Objective: To analyze the disease burden of chronic obstructive pulmonary disease (COPD) and changes in its risk factors among residents in Zhejiang Province from 1990 to 2021, so as to identify key priorities for COPD prevention and control. Methods: Data on COPD mortality and disability-adjusted life years (DALY) for residents in Zhejiang Province from 1990 to 2021 were collected from the Global Burden of Disease (GBD) 2021 database. Standardized mortality and standardized DALY rate were calculated using the GBD 2021 world population standard structure. Premature mortality was computed via the life table method. The average annual percent change (AAPC) was applied to analyze trends in COPD mortality, DALY rate, and premature mortality. Changes in deaths of COPD risk factors were evaluated using population attributable fraction (PAF). Results: From 1990 to 2021, the standardized COPD mortality in Zhejiang Province decreased from 272.40/100 000 to 70.56/100 000 (AAPC=-4.395%), and the standardized DALY rate declined from 4 167.37/100 000 to 1 071.89/100 000 (AAPC=-4.396%). Similar downward trends were observed in both males (AAPC=-3.933%, -4.173%) and females (AAPC=-4.785%, -4.480%), all P<0.05. Crude mortality and DALY rates increased with age, and the crude mortality and DALY rates of various age groups in Zhejiang Province showed decreasing trends from 1990 to 2021 (all P<0.05). The premature mortality declined from 4.37% to 0.60% from 1990 to 2021 (AAPC=- 6.206%), with consistent trends across males and females (AAPC=- 6.144%, - 6.379%, all P<0.05). From 1990 to 2021, particulate matter pollution showed the largest reduction in PAF (- 56.76%), while ambient ozone pollution had the largest increase (103.07%) in Zhejiang Province. By 2021, smoking became the leading risk factor for deaths of COPD (PAF=43.32%). Conclusions The standardized mortality, standardized DALY rate, and premature mortality for COPD show consistent declining trends in Zhejiang Province from 1990 to 2021. However, risk factors such as smoking and ambient ozone pollution require intensified focus to further reduce disease burden of COPD.

Retinal vein occlusion(RVO)is the second most common blinding retinal vascular disease, and its secondary macular edema(ME)is an important cause of visual function impairment in patients. Intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs serves as the first-line treatment, yet it is confronted with such issues as the need for repeated injections and non-response in some patients. Imaging and laboratory biomarkers play a crucial role in the early accurate diagnosis, prediction of disease progression, and evaluation of visual prognosis of RVO-ME. This study systematically reviews the research progress of imaging and laboratory biomarkers related to the prognosis of RVO-ME after anti-VEGF treatment in recent years, covering imaging biomarkers like central retinal thickness and ellipsoid zone integrity, as well as laboratory biomarkers such as serum APLN and aqueous humor IL-6. It summarizes the associations between different biomarkers and the prognosis of anti-VEGF therapy, aiming to provide a basis for the early accurate assessment and optimization of individualized treatment for RVO-ME patients, which holds significant clinical reference value.

