Background The decline of physical activity in the elderly due to aging may increase the risk of sarcopenia. Currently, there is a lack of evidence from large natural populations on the relationship between PA and sarcopenia. Objective To explore the relationship between PA and sarcopenia in the elderly aged 60 years and above in 10 provinces (autonomous regions) of China. Methods Data were retrieved from the 2022—2023 round of the China Development and Nutrition Health Impact Cohort. Personal basic information and PA data were collected by questionnaire survey. Skeletal muscle mass was measured by bio-electrical impedance analysis, muscle strength was measured using a grip dynamometer, and physical performance was reflected by 6-meter walk speed. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used to diagnose sarcopenia. Light physical activity (LPA) duration, moderate-to-vigorous physical activity (MVPA) duration, and total physical activity volume were calculated. A total of 3326 residents aged ≥60 years with complete data were selected as the survey participants. Multiple logistic regression models and restricted cubic splines (RCS) were used to assess the association between PA duration/volume and sarcopenia. Results In 10 provinces (autonomous regions) of China, the prevalence of sarcopenia in the elderly aged 60 years and above was 5.5% (95%CI: 4.7%, 6.2%). The logistic regression analysis showed that compared with the elderly reporting 0-7.0 h·week⁻¹ in LPA duration, the risk of sarcopenia in the elderly with LPA duration of >14.0-21.0 h·week⁻¹ was reduced by 51% (OR=0.49, 95%CI: 0.26, 0.96). Compared with the elderly with total physical activity ≥15.0 metabolic equivalent of task (MET)-h·week⁻¹, those with <7.5 MET-h·week⁻¹ had a 2.24-fold increased risk of sarcopenia (OR=2.24, 95%CI: 1.17, 4.29). The RCS results found that LPA duration and total physical activity volume each showed a nonlinear dose-response relationship with the risk of sarcopenia (P_overall<0.05, P_non-linear<0.05). Compared with the elderly with an LPA duration of 0 h· week⁻¹, the risk of sarcopenia in the elderly with an LPA duration of 12.6 h· week⁻¹ was the lowest (OR=0.42, 95%CI: 0.21, 0.83). Compared with the elderly with a total physical activity volume of 15.0 MET-h· week⁻¹, the elderly with a total physical activity volume of 46.0 MET-h· week⁻¹ had the lowest risk of sarcopenia (OR=0.57, 95%CI: 0.38, 0.84). There was no statistically significant association between weekly MVPA duration and the risk of sarcopenia (P>0.05). Conclusion Increasing weekly LPA duration and total physical activity volume would help to reduce the risk of sarcopenia.

Objective:To analyze the efficacy and safety of 3D-printing-assisted anterolateral thigh perforator flap surgery for the treatment of complex soft tissue defects around the ankle joint.Methods:A total of 160 patients with skin and soft tissue defects around the ankle joint at the First People′s Hospital of Xiaoshan District, Hangzhou, from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a control group and an observation group according to the surgical approach, with 80 patients in each group. The control group underwent traditional anterolateral thigh perforator flap surgery, which included 43 males and 37 females, with an age of 21-62 (34.7±5.6) years. The observation group underwent 3D-printing-assisted anterolateral thigh perforator flap surgery, which included 45 males and 35 females, with an age of 20-66 (34.8±5.6) years. The operative time, flap healing time, and hospital stay duration were compared between the two groups. Serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF-α) were compared between the two groups before surgery and 3 days postoperatively. The ankle joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, the range of motion (ROM) was assessed using the ROM score, and the flap sensation was evaluated using the modified Highet grading system before surgery, 6 months postoperatively, and at the last follow-up. The incidence of adverse reactions such as arterial crisis, venous crisis, infection, and necrosis during the perioperative period was observed. Patient satisfaction was assessed 6 months after treatment.Results:All patients in both groups successfully completed the surgery, with no cases excluded. The operative time, flap healing time, and hospital stay duration were significantly shorter in the observation group than those in the control group (all P<0.001). Compared with preoperative levels, the levels of IL-6, IL-8, CRP, and TNF-α were significantly reduced in both groups 3 days postoperatively (all P<0.001), and these levels were significantly lower in the observation group than those in the control group at 3 days postoperatively (all P<0.001). Six months postoperatively and at the last follow-up, the AOFAS and ROM scores were significantly higher in the observation group than those in the control group (all P<0.05), and the flap sensation grading was significantly better in the observation group than that in the control group (all P<0.05). The incidence of adverse reactions was 7.5% (6/80) in the observation group, which was significantly lower than 18.8% (15/80) in the control group ( P=0.024). The patient satisfaction rate was 95.0% (76/80) in the observation group, which was significantly higher than 72.5% (58/80) in the control group ( P<0.001). Conclusion:3D-printing-assisted anterolateral thigh perforator flap repair for skin and soft tissue defects around the ankle joint can improve perioperative indicators, reduce the incidence of postoperative adverse reactions, promote the recovery of flap sensation and ankle function, attenuate the inflammatory response of the body, and enhance patient satisfaction.

