Volume 105 · Issue 16 · 2025

Children and adolescents are in a critical period for the development of the heart and blood vessels, kidneys and metabolic systems. The health risk accumulation of the cardiovascular-kidney-metabolic (CKM) system formed at this stage has a significant trajectory characteristic and affects health in adulthood. This article elaborates on the multi-stage process from adipose tissue dysfunctional to systemic inflammation, clarifies its initiating role in metabolic homeostasis, explores the bidirectional mechanism between metabolic risk factors and early kidney damage, and establishes the pivotal role of the metabolism-kidney axis in disease progression. It also analyzes the evolution of sub-clinical cardiovascular changes from functional changes to organic damage and establishes a model of the vicious cycle between hemodynamic abnormalities and metabolic disorders. It is advocated that the prevention and control of cardiovascular, renal, and metabolic risks in children and adolescents should be implemented through policy support, a healthy lifestyle, early screening and long-term monitoring, and stratified intervention.

To explore the relationship between the cardiovascular health score of Life′s Essential 8 (LE8) and attention deficit hyperactivity disorder (ADHD) symptoms in children.

A stratified cluster random sampling technique was used to select 2 688 children aged 6 to 12 years from five primary schools in Guangzhou for a questionnaire survey and physical examination. The cardiovascular health of Chinese school-aged children was evaluated using the American Heart Association′s LE8 metrics. The Conners Parent Symptom Questionnaire (PSQ) was utilized to assess symptoms of ADHD (higher scores indicating more severe behavioral problems).

This study included 2 688 children aged 6 to 12 years, comprising 1 461 boys and 1 227 girls, with age of (8.8±1.5) years. The LE8 score was (76.1±9.0) points, and the PSQ score was (16.2±12.0) points. A negative correlation was observed between the LE8 score and the total PSQ score, as well as with scores across five dimensions: conduct problems, learning problems, impulsivity-hyperactivity, anxiety, and the hyperactivity index. The corresponding β(95%CI) were as follows:-0.097 (-0.134--0.060), -0.084 (-0.122--0.047), -0.116 (-0.154--0.079), -0.082 (0.119--0.044), -0.061 (-0.099--0.023) and -0.100 (-0.138--0.063), all P<0.05.

The cardiovascular health score based on LE8 among children aged 6 to 12 years in Guangzhou is negatively correlated with the PSQ score used to assess ADHD symptoms.

To investigate the association between sleep duration and blood pressure levels in school-aged children.

A prospective cohort study was conclucted. The subjects were from the healthy children cohort in western China from 2021 to 2024. The baseline survey was conducted in 2021 in Shimian County, Sichuan Province, and Jiulongpo District Chongqing; in 2022 in Jiulongpo District, Chongqing; and in 2023 in Xishui County, Guizhou Province. Follow-up surveys were carried out in 2023 and 2024. A total of 15 662 participant-visits were finally included in the analysis. Among these, the baseline included 2 716 participants in 2021, 2 766 in 2022, and 1 977 in 2023. The first follow-up included 3 831 participants in 2023 and 2 058 in 2024, while the second follow-up comprised 2 314 participants in 2024. This study collected data on demographic characteristics, lifestyle factors, and sleep status. Additionally, this study conducted uniform measurements of height, weight, blood pressure, and brachial-ankle pulse wave velocity. The restricted cubic spline (RCS) regression model was utilized to examine the nonlinear relationship between average sleep duration, average sleep duration difference between weekends and weekdays, and the risk of elevated blood pressure to identify cutoff values. The association of different average sleep durations and differences in average sleep duration with elevated blood pressure were analyzed using multivariate mixed-effects logistic regression models. Based on the generalized linear mixed model, this study estimated the differences in blood pressure and brachial-ankle pulse wave velocity between various average sleep duration groups and among groups with different average sleep duration differences.

