Table of Content

20 April 2026, Volume 41 Issue 4

Previous Issue    Next Issue

A meta-analysis of the efficacy and safety of romosozumab in the treatment of osteoporosis

Zhu Ruigang, Li Haoqiang, Wang Youkun, Guo Jidong, Wang Qiang

2026, 41(4):  293-300.  doi:10.3969/j.issn.1004-583X.2026.04.001

Asbtract ( 35 )   PDF (2168KB) ( 25 )   HTML ( 4)  

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the clinical efficacy and safety of romosozumab in patients with osteoporosis. Methods A systematic search was conducted in PubMed, Embase, Web of Science, Medline, the Cochrane Library, ClinicalTrials.gov, CNKI, Wanfang, VIP, and SinoMed for randomized controlled trials (RCTs) comparing romosozumab with placebo or other anti-osteoporotic drugs in the treatment of osteoporosis, from database inception to December 31, 2025. After data extraction and quality assessment of the eligible studies, meta-analysis was performed using RevMan 5.3. Results A total of 11 RCTs, including 15,719 patients, were included. The meta-analysis showed that, compared with placebo, romosozumab significantly increased lumbar spine bone mineral density (BMD) (MD=11.75, 95%CI[9.07, 14.42], P<0.01) and total hip bone mineral density (MD=3.31, 95%CI[1.19, 5.42], P=0.002), and reduced the incidence of new vertebral fractures (RR=0.25, 95%CI[0.16, 0.40], P<0.01). However, there was no statistically significant difference between groups in improving femoral neck bone mineral density. In terms of safety, the incidence of adverse events was significantly lower in the romosozumab group than in the placebo group (RR=0.97, 95%CI[0.96, 0.99], P=0.003). Compared with teriparatide, there was no statistically significant difference in the incidence of adverse events between the two groups (RR=1.11, 95%CI[1.00, 1.23], P=0.05). The incidence of adverse events was similar between the romosozumab and alendronate groups, with no statistically significant difference (RR=1.00, 95%CI[0.93, 1.08], P=0.95). The incidence of serious adverse events was similar between the romosozumab group and the placebo, teriparatide, and alendronate groups, with no statistically significant differences. Conclusion Romosozumab can significantly increase lumbar spine and total hip bone mineral density in patients with osteoporosis and reduce the incidence of new vertebral fractures. It has a favorable safety profile, with no increase in adverse event rates.

Clinical feature spectrum of non-motor symptoms in Parkinson's disease at mid-to-high altitude and their associations with the gut microbiota-gut-brain axis

Lin Tao, Wu Weijun

2026, 41(4):  301-306.  doi:10.3969/j.issn.1004-583X.2026.04.002

Asbtract ( 29 )   PDF (850KB) ( 13 )   HTML ( 3)  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the clinical characteristics of non-motor symptoms (NMS) in patients with Parkinson's disease (PD) living at mid-to-high altitude, and to explore their associations with gut microbiota composition, plasma short-chain fatty acids (SCFAs), and inflammatory cytokine levels. Methods A cross-sectional study was conducted. Patients with PD who had long-term residence at mid-to-high altitude areas (Xining, altitude approximately 2295 m; Hainan Prefecture, altitude >3000 m) were enrolled as the PD group (n=45), and age-, sex-, and ethnicity-matched healthy individuals were enrolled as the healthy control group (HC group, n=45). NMS were assessed using the Non-Motor Symptoms Questionnaire (NMSQuest), the Parkinson's Disease Sleep Scale (PDSS), and the Hospital Anxiety and Depression Scale (HADS), while motor symptoms were evaluated using Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III). Morning stool samples and fasting venous blood samples were collected. Gut microbiota was analyzed by 16S rRNA gene sequencing. Plasma SCFAs, including acetate, propionate, and butyrate, were measured by gas chromatography-mass spectrometry. Plasma interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) levels were determined by enzyme-linked immunosorbent assay. Group differences were compared, and Spearman correlation analysis and multivariable linear regression were used to examine associations among variables. Results Compared with the HC group, the PD group had significantly higher total NMSQuest scores, HADS-A scores, and HADS-D scores (all P<0.01), PDSS scores significantly lower(P<0.01), as well as a higher prevalence of constipation (82.2% vs 31.1%, P<0.01). The PD group showed lower gut microbiota α-diversity (Shannon index) than the HC group (P<0.05), and significant differences in β-diversity were observed (PERMANOVA, P=0.001). At the genus level, the abundance of Prevotella was significantly decreased in the PD group, whereas the abundance of unclassified Enterobacteriaceae and Lactobacillus was significantly increased (all P<0.05). Correlation analysis showed that in patients with PD, Prevotella abundance was positively correlated with plasma butyrate levels (r=0.462, P=0.002) and negatively correlated with HADS-D scores (r=-0.384, P=0.010). Plasma butyrate levels were negatively correlated with HADS-D scores (r=-0.356, P=0.018) and TNF-α levels (r=-0.332, P=0.028). Mediation analysis suggested that plasma butyrate partially mediated the association between Prevotella abundance and depressive symptoms (HADS-D score), accounting for 21.7% of the total effect. Conclusion Patients with PD living at mid-to-high altitude bear a substantial NMS burden, particularly with prominent sleep disturbance, anxiety, depression, and constipation. Their gut microbiota composition is dysregulated, characterized by a reduction in butyrate-producing bacteria and an increase in potentially pro-inflammatory bacteria. Such microbial imbalance may contribute to NMS, including depression, by reducing butyrate production and exacerbating systemic inflammation. This study provides new insights into NMS management in PD at high altitude and into interventions targeting the gut-brain axis.

