Table of Content

20 October 2026, Volume 29 Issue 30

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Guidelines Interpretation

Lifestyle Intervention-based Weight Management: an Analysis of Key Highlights from the Partial Update of the 2025 NICE Guideline Overweight and Obesity Management (NG246)

LI Lan, LIU Lidi, ZHANG Peng, LI Dongze, YANG Ziyu, CHENG Yonglang, LIAO Xiaoyang, WAN Zhi

2026, 29(30):  4353-4359.  DOI: 10.12114/j.issn.1007-9572.2025.0512

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Overweight and obesity constitute a significant global public health challenge, impacting individuals across diverse age groups and socioeconomic strata. In 2025, the UK National Institute for Health and Care Excellence (NICE) issued the guideline Overweight and Obesity Management (NG246), which aims to establish an evidence-based therapeutic framework for healthcare practitioners. The NICE guideline underscores the critical role of lifestyle interventions, encompassing behavioral, dietary, and physical activity modalities, and advocates for individualized treatment plans to address the heterogeneous needs of the population. The key updates in this guideline are: (1) Simplifying and optimizing diagnostic tools by recommending differentiated body mass index thresholds for various ethnic groups and strongly endorsing the waist-to-height ratio as the principal assessment tool for central obesity; (2) Elevating the priority of behavioral interventions in weight management, recommending them as the first-line core strategy; (3) Providing more precise, evidence-based recommendations for dietary and physical activity interventions and broadening the implementation settings for weight management. This article aims to interpret the lifestyle intervention component of the NICE guideline and integrate its core principles with the specific context of China, exploring how to effectively apply these updated intervention strategies in the management of overweight and obesity in conjunction with China's domestic guidelines, thereby enhancing the management system and improving the quality of life and health outcomes of affected individuals.

Interpretation of the 2024 U.S. Preventive Services Task Force Recommendation Statement on Fall Prevention in Community-dwelling Older Adults

TANG Bo, YANG Rui, ZHAO Qian, LIU Hong, LIU Lidi, ZHANG Ying, JIANG Lihua, WANG Xiaogang, YANG Rong, LIAO Xiaoyang

2026, 29(30):  4360-4365.  DOI: 10.12114/j.issn.1007-9572.2025.0421

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Falls are the leading cause of injury-related death among adults aged 65 years and older in China. In 2018, the U.S. Preventive Services Task Force (USPSTF) released the Recommendation Statement on Fall Prevention in Community-dwelling Older Adults based on a systematic review of the latest evidence and an evaluation of the benefits and harms of interventions for falls in community-dwelling older adults, and this statement was updated in 2024. Drawing on China's 2022 Expert Consensus on the Comprehensive Management of Fall Risk in Older Adults, this article interprets the updated 2024 USPSTF Recommendation Statement, aiming to provide general practitioners in China with the latest evidence and reference for implementing fall prevention measures in older adults.

Clinical Hot Topics

The Current Situation, Challenges, and Coping Strategies of Preserving Ratio Impaired Spirometry

ZHAO Jiayi, FAN Jian, YU Dehua

2026, 29(30):  4366-4371.  DOI: 10.12114/j.issn.1007-9572.2025.0220

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The preserved ratio impaired spirometry (PRISm) population is a high-risk group for chronic obstructive pulmonary disease, with different clinical characteristics and development trajectories, closely related to various systemic comorbidities and poor prognosis. Currently, researches on PRISm are still in the exploratory stage both domestically and internationally. Due to insufficient understanding of PRISm, such as the lack of standardized clinical classification, imaging evaluation, accurate diagnosis, and prevention and treatment strategies, it is easily overlooked or confused with other common respiratory and comorbidities, resulting in many patients missing the opportunity for early intervention. General practitioners should not only pay attention to the patients with PRISm, but also fully consider their clinical heterogeneity, mechanism relationship with comorbidities, early imaging features, and potential detection targets. They should also focus on community screening of PRISm population and management of comorbidities. This article provides an overview of the current status, challenges, and response strategies of PRISm.

Progress in Research on the Trajectory of Frailty and Its Influencing Factors

HE Yang, YANG Rong, SHEN Can, YI Shanye, LIU Lidi, ZHAO Qian, WAN Zhi, LIAO Xiaoyang

2026, 29(30):  4372-4378.  DOI: 10.12114/j.issn.1007-9572.2024.0586

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Frailty is a geriatric syndrome associated with aging, which increases the risk of adverse events in the elderly. With the progress of population aging, the problem of frailty has been widely concerned. Previous studies mainly focused on frailty, mainly cross-sectional studies, and the studies on frailty trajectory (clustering of individuals with similar frailty over time) and its influencing factors were not clear, and the measures for early intervention of frailty through these studies were not clear. This paper summarized the latest clinical research progress of the risk factors of the frailty trajectory, in order to analyze the factors affecting the frailty trajectory from different angles, and provide new ideas for the comprehensive management of patients with frailty.

Key Advances in the Collapse Assessment and Hip-preserving Treatment of Nontraumatic Osteonecrosis of the Femoral Head

