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.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-15 Cooperative journals: 《中国全科医学》
Abstract： Background Body roundness index（BRI）is a simple measure of central obesity and is strongly associated with cardiovascular disease. People with metabolically obese normal weight（MONW）have a higher risk of cardiovascular disease and are significantly associated with central obesity. The triglyceride glucose（TyG）index is an indicator of insulin resistance. There are limited studies on the relationship between BRI，TyG index and MONW phenotypes in gender#2;specific elderly populations. Objective To explore differences in the risk of prevalence of the BRI and MONW phenotypes in the elderly population by gender，and to explore the TyG index as a potential factor in their differences by gender. Methods Permanent residents ≥ 60 years of age who underwent physical examination in 10 cities and counties in Anhui Province from 2017-07-01 to 2021-06-30 were selected as study subjects. A unified questionnaire was used to collect information on gender， age，and disease history of the study subjects，collect information on physical examination and laboratory tests，and calculate BRI and TyG indices. Men and women will be classified into metabolically healthy normal weight（MHNW）phenotype and MONW phenotype according to metabolic status and BMI level，respectively：male MHNW phenotype（n=5 384），male MONW phenotype（n=6 251）；female MHNW phenotype（n=4 498），female MONW phenotype（n=8 264）. Males and females were divided into 4 levels according to BRI quartiles，males：M1，M2，M3，and M4，and females：F1，F2，F3， and F4，respectively.Logistic regression analyses were performed to explore the association between BRI quartile levels and the risk of elevated TyG index and the risk of prevalence of MONW phenotypes respectively，using the Z test was used to compare the differences between the OR value of male and female. Results A total of 24 397 investigators were included in this study， including 11 635（47.7%）males and 12 762（52.3%）females，with a median age of 67（64，70） years，and 9 882（40.5%） with MHNW phenotype and 14 515（59.5%）with MONW phenotype. Hypertension，diabetes mellitus，dyslipidaemia，systolic blood pressure，diastolic blood pressure，TyG index，BRI，fasting glucose（FPG），total cholesterol（TC），triglyceride （TG），and low-density lipoprotein cholesterol（LDL-C）in the elderly population of different genders with MONW phenotype were higher than in the MHNW phenotype，and smoking and high-density lipoprotein cholesterol（HDL-C）were lower than in the MHNW phenotype（P<0.05）；prevalence of MONW phenotype，hypertension，diabetes mellitus，dyslipidaemia，TyG index，FPG，and TG were higher than those of low level BRI，and HDL-C was lower than those of low level BRI in the elderly population of different genders with high level BRI（P<0.05）. The results of univariate logistic regression analysis showed that the risk of elevated TyG index was increased at BRI M2/F2，M3/F3，and M4/F4 levels in elderly populations of different genders compared with BRI M1/F1 levels（P<0.05）；and the risk of elevated TyG index increased with increasing BRI levels（Ptrend<0.001 for male，Ptrend<0.001 for female）；and the risk of elevated TyG index was higher at BRI M2，M3，and M4 levels in older men than at BRI F2，F3，and F4 levels in older women（P<0.05）. Multifactorial Logistic regression analyses after correction for confounders showed that the risk of MONW phenotype prevalence was increased at the BRI M2/F2，M3/F3，and M4/F4 levels in the elderly population of different genders compared with the BRI M1/F1 level（P<0.05）；and the risk of MONW phenotype prevalence increased with the increase of the BRI level（Ptrend<0.001 for male，Ptrend<0.001 for female）；and the risk of the MONW phenotype was higher in older men than in older women at BRI levels M2 and M4（P<0.05）. Conclusion BRI levels were significantly and positively associated with the risk of the MONW phenotype in older adults of different genders，with high levels of BRI more strongly associated with the risk of the MONW phenotype in older men，with the TyG index being a potential factor contributing to the gender difference.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-15 Cooperative journals: 《中国全科医学》
