Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Primary medical institutions，with the characteristics of comprehensive，continuous，coordinated，convenient and economical，play an important role in the diagnosis and treatment of common and frequently#2; occurring children's diseases，planned immunization and child health management，and lay a solid foundation for children's health services. It is essential to improve the quality of child health services for children under the management of family doctor contract. There are regional differences in the ability of children's health services at primary institutions in China. Therefore， accurate evaluation of the quality of children's health services at primary institutions is helpful to find problems in time and promote the development of children's health services at a higher level. Objective To assess the quality of community children's health services for contracted children，analyze the quality problems and optimization strategies，and provide international vision and decision-making reference for further improving the quality. Methods Taking a district of Chengdu as a typical case，three community health service centers with stronger child health service ability in the district were selected as the sample institutions， and the parents of children contracted by the sample institutions were surveyed with the online questionnaire on the quality of community child health service by using the Chinese version of primary care assessment tool （PCAT）. Results Totally，3 631 parents of contracted children were investigated. The total PCAT score of community child health service quality in the sample centers was（58.72 ± 13.43）. The dimensions with relatively high PCAT scores of community child health service quality includes "continuity"，"community first consultation （service availability and service use）" and "comprehensive service （service provision）"，while the dimensions "children and family-Centered"，"comprehensive （available services）" and "coordination （referral）" had low scores. Conclusion It is suggested to strengthen the supply of diagnosis and treatment services for common pediatric diseases in the community，unblock the referral mechanism of Pediatrics，strengthen the awareness of parents of contracted children to be included in the contracted service team to participate in diagnosis and treatment decisions，and pay attention to the health services for children with non local registered residence.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Population aging has heightened，raising concerns about elderly health. Oral frailty，a novel frailty phenotype in the elderly，directly impacts the quality of life. A thorough grasp of oral frailty's prevalence in the elderly is crucial for formulating effective preventive and interventional strategies. Objective To systematically evaluate the prevalence of oral frailty in the elderly. Methods The CNKI，Wanfang Data，VIP，CBM，PubMed，Web of Science，Embase，CINAHL and Cochrane Library databases were searched for literature related to the study purpose with a time limit of the construction of the database to 19 April 2024. Literature was independently screened，information extracted and quality assessed by 2 researchers， and Meta-analysis was performed using Stata 14.0 software. Results A total of 19 cross-sectional studies were included，with a total sample size of 11 776 cases and a risk of bias quality score of 6-9，all of which were of moderate or high quality. Meta#2;analysis showed that the prevalence of oral frailty in elderly people was 29.5%（95%CI=24.1%-35.2%），and the prevalence of pre-oral frailty was 47.9%（95%CI=40.5%-55.4%）. Subgroup analyses showed that the progressive increase in the prevalence of oral frailty in the elderly with advancing age. Higher prevalence rates of oral frailty were observed in individuals screened using the Oral Frailty Index-8，Chinese elderly，elderly females，residents of medical and nursing care facilities，those withouta spouse，living alone，smokers，and elderly individuals with primary school education or lower（P<0.05）. Conclusion The prevalence of oral frailty is high in the elderly，warranting particular attention to the oral health status of elderly individuals in China who are advanced in age，female，residing in medical and nursing care facilities，living alone without a spouse， smokers，and have lower educational levels.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Obstructive sleep apnea（OSA）is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases，and affects cognitive function and multi-system organ function in the elderly. Therefore，it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society，as the initiator，organized domestic experts in related fields to repeatedly discuss the operation process，requirements，specific ways and methods of noninvasive positive pressure ventilation（NPPV）treatment for elderly OSA patients with reference to domestic and international clinical studies，and finally made this expert consensus，which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Research has linked the physical constitution of overweight/obese individuals to obesity， with a potential bidirectional association. Although FATmax intensity exercise can boost their fitness，the exact magnitude of this benefit needs further study. Objective Systematic evaluation is needed to assess the impact of FATmax intensity exercise on physical fitness indicators among overweight or obese populations. Methods Retrieve RCTs from PubMed，Web of Science，Ebsco，CNKI，VIP，Wanfang（January 2001 to January 2024） on FATmax exercise effects on body composition， cardiovascular endurance，lipid metabolism in overweight/obese patients. Evaluate quality with Cochrane tool，Meta-analyze with RevMan5.4.Results A total of 16 randomized controlled trials were included，including 568 overweight or obese patients. The Meta-analysis results showed that compared with the control group，the FATmax intensity exercise intervention group significantly improved body composition（BMI：WMD=-1.82，P<0.01；BFR：WMD=-2.86，P<0.01；WHR：WMD=-0.04，P<0.01）， cardiovascular endurance（VO2max：WMD=3.34，P<0.01），and lipid metabolism except for TC（TG：WMD=-0.24， P<0.01；HDL-C：WMD=0.14，P<0.01；LDL-C：WMD=-0.27，P<0.01）. Conclusion FATmax exercise benefits body composition，cardiovascular endurance，and lipid metabolism（except TC）in overweight/obese patients. Optimal results vary： ≥ 12 weeks，3-5 times/week，60-minute running for body composition；≥ 12 weeks，5 times/week，<60 minutes combined for VO2max； ≥ 12 weeks，3 times/week，60-minute running for TG； <12 weeks，4 times/week，60-minute combined for HDL-C；<12 weeks，4 times/week，>60-minute combined for LDL-C.