Table of Content

15 October 2025, Volume 28 Issue 29

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World General Practice / Family Medicine

Introduction to the Coding Framework and Usage Process of the International Classification of Primary Care, 3rd Edition (ICPC-3)

JIANG Yue, LI Jie, GU Yuan

2025, 28(29):  0-c5.  DOI: 10.12114/j.issn.1007-9572.2025.0249

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Against the backdrop of accelerated global population aging and the escalating burden of chronic disease multimorbidity, primary care faces three core challenges: fragmented health data, inefficient coordination between medical treatment and prevention, and suboptimal resource allocation. The International Classification of Primary Care, 3rd Edition (ICPC-3) released by the World Organization of Family Doctors (WONCA) in December 2020, maintained its strengths in systematically classifying and encoding reasons for encounter (RFE), health problems, and processes of care. It expanded upon previous versions by adding chapters on functioning-related concepts and refining classifications within an enhanced coding framework. Compared with other disease classification systems, ICPC-3 placed greater emphasis on patient-centeredness. It comprehensively encompassed complex symptoms, undifferentiated conditions, and non-disease states encountered in primary health care, thereby accentuating the value of ICPC-3. The unique dual-axis framework of ICPC-3 enhanced its systematicity and logical coherence, allowing it to complement other disease classification methodologies. Consequently, it achieved widespread global adoption. The present paper systematically introduced the coding framework and operational procedures of ICPC-3, aiming to facilitate its implementation and dissemination within China.

Commentary

Practical Evidence and Reflection on Hypertension Control Strategies in Stroke Prevention and Management in China

SUN Haixin, JIANG Bin

2025, 28(29):  3601-3607.  DOI: 10.12114/j.issn.1007-9572.2025.0183

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Hypertension is the primary cause of both death from stroke and the increased DALY burden of stroke. As the most important modifiable risk factor, the effective prevention and control of hypertension has become the core task of primary and secondary prevention of stroke. In February 2025, the World Stroke Organization and the World Hypertension League released the 2025 WSO/WHL Position Statement: Application of Hypertension Control Strategies in Stroke Prevention and Management. Based on the strategies and recommendations of the statement, this paper analyzes and interprets the practical evidence in the prevention and control of hypertension in China, and gives thoughts on constructing a hypertension prevention and control path with Chinese characteristics, aiming to provide reference for future applications and research of stroke prevention and management in China.

Guidelines·Consensus

Chinese Expert Consensus on Sleep Health and Rehabilitation Management for Community-dwelling Older Adults (2025 Edition)

Community Rehabilitation Working Committee of Chinese Rehabilitation Medical Association

2025, 28(29):  3608-3618.  DOI: 10.12114/j.issn.1007-9572.2025.0205

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Poor sleep quality in older adults is closely associated with a range of adverse health outcomes. Strengthening sleep health and rehabilitation management within existing primary healthcare for older adults can help prevent or slow the onset and progression of many chronic diseases, thereby saving substantial medical resources. However, a comprehensive sleep-rehabilitation management system has yet to be established at the primary healthcare level. To address this gap, the Community Rehabilitation Working Committee of Chinese Rehabilitation Medical Association, has developed the Chinese Expert Consensus on Sleep Health and Rehabilitation Management for Community-dwelling Older Adults (2025 Edition), in collaboration with experts from multiple domestic institutions. Grounded in evidence-based research on sleep rehabilitation and informed by multidisciplinary clinical experience, the consensus considers the current availability of community-level rehabilitation resources and future trends in primary healthcare. It offers consensus-based recommendations on age-related changes in sleep physiology, goals and requirements for sleep management, rehabilitation screening and assessment, management content, and procedural workflows. The publication of this consensus is expected to play a pivotal role in guiding primary healthcare institutions to implement standardized and evidence-based management of sleep rehabilitation in older adults.

Dysphagia Section

Prevalence and Influencing Factors of Silent Aspiration among Patients with Dysphagia

YU Hairong, CHEN Shen, HUANG Jingyi, ZHANG Yuanyuan, LI Mengchao, CUI Yan, JI Minghui, SHEN Jiemiao

2025, 28(29):  3619-3624.  DOI: 10.12114/j.issn.1007-9572.2024.0428

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Background

Silent aspiration lacks clinical manifestations and easily leads to complications such as aspiration pneumonia. At present, there is a lack of research on the current status of silent aspiration and its influencing factors in patients with dysphagia in China.

Objective

To understand the current status of silent aspiration among patients with dysphagia in China and to explore the influencing factors of silent aspiration.

