Table of Content

20 April 2026, Volume 29 Issue 12

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Review

Hepatic-glycemic Interdependence: the Bidirectional Relationship between Type 2 Diabetes and MASLD and Emerging Therapeutic Strategies

CHEN Yiming, HUANG Yiling, JI Fei, LYU Ling, HUANG Yu, WU Zeyu, HANG Qiqi, PING Fan, YANG Meng

2026, 29(12):  1497-1504.  DOI: 10.12114/j.issn.1007-9572.2025.0455

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Metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) frequently coexist and mutually reinforce one another through shared pathological mechanisms, including insulin resistance, disruptions in lipid homeostasis, and chronic low-grade inflammation. MASLD is now recognized as a major comorbid condition in individuals with T2DM and is associated with substantially increased risks of cardiovascular events, progression of hepatic fibrosis, and all-cause mortality. In 2025, the American Diabetes Association (ADA) released a consensus report that, for the first time, incorporates MASLD into the standardized management framework for T2DM. The report provides recommendations for screening, risk stratification, and therapeutic intervention, and highlights the potential hepatoprotective effects of glucose-lowering agents on steatosis, inflammation, and fibrosis. This review summarizes the bidirectional pathophysiological interplay between MASLD and T2DM, synthesizes clinical and translational evidence regarding the hepatic benefits of major antidiabetic drug classes-including incretin-based therapies, sodium-glucose cotransporter-2 inhibitors, and peroxisome proliferator-activated receptor agonists-and proposes individualized management strategies that span lifestyle modification and pharmacologic therapy, guided by fibrosis stage and metabolic comorbidities in alignment with ADA recommendations. The importance of multidisciplinary collaboration in the comprehensive management of patients with T2DM and MASLD is also emphasized.

"Year of Weight Management"·Weight Loss Section

Interpretation and Discussion of the RACGP Guidelines for Preventive Activities in General Practice: Screening for Weight Issues and Preventive Strategies

HE Zhiguang, QIU Shanjiao, CHEN Zhang, LI Anchun, HUANG Wenjing

2026, 29(12):  1505-1510.  DOI: 10.12114/j.issn.1007-9572.2025.0451

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Overweight and obesity represent a major global public health challenge, with significant variations in preventive strategies across national guidelines. This article introduces the core recommendations on weight problem screening and prevention from the tenth edition of the RACGP Guidelines for Preventive Activities in General Practice in Australia, analyzing its characteristics of opportunistic screening model based on WHO screening principles, anti-stigmatization ethical framework, and structured non-drug intervention tools. It also reviews the development status of China's obesity prevention and control system, and compares the differences between China and Australia in screening concepts, ethical considerations, and practical support from the perspective of general practice. This article proposes that China's future obesity prevention should focus on integrating ethical principles into screening and intervention processes, developing localized tools suitable for primary care, and suggests organically integrating weight management into chronic disease management pathways to empower general practitioners in achieving the transition from disease treatment to health management.

A New Chapter in Obesity Treatment: Mechanisms and Clinical Research Progress of Multi-target Peptide Agonists

YAN Manli, ZHANG Baoqing, HUANG Lei, LI Xiang

2026, 29(12):  1511-1519.  DOI: 10.12114/j.issn.1007-9572.2025.0372

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Obesity is a chronic and relapsing disease resulting from interactions between genetic and environmental factors. Its global prevalence continues to rise, making it a major public health challenge. Traditional weight management strategies often yield suboptimal outcomes. In recent years, peptide-based therapies targeting the glucagon-like peptide-1 receptor (GLP-1R), glucose-dependent insulinotropic polypeptide receptor (GIPR), and glucagon receptor (GCGR) have advanced rapidly, with multi-target agonists emerging as a promising new therapeutic trend. This review systematically summarizes the mechanisms and clinical progress of these agents: GLP-1R single-target agonists demonstrate significant efficacy in weight reduction, glycemic control, and multi-organ protection, though interindividual variability and gastrointestinal side effects remain limitations. Dual agonists targeting GLP-1R/GIPR and GLP-1R/GCGR (e.g., Tirzepatide, Mazdutide) further improve metabolic parameters, reduce liver fat, and mitigate cardiovascular risks through synergistic regulation of appetite, energy expenditure, and lipid metabolism. Meanwhile, the triple agonist Retatrutide (targeting GLP-1R/GIPR/GCGR) shows robust potential for weight loss and body composition improvement, while also modulating key lipid metabolic regulators such as ANGPTL3/8, thereby broadening the therapeutic horizon for metabolic diseases. Looking forward, the development of multi-target agents-combined with long-acting formulation technologies, precise subtyping, and individualized treatment strategies-is expected to significantly enhance the efficacy and safety of obesity treatments and alleviate the public health burden.

Construction of Weight Loss Clinic in Grassroots Medical Institutions and Typical Case Studies

ZHANG Han, ZHANG Hua, CAI Genshen, LIAN Dongbo, ZHANG Jing

2026, 29(12):  1520-1524.  DOI: 10.12114/j.issn.1007-9572.2025.0370

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As the global obesity issue becomes increasingly severe, weight loss has become a key task for improving public health and reducing the burden of chronic diseases. Grassroots medical health institutions can effectively advance the prevention and control of obesity, offering clear advantages such as proximity to community needs and strong accessibility of health services. This paper, based on policy background and practical needs, elaborates on the necessity and existing issues in the construction of weight loss clinics in grassroots medical and health institutions, and systematically explores their functional positioning, service models, and the development of both software and hardware capabilities. Furthermore, taking the Weight Loss Clinic at Huichengmen Community Health Service Station in Haidian District, Beijing, as a typical case, this paper analyzes its practical experiences, including relying on academic support from tertiary hospitals, establishing a two-way referral mechanism, and building an intelligent management system. The construction of grassroots weight loss clinics is an important initiative to promote the transformation of grassroots medical services from a "disease-centered" to a "health-centered" approach. Currently, the construction of grassroots weight loss clinics nationwide is still in its early stages, and this paper can provide references and insights for their standardized development.

