中华全科医学

Community-based management plan for sarcopenia in older adults

YU Su, SUN Yange, DING Qian, LI Jing, DU Xueping, ZHANG Ping, WANG Peng, REN Longbing

2026, 24(2): 175-179. doi: 10.16766/j.cnki.issn.1674-4152.004356

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Abstract:
Sarcopenia is a geriatric syndrome characterized by progressive loss of skeletal muscle mass and strength, which significantly increases the risk of falls and disability among older adults and severely impairs quality of life. In China, primary healthcare institutions have relatively limited experience in the recognition and management of sarcopenia, and standardized management strategies remain lacking. As the frontline of sarcopenia prevention and control, primary care settings require practical and evidence-based management protocols. This program was led by the Yuetan Community Health Service Center in Beijing and developed based on the latest domestic and international consensus and guidelines. It was formulated through repeated discussions by a multidisciplinary expert team including general practitioners, geriatricians, nutritionists, and rehabilitation specialists. It aims to provide systematic guidance for primary healthcare workers. The program identified adults aged 65 years and older as the primary management population and follows the principles of "prevention first, combining prevention and treatment" and "personalized intervention". A multidisciplinary collaborative model is established, with general practitioners at the core coordinators and support from nurses, rehabilitation specialists, and nutritionists. Emphasized health education and public awareness through both online and offline chan-nels. Early screening is conducted using calf circumference, SARC-CalF questionnaire, and handgrip strength testing, followed by comprehensive assessment and diagnosis based on muscle mass, muscle strength, and physical performance. Interventions focus on nutrition and exercise, recommending a daily protein intake of ≥1.2 g/kg body weight with appropriate vitamin D supplementation, combined with resistance and aerobic exercise to develop individualized exercise prescriptions. Referral criteria and follow-up mechanisms are also clearly defined. The goal is to standardize community-based sarcopenia management procedures, improve muscle function in older adults, and achieve evidence-based prevention and treatment of sarcopenia.

Guidelines for the integrated traditional Chinese and Western medicine prevention and treatment of diabetic gastrointestinal diseases

Endocrinology and Metabolism Committee of the Chinese Medical Doctor Association Integrated Traditional Chinese and Western Medicine Branch, Endocrinology Professional Committee of Beijing Society of Integrated Traditional Chinese and Western Medicine, Beijing Traditional Chinese Medicine Administration Diabetes Prevention and Treatment Office, National Clinical Key Specialty of Traditional Chinese Medicine Endocrinology, Guang ' anmen Hospital, China Academy of Chinese Medical Sciences

2026, 24(2): 180-191. doi: 10.16766/j.cnki.issn.1674-4152.004357

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Abstract:
The Guidelines for the Integrated Traditional Chinese and Western Medicine Prevention and Treatment of Diabetic Gastrointestinal Diseases were compiled by the Endocrinology Professional Committee of the Beijing Society of Integrated Traditional Chinese and Western Medicine, the Beijing Traditional Chinese Medicine Administration Diabetes Prevention and Treatment Office, and the National Clinical Key Specialty of Traditional Chinese Medicine Endocrinology at Guang ' anmen Hospital, China Academy of Chinese Medical Sciences. These guidelines gathered clinical experts from key specialties in endocrinology and gastroenterology nationwide. Based on the principles of integrated Traditional Chinese and Western medicine, the recommendations were formulated using the consensus conference method and grounded in evidence-based medicine. The guidelines cover the integrated diagnosis, treatment, and rehabilitation of diabetic gastrointestinal diseases. Their development aims to provide a reference for the standardized diagnosis and treatment of diabetic gastrointestinal diseases in China and to enhance the level of integrated Traditional Chinese and Western medicine prevention and treatment for these conditions.

Establishment of a prediction model for sepsis-related liver injury and development of prevention and control strategies based on Lasso-logistic regression

GAO Ting, FU Hong, SHAO Min, GONG Juan

2026, 24(2): 192-195. doi: 10.16766/j.cnki.issn.1674-4152.004358

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Objective In view of the serious harm of sepsis-related liver injury (SALI), this study aims to use lasso logistic regression to build a SALI prediction model and to develop targeted prevention and control strategies. Methods A total of 192 sepsis patients admitted to the First Affiliated Hospital of Anhui Medical University from April 1, 2024 to April 1, 2025 were selected as the research subjects. They were divided into the SALI group (40 cases) and the non SALI group (152 cases) based on whether liver injury occurred. Clinical data from two groups of patients were collected, and univariate analysis was performed to identify factors associated with the occurrence of SALI in sepsis patients. The risk factors of SALI were analyzed by lasso logistic regression, and the SALI risk prediction model was established and verified by ROC curve. Results Significant differences were observed between the two groups in the scores of diabetes, mechanical ventilation, shock, hypoxemia, blood urea, platelet count, blood lactic acid, and sequential organ failure assessment (SOFA) scores (P < 0.05). Lasso-logistic regression analysis showed that diabetes mellitus, combined shock, blood lactic acid, and SOFA scores were independent risk factors for SALI (P < 0.05). ROC curve analysis results showed that SALI can be predicted by combining diabetes, combined shock, blood lactic acid, SOFA scores, and the nomogram model were predictive of SALI, with area under the curve values of 0.615, 0.620, 0.843, 0.937, 0.948, respectively. Among these, the nomogram-based prediction model exhibited the highest predictive performance. Conclusion Diabetes mellitus, combined shock, blood lactic acid levels, and SOFA score are independent risk factors for SALI. The nomogram model constructed based on these factors shows high predictive accuracy and clinical applicability, and may facilitate the development of accurate prevention and control strategies for SALI patients.

Causal relationship between increased waist circumference and sepsis based on bidirectional two-sample Mendelian randomization analysis

LIU Tingting, SUN Zhiling, XIAO Qiao, WEN Jiamin, MA Jiatian, QIU Ying

2026, 24(2): 196-199. doi: 10.16766/j.cnki.issn.1674-4152.004359

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Objective To explore the potential causal relationship between waist circumference and sepsis using a two-sample Mendelian randomization (MR) analysis, providing evidence-based support for the clinical identification of high-risk individuals with central obesity and the development of prevention and intervention strategies for infectious diseases. Methods This study used a two-sample bidirectional Mendelian randomization design. The waist circumference served as the exposure variable (n=462 166), and sepsis was the outcome (11 643 cases and 474 841 controls). Data are sourced from the genome-wide association studies (GWAS) dataset. Single nucleotide polymorphisms (SNPs) associated with waist circumference (P < 5×10^-8) and independent of linkage disequilibrium (distance>10 000 kb, r² < 0.001) were selected as instrumental variables. The inverse variance weighting (IVW) method was used as the primary analytical approach, supplemented with MR-Egger regression, weighted median, simple model, and weighted model analyses. Horizontal pleiotropy was assessed through MR-Egger intercept tests, and sensitivity analysis was conducted using the "leave-one-out" method to ensure the stability and reliability of the results. Results MR analysis showed a significant positive causal relationship between waist circumference and sepsis risk in genetic prediction. The IVW analysis revealed that each standard deviation increase in waist circumference was associated with a 75.3% higher risk of sepsis (OR=1.753, 95% CI: 1.571-1.956, P < 0.001), with consistent results across multiple MR methods. Sensitivity analysis and pleiotropy tests indicated robustness of the findings, with no significant bias. Gender-stratified analysis showed consistent associations between waist circumference and sepsis risk in both men and women. Reverse MR analysis did not identify a significant effect of sepsis on waist circumference. Conclusion This study supports the hypothesis that increased waist circumference may be an independent risk factor for sepsis. These findings underscore the importance of recognizing central obesity as a high-risk condition in populations susceptible to infectious diseases and offer new genetic evidence for the prevention and management of sepsis.

Effects of continuous blood purification therapy on mitochondrial DNA and mitochondrial complex Ⅴ in peripheral blood mononuclear cells of sepsis patients

LI Zhixin, LYU Tie, JIN Liezhou, CHEN Lyujian, YING Lijun

2026, 24(2): 200-204. doi: 10.16766/j.cnki.issn.1674-4152.004360

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Objective To investigate the effects of continuous blood purification (CBP) therapy on mitochondrial DNA (mtDNA) and complex Ⅴ of monocytes in patients with sepsis, and to evaluate whether CBP therapy can improve mitochondrial function. Methods A prospective cohort study was conducted in 2023 to analyze the clinical data of 150 patients with sepsis admitted to the Department of Critical Care Medicine of Shaoxing People ' s Hospital from January 2023 to June 2024. Patients were divided into a CBP group (82 cases) and a non-CBP group (68 cases) according to whether the patients received CBP treatment. After 48 hours of treatment, the levels of mtDNA and mitochondrial complex Ⅴ in monocytes were detected in both groups. Twenty patients with similar age and disease severity were selected from each group. Monocytes were isolated 48 hours after treatment and culture in vitro. The levels of mtDNA, mitochondrial complex Ⅴ, TNF-α, and IL-6 were detected at 4, 8, 12, 24, and 48 hours after LPS stimulation. Results The mtDNA levels in both groups were significantly down-regulated compared with that in the group after 48 hours of treatment, and the mtDNA level in the CBP group was significantly lower than that in the non-CBP group (303.74±90.97 vs. 534.68±113.78, P < 0.01). The level of mitochondrial complex Ⅴ in the CBP group after 48-hour treatment was significantly higher than that in the control group [(101.12±33.46) pg/mL vs. (74.04±25.97) pg/mL, P < 0.01]. However, the complex Ⅴ levels were significantly decreased in the non-CBP group compared with the entry group [(57.54±13.89) pg/mL vs. (72.84±25.30) pg/mL, P < 0.01]. The levels of mtDNA, mitochondrial complex Ⅴ, TNF-α, and IL-6 of monocytes in the CBP group were significantly higher than those in the non-CBP group at 4 and 8h after incubation (P < 0.01). Conclusion CBP therapy may help improve monocyte mitochondrial function in patients with sepsis.