WEI Qiushi

2026, 29(30):  4379-4389.  DOI: 10.12114/j.issn.1007-9572.2026.0009

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Nontraumatic osteonecrosis of the femoral head (NONFH) is a disabling orthopedic condition that predominantly affecting quality of life. Although total hip arthroplasty effectively treats end-stage lesions with significant collapse, for young and active patients, the ultimate goal is hip preservation—delaying or avoiding joint replacement and preserving native joint function. This remains a challenge in both clinical practice and basic research. In this context, a correct understanding of the clinical characteristics and pathological processes of NONFH, along with the appropriate selection of hip preservation strategies, is of great significance. Based on the current research of NONFH, this article first analyzes the correlation between its clinical features and pathological progression, proposing that the initial onset of hip pain indicates the occurrence of subchondral bone fracture or femoral head collapse. By examining the pathological course of "necrosis-repair-collapse-osteoarthritis" in NONFH, it identifies the critical role of cystic lesion in the repair and collapse processes. Targeting the microenvironment within cystic lesion to promote repair and prevent collapse is central to achieving satisfactory outcomes with non-surgical hip preservation. Secondly, the article summarizes methods for predicting collapse and introduces the concept of the anterior and lateral femoral head preservation angles based on the residual healthy bone in the anterolateral weight-bearing region. These angles enable precise assessment of collapse risk. Finally, it reviews the current application and challenges of non-surgical hip preservation, surgical hip preservation, and emerging technological therapies. It emphasizes that accurate diagnosis of NONFH, specifically predicting femoral head collapse or its arrest, is crucial for implementing precise and timely hip preservation. The choice of hip preservation strategy depends on whether the weight-bearing region of the femoral head is at risk of collapse. The anterior and lateral femoral head preservation angles not only predict collapse but also define the indications for hip preservation. Under well-defined indications, utilizing existing treatment modalities and integrating multi-technique, multi-modal approaches to develop individualized comprehensive hip preservation plans aimed at reconstructing mechanical conduction pathways represents a mature strategy in current clinical practice. With continued innovation in biotechnology and regenerative medicine, along with the optimization of treatment pathways through high-quality clinical research, the success rate of hip preservation is expected to further improve.

Article

Correlation between Neutrophil Percentage to Albumin Ratio and Coronary Artery Calcification in Patients with Coronary Heart Disease

YANG Yuqing, LI Wenzhe, ZHU Lijie, YANG Tingjie, GUO Yiming, CHEN Lulin, CAO Yudong, YUAN Jiangshu, YANG Honghui

2026, 29(30):  4390-4396.  DOI: 10.12114/j.issn.1007-9572.2025.0423

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Background

Coronary artery calcification (CAC) is one of the most important pathological features of coronary atherosclerosis and is prevalent among patients with coronary heart disease (CHD). Early identification of CHD patients at risk for CAC is of great clinical significance.

Objective

To investigate the correlation between neutrophil percentage-to-albumin ratio (NPAR) levels and CAC in patients with CHD based on optical coherence tomography (OCT).

Methods

A total of 430 CHD patients who underwent percutaneous coronary intervention (PCI) in the Department of Cardiology at Fuwai Central China Cardiovascular Hospital between January 2022 and August 2023 were included. Clinical data were extracted via the hospital's electronic medical record system. Based on coronary angiography and OCT results, patients were divided into a CAC group (n=212) and a non-CAC group (n=218). Multivariate Logistic regression analysis was used to explore the effect of different NPAR levels and every 1 standard deviation (SD) increase in NPAR on CAC in CHD patients. Subgroup analyses and interaction tests were performed according to age, sex, BMI, and smoking history.

Results

The mean age of the included patients was (61.3±11.3) years. The CAC group had higher levels of age, diabetes, hypertension, white blood cell count, neutrophil count, neutrophil percentage, total cholesterol, fasting blood glucose, and NPAR compared to the non-CAC group. Conversely, the CAC group had lower levels of lymphocyte count, total protein, and albumin (P<0.05). Patients were divided into three groups according to NPAR tertiles: T1 group (NPAR<1.42, n=144), T2 group (1.42≤NPAR<1.63, n=143), and T3 group (NPAR≥1.63, n=143). Significant differences were observed among the three groups regarding the proportions of cholesterol crystals, macrophage infiltration, thrombosis, and plaque erosion (P<0.05). Multivariate Logistic regression results showed that for every 1 SD increase in NPAR, the risk of CAC increased by 1.760 times (OR=2.760, 95%CI=1.842-4.135, P<0.001). The risk of CAC increased progressively from the T1 to T3 groups (P_trend<0.001). The risk of CAC in the T2 and T3 groups was 3.818 times (OR=3.818, 95%CI=2.211-6.594, P<0.001) and 8.585 times (OR=8.585, 95%CI=4.430-16.637, P<0.001) that of the T1 group, respectively. Subgroup analysis suggested that elevated NPAR was a risk factor for CAC across different age, sex, BMI, and smoking status subgroups (P<0.05). However, the multiplicative interaction effects between NPAR and age, sex, BMI, or smoking history were not statistically significant (P_interaction>0.05).

Conclusion

Elevated NPAR levels are significantly and independently associated with an increased risk of CAC in CHD patients, suggesting its potential role as a biomarker reflecting the inflammatory pathological processes underlying CAC.

Association between Remnant Cholesterol Inflammatory Index and Biological Age Acceleration in Middle-aged and Older Chinese Adults: a Nationwide Cohort Study

ZHANG Shuaishuai, CHEN Yue, QIU Jiaojiao, ZHU Ping, WANG Shuxia

2026, 29(30):  4397-4405.  DOI: 10.12114/j.issn.1007-9572.2025.0513

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Background

Inflammation and metabolic processes are closely interrelated and collectively influence aging. The remnant cholesterol inflammatory index (RCII) is a composite biomarker that integrates both inflammatory and metabolic dimensions. Although studies have separately reported the associations of inflammation or metabolic disorders with biological aging, the relationship between the combined inflammatory-metabolic burden and biological aging remains underexplored.

Objective

To investigate the association between RCII and biological age acceleration (BAA).

Methods

This study used cross-sectional data from participants with RCII and biological age data in the China Health and Retirement Longitudinal Study (CHARLS) from waves 2011 and 2015. A total of 11 140 middle-aged and older adults were selected as study subjects. Based on the quartiles of lnRCII levels, participants were divided into four groups: Q1 group (lnRCII≤0.97, n=2 785), Q2 group (0.97<lnRCII≤2.36, n=2 786), Q3 group (2.36<lnRCII≤6.19, n=2 784), and Q4 group (lnRCII>6.19, n=2 785). Biological age was calculated using the Klemera-Doubal method, and BAA was defined as the difference between biological age and chronological age. Multiple linear regression models and restricted cubic splines were performed to explore the association between RCII and BAA. Additionally, subgroup and sensitivity analyses were performed to assess the consistency and robustness of this association across different populations.

