Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-24 Cooperative journals: 《中国全科医学》
Abstract： Based on literature analysis， the paper systematically summarizes the development history， grouping and payment mode of the Home Health Prospective Payment System （HHPPS） in the United States. The Home Health Prospective Payment System has developed three versions since its establishment， and the grouping results are more refined and scientific，from the initial 80 home health resource groups to 432 home health resource groups. This method can effectively control expenses，but it requires a large amount of home health care data， scientific and complete expense settlement system and medical record management system. There are still some difficulties in the promotion and implementation in our country at this stage. Our country should learn from the Home Health Prospective Payment System of the American， establish a unified and standardized evaluation system， develop and improve the home medical service information collection system， promote the development of home care services in various aspects， and finally realize the establishment of a scientific and effective payment model， so as to enable the sustainable development of home care service.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-24 Cooperative journals: 《中国全科医学》
Abstract： Health co prosperity is the conceptual interpretation and application extension of the logic of common prosperity in the field of health. Building a digital collaborative health governance model between Chinese and Western medicine based on the advantages of digital reform is the "Zhejiang model" of health co prosperity and helps to achieve the goal of high quality full life cycle medical and health services. This article is based on the collection of relevant policies on the digital collaboration between Chinese and Western medicine during the construction of the Common Prosperity Demonstration Zone in China and Zhejiang Province. It elaborates on the definition and connotation of health co prosperity，and selects the digital Chinese and Western coordinated health governance model of provincial，grassroots platforms，and medical institutions in Zhejiang Province as a specific case to explain the theme and path of the system design logic，grassroots platform logic，and institutional service logic of health co prosperity，To provide reference and suggestions for the innovative construction and optimization of the collaborative health governance model between Chinese and Western medicine.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-24 Cooperative journals: 《中国全科医学》
Abstract： Background At present，chronic non-communicable diseases have become the major diseases affecting people's health in China. Most of the studies on resource allocation for chronic disease prevention and control are status quo surveys or equity analyses，and there is a lack of representative indicators for evaluating the results. Objective To analyze the changes of the appropriateness of resource allocation for chronic disease prevention and control in Chongqing，and to explore its impact on the effectiveness of chronic disease prevention and control. Methods In accordance with the principle of " exhaustiveness "，this study systematically collected all the literature in the field of chronic diseases in Chongqing from 2010 to 2021 published on the websites of the government，the Health and Planning Commission and its related departments，as well as on open databases such as the CNKI and the Web of Science，and a quantitative analysis was made on the appropriateness of resource allocation for the prevention and control of chronic diseases. After the systematic collection of information，this study was respectively carried out from the four secondary indicators and thirteen tertiary indicators of the appropriateness of resource allocation for chronic disease prevention and control，which was derived from the quantitative standards previously constructed by the research group. The "five-point scale" method was used to semi-quantitatively score the severity of the problem （0 points indicate that there is no problem，5 points indicate that the problem is very serious） and the scores were further calculated to determine the appropriateness of resource allocation. Correlation analysis and linear regression were used to analyze the influence of the appropriateness of resource allocation on the prevention and control of chronic diseases. Results From 2010 to 2021， the appropriateness of resource allocation for chronic disease prevention and control in Chongqing has increased from 6.64% to 27.57%; the appropriateness of human resource allocation has increased from 36.49% to 46.59%，the appropriateness of financial resource allocation has increased from 41.06% to 50.28%，the appropriateness of material resource allocation has increased from 41.40% to 42.96%，and the appropriateness of information resource allocation has increased from 5.73% to 24.09%. Among them，the appropriateness of financial and material resource allocation is significantly negatively correlated with the premature mortality rate of chronic diseases in Chongqing，with correlation coefficients of -0.722 and -0.586，respectively. Conclusion The appropriateness of resources allocation for the prevention and control of chronic diseases in Chongqing has been increasing year by year，but it is still at a lower level in general，and the main reason restricting its development lies in the relatively low information resources allocation; it is important to expedite the enhancement of the appropriateness of resources allocation to cope with the rapid increase of the number of chronic disease cases.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-24 Cooperative journals: 《中国全科医学》