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Diabetes has a high incidence rate and many complications，which was an urgent public health problem，but the prevention and management is still not ideal. Objective To observe the effect of Three Division management on metabolic indicators and self-management levels of diabetes patients with different courses of disease. Methods One hundred and 81 type 2 diabetes patients from April 2021 to April 2022 were managed by the mode of Three Division management and followed up for more than 6 months. The patients were grouped according to the course of disease（Group A：course of disease<1 year；Group B：course of disease 1-5 years；Group C：course of disease 5-10 years；Group D： course of disease>10 years）；In outpatient，the three-division team composed of traditional Chinese medicine practitioners， endocrinologists and caregivers carries out comprehensive treatment such as physique identification，complication screening， medicine，food，exercises and emotion intervention；When patients are at home，the caregivers carry out intelligent management through intelligent Glucose meter equipment and mobile phone APP. We collected changes in blood glucose and body weight indicators in patients with different disease courses after six months of management. Additionally，we used a questionnaire to gather common issues in patient self-management and fill out the Summary of Diabetes Self-Care Activities Measure-6 （SDSCA-6）. Results Through the management of the Three Division management，Group A patients showed significant improvement in reducing fasting blood glucose and postprandial 2-hour blood glucose after the intervention（P<0.05）. The BMI and waist circumference of groups A，B，C，and D were all reduced compared to before the intervention（P<0.05）. Common dietary issues in patient self-management included an unreasonable dietary structure（38.12%），common exercise issues included insufficient exercise volume or intensity（36.46%），and common monitoring issues included insufficient monitoring（37.02%）. The self-management levels of groups A，B，C，and D in the four dimensions of "healthy eating" "self#2;monitoring" "adherence to medical advice" and "education and communication" all improved compared to before the intervention （P<0.001）. Conclusion The Three Division management can improve the self-management ability of diabetes patients and play a good comprehensive role in diabetes. Clinical practice should particularly emphasize the management of patients with a diabetes course of less than one year.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Medically unexplained symptoms （MUS） is a common problem in primary medical care. The etiology of MUS is unclear，which brings continuous pain to patients and affects the doctor-patient relationship. As a result，the management of MUS is a challenge for general practitioners. Combined with relevant literature and guidelines，this paper expounds the diagnosis and treatment ideas of MUS，so as to help general practitioners identify and manage MUS in clinical practice effectively，and finally achieve the purpose of improving the treatment effect of patients and building a harmonious doctor-patient relationship.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Muscle mass loss increases the risk of hyperglycaemia and sarcopenia in patients with type 2 diabetes mellitus（T2DM），and Chinese adults with T2DM are predominantly non-obese，who are more likely to be associated with muscle mass loss than the obese. Objective To establish an individualized Nomogram prediction model for the risk factorsof muscle mass loss in non-obese patients with T2DM. Methods A retrospective study was conducted to select 905 non-obese patients with T2DM admitted to the Affiliated Drum Tower Hospital，Nanjing University from January 2018 to September 2023. The patients were divided into a training set（n=633）and a validation set（n=272）using simple random sampling at a ratio of 7∶3，and the general data and clinical indexes of the two groups of patients were collected and compared. Multivariate Logistic regression analysis was performed to determine risk factors for muscle mass loss in the training set and a Nomogram prediction model was constructed. The predictive value and clinical utility of the Nomogram prediction model were evaluated using receiver operating characteristic（ROC）curve，Hosmer-Lemeshow calibration curve，and decision curve analysis（DCA）， respectively. Results The prevalence of muscle mass loss in non-obese patients with T2DM was 42.3%（383/905）. Comparison of the clinical indicators of the patients in the training and validation sets showed no statistically significant differences（P>0.05）. Multivariate Logistic regression analysis showed that age（OR=1.039，95%CI=1.010-1.070，P=0.009），male（OR=3.425，95%CI=2.133-5.499，P<0.001），BMI<23.5 kg/m2 （OR=19.678，95%CI=11.319-34.210，P<0.001），elevated HbA1c （OR=1.196，95%CI=1.081-1.323，P<0.001），increased visceral fat area（OR=1.021，95%CI=1.010-1.032，P<0.001） were independent risk factors for muscle mass loss in non-obese patients with T2DM. The area under curve（AUC）of the ROC for the Nomogram prediction model to predict the risk of muscle mass loss occurring in patients in the training and validation sets was 0.825（95%CI=0.793-0.856，P<0.001）and 0.806（95%CI=0.753-0.859，P<0.001），respectively. The Hosmer-Lemeshow test showed that the model had a good fit（training set：χ2 =11.822，P=0.159；validation set：χ2 =8.189，P=0.415）. Bootstrap method of plotting the calibration of the model showed that the calibration curves fitted well to the standard curves. The DCA curves showed that it was more beneficial to use the Nomogram prediction model to predict the incidence risk of muscle mass loss in patients with T2DM when the threshold probability of the patient was 0.06 to 0.94. Conclusion Age，male，BMI<23.5 kg/m2 ，elevated HbA1c，and increased visceral fat area are independent risk factors for muscle mass loss in non-obese patients with T2DM. The Nomogram prediction model established in this study can individually predict the risk of muscle mass loss in non#2;obese patients with T2DM，which facilitates the early identification of high-risk groups and the development of individualised interventions.