Chinese General Practice

Reflections on the Academic Development of General Practice

YANG Hui

2026, 29(05): 0-C8. DOI: 10.12114/j.issn.1007-9572.2026.A0002

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Chinese Expert Consensus on the Clinical Application of Lemborexant

Chinese Sleep Research Society, Sleep Medicine Professional Committee of Guangdong Medical Doctor Association, Pharmacy Administration Committee of Guangdong Province Hospital Association, GUO Junlong, ZHENG Ping, JIA Fujun, LI Xueli, ZHAN Shuqin, WANG Yuanqing, GU Ping, FENG Yuan, MO Liqian, HAO Yongci, ZHENG Shuqiong, ZENG Haimei, ZHANG Bin, LI Yilei

2026, 29(05): 545-558. DOI: 10.12114/j.issn.1007-9572.2025.0272

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Insomnia is the most common sleep disorder. It not only significantly disturbs patients' quality of life and occupational performance, but is also associated with physical illness and mental disorders. Lemborexant, a new type of hypnotic drug, is the first dual orexin receptor antagonist (DORA) approved in China. However, there's still a lack of standardized guidelines for the usage of Lemborexant in China. Therefore, Chinese Sleep Research Society, the Sleep Medicine Professional Committee of Guangdong Medical Doctor Association and the Pharmacy Administration Committee of Guangdong Province Hospital Association collaborated with domestic experts in pharmacology and clinical medicine to develop the Expert Consensus on the Clinical Application of Lemborexant in China, elaborating on the pharmacological effects, pharmacokinetics, indications, and clinical application methods of Lemborexant. After multiple rounds of discussions, revisions, and voting, 17 recommendations were finally reached, aiming to provide comprehensive and standardized references and suggestions for the clinical application of Lemborexant.

Assessment of Emergency Health Capabilities for Respiratory Infectious Diseases among Community Medical Staff

JIN Huizi, XU Xin, LI Zhijing, GAO Bing, MA Yonghuai, JI Ying

2026, 29(05): 559-567. DOI: 10.12114/j.issn.1007-9572.2024.0135

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Background

Recent years have seen novel respiratory infectious diseases impose significant health and economic burdens in China. Community health service centers play a crucial role in managing and preventing these diseases. As such, it is imperative that medical staff at these centers develop specific emergency health capabilities to handle the increasing challenges posed by respiratory disease prevention and control. Yet, research into the emergency capabilities of community medical staff for respiratory diseases and their influencing factors remains limited.

Objective

To explore and analyze the different dimensions of the emergency response capacities of community medical staff in respiratory infectious diseases, and to explore the related factors, so as to provide a basis for the evaluation and training of the health emergency response capacities of community medical staff in respiratory infectious diseases.

Methods

In November 2023, a staged convenience sampling method was used to select three districts, Xicheng District, Fengtai District, and Daxing District from the central, urban, and suburban regions of Beijing, and three community health service centers from each district, with about 50 medical staff recruited from each of the community health service centers as the survey respondents. A self-designed questionnaire on health emergency capacities of community medical staff for respiratory infectious diseases was used for this survey.

Results

A total of 509 community medical staff were surveyed in this study, and 507 valid questionnaires were obtained after excluding 2 questionnaires in which the survey respondents' department was a non-operational department or these content of the work was not related to the department's business. The results of the survey showed that the average score of the health emergency response capacities of health care workers in community health service centers in Beijing was (0.598±0.136). Of the 2 primary indicators, the healthcare workers scored (0.602±0.152) for response capabilities and (0.590±0.173) for knowledge preparation. The results of multiple linear regression analyses showed that doctors (β=0.322, P<0.001), senior titles (β=0.118, P=0.012), and those who had participated in 6 or more relevant trainings and emergency response drills in the past year (β=0.225, P<0.001) had a higher emergency response capability scores. Medical staff with a clinical medicine background (β=-0.210, P=0.015) had lower emergency response capability scores among medical staff.

Conclusion

The emergency health capacities of community medical staff in Beijing require enhancement. There is a need for intensified training in deficient areas such as "Legal, Regulations and Standards""Monitoring and Early Warning", and "Reporting". Further attention should be directed towards nurses, medical technicians, pharmacists, staff with lower professional titles, and staff less frequently involved in training and emergency drills.

Constructing and Exploring the Practice of Grassroots Community Pharmacy Studios

CHEN Min, PENG Xiangting, LI Xiaomei, GUAN Wenli, LI Qin, GUO Fuli, YE Rong, ZHAO Caiping

2026, 29(05): 568-573. DOI: 10.12114/j.issn.1007-9572.2024.0145

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Background

Community pharmacy has significant advantages in curbing medication misuse and managing chronic diseases. Nevertheless, pharmacists encounter challenges such as complex job duties, inadequate professional knowledge, and low public awareness. Under the background of government support for innovating and expanding pharmacists' roles, the healthcare alliance has emerged as an ideal solution to the dilemma in community pharmacy.

Objective

This research devote to establish a community pharmacy studio to enhance the quality of community pharmacy services and the outcomes of chronic disease management based on the healthcare alliance model.

