Objective:To analyze the mediating effect of cardiovascular health status (CVH) on the association between educational level and cardiovascular disease (CVD).Methods:The participants were from Shanghai Suburban Adult Cohort and Biobank, and questionnaire survey, physical examination, blood biochemistry were conducted from 2016 to 2020 for baseline information collection, and follow up was conducted until March 31, 2024 based on the medical data, CVD incidence data and death surveillance data at different levels. The associations of educational level, CVH and time to CVD onset of the study population were analyzed using the accelerated failure time model to analyze the mediating effects of CVH, health behaviors, and health factors in the association of educational level and time to CVD onset. The mediating effects of educational level, gender, and age moderated associations were also analyzed.Results:A total of 57 312 participants were included, with 2 780 new cases of CVD during a median follow-up of 6.71 (6.71-6.72) years, and a mean incidence density of 7.77/1 000 person-years (95% CI: 7.48/1 000 person-years -8.06/1 000 person-years). In total, the less educational level and the lower CVH, the higher CVD incidence density ( P<0.05). The results of accelerated failure time models showed that the time ratio for CVD-free survival was 1.15 (95% CI: 1.06-1.24) and 1.33 (95% CI: 1.10-1.60) for moderate and high educational level, respectively. The results of the mediation effect analysis showed that the association between moderate and high educational level and time to CVD onset was 29.60% (20.50%-50.00%) and 36.10% (23.80%-59.00%), 9.97% (5.07%-20.00%) and 13.84% (6.84%-29.00%), 15.24% (9.64%-27.00%) and 17.55% (11.58%-33.00%) of mediators mediated by CVH, health behaviors, health factors, respectively. Among them, there was an exposure-mediated interaction of educational level and a positive moderating effect of age. Conclusion:CVH, health behaviors and health factors had a proportionate mediating effect in the association between educational level and risk of CVD development.

Objective:To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy.Methods:This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by en bloc resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. Results:The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin ( P < 0.001), lateral pelvic sidewall invasion ( P=0.014), and vascular invasion ( P=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, P<0.001) as an independent predictor of RFS. Conclusions:It is safe and feasible to perform TPE with a fascial space priority approach on patients with pelvic malignancy. Positive surgical margins are significantly associated with RFS.

Objective:To analyze the mediating effect of cardiovascular health status (CVH) on the association between educational level and cardiovascular disease (CVD).Methods:The participants were from Shanghai Suburban Adult Cohort and Biobank, and questionnaire survey, physical examination, blood biochemistry were conducted from 2016 to 2020 for baseline information collection, and follow up was conducted until March 31, 2024 based on the medical data, CVD incidence data and death surveillance data at different levels. The associations of educational level, CVH and time to CVD onset of the study population were analyzed using the accelerated failure time model to analyze the mediating effects of CVH, health behaviors, and health factors in the association of educational level and time to CVD onset. The mediating effects of educational level, gender, and age moderated associations were also analyzed.Results:A total of 57 312 participants were included, with 2 780 new cases of CVD during a median follow-up of 6.71 (6.71-6.72) years, and a mean incidence density of 7.77/1 000 person-years (95% CI: 7.48/1 000 person-years -8.06/1 000 person-years). In total, the less educational level and the lower CVH, the higher CVD incidence density ( P<0.05). The results of accelerated failure time models showed that the time ratio for CVD-free survival was 1.15 (95% CI: 1.06-1.24) and 1.33 (95% CI: 1.10-1.60) for moderate and high educational level, respectively. The results of the mediation effect analysis showed that the association between moderate and high educational level and time to CVD onset was 29.60% (20.50%-50.00%) and 36.10% (23.80%-59.00%), 9.97% (5.07%-20.00%) and 13.84% (6.84%-29.00%), 15.24% (9.64%-27.00%) and 17.55% (11.58%-33.00%) of mediators mediated by CVH, health behaviors, health factors, respectively. Among them, there was an exposure-mediated interaction of educational level and a positive moderating effect of age. Conclusion:CVH, health behaviors and health factors had a proportionate mediating effect in the association between educational level and risk of CVD development.

Objective:To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy.Methods:This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by en bloc resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. Results:The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin ( P < 0.001), lateral pelvic sidewall invasion ( P=0.014), and vascular invasion ( P=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, P<0.001) as an independent predictor of RFS. Conclusions:It is safe and feasible to perform TPE with a fascial space priority approach on patients with pelvic malignancy. Positive surgical margins are significantly associated with RFS.

