Background and Aims:Aortic aneurysm,a major cardiovascular disease with high mortality and disability rates,has emerged as a critical global public health challenge.Elevated body mass index(BMI)has been confirmed as an independent risk factor for aortic aneurysm.However,the long-term trends and heterogeneity of the disease burden attributable to high BMI in China-across sex,age,and region-remain insufficiently studied.This study,based on the Global Burden of Disease(GBD)database,aimed to analyze the changes in the disease burden of high BMI-related aortic aneurysm in China from 1990 to 2021 and compare these trends with those in global and socio-demographic index(SDI)-stratified regions.Methods:Data from GBD 2021 were used to extract mortality rates and disability-adjusted life years(DALY)due to aortic aneurysm attributable to high BMI in China from 1990 to 2021.Age-standardized mortality rate(ASMR)and age-standardized DALY rate(ASDR)were calculated.Long-term trends were assessed using the estimated annual percentage change(EAPC)and Joinpoint regression models.An autoregressive integrated moving average model was applied to project trends from 2022 to 2036.Results:During the study period,deaths and DALY from aortic aneurysms attributable to high BMI in China increased nearly sevenfold.ASMR rose from 1 to 3 per 100 000 population(EAPC=3.91),and ASDR increased from 23 to 74 per 100 000(EAPC=4.11),both showing a marked upward trend.Males consistently bore a higher burden across all age groups,particularly among those aged≥65 years.Decomposition analysis revealed that the increased burden in males was mainly driven by epidemiological improvements,while that in females was primarily attributable to population aging.Compared with the United States and global trends,China exhibited a faster increase in high BMI-related aortic aneurysm burden,which is projected to remain elevated over the next 15 years.Conclusion:The disease burden of aortic aneurysm attributable to high BMI continues to rise in China,with pronounced differences across sex and age.Targeted weight management,health interventions,and early screening strategies are urgently needed for high-risk populations to curb the upward trend and optimize public health resource allocation.

Background and Aims:Aortic aneurysm,a major cardiovascular disease with high mortality and disability rates,has emerged as a critical global public health challenge.Elevated body mass index(BMI)has been confirmed as an independent risk factor for aortic aneurysm.However,the long-term trends and heterogeneity of the disease burden attributable to high BMI in China-across sex,age,and region-remain insufficiently studied.This study,based on the Global Burden of Disease(GBD)database,aimed to analyze the changes in the disease burden of high BMI-related aortic aneurysm in China from 1990 to 2021 and compare these trends with those in global and socio-demographic index(SDI)-stratified regions.Methods:Data from GBD 2021 were used to extract mortality rates and disability-adjusted life years(DALY)due to aortic aneurysm attributable to high BMI in China from 1990 to 2021.Age-standardized mortality rate(ASMR)and age-standardized DALY rate(ASDR)were calculated.Long-term trends were assessed using the estimated annual percentage change(EAPC)and Joinpoint regression models.An autoregressive integrated moving average model was applied to project trends from 2022 to 2036.Results:During the study period,deaths and DALY from aortic aneurysms attributable to high BMI in China increased nearly sevenfold.ASMR rose from 1 to 3 per 100 000 population(EAPC=3.91),and ASDR increased from 23 to 74 per 100 000(EAPC=4.11),both showing a marked upward trend.Males consistently bore a higher burden across all age groups,particularly among those aged≥65 years.Decomposition analysis revealed that the increased burden in males was mainly driven by epidemiological improvements,while that in females was primarily attributable to population aging.Compared with the United States and global trends,China exhibited a faster increase in high BMI-related aortic aneurysm burden,which is projected to remain elevated over the next 15 years.Conclusion:The disease burden of aortic aneurysm attributable to high BMI continues to rise in China,with pronounced differences across sex and age.Targeted weight management,health interventions,and early screening strategies are urgently needed for high-risk populations to curb the upward trend and optimize public health resource allocation.