Methods

Three randomized controlled trials were implemented in three communities within a healthcare alliance from April 2023 to March 2024, while all control groups served as negative controls. In Trial one, 254 healthcare professionals were randomly and equally divided into two groups. The experimental 1 group received pharmaceutical literacy training, after which the outcomes were compared with those of the control 1 group. In Trial two, 540 residents were randomly divided into two groups, the experimental 2 group received services from the community pharmacy studio. Pharmaceutical literacy, medication adherence, pharmacist recognition, and service satisfaction were compared between the two groups. In Trial three, 118 chronic disease patients were randomly divided into two groups. The experimental 3 group received individualized medication guidance, and the rates of chronic disease indicator control were compared between the two groups. Data were collected through questionnaires, interviews, and medical record reviews and analyzed by SPSS 24.0 software.

Results

Survey results indicated that the proportion of participants with high pharmaceutical literacy in the experimental 1 group (86.61%, 110/127) was significantly higher than in the control 1 group (68.50%, 87/127), showing a statistically significant difference (χ²=11.966, P<0.01). The research found that the experimental 2 group had a higher proportion of residents with high pharmaceutical literacy compared to the control 2 group (P<0.001), according to comprehensive assessment of community residents' pharmaceutical literacy and service satisfaction. Additionally, the proportion of community residents exhibiting high medication adherence was higher in the experimental 2 group compared to the control 2 group (P<0.05). Furthermore, respondents in the experimental 2 group were satisfied with the pharmacy studio, the degree of satisfaction was significantly higher than that in the control 2 group (P<0.001). Also, the experimental 2 group had a higher proportion of residents recognizing the professional the pharmacist team compared to the control 2 group (P<0.01). The experimental 3 group demonstrated a higher rate of achieving chronic disease control targets than the control 3 group, and a higher proportion of positive evaluations regarding the pharmacist's role compared to the control 3 group (P<0.05).

Conclusion

Supported by healthcare alliance, the community pharmacy studio model, effectively overcame the challenges of community pharmacy development, enhanced the quality of pharmacy services, improved outcomes of patient disease management, and set new standards for the future of community pharmacy. This model provides valuable insights and practical experience for the development and innovation of community pharmacy services in China.

The Operational Status and Evaluation of Fever Clinics in Primary Healthcare Centers in Shanghai: a Mixed Methods Study

YAN Yunyun, GU Jie, QIAN Chanli, ZHU Zhining, SU Jin, DU Zhaohui, HUANG Yanyan, YING Xiaohua

2026, 29(05): 574-582. DOI: 10.12114/j.issn.1007-9572.2024.0387

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Background

In China, the national public health emergency response system was originally established in 2003 to address emerging respiratory infectious diseases. In response to the COVID-19 pandemic, fever clinics were instituted within Primary Healthcare Centers (PHC) to serve as a supplementary measure to the existing healthcare infrastructure during public health emergencies. The final goal is leading to the subsequent development of a more sophisticated public health emergencies medical care system.

Objective

Over the past three years, the utilization rates and visitation numbers of fever clinics have fluctuated irregularly. This study seeks to summarize the operational processes of PHC fever clinics during this period, identify existing challenges, and propose potential strategies for improvement.

Methods

A convenience sampling method was employed to select 16 PHC fever clinics, with one clinic chosen from each of the 16 districts in Shanghai. Managers of these fever clinics were invited to participate in semi-structured, in-depth interviews conducted from November 23, 2023, to June 18, 2024. The interview guide was developed by integrating insights from existing literature, government regulations, and a preliminary survey. The interviews centered on themes related to the establishment, operation, and challenges encountered by the clinics in recent years. The framework analysis method was employed to manage the qualitative data. Quantitative data were collected on the number of patients visiting fever clinics over the past three years, alongside population statistics and jurisdictional areas of each PHC. The correlation among clinic visits, population size, and population density was examined. Additionally, the SWOT framework was applied to assess the strengths, weaknesses, opportunities, and threats associated with PHC fever clinics.

Results

Of the 16 participants interviewed, 14 individuals (87.5%) possessed either vice-high or superior professional titles, with an average professional tenure of (20.0±6.6) years. The qualitative interviews identified five distinct themes pertaining to functions, hardware configurations, operational processes, current operational challenges, and underlying influencing factors. The fever clinics were classified into urban or suburban categories according to their geographic location. Over the past three years, the mean frequency of visits to urban fever clinics had been lower compared to their suburban counterparts. The results of the SWOT analysis revealed that PHC fever clinics had established a more advanced sentinel surveillance network for the prevention and control of respiratory infectious diseases. Nonetheless, the analysis also identified shortcomings in human resources, infrastructure, and inefficiencies in the allocation and use of medical resources.

Conclusion

The PHC fever clinics are strategically located closer to communities, offering a more convenient and cost-effective option for patient access. Additionally, these fever clinics play a crucial role in forming a comprehensive network for the prevention and control of infectious diseases. In Shanghai, there is a notably higher demand for fever clinics situated in suburban areas. However, when compared to the standardized requirements for fever clinic settings, there are deficiencies attributed to the structural limitations of PHC facilities. Furthermore, there was a notable inefficiency in human resource allocation due to the intermittent nature of seasonal respiratory infectious disease epidemics. It is advisable to dynamically adjust the human resource management in PHC fever clinics in accordance with sentinel monitoring data and the prevailing trends of respiratory infectious disease epidemics. Supportive governmental policies and media advocacy can enhance the operational efficiency of fever clinics. The PHC has recommended active service implementation to ensure optimal utilization of these clinics.

