Obesity presents significant challenges in spinal surgery, including higher rates of perioperative complications, prolonged operative times, and delayed recovery. Traditional open spine surgery often exacerbates these risks, particularly in patients with obesity, because of extensive tissue dissection and larger incisions. Endoscopic spine surgery (ESS) has emerged as a promising minimally invasive alternative, offering advantages such as reduced tissue trauma, minimal blood loss, lower infection rates, and faster recovery. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and outcomes of ESS techniques, including fully endoscopic and biportal endoscopic lumbar discectomy and decompression, in patients with obesity and lumbar spine pathologies. A comprehensive literature search of the PubMed/Medline, Embase, and Scopus databases yielded 2,975 studies published between 2000 and 2024, of which 10 met the inclusion criteria. The meta-analysis revealed significant improvements in pain relief (Visual Analog Scale) and functional outcomes (Oswestry Disability Index), with comparable results between patients with and without obesity. Patients who are obese experienced longer operative times and have a slightly higher risk of symptom recurrence; however, ESS demonstrated lower rates of wound infections, shorter hospital stays, and faster recovery than traditional surgery. These findings position ESS as a viable and effective option for managing lumbar spine conditions in patients with obesity, addressing obesity-related surgical challenges while maintaining favorable clinical outcomes. However, limitations such as study heterogeneity and the lack of randomized controlled trials highlight the need for further high-quality research to refine ESS techniques and optimize patient care in this high-risk population.

Obesity presents significant challenges in spinal surgery, including higher rates of perioperative complications, prolonged operative times, and delayed recovery. Traditional open spine surgery often exacerbates these risks, particularly in patients with obesity, because of extensive tissue dissection and larger incisions. Endoscopic spine surgery (ESS) has emerged as a promising minimally invasive alternative, offering advantages such as reduced tissue trauma, minimal blood loss, lower infection rates, and faster recovery. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and outcomes of ESS techniques, including fully endoscopic and biportal endoscopic lumbar discectomy and decompression, in patients with obesity and lumbar spine pathologies. A comprehensive literature search of the PubMed/Medline, Embase, and Scopus databases yielded 2,975 studies published between 2000 and 2024, of which 10 met the inclusion criteria. The meta-analysis revealed significant improvements in pain relief (Visual Analog Scale) and functional outcomes (Oswestry Disability Index), with comparable results between patients with and without obesity. Patients who are obese experienced longer operative times and have a slightly higher risk of symptom recurrence; however, ESS demonstrated lower rates of wound infections, shorter hospital stays, and faster recovery than traditional surgery. These findings position ESS as a viable and effective option for managing lumbar spine conditions in patients with obesity, addressing obesity-related surgical challenges while maintaining favorable clinical outcomes. However, limitations such as study heterogeneity and the lack of randomized controlled trials highlight the need for further high-quality research to refine ESS techniques and optimize patient care in this high-risk population.

Objective: To explore the plasma metabonomic characteristics of patients with type 2 diabetes mellitus and turbid toxin accumulation syndrome. Methods: One hundred and three patients with type 2 diabetes mellitus and turbid toxin accumulation syndrome were enrolled from November 2023 to February 2024 in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and 54 healthy individuals were recruited. The general data of the two groups were analyzed, and the plasma metabolite content was detected using ultra-high performance liquid chromatography-Orbitrap mass spectrometry. Construct an orthogonal partial least squares discriminant analysis model to screen metabolites with significant intergroup changes. The variable importance in projection≥ 1, |log2FC|>1, and P<0.05 were used as the criteria for the screening of differential metabolites. Annotate differential metabolites using internal databases and the human metabolome database, and perform pathway analysis using MetaboAnalyst website. Results: There was no statistically significant difference in gender and age between the two groups.Seventeen potential differential metabolites were identified. The D-4′-phosphopantothenate, 2, 6-dichloroindophenol, 4-methylphenol, hypoxanthine, 11, 12-epoxyeicosatrienoic acids, oleamide, 3-phenyllactic acid contents were higher in patients with type 2 diabetes mellitus and turbid toxin accumulation syndrome than in healthy individuals(P<0.05); 3-anisic acid, 3-iodo-octadecanoic acid, mebendazole, β-alanine, citric acid, trans-aconitic acid, geranyl diphosphate, lysophosphatidylcholine(18∶2), phosphatidylethanolamine(18∶1), and caprolactam contents were lower in patients with type 2 diabetes mellitus and turbid toxin accumulation syndrome than in healthy individuals(P<0.05). Ten metabolic pathways were identified, including the key metabolic pantothenate and coenzyme A biosynthesis pathways. Conclusion Metabolic differences were observed between patients with type 2 diabetes mellitus and turbid toxin accumulation syndrome and healthy individuals, and the underlying mechanism may involve the pantothenate and coenzyme A biosynthesis pathways, jointly mediated by D-4′-phosphopantothenate and β-alanine.