Correlation between myocardial bridge of the left anterior descending coronary artery and parameters of its proximal perivascular adipose tissue

Ding Qiufen, Yang Zhenyu, Li Cuiqin, Wang Jian

2026, 41(4):  307-311.  doi:10.3969/j.issn.1004-583X.2026.04.003

Asbtract ( 32 )   PDF (1117KB) ( 10 )   HTML ( 2)  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the correlation between superficial myocardial bridge (MB) of the left anterior descending artery (LAD) and parameters of its proximal perivascular adipose tissue using coronary CT angiography. Methods A total of 295 patients clinically suspected of coronary atherosclerotic heart disease who underwent coronary CT angiography at the Fifth Division Hospital of Xinjiang Production and Construction Corps between May 2023 and September 2025 were enrolled. No coronary plaques were detected on CT angiography. According to the presence or absence of MB in the LAD, the patients were divided into an MB group (n=134) and a non-MB group (n=161). Sex, age, body mass index, fat attenuation index (FAI), and fat volume (FV) were compared between the two groups. Multiple linear regression was used to determine whether sex, age, body mass index, and left anterior descending-myocardial bridge (LAD-MB) length affected proximal perivascular adipose tissue FAI and FV in the MB group. Results Compared with the non-MB group, the MB group had higher FAI and lower FV (P<0.01). Multiple linear regression analysis showed that LAD-MB length was associated with FAI in the MB group (P<0.05), whereas age, sex, and body mass index were not (P>0.05). Age, sex, body mass index, and LAD-MB length were not associated with FV (P>0.05). Conclusion FAI and FV may serve as potential imaging biomarkers for assessing MB-related vascular inflammation.

Incidence and risk factors of malnutrition-inflammation complex syndrome in patients receiving maintenance hemodialysis at the end stage of renal disease

Jiang Shaoli, Yan Guosheng, Li Lili

2026, 41(4):  312-317.  doi:10.3969/j.issn.1004-583X.2026.04.004

Asbtract ( 23 )   PDF (922KB) ( 7 )   HTML ( 0)  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the incidence of malnutrition-inflammation complex syndrome (MICS) in patients with end-stage renal disease receiving maintenance hemodialysis (MHD) and to analyze its associated risk factors, thereby providing a theoretical basis for the clinical prevention and treatment of MICS. Methods A retrospective analysis was performed on the clinical data of 108 patients who received end-stage MHD at Huanghe S&T College Affiliated Hospital and Henan Provincial People's Hospital from July 2022 to July 2025. According to the occurrence of MICS, the patients were divided into a MICS group and a non-MICS group. General data, dialysis-related data, and laboratory indicators were collected from both groups. Differences between the two groups were compared by univariate analysis, and independent risk factors were identified using a multivariate logistic regression model. Results Among the 108 patients receiving end-stage MHD, 74 were in the MICS group (68.5%) and 34 in the non-MICS group (31.5%). In terms of baseline characteristics, the MICS group was older and had a higher prevalence of diabetes mellitus than the non-MICS group (P<0.05). Regarding dialysis-related indicators, dialysis vintage was longer in the MICS group than in the non-MICS group (P<0.05). For laboratory indicators, the MICS group had lower albumin (Alb) and hemoglobin levels, but higher high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 levels than the non-MICS group (P<0.05). With the occurrence of MICS after end-stage MHD as the dependent variable (no=0, yes=1), variables with statistically significant differences in univariate analysis were assigned and included as independent variables in the model. Multivariate logistic regression showed that age ≥65 years, dialysis vintage ≥3 years, Alb <35 g/L, and hs-CRP ≥10 mg/L were independent risk factors for MICS in patients receiving end-stage MHD (P<0.05). Based on the multivariate logistic regression output, a prediction model for MICS in end-stage MHD was established: Y=0.659×age+0.435×dialysis vintage+0.578×Alb+0.701×hs-CRP-6.583. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of this model for predicting MICS in end-stage MHD was 0.878, with a specificity of 86.50% and a sensitivity of 75.69%. Conclusion The incidence of MICS in patients receiving end-stage MHD is high, reaching 68.52%. Advanced age, prolonged dialysis duration, low serum Alb, and elevated inflammatory markers are independent risk factors. The prediction model constructed on this basis demonstrates good predictive performance.

Mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients

Wang Yan, Yang Heng

2026, 41(4):  318-322.  doi:10.3969/j.issn.1004-583X.2026.04.005

Asbtract ( 31 )   PDF (831KB) ( 7 )   HTML ( 1)  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients. Methods Using convenience sampling, 127 uremic dialysis patients admitted to Nanyang Third People's Hospital from April 2021 to April 2025 were selected. Disease uncertainty, health literacy, and anxiety were assessed using the Mishel Uncertainty in Illness Scale (MUIS), the Health Literacy Scale for Chronic Patients (HLSCP), and the Self-Rating Anxiety Scale (SAS), respectively. Pearson correlation analysis was used to examine associations among the variables. Hierarchical regression analysis and Bootstrap resampling were applied to test the mediating effect of disease uncertainty between health literacy and anxiety. Results A total of 127 questionnaires were distributed, and 116 valid questionnaires were returned, yielding an effective response rate of 91.34%. Among the 116 uremic dialysis patients, the total scores were 75.13±18.76 for MUIS, 64.28±10.97 for HLSCP, and 56.82±6.44 for SAS. Pearson correlation analysis showed that the total MUIS score was positively correlated with the total SAS score (P<0.05) and negatively correlated with the total HLSCP score (P<0.05); the total HLSCP score was negatively correlated with the total SAS score (P<0.05). Mediation analysis indicated that disease uncertainty had a partial mediating effect on the relationship between health literacy and anxiety in uremic dialysis patients, accounting for 53.4% of the total effect. Conclusion Disease uncertainty is an important mediating mechanism through which health literacy influences anxiety in uremic dialysis patients. In clinical practice, anxiety symptoms may be alleviated by improving health literacy and reducing disease uncertainty.

Risk factors for osteoporosis in patients with primary gout and development of a prediction model

Wang Peng, Yu Ling, Xu Lichuan, Pang Min, Li Guo, Zheng Hongkun, Zhang Quanbo, Qing Yufeng

2026, 41(4):  323-327.  doi:10.3969/j.issn.1004-583X.2026.04.006

Asbtract ( 21 )   PDF (837KB) ( 8 )   HTML ( 2)  

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the clinical characteristics and independent risk factors of osteoporosis in male patients with primary gout, and to develop an osteoporosis risk prediction tool for this population to support early clinical screening. Methods A retrospective cohort design was used, involving 348 male patients with primary gout at Xichong County People's Hospital and Affiliated Hospital of North Sichuan Medical College. Clinical data, laboratory indices, and bone mineral density results were collected for all participants. Variables with P<0.05 in the univariate analysis were entered into a multivariate logistic regression model to establish a prediction formula. Receiver operating characteristic curve analysis was used to evaluate the discriminative ability of the model. Bootstrap resampling was performed for internal validation, and the Hosmer-Lemeshow test and calibration curve were used to assess calibration. Results Among the 348 male patients, 31 cases (8.9%) had osteoporosis. Univariate analysis showed that age, disease duration, tophi, diabetes, high-sensitivity C-reactive protein, and serum creatinine were significantly associated with osteoporosis (P<0.05). Multivariate logistic regression identified age, tophi, and serum creatinine as independent risk factors. The prediction model was as follows: Logit(P)=-6.425+0.055×age (years)+1.038×tophi (yes=1, no=0)+0.005×serum creatinine (μmol/L). The initial area under the curve (AUC) of the model was 0.796, and the Bootstrap-corrected AUC was 0.781. The Hosmer-Lemeshow test yielded P=0.422, and the calibration curve indicated good model fit. Conclusion Advanced age, presence of tophi, and elevated serum creatinine are independent risk factors for osteoporosis in male patients with primary gout. The constructed risk prediction model demonstrates good discriminative ability and calibration, and may serve as an effective tool for screening high-risk osteoporosis in middle-aged and elderly male patients with gout.

