Objective To systematically analyze the characteristics of the disease burden of hypertensive heart disease (HHD) in the elderly (≥60 years) globally and in China from 1990 to 2021, and to predict its future trends from 2022 to 2040, with the aim of providing data support for optimizing comprehensive prevention and control strategies for HHD. Methods Based on the Global Burden of Disease (GBD) 2021 database, the number of prevalent cases and disability-adjusted life years (DALYs) of HHD in the elderly were extracted for the world, China, and five regions categorized by sociodemographic index (SDI). Joinpoint regression was used to analyze the temporal trends of age-standardized prevalence rate and age-standardized DALYs rate of HHD in the elderly. A three-factor decomposition method was applied to evaluate the relative contributions of aging, population growth, and epidemiological changes to the variations in the elderly HHD burden. Additionally, a Bayesian age-period-cohort model was used to predict the elderly HHD burden from 2022 to 2040. Results In 2021, the number of prevalent elderly HHD cases reached 10 283 000 globally and 3 412 400 in China, representing increases of 179.20% and 159.20% respectively, compared with 1990. The DALYs of elderly HHD were 18 812 700 person-years globally and 4 731 400 person-years in China, rising by 76.08% and 29.45% respectively from 1990. Meanwhile, the growth rates of the number of prevalent cases and DALYs of elderly HHD varied across different SDI regions. From 1990 to 2021, the age-standardized prevalence rate of elderly HHD in China, as well as the age-standardized DALYs rate of elderly HHD both globally and in China, showed significant downward trends (all average annual percentage changes<0, all P<0.001). In 2021, the 70-74 years age group accounted for the highest proportion of prevalent cases and DALYs of elderly HHD, both globally and in China. Decomposition analysis revealed that population growth was the dominant factor driving the increase in the elderly HHD burden across all regions. The prediction model results indicated that the number of prevalent cases and DALYs of elderly HHD would continue to rise globally and in China from 2022 to 2040, with the growth rate of the elderly HHD burden in China between 2021 and 2040 expected to exceed the global average. Conclusion Over the past 32 years, although the age-standardized disease rates of elderly HHD have mainly shown a downward trend globally and in China, the absolute number of the disease burden has increased substantially. The projection model indicates a continued upward trajectory, with the growth rate in China higher than the global average. Therefore, there is an urgent need to implement precise prevention and control strategies to effectively mitigate the disease burden of elderly HHD.

ObjectiveTo observe the clinical effectiveness and safety of Qingfei Shenshi Decoction （清肺渗湿汤） combined with western medicine for patients with bronchial asthma of heat wheezing syndrome， and to explore its potential mechanism of action. MethodsEighty-six participants with bronchial asthma of heat wheezing syndrome were randomly divided into treatment group and control group， each group with 43 participants. The control group received conventional western medicine， and the treatment group was additionally administered Qingfei Shenshi Decoction orally on the basis of the control group， 1 dose per day. Both groups were treated for 14 days. The primary outcome measure was clinical effectiveness； secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， asthma control test （ACT） score， pulmonary function indices such as forced expiratory volume in 1 second （FEV₁）， forced vital capacity （FVC）， peak expiratory flow （PEF）， serum inflammatory factor levels including interleukin-4 （IL-4）， tumour necrosis factor-α （TNF-α）， and high-sensitivity C-reactive protein （hs-CRP）， and immune function indices including CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺. All outcome measures were evaluated before and after treatment. Vital signs were monitored， and electrocardiography， blood routine， urine routine， liver function， and renal function tests were performed before and after treatment. Adverse events and reactions during the study were recorded. ResultsA total of 80 patients completed the trial with 40 in each group. The total clinical effective rate of the treatment group was 97.5% （39/40）， which was significantly higher than that of the control group （85.0%， 34/40， P＜0.05）. After treatment， both groups showed decreased TCM syndrome scores， IL-4， TNF-α， hs-CRP， and CD8⁺ levels， as well as increased ACT scores， CD3⁺， CD4⁺， CD4⁺/CD8⁺， FEV₁， FVC， and PEF levels （P＜0.05 or P＜0.01）. Moreover， the improvements in these indices were more significant in the treatment group than in the control group （P＜0.05 or P＜0.01）. No significant abnormalities in safety indicators were observed in either group， and no adverse events or reactions occurred. ConclusionQingfei Shenshi Decoction combined with conventional western medicine for patients with bronchial asthma of heat wheezing syndrome can effectively improve the clinical symptoms， pulmonary function， and clinical effectiveness， with good safety. Its mechanism may be related to reducing inflammatory factor levels and regulating T lymphocyte subsets to improve immune function.

