Table of Content

20 March 2026, Volume 29 Issue 09

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Guidelines·Consensus

Expert Consensus on the Use of Traditional Chinese Patent Medicines in the Prevention and Treatment of Pan-vascular Diseases and Their Target Organ Damage

China Association of Promoting of Traditional Chinese Medicine, Integrated Medicine Branch of China Medical Association of Minorities, TAO Lili, LIU Yinan, WANG Qiang, LEI Yan

2026, 29(09):  1089-1108.  DOI: 10.12114/j.issn.1007-9572.2025.0297

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Pan-vascular diseases, one of the leading causes of death among Chinese residents, represent a systemic vascular syndrome characterized by atherosclerosis as a common pathological feature. This condition can lead to damage in multiple target organs, including the heart, brain, kidneys, retina, and peripheral vessels. Current prevention and control efforts face critical challenges. Western medicine's disciplinary specialization often leads to excessive focus on localized lesions, whereas Traditional Chinese Medicine's (TCM) holistic diagnostic and therapeutic system offers distinct advantages in systemic management. Evidence-based research confirms the efficacy of Chinese patent medicines in treating systemic vascular diseases, particularly those related to atherosclerosis. Currently, there is a lack of clinical guidelines based on evidence-based medicine for the prevention and treatment of pan-vascular diseases and their target organ damage using Chinese patent medicines, both domestically and internationally. This consensus was initiated by the China association for the Promotion of Traditional Chinese Medicine. Under the academic guidance of Academician GE Junbo and Academician CHEN Kejie, Experimental research center, China Academy of Chinese Medical Sciences led the formation of the Expert Group for the "Expert Consensus on the Use of Traditional Chinese Patent Medicines in the Prevention and Treatment of Pan-vascular Diseases and Their Target Organ Damage". This consensus was developed through a panel of renowned physicians, covering consensus development methodologies, TCM theoretical interpretations of pan-vascular diseases, evidence-based recommendations for TCM patent medicines in their prevention and treatment, and clinical application considerations. It aims to provide an optimized integrated Chinese and Western medicine solution for the comprehensive management of pan-vascular diseases, standardize the principles of TCM patent medicine use in preventing and treating pan-vascular diseases and target organ damage, and enhance the scientific rigor and standardization of clinical practice.

General Practice Education

Education Training on Health Behaviors Management of Chronic Diseases among Primary Care Providers: a Systematic Review and Meta-analysis

GE Aoqi, GAO Xinyi, LI Jiawei, LI Juanjuan, YUAN Beibei

2026, 29(09):  1109-1120.  DOI: 10.12114/j.issn.1007-9572.2024.0722

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Lifestyle prescriptions are essential for managing chronic diseases patients' behaviors and have been recommended in several international guidelines. Primary healthcare workers play a critical role in delivering lifestyle services, yet their competencies are still insufficient. While existing trials indicate that training can enhance healthcare workers' capacity for health behavior management, comprehensive evidence on the effectiveness of lifestyle education interventions remains limited. This paper systematically reviews the current training programs aimed at improving primary healthcare workers' skills in health behavior management, analyzing their content, format, and outcomes. The paper also identifies existing gaps in chronic disease behavior management training and offers recommendations for improvement. It highlights that current training programs inadequately address patient stress, sleep and social engagement, and there is a lack of standardized training on the fundamental theories and skills of behavior change. While educational interventions have shown some effectiveness in enhancing the knowledge and skills of primary healthcare workers, their impact on improving patient health outcomes remains limited. This paper provides valuable insights for enhancing the quality of chronic disease management by primary healthcare workers.

Community Outpatient Teaching Practice in the Third Year of Standardized Training for General Practice Residents: PQRST Pain Assessment Method Combined with Cardiovascular Risk Assessment for the Diagnosis and Treatment of Atypical Acute Coronary Syndrome

YANG Ling, DU Xueping

2026, 29(09):  1121-1128.  DOI: 10.12114/j.issn.1007-9572.2024.0199

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Background

The hierarchical and progressive objectives of standardized training for general practice residents require that third-year residents (R3) develop the ability to manage patients independently. Supervisors provide guidance on complex and critical cases to foster clinical reasoning and enhance diagnostic and management skills among R3. However, community outpatient teaching often relies on limited content and methods, falling short in cultivating systematic recognition and management of critical diseases such as atypical acute coronary syndrome (ACS).

Objective

To investigate the application of the PQRST pain assessment method combined with cardiovascular risk assessment in community outpatient teaching, with the aim of improving R3's ability to recognize, diagnose, and manage atypical ACS, thereby optimizing the quality of outpatient teaching.

Methods

Case-based learning was employed using a patient presenting with "subxiphoid discomfort for 2 hours after alcohol consumption". The R3 independently conducted the consultation and documented the medical record, while the supervisor observed, supplemented the documentation, and identified problems. The PQRST method was used to systematically collect symptom information, complemented by cardiovascular risk stratification using validated assessment tools. Electrocardiogram (ECG) and cardiac injury markers were utilized to confirm the diagnosis of ACS, followed by prehospital emergency management and referral. Mind map were incorporated into the teaching process to facilitate recording and feedback, reinforcing the R3's clinical reasoning and summarization skills.

