Table of Content

15 August 2026, Volume 29 Issue 23

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Guidelines·Consensus

Guidelines for the Assessment, Treatment, and Prevention of Childhood Obesity in China (Second Edition)

Expert Group on Guidelines for the Assessment, Treatment, and Prevention of Childhood Obesity in China, Professional Committee on Obesity Control in Women and Children, China Maternal and Child Health Research Association

2026, 29(23):  3233-3252.  DOI: 10.12114/j.issn.1007-9572.2026.0076

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Childhood obesity has become a major public health concern in China. To standardize the assessment, treatment, and prevention of childhood obesity, the Expert Group on Guidelines for the Assessment, Treatment, and Prevention of Childhood Obesity in China updated the first edition published in 2021 and developed the Guidelines for the Assessment, Treatment, and Prevention of Childhood Obesity in China (Second Edition) (hereinafter referred to as the guideline). The guideline applies the GRADE approach to systematically assess the quality of evidence and integrates evidence from published systematic reviews and individual studies to formulate evidence-based recommendations tailored to the current situation of children and adolescents obesity in China. The main recommendations include adopting a stratified and phenotype-based screening strategy to facilitate the early identification of obesity and related complications; emphasizing family-centered lifestyle intervention as the cornerstone of treatment; strictly restricting the use of weight-loss medications in children and adolescents; and cautiously considering bariatric surgery, following multidisciplinary evaluation, for adolescents with severe obesity who fail to respond adequately to lifestyle intervention and/or pharmacotherapy.

Monographic Research·MAFLD

The Role of Exercise in the Management of Metabolic-associated Fatty Liver Disease: Interpretation of the International Expert Consensus of ACSM and ESSA

XU Kun, CHENG Jingwei, WANG Congshuai, WANG Yinhao, HU Junpeng, LI Wanyue, LIU Yangqing, XI Yan

2026, 29(23):  3253-3260.  DOI: 10.12114/j.issn.1007-9572.2025.0359

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Exercise is the cornerstone of metabolic-associated fatty liver disease(MAFLD) management and a core approach to reversing hepatic steatosis and reducing cardiovascular risk. Currently, there are no effective therapeutic drugs approved by regulatory authorities for MAFLD, thus patients with MAFLD need more precise exercise prescription guidance. However, there are relatively few exercise guidelines specifically for MAFLD patients at present. With the continuous exploration of this field by experts and scholars, in the past two years, American College of Sports Medicine (ACSM) and Exercise and Sport Science Australia (ESSA) respectively released expert consensuses on exercise guidance recommendations for patients with MAFLD: American College of Sports Medicine (ACSM) International Multidisciplinary Roundtable Report on Physical Activity and Nonalcoholic Fatty Liver Disease and Exercise in the Management of Metabolic-associated Fatty Liver Disease (MAFLD) in Adults: a Position Statement from Exercise and Sport Science Australia. These two expert consensuses comprehensively put forward guiding opinions from the perspectives of the mechanism by which exercise improves hepatic steatosis, the impact of different types of exercise on MAFLD, the benefits of exercise for MAFLD patients, and the formulation of exercise prescriptions. This article interpreted the main contents of the expert consensus, aiming to provide more scientific exercise guidance for domestic MAFLD patients.

Association between Cardiometabolic Index and Hypertension in Elderly Patients with Metabolic Associated Fatty Liver Disease in the Community Population: a Prospective Cohort Study

ZHANG Wenzheng, ZHANG Hongling

2026, 29(23):  3261-3267.  DOI: 10.12114/j.issn.1007-9572.2025.0540

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Background

Metabolic associated fatty liver disease (MAFLD) and hypertension are prevalent chronic conditions in older adults, with accumulating evidence linking both to metabolic dysfunction. The cardiometabolic index (CMI) is a composite parameter that evaluates visceral adipose distribution and metabolic status, yet its association with incident hypertension among elderly MAFLD patients remains to be elucidated.

Objective

To investigate the association of CMI with incident hypertension in elderly patients with MAFLD, and to evaluate the predictive value of CMI for hypertension development in this population.

Methods

Elderly non-hypertensive patients diagnosed with MAFLD during health check-ups at Yingzhong and Zijin Community Health Centers affiliated with Changzhi People's Hospital between January and December 2021 were enrolled. Follow-up investigations were conducted from January 2022 to December 2024, and 426 elderly MAFLD patients who completed follow-up were ultimately included in this study. Baseline characteristics and relevant clinical data were collected, and CMI was calculated. Participants were stratified into three tertile groups based on CMI: T1 (CMI<0.467, n=141), T2 (0.467≤CMI<0.758, n=142), and T3 (CMI≥0.758, n=143). They were further categorized into non-hypertension (n=355) and hypertension (n=71) groups based on incident hypertension during follow-up. Kaplan-Meier survival analysis was performed to estimate the cumulative incidence of hypertension across CMI groups, with between-group differences assessed using the Log-rank test. Multivariate Cox proportional hazards regression and restricted cubic spline (RCS) analysis were used to evaluate the association between CMI and incident hypertension. Sex-stratified analysis and sensitivity analysis were performed to examine the robustness of this association.Furthermore, time-dependent receiver operating characteristic (ROC) curves were constructed to assess the predictive performance of CMI for hypertension development in elderly MAFLD patients.