The Impact of Serum Uric Acid Levels on New-onset Atrioventricular Block: a Prospective Cohort Study

ZHU Chenrui, LI Na, WU Yuntao, ZHAO Haiyan, HUANG Zhe, LIU Yan, JI Chunpeng, WU Shouling

2026, 29(05): 583-590. DOI: 10.12114/j.issn.1007-9572.2024.0638

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Background

Previous studies have shown that elevated serum uric acid (SUA) level is associated with various cardiovascular diseases, such as hypertension, atrial fibrillation, heart failure, and coronary artery disease, but its relationship with cardiac conduction system disorders remains unclear.

Objective

The present community-based cohort study aimed to elucidate the effects of SUA on the risk of developing atrioventricular (AV) block.

Methods

Kailuan Study was a prospective cohort study based on a community population. A total of 87 913 eligible participants who participated in health examination at Kailuan Group between 2006 and 2007 were included as the study cohort. The participants were divided into non-hyperuricemia group (SUA≤420 µmol/L) and hyperuricemia group (SUA>420 µmol/L). Follow-ups were conducted every two years until December 31, 2019. The endpoint event was defined as new-onset AV block. Multivariate Cox proportional hazard models were used to analyze the impact of different SUA levels and each 1 standard deviation (SD) increase in SUA on new-onset AV block.

Results

Among the 87 913 participants, 69 101 males (78.60%) and 18 812 females (21.40%), with a mean age of (50.7±12.0) years. Dring a median follow-up of 11.89 (9.06-12.83) years, 1 037 AV block cases developed. After adjusting for confounding factors, the hyperuricemia group showed a 26% increased risk of incident AV block compared to the non-hyperuricemia group (HR=1.26, 95%CI=1.02-1.54, P=0.030). For each 1 SD increase in SUA level, the risk of incident AV block increased by 12% (HR=1.12, 95%CI=1.05-1.19, P<0.001). Specifically, the hyperuricemia group had a 29% increased risk of incident first-degree AV block compared to the non-hyperuricemia group (HR=1.29, 95%CI=1.05-1.60, P=0.017), and each 1 SD increase in SUA level was associated with a 12% increased risk of incident first-degree AV block (HR=1.12, 95%CI=1.05-1.20, P<0.001). The restricted cubic spline analysis showed a nonlinear relationship between serum UA levels and the risk of developing AV block (P<0.001).

Conclusion

High SUA level is an independent risk factor for AV block, and SUA level is dose-dependently associated with the risk of AV block.

Study of the Therapeutic Effect of Intraoral Balloon Dilation Combined with K-point Stimulation in Patients with Post-stroke Pseudobulbar Palsy Associated Dysphagia and Trismus

HU Naixiao, ZHANG Hao, WANG Bo, QI Xin, DONG Jianhong, XUE Ruizhong, ZHANG Qingsu

2026, 29(05): 591-596. DOI: 10.12114/j.issn.1007-9572.2025.0228

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Background

In patients with post-stroke pseudobulbar palsy, bilateral upper motor neuron injury manifests as trismus, hyperactive jaw-jerk reflex, and swallowing disorders. Among these symptoms, trismus significantly complicates rehabilitation therapies during the oral preparatory and oral phases of swallowing, as well as oral rehabilitation nursing procedures.

Objective

To explore the therapeutic effect of intraoral balloon dilation combined with K-point stimulation in patients with post-stroke pseudobulbar palsy associated dysphagia and trismus.

Methods

Forty patients with post-stroke pseudobulbar palsy associated dysphagia and trismus, who admitted to the China Rehabilitation Research Center from June 2021 to April 2024, were selected for the study. They were randomly assigned to either the control group (n=20) or the observation group (n=20) by the random number table method. The control group received conventional swallowing therapy and K-point stimulation to facilitate mouth opening, while the observation group received intraoral balloon dilation combined with K-point stimulation in addition to conventional swallowing therapy. Both groups underwent 4 weeks of treatment. Swallowing function was assessed using the Mann Assessment of Swallowing Ability and the 2-minute frequency of spontaneous swallowing at pretherapy after 4 weeks of treatment. Mouth opening function was evaluated using effective mouth opening times.

Results

After 4 weeks of treatment, the observation group showed a significantly higher severity score for swallowing difficulties (62.40±7.76) on the Mann Assessment of Swallowing Ability, compared to the control group (56.50±4.45) (P<0.05). The observation group also showed a significantly higher median 2-minute frequency of spontaneous swallowing compared to the control group [1.8 (1.4, 2.2) vs 1.4 (1.0, 1.8)] (P<0.05). Additionally, the observation group had a significantly higher times of effective mouth opening (23.3±1.3) compared to the control group (21.1±1.8) (P<0.05).

Conclusion

Intraoral balloon dilation combined with K-point stimulation can effectively improve dysphagia and trismus in patients with post-stroke pseudobulbar palsy.

Distribution and Influencing Factors of Cardiovascular Health among Community Residents Based on the "Life's Essential 8" Score

XIA Ying, WU Xinri, ZHANG Caiqin, HONG Xin

2026, 29(05): 597-605. DOI: 10.12114/j.issn.1007-9572.2025.0172

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Background

Cardiovascular disease remains the leading cause of morbidity and mortality globally. Cardiovascular health scores are closely associated with cardiovascular disease. Conducting cardiovascular health assessments for individuals can significantly contribute to the improvement of cardiovascular health across the entire life span.