Results

Using the PQRST pain assessment method, the patient's symptoms were confirmed to be consistent with atypical chest pain. Cardiovascular risk assessment categorized the patient as being at"very high-risk". ECG and myocardial injury marker findings confirmed ST-segment elevation myocardial infarction (STEMI). Under the supervisor's guidance, the R3 successfully completed rapid assessment, prehospital management, and orderly referral. After the teaching session, the R3 demonstrated significantly improved ability to recognize atypical ACS, enhanced clinical logical reasoning, and greater familiarity with emergency referral procedures.

Conclusion

The combination of the PQRST pain assessment method and cardiovascular risk assessment improves R3's capacity for early recognition and management of atypical ACS. The integration of mind maps for feedback and summarization helps establish a systematic framework for differential diagnosis. This approach is applicable to teaching critical care management in community outpatient teaching and holds promise for broader implementation.

Article

Association of Triglyceride Glucose Index with Cardiovascular Disease in Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3 Population: a Prospective Cohort Study

LI Qiuchun, SU Ping, PANG Jinhong, CHEN Qiaoqiao, ZHAO Yingying, HE Ruiyan, WANG Yue, CHEN Xueyu, QIAO Junpeng, CHI Weiwei

2026, 29(09):  1129-1136.  DOI: 10.12114/j.issn.1007-9572.2025.0152

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Background

The American Heart Association(AHA) first defined cardiovascular-kidney-metabolic syndrome (CKM) in 2023, elucidating the complex association between metabolic risk factors, chronic kidney disease (CKD) and cardiovascular disease (CVD), and emphasizing that early intervention in CKM stages 0-3 can reduce the risk of end-stage cardiovascular events. Triglyceride glucose index (TYG), as a novel marker of lipid metabolism, has been shown to be associated with CVD in the general population, but its association with CVD in the CKM stages 0-3 population still needs to be supported by evidence-based medical evidence.

Objective

To explore the association between TYG level and CVD risk in patients with CKM stages 0-3.

Methods

From a baseline established in 2015, 46 754 participants meeting CKM stages 0-3 criteria were identified from the Cheeloo Longitudinal Epidemiological Analysis Database (LEAD) during the investigation period (2015-01-01—2017-12-31). Participants were categorized into quartiles based on baseline TYG indices: Q1 (6.79≤TYG<8.19, n=11 979), Q2 (8.19≤TYG<8.55, n=11 493), Q3 (8.55≤TYG<8.93, n=11 647), and Q4 (8.93≤TYG≤11.7, n=11 635). Cox proportional hazards regression models were employed to systematically analyze the association between TYG and CVD risk within this cohort. Survival curves were plotted using the Kaplan-Meier method, and differences in survival rates among different TYG groups were analyzed using the Log-rank test. Dose-response curves were evaluated using restricted cubic splines (RCS) across the total CKM stages 0-3 population. Subgroup analyses by gender (male and female) and CKM stages (<stage 2 and ≥stage 2) were conducted to verify the robustness of the associations. Stratified multivariable Cox models were constructed, incorporating average TYG and cumulative TYG as continuous variables to explore their impact on CVD occurrence.

Results

A total of 46 754 participants were included, comprising 19 884 males (42.5%) and 26 870 females (57.5%), with a median age of 69(65, 73) years. The mean baseline TYG was 8.59±0.60, and 32 837 (70.2%) participants were at CKM stage 2. Cox regression analysis revealed that per unit increase in TYG as a continuous variable was associated with a 19.4% increased risk of CVD incidence (HR=1.194, 95%CI=1.162-1.226, P<0.001). Group analysis indicated that the risk of newly developed CVD in Q4 was 28.0% higher than in Q1 (HR=1.280, 95%CI=1.222-1.341), with a significant dose-response relationship (P<0.05). Cumulative incidences of CVD across Q1-Q4 showed a gradient increase (33.7%, 35.2%, 42.0%, and 43.7%, respectively). Kaplan-Meier curves demonstrated statistically significant differences in CVD incidence rates among Q1-Q4 groups (χ²=328.853, P<0.05). RCS analysis suggested a linear positive correlation between TYG and CVD risk in the overall CKM stages 0-3 population (P<0.001, P_non-lineari=0.282); stratification by CKM stage also showed a linear positive correlation in CKM stages 0-1 (P<0.001, P_non-linear=0.616) and 2-3 (P<0.001, P_non-linear=0.180).

Conclusion

In the 0-3 stage of CKM, TYG is revealed as an early warning of CVD risk in this population, which provides theoretical support for the establishment of a precision prevention strategy based on metabolic-cardiorenal intervention.

Clinical Study of HbA_1c/ApoA-1, TyG-BMI and Their Combination to Predict the Severity of Coronary Artery Calcification

SUN Qinyu, DENG Yifan, YANG Tianxiao, FANG Zhen, JI Jun, HE Shenghu, ZHANG Jing

2026, 29(09):  1137-1145.  DOI: 10.12114/j.issn.1007-9572.2025.0169

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Background

Previous studies have shown that the ratio of glycated hemoglobin A1c to apolipoprotein A-1(HbA_1c/ApoA-1) and the triglyceride-glucose-body mass index (TyG-BMI) are associated with the development of coronary artery disease, but their association with the severity of coronary artery calcification (CAC) remains unclear.

