ObjectiveTo investigate the temporal trend of weight-adjusted-waist index （WWI） and its association with the risk of incident cardiovascular diseases （CVD） among middle-aged and older Chinese adults. MethodsBased on the China Health and Retirement Longitudinal Study （CHARLS）， this research enrolled participants aged 45 and above with complete physical measurement data from the 2011， 2013， and 2015 waves. Complex sampling weights were applied to calculate the mean WWI， and the Mann-Kendall test was used to analyze its trend. From the 2011 baseline survey， individuals with a history of cardiovascular disease or missing key covariates were further excluded. New-onset cardiovascular outcome events were collected during follow-up until 2020. Participants were categorized into Q1–Q4 groups based on baseline WWI quartiles. Multivariable log-binomial regression models were constructed to assess the association between WWI and CVD， while restricted cubic splines were employed to evaluate potential nonlinear relationships. Sensitivity analyses were conducted to verify the robustness of the findings. ResultsFrom 2011 to 2015， the weighted mean WWI among Chinese middle-aged and older adults remained generally stable （2011： 11.17±1.68； 2013： 11.28±1.35； 2015： 11.24±1.59； P for trend <0.05）. During the longitudinal follow-up， 1 784 incident CVD cases were documented. After multivariable adjustment， each unit increase in WWI was associated with a 17% increased risk of CVD （RR： 1.17， 95%CI： 1.10-1.24）. Compared with the Q1 group， the risk of CVD in the Q2， Q3， and Q4 groups increased by 23% （RR： 1.23， 95% CI： 1.07-1.40）， 27% （RR： 1.27， 95% CI： 1.11-1.44）， and 40% （RR： 1.40， 95% CI： 1.22-1.60）， respectively. A significant linear trend was observed between the increasing WWI and elevated CVD risk （P for trend <0.001）. Subgroup analysis revealed a stronger association in participants aged 45-60 years （P for interaction <0.05）. The results of sensitivity analysis were consistent with the main research results. ConclusionsThe overall trend of WWI level in the middle-aged and elderly population in China is stable from 2011 to 2015. The higher level of WWI is associated with an increased risk of CVD， suggesting that WWI may be used as a simple and effective indicator to evaluate the risk of cardiovascular metabolism in middle-aged and elderly people.

Both cold stress and ischemia-reperfusion injury significantly contribute to poor prognosis after liver transplantation(LT).However,limited animal models incorporating both stimuli hinder the advance-ment of transplant-related research.Here,a simplified and reproducible isolated perfused liver model is established to simulate the stresses experienced by livers maximally during transplantation.We provide a detailed protocol for a straightforward technique that requires 20-30 min for harvesting,24-48 h for static cold storage(SCS),and 2 h for normothermic machine perfusion(NMP)to induce LT-like stresses in the liver.Hepatic injury from SCS and NMP(LT-like stresses)is evaluated using three types of parameters.The pH values and hepatic enzyme levels of cold preservation solutions and perfusate serve as dynamic indicators of hepatic injury.Bile production and portal venous resistance directly reflect liver function,whereas pathological analysis visually illustrates the location and extent of injury.This animal model eliminates the influence of hemodynamic and immune factors,yielding highly reproducible results,and is strongly recommended as a standardized animal model for inducing LT-like stresses.

Objective To investigate the safety and efficacy of super-selective arterial embolization in the treatment of abdominal wall hematoma.Methods The clinical data of 11 patients with abdominal wall hematoma,who were admitted to the Northern Jiangsu People's Hospital of China from January 2018 to December 2023,were retrospectively analyzed.All patients received angiography together with super-selective arterial embolization.The effectiveness of embolization treatment was evaluated by the technical success rate and therapeutic effect,and the safety was evaluated by the incidence of complication.Results The median age of the 11 patients was 70 years,91％were female,with a body mass index(BMI)of 25.1 kg/m2,subcutaneous fat thickness of 2.8 cm,and international normalized ratio(INR)of 1.12.DSA showed that 8 patients(72％)had active bleeding signs,3 patients(28％)had no active bleeding signs.Under DSA,a total of 18 responsible vessels,including 6 lumbar arteries(33.3％),5 deep circumflex iliac arteries(27.7％),5 inferior epigastric arteries(27.7％)and 2 iliolumbar arteries(11.3％),were identified and were treated with embolization.The median time spent for operation was 80 minutes.The technical success rate was 100％and the clinical effective rate was 91％.No operation-related major complications occurred,and the median hospital stay was 6 days.Conclusion For the abdominal wall hematoma in aged,obesity patients with underlying diseases,super-selective arterial embolization is a therapeutic method with high technical success rate,high clinical effective rate and satisfactory clinical safety.