OBJECTIVE To investigate the effects and potential mechanism of Qiangxin decoction on mitochondrion of rats with chronic heart failure （CHF）. METHODS The CHF model was established by ligating the left anterior descending branch of the coronary artery. Modeled rats were divided into model group， Qiangxin decoction low-dose and high-dose groups （12.25， 24.50 g/kg， calculated by crude drug）， and chemical medicine group （Sacubitril valsartan sodium tablets， 10.42 mg/kg）， with 10 rats in each group； control group was set up without treatment. Each group of rats was orally administered with the corresponding medication or normal saline twice a day for 28 consecutive days. After the last medication， the contents of N-terminal pro-brain natriuretic peptide （NT-proBNP） and adenosine triphosphate （ATP） in serum and phosphatidic acid （PA） and cardiolipin （CL） in myocardial tissue were all detected； the pathological damage and collagen fibrosis of rat myocardial tissue were observed； the apoptosis of myocardial cells was determined； the ultrastructure of myocardial tissue was observed； the protein expressions of mitofusin 1 （Mfn1）， Mfn2， optic atrophy protein 1 （OPA1） and dynamin-related protein 1 （Drp1） were all detected in myocardial tissue. RESULTS Compared with control group，the serum content of NT-proBNP， apoptotic rate of myocardial cells， and relative expressions of S-OPA1 and Drp1 proteins were all increased significantly； serum content of ATP，contents of PA and CL， and relative expressions of Mfn1， Mfn2 and L-OPA1 proteins were all significantly reduced （P＜0.05）. There were abnormal membrane tissue structure in various layers of myocardial tissue， degeneration and necrosis of myocardial cells， and severe fibrosis； the mitochondria were swollen， with reduced or absent cristae， and uneven matrix density. After intervention with Qiangxin decoction， the levels of the aforementioned quantitative indicators in serum and myocardial tissue of rats （excluding CL content in the Qiangxin decoction low- dose group） were significantly reversed （P＜0.05）； the pathological damage of myocardial tissue had significantly improved， fibrosis had significantly reduced， mitochondrial morphology tended to be normal， cristae had increased， and matrix density was uniform. CONCLUSIONS Qiangxin decoction can regulate myocardial mitochondrial function and structural integrity of CHF rats， thereby improving myocardial energy metabolism and antagonizing myocardial fibrosis， the mechanism of which may be associated with activating PA/Mfn/CL signaling pathway.

