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    15 September 2025, Volume 28 Issue 26
    Guidelines·Consensus
    Guidelines for Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Hemorrhoids (2025 Edition)
    ZHI Congcong, LI Xue, CHENG Yicheng, WANG Xiaolong, ZHENG Lihua
    2025, 28(26):  3217-3228.  DOI: 10.12114/j.issn.1007-9572.2025.0125
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    Hemorrhoids is one of the common anorectal diseases in clinical practice, and its incidence is the first in anorectal diseases. Many new clinical studies have emerged currently on treating hemorrhoids with integrated Chinese and western medicine. To improve the guidance for clinical practice, our team reviewed the 2020 Chinese Guidelines for Hemorrhoid Treatment and assessed the need for updates. We identified 19 clinical problems and 8 outcome indicators that needed revision. A new project, Integrated Chinese and Western Medicine Guidelines for Hemorrhoid Treatment was proposed to the China Association of Traditional Chinese Medicine. We referred to the latest clinical guidelines, conducted systematic reviews, and evaluated research evidence. We also gathered input from experts in both Chinese and western medicine. After thorough discussion, finally, 13 clinical questions were summarized and 17 recommendations were formed. This guideline aims to provide practical, scientific guidance for healthcare workers in all medical institutions. It seeks to promote the standardized use of integrated treatment for hemorrhoids, improve treatment outcomes, reduce recurrence and complications, and improve the quality of life for patients.

    Original Research
    Impact of Short-term Medical Weight Loss on Atherosclerotic Cardiovascular Disease Risk in Patients with Obesity
    XIANG Xinyue, ZHANG Bingqing, OUYANG Yuqin, TANG Wenjuan, FENG Wenhuan
    2025, 28(26):  3229-3239.  DOI: 10.12114/j.issn.1007-9572.2024.0652
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    Background

    Patients with obesity exhibit a higher risk of atherosclerotic cardiovascular diseases (ASCVD). The effects of short-term medical weight loss interventions on the risk level of ASCVD of patients with obesity at multidisciplinary outpatient department need to be elucidated.

    Objective

    To explore the impact of short-term medical weight loss on ASCVD risk in patients with obesity.

    Methods

    A retrospective analysis was conducted involving 172 patients with obesity who completed a 3-month weight loss treatment at the obesity multidisciplinary outpatient department in Nanjing Drum Tower Hospital from July 2019 to May 2024. Demographics, clinical indicators, and cardiovascular disease risk of patient were documented using the Chinese adult ASCVD overall risk assessment flowchart. Based on baseline cardiovascular risk ratings, patients were categorized into a moderate-high risk group (n=58) and a low-risk group (n=114). Moderate-high risk patients were further divided into the risk decreased subgroup (n=36) and the risk stable subgroup (n=22) based on whether their ASCVD risk decreased after treatment, and comparisons were made between the two subgroups regarding demographic and clinical data. Differences in clinical indicators and cardiovascular disease risk at baseline and post-treatment were analyzed, and multifactorial logistic regression analysis was conducted to identify factors related to reduction of the risk level of ASCVD in patients with moderate-high risk obesity. ASCVD risk and weight loss indicators among different medication groups and patients stratified by BMI, gender, and age after 3 months of treatment were analysised.

    Results

    Among the 172 patients, there were 73 males and 99 females, with an average age of 32 (28, 38) years, an average body weight of 89.8 (82.0, 101.2) kg, and an average BMI of 31.6 (30.0, 33.9) kg/m2. After 3 months of treatment, the total weight loss was 8.8% (5.6%, 13.6%), and the BMI decreased to 28.8 (27.0, 30.7) kg/m2. Measurements of waist circumference, waist-to-height ratio, body fat, body fat percentage, fat mass index (FMI), appendicular skeletal muscle mass index (ASMI), total muscle mass, visceral fat area (VFA), systolic blood pressure, diastolic blood pressure, and metabolic indicators [fasting glucose, postprandial blood glucose at 2 hours, fasting insulin, postprandial insulin at 2 hours, homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, cholesterol, low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, and aspartate aminotransferase] all showed significant reductions compared to pre-treatment levels (P<0.05). Before treatment, 114 patients were classified as the ASCVD low-risk group, while 58 patients were classified as the moderate-to-high-risk group. Compared with the moderate-high risk group, the low-risk group showed a decrease in fasting glucose, postprandial blood glucose at 2 hours, postprandial insulin at 2 hours, HOMA-IR, triglycerides, cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and aspartate aminotransferase, while high-density lipoprotein cholesterol increased before treatment (P<0.05). Among the 58 patients with moderate-to-high ASCVD risk before treatment, 36 patients transitioned to low risk after 3 months of treatment (risk decreased subgroup), while 22 patients remained in the moderate-to-high-risk category (risk stable subgroup). After 3 months of treatment, the body weight, BMI, waist circumference, waist-to-height ratio, body fat, body fat percentage, FMI, VFA, fasting insulin, postprandial insulin at 2 hours, insulin resistance index, triglycerides, alanine aminotransferase, and aspartate aminotransferase all decreased compared to pre-treatment levels in both subgroups. The risk decreased subgroup also showed decreases in systolic blood pressure, diastolic blood pressure, fasting blood glucose, cholesterol, and low-density lipoprotein cholesterol (P<0.05). The reductions in BMI, body fat, body fat percentage, FMI, and VFA in the reduction subgroup were significantly greater than those in the risk stable subgroup (P<0.05). Multivariate Logistic regression analysis indicated that BMI (OR=1.257, 95%CI=1.034-1.528, P=0.022) was an independent risk factor influencing the reduction of risk factors in obese patients with moderate-to-high ASCVD risk. For every 1 unit decrease in BMI, the ASCVD risk decreased by 25.7%. After 3 months of treatment, the proportion of patients at moderate-to-high ASCVD risk decreased than before in the liraglutide group (n=51), metformin group (n=61), and untreated group (n=60) (P<0.05), with no significant differences in ASCVD risk levels or weight loss indicators among the three groups (P>0.05). In the group with 28.0 kg/m2≤BMI<32.5 kg/m2 and the group with BMI≥32.5 kg/m2, the proportion of patients at moderate-to-high ASCVD risk decreased after 3 months of treatment, with the 28.0 kg/m2≤BMI<32.5 kg/m2 group showing a greater reduction in the proportion of patients at moderate-to-high ASCVD risk compared to the BMI≥32.5 kg/m2 group (P<0.05). Both the female and male groups showed a decrease in the proportion of patients at moderate-to-high ASCVD risk after 3 months of treatment (P<0.05), with no significant differences in ASCVD risk levels between the two groups (P>0.05). Comparisons between the 18-30 years group and the ≥30 years group also showed no significant differences in ASCVD risk levels (P>0.05) .