The effect of syncope on the overall survival after surgery for hepatocellular carcinoma patients

MU Hong, CAO Pengyu, ZHOU Shan, GUO Tong, CHEN Siyu, Jalalimanesh Rahim, CHEN Yuru, SUN Yulin, LIU Jiexin, XU Bin, MA Li

2026, 24(2): 205-208. doi: 10.16766/j.cnki.issn.1674-4152.004361

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Objective To explore the impact of postoperative syncope on survival of hepatocellular carcinoma (HCC) patients, and aim to provide references for further improving the postoperative management of patients with HCC and the quality of hospice care. Methods HCC patients who underwent surgical resection from January 2014 to December 2017 were included in the study and followed up until death. Basic clinical information and postoperative rehabilitation clinical data were collected for survival analysis, including syncope, distant recurrence and metastasis. The Kaplan-Meier method and the Cox proportional hazards regression model were employed for univariate and multivariate analysis to screen for potential risk factors on overall survival. Results A total of 105 patients were observed until death from HCC, and the overall median survival time was (805.4±45.7) days. Univariate Cox regression analysis demonstrated that the presence of diabetes history, elevated alpha fetoprotein (AFP) levels, distant metastasis within a year, syncope within a year, and higher American Joint Committee on Cancer (AJCC) stage exerted a statistically significant influence on the total survival period after HCC surgery. Multivariate Cox regression analysis demonstrated that elevated AFP value (OR=1.669, 95% CI: 1.031-2.704) and advanced AJCC stage (OR=1.322, 95% CI: 1.037-1.685) were independent risk factors. Conclusion This study hypothesizes that the incidence of syncope in one year has the potential to impact the overall survival of HCC patients post-surgery, and that it may be influenced by other risk factors interactively or indirectly, a factor which requires attention in future research.

A qualitative study of factors influencing pulmonary rehabilitation in patients with interstitial lung disease at home

XU Wenjin, WANG Qing, DAI Jinghong, MIAO Guiling, GAO Li, YANG Wenfen

2026, 24(2): 209-213. doi: 10.16766/j.cnki.issn.1674-4152.004362

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Objective To deeply understand the obstacles and promoting conditions of home-based pulmonary rehabilitation behaviors of patients with interstitial lung disease from the subjective experience of patients, and to provide theoretical support and practical guidance for formulating effective home-based pulmonary rehabilitation plans. Methods Based on the theory of planned behavior, through purposeful sampling and descriptive qualitative research, semi-structured interviews were conducted with 15 patients with interstitial lung disease who had home-based pulmonary rehabilitation experience in a tertiary grade A hospital in Nanjing from September to December 2024. Based on literature review, discussion within the research group, and pre-interviews, an interview outline was drafted. The interview process was recorded. MAXQDA 2022 software was used for data management and analysis, and content analysis was adopted to analyze the data. Results A total of 3 themes and 10 sub-themes were extracted, namely behavioral attitude factors (perceived rehabilitation benefits, fear of movement, negative rehabilitation expectations, and preference for rehabilitation programs), subjective normative factors (positive emotional feedback to motivate rehabilitation behaviors, the "game" driven by social role pressure and responsibility, and the driving effect of positive attitudes of medical staff), and perceived behavioral control factors (adverse physical symptoms, blocked access to rehabilitation resources, insufficient support from the rehabilitation environment). Conclusion The home-based pulmonary rehabilitation behavior of patients with interstitial lung disease is influenced by multiple factors such as behavioral attitude, subjective norms, and perceived behavioral control factors. Medical staff should start from the perspective of patients, comprehensively consider factors such as behavioral attitude, family and social support, and perceived difficulty of rehabilitation, enhance the perceived rehabilitation value of patients with interstitial lung disease, and promote patients to establish a positive behavioral attitude, improve the multi-faceted support system, and reduce the hindering factors for patients to participate in rehabilitation behaviors, providing patients with personalized, comprehensive and dynamically adjusted pulmonary rehabilitation plans.

Study on drug sensitivity and antigenic genotypes of Bordetella pertussis isolates in Chaoyang District, Beijing

ZHUANG Ji, LI Zhen, HOU Yue, JIA Zhe, HU Yingxue, LI Yang, LIU Jie

2026, 24(2): 214-216. doi: 10.16766/j.cnki.issn.1674-4152.004363

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Objective To collect nasopharyngeal swabs from suspected pertussis cases and isolate and culture Bordetella pertussis (Bp) for drug sensitivity and antigen genotype studies, thereby elucidating changes in drug sensitivity and antigen genotypes of Bp isolates in Chaoyang District, Beijing, from 2018 to 2023. Methods A total of 1 200 nasopharyngeal swab samples were collected from patients with suspected pertussis. Real-time fluorescent quantitative PCR was used for pathogen detection. Additionally, the E-test strip method was employed to evaluate the minimum inhibitory concentration (MIC) of Bp against 11 antimicrobial agents, including erythromycin and azithromycin. The genomic DNA of Bp isolates was extracted, and whole-genome sequencing was performed using a next-generation sequencing platform to obtain sequences of antigen genotypes and drug resistance-related loci. Results Sixty strains of Bp were successfully cultured. Epidemiological investigation revealed that 29 patients were under 1 year of age, accounting for 48.3%. Of the isolates, 59 strains exhibited resistance to erythromycin, clindamycin, azithromycin, and clarithromycin (MIC≥256 mg/L), while 1 strain was sensitive to azithromycin. The antigen genotypes of the 60 Bp strains were classified into two types: prn1/ptxP1/ptxA1/fim2-1/fim3-1/tcfA2 (5/60, 8.3%) and prn2/ptxP3/ptxA1/fim2-1/fim3-1/tcfA2 (55/60, 91.7%). All strains belonged to multi-locus sequence typing (MLST) type ST-2. A mutation of A2047G in the 23S rRNA gene was identified in all Bp strains. Conclusion The drug sensitivity and antigen genotype of Bp strains are undergoing notable changes, indicating the need for increased research on Bp strain variations.

Heterogeneous frailty trajectory and prognostic analysis in elderly gastric cancer survivors

ZHOU Yuling, CHEN Jixiang, JING Yu, WU Haiqin, ZHOU Min, SHI Wenyan, FAN Xin

2026, 24(2): 217-220. doi: 10.16766/j.cnki.issn.1674-4152.004364

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Objective To explore the heterogeneous frailty trajectories among older survivors of gastric cancer and to examine their influencing factors and prognostic significance. Methods A total of 488 elderly gastric cancer patients admitted to our hospital between June 2020 and June 2022 were selected. Patients ' frailty was assessed by Tilburg frailty indicator (TFI) at hospital admission and at 1, 3, 6, 9, and 12 months after surgery. Growth mixture modeling (GMM) was used to identify distinct frailty trajectory subtypes. Multifactorial logistic regression was used to analyze the factors associated with different frailty trajectory subtypes. Kaplan-Meier survival curves were used to analyze the relationship between different frailty trajectory subtypes and overall patient survival. Results The GMM model identified three subtypes of frailty trajectories: 252 cases (51.6%) of low-degree declining frailty, 124 cases (25.4%) of medium-degree stable frailty, and 112 cases (23.0%) of medium-degree increasing frailty. Multivariate logistic regression analysis showed that age, diabetes, anemia, marital status, individual monthly income, and mini-nutritional assessment short-form (MNS-SF) score were independent predictors of moderate-degree stable frailty (P < 0.05). Age, diabetes, family caregiver, individual monthly income, MNS-SF score, and social support rating scale (SSRS) score were independently associated with the moderate-degree increasing frailty (P < 0.05). Overall survival rate was higher in the low-degree declining frailty than that in the moderate-degree stable frailty and moderate-degree increasing frailty (P < 0.05). Overall survival was higher in the moderate-degree stable frailty than that in the moderate-degree increasing frailty (P < 0.05). Conclusion Elderly gastric cancer survivors exhibit three frailty trajectory subtypes after surgery. These trajectory subtypes are influenced by different clinical and social factors and are closely associated with prognosis.

Efficacy of Tripterygium Wilfordii Polyglycoside Tablets combined Hydroxychloroquine Sulfate and Golimumab in the treatment of elderly-onset rheumatoid arthritis

YANG Yongqing, WANG Liping

2026, 24(2): 221-224. doi: 10.16766/j.cnki.issn.1674-4152.004365

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Objective To evaluate the efficacy and safety of Tripterygium Wilfordii Polyglycoside Tablets combined Hydroxychloroquine Sulfate and Golimumab therapy in patients with elderly-onset rheumatoid arthritis (EORA). Methods A total of 77 patients diagnosed with EORA at Lanzhou University Second Hospital from June 2018 to December 2022 were enrolled. They were randomly divided into the observation group (40 cases) and the control group (37 cases). Patients were treated for 24 weeks with either Tripterygium glycosides tablets and Hydroxychloroquine Sulfate or Iguratimod combined with golimumab. The primary efficacy endpoints were the American College of Rheumatology 20% (ACR20), 50% (ACR50), and 70% (ACR70) response rates. The secondary efficacy endpoint was the 28-joint Disease Activity Score (DAS28) remission rate. Adverse effects were assessed throughout the treatment period. Results At week 24, the proportions of ACR20, ACR50, ACR70, and DAS28 in the observation group was 97.44% (38/39), 84.62% (33/39), 69.23% (27/39), and 87.18% (34/39), respectively. In the control group, the proportion of ACR20, ACR50, ACR70, and DAS28 was 97.06% (33/34), 88.24% (30/34), 70.59% (24/34), and 76.47% (26/34), respectively. One patient in the observation group was lost to follow-up. In the control group, one patient was lost to follow-up and 2 patients withdrew from the treatment. Conclusion Tripterygium glycosides tablets or Iguratimod combined with Hydroxychloroquine Sulfate and Golimumab can effectively relieve clinical symptoms in patients with EORA with acceptable safety profiles. The treatment regimen in the observation group was more cost-effective. Therefore, Tripterygium glycosides tablets combined with Hydroxychloroquine Sulfate and Golimumab represents a therapeutic strategy worthy of broader clinical application.

