ObjectiveTo analyze the trend of stroke mortality among residents in Handan City of Hebei Province from 2017 to 2023, to evaluate the impact of this mortality on life expectancy, and to provide data support for formulating stroke prevention and control strategies. MethodsStroke mortality surveillance data were collected in Handan City from 2017 to 2023. The crude mortality rate, standardized mortality rate, gender-specific mortality rate, and subtype-specific mortality rate of stroke were calculated. The average annual percentage change (AAPC) was used to analyze the trend of stroke mortality. Arriaga’s decomposition method was used to estimate the influence of stroke mortality on life expectancy across all age groups and different stroke subtypes. ResultsThe standardized mortality rate of stroke in Handan City fluctuated from 63.51/100 000 to 103.54/100 000 from 2017 to 2023, showing a significant decreasing trend (AAPC=-7.46%, P<0.001). The changes in stroke mortality positively contributed 0.94 years to life expectancy growth. The positive contribution from the 65 to 69 years old group was the greatest, with a contribution of 0.23 years. The declines in the mortality rates of hemorrhagic stroke, ischemic stroke and unclassified stroke contributed 19.94%, 14.61% and 0.44% to life expectancy, respectively. The positive contribution in the 65 to 69 years old group was the greatest, with a contribution of 4.90% and 3.57% for hemorrhagic stroke and ischemic stroke, respectively. The 85 years old and above group made the greatest positive contribution to life expectancy for unclassified stroke, with a contribution of 0.08%. ConclusionThe standardized mortality rate of stroke in Handan City showed a declining trend from 2017 to 2023, which positively contributed to the increase of life expectancy. However, it is still recommended to strengthen the prevention and control of stroke, especially for men and people aged 60 years old and above. At the same time, attention should also be paid to the impact of different factors influencing hemorrhagic stroke and ischemic stroke on life expectancy.

Percutaneous coronary intervention(PCI),as one of the primary approaches for revascularization,still faces complications such as restenosis,myocardial ischemia-reperfusion injury and no-reflow/slow-flow phenomena,with no currently effective interventions ensuring long-term efficacy.Based on Li Dongyuan's theory that"fire and original qi cannot coexist",this article inherited Academician Chen Keji's academic perspective on"toxin-stasis pathogenesis"and the hemodynamic characteristics of coronary arteries to propose a"four-stage pathological progression"in post-PCI patients,namely spleen-stomach impairment-original qi deficiency-endogenous yin-fire-toxin-stasis accumulation.It emphasized that the heart vessels rely on qi and blood for nourishment and patency for function,elucidated the therapeutic rationale of Danggui Buxue Decoction,and presented the self-formulated Yixin Hemai Prescription,modified through syndrome differentiation,and performed simultaneous reinforcement and dredging,in order to provide diagnosis and treatment ideas for coronary heart disease after PCI treated with TCM.

Objective:To explore the relationship between life events, anxiety, depression, and behavior problems in adolescents.Methods:From September to October 2022, the cluster sampling method was used to select 5 341 adolescents from 4 middle schools in Xinxiang urban area.The subjects and their parents were investigated by the adolescent self-rating life events check list (ASLEC), generalized anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9), and child behavior checklist (CBCL). SPSS 27.0 software was used for Spearman correlation analysis, and AMOS 28.0 software was used to construct the structural equation model.Results:The scores of anxiety, depression, and behavioral problems were 1 (0, 4), 1 (0, 4), and 3 (0, 10). The total score of life events was 5 (1, 13), and the dimensions scored as follows: interpersonal conflict 1 (0, 4), academic pressure 2 (0, 5), punishment 0 (0, 2), loss 0 (0, 0), health and adaptation problem 0 (0, 1), and others 0 (0, 2). There were positive correlations between life events and its dimensions, depression, anxiety and behavioral problems ( r=0.28-0.69, all P<0.01). In the overall population, anxiety and depression played parallel mediating roles in the impact of life events on behavior problems. Life events could positively predict anxiety ( β=0.68, P<0.01), and anxiety could positively predict behavior problems ( β=0.04, P=0.02). Life events could positively predict depression ( β=0.77, P<0.01), and depression could positively predict behavior problems ( β=0.18, P<0.01). The standardized total effect size of the impact of life events on behavioral problems was 0.622 (95% CI=0.564-0.675). The standardized direct effect size and indirect effect size were 0.460 (95% CI=0.374-0.539) and 0.162 (95% CI=0.108-0.218), accounting for 74.0% and 26.0%of the total effect, respectively. After stratification by gender, the results for male adolescents were consistent with the overall population, while the mediating effect of anxiety was not significant in the female adolescents. Conclusion:Life events can lead to anxiety and depression in adolescents, thereby increasing the risk of behavior problems.

