Objective:To investigate the prevalence of cardiometabolic multimorbidity (CMM) in Chinese middle-aged and elderly population, and the associated factors of cognitive function in CMM patients.Methods:It was a cross-sectional study. Data of demographic characteristics, lifestyle, chronic disease, and cognitive function in middle-aged and elderly subjects were obtained from the Harmonized CHARLS D version 2015 database, subjects with emotional and psychiatric disorders and memory-related disorders, and those with missing chronic disease data were excluded. The factors associated with cognitive function in CMM patients were analyzed with generalized linear regression model.Results:A total of 15 007 respondents aged (61.07±9.70) years were included in the analysis, 7 338 (48.9%) of whom were males. There were 3 303 cases of CMM with a prevalence rate of 22.01%, and the proportion of females was 54.9% (1 814/3 033), and the proportion of males was 45.1% (1 489/3 033). Generalized linear regression analysis showed that age, educational level, place of residence, depressive symptoms were correlated with cognitive function scores of CMM patients (all P<0.05). Conclusion:The prevalence rate of CMM in middle-aged and elderly people in China is higher, and age, education level, place of residence, depressive symptoms are associated with cognitive function in CMM patients.

Objective:To analyze the clinical characteristics and related factors of cognition disorders in elderly hypertensive patients.Methods:It was a cross-sectional study. A total of 612 hypertensive patients with the age of (69.06±6.58) years (median 68.00 years) admitted in the Department of Cardiology, General Hospital of Chinese People′s Liberation Army from October 2022 to April 2024 were enrolled. The demographic and clinical data were collected, the cognition status was assessed with Mini-Mental State Examination (MMSE) at admission. The related factors of cognition disorders were analyzed with univariate and multivariate logistic regression.Results:The results showed that female hypertensive patients and those with older age, lower education, higher fasting blood glucose (FBG) and diabetes mellitus, higher low-density lipoprotein cholesterol (LDL-C) level, higher systolic blood pressure (SBP) and more cardiovascular comorbidities were likely to have cognition disorders (all P<0.05). Multivariate logistic regression analysis showed that smoking history, elevated SBP, elevated heart rate, elevated FBG, and elevated LDL-C were independent risk factors for cognition disorders in elderly hypertensive patients,while higher education level was an independent protective factor (all P<0.05). Conclusion:Smoking, increased SBP, increased heart rate, increased FBG, increased LDL-C and lower education level are independently associated with cognition disorders in elderly hypertensive patients.

Objective:To explore the clinical application of mobile-intelligent medical management system for gout patients.Methods:This study was a randomized controlled trial. One hundred and two patients with gout who visited rheumatology department of the First Hospital of Jilin University from January 2022 to October 2023 were randomly divided into study group ( n=53) and the control group ( n=49). Patients in the study group were managed by the mobil-gout(M-G) health management system which consists of a distant management plateform and an App. The body weight and blood uric acid levels were regularly self-tested by patients, and the information was sent to the system, the doctor gave feed-back advice on medication adjustment and dietary management every 2 weeks. While patients in the control group were managed following the conventional outpatient consultation mode. The serum uric acid levels, liver and kidney function tests and physical examinations were conducted on the day of enrollment and 3 and 6 months after treatment. The number of affected joints and the frequency of attacks were evaluated, and pain was assessed using the visual analog scale (VAS). The efficacy of treatment were compared between two groups. Results:After 3 and 6 months of treatment, the serum uric acid levels in study group were significantly lower than those in control group (408.0 (345.0, 450.0)μmol/L vs. 458.0 (409.0, 482.0)μmol/L, 371.0 (338.5, 409.0) μmol/L vs. 412.0 (368.5, 445.0)μmol/L; Z=3.37, 4.61, P<0.01); and VAS scores were also significantly lower than those in control group (6.66±1.46 vs. 4.68±1.80, 7.45±1.06 vs. 5.88±1.52; t=14.12, 13.72, P<0.01). After 6 months of treatment, the frequency of gout attacks in the study group was significantly lower than that in the control group ( χ2=9.30, P<0.05). As the follow-up period was extended, the average number of joints affected by gout attacks and the frequency of gout attacks in the study group showed a reducing trend compared to the control group, but the differences were not statistically significant ( P>0.05). Conclusions:The M-G medical management system can more effectively control uric acid levels and alleviate symptome for gout patients.