Abstract： The increasing prevalence of chronic diseases globally poses major challenges to the health of societies and individuals. Managing chronic diseases requires long-term treatment and monitoring，placing demands on patients' lifestyles. With the aging of the population and changes in lifestyle，chronic disease prevention and control are becoming more and more important. In recent years，as scientific and technological innovation in the field of healthcare develops in depth，and the application of artificial intelligence in healthcare has gradually become one of the important strategic directions of the country，the traditional method of chronic disease management relies too much on the offline communication between the doctor and the patient， which leads to the doctor not being able to maintain long-term and effective communication and follow up with the patient，and the patient may not be able to be detected and monitored by the doctor in a timely manner when his or her condition changes. In addition，the traditional chronic disease management approach is usually a generalized approach that fails to adequately consider the individual differences of each patient. Given the limitations of traditional chronic disease management methods，this study aims to provide more convenient and efficient primary care services using intelligent robots. Through personalized health management plans，assisted medical diagnosis，and timed medication reminders，the intelligent robot is committed to improving patients' quality of life，reducing the pressure on healthcare resources，and promoting the development of intelligent healthcare management globally.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-15 Cooperative journals: 《中国全科医学》
Abstract： Background Responsiveness is a key goal in evaluating the performance of the health system，and is also an essential basis for improving the capacity of primary health services. Currently，many studies confuse the concepts of responsiveness and satisfaction，and the evaluation of responsiveness is not comprehensive enough，focusing on the level of responsiveness but ignoring its distribution. Objective To understand the responsiveness evaluations of community health services among residents of different ages in Zhejiang Province and to analyze its influencing factors. Methods Utilizing the method of purposive sampling and convenience sampling，six community health service centers in Hangzhou and Taizhou， Zhejiang Province，were selected as the investigation sites from July to August 2022 to assess the responsiveness scale of outpatient residents. The weights of the eight components of responsiveness recommended by the WHO were used to calculate the overall level and distribution of responsiveness. Univariate analysis and multiple linear regression were used to explore the influencing factors on the responsiveness level among residents of different ages. Results The score of responsiveness for community health services in Zhejiang was（8.31±1.04）points，and the responsiveness distribution index was 0.13；residents of different age groups expressed their higher satisfaction with the dimensions of dignity and social support，with scores of（8.60±1.24）points and（8.63±1.20）points，respectively. In contrast，the dimensions of selectivity and autonomy received lower ratings，with scores of（7.96±1.56）points and（8.04±1.33）points，respectively. Household registration was an influencing factor for responsiveness evaluation of community health services among young people，while education level and monthly income were influencing factors for responsiveness evaluation among middle-aged individuals. Conclusion The overall level of community health service responsiveness in Zhejiang Province is good，and the distribution is more balanced. More attention should be paid to the demand and responsiveness of community health services among young people with urban household registration and middle-aged people with a college/bachelor's degree or above. Primary care community health service centers still need to improve in providing patients with access to information about health service plans and the freedom to choose community doctors/nurses，thereby better satisfying the reasonable healthcare service demands of residents.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background At present，the proportion of DRUG-RESISTANT epilepsy（DRE）in children is still maintained at about 30%，and it is often combined with mental retardation，affecting the quality of life，so the diagnosis and treatment of DRE is still a major challenge in neurology. Objective Analyze the genetic and clinical characteristics of DRE in children to provide a theoretical basis for clinical genetic testing. Methods A retrospective analysis of 95 children with DRE who were hospitalized in Hebei Children's Hospital from January 2020 to December 2022. According to the genetic test results， they were divided into gene mutation positive group（44 cases）and gene mutation negative group（51 cases）. Collected general information（including gender，age of onset，medication use，history of febrile convulsions，family history of epilepsy， etc.），clinical features（seizure types，epilepsy syndromes，developmental conditions），and ancillary examinations ［genetic testing，video electroencephalography（VEEG）examination，neuroimaging］ from the children，and analyse the genetic