Objective To systematically evaluate the therapeutic effects of different surgical procedures for ischemic mitral regurgitation (IMR). Methods Computer searches were conducted in CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science, with the search time limit from the inception of the databases to February 2024. Two researchers independently screened the literature, extracted data, used the Cochrane bias risk assessment tool to evaluate the quality of the included studies, and used Stata 17.0 software to analyze the data. Results A total of 19 randomized controlled trials involving 6139 patients were finally included, involving six surgical procedures, and the overall quality of the included studies was relatively high. The results of the network meta-analysis showed that the 30-day all-cause mortality rate of mitral valve repair (MVr) was significantly lower than that of coronary artery bypass grafting (CABG) [OR=0.24, 95%CI (0.07, 0.87), P<0.01], mitral valve replacement (MVR) [OR=0.43, 95%CI (0.23, 0.79), P=0.02], CABG+MVR [OR=0.21, 95%CI (0.04, 0.95), P=0.03] and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip [OR=0.13, 95%CI (0.02, 0.87), P<0.01]. The 30-day all-cause mortality rate of CABG+MVr was significantly lower than that of CABG [OR=0.56, 95%CI (0.33, 0.93), P=0.02] and CABG+MVR [OR=0.48, 95%CI (0.24, 0.94), P=0.04], and the best probability ranking results showed that MVR might be the most effective in reducing the 30-day all-cause mortality rate. The incidence of renal complications in CABG+MVr was significantly lower than that in CABG+MVR [OR=0.42, 95%CI (0.21, 0.83), P=0.01]; the best probability ranking results showed that CABG+MVr might be the most effective in reducing renal complications. Conclusion The current limited evidence suggests that CABG+MVr and MVr may be the best surgical intervention methods for IMR patients at present. Due to the limitations of the number and quality of included studies, the above conclusions still need to be verified by more high-quality studies.

To improve the targeted therapeutic effect of magnolol (Mag) on neuroblastoma, Mag-loaded mitochondria-targeting immunoliposomes modified by datuximab (aGD2) and triphenylphosphine (TPP) (Mag/aGD2-T-ILN) were prepared, and their physicochemical properties, targeting characteristics and anti-tumor activity were evaluated. Physico-chemical properties showed that the surface of Mag/aGD2-T-ILN was smooth and spherical, with good dispersibility. The particle sizes, PDI and Zeta potentials of Mag/aGD2-T-ILN were measured to be (136.5 ± 5.1) nm, 0.184 ± 0.010 and (27.5 ± 3.6) mV, respectively. Mag/aGD2-T-ILN could release the drug continuously and slowly, and maintain good stability at 4 ℃. Cytotoxicity test exhibited that the IC50 of 2-ME/aGD2-T-ILN was (4.07 ± 0.48) µmol/L, and compared with free Mag, the toxicity of Mag/aGD2-T-ILN to SH-SY5Y cells increased by 6.4 times. Cellular binding and uptake assays suggested that Rho-aGD2-T-ILN could specifically target GD2-positive tumor cells and then further reach their mitochondria. Therapeutic efficacy indicated that Mag/aGD2-T-ILN could better suppress the growth of SH-SY5Y tumor cells in the body with lower toxicity and less side-effects. The results demonstrated that the Mag/aGD2-T-ILN nanoparticles system could achieve intracellular endocytosis through specific binding of antibodies and antigens between the carrier and the surface of tumor cells and electrostatic interaction, then effectively delivered and released the drugs into mitochondria by crossing the mitochondrial phospholipid membrane through TPP, and thus achieving mitochondria-targeting therapy of Mag/aGD2-T-ILN. Through the construction of this active targeting delivery system, the clinical application value of datuximab and Mag is improved, providing a novel approach for the clinical treatment of neuroblastoma.