Analysis of the disease characteristics and differential diagnostic factors of patients with Helicobacter pylori infection-related gastritis and autoimmune gastritis

HUA Nan, FANG Ying, YAN Liyuan, CHEN Panyun, LU Shanshan, ZHOU Jianbo

2026, 24(2): 225-230. doi: 10.16766/j.cnki.issn.1674-4152.004366

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Objective To analyze the disease characteristics of patients with Helicobacter pylori (Hp) infection-related gastritis and autoimmune gastritis (AIG), and to explore the factors influencing differential diagnosis, so as to provide a theoretical basis for the early identification of gastritis types. Methods A total of 49 patients diagnosed with Helicobacter pylori infection-associated gastritis who received treatment at Yangming Hospital Affiliated to Ningbo University from September 2022 to December 2023 were selected for the Hp group, and 49 patients with autoimmune gastritis during the same period were selected for the AIG group. The clinical data of the two groups of patients were collected. A retrospective analysis and summary were conducted on the disease characteristics and differential diagnostic factors. Results There were statistically significant differences in gastroparesis cardinal symptom index (GCSI), anti-intrinsic factor antibodies (IFA) positivity, pepsinogen Ⅰ (PG Ⅰ), pepsinogen Ⅱ (PG Ⅱ), PG Ⅰ/PG Ⅱ ratio, and gastrin-17 (G-17) between the two groups of patients (P < 0.05). During gastroscopy, the antral mucosa of HP-related gastritis showed a mixture of red and white, with white being dominant, and submucosal blood vessels were visible. Under AIG gastroscopy, it can be seen that the mucosa in the fundus and body of the stomach is thinning, with alternating red and white regions, primarily white. The presence of submucosal blood vessels are visible, and hyperplastic polyps can be seen, while the antrum of the stomach was relatively normal. The histopathological manifestations of HP-related gastritis were characterized by diffuse infiltration of superficial mononuclear inflammatory cells in the lamina propria and neutrophils in the neck of the gastric glands. Intestinal-type epithelial cells have been observed to replace the epithelial cells in the mucosa of the acid-secreting glands. The histopathological manifestation of AIG was chronic inflammatory cell infiltration, primarily in the basal layer of the lamina propria, with pseudopyloric metaplasia of the glandular epithelium or pancreatic acinar cell metaplasia being visible. Multivariate logistic analysis demonstrated that the PG Ⅰ/PG Ⅱ ratio (OR=0.278, P < 0.001) and G-17 (OR=1.268, P=0.005) were the factors influencing the differential diagnosis between HP-related gastritis and AIG. Conclusion The G17, PG Ⅰ/PG Ⅱ ratio and histopathology can be used to distinguish Hp-related gastritis from AIG, thus improving the accuracy of diagnosis.

Value of combined detection of SFRP2 and SDC2 methylation in fecal samples for colorectal cancer screening and prognostic assessment

WEN Hexin, LIN Jie, JIN Xueze, HAO Bo, ZHANG Zongbing, ZUO Lugen, LIU Mulin

2026, 24(2): 231-234. doi: 10.16766/j.cnki.issn.1674-4152.004367

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Objective To investigate the clinical value of combined detection of SFRP2 and SDC2 gene methylation in faeces for the screening, diagnosis and prognostic assessment of colorectal cancer (CRC), providing a molecular basis for non-invasive screening and individualized treatment. Methods A total of 323 subjects who underwent colonoscopy at the First Affiliated Hospital of Bengbu Medical University between January 2019 and December 2019 were enrolled in the study. The subjects were categorized based on pathological diagnosis, they were divided into the CRC group (n=149), the adenoma group (n=60), and the healthy control group (n=114). The methylation levels of the SFRP2 and SDC2 genes in faecal samples were detected using quantitative real-time PCR (qRT-PCR). The χ² test was utilized to analyze the differences in methylation status among the clinical and pathological characteristics of different patients with CRC. The survival differences between the two groups were then compared using the Kaplan-Meier method. Cox regression models were utilized in order to analyze the independent risk factors affecting prognosis. Results The methylation-positive rates of both SFRP2 and SDC2 in the CRC group were significantly higher than those in the adenoma and healthy control groups (P < 0.001). The application of combined detection techniques resulted in a positive detection rate of 91.95% (137/149) within the CRC group. Statistically significant differences were identified in the positive rates of SFRP2 and SDC2 gene methylation among patients with different degrees of differentiation and different TNM stages of colorectal cancer (P < 0.001). Survival analysis revealed that patients positive for SFRP2 methylation (log-rank χ²=14.300) and SDC2 methylation (log-rank χ²=23.240) exhibited significantly lower overall survival rates (P < 0.001). Cox multivariate analysis identified differentiation degree, TNM stage, and SFRP2 / SDC2 methylation as independent risk factors affecting CRC prognosis (P < 0.05). Conclusion The combined detection of SFRP2 and SDC2 gene methylation in faeces has been demonstrated to enhance the detection rate of CRC. Their levels correlate with tumor differentiation, TNM stage and survival rate, which provides important clinical value for early screening and individualized treatment.

A two-sample Mendelian randomization study on the causal relationship between gastroesophageal reflux disease and irritable bowel syndrome

ZHAI Tianqi, JIANG Zhenyu, ZHANG Jingjie, NIAN Yuanyuan, MENG Xianmei

2026, 24(2): 235-238. doi: 10.16766/j.cnki.issn.1674-4152.004368

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Objective Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are the most common gastrointestinal diseases. GERD and IBS have different degrees of impact on patients ' daily life, work and psychological state. This study aims to explore the causal relationship between GERD and IBS using Mendelian randomization (MR). Methods GERD data and IBS data were all from the GWAS database, including 1 590 227 GERD samples (462 753 cases in the case group and 1 127 474 cases in the control group) and 486 601 cases of IBS samples (53 400 cases in the case group and 433 201 cases in the control group). The above samples were all from the European population. IVW was used as the main analysis method to test the causal relationship between GERD and IBS. IVW and MR-Egger methods were used to test heterogeneity, MR-Egger regression intercept was used to test pleiotropy, "leave one" method was used to test the sensitivity of the study, and F value was used to test whether there was weak instrumental variable bias. Results When GERD was selected as exposure and IBS was used as the outcome, 191 cases of SNPs were screened and included. Results indicated that GERD was a risk factor for the occurrence of IBS, and there was a certain causal relationship (IVW method: OR=1.328, 95% CI: 1.269-1.390, P < 0.05). Reverse MR analysis showed that IBS also increased the risk of GERD (IVW method: OR=1.453, 95% CI: 1.092-1.932, P < 0.05). Conclusion There is a bidirectional causal relationship between GERD and IBS. The GERD increases the risk of IBS, and IBS also has a positive effect on GERD.

Positivity and influencing factors of patients in the recovery period of stroke in the elderly

QIAN Yuan, ZHANG Xiping, DONG Qimin

2026, 24(2): 239-242. doi: 10.16766/j.cnki.issn.1674-4152.004369

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Objective To explore the influencing factors of positivity in elderly stroke patients during recovery period, and to develop more targeted intervention strategies for patient positivity in clinical practice and promote patients ' self-management. Methods Convenience sampling was used to select 241 stroke patients admitted to Hangzhou First People ' s Hospital from January to December 2024 as subjects. Demographic information and disease data were collected through the hospital ' s electronic medical record system. The patient activation measure-13 (PAM-13), perceived social support scale (PSSS), and stroke shame scale were used to measure positivity, social support, and shame, respectively. Multiple linear regression analysis was employed to determine the factors influencing the level of positivity. Results The PAM-13 scores for elderly stroke patients were (59.22±9.36) points, social support scores were (59.06±10.31) points, and shame scores were (46.10±9.17) points. Positivity was positively correlated with perceived social support (r=0.419, P < 0.01) and negatively correlated with shame (r=-0.386, P < 0.01). Multiple linear regression analysis revealed that age (70-80 years, β=-0.103; ≥80 years, β=-0.197), educational level (high school/vocational high school, β=0.121; college or above, β=0.243), per capita monthly household income (≥3 000 yuan, β=0.262), marital status (married, β=0.110), self-care ability (partially self-care, β=0.159; fully self-care, β=0.270), shame score (β=-0.135), and PSSS score (β=0.238) were factors affecting the positivity of elderly stroke patients in the recovery period (P < 0.05). Conclusion The positivity of elderly stroke patients in recovery period is related to age, economic status, educational level, marital status, self-care ability, stigma, and social support level. Targeted intervention strategies should be developed to enhance their levels of positivity.

A qualitative study of the experience of kinesiophobia in elderly patients with chronic obstructive pulmonary disease on stress process model

HE Huan, ZHAO Xue, CAI Peng, ZHAN Xiaoya, MA Lei

2026, 24(2): 243-246. doi: 10.16766/j.cnki.issn.1674-4152.004370

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Objective It has been observed that elderly patients suffering from chronic obstructive pulmonary disease (COPD) have experienced a gradual decline in cardiopulmonary function, resulting in a substantial reduction in their exercise endurance levels. Their concerns include the potential adverse effects of exercise on their respiratory function and the emergence of a fear of exercise. The present study conducted interviews from the perspective of a stress process model to explore in depth the psychological experience and key influencing factors of exercise fear in elderly patients with chronic obstructive pulmonary disease, providing a reference for clinical medical staff to develop relevant intervention measures. Methods Purposive sampling was utilized to select elderly patients suffering from chronic obstructive pulmonary disease from Affiliated Hospital of Guizhou Medical University from May to August 2024, for the purpose of serving as research subjects. Semi-structured interviews were conducted, and a total of 12 patients were interviewed. The utilization of conventional content analysis methodologies is imperative for the purpose of data analysis, summarization and theme extraction. Results The psychological experience of exercise fear in elderly patients with chronic obstructive pulmonary disease was summarized into four themes: (1) Perception and cognitive bias of exercise related stressors (threat of exercise-induced discomfort, imbalanced cognition of exercise benefits/risks, low self-efficacy). (2) The absence of support system (insufficient family support, inaccurate medical information). (3) The utilization of negative coping strategies (active avoidance, emotional focus coping such as anxiety/helplessness). (4) The occurrence of adverse physical and mental consequences (increased fear of movement, restricted functional activities). Conclusion The impact of exercise on the fear experienced by elderly patients diagnosed with chronic obstructive pulmonary disease is influenced by multiple factors. In clinical practice, it is incumbent upon medical staff to promptly correct patients ' cognitive biases towards exercise, provide diverse support, guide patients to adopt positive coping strategies, and provide corresponding psychological counselling to help patients alleviate their experience of exercise fear and promote their recovery.