aetiology and clinical features of DRE. Results Of the 95 children with DRE，55（57.9%）were male and 40（42.1%）were female，with a median age of onset of 0.50（1.00，4.00）years and number of medications used of 3（2，4）；the age of onset of the children in the mutation-positive group was younger than that in the mutation-negative group（Z=-5.322，P=0.001）； comparing the gender of the children，history of febrile seizures，family history of epilepsy，and number of medications used in the two groups，the differences were not statistically significant（P>0.05）. Epileptic syndromes were diagnosed in 38（40.0%） of the children，of which 76.3%（29/38）had onset in the neonatal or infantile period；the percentage of epileptic syndromes was higher in the mutation-positive group than in the mutation-negative group（χ2 =12.065，P=0.001）. Clinical seizure types were diverse，with 2 or more seizure types being the most common，accounting for 52.6%（50/95），followed by a single focal seizure，accounting for 33.7%（32/95）；there was no statistically significant difference in the comparison of seizure types between the two groups of children with DRE（χ2 =2.920，P=0.404）. Developmental screening was improved in 57 children， of whom 43（75.4%）showed varying degrees of developmental delay after the onset of the disease，and 33（76.7%）showed generalised developmental delay；the percentage of children with developmental delay in the mutation-positive group was higher than that in the mutation-negative group（χ2 =5.728，P=0.017）. Genetic variations were detected in 44 cases，resulting in a positive detection rate of 46.3%，predominantly involving ion channel-related mutations，with SCN1A being the most prevalent single-gene mutation. Ninety（94.7%）children had abnormal VEEG examinations，with focal epileptic discharges predominating；the percentage of peak dysrhythmias was higher in the mutation-positive group than in the mutation-negative group（χ2 =7.425，P=0.006）. Structural etiology was present in 25（26.3%）children，including 12 in the mutation-positive group and 13 in the mutation-negative group；the difference in the structural etiology of the children with DRE was not statistically significant when comparing the two groups（χ2 =0.039，P=0.844）. Conclusion Genetic factors are an important etiological factor for DRE in children. The young age of onset and developmental delay suggests that it is related to a genetic etiology，and genetic testing should be actively improved at an early stage，which can help in the early diagnosis of DRE and precise treatment.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background There are a large number of patients with chronic obstructive pulmonary disease（COPD） and bronchiectasis in China，which are chronic respiratory diseases with high morbidity and mortality. Bronchiectasis-COPD overlap syndrome（BCOS）is a special clinical subtype，but it is easy to be ignored. Infection often contributes to their acute exacerbation，but related etiological studies are relatively scarce. Objective To analyze the distribution and drug resistance characteristics of pathogens in bronchiectasis patients without and with COPD，and to compare the differences between them. So as to provide references for rational use of antimicrobial agents. Methods A total of 584 patients with bronchiectasis who were hospitalized in the Department of Pulmonary and Critial Care Medicine of Ma'anshan People's Hospital from January 2016 to January 2023 were enrolled. The patients were divided into two groups according to whether they combined with COPD or not： BE group（335 cases without COPD）and BCOS group（249 cases with COPD）. A retrospective analysis was performed on the composition，antimicrobial susceptibility results and changes of pathogens on patients，and analyze the difference of distribution and drug resistance between the two groups. Results A total of 299 strains were isolated from 584 patients with bronchiectasis， 146 strains from BE group，among them，Gram-negative bacilli 87 strains（59.59 %），Gram-positive bacteria 3 strains （2.05%），Mycobacterium 9 strains（6.16%），Fungus 47 strains（32.19%）. Meanwhile，153 strains from BCOS group， among them，Gram-negative bacilli 80 strains（52.29%），Gram-positive bacteria 1 strains（0.65%），Mycobacterium 2 strains（1.31%），Fungus 70 strains（45.75%）. The composition ratio of Candida albicans were significantly higher in BCOS group than BE group（χ2 =5.274，P=0.022）. The resistance rates of Pseudomonas aeruginosa to imipenem in BE group and BCOS group were 10.64%，25.53%，piperacillin tazobactam 6.98%，15.91%，ciprofloxacin 12.77%，21.28%，amicacin 2.13%， 2.13%，respectively. The resistance rates of Klebsiella pneumoniae to imipenem were 0，14.29%，piperacillin tazobactam 0， 14.29%，ciprofloxacin 15.38%，35.71%，amikacin 0，7.14%，respectively. The resistance rate of Pseudomonas aeruginosa to