Abstract： Background Coronary atherosclerotic heart disease （CHD） is one of the leading causes of mortality worldwide，and research on risk assessment for CHD has been growing annually. However，the issue of data imbalance in these studies is often overlooked，despite its crucial role in enhancing the accuracy of CHD risk identification within classification algorithms. Objective To investigate the factors influencing CHD and to establish predictive models for CHD risk using two data balancing methods based on five algorithms，comparing the predictive value of these models for CHD risk. Methods Utilizing cross-sectional survey data from the 2021 Behavioral Risk Factor Surveillance System （BRFSS） in the United States，a cohort of 112，606 participants was identified，featuring 24 variables related to risk behaviors and health status，with self-reported coronary heart disease （CHD） as the outcome measure. Factors influencing the incidence of CHD were explored through univariate analysis and stepwise logistic regression to select pertinent variables for inclusion in the predictive model. A random sample comprising 10% of the participants （11，261 individuals） was drawn and then randomly divided into training and testing datasets at an 8：2 ratio. To address data imbalance，two over-sampling techniques were employed：random oversampling and the Synthetic Minority Over-sampling Technique （SMOTE）. Based on these methods，CHD predictive models were constructed using five different algorithms：K-Nearest Neighbors （KNN），Logistic Regression，Support Vector Machine （SVM）， Decision Tree，and XGBoost. Results Univariate analysis revealed significant differences （P<0.05） between the CHD and non-CHD groups across all input variables except for rental housing and being informed of prediabetic status. Stepwise logistic regression identified age，gender，BMI，ethnicity，education level，income level，being informed of hypertension，being informed of prehypertension，being informed of pregnancy-induced hypertension，current use of antihypertensive medication， being informed of hyperlipidemia，being informed of diabetes，smoking status，alcohol consumption within the last 30 days， heavy drinking status，and self-assessed health as factors influencing CHD. The performance of risk models using SMOTE showed overall classification accuracies of 59.2%，67.4%，66.2%，69.2%，and 85.9%；recall rates of 75.2%，71.4%，70.5%， 62.9%，and 34.8%；precision of 15.4%，18.2%，17.5%，17.6%，and 28.7%；F-values of 0.256，0.290，0.280，0.275， and 0.315；and AUC values of 0.80，0.78，0.72，0.72，and 0.82，respectively. Using random oversampling，the models achieved classification accuracies of 62.5%，68.5%，69.0%，60.2%，and 70.1%；recall rates of 70.0%，69.5%，71.9%， 69.0%，and 67.6%；precision of 15.8%，18.4%，19.1%，14.8%，and 19.0%；F-values of 0.258，0.291，0.302，0.244， and 0.297；and AUC values of 0.80，0.77，0.72，0.72，and 0.83，respectively. Conclusion This study not only confirmed known factors affecting CHD but also identified potential impacts of self-assessed health level，income level，and education level on CHD. The performance of the five algorithms was significantly enhanced after employing two data balancing methods. Among them，the XGBoost model exhibited superior performance and can be referenced for future optimization of CHD prediction models. Additionally，considering the excellent performance of the XGBoost model and the convenience and interpretability of stepwise logistic regression，a combined use of these approaches after data balancing is recommended in CHD risk prediction models.
Subjects: Medicine, Pharmacy >> Other Disciplines of Medicine and Pharmacology submitted time 2024-04-19 Cooperative journals: 《中国全科医学》
Abstract： Background In order to change the shortage of general practitioners in primary care，China has been implementing a rural order-oriented medical student training program in 2010. Currently，the overall performance intention， performance situation and retention intention of order-oriented medical students in China still remains unclear and need to be supported by more reliable evidence. Objective To systematically evaluate the performance intention rate，actual performance rate and retention intention rate of order-oriented medical students in China and analyze its influencing factors. Methods From January to June 2022，CNKI，Wanfang Data，VIP，PubMed and Embase databases were searched to collect literature related to service intention，performance intention and retention intention for primary care of order-oriented medical students in China with a time period from 2010-01-01 to 2021-12-01，and the language of the literature was limited to Chinese and English. Two investigators independently screened literature and extracted data independently to evaluate the risk of bias of the included studies. Meta-analysis of single-group rates was performed using RevMan 5.4 software. Results A total