Development and validation of an early nomogram prediction model for gestational diabetes mellitus based on routine biomarkers

Ren Jiayin, Chen Chunqin, Liu Fasheng, Shen Hui

2026, 41(4):  328-334.  doi:10.3969/j.issn.1004-583X.2026.04.007

Asbtract ( 34 )   PDF (1374KB) ( 12 )   HTML ( 0)  

Figures and Tables | References | Related Articles | Metrics

Objective To develop and validate a nomogram prediction model for gestational diabetes mellitus (GDM) based on routine antenatal examination indicators, providing a quantitative tool for early risk stratification. Methods A retrospective cohort study was conducted. A total of 4, 547 singleton pregnant women who underwent antenatal examinations at Dongguan Renkang Hospital from September 2018 to December 2024 were included and randomly assigned in a 7∶3 ratio to a development cohort (3, 183 cases) and an internal validation cohort (1, 364 cases). Variables were selected using the least absolute shrinkage and selection operator (LASSO) regression, and a multivariate logistic regression model was constructed to generate the nomogram. Model discrimination, calibration, and potential clinical utility were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA), respectively. Results Multivariate logistic regression analysis showed that age (OR=1.08, 95%CI: 1.06-1.09), pre-pregnancy body mass index (OR=1.05, 95%CI: 1.02-1.08), uric acid (OR=1.00, 95%CI: 1.00-1.01), glycated hemoglobin (OR=3.53, 95%CI: 2.79-4.45), and fasting plasma glucose (OR=2.44, 95%CI: 1.99-3.00) were independent predictors of GDM (pre-pregnancy body mass index, P=0.002; all others P<0.01). The AUC of the prediction model was 0.723 (95%CI: 0.703-0.742) in the development cohort and 0.720(95%CI: 0.690-0.750) in the internal validation cohort, indicating moderate discrimination. The calibration curves showed good agreement between predicted probability and observed risk. DCA indicated that within a threshold probability range of 0.10-0.80, the model provided potential net clinical benefit compared with strategies of screening all or screening none. Conclusion The nomogram model developed in this study, based on routine indicators in early pregnancy, showed moderate predictive performance for GDM risk and may serve as a preliminary tool for early risk stratification. However, further improvement is needed, and its generalizability and clinical utility should be confirmed through multicenter external validation and prospective intervention trials.

Survey of health status and associated factors among residents with diabetes in Henan Province, 2022

Xie Liran, Sang Yanhong, Yu Ling, Rao Xiaojuan, Wang Shanshan, Zhao Mingming

2026, 41(4):  335-340.  doi:10.3969/j.issn.1004-583X.2026.04.008

Asbtract ( 29 )   PDF (837KB) ( 4 )   HTML ( 1)  

Figures and Tables | References | Related Articles | Metrics

Objective To understand the basic sociodemographic characteristics, health status, and the overall control rates of blood glucose, blood pressure, and blood lipids among residents with diabetes in Henan Province, and to analyze the risk factors affecting health, thereby providing scientific evidence for the development of practical primary-level diabetes prevention and management strategies tailored to local conditions. Methods Using a cluster random sampling method, 64, 570 permanent residents with diabetes (defined as living in the area for more than 6 months) were selected from 18 prefecture-level cities and counties/districts in Henan Province. Relevant data were collected through questionnaire surveys, physical examinations, biochemical testing, and regular follow-up. Statistical analysis was performed using SPSS software. Results Among residents with diabetes in Henan Province, females accounted for 60.3% and males for 39.7%. Individuals aged over 60 years accounted for 76.4%, with the 70-79-year age group representing the largest proportion (34.1%). The majority had an education level of junior high school or below (71.7%), and most were engaged in agriculture/forestry/animal husbandry/fishery/water conservancy production (43.7%). Hypertension was present in 60.4% of participants, and the blood pressure control rate (<130/80 mmHg) was 22.8%. The fasting blood glucose control rate (≤7.0 mmol/L) was 67.3%. The non-attainment rate of low-density lipoprotein cholesterol (LDL-C) (≥2.6 mmol/L) was 43.2%. Overweight and obesity together accounted for 49.7%, and renal impairment was found in 14.1%. A total of 77.7% of residents demonstrated good adherence to medical advice, and 82.1% took medications regularly. Conclusion Residents with diabetes in Henan Province are predominantly older adults, individuals with lower educational attainment, and those engaged in agriculture, forestry, animal husbandry, fishery, and water conservancy work. Problems such as a high prevalence of overweight and obesity, low lipid control rates, and renal impairment remain prominent. Therefore, targeted strengthening of primary diabetes prevention and management is needed.

