BACKGROUND: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories. METHODS: This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex. RESULTS: In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight. CONCLUSIONS Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Adipose Tissue ; Body Fat Distribution ; Body Mass Index ; China/epidemiology* ; Cross-Sectional Studies ; Health Surveys ; Phenotype

Objective:To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed.Results:Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed BRAF mutation in 63.7% (65/102), RET fusions in 19.6% (20/102), and TERT promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with BRAF+TERT mutations, 4 with RET fusions, and 4 with BRAF mutation alone. Conclusions:The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as BRAF mutation and RET fusion are common in PTC patients requiring reoperation.

Objective To investigate the value of fragmented QRS complex(fQRS)in the electro-cardiogram,heart rate variability(HRV)and LVEF in evaluating the prognosis in patients with dilated cardiomyopathy(DCM).Methods A retrospective analysis was conducted on 59 DCM pa-tients admitted in the Second Affiliated Hospital of Wannan Medical College from January 2020 to December 2023.According to the occurrence of MACE during 6-month follow-up period,they were classified into a poor prognosis group(26 cases)and a good prognosis group(33 cases).Clin-ical baseline data,positive rate of fQRS,HRV and LVEF were compared between the two groups.Time-domain measurements of HRV included standard deviation of normal NN intervals(SDNN),standard deviation of the averages of NN intervals in all 5 min segments of the entire recording(SDANN),mean of the standard deviation of NN intervals for all 5 min segments of the entire recording(SDNN index),root mean square of standard deviation of NN intervals(r-MSSD)and HRV triangular index.Spearman/Pearson correlation analysis was performed to analyze the correlation of prognosis of DCM with positive rate of fQRS,HRV and LVEF.ROC curve was drawn to analyze the efficiency of fQRS,HRV and LVEF in predicting the prognosis of DCM.Results The poor prognosis group exhibited significantly higher positive rate of fQRS and obvi-ously reduced SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF when compared with the good prognosis group(P＜0.01).Correlation analysis suggested that poor prognosis of DCM was positively correlated with the positive rate of fQRS(P＜0.01),and negatively with SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of above indicators in turn in predicting the prognosis of DCM was 0.718,0.7 56,0.7 62,0.807,0.858,0.805 and 0.747,respectively,and the AUC value of their combination was 0.980(P＜0.01).Conclusion fQRS,HRV and LVEF have important cor-relation with poor prognosis of DCM patients.Their combination can be used as an effective mark-er for clinical evaluation and prediction of poor prognosis of DCM.

OBJECTIVE The non-volatile and volatile chemical components in Yin-Qiao-Qing-Re Tablets were analyzed sepa-rately using ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS/MS)and Gas Chromatography Mass Spectrometry(GC-MS).METHODS The non-volatile components were analyzed using a Waters ACQUITY UPLC BEH C18 column(2.1 mm×100 mm,1.7 μm),with a mobile phase consisting of 0.1％formic acid aqueous solution(A)and acetonitrile(B)for gradient elution,a flow rate of 0.35 mL·min-1,an injection volume of 5 μL,and a column temperature of 30 ℃;the volatile components were analyzed using an Agilent SH-I-5MS column(5％Phenyl Methyl Silox,30 m×250 μm,0.25 μm);the procedure was temperature-programmed,with an injection volume of 1 μL,a split ratio of 10∶1,a flow rate of 1.0 mL·min-1,and an inlet temperature of 200 ℃.RESULTS A total of 134 non-volatile chemical components and 23 volatile components were analyzed and identified from Yin-Qiao-Qing-Re Tablets,among which 49 compounds were confirmed through comparison with reference stand-ards.The non-volatile components mainly include 27 flavonoids,21 organic acids,15 lignans,14 iridoids,12 phenylethanoid glyco-sides,11 saponins,10 alkaloids,5 terpenes,4 amino acids,3 phenylpropanoids,3 nucleosides,3 xanthones,3 phenolic glycosides,2 chromones and 1 carbohydrate.The volatile components mainly include 11 monoterpenes,5 alcohols and phenols,3 alkenes,2 ke-tones,1 ester,and 1 hydrocarbon.CONCLUSION This study rapidly identifies the chemical components of Yin-Qiao-Qing-Re Tablets,laying a preliminary foundation for research on the pharmacodynamic substances of Yin-Qiao-Qing-Re Tablets and the im-provement of quality control standards.

