Table of Content

20 August 2026, Volume 29 Issue 24

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Guidelines·Consensus·Interpretation

Expert Consensus on Nutritional Rehabilitation Management of Adolescent Idiopathic Scoliosis

Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School, China Rehabilitation Science Institute, China Rehabilitation Research Center, Professional Committee on Integrative Nutrition Management, Jiangsu Integrative Medicine Research Society, Specialty Committee of Rehabilitation Engineering and Industry, China Association of Rehabilitation Medicine, Regenerative Repair and Anti-Aging Branch of Guangdong Association for the Development of Rehabilitation Medicine

2026, 29(24):  3393-3408.  DOI: 10.12114/j.issn.1007-9572.2026.0079

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Adolescent idiopathic scoliosis (AIS) is the most prevalent three-dimensional spinal deformity among adolescents aged 10 to 18. With a high incidence, AIS not only compromises physical aesthetics but also poses significant threats to adolescent health by potentially leading to complications such as back pain and cardiopulmonary dysfunction. Nutrition-related factors, including low BMI, low bone mineral density, and vitamin D deficiency, are critical risk factors for the onset and progression of AIS. Conversely, synergistic interventions "combining rational nutritional management with rehabilitative exercise" are vital for controlling curvature progression, enhancing organ function, preventing complications, and improving quality of life. Currently, the lack of unified standards for nutritional and rehabilitative management in AIS has resulted in non-standardized clinical workflows and inconsistent intervention outcomes. Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School; China Rehabilitation Science Institute; China Rehabilitation Research Center; Professional Committee on Integrative Nutrition Management, Jiangsu Integrative Medicine Research Society; Specialty Committee of Rehabilitation Engineering and Industry, China Association of Rehabilitation Medicine; and Regenerative Repair and Anti-Aging Branch of Guangdong Association for the Development of Rehabilitation Medicine initiated a multidisciplinary expert collaboration. Based on the latest evidence-based medicine and clinical practice, this consensus was developed, comprising 19 recommendations. This consensus delineates the core principles and key pathways for nutrition-related risk factors, nutritional screening and assessment methods, intervention strategies, rehabilitative exercise, and multidisciplinary management for AIS patients. It recommends using the Screening Tool for the Assessment of Malnutrition in Pediatrics for nutritional risk screening and diagnosing acute or chronic malnutrition via BMI-for-Age Z-Score and Height-for-Age Z-Score. Furthermore, it emphasizes the importance of adequate intake of protein, calcium, and vitamin D alongside rehabilitative exercise, advocating for a multidisciplinary approach to full-process management. This consensus provides scientific, standardized, and actionable guidance for clinical specialists, nutritionists, therapists, community health workers, and family caregivers, aiming to optimize nutritional and rehabilitative management for AIS patients and improve their long-term prognosis and quality of life.

Interpretation of the Update to the 2024 Version of the Criteria for Potentially Inappropriate Medication in Chinese Elderly (PIM-China)

YANG Wenjuan, XIN Chuanwei, ZHANG Meiling

2026, 29(24):  3409-3415.  DOI: 10.12114/j.issn.1007-9572.2025.0458

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The Potentially Inappropriate Medications (PIM)-China criteria is a screening tool to assess the extent of PIM in aged patients. 2024 PIM-China criteria are the second revision of the criteria since its establishment, aiming to ensure the provision of evidence-based and clinically relevant recommendations for the elderly. This article provides a detailed interpretation of the updated version of the criteria. The new criteria divided into two main parts, which is same as the framework of the 2017 PIM-China criteria. It references six international standards and incorporates substantial updates [Beers, STOPP, FORTA, EU (7)-PIM, Japanese and Korean Standards] based on the latest evidence-based medicine. The new criteria involve the adding of alternative treatment options, as well as the quality of evidence and the strength of recommendation. Moreover, drug-drug interactions and dose adjustments based on renal function were added. Meanwhile, some medications were removed from the 2017 PIM-China criteria according to the actual clinical practice in China. By integrating emerging evidence and expert consensus, the new criteria serve as a pivotal tool for optimizing clinical prescribing practices. These criteria are crucial for reducing adverse drug events, optimizing prescription practices, and improving healthcare for the elderly in China.

Hot Topic Research

Governance Logic and Ecosystem Construction of Healthcare Data Space Led by Digital Policies: an Analytical Framework Based on "Technology-Management-Law"

WANG Hongchuan, ZHANG Jianbo, MA Wei, ZHAO Sidi

2026, 29(24):  3416-3422.  DOI: 10.12114/j.issn.1007-9572.2025.0145

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Under the wave of global digital transformation, the data reform in the healthcare industry is accelerating. Countries around the world are actively enacting digital policies to drive the development of healthcare data. This paper focuses on the construction of the healthcare data space driven by digital policies, systematically analyzes its multi-dimensional challenges in data sharing, privacy and security, technology integration, and ethical governance. By combining the practical experiences of the "European Health Data Space" of the European Union and China's "14th Five-Year Plan" policies, it breaks through data silos with technologies such as federated learning and blockchain - based certification, optimizes resource allocation through hierarchical and penetrating capital allocation, and simultaneously establishes a cross - border data mutual recognition mechanism to strengthen international cooperation. The study believes that the sustainable development of the healthcare data space urgently requires the construction of a trinity governance framework of "technology-management-law", relying on technology and policies to create a multi-agent collaborative ecosystem to solve core problems such as insufficient data standardization, storage bottlenecks, and talent shortages. Through the path analysis that combines theory and practice, this paper provides a systematic reference for the construction of the digital foundation of the Healthy China strategy, and is expected to help transform healthcare data from resource deposition to intelligent services, significantly promoting the popularization of precision healthcare and the coordinated development of global health governance.

Research on the Coupling and Coordination between China's Scientific and Technological Innovation Ability and High-quality Development of Health Care from the Perspective of New Productivity

LING Yichen, PENG Yin, LIU Wenhui, LI Liqing

2026, 29(24):  3423-3433.  DOI: 10.12114/j.issn.1007-9572.2024.0287

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Background

Scientific and technological innovation is not only the core driving force to promote the development of medical and health undertakings, but also the key factor to achieve high-quality development of health undertakings. The improvement of scientific and technological innovation ability plays an irreplaceable role in promoting the comprehensive, coordinated and sustainable development of health care. Therefore, strengthening the benign interaction between the scientific and technological innovation ability and the high-quality development of health care is the only way to promote the harmonious progress of the two and achieve a win-win situation.