Objective

Investigating the association between HbA_1c/ApoA-1, TyG-BMI, and their combination with the severity of CAC.

Methods

A retrospective analysis was performed on 441 patients who underwent coronary artery CT angiography (CTA) at Northern Jiangsu People's Hospital Affiliated to Yangzhou University in 2024. Patients were divided into no/mild calcification group [coronary artery calcification score (CACS)=0-99, n=223] and moderate/severe calcification group (CACS≥100, n=218). Clinical data were collected, and HbA_1c/ApoA-1 and TyG-BMI were calculated. Univariate and multivariate Logistic regression analyses were used to identify risk factors for moderate/severe CAC. The association between HbA_1c/ApoA-1, TyG-BMI, and CACS was assessed using restricted cubic spline (RCS) curves. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of HbA_1c/ApoA-1, TyG-BMI, and their combination for moderate/severe CAC. Subgroup analyses by gender, age, hypertension, type 2 diabetes, smoking, and alcohol consumption history were conducted, with interaction tests using likelihood ratio tests.

Results

The median age of patients was 70.0 (62.0, 75.0) years, including 276 males and 165 females. Multivariate Logistic regression analysis revealed fasting blood glucose (OR=1.018, 95%CI=1.009-1.028), lipoprotein(a) (OR=1.001, 95%CI=1.001-1.002), HbA_1c/ApoA-1 (OR=1.158, 95%CI=1.059-1.267), and TyG-BMI (OR=1.013, 95%CI=1.006-1.020) as risk factors for moderate/severe CAC (P<0.05). When analyzed separately as continuous and categorical variables, HbA_1c/ApoA-1 and TyG-BMI groups Q2, Q3, and Q4 were identified as risk factors for moderate/severe CAC (P<0.05). ROC curve analysis indicated areas under the curve (AUC) for fasting blood glucose, lipoprotein(a), HbA_1c/ApoA-1, and TyG-BMI in predicting moderate/severe CAC were 0.675 (95%CI=0.625-0.725), 0.609 (95%CI=0.557-0.661), 0.672 (95%CI=0.622-0.732), and 0.693 (95%CI=0.644-0.742), respectively. The combined AUC of HbA_1c/ApoA-1 and TyG-BMI was 0.728 (95%CI=0.682-0.775). Nonlinear RCS curve analysis showed a nonlinear relationship between HbA_1c/ApoA-1 and CACS (P_non-linear=0.007), whereas TyG-BMI was linearly related to CACS (P_non-linear=0.636).

Conclusion

HbA_1c/ApoA-1, TyG-BMI, and their combination are significantly correlated with the severity of CAC and have certain predictive value for severe CAC, making them worthy of clinical promotion and application.

BMI Percentile Reference Curves and Trends in Thinness, Overweight, and Obesity among Preschool Children in Macao

ZHANG Sanhua, CHEN Xiaolong, ZHANG Yanfeng

2026, 29(09):  1146-1154.  DOI: 10.12114/j.issn.1007-9572.2025.0307

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Background

In recent years, the prevalence of overweight and obesity has increasingly shifted toward younger ages, posing substantial risks to both the immediate and long-term health of children. In line with China's "Weight Management Year" initiative, the Macao SAR Government has incorporated obesity prevention into the Healthy Macao 2030 Blueprint, promoting a shift from passive treatment to proactive prevention. Therefore, developing a localized and scientifically sound BMI assessment tool for preschool children in Macao is of great significance.

Objective

To establish age- and sex-specific BMI percentile reference curves for preschool children in Macao, and to examine age and secular trends in thinness, overweight, and obesity, thereby providing evidence to support the improvement of growth and developmental health among Macao preschoolers.

Methods

Data were obtained from four rounds of Macao SAR Government physical fitness surveillance conducted in 2005, 2010, 2015, and 2020 with technical support from the China Institute of Sport Science. Preschool children were included, with sample sizes of 1 044, 1 065, 1 072, and 1 113 in the four respective years. Height and weight were collected and stratified by sex and age. BMI percentile curves were generated using the GAMLSS model to determine cut-offs for thinness, overweight, and obesity.

Result

A total of 4 294 children [2 612 boys (60.8%) and 1 682 girls (39.2%); mean age (4.2±1.0) years; mean BMI (15.4±1.6) kg/m²] were included. Using the GAMLSS approach, we developed BMI percentile reference curves, a percentile-based scoring system, and cut-offs for thinness, normal weight, overweight, and obesity, forming a multidimensional BMI assessment framework integrating individualized precision evaluation, percentile scoring, and categorical classifications. The BMI curves declined and then rose with age, with nadirs at approximately 5 years for boys and 5.5 years for girls. Trend analyses showed slight increases in overweight and obesity rates from 2005 to 2020, but no statistically significant trends (P>0.05).

Conclusion

This study providing an individualized and accurate BMI evaluation tool for Macao preschool children, the BMI curves of Macao preschool children declined and then rose with age, with nadirs at approximately 5 years for boys and 5.5 years for girls. It is recommended that Macao increase opportunities for outdoor physical activity and sleep while reducing screen time to curb the early onset of childhood obesity.

