Objectives:To evaluate preoperative imaging anatomic characteristics and risk stratification in patients with pure aortic regurgitation(PAR)who underwent transcatheter aortic valve replacement(TAVR).Methods:A total of 156 consecutive patients with moderate or severe PAR who underwent TAVR from January 2018 to June 2023 in Fujian Provincial Hospital were enrolled.Pre-procedural aortic root computed tomography scans of the patients were analyzed to summarize anatomical risk points and typing.The clinical baseline data,perioperative data,and postoperative 12-month adverse events during follow-up of patients with different typing were compared.Results:The mean age of the 156 PAR patients treated with TAVR was(72.8±6.4)years,69.2%were male,and the STS score was(7.7±2.0)%.The proportion of PAR patients with simple,general and challenging lesions was 9.0%,37.8%and 53.2%,respectively.Results showed that enrolled patients with PAR treated with TAVR were at high risk of valve displacement(47.4%),and the risk of perivalvular leakage(26.9%),ascending aortic dilatation(26.9%),low coronary artery opening(37.2%)and transverse heart(23.7%)were also common.The risk of valve displacement and perivalvular leakage were significantly higher in PAR patients with challenging lesions.The risk of perioperative complications was significantly higher in patients with challenging and general lesions than in patients with simple lesions,and the most common complications were new left bundle branch block and pacemaker implantation.The 12-month adverse event rates after TAVR in PAR patients with simple,general,and challenge lesions were 0%,15.3%,and 32.5%,respectively,and the difference was statistically significant(P=0.004).Multivariate logistic regression analysis showed that PAR patients with challenging lesions had a significantly higher risk of multiple endpoint events 12 months after surgery than those with non-challenging lesions(OR=3.38,95%CI:1.48-8.38,P=0.006).Conclusions:Careful assessment of anatomic risk typing by preoperative imaging in PAR patients undergoing TAVR is important for risk stratification of perioperative complications as well as adverse events during follow-up.

BACKGROUND:The lower-limb muscle strength shows a significant physiological decline with aging.There may be a certain correlation between sedentary behavior,fear of falling,age and lower-limb muscle strength,but the influence path and effect relationship among them are not yet clear.OBJECTIVE:To examine the relationship between sedentary behavior and lower-limb muscle strength,and to explore the influences of fear of falling and age in such an association among community-dwelling older adults.METHODS:This cross-sectional study recruited 331 community-dwelling older adults(aged≥60 years)in Shanghai.A questionnaire survey was conducted to collect basic information,demographic data,etc.The Short Form of the International Physical Activity Questionnaire was applied to measure sedentary time.Lower-limb muscle strength was assessed by the 30-second chair-stand test.Fear of falling was measured by the Chinese version of Fall Efficacy Scale-International.Descriptive statistics analysis,correlation analysis,regression-based path analysis and mediation analyses were performed on the data.RESULTS AND CONCLUSION:Valid data from 318 community-dwelling older adults[78.9%females,mean age(67.8±5.5)years old]were finally included in the analysis.There were 185 with sedentary time≥3 hours and 133 with sedentary time<3 hours.(1)There was a positive correlation between sedentary behavior and fear of falling(P<0.01),and there were negative correlations between lower-limb muscle strength and sedentary behavior(P<0.01)and between lower-limb muscle strength and fear of falling(P<0.001).(2)Sedentary behavior negatively predicted lower-limb muscle strength(β=-0.125,P<0.05),and positively predicted fear of falling(β=0.182,P<0.01).Fear of falling negatively predicted lower-limb muscle strength(β=-0.293,P<0.001).(3)Fear of falling mediated the relationship between sedentary behavior and lower-limb muscle strength(β=-0.053,95%confidence interval:-0.100 to-0.018).(4)Sedentary behavior had a statistically significant predictive effect on fear of falling(β=0.164,P<0.01),indicating that age moderates the effect of sedentary behavior on fear of falling.