The predictive value of serum albumin changes at 1 year of peritoneal dialysis for the risk of death in peritoneal dialysis patients

JIN Li, LYU Jing, WANG Xiaopei, LIANG Changna, LI Zhao, LU Wanhong

2026, 24(2): 247-250. doi: 10.16766/j.cnki.issn.1674-4152.004371

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Objective Hypoalbuminemia before dialysis affects the survival of peritoneal dialysis (PD) patients, but studies on the effect of albumin improvement on survival rate are limited. This study uses follow-up data to analyze the impact of changes in albumin (ALB) levels after one year of PD on patients ' prognosis. Methods A total of 356 PD patients who underwent new catheterization in the Department of Nephrology, the First Affiliated Hospital of Xi ' an Jiaotong University from January 2015 to December 2019 and received regular follow-up for more than 1 year were retrospectively analyzed. According to their ALB levels at baseline and during one year of dialysis, the patients were divided into continuous low ALB group (group A, n=66), ALB increased group (group B, n=113), ALB decreased group (group C, n=24), and continuous high ALB group (group D, n=153). The Kaplan-Meier method was used to compare the cumulative survival rate among different groups, and the Cox proportional hazards regression model was used to evaluate the risk of all-cause mortality. Results Compared with patients whose ALB ≥35 g/L at 1 year of peritoneal dialysis, those with an ALB level of < 35 g/L had significantly lower creatinine, haemoglobin, and handgrip strength levels, while their high-sensitivity C-reactive protein (hs-CRP) and peritoneal protein clearance levels were significantly higher. Multivariate stepwise logistic regression showed that initial high peritoneal protein clearance rate (OR=1.023, P < 0.001) and low grip strength (OR=0.947, P=0.020), high hs-CRP (OR=1.078, P=0.005), and edema (OR=2.447, P=0.001) were independent influencing factors for albumin < 35 g/L at 1 year of peritoneal dialysis. The Cox proportional hazards model showed that albumin < 35 g/L at 1 year of dialysis was an independent influencing factor for death in peritoneal dialysis patients (OR=3.164, P=0.001). Conclusion High peritoneal protein clearance and low handgrip strength in the first month of peritoneal dialysis, high hs-CRP levels and edema, are independent risk factors for predicting albumin < 35 g/L at 1 year of peritoneal dialysis. An increase in post-dialysis ALB can significantly reduce the mortality risk in peritoneal dialysis patients.

Clinical efficacy and safety of doxycycline in pediatric pertussis

HE Yuxuan, WANG Huaping, ZHAO Shiyong, ZHAN Lu

2026, 24(2): 251-254. doi: 10.16766/j.cnki.issn.1674-4152.004372

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Objective To explore the efficacy and safety of doxycycline in treating pertussis in children aged 8 years and above. Methods A retrospective analysis was conducted on 166 children aged ≥ 8 years with pertussis who attended the pediatric outpatient department of Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from December 2023 to May 2024. According to the antibiotics selected, patients were divided into the azithromycin group (62 cases), the trimethoprim sulfamethoxazole (TMP-SMZ) group (48 cases), and the doxycycline group (56 cases). The clinical efficacy, time to symptom relief, and incidence of adverse reactions were compared among the three groups. Results The azithromycin group showed 9 cases of significant effectiveness, 11 cases of effectiveness, and 42 cases of ineffectiveness, with a total effective rate of 32.25%. The TMP-SMZ group demonstrated 14 cases of significant effectiveness, 26 cases of effectiveness, and 8 cases of ineffectiveness, yielding a total effective rate of 83.33%. In the doxycycline group, 18 cases were significantly effective, 26 cases were effective, and 12 cases were ineffective, with a total effective rate of 78.57%. The total effective rate of the azithromycin group was lower than that of the other two groups (P < 0.001 after Bonferroni correction). The times to symptom relief time in the azithromycin, TMP-SMZ, and doxycycline groups were (13.05±4.23) days, (11.00±2.30) days, and (11.23±2.59) days, respectively, with the azithromycin group showing a significantly longer duration (P < 0.05). In terms of adverse reactions, 11 cases in the azithromycin group and 5 cases in the doxycycline group had gastrointestinal symptoms. In the TMP-SMZ group, 14 patients developed adverse reactions, including 4 with gastrointestinal symptoms and 10 with rashes. The TMP-SMZ group had higher incidences of rash and total adverse reactions compared to the doxycycline group (P < 0.017 after Bonferroni correction). Conclusion Doxycycline can effectively alleviate symptoms in children aged 8 years and older with pertussis, with fewer adverse reactions, supporting its clinical application value.

Advantages of midline catheter infusion in the treatment of pediatric complex limb trauma and prediction of associated phlebitis

LU Jingwen, WANG Rui, DONG Haojuan, SUN Huihui

2026, 24(2): 255-258. doi: 10.16766/j.cnki.issn.1674-4152.004373

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Objective Children with complex limb trauma often require prolonged intravenous therapy, during which peripheral venous catheters (PVCs) are associated with a high incidence of phlebitis. This study compared the efficacy of midline catheters (MCs) with PVCs and developed a predictive model for phlebitis to support clinical decision-making. Methods A retrospective analysis was conducted on 86 pediatric patients with complex limb trauma treated at the Department of Pediatric Orthopaedics, Wuxi Ninth People ' s Hospital, between January 2018 and June 2024. Patients were allocated to an observation group (MC, n=60) or a control group (PVC, n=26), and infusion-related risks and complications were compared. MC patients were further subdivided into a phlebitis subgroup (n=30) and a non-phlebitis subgroup (n=30). Risk variables were screened by Lasso regression, independent predictors were identified by logistic regression, and a prediction model was constructed using R software. Results The overall incidence of adverse events in the observation group was significantly lower than in the control group (P < 0.05). Phlebitis rates were 50.00%(30/60) with MC and 69.23% (18/26) with PVC (χ²=3.906, P=0.048). Logistic regression revealed that prolonged intravenous therapy duration (B=0.079, OR=1.082), extended catheter dwell time (B=0.163, OR=1.177), and higher drug irritancy (B=0.562, OR=1.755) were independent risk factors for phlebitis. The derived predictive model demonstrated excellent discriminative ability, with an AUC of 0.933 and an mean absolute error of 0.054. Conclusion MC and PVC exhibit similar first-attempt insertion success rates. However, MC offers longer dwell time, lower infusion-related risks, and fewer complications. The developed phlebitis prediction model accurately estimates the probability of phlebitis in children receiving MC, thereby facilitating evidence-based clinical decision-making.

The efficacy of Gufei Zhike Decoction combined with Montelukast Sodium in children with chronic cough and its influence on immune function and inflammation

FANG Fang, YE Long

2026, 24(2): 259-261. doi: 10.16766/j.cnki.issn.1674-4152.004374

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Objective Attention should be paid to the lingering symptoms of chronic cough in children. This study analyzed the efficacy of Gufei Zhike Decoction combined with Montelukast sodium in the treatment of chronic cough in children (lung and spleen deficiency type) and the influence on immune function and inflammation. Methods A total of 180 children with chronic cough admitted to the Department of Pediatrics of Wenzhou Hospital of Integrated Chinese and Western Medicine from July 2023 to June 2024 were divided into the western medicine group (montelukast sodium) and the combined Chinese and Western medicine group (Gufei Zhike Decoction + montelukast sodium) by random number table method, with 90 cases each, with 1 month of treatment. The clinical efficacy, cough improvement, traditional Chinese medicine (TCM) syndrome score, immune function [immunoglobulin (IgG, IgM, IgA)], and inflammatory response [exhaled nitric oxide (FeNO), serum hypersensitive C-reactive protein (hs-CRP), and interleukin-4 (IL-4)] were compared between the two groups. Results The total effective rate of the combination group was higher than that of the western group [85.56% (77/90) vs. 70.00% (63/90), χ²=6.300, P=0.012]. The duration of cough remission and cough disappearance in the combined group was shorter than that in the western medicine group[(15.23±3.41) d vs. (18.47±3.65) d, (22.19±1.93) d vs. (24.86±2.05) d, P < 0.05]. After 1 month of treatment, TCM syndrome score, FeNO, hs-CRP, and IL-4 levels in both groups decreased, and the combined Chinese and Western medicine group was lower (P < 0.05), while the levels of IgG, IgM, and IgA in both groups increased, and the combined Chinese and Western medicine group was higher (P < 0.05). Conclusion Gufei Zhike Decoction combined with Montelukast sodium can effectively treat chronic cough in children, improve symptoms, improve immune function, and relieve inflammation.

Current status of clinical competency assessment and problem analysis of general practitioners in community health centers in Shanghai Jing'an district

HUA Ming, SHI Jianwei, SHEN Tianhan

2026, 24(2): 262-266. doi: 10.16766/j.cnki.issn.1674-4152.004375

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Objective To analyze the current status and identify weaknesses in clinical competence among community-based general practitioners (GPs) in Jing ' an District, Shanghai, through a comprehensive competency assessment, and to inform strategies for enhancing clinical continuing education and fostering sustainable improvements in GP clinical capabilities. Methods A total of 192 GPs from 15 community health centers in Jing ' an District were organized to participate in the clinical competency assessment (including clinical theoretical knowledge and clinical operational skills) from August and December 2023. Multiple linear regression was employed to identify factors influencing assessment scores. Results The overall mean score of the 192 GPs was 73.42±11.42 (pass rate: 86.46%), with theoretical knowledge scoring 68.77±15.53 (pass rate: 71.35%) and procedural skills 82.48±16.81 (pass rate: 98.96%). Regression analysis revealed that standardized training history (P < 0.001), access to teaching faculty (P < 0.001), and participation in rotational training (P=0.003) significantly influenced theoretical scores. Faculty availability independently affected radiograph interpretation scores (P=0.007). These three factors collectively impacted overall scores (P < 0.001 for training, P < 0.001 for faculty, P=0.025 for rotation). Conclusion Community-based GPs demonstrates suboptimal clinical competence, particularly in theoretical knowledge and electrocardiogram interpretation. Deficiencies are more pronounced among GPs lacking standardized training, teaching faculty support, or rotational experience. To address these gaps, future efforts should focus on optimizing postgraduate and continuing education curricula, establishing dynamic competency evaluation frameworks, strengthening standardized residency training programs, enhancing faculty development, and implementing structured job rotation systems. These measures aim to establish a scientifically sound and sustainable development system for enhancing the clinical competency of general practitioners, thereby collectively driving continuous improvement in their clinical capabilities.