Correlation between Obstructive Sleep Apnea Syndrome and Emotional-behavioural Problems in Preschool Children

GUAN Yanping, WU Yunxiao, XU Zhifei

2026, 29(09):  1155-1160.  DOI: 10.12114/j.issn.1007-9572.2025.0232

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Background

Obstructive sleep apnea syndrome (OSAS) may affect children's cognitive functions, including learning abilities, memory, executive function, and attention.

Objective

To investigat the correlation between OSAS and emotional-behavioral problems in preschool children through the Conners Children Behavioral Questionnaire for parents (Conners' Rating Scale).

Methods

Data were collected from October 2022 to October 2023, 672 cases of children aged 3 to 7 years old who visited the Sleep Center of Beijing Children's Hospital, Capital Medical University for nighttime sleep accompanied by snoring were selected as research subjects. The participating children all completed a full-night polysomnography (PSG) monitoring and Conners' Rating Scale. 477 cases of OSAS children were selected according to the obstructive sleep apnea hypoventilation index (OAHI), including 297 boys and 180 girls; 27 cases aged 3, 164 cases aged 4, 173 cases aged 5, and 113 cases aged 6. Conners' Rating Scale was used to analyze the scores of conduct behavior, learning issues, psychosomatic disorders, impulsivity-hyperactivity, anxiety, and hyperactivity index in OSAS children of different genders and ages. Use Spearman's rank correlation coefficient to analyze the correlation between OSAS-related indicators [sleep efficiency, proportion of non-rapid eye movement sleep stage 1 (N1%), stage 2 (N2%), stage 3 (N3%), and the proportion of rapid eye movement sleep (REM%) to total sleep time, OAHI, oxygen desaturation index (ODI), average blood oxygen saturation (SpO₂), and minimum SpO₂] and the Conners' Rating Scale factor correlations, and multiple linear regression analyses were used to explore the effects of OSAS-related indicators on emotional-behavioral issues in preschool children.

Results

Compared with the Chinese norms, this study found that OSAS boys scored lower on the Conners' Rating Scale for learning problems, while scoring higher on psychosomatic issues, impulsivity-hyperactivity, and hyperactivity index (P<0.05); the OSAS girls in this study scored higher on psychosomatic issues and impulsivity-hyperactivity on the Conners' Rating Scale (P<0.05). Boys scored higher than girls on the Conners' Rating Scale for conduct problems, impulsivity-hyperactivity, and hyperactivity index (P<0.05). There was a statistically significant difference (P<0.05) in the scores for learning problems and psychosomatic disorders on the Conners' Rating Scale among children with OSAS of different ages. The results of the Spearman rank correlation analysis showed that N2% was positively correlated with Conners' Rating Scale learning problem score (P<0.05); N3% and REM% were negatively correlated with Conners' Rating Scale for conduct problems, learning problems, psychosomatic disorders, impulsivity-hyperactivity, anxiety, and hyperactivity index (P<0.05). The results of the multiple linear regression analysis showed that N2% can increase the factor score for learning problems on the Conners' Rating Scale, while N3% can decrease the factor score for conduct behavior, impulsivity-hyperactivity, and anxiety on the Conners' Rating Scale, REM% can lower the factor scores for learning problems and anxiety on the Conners' Rating Scale (P<0.05).

Conclusion

Our research results indicate that compared to the Chinese norm, both boys and girls with preschool OSAS have psychosomatic disorders and impulsive-hyperactivity issues, and boys exhibit more problems than girls concerning conduct behaviors, impulsivity-hyperactivity, and hyperactivity indices. N3% and REM% show a negative correlation with emotional and behavioral issues in preschool children, which may influence certain emotional and behavioral issues to varying degrees.

Clinical Characteristics and Prognosis of Patients with Amyloidosis

XIA Ning, SHI Lan, DING Wanbao, ZHANG Jie, LONG Yi, DAI Hui, ZHANG Can, DAI Hailong

2026, 29(09):  1161-1167.  DOI: 10.12114/j.issn.1007-9572.2024.0565

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Background

Amyloidosis presents with diverse and nonspecific clinical manifestations, leading to frequent misdiagnosis or delayed diagnosis. Early diagnosis and aggressive intervention are critical for improving prognosis.

Objective

To enhance understanding of amyloidosis by analyzing the clinical features and outcomes of patients diagnosed at our center.

Methods

A retrospective analysis was conducted on clinical data from 69 patients diagnosed with amyloidosis at Yan'an Affiliated Hospital of Kunming Medical University between January 2015 and October 2023. Survival outcomes were collected via telephone follow-up. Patients were stratified into deceased and surviving groups based on disease-specific survival. Kaplan-Meier survival curves were generated, and between-group comparisons were performed using the Log-rank test.