OBJECTIVE To investigate the effects and potential mechanism of Qiangxin decoction on mitochondrion of rats with chronic heart failure （CHF）. METHODS The CHF model was established by ligating the left anterior descending branch of the coronary artery. Modeled rats were divided into model group， Qiangxin decoction low-dose and high-dose groups （12.25， 24.50 g/kg， calculated by crude drug）， and chemical medicine group （Sacubitril valsartan sodium tablets， 10.42 mg/kg）， with 10 rats in each group； control group was set up without treatment. Each group of rats was orally administered with the corresponding medication or normal saline twice a day for 28 consecutive days. After the last medication， the contents of N-terminal pro-brain natriuretic peptide （NT-proBNP） and adenosine triphosphate （ATP） in serum and phosphatidic acid （PA） and cardiolipin （CL） in myocardial tissue were all detected； the pathological damage and collagen fibrosis of rat myocardial tissue were observed； the apoptosis of myocardial cells was determined； the ultrastructure of myocardial tissue was observed； the protein expressions of mitofusin 1 （Mfn1）， Mfn2， optic atrophy protein 1 （OPA1） and dynamin-related protein 1 （Drp1） were all detected in myocardial tissue. RESULTS Compared with control group，the serum content of NT-proBNP， apoptotic rate of myocardial cells， and relative expressions of S-OPA1 and Drp1 proteins were all increased significantly； serum content of ATP，contents of PA and CL， and relative expressions of Mfn1， Mfn2 and L-OPA1 proteins were all significantly reduced （P＜0.05）. There were abnormal membrane tissue structure in various layers of myocardial tissue， degeneration and necrosis of myocardial cells， and severe fibrosis； the mitochondria were swollen， with reduced or absent cristae， and uneven matrix density. After intervention with Qiangxin decoction， the levels of the aforementioned quantitative indicators in serum and myocardial tissue of rats （excluding CL content in the Qiangxin decoction low- dose group） were significantly reversed （P＜0.05）； the pathological damage of myocardial tissue had significantly improved， fibrosis had significantly reduced， mitochondrial morphology tended to be normal， cristae had increased， and matrix density was uniform. CONCLUSIONS Qiangxin decoction can regulate myocardial mitochondrial function and structural integrity of CHF rats， thereby improving myocardial energy metabolism and antagonizing myocardial fibrosis， the mechanism of which may be associated with activating PA/Mfn/CL signaling pathway.

Obesity presents significant challenges in spinal surgery, including higher rates of perioperative complications, prolonged operative times, and delayed recovery. Traditional open spine surgery often exacerbates these risks, particularly in patients with obesity, because of extensive tissue dissection and larger incisions. Endoscopic spine surgery (ESS) has emerged as a promising minimally invasive alternative, offering advantages such as reduced tissue trauma, minimal blood loss, lower infection rates, and faster recovery. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and outcomes of ESS techniques, including fully endoscopic and biportal endoscopic lumbar discectomy and decompression, in patients with obesity and lumbar spine pathologies. A comprehensive literature search of the PubMed/Medline, Embase, and Scopus databases yielded 2,975 studies published between 2000 and 2024, of which 10 met the inclusion criteria. The meta-analysis revealed significant improvements in pain relief (Visual Analog Scale) and functional outcomes (Oswestry Disability Index), with comparable results between patients with and without obesity. Patients who are obese experienced longer operative times and have a slightly higher risk of symptom recurrence; however, ESS demonstrated lower rates of wound infections, shorter hospital stays, and faster recovery than traditional surgery. These findings position ESS as a viable and effective option for managing lumbar spine conditions in patients with obesity, addressing obesity-related surgical challenges while maintaining favorable clinical outcomes. However, limitations such as study heterogeneity and the lack of randomized controlled trials highlight the need for further high-quality research to refine ESS techniques and optimize patient care in this high-risk population.