At baseline, there were 7 459 children with an average age of (10.8±2.3) years. Among them, 3 848 were boys, accounting for 51.6% of the total. The overall prevalence rate of elevated blood pressure was 13.4% (1 003/7 459). The age, height, body mass index (BMI), physical activity, and pulse wave velocity in the group with elevated blood pressure were all significantly higher than those in the normal blood pressure group (all P<0.05). The analysis results of the RCS the regression model indicated that the cut-off value for average sleep duration was 9 h/d. When the average sleep duration was less than 9 h/d, a negative correlation was observed between the average sleep duration and the risk of elevated blood pressure (P=0.008). The difference of average sleep duration was positively correlated with an increased risk of elevated blood pressure (P=0.005), with a cut-off value of 2.5 h/d for this difference. Using the average sleep duration of <9 h/d as a reference, the group with an average sleep duration of ≥9 h/d had a decreased risk of elevated blood pressure (OR=0.86, 95%CI: 0.75-0.99). Compared with the difference in average sleep duration of <2.5 h/d, the risk of elevated blood pressure was increased in the group with ≥2.5 h/d′ difference in average sleep duration (OR=1.23, 95%CI: 1.06-1.43). The systolic blood pressure, diastolic blood pressure, and pulse wave velocity were significantly lower in the group with an average sleep duration of ≥9 h/d compared to the group with <9 h/d (all P<0.05). Conversely, these parameters were significantly higher in the group with a difference in average sleep duration of ≥2.5 h/d compared to the group with <2.5 h/d difference (all P<0.05).

Inadequate average sleep duration (<9 h/d) and poor sleep regularity (average sleep duration difference between weekends and weekdays ≥2.5 h/d) are significant risk factors for elevated blood pressure in children.

To explore the association of hydration status with metabolic dysfunction-associated steatotic liver disease (MASLD) and parameters of liver transient elastography in children.

Participants were enrolled from the child cohort conducted to study sensitization, puberty, obesity, and cardiovascular risk (PROC), including 1 643 children surveyed at baseline from October 2018 to June 2019 and 1, 501 children followed up in April 2023. Data on hydration status, MASLD, and liver transient elastography parameters (for 1 499 children) were collected. Hepatic steatosis was defined as ultrasonic attenuation parameter (UAP)≥249 dB/m, and hepatic fibrosis was defined as liver stiffness measurement (LSM)≥8.0 kPa. For children with MASLD, hepatic steatosis or fibrosis were defined as unfavorable liver outcomes. Poisson regression and generalized estimating equations were used to determine the associations of hydration status with MASLD, hepatic steatosis, hepatic fibrosis, and the number of unfavorable liver outcomes when baseline data combined follow-up data.

At baseline, 1 643 children aged [M (Q₁, Q₃)] 6.6 (6.4, 6.8) years, with 828 boys (50.4%) were enrolled. Dehydration was present in 35.0% of children (575/1 643) at baseline and 76.2% (1 144/1 501) of children at follow-up (P<0.001). The incidence of MASLD during follow-up was higher than that at baseline [12.7% (191/1 501) vs 6.9% (113/1 643), P<0.001]. Compared to children with normal hydration, dehydrated children had increased risks of MASLD (RR=1.77, 95%CI: 1.42-2.20), hepatic steatosis (RR=1.28, 95%CI: 1.08-1.52), hepatic fibrosis (RR=1.65, 95%CI: 1.09-2.50), and more unfavorable liver outcomes (RR=1.47, 95%CI: 1.25-1.73) when baseline data combined follow-up data.

Children′s dehydration status is linked to unfavorable liver outcomes, including MASLD, hepatic steatosis and fibrosis, as assessed by transient elastography.

To explore the association between triglyceride-glucose index (TyG) trajectory changes and left ventricular hypertrophy (LVH) in childhood.

A total of 1 515 students from grades 1-5 were selected as subjects in a public primary school in Huantai County, Zibo City, Shandong Province by convenient cluster sampling method from November 2017. Follow-up surveys were conducted every 2 years (2019, 2021, 2023), which involved questionnaire survey, physical examination, cardiac ultrasound and blood biochemical examination. The correlation between changes in TyG and left ventricular structural indicators between 2017 and 2023 was analyzed using a multiple linear regression. The group based trajectory modelling was used to fit the childhood TyG change trajectory model, and divided into high, medium and low level trajectory groups. Additionally, multivariate logistic regression was employed to analyze the relationship between TyG trajectory and LVH in children.