Objective To elucidate the application scope and delineate the criteria of dobutamine stress echocardiography (DSE) in assessing surgical risk associated with valvular heart diseases in patients presenting with reduced left ventricular ejection fraction (LVEF). Methods This retrospective analysis encompassed data from patients with reduced LVEF (LVEF<40%) who underwent DSE prior to valvular heart surgery at the Valvular Surgery Center of Beijing Anzhen Hospital between May 2016 and September 2024. Patients were stratified based on the terminal dose of dobutamine into two cohorts: a limited dose group [receiving a maximum dobutamine dose of <5 µg/(kg·min) due to concomitant conditions such as suspected atrial thrombus, aortic dilation, or previous myocardial infarction] and a non-limited dose group (where dosage was adjusted to either achieve the maximum positive standard or the maximal dose tolerable by the patient). Within the non-limited dose group, patients were further classified into positive and negative response groups. The positive response post DSE was defined based on the following criteria: LVEF≥55% (the maximum positive standard), LVEF<55% but with a 5% improvement (the minimum positive standard) from resting situation, aortic maximum velocity (AVmax)≥400 cm/s, or mean pressure gradient (meanPG)≥40 mm Hg, latter two applicable only to patients with aortic stenosis. Clinical indicators were compared in the three groups. Results A total of 99 patients were enrolled, aged 35 to 87 years, with an average age of (61.7±10.1) years. The number of males was significantly higher than that of females (3:1). There were 61 (61.6%) patients undergoing aortic valve surgery, 25 (25.3%) undergoing mitral valve surgery, and 13 (13.1%) undergoing combined aortic and mitral valve surgery. Nineteen (19.2%) patients experienced adverse symptoms such as palpitations, head and face numbness, dizziness, chest tightness post DSE. Additionally, new-onset or aggravated ventricular premature ventricular contractions were in 40 (40.4%) patients. All above symptoms and signs resolved minutes after cessation of the test. No severe adverse events necessitating oxygen therapy or emergency intervention occurred. Among the 93 patients in the non-limited dose group, 86 were classified in the positive response group and 7 in the negative response group. The left ventricular end diastolic diameter, left ventricular end systolic diameter, and LVEF in the positive group all showed significant improvement compared to preoperative values, and were also significantly better than those in the negative group (P<0.05). All 7 patients with negative DSE results underwent interventional surgery, which was significantly different from the positive group (36 patients, 41.9%). In the limited dose group (n=6), 4 patients with a positive result or a positive trend on DSE underwent median sternotomy, 2 received interventional treatment due to a negative response. No significant differences in mortality were observed among the groups (P>0.05). Conclusion Dobutamine stress echocardiography significantly contributes to risk stratification in surgical interventions for patients with valvular heart disease complicated by reduced LVEF. It aids in determining optimal timing and methods for surgery. With comprehensive patient evaluation and controlled dobutamine dosing, the application of DSE can be safely expanded.

Objective To explore the effect and preliminary mechanism of the plant-derived immunostimulatory molecule,ophiopogonin,on enhancing the immune response of a subunit vaccine with the receptor-binding domain(RBD)of coronavirus spike protein as the antigen.Methods CCK-8 assay was used to determine the cytotoxicity of ophiopogonin D'(OPD')on bone marrow-derived dendritic cells(BMDCs).Female Balb/c mice were randomly divided into RBD,RBD/OPD',RBD/Alum,and control groups.The immunization dose was 5 μg of antigen per mouse and 100 μg of adjuvant per mouse,and immunization was carried out according to the intramuscular injection immunization procedure on days 0,21,and 42.The titers of specific IgG and its subtype antibodies were detected by ELISA.The cytokine levels in the supernatant of splenocytes were detected using ELISA.The number of splenocytes secreting IFN-γ was detected by ELISpot.Laser confocal microscopy was employed to observe the uptake of antigen by BMDCs.The phagocytic ability of BMDCs for antigen was quantitatively analyzed by flow cytometry.The mechanism of its enhanced immune effect was preliminarily explored using transcriptomics technology combined with bioinformatics research.Results When the concentration of OPD'was less than 5 μg/mL,the survival rate of BMDCs was 100%.After a single intramuscular injection in mice,except for a slight decrease in body weight,the other biochemical indicators were within corresponding normal ranges.After intramuscular injection immunization of the vaccine,the titers of serum-specific IgG,IgG1,and IgG2a in the RBD/OPD'group were significantly higher than those in the RBD group(P<0.05).Compared with the RBD group,the RBD/OPD'group induced a high-level Th1 cell immune response of IL-1β,TNF-α,and IFN-γ(P<0.01)and had more lymphocytes secreting IFN-γ(P<0.001).Laser confocal microscopy displayed that BMDCs took up more antigens after OPD'treatment,which was further confirmed with flow cytometry in quantitative analysis on antigen uptake rate(P<0.01).Transcriptomics results indicated that there was more significant enrichment of the PPAR signaling pathway in the RBD/OPD'group than the RBD group,suggesting that OPD'may activate the PPAR signaling pathway to exert its adjuvant effect.Conclusion OPD'effectively enhances the immune response of the RBD subunit vaccine,and its action mechanism may be related to the activation of the PPAR signaling pathway.