Study on the Optimal Time-use Composition of 24-hour Movement Behaviors for Obesity Prevention in College Students

CHEN Xiaolong, JIN Jing, HUA Jialu, LI Yuyu, PAN Youjia, PAN Qi, TU Chunjing, WANG Ping

2026, 29(12):  1525-1532.  DOI: 10.12114/j.issn.1007-9572.2025.0174

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Background

Obesity has become an increasingly serious public health challenge in China, with a steadily rising prevalence. Studies have shown that 24-hour movement behaviors are closely associated with obesity. However, most current guidelines only provide separate time recommendations for individual behaviors without fully considering their interdependence and combined effects within a 24-hour framework.

Objective

To explore the associations between 24-hour movement behaviors and obesity-related outcomes among Chinese university students using the compositional data analysis approach, and to develop an optimal time-use composition for obesity prevention.

Methods

A total of 108 university students from Hangzhou were recruited. 24-hour movement behaviors were monitored using accelerometers. Anthropometric indicators including height, weight, and waist circumference (WC) were measured following standardized protocols, and BMI, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were calculated. Body fat percentage (BFP) and visceral fat area (VFA) were assessed using the InBody 720 bioelectrical impedance analyzer. A compositional multiple regression model was constructed to estimate optimal time allocations and prediction intervals for different movement behaviors.

Results

The composition of 24-hour movement behaviors was significantly associated with obesity-related indicators among college students, including BMI (F=8.25, P<0.01), BFP (F=27.58, P<0.01), WC (F=13.90, P<0.01), WHR (F=13.10, P<0.01), WHtR (F=14.09, P<0.01), and VFA (F=7.04, P<0.01). The optimal 24-hour time-use composition for obesity prevention was identified as: 131 minutes of moderate-to-vigorous physical activity (MVPA)(110-140 min), 208 minutes of light physical activity (LPA) (160-230 min), 663 minutes of sedentary behavior(SB)(620-730 min), and 438 minutes of sleep (360-520 min).

Conclusion

The composition of 24-hour movement behaviors is closely associated with obesity-related indicators among college students. The optimal time-use composition developed in this study aligns with current guidelines for MVPA and sleep, while also providing recommendations for SB and LPA. These findings offer scientific evidence for the optimized allocation of daily activity time and the prevention of obesity in college populations.

Application Progress of Generative Artificial Intelligence in Weight Management

YANG Lei, GUAN Hua

2026, 29(12):  1533-1540.  DOI: 10.12114/j.issn.1007-9572.2025.0308

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Weight management serves as a critical component in the prevention and control of chronic diseases. In 2024, the National Health Commission of China launched a three-year "Weight Management Year" action plan (2025-2027), aiming to enhance public awareness of weight management and promote scientific control methods. Weight management not only focuses on body weight values but also emphasizes comprehensive interventions in diet, physical activity, and lifestyle to prevent chronic diseases and improve quality of life. Generative artificial intelligence demonstrates significant potential in the field of weight management by providing users with personalized dietary advice, exercise plans, and behavioral interventions, thereby improving management outcomes and adherence. This article systematically explores the application pathways and effectiveness of generative artificial intelligence in weight management, highlighting its advantages in achieving dynamic personalization of dietary plans and increasing physical activity levels, while also addressing multiple challenges such as content authenticity, data privacy, algorithmic biases, and long-term adherence. This study provides valuable insights for the optimization of weight management models in China and the further application of generative artificial intelligence in the health domain.

Article

A Survey on the Quality of Diabetes Normative Management at Grassroots Level

YANG Rong, JIN Hua, SHI Ling, YI Chuntao, HOU Jin, CHEN Chen, HUAN Hongmei, NI Hengru, YU Dehua

2026, 29(12):  1541-1547.  DOI: 10.12114/j.issn.1007-9572.2024.0417

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Background

The incidence of diabetes has been increasing year by year, and the management of type 2 diabetes has been included into the basic community health services as an important disease in China. However, at present, there is still a gap in the standard management of diabetes at the grass-roots level, especially in quality and ability.

Objective

To understand the current situation of diabetes management in Shanghai community health institutions and conduct systematic quality evaluation, and to put forward corresponding optimization suggestions for existing problems.

Methods

The research was conducted in May 2022, and the target population included, (1) community health service centres: all community health service centres in 16 administrative districts of Shanghai, with a total of 249 institutions; and (2) community general practitioners: 3 875 community general practitioners were selected by simple random sampling according to the proportion of 50% of the registered population. The questionnaire for medical institutions and the questionnaire for general practitioners were designed to investigate the implementation of diabetes management in community health centres and the implementation of standardized diagnosis and management of diabetes by community general practitioners.

Results

A total of 249 questionnaires concerning diabetes management in primary healthcare institutions were distributed, with 249 valid responses collected, representing a 100.00% response rate. Additionally, 3 875 questionnaires assessing standardised diabetes diagnosis, treatment, and management practices among community general practitioners were distributed, yielding 3 874 valid responses, corresponding to a 99.97% response rate. HbA_1c test was available in all community health institutions in Shanghai, but the screening program for diabetes complications was insufficient, and only 16.9% of community health service centercould test nerve conduction velocity. The types of oral hypoglycemic agents are relatively complete, but the types of insulin are single, and only 7.6% of community health service center are equipped with the new hypoglycemic drug glucagon-like peptide-1 receptor agonist. 57.4% of community health service center have set up diabetes clinics. Community general practitioners have a high degree of recognition for the standardized management of diabetes and have a good grasp of the guidelines for the basic management of diabetes, but they have a poor grasp of the basic knowledge of diabetestreatment drugs, and the correct rate of the application knowledge of oral hypoglycemic drugs and insulin is only 27.9% and 29.0%. When the blood sugar of newly diagnosed diabetic patients is high and the diagnosis of diabetic nephropathy is confirmed, the community general practitioners are more inclined to refer the patients directly to the superior hospital specialty.