Results

During a median follow-up period of 36.00 (27.75, 38.00) months, 71 patients (16.7%) developed incident hypertension. There were statistically significant differences between the non-hypertension and hypertension groups in age, waist circumference, BMI, CMI, TC, TG, LDL-C, and HDL-C (P<0.05). Log-rank test demonstrated that the cumulative incidence of hypertension increased significantly across T1 to T3 groups with elevated CMI levels (χ²=26.468, P<0.001). Multivariate Cox proportional hazards regression analysis revealed that when analyzed as a continuous variable, CMI was significantly and positively associated with incident hypertension in elderly MAFLD patients after adjusting for relevant confounders (HR=1.927, 95%CI=1.381-2.689, P<0.001). When CMI was analyzed as a categorical variable with the T1 group as the reference, the risk of developing hypertension was significantly higher in the T3 group after adjusting for confounders (HR=5.453, 95%CI=2.268-13.109, P<0.001). Interaction analysis showed no statistically significant interaction between CMI and gender (P_interaction=0.557). Sensitivity analysis demonstrated that the association between CMI and hypertension remained significant after excluding participants with MAFLD remission. RCS analysis showed a non-linear dose-response relationship between CMI and the risk of hypertension in elderly MAFLD patients (P_{non-linearity}=0.005). The risk of hypertension exhibited a continuous upward trend with increasing CMI levels, which plateaued when CMI exceeded 1.185. Time-dependent ROC curve analysis showed that CMI demonstrated optimal predictive performance for hypertension at 24 months of follow-up, with an AUC of 0.722 (95%CI=0.618-0.827). Over time, the AUC decreased to 0.648 (95%CI=0.537-0.759) and 0.652 (95%CI=0.542-0.763) at 30 and 36 months, respectively.

Conclusion

CMI is significantly positively associated with incident hypertension in elderly MAFLD patients, and its measurement can be used to assess the short-term (24-month) risk of hypertension development in this population.

The Non-canonical Functions and Therapeutic Prospects of Parkin in Metabolic Associated Fatty Liver Disease

RUAN Hejing, ZHAO Wen, LI Longcan, ZHAO Jiufa, LI Dongdong

2026, 29(23):  3268-3274.  DOI: 10.12114/j.issn.1007-9572.2025.0392

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Metabolic associated fatty liver disease (MAFLD), as the most prevalent chronic liver disease worldwide, features a complex and multifactorial pathogenesis, and no targeted therapeutics are currently available. This review focuses on the E3 ubiquitin ligase Parkin, providing a systematic analysis of its classical and non-classical functions during MAFLD progression. We particularly highlight Parkin's pivotal roles in multiple pathological processes, including the regulation of apoptosis and pyroptosis, mediation of endoplasmic reticulum-mitochondria crosstalk, reprogramming of lipid metabolism, and modulation of hepatic stellate cell activation. It is well established that Parkin-mediated mitophagy via the PINK1/Parkin pathway serves as a central mechanism for maintaining hepatic metabolic homeostasis and suppressing inflammatory responses. However, growing evidence from cross-disease model studies suggests that under lipotoxic stress, Parkin's functional repertoire extends far beyond mitochondrial quality control. Building on this evidence, we propose that Parkin likely participates may potentially participate in multiple MAFLD pathogenic pathways through a series of non-canonical ubiquitination events. Consequently, future therapeutic strategies in MAFLD should aim at coordinated multi-pathway intervention. This perspective opens new avenues for innovative drug discovery targeting Parkin.

Article

Efficacy of Low-frequency Repetitive Transcranial Magnetic Stimulation Combined with Transcutaneous Electrical Acupoint Stimulation for the Treatment of Upper Limb Motor Impairment in Post-stroke Patients: a Randomized Controlled Trial

JI Changmeng, XU Sihui, LI Tianhu, DING Yong, WANG Weiqiang

2026, 29(23):  3275-3280.  DOI: 10.12114/j.issn.1007-9572.2025.0481

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Background

Upper limb motor dysfunction is a common sequela of stroke that severely impairs patients' ability for self-care, making it a primary focus and key challenge in the rehabilitation process.

Objective

To investigate the efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with transcutaneous electrical acupoint stimulation (TEAS) in treating upper limb motor impairment after stroke.

Methods

Seventy post-stroke patients admitted to Zhejiang Rehabilitation Medical Center from June 2024 to October 2025 were enrolled in this study. They were randomly assigned to three groups using a random number table: control group (n=24), rTMS group (n=23), and a combined group (n=23). The control group received routine rehabilitation training, the rTMS group received low-frequency rTMS alongside with routine training, the combined group received both low-frequency rTMS and TEAS (TEAS administered 10 minutes after rTMS) alongside routine training. All three groups underwent continuous treatment for 8 weeks. The Fugl-Meyer Assessment-upper Extremities (FMA-UE) scores, Modified Barthel Index (MBI) scores, latency and amplitude of transcranial magnetic motor-evoked potentials (TMS-MEP), as well as co-contraction rate (CR) and root mean square (RMS) of the biceps brachii were collected and compared before and after treatment.

Results

After treatment, FMA-UE and MBI scores in all three groups were significantly increased compared with baseline values (P<0.05); Post-hoc pairwise comparisons showed that the rTMS group had higher FMA-UE and MBI scores than the control group, the combined group had higher FMA-UE scores than both the control and rTMS groups and higher MBI scores than the control group (P<0.05). Additionally, TMS-MEP latency and amplitude were improved in all three groups after treatment (P<0.05); Post-hoc pairwise comparisons showed that the combined group had shorter latency than the control group and higher amplitude than both the control and rTMS groups (P<0.05). For all three groups, the CR and RMS of the biceps brachii were significantly improved after treatment (P<0.05); Post-hoc pairwise comparisons showed that, the rTMS group had lower RMS than the control group, while the combined group demonstrated lower CR and RMS than both the control and rTMS groups (P<0.05).

Conclusion

The combination of rTMS and TEAS exerts a favorable therapeutic effect on upper limb motor function recovery in post-stroke patients, as it significantly enhances upper limb motor function, corrects abnormal movement patterns, regulates muscle tone, and improves activities of daily living. Its potential therapeutic mechanism may be related to the improvement of neurological function in the affected area.

Research on Atrial Fibrillation Screening Based on Dynamic Multi-scale Feature Fusion and Attention Mechanism

OUYANG Weina, WANG Lu, ZHANG Xuan, TANG Wei, FAN Yongmei

2026, 29(23):  3281-3286.  DOI: 10.12114/j.issn.1007-9572.2025.0197

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Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia and can lead to sudden cardiac death and various complications, imposing a significant social burden. Electrocardiography is the gold standard for diagnosis, but missed and misdiagnoses of atrial fibrillation frequently occur due to variations in physicians' experience. Therefore, it is necessary to develop artificial intelligence models capable of accurately identifying AF in real-world clinically complex electrocardiogram (ECG) data.