ampicillin/sulbactam in BCOS group was significantly lower than that in BE group（P=0.026）. The isolation rates of ESBLs#2;producing enterobacteriaceae（χ2 =4.357，P=0.037）and carbapenem-resistant Pseudomonas aeruginosa in BCOS group were higher than BE group（χ2 =5.593，P=0.018）. From 2016 to 2022，the isolation strains of Pseudomonas aeruginosa in patients with bronchiectasis was the highest，and showed a trend of first decreasing and then increasing. The isolation strains of Klebsiella pneumoniae increased significantly in 2021 and 2022，second only to Pseudomonas aeruginosa. The isolation strains of Mycobacterium from 2020 to 2022 and Aspergillus from 2021 to 2022 showed an upward trend. Conclusion As a special phenotype，BCOS has its own characteristics of pathogen distribution and drug resistance，which deserves attention. Pseudomonas aeruginosa is the most common pathogen isolated from patients with bronchiectasis and BCOS currently. In recent years，the isolation strains of Klebsiella pneumoniae is second only to Pseudomonas aeruginosa. The detection of Mycobacterium and Aspergillus has significantly higher than before，which should be taken seriously，especially in BE patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Currently，the results of lung sound auscultation with either physical or electronic stethoscopes still rely mainly on the doctor's professional auscultation identification ability，which has not yet been able to realise intelligent diagnosis and interpretation. When patients are affected by lung diseases at home，they are unable to detect lung abnormalities on their own and delay treatment；when they are in the process of rescue and treatment of respiratory infectious diseases，in-ear stethoscopes are easily contaminated and cause nosocomial infections. Although stethoscopic sounds contain a wealth of information about health status，the lack of standardised collection methods，classification criteria and analysis tools has limited the objective analysis and application of stethoscopic sounds in practice.In this study，the data collection，arrangement and database design of the lung auscultation sound were carried out by using the unified auscultation sound collection equipment and process.The study used the software metlabR2017a for data management and analysis to create a database of lung auscultation sounds in a healthy group and a group of patients with lung disease.A database of lung auscultation sounds was established for healthy groups and groups of patients with lung diseases.A standard set of classification of auscultatory tones，labelling specifications，audio characteristic signal parameters were developed.Building a system for storing，managing and analysing lung auscultation sound data to provide important data support for research related to the screening and monitoring of lung diseases and the translation of medical artificial intelligence applications.The study accumulated the experience of building an audio database of lung auscultation sounds， provided a useful reference for the management and analysis of the audio database，and laied the foundation for supporting the subsequent application of medical artificial intelligence-assisted auscultation in the screening and monitoring of lung diseases， which was of great medical value and practical application.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Day care service is an important component of the community care service system for elderly people with dementia. However，the concept of dementia day care has not been unified，and its connotation and implementation framework have not been clarified，which greatly affects the continuous construction and high-quality service supply of dementia day care service. The Walker classic concept analysis method was used and five attributes of the concept was introduced including（1） daytime intensive，non-residential care；（2）professional coordination and integrated care focused on families with dementia； （3）public respite care support for families with dementia；（4）a crucial complement to high-quality care for dementia；（5） a driving force in promoting a dementia-friendly community. The preconditions of dementia day care include high care needs， weakened family functions and the dominant role of public care，and the consequences involve dementia，family caregivers and social welfare. The implementation factors identification，implementation strategy design，implementation and effect evaluation were carried out respectively using the consolidated framework for implementation research，the replicating effective programs implementation framework and the RE-AIM evaluation framework in the field of implementation science. The specialization， high quality，integrated care，and the philosophy of the friendly community should be highlighted in the future development of dementia day care. The service content，facilities and implementation process need to be improved to promote the quality of dementia day care service.