    Conclusion

    Short-term medical weight loss in patients with obesity was benefit for effective weight loss and fat reduction, and improvement in ASCVD risk factors. However, for patients with a BMI ≥32.5 kg/m2 and with moderate-high cardiovascular risk level, such weight loss measures are not sufficient to reduce the risk level of ASCVD in the short term, and stronger and durable weight loss measures are the treatment of choice for these patients in the future.

    Association between Marital Status, Social Support and Lifestyle with Cognitive Impairment among Community-dwelling Older Adults: Based on the Baseline Survey of Hubei Memory and Aging Cohort Study
    CUI Yuyang, CHENG Guirong, ZENG Yan, HUANG Zhaolan, TAN Wei
    2025, 28(26):  3240-3247.  DOI: 10.12114/j.issn.1007-9572.2024.0667
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    Background

    The accelerated aging process, combined with the increase in widowhood and social isolation, has led to a rise in chronic diseases, further increasing the social burden.

    Objective

    To explore the association between the marital status of older adults and the prevalence of cognitive impairment, as well as the impact of social support and lifestyle on this association.

    Methods

    A total of 9 466 older adults aged 65 years and above from Wuhan and Xiaogan, Hubei Province, were included in this study from 2018 to 2023. Participants were categorized into a married group (n=7 055) and an unmarried group (n=2 411) based on their marital status. Baseline information was collected through structured questionnaires, and cognitive function was assessed using the Mini-mental State Examnation and the Montreal Cognitive Assessment-basic China (MoCA-BC). A multivariable Logistic regression model was employed to analyze the association between marital status and cognitive impairment in the overall population as well as in subgroups stratified by age and sex. Further analyses explored the independent and combined effects of marital status, social support, and lifestyle habits on cognitive impairment risk.

    Results

    Compared with the elderly with spouses, no spouse was an independent risk factor for cognitive impairment (OR=1.299, 95%CI=1.227-1.376, P<0.001). Further subgroup analysis showed that never married (OR=1.679, 95%CI=1.448-1.947, P<0.001) and widowed (OR=1.282, 95%CI=1.206-1.362, P<0.001) were independent risk factors for cognitive impairment in the elderly. Gender and age stratified analysis showed that never married (OR=2.316, 95%CI=1.680-3.193, P<0.001) and widowed (OR=1.731, 95%CI=1.405-2.131, P<0.001) were independent risk factors for cognitive impairment in elderly men. Widowed was an independent risk factor for cognitive impairment in elderly women (OR=1.163, 95%CI=1.002-1.351, P=0.047). In the 65-74 years old group, never married (OR=1.953, 95%CI=1.390-2.746, P<0.001) and widowed (OR=1.315, 95%CI=1.120-1.545, P=0.001) were independent risk factors for cognitive impairment. In the ≥75 years old group, widowed was an independent risk factor for cognitive impairment (OR=1.470, 95%CI=1.238-1.747, P<0.001). Multivariate Logistic regression analysis on marital status, social support and living habits associated with cognitive impairment showed that compared with the elderly with spouse and social support and healthy living habits, the elderly with spouse and social support but unhealthy living habits (OR=1.262, 95%CI=1.169-1.363, P=0.002), spouse and no social support but healthy lifestyle (OR=1.650, 95%CI=1.479-1.841, P<0.001), spouse and no social support but unhealthy lifestyle (OR=1.777, 95%CI=1.575-2.005, P<0.001), no spouse and social support with healthy lifestyle (OR=1.284, 95%CI=1.189-1.397, P<0.001), no spouse and social support with unhealthy lifestyle (OR=1.999, 95%CI=1.768-2.260, P<0.001), no spouse and social support with unhealthy lifestyle (OR=1.999, 95%CI=1.768-2.260, P<0.001), no spouse and no social support but healthy lifestyle (OR=1.680, 95%CI=1.500-1.882, P<0.001), no spouse and no social support but unhealthy lifestyle (OR=2.422, 95%CI=2.141-2.740, P<0.001), no spouse and no social support but healthy lifestyle (OR=2.422, 95%CI=2.141-2.740, P<0.001) were at increased risk for cognitive impairment.

    Conclusion

    The prevalence of cognitive impairment, especially among older adults without spouses, notably increases, particularly for those who have never married or are widowed. Regardless of marital status, the lack of social support and unhealthy lifestyle are risk factors for cognitive impairment. This study highlights the importance of paying attention to marital status, social support, and lifestyle in the health management of older adults.

    The Impact of Behavioral Lifestyle on Quality of Life in Hypertensive Patients
    HAN Xiao, LI Qiyu, GE Pu, FAN Siyuan, LIU Diyue, WU Yibo, ZHANG Qingshuang
    2025, 28(26):  3248-3258.  DOI: 10.12114/j.issn.1007-9572.2024.0346
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    Background

    Hypertension is one of the most prevalent chronic diseases in China, with its incidence showing a trend toward younger age groups. Unhealthy behavioral lifestyles are a significant risk factor for the development of hypertension. Therefore, it is crucial to investigate the impact of lifestyle behaviors on the quality of life in individuals with hypertension.

    Objective

    To investigate the impact of behavioral lifestyle on the quality of life in hypertensive patients and provide a scientific basis for developing effective behavioral intervention strategies.

    Methods

    The data for this study were derived from the 2022 Psychological and Behavioral Investigation of Chinese Residents (PBICR-2022), with hypertensive individuals as the study population (n=1 525). General characteristics and behavioral lifestyle information of the participants were collected. Physical activity levels were assessed using the International Physical Activity Questionnaire Short Form (IPAQ-7), and quality of life was evaluated using the EuroQol Five-dimensional Five-level Questionnaire (EQ-5D-5L). The impact of behavioral lifestyle on quality of life was analyzed using multiple linear regression and restricted cubic spline models.

    Results

    The median EQ-5D-5L utility value was 0.951 (0.893, 1.000), and the median EQ-VAS score was 75.0 (60.0, 85.0) in hypertensive patients. The results of multiple linear regression analyses indicated that daily breakfast consumption, sleep quality, and daily sitting duration were significant factors influencing the EQ-5D-5L utility values and EQ-VAS scores (P<0.05). Current consumption of sugary beverages and average daily water intake were identified as factors influencing the EQ-VAS scores (P<0.05), while weekly physical activity level was found to be a significant factor for EQ-5D-5L utility values (P<0.05). The restricted cubic spline analysis revealed a linear dose-response relationship between daily sitting duration and both EQ-5D-5L utility values and EQ-VAS scores (Poverall trend<0.05, Pnon-linear>0.05), with both utility values and EQ-VAS scores declining as daily sitting duration increased when the daily sitting duration exceeding four hours. Additionally, a near "n" -shaped nonlinear dose-response relationship was observed between weekly physical activity level and EQ-5D-5L utility values (Poverall trend<0.05, Pnon-linear<0.05). As weekly physical activity level increased, the EQ-5D-5L utility values initially increased and then slightly decreased, with the peak occurring at a weekly physical activity level of 3 750 MET-min/week.