Objective:To examine the spatial and temporal distribution characteristics of first-time callers with suicidal ideation and risk factors related to suicidal ideation in a psychological assistance hotline in Henan Province.Methods:The computerised counselling operating system of the Henan Provincial Psychological Assis-tance Hotline was used to extract data from 31 401 callers who called the hotline between January 2020 and October 2023.A circular distribution and kernel density analysis were employed to investigate the spatial and temporal distri-bution of first-time callers with suicidal ideation.Binary logistic regression analysis was employed to investigate the risk factors for suicidal ideation.Results:A total of 5 494 first-time callers were included in the study,of whom 1 697(30.9％)reported suicidal ideation in the previous two weeks.The temporal distribution of suicidal ideation calls indicated a peak between 12:36 and 01:08.The weekly distribution further revealed that the majority of calls occurred on Fridays.In terms of spatial distribution,the primary hotspots for callers with suicidal ideation were clus-tered around Zhengzhou and Xinxiang.Meanwhile,the secondary hotspots exhibited a dispersed distribution across multiple centers within the province.Logistic regression analysis revealed that being under 20 years old(OR=11.85),being unemployed(OR=1.78),having psychological issues(OR=5.03),experiencing family relation-ship problems(OR=3.67),and facing economic hardships(OR=7.08)were risk factors for suicidal ideation.Conclusion:The time distribution of calls from individuals with suicidal ideation to the psychological as-sistance hotline in Henan Province exhibits a centralized trend,while the spatial distribution of calls demonstrates an imbalance.When receiving initial calls from individuals with suicidal ideation,particular attention should be paid to those aged 20 years old or younger,those who are unemployed,and those experiencing psychiatric,psychological,familial,and economic difficulties.

Platelets are well-known for their functions in blood clotting and vascular repair. However, in recent years, the regulatory role of platelets in the occurrence and development of malignant tumors has received significant attention. While extensive research has been conducted on the regulation of tumors by circulating platelets in peripheral blood, there is a lack of coherence and continuity among these studies. The tumor microenvironment encompasses the intricate network of cellular and acellular elements that surround and interact with tumor cells, creating a supportive ecosystem for their survival and growth. It plays a crucial role in the initiation and progression of tumors. Similar to dark matter in the universe, platelets, as tiny and enigmatic entities, play an essential role in tumor development and treatment within the tumor microenvironment. Although our current understanding of platelet regulation in the tumor microenvironment is limited, they hold immense untapped potential. In-depth studies on the tumor microenvironment have revealed platelets as a meaningful component, influencing various aspects of tumor development, metastasis, and immune evasion. Platelets, through the release of various bioactive substances or direct interaction with tumor cells, impact tumor progression while being influenced by the tumor in return. Therefore, understanding the role and mechanisms of platelets in the tumor microenvironment is of great importance for tumor prevention and treatment. This review provides a summary of the research progress on the interplay between platelets and tumors in the tumor microenvironment, and presents a promising outlook on the potential of platelets in tumor therapy.