of 49 papers were included with a survey period of 2010-2020，involving 22 413 order-oriented medical students. The performance intention rate of order-oriented medical students was 62%［95%CI（55%-69%）］，the performance rate was 95%［95%CI（93%-96%）］，the retention intention rate was 16%［95%CI（13%-19%）］. The results of subgroup analysis showed that the performance intention rate of the literature published in 2011［90%，95%CI（84%-96%）］ was higher than the other years（P<0.01），the performance intention rate was higher in North China［87%，95%CI（84%-90%）］ than the other regions，the performance intention rate of college students［68%，95%CI（67%-69%）］ was higher than the residents in standardization training（P<0.01）；the performance rate of the published literature in 2020 ［99%，95%CI（99%-100%）］ was higher than the other years（P<0.01）， and the performance rate［100%，95%CI（99%-100%）］ in Central China was higher than the other regions（P<0.01）； the retention intention rate of the literature published in 2015［36%，95%CI（2%-70%）］ was higher than the other years（P<0.01）， the retention intention rate［23%，95%CI（4%-41%）］ was higher in South China than the other regions（P<0.01），the retention intention rate of the college students［18%，95%CI（13%-22%）］ was higher than the residents in standardization training and primary care providers performing contracts（P<0.01）. Conclusion The actual performance rate of order-oriented medical students in China is high，but the performance intention rate and retention intention rate are low. Region，time and medical education stage are the influencing factors.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-18 Cooperative journals: 《中国全科医学》
Abstract： The outbreak of COVID-19 has had a huge impact globally. After the infection，a considerable number of patients have been affected by a series of lingering symptoms or sequelae with strong heterogeneity，which we temporarily refer to as "Long COVID". Compared to the well-studied cardiovascular complications caused by COVID-19 during the acute phase，the cardiovascular sequelae in "Long COVID" require greater attention. This review includes the clinical manifestations， mechanisms，and principles of diagnosis and management of cardiovascular sequelae in "Long COVID"，aiming to improve the disease's understanding and reduce its harm scientifically.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-18 Cooperative journals: 《中国全科医学》
Abstract： Background The imaging of COVID-19（COVID-19） in children is different from that of adults，mainly manifested as subpleural ground glass shadows，patchy high-density shadow，and solid shadow，and rarely complicated with pneumomediastinum. The formation of a large number of emphysema can seriously affect the respiratory and circulatory function，resulting in obvious wheezing and hypoxemia，which need to be actively treated. Objective To analyze and summarize the imaging and clinical characteristics of COVID-19 with pneumomediastinum in children. Methods A retrospective analysis was conducted on 8 pediatric patients with COVID-19 complicated with pneumomediastinum admitted to the Department of Pediatrics at Jingzhou Hospital affiliated with Yangtze University from December 1，2022 to January 30，2023，including age，gender，imaging，clinical characteristics，and treatment. Results 8 children were 3.5 years to 12 years，with a female ratio of 3 ∶ 5. High Resolution CT Scan in all children showed double lung infection combined with pneumomediastinum， and multiple emphysema involved the neck and chest wall. The pulmonary manifestations were various：subpleural ground glass shadow，consolidation，tree bud sign，vascular bronchial bundle thickening and bronchial wall thickening，grid sign，etc.，no large consolidation and "white lung" found. One case was observed to have a small amount of pleural effusion. In addition to fever and cough，the clinical manifestations were obvious shortness of breath，pulmonary auscultation，but dry or moist rales were not significant. Four children with mycoplasma infection were treated with azithromycin，and one with B. catarrhalis. was treated with azithromycin. All given oxygen therapy. A patient was treated with an invasive ventilator because traditional treatment was unable to alleviate her dyspnea and hypoxemia. The patient's leucocytes and hypersensitive CRP were significantly increased. After 3 days，the symptoms improved and the machine was successfully withdrawn. 5 cases were treated with intravenous immunoglobulin （IVIG），and 3 cases were treated with glucocorticoids. a week after the review of chest CT，pneumomethinum were completely absorbed，and lung lesions significantly improved. Conclusion Children with pneumomediastinum complicated by COVID-19 were mostly pre-school or school-age children，rare in infants. Pneumomediastinum can coexist with gas accumulation in the neck and chest wall. In addition，pulmonary lesions could involve the stroma or parenchyma，and both lungs were affected， with various manifestations. At the onset of the disease，there were obvious shortness of breath，active oxygen therapy was recommended. When the white blood cell count and hypersensitivity CRP significantly increase，close attention should be paid to respiratory conditions. IVIG and glucocorticoids may have positive effects，and if necessary，a mechanical ventilation should also be used.