    Conclusion

    Adopting the habit of eating breakfast, increasing daily water intake, developing good sleep habits, and reducing the consumption of sugary beverages can improve the quality of life in hypertensive patients. In contrast, daily sitting duration exceeding four hours, as well as insufficient or excessive physical activity, may negatively impact the quality of life of hypertensive patients.

    Predictive Value Waist-to-height Ratio, Waist-to-hip Ratio and Body Mass Index for Metabolic Syndrome
    YIN Jiahui, YANG Xinhui, WANG Jingjing, ZHANG Yajing, WANG Lijuan, FU Zuodi, KONG Xiangshuang, GUO Guangxia, LI Yufeng
    2025, 28(26):  3258-3263.  DOI: 10.12114/j.issn.1007-9572.2024.0549
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    Background

    Metabolic syndrome (MS) significantly increases the risk of chronic diseases like cardiovascular diseases. Early screening and interventions for MS are crucial. Body mass index (BMI) does not reflect central obesity, and the recent guideline suggests the waist-to-height ratio (WHtR) as a new diagnostic indicator for obesity. There is limited research on the predictive value of WHtR for MS.

    Objective

    To explore the correlation of WHtR, waist-to-hip ratio (WHR), and BMI with MS, and compare the predictive value of the three anthropometric indicators for MS.

    Methods

    This study using data available from the metabolic disease survey cohort database conducted from June 2013 to September 2014 in Pinggu, Beijing. MS was diagnosed based on the standards of the Chinese Diabetes Society 2020. Subjects were divided into non-MS and MS groups based on the presence or absence of MS, and the general clinical characteristics of the two groups were compared. Logistic regression analysis was used to identify risk factors for MS, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of WHtR, WHR, and BMI for MS.

    Results

    A total of 4 001 valid cases were included in the analysis, with an average age of (50.3±11.8) years. There were 1 617 cases in the MS group, and 2 384 cases in non-MS group, with a prevalence of MS of 40.4% (1 617/4 001), and the weighted prevalence rate is 39.5%. The WHtR, WHR and BMI in the MS group were all significantly higher than those of the non-MS group (all P<0.05). Multivariable Logistic regression analysis indicated that WHtR≥0.5 (OR=2.074, 95%CI=1.523-2.823), male WHR≥0.90/female WHR≥0.85 (OR=2.646, 95%CI=2.185-3.204), 24.0 kg/m2≤BMI<28.0 kg/m2 (OR=2.259, 95%CI=1.717-2.973), and BMI≥28.0 kg/m2 (OR=4.530, 95%CI=3.320-6.181) were independent risk factors for MS (all P<0.05). The predictive value of WHtR, WHR and BMI for MS was analyzed in the overall population, males, and females, respectively. It was found that the area under the curve (AUC) of WHtR in predicting MS was significantly higher than that of WHR and BMI in all three groups (P<0.05). The AUC of WHtR in predicting MS in the above three groups was 0.835, 0.847, and 0.842, respectively; with the optimal cutoff values of 0.526, 0.526, and 0.548, respectively.

    Conclusion

    WHtR is superior to WHR and BMI in predicting the risk of MS, and it can be used as a simple indicator for predicting the risk of MS.

    Correlation Analysis of Serum Nesfatin-1 and Ghrelin Levels with Glycolipid Metabolism and Type 2 Diabetes Mellitus
    ZHANG Yunuo, LI Ruibin, WANG Wei
    2025, 28(26):  3264-3270.  DOI: 10.12114/j.issn.1007-9572.2024.0251
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    Background

    Food intake and energy expenditure are regulated by both neural signals of hypothalamus and peripheral systems, with the neuropeptide Nesfatin-1, released from hypothalamus, playing a significant role in inhibiting food intake, while Ghrelin, secreted by the digestive mucosa, facilitates food intake. However, the roles of these two neuro peptides in the progression of obesity and diabetes mellitus remain unclear.

    Objective

    This study aims to explore the correlation between Nesfatin-1, Ghrelin, and parameters such as blood glucose levels, insulin resistance, and blood lipids, and to analyze their involvement in glucose and lipid metabolism to provide novel insights for the prevention and treatment of metabolic diseases, including diabetes and obesity.

    Methods

    A total of 170 patients with type 2 diabetes mellitus (T2DM), hospitalized in the Department of Endocrinology at the First Affiliated Hospital of Baotou Medical College between January 2020 and February 2021, were selected as the experimental group. Additionally, 85 healthy individuals who underwent physical examinations during the same period were included as the control group. Comprehensive clinical information and test indexes for both groups were gathered, and serum levels of Nesfatin-1 and Ghrelin were measured using enzyme-linked immunosorbent assay. The correlation among Nesfatin-1, Ghrelin, glucose and lipid metabolism were evaluated using Pearson correlation analysis and Spearman rank correlation analysis. The differences in serum Nesfatin-1 and Ghrelin levels among patients with different courses of diabetes and different chronic complications of diabetes were compared. The predictive values of Nesfatin-1 and Ghrelin for diagnosing diabetes mellitus were assessed by plotting the receiver operating characteristic (ROC) curves.

    Results

    Nesfatin-1 levels were negatively correlated with glycated hemoglobin (HbA1c), fasting blood glucose, body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), insulin resistance index (HOMA-IR), visceral fat area (VFA), and subcutaneous fat area (SFA) [r (rs) equaled to -0.58, -0.59, -0.51, -0.26, -0.23, -0.37, -0.27, respectively, P<0.05]. In contrast, Ghrelin levels exhibited positive correlations with these indicators [r (rs) equaled to 0.41, 0.41, 0.43, 0.15, 0.24, 0.50, 0.30, respectively, P<0.05]. The Nesfatin-1 levels of experimental group was lower than the control group, and the Ghrelin levels of experimental group was higher than the control group (P<0.001). There was no statistically significant difference in the levels of serum Nesfatin-1 and Ghrelin among patients with different courses of diabetes and different chronic complications of diabetes (P>0.05). The ROC curve indicated that Ghrelin had a predictive value for T2DM with an AUC of 0.861 (95%CI=0.816-0.906) and an optimal cutoff value of 30.328 μg/L. For Nesfatin-1, which AUC was 0.764 (95%CI=0.704-0.824) with an optimal cutoff value of 78.579 μg/L.

