BACKGROUND: The American Heart Association (AHA) introduced the concept of cardiovascular-kidney-metabolic (CKM) health and stage, reflecting the interaction among metabolism, chronic kidney disease (CKD), and the cardiovascular system. However, the association between CKM stage and the long-term risk of cardiovascular disease (CVD) has not been validated. This study aimed to evaluate the long-term CVD risk associated with CKM health metrics and CKM stage using data from a population-based cohort study. METHODS: In total, 5293 CVD-free participants were followed up to around 13 years in the Chinese Multi-provincial Cohort Study (CMCS). Considering the pathophysiologic progression of CKM health metrics abnormalities (comprising obesity, central adiposity, prediabetes, diabetes, hypertriglyceridemia, CKD, and metabolic syndrome), participants were divided into CKM stages 0, 1, and 2. The time-dependent Cox regression models were used to estimate the cardiovascular risk associated with CKM health metrics and stage. Additionally, broader CVD outcomes were examined, with a specific assessment of the impact of stage 3 in 2581 participants from the CMCS-Beijing subcohort. RESULTS: Among participants, 91.2% (4825/5293) had at least one abnormal CKM health metric, 8.8% (468/5293), 13.3% (704/5293), and 77.9% (4121/5293) were in CKM stages 0, 1, and 2, respectively; and 710 incident CVD cases occurred during a median follow-up time of 13.3 years (interquartile range: 12.1 to 13.6 years). Participants with each poor CKM health metric exhibited significantly higher CVD risk. Compared with stage 0, the hazard ratio (HR) (95% confidence interval [CI]) for CVD incidence was 1.31 (0.84-2.04) in stage 1 and 2.27 (1.57-3.28) in stage 2. Significant interactive impacts existed between CKM stage and age or sex, with higher CVD risk related to increased CKM stages in participants aged <60 years or females. CONCLUSION These findings highlight the contribution of CKM health metrics and CKM stage to the long-term risk of CVD, suggesting the importance of multi-component recognition and management of poor CKM health in CVD prevention.
Humans ; Female ; Male ; Cardiovascular Diseases/etiology* ; Middle Aged ; Adult ; Cohort Studies ; Renal Insufficiency, Chronic/metabolism* ; Aged ; Risk Factors ; Metabolic Syndrome/metabolism* ; China ; East Asian People

Objective To investigate the correlation between manganese superoxide dismutase(MnSOD),neuro-filament light chain(NfL),and lipoprotein-associated phospholipase A2(Lp-PLA2)and post-stroke cognitive impair-ment(PSCI)and the significance of combined measurement,and to provide a reference for early clinical evaluation and formulation of intervention strategies.Methods One hundred patients with stroke admitted to our hospital from June 2020 to January 2023 were divided into PSCI group and non-PSCI group according to whether PSCI occurred.The two groups were compared in terms of baseline data and MnSOD,NfL,and Lp-PLA2 levels at admission and two and four weeks after admission.Pearson analysis was performed to analyze the correlation between MnSOD,NfL,and Lp-PLA2 and the score of Montreal Cognitive Assessment(MoCA).Multiple linear regression analysis was used to analyze the in-fluencing factors for PSCI.Receiver operating characteristic(ROC)curves were plotted to determine the value of Mn-SOD,NfL,and Lp-PLA2 at admission and two weeks after admission in predicting the occurrence of PSCI.Results The PSCI group showed a significantly higher score of the National Institutes of Health Stroke Scale(NIHSS),a significantly higher percentage of white matter osteoporosis,a significantly higher percentage of cerebral at-rophy,and a significantly lower MoCA score than the non-PSCI group at admission(all P<0.05).MnSOD levels were significantly higher two and four weeks after admission than at admission for both groups;NfL and Lp-PLA2 levels were significantly lower two and four weeks after admission than at admission for both groups;two and four weeks after admis-sion,the PSCI group showed significantly lower MnSOD levels and significantly higher NfL and Lp-PLA2 levels than the non-PSCI group(all P<0.05).At admission and two and four weeks after admission,MnSOD levels were positively cor-related with MoCA scores,while NfL and Lp-PLA2 levels were negatively correlated with MoCA scores(all P<0.05).At admission,NIHSS score,white matter osteoporosis,brain atrophy,MnSOD,NfL,and Lp-PLA2 were all signifi-cantly correlated with MoCA score(all P<0.05).At admission and two weeks after admission,the area under the ROC curve(AUC)of the combination of any two indicators was larger than that of any single index,and the AUC of the com-bination of the three indicators was larger than that of the combination of any two indicators.The AUC of the combina-tion of the three indicators was 0.932 at admission,smaller than 0.944 two weeks after admission,with prediction sen-sitivity of 84.62%and specificity of 93.44%.Conclusion MnSOD,NfL,and Lp-PLA2 are important factors affecting the occurrence of PSCI,which can help early clinical evaluation and prediction of PSCI to facilitate subsequent treat-ment and improve patients prognosis.