Conclusion

The results of this survey showed that the infrastructure, equipment and drugs of diabetes management service in Shanghai community health service center have basically met the quality requirements; Gaps in knowledge of drug use; It is necessary to further improve the diabetes management quality and medical capacity of primary medical and health institutions by increasing the examination and testing items related to the screening of diabetes complications, increasing the types of new hypoglycemic drugs and insulin, strengthening the construction of diabetes specialized clinics, improving the diagnosis and treatment level of general practitioners, and standardizing the diagnosis and treatment behaviors of general practitioners.

Analysis of the Quality of Diagnosis and Treatment of Osteoporosis in Shanghai Community Health Service Institutions

ZHANG Hanzhi, JIN Hua, MA Le, SHI Ling, CHEN Chen, HUAN Hongmei, YU Dehua

2026, 29(12):  1548-1557.  DOI: 10.12114/j.issn.1007-9572.2025.0097

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Background

The diagnosis and treatment level of osteoporosis in Shanghai community health service institutions are still unclear, and systematic evaluation and monitoring are lacking.

Objective

To understand the current status of osteoporosis diagnosis and management in community health service in Shanghai, to evaluate their diagnosis and treatment capacity, and to explore their problems and improvement measures.

Methods

A questionnaire was distributed to 248 community health service centers and 1 873 community general practitioners (GPs) in 16 administrative districts of Shanghai in December 2023 to investigate the current status, knowledge and competence of community health service center and GPs in urban and suburban areas regarding osteoporosis diagnosis and management.

Results

Of the 248 community health centers in the 16 administrative districts of Shanghai, 79 (31.9%) were in the urban area and 169 (68.1%) in the suburbs, and of the 1 873 GPs, 497 (26.5%) were in the urban area and 1 376 (73.5%) in the suburbs. In terms of inspection and testing equipment, the proportion of bone mineral density (BMD) in urban and suburban areas was 92.4% and 50.9%, and the proportion of bone turnover markers was 50.6% and 12.4%, respectively (P<0.05). In terms of drugs, the proportion of bisphosphonates in urban and suburban areas was 73.4% and 45.0%, and the proportion of active vitamin D and its analogues was 69.9% and 53.3%, respectively (P<0.05). In terms of non-drug treatment, the proportion of traditional Chinese medicine suitable technology in urban area and suburban area was 79.7% and 80.5% respectively (P>0.05). Exercise therapy, physical factor therapy and occupational therapy in urban areas were higher than those in suburban areas, 73.4% versus 50.3%, 73.4% versus 37.9%, 65.8% versus 38.5% (P<0.05). The difficulties of disease management mainly included insufficient examination equipment, inadequate treatment drugs, and limited doctors' diagnosis and treatment ability, especially in the suburbs. Regarding the cognition of GPs in community health centers on osteoporosis high-risk groups and screening, the proportion of urban and suburban GPs' cognition on postmenopausal women was 99.2% versus 97.8% (P<0.05), and the proportion of their cognition on the Osteoporosis Self-Screening Tool for Asians (OSTA) was 88.3% versus 84.4% (P<0.05). Regarding the cognition of common symptoms and examinations of osteoporosis, the proportion of urban and suburban GPs' cognition of compression fracture was 97.0% and 92.2% respectively (P<0.05), and the proportion of cognition of bone transformation markers was 67.6% and 45.2% respectively (P<0.05). Regarding the perception of osteoporosis treatment modalities, the proportion of urban and suburban GPs' perception of physical factor therapy and occupational therapy was 89.3% versus 84.7% and 86.3% versus 81.2%, respectively (P<0.05). The difficulties in diagnosis and treatment mainly included: insufficient experience in the use of new drugs, insufficient ability to identify high-risk groups, insufficient ability to assess the risk of osteoporosis, insufficient confidence in diagnosis, and insufficient ability to choose and mix drugs, especially among rural doctors.

Conclusion

All community health service institutions in Shanghai, especially those in the suburbs, need to strengthen the equipment of osteoporosis related examinations and tests such as bone mineral density and bone turnover markers, improve the types of therapeutic drugs such as bisphosphonates, active vitamins and their analogues, and strengthen the development of relevant appropriate technologies including exercise, physiotherapy and work. As for the systematic and comprehensive management of osteoporosis, it is suggested to improve the relevant information construction, coordinate and integrate multidisciplinary teams and multi-party resources.

Prevalence of Depression and the Influencing Factors in Patients with Type 2 Diabetes Mellitus: a National Multicenter Cross-sectional Study

LIAO Qiuhon, TAO Hong, YANG Xiaohui, YUAN Yonggui, LIN Shanshan, XU Wei, LI Yuxiu, PEI Yu

2026, 29(12):  1558-1565.  DOI: 10.12114/j.issn.1007-9572.2025.0215

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Backgroud

Diabetes and depression have become two major public health challenges. Depression can reduce the treatment adherence of patients with diabetes, exacerbate diabetic complications and mortality, and severely affect the quality of life of patients. However, currently, clinicians tend to focus on biological factors while neglecting psychological factors. As a result, the diagnosis rate of depression in diabetic patients is low. Therefore, it is of great clinical significance to actively identify and screen type 2 diabetic patients at risk of depression and to conduct in-depth analysis of various influencing factors.

Objective

With the increasing incidence of diabetes, the related psychological problems are also becoming more and more concerned. In order to overcome the limitations of selection bias in single-center surveys, we conducted a nationwide multicenter survey to investigate the prevalence of depression and its influencing factors among patients with type 2 diabetes mellitus (T2DM) in China, and to provide a basis for developing mental health intervention strategies for diabetic patients.