Results

A total of 11 140 study subjects were included, with a median age of 57 (50, 65) years and a mean biological age of 57.8±9.8 years, including 4 970 males (44.61%) and 6 170 females (55.39%). Statistically significant differences were observed among the four groups in terms of age, BMI, education level, residence, hypertension, diabetes, cardiovascular disease, lipid-lowering treatment, glucose-lowering treatment, remnant cholesterol, RCII, lnRCII, biological age, and BAA (P<0.05). The results of multiple linear regression analysis showed that after adjusting for all covariates, there was a significant positive association between lnRCII and BAA. For each one-unit increase in lnRCII, BAA increased by 0.28 years (β=0.28, 95%CI=0.25-0.32, P<0.001); moreover, for each one-standard deviation (SD) increase in lnRCII, BAA increased by 0.41 years (β=0.41, 95%CI=0.36-0.45, P<0.001); BAA in the Q4 group was 1.10 years higher than that in the Q1 group (β=1.10, 95%CI=0.97-1.23, P<0.001). The restricted cubic spline analysis showed a positive nonlinear dose-response relationship between lnRCII and BAA (P_nonlinearity<0.001). Subgroup analysis results showed a positive association between lnRCII and BAA in all subgroups (P<0.05); there were interactions between lnRCII and BAA in the subgroups of sex, age, BMI, residence, and diabetes, and the associations were more pronounced in females, individuals aged<60 years, obese individuals, urban residents, and those with diabetes (P_interaction<0.05).

Conclusion

Among middle-aged and older Chinese adults, RCII shows a significant positive nonlinear association with BAA, and this association is particularly prominent in females, individuals aged<60 years, obese individuals, urban residents, and those with diabetes. RCII is expected to become a key tool for community-based screening of high-risk populations for "premature aging" and guiding targeted interventions to promote healthy aging.

The Association between the Weight-adjusted Waist Index and Thyroid Function and Autoimmunity: Insights from NHANES Data

WANG Shuaihang, CAO Yedi, CHEN Fei, ZHU Sainan, GAO Ying

2026, 29(30):  4406-4414.  DOI: 10.12114/j.issn.1007-9572.2025.0194

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Background

The relationship between obesity, thyroid function, and thyroid autoimmunity remains unclear. The weight-adjusted waist index (WWI), a novel metric for assessing obesity, enables a more accurate distinction between adipose tissue, muscle mass, and bone mass, and may serve as a superior indicator for elucidating the associations of obesity with thyroid dysfunction and autoimmunity.

Objective

This study aimed to investigate the associations of WWI with thyroid function and thyroid autoantibodies.

Methods

A total of 8 667 eligible participants were included from four cycles of the National Health and Nutrition Examination Survey (NHANES; 2001-2002, 2007-2008, 2009-2010, and 2011-2012), with complete data on WWI, thyroid function, and thyroid autoantibodies. Multivariable linear regression was applied to assess the associations of WWI with thyroid function and thyroid autoantibodies. Subgroup analyses and two-piecewise linear regression models were further conducted, and mediation analyses were performed using C-reactive protein (CRP).

Results

Multivariable linear regression showed that WWI was positively associated with free triiodothyronine (fT₃), total triiodothyronine (T₃), total thyroxine (T₄), and thyroid peroxidase antibody (TPOAb) levels (fT₃: β=0.03, 95%CI=0.01-0.04; T₃: β=4.52, 95%CI=3.66-5.39; T₄: β=0.20, 95%CI=0.14-0.26; TPOAb: β=3.14, 95%CI=0.25-6.04). Subgroup analyses indicated stronger associations between WWI and T₃ in younger individuals (β=6.03, 95%CI=4.06-8.01), those with higher physical activity (β=5.95, 95%CI=3.78-8.13), without hypertension (β=5.46, 95%CI=4.34-6.57), and without diabetes (β=4.57, 95%CI=3.66-5.48). Higher educational attainment strengthened the association between WWI and T₄ (β=0.15, 95%CI=0.07-0.23), and among individuals with higher education and no smoking history, WWI was more strongly associated with TPOAb (β=4.70, 95%CI=0.25-9.14). Saturation and threshold effects of WWI were observed for T₃ and T₄, with inflection points at 11.300 and 12.362, respectively. Mediation analysis suggested that CRP partially mediated the associations of WWI with T₄ and fT₃.

Conclusion

This study showed that the WWI was positively associated with fT₃, T₃, T₄, and TPOAb levels. Nonlinear associations were also observed between WWI and T₃ and T₄ levels, with inflection points at 11.3 and 12.362, respectively. These findings suggest that WWI may be associated with thyroid function and thyroid autoimmunity; however, prospective studies are warranted to further clarify the causal relationships.

Construction and Application of Fall Prevention Continuous Intervention Program for Young-old Patients

YAO Ying, DUAN Liran, HAN Dianli, MIAO Tianxin, CHEN Ke, ZHANG Lan, GU Haiyue

2026, 29(30):  4415-4423.  DOI: 10.12114/j.issn.1007-9572.2025.0501

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Background

Falls represent a significant health threat for older adults in China. The risk of falls increases among young-old patients aged 60 to 74 years, which is also a critical period for achieving optimal benefits from fall prevention interventions. However, effective fall prevention intervention programs tailored to this population remain insufficient.

Objective

To develop a fall prevention continuous intervention program for young-old patients based on the Behavior Change Wheel (BCW) theory and to evaluate its application effects.

Methods

The fall prevention continuous intervention program for young-old patients was developed through evidence synthesis and expert panel discussions. From February to April 2025, 90 hospitalized young-old patients were selected as the study participants and randomly assigned via a random number table into either a control group (n=45) or an intervention group (n=45). The knowledge, attitude and practice of fall prevention, fall efficacy, balance ability and the numbers of fall were compared between the two groups before and after the intervention.

Results

Based on the BCW theoretical framework, we identified six intervention targets across three key dimensions in young-old patients, including "Capability" (poor knowledge of fall prevention, impaired balance), "Opportunity"(insufficient social support, inadequate environmental functionality), and "Motivation" (weak perception of fall risk, poor adherence to preventive measures). Specific behavior change objectives were established accordingly. To address these objectives, a fall prevention intervention program comprising 10 specific measures was developed. During the intervention period, 5 participants dropped out from the intervention group and 4 from the control group, resulting in 40 participants in the intervention group and 41 in the control group for final analysis. No statistically significant differences were observed between the two groups in terms of general characteristics, including gender, age, BMI, education level, living situation, presence of chronic diseases, history of falls, and fall risk scores (P>0.05). During the intervention period, no falls occurred in the intervention group, while one fall was recorded in the control group. At the 12th and 24th weeks of intervention, the intervention group showed significantly higher scores than the control group in fall prevention knowledge, attitude, and practice, fall efficacy, and balance ability (P<0.05), and all indicators showed significant group and time interaction effects (P_interaction<0.05). The improvement trend of each indicator in the intervention group over time was better than that of the control group (P_time<0.05).