Objective To evaluate the effect of age factor on the sedative efficacy of propofol given by closed-loop infusion in patients undergoing gynecological laparoscopic surgery.Methods A total of 100 patients,weighing 55-75 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective gynecological laparoscopic surgery under general anesthesia,were divided into 2 groups (n =50 each) according to age:middle-aged group (45-64 yr) and elderly group (65-75 yr).Propofol was given by closed-loop infusion,and the target plasma concentration was automatically regulated to maintain bispectral index (BIS) value within the target range of 45-55.Remifentanil was given by target-controlled infusion at a target plasma concentration of 2-6 ng/ml to maintain anesthesia,and cisatracurium was injected intermittently to maintain muscle relaxation.The total consumption of propofol and remifentanil,regulating frequency of propofol,time ratio of BIS40-60,global score reflecting performance of closed-loop infusion system,emergence time and extubation time were recorded.Results Compared with middle-aged group,the time ratio of BIS40-60 was significantly increased,global score was decreased,the total consumption of propofol and remifentanil was significantly decreased,the regulating frequency of propofol was increased (P＜0.05),and no significant change was found in emergence time or extubation time in elderly group (P＞0.05).Conclusion The sedative efficacy of propofol given by closed-loop infusion is influenced by age factors when used for gynecologic laparoscopic surgery,and the stability in elderly patients is superior to that in middle-aged patients.

Objective To evaluate the effects of different depths of sedation on postoperative cognitive function in elderly patients with mild cognitive impairment.Methods A total of 100 patients with mild cognitive impairment before surgery,aged 65-75 yr,weighing 55-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective gynecological surgery under general anesthesia,were divided into Ⅰ and Ⅱ groups (n =50 each) using a random number table method.Propofol was given by closed-loop target-controlled infusion,and the target plasma concentration was automatically regulated.The bispectral index value was maintained at 40-50 in group Ⅰ and at＞50-60 in group Ⅱ.Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the cognitive function at 1 day before operation (T0) and 7 days after operation (T1),and the development of postoperative cognitive dysfunction (POCD) was recorded.Venous blood samples were collected at T0 and T1 for determination of the concentrations of serum interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay.Results Compared with the baseline value at T0,MoCA and MMSE scores were significantly decreased at T1,and the serum concentrations of IL-10 and TNF-α were increased in both groups (P＜0.05).Compared with group Ⅰ,MoCA and MMSE scores were significantly decreased at T1,and the incidence of POCD was increased,the serum concentration of TNF-α was increased,and the serum concentration of IL-t0 was decreased in group Ⅱ (P ＜ 0.05).Conclusion Maintaining BIS value at 40-50 during operation can decrease the development of POCD in elderly patients with mild cognitive impairment,which may be related to reduced systemic inflammatory responses.

Objective To summarize the experience of laparoscopic appendectomy(LA).Methods A retrospective analysis was carried out on clinical data of 162 cases of laparoscopic appendectomy in this hospital from August 2002 to April 2005.Results Laparoscopic operation was completed in all the cases but 1 case of intestinal tuberculosis.The operative time was 30~90 min(mean,42 min) and the intraoperative blood loss was 5~10 ml.No complications were noted.Conclusions Laparoscopic appendectomy has advantages of little invasion,less blood loss,rapid recovery,and fewer complications,being a safe and ideal surgical alternative.