    Conclusion

    Nesfatin-1 and Ghrelin regulate glucose and lipid metabolism by influencing blood glucose levels and insulin resistance, and both have predictive value for the diagnosis of diabetes mellitus.

    Expression of the Serum MOTS-c and Its Correlation with Atrial Remodeling in Patients with Atrial Fibrillation
    WEI Jiaohua, PENG Huiru, PENG Jianye, TAN Wenting, HUANG Jine, FANG Li
    2025, 28(26):  3271-3276.  DOI: 10.12114/j.issn.1007-9572.2025.0001
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    Background

    The occurrence of atrial fibrillation (AF) is closely related to atrial remodeling, inflammation, oxidative stress and other factors, among which atrial remodeling is the main pathogenesis. Studies have shown that MOTS-c is a novel mitochondrial-derived peptide with anti-inflammatory, protective oxidative stress and cardiac remodeling effects. However, the expression and role of MOTS-c in AF have not been evaluated.

    Objective

    To explore the expression of MOTS-c in the serum of AF patients and its correlation with atrial remodeling in AF, and to analyze the value of MOTS-c in predicting AF.

    Methods

    A total of 142 patients with AF who were admitted to the Department of Cardiology, the Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University from September 2023 to March 2024 were selected as the AF group. They were divided into paroxysmal AF subgroup (n=49) and non-permanent AF subgroup (n=93). Another 48 patients without AF history admitted during the same period were selected as the control group. The serum MOTS-c levels were detected by using ELISA in each group, and the cardiac ultrasound indicators were measured by cardiac color Doppler echocardiography. The serum MOTS-c levels in groups were compared. The correlation of MOTS-c levels with the cardiac ultrasound indicators in AF patients was identified. Multivariate Logistic regression analysis was used to identify whether serum MOTS-c was an independent risk factor for AF. The optimal cut-off value of serum MOTS-c in predicting AF was determined by the receiver operating characteristic (ROC) curves.

    Results

    The serum MOTS-c levels in the control group and the AF group were (230.31±51.93) μg/L and (158.75±38.69) μg/L respectively; the serum MOTS-c levels in the AF group were lower than that in the control group (t=10.111, P<0.001). The serum MOTS-c levels in patients with paroxysmal AF and non-paroxysmal AF were (175.38±42.03) μg/L and (149.98±33.89) μg/L respectively; the serum MOTS-c levels in the non-paroxysmal AF subgroup were lower than that in the paroxysmal AF subgroup, and the difference was statistically significant (t=3.900, P<0.001). Serum MOTS-c was negatively correlated with left atrial diameter (LAD) in the AF group (r=-0.317, P<0.001). Multivariate Logistic regression analysis showed that LAD (OR=1.481, 95%CI=1.262-1.738, P<0.001) and MOTS-c (OR=0.970, 95%CI=0.958-0.982, P<0.001) were independent influencing factors for AF. ROC curve analysis showed that an area under the curve of serum MOTS-c expression was 0.859 (95%CI=0.794-0.923), the optimal cut-off value was 188.5 μg/L, the sensitivity was 0.88, and the specificity was 0.73.

    Conclusion

    The serum MOTS-c levels were significantly decreased in patients with AF, these are negatively correlated with LAD. MOTS-c may be involved in the process of atrial remodeling in patients with AF. Lowered serum MOTS-c levels may be an independent risk factor for the occurrence of AF and have predictive diagnostic value for AF.

    Analysis of the Trajectory of Postoperative Frailty and Influencing Factors in Patients with Colorectal Cancer
    HU Jieman, TAN Feixiang, YUAN Anxin, CHEN Shiyu, TANG Chulei, YIN Yueheng, BA Lei, XU Qin
    2025, 28(26):  3276-3282.  DOI: 10.12114/j.issn.1007-9572.2024.0407
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    Background

    The incidence of postoperative frailty is notably high among patients with colorectal cancer. Numerous studies have established a strong association between frailty and adverse outcomes, including postoperative complications and mortality. Given that frailty is a dynamic process, there is a scarcity of research exploring its occurrence and progression in colorectal cancer patients.

    Objective

    To investigate the developmental trajectory of postoperative frailty in patients with colorectal cancer and identify its influencing factors through a longitudinal research approach and to provide a theoretical basis for managing frailty in this population.

    Methods

    We employed a convenience sampling method to select patients with colorectal cancer from Jiangsu Provincial People's Hospital between July and December 2022. Data on general information and relevant factors were collected from the participants. The Tilburg Frailty Scale was utilized to assess frailty at four intervals: preoperatively, and then at 1 month, 3 months, and 6 months post-surgery. The growth mixture model was constructed to delineate the developmental trajectory of postoperative frailty and Logistic regression was used to analyze the factors influencing frailty in colorectal cancer patients.

    Results

    A total of 374 patients completed the survey. By fitting the frailty data at four time points, results showed three optimal trajectory models: Health Improvement Type (n=305, 81.5%), Frailty Improvement Type (n=25, 6.7%), and Frailty Persistence Type (n=44, 11.8%). For clinical relevance, the latter two types were merged into a "Frailty Heterogeneity Trajectory". Multivariate Logistic regression analysis revealed several influencing factors for the frailty heterogeneity trajectory: age (OR=1.141, 95%CI=1.065-1.223), nutritional score (OR=0.424, 95%CI=0.303-0.594), number of comorbidities (OR=2.884, 95%CI=1.158-7.184), neoadjuvant therapy (OR=29.510, 95%CI=5.511-158.007), stoma establishment (OR=37.313, 95%CI=8.604-161.819), postoperative chemoradiotherapy (OR=95.071, 95%CI=17.664-511.674), depression level (OR=2.673, 95%CI=1.336-5.350), and social support (OR=0.881, 95%CI=0.797-0.974) (P<0.05) .

    Conclusion

    Postoperative frailty in patients with colorectal cancer demonstrates three distinct developmental trajectories: "Health Improvement Type""Frailty Improvement Type", and "Persistent Frailty Type". Healthcare professionals should identify the heterogeneous trajectory groups early on, particularly the latter two types, and implement targeted interventions to enhance their long-term health outcomes.

    Original Research·Focus Groups
    Emotional Experience of Pregnant Women in Rural China: a Qualitative Study
    GU Xiaolin, CHEN Junyu, CHEN Dan, HAN Guangli, CHEN Yidi, LI Chunhong, LUO Xiaoxi
    2025, 28(26):  3283-3288.  DOI: 10.12114/j.issn.1007-9572.2024.0622
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    Background

    Depression and anxiety are among the most frequently observed adverse emotional states in pregnant women. The inadequacy of mental health services and the paucity of external support often result in the psychological well-being of rural expectant mothers being overlooked, thereby exerting a profound impact on both maternal and neonatal health.