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background The lack of disease self-management awareness in patients after percutaneous coronary intervention（PCI）affects the prognosis，and the prognosis of patients with diabetes is worse. The establishment of chronic disease follow-up system and the collaborative management of the two diseases become the key to the rehabilitation of patients. Objective To construct a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI based on the theory of chronic disease self-management and CICARE communication model，and to explore the application effect. Methods From January to April 2022，literature review，semi-structured interviews and expert correspondence were used to constructed a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI. Patients with coronary heart disease complicated with diabetes who received PCI in the department of cardiology of Chu Hsien-I Memorial Hospital， Tianjin Medical University from May 2022 to December 2022 were selected as research subjects. They were divided into two groups by using the random number table method. The control group（77 cases）received routine follow-up，and the test group（78 cases）received comorbidity follow-up model. The scores of Coronary Heart Disease Self-Management Scale （CSMS）and other outcome indicators were compared between the two groups before discharge，3 months and 6 months after discharge. Results The positive coefficients of experts in the two rounds of expert correspondence were both 100%，the authority coefficient was 0.87，and the coordination coefficient was 0.310 and 0.334，respectively（all P<0.001）. The comorbidity follow-up model included three dimensions，11 modules and 30 contents. Finally，64 patients in each group completed the follow-up. There was an interaction between group and time on the scores of CSMS（F=150.504，P<0.001）. The scores of CSMS at 3 months and 6 months after discharge were higher than those before discharge（P<0.001），and the scores of the test group were higher than those of the control group（P<0.05）. After 6 months，the BMI of the test group was lower than that of the control group（P<0.05）. Conclusion The constructed comorbidity follow-up model after PCI was scientific and effective， which can improve the self-management behavior of patients after PCI and reduce BMI.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background HIV/AIDS is associated with depression， which increases the risk of HIV-associated neurocognitive disorders（HAND）and reduces patient compliance with antiretroviral therapy（ART）， exacerbating the risk of HIV transmission. Few domestic studies have reported on the effectiveness of psychological intervention for depressed patients of People Living with HIV/AIDS（PLWHA）newly diagnosed and its correlation with CD4 + T cell counts. Objective To explore the effectiveness of psychological intervention for newly diagnosed PLWHA with depression and its correlation with CD4 + T cell counts， providing a reference for HIV clinical diagnosis and treatment. Methods From April 2020 to June 2022， a convenient sampling method was used to select newly diagnosed PLWHA with depression from some ART-designated hospitals in Jiangxi Province. While they were diagnosed， ART and psychological intervention were immediately initiated， and the total period of intervention was 12 weeks. Before and after the intervention， the Hamilton Depression Rating Scale（HAMD）and Hamilton Anxiety Rating Scale（HAMA）were used for evaluation， and CD4 + T cell counts were calculated for analysis. Results A total of 200 newly diagnosed PLWHA with depression were included，178 cases of which were effectively followed up with an effective rate of 89.0%. Among 178 cases，88 were mild to moderate depression（49.4%），90 were major depressive disorder（50.6%）， and 173 cases were accompanied by anxiety（97.19%）. The mean CD4 + T cell counts before intervention was（346.39±156.87） cells/μL， and it was（421.93±149.61）cells/μL after intervention. After intervention， the CD4 + T cell counts of newly diagnosed PLWHA with depression were higher than before intervention（t=10.971， P<0.05）， and the total and factor scores of HAMD， HAMA were all lower than before intervention（P<0.05）. Before the intervention， the total scores of HAMD were correlated with the grades of CD4 + T cell counts negatively（500 cells/μL as the cutoff value）（rs=-0.157， P=0.036） and the scores of HAMA positively（rs=0.764，P ≤ 0.001）. After the intervention， the total scores of HAMD were correlated with post-intervention CD4 + T cell counts negatively（rs=-0.150， P=0.046）and the total scores of HAMA strongly positively （rs=0.939， P ≤ 0.001）. In newly diagnosed PLWHA with depression， the total scores of HAMD and HAMA of patients with CD4 + T cell counts <500 cells/μL were higher than those with CD4 + T cell counts ≥ 500 cells/μL（P<0.05）. Conclusion The severity of depression in newly diagnosed PLWHA is associated with CD4 + T cell counts， which could be significantly improved by professional psychological intervention.