Methods

This study was a cross-sectional survey. 212 patients with dysphagia were selected as study subjects among the rehabilitation, neurosurgery, and neurology departments of four hospitals in Nanjing (the First Affiliated Hospital with Nanjing Medical University, the Affiliated Jiangning Hospital of Nanjing Medical University, the Affiliated Sir Run Run Hospital of Nanjing Medical University, and the Dongshan Hospital of Jiangning District of Nanjing) by the convenience sampling method from December 2022 to January 2024. The basic data of the patients were recorded, and the Eating Assessment Questionnaire (EAT-10) score and Barthel Index were used to assess dysphagia risk and ability to perform activities of daily living. Fluoroscopic Fluorescence Swallowing Screening (VFSS) or Flexible Endoscopic Swallowing Function Examination (FEES) was used to diagnose whether the patient experienced aspiration and the type of aspiration. In this study, all patients who had no aspiration during swallowing were categorized as the no aspiration group, all patients who had at least 1 silent aspiration during swallowing were categorized as the silent aspiration group, and all patients who had at least 1 overt aspiration but no silent aspiration during swallowing were categorized as the overt aspiration group. Multivariate Logistic regression analysis was used to explore the influencing factors of silent aspiration and overt aspiration.

Results

Silent aspiration accounted for 47.2% (100/212), overt aspiration 13.2% (28/212), and no aspiration 39.6% (84/212) of patients with dysphagia. Among the 128 patients with aspiration, 78.1% (100/128) were silent aspiration and 21.9% (28/128) were overt aspiration. The results of multivariate Logistic regression analysis showed that the EAT-10 score (OR=1.076, 95%CI=1.028-1.126, P=0.002), gender (female as control, OR=2.231, 95%CI=1.103-4.509, P=0.025), and conscious status (impaired consciousness as control, OR=0.334, 95%CI=0.123-0.911, P=0.032) were influential factors for silent aspiration. EAT-10 scores (OR=1.113, 95%CI=1.046-1.184, P=0.001) and poor self-assessed health (OR=0.194, 95%CI=0.041-0.923, P=0.039) were influential factors for overt aspiration.

Conclusion

The prevalence of silent aspiration is higher among patients with dysphagia and the risk of silent aspiration increases with higher EAT-10 scores, in males, and in those with impaired consciousness.

Intermittent θ Burst Stimulation Combined with Chin Tuck Against Resistance Training for Dysphagia in Stroke Patients: a Randomized Controlled Trial

HAN Xue, LIU Huan, LOU Xiaole, SONG Jianing, ZHANG Ziang, GENG Zongxiao, WANG Shan, ZHANG Yongqing, XU Lei

2025, 28(29):  3625-3630.  DOI: 10.12114/j.issn.1007-9572.2024.0441

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Background

Swallowing dysfunction is a common complication after stroke, and the recovery of swallowing function is important regarding patients' intake of nutrients, improved quality of life, reduced risk of complications, and improved quality of life. Although intermittent θ burst stimulation (iTBS) and chin tuck against resistance (CTAR) have been shown to have significant effects in improving dysphagia, fewer studies have been performed on combining iTBS with CTAR in the treatment of patients with dysphagia in stroke, and its rehabilitative effects need to be further investigated.

Objective

To observe the clinical effects of iTBS combined with CTAR training on swallowing function in stroke patients.

Methods

From March 2023 to July 2024, 90 patients with post-stroke dysphagia attending the Department of Rehabilitation Medicine of the First Affiliated Hospital of Bengbu Medical University were selected. The patients were randomly divided into the routine group (n=30), the CTAR group (n=30), and the combined group (n=30) according to the method of random number table. The routine group received conventional swallowing training, the CTAR group received CTAR training based on the routine group, and the combined group received iTBS based on the CTAR group. Both groups received treatment five times per week for four weeks. The Standard Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS) were used before and after the treatment. Surface electromyography (sEMG) was used to measure the duration of swallowing and the maximum amplitude value of the supraglottic muscle group and to compare the clinical effects of the three groups of patients.

Results

Thirty cases in the routine group, 30 cases in the CTAR group, and 30 cases in the combined group were finally included. After 4 weeks of treatment, the SSA score of the patients in the three groups was lower than those before treatment in the group, the FOIS score and the maximum amplitude value of sEMG were higher than those before treatment in the group, and the duration of swallowing was shorter than those before treatment in the group (P<0.05). After 4 weeks of treatment, the SSA score of the patients in the CTAR group and the combined group was lower than those in the routine group, the FOIS score and the maximum amplitude value of sEMG in the CTAR group and the combined group were higher than those in the routine group, and the duration of swallowing in the CTAR group and the combined group was shorter than those in the routine group (P<0.05) ; the SSA score of the patients in the combined group was lower than those in the CTAR group, the FOIS score and the maximum amplitude value of sEMG in the combined group were higher than those in the CTAR group, and the duration of swallowing in the combined group was shorter than those in the CTAR group (P<0.05). And the overall effective rate of the CTAR group and the combined group was higher than that of the routine group (P<0.017), and the overall effective rate of the combined group was higher than that of the CTAR group (P<0.017) .

Conclusion

CTAR combined with iTBS can improve the swallowing function of stroke patients with dysphagia, reinforce the strength of swallowing muscle groups, and enhance their quality of life.