Conclusion

The continuous intervention plan for preventing falls among young-old patients, which is constructed based on the BCW theory in this study, is scientifically sound and feasible. This plan helps to enhance the knowledge, belief and behavior level of fall prevention, fall efficacy and balance ability of young-old patients, thereby reducing the risk of falls.

Analysis of the Current Status of Metabolic Syndrome among Middle-aged and Elderly People in Shijingshan District, Beijing, and Its Behavioral and Lifestyle Influencing Factors

SUN Xiuqin, FENG Zhenlong, WEI Lanxuan, ZENG Yuxin, LIU Jinbo, MA Lin, AN Zhantian, WANG Hongyu

2026, 29(30):  4424-4430.  DOI: 10.12114/j.issn.1007-9572.2025.0440

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Background

Metabolic syndrome (MS) is a cluster of multiple cardiovascular metabolic risk factors. It has a high prevalence among middle-aged and elderly individuals and can significantly increase the risk of various serious diseases, thus seriously affecting population health and the process of population aging. It is influenced by multiple factors, including demographic characteristics, lifestyle, and genetic factors. Among them, behavioral lifestyle is modifiable and controllable, making it a key focus in the prevention and control of chronic diseases. Given the significant regional differences in lifestyle among residents in China, conducting local research can provide evidence for the prevention and control of MS among middle-aged and elderly individuals in Beijing.

Objective

To investigate the current status of MS among middle-aged and elderly individuals in Shijingshan District, Beijing, and its behavioral and lifestyle-related risk factors, providing a theoretical basis for preventing MS through behavioral and lifestyle interventions among this population.

Methods

This study was conducted using the data from the Beijing Vascular Health Stratification (BVHS) Study. A cross-sectional survey was conducted from July to September 2020 in the Jindingjie Community of Shijingshan District, Beijing. A total of 1 647 permanent residents were selected as study participants, and 1 569 cases were included in the analysis based on inclusion and exclusion criteria. The questionnaire survey included demographic characteristics, behavioral lifestyle factors, and chronic disease prevalence. Chi-square analysis was used for univariate analysis, and multivariate logistic regression analysis was employed to identify risk factors for the occurrence of MS.

Results

Among the 1 569 valid respondents, there were 374 cases of MS, with an MS prevalence of 23.84%. The participants were divided into the MS group (n=374) and the non-MS group (n=1 195). Among the components of MS, overweight and/or obesity had the highest prevalence (65.20%, 1 023 cases), followed by hyperlipidemia (42.32%, 664 cases), hypertension (39.45%, 619 cases), and diabetes (19.50%, 306 cases). For comorbid conditions, the prevalence of overweight and/or obesity combined with hypertension, as well as overweight and/or obesity combined with hyperlipidemia, both exceeded 30%. The co-prevalence of all four MS components was 6.44%. Of the 374 patients with MS, 358 (95.47%) had overweight and/or obesity. Univariate analysis showed significant differences between the MS group and non-MS group in age, education level, physical activity, noon napping duration, daily sleep duration, smoking status, staple food intake, egg intake, and vegetable intake (P<0.05). Multivariate Logistic regression analysis, after adjusting for age and education level, demonstrated that adequate physical activity (OR=0.667, 95%CI=0.456-0.976), 6-8 hours of sleep (OR=0.641, 95%CI=0.495-0.830), more than 8 hours of sleep (OR=0.566, 95%CI=0.368-0.871), and the intake of 8-13 eggs per week (OR=0.361, 95%CI=0.184-0.708) were protective factors for MS (P<0.05), while noon nap duration exceeding 60 minutes (OR=1.508, 95%CI=1.079-2.109) was a risk factor (P<0.05).

Conclusion

Among 1 569 middle-aged and elderly participants in Beijing, the prevalence of MS was 23.84%, with overweight/obesity (65.2%) being the most common component disease. Adequate physical activity, sufficient sleep, and appropriate egg intake were protective factors against MS, while long-duration noon napping risk factors. High staple food intake showed an increasing trend toward higher MS risk, and a higher educational level was associated with a reduced risk of MS. In conclusion, was in the elderly is associated with various behavioral lifestyle factors, including physical activity, diet, and sleep.

Correlation between the Albumin/Gamma-glutamyl Transferase Ratio and Metabolic-associated Fatty Liver Disease in Type 2 Diabetes Mellitus

YAN Ziwei, NIE Jiahua, SHI Yan, WEI Limin

2026, 29(30):  4431-4437.  DOI: 10.12114/j.issn.1007-9572.2024.0605

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Background

In recent years, the incidence and prevalence of metabolic-associated fatty liver disease (MAFLD) have increased annually, and more than 25% of the global population suffers from MAFLD. Type 2 diabetes mellitus (T2DM) is closely related to MAFLD, but simple and accurate predictors of MAFLD in T2DM patients are scant.

Objective

To investigate the correlation between albumin/gamma-glutamyl transferase ratio (AGTR) with T2DM combined with MAFLD, and to construct a nomogram to predict the risk of T2DM combined with MAFLD.

Methods

A total of 1 050 adult patients with T2DM who were hospitalized in the Department of Endocrinology, Hebei General Hospital from 2018 to 2023 were enrolled. After several rounds of rigorous screening, a total of 723 eligible patients were included in the study, involving 430 cases in the T2DM combined with MAFLD group and 293 cases of T2DM without MAFLD. The basic information of patients were collected and analyzed, MAFLD was diagnosed by ultrasound. Spearman correlation analysis was used to analyze the correlation between AGTR and T2DM combined with MAFLD risk factors. Multivariate Logistic regression analysis was used to explore the risk factors for T2DM complicated with MAFLD. An individualized nomogram for predicting the risk of T2DM complicated with MAFLD was constructed and validated.