Oral squamous cell carcinoma(OSCC)accounts for over 90％of oral malignancies,with more than 370 000 new cases and approximately 188 000 deaths annually worldwide.In China,there are roughly 65 000 new cases and 35 000 deaths each year,showing a significant upward trend compared with 2015 statistics.Despite continuous advancements in treatment modalities,the 5-year survival rate remains stagnant at 50％-60％,where tumor heterogeneity and therapy resistance persist as fundamental barriers to precision oncology.To address these critical challenges,this study established a standardized bioban-king protocol for OSCC patient-derived organoids(PDOs)(Patent:Method for constructing an oral squa-mous cell carcinoma organoid bank,ZL202311378598.3).Through groundbreaking optimization of cul-ture media,enzymatic digestion kinetics,and stepwise cryopreservation,we achieved a biobanking suc-cess rate exceeding 95％and pioneered synchronous cultivation of matched primary tumors,lymph node metastases,and adjacent normal mucosa from individual patients,preserving spatial heterogeneity and stromal interactions.Leveraging this platform,we developed high-throughput drug screening:Quantified heterogeneity-driven differential chemoresponse using adenosine triphosphate(ATP)-based viability as-says;We discovered resistance mechanisms:Identified sialylated cancer IgG(SIA-cIgG)-mediated cis-platin resistance(primary/secondary)through PTPN13 suppression,with anti-SIA-cIgG combination therapy demonstrating synergistic efficacy.Besides,we elucidated metastatic drivers:CRISPR-Cas9-edited organoids revealed WDR54 promoted metastasis via H3K4me3/H4K16ac epigenetic reprogramming,activating epithelial-mesenchymal plasticity(EMP)and inducing partial epithelial-mesenchymal transi-tion(pEMT).This"holographic patient-mirroring"platform provided unprecedented resolution for OSCC precision therapy and had been formally incorporated into the Chinese Stomatological Association Techni-cal Guidelines(Technical guideline for establishing patient-derived oral squamous cell carcinoma or-ganoid banks,CHSA 2024-08).Future integration of immune-competent organoids,3D-bioprinted vas-culature,and multi-omics-AI systems will accelerate personalized oncology.These innovations will accelerate clinical translation of personalized therapeutic regimens,ultimately bridging the gap between bench research and bedside application.

Objective To explore the clinical value of shear wave elastic imaging(SWE)for renal cortical elasticity in patients with hypertension.Methods According to the diagnostic criteria of 2020 International Society of Hypertension(ISH)Global Hypertension Practice Guidelines,44 patients with simple hypertension admitted to the Department of Cardiology of our hospital were selected and 46 healthy controls were selected for the same period.The general data and and renal function indicators of blood biochemical were recorded.All subjects were examined by two-dimensional ultrasound and SWE elasticity to obtain the conventional ultrasound parameters and the Young's modulus(YM)value of the right.The above parameters between the two groups were compared.The influence factors were analyzed by multiple linear regression among the YM value of the right renal cortex,the general data,conventional ultrasound indicators and renal function indicators in the simple hypertension group.Results The course,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the simple hypertension group was higher than those in the control group,and the difference was statistically significant(P＜0.05).The YM value of the right renal cortex in the simple hypertension group was higher than that in the control group,and the difference was statistically significant(P＜0.05).The correlation analysis showed that the YM value of the right renal cortex was positively correlated with the duration of hypertension(P＜0.05),but not with age,blood pressure,right renal volume,right renal cortex thickness,right renal artery trunk peak systolic flow velocity(PSV),right renal artery trunk resistance index(RI),blood urea nitrogen,blood creatinine,or uric acid(P＞0.05).Further simple linear regression analysis showed that the duration of hypertension was an independent factor affecting the YM value of the right renal cortex.Conclusion SWE may be used to find the variation in elasticity of renal cortex in patients with simple hypertension.

Objective To understand the current status and development trend of peritoneal dialysis continuing care research in China,with a view to providing reference for medical care practice. Methods Literatures on peritoneal dialysis continuing care from January 2012 to February 2024 was searched using CNKI,Wanfang Data,and VIP databases,and the authors,publishing institutions,and key words were visualized and analyzed using CiteSpace software. Results A total of 253 literatures were included,published in 117 journals,and the number of literatures showed an overall increasing trend,and the overall quality of the literatures was not high. Some institutions and authors had formed a small range of cooperation,and the research hotspots included intervention methods and intervention effects of continuing care for peritoneal dialysis patients. Conclusion High quality peritoneal dialysis continuing care is the research trend in the future. Innovation of peritoneal dialysis management mode,improvement of research depth,strengthening of regional cooperation and construction of specialist medical team are the key points that need urgent attention.