Objective

By introducing the entropy weight TOPSIS method and the coupling coordination degree model, this paper measures the coupling coordination degree of China's scientific and technological innovation ability and high-quality development of health care from 2012 to 2022, aiming to accurately understand the coordinated development of the two, and provide valuable reference for improving China's health science and technology innovation ability, promoting the continuous improvement of medical and health service quality, and realizing the coordinated development and mutual benefit and win-win of science and technology and health care.

Methods

The evaluation index system is constructed from the two dimensions of scientific and technological innovation ability and high quality of health care. The index data are from China Health and Family Planning Statistical Yearbook, China Health Statistical Yearbook, China Statistical Yearbook, and China Science and Technology Statistical Yearbook. The coupling coordination degree model is used to measure the coupling coordination degree between China's scientific and technological innovation ability and high quality development of health care from 2012 to 2022. The Dagum Gini coefficient and Moran index are introduced to analyze the spatial correlation and difference of coupling coordination degree.

Results

From 2012 to 2022, the coupling coordination degree of the two systems of China's scientific and technological innovation ability and high-quality development of health undertakings was on the rise as a whole. In 2012, the average values of mismatch in the eastern, central and western regions were 0.516, 0.552 and 0.374, respectively, which were intermediate coordination and moderate imbalance. In 2022, the average mismatch degree of the eastern, central and western regions were 0.575, 0.590 and 0.404, respectively, which were intermediate coordination, high-quality coordination and reluctant coordination. The overall Gini coefficient of coupling coordination degree gradually decreases and showed a strong spatial positive correlation.

Conclusion

Despite the continuous improvement in the synergistic development level of China's scientific and technological innovation and health services, there remain challenges such as regional imbalances and relatively low coordination in some western regions. To enhance China's health science and technology innovation capability and promote the high-quality development of health services, efforts should be guided by the needs of a Healthy China. This involves establishing a collaborative and efficient health science and technology innovation system, cultivating and attracting high-level scientific and technological innovation talents, and facilitating the transfer, transformation, and application of health science and technology achievements.

Article

Research on the Diagnostic Value of Rasterstereography for Angles Related to Adolescent Idiopathic Scoliosis

ZHANG Boyu, XU Bo, LI Jianguo, YIN He, LUO Pengren, WANG Haojie, JIN Zhefeng, ZHU Liguo

2026, 29(24):  3434-3439.  DOI: 10.12114/j.issn.1007-9572.2024.0656

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Background

Adolescent idiopathic scoliosis (AIS) has a prevalence of 1%-3%, with over one million patients in China, predominantly female. Currently, there is a lack of effective and safe diagnostic tools beyond X-ray.

Objective

This study aimed to evaluate the efficacy of rastertereography (RST) in diagnosing AIS in adolescents and to assess the validity and reliability of spinal sagittal and transverse parameter measurements.

Methods

Data from 70 adolescents with suspected AIS treated at Wangjing Hospital of China Academy of Chinese Medical Sciences in 2023 were randomly selected, including biplanar X-ray, angle of trunk rotation (ATR), and RST measurements. To evaluate the validity of spinal angles provided by RST, Cobb angle, thoracic kyphosis (TK) (T₁-T₁₂), lumbar lordosis (LL) (L₁-L₅), and vertebral rotation angle (ROT) measured by RST were compared with X-ray and manual measurements. Pearson correlation and intraclass correlation coefficient (ICC) consistency tests were performed to validate the diagnostic efficacy of RST. Receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) was employed to describe the diagnostic capability of RST-measured spinal parameters for AIS (defined as Cobb angle≥10°), and Youden's index was used to determine optimal cutoff values (sensitivity and specificity).

Results

The Cobb angle measured by RST was smaller than that by X-ray (t=3.056, P=0.003), with a correlation coefficient of 0.724 and good reliability (ICC=0.710). RST-measured TK was smaller than X-ray values (t=1.511, P=0.135), with a moderate correlation (r=0.538 8, ICC=0.520). RST-measured LL was smaller than X-ray values (t=2.700, P=0.008), with moderate correlation (r=0.595 6, ICC=0.589). RST-measured ROT was significantly greater than ATR (t=3.627, P<0.001), with moderate correlation (r=0.639 0, ICC=0.626). The AUC for RST-measured Cobb angle in diagnosing AIS was 0.895 (95%CI=0.815-0.975), with an optimal cutoff of 8.5° (sensitivity=0.769, specificity=0.889). The AUC for RST-measured ROT was 0.697 (95%CI=0.550-0.844), cutoff=3.75° (sensitivity=0.692, specificity=0.667). ATR had an AUC of 0.638 (95%CI=0.486-0.790), cutoff=2.50° (sensitivity=0.673, specificity=0.566).

Conclusion

Compared with X-ray, RST demonstrated moderate reliability in measuring spinal parameters. Given its operational simplicity, RST may be considered for large-scale early screening in adolescent populations, though cost-effectiveness analyses against traditional methods are warranted.

Association between the Atherogenic Index of Plasma and New-onset Chronic Kidney Disease

ZHANG Xuechao, QI Qi, WU Xinyu, HAN Quanle, LI Lei, DENG Jie, LI Cangtuo, YUE Bocheng, WU Shouling, LI Kangbo

2026, 29(24):  3440-3446.  DOI: 10.12114/j.issn.1007-9572.2024.0578

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Background

Chronic kidney disease (CKD) is a major global public health problem, and its increasing prevalence is closely linked to atherosclerosis. The atherogenic index of plasma (AIP), a simple lipid-based indicator, has demonstrated predictive value for cardiovascular diseases. However, studies examining the association between AIP and the risk of developing CKD remain limited.

Objective

To investigate the association between the AIP and new-onset CKD.

Methods

This prospective cohort study utilized data from 101 510 employees of the Kailuan Group in Tangshan, Hebei Province, who underwent health examinations between June 2006 and October 2007. After applying inclusion and exclusion criteria, 85 253 participants were enrolled. Participants were stratified into four groups (Q1 to Q4) based on baseline AIP quartiles: Q1 (AIP <-0.58), Q2 (-0.58≤AIP <-0.17), Q3 (-0.17≤AIP <0.29), and Q4 (AIP≥0.29). Follow-up continued until December 31, 2021, with new-onset CKD as the endpoint. The cumulative incidence of CKD was plotted using the Kaplan-Meier method, and intergroup differences were assessed with the log-rank test. The association between AIP and CKD was evaluated using Cox proportional hazards regression models.

