Objective: To analyze the association between each regional fat mass and total body bone mineral density (BMD) in children and adolescents aged 7-17 years in Beijing, so as to provide theoretical basis and practical guidance for implementing interventions. Methods: From September to December 2020, a stratified cluster random sampling method was used to select 1 423 children and adolescents aged 7-17 years in Tongzhou District, Beijing. Dual energy X-ray absorptiometry (DXA) was employed to measure regional body composition and total body BMD. Multiple linear regression was used to analyze the association between regional fat mass and total body BMD. Results: The median (interquartile range) fat mass values for total body, upper limbs, abdomen, hips, and thighs were 13.51(8.84, 19.21), 1.59(1.08, 2.23), 0.73(0.39, 1.29), 2.32(1.46, 3.26), 5.29(3.59, 7.21)kg, respectively. After adjusting for covariates, the results of multiple linear regression analysis showed that total body fat mass (β=0.010), abdominal fat mass (β=-0.100), and hip fat mass (β=0.104) were significant associations with total body BMD (all P<0.01). Sexstratified analysis revealed that in boys, total body fat mass (β=0.008) and hip fat mass (β=0.058) were positively associated with BMD, while thigh fat mass (β=-0.038) showed a negative association with total body BMD (all P<0.05). In girls, total body fat mass (β=0.013), hip fat mass (β=0.163), and thigh fat mass (β=0.023) were positively associated with total body BMD, whereas abdominal fat mass (β=-0.196) showed a negative association with total body BMD (all P<0.05). Among children and adolescents with body fat percentage below the standard range, within the standard range and above the standard range, total body fat masses were positively associated with total body BMD (β=0.021, 0.016, 0.015); among children and adolescents with body fat percentage within the standard range while upper limb (β=-0.042), abdominal (β=-0.067), and thigh fat mass (β=-0.018) showed negative associations with total body BMD, and hip fat mass demonstrated a positive association with total body BMD (β=0.082) (all P<0.05). Conclusion Regional fat distribution is associated with total body BMD in children and adolescents, with the nature of these associations varying by sex and body fat percentage.

Carotid artery perivascular adipose tissue (PVAT) can influence plaque formation and progression. Recently, carotid artery PVAT density has emerged as a novel imaging biomarker being capable of reflecting local metabolic and inflammatory states of adipose tissue. It is closely associated with vulnerable plaque characteristics, such as intraplaque hemorrhage, thinning or rupture of the fibrous cap, lipid-rich necrotic core, and calcification. Therefore, carotid artery PVAT density holds promise as a key parameter for early identification of vulnerable carotid plaques and stroke risk prediction. This article reviews the definition and pathophysiological mechanism of PVAT and application of imaging techniques in PVAT, as well as the association between carotid artery PVAT density and vulnerable characteristics of plaques, with the aim of providing references for early identification of asymptomatic high-risk plaques and individualized prevention strategies of ischemic stroke.

Carotid artery perivascular adipose tissue (PVAT) can influence plaque formation and progression. Recently, carotid artery PVAT density has emerged as a novel imaging biomarker being capable of reflecting local metabolic and inflammatory states of adipose tissue. It is closely associated with vulnerable plaque characteristics, such as intraplaque hemorrhage, thinning or rupture of the fibrous cap, lipid-rich necrotic core, and calcification. Therefore, carotid artery PVAT density holds promise as a key parameter for early identification of vulnerable carotid plaques and stroke risk prediction. This article reviews the definition and pathophysiological mechanism of PVAT and application of imaging techniques in PVAT, as well as the association between carotid artery PVAT density and vulnerable characteristics of plaques, with the aim of providing references for early identification of asymptomatic high-risk plaques and individualized prevention strategies of ischemic stroke.