Objective

To investigate the cardiovascular health status, distribution characteristics, and associated factors among community residents in Nanjing, and provide evidence for the prevention and control of cardiovascular disease.

Methods

From September 2022 to August 2024, a total of 45 901 community-dwelling residents aged 35-79 years in Nanjing were selected using a multistage, stratified, cluster random sampling method. All participants completed questionnaires, physical examinations, and laboratory tests. Cardiovascular health was quantitatively assessed using the "Life's Essential 8" scoring system, which included four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (BMI, blood lipids, blood glucose, and blood pressure). Scores <50 were defined as low cardiovascular health, 50-80 as moderate cardiovascular health, and >80 as high cardiovascular health.

Results

The mean overall cardiovascular health score of the participants was (66.9±12.8). Scores were higher in women, married individuals, urban residents, and those not at high risk of cardiovascular disease than men, unmarried individuals, rural residents, and those at high risk of cardiovascular disease (P<0.05). Scores declined with increasing age and improved with higher educational attainment (P<0.05). The mean scores for diet, physical activity, smoking, sleep, body mass index, blood lipids, blood glucose, and blood pressure were (37.7±31.0), (79.8±38.8), (71.6±40.3), (84.7±24.0), (58.8±31.4), (67.4±29.5), (79.9±25.4), and (45.8±33.9), respectively. Of all participants, 7 524 (16.4%) had high cardiovascular health, 34 071 (74.2%) had moderate cardiovascular health, and 4 306 (9.4%) had low cardiovascular health. Multivariable Logistic regression analysis showed that, compared with those with low cardiovascular health, women, individuals aged 55-64 and 65-79 years, those with junior or senior high school or college and above, individuals in other occupations, and those not at high risk of cardiovascular disease were more likely to have moderate cardiovascular health, whereas service workers, white-collar employees, and rural residents were less likely (P<0.05). Women, individuals with junior or senior high school or college and above, those in other occupations, and those not at high risk of cardiovascular disease were more likely to have high cardiovascular health, while individuals aged 45-54 and 55-64 years and rural residents were less likely (P<0.05).

Conclusion

Cardiovascular health among community residents in Nanjing was at a moderate level. Men, older individuals, those with lower education levels, rural residents, and those at high risk of cardiovascular diseases should be prioritized for targeted interventions. Comprehensive improvement in cardiovascular health can be achieved by strengthening interventions on key risk factors such as diet, smoking, and blood pressure.

Analysis on Prognosis and Influencing Factors in Patients with Post-tuberculosis Bronchiectasis

WANG Xue, YANG Chengming, WANG Ziyun, ZHOU Zhong

2026, 29(05): 606-611. DOI: 10.12114/j.issn.1007-9572.2024.0678

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Background

Post-tuberculosis bronchiectasis is one of the significant sequelae of tuberculosis. At present, the specific impact on the prognosis of patients with tuberculous bronchiectasis has not been fully understood.

Objective

To understand the prognosis and influencing factors of patients with post-tuberculosis bronchiectasis and provide scientific basis for improving the prognosis of these patients.

Methods

A total of 337 patients with post-tuberculosis bronchiectasis who were hospitalized in Guiyang Public Health Treatment Center from April 2023 to April 2024 were selected. Telephone follow-up was conducted on their prognosis 6 months after discharge, and they were divided into the good prognosis group and the poor prognosis group. The random forest model and LASSO regression were used to screen and analyze the influencing factors of the prognosis and rank their importance.

Results

The incidence of poor prognosis in 337 patients with post-tuberculosis bronchiectasis was 41.2% (139/337). There were statistically significant differences in age, educational level, BMI, previous smoking, the percentage of forced expiratory volume in one second (FEV₁%pred), alveolar lavage, combined chronic pulmonary heart disease, combined chronic obstructive pulmonary disease, combined hypertension, Pseudomonas aeruginosa infection, post-discharge smoking, post-discharge drinking, lack of daily exercise, living alone, non-compliance with medication as prescribed, and levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) at discharge between the two groups (P<0.05). LASSO regression model analysis was conducted on the variables with significant differences in the univariate analysis, and a total of 9 variables were selected. The results of the random forest model showed that the order of importance of each influencing factor was as follows: non-compliance with medication as prescribed, post-discharge smoking, lack of daily exercise, educational level, combined chronic pulmonary heart disease, discharge IL-6, age, post-discharge drinking, and living alone. The results of the multivariate Logistic regression analysis showed that non-compliance with medication as prescribed (OR=8.394, 95%CI=3.323-21.203), post-discharge smoking (OR=5.294, 95%CI=2.313-12.116), lack of daily exercise (OR=4.555, 95%CI=2.206-9.406), combined chronic pulmonary heart disease (OR=4.331, 95%CI=2.012-9.323), discharge IL-6 (OR=1.054, 95%CI=1.018-1.091), and age ≥ 80 years (OR=5.246, 95%CI=1.097-25.077) were risk factors for the prognosis of patients with post-tuberculosis bronchiectasis (P<0.05), while primary education (OR=0.358, 95%CI=0.143-0.898) and secondary education (OR=0.202, 95%CI=0.074-0.554) were protective factors for the prognosis of patients with post-tuberculosis bronchiectasis (P<0.05).

Conclusion

Patients with post-tuberculosis bronchiectasis have a relatively high incidence of poor prognosis. Non-compliance with medication as prescribed, smoking after discharge, lack of daily exercise, combined chronic obstructive pulmonary disease, IL-6 at discharge, age ≥80 years old, and educational level are important influencing factors for tuberculous bronchiectasis. Targeted measures can be taken based on these influencing factors.