Results

A total of 18 175 patients developed CKD during 13.97 (13.53, 14.17) years of follow-up. With increasing AIP, the cumulative incidence of CKD in the Q1-Q4 groups was 16.87%, 21.49%, 22.31%, and 24.47%, with incidence densities of 13.48/1 000 person-years, 17.83/1 000 person-years, 18.56/1 000 person-years, and 20.77/1 000 person-years, respectively. After correcting for relevant confounders, the HR (95%CI) for incident CKD was 1.24 (1.18-1.29), 1.26 (1.21-1.33) and 1.51 (1.43-1.59) in the Q2-Q4 groups compared with the Q1 group (P_trend<0.001). Further analysis showed that when patients with CKD events at the first 2 years of follow-up, patients with all-cause mortality events during follow-up, patients taking antihypertensive, hypoglycaemic, and lipid-lowering medications at baseline, and patients with myocardial infarction or stroke during follow-up were excluded, the risk of Q4 group was similar to the results of the main analysis and the results were more robust when compared with Q1 group. Subgroup analyses showed that significant interactions were observed for age, sex, BMI, history of hypertension, and history of smoking (P_interaction<0.001), and AIP had a more significant risk in the subgroups of age<60 years, sex, BMI≥28 kg/m², and history of smoking (P<0.05).

Conclusion

An elevated AIP is an independent risk factor for new-onset CKD and serves as an early predictor of its development.

Study on the Predictive Value of Cumulative LDL-C Exposure and Uric Acid/HDL-C Ratio in Elderly Patients with Acute Myocardial Infarction

SUN Qinyu, DENG Yifan, YU Jiling, CAO Gan, YANG Tianxiao, FANG Zhen, JI Jun, HE Shenghu, ZHANG Jing

2026, 29(24):  3447-3453.  DOI: 10.12114/j.issn.1007-9572.2025.0234

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Background

Acute myocardial infarction (AMI) poses a significant threat to the health and quality of life of the elderly. Previous studies have found that higher low-density lipoprotein cholesterol (LDL-C) is an independent risk factor for AMI, and increased uric acid and decreased high-density lipoprotein cholesterol are also associated with AMI.

Objective

To investigate the predictive value of cumulative LDL-C exposure, uric acid to high-density lipoprotein cholesterol ratio (UHR), and their combination on the occurrence of AMI in the elderly.

Methods

A retrospective study was conducted on 737 elderly patients diagnosed with AMI at Northern Jiangsu People's Hospital from January 2019 to December 2023 (experimental group) and 260 elderly patients admitted during the same period who were excluded from the AMI diagnosis (control group). Patient demographics and laboratory test results were collected, and cumulative LDL-C exposure and UHR values were calculated. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for AMI in the elderly. ROC curves were plotted for cumulative LDL-C exposure, UHR, and their combined prediction of AMI in the elderly, and the area under the ROC curve (AUC) was calculated to assess the predictive efficacy of cumulative LDL-C exposure, UHR, and their combination for AMI in the elderly.

Results

The characteristics of male gender, smoking history, alcohol abuse history, history of hypertension, history of type 2 diabetes, BMI, glycated hemoglobin A_1c, white blood cell count, neutrophil count, monocyte count, triglycerides, total cholesterol, HDL-C, LDL-C, lipoprotein a, uric acid, cumulative LDL-C exposure, UHR, apolipoprotein A1, and albumin of the experimental group were compared with the control group, results showed statistically significant differences (P<0.05). Results of multivariate Logistic regression analysis showed that male gender (OR=3.026, 95%CI=1.769-5.178, P<0.001), history of type 2 diabetes (OR=4.834, 95%CI=2.882-8.109, P<0.001), and high level of white blood cell count (OR=1.580, 95%CI=1.368-1.825, P<0.001), LDL-C (OR=3.801, 95%CI=2.712-5.327, P<0.001), cumulative LDL-C exposure (OR=1.898, 95%CI=1.042-3.457, P=0.036), UHR (OR=10.658, 95%CI=5.147-22.069, P<0.001) were independent risk factors for AMI in the elderly, while high level of HDL-C (OR=0.426, 95%CI=0.184-0.986, P=0.046) and albumin (OR=0.989, 95%CI=0.979-0.999, P=0.031) were independent protective factors. ROC curve results showed that the AUC for predicting occurrence of AMI in the elderly based on cumulative LDL-C exposure and UHR was 0.726 (95%CI=0.691-0.761) and 0.700 (95%CI=0.663-0.737), respectively, with sensitivities of 0.696 and 0.742, specificities of 0.650 and 0.607, and cutoff values of 214.86 and 317.06, respectively. The combined AUC was 0.813 (95%CI=0.784-0.842), with a sensitivity of 0.723 and a specificity of 0.730.

Conclusion

History of type 2 diabetes mellitus and high level of leukocytes counts, LDL-C, cumulative LDL-C, UHR are independent risk factors for AMI in the elderly, high level of HDL-C and albumin are independent protective factors. Cumulative LDL-C exposure, UHR and the combination of the two can be used as early biomarkers to effectively identify the occurrence of AMI in the elderly.

Correlation Analysis between Low Iron Status and Clinical Characteristics of Colorectal Cancer Catients

LUO Hao, LUO Yajun, YANG Yi, HU Hai

2026, 29(24):  3454-3460.  DOI: 10.12114/j.issn.1007-9572.2025.0237

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Background

Colorectal cancer (CRC) is the second most common malignant tumor in terms of incidence worldwide. Studies have shown that iron metabolism is involved in multiple aspects of tumor progression, such as tumor cell proliferation and immune microenvironment regulation. Clinically, most CRC patients are accompanied by abnormal serum iron status, among which low serum iron levels are more common. Exploring the correlation between low iron status and colorectal cancer is of great significance for the individualized treatment of colorectal cancer.

Objective

This study aims to comprehensively and systematically investigate the relationship between the internal environment low iron status and various clinical characteristics in patients with colorectal adenocarcinoma.

Methods

Based on a single-center registered retrospective cohort study, 712 patients who were pathologically diagnosed with colorectal adenocarcinoma after surgery at Sichuan Cancer Hospital from January 2017 to June 2023 were consecutively included as research subjects. Indicators including serum iron, transferrin saturation, and various clinical characteristics were collected. Patients were divided into the low iron status group (low iron group, n=363) and the control group with normal iron status (n=349) according to the preoperative serum iron expression level. Propensity score matching (PSM) was used for 1∶1 matching of patients, with a caliper set at 0.2. Finally, 698 matched samples were included (349 cases in both the low iron group and the control group). Univariate and multivariate Logistic regression analysis were used to explore the correlation between low iron status and clinical characteristics.