Objective:To explore the relationship between the triglyceride glucose (TyG) index and the risk of developing hypertension among rural Chinese adults.Methods:A prospective cohort study was conducted from 2007 to 2008, involving 20 194 adults selected through random cluster sampling from a rural community in Luoyang City, Henan Province. Follow-ups were carried out in 2013-2014 and 2018-2020. After excluding participants with hypertension at baseline, those with missing TyG index data, individuals who passed away during follow-up, and those with incomplete hypertension status at the second visit, 9 802 participants were included in the analysis. Baseline and follow-up assessments included questionnaire interviews, physical measurements (including blood pressure), and blood sample collection for fasting lipid and glucose levels. Participants were divided into four groups according to TyG index quartiles, and a modified Poisson regression model was utilized to assess the association between TyG index quartiles and hypertension risk.Results:The study cohort comprised 9 802 participants with a median age of 48 (39, 57) years, including 3 803 males (38.80%). Participants were distributed across TyG index quartiles as follows: TyG<8.2 group (2 224 individuals), TyG 8.2-8.5 group (2 653 individuals), TyG 8.6-8.9 (2 441 individuals), and TyG≥9.0 (2 484 individuals). Over a follow-up period of (11.1±1.3) years, 3 378 subjects developed hypertension, resulting in a cumulative incidence of 34.46% (3 378/9 802). The risk of hypertension increased with higher TyG index quartiles ( Ptrend<0.05). Compared to the TyG<8.2, the TyG 8.2-8.5 ( RR=1.11, 95% CI 1.01-1.22, P=0.023), TyG 8.6-8.9 ( RR=1.16, 95%CI 1.06-1.27, P=0.023), and TyG≥9.0 ( RR=1.20, 95%CI 1.10-1.31, P=0.023) exhibited increased hypertension risk after adjusting for age, gender, educational level, and other potential confounders. Subgroup analyses based on gender and age at baseline yielded results consistent with the main analysis. Conclusions:The TyG index is positively correlated with the risk of developing hypertension in the rural adult population.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorders in women of reproductive age, yet its etiology and pathogenesis remain unclear. Women with PCOS frequently present with insulin resistance, obesity, and infertility, which heightens the risk of various pregnancy complications such as gestational diabetes mellitus (GDM). Research has demonstrated that PCOS patients have a three-fold higher risk of developing GDM compared with healthy pregnant women matched with age and body mass index. Early identification of pregnant women at high risk for GDM and targeted intervention measures can significantly enhance patients' outcomes. Therefore, this article aims to review predictive factors for GDM in patients with PCOS, propose suggestions for screening high-risk factors, and discuss measures to improve lifestyle. The objective is to provide a reference for identifying high-risk pregnant women with GDM and establishing a healthy lifestyle.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorders in women of reproductive age, yet its etiology and pathogenesis remain unclear. Women with PCOS frequently present with insulin resistance, obesity, and infertility, which heightens the risk of various pregnancy complications such as gestational diabetes mellitus (GDM). Research has demonstrated that PCOS patients have a three-fold higher risk of developing GDM compared with healthy pregnant women matched with age and body mass index. Early identification of pregnant women at high risk for GDM and targeted intervention measures can significantly enhance patients' outcomes. Therefore, this article aims to review predictive factors for GDM in patients with PCOS, propose suggestions for screening high-risk factors, and discuss measures to improve lifestyle. The objective is to provide a reference for identifying high-risk pregnant women with GDM and establishing a healthy lifestyle.

Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.

Objective:To investigate the efficacy and safety of Treprostinil in the treatment of children with early decompensation after the Fontan procedure.Methods:A retrospectively analysis was performed on the clinical data of 16 children with early decompensation after the Fontan procedure treated with Treprostinil injection from December 2017 to June 2020 at Fuwai Central China Cardiovascular Hospital.A total of 16 patients were included, including 5 boys (31.2%) and 11 girls (68.8%). The age was (4.6 ±1.2) years, the weight was (16.0±2.1) kg.The changes of central venous pressure (CVP), heart rate (HR), systolic blood pressure (SBP), central venous oxygen saturation (ScvO 2), lactic acid (Lac), oxygenation index and B-type natriuretic peptide (BNP) were recorded at the infusion of Treprostinil and 3 hours, 24 hours, 48 hours and 72 hours after the infusion.The short-term efficacy of Treprostinil was observed[mortality, mechanical ventilation time, and length of intensive care unit (ICU) stay]; paired t-test was used to analyze the above indexes at different time points.The adverse reactions during the administration were also recorded. Results:Of the 16 children, the median mechanical ventilation time was 9 (5, 22) h, and the median ICU stay time was 2 (1, 12)days.After 72 hours of drug administration, CVP, Lac, BNP and HR decreased: CVP decreased from(16±5) mmHg (1 mmHg=0.133 kPa) to (11±2) mmHg ( P<0.001), Lac decreased from(6.8±3.2) mmol/L to (3.2±1.2) mmol/L ( P=0.002), BNP decreased from(980±223) ng/L to (250±120) ng/L( P<0.001), HR decreased from(150±20) times/min to (125±16) times/min( P=0.002); SBP, ScvO 2 and oxygenation index increased: SBP increased from(83±10) mmHg to (98±12) mmHg( P<0.001), ScvO 2 increased from 0.53±0.13 to 0.65±0.11 ( P=0.003), oxygenation index increased from (200±72) mmHg to (298±13) mmHg ( P<0.001), and the differences were statistically significant(all P< 0.05). One case died (6.3%), 2 cases (12.5%) had transient blood pressure drop and 1 case (6.3%) had nausea and vomiting.Besides, no other treatment-related complications were observed. Conclusions:As for children with early decompensation after the Fontan procedure, the intravenous application of Treprostinil can reduce pulmonary artery pressure rapidly, effectively improve circulatory status and oxygenation and ultimately improve the prognosis.