Objective To systematically evaluate the differences in outcomes between functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR) in patients treated with transcatheter edge-to-edge repair (TEER) using the MitraClip device. Methods A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, the CNKI, Wanfang Database, VIP Database, and the CBM from their inception to January 2024. Two researchers independently performed study selection, data extraction, and risk of bias assessment. The quality of cohort studies was evaluated using the Newcastle-Ottawa Scale (NOS). A meta-analysis was performed using Stata 18.0 software. Results A total of 13 cohort studies involving 6 402 patients were included, comprising 4 161 patients in the FMR group and 2 241 in the DMR group. All included studies had NOS scores of ≥6 points. The meta-analysis revealed that compared to the DMR group, the FMR group had a higher 1-year all-cause mortality rate [OR=1.53, 95%CI (1.30, 1.81), P＜0.01] and a higher 1-year rehospitalization rate for heart failure [OR=1.90, 95%CI (1.60, 2.26), P＜0.01]. Conversely, the FMR group had a lower post-procedural mean transmitral gradient [SMD=–0.47, 95%CI (–0.65, –0.30), P＜0.01] and a lower rate of subsequent mitral valve surgery [OR=0.41, 95%CI (0.20, 0.83), P=0.01]. Conclusion Following MitraClip therapy, patients with FMR exhibit favorable short-term outcomes, but their mid- to long-term outcomes are inferior to those of patients with DMR. When determining the treatment strategy with MitraClip, the specific etiology of mitral regurgitation should be considered for a more accurate prediction of therapeutic efficacy and prognosis.

BACKGROUND: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories. METHODS: This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex. RESULTS: In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight. CONCLUSIONS Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Adipose Tissue ; Body Fat Distribution ; Body Mass Index ; China/epidemiology* ; Cross-Sectional Studies ; Health Surveys ; Phenotype

Objective To analyze the correlation between the poor position of pedicle screw after lumbar internal fixation and the occurrence of postoperative neurological symptoms.Methods The clinical data of patients who underwent lumbar pedicle screw surgery in our hospital from January 2017 to December 2023 were analyzed retrospectively.Record the patient's sex,age,diagnosis,surgical segment,the presence of postoperative neurological complications,the types of neurological complications.According to the postoperative CT,the screw penetration zone and grade were evaluated,and the distribution of different pedicle screw penetration types was recorded.The correlation between different types of pedicle screw penetration and postoperative neurological symptoms was analyzed.Results A total of 184 patients were included,including 80 males and 104 females.Age ranged from 18 to 82 years,with an average of 60.1±14.2 years.35 patients developed new neurological symptoms after operation.The incidence of postoperative neurological symptoms caused by pedicle medial quadrant screw penetration and lower quadrant screw penetration was higher than that of pedicle superior quadrant and lateral quadrant screw penetration.From L1 to L5,the risk of postoperative neurological symptoms caused by screw penetration in the medial quadrant of the pedicle increases gradually.When the penetration distance of pedicle medial quadrant screws in L4 and L5 segments is≥2mm,the risk of postoperative neurological symptoms is high.When the penetration distance of pedicle medial quadrant screws in L1,L2 and L3 segments is greater than 4mm,the risk of postoperative neurological symptoms is high.The distance of pedicle screw penetrating the medial quadrant of pedicle was positively correlated with the incidence of postoperative neurological symptoms(P<0.05).Conclusion The lateral and superior quadrants of the pedicle may be regarded as safety zones for lumbar pedicle screw placement.For the L1～L3 segments,screw penetration depth should not exceed 4 mm;whereas for the L4～L5 segments,the safety threshold must be strictly controlled within 2 mm.

AIM:To explore the effect of sinomenine hydrochloride(SH)on microcirculation and renal func-tion in type 2 diabetic db/db mice with a focus on the diacylglycerol(DAG)/protein kinase C(PKC)signaling pathway.METHODS:Eighteen 6-week-old male db/db mice were randomly divided into three groups:model group(saline),LY group(administered with 1 mg·kg-1·d-1 LY333531),and SH group(administered with 124.8 mg·kg-1·d-1 SH).Addi-tionally,6 age-matched db/m mice comprised the control group(saline).Daily intragastric administration lasted 6 weeks.Body mass,fasting blood glucose(FBG),urinary microalbumin(mALB),urinary creatinine(UCr)and urinary β2-micro-globulin(β2-MG)were measured in each group.The serum levels of endothelin-1(ET-1),endothelial nitric oxide syn-thase(eNOS),collagen type Ⅳ(Col Ⅳ)and laminin(LN),and the levels of DAG and PKC in renal tissues were ana-lyzed by enzyme-linked immunosorbent assay(ELISA).The morphological changes of renal tissues were assessed using HE and PAS staining,and kidney ultrastructure was examined via transmission electron microscopy.Immunohistochemis-try and Western blot were used to detect PKC and p-PKC levels in renal tissues.RESULTS:Compared with model group,the mice in both LY and SH groups showed decreased body mass(P＜0.05),with significantly reduced FBG level in LY group(P＜0.01).In addition,the urinary mALB and β2-MG levels were markedly decreased(P＜0.01),while UCr level was significantly increased(P＜0.01).Serum ET-1,Col Ⅳ and LN levels were significantly lower(P＜0.01),whereas eNOS level was notably higher(P＜0.01).Renal tissue DAG and PKC levels,as well as p-PKC expression were significantly reduced(P＜0.01).Improvements in renal tissue pathology and ultrastructure were observed.CONCLU-SION:Sinomenine hydrochloride improves microcirculation in diabetic db/db mice by modulating DAG/PKC signaling pathway,thus exerting protective effect on the kidney.