Hydration status refers to the balance between the intake and discharge of water in the body. When the ingested and discharged water are roughly equal and the body is in water balance, it is the normal hydration status, and when the water intake is too little or too much, it is the "dehydration" or "overhydration status". The hydration status of the body not only affects metabolism, but also affects the functions of the urinary system, cardiovascular system, nervous system, etc. In order to further clarify the relationship between body hydration status and decompression sickness (DCS), this paper reviewed relevant studies and analyzed the interaction between hydration and decompression safety during diving. The primary causes of dehydration in diving are "hyperbaric diuresis", "immersion diuresis", breathing dry gas, heat, and cold. Dehydration not only promotes the occurrence of DCS but also reduces the aerobic work efficiency and athletic performance of divers, as well as affects cognition and mood. A study found that appropriate rehydration before and during diving can reduce the risk of DCS, which possibly associates with the increase of blood volume, plasma surface tension, and vasoconstriction. Fluid therapy is also important for those who already have DCS. This paper analyzed the amount, nature, timing, and effect of rehydration involved in the above links, comprehensively sorted out the relationship between hydration and diving safety, summarized the existing problems, and provided reference for practical application and future research.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To observe the clinical efficacy of intravenous transplantation of human umbilical cord blood mononuclear cells(hUCB-MNC)in the treatment of patients with mild-to-moderate Alzheimer disease(AD).Methods Fifty patients with mild-to-moderate AD were randomly divided into treatment group and control group,with 25 cases in each group.The treatment group received intravenous infusion of hUCB-MNC,while the control group was given donepezil hydrochloride by oral administration.The course of treatment was 12 weeks in both groups.We evaluated 1H-proton magnetic resonance spectroscopy(1H-MRS)parameters[N-acetylaspartate/creatinine(NAA/Cr),choline/cre-atinine(Cho/Cr),inositol/creatinine(mI/Cr),and N-acetylaspartate/inositol(NAA/mI)ratios],urinary AD7c-NTP level,and Montreal Cognitive Assessment(MoCA)score in both groups before and after treatment.Results After treat-ment,the treatment group showed significant increases in the total MoCA score and the score of each cognitive domain;and the treatment group had significant greater improvements in memory,visuospatial and executive function,attention,and orientation than the control group(all P<0.05).After treatment,the treatment group showed significantly increased NAA/Cr,Cho/Cr,and NAA/mI ratios and a significantly decreased mI/Cr ratio;and the improvements in NAA/Cr,Cho/Cr,NAA/mI,and mI/Cr were significantly greater in the treatment group than in the control group(all P<0.05).The uri-nary AD7c-NTP level in the treatment group was significantly reduced after treatment,and the improvement was signifi-cantly better compared with the control group(both P<0.05).Conclusion Intravenous transplantation of hUCB-MNC can significantly improve memory,visuospatial and executive function,and other cognitive domains as well as brain me-tabolism and neuronal damage in patients with mild-to-moderate AD.1H-MRS and urinary AD7c-NTP evaluations can pro-vide new ideas for the clinical treatment of AD.

Objective:To investigate the curative effect of transfer of free anteriolateral thigh flap (ALTF) with partial iliotibial tract on reconstruction of composite tissue defects in dorsal wrist/hand.Methods:Ten patients who were admitted in the Department of Hand Surgery of Yongkang Orthopaedic Hospital from March 2018 to August 2022 were entered in the study due to extensive composite tissue defects in dorsal wrists and hands. The patients were 24-48 (37 in average) years old. All patients had tendon defects in 3 or more digits with 35 digits in total. The length of the tendon defects were 5.0-11.0 cm in various digits. The soft tissue defects ranged from 6.0 cm×8.0 cm to 11.0 cm×21.0 cm in size. Six patients had defects accompanied with metacarpal and phalangeal bone fracture and joint capsule. In emergency surgery, all patients received thorough debridement and VSD coverage after internal fixation for combined fractures. At 3-5 days after the primary surgery, free ALTF transfer with partial iliotibial tract was employed to reconstruct the defects on dorsal wrists and hands and the digit extension function. The size of flap was 6.0 cm×9.0 cm-9.0 cm×17.0 cm, and the rest of defect wound was covered by skin graft. All the donor sites were sutured directly, except 1 that received abdominal skin graft. Patients had the follow-ups in outpatient clinics, or via telephone or Wechat, to observe the sensation and appearance of the flap, and the healing of the donor site. The recovery of the extension function of the hand was evaluated according to the totle active motion (TAM) system.Results:All flaps survived except one that had vascular compromise after the surgery and it survived after two explorations and a vascular transfer. Postoperative follow-ups lasted for 6 to 24 months, with 13 months in average. At the last follow-up, a all the flaps were found soft in texture and slightly swollen in appearance. There was no obvious pigmentation or rupture of skin and extensor tendon. Sensory recovery achieved to S 2 in 7 patients and S 3 in 3 patients. The hand function was evaluated according to TAM system and rated as excellent for 3 digits, good for 18 digits, fair for 9 digits and poor for 5 digits. There were linear scars in the donor sites. Conclusion:Free ALTF transfer with partial iliotibial tract in the reconstruction of composite tissue defect of dorsal wrists and hands can not only reconstruct the wound surface, but also the extension of digits, which cuts short the course of treatment.