    Objective

    This study, adopting a socio-ecological framework, explores the emotional regulation experiences of rural pregnant women in China, aiming to furnish empirical insights that may inform early intervention strategies for primary healthcare practitioners.

    Methods

    A purposive sampling strategy was utilized to recruit rural pregnant women exhibiting negative emotional experiences from villages under the jurisdiction of Anda City, Suihua, Heilongjiang Province, and Honggang District, Daqing, Heilongjiang Province, during the period spanning October 1 to December 1, 2023. Participants were enlisted through outreach medical consultations and maternal health record registration conducted by higher-tier maternal and child health institutions. Semi-structured interviews were employed for data collection, with information gathered via audio recordings and subsequently transcribed verbatim. The collected data underwent rigorous analysis through Colaizzi's descriptive phenomenological framework, executed by two independent coders.

    Results

    A total of 13 participants were incorporated into the study. Through meticulous examination of the interview data, three principal themes and eleven subordinate sub-themes were delineated: (1) Microsystemic level: the ramifications of somatic symptoms, amplified anxieties regarding childbirth, perturbations in self-perception, and substantive alterations in lifestyle. (2) Mesosystemic level: the precipitous escalation in child-rearing expenditures, pronounced familial discord, and a dearth of peer support mechanisms. (3) Macrosystemic level: suboptimal healthcare encounters, insufficiencies in informational support, structural disequilibrium between service provision and demand, and intensifying societal pressures.

    Conclusion

    The emotional adversities confronted by rural pregnant women emanate from a constellation of interwoven determinants. Mitigating these psychological challenges necessitates a holistic and stratified approach that engages the expectant mothers themselves, their familial environments, and the grassroots medical infrastructure. Recognizing and refining the emotional regulation experiences of rural pregnant women through empirically substantiated, tailored interventions is paramount. Such efforts are pivotal in augmenting their emotional resilience and, consequently, advancing maternal and neonatal health outcomes.

    Classification Study of Self-management Types among Pregnant Women in Rural Areas Based on Cluster Analysis
    CHEN Junyu, HAN Guangli, LI Chunhong, CHEN Yidi, YANG Nana, LUO Xiaoxi
    2025, 28(26):  3289-3293.  DOI: 10.12114/j.issn.1007-9572.2024.0292
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    Background

    In rural areas, the self-management levels of pregnant women not only remain generally low but also vary significantly among individuals, thereby necessitating a detailed investigation into their behavioral patterns to facilitate their classification into distinct groups.

    Objective

    This analysis explores the types and characteristics of self-management among pregnant women in rural areas to provide references for devising targeted management strategies.

    Methods

    From January to August 2023, a convenience sampling method was employed to select pregnant women from Suihua City and Daqing City in Heilongjiang Province, and Changchun City in Jilin Province. Surveys were conducted using a general data questionnaire, a self-management scale for pregnant women, a general self-efficacy scale, an internal motivation scale, and a prenatal care knowledge scale. Cluster analysis was performed using SPSS 25.0 to classify the subjects into different types based on their self-management traits and compare their general characteristics.

    Results

    A total of 481 questionnaires were distributed, and 470 valid questionnaires were retrieved, with a valid questionnaire recovery rate of 97.7%. It was found that the total score for self-management behaviors among the surveyed rural pregnant women stood at (70.2±16.4). Four distinct types were identified through optimal clustering: typeⅠ, characterized by low awareness non-participants (25.3%, n=119) ; typeⅡ, those who engage through guided cooperation (29.4%, n=138) ; typeⅢ, those under supervised directive (18.7%, n=88) ; and typeⅣ, proactive participants (26.6%, n=125). Noteworthy were the significant statistical differences that emerged across such variables as educational backgrounds, occupations, annual incomes, number of pregnancies, gestational weeks, whether pregnancies were planned, histories of chronic diseases, and complications during pregnancy among the four types (P<0.05). Furthermore, the comparison of scores across different self-management dimensions revealed significant statistical differences, with adherence to medical advice scoring the highest and fetal monitoring behavior scoring the lowest (P<0.05) .

    Conclusion

    The four types of self-management among rural pregnant women, identified based on differentiated characteristics in prenatal care knowledge, self-efficacy, and behavioral motivation, exhibit a high degree of heterogeneity. Type Ⅰ, characterized by low awareness non-participants, faces the dual challenge of inadequate knowledge reserves and lack of behavioral motivation. Type Ⅱ, those who engage through guided cooperation, is marked by low self-efficacy but good compliance with external guidance. TypeⅢ, those under supervised directive, lacks intrinsic motivation and relies heavily on external supervision for regulating self-management behaviors. Type Ⅳ, proactive participants, represents the most optimal group, possessing strong prenatal care knowledge, high self-efficacy, and effective self-management behaviors. Therefore, in clinical practice, targeted intervention strategies can be developed according to each type, in order to further enhance the self-management capabilities of rural pregnant women and optimize prenatal care services.

    Maternal Preferences in Contraceptive Decision-making: an Analysis of Influencing Factors
    CHOU Xintong, PENG Hanyu, MA Hui, ZHANG Zhen, SU Xian, QIU Hongyan
    2025, 28(26):  3294-3299.  DOI: 10.12114/j.issn.1007-9572.2024.0601
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    Background

    Despite ongoing adjustments and optimizations to fertility policies, deficiencies persist in contraceptive service provision for pregnant and postpartum women, potentially increasing the risk of unintended and short-interval pregnancies. Currently, contraceptive decision-making is largely concentrated in the postpartum period, with relatively delayed timing, whereas prenatal contraceptive decision-making remains insufficiently addressed.

    Objective

    To investigate maternal preferences and associated factors regarding the three contraceptive decision-making models—physician-led, patient-led, and shared decision-making—with a particular focus on their needs for postpartum contraceptive decision-making during the prenatal period.

    Methods

    A cross-sectional survey was conducted among women aged 18-45 years who delivered healthy live births between January and July 2023 at Wuzhong People's Hospital and Yinchuan Maternal and Child Health Hospital and attended postpartum follow-up visits at (42±7) days. The questionnaire gathered information on participants' demographic characteristics, the current status of prenatal contraceptive decision-making services, postpartum contraceptive practices, and contraceptive decision-making preferences. Maternal contraceptive decision-making preferences were assessed using the Problem Solving Decision-making (PSDM) Scale. Multiple Logistic regression analyses were performed to identify factors influencing maternal preferences for contraceptive decision-making.