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background Serum remnant cholesterol（RC）is associated with the onset of ischemic stroke（IS）. However，studies on the correlation between RC levels and recurrent IS are limited，and the predictive value of RC in recurrent IS has not been analyzed. Objective To investigate the correlation between serum RC and the recurrence of IS，and to evaluate the predictive value of RC levels in recurrent IS by detecting serum RC levels in patients with IS. Methods Patients diagnosed as IS and hospitalized in the First Affiliated Hospital of Nanchang University，the Second Affiliated Hospital of Nanchang University，the Second Hospital of Nanchang，and the Third Hospital of Nanchang from March 2019 to March 2021 were included in the study. Relevant clinical information within 48 hours of admission was collected. All patients were followed up for 12 months to record the cases of recurrent IS. COX regression and Restricted Cubic Spline（RCS）were performed to identify the correlation between RC levels and recurrent IS. Receiver operating characteristic（ROC）curves were plotted to evaluate the predictive value of RC levels in recurrent IS. Results A total of 1 023 eligible patients were included in the study，and 107（10.46%）of them experienced IS recurrence within 1 year. Multivariable Cox regression analysis showed that RC was an independent risk factor for recurrent IS（HR=2.709，95%CI=1.150-6.382； P<0.05）. There was a nonlinear positive dose-response relationship between RC levels and the risk of recurrent IS（P-Nonlinear=0.0193）. The area under the curve（AUC）of RC in discriminating 1-year recurrence of IS was 0.687（95%CI：0.631-0.743），with the optimal cutoff of 0.58 mmol/L. There was a significant difference in the AUC between the combination detection of RC and the Essen Stroke Risk Score（ESRS）versus ESRS alone in discriminating 1-year recurrence of IS（Z=2.3562，P<0.05）. Conclusion RC is an independent risk factor for recurrent IS， showing a predictive value in the recurrence of IS.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background Older people with chronic diseases in the community have a higher risk of impaired cognitive function，which seriously threatens their quality of life. Improving cognitive function is crucial for enhancing their quality of life. However，there is heterogeneity in the forms of individual cognitive impairment，and how to effectively improve their cognitive function needs to be further explored. Objective To explore the Latent class of cognitive function among older people with chronic diseases in the community，and analyze the influence factors of different categories，to provide a reference for formulating targeted cognitive function improvement strategies for older people with chronic diseases in the community. Methods Convenience sampling was used to recruit 502 older people with chronic diseases in the community who visited the Tianjin University of Traditional Chinese Medicine Affiliated Baokang Hospital from September to December 2022，using the General Information Questionnaire，Mini-mental State Examination，Activity of Daily Living Scale，Social Support Rating Scale，and Cognitive Reserve Questionnaire. Mplus 8.3 was used to conduct a latent class analysis of cognitive function among older people with chronic diseases in the community and establish a subgroup model. Univariate analysis and unordered multiple Logistic regression were used to analyze the influence factors of cognitive function among older people with chronic diseases in different categories. Results In this study，a total of 526 questionnaires were distributed and 502 valid questionnaires were recovered，with an effective response rate of 95.44%. The cognitive function among 502 older people with chronic diseases in the community was classified into three categories：high cognition with memory impairment group（n=253），moderate cognition with attention impairment group（n=158），and low cognition with overall impairment group（n=91）. Unordered multivariate Logistic regression analysis showed that the high cognition with memory impairment group compared to the low cognition with overall impairment group， older people aged 60-74 years（OR=2.315，95%CI=1.163-4.608，P=0.017），with two chronic diseases（OR=4.105， 95%CI=1.807-9.327，P=0.001），normal blood pressure（OR=2.763，95%CI=1.414-5.400，P=0.003），normal blood lipids（OR=2.016，95%CI=1.014-4.008，P=0.046），higher CR scores（OR=1.031，95%CI=1.005-1.057，P=0.018）， and