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Study on the value of the DOSE index in assessing impaired exercise tolerance in community patients with stable chronic obstructive pulmonary disease

YANG Lulu, SHI Minghui, HE Jiaze, QUMU Shiwei, YANG Ting

Objective This study aims to explorea method for primary healthcare units to assess exercise endurance impairment in patients with chronic obstructive pulmonary disease (COPD) using the DOSE index as the core indicator. Additionally, the study aims to determine the critical value of this indicator for predicting exercise endurance impairment in patients with COPD. Methods A total of 117 stable COPD patients who were monitored at the China-Japan Friendship Hospital from September 2019 to April 2022 were included in the retrospective analysis. Patients with a six-minute walk distance (6MWD) of less than 350 m were determined to be exercise tolerance. Information on lung function, the modified medical research council (mMRC), smoking status, and acute exacerbations in the previous year was calculate the DOSE index for each patient. Lung function, 6MWD, mMRC scores, and DOSE index were compared between the two groups divided based on 6MWD. The relationship between 6MWD and the DOSE index was investigated using Spearman's correlation analysis; Finally, the effectiveness of the DOSE index in assessing impaired exercise tolerance in COPD patients was analyzed using a receiver operating characteristic (ROC) Curve. Results A total of 117 patients with stable COPD were included in this study. The mean 6MWD was (416.94±117.16) m and the mean DOSE index was 3(1, 5) points. Among the participants, 29 had a 6MWD < 350 m, while 88 had a 6MWD ≥350 m. Significant differences were observed between these two groups in terms of age, FVC%pred, FEV₁%pred, 6MWD, mMRC score, and DOSE index. Notably, there was a strong inverse relationship between the DOSE index and 6MWD (r=-0.456, P < 0.001). Physicians should be particularly vigilant about impaired exercise tolerance in COPD patients. Conclusion The DOSE index, with a predictive threshold of 5 points, exhibits a strong and negative correlation with 6MWD, making it a valuable tool in assessing impaired exercise tolerance among COPD patients. Its simplicity and ease of administration make the DOSE index suitable for implementation in primary healthcare settings.

Prediction of prognosis in elderly nHCM patients using nomogram based on CMR and clinical characteristics

LIU Lei, LI Tianjiao, SUN Bin, REN Hongqiang

Objective To investigate the survival prognosis of elderly patients with non-obstructive hypertrophic cardiomyopathy (nHCM), and to establish a nomogram based on cardiac magnetic resonance (CMR) parameters and clinical characteristics to predict the overall survival (OS) of patients with nHCM. Methods A total of 179 patients with nHCM admitted to the Cardiovascular Center of Suining Central Hospital and Nanchong Central Hospital from June 2015 to November 2021 were retrospectively analyzed. Multivariate Cox regression analysis was used to determine the independent prognostic factors associated with OS and nomogram was drawn. The internal validation was performed by Bootstrap. Results Multivariate Cox regression analysis showed that the prognostic factors were galectin-3 (Gal-3), ventricular tachycardia, apical aneurysm, late gadolinium enhancement (LGE), exercise stress test. The Bootstrap correction value of c-index was 0.908(95% CI: 0.869-0.947); The area under the curve of 1, 3, and 5-year survival rate calculated by multi time point ROC curve were 0.907, 0.935, and 0.921 for discrimination analysis. The calibration curve showed that the predicted estimated risk had good accuracy with the actual observation results. Conclusion The elevation of Gal-3, ventricular tachycardia, apical ventricular aneurysm, positive exercise stress test, and positive LGE based on CMR parameters are independent risk factors that affect the prognosis of elderly nHCM patients. The nomogram constructed based on the above indicators can be used to individualize the assessment of the prognosis of elderly nHCM patients.