Evidence-based summary of pain management in adult ICU patients

Jin Junhao, Wang Yonghua, Wang Jiaxi, Gao Caoji, Jiang Lingli, Chen Juan

2026, 41(4):  341-347.  doi:10.3969/j.issn.1004-583X.2026.04.009

Asbtract ( 45 )   PDF (1126KB) ( 11 )   HTML ( 1)  

Figures and Tables | References | Related Articles | Metrics

Objective To retrieve, appraise, and summarize the latest evidence on pain management in adult patients in the intensive care unit (ICU), providing a reference for clinical management and practice. Methods Following the top-down “6S” evidence pyramid model, relevant databases and websites were searched for literature related to pain management in adult ICU patients. The search period was from January 1, 2015 to August 11, 2025. Researchers who had received evidence-based nursing training appraised the quality of the included literature and completed evidence extraction and synthesis. Results A total of 13 articles were included, comprising 4 clinical decisions, 4 guidelines, 1 systematic review, and 4 expert consensuses. Thirty-two evidence statements were summarized across 7 aspects: basic principles of analgesic management, pain assessment, pharmacological pain management, non-pharmacological pain relief measures, procedure-related pain, pain management in special populations, and training and quality improvement in pain management. The core updated evidence included: emphasizing the principle of analgesia first; clarifying the leading role of nurses in pain assessment and non-pharmacological analgesia; refining strategies for minimizing opioid use; explicitly proposing guidance on the sequence of withdrawal for patients receiving multiple sedative-analgesic drugs; systematically recommending preventive analgesia for procedure-related pain; and incorporating pain management training and quality indicators into the recommendations. Conclusion The evidence-based findings summarized in this study regarding pain management in adult ICU patients are scientifically sound and practically applicable, and may serve as a reference for optimizing pain management and improving nursing quality in adult ICU patients.

Hypopituitarism in an elderly patient presenting with hypoglycemic coma: A case report and literature review

Xue Xingwei, Liu Ligang

2026, 41(4):  348-351.  doi:10.3969/j.issn.1004-583X.2026.04.010

Asbtract ( 34 )   PDF (954KB) ( 16 )   HTML ( 1)  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the clinical features, diagnostic approach, and causes of missed diagnosis in an elderly patient with hypoglycemic coma as the initial manifestation of hypopituitarism, and to provide reference for early recognition and intervention. Methods A case of an elderly woman with panhypopituitarism and pituitary crisis caused by primary empty sella was reported. Her clinical data and diagnostic and treatment process were reviewed, and the relevant literature was summarized. Results The patient initially presented with fatigue and hypoglycemic coma. Admission laboratory tests showed markedly reduced levels of multiple pituitary hormones and target gland hormones. Brain magnetic resonance imaging revealed empty sella. She was diagnosed with panhypopituitarism due to primary empty sella and pituitary crisis (hypoglycemic type plus hyponatremic type). After treatment with glucocorticoid and low-dose thyroid hormone replacement, along with symptomatic and supportive therapy to correct hypoglycemia and hyponatremia, the patient regained consciousness, symptoms improved, serum sodium and blood glucose returned to normal, and she was discharged for follow-up. Conclusion Hypopituitarism in elderly patients lacks specific clinical manifestations and is easily missed when presenting with atypical symptoms such as hypoglycemic coma and electrolyte disturbances. In elderly patients with unexplained hypoglycemia, hyponatremia, or hypothyroidism, pituitary function should be promptly evaluated and brain imaging performed. Early diagnosis and standardized hormone replacement therapy can effectively prevent progression to pituitary crisis and reduce mortality.