Background/Aims: Some inflammatory bowel disease (IBD) patients in remission suffer from irritable bowel syndrome (IBS)-like symptoms (IBD-IBS). The pathogenesis has not yet been elucidated. The study aim is to evaluate relationships among quality of life (QOL), psychological status, and visceral sensitivity, and explore the formation mechanism of IBD-IBS. Methods: Forty-seven patients with Crohn’s disease in remission, 24 ulcerative colitis in remission, 26 IBS, and 20 healthy controls were included in the study. The abdominal pain, QOL, anxiety, and depression were evaluated through questionnaires. Visceral sensitivity was measured by rectal balloon distension. The serum levels of 5-hydroxytryptamine (5-HT) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay. The expressions of tryptase, 5-HT, NGF, and related receptors in colonic tissues were detected by immunohistochemistry and western blot. Results: Prevalence of IBS-like symptoms in Crohn’s disease and ulcerative colitis patients in clinical remission was 29.8% and 50.0%, respectively. The QOL was lower, the anxiety/depression scores were higher in IBD-IBS patients than those without IBS-like symptoms. Additionally, patients with IBD-IBS existed visceral hypersensitivity. Besides, abdominal pain was associated with poor QOL, visceral hypersensitivity, anxiety, and depression in IBD-IBS patients. The number of mast cells (MCs) and expressions of 5-HT, NGF, and related receptors were higher in IBD-IBS patients than those with no such symptoms. The serum levels of 5-HT and NGF positively correlated with abdominal pain and visceral hypersensitivity. Conclusion IBD-IBS patients may have low QOL and psychological abnormalities, as wells as visceral hypersensitivity which may be related to increased 5-HT and NGF levels released from activated mast cells.

Background/Aims: Some inflammatory bowel disease (IBD) patients in remission suffer from irritable bowel syndrome (IBS)-like symptoms (IBD-IBS). The pathogenesis has not yet been elucidated. The study aim is to evaluate relationships among quality of life (QOL), psychological status, and visceral sensitivity, and explore the formation mechanism of IBD-IBS. Methods: Forty-seven patients with Crohn’s disease in remission, 24 ulcerative colitis in remission, 26 IBS, and 20 healthy controls were included in the study. The abdominal pain, QOL, anxiety, and depression were evaluated through questionnaires. Visceral sensitivity was measured by rectal balloon distension. The serum levels of 5-hydroxytryptamine (5-HT) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay. The expressions of tryptase, 5-HT, NGF, and related receptors in colonic tissues were detected by immunohistochemistry and western blot. Results: Prevalence of IBS-like symptoms in Crohn’s disease and ulcerative colitis patients in clinical remission was 29.8% and 50.0%, respectively. The QOL was lower, the anxiety/depression scores were higher in IBD-IBS patients than those without IBS-like symptoms. Additionally, patients with IBD-IBS existed visceral hypersensitivity. Besides, abdominal pain was associated with poor QOL, visceral hypersensitivity, anxiety, and depression in IBD-IBS patients. The number of mast cells (MCs) and expressions of 5-HT, NGF, and related receptors were higher in IBD-IBS patients than those with no such symptoms. The serum levels of 5-HT and NGF positively correlated with abdominal pain and visceral hypersensitivity. Conclusion IBD-IBS patients may have low QOL and psychological abnormalities, as wells as visceral hypersensitivity which may be related to increased 5-HT and NGF levels released from activated mast cells.