BACKGROUND: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories. METHODS: This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex. RESULTS: In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight. CONCLUSIONS Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Adipose Tissue ; Body Fat Distribution ; Body Mass Index ; China/epidemiology* ; Cross-Sectional Studies ; Health Surveys ; Phenotype

Objective To investigate the clinical application value of contrast-enhanced chest CT in the detection of responsible vessels for hemoptysis before selective arterial embolization(SAE).Methods The clinical data of 74 patients with hemoptysis trea-ted with interventional therapy and preoperative contrast-enhanced chest CT and digital subtraction angiography(DSA)were ana-lyzed retrospectively.The responsible vessels were identified and then embolized via angiography.The detection of the responsible vessels via preoperative contrast-enhanced chest CT was analyzed.The patients were followed up to observe the efficacy and compli-cations,and the influencing factors of interventional efficacy and recurrence were analyzed.Results A total of 245 responsible ves-sels were detected by preoperative contrast-enhanced chest CT,including bronchial arteries(n=178),ectopic bronchial arteries(n=10)and non-bronchial systemic artery(NBSA)(n=57),which could accurately show the anatomical information of responsible vessels.A total of 4 posterior intercostal arteries were missed.The diagnostic accuracy was 98.4％(245/249).All patients were followed up for 12 to 25.6 months.The immediate hemostasis rate was 93.2％(69/74)and the effective rate was 79.7％(59/74),respectively.The factors affecting the efficacy were bronchial artery to pulmonary circulation fistula,pleural thickening at the bleeding site,and underly-ing lung disease.Among the 59 patients with effective treatment,underlying lung disease was the influencing factor for postoperative recurrence.Conclusion Contrast-enhanced chest CT can provide anatomical information about the responsible vessels for interven-tional therapy of hemoptysis,improving surgical efficiency and reducing the recurrence rate of hemoptysis.

Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma (LRHCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of 211 patients who under LRHCCA in the Second Hospital of Hebei Medical University from May 2014 to June 2022 were collected. There were 135 males and 76 females, aged (63±8)years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. Results:(1) Surgical situations. All 211 patients underwent LRHCCA successfully, with the operation time as 350 (300,390)minutes, volume of intraoperative blood loss as 400(200,800)mL, and intraoperative red blood cell transfusion as 2.0(range, 0-15.0)U, respectively. As partial portal vein invasion, 10 of 211 patients underwent portal vein resection and reconstruction. Results of intraoperative histopathology examination showed negative margin of portal vein. The operation time, volume of intraoperative blood loss, intraopera-tive red blood cell transfusion of the 10 patients was (400±53)minutes, 1 200(range, 800-3 000)mL, 5.5(range, 4.0-15.0)U, respectively. (2) Postoperative situations. Of the 211 patients, there were 63 cases of the Bismuth type Ⅰ, 65 cases of the Bismuth type Ⅱ, 22 cases of the Bismuth type Ⅲa, 26 cases of the Bismuth type Ⅲb, 35 cases of the Bismuth type Ⅳ. The R 0 resection rate was 95.73%(202/211). There were 202 patients identified as adenocarcinoma of the bile duct, including 7 cases with poorly differentiated tumor, 189 cases with moderate to poorly differentiated tumor, 3 cases with moderate to well differentiated tumor, 3 cases with well differentiated tumor. There were 8 patients with poorly differentiated biliary mucinous adenocarcinoma, 1 patient with intraductal papillary neoplasm with high-grade epithelial dysplasia. There were 24 cases of stage Ⅰ, 98 cases of stage Ⅱ, 30 cases of stage ⅢA, 34 cases of stage ⅢB, 19 cases of stage ⅢC, 6 cases of stage ⅣA. Of the 211 patients, there were 25 cases with postoperative biliary fistula, 11 cases with postoperative abdominal infection, 3 cases with postoperative bleeding as anastomotic bleeding after biliary fistula, 2 cases with postoperative gastric emptying disability, 1 case with postoperative acute liver failure. There were 7 patients undergoing postoperative unplanned reoperation, including 3 cases with emergency operation for hemostasis, 4 cases with abdominal exploration debridement and drainage for severe abdominal infection. There were 3 cases dead during perioperative period, including 1 case of acute liver failure, 1 case of systemic infection and multiple organ failure, 1 case of exfoliated deep venous thrombosis of lower extremities and acute pulmonary embolism. The postoperative duration of hospital stay was (15±5)days of the 211 patients and (17±4)days of patients undergoing portal vein resection and reconstruction. The cost of hospital stay of the 211 patients was (11.7±1.7)ten thousand yuan. (3) Follow-up. Of the 211 patients, 188 patients were followed up for 21(range, 4?36)months. The median survival time of 188 patients was 22 months, and the postoperative 1-, 2- and 3-year survival rate was 90.9%, 43.1% and 18.7%, respectively. Conclusion:LRHCCA is safe and feasible, with satisfactory short-term effect, under the coditions of clinicians with rich experience in laparoscopic surgery and patients with strict surgical evaluation.