Objective To analyze the correlation between the poor position of pedicle screw after lumbar internal fixation and the occurrence of postoperative neurological symptoms.Methods The clinical data of patients who underwent lumbar pedicle screw surgery in our hospital from January 2017 to December 2023 were analyzed retrospectively.Record the patient's sex,age,diagnosis,surgical segment,the presence of postoperative neurological complications,the types of neurological complications.According to the postoperative CT,the screw penetration zone and grade were evaluated,and the distribution of different pedicle screw penetration types was recorded.The correlation between different types of pedicle screw penetration and postoperative neurological symptoms was analyzed.Results A total of 184 patients were included,including 80 males and 104 females.Age ranged from 18 to 82 years,with an average of 60.1±14.2 years.35 patients developed new neurological symptoms after operation.The incidence of postoperative neurological symptoms caused by pedicle medial quadrant screw penetration and lower quadrant screw penetration was higher than that of pedicle superior quadrant and lateral quadrant screw penetration.From L1 to L5,the risk of postoperative neurological symptoms caused by screw penetration in the medial quadrant of the pedicle increases gradually.When the penetration distance of pedicle medial quadrant screws in L4 and L5 segments is≥2mm,the risk of postoperative neurological symptoms is high.When the penetration distance of pedicle medial quadrant screws in L1,L2 and L3 segments is greater than 4mm,the risk of postoperative neurological symptoms is high.The distance of pedicle screw penetrating the medial quadrant of pedicle was positively correlated with the incidence of postoperative neurological symptoms(P<0.05).Conclusion The lateral and superior quadrants of the pedicle may be regarded as safety zones for lumbar pedicle screw placement.For the L1～L3 segments,screw penetration depth should not exceed 4 mm;whereas for the L4～L5 segments,the safety threshold must be strictly controlled within 2 mm.

ObjectiveTo evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) for muscle atrophy in patients with immobilization after surgical fixation of foot and ankle fractures.MethodsThis was a two-arm randomized controlled trial wherein 80 patients were recruited and divided into control (n = 40) and intervention (n = 40) groups. The control group received conventional orthopedic treatment, whereas the intervention group received TEAS and conventional treatment. The intervention group received TEAS 3 times a week for 30 min each time for 8 weeks. The primary outcomes were muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris and gastrocnemius muscles, whereas the secondary outcome measure was echo intensity (EI). Data were collected before the fixation operations (baseline assessment) and 4 and 8 weeks after intervention.ResultsCompared with baseline, the MT and CSA were reduced in both groups by the end of treatment, whereas EI increased in both groups. At week 4, the reduction in the rectus femoris CSA in the intervention group was significantly lower than that in the control group (P = .02); however, the between-group differences in the MT and EI (all P .05) were not significant. No serious adverse events were observed in either group.ConclusionOur study showed that TEAS can improve muscle atrophy by attenuating the decline in the muscle CSA. Because this was only a pilot trial, subsequent studies will need longer follow-ups and larger sample sizes.

Objective To systematically evaluate the clinical effects of remote ischaemic preconditioning (RIPC) in elective vascular surgery. Methods Electronic searches were conducted in The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP Database, and CBM. Relevant randomized controlled trials (RCTs) were screened according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software, and the risk of bias was assessed using the Cochrane risk of bias tool. Results A total of 15 studies involving 1 382 patients were included. The meta-analysis results showed no statistically significant difference between RIPC and non-RIPC groups in reducing perioperative mortality in elective vascular surgery (P>0.05). There were also no statistically significant differences between the two groups of vascular surgery patients regarding the incidence of myocardial infarction, renal injury, postoperative stroke, postoperative length of hospital stay, duration of surgery or total anesthesia time, or the incidence of limb injury, arrhythmia, heart failure, and pneumonia (P>0.05). Conclusion For patients undergoing elective vascular surgery, there are no significant differences between RIPC and non-RIPC in terms of perioperative mortality and other clinical endpoint outcomes.

Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.