    Results

    In this study, a total of 650 questionnaires were collected. After excluding 34 due to duplicate data and significant missing values, 616 valid questionnaires were included in the final analysis. Among these, 612 postpartum women (99.4%) had not received any antenatal contraceptive decision-making services, while only 4 (0.6%) had. Of the 4 women who received such services, 1 relied on doctor- (or nurse-) led decision-making, while 3 preferred autonomous decision-making. A total of 533 (86.5%) participants expressed a need for shared decision-making regarding postpartum contraception during the prenatal period, and 545 (88.5%) were willing to receive shared decision-making services for postpartum contraception before delivery. Multiple Logistic regression analysis indicated that, compared with a preference for autonomous decision-making, acceptance of postpartum shared decision-making services was a significant factor influencing the preference for shared decision-making (OR=0.231, 95%CI=0.062-0.864, P<0.05) .

    Conclusion

    Maternal acceptance of the shared decision-making model for contraception is relatively high, yet the actual receipt of related services remains low. Efforts should be made to enhance pregnant and postpartum women's awareness of and participation in shared decision-making during the prenatal period, promoting the integration of prenatal and postpartum contraceptive services to further safeguard maternal and infant health.

    Original Research·Research Trends of Traditional Chinese Medicine
    Clinical Efficacy Study on the Treatment of Erectile Dysfunction with Miao Medicine Bamboo-based Medicinal Moxibustion Therapy: a Randomized Controlled Study
    XIAO Caihong, CUI Jin, QUAN Fei, YAN Mingxi, LU Chunxia, CHEN Yinglong
    2025, 28(26):  3300-3306.  DOI: 10.12114/j.issn.1007-9572.2024.0404
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    Background

    Erectile dysfunction (ED) has a high incidence and causes significant harm. The Miao medicine bamboo-based medicinal moxibustion therapy belongs to the traditional "moxibustion with medication interposed". It is commonly used in clinical practice for the treatment of ED. But it lacks clinical evidence.

    Objective

    To explore the clinical efficacy of the Miao medicine bamboo-based medicinal moxibustion therapy in the treatment of ED.

    Methods

    Sixty patients with ED from the outpatient Department of the Acupuncture and Department of Moxibustion and the Urology, First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from December 2021 to March 2024 were selected as the research objects. They were divide into the Sildenafil group and the Miao medicine bamboo-based medicinal moxibustion group using the random number table method. Each group had 30 cases. In the Sildenafil group, 50 mg of sildenafil citrate tablets were taken orally 1 hour before sexual activity. In the Miao medicine bamboo-based medicinal moxibustion group, the indirect moxibustion method was adopted. The acupoints selected were CV 6 (Qi Hai), CV 4 (Guan Yuan), CV 3 (Zhong Ji), KI 12 (Da He), and CV 2 (Qu Gu) ; BL 23 (Shen Shu), BL 32 (Ci Liao), BL 30 (Bai Huan Shu), BL 34 (Xia Liao), and BL 54 (Zhi Bian). The two groups of acupoints were used alternately. The treatment was done once every other day. Each treatment lasted for 40 minutes. Both groups were treated for 30 days. After treatment, the efficacy of the two groups was evaluated. The changes in serum testosterone (T) levels before and after treatment in both groups were compared. The scores of the International Index of Erectile Function (IIEF), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and TCM clinical syndrome scores before and after treatment and during the follow-up period (2 weeks after treatment) were also compared between the two groups.

    Results

    Two patients in the Miao medicine bamboo-based medicinal moxibustion group withdrew from the trial. The total effective rate in the Miao medicine bamboo-based medicinal moxibustion group was 85.71% (24/28). The total effective rate in the Sildenafil group was 86.67% (26/30). There was no statistically significant difference between the two groups (χ2=3.291, P=0.385). Intra-group comparison: there was no statistically significant difference in T before and after treatment in the Miao medicine bamboo-based medicinal moxibustion group (P>0.05), while T increased after treatment in the Sildenafil group compared to before treatment (P<0.05). The IIEF scores in both groups increased after treatment and during the follow-up period compared with those before treatment (P<0.05). There was no statistically significant difference in the IIEF scores during the follow-up period compared with those after treatment in the Miao medicine bamboo-based medicinal moxibustion group (P>0.05). The IIEF scores during the follow-up period in the Sildenafil group were lower than those after treatment (P<0.05). The SAS, SDS, and TCM syndrome scores in the Miao medicine bamboo-based medicinal moxibustion group decreased after treatment and during the follow-up period compared with those before treatment (P<0.05). There was no statistically significant difference in the SAS, SDS, and TCM syndrome scores before and after treatment and during the follow-up period in the Sildenafil group (P>0.05). The SAS, SDS, and TCM syndrome scores in the Miao medicine bamboo-based medicinal moxibustion group during the follow-up period were lower than those after treatment (P<0.05). Inter-group comparison: after treatment, the T value and IIEF scores in the Sildenafil group were higher than those in the Miao medicine bamboo-based medicinal moxibustion group (P<0.05). After treatment, the SAS, SDS, and TCM syndrome scores in the Miao medicine bamboo-based medicinal moxibustion group were lower than those in the Sildenafil group (P<0.05). During the follow-up period, the SAS, SDS, and TCM syndrome scores in the Miao medicine bamboo-based medicinal moxibustion group were lower than those in the Sildenafil group (P<0.05). There was no statistically significant difference in the IIEF scores between the two groups of subjects during the follow-up period (P>0.05). During the treatment process, 2 cases in the Sildenafil group experienced symptoms such as dry mouth, headache, and facial flushing. These symptoms could be relieved by rest. No serious adverse events occurred in either the Sildenafil group or the Miao medicine bamboo-basedmedicinal moxibustion group.

    Conclusion

    The efficacy of the Miao medicine bamboo-based medicinal moxibustion therapy is equivalent to that of sildenafil in the treatment of ED. The Miao medicine bamboo-based medicinal moxibustion therapy has more advantages than sildenafil in improving the short-term and long-term anxiety and depression symptoms and TCM syndrome scores of patients with ED. Sildenafil is superior to the Miao medicine bamboo-based medicinal moxibustion therapy in improving the T value and short-term erectile function of patients with ED.

    Traditional Chinese Medicine Factors Associated with Diabetic Nephropathy Diagnosed by Renal Biopsy
    ZHANG Ruimin, DONG Zheyi, LI Shuang, WANG Qian, CHEN Xiangmei
    2025, 28(26):  3307-3313.  DOI: 10.12114/j.issn.1007-9572.2024.0300
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    Background

    Diabetic nephropathy (DN) is the common microvascular complication of diabetes mellitus, and also one of the main causes of end-stage renal disease. Renal biopsy is the gold standard for the pathological diagnosis of DN. Previous studies on traditional Chinese medicine (TCM) factors influencing DN lack the basis of renal biopsy, potentially leading to an inaccurate participant recruitment (selection bias) .