Objective:To investigate the impact of different luteal phase support protocols on pregnancy outcomes in patients aged ≤35 years undergoing modified natural cycle frozen-thawed embryo transfer (mNC-FET).Methods:A retrospective cohort study was conducted to analyze 2 086 cycles of patients aged ≤35 years who received mNC-FET cycles in Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2020. The cycles were divided into three groups based on luteal phase support protocols used. The patients received a combination of progesterone soft capsule and dydrogesterone in the group A (446 cycles), the patients received dydrogesterone in the group B (439 cycles), and the patients received a combination of progesterone vaginal sustained-release gel and dydrogesterone in the group C (1 201 cycles). The pregnancy and perinatal outcomes were compared between groups A and B, groups C and B after matching the baseline data in a ratio of 1∶1 using the propensity score matching (PSM). The effect of different luteal phase support on live birth rate was analyzed after adjusting for confounding factors affected by univariate and multivariate generalized estimating equation (GEE).Results:After PSM, there were no significant differences between groups A and B, groups C and B in human chorionic gonadotropin positive rate, clinical pregnancy rate, ectopic pregnancy rate, live birth rate in transplant cycle, incidence of low weight, macrosomia, premature delivery rate, pregnancy complication rate and incidence of birth defects (all P>0.05). GEE analysis showed that three different luteal phase support regimens were not associated with live birth rate. Conclusion:In the mNC-FET cycle, patients aged ≤35 years who chose dydrogesterone alone as luteal phase support drug, had no difference in live birth rate and perinatal outcome between progesterone soft capsules or progesterone vaginal sustained-release gel combined with dydrogesterone, but the outcome still needs to be confirmed by large sample prospective studies.

Objective:To investigate the pregnancy outcomes in patients ≤35 years old with diminished ovarian reserve (DOR) undergoing intrauterine insemination (IUI).Methods:A retrospective cohort study was conducted by analyzing the clinical data of 6 229 IUI cycles performed in patients aged ≤35 years at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between June 2016 and March 2024. Based on serum anti-Müllerian hormone (AMH) levels, the subjects were divided into two groups: patients with AMH <1.1 μg/L were classified as the DOR group (489 cycles), and patients with AMH ≥1.1 μg/L were classified as the normal ovarian reserve (NOR) group (5 740 cycles). Propensity score matching (PSM) was applied to control for confounding factors, after 1∶1 PSM matching, 486 cycles were included in each group. Clinical pregnancy rate, miscarriage rate, live birth rate, biochemical pregnancy rate, and ectopic pregnancy rate were compared between the two groups by generalized estimating equations.Results:The clinical pregnancy rate was 21.19% (103/486) in DOR group and 24.07% (117/486) in NOR group, with no statistically significant difference ( P=0.294). The live birth rate was 18.31% (89/486) in DOR group and 20.16% (98/486) in NOR group, also without significant difference ( P=0.469). Additionally, no significant differences were observed in miscarriage rate, biochemical pregnancy rate, or ectopic pregnancy rate between the two groups (all P>0.05). Conclusion:In patients aged ≤35 years with DOR, pregnancy outcomes from IUI are comparable to those in young patients with NOR.

Intracranial arterial dolichoectasia(IADE)is a major arterial disease characterized by artery elongation,dilatation,and curvature.Although the pathological mechanism of IADE is unclear,recent studies have suggested a close relationship with matrix metalloproteinases(MMPs).This review summarizes the possible pathological mechanism of IADE induced by MMPs in terms of MMPs activation and the occurrence and development of IADE,the correlation between MMPs activation and positive remodeling causing IADE,and the relationship between hemodynamic changes,MMPs activation and IADE and between IADE-associated diseases and MMPs,to provide potential therapeutic targets for the effective prevention and treatment of IADE.