Comprehensive Evaluation of Prognostic Factors Affecting Dysphagia after Stroke: an Umbrella Review

LI Yibing, JIA Hongbo, FAN Xiaonong, ZHAO Wenjun, LIU Wei, GE Wenyi, LI Songjiao, LEI Kangchen, ZHANG Menglong, ZHANG Weiwei, CHEN Yang, LI Li

2025, 28(29):  3631-3637.  DOI: 10.12114/j.issn.1007-9572.2025.0063

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Background

Post-stroke dysphagia (PSD) is a common and severe complication of stroke, significantly reducing patients' quality of life and increasing mortality risk. Although multiple factors have been proposed to correlate with PSD prognosis, the quality of evidence supporting these associations remains systematically underevaluated.

Objective

To systematically evaluate risk and protective factors influencing PSD prognosis and assess the quality of evidence for each factor.

Methods

Eight databases (PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, VIP, and SinoMed) were searched from their inception to November 3, 2024 to identify systematic reviews investigating prognostic factors for PSD. The methodological quality of the included reviews was appraised using the AMSTAR 2 checklist. A four-tiered evidence grading system was applied to evaluate the certainty of the prognostic factors. Data from all relevant original studies within the systematic reviews were synthesized and re-analyzed using Stata 16 and RevMan 5.4.

Results

Five systematic reviews (encompassing 39 original studies) were included, identifying 45 prognostic factors associated with PSD. Only one factor (impaired consciousness) was supported by strong evidence. Nine factors—age, sex, cognitive impairment, dysphagia severity, malnutrition, bilateral stroke, activities of daily living, NIHSS score, and mRS score—demonstrated highly suggestive evidence, while the remaining factors were supported by weak evidence.

Conclusion

Prognostic factors for PSD can be categorized into reversible and irreversible determinants. Clinical interventions should prioritize modifiable factors to optimize rehabilitation outcomes. Further high-quality studies are warranted to validate these associations and refine evidence-based management strategies.

Exploration of Technologies and Methods for Constructing a Swallowing Acoustic Database

LI Dan, LIU Tao, LUO Wei, SONG Hongdan, SHANG Shaomei

2025, 28(29):  3638-3644.  DOI: 10.12114/j.issn.1007-9572.2025.0238

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Dysphagia is common among elderly people and may lead to aspiration, malnutrition, and pulmonary infections if not properly managed. Acoustic-based assessment offers a non-invasive, practical, and remotely applicable approach, yet current research is limited by small sample sizes and a lack of standardized data protocols. This study recruited 650 older adults from 13 care institutions in Beijing and Shijiazhuang, with 635 completing valid audio tasks. A total of 7 922 high-quality recordings were collected, including swallowing, coughing, and speech sounds. From each audio clip, 23 acoustic features across time, frequency, energy, and nonlinear domains were extracted, yielding 182 206 feature data points. Waveform, spectrogram, and time-frequency analyses confirmed significant differences across sound types, highlighting the discriminative value of acoustic features. A standardized workflow for audio collection, processing, and feature extraction was developed, resulting in a comprehensive swallowing acoustic database. This database provides essential support for recognizing acoustic biomarkers, building AI-driven identification models and advancing remote dysphagia assessment. It has significant scientific research value and broad application prospects.

Article

Cohort Study on the Association between the Atherogenic Index of Plasma and the Risk of Incident Heart Failure in a Physical Examination Population

DENG Jie, QI Qi, WU Xinyu, HAN Quanle, LI Lei, JIANG Yue, YU Jing, WU Ruojie, WU Shouling, LI Kangbo

2025, 28(29):  3645-3652.  DOI: 10.12114/j.issn.1007-9572.2025.0087

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Background

Heart failure (HF) is the end stage of a variety of cardiovascular diseases, high incidence, poor prognosis, seriously affect the quality of life of patients. The atherogenic index of plasma (AIP) is closely related to atherosclerosis, coronary heart disease and other cardiovascular diseases, and atherosclerosis is an important risk factor for heart failure.

Objective

To investigate the effect of the AIP index on the risk of new-onset HF.

Methods

This is a retrospective cohort study. 99 755 active and retired employees of Kailuan Group who participated in the health examination of the 11 hospitals affiliated to Kailuan General Hospital from June 2006 to October 2007 were selected as the observation population, and the subjects were divided into 4 groups according to baseline AIP quartile, namely Group Q1: AIP <-0.56 (n=24 937) ; Group Q2: -0.56≤AIP <-0.16 (n=24 940) ; Group Q3: -0.16≤AIP <0.31 (n=24 938) ; Group Q4: AIP≥0.31 (n=24 940). Follow-up continued until 31 December 2021, during which the incidence of HF was recorded once a year. The incidence density of HF in the 4 groups was calculated. The cumulative incidence of HF in the 4 groups was calculated using the Kaplan-Meier method. The effect of AIP on the risk of new-onset HF was analysed by Cox regression.