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background With the acceleration of China's aging population，the prevalence of chronic diseases and comorbidity patterns pose significant challenges to global health. There is a close relationship between the prevalence of chronic diseases and individuals' self-rated health （SRH） status. However，there is limited research on the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang，China，and their impact on SRH status. Objective To understand the prevalence of chronic diseases and comorbidity patterns among middle#2;aged and elderly populations in rural areas of Xinjiang and to explore the impact of chronic diseases and comorbidity patterns on SRH status，providing effective reference for improving the health level of this population. Methods The data for this study were derived from the survey database of the National Social Science Foundation project （17BRK030） from 2016 to 2019. A questionnaire survey was conducted on the demographic characteristics，chronic disease status，and self-rated health status of male and female heads of households. Ordered logistics regression analysis was used to screen the influencing factors of SRH status. SOM network training analysis and partial least squares method were employed to evaluate the interrelationships among 14 chronic diseases and the degree of their impact on SRH status. Results A total of 3 400 middle-aged and elderly individuals were surveyed. Residents' SRH status varied significantly by geographical distribution，gender，age，education level，occupation， marital status，illness or disability，and chronic disease status（P<0.05）. Geographical region as southern Xinjiang，education level of primary school and below，and presence of chronic diseases were identified as risk factors for SRH status. Being male， aged 45-59 years，occupation as pastoralists，staff of government or public institutions，or technical workers，being divorced， and having illness or disability were identified as protective factors for SRH status. The prevalence of chronic diseases among middle-aged and elderly populations in rural areas of Xinjiang was 71.96%. The top three diseases were hypertension （36.67%）， arthritis or rheumatism（18.09%），and heart disease（11.91%）. The comorbidity rate of chronic diseases was 22.18%，with hypertension（23.19%），arthritis or rheumatism（19.62%），and heart disease（17.84%） being the top three comorbid diseases. The predominant comorbidity pattern was the co-occurrence of two chronic diseases（78.18%）. The most common comorbidity pattern among individuals with two chronic diseases was hypertension combined with heart disease，and among those with three chronic diseases was hypertension combined with heart disease and arthritis or rheumatism. The impact of chronic disease status on SRH status revealed that individuals with chronic diseases had significantly lower SRH status than those without chronic diseases，and individuals with two or more chronic diseases had lower SRH status than those with one chronic disease. Conclusion The prevalence of chronic diseases and comorbidity among middle-aged and elderly populations in rural areas of Xinjiang is high. Chronic respiratory diseases，arthritis or rheumatism，heart disease，anemia，and other chronic diseases have a significant impact on SRH status. Therefore，it is necessary to further strengthen the construction of chronic disease service systems，improve the health records of middle-aged and elderly individuals，establish specialized clinics for chronic disease comorbidity to detect and control the comorbidity of chronic diseases among middle-aged and elderly populations. Additionally， efforts should be made to enhance health education for middle-aged and elderly groups，increase awareness of chronic diseases， and promote active and healthy lifestyles to improve the health level and quality of life of middle-aged and elderly populations.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background Nonalcoholic fatty liver disease（NAFLD）is a common digestive system disease，which is often diagnosed by imaging methods in clinical work. At present，there is a lack of research on the effectiveness evaluation of imaging diagnostic methods with histology as the gold standard. Objective To study the consistency of imaging and histological diagnosis of NAFLD，and to analyze the influencing factors of gallstone disease（GD）complicated with NAFLD. Method From January 2021 to July 2022，53 patients with GD who underwent simple cholecystectomy and liver biopsy were selected from the Department of Hepatobiliary surgery，Nanjing Hospital affiliated to Nanjing University of traditional Chinese Medicine. The demographic characteristics，BMI，systolic blood pressure（SBP）and diastolic blood pressure（DBP）of the subjects were collected，and the laboratory indexes，imaging and histological results were collected. The consistency of imaging and histological diagnosis of NAFLD was evaluated by Kappa consistency test. According to the histological diagnostic criteria，the subjects were divided into NAFLD group（n=15）and non-NAFLD group（n=38）. Multivariate Logistic regression analysis was used to explore the