Effect of FKBP5 gene polymorphism on hair cortisol predicting suicidal intent in patients with depression

LUO Fugang, HE Xi, WU Yuejing

2026, 24(2): 267-270. doi: 10.16766/j.cnki.issn.1674-4152.004376

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Objective To analyze the impact of the rs1360780 polymorphism in the FKBP5 gene on the predictive value of hair cortisol levels for suicidal intention in patients with depression, and clarify factors related to suicidal intention and the clinical value of hair cortisol as an objective biomarker. Methods A total of 80 depressive patients with suicidal intention who were diagnosed and treated in Hangzhou Seventh People' s Hospital from May 2022 to May 2024 were selected as the observation group, and depressive patients without suicidal intention who had similar basic information, living habits and disease history were selected as the control group at a ratio of 1∶1. The Hamilton depression rating scale (HAMD), self-rating suicidal ideation scale (SIOSS), FKBP5 rs1360780 polymorphism, hair and serum cortisol levels of different patients were compared, and the risk factors of suicidal intent were analyzed. Results In rs1360780 CT/TT, rs1360780 CC and all patients, serum and hair cortisol levels were positively correlated with HAMD and SIOSS. Self-guilt (OR=2.568, 95% CI: 1.345-4.903), anxiety (OR=2.077, 95% CI: 1.313-3.286), despair (OR=1.024, 95% CI: 1.008-1.040), rs1360780 CT/TT (OR=3.831, 95% CI: 2.436-6.024), HAMD (OR=2.440, 95% CI: 1.847-3.223) and SIOSS (OR=1.506, 95% CI: 1.060-2.138) were significantly different. Conclusion The predictive value of hair cortisol levels in depression patients for depression suicide is influenced by the presence of the T allele FKBP5 rs1360780.

Analysis of the current situation and influencing factors of health education demands of parents of children undergoing bronchoscopy

CUI Yuhui, WEI Wenya, HUANG Lina, QI Meitao, LIU Xuejiao, HUO Peiqing

2026, 24(2): 271-274. doi: 10.16766/j.cnki.issn.1674-4152.004377

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Objective This study aims to explore the current status of health education needs of parents of children undergoing bronchoscopy and analyze its influencing factors, providing a scientific basis for formulating targeted intervention measures. Methods According to the order of admission, 200 parents of children who underwent bronchoscopy examination at Hebei Children' s Hospital from March 2023 to February 2024 were selected as the research subjects. The health education needs of the parents of the children were investigated in the form of questionnaires. The parents with the top 25% total score were assigned to the group with higher needs, and the rest were assigned to the groups with average needs and no needs. The logistic regression model was used to analyze the factors influencing parents' health education demands, and the ROC curve was used to analyze the predictive value of the influencing factors for the current situation of parents' health education demands. Results Among the 200 parents of the children patients, 53 parents (26.5%) had a relatively high demand for disease knowledge and health education. Parents' age, educational level, occupation, and monthly family income are factors influencing the demand for health education (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of monthly household income, parents' educational level, occupation, age, and combined prediction were 0.715 (95% CI: 0.655-0.765), 0.783 (95% CI: 0.722-0.835), and 0.727 (95% CI: 0.683-0.782), 0.661 (95% CI: 0.601-0.711), 0.878 (95% CI: 0.815-0.920). The vast majority of parents (85.0%, n=170) preferred to obtain health education information online. The group with higher demands has a higher demand for health education in terms of preoperative preparation, intraoperative cooperation, postoperative care, and complication prevention. Conclusion Medical staff should provide targeted health education services based on the monthly family income, educational level, occupation, age, and other conditions of the parents of the child patients.

The diagnostic value of Xpert MTB/RIF for NTM pulmonary disease in smear-positive patients and analysis of the species distribution characteristics of NTM

LIU Wenbin, TANG Leiming, WANG Min, CAI Chengsong, PAN Feng

2026, 24(2): 275-279. doi: 10.16766/j.cnki.issn.1674-4152.004378

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Objective To evaluate the diagnostic value of Xpert MTB/RIF for nontuberculous mycobacterial (NTM) pulmonary disease among smear-positive patients and analyze the species distribution of NTM, thereby enhancing the clinical early diagnostic capability for such patients. Methods A total of 122 inpatients admitted to the Affiliated Hospital of Hangzhou Normal University from April 2020 to September 2024 were retrospectively selected as research subjects, including 73 cases of NTM lung disease and 49 cases of pulmonary tuberculosis. With smear-positive patients as the analysis subgroup, Kappa analysis was used to verify the consistency of Xpert and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the differential diagnosis of NTM lung disease and pulmonary tuberculosis, and the species distribution characteristics of NTM were analyzed simultaneously. Results The positivity rates of Xpert MTB/RIF were 1.92% (1/52) in smear-positive NTM pulmonary disease, 0% (0/21) in smear-negative NTM pulmonary disease, 100.00% (38/38) in smear-positive pulmonary tuberculosis, and 72.73% (8/11) in smear-negative pulmonary tuberculosis. One case of Mycobacterium abscessus subsp. abscessus was misclassified as Mycobacterium tuberculosis by Xpert MTB/RIF. Among the 73 NTM pulmonary disease cases, single-strain infection accounted for 79.45% (58/73), and mixed infections with two or more NTM strains accounted for 20.55% (15/73). Among the 89 NTM strains detected by MALDI-TOF MS, the more common species were Mycobacterium intracellulare (62.92%, 56/89) and Mycobacterium abscessus (17.98%, 16/89). Xpert MTB/RIF and MALDI-TOF MS demonstrated excellent concordance in distinguishing NTM pulmonary disease from pulmonary tuberculosis among smear-positive patients (Kappa=0.938, P < 0.001). Conclusion Mycobacterium intracellulare was the most common NTM species in patients with NTM pulmonary disease, followed by Mycobacterium abscessus. Xpert MTB/RIF can effectively differentiate NTM pulmonary disease from pulmonary tuberculosis in smear-positive patients and exhibits significant clinical value for the diagnosis of smear-positive NTM pulmonary disease.

Relationship between brain symptoms and the expression of intestinal flora metabolites and endoplasmic reticulum stress products in patients with mild carotid stenosis

GONG Chu, ZHAO Yiting, TANG Xinle, DU Minjie, ZHANG Yuxiang

2026, 24(2): 280-284. doi: 10.16766/j.cnki.issn.1674-4152.004379

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Abstract:
Objective To explore the relationship between the occurrence of brain symptoms and the expression of intestinal flora metabolites and endoplasmic reticulum stress products in patients with mild carotid stenosis. Methods This study retrospectively analyzed the data sets of 87 patients who received carotid ultrasound examination in our hospital from January 2021 to June 2023, the mRNA level of the endoplasmic reticulum stress marker C/EBP homologous protein (CHOP) in peripheral blood was analyzed by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The fresh stool samples were collected for the first time after admission, and the levels of short-chain fatty acids (SCFAs) in the samples were analyzed by high-performance liquid chromatography. Results Plaque length, plaque area, and CHOP mRNA expression in peripheral blood in the symptomatic group increased significantly (P < 0.05), while the levels of intestinal flora metabolites such as acetic acid, propionic acid, butyric acid, isovaleric acid, and valeric acid decreased significantly (P < 0.05). CHOP mRNA expression was positively correlated with plaque length and plaque area (r=0.299 and 0.221, all P < 0.01), and negatively correlated with the levels of acetic acid, propionic acid, butyric acid, isovaleric acid, and valeric acid (r=-0.324, -0.285, -0.450, -0.233, and -0.332, all P < 0.05). The length of plaque was negatively correlated with butyric acid and isovaleric acid (r=-0.302 and -0.313, both P < 0.01). The plaque area was negatively correlated with propionic acid, butyric acid, and isovaleric acid (r=-0.230, -0.261, and -0.276, all P < 0.05). The prediction ability of butyric acid was the highest. When the cutoff value was 8.8, its AUC was 0.902, sensitivity was 77.1%, and specificity was 84.0%. Followed by CHOP mRNA expression, when the cutoff value was 0.60, its AUC was 0.811, sensitivity was 62.9%, and specificity was 94.0%. Conclusion The decrease of fecal acetic acid, propionic acid, butyric acid, isovaleric acid, and valeric acid levels and the increase of CHOP mRNA expression in peripheral blood may be related to the occurrence of brain symptoms, and these changes are related to the characteristics of carotid plaque.

Advances in research on acute sarcopenia in older adults

ZHU Zhongxin, JIN Fang, JIN Chuchu, ZHU Liming, YAO Xiaocong

2026, 24(2): 285-288. doi: 10.16766/j.cnki.issn.1674-4152.004380

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Acute sarcopenia is a muscle disorder commonly observed in the elderly, primarily triggered by acute diseases, surgeries, or hospitalization-related stress events, and is characterized by a rapid loss of muscle mass and function. With the acceleration of global population aging, acute sarcopenia has emerged as a critical public health challenge, exerting a substantial negative impact on patients' quality of life and clinical prognosis. The development of sarcopenia is closely associated with age-related physiological changes, including a gradual reduction in physical activity and progressive physiological muscle decline. These changes are often exacerbated by comorbid factors such as frailty, malnutrition, and osteoporosis, which increase the risk of sarcopenia. Research indicates a high incidence of acute sarcopenia among hospitalized elderly patients. However, due to the lack of routine muscle mass and function assessments in clinical practice, diagnostic rates remain low and actual prevalence is likely underestimated. Acute sarcopenia not only prolongs patient hospitalization but also increases complications and mortality risks, thereby markedly worsening patient outcomes and life quality. The pathogenesis of acute sarcopenia is complex, primarily involving muscle disuse, inflammatory responses, endocrine disorders, and mitochondrial damage. Intervention strategies for acute sarcopenia encompass exercise training, nutritional interventions, neuromuscular electrical stimulation, and pharmacological treatments. Despite notable research progress, significant challenges remain in elucidating the molecular mechanisms, establishing diagnostic standards, and developing therapeutic strategies. Future research should prioritize the identification of early diagnostic markers, the optimization of personalized treatment approaches, and the establishment of multidisciplinary diagnostic and management models led by geriatric medicine to enhance clinical outcomes. Accordingly, this review comprehensively summarizes the latest research advances in acute sarcopenia, including its definition, epidemiological characteristics, pathogenesis, treatment strategies, and preventive measures, aiming to provide clinicians with effective diagnostic and therapeutic insights and directions for future investigations.