Results

Compared with the T2DM without MAFLD group, the levels of BMI, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), bile acids (BA), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), apolipoprotein B (ApoB), uric acid (UA) in the T2DM combined with MAFLD group were significantly higher, while age, duration of T2DM, albumin (ALB), and high-density lipoprotein cholesterol (HDL-C) were significantly lower (P<0.05). Patients were divided into T1-T3 groups according to the AGTR tertiles. The general data of the three groups were compared. BMI, ALT, GGT, FBG, TC, TG, LDL-C, VLDL-C, ApoB, and UA were significantly lower than those of T1 and T2 groups, while HDL-C and AST were significantly lower than T1 groups (P<0.05). Age and course of T2DM in T3 group were significantly higher than those of T1 and T2 groups (P<0.05). BMI, ALT, AST, GGT, TG, VLDL-C, and UA in T2 group were significantly lower than those of T1 groups (P<0.05). Spearman correlation analysis showed that AGTR was positively correlated with age, course of T2DM, ALB, and HDL-C (P<0.05), and negatively correlated with VLDL-C, BMI, ALT, AST, GGT, BA, FBG, TC, TG, LDL-C, ApoB, and UA (P<0.05). Multivariate Logistic regression analysis showed that the increased BMI (OR=1.256, 95%CI=1.187-1.330), increased TG (OR=1.272, 95%CI=1.043-1.551), and the decreased AGTR (OR=0.707, 95%CI=0.562-0.890) were the influencing factors for the risk of T2DM combined with MAFLD (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the nomogram involving BMI, TG and AGTR effectively predict the risk of MAFLD in T2DM patients, with the area under the curve (AUC) of 0.827 (95%CI=0.790-0.864). The calibration curve showed that the predicted value was close to the ideal curve, indicating a good consistency. The clinical decision curve showed that the nomogram had good clinical prediction effect on T2DM combined with MAFLD.

Conclusion

AGTR increase is a protective factor for T2DM combined with MAFLD. The individualized nomogram constructed based on BMI, TG, and AGTR can effectively predict the risk of T2DM combined with MAFLD.

Exploratory Study on Screening of Multiple Inherited Metabolic Disorders in Newborns in Hainan Province

ZHAO Peizhen, ZHAO Zhendong, XU Haizhu

2026, 29(30):  4438-4444.  DOI: 10.12114/j.issn.1007-9572.2025.0292

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Background

The prevalence of neonatal inherited metabolic disorders exceeds 0.5%. This study represents the first comprehensive population-wide screening for these conditions in Hainan Province, contributing to the prevention and control of birth defects in the region and establishing diagnostic laboratory capabilities for inherited metabolic diseases.

Objective

To investigate the incidence of multiple inherited metabolic disorders (IMDs) among newborns in Hainan Province and provide reliable methods and data to support birth defect prevention and control.

Methods

This study used dried blood spot (DBS) samples collected from heel pricks of newborns born between February and December 2024 across all obstetric healthcare facilities in Hainan Province. Screening was performed using tandem mass spectrometry, and reference ranges for relevant biomarkers were established using the percentile method. Suspected cases were recalled for confirmatory diagnosis via gas chromatography-mass spectrometry (GC-MS) and gene sequencing.

Results

A total of 84 184 DBS samples from newborns were collected. Using the percentile method, reference ranges for 14 amino acids, 36 acylcarnitines, 1 ketone, 2 adenosines, and 4 lysophosphatidylcholines were established in 29 676 samples, providing the first normative reference data for Hainan Province. Thirty-eight cases of IMDs were diagnosed, yielding an incidence rate of 1/2 215 (38/84 184). Twelve distinct diseases were confirmed, including phenylketonuria (PKU), hypermethioninemia (HMet), multiple sulfatase deficiency (MUSD), citrin deficiency (CD), primary carnitine deficiency (PCD), short-chain acyl-CoA dehydrogenase deficiency (SCADD), carnitine palmitoyltransferaseⅠ deficiency (CPTⅠ), carnitine-acylcarnitine translocase deficiency (CACT), 3-methylcrotonyl-CoA carboxylase deficiency (MCCD), glutaric acidemia typeⅠ (GA-Ⅰ), glutaric acidemia typeⅡ (GA-Ⅱ), and short/branched-chain acyl-CoA dehydrogenase deficiency (SBCADD), with incidence rates ranging widely from 1/84 184 to 1/6 475. PCD (13 cases), SCADD (6 cases), and CD (5 cases) ranked as the three most prevalent disorders. 42 mutation sites across 12 genes were identified.

Conclusion

This study establishes the first reference ranges for newborn IMD screening in Hainan Province, providing critical reference criteria for subsequent screening programs. Following the implementation of a comprehensive free screening initiative, the data revealed a relatively high incidence of IMDs in Hainan newborns, with notable genetic complexity and diversity. Disorders of fatty acid metabolism-PCD, SCADD, and CD-were the most frequently detected. These findings underscore the importance of expanded newborn IMD screening in Hainan Province for the prevention and control of birth defects.

Article·Research Trends of Traditional Chinese Medicine

Clinical Efficacy and Preliminary Exploration of Neural Mechanisms of Tendon-regulating and Bone-setting Combined with Dynamic Neuromuscular Stabilization Technique in the Treatment of Chronic Nonspecific Low Back Pain: a Randomized Controlled Study

ZHANG Yipin, ZHANG Yukang, GU Xinyu, QIAN Qunqun, CHENG Lulu, LI Dongjing, CHEN Zhaohui

2026, 29(30):  4445-4452.  DOI: 10.12114/j.issn.1007-9572.2026.0033

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Background

Chronic non-specific low back pain (CNLBP) is a highly prevalent musculoskeletal disease worldwide, which severely impairs patients' quality of life. Most existing studies primarily focus on biomechanical improvements while neglecting the modulatory role of the central nervous system in pain perception. From three perspectives-neurophysiology, biomechanics, and integrated traditional Chinese and Western medicine-this study aims to explore novel strategies for the prevention and treatment of CNLBP.