influencing factors of NAFLD in patients with GD. Results The imaging detection rate of NAFLD in GD patients was 20.7%（11/53），which was lower than that of histology（28.3%）（15/53）（Kappa=0.404，P=0.001）. The sensitivity of imaging diagnosis was 60.0%（9/15），the specificity was 94.7%（36/38），and the rate of missed diagnosis was 40.0%（6/15）. There were 8 cases of nonalcoholic fatty liver（NAFL），7 cases of nonalcoholic steatohepatitis（NASH） and no NASH associated cirrhosis in 15 patients with histological manifestation of NAFLD. The proportion of fibrosis in the NASH group was higher than that in the NAFL group. There were significant differences in the levels of BMI，SBP，fasting blood glucose（FPG）and aspartate aminotransferase（AST）between NAFLD group and non-NAFLD group（P<0.05）. Multivariate Logistic regression analysis showed that BMI（OR=1.5，95%CI=1.084~2.075，P=0.014）and FPG（OR=2.163， 95%CI=1.246~3.756，P=0.006）were the influencing factors of GD patients with NAFLD. Conclusion Compared with histological diagnosis，the missed diagnosis rate of imaging diagnosis of NAFLD is higher，and the incidence of NAFLD may be underestimated by imaging diagnosis as a means of epidemiological investigation. High BMI and high FPG are the main risk factors of GD complicated with NAFLD.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background Adolescence is a high-risk period for obesity，and it is crucial and urgent to implement obesity control among adolescents. However，existing interventions commonly face challenges in sustainability and scalability. Asset assessment to identify and leverage existing community assets and strengths is essential to facilitate and maintain the implementation of these programs. Objective To assess assets for obesity control among middle school students，and to identify the advantages and deficiencies in the current policy，physical，social，and information environments，along with suggestions for improvements. Methods From 2023 to January 2024，purposive sampling method was adopted，face-to-face one-by-one interviews were conducted with 11 staff members involved in obesity control for middle school students from the Center for Disease Control and Prevention，Education Bureau，and three middle schools in a major city in East China. Additionally，eight parents and their children from each of the three schools were invited to participate in focus group discussions，with 6 groups and 8 participants per group. Thematic analysis was applied to analyze the interview data. Results This study found that the advantages in obesity control for middle school students primarily included policies and conditions ensured for obesity surveillance，nutritional school lunch and physical activity，along with media for health communication. The main deficiencies were the lack of specific policies for efficient obesity control，insufficient physical and social assets to support healthy eating and physical activity，and the quality and intensity of information assets supporting to facilitate changes in knowledge，attitude，and behaviors. In response to these challenges，participants suggested the implementation of both rigid regulations and flexible incentives，improvement of asset accessibility，encouragement of multi-stakeholder cooperation，and strengthening of health communication. Integrating existing assets and suggestions for improvement has formed an asset assessment checklist，corresponding to 10 assets from the policy environment，8 from the physical environment，20 from the social environment，and 12 from the information environment. Conclusion Several assets exist for obesity control among middle school students and identifies areas for improvement. Subsequent efforts in obesity control for middle school students should be made on promoting intervention strategies to better align with the context based on the asset assessment checklist to diagnose the current status of assets，thus enhancing the efficacy and sustainability of the program.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： General practitioners with sub-specialties can not only provide high-quality general medical services， but also provide a certain depth of specialized medical services. The combination of general practitioners with sub-specialties of different specialties can provide relatively comprehensive and certain depth of basic medical services for residents in their jurisdictions. Under the situation that the professional service capacity of mental health cannot meet the needs of residents，the necessity of encouraging some general practitioners to develop mental health subspecialties has become increasingly prominent. This article analyzes the necessity of training general practitioners with psychosis subspecialty; The advantages of developing psychosis subspecialty among general practitioners; The obstacles to promoting the development of psychosis sub-expertise of general practitioners in primary care are proposed：the construction of general practitioners training bases for psychosis sub#2;expertise; The learning platform for general practitioners with psychosis sub-expertise was expanded; Construction of sub-specialty teachers of psychosis; Policy and financial support，salary and promotion incentive policies，etc.，are expected to help general practitioners develop psychosis sub-expertise.