Objective

To establish a clinical ECG database with multiple positive categories, and based on deep learning technology, utilize static ECG signal data to train a convolutional neural network (CNN) model for AF detection, aiming to improve the accuracy of automated AF diagnosis.

Methods

A total of 10 000 patients who met the inclusion and exclusion criteria and visited the Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) in 2023 were selected. Among them, 1 462 cases were diagnosed with AF, and 8 538 cases were non-AF. General patient information (ages and genders) and static ECG data were collected to establish a clinical ECG database with multiple positive categories. The overall dataset was divided into training set (n=8 000), validation set (n=1 000), and test set (n=1 000) at 8∶1∶1 ratio. An advanced convolutional neural network model, AF Networks (AFNet), was developed using the training set for AF detection. The model's performance was evaluated using the validation and test sets, with metrics including sensitivity, positive predictive value, F1 score, accuracy, and the area under the ROC curve (AUC). These metrics were used to assess the model's performance in ECG diagnostic tasks and to analyze its strengths and limitations.

Results

No statistically significant differences were observed in the comparisons across the three datasets for gender (χ²=1.32, P=0.517), age (F=0.87, P=0.419), and ECG distribution (χ²=2.666, P=0.264). In the test set, the AFNet model demonstrated a sensitivity of 98.00%, specificity of 99.29%, positive predictive value of 96.08%, negative predictive value of 99.65%, accuracy of 99.10%, an F1-score of 0.97, and AUC of 0.99 for diagnosing atrial fibrillation. In the validation set, the AFNet model also achieved high performance, with sensitivity, positive predictive value, accuracy, and F1-score reaching 96.81%, 95.80%, 99.67%, and 0.96, respectively.

Conclusion

The AFNet neural network model demonstrated efficient feature extraction for AF detection in a clinical ECG database with multiple positive categories. This is of great clinical value for AF screening.

Correlation Analysis between Triglyceride-glucose Index, Triglyceride-glucose-BMI and Vulnerable Plaques in Patients with Acute Coronary Syndrome

LI Wenzhe, YANG Yuqing, YANG Tingjie, GUO Yiming, CHEN Lulin, CAO Yudong, YUAN Jiangshu, YANG Honghui, WANG Che

2026, 29(23):  3287-3293.  DOI: 10.12114/j.issn.1007-9572.2025.0348

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Background

Triglyceride-glucose (TyG) index and triglyceride-glucose-body mass index (TyG-BMI) are considered to be alternative indicators of insulin resistance (IR) and have been shown to be associated with cardiovascular disease. However, evidence regarding their correlations with atherosclerotic plaque characteristics in patients with acute coronary syndrome (ACS) remains limited.

Objective

This study aimed to investigate the associations of the TyG index and TyG-BMI with vulnerable plaque at the culprit lesion in patients with ACS.

Methods

A total of 577 patients with ACS who were admitted to Central China Fuwai Hospital of Zhengzhou University from June 2020 to December 2023 were enrolled retrospectively. All patients underwent coronary angiography and optical coherence tomography (OCT) image. According to the diagnostic criteria of thin-cap fibroatheroma (TCFA), patients were divided into non-TCFA group (339 cases) and TCFA group (238 cases). The baseline data coronary angiography results and OCT images were compared. Multivariate Logistic regression was performed to identify factors associated with TCFA. Subgroup analyses were conducted according to glycemic status. The receiver operating characteristic (ROC) curves of TyG index and TyG-BMI index in the diagnosis of TCFA in different subgroups was analyzed, and the area under the ROC curve (AUC) of the two indexes in each subgroup was calculated to evaluate the diagnostic efficacy.

Results

The TyG index [9.01 (8.60, 9.50) vs. 8.58 (8.19, 8.92), P<0.001] and TyG-BMI index [239.96 (217.72, 264.50) vs. 218.81 (198.02, 242.60), P<0.001] in the TCFA group were higher than those in the non-TCFA group. The proportions of macrophage infiltration, plaque rupture, and punctate calcification in the TCFA group were higher than those in the non-TCFA group (P<0.05). After adjusting for confounding factors, the results of multivariate Logistic regression analysis showed that elevated TyG index (OR=4.216, 95%CI=2.924-6.079, P<0.001) and TyG-BMI index (OR=1.011, 95%CI=1.005-1.016, P<0.001) were risk factors for TCFA occurrence. Patients were divided into diabetic subgroups, prediabetic subgroups, and non-diabetic subgroups based on different glucose metabolic states, with 284 cases, 212 cases, and 81 cases respectively. Subgroup analysis showed that elevated TyG index was a risk factor for TCFA occurrence in different glucose metabolic states, while elevated TyG-BMI index was only a risk factor for TCFA occurrence in the diabetic subgroup (P<0.05). The ROC curves results showed that the AUCs of the TyG index and TyG-BMI index for predicting TCFA occurrence in the diabetic subgroup were 0.729 and 0.660, respectively; in the prediabetic subgroup, they were 0.695 and 0.634, respectively; and in the non-diabetic subgroup, they were 0.697 and 0.629, respectively.

Conclusion

Both the TyG index and TyG-BMI are associated with the presence of vulnerable plaque in ACS patients. The TyG index demonstrates superior diagnostic value over TyG-BMI for predicting vulnerable coronary atherosclerotic plaques in ACS patients.

Interpretable Machine Learning Models for Predicting the Risk of Incident Cardiometabolic Multimorbidity in Chinese Postmenopausal Women

YUAN Hangtao, HONG Yan, YUAN Peihong, LIN Bo, CUI Xiaoyun, LI Weiwei

2026, 29(23):  3294-3306.  DOI: 10.12114/j.issn.1007-9572.2025.0358

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Background

Cardiovascular diseases are prevalent in China, with cardiometabolic multimorbidity (CMM) being a common comorbidity pattern. Postmenopausal women represent a high-risk group for cardiovascular diseases, yet there is a lack of predictive models for CMM risk specifically in this population.