Objective:To investigate the clinical characteristics of left-sided infective endocarditis (IE) without underlying valvular heart diseases (VHD).Methods:This was a retrospective study. Clinical data of 206 patients with left-sided IE (age: (50.4±16.1) years; 144 males (69.9%)) discharged from Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2011 to May 2021 were retrospectively analyzed, including 129 cases with underlying VHD (IE+VHD group) and 77 cases without underlying VHD (IE group). The 6-month survival rate of patients after discharge was analyzed with Kaplan-Meier survival curve; and the 6-month survival rates of the patients with different sizes of endocardial vegetation and different treatment modalities in the IE group were further analyzed with log-rank method.Results:The proportions of patients with age ≥65 years old, arrhythmia and aortic valve involvement, and the in-hospital mortality in the IE group were significantly lower than those in the IE+VHD group ( P<0.05). However, the proportion of patients with fever and speech vague/limb movement disorder/headache, those with mitral valve involvement in the IE group were significantly higher than those in the IE+VHD group ( P<0.05). The median value of C-reactive protein (CRP) in the IE group was significantly higher than that in the IE+VHD group ( P<0.05). Nevertheless, the median value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the IE group was significantly lower than that in the IE+VHD group ( P<0.05). There were as no significant differences in the positive rates of bacterial/fungal blood cultures and the proportion of patients with mitral and aortic valve involvement of endocardial vegetation between the two groups (all P>0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference in 6-month survival rate of patients between the IE group and IE+VHD group (88.7% vs. 93.6%, log-rank χ2=0.887, P=0.346). In the IE group, the 6-month survival rate after discharge in patients with maximum diameter of vegetation ≤10 mm was higher than that in patients with maximum diameter of vegetation >10 mm (96.3% vs. 80.7%, log-rank χ2=4.111, P=0.043). There was no significant difference in 6-month survival rate between patients treated with antibiotics combined with surgery and those treated with antibiotics alone (96.2% vs. 78.6%, log -rank χ 2=2.976, P=0.084). Conclusion:Compared to left-sided IE patients with underlying VHD, patients without underlying VHD are likely to have a younger age, more mitral valve involvement and lower in-hospital mortality; for those patients with maximum diameter of vegetation ≤10 mm there is a higher survival rate, and antibiotics combined with surgery may help to improve the survival rate.

Objective:To formulate a community teacher standard for the training of general practitioner program (direction in hospice care).Methods:This was a qualitative study. Twenty-nine experts in general practice and hospice care from various teaching hospitals and community health service centers were invited to participate in two rounds of Delphi consultation from April to August 2022. Based on the results of the consultation, a standard for community faculty training in comprehensive care and end-of-life care for general practitioners was formulated, and the weight coefficients of the indicators were calculated.Results:Of the 29 experts, 11 (37.9%) were male, their age was (52.9±8.9) years, and their working life was (17.0±7.2) years. In the two rounds of expert consultation, the expert positive coefficient was 100.0% (29/29) and 96.6% (28/29), the expert authority coefficient was 0.789 and 0.851, and the expert opinion coordination coefficient W of the importance of all indicators was 0.124 and 0.131, respectively ( χ2=123.01, 131.71, P<0.05). Finally, a set of community-based teacher standard for general practitioner specialty training (direction in hospice care) was established, which consisted of 4 first-level indicators and 30 second-level indicators. The four first-level indicators were basic literacy, clinical qualification and ability, teaching qualification and ability, and scientific research ability, all with the weight coefficients of 0.254, 0.254, 0.252 and 0.240, respectively. Conclusion:The standard of teachers in the community base of general practitioner specialty training (direction in hospice care) established in this study is more scientific, which is conducive to the comprehensive evaluation of teachers in the community training base.

Objective:To understand the status quo of general practice postgraduate researches through visualized analysis of masters′ theses.Methods:The master′s theses in general medicine from January 2007 to December 2022 were retrieved from China Knowledge and Wanfang databases. The number and regional distribution of theses, the degree-granting institutions were analyzed; the performed keywords were visualizde with CiteSpace and VOSviewer softwares.Results:A total of 1 688 master′s theses in general practice were included in the analysis. The highest number of theses ( n=345) were published in 2022. The theses from institutions in the eastern, central and western regions of China accounted for 45.67% (771/1 688), 22.16% (374/1 688) and 32.17% (543/1 688), respectively, and those in Shaanxi Province accounted for the highest proportion at 13.68% (231/1 688). A total of 3 755 keywords were included in the theses, and the top three were diabetes mellitus (115/3 755), risk factors (77/3 755) and clinical efficacy (71/3 755). The results of keyword clustering and timeline mapping showed that the research topics were mainly clustered around five themes: clinical treatment and drug efficacy/safety for diabetes mellitus, training of general practitioners and evaluation of general practice services, risk factors related to common chronic diseases in the community, risk factors and cognitive changes in cerebrovascular diseases, and pathogenic mechanisms of cardiovascular diseases. The results of the emergent words showed that recent research hotspots mainly included obesity, older adults, and cognitive function. Conclusions:The number of general practice master′s theses published in China is increasing rapidly with an uneven regional distribution; and the research topics are diverse, mainly focusing on the diagnosis and treatment of chronic diseases and analysis of related risk factors.