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background Central precocious puberty（CPP） is a common endocrine disease in children，which shows an increasing trend year by year in recent years. It can be divided into fast-progressing central precocious puberty（RP-CPP） and slow-progressing central precocious puberty（SP-CPP） through pubertal development. RP-CPP has great harm，but it is difficult to distinguish it from SP-CPP in early clinical stage，mainly relying on the progress of adolescent development and bone age during follow-up. At present，there is a lack of effective laboratory indicators to predict RP-CPP. Objective To investigate the relationship between luteinizing hormone（LH）/follicle-stimulating hormone （FSH） ratio and pubertal development. Methods CPP girls aged 4-10 years old（n=380） admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2020 to May 2022 were regression selected and divided into RP-CPP group （n=130） and SP-CPP group（n=250 cases）according to indicators such as puberal development process. Clinical characteristics of the two groups were compared and analyzed. Univariate and multivariate Logistic regression analysis of the influencing factors of RP-CPP was performed，and ROC curve of LH/FSH ratio on the predictive value of RP-CPP was drawn. Results The height，weight，BMI，IGF-1，difference between bone age and actual age，bilateral ovarian volume，LH base value，estradiol level，LH base value /FSH base value， and LH peak /FSH peak value of girls in RP-CPP group were all higher than those in SP-CPP group，with statistical significance （P<0.05）. Regression analysis showed that CPP patients progressed to RP-CPP related serological indexes when LH base value and LH peak /FSH peak were detected. LH base /FSH base value and LH peak /FSH peak were positively correlated with height， IGF-1，LH base value，estradiol level，LH peak，ovarian volume and bone age（P<0.05）. ROC curve showed that the LH base /FSH base value and LH peak /FSH peak value were more sensitive and specific than other indexes to the predictive value of RP-CPP. When the LH base /FSH base value was 0.63，the Yoden index reached a maximum of 0.258（sensitivity 43.1%， specificity 82.7%，AUC=0.644）. When the LH peak /FSH peak was 1.39，the maximum Jorden index was 0.276（sensitivity 74.6%，specificity 53.0%，AUC=0.655）. The combined prediction model is better than the single index prediction model （AUC=0.668）. The basal gonadotropin levels of children without clinical intervention were analyzed after 6 months of follow#2;up. It was found that the height increase，ΔLH，ΔFSH，bone age increase and ovarian volume increase in RP-CPP group were significantly higher than those in SP-CPP group after 6 months of follow-up，and the difference was statistically significant （P < 0.05）. Conclusion LH base /FSH base value and LH peak /FSH peak are early predictors of RP-CPP. When LH/FSH base value ≥ 0.63 or LH peak/FSH peak ≥ 1.39，the possibility of RP-CPP should be considered，and the combined predictive value of the two indicators is better than that of a single indicator. It can be used as an auxiliary reference index for clinical application of gonadotropin-releasing hormone analogue therapy.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background Cardiometabolic multimorbidity （CMM） was one of the most common comorbidity aggregation patterns in different regions and populations，with a high risk of mortality. However，studies on the clinical and medication characteristics of CMM were limited. Objective To study the clinical characteristics and medication patterns of patients with CMM in the real world，and provide reference basis for the prevention and management of CMM. Methods Outpatient patients who were diagnosed with cardiometabolic multimorbidity in the hospital information system（HIS）from January 2023 to June 2023 were selected. Basic prescription information was collected and analyzed using frequency analysis and association rule analysis methods. Results A total of 7 059 patients with CMM were included，of which 3 960（56.1%） were male and 3 099（43.9%） were female，with an age range of 18 to 97 years and a mean age of （58.1±13.7） years. The results showed that 3910 patients with less than 5 types of medication，accounting for 55.4%；2 740 patients with 5-9 types of medication，accounting for 38.8%；and 409 patients with more than 10 types of medication，accounting for 5.8%. Hypertension，dyslipidemia，and diabetes were the core diseases of CMM. Among the comorbidities of cardiovascular metabolic diseases，chronic gastritis，renal insufficiency，and hyperuricemia were more common. In the prescription of patients with CMM，statins，calcium channel blockers（CCB），angiotensin receptor blockers（ARB），metformin，and sodium-dependent glucose transporters 2 inhibitors（SGLT2i） were the core medications. Conclusion Our findings suggestchronic gastritis，renal insufficiency，and hyperuricemia are more common diseases in patients with CMM. Screening and prevention should be strengthened and treatment strategies should be adjusted. In the CMM drug prescription，lipid-lowering， antihypertensive，and hypoglycemic drugs are the core drugs used.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-31 Cooperative journals: 《中国全科医学》
Abstract： To provide researchers with a comprehensive understanding of the Psychology and Behavior Investigation of Chinese Residents（PBICR），this paper introduces its background and features from four aspects. In terms of design concepts，PBICR focuses on many aspects of mental health and health behaviours in the Chinese population，takes full account of timeliness and efficiency，adheres to the original intention of data openness and data sharing，builds a high-quality database with a large-sample，multi-centre，repetitive，nationwide cross-sectional design，and promotes data mining and exchange and cooperation; in terms of survey implementation，PBICR adopts a proportional to the size of the population，a combination of multilayer sampling and quota sampling，obtains data through face-to-face field surveys，and implements a rigorous sampling methodology. In terms of survey implementation，PBICR adopts a combination of population size-proportional，multistage random sampling and quota sampling sampling，and obtains data through face-to-face field surveys with strict quality control to ensure the representativeness and reliability of the samples; in terms of output，PBICR's research content is rich and updated in line with international hotspots，which can satisfy the demand for research on diversified variables and data，and the results of its past research have a higher influence in many fields such as public health，management，communication，and psychology; Looking ahead，PBICR will gradually complete the construction of databases from the general database to sub-databases，pay attention to special populations and a wide range of regions around the world，add tracking surveys and biomedical data research perspectives，and have great research potential to drive research on the mental and behavioural health of Chinese residents through the overall layout of the multi-dimensional.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-23 Cooperative journals: 《中国全科医学》