Objective

To compare the clinical efficacy of manual therapy (tendon-regulating and bone-setting ) combined with dynamic neuromuscular stabilization (DNS) for patients with chronic non-specific low back pain.

Methods

A total of 72 chronic non-specific low back pain (CNLBP) patients admitted to the Tendon Injury Outpatient Department of the First Clinical Medical College, Anhui University of Chinese Medicine from August 2024 to August 2025 were randomly divided into two groups (1∶1) via a computer-generated random number table, with 36 cases each. Three patients withdrew due to personal reasons (1 in the experimental group, 2 in the control group). The control group received sham manipulation plus DNS training (3 times/week for 4 weeks), while the experimental group received tendon-regulating and bone-setting manipulation plus DNS training (2 times/week for 4 weeks). Visual Analogue Scale (VAS), Roland-Morris Disability Questionnaire (RMQ), Pain Catastrophizing Scale (PCS) scores, and surface electromyography (sEMG) co-contraction ratio (CCR) of lumbar and abdominal muscles were compared before and after treatment, with adverse events monitored.

Results

Before treatment, there were no significant differences in the baseline data between the two groups (P>0.05). After treatment, the VAS score, RMQ score, PCS and its subscale scores, as well as the surface electromyography CCR of the lumbocrural and abdominal muscles in both groups were significantly improved compared with those before treatment (P<0.05); moreover, the degree of improvement in the experimental group was significantly superior to that in the control group (P<0.05).

Conclusion

Tendon-regulating and bone-setting manipulation combined with DNS can effectively alleviate pain, improve functional impairment and pain catastrophizing thinking, enhance muscle co-contraction function, and show good safety. Its clinical efficacy is superior to that of DNS monotherapy.

Efficacy and Mechanisms of Acupuncture Combined with Acupoint Plaster Therapy for Allergic Rhinitis: a Pharyngeal Microbiota-based Randomized Controlled Study

LIN Yufang, HE Jiaojun

2026, 29(30):  4453-4462.  DOI: 10.12114/j.issn.1007-9572.2025.0333

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Background

Allergic rhinitis (AR) is closely linked to local inflammation and microbiota composition in the nasopharynx. Existing mechanistic studies of acupuncture in AR have mainly addressed immune and inflammatory modulation; its effects on the pharyngeal microbiota remain largely unexplored.

Objective

To compare the clinical efficacy of acupuncture combined with acupoint plaster versus acupoint plaster alone in AR, and to characterize treatment-related changes in the oropharyngeal and nasopharyngeal microbiota.

Methods

In this single-center, open-label randomized controlled trial, 64 AR patients were recruited at the Department of Acupuncture and Moxibustion, Zhejiang Hospital (from May to November 2024) and randomized to combined treatment (acupuncture+acupoint plaster, n=32) or plaster alone (n=32). Clinical outcomes were measured with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Oropharyngeal and nasopharyngeal samples were collected pre- and post-intervention and profiled by 16S rRNA gene sequencing.

Results

Six patients (three per group) withdrew; 29 participants per group completed the protocol. Both groups showed significant post-treatment reductions in RQLQ scores, with the combined treatment group showing greater improvement than plaster alone (P<0.01). Microbiota analyses revealed divergent responses: in the combined-treatment group, post-treatment, shared dominant oropharyngeal taxa in both groups included Rothia, Staphylococcus, skin-associated Corynebacterium, and various rod-shaped bacilli; the combined group showed an increase in short rod-shaped bacteria in the oropharynx, while the control group had increased oropharyngeal Staphylococcus (P<0.05). Nasopharyngeal communities were dominated across timepoints by Streptococcus, Clostridium, Neisseria, Prevotella, Rothia, Haemophilus, Veillonella and related taxa; after treatment, Streptococcus increased and Haemophilus decreased in both groups. Differential abundance analysis showed that bacilli, Staphylococcus, Acinetobacter and Cutibacterium were significantly more abundant in the oropharynx than the nasopharynx (P<0.001), whereas Veillonella, Neisseria, Prevotella, Haemophilus, Streptococcus and Clostridium were more abundant in the nasopharynx (P<0.001). After treatment, Rothia abundance in the nasopharynx was higher than in the oropharynx in the combined-treatment group (P<0.05). LEfSe profiling indicated an expansion of dominant taxa in the oropharynx after combined therapy (71/24 taxa), whereas plaster alone was associated with a net reduction of dominant taxa (12/41). In the nasopharynx, the combined group showed stable numbers of dominant taxa (10/10) while the control group decreased (2/14).

Conclusion

Both acupuncture combined with acupoint plaster and acupoint plaster alone improve clinical symptoms in AR. However, combined therapy is associated with increased oropharyngeal microbial richness and expansion of dominant taxa, whereas plaster alone tends to reduce microbial richness and dominant taxa in both oropharyngeal and nasopharyngeal niches. Distinct microbial compositions exist between the oropharynx and nasopharynx. The therapeutic effects of acupuncture combined with acupoint plaster on AR may be mediated, at least in part, by modulation of pharyngeal microbiota structure, including an increased abundance of Rothia in the nasopharynx.

Epidemiology and Comorbidities of Insomnia: Research Advances from an Integrated Chinese and Western Medical Perspective

LI Hangzhi, WANG Jiepeng, ZHANG Xiaoyi, FANG Chaoyi

2026, 29(30):  4463-4471.  DOI: 10.12114/j.issn.1007-9572.2026.0203

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Insomnia is the most prevalent sleep disorders encountered in clinical practice. Epidemiological surveys indicate that the global prevalence of insomnia in the general population remains persistently high, a trend similarly observed in China, where the condition is closely associated with factors such as age, sex, and stressful life events. While both modern medicine and traditional Chinese medicine (TCM) offer systematic accounts of the diagnosis and comorbidities of insomnia, these two frameworks have yet to be systematically integrated. This article provides a comprehensive review of current knowledge and recent advances in the epidemiological characteristics, and comorbidities of insomnia from both the Western and TCM perspectives. It examines the intersections and interrelations between these two distinct diagnostic and evaluative paradigms, proposing that conceptual correspondences and theoretical complementarities exist between them, although these require further validation through modern evidence-based approaches. The integration of Chinese and Western medicine enables cross-referencing in the diagnosis and management of insomnia, allows for a shared epidemiological risk-factor framework, and offers complementary advantages "particularly in the management of comorbidities" thus providing clinicians with a more comprehensive and integrated strategy for diagnosis and treatment.