A total of 1 111 subjects with an average age of (8.3±1.5) years were included, including 582 (52.4%) boys. There were 391 (35.2%), 596 (53.6%) and 124 (11.2%) children in TyG low, medium and high level trajectory groups, respectively. TyG, left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic dimension (LVDD), left ventricular posterior wall thickness (LVPWT) and interventricular septal thickness (IVST) in TyG high level trajectory group were all higher than those in low and medium level trajectory groups (all P<0.05). Compared with the TyG normal-normal group, the LVM, LVMI, LVDD in the TyG normal-high group, LVM in the TyG high-normal group and LVM, LVMI, LVDD, LVPWT and IVST in the TyG high-high group were all increased (all P<0.05). Compared with the TyG low level trajectory group, the risk of LVH was increased in the total population [OR (95%CI): 3.69 (1.79-7.61)] and boys [OR (95%CI): 5.48 (1.95-15.44)].

High TyG in childhood increases the risk of LVH. If the TyG can be controlled to normal levels early, the risk of LVH can be effectively reduced.

To explore the effect of psycho-cardiological treatment on improving cardiovascular prognosis and economic effectiveness in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI).

This randomized control trial enrolled inpatients with CAD after PCI from August 2021 to May 2024 in Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital. Baseline information was collected, and depression, anxiety, insomnia status were assessed. Patients were divided into a conventional treatment group (conventional CAD medication therapy) and psycho-cardiological treatment group (conventional CAD treatment+antidepressant/anti-anxiety/traditional Chinese medicine+WeChat group management). Specialized cardiovascular physicians would follow up from 2, 4, 13, 26, 52, 78, 104 weeks after the patients discharging from hospital. The Kaplan-Meier was employed to draw survival curve, and log-rank test was used for groups comparison. Cox regression model was applied for analyzing the risk factors of cardiac events in CAD patients following PCI. The impact of psycho-cardiological treatment on adverse cardiac events was analyzed, and cost-effectiveness ratio (CER) and incremental cost-effective ratio (ICER) were calculated.

This study included 519 CAD patients after PCI, with median age 60 (53, 67) years, of whom there were 374 males (72.1%). Among them, 249 patients were in the conventional treatment group, with median age 61 (53, 68) years, of whom there were 183 males (73.5%), and 270 were in the psycho-cardiological treatment group, with median age 59 (53, 66) years, of whom there were 191 males (70.7%). Compared to conventional treatment group, psycho-cardiological treatment significantly reduced cardiac adverse events (9.6% vs 1.9%, P<0.001). The results of the multifactorial analysis showed that psycho-cardiological therapy reduced the risk of cardiovascular events in patients with an HR (95%CI) of 0.261 (0.231, 0.295); with an increase of each 1-year in age, the risk of cardiovascular events in patients increased by 3.3% with an HR (95%CI) of 1.033 (1.028, 1.038).The CER of psycho-cardiological treatment group (CER: 717.66) was significantly lower than that of the conventional treatment group (CER:775.39), and the ICER was 47.99, indicating that gaining a 1% increase in effectiveness required an additional cost of 47.99 RMB.

Psycho-cardiological treatment is beneficial in reducing cardiac events in CAD patients after PCI and improving cardiac prognosis, moreover, it also contributes to lowering the CER, thereby reducing the burden of cardiovascular disease.

To compare the efficacy of ultrasound-guided microwave ablation and sclerosing agents in the treatment of head and neck venous malformations.

Patients with head and neck venous malformations treated by ultrasound guidance at Sichuan Cancer Hospital were retrospectively enrolled from August 2019 to May 2024. The patients were divided into the ablation group and the sclerotherapy group according to different treatment methods, and the lesion volume reduction rate (VRR), efficacy evaluation, number of treatments, cosmetic grading score (CGS), pain numerical rating scale (NRS), patient satisfaction and postoperative complications were compared between the two groups before the surgery and at the last follow-up after the surgery. Follow-up was conducted every 3 months after surgery until there was no significant change in the lesion for half a year and the patient had no other discomfort.