Objective:To investigate the embryo transfer strategies of early follicular phase prolonged protocol, to reduce the risk of multiple birth rate while achieving a higher live birth rate.Methods:It was a retrospective cohort study. Patients who underwent gonadotropin-releasing hormone (GnRH) agonist protocols in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to February 2019 were included. According to the type of embryos transferred, we divided all cycles into four groups, fresh cycle cleavage stage embryo transfer group (group A), fresh cycle blastocyst transfer group (group B), freeze-thaw cleavage stage embryo transfer group (group C), freeze-thaw blastocyst transfer group (group D). The main outcome measures were live birth rate and multiple birth rate. Binary logistic regression was used to correct confounding factors.Results:The risk of moderate to severe ovarian hyperstimulation syndrome (OHSS) in group A [4.8% (110/2283)] was higher than that in group C [1.0% (6/614), P<0.001] and group D [2.1% (16/762), P<0.001]. The risk of moderate to severe OHSS in group B [3.8% (42/1116)] was higher than that in group C ( P<0.001). The multiple birth rate of the two embryos transfer group [group A 23.4% (535/2283), group C 20.8% (128/614) ] was significantly higher than that of the one blastocyst transfer group [group B 1.4% (16/1116), group D 0.9% (7/762)], and the difference was statistically significant ( P<0.001). The clinical pregnancy rate [68.7% (767/1116)] and the live birth rate [59.6% (665/1116)] of group B were higher than those of group A [63.5% (1449/2283), P=0.003; 54.8% (1250/2283), P=0.008], group C [60.1% (369/614), P<0.001; 51.6% (317/614), P=0.001] and group D [62.7% (478/762), P=0.007; 52.8% (402/762), P=0.003], but there was no statistical difference among group A, group C and group D. Taking group B as a reference, the live birth rate of group A (a OR=0.86, 95% CI=0.74-0.99, P=0.044), group C (a OR=76, 95% CI=0.62-0.93, P=0.008) and group D (a OR=0.79, 95% CI=0.65-0.95, P=0.013) was lower than that of group B. Conclusion:For the early follicular phase prolonged protocol, based on the control of OHSS, fresh cycle single blastocyst transplantation is preferred. While obtaining a higher live birth rate, the multiple birth rate is significantly reduced.

Objective:To investigate the embryo transfer strategies of early follicular phase prolonged protocol, to reduce the risk of multiple birth rate while achieving a higher live birth rate.Methods:It was a retrospective cohort study. Patients who underwent gonadotropin-releasing hormone (GnRH) agonist protocols in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to February 2019 were included. According to the type of embryos transferred, we divided all cycles into four groups, fresh cycle cleavage stage embryo transfer group (group A), fresh cycle blastocyst transfer group (group B), freeze-thaw cleavage stage embryo transfer group (group C), freeze-thaw blastocyst transfer group (group D). The main outcome measures were live birth rate and multiple birth rate. Binary logistic regression was used to correct confounding factors.Results:The risk of moderate to severe ovarian hyperstimulation syndrome (OHSS) in group A [4.8% (110/2283)] was higher than that in group C [1.0% (6/614), P<0.001] and group D [2.1% (16/762), P<0.001]. The risk of moderate to severe OHSS in group B [3.8% (42/1116)] was higher than that in group C ( P<0.001). The multiple birth rate of the two embryos transfer group [group A 23.4% (535/2283), group C 20.8% (128/614) ] was significantly higher than that of the one blastocyst transfer group [group B 1.4% (16/1116), group D 0.9% (7/762)], and the difference was statistically significant ( P<0.001). The clinical pregnancy rate [68.7% (767/1116)] and the live birth rate [59.6% (665/1116)] of group B were higher than those of group A [63.5% (1449/2283), P=0.003; 54.8% (1250/2283), P=0.008], group C [60.1% (369/614), P<0.001; 51.6% (317/614), P=0.001] and group D [62.7% (478/762), P=0.007; 52.8% (402/762), P=0.003], but there was no statistical difference among group A, group C and group D. Taking group B as a reference, the live birth rate of group A (a OR=0.86, 95% CI=0.74-0.99, P=0.044), group C (a OR=76, 95% CI=0.62-0.93, P=0.008) and group D (a OR=0.79, 95% CI=0.65-0.95, P=0.013) was lower than that of group B. Conclusion:For the early follicular phase prolonged protocol, based on the control of OHSS, fresh cycle single blastocyst transplantation is preferred. While obtaining a higher live birth rate, the multiple birth rate is significantly reduced.