Objective To analyze the disease burden of chronic kidney diseases (CKD) attributed to high body mass index (BMI) in China from 1992 to 2021 and predict the disease burden for the next decade, and to provide evidence for the prevention and treatment of CKD. Methods Using the Global Burden of Disease (GBD) database and the Joinpoint model, the average annual percentage rate change (AAPC) of the mortality rate and disability-adjusted life year (DALY) rate was calculated to describe and analyze the CKD disease burden attributed to high BMI in China from 1992 to 2021. The ARIMA model was employed to predict and analyze the change trend of the CKD disease burden. Results From 1992 to 2021, the mortality rate and DALY rate attributed to high BMI-induced chronic kidney disease showed an upward trend. Compared to 1992, the attributed number of deaths increased by 324.38%, and DALYs increased by 268.56%; the mortality rate increased by 64.00%, and the DALY rate grew by 51.62%. From 1992 to 2021, the mortality rate and DALY rate for males were lower than those for females, but the growth rate for males exceeded that of females. From 1992 to 2021, the mortality rate and DALY rate of chronic kidney disease attributed to high BMI in China increased with age. The average annual change rate of chronic kidney disease attributed to high BMI in China from 1992 to 2021 (mortality rate: 1.40 per 100,000 (95% CI: 1.04–1.76), DALY rate: 1.43 per 100 000 (95% CI: 1.17–1.70)) was higher than thHuaiyin Normal University, Huai'anher social demographic index (SDI) regions. The ARIMA model predicted that the age-standardized mortality rate increased from 2.91 per 100 000 in 2022 to 3.05 per 100 000 in 2026, and the age-standardized DALY rate increased from 69.65 per 100 000 in 2022 to 73.58 per 100 000 in 2026. Conclusion Chronic kidney disease attributed to high BMI in China is on the rise, and it will continue to grow in the future. The focus of CKD prevention and control should be on males and the elderly, while active measures should be taken to reduce the occurrence and progression of chronic kidney disease.

OBJECTIVE: To investigate the clinical efficacy of bilateral targeted puncture in percutaneous vertebroplasty(PVP) based on the vertebral osteodense zone. METHODS: A retrospective analysis was conducted on 76 patients with fresh symptomatic osteoporotic vertebral compression fractures, characterized by the presence of a dense zone, who underwent percutaneous vertebroplasty (PVP) between January 2021 and December 2021. All patients involved single-level vertebral fractures. There were 19 males and 57 females, aged from 62 to 88 years old, with an average of (68.5±12.5) years old. All patients underwent bilateral transpedicular puncture procedures. Preoperative CT or MRI was utilized to ascertain the relative position of the bone osteodense zone within the vertebral body (specifically, whether this zone is situated in the upper one-third or one-quarter of the left or right sagittal plane). Considering the head and tail regions of the dense zone as puncture targets, the puncture points and paths were meticulously planned, and the working channel was subsequently established. Under continuous monitoring by a C-arm X-ray machine, bone cement was carefully and gradually injected. The operation time, bone cement injection volume, and bone cement leakage were recorded. The visual analogue scale (VAS) and Oswestry disablity index (ODI) were used to evaluate the effectiveness of the operation. ODI and anterior height (AH) of the vertebral body were used to evaluate the efficacy. RESULTS: All patients successfully completed the surgery and were followed up for (8.0±1.0) months. The operation time was (36.57±11.25) min, the volume of bone cement injection was(6.07±1.19) ml, and 21 patients of bone cement leakage. There were 3 patients with the VAS exceeded 4 points two days postoperatively, indicating suboptimal pain management. At the three time points of pre-operation, 2 days post-operation and 6 months post-operation, the VAS scores were(7.82±1.29), (2.11±0.44), and (2.04±0.67) respectively;the ODI percentages were(75.65±7.23)%, (29.45±4.16)%, and(28.68±5.62)%;and the AH values were (11.02±1.30), (12.87±3.91), and (12.91±3.86) cm. The differences were all statistically significant(P<0.05). The aforementioned three indices demonstrated significant improvement at both 2 days and 6 months post-operation (all P<0.05). There were no statistically significant differences in these indices between the 2-day and 6-month post-operative periods(P>0.05). The postoperative outcome was satisfactory and durable, with no evidence of vertebral height reduction. CONCLUSION Bilateral targeted puncture based on the osteodense dense zone within the vertebral body can achieve bilateral symmetrical and upright full vertebral bone cement reinforcement without increasing bone cement leakage, achieving good early efficacy and preventing late vertebral collapse. This has positive significance for further improving the efficacy of percutaneous vertebroplasty.
Humans ; Male ; Female ; Vertebroplasty/methods* ; Aged ; Middle Aged ; Aged, 80 and over ; Retrospective Studies ; Spinal Fractures/surgery* ; Fractures, Compression/surgery* ; Punctures ; Bone Cements ; Osteoporotic Fractures/surgery*