Objective:To analyze the safety and efficacy of single percutaneous vertebroplasty (PVP) in the treatment of multi-segment osteolytic spinal metastases.Methods:A retrospective analysis was conducted on 113 patients with multi-segment osteolytic spinal metastases treated with PVP at Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2019, including 50 males and 63 females. The age ranged from 47 to 85 years, with a mean of (66.9±1.52) years. Patients were divided into two groups based on the number of affected vertebrae undergoing surgery: the conventional surgery group ( n=72), with a maximum of three vertebral bodies undergoing PVP during each surgery; the multivertebral surgery group ( n=41), received PVP on more than three vertebral bodies in one surgery. Visual analogue scale(VAS) of pain, Oswestry disability index (ODI), general health status (GH), and mental health status (MH) were assessed before and after PVP to evaluate the efficacy of the procedure. Complications of the patients were systematically assessed to evaluate safety. Measurement data was expressed as mean±standard deviation( ± s), independent sample t-test was used for inter-group comparison, and paired sample t-test was used for intra-group comparison; the comparison of count data was conducted using Chi-square test. Results:After 6 months of surgery, the ODI score, GH score and MH score of the conventional surgery group was (35.28±1.74)%, 57.85±2.11 and 61.20±3.67, all of which improved significantly compared to before surgery, and the difference was statistically significant ( P<0.05). After 6 months of surgery, the ODI score, GH score and MH score of the multivertebral surgery group was (35.67±1.92)%, 64.12±1.35 and 59.80±3.81, all of which improved significantly compared to before surgery, and the difference was statistically significant ( P<0.05). There was no significant difference in ODI score and MH score between the two groups after 6 months of surgery ( P>0.05). At one week after surgery, the pain VAS score in the conventional surgery group (3.51±0.21) was lower than that in the multivertebral surgery group (3.98±0.32), and the difference was statistically significant ( P<0.05). GH score in the conventional surgery group showed significantly greater improvement than that in the multivertebral surgery group after 6 months of surgery, and the difference was statistically significant ( P<0.05). Bone cement leakage occurred in 21 vertebra of the conventional surgery group, and 24 vertebra of the multivertebral surgery group, with leakage rates of 14.8% and 13.0%, respectively, with no statistical significance between the two groups ( P>0.05). Conclusions:Single PVP surgery can safely and effectively alleviate the pain of multi-segment osteolytic spinal metastases and improve spinal mobility. Meanwhile, improving mental health and reducing functional impairments. But the short-term pain relief and long-term general health of the multivertebral surgery group were lower than those of the conventional surgery group.

Objective:To explore interspinous fusion capacity after interspinous distraction fusion (ISDF) device implantation, a preliminary biomechanical analysis and histological evaluation were performed.Methods:The experimental animals were procured from the Science and Research Laboratory Animal Center of Beijing Friendship Hospital, Capital Medical University. The animals were 8-9 weeks old and with an average weight of 25 kg. 15 mini-pigs were randomly divided into three groups, the sham operation group, the decompression group and the ISDF fixed decompression group, 5 animals per group. The sham operation group was treated with simple incision and exposed lamina suture. The decompression group received unilateral decompression and the ISDF fixed decompression group experienced unilateral hemilaminectomy decompression and ISDF fixation. The graft-bed site was filled with purified bone graft material without any autograft bone. After 6 months feeding, all experimental animals were sacrificed and the corresponding lumbar vertebrae was obtained. The samples were fixed on the spinal test system and the range of motion of flexion-extension, lateral bending and rotation were tested through a multiaxial robotic system. The ISDF device samples were embedded for hard tissue sections and stained with hematoxylin-eosin and toluidine blue to assess new bone formation. Normally distributed measurement data were expressed as mean±standard deviation( ± s), and independent samples t-test were used for comparisons between groups. Results:In comparison to the sham operation group, the decompression group exhibited a statistically significant increase in intervertebral mobility, with an average of 61.6% in anterior flexion, 44.7% in posterior extension, 65.0% in left lateral flexion, 49.6% in right lateral flexion, 83.8% in left rotation, and 64.2% in right rotation ( P<0.05). In comparison to the decompression group, the ISDF fixed decompression group exhibited a statistically significant decrease in intervertebral mobility, with an average of 40.0% in anterior flexion, 21.3% in posterior extension, 31.7% in left lateral flexion, 22.3% in right lateral flexion, 28.7% in left rotation, and 35.3% in right rotation ( P<0.05). Well-defined bone tissue can be observed in the histological images of ISDF fixed decompression group samples after 6 months. In the histological part, toluidine blue staining showed extensive new bone formation. The hyperchromatic osteoblasts cells and density bone tissue can be observed in hematoxylin-eosin staining slides. Conclusions:The implantation of ISDF provide the necessary stabilization for promoting fusion. The osteogenesis that occurs within graft-bed site of the ISDF device offers the possibility of interspinous fusion.