Abstract： Background Currently，the treatment of refractory epilepsy（RE）in children is still a difficult point in epilepsy treatment. In China，pirenzapine（PER）is still a new drug for treating RE in children，and there is currently a lack of recommendations for adding PER to the treatment of RE in children. And in Chinese reports，the sample size of RE patients treated with PER is relatively small. Therefore，the efficacy of PER for pediatric RE，especially for young children with RE，still needs to be further studied with a large sample size. Objective To explore the efficacy，possible indications，adverse reactions，and tolerability of PER addition therapy for RE in children. Methods A self-control and retrospective analysis was conducted on children with RE aged 0-18 who were treated at the Women and Children's Hospital affiliated with Qingdao University from January 2022 to January 2023. The frequency of seizures at different observation points before and after the addition of PER treatment was compared，and the effective rate of PER was evaluated. Adverse drug reactions and drug retention rates were recorded，and the clinical characteristics of the effective and ineffective groups of PER were analyzed. Result A total of 192 study subjects were included. After adding PER treatment，the effective rates at 12，24，and 36 weeks were 56.3%（108/192），62.1%（113/182），and 69.7%（122/175），respectively，and the seizure free rates were 19.3%（37/192），21.4%（39/182），and 24.6%（43/175）. The incidence of adverse reactions was 16.1%（31/192），mainly including dizziness，irritability，weakness，and drowsiness. The last follow-up drug retention rate was 91.1%（175/192）. There was a statistically significant difference（P<0.05）in the onset age，duration of anti-epileptic treatment，type of origin，seizure form，frequency of seizures before the addition of PER，number of combined anti-epileptic drugs（ASMs），and ketogenic diet/surgical treatment between patients with RE who received continuous medication for 12 weeks. In addition，178 children underwent EEG examination，and 167 children underwent cranial magnetic resonance imaging examination. There was a statistically significant difference （P<0.05）in the electroencephalogram（EEG）and head magnetic resonance imaging（MRI）results between patients who received effective and ineffective treatment. In the results of electroencephalogram examination，the effective rate of discharge in the anterior（anterior，middle，temporal anterior，and middle）part of the brain is higher；In the results of cranial imaging examination，the normal group had a higher effective rate，followed by children with mainly white matter damage. Conclusion The overall effective rate and retention rate of PER addition therapy for RE in children are high，with mild adverse reactions and good drug tolerance. It is more effective for children with RE who have a late onset age，seizures in the form of motor seizures，focal origin，short course of anti-epileptic treatment，fewer combination medications，and less frequency of seizures. In electroencephalography，patients with normal discharge in the anterior（anterior，middle，anterior temporal，and middle temporal）of the brain and normal results in cranial magnetic resonance imaging have a higher effective rate.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-22 Cooperative journals: 《中国全科医学》
Abstract： Background Previous studies have confirmed that screen exposure is widespread in preschool children and is related to children's emotional and behavioral problems. Most of the existing studies focus on normal preschool children， but the research on screen exposure and emotional and behavioral problems of preschool autistic children is relatively rare. Objective To investigate the screen exposure and the abnormal detection of emotional and behavioral problems in preschool children with autism，and to explore the association between screen exposure and emotional and behavioral problems in preschool children with autism. Methods Preschool children with autism who met the diagnostic and Statistical Manual of Mental Disorders（DSM-V）autism diagnostic criteria and visited the Department of Child Development and Behavior of the Third Affiliated Hospital of Zhengzhou University from February to August 2022 were selected as the autism group. At the same time， children with normal development in kindergartners in Zhengzhou were selected as the normal control group. The screen exposure questionnaire and the Strengths and Difficulties Questionnaire（parent version）were completed by the main caregivers of the children in the two groups. Results There were significant differences between the two groups in terms of screen time，parents' response to screen management，and screen deprivation （P<0.001）. Compared with the control group，the children in the two groups had significantly higher detection rates of prosocial behavior，total difficulties，and sub-dimensions（emotional symptoms，conduct problems，hyperactivity/inattention problems，and peer problems） （P<0.001）. Logistic regression showed that the influencing factors of emotional and behavioral problems in preschool ASD children included placing electronic devices in the sleeping or playing space，whether caregivers interacted with each other during watching，caregivers' attitudes toward children's electronic screen watching，whether they were active or passive participants in touching electronic screens，and children's reactions to forced turning off electronic screens（P<0.05）. Conclusion Screen exposure can affect the emotional and behavioral problems of preschool children with autism. Parents should rationally plan screen use for preschool children with autism.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-20 Cooperative journals: 《中国全科医学》