Objective

To develop an interpretable machine learning (ML) model to predict the risk of CMM among Chinese postmenopausal women, based on data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods

The study included postmenopausal women aged≥45 years from the CHARLS cohort in 2011 who were free of CMM at baseline. Data on demographic characteristics, family background, health status, and laboratory indicators were collected at baseline and during follow-up in 2013, 2015, 2018, and 2020 to observe CMM incidence. Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) algorithm. Seven ML algorithms were constructed for risk prediction. The optimal model was further optimized on the test set using a combined strategy of "class_weight='balanced' dynamic weighting+optimal threshold selection" and visually interpreted using Shapley Additive Explanations (SHAP). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, and F1-score.

Results

A total of 5 575 participants completed the 4 rounds of follow-up and were included, comprising 4 363 in the non-CMM group and 1 212 in the CMM group. Over a median follow-up of 9 years, the cumulative incidence of CMM was 21.74%. LASSO regression identified 22 key features as significant predictors of CMM: self-rated health, mental disorders, arthritis, dyslipidemia, kidney disease, retirement status, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean pulse rate, waist circumference, BMI, headache, lower back pain, serum creatinine (Scr), triglycerides (TG), C-reactive protein (CRP), glycated hemoglobin (HbA_1c), uric acid (UA), age, Center for Epidemiologic Studies Depression Scale (CES-D) score, smoking status, and geographic region. Among the models, the Logistic regression (LR) model demonstrated the best predictive performance (test set AUC=0.758, accuracy =79.2%). The SHAP mean bar plot revealed core predictors: SBP, HbA_1c, geographic region, waist circumference, CES-D score, BMI, DBP, and age. The SHAP summary plot indicated that higher values of SBP, HbA_1c, waist circumference, and others were associated with increased predicted CMM risk.

Conclusion

This study develops a clinically interpretable prediction model for CMM in Chinese postmenopausal women, with the LR algorithm showing favorable performance. Key risk factors include SBP, HbA_1c, and waist circumference. The model provides an evidence-based tool for screening high-risk individuals and guiding personalized interventions.

Mediating Effect of Fear of Disease Progression between Cancer Information Overload and Participation in Treatment Decision-making in Young and Middle-aged Cervical Cancer Patients

ZHANG Shifei, GU Zhie, LYU Ya, YU Hailong

2026, 29(23):  3307-3314.  DOI: 10.12114/j.issn.1007-9572.2025.0039

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Background

Cervical cancer is a common malignant tumor among women worldwide, with the incidence rate among young and middle-aged patients increasing annually. This demographic faces dual pressures of fear of disease progression and cancer-related information overload, which can easily diminish their engagement in treatment decision-making. Existing research predominantly focused on individual factors, while lacking systematic exploration of the mediating mechanism through which information overload suppressed decision-making participation via fear-related emotional responses.

Objective

To explore the mediating effect of fear of disease progression between cancer information overload and participation in treatment decision-making in young and middle-aged cervical cancer patients.

Methods

Using convenience sampling, 240 middle-aged and young cervical cancer patients admitted to the Department of Oncology, Wuxi Maternal and Child Health Hospital from May to November 2024 were selected as research subjects. A cross-sectional survey was conducted using general information questionnaires, the Cancer Information Overload Scale, the Fear of Progression Questionnaire-short Form, and the Cancer Patient Participation in Treatment Decision-making Questionnaire. Mediation effect analysis was performed using Model 4 in the Process plugin.

Results

A total of 240 questionnaires were distributed, and 221 valid questionnaires were collected, with a valid recovery rate of 92.1%. 221 young and middle-aged cervical cancer patients had a total score of (22.96±3.04) on the Cancer Information Overload Scale, (42.05±6.08) on the Simplified Scale of Fear of Disease Progression, and (33.81±7.50) on the Questionnaire of Participation in Decision-making by Patients with Cancer in the Treatment of Cervical Cancer. Total scores of cancer information overload was positively correlated with fear of disease progression scores (r=0.562, P<0.01) and negatively correlated with cancer patients participation in treatment decision-making scores (r=-0.460, P<0.01), and fear of disease progression scores was negatively correlated with cancer patients' participation in treatment decision-making scores (r=-0.473, P<0.01). Multiple linear regression analysis indicated that monthly per capita household income (β=-1.546, P=0.004), cancer information overload (β=-0.676, P<0.001), and fear of disease progression (β=-0.396, P<0.001) were influencing factors for treatment decision-making participation among cancer patients. Mediation effect analysis revealed that cancer information overload exerted a negative predictive effect on treatment decision-making participation (β=-0.27, P<0.001); cancer information overload positively predicted fear of disease progression (β=0.56, P<0.001), while fear of disease progression had a negative predictive effect on treatment decision-making participation (β=-0.32, P<0.001). The results of the mediation effect analysis showed that fear of disease progression had a mediation effect value of -0.18 (P<0.001) between cancer information overload and participation in treatment decision-making in young and middle-aged cervical cancer patients, which accounted for 39% of the total effect (-0.18/-0.46), and served as a partial mediation effect.

Conclusion

Both cancer information overload and fear of disease progression can directly affect the participation decision of young and middle-aged cervical cancer patients in treatment, and cancer information overload can also indirectly affect the participation decision of patients in treatment through fear of disease progression. Medical personnel should actively take relevant measures to help patients screen and process invalid information and reduce their fear of disease, so as to improve the motivation of cancer patients to participate in treatment decision-making.

The Clinical Characteristics of High-grade Squamous Intraepithelial Lesions and Diagnostic Value of Endocervical Curettage in Women Aged Under 30 Years

CHEN Jing, WANG Chaoxing, QIAN Ruiya, LIU Yong

2026, 29(23):  3315-3319.  DOI: 10.12114/j.issn.1007-9572.2025.0114

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Background

Since the approval of HPV vaccines in China in 2017, a portion of young women have been vaccinated. However, whether HPV vaccination affects the detection of HSIL in young women and the diagnostic value of ECC remains unclear.