Proactive Health Intervention Research

Application of Exercise Snacks in Chronic Disease Management: a Scoping Review

LI Xiling, ZHANG Fan, YANG Xinyue, YANG Heng

2026, 29(30):  4472-4479.  DOI: 10.12114/j.issn.1007-9572.2026.0058

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Background

Exercise is closely associated with the prognosis management of chronic diseases. Against the backdrop of limitations such as time and venue constraints in traditional exercise interventions, the practical challenge of insufficient adherence exists in exercise management for chronic disease populations. Existing studies indicate that exercise snacks, as a flexible, short-duration, moderate-to-high-intensity novel physical activity model, hold potential application prospects in chronic disease management. However, there remains a lack of systematic summary regarding their intervention protocols, applicability, and safety in chronic disease populations.

Objective

To conduct a scoping review of research on the application of exercise snacks in chronic disease populations, in order to inform future practice and research in this field.

Methods

Guided by the methodological framework of the scoping review, literature was searched in CNKI, Wanfang Data, VIP, Chinese Biomedical Literature Database, PubMed, Web of Science, CINAHL, Cochrane Library, and Embase from inception to December 2025. The included studies were summarized and analyzed.

Results

A total of 12 studies were included, with study populations mainly comprising individuals with diabetes and those with overweight/obesity. The results showed that the intervention modalities of exercise snacks mainly included stair climbing, bodyweight exercises, resistance training, balance exercises, and cycling. The intervention settings were primarily laboratory and home environments. The duration of each exercise bout ranged mainly from 15 seconds to 10 minutes. Exercise frequency varied across studies, but generally involved multiple dispersed bouts per day, and the prescribed intensity was mainly moderate to high. The outcome measures mainly included blood glucose, insulin, blood pressure, body composition, cardiorespiratory fitness, physical function, psychological status, health-related quality of life, exercise adherence, etc.

Conclusion

Exercise snacks demonstrate good feasibility and application potential in chronic disease populations. Future research should expand study populations and settings, validate their sustainable health benefits through multicenter long-term studies, and explore integrating exercise snacks into primary care chronic disease management, thereby providing a more comprehensive basis for exercise management in Chinese chronic disease populations.

Perceptions and Experiences of Zero-time Exercise among Community-dwelling Older Adults: a Qualitative Study

HE Qizhen, ZHONG Qingling, XU Jin, YU Yi, ZHAO Yuefei

2026, 29(30):  4480-4488.  DOI: 10.12114/j.issn.1007-9572.2025.0490

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Background

In the context of population aging, community-dwelling older adults commonly experience insufficient physical activity and difficulty maintaining regular exercise. Zero-time exercise (ZTEx) is lifestyle-based and fragmented, making it easier to integrate into daily life; however, qualitative evidence on older adults' lived experiences and perceptions of ZTEx remains limited.

Objective

To explore how community-dwelling older adults understand ZTEx and its practical characteristics in everyday life, and to provide experience-based evidence for health promotion in older populations.

Methods

A qualitative research design was adopted. From April to June 2025, 20 older adults from three communities in Nanchang City were selected using purposive sampling. Data were collected through non-participant observation and semi-structured interviews, and analyzed using Colaizzi's seven-step method to identify and summarize themes.

Results

Among the 20 participants, 10 were men (50%) and 10 were women (50%), with a mean age of 66.1±3.4 years. Four themes (adoption drivers, exercise patterns, health perceptions, and sustainability challenges) and 12 subthemes were identified. Participants generally perceived ZTEx as a lifestyle-oriented, low-threshold activity strategy, mainly used to maintain daily functional ability, enhance confidence in mobility, and promote self-health management. Continued practice was influenced by differences in understanding exercise intensity and safety, physical functional limitations, and insufficient professional guidance.

Conclusion

ZTEx demonstrates good acceptability and practical potential among community-dwelling older adults. However, sustained implementation still depends on further improvements in standardized guidance and community support conditions.

Evidence-based Medicine

Network Meta-analysis of the Efficacy of Different Bone-modifying Drugs in the Treatment of Patients with Bone Metastases from Solid Tumours or Multiple Myeloma

HU Yuting, YAN Ying, YAN Mingjie, WANG Huijun, HAN Hu

2026, 29(30):  4489-4502.  DOI: 10.12114/j.issn.1007-957.2024.0592

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Background

Skeletal-related events (SREs) are severe complications in patients with bone metastases from solid tumors or multiple myeloma. Bone-modifying agents (BMAs) offer the advantage of a targeted drug delivery system to bone tissue compared to traditional treatment methods. However, given the variety of BMAs and the relative complexity of drug treatment strategies, determining the appropriate drug and dosing frequency is a significant challenge currently faced by BMAs.

Objective

A network meta-analysis comparing the efficacy of different BMAs in the treatment of patients with bone metastases from solid tumors or multiple myeloma.

Methods

Two researchers independently searched PubMed, Cochrane Library, Embase, Clinical Trials, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and VIP databases for randomized controlled trials (RCTs) on bone-modifying agents in the treatment of patients with bone metastases from solid tumors or multiple myeloma, following the predefined search strategy. The search timeframe spanned from the inception of each database to January 2024. The quality of the included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using R 4.3.3 and STATA 17.0 software.