Results

A total of 69 patients with amyloidosis were included. Among them, 35 had cerebral amyloid angiopathy (CAA) with a median age at diagnosis of 72 (66, 80) years. The main clinical manifestations were intracerebral hemorrhage, cognitive impairment, or dementia. Six (17.1%) CAA patients died of intracerebral hemorrhage during initial hospitalization. Twelve patients had cutaneous amyloidosis with a median age at diagnosis of 67.0 (53.5, 75.5) years, presenting with miliary to mung bean-sized papules on the anterior tibia, extensor sides of the limbs, and back. Three patients had laryngeal amyloidosis, mainly presenting with hoarseness, throat discomfort, and a foreign body sensation in the larynx. Six patients had multiple myeloma (MM) complicated with light chain amyloidosis, with a mean age of 60.8±9.0 years and a median overall survival of 3.5 months. Five (83.3%) patients had involvement of two or more organs, and one (16.7%) had single-organ involvement. All six patients had edema, five (83.3%) had chest tightness and dyspnea, one (16.7%) had bone pain, and one (16.7%) had numbness in the extremities. One patient died of sudden cardiac death before treatment. Thirteen patients had systemic amyloidosis, including 12 with AL amyloidosis and one with AA amyloidosis. The 12 AL amyloidosis patients mainly presented with fatigue (10 cases, 83.3%), edema (9 cases, 75.0%), followed by foamy urine (6 cases, 50.0%) and chest tightness (6 cases, 50.0%). Other symptoms included dyspnea, weight loss, limb numbness, anorexia, and irregular bowel movements. Five (41.7%) had involvement of one organ, and seven (58.3%) had involvement of two or more organs. The most commonly affected organs were the kidneys (9 cases, 75.0%) and heart (8 cases, 66.7%), followed by the liver (3 cases, 25.0%). In AL amyloidosis patients, the 24-hour urine protein level was significantly higher in the deceased group than in the surviving group (P<0.05). Kaplan-Meier analysis showed a median survival time of 18.3 months for AL amyloidosis patients. Log-rank test indicated that patients with involvement of two or more organs had shorter survival times than those with single-organ involvement (χ²=4.757, P=0.029). The overall median survival time for MM patients with light chain amyloidosis was 3.5 months, with one patient dying during initial diagnosis. Among MM patients with light chain amyloidosis, those with anemia had significantly shorter survival times than those without anemia (χ²=5.000, P=0.025). Patients with heart function classⅣ had significantly shorter survival times than those with heart function classⅡ-Ⅲ (χ²=5.052, P=0.029). Untreated patients had significantly shorter survival times than treated patients (χ²=5.000, P=0.025).

Conclusion

The clinical manifestations of amyloidosis are highly diverse, and the prognosis varies significantly among different types. CAA predominantly affects the elderly and has a high mortality rate in the acute phase when complicated with intracerebral hemorrhage. Patients with MM complicated with light chain amyloidosis often present with symptoms related to amyloidosis involvement of vital organs such as the heart and kidneys. Anemia and heart function class Ⅳ may be adverse prognostic factors, while active treatment may improve prognosis. AL amyloidosis patients with involvement of multiple organs have a poor prognosis.

A Bibliometric and Visualized Analysis of Research Trends in the Relationship between Neurological Disorders and Gut Microbiota from 2000 to 2024

GUO Yangyang, ZHANG Linlin, SHI Guangzhi, ZHANG Jindong

2026, 29(09):  1168-1179.  DOI: 10.12114/j.issn.1007-9572.2024.0720

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Background

Neurological disorders severely impact patients' quality of life. These disorders have multifactorial etiologies, including genetic, infectious, and immunological factors. Emerging evidence highlights the role of gut microbiota in these disorders through the gut-brain axis. However, the research hotspots and trends in this field remain inadequately characterized.

Objective

This study aims to conduct a visual analysis of the literature related to neurological disorders and gut microbiota, with the goal of understanding the current research landscape both domestically and internationally. Furthermore, it seeks to explore the research hotspots and emerging trends, thereby providing a reference for future studies.

Methods

Relevant literature was retrieved from the Web of Science Core Collection database from January 1, 2000 to July 29, 2024. Using CiteSpace software, a visual analysis was performed from multiple aspects, including publication volume, co-citation analysis, highly cited papers, citation burst papers, keyword co-occurrence, national collaboration, institutional collaboration, and author collaboration.

Results

A total of 5 239 articles were included, with a steady increase in publication volume since 2012, surpassing 1 000 articles in 2022. The research hotspots primarily concentrated on Parkinson's disease, Alzheimer's disease, ischemic stroke, and amyotrophic lateral sclerosis. Citation analysis revealed that the relationship between gut microbiota and CNS diseases had become a prominent research focus in recent years. Moreover, co-occurrence analysis of keywords further highlighted the frequent appearance of important research topics such as short-chain fatty acids, the gut-brain axis, and gut microbiota dysbiosis, indicating a high level of attention to these areas. High-citation articles and citation burst analysis showed that the research trend was centered on the mechanisms through which gut microbiota influence neurodegenerative diseases and other CNS disorders, particularly focusing on the regulatory roles of short-chain fatty acids, gut microbiota diversity, and the gut-brain axis.

Conclusion

CiteSpace-based bibliometric analysis suggests a potential association between gut microbiota and neurological disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis. Modulation of gut microbiota may offer a promising therapeutic avenue for the management of these conditions. Further longitudinal studies and clinical trials are warranted to validate this hypothesis and to elucidate the underlying mechanisms by which the gut microbiota influences neurological disease pathogenesis.