Results

During a mean follow-up of 14.07 (13.79, 14.24) years, there were 3 337 (3.35%) cases of new HF. There were 675, 734, 940 and 988 cases in group Q1-Q4, respectively, and the incidence density was 1.95/1 000, 2.13/1 000, 2.73/1 000 and 2.87/1 000 years, respectively. The cumulative incidence of new HF in the Q1-Q4 group was 2.47%, 2.68%, 3.48% and 3.63%, respectively. According to the Log-rank test, the differences were statistically significant (χ²=76.90, P<0.001). In multivariate Cox regression analysis, compared with Q1, the risk for new-onset HF in Q3 and Q4 was 1.16 (95%CI=1.05-1.28) and 1.20 (95%CI=1.08-1.33), respectively, and the differences were statistically significant (P<0.05) .

Conclusion

AIP is an independent risk factor for new-onset HF, and the risk of new HF increases with the increase of AIP level. Early screening and evaluation of patients at high risk of HF can be achieved through AIP.

Relationship between Thyroid Hormone Sensitivity Indices and Osteoporosis in Patients with Normal Thyroid Function Type 2 Diabetes Mellitus

ZHANG Yuan, CHEN Guanhua, LYU Shanshan, JING Yali

2025, 28(29):  3653-3659.  DOI: 10.12114/j.issn.1007-9572.2024.0629

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Background

With the increasing aging population, the prevalence of osteoporosis in patients with type 2 diabetes mellitus (T2DM) is rising year by year. It has also been found that impaired sensitivity to thyroid hormone is associated with abnormal bone metabolism. However, there are few studies on the relationship between thyroid hormone sensitivity and the risk of osteoporosis in patients with T2DM.

Objective

To analyze the relationship between thyroid hormone sensitivity index and osteoporosis in T2DM patients with normal thyroid function.

Methods

This cross-sectional study included 723 T2DM patients with normal thyroid function admitted to the Department of Endocrinology of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from 2022 to 2023. Based on the results of bone mineral density (BMD) measurements, the patients were divided into three groups: normal bone mass group (n=362), osteopenia group (n=291), and osteoporosis group (n=70). The thyroid feedback quotient index (TFQI), thyroid-stimulating hormone index (TSHI), thyroid-stimulating hormone resistance index (TT4RI), and the ratio of free triiodothyronine to free thyroxine (FT₃/FT₄) were measured and calculated in each patient to assess thyroid hormone sensitivity. One-way analysis of variance (ANOVA) and chi-square test were used for intergroup comparisons. Spearman's rank correlation analysis and ultivariate Logistic regression analysis were employed to explore the association between thyroid hormone sensitivity indices and the risk of osteoporosis in T2DM patients. The receiver operating characteristic curve (ROC curve) was used to evaluate the value of TFQI in predicting osteoporosis

Results

The osteoporosis group had higher age, proportion of females, diabetes duration, systolic blood pressure, 2-hour postprandial glucose (2 hPG), high-density lipoprotein cholesterol (HDL-C), and TFQI compared with the normal bone mass group (P<0.05). In contrast, BMI, alanine aminotransferase (ALT), diastolic blood pressure, creatinine, triglycerides, FT₃, and FT₃/FT₄ were lower in the osteoporosis group than in the normal bone mass group (P<0.05). The osteoporosis group also had higher age, proportion of females, diabetes duration, systolic blood pressure, 2 hPG, HDL-C, and TFQI compared with the osteopenia group (P<0.05), while ALT, creatinine, triglycerides, FT₃, and FT₃/FT₄ were lower (P<0.05). Spearman rank correlation analysis showed that the occurrence of osteoporosis in T2DM patients was positively correlated with TFQI (r_s=0.553, P<0.001) and negatively correlated with FT₃ and FT₃/FT₄ (r_s=-0.098, P=0.009; r_s=-0.080, P=0.031). Multivariate Logistic regression analysis revealed that, after adjusting for confounding factors, TFQI was positively associated with the risk of osteoporosis in T2DM patients (OR=6.612, 95%CI=5.793-8.192, P<0.05). The area under the ROC curve (AUC) for predicting the risk of osteoporosis in T2DM patients using TFQI was 0.831 (95%CI=0.794-0.867), with a best cutoff value of -0.029. The sensitivity and specificity were 100.0% and 55.4%, respectively.

Conclusion

Elevated levels of TFQI are associated with a higher risk of osteoporosis in T2DM patients with normal thyroid function, suggesting that reduced central sensitivity to thyroid hormone in this population is related to the development of osteoporosis.

A Cross-sectional Study on the Relationship between Social Support and Depression in Community Population

ZHAO Ziqi, CHEN Jiaqi, ZHU Hongmin, ZHENG Yizhan, WANG Huan, HU Jiaqi, LIU Mingyue, WANG Nan, LUO Zhenghao, CHEN Xinyang, LI Zheng, ZHANG Shangmingzhu, ZHANG Haoruo, XUAN Xiaoqing, WU Jianhui, ZHANG Xiujun

2025, 28(29):  3660-3667.  DOI: 10.12114/j.issn.1007-9572.2024.0609

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Background

Depression is an increasingly serious public health problem worldwide, and the relationship between depression diagnosed using personality disorder formulaic interviews (SCID) and social support according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) is currently unclear.