A Study of the Causal Effect of Gut Microbiota on Genetic Prediction of Metabolic Syndrome

LUO Xiu, MA Zhaoli, HUANG Mengyu, REN Qian

2026, 29(05): 612-622. DOI: 10.12114/j.issn.1007-9572.2024.0327

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Background

Many observational studies have found an association between the gut microbiome and metabolic syndrome (MetS) and its components, but the causal relationship between them is not yet clear.

Objective

To explore a bidirectional causal relationship between the gut microbiota and the MetS and its components.

Methods

This study obtained gut microbiota-associated single nucleotide polymorphisms from MiBioGen, obtained summary statistics of MetS and its components in the UK Biobank, Complex Trait Genetics (CTG), and other consortiums studies, and performed bidirectional two-sample Mendelian randomization analyses to assess the relationship between causal relationships. In addition, a series of sensitivity analyses were performed to verify the robustness of the Mendelian randomization analysis results. To obtain a more rigorous causal interpretation, Bonferroni correction was used to test the strength of the causal relationship between gut microbiota and MetS.

Results

Inverse variance weighted estimation showed that Bifidobacteriaceae (OR=0.96, 95%CI=0.93-0.98, P=1.49×10^-3) had a significant negative causal relationship with MetS. There was a significant positive causal relationship between some gut microbiota and waist circumference, such as class.Melainabacteria (OR=1.02, 95%CI=1.01-1.03, P=1.90×10^-3), order.Gastranaerophilales (OR=1.02, 95%CI=1.01-1.03, P=1.61×10^-3), order.NB1n (OR=1.02, 95%CI=1.01-1.03, P=2.00×10^-3), and genus..Eubacteriumhalliigroup (OR=1.03, 95%CI=1.01-1.04, P=6.97×10^-4), among others. However, inverse Mendelian randomization analysis did not support a causal relationship. Sensitivity analyses showed there was no heterogeneity or horizontal pleiotropy.

Conclusion

This bidrectional Mendelian randomization study provides evidence of a clear causal relationship of gut microbiota on MetS and components, but does not support reverse causality. This finding provides new ideas for the management of MetS. Further randomized controlled trials are still needed in the future to elucidate the relationship between the effects of microbial agents such as probiotics on MetS.

Autophagy Related Proteins Beclin-1 and LC3-ⅡExpression in Lung Cancer Metaststic Pleural Effusion

YAO Wenjing, WANG Cuifeng, GAO Jinliang, REN Meiying, JING Xuefen, FU Yuhua

2026, 29(05): 623-630. DOI: 10.12114/j.issn.1007-9572.2023.0812

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Background

Malignant pleural effusion, a critical clinical indicator of advanced-stage malignancy and metastatic progression. The existing methods for the diagnosis of the nature of pleural effusion have defects and shortcomings, and it is impossible to timely and effectively determine the nature of pleural effusion. Metastatic lung cancer constitutes the primary etiology of malignant pleural effusion. While the roles of autophagy-related proteins Beclin-1 and LC3-Ⅱ in lung cancer pathogenesis have been well established through multiple studies, their expression patterns and potential as diagnostic biomarkers in MPE urgently require further investigation.

Objective

To analyze the expression of autophagy-related proteins Beclin-1 and LC3-Ⅱ in lung cancer-associated malignant pleural effusion, and to evaluate their potential value in early clinical diagnosis.

Methods

From May 2022 to July 2023, we performed bioinformatics analysis of Beclin-1 and LC3 using GEO, GEPIA2, and GeneMANIA databases. Pleural effusion samples were collected from patients who had not received any clinical treatment at the Clinical Laboratory Cell Room of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, from 2018 to 2023. The collected pleural effusion samples were grouped through liquid-based thin-layer cytology smears combined with clinical data, dividing them into a malignant group (95 cases) and a benign control group (190 cases). The expression of Beclin-1 and LC3-Ⅱat the gene and protein levels was detected by RT-PCR and Western Blotting methods, respectively, and the expression level of LC3-Ⅱ protein was confirmed using immunofluorescence assay.

Results

Bioinformatics analysis confirmed the inclusion of Beclin-1 and LC3 in the differentially expressed gene profile of lung cancer. RT-PCR revealed significantly higher mRNA expression levels of both Beclin-1 and LC3-Ⅱ in benign controls versus malignant cases (P<0.05). Western Blotting analysis showed elevated Beclin-1 and LC3-Ⅱ protein abundance in benign specimens compared to malignant group (P<0.05). Immunofluorescence microscopy identified increased FITC-labeled LC3-Ⅱ puncta in benign controls.

Conclusion

By analyzing the expression differences of autophagy-related proteins Beclin-1 and LC3-Ⅱ in benign pleural effusion and metastatic malignant pleural effusion of lung cancer, may facilitate early diagnosis of MPE and provide novel perspectives for differential diagnosis and targeted therapeutic strategies.

Disease Burden of Hypercholesterolemia among Individuals Aged 60 and above Globally and in China from 1990 to 2021: Trend Analysis and Model-based Projection

LIU Fan, LI Jiali, KE Lixin, ZHANG Qiang, CHEN Jiahui, LU Cuncun, ZHAO Xinke

2026, 29(05): 631-640. DOI: 10.12114/j.issn.1007-9572.2025.0113

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Background

Hypercholesterolemia is an independent risk factor for atherosclerotic cardiovascular diseases, exerting a profound impact on the health of the elderly. However, evidence regarding the disease burden of hypercholesterolemia in the elderly remains limited and requires further elucidation.