Abstract： Background Atherosclerosis（AS）is the main pathological basis of cardiovascular disease and is characterized by vascular endothelial inflammation，thus targeting inflammation-related mechanisms is the key to prevention and treatment of AS. Objective To investigate the effect of the hexosamine biosynthesis pathway（HBP）on adhesion molecules and its regulatory role in vascular endothelial inflammation. Methods From August to December 2022，24 SPF grade C57BL/6 female mice were divided into control group，DON group，HFD group，HFD+DON group according to randomized block design method using body weight stratification. Serum and aortic tissue from the mice were collected after 15 weeks of administration of high-fat diet and intraperitoneal injection of DON. The lipid levels of mice were detected using biochemical kits before and after intervention，pathological changes in the aortic root were detected by HE staining，and the expression levels of intercellular adhesion molecule-1（ICAM-1）and vascular cell adhesion molecule-1（VCAM-1）were detected by immunofluorescence staining，ELISA and Western blot. Results After 15 weeks of intervention，compared with the control group，the levels of LDL-C and TC were increased significantly in the HFD group，while HDL-C was reduced significantly（P<0.05）；There was no change in the lipid levels between the HFD group and the HFD+DON group. HE staining results showed that the vascular intima was thickened，the morphology of vascular smooth muscle was abnormal，the structure was disorganized，and a largenumber of foam cells were seen in HFD group. The smooth muscle cells of mice were neatly aligned，the endothelial cell layer was continuous，the number of foam cells was reduced significantly，and the cell gap was normal basically in the HFD+DON group. The results of immunofluorescence staining，ELISA and Western blot showed that the expression of ICAM-1 and VCAM-1 was down-regulated in the HFD+DON group compared with the HFD group. Conclusion Inhibition of HBP can down-regulate the expression of ICAM-1 and VCAM-1，and play a role in improving vascular endothelial inflammation.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-20 Cooperative journals: 《中国全科医学》
Abstract： Background Chronic obstructive pulmonary disease（COPD） is one of the most common respiratory diseases in elderly patients，and a decrease in oxygen saturation during activity is a common phenomenon correlated with the prognosis. Current assessment of exercise-induced hypoxia（EID） has yielded controversial results. Objective To explore methods suitable for inducing EID in community and home-based COPD patients. Methods This was a retrospective study involving 76 patients with stable COPD admitted to China-Japan Friendship Hospital from January 2021 to August 2023. Resting oxygen saturation and the lowest oxygen saturation during exercise（ΔSpO2） in the six-minute walk test 6MWT） were recorded. Based on the criterion of ΔSpO2 ≥ 4% for the diagnosis of EID，patients were assigned into non-EID group and EID group. Pulmonary function indicators，ΔSpO2 during 30-second sit-to-stand-test（30s STST），and COPD Assessment Test （CAT） were compared between the two groups. The correlation of ΔSpO2 in 6MWT with ΔSpO2 of 30s STST and CAT scores was identified. The predictive value of ΔSpO2 of 30s STST，CAT score，andΔSpO2 of 30s STST combined with CAT score in predicting EID was analyzed using the receiver operating characteristic（ROC） curves. Results There were significant differences in the ΔSpO2 of 30s STST and CAT score between non-EID group and EID group. The cut-off value of ΔSpO2 of 30s STST in predicting EID was 2，with the sensitivity，specificity and area under the curve（AUC） of 59.6%，82.8%， 0.730（95%CI=0.614-0.846，P<0.05），respectively. The cut-off value of CAT scores in predicting EID was 13，with the sensitivity，specificity and AUC of 48.9%，79.3%，0.712（95%CI=0.596-0.828，P<0.05），respectively. The cut-off value of ΔSpO2 of 30s STST combined with CAT scores in predicting EID was 0.593，with the sensitivity，specificity and AUC of 70.2%，72.4% and 0.765 （95%CI 0.659-0.871，P<0.001），respectively. Conclusion ΔSpO2 of 30s STST ≥ 2% and CAT score ≥ 13 points alarm the development of EID. The 30s STST and CAT can be used as community and home-based measures to predict the induction of EID in patients with stable COPD.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-20 Cooperative journals: 《中国全科医学》
Abstract： Background Carotid atherosclerosis（CAS）is often considered an early warning signal for cardiovascular diseases（CVD）. The diagnostic technique of carotid artery Doppler ultrasonography has not been included in public health service programs，and the Framingham Risk Score（FRS）lacks accuracy in assessing CAS risk，hindering the identification of CAS by primary healthcare personnel. Currently，there is a lack of research on machine learning methods to identify CAS in the medium-high risk population assessed by FRS. Objective To construct a CAS risk prediction model for the medium-high riskpopulation assessed by FRS using machine learning methods，compare its discriminative efficacy，select the optimal model，and assist primary healthcare personnel in identifying CAS more conveniently and accurately. Methods A total of 674 local residents from two townships in Liuzhou City，Guangxi Zhuang Autonomous Region，who met the inclusion criteria from 2019 to 2021 and 2023，were selected as the study subjects. Relevant information was collected，and biochemical indicators were measured in fasting blood and urine samples. FRS was used to assess the risk of CVD occurrence，and carotid ultrasound was used to diagnose CAS. Among the 517 subjects from 2019 to 2021，a random 8 ∶ 2 split was used to create a training set and a validation set. The training set was used to build Logistic regression，Random Forest（RF），Support Vector Machine（SVM），Extreme