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
ZHOU Jun
LIU Xiaoyu
WANG Ping
YAN Yan
LIN Jiaming
ZHANG Kuaiyue
DONG Pengxuan
LIU Yuzhi
HU Xiaocong
MI Baohong
WANG Rongtian
CHEN Yuefeng
CHEN Weiheng
Abstract： Background Knee osteoarthritis is a common clinical condition with a decades-long course. Long term and personalised health management in community hospitals is the best way to prevent and treat KOA，and non-surgical treatment is an effective way to slow joint degeneration and postpone joint replacement surgery. Objective To understand the population characteristics，clinical staging and treatment modality characteristics of the population attending community hospitals for knee osteoarthritis，in order to provide a basis for optimising the treatment protocol for knee osteoarthritis at the grassroots level. Method All streets in the urban area of Beijing were randomly selected for the study using the whole cluster sampling method，and Hepingli Street in Dongcheng District，Beijing was censored for all patients who attended all community hospitals（7） belonging to the street in January-June 2022，and general information，medical history，personal history，clinical staging，K-L grading and treatment modalities were collected. Results A total of 3 615 KOA patients were included in this study，including 1 327 males（36.71%） and 2 288 females（63.29%），aged（71.8±13.3） years. There were 867 cases（23.98%） in the onset period，209 cases（55.57%） in the remission period and 739 cases（20.45%） in the rehabilitation period. Gender and age of patients with different clinical stages were not correlated with clinical stages （P>0.05），while BMI（K=0.235） and KL grading（K=0.406） were correlated with clinical stages（P<0.001）. During the attack period，4~5 kinds of treatment methods（48.67%） were combined，and the treatment methods were mainly traditional Chinese patent medicines and simple preparations for external use（68.97%），475 cases（54.79%） of traditional Chinese patent medicines and simple preparations for oral use，and 396 cases（45. 67%） of health education; in the remission stage，2-3 treatment methods were used in combination（48.58%），mainly including 1 084 cases（53.96%） of traditional Chinese patent medicines and simple preparations for external use，1047 cases（52.12%） of health education and 790 cases（39.32%） of cupping; in the rehabilitation stage，2-3 kinds of treatment methods were used in combination（47.23%）. The main treatment methods were health education in 488 cases（66.04%），traditional exercises in 286 cases（38.70%），and external use of traditional Chinese patent medicines and simple preparations in 279 cases（37.75%）. There was a correlation between clinical stage and type of combination therapy（K=0.356，P<0.05）. Conclusion Patients in community hospitals are mainly in remission，and treatment is often combined with various methods of traditional Chinese patent medicine and simple preparations，and traditional exercises are also widely used.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： Background The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasing，leading to a significant impact on both their physical and mental well-being due to stress urinary incontinence. Objective This study investigates the impact of menopausal hormone therapy（MHT）in conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate stress urinary incontinence（SUI）. Methods A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital in 2022 were selected. They were allocated into the MHT group and the control group in a 2∶1 ratio using a random number table method，and the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen and progestogen therapy（EPT）in a 1∶1 ratio. Both the control group and the MHT group underwent pelvic floor muscle training（PFMT），commonly referred to as Kegel exercises，for 15-30 minutes per session，2-3 times daily，and 2-3 times weekly，over a continuous period of 12 months. The control group received KunTai capsules orally in combination with PFMT，with 4 capsules taken per dose，3 times a day，for 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy（1 mg estradiol valerate + 10 mg dydrogesterone，once daily），continuous sequential estrogen-progestin therapy（femoston 12 courses），and the Tibolone subgroup takes tibolone orally，all of which were administered continuously for 12 months. The study examined serum estradiol（E2）and follicle-stimulating hormone（FSH）levels within and between groups and subgroups before and after treatment. In addition，measurements were obtained for urethral rotation angle（URA），bladder detrusor thickness（BDT），posterior vesicourethral angle（PVUA），levator hiatus area（LHA），urinary incontinence quantification，urinary incontinence score，clinical efficacy，as well as changes in the modified Kupperman Menopausal Index（KMI）score，and the modified oxford staging（MOS）. Results Upon completion of the study，7 participants from the MHT group were lost to follow-up（5 in the Tibolone subgroup and 2 in the EPT subgroup），with 3 participants from the control group also lost to follow-up. In the end，a total of 65 participants were included. After 1 year of treatment，there were no statistically significant differences in FSH，E2，and MOS between the MHT group and the control group（P>0.05）. After 1 year of treatment，there were no statistically significant differences in PUVA，BDT，and URA between the MHT group and the control group（P>0.05）.However，the LHA of the MHT group was significantly lower than that of the control group（P=0.028）. After 1 year of treatment，there were no statistically significant differences in PUVA，BDT，URA，and LHA between the EPT and Tibolone subgroups（P>0.05）. Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT group（P=0.010）. Conversely，no statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroups（P=0.724）. After 1 year of treatment，the MHT group showed lower urinary incontinence quantity，urinary incontinence score，and KMI score compared to the control group（P<0.05）. Before and after the treatment，there were no statistically significant differences in urinary incontinence quantity，urinary incontinence score，and KMI score between the EPT and Tibolone subgroups（P>0.05）. Conclusion The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Nevertheless，there is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： The Screening Tool of Older Person's Potentially Inappropriate Prescriptions（STOPP）and the Screening Tool to Alert to Right Treatment（START）were initially developed by a panel of experts from Cork University Hospital，Ireland in 2008，and underwent a second update in 2015. Since their inception，these criteria have played a pivotal role in identifying potentially inappropriate medication use in the elderly，enhancing oversight of medication misuse in older individuals，and reducing adverse drug events among the elderly. In 2023，the third edition of the STOPP/START criteria was released，providing updated and more practical evidence-based guidance. Building upon the second edition，this iteration includes the addition，revision，and removal of certain criteria，resulting in a total of 190 new standards for potentially inappropriate medication use. This latest version incorporates the most recent research findings and clinical evidence related to appropriate medication use in older adults. We provide a detailed analysis of the STOPP/START criteria （version 3），offering valuable insights for the updating and refinement of potentially inappropriate medication criteria in our country. Furthermore，it presents recommendations for future research in this field.