Article·Helth Service Research

A Comprehensive Evaluation Study on the Medical Service Capacity of County-level Medical and Health Sub-centers in Sichuan Province

LI Dan, ZHU Liyan, NI Xiaorong, CHEN Li, YAO Weizi, XIONG Ying, LI Jiawei

2026, 29(09):  1180-1186.  DOI: 10.12114/j.issn.1007-9572.2024.0468

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Background

Grassroots medical and health institutions in our country are responsible for providing basic public health services and basic medical services to residents. However, there are still weak service capabilities in grassroots medical care, which cannot truly meet the medical needs of the people. The construction of county-level medical and health sub centers (hereinafter referred to as "sub centers") is an important step for the country to promote the development of grassroots healthcare. The study of whether the medical service capacity has been improved before and after the construction of sub centers has significant practical significance.

Objective

To evaluate the medical service capacity of county-level medical and health sub-centers in Sichuan Province, and to provide a reference for continuously promoting the service capacity of sub-centers and primary medical and health institutions.

Methods

Taking 135 county-level medical and health sub centers built in Sichuan Province in 2023 as the research object, they were divided into five major regions: Chengdu Plain Economic Zone, South Sichuan Economic Zone, Northeast Sichuan Economic Zone, Panxi Economic Zone, and Northwest Sichuan Ecological Economic Zone. In January 2024, relying on the Sichuan Provincial Health Commission, a survey questionnaire was conducted on each center to obtain the number of beds per thousand population, the number of health technicians per thousand population, the bed utilization rate, the annual number of outpatient and emergency visits, the annual number of traditional Chinese medicine diagnoses and treatments, the annual number of hospitalizations, and the number of common diseases that can be identified and initially treated from 2021 to 2023, in order to evaluate their medical service capabilities. Using TOPSIS and rank-sum ratio (RSR) methods to comprehensively evaluate the changes in medical service capabilities of sub centers from 2021 to 2023, and using multiple stepwise linear regression analysis to identify the influencing factors of medical service capabilities.

Results

The TOPSIS results showed that the C_i values in all regions were the lowest in 2021 and the highest in 2023. Except for the Panxi Economic Zone, there was a significant gap in the ability levels between sub centers within other regions. The RSR results showed that in 2023, the sub center capacity level of Chengdu Plain Economic Zone was the best, followed by the Northeast Sichuan Economic Zone, and the other regions were relatively poor. The results of multiple stepwise regression analysis showed that seven factors, including the number of beds per thousand population, had a positive impact on the evaluation results (P<0.05). Among them, the number of beds per thousand population (B=0.667, t=26.170, P<0.001) and the number of emergency visits (B=0.628, t=21.162, P<0.001) had the most significant impact.

Conclusion

The construction of sub centers has achieved significant results, but there is a significant gap between regions and institutions. Efforts can be made to promote the sustainable development of sub center and grassroots medical service capabilities through reasonable allocation of beds, strengthening talent team construction, and actively guiding grassroots medical treatment.

The Characteristics of Family Doctor Service Demand for Functional Building Population Based on KANO Model

CAI Chengjun, XU Xin, SHAO Jie, ZHOU Lulu, ZHANG Shengbing, HUANG Jiaoling, SHI Jianwei, MI Yikai, HUANG Qian

2026, 29(09):  1187-1193.  DOI: 10.12114/j.issn.1007-9572.2024.0503

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Background

With the continuous deepening of the family doctor contract service system, how to effectively cover the functional building population with family doctor contract services has become one of the focuses of attention. Effectively understanding the demand characteristics of this group of people is an important means to establish effective strategies.

Objective

To understand the demand for family doctor contract services among functional building populations, and provide reference for improving and optimizing family doctor contract services in functional buildings.

Methods

In March April 2024, a typical sampling method was used to select 3 functional buildings in the jurisdiction of the research group, and a cluster random sampling method was used to select 396 middle-aged and young people from functional communities for a questionnaire survey. The questionnaire includes general demographic information, KANO questionnaire on the demand for family doctor contract services, the time period of receiving the most family doctor contract services in the past 6 months, and willingness to pay. Conduct reliability and validity analysis of the KANO questionnaire on the demand for family doctor contract services, construct a Better-Worse matrix to analyze the KANO demand characteristics of 19 service items, and conduct sensitivity analysis based on different service periods and payment intentions.

Results

A total of 396 valid survey questionnaires were collected, and the Cronbach's α of the scale formed by 19 signed service items was 0.991. According to the KANO model, a preliminary classification of the items showed that 19 items belonged to the category of undifferentiated attributes. A better worse matrix was constructed to further divide the demand attributes. In the diagnosis and treatment service, 2 items were classified, including "medication dispensing service" and "expert consultation service". In the health management service, 9 items, including "interpretation of physical examination reports and health consultation", "prevention and treatment of eye diseases", and "prevention and treatment of cervical spondylosis", belonged to the category of "expected attributes". In the diagnosis and treatment service, the "extended prescription" service belonged to the category of attractive attributes, while the rest belonged to the category of undifferentiated attributes. Sensitivity analysis shows that the "long prescription" service has the highest SR value one hour before work and on weekends. The service of "TCM constitution identification/massage/moxibustion/cupping/scraping/acupuncture and moxibustion" has the highest SR value in one hour at noon. The SR value of "expert consultation" services is highest when the willingness to pay is between 0-50 yuan/person/year and≥201 yuan/person/year. The SR value of "TCM constitution identification/massage/moxibustion/cupping/scraping/acupuncture and moxibustion" service is the highest when the willingness to pay is 151-200 yuan/person/year.