Aim To investigate the promotional effects of neutrophil extracellular traps(NETs)on renal tissue damage and intestinal flora disruption induced by dia-betic kidney disease(DKD)and the potential mecha-nisms.Methods C57BL/6 mice were divided into:control group(NC),DNase Ⅰ control group(DNase Ⅰ)diabetic nephropathy group(DKD),and DNase Ⅰ treated group(DKD+DNase Ⅰ).The pathological changes of mouse kidney were observed by PAS,MAS-SON,and HE staining.The expression and distribu-tion of the relevant proteins of NETs in renal tissue of the mice in each group were observed by immunohisto-chemistry.The expression and distribution of coke-death-related proteins in the kidney tissues of mice in each group were observed by immunohistochemistry.The protein expression of NETs-related indexes,focal death-related indexes and NF-κB signaling pathway-re-lated indexes in kidney tissue of mice in each group were detected by immunoblotting.Results The ex-pression of indicators related to NETs was elevated in the DKD group,and their expression decreased after degradation of NETs by DNase Ⅰ(P＜0.01).Patho-logical staining results showed that the kidneys of DKD mice were structurally abnormal,and the structure was improved after degradation of NETs by DNase Ⅰ.The results of immunohistochemical staining and immunob-lotting showed that the expression of pyroptosis-related proteins in kidney tissues of mice in the DKD group was elevated compared with that in the control group(P＜0.01).NF-κB-related signaling pathway protein expression profile expression rose,and its expression decreased after degradation of NETs by DNase Ⅰ(P＜0.01)Conclusions NETs are generated in diabetic nephropathy and promote the onset of renal focal death and activation of the NF-κB signaling pathway,thereby exacerbating diabetes-induced kidney injury.

Deep sternal wound infection (DSWI) is one of the potential and catastrophic complications after cardiac surgery. Despite the use of smaller incisions, routine application of prophylactic antibiotic and optimized blood glucose management, the incidence rate of DSWI still fluctuates between 1% and 5%. The early symptoms and signs of DSWI are not often obvious, making it too late for the clinicians to intervene in the process. Once left untreated, DSWI carries a very high mortality rate. Therefore, early prevention, diagnosis, and appropriate management of DSWI are crucial in preventing its progression to life-threatening outcomes. Considering the clinical severity and treatment complexity of DSWI, this article focuses on preventive experiences in each stage of DSWI, and reconstructive strategies after DSWI happens, raising attention among the medical community regarding DSWI.

Objective:To explore effect of Glioma-associated oncogene family zinc finger 1(GLI1)on hypoxia induced trans-formation of NR8383 to M1 phenotype and development of pulmonary hypertension(PH).Methods:Fifteen adult male Wistar rats were randomly divided into control group,hypoxia PH model group and hypoxic PH with GANT61 treatment group,with 5 rats in each group.PH related indexes of rats were detected by small animal ultrasound and right cardiac catheter experiment to determine effect of GLI1 specific inhibitor GANT61 on progression of PH.Pulmonary arterial thickness was measured by HE staining.α-SMA and M1 polarization markers TNF-α and IL-1β expressions were determined by immunohistochemistry.M1 polarization markers CD86 and TNF-α expressions were determined by immunofluorescence.GLI1 expression and NF-κB protein were detected by Western blot.mRNA expressions of iNOS,CD86,TNF-α,IL-1β and IL-12 were detected by qRT-PCR.CHIP-PCR verified that GLI1 regulates NF-κB promoter activity.IL-12 content was detected by ELISA.Rat pulmonary artery smooth muscle cells proliferation was detected by CCK-8.Results:GLI1 inhibitor GANT61 could alleviate symptoms of PH in hypoxic rats(P<0.05).Compared with hypoxic group,inhibition of GLI1 reduced expressions of TNF-α and IL-1β in rat lung tissue(P<0.05).In cell experiments,hypoxia induced M1 polarization of NR8383 by up-regulating GLI1 to activate NF-κB pathway,GLI1 overexpression increased expressions of iNOS,CD86,TNF-α,IL-1β and IL-12 in M1 macrophages(P<0.05).NR8383 culture supernatants could stimulate pulmonary artery smooth muscle cell proliferation(P<0.05)and contribute to development of PH.Conclusion:Hypoxia activates NF-κB pathway by up-regulating GLI1 to induce M1 polarization of macrophages contributes to development of PH.