Results

A total of 64 RCTs were included, involving 28 773 patients. The interventions involved were: placebo/no bone-modifying agents group (PLA), standard dosing of denosumab originator group (DENO), standard dosing of zoledronic acid group (ZA), standard dosing of ibandronic acid group (IBA), standard dosing of pamidronate group (PAM), longer-interval dosing of pamidronate group (PAM^*), standard dosing of clodronate group (CLO), standard dosing of risedronate group (RIS), standard dosing of alendronate group (ALE), standard dosing of denosumab biosimilar group (DENO^#), longer-interval dosing of denosumab originator group (DENO^*), and longer-interval dosing of zoledronic acid group (ZA^*), totaling 12 different intervention measures. For the incidence of total SREs, the surface under the cumulative ranking curve (SUCRA) showed the following ranking: DENO (82.29%) >DENO^* (81.48%) >DENO^# (76.09%) >ZA (59.74%) >ZA^* (55.53%) >IBA (43.19%) >PAM^* (42.21%) >CLO (37.37%) >PAM (31.87%) >RIS (31.26%) >PLA (8.97%). For the time to first SREs, the SUCRA ranking was: DENO^* (85.45%) >DENO (83.89%) >IBA (56.72%) >ZA (53.35%) >PAM (44.39%) >ZA^* (42.58%) >DENO^# (27.04%) >PLA (6.59%). Regarding overall survival (OS), the SUCRA ranking was: ZA^* (79.66%) >IBA (79.05%) >DENO (73.19%) >ZA (64.14%) >CLO (42.96%) >PAM (30.55%) >PLA (18.95%) >RIS (11.49%). For progression-free survival (PFS), the SUCRA ranking was: ZA (75.90%) >ALE (68.08%) >PAM (53.91%) >PLA (31.73%) >CLO (20.37%). Subgroup analysis revealed there was no statistically significant differences between the standard dosing group and the extended-interval dosing group in overall incidence of SREs or the time to the first SREs (Overall incidence of SREs: RR=1.00, 95%CI=0.89-1.13, P=0.960; The time to the first SREs: HR=0.97, 95%CI=0.74-1.27, P=0.775).

Conclusion

Current evidence suggests that denosumab may be the best pharmacological intervention available for the treatment of patients with bone metastases from solid tumours or multiple myeloma. In this regard, extended dosing frequency may be an acceptable treatment regimen option.

Efficacy and Safety of Antibiotic Bone Cement Combined with Vacuum Sealing Drainage for Diabetic Foot: a Meta-analysis

GUO Zhihong, CHEN Yingying, LIU Dewu

2026, 29(30):  4503-4512.  DOI: 10.12114/j.issn.1007-9572.2025.0102

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Background

Diabetic foot ulcers (DFU) represent prevalent chronic wounds with significant negative impacts on patients' health and socioeconomic status. Antibiotic bone cement (ABC) has emerged as a therapeutic option, though its efficacy and safety require comprehensive evaluation.

Objective

To perform a meta-analysis of randomized controlled trials (RCT) assessing the efficacy and safety of ABC for DFU, thereby providing evidence-based guidance for clinical practice.

Methods

We systematically searched CNKI, Wanfang Data, VIP, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science for RCT published until January 2025. Thirteen RCT involving 843 patients were included. The intervention group received ABC combined with vacuum sealing drainage (VSD), while controls received VSD alone. Outcomes included wound healing time, clinical efficacy rate, bacterial clearance time, hospital stay, surgical frequency, amputation rate, visual analogue scale (VAS) scores, and adverse events. RevMan 5.3 was used with random-effects models for heterogeneous data.

Results

The meta-analysis demonstrated that combined ABC therapy significantly: reduced wound healing time (MD=-14.46, 95%CI=-19.69 to -9.23; P<0.05), increased clinical efficacy rates (OR=7.81, 95%CI=3.94 to 17.48, P<0.05), shortened bacterial clearance time (MD=-4.04, 95%CI=-5.13 to -2.94, P<0.05), decreased positive bacterial cultures at 1-week post-treatment (OR=0.27, 95%CI=0.14 to 0.50, P<0.05), lowered amputation rates (OR=0.14, 95%CI=0.03 to 0.62, P=0.01), reduced surgical frequency (MD=-1.77, 95%CI=-2.52 to -1.03, P<0.05); decreased VAS scores (MD=-1.96, 95%CI=-2.35 to -0.57, P<0.05). Additionally, no adverse events were reported across the included studies. For wound healing time, it was divided into Wagner 5 group and non-Wagner 5 group according to different research subjects, and divided into combination group and monotherapy group according to different types of antibiotics. The results of the non-Wagner 5 group showed that ABC combined with VSD treatment could significantly shorten the wound healing time of DFU patients compared with VSD treatment alone (MD=-6.31, 95%CI=-7.88 to -4.74, P<0.05); The results of the Wagner grade 5 group showed that there was no significant difference between the experimental group and the control group (MD=-8.02, 95%CI=-20.11 to 4.07, P=0.19). The results of the antibiotic alone group showed that ABC combined with VSD treatment could shorten the wound healing time of DFU patients compared with VSD alone (MD=-4.52, 95%CI=-5.81 to -3.23, P<0.05). The results of the combination antibiotic group showed that ABC combined with VSD treatment could significantly shorten the wound healing time of DFU patients compared with VSD alone (MD=-14.21, 95%CI=-18.20 to -10.21, P<0.05). For the length of hospitalization, according to the age of the study subjects, they were divided into the average age greater than 60 years old group and the average age less than 60 years group. The results of the mean age group greater than 60 years showed that ABC combined with VSD treatment could shorten the hospital stay of DFU patients compared with VSD treatment alone (MD=-6.82, 95%CI=-10.93 to -2.71, P=0.001). The results of the average age less than 60 years old group showed that there was no significant difference between the experimental group and the control group (MD=-5.11, 95%CI=-17.78 to 7.56, P=0.45). For the number of surgeries, according to the wound treatment methods, it is divided into a group with skin graft and a group without skin grafting. The results of the no skin graft group showed that ABC combined with VSD treatment could reduce the number of surgeries in DFU patients compared with VSD treatment alone (MD=-1.79, 95%CI=-2.13 to -1.46, P<0.05). The results of the skin graft group showed that ABC combined with VSD treatment could significantly reduce the number of surgeries in patients with DFU compared with VSD treatment alone (MD=-1.89, 95%CI=-3.27 to -0.50, P=0.008). Sensitivity analysis was performed and the results of this study were found.

Conclusion

In this study, ABC combined with VSD is a safe and effective therapy for DFU, especially for non-Wagner grade 5 patients and the elderly, and the combination of antibiotics and skin grafting can further enhance the efficacy.