higher SSRS scores（OR=1.031，95%CI=1.007-1.105，P=0.023）were more likely to belong to the high cognition with memory impairment group，while those with higher ADLS scores（OR=0.920，95%CI=0.885-0.957，P<0.001）were more likely to belong to the low cognition with overall impairment group. Similarly，in the moderate cognition with attention impairment group compared to the low cognition with overall impairment group，older people with chronic diseases in the community with two chronic diseases（OR=2.862，95%CI=1.254-6.529，P=0.012），normal blood pressure（OR=2.655，95%CI=1.350-5.225， P=0.005），normal blood lipids（OR=2.310，95%CI=1.147-4.652，P=0.019），and higher SSRS scores（OR=1.077， 95%CI=1.027-1.129，P=0.002）were more likely to belong to the moderate cognition with attention impairment group，while those with higher ADLS scores（OR=0.948，95%CI=0.913-0.984，P=0.005）were more likely to belong to the low cognition with overall impairment group. Conclusion There are significant differences in the classification characteristics of cognitive function among older people with chronic diseases in the community. Age，number of chronic diseases，blood pressure，blood lipids，cognitive reserve，social support，and activities of daily living are the influencing factors of the latent classes of cognitive function. Medical staff should actively identify the cognitive function characteristics of different categories of older people with chronic diseases in the community，and provide timely and effective intervention measures to improve the cognitive function level of older people with chronic diseases in the community.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background There are a large number of middle-aged and elderly patients with chronic diseases. However，there is currently limited research on the depression status and influencing factors of middle-aged and elderly patients with chronic diseases nationwide. Objective By exploring the depression status and influencing factors of middle-aged and elderly patients with chronic diseases in China，to provide a reference for improving their mental health status. Methods According to the fifth round of national survey data conducted by the China Health and Retirement Longitudinal Study（CHARLS）in 2020， a total of 12 551 middle-aged and elderly patients with chronic diseases were selected as the study objects. The depression status of the study objects was measured using the Depression Scale（CES-D），and the main factors affecting the depression status of middle-aged and elderly patients with chronic diseases were analyzed using the chi-square test and multivariate Logistic regression. Results Among middle-aged and elderly patients with chronic diseases，the proportion of those with depressive symptoms（5 111/12 551）. The results of multivariate logistic regression analysis showed that：gender（male：OR=0.613， 95%CI=0.553-0.680），age（65-<75 years old：OR=0.862，95%CI=0.769-0.965； ≥ 75 years old：OR=0.604， 95%CI=0.510-0.716），presence of spouse/partner living together or not（have OR=0.730，95%CI=0.648-0.822），places of residence（rural：OR=1.515，95%CI=1.387-1.654），educational levels（junior high school：OR=0.727，95%CI=0.657- 0.805；senior high school and above：OR=0.561. 95%CI=0.488-0.646），social status（1 item：OR=0.870，95%CI=0.793- 0.956； ≥ 2 items：OR=0.866，95%CI=0.779-0.963），satisfaction with child relationships（satisfaction：OR=0.266， 95%CI=0.218-0.324），smoking（OR=1.131，95%CI=1.014-1.263），alcohol consumption（OR=0.873，95%CI=0.795- 0.959），nighttime sleep duration（6~<8 h：OR=0.539，95%CI=0.493-0.590； ≥ 8 h：OR=0.443，95%CI=0.396- 0.495），BADL（damaged：OR=1.875，95%CI=1.692-2.077），IADL（damaged：OR=2.251，95%CI=2.030-2.496）， number of chronic diseases（2 types：OR=1.202，95%CI=1.076-1.342；3 types：OR=1.452，95%CI=1.289-1.636； ≥ 4 items：OR=1.954，95%CI=1.749-2.183）are the influencing factors of depression symptoms in middle-aged and elderly patients with chronic diseases（P<0.05）. Conclusion The incidence of depressive symptoms in middle-aged and elderly patients with chronic diseases is 40.7%，and the situation is not optimistic. Their depression is influenced by various factors. Healthcare institutions and policymakers should pay attention to their mental health and take targeted measures from personal，family， community，and other aspects to improve.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： Background The pan-immune inflammatory value (PIV) and systemic immune-inflammatory index (SII) are considered novel inflammatory markers for assessing the risk of atherosclerotic cardiovascular diseases. However, few studies have confirmed the impact of PIV and SII on atherosclerotic plaques.
Objective To explore the relationship between PIV, SII, and vulnerable atherosclerotic plaques in patients with acute coronary syndrome (ACS) using optical coherence tomography (OCT) .
