OBJECTIVE: This study aimed to explore the association between body mass index (BMI) and mortality based on the 10-year population-based multicenter prospective study. METHODS: A general population-based multicenter prospective study was conducted at four sites in rural China between 2013 and 2023. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between BMI and mortality. Stratified analyses were performed based on the individual characteristics of the participants. RESULTS: Overall, 19,107 participants with a sum of 163,095 person-years were included and 1,910 participants died. The underweight (< 18.5 kg/m ²) presented an increase in all-cause mortality (adjusted hazards ratio [ aHR] = 2.00, 95% confidence interval [ CI]: 1.66-2.41), while overweight (≥ 24.0 to < 28.0 kg/m ²) and obesity (≥ 28.0 kg/m ²) presented a decrease with an aHR of 0.61 (95% CI: 0.52-0.73) and 0.51 (95% CI: 0.37-0.70), respectively. Overweight ( aHR = 0.76, 95% CI: 0.67-0.86) and mild obesity ( aHR = 0.72, 95% CI: 0.59-0.87) had a positive impact on mortality in people older than 60 years. All-cause mortality decreased rapidly until reaching a BMI of 25.7 kg/m ² ( aHR = 0.95, 95% CI: 0.92-0.98) and increased slightly above that value, indicating a U-shaped association. The beneficial impact of being overweight on mortality was robust in most subgroups and sensitivity analyses. CONCLUSION This study provides additional evidence that overweight and mild obesity may be inversely related to the risk of death in individuals older than 60 years. Therefore, it is essential to consider age differences when formulating health and weight management strategies.
Humans ; Body Mass Index ; China/epidemiology* ; Male ; Female ; Middle Aged ; Prospective Studies ; Rural Population/statistics & numerical data* ; Aged ; Follow-Up Studies ; Adult ; Mortality ; Cause of Death ; Obesity/mortality* ; Overweight/mortality*

ObjectiveTo investigate the application of the novel inflammatory factor adsorption column CA280 combined with low-dose plasma exchange （LPE） in patients with acute-on-chronic liver failure （ACLF）. MethodsA prospective cohort study was designed， and a total of 93 ACLF patients who were admitted to The Ninth Hospital of Nanchang from June 2023 to January 2025 were enrolled and randomly divided into DPMAS+LPE group with 50 patients and CA280+LPE group with 43 patients. In addition to comprehensive medical treatment， the patients in the DPMAS+LPE group received DPMAS and LPE treatment， and those in the CA280+LPE group received CA280 and LPE treatment. The two groups were observed in terms of routine blood test results， liver function parameters， renal function markers， electrolytes， coagulation function parameters， cytokines， adverse events， and 28-day prognosis before surgery （baseline）， during surgery （DPMAS or CA280）， and after surgery （after sequential LPE treatment）. The paired t-test was used for comparison of normally distributed continuous data before and after treatment within each group， and the independent-samples t test was used for comparison between groups； the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment within each group， and the Mann-Whitney U test was used for comparison between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups， and the Spearman test was used for correlation analysis. ResultsAfter CA280 treatment， the ACLF patients had significant reductions in the levels of cytokines （IL-6， IL-8， IL-10， TNF-α， and IFN-γ）， liver function parameters （ALT， AST， ALP， TBil， DBil， Alb， and glutathione reductase）， and the renal function marker urea nitrogen （all P<0.05）， and in terms of coagulation function parameters， there were significant increases in prothrombin time， activated partial thromboplastin time （APTT）， thrombin time， and international normalized ratio （INR） and significant reductions in prothrombin activity （PTA） and fibrinogen （FIB） （all P<0.05）. Compared with the DPMAS+LPE group， the CA280+LPE group showed better improvements in the serum cytokines IL-8 （Z=-2.63， P=0.009）， IL-10 （Z=-3.94， P<0.001）， and TNF-α （Z=-1.53， P=0.023）， and the two artificial liver support systems had a similar effect in improving liver function （ALT， AST， GGT， GR， TBil， and DBil） （all P >0.05）， but the CA280+LPE group showed a significantly greater reduction in Alb （Z=-2.08， P=0.037）. CA280+LPE was more effective in reducing uric acid （Z=-2.97， P=0.003）. Compared with DPMAS+LPE， CA280+LPE treatment resulted in a significant reduction in INR （Z=-4.01， P<0.001）， a significant increase in APTT （Z=-2.53， P=0.011）， and significant greater increases in PTA （Z=-6.28， P<0.001） and FIB （Z=-3.93， P<0.001）. There were no significant differences in the incidence rates of adverse reactions and the rate of improvement at discharge between the two groups （all P>0.05）. The Spearman correlation analysis showed that IL-6 was significantly correlated with WBC （r=0.22， P=0.042）， TBil （r=0.29， P=0.005）， and FIB （r=-0.33， P=0.003）； IL-8 was positively correlated with APTT （r=0.37， P<0.001） and INR （r=0.25， P=0.013）； TNF-α was significantly correlated with WBC （r=0.40， P<0.001） and TBil （r=0.34， P<0.001）. ConclusionCompared with DPMAS， CA280 combined with LPE can effectively clear proinflammatory cytokines and improve liver function in ACLF patients， but it has a certain impact on Alb and coagulation function. This regimen provides a new option for the individualized treatment of ACLF and can improve the short-term prognosis of patients， but further studies are needed to verify its long-term efficacy.