BACKGROUND:The lower-limb muscle strength shows a significant physiological decline with aging.There may be a certain correlation between sedentary behavior,fear of falling,age and lower-limb muscle strength,but the influence path and effect relationship among them are not yet clear.OBJECTIVE:To examine the relationship between sedentary behavior and lower-limb muscle strength,and to explore the influences of fear of falling and age in such an association among community-dwelling older adults.METHODS:This cross-sectional study recruited 331 community-dwelling older adults(aged≥60 years)in Shanghai.A questionnaire survey was conducted to collect basic information,demographic data,etc.The Short Form of the International Physical Activity Questionnaire was applied to measure sedentary time.Lower-limb muscle strength was assessed by the 30-second chair-stand test.Fear of falling was measured by the Chinese version of Fall Efficacy Scale-International.Descriptive statistics analysis,correlation analysis,regression-based path analysis and mediation analyses were performed on the data.RESULTS AND CONCLUSION:Valid data from 318 community-dwelling older adults[78.9%females,mean age(67.8±5.5)years old]were finally included in the analysis.There were 185 with sedentary time≥3 hours and 133 with sedentary time<3 hours.(1)There was a positive correlation between sedentary behavior and fear of falling(P<0.01),and there were negative correlations between lower-limb muscle strength and sedentary behavior(P<0.01)and between lower-limb muscle strength and fear of falling(P<0.001).(2)Sedentary behavior negatively predicted lower-limb muscle strength(β=-0.125,P<0.05),and positively predicted fear of falling(β=0.182,P<0.01).Fear of falling negatively predicted lower-limb muscle strength(β=-0.293,P<0.001).(3)Fear of falling mediated the relationship between sedentary behavior and lower-limb muscle strength(β=-0.053,95%confidence interval:-0.100 to-0.018).(4)Sedentary behavior had a statistically significant predictive effect on fear of falling(β=0.164,P<0.01),indicating that age moderates the effect of sedentary behavior on fear of falling.

Objectives:To evaluate preoperative imaging anatomic characteristics and risk stratification in patients with pure aortic regurgitation(PAR)who underwent transcatheter aortic valve replacement(TAVR).Methods:A total of 156 consecutive patients with moderate or severe PAR who underwent TAVR from January 2018 to June 2023 in Fujian Provincial Hospital were enrolled.Pre-procedural aortic root computed tomography scans of the patients were analyzed to summarize anatomical risk points and typing.The clinical baseline data,perioperative data,and postoperative 12-month adverse events during follow-up of patients with different typing were compared.Results:The mean age of the 156 PAR patients treated with TAVR was(72.8±6.4)years,69.2%were male,and the STS score was(7.7±2.0)%.The proportion of PAR patients with simple,general and challenging lesions was 9.0%,37.8%and 53.2%,respectively.Results showed that enrolled patients with PAR treated with TAVR were at high risk of valve displacement(47.4%),and the risk of perivalvular leakage(26.9%),ascending aortic dilatation(26.9%),low coronary artery opening(37.2%)and transverse heart(23.7%)were also common.The risk of valve displacement and perivalvular leakage were significantly higher in PAR patients with challenging lesions.The risk of perioperative complications was significantly higher in patients with challenging and general lesions than in patients with simple lesions,and the most common complications were new left bundle branch block and pacemaker implantation.The 12-month adverse event rates after TAVR in PAR patients with simple,general,and challenge lesions were 0%,15.3%,and 32.5%,respectively,and the difference was statistically significant(P=0.004).Multivariate logistic regression analysis showed that PAR patients with challenging lesions had a significantly higher risk of multiple endpoint events 12 months after surgery than those with non-challenging lesions(OR=3.38,95%CI:1.48-8.38,P=0.006).Conclusions:Careful assessment of anatomic risk typing by preoperative imaging in PAR patients undergoing TAVR is important for risk stratification of perioperative complications as well as adverse events during follow-up.

Objectives:To evaluate the learning curve of transcatheter aortic valve replacement(TAVR)in a single center by single operator using Venus A valve. Methods:A total of 150 patients with severe aortic stenosis who underwent TAVR using Venus A valve in Fujian Provincial Hospital from July 2018 to May 2022 were selected.According to the time order of TAVR,the 1st-50th patients were included in group A,the 51st-100th patients were included in group B and the 101st-150th patients were included in group C.The basic clinical data,perioperative parameters and postoperative follow-up data of the three groups were analyzed. Results:All high-risk patients with severe aortic stenosis had an average STS score(7.9±1.5)and were treated with Venus A valve.The total operation time of group A,group B and group C was(226.2±86.3)min,(115.2±47.1)min,(108.2±38.1)min;the peripheral path operation time was(45±10)min,(20±7)min,(18±6)min;the valve release time was(13.0±2.3)min,(5.0±2.1)min,(3.0±1.7)min;the X-ray fluoroscopy time was(24±8)min,(11±5)min,(10±3)min;the radiation dose was(1 266±227)mGy,(532±132)mGy,(519±108)mGy;and the total incidence of perioperative adverse events was 46%,18%,16%,respectively.The differences were statistically significant(all P<0.05).The total incidence of adverse events during follow-up within 6 months for patients in group A,group B,and group C were 6%,2%,and 0%(P>0.05).With the increase of TAVR cases,the correlation curve of each time node of TAVR and radiation dose tended to be stable after the 50th-60th cases. Conclusions:With the increase of procedural experience,the total operation time,operative time nodes,radiation dose and perioperative adverse events of TAVR with Venus A valve decreases gradually,and the operator usually needs 50-60 cases to cross the TAVR learning curve.