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： General practice teaching clinic is an important training method to develop clinical thinking and improve general practice diagnosis and treatment ability of general practice residents. In this paper，we used a patient with fatigue as the main manifestation as a teaching case to introduce the Murtagh safe diagnostic strategy proposed by John Murtagh，a famous Australian general medicine expert，to inspire the diagnosis and differential diagnosis of fatigue for the general practice residents in the general practice teaching clinic：（1）What are the common diseases that cause fatigue? （2）What are the important diseases that should not be ignored? （3）What are the easily missed diseases of fatigue? （4）Are there underlying easily masked diseases? （5）Is there something the patient is not saying? Combined with the history，physical examination and laboratory findings，a preliminary diagnosis of antineutrophil cytoplasmic antibody-associated vasculitis causing rapidly progressive glomerulonephritis is highly probable.The timely referral got nephropathology which confirms the etiology of the fatigue was antineutrophil cytoplasmic antibody-associated glomerulonephritis，and achieved satisfactory outcome. Based on the Murtagh safe diagnostic strategy，the instructor helped the general practice residents to construct a systematic knowledge framework for the identification and analysis of fatigue，so as to improve their clinical logical thinking ability and the ability to solve practical clinical problems. Using the mind mapping as an auxiliary tool，the diagnosis and differential diagnosis of the Murtagh safe diagnostic strategy were concretized and visualized，so as to optimize the teaching effect.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： Background Chronic atrophic gastritis is a common clinical precancerous lesion，which is prone to recurrent attacks and seriously affects the quality of life of patients. At present，Western medicine has limited effect in the treatment of chronic atrophic gastritis，while acupuncture has good results in the treatment of chronic atrophic gastritis，but which acupuncture therapy is the best still inconclusive. Objective To compare the clinical efficacy among different acupuncture and moxibustion therapies on chronic atrophic gastritis by means of network Meta-analysis. Methods The articals of randomized controlled trials for chronic atrophic gastritis treated with acupuncture and moxibustion therapies were searched from CNKI，Wanfang database，VIP database，CBM database，PubMed，Embase and Web of Science until April 30，2023 according tothe inclusion exclusion criteria. Literature quality assessment was based on ROB 2 bias assessment tool，network meta-analysis was performed using Rstudio software，and funnel plotting was used Stata software for publication bias risk assessment. Results 26 articles involving 10 interventions with a sample size of 2 068 cases were included. The results of network meta-analysis showed that in terms of clinical effective rate，there were five acupuncture therapies that were superior to conventional Western medicines，such as Western medicine combined with Acupoint injection，Catgut embedment in acupoint therapy，Western medicine combined with acupuncture，Needle warming therapy and Acupuncture（P<0.05）. The SUCRA ranking result was Western medicine combined with Acupoint injection（0.86）>Catgut embedment in acupoint therapy（0.80）>Western medicine combined with acupuncture（0.67）>Needle warming therapy and Acupuncture（0.59）>Western medicine combined with thunder-fire moxibustion（0.58）>Acupuncture（0.48）>Western medicine combined with ginger separated moxibustion（0.40）>Thunder-fire moxibustion（0.31）>Western medicine combined with electroacupuncture（0.24）>Conventional Western medicine（0.06）. In improving the efficacy of gastroscopy，there were five acupuncture therapies that were superior to conventional Western medicines，such as catgut embedment in Acupoint therapy，Needle warming therapy，Western medicine combined with acupuncture，Acupuncture and Western medicine combined with Acupoint injection（P<0.05）. The SUCRA ranking results show：Catgut embedment in acupoint therapy（0.80）>Needle warming therapy and Acupuncture（0.72）>Western medicine combined with acupuncture（0.58）>Acupuncture（0.47）>Western medicine combined with Acupoint injection（0.41）>conventional Western medicine（0.01）. In terms of pathological efficacy，there were five acupuncture therapies that were superior to conventional Western medicines，such as Catgut embedment in acupoint therapy and Needle warming therapy and Acupuncture（P<0.05）. The SUCRA ranking results show：Catgut embedment in acupoint therapy（0.79）>Western medicine combined with Acupuncture（0.59）>Needle warming therapy and Acupuncture（0.53）>Acupuncture（0.52）>Western medicine combined with Acupoint injection（0.51）>Conventional Western medicine（0.06）. Conclusion Western medicine combined with Acupoint injection is preferred for patients with obvious clinical symptoms，while Catgut embedment in acupoint therapy is preferred for patients with no obvious symptoms. Catgut embedment in acupoint therapy can not only improve the clinical effective rate，but also improve the efficacy of gastroscopy and pathological than other acupuncture treatments.