Objective To evaluate the pharmacokinetics(PK)and pharmacodynamics(PD)of propofol injectable emulsion,and to assess the bioequivalence of test and reference formulations in healthy Chinese adult volunteers.Methods Thirty-two healthy Chinese adult volunteers were recruited and randomly assigned to a fasting.single-dose,two-period and double-crossover study.Propofol was given to eligible subjects at a speed of 30 μg·kg-1·min-1 for 30 min.The concentration of propofol in plasma was determined by avalidated high performance liquid chromatography-tandem mass spectrometery(HPLC-MS/MS)method.The PK parameters of the two preparations were calculated.Bispectral index(BIS)was measured to calculate the PD parameters of two formulations.Adverse events during the trial were recorded.Results Thirty-one volunteers were included in the pharmacokinetic parameter set.The mean values of PK parameters of test andreference formulations were as follows:Cmax were(660.87±110.25)and(683.13±125.75)ng·mL-1;AUC0-t were(473.50±86.03)and(478.40±80.25)h·ng·mL-1;AUC0-∞ were(500.45±96.49)and(507.84±88.00)h·ng·mL-1;tmax were 0.47(0.25,0.53)and 0.50(0.40,0.54)h;t1/2 were(2.97±1.74)and(3.08±1.82)h.Thirty-one volunteers were included in the bioequivalence set.The 90％confidence intervals(CI)for the geometric mean ratios of Cmax,AUC0-t,AUC0-∞ were 92.64％-101.39％,96.43％-101.00％,95.67％-100.70％,respectively.The mean values of PD parameters of test and reference formulations were as follows:BISmin were(75.94±13.66)and(74.39±12.32);BISAUC0-60minwere 5 569.85±182.78 and 5 575.68±166.19;T-BISmin were 23.00 and 29.00 min,respectively.There were no serious adverse events.Conclusion Two formulations of propofol injectable emulsion were bioequivalent and both of them exhibited good safety.

Objective:To explore the predictive value of electrocardiogram repolarization related parameters combined with serum brain natriuretic peptide(BNP)and 25 hydroxyvitamin D3[25-(OH)-D3]for malignant arrhythmia(MA)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction.Methods:This study was a prospective single-center study,120 patients with acute myocardial infarction who underwent PCI in our hospital from June 2022 to June 2024 were selected,they were divided into combined group(n=25)and non combined group(n=95)based on whether MA occurred within 72 h after PCI.All patients underwent routine electrocardiogram examination,the mean R wave to R wave(RR)interval,QRS start to T end(QT)interval,T wave time,corrected QT(QTc)interval,T wave peak to T wave end(Tp-e)interval,T wave amplitude,and other electrocardiogram repolarization related parameters between two groups were measuredand compared.The serum BNP and 25-(OH)-D3 levels between two groups were detected and compared.Influencing factors were analyzed by single and multiple logistic regression analysis.Predict value was analyzed by receiver operating characteristic(ROC)curve.Results:The mean QT interval and QTc interval in the combined group were significantly lower than those in the non combined group(P＜0.05).The serum BNP levels in the combined group was significantly higher than that in the non combined group,and the serum 25-(OH)-D3 level was significantly lower than that in the non combined group(both P＜0.05).Univariate analysis showed that there were statistically significant differences in terms of age,number of vascular lesions,cardiac troponin I(cTnI),and creatine kinase MB(CK-MB)(P＜0.05).Multiple logistic regression analysis showed that serum CK-MB and BNP were independent risk factors for MA after PCI in patients with acute myocardial infarction,while mean QT interval,mean QTc interval,and elevated 25-(OH)-D3 were independent protective factors(P＜0.05).Draw ROC curves,and the results show that the mean QT interval,mean QTc interval,serum BNP,and 25-(OH)-D3 levels alone predict the area under curve(AUC)for postoperative MA after PCI was 0.762(0.706-0.817),0.822(0.772-0.871),0.809(0.757-0.862),and 0.709(0.642-0.775),respectively,the AUC for combined prediction was 0.882(0.843-0.920).Conclusion:Electrocardiogram repolarization related parameters such as mean QT interval and QTc interval for MA after PCI in patients with acute myocardial infarction were lower,serum BNP is increased,and 25-(OH)-D3 is decreased,the combined detection of these indicators has high predictive value for postoperative MA after PCI.