Breast cancer (BC) is one of the most prevalent malignant tumors affecting women worldwide, with its incidence rate continuously increasing. As a result, treatment strategies for this disease have received considerable attention. Research has highlighted the crucial role of the Hedgehog (Hh) signaling pathway in the initiation and progression of BC, particularly in promoting tumor growth and metastasis. Therefore, molecular targets within this pathway represent promising opportunities for the development of novel BC therapies. This study aims to elucidate the therapeutic mechanisms by which natural compounds modulate the Hh signaling pathway in BC. By conducting a comprehensive review of various natural compounds, including polyphenols, terpenes, and alkaloids, we reveal both common and unique regulatory mechanisms that influence this pathway. This investigation represents the first comprehensive analysis of five distinct mechanisms through which natural compounds modulate key molecules within the Hh pathway and their impact on the aggressive behaviors of BC. Furthermore, by exploring the structure-activity relationships between these compounds and their molecular targets, we shed light on the specific structural features that enable natural compounds to interact with various components of the Hh pathway. These novel insights contribute to advancing the development and clinical application of natural compound-based therapeutics. Our thorough review not only lays the groundwork for exploring innovative BC treatments but also opens new avenues for leveraging natural compounds in cancer therapy.

Based on "Health China" strategy, health humanities education of medical students should be strengthened. The health humanistic education treats all medical students as the object, and infiltrates the humanities into the whole process of health education of medical students in an all-round way, so as to improve health literacy and promote health. Following the strategic deployment of "Health China" and guided by "Health China 2030" Planning Outline, health humanistic education should establish the era orientation of "health first", "people’s health as the center" and "joint construction and sharing", adapt the needs of medical humanistic reform from "disease-centered" to "health-centered", cultivate medical talents with benevolence and skill to meet the needs of a better life, train general practitioners to ensure people’s health in an all-round and all-cycles.

Objective:To provide basis for personalized health interventions for military pilots by analyzing the longitudinal variation trend of waist circumference and its correlation with BMI and lipid metabolism indicators among military pilots.Methods:A retrospective analysis was used on the base of collecting the physical examination data of 323 pilots who had been consecutively recuperated for 3 times and completed 3 health indicator examinations in Air Force Healthcare Center for Special Services Hangzhou from January of 2017 to January of 2022. The pilots were divided into waist circumference <85 cm group, ≥85-90 cm group, and ≥90 cm group. According to their waist circumference change trend, they were divided into increased group (difference of waist circumference >0 cm) and decreased group (difference of waist circumference ≤0 cm). According to the 5-year change rate of waist circumference (Δ5), they were divided into waist circumference relative increased group (Δ5>3%), relative stable group (-3%≤Δ5≤3%), and relative decreased group (Δ5<-3%). The stratification of different waist circumference, the 5-year change rate of waist circumference and BMI, blood lipid indexes and abnormal rate of hyperlipidemia were compared. Waist circumference was measured and determined according to the relevant standards for flying personnel and adults.Results:①The mean waist circumference of 323 pilots was close to the value of pre-central obesity. The mean BMI had reached the overweight standard, and the mean TG and TC were at high end of normal values.②During the 5-year period, the values of blood lipid metabolism indicators were repeatedly measured 3 times, and the mean values of TG, TC, and LDL-C showed an increasing trend, with significant differences ( F=7.39, 9.49, 3.67, P=0.001,<0.001, =0.026) and the mean values of TG and TC of the third measurement had approached to high limit. ③The results of BMI, TG in 3 measurements, LDL-C in the first and third measurements, TC in the first measurement and the incidence of hyperlipidemia were all increased with the increase of waist circumference and the differences were significant ( F=3.06-133.39, χ2=9.08-22.99, all P<0.05); HDL-C decreased with the increase of waist circumference, with significant differences ( F=6.32, 9.78, 10.86, P=0.002, <0.001, <0.001). The mean BMI of the ≥85-90 cm group reached the overweight level in the 3 measurements. The mean values of TG and TC in the first 2 measurements were at high end of normal value, but the mean values in the third measurement were higher than the normal range. The mean values of BMI, TG, and TC in ≥90 cm group were all within the abnormal range. ④ The 5-year change rate of BMI and LDL-C in the waist circumference increased group were higher than those in the waist circumference decreased group ( F=26.02, 14.95, both P<0.001). ⑤The waist circumference relative stable and relative increased group had a higher incidence of new hyperlipidemia, with 27 cases (21.77%) and 24 cases (20.00%) respectively. The waist circumference relative decreased group had the highest improvement rate of hyperlipidemia in 5 cases (6.33%), but the difference was not significant (all P>0.05). Conclusions:The abnormal rates of waist circumference, BMI, and blood lipids in military pilots are relatively high and show an increasing trend. The changes in waist circumference are closely related to BMI and blood lipids, and maintaining waist circumference within a normal range helps to maintain stability of blood lipid metabolism.

