OBJECTIVES: To analyze the association between biological aging markers (phenotypic age and phenotypic age acceleration) and valvular heart diseases. METHODS: Research subjects who met the inclusion and exclusion criteria were selected from the UK Biobank from 2006 to 2010. The phenotypic age and phenotypic age acceleration were calculated. Cox multivariate analysis was used to examine the relationship between the aging markers and valvular heart diseases. Sensitivity analysis was conducted by removing missing values and subgroup analysis. The predictive accuracy of phenotypic age and phenotypic age acceleration for valvular heart diseases was analyzed using receiver operating characteristic (ROC) curves, and a clinical decision curve was generated based on logistic regression. RESULTS: A total of 411 687 subjects were included in the study, among whom there were 14 258 patients with valvular heart diseases. The overall median follow-up time was 12.80 years, the median follow-up time for patients with non-rheumatic aortic valve diseases (n=5238), non-rheumatic mitral valve diseases (n=4558), and non-rheumatic tricuspid valve diseases (n=411) were 12.82 years, 12.83 years and 12.84 years, respectively. After adjusting for demographic factors (gender, race, education, Townsend deprivation index), anthropometric factors (body mass index), lifestyle factors (smoking, alcohol consumption, Dietary Approaches to Stop Hypertension score), hypertension and hyperlipidemia, Cox multivariate analysis showed phenotypic age and phenotypic age acceleration were independent risk factors for valvular heart diseases, including non-rheumatic aortic valve diseases, non-rheumatic mitral valve diseases, and non-rheumatic tricuspid valve diseases (phenotypic age: corrected HR=1.04, P<0.01; phenotypic age acceleration: corrected HR=1.03, P<0.01), which was also confirmed by sensitivity analysis. ROC curves and clinical decision curves demonstrated that compared with the phenotypic age acceleration, phenotypic age had higher accuracy (the areas and the curves were 0.721 and 0.599) and higher net benefit in predicting valvular heart diseases. Moreover, compared with a single indicator, the combination of the two indicators had higher accuracy (the area under the curve was 0.725) and higher net benefit. CONCLUSIONS Phenotypic age and phenotypic age acceleration,as markers of biological aging, are independent risk factors for valvular heart diseases. Compared with phenotypic age acceleration, phenotypic age has a greater advantage in predicting valvular heart diseases. Overall, the combination of the two indicators offers a more effective approach for predicting valvular heart diseases.
Humans ; Male ; Female ; Heart Valve Diseases/epidemiology* ; Middle Aged ; Aged ; Aging ; Adult ; Biomarkers ; Phenotype ; Risk Factors ; Aged, 80 and over

Objective:To investigate the efficacy and complications of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus in children.Methods:This study was a retrospective analysis. A total of 120 children with hydrocephalus admitted to Xi'an Children's Hospital from January 2021 to March 2024 were selected. Among them, 49 children who underwent VPS treatment were included in the VPS group, and 71 children who underwent ETV treatment were included in the ETV group. Perioperative indicators, complication rates, postoperative recovery outcomes, levels of neurological injury markers, and developmental status at 6 months postoperatively were compared between the two groups. Measurement data with normal distribution were expressed as Mean ± SD, and intergroup comparisons was performed by independent samples t-test; counting data were expressed as case (%), and intergroup comparisons were performed by χ2 test. Results:The operation time [(83.26±10.67) min], time to first flatus [(2.58±0.44) days], and total complication rate [24.49% (12/49)] in the VPS group were all higher than those in the ETV group [(74.68±8.64) min, (2.21±0.42) days, and 9.86% (7/71)], while the one-time success rate [81.63% (40/49)] was lower than that in the ETV group [95.77% (68/71)]. The differences between the groups were statistically significant ( t=4.85, P<0.001; t=4.65, P<0.001; χ2=4.66, P=0.031; χ2=4.97, P=0.026, respectively). On postoperative day 3, the Glasgow Coma Scale score in the VPS group [(12.46±0.72) points] was lower than that in the ETV group [(12.89±0.67) points], and on postoperative day 7, the National Institutes of Health Stroke Scale score in the VPS group [(8.96±1.09) points] was higher than that in the ETV group [(8.54±1.02) points], with statistically significant differences ( t=3.35, P=0.001; t=2.16, P=0.033, respectively). On postoperative day 3, the levels of central nervous system-specific protein [(12.57±2.51) mg/L], high mobility group box 1 protein [(28.83±3.77) μg/L], and neuron-specific enolase [(21.47±2.56) μg/L] in the VPS group were all higher than those in the ETV group [(10.54±2.11) mg/L, (25.63±3.26) μg/L, (19.27±2.31) μg/L], and the differences were statistically significant ( t=5.04, P<0.001; t=4.96, P<0.001; t=4.91, P<0.001, respectively). At 6 months postoperatively, the developmental quotient score in the VPS group [(84.15±3.14) points] was lower than that in the ETV group [(86.51±3.27) points], and the difference was statistically significant ( t=3.93, P<0.001). Conclusion:Both VPS and ETV can be used for the treatment of hydrocephalus in children. However, ETV has a higher one-time success rate, better perioperative indicators, fewer complications, and superior postoperative neurological recovery compared to VPS.