Objective

To explore the relationship and improvement strategies between social support and depression in community populations.

Methods

From September 2022 to November 2023, a total of 2 549 people from Majiagou Community in Kailuan, Tangshan City, Hebei Province were collected for health examinations, the collection of social support is conducted by using Social Support Rating Scale (SSRS), and the diagnosis of depression is carried out through SCID in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Logistic regression model was used to analyze the correlation between social support and depression, Lasso regression analysis was used to obtain variable importance, and further analyzed the relationship between social support and depression using subgroup analysis.

Results

This study included a total of 2 189 individuals who met the inclusion and exclusion criteria, including 312 individuals (14.25%) with depression and 1 877 individuals (85.75%) without depression. The prevalence of depression in high-level social support was 12.07% (225/1 864), in moderate level social support it was 19.84% (51/257), and in low-level social support it was 52.94% (36/68). In Lasso regression analysis, social support (coefficient=1.082) was the most important variable affecting depression. Through multiple Logistic regression, it was found that a decrease in social support level was associated with an increased risk of depression. Compared with high-level social support, the OR (95%CI) of moderate level social support and low-level social support were 1.535 (1.072-2.198) and 4.993 (2.823-8.830), respectively, and this relationship existed in different age, gender, and well-being subgroups.

Conclusion

The improvement of social support level among the community population is related to the reduction of the risk of depression, and relevant measures should be taken to enhance the level of social support among the community population.

Association of Longitudinal Trajectories of Triglyceride-glucose Index and Liver Stiffness Status in Elderly People

LIU Xiaoxue, LYU Liang, FENG Wanting, YANG Huifang, TENG Yilin, MA Tianpei, ZHANG Tao, JIANG Xia, LONG Lu, LIAO Jiaqiang, FAN Mengyu, WANG Chuan, YANG Dailan, LI Jiayuan, ZHANG Ben

2025, 28(29):  3668-3673.  DOI: 10.12114/j.issn.1007-9572.2024.0531

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Background

The triglyceride-glucose (TyG) index is closely related to liver diseases. However, there is a lack of studies on the association between the longitudinal TyG index trajectories and liver stiffness in the elderly population, both at home and abroad.

Objective

This study aims to analyze the association between longitudinal trajectories of triglyceride-glucose index and liver stiffness status in elderly individuals.

Methods

The population was derived from the West China Elderly Preventive and Treatment Merging Cohort, comprising 2 736 individuals who participated in three or more health examinations between 2017 and 2022. Participants were aged ≥60 years, had complete triacylglycerol and blood glucose measurements, and had no history of chronic liver disease at baseline. The group trajectory model (GBTM) was applied to establish the long-term longitudinal trajectories of the TyG index, and a binary Logistic regression model was used to analyze the association between the longitudinal trajectories of the TyG index and liver stiffness.

Results

Among the participants, 376 individuals (13.7%) had elevated liver stiffness (LSM>7 kPa). The TyG longitudinal trajectories were divided into 5 groups, including 337 individuals (12.3%) in the low-stable group, 1 172 individuals (42.8%) in the medium-low-stable group, 921 individuals (33.7%) in the medium-stable group, 268 individuals (9.8%) in the medium-high-increasing group, and 38 individuals (1.4%) in the highest-to-medium-high group. Logistic regression analysis showed that, after adjusting for confounding factors, compared to the low-stable group, the medium-low-stable group (OR=1.94, 95%CI=1.13-3.43), medium-stable group (OR=3.04, 95%CI=1.57-5.99), medium-high increasing group, and highest-to-medium-high group (OR=3.31, 95%CI=1.02-10.36) had increased risk for elevated liver stiffness.

Conclusion

Elderly populations should be concerned about changes in the level of the TyG index, and when the TyG index is persistently high (≥8.78), liver health should be further examined.

Association between Dietary Inflammation Index and Gestational Anemia in Pregnant Women under Different Dietary Patterns

DONG Chenxian, SHAO Jianjiang, YAO Teng, ZHAI Jinchan, MA Jiaolong, HU Yunhua, LIU Wen, NIU Qiang, LI Xiaoju, YAN Yizhong

2025, 28(29):  3674-3683.  DOI: 10.12114/j.issn.1007-9572.2024.0625

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Background

According to WHO, 37% of pregnant women suffer from anemia. Anemia in pregnant women increases the risk of adverse pregnancy outcomes, with inflammatory anemia being particularly common. During pregnancy, the body experiences chronic low-grade inflammation, and dietary quality plays a crucial role in linking inflammation levels to pregnancy outcomes. The Dietary Inflammatory Index (DII) is a tool to assess the inflammatory potential of diets, and various dietary patterns exert distinct effects on inflammation.

Objective

To assess the dietary inflammatory potential of pregnant women using the DII, identify predominant dietary patterns, and explore the association between the DII and the risk of developing anemia in pregnancy across different dietary patterns.