Objectives:To analyze the clinical application effect of the preloaded snare technique in patients with risk of atrial septal occluder migration during percutaneous atrial septal defect(ASD)occlusion.Methods:The clinical data of 24 patients with secundum ASD who underwent preloaded snare-assisted transcatheter closure in Fuwai Central China Cardiovascular Hospital between December 2022 and August 2024 were retrospectively analyzed.The preprocedural echocardiography revealed that all patients presented with large secundum ASD or insufficient margins,indicating potential risk of device migration during percutaneous ASD occlusion.Consequently,preloaded snare technique was applied for ASD closure.Postprocedural evaluations were conducted to assess device stability(migration or shedding),residual shunt,pericardial effusion,and new-onset arrhythmia during the procedure,immediately after intervention,and at 1-month follow-up.Results:Among 24 patients,there were 4 males,with an average age of(37.88±13.18)years and an average weight of(59.70±10.78)kg.Twenty-two cases underwent successful interventional closure.Two cases occurred atrial septal occluder migration during the procedure,both were successfully retrieved using the preloaded snare and subsequently scheduled for surgical repair.Postprocedural electrocardiograms and echocardiograms(obtained immediately and at 1-month follow-up)demonstrated no device migration,residual shunt,occluder dislodgement,pericardial effusion,or new-onset arrhythmias.Conclusions:The preloaded snare technique can reduce the risk of atrial septal occluder migration and shedding,simplify the process of retrieving the occluder,enhance the safety of the intervention,and avoid emergency surgical intervention in high-risk populations.

Objective To explore the efficacy and safety of TACE and apatinib combined with camrelizumab for treating giant hepatocellular carcinoma(HCC).Methods Totally 78 patients with giant HCC were retrospectively collected,including 22 cases received TACE and apatinib combined with camrelizumab(TACE+AC group)and 56 cases received TACE and apatinib(TACE+A group).Propensity score matching analysis was used to select 44 cases(TACE+A'group)from TACE+A group who were matched to those in TACE+AC group at 1:2 ratio.The overall survival(OS),progression-free survival(PFS)and the adverse events were recorded and compared among groups.Results Patients in TACE+AC group had a median OS of 17.8(95％CI:17.5-18.1)months and a median PFS of 8.8(95％CI:5.4-12.3)months,which in TACE+A'group was 9.8(95％CI:7.6-12.1)months and 5.5(95％CI:2.7-8.3)months,respectively.The overall OS rate and PFS rate in TACE+AC group were significantly higher than those in TACE+A' group(both P<0.05).The incidences of thyroid dysfunction,immune pneumonia and reactive cutaneous capillary endothelial proliferation in TACE+AC group were significantly higher than those in TACE+A' group(all P<0.05).No death associated with adverse events occurred.Conclusion Compared with TACE and apatinib,further combining with camrelizumab could get better survival benefit for giant HCC patients with acceptable adverse events.

Objective:To screen the optimal machine learning model for predicting the recurrence condition of hepatocellular carcinoma (HCC) at different time points post-surgery, based on the cutoff value of the Ki67 positive proliferation index condition calculated from recurrence-free survival and combined with various clinical features.Methods:retrospective study included initially treated patients with solitary HCC who underwent radical surgery at the Fifth Medical Center of the PLA General Hospital from January 2013 to March 2023. Data included general clinical data, preoperative laboratory parameters, and surgical pathology information about the subjects. The postoperative recurrence status was assessed by querying the medical record system or by telephone follow-up. The Ki67 positive index cutoff value was determined by the X-tile software based on the patient's recurrence-free survival status and time analysis. Survival rates were calculated using the Kaplan-Meier method, and survival curves were plotted. The study population was randomly divided into training and testing groups in a 7:3 ratio using a computer-generated random number method. The minimum redundancy maximum relevance (mRMR) method was used for feature variable selection. Predictive models for postoperative HCC recurrence conditions in patients with HCC were constructed using random forest, support vector machine, logistic regression, and gradient boosting decision tree machine learning algorithms. Inter-group comparisons for continuous data were performed using the t-test or Mann-Whitney U test. Inter-group comparisons of enumeration data were performed using the Pearson χ2 test, continuity-corrected χ2 test, or Fisher's exact test. Results:The cutoff values for the Ki67 positivity index were 0.3 and 0.5 in 510 cases, with a follow-up time ranging from 1.2 to 11.4 years (median: 6.2 years). The recurrence-free survival time was between 1 and 135 months (median: 32 months), with recurrence-free survival rates post-surgery at 1, 2, 3, and 5 years were 87.5%, 77.1%, 61.2%, and 54.5%, respectively. The top five variables predicted HCC recurrence and non-recurrence conditions following surgical follow-up at 6 months, 1 year, 2 years, and beyond 2 years, in accordance with information obtained by the mRMR screen out. The Ki67 positivity index screened a successfully constructed machine learning model to predict HCC recurrence and non-recurrence conditions following surgical follow-up at 6 months, 1 year, 2 years, and beyond 2 years. The machine learning model based on the gradient boosting decision tree algorithm had the best prediction performance among them (areas under the receiver operating characteristic curves for predicting HCC recurrence within six months in the training and validation sets were 0.996 and 0.946, and accuracies were 0.972 and 0.935, respectively).Conclusion:A machine learning model was successfully constructed using the Ki67 positivity index combined with four readily available clinical features to predict HCC recurrence. The machine learning model based on the gradient boosting decision tree algorithm demonstrated the best performance in terms of predicting HCC recurrence within six months after surgery.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

