Objective To observe the value of interventional treatment of lumbar disc herniation(LDH)based on degree of degeneration and fibrous ring rupture.Methods Totally 198 patients with LDH were retrospectively enrolled.Based on findings in digital subtraction angiography(DSA),the degree of degeneration and fibrous ring rupture were evaluated and different treatments were performed,and the efficacies were observed.Results Intradiscal electrothermal annuloplasty(IDET)were performed in 48 cases with fibrous ring degeneration and rupture of intervertebral disc but without protrusion,percutaneous lumbar diskectomy(PLD)/percutaneous laser disk decompression(PLDD)+ozone ablation were performed in 25 cases with grade 1 degeneration and grade 2 rupture with mild protrusion,targeted radiofrequency+ozone ablation were done in 23 cases with grade 2 degeneration and grade 2 or above rupture with mild protrusion,collagenase dissolution+PLD were done in 100 cases with grade 2 or above degeneration and grade 2 or above rupture with moderate or above protrusion and contrast agent entered into protruded intervertebral disc,while percutaneous cement discoplasty(PCD)were performed in 2 cases with grade 3 degeneration and grade 3 rupture with intervertebral stenosis.Twelve months after treatment,among 198 cases,excellent,good,acceptable and poor therapeutic effect was observed in 75,101,16 and 6 cases,respectively,with the effective rate of 96.97%(192/198).Conclusion Interventional treatments of LDH based on the degree of degeneration and fibrous ring rupture were valuable.

Objective:To analyze the long-term trends in cause-specific mortality across different sexes and age groups in China from 1990 to 2021, and quantitatively assess the impact of population aging on cause-specific deaths by sex.Methods:Based on data from the Global Burden of Disease Study 2021, this study extracted the number of deaths, crude mortality rates and age-standardized mortality rates (ASMRs) for all causes, Level 1 causes (communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; injuries) and Level 3 causes in China from 1990 to 2021, stratified by sex and age group. This study analyzed the current situation and long-term trends in mortality in China, applying decomposition analysis to quantify the impact of population aging on the number of deaths.Results:In 2021, the ASMRs of all-cause death and the three primary causes of death in Level 1 in China were 644.68, 26.59, 575.55, and 41.82 per 100 000, respectively. The ASMRs of the three primary causes continued to decline, with the smallest decrease observed in non-communicable diseases [EAPC=-1.79%, 95% CI (-1.92%, -1.66%)] and the largest in communicable, maternal, neonatal, and nutritional diseases (CMNND) [EAPC=-5.86%, 95% CI (-6.06%, -5.65%)]. The ASMRs were higher in males than females, with a smaller decline. Mortality was higher in the elderly. CMNND deaths mainly occurred in children under 5 and the elderly; non-communicable disease deaths were concentrated in the elderly; injury deaths were relatively evenly distributed across age groups. The proportion of CMNND deaths decreased annually, while the proportion of non-communicable disease deaths increased. From 1990 to 2021, population aging contributed to an increase of 8.11 million all-cause deaths, 167 464.42 CMNND deaths, 7.74 million non-communicable diseases deaths, and 196 287.78 injury deaths. The impact of population aging differed by sex and disease, with male and female aging-related deaths increasing by 4.47 million and 3.70 million, respectively. Compared to 1990, the age-specific mortality rate contributions in 2021 were -72.82% for males and -93.87% for females, with variations by sex and disease. Conclusion:The composition of disease-related deaths in China has changed notably. Population aging is linked to the sharp rise in deaths, with varying impacts across sexes and diseases. Reducing disease mortality can help lessen the negative effects of population aging.

Objective:To analyze the long-term trends in cause-specific mortality across different sexes and age groups in China from 1990 to 2021, and quantitatively assess the impact of population aging on cause-specific deaths by sex.Methods:Based on data from the Global Burden of Disease Study 2021, this study extracted the number of deaths, crude mortality rates and age-standardized mortality rates (ASMRs) for all causes, Level 1 causes (communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; injuries) and Level 3 causes in China from 1990 to 2021, stratified by sex and age group. This study analyzed the current situation and long-term trends in mortality in China, applying decomposition analysis to quantify the impact of population aging on the number of deaths.Results:In 2021, the ASMRs of all-cause death and the three primary causes of death in Level 1 in China were 644.68, 26.59, 575.55, and 41.82 per 100 000, respectively. The ASMRs of the three primary causes continued to decline, with the smallest decrease observed in non-communicable diseases [EAPC=-1.79%, 95% CI (-1.92%, -1.66%)] and the largest in communicable, maternal, neonatal, and nutritional diseases (CMNND) [EAPC=-5.86%, 95% CI (-6.06%, -5.65%)]. The ASMRs were higher in males than females, with a smaller decline. Mortality was higher in the elderly. CMNND deaths mainly occurred in children under 5 and the elderly; non-communicable disease deaths were concentrated in the elderly; injury deaths were relatively evenly distributed across age groups. The proportion of CMNND deaths decreased annually, while the proportion of non-communicable disease deaths increased. From 1990 to 2021, population aging contributed to an increase of 8.11 million all-cause deaths, 167 464.42 CMNND deaths, 7.74 million non-communicable diseases deaths, and 196 287.78 injury deaths. The impact of population aging differed by sex and disease, with male and female aging-related deaths increasing by 4.47 million and 3.70 million, respectively. Compared to 1990, the age-specific mortality rate contributions in 2021 were -72.82% for males and -93.87% for females, with variations by sex and disease. Conclusion:The composition of disease-related deaths in China has changed notably. Population aging is linked to the sharp rise in deaths, with varying impacts across sexes and diseases. Reducing disease mortality can help lessen the negative effects of population aging.