Objective:To investigate the correlation between thyroid function and the total cerebral small vessel disease score in the elderly.Methods:This cross-sectional study included elderly people who underwent physical examinations at the Geriatrics Department of Beijing Hospital from April 2019 to December 2020. Participants were devided into 5 groups based on the total score of cerebral small vessel disease: 0, 1, 2, 3, and 4. General clinical data were collected through physical examination reports and outpatient medical records. All participants underwent a 3T brain magnetic resonance imaging (MRI), scan and data were collected to calculate the total cerebral small vessel disease score. Fasting venous blood samples were taken in the morning to measure thyroid hormone levels. Relationships between thyroid hormone levels and lacunar infarcts, microbleeds, white matter hyperintensities (WMH), enlarged perivascular spaces, and total cerebral small vessel disease score were analyzed using Spearman correlation. Multivariate ordinal logistic regression was also used to analyze factors associated with total cerebral small vessel disease score.Results:A total of 545 elderly individuals were included, with a mean age of (75.16±9.18) years, and 505 (92.7%) were male. The number of subjects with a total cerebral small vessel disease score of 0 were 207 (38.0%), 1 were 182 (33.4%), 2 were 99 (18.2%), 3 were 41 (7.5%), and 4 were 16 (2.9%). Statistical significant differences were found in age, fasting blood glucose, systolic blood pressure, triiodothyronine (TT3), free triiodothyronine (FT3), and the proportion of hypertensive patients among the groups (all P<0.05). Spearman correlation analysis showed that TT3 ( r=-0.138, P=0.001) and FT3 ( r=-0.213, P<0.001) were negatively correlated with total cerebral small vessel disease score. Multivariate ordinal logistic regression analysis revealed that age was independently and positively associated with total cerebral small vessel disease score ( OR=1.139, 95% CI: 1.087-1.193, P<0.001), while FT3 was independently and negatively associated with total cerebral small vessel disease score ( OR=0.331, 95% CI: 0.118-0.929, P=0.009). Conclusion:In the elderly population, FT3 levels are independently and negatively associated with total cerebral small vessel disease score.

Cognitive frailty, as one of the independent dimensions of frailty syndrome, has received increasing attention from researchers in recent years. Cognitive frailty not only reduces the quality of life for elderly people, but also increases the risk of adverse outcomes such as falls, disabilities, hospitalization, dementia, and death. This article introduces the concept, assessment methods, influencing factors, and intervention measures of cognitive frailty, emphasizing the important role of general practitioners in screening and management of cognitive frailty.

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia, which can damage the blood-retinal barrier and cause diabetic retinopathy (DR); hypertension can cause arteriosclerosis of retinal arterioles with the disease progression; dyslipidemia can cause atherosclerosis, and severe hypertriglyceridemia can lead to fundus changes. Optical coherence tomography angiography (OCTA) is a novel non-invasive fundus angiography technique to quantify the changes of retinal microcirculation. This article elaborate the principle and advantages of OCTA technique, reviews its application in evaluation of fundus microcirculation in patients with DR, hypertensive retinopathy and dyslipidemia, and also discusses the development prospect of OCTA in analysis of retinal microcirculation in the future.

Objective:To explore the association between uric acid and new-onset chronic kidney disease (CKD) in middle-aged and elderly hypertensive patients.Methods:This was a retrospective cohort study. Middle-aged and elderly hypertensive patients who had attended at least two annual health examinations at Yongshun Community Health Service Center in Tongzhou District, Beijing, from June 2016 to December 2020 were enrolled. The time interval between the two physical examinations was three years. The first physical examination time served as the baseline, and the second as the end of follow-up. Based on the uric acid level at baseline, the participants were divided into the normal uric acid group and the hyperuricemia group. The relevant clinical data of the participants were collected. The endpoint of the study was new-onset CKD. A multivariate logistic regression model was used to analyze the association between uric acid and new-onset CKD in hypertensive patients.Results:A total of 2 472 middle-aged and elderly hypertensive patients with an average age of (62.43±7.02) years were included. Of these, 733(29.7%) were male. There were 710 patients with hyperuricemia (hyperuricemia group) and 1 762 patients with normal uric acid levels (normal uric acid group).After adjusting for age, sex, body mass index (BMI), systolic blood pressure, diabetes mellitus, estimated glomerular filtration rate (eGFR), and uric acid-lowering treatment, multivariate logistic regression analysis showed that combined with hyperuricemia was an independent risk factor for new-onset CKD in middle-aged and elderly hypertensive patients ( OR=3.00, 95% CI: 1.87-4.80, P<0.001). The results of multivariate logistic analysis showed that elevated uric acid level was an independent risk factor for new-onset CKD in both male and female middle-aged and elderly hypertensive patients (both P<0.05), and there was no sex interaction ( P for interactio n>0.05). The results of multivariate logistic analysis showed that the combination of asymptomatic hyperuricemia was an independent risk factor for new-onset CKD in middle-aged and elderly hypertensive patients ( OR=3.00, 95% CI: 1.87-4.80, P<0.001), and there was no gender interaction ( P for interactio n>0.05). Conclusions:Hyperuricemia is an independent risk factor for new-onset CKD in middle-aged and elderly hypertensive patients, and elevated uric acid levels increase the risk of new-onset CKD in both male and female patients. Moreover, asymptomatic hyperuricemia may increase the risk of new-onset CKD.