Objective:To compare the clinical outcomes between all-inside and conventional transtibial tunnel reconstructions for posterior cruciate ligament (PCL) injuries.Methods:A retrospective study was conducted to analyze the clinical data of the 108 patients who had been treated for PCL injuries at Department of Arthrosis Surgery, Xuzhou Renci Hospital, from March 2021 to March 2023. There were 48 females and 60 males, with an age of (30.3±10.8) years and an injury-to-surgery interval of (25.7±6.4) days. Of them, 49 left and 59 right knees were affected. By the difference in the tunnel reconstruction, the patients were divided into 2 groups: an all-inside group ( n=52) in which the PCL was reconstructed using the all-inside techniques and a conventional group in which the PCL was reconstructed using the conventional techniques. The following were observed and compared: operation time and postoperative hospital stay; visual analogue scale (VAS) pain scores, The International Knee Documentation Committee (IKDC) subjective scores and Lysholm knee function scores at preoperation, postoperative 3 months and the last follow-up; posterior drawer test, posterior sag sign, reverse Lachman test and the diameter and morphology of the PCL shown by the knee joint MRI at the last follow-up. Results:The baseline characteristics were comparable between the 2 groups ( P>0.05). All patients were followed up for (12.3±1.2) months. The all-inside group incurred significantly longer operation time [(128.3±7.6) min] than the conventional group [(103.5±6.9) min] ( P<0.05), but no significant difference was observed in postoperative hospital stay between the 2 groups ( P> 0.05). There was no significant difference in VAS pain score, IKDC subjective score, or Lysholm score between the 2 groups at preoperation, postoperative 3 months or the last follow-up ( P>0.05). In both groups, the VAS pain scores, IKDC subjective scores and Lysholm scores at postoperative 3 months and the last follow-up were significantly improved compared with those at preoperation ( P<0.05). At the last follow-up, the posterior drawer test, posterior sag sign, reverse Lachman test were negative in both groups, and the knee joint MRI showed good diameter and morphology of the PCL reconstructed. Conclusions:Both conventional and all-inside reconstructions yield satisfactory clinical outcomes for PCL injuries, demonstrating comparable functional recovery and complication incidence. However, the all-inside technique requires longer operation time than the conventional approach.

Objective To evaluate the pharmacokinetics(PK)and pharmacodynamics(PD)of propofol injectable emulsion,and to assess the bioequivalence of test and reference formulations in healthy Chinese adult volunteers.Methods Thirty-two healthy Chinese adult volunteers were recruited and randomly assigned to a fasting.single-dose,two-period and double-crossover study.Propofol was given to eligible subjects at a speed of 30 μg·kg-1·min-1 for 30 min.The concentration of propofol in plasma was determined by avalidated high performance liquid chromatography-tandem mass spectrometery(HPLC-MS/MS)method.The PK parameters of the two preparations were calculated.Bispectral index(BIS)was measured to calculate the PD parameters of two formulations.Adverse events during the trial were recorded.Results Thirty-one volunteers were included in the pharmacokinetic parameter set.The mean values of PK parameters of test andreference formulations were as follows:Cmax were(660.87±110.25)and(683.13±125.75)ng·mL-1;AUC0-t were(473.50±86.03)and(478.40±80.25)h·ng·mL-1;AUC0-∞ were(500.45±96.49)and(507.84±88.00)h·ng·mL-1;tmax were 0.47(0.25,0.53)and 0.50(0.40,0.54)h;t1/2 were(2.97±1.74)and(3.08±1.82)h.Thirty-one volunteers were included in the bioequivalence set.The 90％confidence intervals(CI)for the geometric mean ratios of Cmax,AUC0-t,AUC0-∞ were 92.64％-101.39％,96.43％-101.00％,95.67％-100.70％,respectively.The mean values of PD parameters of test and reference formulations were as follows:BISmin were(75.94±13.66)and(74.39±12.32);BISAUC0-60minwere 5 569.85±182.78 and 5 575.68±166.19;T-BISmin were 23.00 and 29.00 min,respectively.There were no serious adverse events.Conclusion Two formulations of propofol injectable emulsion were bioequivalent and both of them exhibited good safety.