OBJECTIVE: To observe the effects of moxibustion at different temperatures on cognitive function and blood glucose levels in patients with cognitive impairment associated with type 2 diabetes mellitus (T2DM). METHODS: A total of 66 T2DM patients with cognitive impairment were randomly assigned to a high-temperature group (22 cases, 1 case dropped out, 1 case was eliminated), a medium-temperature group (22 cases, 2 cases were eliminated), and a low-temperature group (22 cases, 2 cases were eliminated). All groups received moxibustion at Baihui (GV20), Dazhui (GV14), and Shenting (GV24) based on their existing glycemic control treatment. Moxibustion temperatures were maintained at 44-46 ℃ (high-temperature group), 41-43 ℃ (medium-temperature group), and 38-40 ℃ (low-temperature group), respectively, for 20 min per session, every other day, 3 times a week for 3 months. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, short-term memory (STM) accuracy and average reaction time, Rey-Osterrieth complex figure (ROCF) score, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were assessed before and after treatment. Clinical efficacy was evaluated after treatment. RESULTS: After treatment, MMSE scores in all three groups were higher than those before treatment (P<0.05). In the high-temperature group, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, naming, language, and abstraction were higher than those before treatment (P<0.05); the scores of ROCF copy, immediate recall, and delayed recall were higher than those before treatment (P<0.05); the HbA1c level was lower than that before treatment (P<0.05). In the medium-temperature group, the total MoCA score and the scores of memory and delayed recall, attention, and language were higher than those before treatment (P<0.05). STM accuracy was higher than before treatment (P<0.05), and STM average reaction time was shorter than before treatment (P<0.05) in both the high-temperature and medium-temperature groups. After treatment, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, and language in the high-temperature group were higher than those in the medium- and low-temperature groups (P<0.05); MMSE score, STM accuracy, and ROCF immediate recall and delayed recall scores were higher than those in the medium- and low-temperature groups (P<0.05); STM average reaction time was shorter than that in the medium- and low-temperature groups (P<0.05); HbA1c level was lower than that in the low-temperature group (P<0.05). The total MoCA score, attention score, and MMSE score in the medium-temperature group were higher than those in the low-temperature group (P<0.05), and STM average reaction time was shorter than that in the low-temperature group (P<0.05). There were no statistically significant differences in FPG within or between the three groups before and after treatment (P>0.05). The total effective rates were 75.0% (15/20) in the high-temperature group, 50.0% (10/20) in the medium-temperature group, and 15.0% (3/20) in the low-temperature group; the total effective rate in the high-temperature group was significantly higher than that in the low-temperature group (P<0.05). CONCLUSION Moxibustion at different temperatures has a dose-effect relationship in treating cognitive impairment in T2DM patients. A temperature range of 44-46 ℃ is more effective in improving cognitive function and stabilizing average blood glucose levels over 2-3 months.
Humans ; Diabetes Mellitus, Type 2/therapy* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognitive Dysfunction/psychology* ; Cognition ; Temperature ; Blood Glucose/metabolism* ; Adult ; Acupuncture Points

Objectives:To evaluate the feasibility and clinical efficacy of eccentric occluder for the treatment of ventricular septal defect(VSD)without distance from the aortic valve.Methods:This analysis included 16 patients(9 males and 7 females)with VSD without distance from the aortic valve,who were treated at Fuwai Central China Cardiovascular Hospital from February 2022 to June 2024.Ten cases had mild right coronary sinus prolapse,and 2 had mild aortic valve regurgitation.All patients were diagnosed with VSD located zero-distance from aortic valve through transthoracic echocardiography(TTE)and left ventricular angiography.Eccentric occluder was used for interventional closure.TTE and 12-lead electrocardiography(ECG)were performed at 1 month,3 months,and 6 months after surgery to observe the presence of residual shunt,aortic valve regurgitation,and cardiac electrical conduction abnormalities.Results:Transcatheter closure was successful in 15 patients,procedure failed in one patient due to the unstable fixation of the occluder.Average diameter of the defect is(4.37±1.53)mm,and the diameter of the occluder is 6.5(6.0,8.0)mm.Postoperative left ventricular angiography showed minimal residual shunt in 3 cases,and no complications such as pericardial tamponade,hemolysis,thromboembolism,or infection,were observed.At one month after occlusion,TTE results showed that residual shunt disappeared in 3 patients with residual shunt.During 3-month and 6-month follow-up,all the occluders were well-positioned with no new aortic valve regurgitation or worsening of the original regurgitation,and no atrioventricular block or bundle branch block and other electrocardiographic conduction abnormalities.Conclusions:The use of eccentric occluder for intervention of ventricular septal defect patients without distance from the aortic valve is safe and effective.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.