Objective:To investigate the effects of toosendanin(TSN)on the proliferation,apoptosis,migration and invasion of esophageal squamous cell carcinoma(ESCC)KYSE150 cells,and to elucidate its underlying molecular mechanisms.Methods:CCK-8 assay,colony formation assay,and EdU assay were used to assess the effects of varying TSN concentrations(0.062 5,0.125,and 0.25 μmol/L)on KYSE150 cell proliferation.The impacts of TSN on the apoptosis,migration,and invasion of KYSE150 cells were evaluated using flow cytometry,wound healing assay,and Transwell chamber assay,respectively.The expression of hypoxia-inducible factor 1 alpha(HIF1A)in esophageal cancer tissues was analyzed using the GEPIA database.qPCR was used to detect the expression level of HIF1A mRNA in human esophageal epithelial Het-1A and KYSE150 cells,and in TSN-treated KYSE150 cells.Western blot(WB)was performed to detect the effects of TSN on the upstream signaling pathway AKT/mTOR of HIF1A and the expression of downstream proteins related to cell migration,invasion,and apoptosis.Results:TSN of varying concentrations significantly inhibited proliferation,migration,and invasion of KYSE150 cells and promoted apoptosis in a dose-dependent manner(P<0.05 or P<0.01).HIF1A mRNA was highly expressed in KYSE150 cells,and its expression was significantly downregulated after TSN treatment(P<0.05 or P<0.01).TSN markedly downregulated the expression of HIF1A and key upstream signaling proteins p-AKT and p-mTOR.In addition,TSN significantly suppressed the expression of downstream proteins associated with cell migration,invasion,and apoptosis,including N-cadherin,vimentin,Bcl-2,and caspase-3,while upregulating the expression of E-cadherin(P<0.05 or P<0.01).Conclusion:TSN inhibits the proliferation,migration,and invasion,and induces apoptosis in ESCC KYSE150 cells by down-regulating HIF1A expression through suppression of the AKT/mTOR signaling pathway.