Objective:To explore the clinical characteristics and prognoses of severe autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).Methods:A retrospective analysis was performed. The clinical data of 12 patients with severe GFAP-A admitted to Department of Neurology, Guangdong 999 Brain Hospital from January 2018 to June 2023 were collected, including demography, clinical manifestations, MRI features, laboratory examination results (such as antibodies), treatments and prognoses.Results:Among the 12 patients, 9 were male and 3 were female, with an average onset age of (46.58±17.53) years. Primary symptoms included headache, limb weakness, limb numbness, mental disorder, epileptic seizure, and urinary and defecation disorder; 9 patients had fever before onset. With aggravated severe GFAP-A, 12 patients had impaired consciousness, 12 had respiratory failure, 6 had unstable blood pressure and heart rate, and 2 had status epilepticus. Cranial MRI indicated abnormal lesions in all 12 patients, including 10 with brainstem involvement (7 had involved medulla oblongata); 10 showed soft meningeal enhancement. In 8 patients received MRI of the whole spinal cord, 7 had abnormal spinal cord lesions; point-like enhancement of the whole spinal meninges was observed in 6 of the 7 patients. All 12 patients had positive cerebrospinal fluid GFAP-IgG, and 3 patients also had positive serum GFAP-IgG. All patients accepted glucocorticoids and immunoglobulin immunotherapy, and 1 patient was supplemented with mycophenolate mofetil; 8 patients had good prognosis, and 4 patients died. Pulmonary infection, hyponatremia, hypoproteinemia, and deep vein thrombosis were the common complications.Conclusion:Patients with severe GFAP-A mainly manifest as meningoencephalitis and meningoencephalomyelitis, and are likely involved medulla oblongata, enjoying rapid clinical progression; even with early immunotherapy, high mortality rate is still noted.

Objective To understand the current status and development trend of peritoneal dialysis continuing care research in China,with a view to providing reference for medical care practice. Methods Literatures on peritoneal dialysis continuing care from January 2012 to February 2024 was searched using CNKI,Wanfang Data,and VIP databases,and the authors,publishing institutions,and key words were visualized and analyzed using CiteSpace software. Results A total of 253 literatures were included,published in 117 journals,and the number of literatures showed an overall increasing trend,and the overall quality of the literatures was not high. Some institutions and authors had formed a small range of cooperation,and the research hotspots included intervention methods and intervention effects of continuing care for peritoneal dialysis patients. Conclusion High quality peritoneal dialysis continuing care is the research trend in the future. Innovation of peritoneal dialysis management mode,improvement of research depth,strengthening of regional cooperation and construction of specialist medical team are the key points that need urgent attention.

Astragalosides are the main active constituents of traditional Chinese medicine Huang-Qi, of which cycloastragenol-type glycosides are the most typical and major bioactive compounds. This kind of compounds exhibit various biological functions including cardiovascular protective, neuroprotective, etc. Owing to the limitations of natural sources and the difficulties encountered in chemical synthesis, re-engineering of biosynthetic machinery will offer an alternative and promising approach to producing astragalosides. However, the biosynthetic pathway for astragalosides remains elusive due to their complex structures and numerous reaction types and steps. Herein, guided by transcriptome and phylogenetic analyses, a cycloartenol synthase and four glycosyltransferases catalyzing the committed steps in the biosynthesis of such bioactive astragalosides were functionally characterized from Astragalus membranaceus. AmCAS1, the first reported cycloartenol synthase from Astragalus genus, is capable of catalyzing the formation of cycloartenol; AmUGT15, AmUGT14, AmUGT13, and AmUGT7 are four glycosyltransferases biochemically characterized to catalyze 3-O-xylosylation, 3-O-glucosylation, 25-O-glucosylation/O-xylosylation and 2'-O-glucosylation of cycloastragenol glycosides, respectively. These findings not only clarified the crucial enzymes for the biosynthesis and the molecular basis for the structural diversity of astragalosides in Astragalus plants, also paved the way for further completely deciphering the biosynthetic pathway and constructing an artificial pathway for their efficient production.