Methods

A nationwide multicenter observational study was conducted using a probability proportional to size (PPS) sampling method. A total of 2 137 patients with T2DM were recruited from 52 hospitals across China. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms (PHQ-9≥10 indicated depression). Through a review of the literature, 29influential factors were identified: fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, and lipid profiles, triglyceride-glucose index (TyG), diabetes duration, diabetes complications, anddiabetes comorbidities. Multivariate logistic regression analysis was performed to identify factors associated with depression in T2DM patients. Use the statistical software R package to analyze whether there is a nonlinear relationship between age, TyG, and depression and calculate the inflection point.

Results

Among 1 659 patients with type 2 diabetes, the prevalence of depression was 13.3% (220 cases). Multivariate logistic regression analysis identified the following independent risk factors for depression in type 2 diabetes patients: gender (female OR=1.815, 95%CI=1.220-2.701), age (OR=0.969, 95%CI=0.952-0.987), education level (below high school: OR=1.488, 95%CI=1.049-2.11), marital status (unmarried and others: OR=1.864, 95%CI=1.068-3.254), BMI (OR=0.936, 95%CI=0.896-0.977), ecomomic difficulties (OR=3.654, 95%CI=2.403-5.558), duration of disease (OR=1.031, 95%CI=1.006-1.057), diabetic peripheral neuropathy (OR=2.17, 95%CI=1.275-3.693), cardiovascular disease (OR=1.844, 95%CI=1.248-2.723), hypertension (OR=1.625, 95%CI=1.163-2.271), and TyG (OR=1.717, 95%CI=1.026-2.874)(P<0.05). After controlling for confounding factors, TyG showed a linear positive correlation with depression (P_nonlinear=0.191), while age exhibited a linear negative correlation with depression in the male population (P_nonlinear=0.946). The age of women was not linearly related to depression (P_nonlinear=0.013), and the time inflection point of the relationship was 49 years old (OR=0.921, 95%CI=0.857-0.99, P_nonlinear=0.025; OR=1.036, 95%CI=1.003-1.07, P_nonlinear=0.0323).

Conclusion

The prevalence of depression among Chinese patients with T2DM was 13.3%. Patients with low education levels, non-marital status, financial difficulties, high TyG index, and comorbid conditions such as diabetic peripheral neuropathy, cardiovascular disease, and hypertension were more likely to develop depression. Among male patients, the prevalence of depression decreased with increasing age. Among female patients, the relationship between age and the incidence of depression in the diabetic population followed a J-shaped curve, The risk of depression increases again after the age of 49. Early screening and intervention for depression are recommended for these high-risk groups to improve the overall health status and quality of life of T2DM patients.

Effects and Efficacy of Intravenous Oxycodone on Respiratory Mechanics in Mechanically Ventilated Patients

YANG Fang, WANG Lin, LIU Miao, DONG Keqi

2026, 29(12):  1566-1571.  DOI: 10.12114/j.issn.1007-9572.2025.0273

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Background

Mechanically ventilated patients in the intensive care unit (ICU) experience both nociception and pain-related distress, while simultaneously being at risk of ventilator-induced lung injury (VILI). Implementing individualized analgesic regimens is crucial to facilitate lung-protective ventilation strategies. Although preclinical studies suggest that oxycodone may attenuate VILI, clinical evidence supporting its use in critically ill patients remains limited, particularly in the ICU setting.

Objective

To evaluate the effects of intravenous oxycodone on respiratory mechanics and clinical outcomes in mechanically ventilated ICU patients, with a specific focus on those who have undergone abdominal surgery, thereby providing a novel theoretical basis and practical guidance for optimizing analgesic management and mitigating VILI risk.

Methods

A prospective randomized controlled trial was conducted. A total of 94 adult patients (aged≥18 years) requiring analgesic intervention, with a mechanical ventilation duration exceeding 24 hours and an Critical-care Pain Observation Tool (CPOT) score ≥3, were enrolled from the ICU of Zhoushan Hospital between August 2023 and March 2025. Participants were randomly assigned to either the sufentanil group or the oxycodone group, with 47 patients in each group. Both groups received standard treatment for underlying conditions and were managed with mechanical ventilation according to a conventional lung-protective ventilation strategy. The sufentanil group received a continuous intravenous infusion of sufentanil via micropump (loading dose: 0.5-1.0 μg/kg; maintenance dose: 0.02-0.15 μg·kg^-1·h^-1), while the oxycodone group received a continuous intravenous infusion of oxycodone injection (diluted to 1 mg/mL with 0.9% saline or 5% glucose solution; loading dose: 0.03 mg/kg; initial maintenance dose: 2 mg/h). Dosages were adjusted based on CPOT scores to maintain pain control with a target CPOT score below 3. Both groups received propofol for sedation as clinically indicated. Routine assessments included pain evaluation, respiratory mechanics monitoring, and arterial blood gas analysis. Outcome measures included demographic characteristics, airway peak pressure (Ppeak), airway plateau pressure (Pplat), driving pressure (ΔP), dynamic compliance (Cdyn), mechanical power MP), oxygenation index (P/F), and ventilation ratio (VR), recorded at baseline (0 h) and at 4 h, 12 h, and 24 h after initiation of analgesia. Additionally, cumulative analgesic consumption over 24 hours (converted to morphine equivalent), total propofol dose over 24 hours, duration of MV, and length of ICU stay (ICU-LOS) were documented. The study compared the effects of the two analgesic regimens on respiratory mechanics and clinical efficacy. A prespecified subgroup analysis was performed among 37 patients who underwent abdominal surgery (sufentanil subgroup: n=17; oxycodone subgroup: n=20).