Objective To explore the feasibility of using the left inferior phrenic vein as an anatomical landmark and prioritizing the dissection of the central adrenal vein in retroperitoneal laparoscopic left adrenalectomy(RLLA).Methods 116 patients who had RLLA carried out in our hospital between January 2021 and December 2023 were chosen.They were separated into the experimental group(RLLA with the left inferior phrenic vein as an anatomical landmark and prioritizing the dissection of the central adrenal vein)and the control group[conventional three-layer method anatomic retroperitoneal laparoscopic adrenalectomy(RLA)],with 58 cases in each group.The clinical data of the two groups were compared,and the intraoperative and postoperative 24 h clinical indicators,stress indicators,immune function,and complications were evaluated.Results RLLA was successfully completed in two groups,and no cases were converted to open surgery.The operation time,time for searching the central vein,retention time of the drainage tube and postoperative hospital stay in the experimental group were significantly shorter than those in the control group.The intraoperative blood loss and postoperative drainage volume were significantly less than those in the control group,the differences were all statistically significant(P<0.05);There was no statistically significant difference in the recovery time of gastrointestinal function between the two groups of patients after surgery(P>0.05).There were no statistically significant differences in preoperative inflammatory factors,stress indicators and immune function indicators between the two groups of patients(P>0.05).The white blood cell(WBC),C-reaction protein(CRP)and interleukin-6(IL-6)of the two groups of patients 24 hours after the operation were significantly higher than those before the operation,but the experimental group was significantly lower than the control group,the differences were statistically significant(P<0.05).The malondialdehyde(MDA)of the two groups of patients 24 hours after the operation was significantly higher than that before the operation,while the superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)were significantly lower than those before the operation,and the MDA in the experimental group was significantly lower than that in the control group,and the SOD and GSH-Px were significantly higher than those in the control group(P<0.05).The levels of CD4+and CD4+/CD8+in experimental groups of patients 24 hours after the operation were significantly decreased than those before the operation,and the levels of CD3+,CD4+and CD4+/CD8+in the experimental group were significantly higher than those in the control group.The differences were statistically significant(P<0.05).There was no statistically significant difference in CD8+between the two groups of patients 24 hours after surgery(P>0.05).The number of cases with intraoperative blood pressure fluctuations in the experimental group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Neither peritoneal injury,renal pedicle vascular injury or retroperitoneal hematoma occurred during or after the operation in the two groups of patients.Conclusion In RLLA,using the left inferior phrenic vein as an anatomical landmark and prioritizing the dissection of the central adrenal vein is feasible,which can improve surgical indicators,reduce stress response and immune response,and have clinical application value.

Objective To enhance the mechanical properties of trichiral honeycomb sandwich structures and satisfy the design criteria for vertebral implant structures.Methods A chiral-like honeycomb sandwich structure with an auxiliary support structure was constructed for optimal design.The finite element method was used to study the influence of the auxiliary support structure on the chiral-like honeycomb sandwich structure and the relationship between the support position and mechanical property parameters.Furthermore,the influence of the deformation mechanism of different structures on mechanical properties was discussed.Results All chiral-like honeycomb sandwich structures exhibited enhanced mechanical properties in comparison to trichiral honeycomb sandwich structures.The mechanical properties of the chiral-like dCW honeycomb sandwich structure with the auxiliary support structure positioned perpendicular to the ligament were optimal,and this position represented the optimal support position.When the volume was used as a control variable,the compressive stiffness,stiffness-to-mass ratio,and transverse strain of the chiral-like honeycomb sandwich structure in the x1 direction were significantly correlated with the change of the support position,and all of them were positively correlated.Conclusions As a novel chiral-like honeycomb structure,it provides a biomechanical basis for the optimal design and clinical application of honeycomb sandwich structures as vertebral implant structures.