Objective:To provide basis for personalized health interventions for military pilots by analyzing the longitudinal variation trend of waist circumference and its correlation with BMI and lipid metabolism indicators among military pilots.Methods:A retrospective analysis was used on the base of collecting the physical examination data of 323 pilots who had been consecutively recuperated for 3 times and completed 3 health indicator examinations in Air Force Healthcare Center for Special Services Hangzhou from January of 2017 to January of 2022. The pilots were divided into waist circumference <85 cm group, ≥85-90 cm group, and ≥90 cm group. According to their waist circumference change trend, they were divided into increased group (difference of waist circumference >0 cm) and decreased group (difference of waist circumference ≤0 cm). According to the 5-year change rate of waist circumference (Δ5), they were divided into waist circumference relative increased group (Δ5>3%), relative stable group (-3%≤Δ5≤3%), and relative decreased group (Δ5<-3%). The stratification of different waist circumference, the 5-year change rate of waist circumference and BMI, blood lipid indexes and abnormal rate of hyperlipidemia were compared. Waist circumference was measured and determined according to the relevant standards for flying personnel and adults.Results:①The mean waist circumference of 323 pilots was close to the value of pre-central obesity. The mean BMI had reached the overweight standard, and the mean TG and TC were at high end of normal values.②During the 5-year period, the values of blood lipid metabolism indicators were repeatedly measured 3 times, and the mean values of TG, TC, and LDL-C showed an increasing trend, with significant differences ( F=7.39, 9.49, 3.67, P=0.001,<0.001, =0.026) and the mean values of TG and TC of the third measurement had approached to high limit. ③The results of BMI, TG in 3 measurements, LDL-C in the first and third measurements, TC in the first measurement and the incidence of hyperlipidemia were all increased with the increase of waist circumference and the differences were significant ( F=3.06-133.39, χ2=9.08-22.99, all P<0.05); HDL-C decreased with the increase of waist circumference, with significant differences ( F=6.32, 9.78, 10.86, P=0.002, <0.001, <0.001). The mean BMI of the ≥85-90 cm group reached the overweight level in the 3 measurements. The mean values of TG and TC in the first 2 measurements were at high end of normal value, but the mean values in the third measurement were higher than the normal range. The mean values of BMI, TG, and TC in ≥90 cm group were all within the abnormal range. ④ The 5-year change rate of BMI and LDL-C in the waist circumference increased group were higher than those in the waist circumference decreased group ( F=26.02, 14.95, both P<0.001). ⑤The waist circumference relative stable and relative increased group had a higher incidence of new hyperlipidemia, with 27 cases (21.77%) and 24 cases (20.00%) respectively. The waist circumference relative decreased group had the highest improvement rate of hyperlipidemia in 5 cases (6.33%), but the difference was not significant (all P>0.05). Conclusions:The abnormal rates of waist circumference, BMI, and blood lipids in military pilots are relatively high and show an increasing trend. The changes in waist circumference are closely related to BMI and blood lipids, and maintaining waist circumference within a normal range helps to maintain stability of blood lipid metabolism.

Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.
Male ; Female ; Humans ; Aged ; Natriuretic Peptide, Brain ; Simendan/therapeutic use* ; Non-ST Elevated Myocardial Infarction ; Heart Failure/drug therapy* ; Peptide Fragments ; Arrhythmias, Cardiac ; Biomarkers ; Prognosis

Objective: To analyze the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019, and to study the current burden of disease in relevant populations. Methods: In October 2021, based on data from the global burden of disease 2019 (GBD 2019) study, population attributable fraction (PAF), number of deaths, mortality, disability-adjusted life year (DALY) and DALY rate of Chinese and global populations with different ages and genders in 1990 and 2019 were extracted and analyzed. The rate of change was calculated, the mortality rate was normalized by the age structure of the world standard population, and the causes of disease burden caused by high temperature exposure of Chinese residents were analyzed. Results: In 2019, compared with 1990, the PAF of Chinese and global population decreased by 43.98% and 12.41% respectively, the number of deaths increased by 29.55% and 49.40% respectively, the crude mortality rate increased by 7.81% and 3.30% respectively, the DALY decreased by 48.12% and 14.41% respectively, and the DALY rate decreased by 56.82% and 40.82% respectively. The mortality rate of the ≥70 age group was higher than that of other groups. The disease burden indicators such as PAF, standardized mortality and DALY attributable to high temperature exposure in men were higher than those in women. In 2019, the main cause of DALY affected by high temperature exposure in Chinese population was ischemic heart disease (84400 person-years), and the main cause of death was ischemic heart disease (4900 cases). Conclusion: The burden of diseases attributable to high temperature exposure is still serious in China and the world at large. Targeted interventions should be formulated for men, the elderly and people with occupational exposure, and a sound surveillance system should be established to reduce the burden of diseases caused by high temperature exposure.
Humans ; Male ; Female ; Aged ; Quality-Adjusted Life Years ; Temperature ; Cost of Illness ; China/epidemiology* ; Myocardial Ischemia