Methods

Pregnant women aged ≥18 years who regularly attended maternity checkups at the First Affiliated Hospital of Shihezi University from April 2023 to April 2024 were enrolled in the study. Data on demographics, lifestyle behaviors, and dietary intake were collected. Socio-demographic and lifestyle behavioral information were obtained through questionnaires. The Food Frequency Questionnaire (FFQ) was used to assess dietary intake, calculate the DII, and stratify pregnant women into tertiles based on the DII: the lowest tertile (T1), the second tertile (T2), and the highest tertile (T3). Principal component analysis was used to assess food groups and extract dietary patterns. Multivariable Logistic regression analysis was performed to estimate the association between the DII, dietary patterns, and the risk of anemia in pregnancy. Dose-response relationships were analyzed using restricted cubic spline (RCS) plots.

Results

A total of 653 pregnant women were included, with DII scores ranging from -4.87 to 3.37, the average value was (0.36±1.94). Participants were stratified into tertiles: 217 in T1, 218 in T2, and 218 in T3. Among them, 172 (26.3%) were diagnosed with anemia during pregnancy, with a mean DII of (0.64±1.95). Four dietary patterns were identified: diversity, fish-shrimp-legumes, milk-egg, and processed food patterns. Multivariable Logistic regression analysis revealed a positive association between DII and the risk of anemia during pregnancy after adjusting for confounders (OR=1.21, 95%CI=1.05-1.39, P<0.05). In the overall population, the risk of anemia in the T3 group was 3.05 times higher than in the T1 group (95%CI=1.62-5.75, P<0.05). Among women characterized by milk-egg and processed food patterns, the risk of anemia in the T3 group was 7.69 times (95%CI=1.67-35.45, P<0.05) and 5.17 times (95%CI=1.29-20.63, P<0.05) higher than in the T1 group, respectively. RCS analysis showed that in the overall population, a DII>0.7 was associated with an increased risk of anemia during pregnancy.

Conclusion

The inflammatory potential of the diet is positively associated with the risk of anemia during pregnancy, particularly among women characterized by milk-egg and processed food patterns. Therefore, reducing the consumption of pro-inflammatory foods and promoting a balanced diet are essential.

The Value of Enzyme-linked Immunospot Assay in Identifying Causative Agents in Patients with Hypersensitivity Reactions to Antitubercular Agents

WU Yuqing, LIU Zhou, LIAO Yongmei

2025, 28(29):  3684-3687.  DOI: 10.12114/j.issn.1007-9572.2023.0573

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Background

Hypersensitivity reactions of antitubercular agents are very common in clinical practice. Drug provocation test is the only effective method to find out the causative agents, but it may cause re-sensitization or even shock, which can be life-threatening in severe cases; there are also patients who abandon treatment leading to drug resistance and dissemination of TB bacteria. Due to the fact that the conventional anti-tuberculosis treatment regimen involves the combination of four drugs, it is an urgent challenge for clinicians to quickly, safely, and accurately identify causative agents.

Objective

To evaluate the clinical application value of enzyme-linked immunospot assay in identifying causative agents in patients with hypersensitivity reactions to antitubercular agents.

Methods

A total of 50 patients with hypersensitivity reactions during the treatment of primary pulmonary tuberculosis hospitalized in Jiangxi Chest Hospital from 2021 to 2022 were selected. Mononuclear cells of peripheral blood were collected from patients in the acute phase of allergy, drug specific IFN-γ releasing cells was detected by enzyme-linked immunospot assay, and the drug provocation test (DPT) was used as the gold standard for determining which drug causes hypersensitivity reactions; the clinical value of the enzyme-linked immunospot assay in identifying hypersensitivity reactions caused by the antituberculosis quadruple regimen (isoniazid, ethambutol, rifampicin, pyrazinamide) .

Results

The sensitivity of the enzyme-linked immunospot assay in recognizing hypersensitivity reactions due to isoniazid, ethambutol, rifampicin, and pyrazinamide were 69.2% (35/50) 、61.5% (31/50) 、75.0% (38/50) 、66.7% (33/50), and the specificity were 97.3% (49/50) 、100.0% (50/50) 、100.0% (50/50) 、100.0% (50/50), respectively.

Conclusion

Enzyme linked immunospot assay can be used as an effective method for in vitro detection when causative agents identification is required in patients with hypersensitivity reactions to antitubercular agents at the acute stage.

The Utilization and Influencing Factors of Health Services for Middle Aged and Elderly Chronic Disease Patients

TANG Ling, ZHANG Guoliang, LI Zhenkun, SI Shengbo, LIU Qiang, CHEN Ren, REN Bailing

2025, 28(29):  3688-3693.  DOI: 10.12114/j.issn.1007-9572.2024.0182

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Background

Middle aged and elderly people are at high risk of chronic diseases, and chronic diseases pose challenges to healthcare services for them. Exploring the influencing factors of healthcare service utilization for middle-aged and elderly patients with chronic diseases is of great significance.

Objective

Analyze the utilization of health services among middle-aged and elderly patients with chronic diseases and its influencing factors, providing a basis for improving the level of health service utilization.