Objective To explore the distribution characteristics of common TCM syndromes in colorectal cancer;To provide a basis for standardized research on syndrome of colorectal cancer.Methods The literature related to TCM syndromes of colorectal cancer was retrieved from CNKI,Wanfang Data,VIP and SinoMed.Information on syndrome types and symptoms was extracted to establish a traditional Chinese medicine syndrome database for colorectal cancer.Frequency statistics were used to analyze distribution of colorectal cancer syndrome types and their symptom characteristics.Lantern 5.0 software was used to establish a latent structure model based on the LTM-EAS algorithm,and factor analysis and systematic clustering analysis were conducted using SPSS 27.0 software to infer potential patterns.Based on the results of comprehensive frequency statistics,systematic clustering and latent structure analysis,common TCM syndrome types and symptom characteristics of colorectal cancer were obtained.Results A total of 929 articles were included,totaling 2 465 syndrome items,involving 97 syndrome types,with high frequency of qi-blood deficiency syndrome,dampness and heat accumulation syndrome,spleen-kidney yang deficiency syndrome,etc.,and 281 symptoms,including abdominal distension,anorexia,abdominal pain and mental fatigue,etc.The latent structure analysis obtained 23 hidden variables,and 8 common syndromes were obtained according to professional knowledge.Factor analysis obtained 17 common factors,and further systematic cluster analysis inferred 9 potential syndrome types.Conclusion Common syndrome of colorectal cancer can be divided into 9 types,which are dampness and heat accumulation syndrome,blood stasis toxicity internal obstruction syndrome,qi stagnation and blood stasis syndrome,dampness and heat stasis toxicity syndrome,spleen deficiency and phlegm-dampness syndrome,spleen qi deficiency syndrome,qi and blood deficiency syndrome,liver-kidney yin deficiency syndrome,and spleen-kidney yang deficiency syndrome.The symptom characteristics of each syndrome are significant,which can provide reference for clinical differentiation and lay foundation for standardized research on syndrome.

Objective To enhance the mechanical properties of trichiral honeycomb sandwich structures and satisfy the design criteria for vertebral implant structures.Methods A chiral-like honeycomb sandwich structure with an auxiliary support structure was constructed for optimal design.The finite element method was used to study the influence of the auxiliary support structure on the chiral-like honeycomb sandwich structure and the relationship between the support position and mechanical property parameters.Furthermore,the influence of the deformation mechanism of different structures on mechanical properties was discussed.Results All chiral-like honeycomb sandwich structures exhibited enhanced mechanical properties in comparison to trichiral honeycomb sandwich structures.The mechanical properties of the chiral-like dCW honeycomb sandwich structure with the auxiliary support structure positioned perpendicular to the ligament were optimal,and this position represented the optimal support position.When the volume was used as a control variable,the compressive stiffness,stiffness-to-mass ratio,and transverse strain of the chiral-like honeycomb sandwich structure in the x1 direction were significantly correlated with the change of the support position,and all of them were positively correlated.Conclusions As a novel chiral-like honeycomb structure,it provides a biomechanical basis for the optimal design and clinical application of honeycomb sandwich structures as vertebral implant structures.

Malignant tumors represent a significant contributor to the increasing global burden of disease.Contemporary medical therapies often face challenges such as high recurrence rates and considerable adverse effects,making the exploration of more efficient and safer treatment strategies for cancer patients a current research priority.Traditional Chinese Medicine(TCM)has demonstrated unique value in oncology,exhibiting comprehensive advantages including multi-target effects,diverse active components,and low drug resistance,particularly in enhancing efficacy,reducing toxicity,improving prognosis,and elevating patients'quality of life.Through a literature review and based on the Cancer Toxin pathogenesis theory,this article systematically elaborates on the antitumor effects and underlying mechanisms of Qi-regulating and detoxifying Chinese medicines,aiming to provide new insights and scientific evidence for the TCM-based diagnosis and treatment of malignant tumors.

Objective To observe the effectiveness and safety of DiaSphere embolized microsphere TACE for treating primary hepatocellular carcinoma(HCC).Methods Totally 188 patients with HCC were prospectively enrolled and randomly assigned to research group(n=93)and control group(n=95),who underwent TACE with DiaSphere embolized microspheres and Embosphere embolized microspheres,respectively.The incidence of TACE-related adverse events were recorded.The therapeutic efficacy 1 month after the first TACE,also 1 and 3 months after the last TACE,and liver functions 1 month after the first and last TACE were compared between groups.Results In research group,there were 69 cases underwent 1 time TACE,22 cases underwent 2 times and 2 cases underwent 3 times TACE,while in control group,there were 82 cases underwent 1 time and 13 cases underwent 2 times TACE,respectively.No statistical difference of the incidence of adverse events was found between groups(77.42%[72/93]vs.76.84%[73/95],P=1.000).One month after the first TACE,7 cases in research group and 11 cases in control group were lost to follow-up,respectively.One month after the last TACE,12 cases were lost to follow-up in both groups,and 3 months after the last TACE,28 cases were lost to follow-up in both groups.No significant difference of objective response rate nor disease control rate was found between groups at the above time points(all P＞0.05).One month after the first and last TACE,liver function indicators were not different between groups(all P＞0.05).Conclusion Both the short-term efficacy and safety of TACE with DiaSphere embolized microspheres for treating HCC were good.