Objective To analyze the disease burden trend of non-rheumatic degenerative mitral valve disease (NR-DMVD) in China from 1990 to 2023 and compare it with global levels and those in the United States and India. Methods Based on the Global Burden of Disease (GBD) 2023 database, data on incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for NR-DMVD were extracted. Joinpoint regression, decomposition analysis, and autoregressive integrated moving average model (ARIMA) were used to analyze trends, drivers, and project burden to 2040. Results In 2023, China's age-standardized DALY rate (2.56/100 000) and mortality rate (0.037/100 000) for NR-DMVD were significantly lower than those in the United States, India, and globally, while its age-standardized incidence rate (10.39/100 000) and prevalence rate (126.03/100 000) showed slow increases. From 1990 to 2023, the estimated annual percentage changes (EAPC) for China's age-standardized DALY rate and mortality rate were –2.11% [95%CI (–2.25%, –1.98%)] and –4.54% [95%CI (–4.92%, –4.16%)], respectively, while the incidence rate and prevalence rate continued to rise; India showed increasing trends in all burden indicators. Decomposition analysis indicated that population aging was the primary driver of the increase in DALYs and prevalence cases, while epidemiological improvement was the key factor that led to the reduction in the number of deaths. Joinpoint analysis showed that China's age-standardized DALY rate declined most rapidly between 2000 and 2013, while the age-standardized mortality rate decreased fastest between 2007 and 2013. ARIMA models projected that China's prevalence rate would continue to rise and mortality rate would continue to decline through 2040. Conclusion NR-DMVD in China exhibits a dual-track pattern of "declining mortality but rising prevalence", driven by population aging. A tiered prevention and control system focusing on the elderly and high-risk male groups is needed.

Objective To evaluate the reporting quality and influencing factors of patient-reported outcome (PRO) data in randomized controlled trials (RCTs) of lung cancer. Methods RCTs of lung cancer with PRO as either primary or secondary endpoints were searched from PubMed, EMbase, Medline, CNKI, Wanfang Data, and VIP databases between January 1, 2010 and April 20, 2024. Reporting quality of included RCTs were assessed based on the CONSORT-PRO extension. Descriptive statistics and bivariate regression analysis were used to describe the reporting quality and analyze the factors influencing the reporting quality. Results A total of 740 articles were retrieved. After screening, 53 eligible RCTs of lung cancer with 22 780 patients were included. The patients were mainly with non-small cell lung cancer (84.91%), with the median sample size of the included studies was 364.0 (160.5, 599.5) patients. The primary PRO tool used was the EORTC QLQ-C30 (60.38%). There were 52 (98.11%) studies whose PRO measured the domain of "symptom management of cough, dyspnea, fatigue, pain, etc.", and 45 (84.91%) studies measured "health-related quality of life". Multicenter studies accounted for 84.91%, and randomized non-blind trials accounted for 62.26%. PRO was used as the primary endpoint in 33.96% of the studies and as secondary endpoints in 66.04%. The reliability and validity of the PRO tools were explicitly mentioned in 11.32% and 7.55% of the studies, respectively. The average completeness of reporting according to the CONSORT-PRO guidelines was 60.00%, ranging from 25.00% to 93.00%. The main factors affecting the completeness of CONSORT-PRO reporting included sample size and publication year. For every increment in sample size, the completeness of reporting increased by 27.5% (SE=0.00, t=2.040, P=0.046). Additionally, studies published after 2018 had a 67.2% higher completeness of reporting compared to those published in or before 2018 (SE=17.8, t=–3.273, P=0.006). Conclusion The study reveals that the overall reporting quality of PRO in lung cancer RCTs is poor. Particularly, the reporting of PRO measures reliability and validity, PRO assumptions, applicability, and handling of missing data need further improvement. Future research should emphasize comprehensive adherence to the CONSORT-PRO guidelines.