Metastasis is a pivotal and intricate process in the progression of malignant tumors,strongly correlating with poor prognosis.Approximately 90%of cancer-related mortality is attributed to metastasis,with the five-year survival rate for patients with metastatic solid tumors ranging from 5%to 30%.Consequently,a comprehensive understanding of the underlying biological mechanisms driving metastasis is essential for unraveling its core processes and developing novel therapeutic strategies.The metastatic cascade involves tumor cells navigating numerous biological barriers,including detachment from the primary tumor,invasion of blood vessels or lymphatics,survival in circulation,extravasation into distant organs and subsequent adaptation to the microenvironment.To surmount these challenges,tumor cells undergo phenotypic changes,genetic mutations and dysregulating signaling pathways.Additionally,microenvironmental factors(such as angiogenesis,matrix remodeling and immune evasion)play a critical role,orchestrating the initiation and growth of metastatic lesions in an interdependent manner.Organ-specific metastasis,a distinct subset of metastasis,involves dynamic bidirectional interactions between tumor cells and the microenvironment of target organs.These interactions determine the selectivity of metastatic spread and drive the adaptive evolution of both the tumor and the organ,which encompasses multiple layers of cellular interactions,including cell-cell and cell-matrix signaling.Tumor cell mutations,the release of specific signaling molecules,the capacity to withstand circulatory pressures,and signaling exchanges with target organs collectively govern the selective nature of organ-specific metastasis.Furthermore,factors intrinsic to the target organ-such as its regenerative potential,metabolic profile,immune surveillance mechanisms and matrix stiffness-further facilitate the adaptive remodeling of metastatic cells within these environments.Thus,the bidirectional selection and adaptation between tumor cells and target organs form a dynamic,complex system that reshapes our understanding of metastatic tumor development.While current research emphasizes shared biological features in metastasis,the successful formation of metastatic tumors depends not only on these common mechanisms but also on the unique characteristics governing organ-specific metastasis.The interplay between generalizable and organ-specific mechanisms profoundly influences the metastatic outcome.This review aimed to consolidate our current knowledge of these shared and distinct processes,analyze the evolving understanding of the bidirectional selection between tumor cells and target organs,and assess the current status of metastatic risk prediction models for patients without metastasis.Furthermore,the paper discussed the challenges and opportunities in managing advanced-stage metastatic tumors,offering new insights and potential clinical strategies to improve prognosis and treatment outcomes.

The amino-terminal pro-C-type natriuretic peptide(NT-proCNP)is a diagnostic inflam-matory marker clinically used for diagnosing bacterial infections.This study aims to establish a phage display library of single-chain variable fragment(scFv)antibodies against canine NT-proC-NP and to screen for scFvs with high binding affinity to NT-proCNP.Initially,NT-proCNP was prepared using prokaryotic expression system and was used to immunize New Zealand White rab-bits.Upon achieving the desired serum titer,total RNA was extracted from the splenocytes of rab-bits and reverse transcribed into cDNA.Using this cDNA as a template,degenerate primers were employed to amplify the genes of the rabbit antibody light chain variable region(VL)and heavy chain variable region(VH).The VL and VH regions were spliced together to form a complete scFv fragment via overlap extension PCR.The scFv was then ligated into the phagemid pComb3XSS and electroporated into competent E.coli TG1 cells to construct a rabbit-derived anti-NT-proCNP scFv immunological library.This library underwent four rounds of enrichment and screening to isolate specific single-chain antibodies.The selected antibody was subsequently ex-pressed in a soluble form within a prokaryotic system,and its immunological activity was evalua-ted.Using phage display technology,this study successfully identified a single-chain antibody scFv-1-CNP with strong antigen-binding activity and genetic sequence characteristics of scFvs,providing a research direction for further exploration of scFv applications in the detection of NT-proCNP.

Objective: To assess the risk factors for symptomatic intracranial hemorrhage ( sICH) after endovascu- lar therapy ( EVT) in patients with acute anterior circulation large vessel occlusion． Methods: A retrospective a- nalysis was used to analyze the clinical data of 273 anterior circulation large vessel occlusion ( ACLVO) patients with EVT，of which 158 were male and 115 were female; ages ranged from 33 to 94 years old［71 ( 59，78) years old］，and sICH occurred in 61 cases．The patients' gender，age，history of smoking and alcohol consumption，his- tory of illness，history of oral anticoagulant / anti-antibiotic administration，oral anticoagulant / antiplatelet medication status，intravenous thrombolytic therapy，admission blood pressure，hospitalization days，occlusion location，proce- dure duration，number of times of thrombus retrieval，cause of stroke ( TOAST classification) ，revascularization status ( mTICI ≥2b) ，and admission ASPECT score，admission APACHEII score，and admission NHISS score were collected．Univariate analysis was used to compare the differences in the above indicators between the non- SICH group and the sICH group． Multivariable Logistic regression analysis was used to evaluate the independent factors for the occurrence of sICH after EVT． Results: The results of univariate analysis showed that mTICI ≥ 2b， admission ASPECT score，and post-EVT sICH were significantly negatively correlated ( P＜0. 05) ，while occlusion location ( ICA) ，admission APACHE-Ⅱ score，admission NHISS score＞20，and admission mRS score were sig- nificantly positively correlated with post-EVT sICH ( P＜0. 05) ．The results of the multivariable Logistic regression analysis indicated that mTICI≥2b ( OR = 0. 314，95% CI: 0. 106－0. 929) and admission ASPECT score ( OR = 0. 775，95% CI: 0. 604－0. 995) are protective factors for sICH after EVT，while occlusion location ( ICA) ( OR = 2. 047，95% CI: 1. 033－4. 054) and admission APACHE-Ⅱ score ( OR = 1. 236，95% CI: 1. 140 －1. 340) were risk factors for sICH after EVT． Conclusion Higher admission APACHEII score，lower admission ASPECT score，occlusion location ( ICA) ，and mTICI ＜2b are independent risk factors for the development of sICH after EVT in patients with acute ACLVO．