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： Background Low back pain（LBP）in middle-aged and elderly adults has become a significant public health issue worldwide. Physical activity and sleep are two core components of the 24-hour lifecycle，and maintaining adequate physical activity and good sleep are crucial for health，both of which are associated with LBP. Objective To investigate the prevalence of LBP in middle-aged and elderly adults in China，analyze the independent and combined effects of physical activity and sleep on its occurrence，and provide scientific evidence for behavioral health. Methods Based on the 2018 China Health and Retirement Longitudinal Study，participants without demographic，physical activity，sleep，and LBP data were excluded. A total of 13 496 eligible individuals aged 45 to 69 were included，and their demographic and behavioral information was collected. Binary logistic regression and multiple linear regression were used to examine the relationship between physical activity，sleep duration，and LBP，and a mediation model was constructed to analyze the mediating effect of sleep duration on the association between physical activity and LBP. Results The prevalence of LBP among the 13，496 participants was 39.0%（n=5 269）.Inadequate sleep（<7 hours）was reported by 57.1%（n=7 704）of middle-aged and elderly adults in China，with 11.6%（n=1561）engaging in mild physical activity and 88.4%（n=11 935）engaging in moderate to high-intensity physical activity. The multicollinearity diagnosis results for confounding variables（e.g.，gender，age，alcohol consumption，and smoking） showed that all variance inflation factors were less than 5，indicating no collinearity. Regression analysis revealed a positive correlation between physical activity and LBP（β=0.120，P<0.05），a negative correlation between sleep duration and LBP（β=-0.220，P<0.01），and a negative correlation between physical activity and sleep duration（β=-0.081，P<0.05）. The mediation analysis of categorical variables indicated Z=2.223>1.96，and the path from physical activity to LBP was not significant（β=0.105，P>0.05），suggesting a complete mediating effect of sleep duration on the association between physical activity and LBP. Conclusion Over one-third of middle-aged and elderly adults in China suffer from LBP. Higher levels of physical activity or shorter sleep duration are associated with increased risk of LBP. Sleep duration plays a complete mediating role in the association between physical activity and LBP，where the increased risk of LBP associated with high-intensity physical activity is completely transmitted through reduced sleep duration. Adequate sleep duration plays an important role in reducing the risk of LBP associated with high-intensity physical activity. This study suggests that older adults should adjust their exercise intensity according to their own conditions and maintain adequate sleep duration to reduce the risk of LBP.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-09 Cooperative journals: 《中国全科医学》
Abstract： Non-alcoholic fatty liver disease（NAFLD）is a progressive disease. NAFLD，viral hepatitis B，viral hepatitis C， and alcoholic liver disease are the major cause of chronic liver disease in the world. Without effective intervention measures， NAFLD can gradually deteriorate to non-alcoholic steatohepatitis，fatty liver fibrosis，liver cirrhosis and even hepatocellular carcinoma，and may become the main cause of end-stage liver disease in the future. The prevalence and incidence of NAFLD are increasing in the world，and the problem is becoming more and more serious. On the basis of relevant data collection and literature research，this article analyzes the epidemiological characteristics in gender and region of NAFLD，and discusses the possible effects of hormones and environment，and other risk factors on NAFLD，so as to provide new ideas for the prevention and control of NAFLD.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-09 Cooperative journals: 《中国全科医学》
Abstract： Severe acute respiratory syndrome coronavirus 2（SARS-CoV-2）infection is a major public health emergency in the world in the past century，which poses a major threat to the global health system. After rehabilitation from SARS-CoV-2 infection，some patients may experience multiple respiratory symptoms for a long time，which is called the acute sequelae of SARS-CoV-2 infection. Post-COVID-19 pulmonary fibrosis（PCPF）as one of them，can affect the respiratory function and quality of life of patients to varying degrees. Regarding the treatment of PCPF is a hot topic in current research，and this article provides a review of treatment methods for PCPF，aiming to improve the prognosis of PCPF patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-09 Cooperative journals: 《中国全科医学》