Methods This retrospective study included 525 ACS patients treated at the Second Affiliated Hospital of Zhengzhou University from December 2020 to June 2023. All patients underwent coronary angiography and OCT imaging. Patients were further categorized into low PIV (<337.86, 79 cases) and high PIV (≥337.86, 139 cases) groups based on the optimal PIV cutoff value, as well as into low SII (<775.63, 74 cases) and high SII (≥775.63, 144 cases) groups based on the optimal SII cutoff value. Data were collected and analyzed. Multifactorial ordinal Logistic regression analysis was used to explore the influencing factors of TCFA. Receiver operating characteristic (ROC) curves were plotted for PIV and SII in diagnosing TCFA, and the area under the curve (AUC) was calculated. Based on the diagnostic criteria for thin-cap fibroatheroma (TCFA), patients were divided into a non-TCFA group (112 cases) and a TCFA group (106 cases) .
Results The TCFA group had higher proportions of hypertension, diabetes, pan-PIV, SII, C-reactive protein (CRP), smoking history, and preoperative systolic pressure compared to the non-TCFA group (P<0.05). Multifactorial Logistic regression analysis showed that PIV (OR=1.015, 95%CI=1.010-1.020, P<0.001) and SII (OR=1.005, 95%CI=1.003-1.007, P<0.001) were risk factors for TCFA. ROC curve results indicated that the AUCs for PIV and SII in diagnosing TCFA were 0.785 (95%CI=0.725-0.845, P<0.001) and 0.707 (95%CI=0.639-0.776, P<0.001), respectively. The high PIV group showed higher rates of macrophage infiltration, punctate calcification, and vulnerable plaques than the low PIV group (P<0.05). The high SII group showed higher rates of macrophage infiltration, microchannels, and vulnerable plaques than the low SII group (P<0.05). The high PIV group had thinner fibrous caps, larger maximum lipid core angle, average lipid core angle, lipid core length, and lipid index compared to the low PIV group (P<0.05), and the high SII group had thinner fibrous caps, larger maximum lipid core angle, average lipid core angle, lipid core length, and lipid index compared to the low SII group (P<0.05) .
Conclusion High levels of PIV and SII may be associated with the incidence of vulnerable plaques in patients with ACS. PIV and SII levels have potential value in assessing the characteristics and vulnerability of coronary atherosclerotic plaques in ACS patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-10 Cooperative journals: 《中国全科医学》
Abstract： Background The assessment of psychological resilience can facilitate an understanding of how patients utilize internal and external resources to adapt to adversities，traumas，significant life stressors，and disease treatment. At present，the unity of self-reported scales for assessing the psychological resilience of cancer patients remains controversial. Furthermore，systematic integration and standardized evaluation are limited regarding these scales' measurement properties， which complicates the selection of a scientifically valid and reasonable tool. Objective To systematically assess the measurement properties of a psychological resilience evaluation tool for cancer patients and critically examine the study's methodological quality，therefore to provide a reference for healthcare professionals in selecting a high-quality assessment tool. Methods A systematic search of databases like PubMed，Embase，Web of Science，Cochrane Library，CINAHL，CNKI，VIP，CBM， and Wanfang was conducted for literature related to the evaluation of the measurement properties of the Cancer Psychological Resilience Scale. The search was done within the time frame of the database's creation to 2023-02-14. All identified articles were rated by two independent assessors following the COSMIN guidelines. Results Thirteen studies were included，and among the nine cancer psychological resilience tools were the 10-item Connor-Davidson Resilience Scale（CD-RISC-10），the Resilience Scale Specific to Cancer（RS-SC），the 10-item Resilience Scale Specific to Cancer（RS-SC-10），the 14-item Resilience Scale（RS-14），the Brief Resilient Coping Scale（BRCS），the SV-RES Resilience Scale（SV-RES），the Ego-Resiliency Scale（ER89-R12），the Pain Resilience Scale（PRS），and the Shift and Persist Questionnaire. All scales—aside from the RS-SC-10，which suggested a "C" because of its poor cross-cultural validity—were rated "B" because of their ambiguous content validity and differing levels of evidence. Conclusion This systematic review provides an overview of psychological resilience assessment tools used in cancer patients. The RS-SC stands out as being one of the most robust instruments for measuring psychological resilience in patients. Evidence needs to be generated and used in the clinical setting.
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