A total of 76 patients including 20 males and 56 females were enrolled, with a mean age of (35.4±17.6) years. There were 34 patients (11 males and 23 females) in the ablation group, with a mean age of (36.6±18.3) years and 37 lesions. Fourty-two patients (9 males and 33 females) were in the sclerotherapy group, with a mean age of (34.4±17.2) years and 45 lesions. The follow-up time of the ablation group and sclerotherapy group was (12.3±0.7) months and (12.0±0.5) months, respectively. The number of treatments in the ablation group was less than that in the sclerotherapy group [(1.1±0.2) vs (3.1±1.0), P<0.05]. There were no significant differences in VRR, efficacy evaluation, CGS score, NRS score, and satisfaction score between the two groups (all P>0.05). The volume of lesions in both the ablation group and the sclerotherapy group was reduced at the last follow-up after the surgery compared with that before the surgery [ablation group: 3.7 (1.6, 15.2) vs 0.7 (0.2, 2.5) cm³, sclerotherapy group: 5.3 (0.6, 11.0) vs 0.5 (0.1, 3.3) cm³], and the CGS score and NRS score were lower than those before surgery [ ablation group: (3.9±0.3) vs (1.4±0.7), (4.9±0.8) vs (1.1±0.9), sclerotherapy group: (3.9±0.3) vs (1.2±0.5), (5.0±0.7) vs (1.2±1.0)] (all P<0.05). None of the patients in either group developed serious complications.

Ultrasound-guided microwave ablation is safe and effective in the treatment of head and neck venous malformations, and can reduce the number of treatments compared with conventional sclerotherapy.

To investigate the relationship between the extracellular-to-

A multicenter cross-sectional study was conducted. The clinical data of adult patients receiving MHD treatment at 18 hemodialysis centers in Guizhou Province from June to August in 2021 and the same period in 2022 were collected. Physical measurements, body composition measurements, and questionnaire surveys were performed. Psychological assessment was conducted using the Beck Depression Inventory, with a score of 14 or above indicating the presence of depressive symptoms. Patients were divided into four groups based on the quartiles of the ECW/ICW ratio, and the relationship between the ECW/ICW ratio and depressive symptoms in MHD patients was explored using logistic regression analysis. Subgroup analyses were further conducted to assess the stability of the results.

A total of 3 195 patients were included in the study, consisting of 1 979 males and 1 216 females, with a median (Q₁, Q₃) age of 55 (45, 65) years. According to the Beck Depression Inventory, approximately 11.1% (355/3 195) had depressive symptoms. Multivariable logistic regression analysis revealed that, in the unadjusted model, the risk of depression for patients in the highest ECW/ICW quartile (Q4) was 2.24 times higher than that of the lowest quartile (Q1) (OR=2.24, 95%CI: 1.62-3.08, P<0.001). After further adjustment for covariates such as gender, age, hypertension, and diabetes, the risk of depression for patients in Q4 remained 1.75 times higher than that of Q1 group (OR=1.75, 95%CI: 1.20-2.54, P=0.003). The independent association between a high ECW/ICW ratio and the risk of depression was stable across different age groups, genders, education levels, and in the presence of comorbidities such as hypertension, diabetes, and stroke history (all P for interaction>0.05).

An increased ECW/ICW ratio is associated with an increased risk of depression in MHD patients.

To investigate the dynamic trajectories of platelet (PLT) changes following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) and analyze their association with postoperative adverse events.

This retrospective study included patients with AAA who underwent EVAR at the Department of Vascular Surgery, Changhai Hospital of the Naval Medical University, between January 2000 and February 2024. Latent class growth modeling (LCGM) and growth mixture modeling (GMM) were employed to identify distinct PLT trajectory patterns relative to baseline levels within seven days postoperatively. Logistic regression was conducted to assess the association between PLT trajectory groups and postoperative adverse events. The Kaplan-Meier survival analysis was performed to evaluate the occurrence of adverse events within 30 days postoperatively, and the log-rank test was employed for comparsion between groups.