To explore the application of humanistic care in children's fever clinics,the children's fever clinics of Guangzhou Women and Children's Medical Center conducted relevant research using narrative medicine as a guiding concept.This paper elaborated on the medical humanistic dilemmas and narrative care needs in children's fever clinics,and focused on exploring the practice paths of narrative medicine in pediatric with Chinese characteristics from five dimensions,including the cultivation of nursing staff's abilities of professional narrative and humanistic care,the establishment of health lectures featuring narrative patient education,the alleviation of medical anxiety for children and their families,related support of narrative nursing,and caring services.The aim was to improve the narrative care ability of nurses in children's fever clinics,develop methods for pediatric patients that can eliminate the fear of seeking medical treatment,and protect children's physical and mental health.A carrier of care,support,and emotional expression can be provided for parents.The foundation for nursing staff to achieve professional growth through narrative reflection can be laid.Thus,it can assist in establishing a life narrative community relationship between doctors and patients,and jointly explore the meaning of life.

Objectives:To investigate the effect of body mass index(BMI)on perioperative and long-term prognosis of patients with severe aortic stenosis(AS)after transcatheter aortic valve replacement(TAVR). Methods:This retrospective study imcluded 180 patients with severe AS who received TAVR in Fujian Provincial Hospital from January 2019 to January 2022.According to the BMI,patients were divided into four groups:low weight group(BMI<18.5 kg/m2,n=23),normal weight group(18.5 kg/m2≤BMI<24.0 kg/m2,n=65),overweight group(24.0 kg/m2≤BMI<28.0 kg/m2,n=57),obesity group(BMI≥28.0 kg/m2,n=35).The general clinical characteristics,imaging parameters,perioperative indexes,all-cause death and the incidence of other adverse cardiac events during(18.0±6.8)months follow-up were compared among different groups.Risk factors for the perioperative complications and long-term outcomes of TAVR were evaluated. Results:The prevalence of hypertension and diabetes,left ventricular end-diastolic diameter,ventricular septal thickness and left ventricular posterior wall thickness were significantly higher in the obese group than in normal weight group(all P<0.05).The level of prealbumin in low weight group was lower than in normal weight group(P<0.05).The total perioperative complications in low weight group were higher than in normal weight group(60.9%vs.12.3%,P=0.042).During(18.0±6.8)months follow-up,the incidence of all-cause death in the low weight group was significantly higher than that in normal weight group,overweight group and obese group(17.4%vs.4.6%vs.3.5%vs.5.7%,P=0.003).Kaplan-Meier survival analysis evidenced higher mortality rate in low weight group at 18 months after TAVR(log-rank P<0.01).Multivariate Cox regression analysis showed that the risk of long-term adverse cardiovascular events was significantly higher in low weight group than in normal weight group(HR=7.633,95%CI:1.012-57.564,P=0.049). Conclusions:Low weight patients with severe AS have a higher incidence of perioperative complications and a poor long-term prognosis.Such patients should appropriately strengthen their nutritional intake and adjust their body weight to normal levels before performing TAVR.