Results

Among the 712 patients, 363 cases (50.98%) had low iron status in the internal environment. Before PSM matching, there were statistically significant differences between the control group and the low iron group in the American Society of Anesthesiologists (ASA) classification, the proportion of cancer obstruction, and the proportion of anemia (P<0.05); after PSM matching, the differences in ASA classification, the proportion of cancer obstruction, and the proportion of anemia between the two groups were still statistically significant (P<0.05). After PSM, the expression levels of white blood cell count (WBC), C-reactive protein (CRP), plateletcrit (PCT), and carcinoembryonic antigen (CEA) in the low iron status group were higher than those in the control group, while the levels of lymphocyte count (LY), albumin (ALB), and serum total cholesterol (TC) were lower than those in the control group (P<0.05). Before and after PSM, there were statistically significant differences between the two groups in tumor location, International Union Against Cancer (UICC) TNM stage, degree of differentiation, mismatch repair (MMR) expression status, microsatellite stability status, nerve and vascular invasion, liver and lung metastasis rates, and tumor length (P<0.05). After controlling for baseline confounding factors using PSM, anemia was separated as an independent predictive variable for multivariate Logistic regression analysis. The results showed that when anemia was not included, tumor location rectum (OR=0.41, 95%CI=0.25-0.67, P<0.01), UICC stageⅣ (OR=3.50, 95%CI=1.65-7.82, P<0.01), vascular invasion (OR=1.63, 95%CI=1.01-2.63, P=0.04), tumor length (OR=1.16, 95%CI=1.03-1.30, P<0.01), ALB (OR=0.90, 95%CI=0.85-0.95, P<0.01), PCT (OR=1.12, 95%CI=1.08-1.15, P<0.01), and LY (OR=0.51, 95%CI=0.35-0.72, P<0.01) were independent influencing factors for low iron status in patients with colorectal adenocarcinoma. When anemia was included in the multivariate Logistic regression analysis, anemia (OR=7.03, 95%CI=4.40-11.25, P<0.01) became an independent influencing factor for low iron status, while tumor location was no longer an independent influencing factor. The remaining factors, including tumor length, UICC stageⅣ, vascular invasion, and peripheral blood LY, PCT, and ALB, were still independent factors associated with low iron status in patients with colorectal adenocarcinoma (P<0.05).

Conclusion

The internal environment iron status of patients with colorectal adenocarcinoma is closely associated with tumor invasiveness (including tumor stage, neurovascular invasion, and tumor length) as well as inflammatory indicators. Rectal tumor location, along with higher levels of ALB and LY, are protective factors against low iron status in patients with colorectal adenocarcinoma. In contrast, anemia, UICC stageⅣ, vascular invasion, longer tumor length, and higher PCT are risk factors for low iron status.

Impact of Immune Inhibitory Factors Programmed Cell Death Ligand 1 and T Cell Immunoglobulin Mucin-3 on the Prognosis of Hepatocellular Carcinoma Patients

ZHAO Sinan, LIN Shan, KANG Xi, WANG Chunyan, WANG Shunxiang

2026, 29(24):  3461-3465.  DOI: 10.12114/j.issn.1007-9572.2023.0543

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Background

Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, with approximately 415 000 new cases annually in China, accounting for nearly half of the global HCC incidence. HCC can trigger immune escape through various immunosuppressive factors, ultimately leading to tumor progression and metastasis. Programmed cell death ligand 1 (PD-L1) and T cell immunoglobulin mucin-3 (TIM3), recently identified as immunosuppressive factors expressed in HCC, have an unclear relationship with patient prognosis.

Objective

To analyze the impact of PD-L1 and TIM3 expression levels on the prognosis of HCC patients using a retrospective cohort study.

Methods

This retrospective cohort study analyzed the clinicopathological data of 82 HCC patients who underwent radical resection at the Department of Hepatobiliary Surgery, Fourth Hospital of Hebei Medical University, from 2015 to 2018. Multicolor fluorescence immunohistochemistry was used to detect the number and proportion of PD-L1^- positive and TIM3^- positive tumor cells in paraffin-embedded sections. The survival ROC method was applied to determine variable cutoff values, and patients were grouped based on expression levels. Patients were divided into PD-L1⁺ (n=21) and PD-L1^- (n=61) groups based on PD-L1 expression, TIM3⁺ (n=39) and TIM3^- (n=43) groups based on TIM3 expression, and four groups based on combined PD-L1 and TIM3 expression: PD-L1⁺/TIM3⁺ (n=17), PD-L1⁺/TIM3^- (n=4), PD-L1^-/TIM3⁺ (n=23), and PD-L1^-/TIM3^- (n=38). The Kaplan-Meier method with Log-rank test was used to analyze differences in overall survival (OS) among groups.

Results

Kaplan-Meier analysis with Log-rank test showed no statistically significant difference in median OS between the PD-L1⁺ (n=21) and PD-L1^- (n=61) groups (median OS: 23.3 months vs. 52.0 months, P=0.051), nor between the TIM3⁺ (n=39) and TIM3^- (n=43) groups (median OS: 27.6 months vs. 52.9 months, P=0.210). Similarly, no statistically significant difference was observed in median OS between the PD-L1⁺/TIM3⁺ (n=17) and PD-L1^-/TIM3^- (n=38) groups (median OS: 18.5 months vs. 53.4 months, P=0.030).

Conclusion

Differences in the expression of PD-L1 or TIM3 alone are insufficient to impact the prognosis of HCC patients. However, patients with high expression of both PD-L1 and TIM3 exhibit significantly shorter overall survival compared to those with low expression of both markers. This suggests that PD-L1 and TIM3 may play a synergistic role in the immune escape process of HCC.

Consistency and Diagnostic Performance of Coronary Computed Tomography-derived Fractional Flow Reserve: Based on Different Deep Learning Algorithms

ZHOU Yichun, HAN Yeming, ZHANG Pengfei, SONG Wenwen, WAN Xiaoyu, LI Qimou, LIU Quande, YANG Wei, PAN Jichen, LI Xinhao, LI Dumin, YU Dexin, DONG Mei, LIANG Yongfeng, HU Shanshan, LYU Lijuan, ZHANG Mei

2026, 29(24):  3466-3475.  DOI: 10.12114/j.issn.1007-9572.2024.0476

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Background

Computed tomography-derived fractional flow reserve (CT-FFR) has been shown to have good diagnostic performance for coronary artery stenosis, but the consistency of CT-FFR calculated by different deep learning algorithms has not been evaluated.

Objective

This study aims to assess the consistency of CT-FFR in diagnosing coronary artery stenosis based on two deep learning algorithms and validate its diagnostic performance using invasive coronary angiography (ICA) or invasive fractional flow reserve (FFR) as references.