Objective:To assess the influencing factors of glycemic control among type 2 diabetes mellitus (T2DM) patients, in particular the correlations between peripheral blood eosinophils and metabolic indicators such as glucose, lipids, and uric acid (UA) in these patients.Methods:T2DM patients who were regularly followed up in the Intensive Diabetes Mellitus Clinic of Peking Union Medical College Hospital from January 2016 to September 2024 were prospectively selected as the research subjects. The clinical data of these patients at their first visit and at the 3rd, 6th, 9th, and 12th months of follow-up were collected. The potential correlations of peripheral blood eosinophils with blood glucose control, lipid metabolism, UA metabolism, and inflammation as well as their influencing factors were analyzed.Results:A total of 161 T2DM patients were included. The glycated hemoglobin A1c (HbA1c) compliance rate was significantly higher during the follow-up visits (3, 6, 9, and 12 months) than baseline (all P<0.05) but showed no significant correlation with the count or percentage of peripheral blood eosinophils. Spearman correlation analysis showed that the percentage of peripheral blood eosinophils was negatively correlated with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) ( P=0.049) and high-density lipoprotein cholesterol (HDL-C) ( P=0.002) and positively with serum triglyceride (TG) ( P=0.034) and UA levels ( P<0.001). A further linear regression model analysis of these four variables and the percentage of eosinophils revealed that the percentage of peripheral blood eosinophils was only linearly correlated with serum UA level ( P<0.001). Conclusion:The percentage of peripheral blood eosinophils in T2DM patients is independently correlated with serum UA level, and monitoring serum UA level is important in T2DM management. Early identification and intervention of hyperuricemia can help provide more comprehensive and precise medical interventions for T2DM patients.

Objective:To explore the relationship between life events, anxiety, depression, and behavior problems in adolescents.Methods:From September to October 2022, the cluster sampling method was used to select 5 341 adolescents from 4 middle schools in Xinxiang urban area.The subjects and their parents were investigated by the adolescent self-rating life events check list (ASLEC), generalized anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9), and child behavior checklist (CBCL). SPSS 27.0 software was used for Spearman correlation analysis, and AMOS 28.0 software was used to construct the structural equation model.Results:The scores of anxiety, depression, and behavioral problems were 1 (0, 4), 1 (0, 4), and 3 (0, 10). The total score of life events was 5 (1, 13), and the dimensions scored as follows: interpersonal conflict 1 (0, 4), academic pressure 2 (0, 5), punishment 0 (0, 2), loss 0 (0, 0), health and adaptation problem 0 (0, 1), and others 0 (0, 2). There were positive correlations between life events and its dimensions, depression, anxiety and behavioral problems ( r=0.28-0.69, all P<0.01). In the overall population, anxiety and depression played parallel mediating roles in the impact of life events on behavior problems. Life events could positively predict anxiety ( β=0.68, P<0.01), and anxiety could positively predict behavior problems ( β=0.04, P=0.02). Life events could positively predict depression ( β=0.77, P<0.01), and depression could positively predict behavior problems ( β=0.18, P<0.01). The standardized total effect size of the impact of life events on behavioral problems was 0.622 (95% CI=0.564-0.675). The standardized direct effect size and indirect effect size were 0.460 (95% CI=0.374-0.539) and 0.162 (95% CI=0.108-0.218), accounting for 74.0% and 26.0%of the total effect, respectively. After stratification by gender, the results for male adolescents were consistent with the overall population, while the mediating effect of anxiety was not significant in the female adolescents. Conclusion:Life events can lead to anxiety and depression in adolescents, thereby increasing the risk of behavior problems.