Objective:To investigate the efficacy and complications of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus in children.Methods:This study was a retrospective analysis. A total of 120 children with hydrocephalus admitted to Xi'an Children's Hospital from January 2021 to March 2024 were selected. Among them, 49 children who underwent VPS treatment were included in the VPS group, and 71 children who underwent ETV treatment were included in the ETV group. Perioperative indicators, complication rates, postoperative recovery outcomes, levels of neurological injury markers, and developmental status at 6 months postoperatively were compared between the two groups. Measurement data with normal distribution were expressed as Mean ± SD, and intergroup comparisons was performed by independent samples t-test; counting data were expressed as case (%), and intergroup comparisons were performed by χ2 test. Results:The operation time [(83.26±10.67) min], time to first flatus [(2.58±0.44) days], and total complication rate [24.49% (12/49)] in the VPS group were all higher than those in the ETV group [(74.68±8.64) min, (2.21±0.42) days, and 9.86% (7/71)], while the one-time success rate [81.63% (40/49)] was lower than that in the ETV group [95.77% (68/71)]. The differences between the groups were statistically significant ( t=4.85, P<0.001; t=4.65, P<0.001; χ2=4.66, P=0.031; χ2=4.97, P=0.026, respectively). On postoperative day 3, the Glasgow Coma Scale score in the VPS group [(12.46±0.72) points] was lower than that in the ETV group [(12.89±0.67) points], and on postoperative day 7, the National Institutes of Health Stroke Scale score in the VPS group [(8.96±1.09) points] was higher than that in the ETV group [(8.54±1.02) points], with statistically significant differences ( t=3.35, P=0.001; t=2.16, P=0.033, respectively). On postoperative day 3, the levels of central nervous system-specific protein [(12.57±2.51) mg/L], high mobility group box 1 protein [(28.83±3.77) μg/L], and neuron-specific enolase [(21.47±2.56) μg/L] in the VPS group were all higher than those in the ETV group [(10.54±2.11) mg/L, (25.63±3.26) μg/L, (19.27±2.31) μg/L], and the differences were statistically significant ( t=5.04, P<0.001; t=4.96, P<0.001; t=4.91, P<0.001, respectively). At 6 months postoperatively, the developmental quotient score in the VPS group [(84.15±3.14) points] was lower than that in the ETV group [(86.51±3.27) points], and the difference was statistically significant ( t=3.93, P<0.001). Conclusion:Both VPS and ETV can be used for the treatment of hydrocephalus in children. However, ETV has a higher one-time success rate, better perioperative indicators, fewer complications, and superior postoperative neurological recovery compared to VPS.

Objectives:To verify the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of its clinical application.Methods:A convenience sampling method was used to collect 129 geriatric patients who underwent inguinal hernia surgery from January 2018 to January 2023 in nine hospitals in Liaoning Province. There were 120 males and 9 females, of whom 89 patients were 60 to <75 years old, 33 patients were 75 to <85 years old and 7 patients were ≥85 years old. The 129 patients included 11 elderly patients with inguinal hernia who had recovered from preoperative infection with COVID-19. Statistical methods such as Cronbach′s coefficient, Kaiser-Meyer-Olkin test, Bartlett′s test, Pearson′s correlation analysis, etc. were calculated to verify the reliability indexes such as feasibility, content validity, structural validity, criterion-related validity, internal consistency reliability, and re-test reliability. Taking the 5-item modified frailty index (5-mFI) as the gold standard, the area under the curve was used to analyze the ability of the two scales to predict the occurrence of postoperative acute urinary retention, postoperative delirium, poor incision healing, operative hematoma seroma, and postoperative complications.Results:The frailty assessment scale for elderly patients with inguinal hernia showed good reliability and validity (valid completion rate of 99.2%; item content validity index of 1.000, and the scale content validity index of 1.000; exploratory factor analysis extracted a total of 1 principal component, and factor loadings of each item of 0.565 to 0.873; the AUC for frailty diagnosis using 5-mFI as the gold standard of 0.795 ( P<0.01) Cronbach′s coefficient of 0.916, retest reliability coefficient of 0.926), it could effectively predict postoperative acute urinary retention, delirium, hematoma seroma in the operative area and total complications (AUC of 0.746, 0.870, 0.806, and 0.738, respectively; all P<0.05), and prediction efficiency was higher than that of 5-mFI (AUC of 0.694, 0.838, 0.626 and 0.641, P<0.05 for delirium only), but both scales were inaccurate in predicting poor incision healing (AUC of 0.519, P=0.913 for the frailty assessment scale and 0.455, P=0.791 for the 5-mFI). Conclusions:The frailty assessment scale for elderly patients with inguinal hernia is reliable and significantly predicts the occurrence of postoperative adverse events in elderly inguinal hernia patients. The scale can also be used for preoperative frailty assessment in elderly patients with inguinal hernia after rehabilitation from COVID-19 infection.