Objective To observe the value of interventional treatment of lumbar disc herniation(LDH)based on degree of degeneration and fibrous ring rupture.Methods Totally 198 patients with LDH were retrospectively enrolled.Based on findings in digital subtraction angiography(DSA),the degree of degeneration and fibrous ring rupture were evaluated and different treatments were performed,and the efficacies were observed.Results Intradiscal electrothermal annuloplasty(IDET)were performed in 48 cases with fibrous ring degeneration and rupture of intervertebral disc but without protrusion,percutaneous lumbar diskectomy(PLD)/percutaneous laser disk decompression(PLDD)+ozone ablation were performed in 25 cases with grade 1 degeneration and grade 2 rupture with mild protrusion,targeted radiofrequency+ozone ablation were done in 23 cases with grade 2 degeneration and grade 2 or above rupture with mild protrusion,collagenase dissolution+PLD were done in 100 cases with grade 2 or above degeneration and grade 2 or above rupture with moderate or above protrusion and contrast agent entered into protruded intervertebral disc,while percutaneous cement discoplasty(PCD)were performed in 2 cases with grade 3 degeneration and grade 3 rupture with intervertebral stenosis.Twelve months after treatment,among 198 cases,excellent,good,acceptable and poor therapeutic effect was observed in 75,101,16 and 6 cases,respectively,with the effective rate of 96.97%(192/198).Conclusion Interventional treatments of LDH based on the degree of degeneration and fibrous ring rupture were valuable.

Objective:To investigate the effects of prophylactic flow restriction for brachiocephalic arteriovenous fistula on postoperative high-flow-related complications and patency rate in patients undergoing hemodialysis.Methods:Clinical data of patients with end-stage renal disease who underwent brachiocephalic arteriovenous fistula surgery for hemodialysis from February 2017 to May 2022 in Department of Nephrology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine were retrospectively analyzed.During surgery,a 4-5 mm vascular suture loop was placed around the vein near the anastomosis as a flow restriction device in 43 patients(flow restriction group),while 42 patients did not receive the prophylactic flow restriction ring(control group).All patients were followed up for 1 to 5 years.The incidence rates of complications related to the hemodialysis access pathway,including distal ischemia syndrome,the formation of arteriovenous fistula aneurysms,thrombus,high-flow congestive heart failure,anastomosis of the vein within 1 cm of the anastomosis and cephalic arch stenosis,were compared between the two groups.The natural blood flow rate of the arteriovenous fistula,anastomosis size,the internal diameter of the vein near the anastomosis,primary patency rate,assisted primary patency rate,and secondary patency rate of the arteriovenous fistula,were also evaluated and compared between the two groups.Logistic regression analysis was used to investigate the factors affecting arteriovenous fistula patency rates,as well as the impact of the flow-restricting ring on postoperative factors.Results:Ultrasound measurements showed that the internal diameter of the vein at the site of the flow restriction ring in the flow restriction group was(3.7±0.6)mm at three months postoperatively,which was significantly smaller than the internal diameter of the narrowest part of the vein near the anastomosis in the control group[(4.1±1.0)mm,t=-2.416,P＜0.01].The postoperative anastomotic diameter and natural blood flow rate of the arteriovenous fistula in the flow restriction group were both significantly lower than those in the control group(both P＜0.05).Furthermore,the incidence rates of various complications in the flow restriction group were significantly lower than those in the control group(all P＜0.05).At 6,12,and 24 months postoperatively,the primary patency rate and assisted primary patency rate in the flow restriction group were significantly higher than those in the control group(both P＜0.05),while there was no significant difference in secondary patency rates between the two groups(P＞0.05).Binary logistic regression analysis indicated that age,diabetes,and natural blood flow rate of the arteriovenous fistula at 3 months postoperatively were independent risk factors for primary patency rate,while the flow restriction for brachiocephalic arteriovenous fistula was an independent protective factor for primary patency rate(P＜0.01 or P＜0.05).The application of flow restriction was negatively correlated with anastomotic diameter at 6 and 12 months,natural arteriovenous fistula blood flow,and the incidence rates of cephalic arch stenosis and aneurysm formation(all P＜0.05).Conclusion:The prophylactic constriction during brachiocephalic arteriovenous fistula surgery in patients undergoing hemodialysis can limit the size of the anastomosis and postoperative arteriovenous fistula blood flow,reducing complications such as cephalic arch stenosis and high-flow heart failure,and increasing primary patency rates of arteriovenous fistula and delay the reintervention of the fistula.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.