Objective

To understand the clinical characteristics of high-grade squamous intraepithelial lesion (HSIL) in women under 30 years and to explore the value of endocervical curettage (ECC) under colposcopy in detecting HSIL.

Methods

A retrospective analysis was performed on patients under 30 years of age who underwent colposcopy-guided cervical biopsy and/or ECC in the Colposcopy Room of the Gynecological Clinic, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from June 2021 to June 2022. A total of 427 cases were enrolled. All patients underwent cytology and high-risk HPV testing, and were referred for colposcopy due to abnormal screening results. With pathological results as the gold standard for diagnosis, the diagnosis of cervical intraepithelial lesions was made in accordance with the WHO 2014 two classification system, which included high-grade squamous intraepithelial lesion (HSIL) and low-grade squamous intraepithelial lesion (LSIL). The HSIL detection rate was defined as the number of cases with HSIL detected by cervical biopsy and/or ECC divided by the total number of cases. The biopsy detection rate was defined as the number of cases with HSIL detected by cervical biopsy divided by the total number of cases. The ECC detection rate was defined as the number of cases with HSIL detected by ECC divided by the total number of cases. The additional HSIL detection rate of ECC was defined as the number of cases with HSIL detected by ECC but not found in cervical biopsy divided by the total number of cases, so as to evaluate the diagnostic value of ECC. Multivariate Logistic regression analysis was used to explore the clinical characteristics of HSIL detection in women under 30 years old.

Results

Among the 427 patients, 155 cases (36.3%) underwent only multi-point cervical biopsy, with 19 cases diagnosed with HSIL; 272 cases (63.7%) underwent both multi-point biopsy and ECC, with 76 cases diagnosed with HSIL, among which 2 cases were additionally detected by ECC. The overall HSIL detection rate was 22.2% (95/427), the biopsy detection rate was 21.8% (93/427), the ECC detection rate was 1.6% (7/427), and the additional HSIL detection rate by ECC was 0.5% (2/427). Results of multivariate Logistic regression analysis showed that cytological HSIL (OR=7.274, 95%CI=1.901-27.828) and positive HPV 16/18 (OR=10.833, 95%CI=1.317-89.135) were risk factors for HSIL detection (P<0.05).

Conclusion

In women under 30 years old, cytology HSIL and HPV 16/18 infection are two independent risk factors affecting HSIL detection. ECC has little additional significance in detecting HSIL in people under 30 years old. It is suggested that ECC may not be necessary for women under 30 years who do not have the two independent risk factors mentioned above.

Correlation of Selected Blood Biomarkers with 24-hour Urine Protein Excretion in 3 774 Pediatric Patients with IgA Vasculitis Nephritis

GAO Min, DING Ying, HAN Shanshan, XU Yan, WU Ruihong, LI Yudi

2026, 29(23):  3320-3328.  DOI: 10.12114/j.issn.1007-9572.2025.0053

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Background

IgA vasculitis nephritis (IgAVN) is one of the common systemic small vessel vasculitides in childhood, but there are few comprehensive studies on the relationship between blood indicators and urine protein quantification in affected children.

Objective

To investigate the changes in 24-hour urinary protein quantification in children with IgAVN and its correlation with certain blood indicators in these children.

Methods

Selected children with IgAVN who visited the First Affiliated Hospital of Henan University of Chinese Medicine from 2013 to 2023, and collected their 24-hour urine protein quantification, basic information, and related laboratory examination indicators for retrospective analysis. The Mann-Whitney test, Kruskal-Wallis test, and Spearman rank correlation analysis were used to explore the relationship between 24-hour urine protein quantification and the children's blood indicators.

Results

A total of 3 774 IgAVN pediatric cases were included, with 2 230 males and an average age of onset of 10.0 (7.0, 12.0) years; 1 544 females, with median age of onset of 10.0 (7.0, 12.0) years. The 24-hour urine protein quantification in IgAVN children showed no statistically significant differences across different genders, M% and MCHC ranges in blood tests, ALT ranges in liver and kidney function tests, C3, C4, IgA, and IgM ranges in the six immune markers, or CD3⁺ T cell%, CD3⁺ CD8⁺ T cell%, and CD4⁺ T cell/CD8⁺ T cell ranges in T cell subsets (P>0.05). Spearman rank correlation analysis revealed that 24-hour urine protein quantification was negatively correlated with age (r_s=-0.179, P<0.001). The 24-hour urine protein quantification was positively correlated (P<0.05) with the white blood cell count (WBC), platelet count (PLT), percentage of neutrophils (N%) in routine blood test, erythrocyte sedimentation rate (ESR), and aspartate aminotransferase (AST), blood urea nitrogen (BUN), lactate dehydrogenase (LDH), triglycerides (TG), cholesterol (CHOL) in liver and kidney function indexes, immunoglobulin E (IgE) in the immunological panel, and D-dimer (D2) and thrombin time (TT) in the six coagulation tests, as well as CD3⁺ T cell, CD3⁺ CD8⁺ T cell in T cell subsets. The 24-hour urine protein quantification was negatively correlated (P<0.05) with red blood cell count (RBC), hemoglobin (Hb), lymphocyte percentage (L%), eosinophil percentage (E%), C-reactive protein (CRP) in the blood routine, total protein (TP), albumin (ALB), indirect bilirubin (IBIL), alkaline phosphatase (ALP), creatinine (Cr), uric acid (UA), calcium (Ca) in liver and kidney function, IgG in the immunological panel, international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB) in the six coagulation tests, as well as CD3⁺ CD4⁺ T cell%, CD4⁺ T cell/CD8⁺ T cell in T cell subsets.