Abstract： Background As the leading cause of death in the world，cardiovascular diseases pose a serious threat to human health. Diet has attracted much attention as an important intervention，but the effect of carbohydrates on cardiovascular disease is unknown. Objective To analyze the evidence of the correlation between carbohydrate intake and cardiovascular disease risk. Methods Wanfang Data,CNKI,VIP,SinoMed,PubMed,Cochrane Library and EMBase were searched by computer for randomized controlled trials on the risk of carbohydrates and cardiovascular disease published from inception to January 2023. Two researchers performed literature screening，data extraction，and quality evaluation separately. RevMan 5.3 was used for data analysis. Results A total of 16 randomized trials were included. Carbohydrate could significantly reduce triglyceride level by 0.17 mmol/L（95%CI=-0.24--0.10，P<0.000 01）. The level of triglyceride decreased by 0.25 mmol/L（95%CI=-0.33--0.17，P<0.000 01） in carbohydrate diet intervention for less than 6 months，and 0.15 mmol/L（95%CI=-0.29--0.01，P=0.04） in 12-23 months group. Plasma HDL-C level increased by 0.09 mmol/L（95%CI=0.07-0.10，P<0.000 01），and plasma LDL-C level increased by 0.10 mmol/L（95%CI=0.02-0.17，P=0.01）. Conclusion The overall effect of low carbohydrate diet on cardiovascular risk factors is more favorable below 6 months and 6-11 months，but it has no significant effect on cardiovascular risk factors after 2 years，and its long-term effect needs further study.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-04-03 Cooperative journals: 《中国全科医学》
MA Yiping
YUAN Yujuan
NIGERE Alimu
ABULAJIANG Aihemaiti
MA Qingyu
PALIDA Yushanjiang
MUYESAI Nijiati
Abstract： Background Acute myocardial infarction（AMI）is the leading cause of cardiovascular disease morbidity and mortality worldwide，and despite the widespread use of biomarkers for myocardial necrosis，morbidity and mortality of AMI remain high. Objective To investigate the expression levels and clinical significance of miR-126，mitochondrial components and adhesion molecules in endothelial microparticles（EMPs）. Methods A total of 50 patients with AMI，50 patients with stable coronary artery disease（SCAD）and 50 healthy subjects were enrolled in the People's Hospital of Xinjiang Uygur Autonomous Region from September 2021 to September 2022. AMI patients and SCAD patients were hospitalized in our hospital and received percutaneous coronary intervention（PCI），and all healthy subjects were evaluated by the physical examination center of our hospital. Peripheral blood samples and general data of three groups were collected. The morphology of the microparticles（MPs） was observed by transmission electron microscopy（TEM），the level of EMPs was identified by flow cytometry，and the expression of miR-126 in EMPs was detected by fluorescence quantitative PCR. ELISA was used to detect the levels of mitochondrial reactive oxygen species（ROS）and intracellular adhesion molecules ［vascular cell adhesion molecule-1 （VCAM-1），intercellular adhesion molecule-1（ICAM-1），E-selectin，and P-selectin］ in EMPs. Results As observed by TEM，the membrane structure of the isolated MPs was intact and its diameter ranged from 100 to 400 nm. Compared with the control group，the expression of miR-126 in plasma EMPs in the AMI group was significantly decreased（Z=4.979， P<0.001），the expression of ROS was significantly increased（Z=9.651，P<0.001），the expression of VCAM-1 was increased（Z=2.336，P=0.019），and the expression of ICAM-1（Z=5.894，P<0.001），E-selectin（Z=2.730，P=0.019） and P-selectin（Z=6.470，P<0.001） were increased. Multivariate Logistic regression analysis showed that the decreased expression of miR-126（OR=0.026，95%CI=0.003-0.210，P=0.001） was a protective factor for AMI，increased expression of ROS（OR=1.009，95%CI=1.005-1.013，P<0.001） and P-selectin（OR=1.063，95%CI=1.022-1.105，P=0.002）were risk factors for AMI. The receiver operator characteristic curve（ROC） showed that the area under the curve of miR-126 for the diagnosis of AMI was 0.816，the area under the curve of ROS for the diagnosis of AMI was 0.892，the area under the curve of P-selectin for the diagnosis of AMI was 0.728，and the area under the curve of miR-126，ROS and P-selectin combined diagnosis was 0.950. Conclusion In EMPs，miR-126，ROS，P-selectin and their combined indicators all have diagnostic value for AMI，and the combined indicators of the three have the highest diagnostic value，indicating that they may be potential diagnostic indicators for AMI patients.