Objective:To explore clinical features, diagnosis, localization, and therapeutic strategy of migratory pharyngeal and cervical esophageal foreign bodies.Methods:A total 23 cases of pharyngeal and cervical esophageal migratory foreign bodies were admitted between January 2015 and December 2021. There were 14 females and 9 males with the age ranged from 35 to 82 (55.0±12.7)years. In all the cases, esophageal CT was taken to confirm the esophageal foreign body. Multiplanar reconstruction (MPR) was performed to locate the foreign body from the horizontal, coronal and sagittal dimensions as well as the corrected reconstructed MPR. According to the location of the foreign body, appropriate surgical method was selected.The symptoms, complications, types of foreign body, positioning, surgical methods, and relevant information were recorded.Data were analyzed using the descriptive method and SPSS 25.0 software.Results:The clinical symptoms of 23 migrating esophageal foreign bodies included pharyngodynia (20/23), foreign body sensation (6/23), hoarsenss (1/23), difficulty in turning neck(1/23), difficulty in opening mouth (1/23), fever (7/23), poor appetite (1/23), and abdominal pain (1/23). The foreign bodies included 19 fish bones, 2 wires, 1 embroidery needle and 1 chicken bone. There were 9 cases (39.1%) of foreign bodies located in extraluminal cervical esophagus, 2 cases (8.7%) of foreign bodies located in the muscular layer of the cervical esophagus and 12 cases (52.2%) of foreign bodies located in pharynx. Twenty-one cases of foreign bodies were removed by cervical lateral incision, in which 11 were removed by cervical lateral incision directly, 10 by the second lateral cervical incision after the foreign bodies were accurately located by MPR and/or corrected MPR, 1 foreign body was removed by incision of the pharyngeal mucosa under suspension laryngoscope, 1 foreign body was removed by tracheoscopy. Compared with patients with intraluminal foreign bodies ( n=308) treated in the same period, intake of fishbone [19 (19/23) vs. 133 (82.6% (43.2%, 133/308), OR=7.31] and first visit was more than 24 hours [20(87.0%, 20/23) vs. 77(25.0%, 77/308), OR=17.2] were the significant risk factors of migratory esophageal foreign bodies. Conclusions:MPR and the corrected MPR can accurately locate the migrating pharyngeal and cervical esophageal foreign bodies, by providing more intuitive imaging evidence for doctors, which provide imaging basis for formulation of surgical programs. Foreign bodies in pharyngeal and cervical esophagus need to be treated as soon as possible, otherwise they are easy to migrate, leading lead to serious complications.

Objective:To analyze the changes of mean arterial pressure (MAP) and end expiratory carbon dioxide (ETCO 2) in patients after emergency endotracheal intubation (ETI). To explore the values of MAP and ETCO 2 monitoring in early prediction of severe cardiovascular collapse (CVC) after emergency ETI. Methods:The clinical data of adult patients who underwent ETI from March 2015 to May 2020 were collected consecutively in the emergency departments of Peking Union Medical College Hospital. The values of MAP and ETCO 2 were observed and recorded at 5, 10, 30, 60 and 120 min after intubation. According to whether severe CVC occurred after ETI, the patients were divided into the severe CVC group and non-severe CVC group. The values of MAP and ETCO 2 were compared at the same time points between the two groups and the adjacent time points within the groups. The correlation between MAP and ETCO 2 after ETI was also analyzed. ROC curve was used to analyze the ability of MAP and ETCO 2 at 5 min and 10 min after ETI to predict severe CVC. Results:Totally 116 patients were enrolled in this study, among them 75 (64.7%) cases had severe CVC after ETI. The majority were male and elderly patients in the severe CVC group. The values of MAP and ETCO 2 in 5, 10, 30, 60 and 120 min after ETI in severe CVC group were significantly lower than those in the non-severe CVC group. The values of MAP and ETCO 2 in the two groups showed simultaneous decrease from 5 min to 30 min after ETI, reached the lowest value at 30 min after ETI, and appeared the synchronous recover from then to 120 min after ETI. After ETI, the changes of MAP was correlated with that of ETCO 2 ( rs = 0.653, P<0.01). At 5 min after ETI, MAP could predict severe CVC (AUC=0.86, P<0.01), MAP≤72 mmHg was the best cutoff value (sensitivity 78.7%, specificity 87.8%); ETCO 2 could also predict severe CVC (AUC=0.85, P<0.01), and ETCO 2≤35 mmHg was the best cutoff value (sensitivity 77.3%, specificity 85.4%). At 10 min after ETI, MAP could predict severe CVC (AUC = 0.90, P<0.01), MAP≤67 mmHg was the best cutoff value (sensitivity 89.3%, specificity 85.4%), ETCO 2 could also predict severe CVC (AUC=0.87, P<0.01), and ETCO 2≤33 mmHg was the best cutoff value (sensitivity 81.3%, specificity 78.0%). There was no significant difference in the ability of prediction between any two indexes of the MAP and ETCO 2 at 5 min and 10 min after ETI ( P>0.05). Conclusions:Patients with severe CVC after ETI have early signs of decreased MAP and ETCO 2, but the delayed recognition and insufficient intervention may be related to the occurrence and development of severe CVC. MAP and ETCO 2 at the early stage after ETI have high accuracy in predicting severe CVC. MAP≤72 mmHg, ETCO 2≤35 mmHg at 5 min after intubation, MAP≤67 mmHg and ETCO 2≤33 mmHg at 10 minutes after intubation all suggest the possibility of severe CVC.