OBJECTIVE: Because of the limited number of studies and small sample sizes, whether metabolic syndrome (MS) leads to the occurrence and progression of osteoporosis and the possible underlying mechanisms require further investigation. This study aimed to investigate the association between MS and osteoporosis, along with its influencing factors. METHODS: This observational cross-sectional study included 139,470 individuals aged ≥ 18 years who underwent health examinations from September 2014 to March 2022. Based on bone mineral density (BMD) screening results, the participants were categorized into a suspected osteoporosis or non-osteoporosis group (control). Participants were further divided into those who met 0 MS criteria, 1 MS criterion, 2 MS criteria, and ≥ 3 MS criteria (MS group). Participants who had undergone health examinations at least twice formed the follow-up cohort; a self-matched analysis was performed on those with follow-up periods ≥ 5 years and unchanged MS grouping. RESULTS: Several examination indicators in the suspected osteoporosis group showed statistically significant differences compared with the control group. The proportion of suspected osteoporosis in the MS group was significantly increased compared with that in the 0 MS criteria group (odds ratio [ OR]: 1.215, Z = 29.11, P < 0.001, 95% confidence interval: 1.199-1.231). After adjusting for age, sex, smoking, and alcohol consumption, the 2 MS criteria group and MS group still had OR values > 1 ( P < 0.001). In the follow-up cohort, the proportion of suspected osteoporosis increased gradually with an increase in the number of MS criteria met at baseline and during each follow-up visit ( P < 0.05), with the highest proportion observed in the MS group. However, the proportion of suspected osteoporosis did not increase significantly over time in the different MS groups ( P > 0.05). In the follow-up cohort, the proportion of individuals transitioning from normal BMD to suspected osteoporosis was higher in the MS group after ≥ 5 years of follow-up compared with the group meeting 0 MS criteria (0.08% versus 1.15%, χ ² = 10.76, P = 0.001). There was no significant difference in BMD values for the 0 MS criteria group after 5 years ( P > 0.05), whereas the other three groups experienced a significant decrease in BMD values after 5 years ( P < 0.05). CONCLUSION MS is an independent risk factor for osteoporosis, and the effect of risk factors related to MS on osteoporosis may exceed that of aging alone. The specific mechanisms warrant further investigation.
Humans ; Osteoporosis/etiology* ; Female ; Male ; Metabolic Syndrome/complications* ; Middle Aged ; Cross-Sectional Studies ; China/epidemiology* ; Aged ; Adult ; Bone Density ; Risk Factors

BACKGROUND: Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders. METHODS: This was a retrospective study performed at the Institute of Health Management, Chinese People's Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test. RESULTS: The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs . 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs . 9.44% [1692/17,926], 95% CI 8.94-9.79%, P  < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs . 1.85% [332], 95% CI 1.61-2.00%, P  < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs . 0.59% [105], 95% CI 0.47-0.70%, P  < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]). CONCLUSIONS The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.
Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Early Detection of Cancer ; Colonoscopy/methods* ; Adenoma/epidemiology* ; Colorectal Neoplasms/epidemiology*

Objective To study the adverse effects on periodontal tissues caused by crownless roots in elderly people with osteoporosis. Methods Totally 60 12?week SD rats(30 male and 30 female)were randomly divided into the control group(10 male and 10 female sham?operated rats)and the osteoporosis group(20 male and 20 female castrated rats). After 12 weeks,the bone mineral density of right femora was measured by dual energy X?ray for all rats to confirm osteoporosis. The right molar crown was pinched off with haemostatic forceps and the molar root was retained. The 10 con?trol rats and the 20 experimental rats were sacrificed respectively at postoperative 2 and 4 weeks. The periodontal tissues of right molar were sampled and the morphology of the parodontium and the alveolar bone was observed by haematoxylin and eosin(HE)staining and the expression of tumour necrosis factor?alpha(TNF?α)and inducible nitric oxide synthase?2(NOS2)was detected by immunohistochemical staining and real time fluores?cent quantitative PCR(qRT?PCR). Results The HE slices indicated that the periodontal tissues in the osteoporosis group were significantly im?paired compared to the control group as the structure of parodontium loosened. Bone impairment aggravated over time. TNF?αstaining showed as a few claybank spots on the parodontium in the control group,while the staining colour was darkened in the osteoporosis group. The expression of TNF?αmRNA was significantly higher in the osteoporosis group than in the control group(P<0.05). The result of NOS2 was contrary to that of TNF?α. The differences in TNF?αand NOS2 were not statistically significant at 2 and 4 weeks(P>0.05). Conclusion The crownless roots in rats with os?teoporosis cause adverse effects of periodontal tissues as the roots accelerate absorption of the surrounding alveolar tissues. It is indicated that crown?less roots in elderly people with osteoporosis should be removed as soon as possible.