Bone Diseases, Metabolic ; Fractures, Compression/surgery* ; Humans ; Osteoporotic Fractures/surgery* ; Spinal Fractures/surgery* ; Treatment Outcome

Objective:To study the retrocolonic approach for laparoscopic pancreaticoduodenec-tomy (LPD).Methods:The clinical data of 53 patients who underwent LPD using the retrocolonic approach at the Second Hospital of Hebei Medical University from January 2019 to December 2021 were analyzed retrospectively. There were 36 males and 17 females, aged (61.9±8.8) years old. The operation time, intraoperative bleeding and postoperative complications were analysed.Results:LPD was successfully performed in 53 patients via the retrocolonic approach. The operation time was (285.7±49.8) min, and the resection time for specimens was (120.0±10.5) min. The median intraoperative blood loss was 200 ml and blood loss ranged from 50 to 800 ml. Among the 53 patients, 3 patients underwent combined portal vein resection and reconstruction (end-to-end anastomosis). The operation time was 300, 325 and 385 min, respectively, and the intraoperative blood loss was 400-800 ml. During the operation, 5 patients (9.43%) had transection of the middle colonic artery and underwent resection of part of the transverse mesocolon due to invasion of the transverse mesocolon by tumours. Postoperative complications occurred in 5 patients (9.43%), including 4 patients with pancreatic fistula and 1 patient with hemorrhage and with delayed gastric emptying. The postoperative passage of first flatus was (5.40±1.14) days in 5 patients with transection and (2.92±1.03) days in 48 patients without transection of the middle colonic artery. All patients were discharged home successfully. The postoperative pathological results showed all patients to achieve R 0 resection. Conclusion:Laparoscopic pancreaticoduodenectomy via the retrocolonic approach was safe and feasible for patients with a large duodenal tumor, pancreatic head uncinate process tumor with or without invasion of the portal vein and mesenteric vessels.

Sulforaphane (SFN), a natural anti-tumor compound from cruciferous vegetables, has been reported to induce protective autophagy to cancer cells, which might impair the anti-tumor efficiency of SFN. However, the accurate function and mechanism of SFN inducing autophagy in cancers are still obscure, especially in esophageal squamous cell carcinoma (ESCC), one of malignancies with high incidence in North China. Here, we mainly explored the potential function of autophagy upon SFN treatment in ESCC and molecular mechanism. We demonstrated that SFN could inhibit cell proliferation and induce apoptosis by activating caspase pathway. Moreover, we found activation of NRF2 pathway by SFN was responsible for the induction of autophagy and also a disadvantage element to the anti-tumor effects of SFN on ESCC, indicating that SFN might induce protective autophagy in ESCC. We, therefore, investigated effects of autophagy inhibition on sensitivity of ESCC cells to SFN and found that chloroquine (CQ) could neutralize the activation of SFN on NRF2 and enhance the activation of SFN on caspase pathway, thus improved the anti-tumor efficiency of SFN on ESCC

Objective:To study the use of contrast-enhanced ultrasonography (CE-US) and contrast-enhanced MRI(CE-MRI) in evaluation of therapeutic effect of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC).Methods:A retrospective study was conducted on 60 patients with HCC (with 114 lesions), who were treated with TACE in Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018. There were 53 males and 7 females, age ranged from 47 to 84 (mean age 61.9) years. CE-US, CE-MRI and digital subtraction angiography (DSA) were performed in all these patients within one week after TACE. Using DSA as the gold standard, the sensitivity, specificity and accuracy in the detection of residual lesions were compared between the two imaging methods. The consistency of results between CE-US and CE-MRI was analyzed.Results:CE-MRI and CE-US showed presence of active tumor foci (residual and/or recurrent lesion) in 78 lesions, and complete inactivation of HCC foci in 26 lesions. Ten lesions were diagnosed as active foci by CE-MRI, which were missed by CE-US. The diagnostic accuracy of CE-MRI was 100.0% (114/114), which was significantly better than the 91.2% (104/114) of CE-US ( P<0.05). The Kappa value between CE-US and CE-MRI was 0.781. The diagnostic coincidence between CE-MRI and CE-US was quite high. Among small lesions of less than 5 cm, the diagnostic accuracy of CE-MRI was 100.0% (78/78), which was significantly better than the 88.5% (69/78) of CE-US ( P<0.05). In large lesions of greater than 5 cm, the diagnostic accuracy of CE-MRI was comparable to that of CE-US. The difference was not significant ( P>0.05). The sensitivity of CE-MRI in detection of active lesions was higher than that of CE-US, and the specificity of the two imaging methods was consistent. The Kappa value between CE-US and CE-MRI was 0.747 for small lesions of less than 5cm, and 0.873 for large lesions of greater than 5 cm. The diagnostic coincidence between CE-MRI and CE-US was quite high. Conclusion:CE-MRI and CE-US can both be used as reliable imaging methods for evaluating the therapeutic effect of TACE for HCC.