Objective

To analyze the disease burden and temporal trends of hypercholesterolemia among the elderly globally and in China from 1990 to 2021, thereby providing a reference for optimizing health resource allocation and precisely formulating management strategies.

Methods

Data on deaths and disability-adjusted life years (DALYs) of "High LDL cholesterol" in individuals aged≥60 years globally, in China, and across 5 sociodemographic index (SDI) regions were collected from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression was used to analyze temporal trends in age-standardized mortality rate (ASMR) and DALYs rate (ASDR). A three-factor decomposition method was used to quantify the relative impacts of population aging, population growth, and epidemiological changes on the burden. The Bayesian age-period-cohort model was employed to predict the number of deaths and DALYs from 2022 to 2035.

Results

In 2021, global and Chinese elderly experienced 2 779 100 and 692 000 hypercholesterolemia-related deaths, increasing 50.34% and 252.34% from 1990, and the DALYs were 50 226 100 and 12 170 100 person-years, rising by 46.62% and 200.96%, respectively. Globally, both ASMR and ASDR for elderly hypercholesterolemia showed a decreasing trend overall (AAPC_ASMR=-1.65%, 95%CI=-1.81% to -1.48%, P<0.001; AAPC_ASDR=-1.51%, 95%CI=-1.67% to -1.36%, P<0.001) from 1990 to 2021, whereas they remained relatively stable in China (P=0.089, P=0.388). The overall ASMR of elderly men in China has been on the rise, with an average annual increase of 0.71% (95%CI=0.31% to 1.11%, P<0.001). In 2021, elderly males globally and in China exhibited a higher number of deaths and DALYs, as well as higher ASMR and ASDR, than elderly females. Except for the high-SDI region, the number of deaths and DALYs of hypercholesterolemia in the total elderly population in other SDI regions in 2021 increased to varying degrees compared with 1990. Furthermore, in 2021, the 80-84 years age group accounted for the largest proportion of deaths both globally (463 100 cases, 16.66%) and in China (128 300 cases, 18.54%). Population growth was identified as the main driver of increasing disease burden among all regions. The Bayesian age-period-cohort model indicated that the disease burden of hypercholesterolemia among the elderly population would continue to rise globally and in China from 2022 to 2035. By 2035, the number of deaths and DALYs from hypercholesterolemia in the global elderly population would increase by 42.67% and 41.20%, respectively, compared with 2021, while in China they would increase by 82.76% and 72.18%, respectively.

Conclusion

The disease burden of hypercholesterolemia among the elderly is substantial both globally and in China, and is expected to grow steadily. To effectively mitigate this escalating burden, it is imperative to enhance public health consciousness, refine the allocation of health resources, and strengthen the research and development of novel lipid-lowering medications.

Prevalence Trend and Prediction of Hypertensive Heart Disease in the World and China from 1990 to 2021

LEI Yingying, ZHENG Siying, WANG Wenxin, JIANG Hong

2026, 29(05): 641-648. DOI: 10.12114/j.issn.1007-9572.2024.0350

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Background

Hypertension has emerged as the leading global cause of mortality, with hypertensive heart disease(HHD) representing one of its most severe long-term complications. Despite rising trends in HHD prevalence and mortality globally and in China, comprehensive analyses of its epidemiological patterns and evolving risk factors remain limited. This study aims to characterize the historical trends and risk factors associated with HHD globally and in China, providing evidence to guide effective prevention and control strategies.

Objective

To characterize the epidemiological patterns and identify key risk factors of HHD both globally and in China from 1990 to 2021, and to forecast future trends in its burden.

Methods

Data were obtained from the Global Burden of Disease Study 2021. Line charts and grouped bars plots were uesd to illustrate demographic and temporal distribution patterns. The estimated annual percentage change(EAPC) in age-standardized prevalence and mortality rates was calculated using R software(version 4.3.2). Changes in risk factor contributions over time were assessed using standardized mortality data. An ARIMA model was employed to forecast trends in HHD burden from 2022 to 2030.

Results

Between 1990 to 2021, the global age-standardized prevalence rate of HHD increased slightly [EAPC=0.56%(0.52% to 0.59%)], while the mortality rate showed a slight decline [EAPC=-0.68%(-0.77% to 0.59%)]. In contrast, China experienced a significant decrease in both prevalence [EAPC=-0.68%(-0.90% to 0.45%)] and mortality [EAPC=-2.68%(-3.05% to 2.31%)]. In 2021, China's age-standardized prevalence and mortality rates were 192.47 and 18.85 per 100 000 population, respectively-substantially higher than global averages of 148.32 and 16.32 per 100 000. Both globally and in China, the burden of HHD was disproportionately higher among older adults compared to younger individuals, and in males compared to females. Throughout the study period, high blood pressure remained the leading risk factor for HHD-related mortality. By 2021, high dietary sodium intake had become the second most important contributor to HHD mortality in China. Projections suggested that by 2030, the global prevalence would rise marginally to 151.52 per 100 000, while China was expected to increase markedly to 279.09 per 100 000. Mortality rates were projected to decline further, reaching 12.68 per 100 000 globally and 15.27 per 100 000 in China.