Results

There was no significant interaction effect between group and time on respiratory mechanics and oxygenation/ventilation parameters (P>0.05). The main effect of group on these parameters was not statistically significant (P>0.05), whereas the main effect of time was significant for Ppeak, MP, and VR (P<0.05). Subsequent intergroup comparisons were conducted for total morphine equivalent dose (24-hour analgesic requirement), total propofol dose (24-hour sedative requirement), duration of mechanical ventilation, and ICU length of stay (LOS), with no statistically significant differences observed (P>0.05). However, a subgroup analysis restricted to patients who underwent abdominal surgery demonstrated a statistically significant difference in propofol dosage between the oxycodone and sufentanil groups (P<0.05).

Conclusion

Both oxycodone injection and sufentanil injection can effectively improve respiratory mechanics parameters and oxygenation-ventilation indices in mechanically ventilated ICU patients, thereby facilitating the implementation of lung-protective ventilation strategies and reducing the risk of VILI. In post-abdominal surgery patients requiring mechanical ventilation, oxycodone injection demonstrates superior efficacy in pain relief, allows for reduced use of sedative agents, mitigates clinical risks associated with high-dose sedation, and exhibits a more favorable safety profile.

Correlation Study between Diabetes Mellitus and Lung Function in Male People

SONG Lu, LAN Zhigang, ZHOU Wei, FENG Liping, LIU Yunqiu, CHEN Shuohua, WANG Liye

2026, 29(12):  1572-1578.  DOI: 10.12114/j.issn.1007-9572.2025.0283

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Background

Currently, there are 537 million patients with diabetes mellitus in the world, with the greatest number of affected people in China. Accumulating studies have found that the lungs are also the target organs of diabetes mellitus. Previous cross-sectional studies on diabetes mellitus and lung function have consistently concluded that people with diabetes mellitus have lower lung function than unaffected individuals. However, longitudinal studies are scant on diabetes mellitus and the decline rate of lung function, and the existing conclusions are inconsistent.

Objective

To investigate the association between diabetes mellitus and lung function in male people.

Methods

From 2014 to 2020, 18 438 male employees receiving lung function test and other physical examinations in Kailuan General Hospital were involved in this study, including 12 448 who completed the second lung function test. They were assigned into the normal fasting plasma glucose group (FPG<6.1 mmol/L, n=15 727), impaired fasting glucose group (IFG group, 6.1 mmol/L≤FPG<7.0 mmol/L, n=1 490) and diabetes mellitus group (FPG≥7.0 mmol/L or a history of diabetes mellitus, or use of hypoglycemic drugs, n=1 221) based on the blood glucose levels. A generalized linear model was used to analyze the association of different blood glucose levels with lung function indicators [FVC%pred (percentage of predicted value for forced vital capacity), FEV₁%pred (percentage of predicted value for forced expiratory volume in one second), MMEF% (percentage of predicted value for maximum mid-expiratory flow), and FEV₁/FVC (the ratio of forced expiratory flow in one second to forced vital capacity)] and decline rate of lung function.

Results

Among the 18 438 observed subjects, the average age was 42.90±9.73 years. FVC%pred and FEV₁%pred were significantly lower in the diabetes mellitus group than the normal FPG and IFG groups, and MMEF%pred was significantly higher in the IFG group than the normal FPG and diabetes mellitus group (P<0.05). No significant difference was found in the decline rate of lung function among the three groups (P>0.05). After adjusting for confounders, the generalized linear analysis showed that with the reference of the normal FPG group, diabetes mellitus was negatively correlated with FVC%pred (B=-1.000, 95%CI=-1.784 to -0.218, P=0.012) and FEV₁%pred (B=-1.266, 95%CI=-2.236 to -0.296, P=0.011), but not associated with MMEF%pred and FEV₁/FVC (P>0.05). There was no correlation between IFG and diabetes with the decline rate of lung function indicators (P>0.05).

Conclusion

Diabetes mellitus are negatively associated with lung function indicators (FVC%pred, FEV₁%pred) in male people. However, we did not find an association of diabetes mellitus with the decline rate of lung function in men.

Study on the Differences in Blood Lipid Levels among Different Ethnic Groups in Xinjiang Uyghur Autonomous Region after Treatment with PCSK9 Inhibitors

LIU Ziyang, JIN Menglong, LIU Sen, WEI Mengwei, SUBINUER· Jureti, FU Zhenyan

2026, 29(12):  1579-1587.  DOI: 10.12114/j.issn.1007-9572.2024.0308

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Background

Cardiovascular disease (CVD) is a leading cause of death worldwide, and hyperlipidemia is a significant risk factor for CVD. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as an important target for lipid-lowering therapy and CVD prevention.

Objective

To investigate the differences in blood lipid levels among Han, Uyghur, Kazakh, Hui, and Mongolian ethnic groups in Xinjiang after treatment with PCSK9 inhibitors and to explore ethnic variations.

Methods

This retrospective cohort study included 4 167 patients with hyperlipidemia from Han, Uyghur, Kazakh, Hui, and Mongolian ethnic groups who were hospitalized in the Heart Center of the First Affiliated Hospital of Xinjiang Medical University between April 2019 and May 2024 and received evolocumab or alirocumab for lipid-lowering therapy for more than 4 weeks. Baseline data were collected, and multiple linear regression analysis was used to explore the correlation between ethnicity and blood lipids in different categories of hyperlipidemia patients.