Objective:To investigate the impact of different luteal phase support protocols on pregnancy outcomes in patients aged ≤35 years undergoing modified natural cycle frozen-thawed embryo transfer (mNC-FET).Methods:A retrospective cohort study was conducted to analyze 2 086 cycles of patients aged ≤35 years who received mNC-FET cycles in Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2020. The cycles were divided into three groups based on luteal phase support protocols used. The patients received a combination of progesterone soft capsule and dydrogesterone in the group A (446 cycles), the patients received dydrogesterone in the group B (439 cycles), and the patients received a combination of progesterone vaginal sustained-release gel and dydrogesterone in the group C (1 201 cycles). The pregnancy and perinatal outcomes were compared between groups A and B, groups C and B after matching the baseline data in a ratio of 1∶1 using the propensity score matching (PSM). The effect of different luteal phase support on live birth rate was analyzed after adjusting for confounding factors affected by univariate and multivariate generalized estimating equation (GEE).Results:After PSM, there were no significant differences between groups A and B, groups C and B in human chorionic gonadotropin positive rate, clinical pregnancy rate, ectopic pregnancy rate, live birth rate in transplant cycle, incidence of low weight, macrosomia, premature delivery rate, pregnancy complication rate and incidence of birth defects (all P>0.05). GEE analysis showed that three different luteal phase support regimens were not associated with live birth rate. Conclusion:In the mNC-FET cycle, patients aged ≤35 years who chose dydrogesterone alone as luteal phase support drug, had no difference in live birth rate and perinatal outcome between progesterone soft capsules or progesterone vaginal sustained-release gel combined with dydrogesterone, but the outcome still needs to be confirmed by large sample prospective studies.

Objective:To investigate the pregnancy outcomes in patients ≤35 years old with diminished ovarian reserve (DOR) undergoing intrauterine insemination (IUI).Methods:A retrospective cohort study was conducted by analyzing the clinical data of 6 229 IUI cycles performed in patients aged ≤35 years at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between June 2016 and March 2024. Based on serum anti-Müllerian hormone (AMH) levels, the subjects were divided into two groups: patients with AMH <1.1 μg/L were classified as the DOR group (489 cycles), and patients with AMH ≥1.1 μg/L were classified as the normal ovarian reserve (NOR) group (5 740 cycles). Propensity score matching (PSM) was applied to control for confounding factors, after 1∶1 PSM matching, 486 cycles were included in each group. Clinical pregnancy rate, miscarriage rate, live birth rate, biochemical pregnancy rate, and ectopic pregnancy rate were compared between the two groups by generalized estimating equations.Results:The clinical pregnancy rate was 21.19% (103/486) in DOR group and 24.07% (117/486) in NOR group, with no statistically significant difference ( P=0.294). The live birth rate was 18.31% (89/486) in DOR group and 20.16% (98/486) in NOR group, also without significant difference ( P=0.469). Additionally, no significant differences were observed in miscarriage rate, biochemical pregnancy rate, or ectopic pregnancy rate between the two groups (all P>0.05). Conclusion:In patients aged ≤35 years with DOR, pregnancy outcomes from IUI are comparable to those in young patients with NOR.

Intracranial arterial dolichoectasia(IADE)is a major arterial disease characterized by artery elongation,dilatation,and curvature.Although the pathological mechanism of IADE is unclear,recent studies have suggested a close relationship with matrix metalloproteinases(MMPs).This review summarizes the possible pathological mechanism of IADE induced by MMPs in terms of MMPs activation and the occurrence and development of IADE,the correlation between MMPs activation and positive remodeling causing IADE,and the relationship between hemodynamic changes,MMPs activation and IADE and between IADE-associated diseases and MMPs,to provide potential therapeutic targets for the effective prevention and treatment of IADE.