Conclusion

While China has made considerable progress in reducing the overall burden of HHD since 1990, the disease remains a major public health concern, especially among elderly individuals and men. High blood pressure and high dietary sodium intake are currently important risk factors contributing to HHD mortality. Although China has achieved significant progress in the prevention and treatment of HHD, projected data still indicate a substantial burden of the disease in terms of prevalence and mortality. Therefore, it is necessary to further strengthen comprehensive prevention strategies across all stages of the disease continuum, with particular attention directed toward high-risk populations such as the elderly and males, as well as more effective management of key modifiable risk factors, including excessive dietary sodium intake.

Study on Erchen Decoction Intervening in ATG7/FTH1 Pathway to Improve Follicular Function of Rats with Phlegm-damp PCOS

LYU Xiaojiao, BAI Zihan, MA Yan, CHEN Wei, QU Yang, SUI Guoyuan, SHANG Bing, CONG Peiwei

2026, 29(05): 649-655. DOI: 10.12114/j.issn.1007-9572.2024.0637

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Background

Polycystic ovary syndrome (PCOS) is a gynecologic endocrine and metabolic disease with no clear cause, the prevalence is getting younger and more prevalent. Therefore, the pathogenesis of PCOS at the molecular biological level was studied to provide relevant evidence for clinical treatment and protect women's health.

Objective

Based on the theory of "phlegm dampness" constitution leading to infertility in Traditional Chinese Medicine, the ameliorating effect of Erchen decoction on autophagy-dependent ferroptosis in PCOS ovarian granulosa cells was discussed.

Methods

The Experimental Animal Center of Liaoning University of Traditional Chinese Medicine provided SPF-grade laboratories and 32 female SD rats. After one week of adaptive feeding, 32 rats were randomly divided into a control group (n=10) and a model group (n=22). The control group was given regular maintenance feed for the entire duration of 12 weeks. The model group was fed with high-fat feed throughout the whole process, and letrozole solution was gavaged every day during the modeling period. After the modeling was completed, rats with estrous cycle disorders from the model group were selected as the treatment group (n=12), and they were treated with the decoction of Erchen decoction by gavage daily for 4 consecutive weeks. After the samples were collected, the rat ovaries were stained by HE staining to observe the pathological changes, transmission electron microscopy (TEM) was used to show the mitochondrial morphology of ovarian granulosa cells in three groups of rats. Western Blotting was used to detect the changes in ATG7, P62, Beclin1, LC3-Ⅰ, LC3-Ⅱ, LC3-Ⅱ/LC3-Ⅰ, FTH1, ISCU2 protein levels in rat ovarian granulosa cells. Oxygraph-2k mitochondrial function assay system was used to detect changes in mitochondrial oxygen consumption rate in ovarian granulosa cells.

Results

Ovarian cystic follicle increased in rats of the model group, the corpus luteum was reduced and the mitochondria of ovarian granulosa cells showed autophagy and ferroptosis. Partial recovery of morphology was observed in treatment group after treatment. Compared with the control group, the protein expressions of ATG7, P62, Beclin1 and LC3-Ⅱ in the model group increased (P<0.05), the ratio of LC3-Ⅱ/LC3-Ⅰ increased (P<0.05), and LC3-Ⅰ, FTH1 and ISCU2 protein levels decreased (P<0.05). Compared with the model group, the protein levels of ATG7, P62, Beclin1, and LC3-Ⅱ in the treatment group decreased (P<0.05), the ratio of LC3-Ⅱ/LC3-Ⅰ decreased (P<0.05), and the protein level of FTH1 increased (P<0.05). There was statistical significance in oxygen consumption rates of ETS, CⅠ and CⅡ among the three groups (P<0.05). The oxygen consumption rates of ETS, CⅠ and CⅡ in the model group were lower than those in the control group, and those in the treatment group were higher than those in the model group, with statistical significance (P<0.05).

Conclusion

Erchen decoction can reverse autophagy-dependent ferroptosis of ovarian granulosa cells through the ATG7/FTH1 pathway, and improve the follicular function of rats with phlegm-damp PCOS.

Current Situation Analysis of Outcome Indexes of Randomized Controlled Trial on Treatment of Peptic Ulcer with Chinese Medicine

TIAN Rong, LI Kaiyang, YANG Mei, HUANG Jing, ZHANG Fei, ZHAO Qi

2026, 29(05): 656-667. DOI: 10.12114/j.issn.1007-9572.2025.0107

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Background

Peptic ulcer (PUD) is a common disease of the digestive system. Traditional Chinese Medicine (TCM) treatment is an effective treatment for PUD. However, in the randomized controlled trials (RCTs) of TCM treatment of this disease, there are great limitations in the selection of methodological quality and outcome indicators, which brings some challenges to efficacy evaluation and data integration analysis.

Objective

To systematically review the application status and experimental design points of RCTs outcome indicators of TCM intervention in PUD in the past 15 years, aiming to provide reference for the construction of core indicator set of TCM treatment of PUD and the optimization of clinical trial design.

Methods

Computerized searches were conducted in Chinese databases: CNKI, Wanfang Data, VIP, and SinoMed, as well as international authoritative databases: PubMed, Embase, Cochrane Library, and Web of Science for RCTs on the treatment of PUD with TCM. The search time frame was from 2010 to 2024. Cochrane bias risk assessment was performed on the included literature, and relevant outcome indicators were counted, summarized and analyzed.