Results

A total of 2 634 Han patients (63.2%), 1 027 Uyghur patients (24.6%), 218 Kazakh patients (5.2%), 251 Hui patients (6.0%), and 37 Mongolian patients (1.0%) were included. Statistically significant differences were observed among Han, Uyghur, Kazakh, Hui, and Mongolian patients in terms of gender, body weight, BMI, education level, smoking, alcohol consumption, hypertension, aspartate aminotransferase (AST), total bilirubin, use of statins, ezetimibe, proportion of PCSK9 inhibitor use, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) (P<0.05). Multiple linear regression analysis showed that after treatment with PCSK9 inhibitors, Uyghur patients had 4.713% and 11.173% higher TC and LDL-C levels, respectively, and 6.889% lower HDL-C levels compared to Han patients (P<0.05). Kazakh patients had 5.925%, 5.925%, and 12.720% higher TC, HDL-C, and LDL-C levels, respectively, and 23.792% lower TG levels compared to Han patients (P<0.05). Mongolian patients had 14.025% higher TC levels compared to Han patients (P<0.05). After treatment with evolocumab, Uyghur patients had 5.196% and 11.173% higher TC and LDL-C levels, respectively, and 4.720% lower HDL-C levels compared to Han patients (P<0.05). Kazakh patients had 7.399%, 5.925%, and 17.220% higher TC, HDL-C, and LDL-C levels, respectively, and 25.011% lower TG levels compared to Han patients (P<0.05). Hui patients had 1.599% lower HDL-C levels compared to Han patients (P<0.05), while Mongolian patients had 21.899% and 13.240% higher TC and HDL-C levels, respectively, compared to Han patients (P<0.05). After treatment with alirocumab, Uyghur patients had 10.662% higher LDL-C levels and 12.502% lower HDL-C levels compared to Han patients (P<0.05). Stratified analysis by age and gender showed that male patients treated with PCSK9 inhibitors had 4.472% and 10.917% higher TC and LDL-C levels, respectively, and 6.675% lower HDL-C levels in Uyghur patients compared to Han patients (P<0.05). Kazakh patients had 4.713% higher HDL-C levels and 26.549% lower TG levels compared to Han patients (P<0.05). Hui patients had 4.940% lower HDL-C levels compared to Han patients (P<0.05). Female patients treated with PCSK9 inhibitors had 9.648% higher LDL-C levels and 8.589% lower HDL-C levels in Uyghur patients compared to Han patients (P<0.05). Kazakh patients had 11.173% higher TC levels compared to Han patients (P<0.05). In patients younger than 60 years treated with PCSK9 inhibitors, Uyghur patients had 6.905% and 15.878% higher TC and LDL-C levels, respectively, and 5.811% lower HDL-C levels compared to Han patients (P<0.05). Kazakh patients had 16.145% higher LDL-C levels and 28.879% lower TG levels compared to Han patients (P<0.05). There were no statistically significant differences in TC, TG, HDL-C, and LDL-C levels between Hui and Han patients (P>0.05). Mongolian patients had 17.761% higher TC levels compared to Han patients (P<0.05). In patients 60 years and older treated with PCSK9 inhibitors, Uyghur patients had 8.167% lower HDL-C levels compared to Han patients (P<0.05). Kazakh patients had 6.905% higher HDL-C levels and 17.965% lower TG levels compared to Han patients (P<0.05).

Conclusion

After treatment with PCSK9 inhibitors, Uyghur patients had higher TC and LDL-C levels and lower HDL-C levels compared to Han patients. Kazakh patients had higher TC, HDL-C, and LDL-C levels and lower TG levels compared to Han patients. There were no significant differences in TC, TG, HDL-C, and LDL-C levels between Hui and Han patients. Mongolian patients had higher TC levels compared to Han patients.

Multidimensional Relationship of "TCM Syndrome Type, Clinical Feature and Molecular Typing" in Postmenopausal Patients with Knee Osteoarthritis

HE Xiaoming, HE Mincong, WEI Tengfei, LIN Tianye, LIU Wengang, ZHANG Qingwen, HE Wei, WEI Qiushi

2026, 29(12):  1588-1598.  DOI: 10.12114/j.issn.1007-9572.2024.0274

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Background

Osteoporosis (OP) is a common clinical phenomenon in patients with knee osteoarthritis (KOA), but there lacks an unified homotherapy for heteropathy of OP and KOA.

Objective

To explore the multi-dimensional relationship of "traditional Chinese medicine (TCM) syndrome type- clinical feature-molecular typing" in patients with postmenopausal KOA, thus providing references for homotherapy for heteropathy of OP and KOA.

Methods

A total of 300 patients with postmenopausal KOA and treated with knee replacement surgery at the Joint Center of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from 2021 to 2023 were retrospectively included. According to the results of bone density measurement (BMD), patients were divided into three groups: normal bone density group, osteopenia group, and osteoporosis group, with 100 patients in each group. The correlation between the TCM syndrome type and BMD was analyzed in postmenopausal KOA patients by a correspondence analysis. The clinical symptoms [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score], laboratory indicators [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum calcium, phosphorus, alkaline phosphatase (ALP), and lipids)], and imaging indicators [Kellgren-Lawrence (K-L) grade, hip knee ankle angle (HKA), joint line convergence angle (JLCA), tibial plateau subchondral area, and low-density area] were investigated and compared among postmenopausal KOA patients with different TCM syndrome types. The knee joint tissues of KOA patients with different TCM syndrome types were analyzed by molecular biology, and the key target molecules were clarified. Subsequently, the key targets obtained by bioinformatics were detected by Western Blotting and immunohistochemistry experiments, and their expression differences were compared. An initial molecular classification of TCM syndrome types was established in patients with postmenopausal KOA.