Conclusion

This study found a significant association between 24-hour urinary protein quantification in children with IgAVN and various systemic indicators: it is positively correlated with renal function impairment (BUN, LDH), lipid metabolism disorders (TG, CHOL), Th1 immune polarization (CD3⁺ CD8⁺ T cell), and a hypercoagulable state (D2, TT); and negatively correlated with liver synthetic function (ALB, TP), immune regulation (CD3⁺ CD4⁺ T cell%), and coagulation factors (FIB). This finding provides a certain clinical basis for further revealing the pathological mechanisms of IgAVN, establishing a clinical monitoring and early warning system, and optimizing treatment strategies.

The Effect of Sleep Fragmentation on Cardiac Remodeling in High-fat Fed Mice

YANG Lening, WANG Liming, ZHAO Chenxu, LI Ge, GAO Ying

2026, 29(23):  3329-3335.  DOI: 10.12114/j.issn.1007-9572.2025.0002

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Background

Sleep fragmentation (SF) is one of the hallmarks of sleep disorders, and the mechanism in cardiac remodeling is still unclear.

Objective

To observe the effect of SF on cardiac remodeling in mice with high-fat diet.

Methods

The research period was from August 2023 to June 2024. Twenty-one 8-week-old male C57BL/6J mice were randomly divided into the high-fat sleep fragmentation group (SF group, n=11) and the high-fat control group (Ctrl group, n=10). They were placed in the sleep deprivation apparatus and the normal cage respectively. Both groups were given 45% high-fat feed, and the sleep fragmentation intervention lasted for 5 months. The degree of cardiac hypertrophy was evaluated by heart weight/body weight (HW/BW) and heart weight/tibia length (HW/TL). The changes in cardiac structure were evaluated by echocardiography. Myocardial HE staining, Masson staining, and WGA staining were used to observe the size of myocardial cells and collagen content. The heart tissues of mice were sequenced for transcriptomics and metabolomics and the mechanism in cardiac remodeling was analyzed.

Results

Compared with the Ctrl group, the heart weight of the SF group increased (P<0.05), HW/BW and HW/TL rose (P<0.05), left ventricular internal dimension diastole, left ventricular internal dimension in systole, left ventricular end-diastolic volume, left ventricular end-systolic volumes all increased (P<0.05), and the left ventricular posterior wall thickness during diastole decreased (P<0.05). HE staining showed that compared with the Ctrl group, the heart of the SF group was enlarged and the cardiomyocytes were enlarged; the statistical graph of Masson staining showed that compared with the Ctrl group, the myocardial fibrosis of the SF group increased (P<0.01); the statistical graph of WGA staining showed that compared with the Ctrl group, the cardiomyocytes of the SF group were enlarged (P<0.001). The transcriptomics results suggested that the TGF-β signaling pathway in the SF group was upregulated. Metabolomics suggested that the increase in cardiac remodeling in the SF group was related to the downregulation of glycerophospholipid metabolism pathways.

Conclusion

Sleep fragmentation can lead to cardiac enlargement, ventricular dilation, ventricular wall thinning, increased collagen content, and cardiac remodeling in mice with a high-fat diet. The mechanism may be related to up-regulation of TGF-β signaling pathway and down-regulation of glycerophospholipid metabolism.

Article·Research Methodology

Factor Structure Analysis of Alzheimer's Disease Knowledge Scale in Community Doctors

QIU Shuxian, WU Wanting, ZHAO Mei, ZHANG Haifeng, LI Tao, YU Xin, WANG Huali

2026, 29(23):  3336-3341.  DOI: 10.12114/j.issn.1007-9572.2023.0718

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Background

The number of persons living with Alzheimer's disease (AD) will increase dramatically in China. Community physicians play an increasingly critical role in its early screening and management. However, the structure and applicability of the Alzheimer's Disease Knowledge Scale (ADKS) within this population remain unclear.

Objective

To explore the factor structure of ADKS in Chinese community physicians.

Methods

A cross-sectional online survey was conducted from December 1, 2021, to January 7, 2022, using convenience sampling. Demographic information and ADKS scores were collected from participating community physicians. Exploratory factor analysis (EFA) using principal component analysis with varimax rotation was performed to identify the underlying factor structure. Confirmatory factor analysis (CFA) was subsequently carried out in R 4.3.0 with the Lavaan package to evaluate model fit, and the final model was visualized using semPlot.

Results

A total of 5 313 persons viewed at the online survey, with 1 288 community physicians completing the questionnaire. Among the 1 288 participants, 389 (30.2%) were male and 899 (69.8%) were female, with an average age of (38.5±9.2) years. A total of 419 (32.5%) participants held below-bachelor qualifications, while 869 (67.5%) had a bachelor's degree or higher. EFA extracted eight factors with eigenvalues of 2.58, 1.73, 3.22, 1.11, 1.43, 1.37, 1.64, and 1.35, collectively explaining 48.13% of the total variance. These factors were labeled as knowledge about disease causes, symptoms, patient experience, comorbidity, differential diagnosis, treatment and rehabilitation, care needs, and life impact. CFA indicated acceptable model fit (GFI=0.929, χ²/df=3.71, RMSEA =0.046). All items showed factor loadings above 0.3, and moderate correlations were observed among the eight factors.

Conclusion

The ADKS demonstrated a clear and clinically interpretable 8-factor structure when applied to community physicians. This model comprehensively covers key domains of AD knowledge from a clinical practice perspective, supporting the use of the scale as a reliable instrument for systematically assessing AD-related knowledge in community physicians.

Analysis of Methods for Raising Clinical Questions and Influencing Factors in Domestic and International Clinical Practice Guideline Development Manuals

LIN Zina, CUI Liangyu, JING Tianyue, LIU Dasheng, ZHAO Xueyao, HAN Xuejie, WANG Liying

2026, 29(23):  3342-3350.  DOI: 10.12114/j.issn.1007-9572.2025.0419

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Background

With the rapid increase of integrated Traditional Chinese Medicine (TCM) and Western medicine guidelines, their methodological development must integrate international evidence-based frameworks while closely aligning with localized clinical practices. As a pivotal step in guideline formulation, the scientific rigor and practical relevance of clinical problem structuring directly determine guideline quality, necessitating a systematic synthesis of its methodologies and influencing factors.

