreased by 8.9%, "Frequently consulting Western medicine practitioners" decreased by 18.8%. The results of the multifactorial multicategory Logistic regression analysis showed that: with the reference of not agreeing that "Chinese medicine is more effective", year, education level, region, satisfaction with recent medical treatment, and satisfaction with the health care system were the factors influencing residents' agreement with "Chinese medicine is more effective" (P<0.05) ; the year and region were the factors influencing residents' neutral attitude towards "Chinese medicine is more effective" (P<0.05). Year, education level, region, satisfaction with recent medical treatment, and satisfaction with the health care system were the factors influencing residents' agreement with "Chinese medicine is more effective" (P<0.05) ; Year and region were the factors influencing residents' neutral attitude towards "Chinese medicine is more effective" (P<0.05). Taking "never consulting TCM" as a reference, gender, household registration, age, region, whether suffering from chronic diseases or disabilities, self-assessed health status, and satisfaction with recent medical treatment were the factors influencing residents' frequent consulting of TCM (P<0.05) ; year, age, whether suffering from chronic diseases or disabilities, self-assessed health status, frequency of socialization, and accessibility to high-quality medical treatment were the factors influencing residents' sometimes consulting of TCM (P<0.05) .

Conclusion

The recognition of Chinese medicine by Chinese residents changed slightly between 2011 and 2021, and the gap between the frequency of Chinese and Western medicine visits decreased. There are regional differences in residents' attitudes and behaviors toward TCM; residents in the central region have a higher recognition of TCM but a relatively lower frequency of TCM visits; residents with lower education levels agree that TCM is more effective than Western medicine; residents who are elderly, urban, and suffer from chronic illnesses or disabilities have a higher frequency of TCM visits; and recent satisfaction with medical care is the main influencing factor on residents' attitudes toward TCM and their visiting behaviors.

Evidence-based Medicine

Efficacy and Safety of Belimumab, Anifrolumab, and Telitacicept on the Treatment of Systemic Lupus Erythematosus: a Network Meta-analysis

LI Hao, LI Jiangtao, LIU Dan, WANG Jianjun

2025, 28(23):  2924-2933.  DOI: 10.12114/j.issn.1007-9572.2023.0864

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Background

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. At present, three biological agents have been approved for treating SLE, including belimumab, anifrolumab, and telitacicept. However, a direct comparison of their efficacy and safety is lacking.

Objective

To analyze the clinical efficacy and safety of belimumab, anifrolumab, and telitacicept on the treatment of SLE using network meta-analysis.

Methods

Randomized controlled trials (RCTs) reporting belimumab, anifrolumab, and telitacicept to treat SLE were searched in the databases of PubMed, Web of Science, Cochrane Library, and Embase from the establishment of the databases to August 2023. After screening the relevant literatures and obtaining data from eligible RCTs based on the inclusion and exclusion criteria, direct or network meta-analysis was performed using the RevMan 5.4.1, R language 4.3.1, and Aggregate Data Drug Information System (ADDIS) 1.16.8 software.

Results

After screening, 4 789 SLE patients from 12 RCTs were included, including 2 721 patients in the experimental group and 2 068 patients in the placebo group. The direct meta-analysis results showed that the relief rate of SLE responder index 4 (SRI4) in SLE patients treated with belimumab, anifrolumab, and telitacicept was significantly higher in the experimental group compared with that of the placebo group (OR=1.62, 95%CI=1.40-1.88, P<0.001; OR=2.39, 95%CI=1.70-3.37, P<0.001; OR=6.28, 95%CI=3.20-12.33, P<0.001). Compared with that of the placebo group, the proportion of SLE patients with a reduced oral corticosteroid dosage after belimumab and anifrolumab treatment was significantly higher (OR=1.48, 95%CI=1.09-2.02, P<0.001; OR=2.45, 95%CI=1.69-3.54, P<0.001), and the severe recurrence (SR) rate was significantly lower (OR=0.59, 95%CI=0.49-0.71, P<0.001; OR=0.52, 95%CI=0.39-0.69, P<0.001). The incidence of total adverse events (TAEs) of anifrolumab and telitacicept was significantly higher than that of the placebo group (OR=1.80, 95%CI=1.25-2.59, P=0.001; OR=2.13, 95%CI=1.18-3.83, P=0.01), while the incidence of serious adverse events (SAEs) of anifrolumab was significantly lower (OR=0.67, 95%CI=0.46-0.97, P=0.04). There were no significant differences in the incidence of TAEs (OR=0.89, 95%CI=0.72-1.08, P=0.24) and SAEs (OR=0.82, 95%CI=0.59-1.12, P=0.25) between the belimumab group and placebo group. The results of network meta-analysis showed that the highest SRI4 was detected after the treatment of telitacicept, followed by anifrolumab, subcutaneous injection of belimumab and intravenous injection of belimumab. The highest incidence of TAEs was detected after the treatment of telitacicept, followed by anifrolumab, intravenous injection of belimumaband subcutaneous injection of belimumab.

Conclusion

Aelimumab, anifrolumab, and telitacicept all exhibit good clinical efficacy on the treatment of SLE, especially telitacicept. Although anifrolumab and telitacicept increase the overall incidence of TAEs after treatment, they reduce the incidence of SAEs. Belimumab exhibits the highest safety on treating SLE.