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2024-04-01
Abstract： Objective To investigate the effects and molecular mechanism of recombinant human adiponectin (APN) on arsenic induced lipid deposition in hepatic HepG-2 cells. Methods The experiments were divided into control group, sodium arsenite (SA) exposure group, rAPN intervention + SA exposure group, and protein kinase B (AKT) inhibitor (GSK690693) intervention + SA exposure group. After cultured HepG-2 cells in vitro were treated respectively, the characteristics of cellular lipid deposition were observed by oil red O staining of cells smears, and the methods of biochemical or enzyme-linked immunosorbent assay (ELISA) were applied to determine the levels of intracellular mitochondrial membrane potential (ΔΨm), mitochondrial carnitine palmitoyltransferase-1 (CPT-1) activity, free fatty acids (FFAs) and APN. Western-blotting (WB) was applied to detect the levels of phosphorylated AKT (p-AKT), mitochondrial Glutathione S-transferase K1 (GSTK1) and inflammatory factor Caspase-1. Results Compared with control group, SA exposed group showed intracellular lipid deposition and the decreased levels of mitochondria ΔΨm, CPT1 activity, GSTK1 or APN, while the levels of FFAs, p-AKT and Caspase-1 increased. Compared with SA exposed group, recombinant human APN (rAPN) intervention led to the alleviated lipid deposition in hepatocytes and the increased levels of ΔΨm, CPT1 activity, GSTK1 or APN, while the levels of FFAs, p-AKT and Caspase-1 decreased. Similarly, the intervention of AKT inhibitor showed also the reduced cellular lipid deposition and the upregulated levels of ΔΨm, CPT1 or GSTK1, while the levels of p-AKT and caspase-1 downregulated. Conclusion Arsenic induced lipid deposition in HepG-2 cells is associated with AKT signaling, and APN can antagonize arsenic-induced lipid metabolism disorder and lipid deposition in hepatocytes via inhibiting AKT signaling.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-01
Abstract： Objective To explore the intervention effect of Lentinan (LNT) on liver lipid deposition induced by sodium arsenite (SA) in C57BL/6 mice. Methods The experiment was divided into four groups (8 mice/group): control group, SA exposure group, LNT intervention+SA exposure group, LNT control group. C57BL/6 mice were exposed by SA (SA dissolved in deionized water, drinking water exposure 10.0 mg/L, 8 weeks) and LNT intervention treatment (1.0 mg/kg, intramuscular injection, once every other day, 8 weeks). After the experiment, liver tissue samples were collected and the characteristics of liver lipid deposition were observed by oil red O staining of liver tissue sections. The levels of triglyceride (TG) and adiponectin (APN) in the liver tissue of mice were detected by enzyme-linked immunosorbent assay (ELISA), and the statistical differences between the groups were analyzed by analysis of variance (ANOVA) and least significant difference (LSD). Results Compared with control group, SA exposure mice showed that lipid deposition in liver tissues, decreased APN level, and increased TG level (P<0.05). Compared with SA exposure group, LNT intervention+SA exposure group showed that the reduced degree of liver lipid deposition, the increased level of APN, and the decreased level of TG (P<0.05). For LNT control group, similar to the control group, the liver tissue morphology was normal, and the levels of APN and TG had no statistical difference compared with the control group (P>0.05). Conclusion SA-induced liver lipid deposition in C57BL/6 mice may be related to the down-regulation of APN level. LNT intervention can increase APN level to antagonize SA-induced liver lipid deposition in C57BL/6 mice.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-01 Cooperative journals: 《中国全科医学》
Abstract： Background Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currently，there is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services. Objective To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou City，Anhui Province，to describe the association between patient medication behavior and patient characteristics，to explore the influencing factors of medication adjustment，and to analyze the rationality of medication use in primary hypertensive patients. Methods Using cluster sampling，from July to August 2021，48 administrative villages were randomly selected from Jieshou City，Anhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level（2020 Edition）"，the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories：category A includes angiotensin-converting enzyme inhibitors（ACEIs）and angiotensin receptor blockers（ARBs），category B includes beta-blockers，category C includes calcium channel blockers（CCBs），category D includes diuretics，and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study，"combination medication" refers to taking a combination drug or two or more antihypertensive drugs，and "medication adjustment" refers to patients previously taking other antihypertensive drugs. Results A total of 3，005 hypertensive patients were included in this study，including 1 291 males（43.0%）and 1 714 females（57.0%），with an average age of（65.5±9.8）years. The medication rate of hypertension was 79.1%，and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs，the rates of different types of antihypertensive drugs from high to low were（some patients had combination medication）：category E（39.6%），category C（35.1%），category D（20.3%），category A（20.1%），and category B（3.7%）；the most frequently taken antihypertensive drug was compound lisinopril（33.7%）. For patients with an average annual blood pressure ≥ 160/100 mmHg，12.2% and 4.9% still did not take antihypertensive drugs. Patients' combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure ≥ 100 mmHg" and "with complications"，the rates of adjusted category A and C antihypertensive drugs increased relatively more；for patients with an average annual "systolic pressure ≥ 160 mmHg" and "without complications"，the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication（OR=1.042，95%CI=1.031-1.053，P<0.001），education level above junior high school（OR=1.488，95%CI=1.195-1.853，P<0.001），combined hyperlipidemia（OR=1.267，95%CI=1.052-1.525，P=0.013），combined cardiovascular complications（OR=1.394，95%CI=1.166-1.667，P<0.001），and combined cerebrovascular complications（OR=1.258，95%CI=1.040-1.522，P=0.018）were promoting factors for medication adjustment in patients，while advanced age（OR=0.980，95%CI=0.971-0.990，P<0.001）was an inhibiting factor for medication adjustment. Conclusion The medication rate among rural hypertensive patients in Jieshou City is high，mainly involving category E and C antihypertensive drugs. The use of various antihypertensive drugs by primary care physicians is generally reasonable，but the management of medication，especially the application of combination medication strategies for patients with secondary hypertension and those with complications，needs to be improved.
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