Objective

To review domestic and international guideline development manuals, summarizing the methods and influencing factors for clinical question formulation, and provide references for the formulation of clinical issues.

Methods

This study involved a comprehensive search for clinical practice guideline methodological guidance manuals through databases such as PubMed, Embase, Web of Science, CNKI, Wanfang Data, SinoMed, and VIP, as well as web searches. The search period covered from the inception of these databases to May 2025. Relevant data on clinical questions were extracted from the manuals, and descriptive analysis was used for collation and summarization.

Results

A total of 53 domestic and international guideline development manuals were collected. The study found that methods for collecting clinical questions primarily include internal decision-making by guideline teams, literature search, and solicitation of opinions from multiple stakeholders. Factors influencing the determination of clinical questions mainly include policy and clinical decision relevance, target user positioning, clinical necessity, question controversy, anticipated outcome positioning, evidence support, and feasibility. The decomposition formats for clinical questions have evolved from the PICO framework into nine variations, including PICOM, PICOT, PICOTS, PICOTT, PECOT, PInGO, PERO, PIPOH, and DSCO.

Conclusion

The formulation of clinical questions should be centered on the actual needs of clinical practice, utilizing multi-channel, multi-angle, and multi-faceted information collection strategies to enhance the objectivity and comprehensiveness of the questions. The deconstruction of clinical questions using formats such as PICO can enhance the pertinence and feasibility of the final recommendations in the guidelines, guaranteeing the quality of the guidelines. This provides a reference for the development of guidelines in Traditional Chinese Medicine and integrated traditional Chinese and Western medicine.

Article·Study of Evidence-based Medicine

A Systematic Review of Guidelines and Expert Consensus Related to Pain Management in Endometriosis

XIE Wan, TU Xulian, WU Liping, LIU Xia, LI Xiaoyan, LENG Mingyue, YANG Xueqing, LI Li

2026, 29(23):  3351-3358.  DOI: 10.12114/j.issn.1007-9572.2025.0016

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Background

As the understanding of pain management in endometriosis deepens, an increasing number of related guidelines and expert consensus have emerged both domestically and internationally, providing significant guidance and reference for clinical practice. However, the quality of these guidelines and expert consensuses is inconsistent, necessitating a systematic review to guide clinical practice.

Objective

To systematically evaluate the quality of guidelines and expert consensus related to pain management in endometriosis, thereby providing an evidence base for the development of pain management protocols.

Methods

Evidence-based guidelines involving recommendations for pain management in endometriosis were searched in CNKI, SinoMed, Wanfang Data, VIP, PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Guideline Central, GIN, as well as the official websites of ACOG, NICE, SIGN, WHO, IASP, APS and BPS, and other sources from inception to 12 November, 2024. AGREEⅡ was utilized to assess the quality of guidelines and expert consensus related to pain management in endometriosis, and relevant recommendations were summarized.

Results

A total of 15 guidelines/expert consensus were ultimately included, of which 9 were guidelines and 6 were expert consensuses. 7 guidelines/expert consensus were from China, and 8 were from abroad. The publication dates ranged from 2018 to 2024. Among the 6 domains of AGREE Ⅱ, the average scores of the 15 guidelines/expert consensuses were as follows: scope and purpose (83.15%), stakeholder involvement (71.11%), rigor of development (44.79%), clarity of presentation (65.74%), applicability (35.55%), editorial independence (87.78%). 33 recommendations were extracted and summarized from 15 guidelines/expert consensus, involving 6 domains, namely general principles of pain management, pain assessment, medication management, surgical management, non-pharmacologic/surgical management, health education.

Conclusion

The quality of the included guideli`nes/expert consensus is at a moderate level and provides a reference point for clinical practice, but further improvement is needed in the areas of the rigour of development and applicability.

Meta-analysis of Influencing Factors of Relapse in Chinese Patients with Schizophrenia

PEI Ruqing, ZHOU Yuqiu, ZHANG Siyu, LIU Xijun

2026, 29(23):  3359-3370.  DOI: 10.12114/j.issn.1007-9572.2025.0255

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Background

Schizophrenia is a prevalent and severe mental disorder characterized by a high rate of disability and relapse. While certain studies on the influencing factors of schizophrenia relapse have been conducted in western countries or regions, the applicability of their findings to the Chinese patient population is limited due to differences in cultural backgrounds and variations in patient demographics. Therefore, identifying the local factors that influence relapse in the Chinese context is of great significance.

Objective

To explore the influencing factors for relapse in patients with schizophrenia in China, and to provide evidence-based basis for clinical intervention.

Methods

Studies on relapse risk factors in Chinese patients with schizophrenia were collected by searching the databases of CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Cochrane Library, Ovid Medline and Web of Science. The retrieval time was from building the database to May 18, 2025. The literature was screened based on predefined inclusion and exclusion criteria, followed by data extraction and quality assessment of the selected studies. A Meta-analysis was conducted using RevMan 5.4.

Results

The analysis included 21 studies, comprising 6 496 subjects, and 14 influencing factors were extracted. Results indicated that several factors significantly increased the risk of relapse: no spouse (I²=71%, OR=1.71, 95%CI=1.26-2.32, P<0.01), long disease course (I²=30%, OR=1.25, 95%CI=1.07-1.45, P<0.01), family history (I²=48%, OR=2.60, 95%CI=2.01-3.35, P<0.01), drinking history (I²=0, OR=2.22, 95%CI=1.60-3.08, P<0.01), paranoid type (I²=83%, OR=3.47, 95%CI=1.90-6.34, P<0.01), poor medication adherence (I²=92%, OR=3.59, 95%CI=2.44-5.29, P<0.01), negative life events (I²=93%, OR=2.81, 95%CI=1.35-5.87, P<0.01), positive mood swings (I²=84%, OR=2.66, 95%CI=1.31-5.38, P<0.01), lack of family support (I²=79%, OR=2.61, 95%CI=1.71-3.99, P<0.01) and unemployment/out of school (I²=0, OR=2.52, 95%CI=2.09-3.04, P<0.01). Protective factors included high level of social support (I²=0, OR=0.19, 95%CI=0.13-0.28, P<0.01) and regular follow-up appointments (I²=9%, OR=0.28, 95%CI=0.17-0.46, P<0.01). Subgroup analysis suggested that regular follow-up appointments (I²=9%, OR=0.28, 95%CI=0.17-0.46, P<0.01) and unemployment/out of school (I²=0, OR=2.52, 95%CI=2.09-3.04, P<0.01) were unique influencing factors for community patients.