Objective To construct the animal model,and to study the expression and clinical signifi-cance of YKL-40 in the progress of chronic renal failure complicating cardiac dysfunction.Methods C57BL/6N mice were chosen as the experimental subjects and divided into the blank control(BC)group,renal failure(RF)group,heart failure(HF)group and renal combined heart failure group.The renal failure model was constructed by adenine perfusion.The heart failure model was constructed by subcutaneous injection of isopro-terenol.The renal failure and heart failure group model was established by adenine perfusion combined with subcutaneous injection of isoproterenol.The validity of constructed models was evaluated by creatinine(SCr),urea nitrogen(BUN)and BNP levels,renal ultrasound and ultrasonic cardiogram examination results.The levels of C-reactive protein(CRP)and YKL-40 were detected by ELISA,and the YKL-40 mRNA expression level in kidney and heart tissues was measure by RT-qPCR.The Image J software was used to calculate the collagen fiber area of the Masson staining results.Results Except the blank control group,the mice weights in the other 3 groups were decreased,and the differences were statistically significant(P＜0.05).SCr,BUN,average renal cross sectional area,average renal volume and renal CVF in the renal failure group and renal combined heart failure group were higher than those in the blank control group and heart failure group(P＜0.05).The levels of LVEF,LVCO,LVSV,LVFS,LVPWd and LVPWs in the heart failure group and renal combined heart failure group were lower than those in the blank control group and renal failure group(P＜0.05).LVEF and LVFS in the renal combined heart failure group were higher than those in the heart failure group(P＜0.05).Compared with the blank control group,the serum CRP and YKL-40 levels in the other three groups were higher(P＜0.05);the CRP and YKL-40 levels in the renal combined heart failure group were higher than those in the renal failure group and heart failure group(P＜0.05).In the myocardial tis-sues,the YKL-40 mRNA expression level in the heart failure group and renal combined heart failure group was higher than those in the blank control group and renal failure group(P＜0.05).YKL-40 had the correla-tion with CRP(r=0.88,P＜0.05).Serum YKL-40 had the correlation with renal tissue YKL-40 gene expres-sion(r=0.77,P＜0.05),and had the correlation with the renal tissue CVF(r=0.89,P＜0.05).Conclusion YKL-40 has the influencing effect on renal failure complicating heart dysfunction,and could serve as the biomarker to mo-nitor the renal insufficiency complicating heart function abnormality.

Objective To investigate the current status of cardiovascular nurses in intake and output recording of heart failure patients,and to provide a basis for further standardizing these practices.Methods A convenience sampling method was used to survey 7,761 cardiovascular nurses from 31 provinces in China in May 2024 using a self-designed questionnaire.The survey content included the content and methods of recording fluid intake and output,methods of liquid measurement,health education for patients and caregivers,and verification of the accuracy of fluid intake and output records.The chi-square test was used for comparison between groups.Results A total of 7,726 valid questionnaires were collected,with an effective response rate of 99.55％.Solid food(85.00％)and insensible water loss such as sweat(59.63％)were the lowest proportion items in the recording of intake and output,respectively.A total of 6,343 nurses(82.10％)reported that their wards had standardized"intake and output record forms".A total of 3,782 nurses(48.95％)were able to use graduated measuring cups to quantify water intake,and 3,587 nurses(46.43％)could use a"food water content table"to convert the water content of solid foods.Additionally,5,050 nurses(65.36％)involved patients and caregivers in the recording of intake and output,and 5,419 nurses(70.14％)provided health education on intake and output recording to patients and caregivers.Furthermore,4,753 nurses(61.52％)verified the accuracy of the 24-hour intake and output records after completion.Nurses whose wards regularly provided training on intake and output recording,as well as those whose wards included the accuracy of intake and output recording in quality control,demonstrated better practice outcomes in this regard(P＜0.001).Conclusion The current clinical nursing practice of cardiovascular nurses in recording the intake and output of heart failure patients needs improvement.Relevant academic organizations should further refine the standards related to intake and output recording.Medical institutions should focus on strengthening training and quality control,optimizing clinical operation procedures,and providing material,institutional,and human resource support to improve the accuracy of fluid intake and output recording for heart failure patients and ensure patient safety.

Childhood tumors pose a significant threat to the health of children.Compared with adult tumors,childhood tumors have unique biological characteristics and clinical outcomes.These tumors affect the growth and development and quality of life of children and increase the burden on families and society.This article summarizes the research updates on the epidemiological characteristics,risk factors,detec-tion methods,and treatment strategies of childhood tumors.Owing to differences in medical and public health systems across regions with a varying socio-demographic index(SDI),childhood tumors tend to have a relatively high incidence in high SDI regions and relatively high mor-tality in low SDI regions.Meanwhile,the rapid development of genomics and immunology has provided important technical support for pre-cision medicine in childhood tumors.This article provides a comprehensive review from the perspective of graded prevention,providing sci-entifically valid theoretical references and practical directions to improve the prevention and control system of childhood tumors.