Objectives:To verify the reliability and validity of the frailty assessment scale for elderly patients with inguinal hernia and to evaluate the value of its clinical application.Methods:A convenience sampling method was used to collect 129 geriatric patients who underwent inguinal hernia surgery from January 2018 to January 2023 in nine hospitals in Liaoning Province. There were 120 males and 9 females, of whom 89 patients were 60 to <75 years old, 33 patients were 75 to <85 years old and 7 patients were ≥85 years old. The 129 patients included 11 elderly patients with inguinal hernia who had recovered from preoperative infection with COVID-19. Statistical methods such as Cronbach′s coefficient, Kaiser-Meyer-Olkin test, Bartlett′s test, Pearson′s correlation analysis, etc. were calculated to verify the reliability indexes such as feasibility, content validity, structural validity, criterion-related validity, internal consistency reliability, and re-test reliability. Taking the 5-item modified frailty index (5-mFI) as the gold standard, the area under the curve was used to analyze the ability of the two scales to predict the occurrence of postoperative acute urinary retention, postoperative delirium, poor incision healing, operative hematoma seroma, and postoperative complications.Results:The frailty assessment scale for elderly patients with inguinal hernia showed good reliability and validity (valid completion rate of 99.2%; item content validity index of 1.000, and the scale content validity index of 1.000; exploratory factor analysis extracted a total of 1 principal component, and factor loadings of each item of 0.565 to 0.873; the AUC for frailty diagnosis using 5-mFI as the gold standard of 0.795 ( P<0.01) Cronbach′s coefficient of 0.916, retest reliability coefficient of 0.926), it could effectively predict postoperative acute urinary retention, delirium, hematoma seroma in the operative area and total complications (AUC of 0.746, 0.870, 0.806, and 0.738, respectively; all P<0.05), and prediction efficiency was higher than that of 5-mFI (AUC of 0.694, 0.838, 0.626 and 0.641, P<0.05 for delirium only), but both scales were inaccurate in predicting poor incision healing (AUC of 0.519, P=0.913 for the frailty assessment scale and 0.455, P=0.791 for the 5-mFI). Conclusions:The frailty assessment scale for elderly patients with inguinal hernia is reliable and significantly predicts the occurrence of postoperative adverse events in elderly inguinal hernia patients. The scale can also be used for preoperative frailty assessment in elderly patients with inguinal hernia after rehabilitation from COVID-19 infection.

Objective: To evaluate the effect of sexuality education for parents of preschoolers, to provide a basis for sexuality educational programs in rural settings. Methods: This community intervention trial chose four kindergartens in Jiangyang District of Luzhou City as the intervention group and other four kindergartens in Jiangyou City of Mianyang City of Sichuan Province as the control group. Sexuality education for parents was carried out in the intervention group, and the control group received routine arrangement. The baseline survey was conducted from March to May 2019, and the final survey was conducted in December 2019. The investigators conducted a face to face or self filled questionnaires among each parent who agreed to participate in the survey by using the self designed questionnaire "Research on Current Situation and Countermeasures of Early Childhood Sexuality Education in Rural Areas (Parent)". Results: Before the intervention, there was no significant difference in the basic information of parents and their children, and the situation of early childhood sexuality education between the intervention group and the control group( P > 0.05 ). After intervention, parents of the intervention group and the control group showed differences in correct rate of the knowledge regarding early childhood sexuality education (41.5%，32.1%), proportion of recognition of parental responsibility (90.7%， 81.3 %), sexuality education in the family (55.7%，45.9%), sexuality education in schools (70.2%，39.1%) and attitude behavior consistency (28.9%，16.3%) ( χ 2=4.05，8.05，4.17，42.48，9.59， P <0.05). Conclusion Sexuality education towards parents is effective through improving knowledge, responsibility, the implementation of sexuality education in the family, and attitude behavior consistency among parents.

Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.

Objective:To observe the efficacy and safety of individual dose of intravitreal conbercept (IVC) in the treatment of retinopathy of prematurity (ROP) before type 1 threshold.Methods:A retrospective case study. From January to July, 2019, 23 cases (46 eyes) of children with type 1 pre-threshold ROP were included in the study. Among them, 14 cases (28 eyes) were male and 9 cases (18 eyes) were female. The mean gestational age at birth was 28.06±1.73 weeks. The average birth weight was 1.14±0.19 kg. The mean corrected gestational age was 34.38±1.41 weeks at the time of first intravitreal injection of IVC. The axial length (AL) of children was measured by A-mode ultrasound before IVC for the first time. According to the calculation of AL, the corresponding injection dose range was 14.23-16.19, 16.20-17.57, 17.58-18.63 mm and the injection dose of IVC was 0.015, 0.020, 0.025 ml (including IVC was 0.15, 0.20, 0.25 mg, respectively). The first IVC dose was 0.015 ml. On the first day before IVC and on the first and seventh days after IVC, 2 ml of arterial blood was taken from children, serum vascular endothelial growth factor (VEGF) concentration was detected. The follow-up time after treatment was ≥1 year. After one year of follow-up, the effective rate and recurrence rate of IVC for the first time were tested by χ2 tests. The short-term changes of injection times, injection intervals, retinal vascularization time and serum VEGF concentration in children were tested by t test. Results:Retinal neovascularization subsided and vascular buckling decreased in all eyes. Iris neovascularization subsided, 1-3 weeks after IVC for the first time. Within one year after the first IVC, 16 eyes underwent IVC twice with or without new blood vessels at the junction of the vascular area. The average corrected gestational age was 40.56±3.81 weeks. The injection dose of IVC was 0.015 ml and 0.020 ml for 2 eyes and 14 eyes, respectively.The mean interval from IVC for the first time was 40.89±8.99 days. Of the 16 eyes who underwent IVC twice, 8 eyes showed neovascularization again in the retinal area with or without blood vessels. The average corrected gestational age was 43.00±1.41 weeks. The injection dose of IVC was 0.020 ml and 0.025 ml for 3 eyes and 5 eyes, respectively. The mean interval of the second IVC was 28.60±6.07 days. The mean interval from the first IVC was 69.20±12.40 days. At the end of follow-up, all eyes were treated effectively (100%, 46/46). The mean time of retinal vascularization was 46.31±3.42 weeks. The average number of injections was 1.52±0.76. On the first day before IVC and on the first and seventh days after IVC, the average serum VEGF concentrations were 111.21±148.71, 25.60±27.71 and 42.99±38.01 pg/ml, respectively. Serum VEGF concentration was significantly lower than that before IVC on the 1st and 7th day after IVC ( Z=-4.054, -2.779; P<0.05). Serum VEGF concentration was higher 7 days after IVC than 1 day after IVC, and the difference was statistically significant ( Z=-2.505, P<0.05). All eyes were not treated by laser photocoagulation or vitrectomy. No eye complications such as lens opacification, endophthalmitis and retinal detachment related to drugs or treatment methods were found in all patients. Conclusion:Intravitreal injection of individualized dose of IVC is effective in the treatment of type 1 pre-threshold ROP. Seven days after treatment, serum VEGF concentration of patients’serum decreases.

In recent years, the incidence of hepatocellular carcinoma (HCC) has risen year by year, leading to a high mortality rate. At present, surgical treatment is the major cure for HCC, and in general, HCC is diagnosed at late stages. Due to the heterogeneity of HCC and different sensitivities to drugs, the treatment efficacy of advanced HCC is poor. In this paper, we retrospectively analyzed the prog-ress of HCC treatments and reviewed important progression, which provides new view for the clinical improvement of the total surviv-al of patients with HCC.