OBJECTIVE The non-volatile and volatile chemical components in Yin-Qiao-Qing-Re Tablets were analyzed sepa-rately using ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS/MS)and Gas Chromatography Mass Spectrometry(GC-MS).METHODS The non-volatile components were analyzed using a Waters ACQUITY UPLC BEH C18 column(2.1 mm×100 mm,1.7 μm),with a mobile phase consisting of 0.1％formic acid aqueous solution(A)and acetonitrile(B)for gradient elution,a flow rate of 0.35 mL·min-1,an injection volume of 5 μL,and a column temperature of 30 ℃;the volatile components were analyzed using an Agilent SH-I-5MS column(5％Phenyl Methyl Silox,30 m×250 μm,0.25 μm);the procedure was temperature-programmed,with an injection volume of 1 μL,a split ratio of 10∶1,a flow rate of 1.0 mL·min-1,and an inlet temperature of 200 ℃.RESULTS A total of 134 non-volatile chemical components and 23 volatile components were analyzed and identified from Yin-Qiao-Qing-Re Tablets,among which 49 compounds were confirmed through comparison with reference stand-ards.The non-volatile components mainly include 27 flavonoids,21 organic acids,15 lignans,14 iridoids,12 phenylethanoid glyco-sides,11 saponins,10 alkaloids,5 terpenes,4 amino acids,3 phenylpropanoids,3 nucleosides,3 xanthones,3 phenolic glycosides,2 chromones and 1 carbohydrate.The volatile components mainly include 11 monoterpenes,5 alcohols and phenols,3 alkenes,2 ke-tones,1 ester,and 1 hydrocarbon.CONCLUSION This study rapidly identifies the chemical components of Yin-Qiao-Qing-Re Tablets,laying a preliminary foundation for research on the pharmacodynamic substances of Yin-Qiao-Qing-Re Tablets and the im-provement of quality control standards.

Objective To investigate the value of fragmented QRS complex(fQRS)in the electro-cardiogram,heart rate variability(HRV)and LVEF in evaluating the prognosis in patients with dilated cardiomyopathy(DCM).Methods A retrospective analysis was conducted on 59 DCM pa-tients admitted in the Second Affiliated Hospital of Wannan Medical College from January 2020 to December 2023.According to the occurrence of MACE during 6-month follow-up period,they were classified into a poor prognosis group(26 cases)and a good prognosis group(33 cases).Clin-ical baseline data,positive rate of fQRS,HRV and LVEF were compared between the two groups.Time-domain measurements of HRV included standard deviation of normal NN intervals(SDNN),standard deviation of the averages of NN intervals in all 5 min segments of the entire recording(SDANN),mean of the standard deviation of NN intervals for all 5 min segments of the entire recording(SDNN index),root mean square of standard deviation of NN intervals(r-MSSD)and HRV triangular index.Spearman/Pearson correlation analysis was performed to analyze the correlation of prognosis of DCM with positive rate of fQRS,HRV and LVEF.ROC curve was drawn to analyze the efficiency of fQRS,HRV and LVEF in predicting the prognosis of DCM.Results The poor prognosis group exhibited significantly higher positive rate of fQRS and obvi-ously reduced SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF when compared with the good prognosis group(P＜0.01).Correlation analysis suggested that poor prognosis of DCM was positively correlated with the positive rate of fQRS(P＜0.01),and negatively with SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of above indicators in turn in predicting the prognosis of DCM was 0.718,0.7 56,0.7 62,0.807,0.858,0.805 and 0.747,respectively,and the AUC value of their combination was 0.980(P＜0.01).Conclusion fQRS,HRV and LVEF have important cor-relation with poor prognosis of DCM patients.Their combination can be used as an effective mark-er for clinical evaluation and prediction of poor prognosis of DCM.

Objective:To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC).Methods:This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed.Results:Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed BRAF mutation in 63.7% (65/102), RET fusions in 19.6% (20/102), and TERT promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with BRAF+TERT mutations, 4 with RET fusions, and 4 with BRAF mutation alone. Conclusions:The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as BRAF mutation and RET fusion are common in PTC patients requiring reoperation.

Objective To investigate the clinical application value of contrast-enhanced chest CT in the detection of responsible vessels for hemoptysis before selective arterial embolization(SAE).Methods The clinical data of 74 patients with hemoptysis trea-ted with interventional therapy and preoperative contrast-enhanced chest CT and digital subtraction angiography(DSA)were ana-lyzed retrospectively.The responsible vessels were identified and then embolized via angiography.The detection of the responsible vessels via preoperative contrast-enhanced chest CT was analyzed.The patients were followed up to observe the efficacy and compli-cations,and the influencing factors of interventional efficacy and recurrence were analyzed.Results A total of 245 responsible ves-sels were detected by preoperative contrast-enhanced chest CT,including bronchial arteries(n=178),ectopic bronchial arteries(n=10)and non-bronchial systemic artery(NBSA)(n=57),which could accurately show the anatomical information of responsible vessels.A total of 4 posterior intercostal arteries were missed.The diagnostic accuracy was 98.4％(245/249).All patients were followed up for 12 to 25.6 months.The immediate hemostasis rate was 93.2％(69/74)and the effective rate was 79.7％(59/74),respectively.The factors affecting the efficacy were bronchial artery to pulmonary circulation fistula,pleural thickening at the bleeding site,and underly-ing lung disease.Among the 59 patients with effective treatment,underlying lung disease was the influencing factor for postoperative recurrence.Conclusion Contrast-enhanced chest CT can provide anatomical information about the responsible vessels for interven-tional therapy of hemoptysis,improving surgical efficiency and reducing the recurrence rate of hemoptysis.

Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma (LRHCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of 211 patients who under LRHCCA in the Second Hospital of Hebei Medical University from May 2014 to June 2022 were collected. There were 135 males and 76 females, aged (63±8)years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. Results:(1) Surgical situations. All 211 patients underwent LRHCCA successfully, with the operation time as 350 (300,390)minutes, volume of intraoperative blood loss as 400(200,800)mL, and intraoperative red blood cell transfusion as 2.0(range, 0-15.0)U, respectively. As partial portal vein invasion, 10 of 211 patients underwent portal vein resection and reconstruction. Results of intraoperative histopathology examination showed negative margin of portal vein. The operation time, volume of intraoperative blood loss, intraopera-tive red blood cell transfusion of the 10 patients was (400±53)minutes, 1 200(range, 800-3 000)mL, 5.5(range, 4.0-15.0)U, respectively. (2) Postoperative situations. Of the 211 patients, there were 63 cases of the Bismuth type Ⅰ, 65 cases of the Bismuth type Ⅱ, 22 cases of the Bismuth type Ⅲa, 26 cases of the Bismuth type Ⅲb, 35 cases of the Bismuth type Ⅳ. The R 0 resection rate was 95.73%(202/211). There were 202 patients identified as adenocarcinoma of the bile duct, including 7 cases with poorly differentiated tumor, 189 cases with moderate to poorly differentiated tumor, 3 cases with moderate to well differentiated tumor, 3 cases with well differentiated tumor. There were 8 patients with poorly differentiated biliary mucinous adenocarcinoma, 1 patient with intraductal papillary neoplasm with high-grade epithelial dysplasia. There were 24 cases of stage Ⅰ, 98 cases of stage Ⅱ, 30 cases of stage ⅢA, 34 cases of stage ⅢB, 19 cases of stage ⅢC, 6 cases of stage ⅣA. Of the 211 patients, there were 25 cases with postoperative biliary fistula, 11 cases with postoperative abdominal infection, 3 cases with postoperative bleeding as anastomotic bleeding after biliary fistula, 2 cases with postoperative gastric emptying disability, 1 case with postoperative acute liver failure. There were 7 patients undergoing postoperative unplanned reoperation, including 3 cases with emergency operation for hemostasis, 4 cases with abdominal exploration debridement and drainage for severe abdominal infection. There were 3 cases dead during perioperative period, including 1 case of acute liver failure, 1 case of systemic infection and multiple organ failure, 1 case of exfoliated deep venous thrombosis of lower extremities and acute pulmonary embolism. The postoperative duration of hospital stay was (15±5)days of the 211 patients and (17±4)days of patients undergoing portal vein resection and reconstruction. The cost of hospital stay of the 211 patients was (11.7±1.7)ten thousand yuan. (3) Follow-up. Of the 211 patients, 188 patients were followed up for 21(range, 4?36)months. The median survival time of 188 patients was 22 months, and the postoperative 1-, 2- and 3-year survival rate was 90.9%, 43.1% and 18.7%, respectively. Conclusion:LRHCCA is safe and feasible, with satisfactory short-term effect, under the coditions of clinicians with rich experience in laparoscopic surgery and patients with strict surgical evaluation.

Objective:To study the retrocolonic approach for laparoscopic pancreaticoduodenec-tomy (LPD).Methods:The clinical data of 53 patients who underwent LPD using the retrocolonic approach at the Second Hospital of Hebei Medical University from January 2019 to December 2021 were analyzed retrospectively. There were 36 males and 17 females, aged (61.9±8.8) years old. The operation time, intraoperative bleeding and postoperative complications were analysed.Results:LPD was successfully performed in 53 patients via the retrocolonic approach. The operation time was (285.7±49.8) min, and the resection time for specimens was (120.0±10.5) min. The median intraoperative blood loss was 200 ml and blood loss ranged from 50 to 800 ml. Among the 53 patients, 3 patients underwent combined portal vein resection and reconstruction (end-to-end anastomosis). The operation time was 300, 325 and 385 min, respectively, and the intraoperative blood loss was 400-800 ml. During the operation, 5 patients (9.43%) had transection of the middle colonic artery and underwent resection of part of the transverse mesocolon due to invasion of the transverse mesocolon by tumours. Postoperative complications occurred in 5 patients (9.43%), including 4 patients with pancreatic fistula and 1 patient with hemorrhage and with delayed gastric emptying. The postoperative passage of first flatus was (5.40±1.14) days in 5 patients with transection and (2.92±1.03) days in 48 patients without transection of the middle colonic artery. All patients were discharged home successfully. The postoperative pathological results showed all patients to achieve R 0 resection. Conclusion:Laparoscopic pancreaticoduodenectomy via the retrocolonic approach was safe and feasible for patients with a large duodenal tumor, pancreatic head uncinate process tumor with or without invasion of the portal vein and mesenteric vessels.