Association between age-friendliness of communities and cognitive function among older adults

YAN Fei, CHAI Qichen, LYU Jing, CHEN Jin

Objective To investigate the association between age-friendliness of communities (AFC)and cognitive function in the elderly and provide scientific basis for the construction of healthy aging. Methods A total of 5 940 permanent residents aged 65 and over in urban and suburban/rural areas in Hangzhou, Ningbo and Lishui of Zhejiang Province were studied from April 2022 to July 2022. A cross-sectional survey was used to collect basic personal information of the subjects, and the community age-friendliness and cognitive function of the subjects were assessed using the AFC rating scale and the 8-item dementia ascertainment (AD8) scale respectively. Multivariate logistic regression was used to analyze the risk factors for cognitive dysfunction and the association between AFC and cognitive function in older people. Results A total of 6 000 people were screened and a total of 5 940 valid questionnaires were collected. The results of binary logistic regression analysis showed that the scores of residential environment, transport environment, community environment and social inclusion were influencing factors for cognitive dysfunction (P<0.05), OR (95% CI) were 0.924 (0.877-0.973), 0.925 (0.875-0.978), 0.946 (0.895-0.999) and 0.927 (0.876-0.982) respectively. Conclusion Poor residential environment, transport, community and social inclusion environments are independent risk factors for cognitive impairment. The measures to improve the degree of age-friendly community are helpful in improving cognitive function.

A study on the correlation between multimorbidity and motoric cognitive risk syndrome in rural older adults

DAI Chen, ZHANG Yan, ZHANG Jingya, WANG Qing, LOU Xu, CHEN Ren, SHEN Guodong

Objective To investigate the cross-sectional relationship between multimorbidity and motoric cognitive risk syndrome (MCR) among older adults in Anhui province, China. To explore the association between the number of chronic diseases and MCR in order to provide a basis for the development of strategies and measures to prevent MCR in rural areas. Methods A cross-sectional study was conducted among 652 older adults in rural areas of Lu' an and Fuyang City, Anhui Province, China, participants self-reported their chronic disease status. MCR was assessed by combining slow gait with subjective cognitive decline, and logistic regression was used to analyze the relationship between multimorbidity and MCR. Results Older adults with chronic disease had a higher likelihood of experiencing MCR (OR=2.926, 95% CI: 1.256-6.816, P=0.013). Further, the presence of three chronic diseases in older adults was associated with the highest risk of MCR (OR=4.946, 95% CI: 1.811-13.506, P=0.002). Logistic regression analysis showed that older adults with specific multimorbidity patterns, such as hypertension+depression (OR=2.433, 95% CI: 1.294-4.573, P=0.006) and hypertension+hyperlipidemia+depression (OR=4.632, 95% CI: 1.978-10.848, P<0.001), were more prone to developing MCR. Conclusion MCR is associated with multimorbidity among older adults in rural Anhui province, China.

Practice and exploration of project-driven cultivation of scientific research potential of medical innovative talents

HUANG Chen, ZHANG Yuan, ZHANG Renchao, WU Weidong, LUO Zai, ZHANG Pengshan, FANG Yuan, HAN Chao, QIU Zhengjun

Objective In response to the addressing current challenges in medical talent cultivation, this study aims to chart a novel strategy for developing the research potential of new medical innovators, and to furnish a theoretical foundation and practical insights for the cultivation of new medical talents. Methods Driven by specific research projects, the study established an innovative research team led by mentors and supported by graduate students. Guided by the flipped classroom concept and oriented towards students' concerns, the study conducted theoretical lectures and experimental training. The goal was to create an integrated and sequential medical talent cultivation mode, a normalized and sustainable collaboration mechanism in medical education, a project-based and individualized medical research innovation model, and an interactive and systematic course evaluation feedback system. Additionally, diverse and comprehensive standards for evaluating research outcomes had been implemented. The study quantitatively assessed its practical impact across three levels: talent cultivation, scientific research innovation, and pedagogical innovation. Results The study had successfully established an integrated and sequential talent cultivation mode for high school students, undergraduates, and postgraduates. This cultivation mode comprehensively enhanced students' foundational skills, motivation, and engagement in scientific research, thereby elevating both students' research potential and teachers' instructional proficiency. Positive outcomes had been observed in talent cultivation, scientific research innovation, and teaching innovation, evident through achievements such as thesis writing, award selection, project applications, and results transformation. Conclusion The proposed new medical innovation talent cultivation model, anchored in an innovative scientific research and teaching team led by mentors and postgraduates, presents a sequential cultivation system spanning high school to postgraduate levels. Emphasizing project-driven development of the scientific research potential of medical innovation talents, this model introduces a fresh perspective for nurturing innovative talents in medicine. It holds considerable practical significance and guiding value for the advancement of new medicine in China.