Conclusion

The functional building population has high expectations for specialized health management services under the contract of family doctors, and the demand content is diversified. At the same time, the contracted diagnosis and treatment services provided by family doctors, such as long prescriptions, drug dispensing, and expert consultations, are the cornerstone of meeting the service needs of middle-aged and young people. Further optimization and improvement of service content design for this type of population should be carried out.

Evidence-based Medicine

Efficacy and Safety of Selective Cardiac Myosin Inhibitors in the Treatment of Hypertrophic Cardiomyopathy: a Meta-analysis

ZHANG Huijuan, LI Xinghui, ZHANG Xiaoming, YIN Long, SHAO Long

2026, 29(09):  1194-1202.  DOI: 10.12114/j.issn.1007-9572.2024.0033

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Background

Hypertrophic cardiomyopathy (HCM) is a genetic disorder, characterized primarily by left ventricular outflow tract obstruction and asymmetric myocardial hypertrophy, which predisposes to sudden cardiac death and malignant arrhythmias. Although current pharmacological treatments can alleviate symptoms, they are not specific therapeutic approaches. With the increase in clinical studies on the novel targeted therapy of cardiac myosin inhibitors for HCM, there is currently a lack of systematic reviews evaluating the efficacy of these drugs.

Objective

To assess the efficacy and safety of cardiac myosin inhibitors in the treatment of HCM.

Methods

Systematic searches were conducted in PubMed, EmBase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and the China Biology Medicine disc, up to November 9, 2023, for randomized controlled trials (RCTs) of cardiac myosin inhibitors, including Mavacamten and Aficamten in HCM. Review Manager 5.4.1 software was utilized to conduct the statistical analysis.

Results

A total of 6 RCTs were included[5 related to Mavacamten (4 original studies and 1 sub-study) and 1 related to Aficamten], involving 544 patients. The meta-analysis showed that, compared to placebo, the cardiac myosin inhibitors group exhibited significant reductions in peak gradient pressure under resting conditions in the left ventricular outflow tract (LVOT) (SMD=-1.24, 95%CI=-1.44 to -1.04, P<0.000 01), and under Valsalva maneuver (SMD=-1.37, 95%CI=-1.57 to -1.17, P<0.000 01), alongside at least a≥1 level improvement in the NYHA functional classification (NYHA-FC) (RR=2.22, 95%CI=1.77 to 2.78, P<0.000 01). Secondary endpoints showed reductions in the myocardial markers NT-proBNP (SMD=-1.28, 95%CI=-2.25 to -0.30), P=0.01] and cardiac troponin (SMD=-0.68, 95%CI=-1.32 to -0.04, P=0.04), improvement in the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical score (SMD=0.42, 95%CI=0.07 to 0.78, P=0.02), an increase in the rate of patients reaching the composite endpoint events (RR=1.92, 95%CI=1.28 to 2.88, P=0.002), and a reduction in the number of patients needing or eligible for septal reduction therapy (SRT)(RR=0.29, 95%CI=0.22 to 0.39, P<0.000 01). Echocardiographic parameters indicated that cardiac myosin inhibitors could improve the left ventricular mass index (LVMI)(SMD=-0.82, 95%CI =-1.45 to -0.18, P=0.01), decrease the left atrial volume index (LAVI)(SMD=-0.58, 95%CI=-0.90 to -0.27, P=0.000 3), but could also lead to a reduction in the left ventricular ejection fraction (LVEF)(SMD=-0.46, 95%CI =-0.65 to -0.27, P<0.000 01). In terms of safety, the incidence of at least one adverse event in the cardiac myosin inhibitor group was higher than in the placebo group (RR=1.12, 95%CI=1.02 to 1.22, P=0.02), but there was no statistically significant difference in other safety outcomes, including serious adverse events (RR=1.14, 95%CI=0.62 to 2.07, P=0.67), atrial fibrillation (RR=1.27, 95%CI=0.45 to 3.58, P=0.65), nausea (RR=1.77, 95%CI=0.52 to 6.04, P=0.36), dizziness (RR=1.88, 95%CI=0.75 to 4.71, P=0.18), and fatigue (RR=1.35, 95%CI=0.51 to 3.63, P=0.55) compared to the placebo group.

Conclusion

Cardiac myosin inhibitors can improve the peak gradient pressure in the LVOT, enhance NYHA functional classification, reduce myocardial markers, alter cardiac structure, and improve patients' quality of life in HCM, with relatively high safety. They offer clinical benefits to patients with HCM but may reduce LVEF.

Moxibustion Combined with Three-step Therapy in the Treatment of Cancer Pain: a Network Meta-analysis

WANG Fei, HAN Weiyu, SUN Tao

2026, 29(09):  1203-1211.  DOI: 10.12114/j.issn.1007-9572.2025.0089

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Background

Cancer pain is one of the most common complications in cancer patients. Three-step analgesic therapy is widely used clinically to relieve pain, but its efficacy is still limited, and some patients fail to achieve the ideal analgesic effect. Moxibustion therapy demonstrates promising efficacy in relieving cancer pain. However, there is still a lack of systematic evidence on the optimal selection of different moxibustion therapy protocols, which needs to be further explored.