    Objective

    To investigate the distribution of TCM syndrome types in DN patients and the relevant TCM syndrome elements in those with massive proteinuria and renal insufficiency, thereby providing TCM research directions in the pathogenesis of DN.

    Methods

    From January 2022 to January 2024, TCM and clinical data of 78 patients diagnosed with type 2 diabetes mellitus (T2DM) with a confirmation of DN through renal biopsy in the Department of Nephrology of First Medical Center of Chinese PLA General Hospital were included. The distribution and clinical characteristics of TCM syndrome types were explored. Binary Logistic regression was employed to explore the TCM syndrome elements associated with massive proteinuria (24-hour urinary protein quantification>3.5 g) and estimated glomerular filtration rate (eGFR) <60 mL·min-1· (1.73 m2) -1 in DN patients.

    Results

    According to the classification of chronic kidney disease (CKD), there were 11 cases in stageⅠgroup, 19 in stageⅡgroup, 22 in stageⅢgroup, 21 in stageⅣgroup, and 5 in stageⅤgroup. There were significant differences in hemoglobin, eGFR, serum albumin, serum creatinine, serum urea nitrogen, and 24-hour urinary protein in DN patients with different CKD stages groups (P<0.05). Based on the TCM syndrome, there were 11 cases of Yin deficiency and dry heat syndrome, 23 of syndrome of deficiency of both Qi and Yin, 15 of liver-kidney Yin deficiency syndrome, and 29 of spleen-kidney Yang deficiency syndrome. Significant differences were found in hemoglobin, eGFR, serum total protein, serum albumin, serum creatinine, and serum urea nitrogen among DN patients with varying TCM syndrome types (P<0.05). There was a significant difference in the distribution of TCM syndrome types among DN patients in stageⅠ-Ⅴ CKD (P<0.05). In the stageⅠ group, the proportions of Yin deficiency and dry heat syndrome (5/11, 45.5%) and syndrome of deficiency of both Qi and Yin (3/11, 27.3%) were relatively high. In the stage Ⅱ group, the proportions of syndrome of deficiency of both Qi and Yin and liver-kidney Yin deficiency syndrome were 42.1% (8/19) and 31.6% (6/19) respectively. In the stageⅢ group, spleen-kidney Yang deficiency syndrome and syndrome of deficiency of both Qi and Yin accounted for 54.5% (12/22) and 31.8% (7/22), respectively. In the stageⅣ group, spleen-kidney Yang deficiency syndrome and liver-kidney Yin deficiency syndrome accounted for 52.4% (11/21) and 28.6% (6/21), respectively. In the stage Ⅴ group, spleen-kidney Yang deficiency syndrome occupied the highest proportion (3/5, 60.0%). Correspondence analysis indicated that Yin deficiency and dry heat syndrome, syndrome of deficiency of both Qi and Yin, and spleen-kidney Yang deficiency syndrome corresponded to CKD stageⅠ, Ⅱ andⅤ, respectively. Yang deficiency syndrome (OR=3.545, 95%CI=1.270-9.895, P=0.016) and heart location of disease (OR=3.208, 95%CI=1.082-9.511, P=0.035) were the influencing factors of DN combined with massive proteinuria. Yang deficiency syndrome (OR=3.000, 95%CI=1.141-7.890, P=0.026) was the influencing factor of DN combined with eGFR<60 mL·min-1· (1.73 m2) -1.

    Conclusion

    The distribution of TCM syndromes of DN transits from Yin deficiency and Qi deficiency to Yang deficiency with the worsening of CKD staging. Yang deficiency syndrome and disease location of heart are factors influencing DN with massive proteinuria, and Yang deficiency syndrome is influencing factor for DN with eGFR<60 mL·min-1· (1.73 m2) -1. TCM syndrome differentiation combined with modern medicine is conducive to grasping the pathogenesis of DN and advantaging integrated TCM and Western medicine diagnosis and treatment.

    Original Research·Epidemiological Study
    Trends in Cervical Cancer Burden in China from 1990 to 2021 and Prediction for 2022 to 2035
    SHANG Zhonghua, JIANG Zhiyue, HUANG Zhaohui, YANG Xing, LIU Haiyan, ZHANG Li
    2025, 28(26):  3314-3320.  DOI: 10.12114/j.issn.1007-9572.2024.0595
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    Background

    Cervical cancer is the fourth most common cancer in women worldwide, causing a huge burden of disease in countries around the world, and is currently an important public health problem facing the world, especially in developing countries.

    Objective

    To examine the trends in cervical cancer burden in China from 1990 to 2021 and to project the burden from 2022 to 2035, providing a scientific basis for formulating and adjusting prevention and control strategies.

    Methods

    Utilizing data from the 2021 Global Burden of Disease (GBD) study, we analyzed the temporal trends in cervical cancer age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate in China between 1990 and 2021 using the estimated annual percentage change (EAPC). These trends were compared with those in developed countries such as the United Kingdom. Additionally, the Bayesian age-period-cohort (BAPC) model was used to predict cervical cancer burden in China from 2022 to 2035.

    Results

    The ASIR of cervical cancer in China increased from 11.80 per 100 000 in 1990 to 13.37 per 100 000 in 2021 (EAPC=0.88, 95%CI=0.70-1.07). The ASMR decreased from 6.98 per 100 000 in 1990 to 4.64 per 100 000 in 2021 (EAPC=-1.05, 95%CI=-1.20 to -0.89), and the age-standardized DALYs rate decreased from 228.2 per 100 000 in 1990 to 149.8 per 100 000 in 2021 (EAPC=-1.07, 95%CI=-1.22 to -0.92). Between 1990 and 2021, the proportion of cervical cancer cases in women aged 35 and older increased from 86.41% to 92.12%, while the proportion of DALYs in this group rose from 88.48% to 95.07%. Furthermore, the proportion of deaths in women aged 40 and older increased from 86.42% in 1990 to 95.54% in 2021. A notable upward trend in cervical cancer incidence was observed in women aged 25-54, with the most pronounced increase in the 45-49 age group (EAPC=1.49, 95%CI=1.20-1.78). Among women under 60, the 45-49 age group showed the smallest decline in mortality and DALYs rates. By 2035, the projected age-standardized incidence, mortality, and DALYs rates for cervical cancer in China are expected to decrease to 11.8, 3.4, and 112.8 per 100 000, respectively.

    Conclusion

    From 1990 to 2021, the standardized incidence rate of cervical cancer in China showed a slow upward trend, while the standardized mortality rate and standardized DALYs rate showed a slow downward trend. It is predicted that the incidence, death and DALYs burden of cervical cancer in China will decrease by 2035. People over 35 years of age constitute the main body of cervical cancer disease burden and are the core target population for prevention and control strategies. Based on existing prevention and control experience, it is recommended to accelerate the national coverage strategy of HPV vaccination for girls aged 9-14 years; and accurately improve the coverage rate of cervical cancer screening for 35-44 years. By constructing a comprehensive prevention and control system covering the whole life cycle, in order to effectively reduce the burden of cervical cancer in China.