Methods

Selected 5 280 samples aged ≥45 with chronic diseases from the China Health and Retirement Longitudinal Study (CHARLS) 2020 database. Drawing on the Anderson Health Service Utilization Behavior Model, the study variables include: (1) propensity factors, including demographic characteristics such as age, gender, place of residence, marital status, smoking, alcohol consumption, social structure, and health behavior. (2) Enabling factors include the ability to access healthcare services, such as economic living standards (personal annual income), medical insurance, and delayed or cancelled medical services due to the impact of the pandemic. This study ranked individual annual income in descending order and divided it into three equal parts on average. The first third was the low-income group, the middle third was the middle-income group, and the last third was the high-income group. (3) Demand factors, including activities for daily living (ADL) status, self-rated health status, life satisfaction, number of chronic diseases, and personal cognition and evaluation. Dependent variable: health service utilization (outpatient/inpatient service utilization). Using multiple Logistic regression model to analyze the influencing factors of health service utilization among middle-aged and elderly patients with chronic diseases in China.

Results

Among 5 280 chronic disease patients, 1 487 (28.16%) had outpatient visits in the past month, and 1 393 (26.38%) had inpatient visits in the past year. The results of multiple Logistic regression analysis showed that self-assessment of health status, delayed or cancelled medical services due to the impact of the epidemic, chronic disease incidence, and daily living activity ability were the influencing factors of outpatient service utilization (P<0.05). Alcohol consumption, medical insurance, self-assessment of health status, postponement or cancellation of medical services due to the impact of the epidemic, chronic disease incidence, and daily living activity ability were the influencing factors of hospitalization service utilization (P<0.05) .

Conclusion

Strengthen attention to middle-aged and elderly chronic disease patients who drink alcohol, lack medical insurance, self evaluate poor health, have a large number of chronic diseases, and have ADL dysfunction, pay attention to the medical and health service needs of this population, and further improve the utilization level of health services.

Article·Clinical Tools and Methods

Quality Evaluation of Methodology on the Changes in Traditional Chinese Medicine Syndromes of Stroke and Risk Population

SU Qing, XU Yao, LI Yihang, WANG Liyan, CAI Yefeng, NI Xiaojia

2025, 28(29):  3694-3702.  DOI: 10.12114/j.issn.1007-9572.2024.0439

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Background

The longitudinal changes of Chinese medicine syndrome in the participants with stroke and its risk factors are essentials to the treatment with syndrome differentiation of traditional Chinese medicine for cerebrovascular diseases.

Objective

To evaluate the methodological quality of cohort studies about longitudinal changes of Chinese medicine syndrome in stroke and its risk factors.

Methods

The CNKI, Wanfang Data, CBM database and PubMed were electronically searched for cohort studies about longitudinal changes of Chinese medicine syndrome in stroke and its risk factors from establishment to December, 2023. Two investigators were independently responsible for screening articles and extracting data. The methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) .

Results

A total of 22 articles including 21 cohort studies were included to the review. The median of NOS scores was 5 (4, 5). In details, NOS items scored best included item 2 "Selection of the Non-Exposed Cohort" (100.00%), item 4 "Demonstration That Outcome of Interest Was Not Present at Start of Study" (100.00%), and item 3 "Ascertainment of Exposure" (90.91%). Items scored least included item 1 "Representativeness of the Exposed Cohort" (9.09%), item 6 "Assessment of Outcome" (9.09%), and item 5 "Comparability of Cohorts on the Basis of the Design or Analysis" (18.18%). Subgroup analysis suggested that journal grade was potential factors influencing methodology quality (Z=-2.554, P=0.011) .

Conclusion

The methodological quality of cohort studies about longitudinal changes of Chinese medicine syndrome in the participants with stroke and its risk factors was of moderate methodological quality. The efforts to improve the participant representativeness, out ascertainment, quality of follow-ups and controlling confounders specific to Chinese medicine syndrome should be further encouraged.

The Construction of the PROs Scale and Its Theoretical Model for Patients with Perimenopausal Depressive Disorder Treated with Traditional Chinese Medicine

MA Huaping, LI Hongpei, HU Wenyue, HU Yuli, MOU Lei, WU Yue, CHEN Runming, HAN Zhenyun

2025, 28(29):  3703-3710.  DOI: 10.12114/j.issn.1007-9572.2023.0493

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Background

Perimenopausal depressive disorder (PDD) is a serious mood disorder that occurs before and after menopause, traditional Chinese medicine have advantages such as holistic regulation and syndrome differentiation and treatment in treating PDD, but currently lacks a specialized traditional Chinese medicine efficacy evaluation tool for PDD.

Objective

To introduce patient-reported outcomes (PROs) and construct a PDD-PROs scale and its theoretical model under the guidance of traditional Chinese medicine theory.