Methods

From January 2017 to June 2021, a total of 389 patients with suspected or confirmed coronary artery disease (CAD) were enrolled at Qilu Hospital of Shandong University. The cohort included patients who underwent coronary computed tomography angiography (CCTA), ICA, or FFR measurement. Among them, 55 patients underwent ICA within 90 days after CCTA, and 23 patients underwent FFR measurement after CCTA. Bland-Altman analysis was used to evaluate the consistency of CT-FFR based on Software 1 and Software 2, and the diagnostic performance of CT-FFR was compared with that of CCTA, using ICA or invasive FFR as the reference. ROC curves for both CT-FFR methods were plotted in diagnosing coronary artery stenosis, and calculated the area under the curve (AUC), and compared the diagnostic performance of CT-FFR with that of CCTA.

Results

A total of 389 patients were included, comprising 181 men (46.5%) and 208 women (53.5%), with a mean age of 55.1±10.9 years; in total, 1 161 coronary arteries were analyzed. Based on Software 1, 172 vessels (14.8%) were identified as having functionally significant stenosis, while Software 2 identified 114 vessels (9.8%). Bland-Altman plots showed that CT-FFR derived from Software 1 slightly overestimated values, with a mean difference of 0.05 overall (0.05 in LAD, 0.04 in LCX, and 0.05 in RCA). Correlation analysis demonstrated moderate associations between CT-FFR and invasive FFR (r=0.44 for Software 1; r=0.53 for Software 2). Bland-Altman analysis showed good agreement with invasive FFR, with mean differences of -0.03 (Software 1) and -0.06 (Software 2). In diagnostic performance, CCTA had the highest sensitivity (97.8%) and negative predictive value (98.5%), but lower specificity (66.7%) and positive predictive value (57.7%). In contrast, Software 1-based CT-FFR achieved 89.1% sensitivity, 80.8% specificity, 68.3% PPV, 94.1% NPV, and 83.4% accuracy, while Software 2-based CT-FFR showed 80.4% sensitivity, 93.9% specificity, 86.0% PPV, 91.2% NPV, and 89.7% accuracy. ROC curve analysis confirmed that both CT-FFR outperformed CCTA, with AUC values of 0.91 (Software 1), 0.89 (Software 2), compared to 0.82 for CCTA (P<0.05).

Conclusion

Good consistency was observed between the CT-FFR values based on Software 1 and Software 2, although a slight overestimation was found for CT-FFR based on software 1. Overall, CT-FFR demonstrated good diagnostic performance in detecting the functional significance of coronary stenosis.

A WeChat Mini-program-based Telerehabilitation Program for Stable COPD: Multidimensional Efficacy and Adherence Study

QI Jing, CAI Qing, ZHANG Wanting, GU Yan

2026, 29(24):  3476-3485.  DOI: 10.12114/j.issn.1007-9572.2025.0362

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Background

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Pulmonary rehabilitation (PR) is an integral nonpharmacological component of chronic disease management, but global participation in PR is low (<3%). Pulmonary telerehabilitation (TPR) delivered via video or mobile applications can overcome barriers of travel, distance, and cost and may increase access to home-based PR.

Objective

To comprehensively evaluate the effects of a WeChat mini-program-based PTR program on exercise capacity, health-related quality of life, lung function, psychological status, sleep quality, and adherence in patients with stable COPD.

Methods

From October 2022 to October 2024, 82 stable COPD patients attending the Respiratory Department of the Affiliated Hospital of Inner Mongolia Medical University were enrolled in this randomized study. Patients were assigned by random number table to either: the intervention group (home-based PTR through a WeChat mini-program, n=42) or the control group (outpatient face-to-face PR, n=40). Both groups received rehabilitation three times weekly for 12 weeks. Assessments were performed at baseline (T1), week 8 (T2), and week 12 (T3). Primary and secondary outcomes included: 6-minute walk distance (6MWD) for exercise capacity; modified Medical Research Council dyspnea scale (mMRC); St. George's Respiratory Questionnaire (SGRQ) for health-related quality of life; Hospital Anxiety and Depression Scale (HADS); Pittsburgh Sleep Quality Index (PSQI); and spirometry measured at T1 and T3. Adherence and safety were evaluated after 12 weeks.

Results

Exercise capacity: there was a significant group × time interaction for 6MWD (P_interaction<0.05); the main effect of time was significant (P_time<0.05), while the main effect of group was not significant (P_group>0.05). Dyspnea (mMRC): no significant group × time interaction, and no significant main effects of group or time on mMRC scores (P>0.05). Quality of life (SGRQ): no significant interaction between group and time for SGRQ symptom, activity, impact domains, or total score (P_interaction>0.05); group main effects were not significant (P_group>0.05), whereas time main effects were significant (P_time<0.001). Psychological status: both groups showed significant reductions in HADS anxiety and depression scores over the study period (P<0.05). Sleep quality and lung function: no significant group×time interactions or main effects of group were observed for PSQI scores (P>0.05). The main effect of time was significant for the total PSQI score (P_time<0.05), but not for the other subscale scores (P_time>0.05). Comparisons of spirometric indices [forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), forced expiratory volume in 1 second as a percentage of the predicted value (FEV₁%pred), FEV₁/FVC] between groups at T1 and T3 showed no significant differences (P>0.05); within-group comparisons between T1 and T3 were also not significant (P>0.05). Adherence: the intervention group demonstrated significantly better adherence than the outpatient control group (χ²=5.00, P<0.05).

Conclusion

A WeChat mini-program-based PTR program is at least comparable to outpatient face-to-face PR in improving exercise capacity, health-related quality of life, and psychological status in stable COPD patients, and it achieves higher patient adherence. It represents a feasible alternative to conventional outpatient PR.

Study on the Relationship between Negative Attention Bias, Interpretation Bias and Depression in College Students

XU Xiliang, LIU Mingfan, CHENG Guo, YANG Lihao

2026, 29(24):  3486-3492.  DOI: 10.12114/j.issn.1007-9572.2023.0492

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Background

In China, college students have become a high-risk group for depression. Maladaptive attentional bias and interpretation bias are significant factors contributing to the onset and maintenance of depression. Previous studies have examined the characteristics of attentional and interpretation biases in depressed individuals, yet the mechanisms through which these biases influence depression remain unclear.

Objective

This study aimed to investigate the relationships between negative attentional bias, interpretation bias and depression among college students, as well as to explore the mediating and moderating effects of interpretation bias in the association between attentional bias and depression.

Methods

Using a random sampling method, 66 university students from Xinyang University were selected as research participants between January and February 2023. The Beck Depression Inventory (2nd Edition) (BDI-Ⅱ) was used to assess the participants' depressive symptoms. An eye tracker was employed to record the participants' total gaze time bias scores, and bias interpretation materials were distributed to collect interpretation bias scores from the participants. The analysis of correlation was conducted using Spearman's correlation analysis, the mediation effect was tested using PROCESS, and the moderating effect of interpretation bias was examined through linear regression.