    Trend Analysis of the Changing Disease Burden of Pancreatitis in China and Worldwide from 1990 to 2021 and Prediction for 2022 to 2031
    LUO Xinyu, LIU Jin, CHEN Hailong
    2025, 28(26):  3321-3327.  DOI: 10.12114/j.issn.1007-9572.2025.0025
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    Background

    Pancreatitis is a common disease of the digestive system, seriously affecting the quality of life of patients and imposing a public medical burden on families and society.

    Objective

    To analyse the trend of change in the burden of pancreatitis in China from 1990 to 2021, compare it with the global burden of disease, and predict the burden of pancreatitis in China from 2022 to 2031, so as to provide a reference basis for the prevention and treatment of pancreatitis in China.

    Methods

    Utilizing open data from the Global Burden of Disease (GBD) database (1990-2021), we analyzed the characteristics of pancreatitis burden in China and worldwide. Temporal trends in pancreatitis burden were calculated using the Joinpoint regression model, and the autoregressive integrated moving average model (ARIMA) was extended to predict the disease burden of pancreatitis from 2022 to 2031.

    Results

    In China, the age-standardized incidence rate (ASIR) decreased from 35.352 per 100 000 in 1990 to 23.529 per 100 000 in 2021, the age-standardized prevalence rate (ASPR) declined from 35.326 per 100 000 to 24.146 per 100 000, the age-standardized mortality rate (ASMR) dropped from 0.983 per 100 000 to 0.637 per 100 000, and the age-standardized DALY rate (ASDR) fell from 29.770 per 100 000 to 18.267 per 100 000. Globally, ASIR, ASPR, ASMR, and ASDR also exhibited declining trends, but with smaller magnitudes of decline. The average annual percentage changes (AAPC) for China's ASIR, ASPR, ASMR, and ASDR were -1.340, -1.246, -1.400, and -1.574, respectively, which significantly outperformed the global declining trends (-0.441, -0.990, -0.468, and -0.527). Over the next decade, the ASPR of pancreatitis in China is projected to decrease from 24.08 per 100 000 in 2022 to 21.21 per 100 000 in 2031, ASMR are expected to decline from 0.64 per 100 000 to 0.53 per 100 000, and ASDR are predicted to drop from 17.98 per 100 000 to 14.63 per 100 000.

    Conclusion

    Analysis of data from 1990 to 2021 indicates that the disease burden of pancreatitis has shown a declining trend both in China and globally. In China, the ASIR, ASPR, ASMR, and ASDR have all demonstrated decreasing trends. The corresponding AAPC were significantly more favorable than the global levels. Projections based on the ARIMA model suggest that the ASIR in China will remain stable over the next decade, while the ASPR, ASMR, and ASDR associated with pancreatitis are predicted to decline.

    Review & Perspectives
    Advances in Targeted Combination Therapy for Patients with Brain Metastases from EGFR-mutated Non-small Cell Lung Cancer
    WANG Yajing, DUAN Xiaoyang, HOU Ran, HUANG Yajie, SHI Jian
    2025, 28(26):  3328-3337.  DOI: 10.12114/j.issn.1007-9572.2024.0101
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    Brain metastases are a major factor in the poor prognosis of patients with non-small cell lung cancer. The incidence of brain metastases is higher in patients with EGFR-mutated non-small cell lung cancer, and tyrosine kinase inhibitors targeting it have become the first-line treatment for patients with stable brain metastases from EGFR-mutated NSCLC due to their excellent efficacy and safety, especially third-generation EGFR-TKIs. This article provided a review of the efficacy, safety, and future challenges of single-agent EGFR-TKIs and combination therapy in patients with brain metastases from EGFR-mutant non-small cell lung cancer. This article suggested that EGFR-TKI in combination with chemotherapy might be a potential alternative treatment option for patients with EGFR-mutated NSCLC brain metastases, especially for Asian patients, whereas for EGFR-TKI in combination with antiangiogenic or radiotherapy, the frontal benefit of the combination therapy was not obvious, and large prospective studies could be conducted to further validate and find individualized treatment options based on stratification factors such as EGFR mutation type, comorbid mutations, and clinicopathological features. As for EGFR-TKI combined with immunotherapy, the safety of the combined treatment still needed to be further explored.

    Symptom Clusters in Gastric Cancer Patients Receiving Chemotherapy: a Scoping Review
    HUANG Yulin, WANG Haoyun, LI Yanmei, XIAO Xueying
    2025, 28(26):  3338-3344.  DOI: 10.12114/j.issn.1007-9572.2024.0280
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    Background

    Symptom clusters refers to two or more than two symptoms occurring at the same time and influencing each other. At present, symptom clusters in gastric cancer patients receiving chemotherapy obtained from different studies are not same, and there is a certain heterogeneity, which is not conducive to the management and intervention of symptom clusters.

    Objective

    To identify the characteristics, composition and assess the current research status of the symptom clusters of gastric cancer patients receiving chemotherapy, and to provide valuable insights for future studies on symptom clusters.

    Methods

    Following the PRISMA extended list of scope review report as the methodological framework, a literature search was performed in the PubMed, Web of Science, Medline, CINAHL, CNKI, Wanfang Data, VIP and SinoMed databases to identify relevant studies about symptom clusters in patients with gastric cancer from inception until May 24, 2023. The included studies were thoroughly analyzed to extract pertinent information.

    Results

    A total of 12 articles were included. The elements of identifying symptom clusters included symptom assessment and analysis methods. There were 20 kinds of symptom clusters during chemotherapy. Before chemotherapy, the symptom clusters of disease, the symptom clusters digestive tract, the symptom clusters of emotional, the symptom clusters of stomach specific and the symptom clusters of nervous system appearing. After the first chemotherapy, the symptom clusters of physical, the symptom clusters of image change and the symptom clusters of energy deficiency appearing. After the 3rd chemotherapy, the type and composition of symptom clusters after chemotherapy were the most complex. After the 6th chemotherapy, the symptom clusters of chemotherapy would appear.

    Conclusion

    During receiving chemotherapy, the gastric cancer patient experienced a variety of symptom clusters with dynamic change, which changes with the progression of chemotherapy stage. Future research can explore the gastric cancer patients with specific symptom assessment tools, combined with the symptoms of advanced analysis technology such as network analysis, to accurately identify symptoms clusters at an early stage and build the symptoms of precise management solution.