Results

The main TCM syndrome types in postmenopausal women with KOA included the liver and kidney deficiency (n=122), Qi stagnation and blood stasis (n=96), cold and damp obstruction (n=72), and phlegm and blood stasis (n=10). Qi stagnation and blood stasis was the major TCM syndrome type in postmenopausal KOA patients with a normal BMD, while the liver and kidney deficiency dominant in those with decreased bone density and osteoporosis. There was a significant difference in the distribution of TCM syndrome times among the three groups (χ2=55.27, P<0.001). Logistic regression analysis showed that patients with the TCM syndrome of liver and kidney deficiency had a significantly higher risk of decreased bone density (OR=2.37, 95%CI=1.20-4.69, P=0.013) and osteoporosis (OR=3.39, 95%CI=2.41-4.76, P<0.001). Patients with the TCM syndrome of liver and kidney deficiency had significantly higher WOMAC body function scores and total WOMAC scores than those with Qi stagnation and blood stasis (P<0.05). There were no significant differences in ESR, CRP, total calcium, phosphorus, ALP, and four blood lipids between patients with the TCM syndrome types of liver and kidney deficiency, and Qi stagnation and blood stasis (P>0.05). The HKA was significantly smaller in patients with the TCM syndrome of liver and kidney deficiency than those with Qi stagnation and blood stasis, and the JLCA and tibial plateau subcutaneous low-density area were significantly larger (P<0.05). There was no significant difference in the area of the tibial plateau between the two TCM types of patients (P> 0.05). There was a significant difference in K-L grade between the TCM syndrome types of liver and kidney deficiency and Qi stagnation and blood stasis (P<0.05), with the former being R- significantly greater than the latter (P<0.05). Western Blotting and immunohistochemistry experiments showed that the expression levels of C-X-C chemokine ligand 8, tumor necrosis factor-alpha and interleukin-1beta molecules were significantly higher in patients with the TCM syndrome type of Qi stagnation and blood stasis, while the expression levels of peroxisome proliferator-activated receptor gamma, stearoyl-CoA desaturase and CCAAT/enhancer-binding protein alpha molecules were significantly higher in patients with the TCM syndrome type of liver and kidney deficiency (P<0.05).

Conclusion

The multidimensional relationships between "TCM syndrome type-clinical features-molecular typing" in postmenopausal KOA patients are as follows: patients with Qi stagnation and blood stasis have normal bone mass and increased expressions of inflammation-related molecules, and those with liver and kidney deficiency have decreased/osteoporotic bone mass and increased expressions of lipid metabolism-related molecules. Compared with Qi stagnation and blood stasis, patients with liver and kidney deficiency have a higher risk of decreased bone mass, osteoporosis, and lower limb inversion deformity. Their tibial plateau subchondral low-density area is significantly larger, knee function is significantly impaired, and the K-L grade is more severe.

Treatment Practice and Analysis under the Collaboration between Doctors and Pharmacists in Patient with Diffuse Large B-Cell Lymphoma Complicated by Severe Renal Insufficiency

LIU Jinglin, LI Wei, ZHANG Xiaolong, SONG Xiaokun, ZHOU Xibei, WANG Guanyuan, ZHANG Jie

2026, 29(12):  1599-1606.  DOI: 10.12114/j.issn.1007-9572.2025.0061

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Background

The main treatment for diffuse large B-cell lymphoma is immunochemotherapy. However, the transport of most chemotherapy drugs in the body relies on the participation of the kidneys. For patients with diffuse large B-cell lymphoma, the coexistence of severe renal insufficiency undoubtedly poses a significant challenge to treatment. During the treatment process, doctors and pharmacists need to closely cooperate to maximize the therapeutic benefits for patients while ensuring their safety.

Objective

To explore the treatment service model for patients with diffuse large B-cell lymphoma complicated by acute renal failure, so as to establish effective preventive and treatment measures.

Methods

Taking the clinical data of a patient with diffuse large B-cell lymphoma complicated with severe renal insufficiency who received polatuzumab vedotin combined with chemotherapy as an example. Explore the etiology, prognostic assessment, treatment feasibility, risk assessment and management of tumor lysis syndrome, adjustment of treatment regimens, key points of pharmaceutical care analysis and determination of dialysis timing, etc.

Results

The patient's treatment process was stable, and no tumor lysis syndrome occurred. After 2 cycles of treatment, the symptoms of tumor compression were relieved, acute renal failure was effectively alleviated, and the lactate dehydrogenase level tended to be normal.

Conclusion

There are significant individual differences among patients with diffuse large B-cell lymphoma complicated by renal failure. The clinical treatment regimens should be individualized based on clear examinations and comprehensive assessments. Doctors and pharmacists should strengthen communication to ensure the safety and effectiveness of treatment.

Acidic Preconditioning Activates the Sodium-hydrogen Exchanger 1 to Regulate Intracellular pH Homeostasis and Reduce Renal Ischemia-reperfusion Injury

CHEN Annan, YAN Zhixin, ZHANG Jian, SHEN Bo, DING Xiaoqiang, SONG Nana

2026, 29(12):  1607-1617.  DOI: 10.12114/j.issn.1007-9572.2024.0105

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Background

Appropriate intracellular pH is essential for the proper functioning of cells. Acidic pretreatment can induce intracellular acidic adaptation and improve cells' ability to withstand harmful stress, a process known as acidic preconditioning (AP). Sodium-hydrogen exchanger 1 (NHE1) is commonly found in renal tubular epithelial cells and serves as a key channel for the excretion of H⁺. Nevertheless, the role of NHE1 in renal AP are still not fully understood.

Objective

This study developed an AP model in the human renal tubular epithelial cell line (HK2) that effectively mitigates hypoxia/reoxygenation (H/R) injury. The research also clarified the mechanism of AP in regulating pHi homeostasis via regulating NHE1, which was further validated in a mouse ischemic preconditioning(IPC) model.