Methods

From April to June 2022, computer searches were conducted on databases such as CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library for literature on traditional Chinese medicine treatment of PDD published up to April 17, 2022, and literature analysis was performed. From September to November 2022, a retrospective analysis of the medical records of 136 PDD patients who visited the outpatient departments of Shenzhen Hospital (Longgang), Beijing University of Chinese Medicine, and Dongfang Hospital of Beijing University of Chinese Medicine from January 2017 to August 2022 was conducted. Based on a self-designed interview outline, one-to-one semi-structured interviews with PDD patients were conducted to establish an item pool. A multidisciplinary expert consultation group related to PDD was selected and established, and three rounds of expert consensus using the Delphi method began in December 2022.

Results

A total of 123 articles were included, involving 5 categories and 12 postmenopausal depression outcome evaluation scales. Retrospective medical record analysis and patient interviews showed that, the cumulative frequency of clinical symptoms of PDD was 1 465 times, involving 176 clinical symptoms. After three rounds of expert consensus using the Delphi method, the Traditional Chinese Medicine PROs Scale for PDD and its theoretical model were ultimately formed, including 4 dimensions (psychological dimension, physiological dimension, social dimension, and overall evaluation) and 43 items.

Conclusion

This study introduced the internationally mature PROs, used literature analysis, medical record review, and patient interview methods to construct an item pool, and successfully constructed the PDD-PROs scale and its theoretical model through three rounds of expert consensus using the Delphi method under the guidance of traditional Chinese medicine theory, which can be used in the research of efficacy evaluation of traditional Chinese medicine TCM treatment for PDD.

Review & Perspectives

Research Progress on Prognostic Biomarkers after Cerebral Infarction: Mechanisms and Clinical Applications

NONG Jingtang, YANG Chengmin, MO Shenglong, LU Zhicheng, TANG Lina, JIAN Chongdong, SHANG Jingwei

2025, 28(29):  3711-3720.  DOI: 10.12114/j.issn.1007-9572.2024.0332

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Ischemic stroke (IS) is one of the leading causes of disability and death worldwide. Various biomarkers closely associated with IS prognosis have been identified in recent years. This paper reviewed the mechanisms of action of blood cell analysis related indicators, omega-3 polyunsaturated fatty acids, IL-6, TNF-α, miRNA, and extracellular vesicles in ischemic stroke and their research progress as predictive biomarkers. The concentrations of blood cell analysis related indicators, omega-3 polyunsaturated fatty acids, IL-6 and TNF-α were closely related to the severity and prognosis of IS. Among them, a higher baseline red blood cell volume distribution width was associated with an increased risk of recurrent ischemic stroke, and was negatively correlated with the recurrence time of ischemic stroke. miR-21 improved neuronal functional recovery by inhibiting apoptosis and promoting neuronal survival, while miR-155 exacerbated brain injury by regulating inflammatory responses, with its expression level predicting IS recurrence. Moreover, miR-126 played a crucial role in angiogenesis and neuroprotection. Extracellular vesicles, carrying anti-inflammatory factors, neurotrophic factors, antioxidant enzymes, and heat shock proteins, mitigate inflammation and damage caused by ischemia-reperfusion, significantly influencing IS prognosis. Despite the tremendous potential of these biomarkers in IS prognosis assessment, their clinical application faced several challenges, including interindividual differences, inadequate research on long-term effects and safety, and issues with technical standardization. Future research should focus on elucidating the mechanisms of action of these biomarkers, developing standardized detection methods, and conducting large-scale clinical validation, to apply them in clinical practice to improve the prognosis and quality of life of IS patients.

Research Progress on Anticoagulant Therapy for Deep Vein Thrombosis in Different Parts of the Lower Extremity

MA Jingtao, HUANG Jie, ZHANG Ye, CHEN Meng, ZHANG Zhiying

2025, 28(29):  3721-3728.  DOI: 10.12114/j.issn.1007-9572.2024.0472

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Lower extremity deep vein thrombosis (LEDVT) is one of the common vascular diseases with its incidence increasing annually. Although extensive research has focused on treating LEDVT, personalized management strategies remain limited. This review systematically discussed the recommended duration of anticoagulant therapy for LEDVT in various locations of the lower extremities and summarized the evidence-based recommendations for the anticoagulation treatment of different parts of the calf intermuscular vein, calf axial vein, femoropopliteal vein, and iliofemoral vein. This review further emphasized that in different parts of the lower extremities, the incidence of distal deep vein thrombosis (DDVT) was high, while the probability of proximal deep vein thrombosis (PDVT) complicated with pulmonary embolism (PE) and post-thrombosis syndrome (PTS) was greater. Short-term anticoagulation (2-6 weeks) was recommended for DDVT. A prolonged anticoagulation course could not bring more benefits, whereas increased the risk of bleeding. PDVT and mixed LEDVT of lower extremities should be treated with medium and long-term anticoagulation (≥ 3 months), especially for femoropopliteal deep vein thrombosis (FDVT) that did not meet the indications of interventional treatment. Indefinite anticoagulation treatment only delayed the recurrence of thromboembolism, but did not really reduce the risk of thrombosis recurrence. The results of this review could provide reference for further understanding of LEDVT and optimization of anticoagulation course, as well as for personalized anticoagulation treatment of LEDVT.