Objective:To evaluate the incidence, clinical features, factors affecting initial diagnosis, efficacy, and safety of therapy and prognosis of small intestinal Dieulafoy lesions (DL).Methods:Clinical data including clinical background, diagnosis, and treatment details of patients who were admitted to the Department of Gastroenterology, Air Force Medical Center, for suspected small bowel bleeding, diagnosed as having small bowel DL and treated with balloon-assisted enteroscopy (BAE) were retrospectively analyzed from November 2017 to March 2024.Results:Among 800 patients, 30 cases (3.75%, 30/800, 17 males and 13 females) were diagnosed as having small intestine DL with the mean age of 60.90 years. Clinical symptoms included melena (56.67%, 17/30), hematochezia (43.33%, 13/30), and hemodynamic instability (30.00%, 9/30). Active bleeding occurred in 23 (76.67%) patients. Comorbidities existed in 70.00% (21/30) and 33.33% (10/30) used long-term antithrombotic agents. Diagnosis was confirmed after a single BAE in 63.33% (19/30) and after multiple BAEs (mean 1.6 procedures) in 36.67% (11/30). Lesions were predominantly located at jejunal. All patients achieved successful treatment with a single BAE procedure. The median follow-up period was 12.25 months (range: 5.25-23.00 months). Five cases (16.67%) experienced recurrent bleeding, with one case transfered to surgical intervention. Two cases (6.67%) reported post-operative symptoms of dizziness and fatigue, which resolved after symptomatic management. Multivariate analysis showed that long-term oral anticoagulant therapy ( OR=0.06, 95% CI: 0.01-0.73) was an independent predictor of single-session diagnosis. Conclusion:Small intestinal DL is rare and challenging to diagnose. Antithrombotic therapy may facilitate the diagnosis of DL at the first BAE. Jejunal localization is common, and combined endoscopic therapy (including clipping) is effective and safe.

Objective To compare the diagnostic performance of three breast MRI measurement methods—RECIST 1.1,the optimal method,and three-dimensional(3D)volumetric assessment—in assessing the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer patients,with the objective of identifying the most clinically practical approach.Methods A total of 110 breast cancer patients who underwent NAC followed by surgical treatment between 2019 and 2023 were included in the study.Breast magnetic resonance imaging(MRI)was conducted within one week before and after the completion of NAC.Tumor response was evaluated using RECIST 1.1 criteria,widely recognized as the optimal method,as well as 3D volume measurement.Pathological response was determined according to the Miller-Payne grading system.Sensitivity,specificity,accuracy,and the area under the receiver operating characteristic curve(AUC)were computed and compared using the DeLong test.Results The AUC values for RECIST 1.1,the optimal method,and 3D volumetric assessment were 0.768,0.795,and 0.883,respectively.The 3D volumetric assessment exhibited significantly better discriminative performance(P＜0.05),with the highest sensitivity(98.9％),specificity(77.8％),and accuracy(95.5％).Additionally,the optimal method demonstrated superior performance over RECIST 1.1 across multiple parameters.Conclusions 3D volumetric mea-surement demonstrates superior performance compared to RECIST 1.1 and the optimal method in evaluating the response to NAC,offering a more accurate and comprehensive assessment tool.Additionally,the optimal method shows advantages over RECIST 1.1 and may serve as a practical alternative in settings where 3D software is not available.

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Objective To compare the diagnostic performance of three breast MRI measurement methods—RECIST 1.1,the optimal method,and three-dimensional(3D)volumetric assessment—in assessing the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer patients,with the objective of identifying the most clinically practical approach.Methods A total of 110 breast cancer patients who underwent NAC followed by surgical treatment between 2019 and 2023 were included in the study.Breast magnetic resonance imaging(MRI)was conducted within one week before and after the completion of NAC.Tumor response was evaluated using RECIST 1.1 criteria,widely recognized as the optimal method,as well as 3D volume measurement.Pathological response was determined according to the Miller-Payne grading system.Sensitivity,specificity,accuracy,and the area under the receiver operating characteristic curve(AUC)were computed and compared using the DeLong test.Results The AUC values for RECIST 1.1,the optimal method,and 3D volumetric assessment were 0.768,0.795,and 0.883,respectively.The 3D volumetric assessment exhibited significantly better discriminative performance(P＜0.05),with the highest sensitivity(98.9％),specificity(77.8％),and accuracy(95.5％).Additionally,the optimal method demonstrated superior performance over RECIST 1.1 across multiple parameters.Conclusions 3D volumetric mea-surement demonstrates superior performance compared to RECIST 1.1 and the optimal method in evaluating the response to NAC,offering a more accurate and comprehensive assessment tool.Additionally,the optimal method shows advantages over RECIST 1.1 and may serve as a practical alternative in settings where 3D software is not available.