Results

Depression scores were positively correlated with total gaze duration bias scores (r_s=0.688, P<0.01) and negatively correlated with relative interpretation bias scores (r_s=-0.731, P<0.01). Additionally, total gaze duration bias scores and relative interpretation bias scores showed a negative correlation (r_s=-0.580, P<0.01). The indirect effect of interpretation bias was 0.278, accounting for 42% of the total effect (95%CI=0.148-0.453), confirming its mediating role. Furthermore, the interaction between total gaze duration bias and relative interpretation bias was significant (β=-3.479, P<0.05), indicating a moderating effect of interpretation bias.

Conclusion

Negative attentional bias, interpretation bias and depression are significantly interrelated among college students. Negative attentional bias not only directly influences depression but also indirectly exacerbates it through interpretation bias. Moreover, interpretation bias moderates the impact of attentional bias on depression, suggesting that adaptive interpretation patterns may mitigate the adverse effects of negative attentional processing.

The Latent Profile Analysis of Functional Fitness and Influencing Factors in Community-dwelling Older Adults

NI Yidan, WANG Ying, ZHU Yuke, XU Jing, WANG Li

2026, 29(24):  3493-3499.  DOI: 10.12114/j.issn.1007-9572.2025.0329

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Background

Functional fitness represents a composite measure of multi-dimension of physical capacity. However, it remains unclear whether the multiple dimensions of functional fitness exhibit consistent patterns or heterogeneous characteristics across different elderly individuals., whether distinct population subgroups demonstrate similar or divergent categorical traits.

Objective

To analyze the latent categorical characteristics of functional fitness levels among community-dwelling older adults and identify their associated influencing factors.

Methods

From March to November 2021, multi-stage stratified sampling was conducted in Suzhou to collect senior fitness test (SFT) data from 1 122 community-dwelling older adults. Integrating data on general demographic characteristics and health status indicators, latent profile analysis (LPA) was employed to identify latent categories of functional fitness, followed by multivariate Logistic regression to explore influencing factors.

Results

Among the 1 122 participants, 458 were male (40.8%) and 664 were female (59.2%), with a mean age of (69.34±6.54) years. LPA supported a three-category model, classifying the participants into high (n=431, 38.4%), moderate (n=582, 51.9%), and low (n=109, 9.7%) functional fitness groups respectively. All test indicators showed parallel trends across the three groups, suggesting that the structure of functional fitness is characterized by overall consistency rather than multi-dimensional heterogeneity. Notably, the timed up and go test (TUGT) exhibited the largest difference among the three groups, while inter-group differences in flexibility indicators were relatively small. Multivariate Logistic regression results revealed that, compared with the high functional fitness group: older adults with advanced age (OR=1.298), male sex (OR=2.399), low educational level (primary school or below) (OR=6.748, 19.052), and chronic diseases (OR=3.475) had a significantly higher risk having low functional fitness (P<0.05); older adults with advanced age (OR=1.109), male sex (OR=1.448), low educational attainment (OR=1.596, 2.204, 2.465), chronic diseases (OR=1.588), and self-paid medical expenses (OR=2.200) were more likely to be in the moderate functional fitness group (P<0.05). The participants with low educational level had the highest risk of having low physical fitness level (OR=6.748-19.052).

Conclusion

The multi-dimensional functional fitness levels of community-dwelling older adults can be categorized into high, moderate, and low tiers based on overall performance. TUGT is recommended as a preferred indicator for screening functional fitness in this population. Targeted health education, early screening, and functional fitness interventions should be prioritized for older adults with advanced age, male sex, chronic diseases, and particularly those with low educational attainment.

Article·Study of Evidence-based Medicine

Diabetes Prevalence among Older Adults in China: a Systematic Review and Meta-analysis

WANG Rui, LUO Shuoming, YANG Liang, WANG Peng, ZHAO Yang, WANG Qi, ZHOU Zhiguang

2026, 29(24):  3500-3508.  DOI: 10.12114/j.issn.1007-9572.2025.0426

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Background

Against the backdrop of China's ageing population and persistently rising diabetes prevalence, the health and socio-economic burden posed by diabetes among the elderly continues to intensify. Although multiple studies in China have reported diabetes prevalence among older adults, the evidence remains fragmented, lacking systematic reviews and meta-analyses to comprehensively quantify its epidemiological status. A thorough understanding of diabetes prevalence in this population is a crucial prerequisite for advancing targeted prevention and control measures and optimising the allocation of healthcare resources.

Objective

In accordance with systematic review and meta-analysis protocols, a systematic search of Chinese and English databases was conducted to identify studies published between 2000 and 2023 investigating diabetes prevalence among Chinese older adults (≥60 years). A meta-analysis was performed to synthesise prevalence estimates and conduct subgroup analyses.

Methods

A systematic search of Chinese and English databases (including CNKI, Wanfang Data, PubMed, Embase, Web of Science, and Scopus) was conducted to collect research literature published between 2000 and 2023 concerning the prevalence of diabetes among elderly individuals in China. Meta-analysis was performed using Stata software, with I² used to assess heterogeneity. Based on the results, either a fixed-effect model or random-effects model was selected to combine and calculate the overall prevalence and prevalence within subgroups.

Results

This study included 20 publications, encompassing 872 633 participants from elderly populations across 31 provinces. Meta-analysis results indicated that the prevalence of diabetes among Chinese older adults was 18.67% (95%CI=15.86%-21.47%). After excluding standardised rates, the crude prevalence was 19.22% (95%CI=16.15%-22.30%). The prevalence rate was 18.20% (95%CI=14.74%-21.66%) among males and 19.06% (95%CI=15.98%-22.13%) among females. By age group, the prevalence among those aged 60-69 years was 17.60% (95%CI=13.73%-21.47%), 19.62% (95%CI=13.51%-25.73%) among those aged 70-79 years, and 19.52% (95%CI=15.41%-23.63%) among those aged≥80 years. The prevalence among urban elderly residents was 16.85% (95%CI=11.21%-22.50%), higher than that among rural residents at 14.20% (95%CI=8.97%-19.42%). By educational attainment, the prevalence was 18.58% (95%CI=15.84%-21.31%) among those with junior secondary education or above, and 13.93% (95%CI=9.18%-18.68%) among those with primary education or below. Stratified by BMI, the prevalence rates among individuals with BMI <18.5 kg/m², 18.5-23.9 kg/m², 24.0-27.9 kg/m², and≥28.0 kg/m² were 14.46% (95%CI=5.75%-23.16%), 17.73% (95%CI=14.60%-20.86%), 29.15% (95%CI=17.40%-40.90%), and 31.74% (95%CI=22.65%-40.83%), respectively. Sensitivity analyses yielded stable results, with no evidence of significant publication bias.