Objective To systematically evaluate the factors that promote and hinder exercise in frail older adults,and to provide references for the formulation of exercise intervention programs.Methods We searched PubMed,Web of Science,Embase,CINAHL,Cochrane library,CNKI,Wanfang,VIP database,and China Biomedical Literature Database for qualitative studies on exercise facilitators and hindrances in frail older adults,and the search time period was from the establishment of the databases to September 1,2024.The quality of the literature was evaluated using the Joanna Brigg Institute Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research(2016),and the results were integrated by integrating methods.Results A total of 18 studies were included,and 72 research results were extracted,and 10 categories were summarized.The final synthesis included 2 integrated results:the facilitators included personal exercise motivation,physical and psychological benefits,positive interpersonal interactions,multiple social support systems and person-centred exercise programme;the impediments included underlying diseases and somatic functional limitations,negative psychological status,low health literacy,family role conflicts and limits of the environment.Conclusion Exercise for frail older adults is affected by a variety of factors.Healthcare professionals should improve the positive perception of exercise for frail older people and help them overcome psychological barriers;establish an all-round support system to enhance the sense of social contact of the frail elderly;formulate a personalised exercise programme with a human-centred approach to enhance the motivation of the frail elderly.

Objective:To investigate the prevalence of infertility and the factors affecting it in women of reproductive age in Qinghai Province.Methods:From July to December 2024, a multi-stage stratified cluster random sampling approach was used to recruit women aged 20-49 years in 10 districts across 8 cities in Qinghai Province for a questionnaire survey assessing the prevalence of infertility. Univariate and multivariate binary logistic regression analyses were then performed to identify factors associated with infertility in Qinghai Province.Results:A total of 3 925 questionnaires were distributed, with 3 837 valid responses ultimately collected. Preliminary screening identified 581 infertility cases, yielding an infertility rate of approximately 15.1%. Among these, 170 cases were primary infertility and 411 were secondary infertility, accounting for 29.26% and 70.74% of infertility cases, respectively. The highest infertility rate was observed in Yushu City, Yushu Prefecture, at 26.1% (71/272), followed by Chengxi District, Xining City at 25.3% (174/688). The lowest infertility rate was recorded in Delingha City, Haixi Prefecture, at only 2.9% (9/311). Univariate analysis revealed that household registration status ( P<0.001), age ( P=0.016), age at marriage ( P=0.001), highest educational attainment ( P<0.001), per capita annual income ( P=0.001), body mass index (BMI, P=0.005), altitude ( P<0.001), age at menarche ( P=0.011), menstrual regularity ( P<0.001), menstrual cycle ( P=0.001), menstrual duration ( P<0.001), presence of blood clots ( P<0.001),whether the women smoking ( P=0.008), whether the women staying up late ( P=0.022), and whether the husband staying up late ( P<0.001) were independent factors for infertility. Multivariate binary logistic regression analysis revealed that non-agricultural household registration ( OR=1.637, 95% CI: 1.304-2.054, P<0.001), BMI≥24.0 kg/m2 ( OR=1.326, 95% CI: 1.077-1.632, P=0.008), age at menarche >14 years ( OR=1.405, 95% CI: 1.158-1.705, P=0.001), irregular menstrual cycles ( OR=1.512, 95% CI: 1.127-2.029, P=0.006), menstrual cycle <21 d ( OR=1.572, 95% CI: 1.237-1.998, P<0.001), menstrual duration <7 d ( OR=2.080, 95% CI: 1.529-2.831, P<0.001), and smoking ( OR=2.359, 95% CI: 1.056-5.271, P=0.036) were independent risk factors for infertility. Age and altitude were not independent risk factors for infertility in Qinghai Province. Conclusion:The prevalence of infertility in Qinghai Province is approximately 15.1%. Non-agricultural household registration, BMI≥24.0 kg/m2, age at menarche >14 years, irregular menstrual cycles, menstrual cycle <21 d, menstrual duration <7 d, and smoking are factors influencing infertility, while high altitude does not increase the risk of infertility among women in Qinghai Province.