Incidence and Risk of Cardiovascular Toxicity with Fruquintinib in Metastatic Colorectal Cancer: a Meta-analysis

WANG Xiaolin, LI Qiuyue, ZHOU Yanjun, ZHANG Jinhui, LIANG Tao

2025, 28(23):  2934-2940.  DOI: 10.12114/j.issn.1007-9572.2024.0203

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Background

38.4% of patients with colorectal cancer died from non-cancer disease, with cardiovascular disease being the most important cause, accounting for 20.3% of the total deaths. Cardiovascular toxicity associated with targeted therapy is not uncommon, most notably hypertension.

Objective

The study aimed to determine the overall incidence and risk of cardiovascular toxicity associated with fruquintinib in metastatic colorectal cancer.

Methods

We searched CNKI, Wanfang Data, CBM, PubMed, Embase, Web of Science and Cochrane Library databases for single-arm clinical trials and randomized controlled trials (RCTs) relevant to fuquintinib therapy in patients with metastatic colorectal cancer. The search time limit was from the establishment of the databases to May 2024. Literature screening, data extraction, and quality evaluation were performed independently by two investigators. The meta-analysis was conducted using R 4.3.3 software.

Results

Eight articles involving six single-arm clinical trials and three randomized controlled trials were included. The meta-analysis results showed that the incidence rates of all-grade hypertension and hemorrhage were 35% (95%CI=0.25-0.45) and 24% (95%CI=0.10-0.37), respectively. For high-grade events, the rates were 15% for hypertension (95%CI=0.10-0.20), 1% for hemorrhage (95%CI=0-0.02), 3% for embolic and thrombotic events (95%CI=0.02-0.05), and 1% for cardiac diseases (95%CI=0-0.02). Fruquintinib was associated with increased risks for both all-grade and high-grade hypertension, as well as all-grade hemorrhage, with RR of 3.93 (95%CI=2.95-5.24), 12.33 (95%CI=5.31-28.63), and 1.84 (95%CI=1.36-2.50) respectively, but not for high-grade hemorrhage (RR=1.06, 95%CI=0.35-3.23), embolic and thrombotic events (RR=3.35, 95%CI=0.89-12.55), or cardiac diseases (RR=0.62, 95%CI=0.18-2.14) .

Conclusion

The use of fruquintinib is associated with a significantly increased risk of developing cardiovascular toxicity, primarily for lower-grade events, in patients with metastatic colorectal cancer.

Review & Perspectives

Research Progress on the Role of Copper Homeostasis Regulation Mechanism in Cognition Disorder

ZHOU Lianpeng, LI Weifeng, DONG Xingang, WANG Xiaoyuan

2025, 28(23):  2941-2949.  DOI: 10.12114/j.issn.1007-9572.2024.0200

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Cognitive impairment is often manifested as a series of brain function deficits such as learning, memory, intellectual, emotional, and executive deficits. It often occurs in neurological disorders, aging, and the postoperative period. Currently, the pathogenesis of the disease is unclear, and the blood-brain barrier, oxidative stress, autophagy, inflammation, mitochondria, and neurotransmitters have all been implicated in cognitive dysfunction. Recent studies found that copper homeostasis associated with copper metabolism and copper death had a regulatory role in cognitive function, which may be a key mechanism in the development of cognitive impairment. In this paper, we systematically introduced the role of copper homeostasis regulatory mechanisms in cognitive impairment from the perspectives of mitochondria, glial cells, oxidative reactions, inflammatory factors, neurotransmitters, etc. (When copper homeostasis was imbalanced, copper ion levels were disturbed, electrolyte metabolism was abnormal, and a series of reactions, such as oxidative stress, inflammatory aggregation, mitochondrial disorders, and glial cell damage, occur, and even induce neuronal copper death) and summarised the role of copper homeostasis in cognitive impairment. The role of copper homeostasis in cognitive disorders was summarised, to provide new insights into the pathogenesis of cognitive disorders, as well as bringing new solutions to the treatment of the disease.

Research Progress of Targeted Therapy and Immunotherapy for Pancreatic Cancer

RUAN Wanbai, LI Junfeng, YIN Yanmei, PENG Lei, ZHU Kexiang

2025, 28(23):  2950-2960.  DOI: 10.12114/j.issn.1007-9572.2024.0195

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Pancreatic cancer is a highly malignant disease with a poor prognosis. Currently, there is a lack of effective early detection methods, resulting in most patients being diagnosed at an advanced stage or with distant metastasis. Furthermore, the unique tumor microenvironment poses challenges for traditional treatment modalities such as surgery, radiotherapy, and chemotherapy. This article provided a comprehensive review of the latest advancements in pancreatic cancer treatment both domestically and internationally. It also summarized relevant literature on targeted therapy and immunotherapy for pancreatic cancer. The article highlighted that continuous developments in gene sequencing and multi-omics research deepened our understanding of the molecular mechanisms and gene expression profiles associated with pancreatic cancer. Consequently, numerous signaling pathways and targets had been identified along with an array of targeted therapy and immunotherapy drugs. As a result, the treatment approach for pancreatic cancer was gradually shifting from a conventional "one-size-fits-all" strategy to more precise individualized treatments, ushering in new possibilities for combating this disease. This study offered novel insights that could guide further research on targeted therapy and immunotherapy for pancreatic cancer