Research progress on the mechanism of traditional Chinese medicine in the prevention and treatment of non-alcoholic fatty liver disease

WANG Yanan, ZHANG Jinpeng, XIA Meihui, REN Qianyi, HAN Xinhui, LIANG Guoying

2026, 24(2): 289-293. doi: 10.16766/j.cnki.issn.1674-4152.004381

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The incidence of Non-alcoholic fatty liver disease (NAFLD) has increased markedly and it has become a global health issue. NAFLD is characterized by an abnormal accumulation of fat in hepatocytes and is a metabolic disorder with a complex pathological mechanism closely related to insulin resistance, endoplasmic reticulum stress, mitochondrial dysfunction, oxidative stress, autophagy and abnormal gut microbiota. At present, Western medicine has not identified a specific pharmaceutical treatment for NAFLD, whereas traditional Chinese medicine (TCM) has demonstrated unique advantages and significant potential in the prevention and treatment of NAFLD. According to TCM, the fundamental cause of the disease lies in the liver' s inability to maintain adequate dispersion and dredging function and the spleen' s incapacity to carry out its normal transportation and transformation processes. This results in the complex interplay of phlegm-dampness and blood stasis, which impede the liver collaterals, leading to causing the accumulation of turbid and fatty qi within the liver. With regard to the treatment of this condition, the fundamental principles are to soothe the liver and strengthen the spleen, as well as to resolve turbidity and remove stasis. In recent years, a significant number of studies have concentrated on the mechanism of action of TCM compound prescriptions, single herbs and active ingredients, revealing the core pathways through which they effectively intervene in the progression of NAFLD through multi-target and multi-pathway coordinated regulation. However, there is a paucity of comprehensive review articles on the mechanism of TCM in the prevention and treatment of NAFLD. This review systematically integrates the latest research results of TCM in the prevention and treatment of NAFLD, and carries out a profound analysis of its multi-level and multi-target action mechanisms at the molecular, cellular, and system levels based on a holistic view and the principle of syndrome differentiation and treatment. This provides a unique perspective for a deeper understanding of the complex pathogenesis network of NAFLD, as well as provides a solid theoretical basis and important research direction for the precise clinical application of TCM and the development of innovative therapies based on traditional Chinese medicine.

Application of Hammersmith infant neurological examination combined with early acupuncture in the rehabilitation treatment of high-risk infants with brain injury

BAI Yupei, ZENG Jiaofeng, LI Yujie, HAN Meimei, LIU Zhenzhen, LYU Nan

2026, 24(2): 294-298. doi: 10.16766/j.cnki.issn.1674-4152.004382

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Objective At present, there is still a lack of unified norms for the early rehabilitation of children at high risk of brain injury. This article explores the application value of Hammersmith Infant Neurological Examination (HINE) combined with early acupuncture in the rehabilitation treatment of infants at high risk of brain injury, with the aim of providing a basis for the treatment of such children in the future. Methods A total of 88 high-risk children with brain injury admitted to Henan Children' s Hospital from November 2022 to May 2024, were selected and randomly divided into the conventional group and the treatment group. Under the strict screening, 42 cases in each group were included. The conventional group received conventional rehabilitation training and the treatment group received conventional rehabilitation training+ HINE combined with early acupuncture treatment, with 3 months of treatment. The total effective rate of treatment, exercise capacity [gross motor function measure (GMFM88) and fine motor function measure (FMFM)], neurological functions [serum myelin basic protein (MBP), brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE)], cerebral hemodynamics [mean cerebral arterial flow velocity (Vm), peak systolic velocity (Vs) of arteries, vascular resistance index (RI)], and complications of the two groups were compared. Results The treatment group had higher total effective rate [95.24% (40/42) vs. 76.19% (32/42), χ²=6.222, P=0.013]. After treatment, the scores of area A and area B of GMFM88 and FMFM, the level of serum BDNF, Vm, and Vs in the treatment group were all higher than those in the conventional group, while serum MBP, NSE, and RI were all lower (P < 0.05). There was no significant difference in short-term and long-term complications between the two groups (P>0.05). Conclusion HINE combined with early acupuncture is beneficial to improving the rehabilitation treatment effect of high-risk infants with brain injury, improving the motor development of children, promoting neural repair and protection of children, and increasing the blood perfusion of brain tissue in children.

Analysis of the application effect of intelligent electronic tag systems in vaccine management

WANG Jun, LlU Xiaohua, LIANG Jiazhi, CHEN Xudong, CHEN Junhu, HUANG Zhuhang, ZHU Fangjun

2026, 24(2): 299-301. doi: 10.16766/j.cnki.issn.1674-4152.004383

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Abstract:
Objective To evaluate the effectiveness of intelligent electronic tag system in vaccine management and to provide a reference for further research and application by disease prevention and control institutions in China. Methods Six vaccination clinics in Haizhu District, Guangzhou, were selected as the intelligent electronic tag group, while another 6 vaccination clinics (18 clinics) as the paper-based tag group using a simple random sampling method from January 1, 2022 to December 31, 2023. The intelligent electronic tag group of vaccination clinics adopted the intelligent electronic tag system provided by Suzhou Lengwang Network Technology Co., Ltd. for management and monitoring, while the paper-based tag group used traditional paper tag management. Each group extracted 400 sets of daily management data since January 2022. The two groups were compared and analyzed with respect to indicators such as vaccine inventory time, daily stocktaking time, incorrect vaccine retrieval, incorrect vaccine placement, and vaccine scrap rate. Results The intelligent electronic tag system achieved the "six unifications" in vaccine management. Compared with paper-based tag management, the intelligent electronic tag system reduced the average daily vaccine inventory and picking time by (2.1±0.2) hours (t=132.816, P < 0.001). The intelligent electronic labeling system recorded 7 vaccine registration errors (1.75%), while the paper-based tag system recorded 40 errors (10.00%), the difference was statistically significant (χ²=24.616, P < 0.001). A total of 1 409 doses of vaccines were scrapped under intelligent electronic tag system, with a vaccine scrap rate of 0.34%, while 3 291 doses were scrapped under paper-based tag system, with a vaccine scrap rate of 1.80%, this difference was also statistically significant (χ²=3 400.141, P < 0.001). Conclusion The intelligent electronic tag system complies with the requirements of the Vaccine Administration Law of the People' s Republic of China regarding vaccine expiration date management. It enables efficient and systematic vaccine management, decreases vaccine administration errors and wastage, and improves the efficiency of vaccine management in vaccination clinics.

The application of flipped classroom based on virtual reality technology in clinical teaching of oncology

ZHANG Qiong, KONG Shengnan, LI Yize, YANG Jing, ZHANG Hongmei

2026, 24(2): 302-305. doi: 10.16766/j.cnki.issn.1674-4152.004384

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Objective The virtual reality training system is applied in medical education by constructing a three-dimensional human anatomical model. The flipped classroom is a student-centered interactive teaching mode. This study aims to explore the application effect of virtual reality technology combined with the flipped classroom in clinical oncology teaching. Methods A total of 50 postgraduate students with professional degrees and standardized training residents who received standardized training in the Oncology Department of the First Affiliated Hospital of the Air Force Medical University from 2021 to 2023 were selected as participants. They were divided into an experimental group (25 people) and a control group (25 people) using the random number method. Taking breast cancer clinical teaching as an example, the experimental group adopted the flipped classroom teaching model based on virtual reality technology for clinical practice teaching, while the control group received traditional teaching. The teaching effects of the two teaching methods were compared through clinical skills assessment, questionnaire surveys, and satisfaction feedback. Results Compared with the control group, the experimental group showed significantly higher assessment scores in the mastery of diagnosis and treatment principle formulation and in cutting-edge clinical research knowledge (25.84±2.61 vs. 23.64±3.49, t=2.535, P=0.018; 25.64±2.27 vs. 22.56±3.39, t=3.774, P < 0.001). Moreover, the experimental group exhibited substantial improvements in self-directed learning ability, literature retrieval skills, memory and mastery of tumor TNM staging, staging accuracy, and interest in oncology learning. The differences between the two groups were statistically significant (P < 0.05). Conclusion The application of the flipped classroom based on virtual reality technology in clinical oncology teaching has significantly improved students' self-directed learning ability, literature retrieval skills, memory and mastery of tumor TNM staging, and interest in oncology learning. It also notably enhances their assessment scores in mastering diagnosis and treatment principles and cutting-edge clinical research. This approach plays a positive role in increasing teaching satisfaction and improving teaching effectiveness, making it worthy of further promotion and application.

The practice and experience of combining flipped classroom with CBL teaching model in urology clinical education

LI Yanze, NING Jinzhuo, KANG Peng, YUAN Run, YAO Xiaobing, XIE Jinna, LI Haoyong

2026, 24(2): 306-308. doi: 10.16766/j.cnki.issn.1674-4152.004385

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Objective To address issues in traditional clinical education such as students passively receiving foundational knowledge and the disconnection between clinical theory and practice, this study explores the effectiveness of the flipped classroom model combined with the case-based learning (CBL) teaching model in urology clinical education. Methods A total of 80 undergraduate clinical medicine students undertaking internships in the Department of Urology at Renmin Hospital of Wuhan University from September 2022 to June 2024 were selected and randomly divided into an experimental group (n=40) and a control group (n=40). The experimental group received the flipped classroom combined with CBL teaching model, while the control group followed traditional teaching methods. The two groups were compared in terms of theoretical knowledge assessment scores, diagnostic and therapeutic thinking assessment scores, practical skills assessment scores, and teaching effectiveness questionnaires. Results The experimental group outperformed the control group in theoretical knowledge (89.5±4.2 vs. 82.1±5.1), diagnostic and therapeutic thinking (78.4±2.5 vs. 71.6±2.1), and practical skills (91.3±3.8 vs. 83.6±4.6; all P < 0.05). Additionally, the experimental group reported significantly higher satisfaction with enhancing self-directed learning ability (92.5%, 37), cultivating clinical thinking (97.5%, 38), and improving teamwork skills (90.0%, 36) compared to the control group (72.5%, 29; 67.5%, 27; 62.5%, 25; P < 0.05). Conclusion The flipped classroom model combined with CBL teaching significantly improves students' clinical theoretical knowledge, practical skills, and teaching satisfaction in urology clinical education, demonstrating value for broader application.