Objective

To comprehensively evaluate the efficacy and safety of different moxibustion therapies combined with three-step therapy for the treatment of cancer pain using network meta-analysis, aiming to identify the optimal moxibustion protocol.

Methods

Electronic searches were performed in databases including CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase, and Cochrane Library to comprehensively collect randomized controlled trials (RCTs) on moxibustion combined with the three-step therapy for cancer pain, spanning from inception to September 2024. Two researchers independently screened the literature, extracted data and used Stata 16.0 software to analyze the data and draw relevant graphs.

Results

A total of 13 RCTs involving 988 patients were included, evaluating 3 kinds of moxibustion methods, 3 kinds of moxibustion duration, and 4 kinds of acupoint selection methods. The results of network meta-analysis showed that: the effective rates ranking of moxibustion methods: suspended moxibustion (97.1%) > moxa cone moxibustion (56.1%) > thunder-fire moxibustion (44.7%) > control group (2.1%); the effective rates ranking of the total duration of moxibustion ranked as follows: within 300 min (71.5%) > over 600 min (65.2%) > 300-600 min (57.8%); the effective rates ranking of acupoint selection was trunk (83.5%) > Ashi (68.4%) > limbs (66.3%) > distal-proximal matching (30.9%). Three studies reported moxibustion related adverse reactions, including blisters, moxibustion syncope and rash. Most of them were mild, and most of them were absorbed by themselves or relieved by simple treatment. The total dropout rate of the included studies was 0.6% (6/988).

Conclusion

Moxibustion combined with the three-step therapy can relieve cancer pain effectively and safely. Compared to other moxibustion methods, suspended moxibustion appears more effective in improving cancer pain. In practice, it is recommended that the total course of moxibustion duration should not exceed 300 minutes, prioritizing acupoints on the trunk, as this may be a more suitable moxibustion regimen. The above conclusions still need verification through higher-quality randomized controlled trials.

Review & Perspectives

Advances in the Association between Metabolic Dysfunction-associated Steatotic Liver Disease, Type 2 Diabetes Mellitus and Cardiovascular Complications

HUANG Ying, ZHOU Zhiyuan, PAN Zhixiong, ZHU Qun

2026, 29(09):  1212-1216.  DOI: 10.12114/j.issn.1007-9572.2024.0613

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Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes mellitus (T2DM). MASLD and its associated liver fibrosis contribute to the onset and progression of T2DM through the induction of insulin resistance and direct disruption of hepatic glycogen synthesis. Additionally, MASLD significantly elevates cardiovascular risk and mortality in patients with T2DM, mediated by abnormality of vascular endothelial factors and dyslipidemia resulting from insulin resistance, as well as hypercoagulability. In terms of pharmacological treatment, certain novel multi-target hypoglycemic agents have been proven to be efficacious in reducing intrahepatic lipid deposition and improving liver enzyme levels, while also having the potential to mitigate the progression of liver fibrosis. Altogether, this article reviews the association, mechanism and pharmacological treatment of MASLD and its associated liver fibrosis with T2DM and its cardiovascular complications, aiming to provide novel insights for the clinical diagnosis and treatment of patients with T2DM and MASLD.

Research Progress of Paradoxical Bone Formation in Osteoporosis

YANG Yang, GAO Xi

2026, 29(09):  1217-1224.  DOI: 10.12114/j.issn.1007-9572.2024.0675

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Osteoporosis is a common clinical bone disease caused by a variety of causes, it increases osteoclast production mainly by changing the inflammatory microenvironment of the body, the end result is increased bone resorption and decreased bone mass. Paradoxical bone formation is a process that regulates bone formation and increases bone mass, it can affect macrophage efferocytosis by regulating apoptosis in some osteoblasts, ultimately promoting osteoblast differentiation. Osteoblasts are mainly involved in bone formation, osteoclasts are involved in bone resorption, both of them mediate the regulation of bone homeostasis, and about 50% of the osteoblasts that underwent bone remodeling under normal homeostasis were apoptotic. When promoting the apoptosis of osteoblasts to paradoxical bone formation occurs, macrophages are recruited and perform efferocytosis, under the action of efferocytosis, macrophages were polarized into M2 macrophages, M2 macrophages regulate osteoblast differentiation, inhibit osteoclast generation, and inhibit bone resorption, at the same time, it enables the new osteoblasts to occupy the place of the original osteoblasts and continue to participate in bone formation. Because the amount of bone formation of the new osteoblasts is higher than that of the original osteoblasts, the final result is an increase in bone mass after apoptosis compared to before apoptosis. Promoting the apoptosis of some osteoblasts in the body with osteoporosis may reverse increase bone mass, paradoxical bone formation may be a new direction for the treatment of osteoporosis. Therefore, this paper proposes the treatment of osteoporosis by "paradoxical bone formation" and analyzes its related mechanism, in order to provide new ideas for the research and treatment of osteoporosis.