Objective:To analyze the efficacy and safety of 3D-printing-assisted anterolateral thigh perforator flap surgery for the treatment of complex soft tissue defects around the ankle joint.Methods:A total of 160 patients with skin and soft tissue defects around the ankle joint at the First People′s Hospital of Xiaoshan District, Hangzhou, from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a control group and an observation group according to the surgical approach, with 80 patients in each group. The control group underwent traditional anterolateral thigh perforator flap surgery, which included 43 males and 37 females, with an age of 21-62 (34.7±5.6) years. The observation group underwent 3D-printing-assisted anterolateral thigh perforator flap surgery, which included 45 males and 35 females, with an age of 20-66 (34.8±5.6) years. The operative time, flap healing time, and hospital stay duration were compared between the two groups. Serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF-α) were compared between the two groups before surgery and 3 days postoperatively. The ankle joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, the range of motion (ROM) was assessed using the ROM score, and the flap sensation was evaluated using the modified Highet grading system before surgery, 6 months postoperatively, and at the last follow-up. The incidence of adverse reactions such as arterial crisis, venous crisis, infection, and necrosis during the perioperative period was observed. Patient satisfaction was assessed 6 months after treatment.Results:All patients in both groups successfully completed the surgery, with no cases excluded. The operative time, flap healing time, and hospital stay duration were significantly shorter in the observation group than those in the control group (all P<0.001). Compared with preoperative levels, the levels of IL-6, IL-8, CRP, and TNF-α were significantly reduced in both groups 3 days postoperatively (all P<0.001), and these levels were significantly lower in the observation group than those in the control group at 3 days postoperatively (all P<0.001). Six months postoperatively and at the last follow-up, the AOFAS and ROM scores were significantly higher in the observation group than those in the control group (all P<0.05), and the flap sensation grading was significantly better in the observation group than that in the control group (all P<0.05). The incidence of adverse reactions was 7.5% (6/80) in the observation group, which was significantly lower than 18.8% (15/80) in the control group ( P=0.024). The patient satisfaction rate was 95.0% (76/80) in the observation group, which was significantly higher than 72.5% (58/80) in the control group ( P<0.001). Conclusion:3D-printing-assisted anterolateral thigh perforator flap repair for skin and soft tissue defects around the ankle joint can improve perioperative indicators, reduce the incidence of postoperative adverse reactions, promote the recovery of flap sensation and ankle function, attenuate the inflammatory response of the body, and enhance patient satisfaction.

Objective:Interruption of aortic arch(IAA)is a rare congenital heart disease.This study aims to investigate echocardiographic features and pathological ultrastructural characteristics of fetal IAA and to further analyze its pathological evolution. Methods:A retrospective analysis was conducted on prenatal echocardiographic,post-surgical,or autopsy findings of fetuses prenatally diagnosed with IAA.Prenatal echocardiographic tracking was used to observe the internal diameters and Z-scores of different segments of the aortic arch and the changes in the narrowed section.These observations were combined with autopsy and pathological findings to explore the potential intrauterine evolution of IAA and its cytological basis. Results:The study included 34 fetuses with IAA,with 3,3,and 28 fetuses prenatally diagnosed with aortic arch dysplasia(AAD),coarctation of aorta(CoA),and IAA,respectively.The 3 AAD and 3 CoA fetuses chose termination of pregnancy 1 to 2 weeks after prenatal ultrasound diagnosis,and autopsy confirmed IAA.Among the 28 fetuses prenatally diagnosed with IAA,6 cases of CoA progressively worsened,eventually evolving into type A IAA as observed through echocardiographic follow-up.The remaining 22 cases were diagnosed as IAA on the first prenatal ultrasound.Postnatal surgery corrected 3 cases,while 27 cases opted for pregnancy termination,and 4 cases resulted in intrauterine death.Echocardiographic features of the fetal IAA included a significantly smaller left ventricle compared with the right or negligible difference on the four-chamber view,a significantly smaller aorta than the pulmonary artery on the three-vessel view,and a lack of connection between the aorta and the descending aorta on the three-vessel-trachea and aortic arch views.The aortic arch appears less curved and more rigid,losing the normal"V"shape between the aorta,ductus arteriosus,and descending aorta.Color Doppler ultrasound showed no continuous blood flow signal at the interruption site,with reversed blood flow visible in the ductus arteriosus.Transmission electron microscopy of 7 IAA fetuses revealed numerous disorganized smooth muscle cells between the elastic membranes near the aortic arch interruption site,significantly increased in number compared with the proximal ascending aorta.The elastic membranes were thicker and more twisted near the interruption site.The interruption area lacked normal endothelial cells and lumen,with only remnants of necrotic endothelial cells,disorganized short and thick elastic membranes,and randomly arranged smooth muscle cells. Conclusion:Prenatal echocardiography is the primary diagnostic tool for fetal IAA.Post-surgical follow-up and autopsy help identify complications and disease characteristics,enhancing diagnostic accuracy.Some fetal IAA may evolve from AAD or CoA,with potential pathogenesis related to ischemia,hypoxia,and migration of ductal constrictive components.