Results

A total of 323 RCTs with 34 933 patients were included. The maximum sample size of single study was 498 cases, the minimum was 40 cases, and the average sample size was 108 cases. Among the 171 reports of TCM syndromes, the highest frequency of use was spleen and stomach deficiency cold (31 articles, 18.13%); 47 articles were treated with pure TCM, and 276 articles were treated with integrated Traditional Chinese and Western Medicine. The course of treatment was mostly 4 weeks (119 times, 36.84%); the outcome indicators were divided into 6 categories according to functional attributes. A total of 170 outcome indicators were reported, with a total frequency of 1 962 times. The outcome indicators with higher frequency of use were total clinical effective rate (233 times, 11.88%), Helicobacter pylori eradication rate (165 times, 8.41%), and adverse reactions (155 times, 7.90%). The risk assessment of bias in the included literature was not clear.

Conclusion

The RCTs of PUD treated with TCM still exist in the following aspects: the dialectical classification and disease staging of TCM are not standardized, the methodological design (blind method, distribution concealment) needs to be improved, the primary and secondary outcome indicators are not clearly distinguished, the clinical efficacy standards are not unified, the measurement time gap of outcome indicators is large, the scoring criteria of TCM syndromes/symptoms is diversified, the ethical registration needs to be paid attention to, and the report of safety indicators is not standardized. It is suggested to actively carry out the research on the core index set of TCM treatment of PUD, optimize and improve the methodological quality, and provide high scientific, reliable and practical evidence for the clinical practice of TCM treatment of PUD.

Factors Influencing Symptom Clusters in Patients with Gastrointestinal Cancers: a Scoping Review

SHI Jiaqi, WANG Yuxin, LUO Jiani, JIANG Qi, WU Shanyu, JIN Toufeng

2026, 29(05): 668-675. DOI: 10.12114/j.issn.1007-9572.2024.0584

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Background

The symptom clusters in gastrointestinal cancer patients are influenced by physiological factorsand psychological factors. Current research predominantly focus on lung cancer, breast cancer and other high-incidence cancers, and with insufficient dynamic assessment and mechanistic exploration.

Objective

A comprehensive review and analysis of symptom clusters in gastrointestinal cancer patients is conducted, aiming to provide a reference for precision management tailored to different types of gastrointestinal cancer patients.

Methods

A comprehensive literature search was conducted across eight databases, including Embase, PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP Database and SinoMed, with the search time frame spanning from database inception to July 2024. Data regarding symptom clusters in gastrointestinal cancer patients was extracted according to inclusion and exclusion criteria, and the basic characteristics, symptom group assessment tools, category characteristics and influencing factors of the included literature were analyzed.

Results

A total of 4 163 articles were retrieved and 14 were included. Four common symptom clusters were identified, comprising gastrointestinal, psychological, fatigue, and neurologic-related symptoms. These symptom clusters were assessed using a variety of tools, predominantly multi-symptom assessment instruments. The factors influencing symptom clusters primarily encompass sociodemographic and disease-related factors, biological indicators, and individual psychological factors.

Conclusion

Future studies should explore patient-specific symptom assessment tools for gastrointestinal cancers. Using network analysis, multimodal predictive modeling, and other advanced analysis techniques, we enhanced the accuracy of identifying symptom clusters and subsequently explored the development of a precise symptom cluster management strategy.

Frailty in Patients with Knee Osteoarthritis: a Scoping Review

TIAN Ziwei, YANG Zhilan, ZHAO Huimin, ZHAI Yanping, LI Hongyan, DU Miao, JIN Yuanyuan, SONG Zeyu

2026, 29(05): 676-680. DOI: 10.12114/j.issn.1007-9572.2025.0012

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Background

Knee osteoarthritis (KOA) is the fourth most disabling disease globally, with an increasing incidence and disability rate. Frailty is associated with KOA and significantly reduces the quality of life of KOA patients.

Objective

To conduct a scoping review of the current status of frailty in KOA patients, assessment tools, influencing factors, and intervention measures, in order to provide theoretical support for early prediction of frailty progression and personalized intervention measures.

Methods

A systematic review was conducted using a combination of subject headings and free terms to search for relevant studies on the prevalence, assessment tools, influencing factors, and intervention methods for frailty in patients with KOA in Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, VIP, and SinoMed. The search period was from the establishment of the databases to December 12, 2024. Two researchers independently summarized, categorized, and analyzed the literature data.

Results

A total of 13 articles were finally included. The study results showed that the incidence of frailty in KOA patients was 8.2% to 67.8%, and the incidence and severity of frailty in patients were different in different studies. There were many types of assessment tools, but there was a lack of specific assessment tools in general. The commonly used tools in the study were the SOF index, the FRAIL scale, and the Fried phenotype. The influencing factors mainly included demographic and social factors, disease-related factors, and psychological and behavioral factors. The intervention measures included exercise training, combined Traditional Chinese Medicine and exercise therapy, and injection therapy.

Conclusion

The incidence of frailty in KOA patients varies to some extent, there is a lack of specific assessment tools now, and a more suitable frailty prediction assessment tool for KOA patients in China can be compiled in the future to provide a time node for precise intervention of frailty. Meanwhile, focus should be placed on the risk factors that affect the frailty of KOA patients to delay the progression of frailty and improve their quality of life.

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