Colorectal cancer is the third leading cause of cancer-related mortality worldwide.Hepatic resection is the standard treatment for colorectal cancer liver metastasis.Microwave ablation(MWA),as a minimally invasive therapeutic approach,offers an alternative treatment option for these patients.But the clinical efficacy of hepatic resection and MWA in treating colorectal cancer liver metastasis patients is still inconclusive.Literatures were retrieved on comparative studies about the treatment of colorectal cancer liver metastasis with hepatic resection and MWA from multiple databases,including sinoMed,PubMed,Web of Science,EMBASE,CNKI,Wanfang,etc.The cutoffdate of retrieval was September 2024.Finally,a total of 13 studies comprising 2 057 patients,were included in this study.The papers were assessed using the Newcastle-Ottawa Scale and Jadad Scale.All included studies were of high quality.Data extraction focused on postoperative complications,length of hospital stay,surgical duration,hospitalization costs,and patient survival outcomes,including overall survival(OS)and disease-free survival(DFS).A meta-analysis was performed using Review Manager 5.4 software.There were no significant differences in OS(HR=1.03,95%CI:0.85-1.25,P=0.77)and DFS(HR=1.27,95%CI:0.94-1.71,P=0.13)between the MWA group and the hepatic resection group.In the subgroup analysis of patients with≤5 liver metastases and size of metastases≤3 cm,there were no statistically significant differences in OS and DFS between the MWA group and the hepatic resection group.The MWA group exhibited shorter hospital stay,reduced hospitalization costs,decreased surgical duration,less intraoperative blood loss,and lower incidence of complications compared to the hepatic resection group(P＜0.05).Therefore,for patients with colorectal liver metastases characterized by a number of liver metastases≤5 and size of metastases≤3 cm,MWA serves as an effective alternative to hepatic resection,with a lower morbidity associated with treatment.Further validation of these findings is warranted through additional randomized controlled trials and cohort studies.The registration number of this Meta-analysis on the PROSPERO platform is CRD42024610278.

Objective To systematically evaluate the factors that promote and hinder exercise in frail older adults,and to provide references for the formulation of exercise intervention programs.Methods We searched PubMed,Web of Science,Embase,CINAHL,Cochrane library,CNKI,Wanfang,VIP database,and China Biomedical Literature Database for qualitative studies on exercise facilitators and hindrances in frail older adults,and the search time period was from the establishment of the databases to September 1,2024.The quality of the literature was evaluated using the Joanna Brigg Institute Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research(2016),and the results were integrated by integrating methods.Results A total of 18 studies were included,and 72 research results were extracted,and 10 categories were summarized.The final synthesis included 2 integrated results:the facilitators included personal exercise motivation,physical and psychological benefits,positive interpersonal interactions,multiple social support systems and person-centred exercise programme;the impediments included underlying diseases and somatic functional limitations,negative psychological status,low health literacy,family role conflicts and limits of the environment.Conclusion Exercise for frail older adults is affected by a variety of factors.Healthcare professionals should improve the positive perception of exercise for frail older people and help them overcome psychological barriers;establish an all-round support system to enhance the sense of social contact of the frail elderly;formulate a personalised exercise programme with a human-centred approach to enhance the motivation of the frail elderly.

Intricate nature of Immunology teaching,characterized by diverse cellular types,complex molecular mechanisms,and highly dynamic immune responses,poses significant challenges.Utilization of artificial intelligence(AI)technology to provide personalized learning pathways and resources for Immunology education has emerged as a critical direction in contemporary educational reform.By examining current domestic application status and specific teaching practices,this article explores gap between AI technology and traditional teaching theories,analyzes issues such as deep integration and transformation of teacher's role.Special attention is also given to ethical considerations,including privacy protection,fairness and accessibility,and ethical implications of data processing.In response to these issues,authors propose a set of comprehensive recommendations,including establishing a student-centered learning model,strengthening teaching staff capabilities,improving privacy protection and algorithmic transparency,promoting educational equity,and reinforcing ethical education,aiming to support healthy and sustainable development of AI technology within Immunology education,offering valuable insights for reform and innovation of Immunology education.