A total of 1 911 patients were included, comprising 1 602 males and 309 females, with a mean age of (71.37±9.32) years. LCGM combined with GMM identified four distinct PLT trajectory groups: severe decline group (n=114), moderate decline group (n=492), mild decline group (n=1 141), and increase (n=164) group. After adjusting for confounding factors, logistic regression confirmed that patients in the severe decline group (OR=2.23, 95%CI:1.34-3.69) and moderate decline group (OR=1.81, 95%CI:1.34-2.46) had a significantly increased risk of adverse events compared with the mild decline group, while no significant difference was observed in the increase group (P>0.05). Kaplan-Meier survival analysis demonstrated that, compared with the mild decline group, both the severe decline group (log-rank χ²=27.65, P<0.001) and the moderate decline group (log-rank χ²=22.97, P<0.001) had a significantly higher risk of adverse events [30.7% (35/114) and 22.4% (110/492) vs 13.7% (156/1 141)].

The dynamic trajectories of PLT following EVAR exhibit significant heterogeneity, patients with a moderate or severe postoperative decline in PLT count had a significantly increased risk of adverse events.

To construct a risk prediction model for cryptogenic stroke (CS) secondary to right-to-left shunt (RLS) caused by patent foramen ovale (PFO) in young people using combined transthoracic echocardiography with contrast (cTTE) and transesophageal echocardiography (TEE), and to explore its predictive efficacy.

A retrospective analysis was conducted on clinical data from young patients diagnosed with RLS due to PFO by cTTE and TEE at Xiangya Third Hospital of Central South University between January 2016 and November 2024. Patients were divided into stroke and non-stroke groups based on whether they had CS. cTTE and TEE parameters were compared between the two groups. Multivariate logistic regression was used to identify the relevant factors of CS occurrence, and a predictive model was constructed with a nomogram. Internal validation was performed using the bootstrap method with 1 000 resamplings. Model performance and clinical utility were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

A total of 82 patients were included, including 38 males and 44 females, aged [M(Q₁, Q₃)] 20 (17, 22) years. There were 37 cases in the stroke group and 45 cases in the non-stroke group. No statistically significant differences in age or gender were observed between the two groups (all P>0.05). Multivariate logistic regression analysis revealed that a larger left atrial opening diameter of the PFO during the Valsalva maneuver on cTEE (OR=3.880, 95%CI: 1.005-14.982) and a longer PFO tunnel length (OR=1.311, 95%CI: 1.042-1.649) were risk factors for CS. Conversely, a smaller PFO-inferior vena cava angle (OR=0.821, 95%CI: 0.726-0.928) was identified as a protective factor against CS. Based on these findings, a predictive model was developed and visualized as a nomogram. The area under the curve (AUC) of the modeling group was 0.928 (95%CI: 0.873-0.983), and the AUC of the internal validation group was 0.932(95%CI: 0.870-0.976). The calibration curve and clinical decision curve showed good consistency and benefit of the model.

The risk prediction model constructed using multimodal ultrasound in young PFO with RLS patients has a certain predictive value for the risk of CS occurrence.