Conclusion

The prevalence of diabetes among the elderly population in China reached 18.67% between 2000 and 2023. Differences in diabetes prevalence were observed across gender, age, urban-rural location, educational attainment, and BMI subgroups. Overall, the prevalence was slightly higher among women than men, and increased with advancing age. Urban elderly individuals exhibited higher prevalence than their rural counterparts, while those with higher educational attainment had higher rates than those with lower educational attainment. Differences were particularly pronounced across BMI subgroups, with significantly higher diabetes prevalence among overweight and obese elderly individuals compared to those of normal or underweight status.

Efficacy and Safety of Semaglutide in Patients with Heart Failure: a Meta-Analysis

LI Xueni, LIU Gejing, LIU Yongming

2026, 29(24):  3509-3519.  DOI: 10.12114/j.issn.1007-9572.2025.0289

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Background

The multi-target effects of semaglutide make it a breakthrough therapy for managing diabetes and obesity, offering comprehensive benefits particularly for patients with cardiovascular disease. However, its clinical applications for patients with heart failure (HF) are still under active investigation.

Objective

To systematically review the efficacy and safety of subcutaneous semaglutide in the treatment of HF regardless of the presence of obesity or type 2 diabetes (T2DM).

Methods

We searched Cochrane Library, PubMed, Embase, CNKI, Wanfang Data and VIP database from inception to November 2, 2024 for randomized controlled trials about subcutaneous semaglutide in the treatment of HF, where the experimental group received subcutaneous semaglutide and the control group received placebo. Data on HF hospitalization rate, cardiovascular death rate, all-cause death rate, serious adverse events, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and 6-minute walk distance (6-MWD) were collected and analyzed by two investigators who independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Subgroup analyses were performed based on comorbidities and different dosages, and data were statistically analyzed using Review Manager 5.3 software.

Results

A total of 4 randomized controlled studies, with a total of 6 109 patients (3 070 in the experimental group and 3 039 in the control group). Meta-analysis results showed that compared with placebo, subcutaneous semaglutide reduced the risk of cardiovascular death (RR=0.75, 95%CI=0.61-0.92, P=0.005), all-cause death (RR=0.81, 95%CI=0.67-0.98, P=0.03) and serious adverse events (RR=0.53, 95%CI=0.41-0.68, P<0.000 01). Subgroup analysis found that subcutaneous semaglutide could increase KCCQ-CSS (MD=7.58, 95%CI=4.40-10.77, P<0.000 01) and 6-MWD (MD=16.91, 95%CI=8.98-24.83, P<0.000 1) and reduced the risk of HF hospitalization (RR=0.41, 95%CI=0.26-0.65, P=0.000 1) of patients in HF with preserved ejection fraction (HFpEF) with obesity. In patients without T2DM, semaglutide was superior to placebo in reducing the risk of HF hospitalization (RR=0.16, 95%CI=0.04-0.68, P=0.01) and cardiovascular death (RR=0.76, 95%CI=0.60-0.97, P=0.03); similarly, in patients with a weekly dose of 2.4 mg, semaglutide reduced the risk of HF hospitalization (RR=0.29, 95%CI=0.14-0.58, P=0.000 5) and cardiovascular death (RR=0.75, 95%CI=0.59-0.95, P=0.02) compared with placebo, but the efficacy of the weekly dose of 1.0 mg was not significant compared with placebo.

Conclusion

Current evidence shows that subcutaneous semaglutide can reduce the risk of cardiovascular death, all-cause death and serious adverse events of heart failure patients while improving quality of life and activity tolerance and reducing risk of HF hospitalization in patients with HFpEF and obesity. Due to limited quantity and populations of the included studies, more high-quality studies are needed to verify the above conclusion.

Article·Research Methodology

Development, Reliability and Validity of the Sports Health Literacy Assessment Instrument for Middle School Students Based on CTT and Rasch Model

ZAN Ziqing, LIU Lizhu, LI Mengyu, ZHANG Siqi, LIU Lu, YOU Lili

2026, 29(24):  3519-3527.  DOI: 10.12114/j.issn.1007-9572.2023.0352

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Background

Regular physical activity has been shown to help improve mental health, quality of life, and well-being. Physical inactivity among children and adolescents is becoming a major global public health problem. China's policy emphasizes the need to improve the physical health level of adolescents, and emphasizes the construction of an evaluation system with multi-dimensional content and diverse methods. The development and application of youth sports health literacy (SHL) assessment tools will further promote the in-depth development of physical health education for middle school students.

Objective

To develop and verify the reliability and validity of the SHL questionnaire for middle school students in China based on the Rasch analysis of classical test theory (CTT) and item response theory (IRT), and to explore the form and appropriateness of different levels and categories of adolescent SHL measurement items.

Methods

Based on the theoretical structure of health literacy, a questionnaire was developed based on the actual situation of Chinese adolescents through policy combing, literature research and expert interviews. In June to July 2022, a total of 1 651 middle school students in urban and suburban counties in four provinces and cities with different levels of economic development were selected for on-site testing. The quality analysis of the SHL questionnaire was carried out by combining CTT and Rasch model analysis, including one-dimensional test, individual and item reliability and discrimination analysis, model fit test, difficulty analysis and item-specific fit index analysis, internal consistency reliability, Spearman correlation analysis and hierarchical exploratory factor analysis.

Results

A total of 1 651 valid samples were included, with an effective recovery rate of 99.88%. The single-dimensional test of motor knowledge and skill dimension of the classification items of the SHL questionnaireⅡwas basically passed, and the reliability of the items and participants was >0.7, and the separation degree was >1.5. The difficulty distribution of the White plot entries follows a normal distribution, but the upper entry does not correspond to it. Three items were poorly fitted, and the overall fit was good. The reliability of the three dimensions of scale items was good, Cronbach's α coefficients were 0.943, 0.878 and 0.921, respectively, and the overall Cronbach's α coefficient was 0.956. Exploratory factor analysis extracted 6, 5 and 3 factors in each dimension, and finally the behavior dimension did not delete the entries, the motivation dimension deleted 5 items, and the influencing factor dimension deleted 3 items to form a questionnaire.

Conclusion

The theoretical framework of the middle school students' SHL questionnaire is scientific and reasonable, and the quality analysis results of the questionnaire based on CTT and Rasch model are good, which has good pertinence and practical significance, and the quality evaluation of the revised questionnaire needs further research.