Conclusion

Relapse of schizophrenia is influenced by a combination of factors, and the risk of relapse needs to be reduced through multidimensional interventions such as strengthening medication management, improving family support, and optimizing community follow-up.

Review & Perspectives

A Review of Role of miRNA in Ulcerative Colitis and Traditional Chinese Medicine Intervention

WU Ermei, SUN Dajuan, DENG Hualiang

2026, 29(23):  3371-3378.  DOI: 10.12114/j.issn.1007-9572.2024.0458

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Ulcerative colitis (UC) is a chronic nonspecific inflammatory bowel disease with a long course, easy recurrence, difficult treatment, and a risk of cancer crisis. So far, its pathogenesis remains unclear. MicroRNA (miRNA), a class of non-coding RNA, has been recognized as important regulators of gene expression. Studies have shown that miRNA exhibits differential expression in UC and targets miRNA to participate in post-transcriptional gene expression regulation in UC, mainly regulating intestinal epithelial barrier function, immune homeostasis and inflammatory balance in UC. Therefore, miRNA-based drugs are expected to be potential innovative drugs for UC. Traditional Chinese Medicine (TCM) boasts a broad spectrum of applications for the prevention and treatment of UC, offering significant efficacy and unique advantages such as multi-targeting and multi-pathway effects. However, there is still a lack of review on regulating miRNA by TCM to prevent UC. This article reviewed the mechanisms of miRNA in UC and the research findings on TCM compounds and active components' intervention in miRNA regulation for UC treatment. It was found that TCM could modulate the differential expression of miRNA thereby participating in the regulation of various pathological and physiological processes such as intestinal epithelial barrier damage, apoptosis, inflammation, and abnormal differentiation of immune cells. This modulation contributed to alleviate UC. This review is expected to provide theoretical reference and research guidance for future studies on regulating miRNA therapy for UC.

Clinical Application Progress of Diffusing Capacity of the Lung for Carbon Monoxide in Chronic Obstructive Pulmonary Disease

WANG Longyu, LI Ya, MA Qian, JIA Peilin, ZHANG Hailong

2026, 29(23):  3379-3384.  DOI: 10.12114/j.issn.1007-9572.2025.0274

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Pulmonary function testing, regarded as the "gold standard" for the classification and evaluation of therapeutic efficacy in chronic obstructive pulmonary disease (COPD), is a core method for its diagnosis and management. Among these tests, pulmonary ventilation parameters can effectively reflect the degree of airway obstruction; however, they are limited in detecting early lung parenchymal damage and microvascular lesions. In contrast, the diffusing capacity of the lung for carbon monoxide (DLCO) is an important indicator of pulmonary gas exchange function, which responds sensitively in the early stages of COPD and provides valuable clues for early disease detection. This article systematically discussed the role of DLCO in the early identification of COPD, assessment of disease severity, risk of acute exacerbations, long-term prognosis, and summarized its unique clinical value in COPD and related comorbidities. DLCO might serve as an alternative indicator for disease evaluation or prognostic assessment in patients with poor lung function or advanced age who were unable to complete pulmonary ventilation testing. Furthermore, in patients with COPD complicated by pulmonary hypertension, heart failure, or lung cancer, DLCO could effectively reflect the severity of comorbidities and assist in prognostic evaluation. This review provided a useful reference for future studies on DLCO in patients with COPD and its comorbid conditions.

Clinical Research Progress on Programmed Death 1/Programmed Death-ligand 1 Inhibitors Combined with Novel Therapies in Advanced Non-small Cell Lung Cancer

DUAN Yi, YANG Qingcheng, SHI Yuanlong, HE Liangliang, FAN Daoguang, GAO Yonglong, DUAN Lincan, CHEN Nan

2026, 29(23):  3385-3392.  DOI: 10.12114/j.issn.1007-9572.2024.0685

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Lung cancer remains the leading cause of cancer-related deaths worldwide, contributing significantly to the global cancer burden. Among its pathological types, non-small cell lung cancer (NSCLC) is the most common. Advanced NSCLC poses a pressing need for improved therapeutic strategies due to its high recurrence rates and drug resistance. Programmed death 1/Programmed death-ligand 1 (PD-1/PD-L1) inhibitors, a novel class of immunotherapies, have shown promising clinical efficacy, particularly when combined with chemotherapy and targeted therapies. However, their application continues to face significant challenges, including increased toxicity, complex resistance mechanisms, high costs, and the absence of standardized treatment protocols. This review examined the progress of PD-1/PD-L1 inhibitors combined with innovative therapies for advanced NSCLC, including tumor vaccines, immunomodulatory therapy, novel targeted therapy, and novel radiotherapy. The findings suggested that combination therapies offer advantages in improving progression-free survival and overall survival for patients, with some studies indicating that those with high PD-L1 expression might derive greater benefits. In terms of safety, most combination regimens did not significantly increase the incidence of severe adverse events. However, mild immune-related or treatment-specific reactions remained a concern. Although current studies were generally limited by small sample sizes, leaving the generalizability and reliability of findings to be further validated, future directions included conducting large-scale multicenter trials, investigating resistance mechanisms, and integrating novel biomarkers with genomic technologies. These advancements were expected to optimize therapeutic strategies and pave the way for individualized and precise treatment approaches in advanced NSCLC.