To investigate the 50% effective dose (ED₅₀) and the 95% effective dose (ED₉₅) of remimazolam combined with oxycodone to inhibit the response of modified nasopharyngeal airway insertion for hysteroscopic surgery in female patients of different ages. Female patients aged 25-75 years who underwent hysteroscopic surgery with American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅲ were prospectively enrolled from Beijing Tongren Hospital Affiliated to Capital Medical University from December 2023 to February 2024. All patients were divided into young and middle-aged group (25-<60 years old) and elderly group (≥60 years old). During the induction of anesthesia, atropine 0.2 mg, dexamethasone 5 mg, and oxycodone 0.1 mg/kg were injected intravenously in sequence. Three minutes later, remimazolam was injected intravenously. Once the eyelash reflex disappeared and Patient State Index (PSI)<50, a well-lubricated modified nasopharyngeal airway was inserted through the nasal cavity. The modified Dixon sequential method was applied. When inserting the modified nasopharyngeal airway, the presence of coughing, shaking the head, swallowing, and body movement was considered positive, while the absence of these symptoms was considered negative. The initial doses of remimazolam in both groups were 0.3 mg/kg with a dose increase and decrease gradient of 0.01 mg/kg. The first dose for the young and middle-aged group and the elderly group was determined to be 0.28 mg/kg and 0.26 mg/kg respectively based on the insertion reactions. The ED₅₀, ED₉₅ and 95% confidence intervals (CI) for inhibiting the reaction of modified nasopharyngeal airway insertion when using remimazolam combined with oxycodone of the two groups were compared. The adverse events after the induction of anesthesia were recorded. A total of 28 cases in young and middle-aged group, aged (40.2±6.1) years, and 29 cases in the elderly group, aged (66.3±3.2) years, were included. The ED₅₀ of the young and middle-aged group was 0.284 (95%CI:0.274-0.293) mg/kg, which was higher than that of the elderly group at 0.260 (95%CI:0.244-0.273) mg/kg (P=0.002). The ED₉₅ of the young and middle-aged group was 0.303 (95%CI: 0.293-0.365) mg/kg, which was higher than that of the elderly group at 0.286 (95%CI: 0.273-0.430) mg/kg (P=0.003). There were no adverse events such as nasopharyngeal pain, dizziness, lethargy, nausea and respiratory depression. One patient in the elderly group had transient hypoxemia after induction of anesthesia, which improved after mandibular support. In this study, when remimazolam was combined with oxycodone, the ED₅₀ for inhibiting the response to the modified nasopharyngeal airway insertion for hysteroscopic surgery in young and middle-aged and elderly female patients was 0.284 and 0.260 mg/kg, respectively, and the ED₉₅ was 0.303 and 0.286 mg/kg, respectively. The difference should be noted in the clinical use of drugs.

This paper reports a case of focal segmental glomerulosclerosis associated with MYH9 gene mutation with normal platelet count. A 24-year-old male was admitted to hospital due to "hypertension for more than 7 years, elevated serum creatinine and proteinuria for half a year". He had no family history of kidney disease, and his blood routine was normal. The pathological diagnosis of renal biopsy was non-specific focal segmental glomerulosclerosis with ischemic kidney injury. The whole exon gene sequencing results showed MYH9: c.2095G>A (p.Glu699Lys) mutation, which was judged to be a suspected pathogenic mutation. His parents were wild-type. Electroaudiometric tests revealed high-frequency hearing impairment in both ears. Rituximab and supportive therapy were given. During follow-up, renal function was stable and urinary protein was relieved.

Psoriasis is a common systemic inflammatory disease, which seriously affects the quality of life of patients. In the past 20 years, the launch of different types of biological agents has significantly improved the treatment effect of psoriasis, but its logistics and storage require special conditions, and its use is mostly injection, which hinders the accessibility of drugs. Small molecule targeted drugs have emerged in recent years, and psoriasis treatment drugs that have entered the field of vision include Janus kinase (JAK) inhibitors [targeting JAK1, JAK2, JAK3, tyrosine kinase 2 (TYK2)] and phosphodiesterase 4 (PDE4) inhibitors, which have the advantages of low cost and convenient medication. There are not many small molecule targeted drugs for the treatment of psoriasis on the market so far, but it is reported that a variety of products are under development, such as oral interleukin (IL) -17A and IL-23 receptor inhibitors, Retinoic acid receptor-related orphan receptor (ROR) γ T reverse agonist, A3 adenosine receptor (A3AR) agonist, related clinical research has become a hot area. This article briefly summarizes the latest clinical trial evidence, medication experience and post-marketing monitoring data of various small molecule drugs related to psoriasis from 2023 to 2024, providing a basis for small molecule targeted therapy of psoriasis based on different clinical scenarios.