Objective To compare the performance of three deep-learning models （VGG19, Inception-V3 and Inception-ResNet-V2） in automatic bone age assessment based on pelvic X-ray radiographs. Methods A total of 962 pelvic X ray radiographs taken from adolescents （481 males, 481 females） aged from 11.0 to 21.0 years in five provinces and cities of China were collected, preprocessed and used as objects of study. Eighty percent of these X ray radiographs were divided into training set and validation set with random sampling method and used for model fitting and hyper-parameters adjustment. Twenty percent were used as test sets, to evaluate the ability of model generalization. The performances of the three models were assessed by comparing the root mean square error （RMSE）, mean absolute error （MAE） and Bland-Altman plots between the model estimates and the chronological ages. Results The mean RMSE and MAE between bone age estimates of the VGG19 model and the chronological ages were 1.29 and 1.02 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-V3 model and the chronological ages were 1.17 and 0.82 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-ResNet-V2 model and the chronological ages were 1.11 and 0.84 years, respectively. The Bland-Altman plots showed that the mean value of differences between bone age estimates of Inception-ResNet-V2 model and the chronological ages was the lowest. Conclusion In the automatic bone age assessment of adolescent pelvis, the Inception-ResNet-V2 model performs the best while the Inception-V3 model achieves a similar accuracy as VGG19 model.
Adolescent ; Adult ; Age Determination by Skeleton ; Child ; China ; Female ; Humans ; Male ; Pelvis ; Radiography ; Young Adult

To investigate the expression, clinical significance, and biological function of the long non-coding RNA (lncRNA) ADAMTS9-AS2 in colorectal cancer (CRC).
 Methods: Gene microarray analysis was performed to explore the expression of ADAMTS9-AS2 in CRC. Real-time PCR was used to verify its expression in 20-paired CRC tissues and adjacent non-tumor tissues. We further explored the relationship between ADAMTS9-AS2 expression and clinicopathological features, and its prognostic role in relapse-free survival (RFS) among early stage CRC patients using Kaplan-Meier and Cox regression analyses. In vitro assays, cell counting kit-8 assay, colony formation assay, and Transwell assay were used to evaluate the biological function of ADAMTS9-AS2 in CRC.
 Results: ADAMTS9-AS2 was down-regulated in CRC patients according to the gene microarray analysis, which was confirmed in CRC tissues and cells. High expression of ADAMTS9-AS2 was associated with a higher 5-year RFS rate (83.8% vs 73.5%, P=0.041) and it was an independent prognostic factor for RFS [hazard ratio (HR)=0.528; 95% CI 0.299 to 0.932; P=0.028] at the early stage of CRC. ADAMTS9-AS2 overexpression in CRC cells inhibited cell proliferation, migration, and invasion, while suppression of ADAMTS9-AS2 showed opposite effects.
 Conclusion: ADAMTS9-AS2 is a valuable prognostic factor for CRC and may function as a tumor suppressor in CRC via inhibiting cell proliferation and metastasis.
ADAMTS9 Protein ; genetics ; Cell Movement ; Cell Proliferation ; Colorectal Neoplasms ; genetics ; Gene Expression Regulation, Neoplastic ; Humans ; Neoplasm Recurrence, Local ; RNA, Long Noncoding

Objective To realize the automated bone age assessment by applying deep learning to digital radiography(DR)image recognition of left wrist joint in Uyghur teenagers, and explore its practical ap-plication value in forensic medicine bone age assessment. Methods The X-ray films of left wrist joint after pretreatment, which were taken from 245 male and 227 female Uyghur nationality teenagers in Uygur Autonomous Region aged from 13.0 to 19.0 years old, were chosen as subjects. And AlexNet was as a regression model of image recognition. From the total samples above, 60% of male and fe-male DR images of left wrist joint were selected as net train set, and 10% of samples were selected as validation set. As test set, the rest 30%were used to obtain the image recognition accuracy with an error range in ±1.0 and ±0.7 age respectively, compared to the real age. Results The modelling results of deep learning algorithm showed that when the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the net train set was 81.4% and 75.6% in male, and 80.5% and 74.8% in female, respectively. When the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the test set was 79.5% and 71.2% in male, and 79.4% and 66.2% in female, respectively. Conclusion The combination of bone age research on teenagers' left wrist joint and deep learning, which has high accuracy and good feasi-bility, can be the research basis of bone age automatic assessment system for the rest joints of body.