Preliminary Development of a Syndrome Efficacy Evaluation Scale for Hypothyroidism Secondary to Hashimoto's Thyroiditis: Based on Expert Consultation and Clinical Investigation

SI Xinying, MA Wenyuan, GUO Zhixun, QI Shuo, CHEN Xiaoheng, LI Zhe, LI Lu, DING Zhiguo

2026, 29(24):  3528-3537.  DOI: 10.12114/j.issn.1007-9572.2025.0084

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Background

In the clinical management of hypothyroidism secondary to Hashimoto's thyroiditis (HT-induced hypothyroidism), traditional Chinese medicine (TCM) demonstrates unique advantages through holistic regulatory effects. However, current clinical studies often lack quantitative and standardized tools for evaluating the efficacy of TCM syndrome.

Objective

To preliminarily develop a syndrome efficacy evaluation scale for HT-induced hypothyroidism.

Methods

The study period was from August 2023 to April 2024. Guided by international scale development principles and TCM theory, a theoretical framework was constructed. An initial item pool was established through literature review and preliminary clinical investigations. Subjective screening was conducted using the Delphi expert consultation method, while objective screening employed item distribution analysis, discrete trend analysis, Cronbach's α coefficient analysis, and correlation coefficient analysis.

Results

In this study, we successfully established a core group of the scale (including 4 senior physicians, 3 attending physicians, 2 postgraduate students, and 1 statistical expert) and a working group (5 postgraduate students), which worked through the mechanism of collaborative meetings. Two rounds of expert consultations yielded 44 valid questionnaires, with expert response rates of 92.30% and 93.75%, and authority coefficients of 0.85 and 0.92. Eight syndromes and 70 four diagnostic information items were initially identified. Subsequent clinical investigations (419 valid questionnaires) and four statistical methods led to the exclusion of redundant items: 9 for Yang deficiency syndrome, 3 for Qi deficiency syndrome, 4 for Qi stagnation syndrome, 1 for Phlegm syndrome, 6 for Blood stasis syndrome, 4 for Yin deficiency syndrome, 3 for Pathogeny syndrome, and 2 for Blood deficiency syndrome. The finalized scale comprises 8 syndrome (Yang deficiency syndrome, Qi deficiency syndrome, Qi stagnation syndrome, Phlegm syndrome, Blood stasis syndrome, Yin deficiency syndrome, Pathogeny syndrome, Blood deficiency syndrome) and 48 four diagnostic information items.

Conclusion

This study has preliminarily established a TCM syndrome efficacy evaluation scale for HT-induced hypothyroidism, which can provide a basis for the quantification of items and a set of reference methods for the development of evidence efficacy evaluation scales.

Review & Perspectives

A Scoping Review on Triage for Palliative Care Patients Based on Priority Decision-making

LIU Yahui, XU Yanan, YUAN Ling, WU Ligui, ZHOU Yujie, KANG Yubiao

2026, 29(24):  3538-3544.  DOI: 10.12114/j.issn.1007-9572.2024.0445

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Background

Palliative care, as an essential medical service to improve the quality of life for patients in advanced stages, relies on the rationality of tiered diagnosis and treatment as well as resource allocation, which directly impacts patients' medical experiences and outcomes. However, current research on priority decision-making for triaging palliative care patients remains fragmented both domestically and internationally, and there is still a lack of systematic summaries and standardized guidance tools.

Objective

This study aims to conduct a scoping review of domestic and international research on triage decisions for palliative care patients based on prioritization. The goal is to provide a reference for the development of assessment tools for graded referrals in palliative care and to inform future decisions regarding referral processes.

Methods

The methodology was based on the Joanna Briggs Institute's guidelines for scoping reviews. A comprehensive search was conducted in databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and China Biomedical Literature Database. The search covered studies published from the inception of each database up until April 2024. Relevant studies were identified, summarized, and analyzed.

Results

A total of 13 studies were included. From these, three categories of influencing factors and six assessment tools were identified. The influencing factors in palliative care triage include the severity and stability of the disease, patient and caregiver needs and preferences, and the availability and provision of medical resources. The assessment tools consider various factors such as symptoms, psychological aspects, caregiver needs, and care settings to categorize patients and determine their priority for accessing palliative care resources.

Conclusion

Graded diagnosis and treatment are crucial components of the palliative care system. It is essential to prioritize the development and refinement of triage concepts related to palliative care. Under this guidance, standardized and unified assessment tools or criteria should be established to match medical resources with patient needs. This will ensure that patients are referred to appropriate levels of palliative care institutions based on priority, thereby promoting the effective implementation of graded diagnosis and treatment policies and ensuring the rational use of resources.

Application of Digital-intelligent Technology in Electrocardiographic Monitoring for Acute Myocardial Infarction: a Scoping Review

WU Liyun, SUN Huajing, GU Yiqing, MEI Ziqi, JIN Shengji, ZHANG Suju, ZHU Yun, ZHANG Yao, LI Qin, LIU Xiaomiao, WANG Qing, BAI Yamei, XU Guihua

2026, 29(24):  3545-3552.  DOI: 10.12114/j.issn.1007-9572.2025.0265

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Background

Acute myocardial infarction (AMI) is a highly critical and acute condition, and early electrocardiographic monitoring is vital for prognosis. Traditional monitoring has limitations such as poor real-time performance and insufficient capture of sudden arrhythmias. Digital-intelligent technology, which integrates digital, information, and intelligent technologies, offers a novel pathway for AMI monitoring.

Objective

To systematically summarize the current applications, clinical effects, and existing challenges of digital-intelligent technologies in AMI electrocardiographic monitoring, thereby providing a reference for its standardized application and further research.

Methods

Following the Joanna Briggs Institute (JBI) scoping review guidelines, databases including PubMed, Cochrane Library, CINAHL, Embase, Scopus, Web of Science, CNKI, CBM, VIP, and Wanfang Data were searched from inception to February 2, 2025. Relevant studies were selected for comprehensive analysis.

Results

A total of 21 studies from 5 countries were included, comprising randomized controlled trials and prospective studies. Digital-intelligent technologies included remote ECG monitoring systems, wearable devices, AI-assisted diagnosis systems, and mobile devices, which were applied across the full spectrum of patient care, from pre-hospital emergency and in-hospital monitoring to home management. These technologies were shown to improve the detection rate of abnormal ECG, shorten critical treatment time windows, reduce medical costs, and improve prognosis. However, several challenges persist, including the need for data accuracy validation, inadequate privacy protection, fragmented device functionality, and poor user adherence among special populations.

Conclusion

Digital-intelligent technologies are feasible and effective in AMI monitoring, enhancing diagnosis and therapeutic efficiency. Future efforts should focus on technical standardization, data security and privacy protection, functional integration, and age-friendly design to promote clinical translation and application, aligning with the "Healthy China 2030" initiative.