Construction of iceberg model based on the post competency of general practitioner faculty under the background of healthy China

JIN Lijiao, LIU Weirong, GONG Haidong, WU Yue, GUO Lin, WANG Junlin

2026, 24(2): 309-313. doi: 10.16766/j.cnki.issn.1674-4152.004386

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Abstract:
Objective Since its introduction to China in the 1980s, general practice has made significant progress. However, there is currently a lack of a unified and comprehensive system for the construction of general practice teaching faculty in China, and the post competency of general practice teaching faculty is not yet systematically defined. This study aims to construct a competency model for general practitioner faculty under the background of "Healthy China 2030", and providing theoretical reference for the standardization construction of the current general practitioner faculty. Methods A survey questionnaire on the competency characteristics of general practitioner faculty was developed through literature review, semi-structured interviews, and expert consultation. An exploratory factor analysis was used to construct a competency model for general practitioner faculty, and confirmatory factor analysis was used to further verify the construction of the model about the scientific and validity. Results The constructed competency model for general practitioner faculty included 6 dimensions and 30 competency feature items, the results showed that: χ²/df=1.769, P < 0.001, GFI=0.918, IFI=0.963, TLI=0.959, CFI=0.963, RMSEA=0.039, the validity of the model was good, and it could well represent the competency elements of current general practitioner faculty, and comprehensively summarized of the competencies that general practitioners in China should possess under the background of a healthy China. Conclusion The competency model for general practice faculty constructed in this study has good scientific and feasibility, further enriching the theoretical basis for the construction of the general practice faculty team, providing reference for the establishment of admission, training, and assessment standards for general practice faculty, and providing useful references for the overall quality improvement of the general practice faculty team. At the same time, it also has directional guidance for the professional development of general practice faculty, clarifying the direction and goals of ability improvement.

Patient-centered diagnostic and therapeutic framework for bitter taste in general practice

SUN Junsheng, WU Jingshen, HUANG Weixin, LIU Xu, REN Jingjing, YAO Dingye

2026, 24(2): 314-317. doi: 10.16766/j.cnki.issn.1674-4152.004387

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Abstract:
Objective To develop a patient-centered diagnostic and therapeutic strategy and practice framework for bitter taste, with the aim of providing general practitioners with a standardized approach for diagnosis. Methods A systematic literature review was conducted to explore the classification and etiology of bitter taste in the mouth. This review integrated the understanding from both traditional Chinese medicine and Western medicine. The SOAP documentation method, was employed in combination with the RAPRIOP management model, which was developed for primary care. This resulted in the exploration of multidisciplinary collaborative diagnostic and treatment pathways. Results Bitter taste in the mouth is classified into transient and persistent types based on clinical characteristics, and into organic and non-organic types based on etiology. In clinical practice, bio-psycho-social multi-dimensional information is integrated using the SOAP documentation method. Subjective data (S) are obtained through the collection of a patient ' s biological history, combined with the BATHE interview method. Objective data (O) are acquired via a combination of focused and systematic physical examinations, ancillary tests, and scale assessments. Etiology acute/critical conditions, and severity are comprehensively evaluated (A); and a plan (P) is developed using the RAPRIOP management model, encompassing seven elements: rebuilding confidence, recommendations, prescriptions, referrals, examinations, observation, and prevention. Moreover, a multidisciplinary diagnostic and treatment model centered on general practice, supported by specialty collaboration, and characterized by the integration of traditional Chinese and Western medicine is constructed. This is complemented by a three-tier prevention system, forming a systematic diagnostic and treatment framework. Conclusion The SOAP documentation method systematically integrates bio-psycho-social multi-dimensional information, providing structured support for the precise assessment of bitter taste in the mouth; the RAPRIOP management model can orderly implement full-process intervention measures.

Analysis of the improvement effect of defective medical record homepage from the perspective of diagnosis related groups

GU Xiaomin, CHEN Yinan

2026, 24(2): 318-320. doi: 10.16766/j.cnki.issn.1674-4152.004388

6 0

Abstract:
Objective To analyze the impact of the quality of filling in the medical record homepage on the grouping of diagnosis related groups (DRGs) and the settlement of medical insurance expenses, and to explore the effect of quality control measures on improving defective medical record homepages, thereby enhancing hospital DRG management. Methods We conducted a retrospective analysis of 8 776 inpatient discharge records with defects in the medical record homepage from Huzhou Central Hospital in 2022. Using data before and after the quality-control (QC) intervention. We compared differences in key indicators, including case inclusion rate, number of DRG groups, cost consumption index, time consumption index, and reimbursement balance. Results After QC, the case inclusion rate increased from 91.12% (8 014 cases) to 99.78% (8 776 cases). Cases in the normal-multiplier group rose to 7 650 (87.17%), while those in the high-multiplier group decreased to 524 (5.97%). The number of DRG groups increased by 19, and the case-mix index decreased by 0.22. The cost and time consumption indices declined from 1.14 and 1.21 to 1.01 and 1.02, respectively. The reimbursement balance also improved, most notably in digestive system diseases, where it shifted from CNY -2.216 9 million to CNY -0.169 2 million. All pre- vs. post-QC comparisons were statistically significant (P < 0.05). Conclusion The introduction of quality control measures significantly improves the quality of filling in the medical record homepages, optimizes case classification and resource allocation, reduces medical expenses and time consumption, and improves DRG management and medical service efficiency. These measures effectively enhance the hospi-tal's overall management and medical quality of practice, providing valuable references. Future work should continue to deepen quality control measures and explore more innovative management strategies to further improve the medical service quality and efficiency.

A scoping review of intervention strategies for kinesiophobia after total knee arthroplasty

YANG Lin, SHU Jing, CAO Lizhen

2026, 24(2): 321-324. doi: 10.16766/j.cnki.issn.1674-4152.004389

6 0

Abstract:
Objective A scoping review of research on intervention strategies for kinesiophobia after total knee arthroplasty was conducted to summarize the form and content of the different strategies implemented and their conclusions, with a view to informing further research by academics and healthcare professionals in the future. Methods A systematic search of the following databases was conducted in: PubMed, Embase, Web of Science, Cochrane Library, China Knowledge, Wipro, Wanfang and Biomedical Literature Service. The search was conducted with the aim of conducting a scoping review, and the timeframe for the construction of the database was taken into consideration. The end point of the timeframe was to December 2023. The objective of the review was to collect literature related to intervention strategies for kinesiophobia after total knee arthroplasty. The included literature was then summarized and analyzed descriptively. Results Initially, 1 247 papers were retrieved, and after eliminating duplicates and papers that did not meet the inclusion criteria, 21 papers were finally included, published from 2013-2023, including 15 in Chinese and 6 in English, including 5 types of cognitive-behavioral intervention therapies, functional exercises, watching videos, pain diaries, and multidisciplinary collaboration. Conclusion The effectiveness of different intervention strategies in improving patients' kinesiophobia and mental health status varies, yet no intervention has been identified as optimal therapeutic option. Future research should concentrate on exploring the most effective intervention strategies for kinesiophobia, developing uniform and standardized evaluation criteria, and selecting and developing scientific and standardized intervention strategies based on patients' actual conditions and medical resources.

A qualitative study of symptomatic experience and coping in patients with postoperative chemotherapy for ovarian cancer based on symptom management theory model

XU Ke, YANG Liu, DENG Xiumin, JIA Chenyu, LU Tingting, LI Jinzhi

2026, 24(2): 325-329. doi: 10.16766/j.cnki.issn.1674-4152.004390

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Abstract:
Objective To explore the symptom experience and coping strategies of ovarian cancer patients undergoing postoperative chemotherapy, the study aims to provide a reference for constructing a more precise and individualized symptom management program, which will help patients more effectively address the challenges posed by chemotherapy and enhance their overall quality of life. Methods Using the phenomenological method in qualitative research, from October 2023 to February 2024, a semi-structured, in-depth face-to-face interview was conducted with 17 ovarian cancer patients undergoing postoperative chemotherapy in the Department of Gynecology at the First Affiliated Hospital of Bengbu Medical University. The participants were selected using an objective sampling method. Based on a literature review and expert opinions, an interview outline was developed, focusing on three core aspects of the symptom management theoretical model. After a pre-interview, the outline was revised and finalized. The Colaizzi 7-step analysis method was adopted to summarize similar data through repeated reading, comparison, analysis, reasoning, and summation, ultimately leading to the formation of themes. Results The symptom experience and response of postoperative chemotherapy patients with ovarian cancer can be summarized into three main themes: symptom experience (multiple physiological symptoms, deep psychological trauma, socio-economic aspects); symptom management strategies (weak awareness of symptom management, large need for symptom management, poor symptom management approach); symptom management effect (passive coping with symptoms, leisurely coping with symptoms). Conclusion The symptom burden of patients with postoperative chemotherapy for ovarian cancer involves physiological, psychological, and social aspects, and patients still face many obstacles and unmet needs in symptom management. Therefore, medical staff should pay attention to patients 'symptom response and response needs, develop systematic symptom management programs, and strengthen psychological counseling and home support to help them improve the self-management awareness of symptoms and self-management ability, and improve the quality of life.