Objective: To investigate the epidemiological characteristics and spatial-temporal clustering characteristics of scarlet fever in Jinhua City, Zhejiang Province from 2005 to 2023, so as to provide a reference for improving the prevention and control strategy of scarlet fever. Methods: The data of scarlet fever cases in Jinhua City from 2005 to 2023 were collected from the China Information System for Disease Control and Prevention, and descriptive epidemiological method was used to analyze the epidemiological characteristics of scarlet fever. The average annual percent change (AAPC) was calculated to analyze the trend of scarlet fever incidence from 2005 to 2023. The spatial-temporal clustering of scarlet fever was identified using spatial autocorrelation analysis and space-time scanning analysis. Results: A total of 1 494 scarlet fever cases were reported in Jinhua City from 2005 to 2023, and the average annual reported incidence rate was 1.41/100 000, with no significant change trend (AAPC=1.706%, P>0.05). There were two incidence peaks, from April to June and from November to January of the next year. There were 937 males and 557 females, with a male to female ratio of 1.68∶1. The age was mainly <10 years (1 391 cases, 93.11%), of which 3-<7 years was the high incidence age group (936 cases, 62.65%). There were 1 466 cases of preschool children, students, and scattered children, accounting for 98.13%. The average annual reported incidence of scarlet fever in Dongyang City, Pujiang County, and Yongkang City was 4.58/100 000, 3.04/100 000, and 1.99/100 000, respectively. The spatial autocorrelation analysis showed that there was a positive spatial correlation between the incidence of scarlet fever in Jinhua City from 2005 to 2023 (Moran's I=0.579, P<0.05), and the high-high clustering areas were mainly distributed in Dongyang City and Pujiang County. The spatial-temporal scanning analysis showed that there were 8 spatial-temporal clustering areas of scarlet fever in Jinhua City from 2005 to 2023. The class Ⅰ clustering area was 9 towns in Dongyang City, and the clustering period was from August 2013 to December 2022. There were 7 class Ⅱ clusters, covering some streets in Pujiang County, Dongyang City, Yongkang City, Yiwu City, and Pan'an County. Conclusions From 2005 to 2023, the incidence of scarlet fever in Jinhua City was relatively low, and children aged 3-<7 years had a high incidence, and there was a spatiotemporal clustering. The peak incidence was from April to June and from November to January of the next year. Dongyang City, Pujiang County, and Yongkang City had high incidence areas.

Objective: To analyze the epidemiological characteristics of leptospirosis in Jinhua City, Zhejiang Province, from 2007 to 2024, so as to provide a basis for improving the prevention and control strategies of leptospirosis. Methods: Data pertaining to leptospirosis cases in Jinhua City from 2007 to 2024 were collected through the Monitoring and Reporting Management System of the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the distribution characteristics of leptospirosis in terms of time, region, population, interval from the onset of the disease to diagnosis and the outbreak of the epidemic. Results: A total of 81 cases of leptospirosis were reported in Jinhua City from 2007 to 2024, with an average annual reported incidence of 0.08/100 000. The peak incidence occurred from August to September, with 57 cases accounting for 70.37%. Leptospirosis cases were reported in 9 counties (cities, districts) in Jinhua City. Pan'an County reported the most cases, with 52 cases accounting for 64.20%. There were 54 male cases and 27 female cases, with a male-to-female ratio of 2∶1. The majority of cases were aged over 40 years, with 73 cases accounting for 90.12%. The average reported incidence of leptospirosis showed an upward trend with the increase of age (P<0.05), and the highest incidence of leptospirosis was at the 60-<80 age group (0.21/100 000). The majority of patients were farmers, with 77 cases accounting for 95.06%. The median interval from onset to diagnosis was 4.00 (interquartile range, 6.00) days. There were significant differences in the interval from onset to diagnosis among cases in Dongyang City compared with Pan'an County, Wuyi County, and Wucheng District, between Pan'an County and Jindong District, Wucheng District, and between Wuyi County and Wucheng District (all P<0.05). In 2007, one outbreak of leptospirosis was reported, which occurred in Jiuhe Township, Pan'an County, with 36 reported cases. Conclusions The reported incidence of leptospirosis in Jinhua City from 2007 to 2024 is generally low. The high-incidence period is from August to September, and Pan'an County is the high-incidence area. Males over 40 years and farmers are the key populations for prevention and control. It is recommended to strengthen epidemic surveillance and health education for high-risk populations.