Nutritional risk screening and influencing factors in patients with type 2 diabetes

LI Jing, ZHOU Yusen, HAO Shuli, WU Wei, MA Guoqi

Objective To systematically analyze the nutritional status of type 2 diabetes (T2DM) patients based on nutrition risk screening (NRS2002), and screen the main impact indicators of nutritional risk. Methods A total of 196 T2DM patients were obtained from the People's Hospital of Bozhou between October 10, 2022 and May 9, 2023. The patients were divided into nutritional risk group (35 cases) and non-nutritional risk group (161 cases) based on the presence or absence of nutritional risk. Statistical analysis was used to investigate the differences in gender and related biochemical indicators (hemoglobin, glycated hemoglobin, albumin, total cholesterol, triglycerides, urea nitrogen, creatinine) between patients with and without nutritional risk. The independent influencing factors of nutritional risk were analyzed using multiple logistic regression analysis. Results There was no significant difference in the occurrence of nutritional risks between different genders (P>0.05). The relevant clinical biochemical test results showed that T2DM patients with nutritional risk had significant differences in serum hemoglobin [(122.29±10.07) g/L], albumin [(40.98±3.61) g/L], urea nitrogen [(6.97±0.16) mmol/L], and creatinine [(86.91±5.96) mmol/L] levels compared to non-nutritional risk patients [(128.15±9.96) g/L, (43.38±4.34) g/L, (5.81±0.92) mmol/L, (79.75±8.56) mmol/L, respectively, P < 0.05]. There was no significant difference in the statistics of glycated hemoglobin, total cholesterol, and serum triglycerides between patients with and without nutritional risk (P>0.05). Multiple logistic regression analysis was used to analyze hemoglobin, albumin, urea nitrogen, and creatinine. The results showed that hemoglobin, albumin, and creatinine were related risk factors for nutritional risk in T2DM patients. Conclusion NRS2002 is applied to assess the nutritional status of patients with T2DM, and haemoglobin, albumin and creatinine levels are influential factors in the occurrence of nutritional risk in patients with T2DM.

About Journal

Founded in 2003， monthly

Responsible Authority：National Health Commission of the People's Republic of China

Sponsors：Chinese Preventive Medicine Association, Anhui General Medicine Association

Editor-in-Chief：WANG Fu-sheng

ISSN 1674-4152

CN 11-5710/R

Publishing：Publishing House of Chinese Journal of General Practice

Domestic Subscription：Local Post Office, China

Subscription Code Number：26-200

Overseas Subscription：China International Book Trading Corporation (P.O.Box 399 Beijing, China, 100044)

Overseas Subscription Number：BM1857

Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).

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General Practice Forum

Practice and exploration of project-driven cultivation of scientific research potential of medical innovative talents

HUANG Chen, ZHANG Yuan, ZHANG Renchao, WU Weidong, LUO Zai, ZHANG Pengshan, FANG Yuan, HAN Chao, QIU Zhengjun

2024, 22(2): 175-178. doi: 10.16766/j.cnki.issn.1674-4152.003358

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Special Topic/Influencing Factors of Cognitive Function in the Elderly

A study on the correlation between multimorbidity and motoric cognitive risk syndrome in rural older adults

DAI Chen, ZHANG Yan, ZHANG Jingya, WANG Qing, LOU Xu, CHEN Ren, SHEN Guodong

2024, 22(2): 179-182. doi: 10.16766/j.cnki.issn.1674-4152.003359

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Special Topic/Influencing Factors of Cognitive Function in the Elderly

Association between age-friendliness of communities and cognitive function among older adults

YAN Fei, CHAI Qichen, LYU Jing, CHEN Jin

2024, 22(2): 183-186. doi: 10.16766/j.cnki.issn.1674-4152.003360

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