Gradient Boosting（XGBoost），and Gradient Boosting Decision Tree（GBDT）models，while the validation set was used for internal validation. The 157 subjects from 2023 served as the test set for external validation. Feature variables were selected using Lasso regression analysis，and discriminative efficacy was evaluated using sensitivity，specificity，accuracy，F1 score，and area under curve（AUC）value. External validation assessed the generalization ability of the optimal model using AUC value，and the Shapley Additive exPlanation（SHAP）method explored the important variables influencing the optimal model's identification of CAS. Results Lasso regression analysis identified 15 feature variables：age，BMI，systolic blood pressure（SBP）， smoking，drinking，hypertension，total cholesterol，high density lipoprotein cholesterol，C-reactive protein（CRP），fasting plasma glucose，apolipoprotein B（ApoB），lipoprotein（a）（LPA），aspartate aminotransferase （AST），AST/ alanine aminotransferase，urinary microalbumin creatinine ratio. The constructed Logistic regression，RF，SVM，XGBoost，and GBDT models exhibited high AUC values，with the GBDT model showing the best discriminative performance. Its sensitivity， specificity，accuracy，F1 score，and AUC value were 0.755 1，0.836 4，0.798 1，0.778 9，and 0.834 9，respectively，and the external validation AUC value was 0.794 0. The SHAP method revealed that age，SBP，CRP，LPA，and ApoB were the top five factors influencing the GBDT model's identification of CAS. Conclusion Logistic regression，RF，SVM，XGBoost，and GBDT models for identifying CAS based on machine learning all demonstrated high discriminative performance，with the GBDT model exhibiting the best comprehensive discriminative efficacy and strong generalization ability.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-17 Cooperative journals: 《中国全科医学》
Abstract： Background Acute coronary syndrome（ACS） is a group of pathological clinical syndromes with coronary atherosclerotic plaque rupture or erosion，followed by complete or incomplete occlusion of thrombosis. The selection of specific and sensitive serological markers and detection methods has important clinical value for rapid and accurate early diagnosis，assessment of the condition，and adoption of treatment measures in ACS patients. Objective Explore the relationship between plasma nucleolin（NCL） levels in ACS patients and the stability and severity of coronary artery plaques in ACS patients，as well as the value of NCL in predicting ACS. Method 117 patients admitted to the Cardiovascular Department of Changsha First Hospital in 2022 and completed coronary angiography were selected as the study subjects，all of whom met the ACS standards. 36 cases were unstable angina（UA group），36 cases were non ST segment elevation myocardial infarction（NSTEMI group），and 45 cases were ST segment elevation myocardial infarction（STEMI group）（all considered ACS patients）， with 39 non ACS patients selected as the control group. Collect patient blood samples and general clinical data，and detect plasma levels of nucleolin，C-reactive protein（CRP），and low-density lipoprotein cholesterol（LDL-C）. According to the results of coronary angiography，ACS patients were divided into non lesion group，single vessel lesion group，double vessel lesion group， and multi vessel lesion group. According to ultrasonic echo characteristics，ACS patients were divided into vulnerable plaque group and stable plaque group. Those without atherosclerotic plaque were classified as plaque free group. Evaluate the correlation between NCL expression levels and CRP and LDL-C levels in various groups of ACS patients；Analyze the correlation between the number of coronary artery lesions，severity of coronary artery lesions，and Gensini score in NCL and ACS patients；Multiple logistic regression analysis was used to identify independent risk factors for the occurrence of ACS in plasma NCL，and receiver operating characteristic（ROC） curves were used to evaluate the optimal threshold for predicting ACS occurrence in NCL. Result The levels of NCL，LDL-C，and CRP in the UA，NSTEMI，STEMI groups were significantly higher than those in the control group，and there was a positive correlation of NCL levels with LDL-C and CRP （P<0.05）. After comparing the NCL levels of patients with different degrees of carotid plaque，it was found that the level of the vulnerable plaque group was higher than that of the stable plaque group，while the level of the stable plaque group was higher than that of the plaque free group. Therefore， the NCL level was positively correlated with the degree of carotid plaque（P<0.05）. The NCL levels of patients with multivessel coronary artery disease were higher than those of patients with double-vessel coronary artery disease（P<0.05），while the levels of double-vessel disease patients were higher than those of patients with single-vessel coronary artery disease （P<0.05）， indicating a significant positive correlation of NCL levels with the number of diseased coronary vessels （P<0.05）. The NCL levels in high Gensini score group were significantly higher than those in the low and medium groups（P<0.05），and there was a significant positive correlation of the number of diseased coronary vessels with Gensini score （P<0.05）. Multivariate logistic regression analysis showed that NCL was an independent risk factor for ACS，and ROC curve analysis suggested that the optimal diagnostic threshold for NCL was 0.765. Conclusion The expression level of plasma nucleolin has certain clinical significance for evaluating plaque stability in ACS patients，and has certain reference value for ACS identification and risk stratification prediction. The plasma NCL level is positively correlated with the number of coronary artery lesions and Gensini score，and can serve as a reference indicator for predicting and evaluating the severity of coronary artery lesions to a certain extent. Elevated plasma NCL levels may be an independent risk factor for the occurrence of ACS and have predictive diagnostic value for ACS.
Hits
Hits
Downloads
Comment