Objective:To analyze the efficacy and influencing factors of cyclosporine(CsA)alone in the treatment of children with acquired aplastic anemia(AA).Methods:The clinical data of children diagnosed with AA and treated with CsA alone from January 1,2016 to December 31,2020 in the Children's Hospital of Chongqing Medical University were collected,and the efficacy and influencing factors of CsA treatment were evaluated.Results:Among the 119 patients,there were 62 male and 57 female,with a median age of 7 years and 1 month.There were 45 cases of very severe AA(VSAA),47 cases of severe AA(SAA),and 27 cases of non-severe AA(NSAA).At 6 months after treatment,the efficacy of VSAA was lower than that of SAA and NSAA,and there was a statistical difference(P＜0.01).6 cases died early,16 cases relapsed,2 cases progressed to AML and ALL.The results of univariate analysis showed that the high proportion of lymphocyte in the bone marrow at 6 months was an adverse factor for the efficacy of CsA,while high PLT count was a protective factor(P=0.008,P=0.002).The ROC curve showed that the cut-off values of PLT count and the proportion of bone marrow lymphocyte at 6 months were 16.5 × 109/L,68.5％,respectively.Multivariate analysis showed that the high proportion of lymphocyte in bone marrow at 6 months was an independent adverse factor for IST(P=0.020,OR=0.062),and high PLT count was a protective factor(P=0.044,OR=1.038).At 3 months of treatment,CsA response and NSAA were the risk factor for recurrence(P=0.001,0.031).Conclusion:The efficacy of NSAA was higher than that of SAA and VSAA after 6 months of treatment with CsA alone.A high PLT count at the initial diagnosis was a good factor for the effectiveness of CsA,and a high proportion of bone marrow lymphocyte was an unfavorable factor.CsA response at 3 months and NSAA were risk factors for recurrence.

Objective:To analyze the safety and efficacy of ultrasound-guided percutaneous thermal ablation treatment for multiple T1N0M0 papillary thyroid carcinoma(PTC)with over 5 years follow-up.Methods:From January 2014 to January 2019,a retrospective analysis was conducted on patients with multiple T1N0M0 PTC who underwent ultrasound-guided thermal ablation.Patients with bilateral or unilateral lobes with isthmus PTC were enrolled in this study and were followed up at 1,3,6,12,24,36,48,and 60 months after ablation.The clinical data,ultrasound characteristics and ablation parameters of recurrent and non-recurrent patients were compared,and the efficacy and influencing factors of thermal ablation for multiple T1N0M0 PTC were analyzed.Results:After over 5 years follow-up,a total of 11 patients(16.18％)relapsed,57 patients(83.82％)did not re-lapse.No lymph node and distant metastasis were found.No significant correlation was detected between the recurrence and clinical features,ultrasound findings and ablation parameters(P＞0.05).Among the patients with recurrence,1 patient underwent observation,2 patients underwent total thyroidectomy,and the other 8 patients successfully underwent secondary ablation,all of which had no obvious adverse reactions.Conclusion:The ablation of multiple PTC in T1N0M0 stage is safe and effective,with a recurrence rate of 16.18％over 5 years follow-up,and ablation has no effect on second treatment for recurrent patients.

Objective: Surgical procedures for patients with posttraumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery. Methods: We consecutively enrolled PTS patients (arachnoid lysis group, n = 42; shunting group, n = 14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal magnetic resonance imaging preoperatively, 3–12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and blood-spinal cord barrier disruption was detected by quotient of albumin (Qalb, cerebrospinal fluid/serum). Results: The ages (p = 0.324) and sex (p = 0.065) of the PTS and control groups did not differ significantly. There were also no significant differences in age (p = 0.216), routine blood data and prognosis (p = 0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (p < 0.001), and the shunting group had a significantly higher QAlb (p < 0.001) than the arachnoid lysis group. A high preoperative QAlb (odds ratio, 1.091; 95% confidence interval, 1.004–1.187; p = 0.041) was identified as the predictive factor for the shunting procedure, with the receiver operating characteristic curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67. Conclusion Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb > 12.67, shunting represents the final recourse, necessitating the exploration and development of novel treatments for these patients.