Based on the 5G regional pre-hospital and in-hospital emergency medical service system engineering research

YANG Yihong, LIU Hongbo, ZHOU Jiehao, SHI Chunyan, ZOU Beilei

2026, 24(2): 330-334. doi: 10.16766/j.cnki.issn.1674-4152.004391

5 0

Abstract:
Objective To explore a new emergency model that achieves seamless connectivity and coordinated treatment between pre-hospital and in-hospital services, as well as among all tightly-knit hospital alliances integrated into the platform, by constructing a regional 5G-powered smart platform for pre-hospital and in-hospital emergency care. Methods The project made full use of the modern Internet of Things and 5G network technology to build a 5G regional pre-hospital and in-hospital intelligent emergency medical service system. The research group collected 200 grade Ⅰ and Ⅱ critical patients transported by 5G emergency vehicles from December 2023 to March 2024 and set them as the observation group. Another 200 grade Ⅰ and Ⅱ critical patients transported by other non-5G conventional emergency vehicles in the same period, set as the control group. Statistical analysis was performed using SPSS software to compare the two sets of relevant clinical data. Results The project team had built a 5G regional intelligent first aid platform with Fuyang People's Hospital as the center, seamless connection and coordinated treatment before the hospital and among the close medical consortium units integrated into the platform. In the observation group of patients with grade Ⅰ and Ⅱ, the number of cases with seamless pre-hospital and hospital information, the number of patients guided by hospital remote consultation, the time of hospital emergency triage, and the success rate of hospital emergency rescue were all better than those of the control group (P < 0.05). In the observation group, 61 (30.5%) patients with one-click seamless information docking before the hospital and 14 (7.0%) patients with remote consultation guidance mainly included acute and critical diseases such as cardiac arrest, chest pain, stroke and acute poisoning. Only two patients in the control group had pre-hospital and in-hospital information docking, and no remote real-time consultation and guidance, so the number of both was significantly less than that of the observation group. Conclusion Based on the 5G regional pre-hospital and in-hospital emergency medical service system is significantly better than the traditional first-aid mode, so this project is suitable for regional replication and promotion in Fuyang area.

The mediating effect of patient safety culture between head nurses' multiple leadership styles and nurses' occupational burnout

ZHANG Yujian, XU Wenxue, WANG Lijun, LIU Yadong, WANG Qian, CAO Yingjuan

2026, 24(2): 335-339. doi: 10.16766/j.cnki.issn.1674-4152.004392

3 0

Abstract:
Objective To explore the mediating role of patient safety culture in the relationship between head nurses' multiple leadership styles and nurses' occupational burnout, in order to provide a new perspective and a new path for the intervention of nurses' occupational burnout. Methods Using stratified convenience sampling, 1 673 registered nurses from 10 tertiary general hospitals in different prefecture-level cities of Shandong Province were selected as subjects for the survey from August to October 2024. The survey utilized the general information questionnaire (GIQ), multiple leadership styles scale (MLSS), Maslach burnout inventory-human service survey (MBI-HSS), and patient safety culture assessment questionnaire (PSCAQ). Statistical analysis was performed using SPSS 25.0 software. Pearson correlation analysis was employed to explore the associations between variables, and the Bootstrap method was used to analyze the mediating effect. This study examined the correlation between head nurses' multiple leadership styles and nurses' current state of job burnout, and explored the mediating effect of patient safety culture between the two. Results The scores for head nurses' multiple leadership styles, nurses' occupational burnout, and patient safety culture were 33.59±22.87, 56.78±20.34, and 103.74±15.78, respectively. The positive rate of nurses' occupational burnout was 39.7% (664 nurses). The total score of occupational burnout was negatively correlated with transformational leadership style (r=-0.542, P < 0.01) and positively correlated with transactional leadership style (r=0.321, P < 0.01). Patient safety culture played a significant mediating role in the effects of both transactional and transformational leadership styles on occupational burnout. Conclusion The degree of nurses' occupational burnout is relatively severe. The transformational leadership style can directly or indirectly reduce nurses' occupational burnout through the mediating effect of patient safety culture, enhancing the level of patient safety culture.

Study on the application effect of operation room management based on PDCA mode in patients with lung cancer surgery

JIA Yujuan, ZHANG Xize, LI Yan, CHENG Zhifang

2026, 24(2): 340-344. doi: 10.16766/j.cnki.issn.1674-4152.004393

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Abstract:
Objective To investigate the efficacy of the PDCA model in managing operating rooms, with a specific focus on its potential to mitigate the stress response of patients undergoing lung cancer surgery, and to minimize the occurrence of postoperative complications. The findings of this study are expected to provide a scientific foundation and practical guidance for the refinement of perioperative management for patients undergoing lung cancer surgery. Methods A cohort of 96 patients who underwent surgical intervention for lung cancer at the First Affiliated Hospital of Henan University of Traditional Chinese Medicine between January 2022 and January 2024 was selected and classified into the control group and the observation group according to random number table, with 48 cases in each group. The control group was managed in accordance with conventional operating room protocols, while the observation group was managed in accordance with an operating room-based PDCA model. The preoperative and postoperative metrics, stress indexes, the postoperative complication rate, and nursing satisfaction of two groups were compared. Results The durations for initial ambulation, intraoperative blood loss, first voiding, length of hospital stay, and time to first anal gas emission in the observation group were significantly lower than those in the control group (P < 0.05). Preoperatively, there was an absence of notable disparity in the stress biomarkers, namely epinephrine (E), cortisol (Cor), and norepinephrine (NE), between the two cohorts (P>0.05). Post operatively, elevations in the concentrations of Cor, E, and NE were observed in both groups; however, the magnitudes of these increases were notably attenuated in the observation group relative to the control group (P < 0.05). The observational cohort demonstrated a postoperative complication incidence rate of 10.42% (5/48), which was substantially inferior to the 33.33% (16/48) recorded in the control cohort (P < 0.05). The satisfaction levels of patients with regard to nursing care in the observation group amounted to 93.75% (45/48), which was considerably elevated in comparison to the 79.17% (38/48) recorded in the control group (P < 0.05). Conclusion The operating room management based on the PDCA model has been shown to effectively improve the operation period index, reduce the stress response of patients undergoing lung cancer surgery, reduce the incidence of postoperative complications and improve nursing satisfaction, which is worthy of clinical application.

Best evidence summary of nurse-led nasogastric tube feeding in adult patients receiving enteral nutrition

JIANG Mingjin, LIN Ying, JIANG Ying, XU Li

2026, 24(2): 345-349. doi: 10.16766/j.cnki.issn.1674-4152.004394

4 0

Abstract:
Objective To comprehensively search, evaluate, and integrate the best evidence for nurse-led adult nasogastric tube feeding care, providing a theoretical basis for evidence-based practice in nasogastric feeding care for nursing staff. Methods Based on the "6S" evidence model, a systematic search was conducted on relevant guideline websites and databases both domestically and internationally. Chinese databases included: China Biology Medicine disc, CNKI, Wanfang, VIP, Yimai Guide Network, and DXY. English databases included: BMJ, Up To Date, JBI, PubMed, Cochrane Library, ASPEN, ESPEN, BAPEN, AGA nutrition societies, GIN, NGC, NICE, and so on. The search period was from the establishment of the databases to September 2023. Results A total of 14 articles were included, consisting of 7 guidelines, 2 clinical decisions, 1 expert consensus, and 4 systematic reviews. Nine themes were summarized and integrated, totaling 21 pieces of evidence, including organization and management, assessment and screening, pre-feeding preparation, feeding implementation procedures, feeding monitoring, traditional Chinese medicine nursing, feeding equipment management, feeding termination criteria, and health education. Conclusion This study summarized and integrated the best evidence for nurse-led nasogastric tube feeding for patients requiring enteral nutrition, providing clinical nursing staff with an evidence-based, comprehensive nasogastric feeding operational process. Practitioners should combine the evidence with clinical context, enhance the evidence-based practice capabilities of nursing staff, and selectively apply the best evidence to improve the quality of nasogastric feeding care and patient nutritional status and outcomes.

A case report and literature review of cerebellar cognitive affective syndrome

YAO Hongyan, TANG Lian, WANG Qian, ZHANG Yumei

2026, 24(2): 350-353. doi: 10.16766/j.cnki.issn.1674-4152.004395

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Abstract:
Clinically, patients suffering from cerebellar damage may present with cognitive impairment and affective dysregulation. These clinical manifestations are typically less severe than the cognitive deficits caused by cerebral damage and are often overlooked in clinical practice. This case report describes a patient with hemangioblastoma who developed mild cognitive impairment and affective dysregulation due to cerebellar or cerebellar circuit damage. The patient, a 43-year-old male, was admitted with a three-month history of gait instability, accompanied by slowed responses, anxiety and visual disturbances over the preceding 1.5 months. Following comprehensive neuropsychological assessments, a diagnosis of probable cerebellar cognitive affective syndrome (CCAS) was established. Following the administration of personalized functional rehabilitation, the patient exhibited a substantial improvement in symptoms. The objective of this report is to furnish clinical insights into the diagnosis and management of CCAS.

Therapeutic adjustment of tyrosine kinase inhibitor-related liver injury in patients with chronic myeloid leukemia: a case report

YU Zhuruohan, PEI Renzhi, LU Ying, LIN Li

2026, 24(2): 354-356. doi: 10.16766/j.cnki.issn.1674-4152.004396

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Abstract:
The individualized management of tyrosine kinase inhibitor (TKI)-related intolerance in chronic myeloid leukemia (CML) remains a clinical challenge. The present case report concerns an elderly male patient with chronic-phase CML who developed grade 3 hematological toxicity and drug-induced liver injury after imatinib therapy and remained intolerant despite dose reduction. Subsequent switches to flumatinib and nilotinib were discontinued due to progressive elevation of liver enzymes and gastrointestinal adverse events. A stepwise reduction in the dosage of dasatinib was initiated, resulting in the achievement of a deep molecular response (MR4.0; BCR-ABLIS≤0.01%) and the reversal of liver fibrosis within a period of four months. This case demonstrates the necessity to dynamically evaluate efficacy and toxicity during TKI therapy and promptly adjust treatment regimens. The toxicity profiles of TKIs exhibit significant interindividual variability: flumatinib demonstrates lower hepatotoxicity but prominent gastrointestinal effects, nilotinib may aggravate liver fibrosis, and dasatinib balances efficacy and safety through dose optimization. For patients with limited financial resources, dose-reduction strategies employing second-generation TKIs constitute a viable alternative. This case study offers practical insights into individualized management for patients with multi-line TKI intolerance.

About Journal

Current Issue
2026, Volume 24, Issue 2

Submission System

About Journal

Current Issue 2026, Volume 24, Issue 2

Submission System

Current Issue
2026, Volume 24, Issue 2