Objective: To investigate the value of the Chinese visceral adiposity index (CVAI) in predicting hypertension risk, so as to provide a tool for the early assessment of hypertension risk. Methods: Health examination individuals aged ≥18 years were selected from four medical institutes in Jinhua City, Zhejiang Province in 2022. Data on basic information, lifestyle, disease history, body mass index, waist circumference, blood pressure, and blood biochemical indicators were collected through questionnaire surveys and physical examinations. CVAI was calculated to assess levels of visceral fat accumulation, divided by quartiles into Q1, Q2, Q3, and Q4 groups. The relationship between CVAI and hypertension was analyzed using a multivariable logistic regression model, and their dose-response relationship was examined using a restricted cubic spline model. The value of CVAI in predicting hypertension risk was evaluated using receiver operating characteristic (ROC) curve. Results: A total of 23 791 individuals were enrolled, with a median age of 68.00 (interquartile range, 14.00) years. Among them, 10 178 (42.78%) were males and 13 613 (57.22%) were females. The median CVAI was 111.40 (interquartile range, 48.23). Hypertension was identified in 15 563 cases, with a prevalence of 65.42%. After adjusting for lifestyle, disease history, and blood biochemical indicators, the multivariable logistic regression analysis revealed that hypertension risk in the CVAI Q2, Q3, and Q4 groups were 2.012 (95%CI: 1.865-2.170), 3.059 (95%CI: 2.826-3.311), and 5.099 (95%CI: 4.672-5.565) times that of the Q1 group, respectively. The restricted cubic spline model revealed a non-linear relationship between CVAI and hypertension risk (Pnon linearity<0.05). Hypertension risk increased more rapidly when the CVAI was ≥81.03. The area under the ROC curve for CVAI in predicting hypertension risk was 0.691, with an optimal cutoff value of 106.01, which falls within the Q2 group. Conclusions There was a nonlinear dose-response relationship between CVAI and hypertension. CVAI can predict the risk of hypertension, and 106.01 can serve as an early warning threshold for risk screening.

Background::Histological healing is closely associated with improved long-term clinical outcomes and lowered relapses in patients with ulcerative colitis (UC). Here, we developed a novel diagnostic criterion for assessing histological healing in UC patients.Methods::We conducted a retrospective cohort study in UC patients, whose treatment was iteratively optimized to achieve mucosal healing at Shanghai Tenth People’s Hospital of Tongji University from January 2017 to May 2022. We identified an inflammatory cell enumeration index (ICEI) for assessing histological healing based on the proportions of eosinophils, CD177 + neutrophils, and CD40L + T cells in the colonic lamina propria under high power field (HPF), and the outcomes (risks of symptomatic relapses) of achieving histological remission vs. persistent histological inflammation using Kaplan-Meier curves. Intrareader reliability and inter-reader reliability were evaluated by each reader. The relationships to the changes in the Nancy index and the Geboes score were also assessed for responsiveness. The ICEI was further validated in a new cohort of UC patients from other nine university hospitals. Results::We developed an ICEI for clinical diagnosis of histological healing, i.e., Y = 1.701X 1 + 0.758X 2 + 1.347X 3 - 7.745 (X 1, X 2, and X 3 represent the proportions of CD177 + neutrophils, eosinophils, and CD40L + T cells, respectively, in the colonic lamina propria under HPF). The receiver operating characteristics curve (ROC) analysis revealed that Y <-0.391 was the cutoff value for the diagnosis of histological healing and that an area under the curve (AUC) was 0.942 (95% confidence interval [CI]: 0.905-0.979) with a sensitivity of 92.5% and a specificity of 83.6% ( P <0.001). The intraclass correlation coefficient (ICC) for the intrareader reliability was 0.855 (95% CI: 0.781-0.909), and ICEI had good inter-reader reliability of 0.832 (95% CI: 0.748-0.894). During an 18-month follow-up, patients with histological healing had a substantially better outcome compared with those with unachieved histological healing ( P <0.001) using ICEI. During a 12-month follow-up from other nine hospitals, patients with histological healing also had a lower risk of relapse than patients with unachieved histological healing. Conclusions::ICEI can be used to predict histological healing and identify patients with a risk of relapse 12 months and 18 months after clinical therapy. Therefore, ICEI provides a promising, simplified approach to monitor histological healing and to predict the prognosis of UC.Registration::Chinese Clinical Trial Registry, No. ChiCTR2300077792.