Methods

The experiment was conducted from June to December 2023 at the Laboratory of Nephrology, Zhongshan Hospital, Fudan University. HK2 cells were subjected to hypoxia for 24 hours and then reoxygenation for 1 hour to establish an in vitro model of acute kidney injury(AKI); C57BL/6 mice were performed 35 minutes occlusion of bilateral renal artery following reperfusion for 24 hours to establish in vivo model of AKI; Mice were clamped on both sides of the renal artery for 15 minutes and then perfused for 4 days since I/R. C57BL/6 mice were randomly divided into sham group (Sham), IPC group, I/R group and IPC+I/R group, n=6 in each group, among which the mice in the IPC+I/R group referred to bilateral renal arteries of the mice were occluded for 15 minutes and then perfused for 4 days before I/R was performed. The in vitro experiment was divided into three parts. Part 1: to establish the AP model, HK-2 cells were treated with pH 6.6 acidic medium (A) followed by pH 7.4 normal medium (R) before subjecting them to H/R. Part 2: small interfering RNA against NHE1 (siNHE1) was used to knock down NHE1 expression; Part 3: HK2 cells were treated with low chloride medium at pH 6.6 in phase A and normal chloride medium at pH 7.4 in phase R. Cell viability was evaluated using the CellTiter-Lumi luminescence method, apoptosis levels were assessed through Western Blotting, Tunel staining, and Annexin V-FITC/PI double staining. The activity of NHE1 and pHi were detected by BCECF-AM probe and NH4Cl-prepulse technology. The ability of maintenancing steady-state of pHi was evaluated by extracellular pH(pHe)-pHi curve, and the expression of NHE1 was detected through immunofluorescence in kidney tissue and HK2 cells.

Results

Treatment with acidic conditions for 12 hours and subsequent recovery in normal medium for 6 hours significantly decreased the expression levels of cleaved caspase 3 and cleaved caspase 9 following hypoxia/reoxygenation (H/R) treatment, as well as reduced the proportion of Annexin V and Tunel positive cells (P<0.05). Furthermore, AP mitigated intracellular acidification post H/R treatment (P<0.05), increased NHE1 expression and activity, and shifted the pHe-pHi curve upwards; silencing NHE1 expression resulted in a downward shift of the pHe-pHi curve after AP treatment. Knocking down NHE1 attenuated the protective effects of AP against H/R injury, leading to higher expression levels of cleaved caspase 3 and cleaved caspase 9 (P<0.05). Treatment with low-chloride medium abolishes the impact of acidic stimulation on pHi, while also reversing the upregulation of NHE1 expression and the upward shift of the pHe-pHi curve post AP (P<0.05). There was a decrease in pHi fluctuations after ischemia/reperfusion (I/R) (P<0.05) and an upward shift in the pHe-pHi curve after IPC. IPC also significantly decreased the expression levels of KIM1 and cleaved caspase 3, while upregulating NHE1 expression after I/R (P<0.05). Additionally, IPC facilitated the colocalization of NHE1 and LTL after I/R.

Conclusion

AP promotes the maintenance of pHi homeostasis by increasing NHE1 expression and activity via transient fluctuations in pHi, leading to intracellular acidic adaptation and mitigating H/R injury.

General Practitioners Prescribe Medical Exercise to Promote the Integration of Sports and Medicine

LI Chunlian, ZHANG Ying, GUO Mingzhao, HE Meichen, XU Lingling, WANG Yongchen

2026, 29(12):  1618-1623.  DOI: 10.12114/j.issn.1007-9572.2024.0573

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The "Healthy China 2030" initiative clearly proposes to establish an exercise prescription library to promote the integration of sports and medicine and give full play to the role of scientific fitness in the prevention and rehabilitation of chronic diseases. However, how general practitioners in primary care institutions can play a role in prescribing medical exercise to patients is still under exploration. Based on the current status of exercise prescription at home and abroad, this study mainly uses literature search and data collection methods, supplemented by expert consultation and field research methods, to explore the responsibilities and importance of general practitioners in the application of medical exercise prescription, summarize the shortcomings and put forward corresponding suggestions to promote the integrated development of community sports and medicine.

Methodology and Tool Development

Children's Type 1 Diabetes-specific Self-reported Outcomes Scales: Measurement Properties Evaluation Based on COSMIN Guidelines

YAN Beibei, XU Huaifu

2026, 29(12):  1624-1632.  DOI: 10.12114/j.issn.1007-9572.2023.0560

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Background

Type 1 diabetes mellitus in children is progressively younger, and there is a lack of quality standardized studies on specific self-reported outcomes scales for pediatric and adolescent patients.

Objective

To evaluate the measurements properties of children's type 1 diabetes-specific self-reported outcomes reports and the methodological quality of related researches based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN).

Methods

CNKI, Wanfang Data, VIP, Medline, Web of Science and Embase were searched for the studies on the development of children's type 1 diabetes-specific self-reported outcomes scales and validation of the measurements properties from inception to March, 2023. Two investigators cross-screened, checked and extracted the data, described and evaluated the included scales and researches by COSMIN list, to finally form the recommendations.

Results

A total of 24 development or validation studies related to 11 children's type 1 diabetes-specific self-reported outcomes scales were included. Pediatric Quality of Life Inventory 3.2 Diabetes Module (PedsQL^TM3.2-DM), MIND Youth Questionnaire (MY-Q), Diabetes Quality of Life for Youths (DQOL-Y), Problem Areas in Diabetes-Teen Version (PAID-Teens), DISABKIDS Diabetes-Specific Module (DSM-10), FinDiab Quality-of-life Questionnaire (FDQL) and the Quality of Life Survey for Children and Adolescents with Diabetes in Chongqing are all recommended as Grade B, while PedsQL^TM3.0-DM, Problem Areas in Diabetes Survey-Pediatric Version (PAID-Peds), Type 1 Diabetes and Life (T1DAL) and ADDQoL-Teen are all recommended as Grade C. At the same time, the measurement properties of the children's type 1 diabetes-specific self-reported outcomes scales were insufficient and the reports were not comprehensive.

Conclusion

The methodological quality and measurement properties of the ratings of children's type 1 diabetes-specific self-reported outcomes scales at home and abroad are mostly grades B and C, which need to be further improved, and some potential scales deserve further study and application.