BACKGROUND: Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021. METHODS: Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index. RESULTS: In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval [UI]: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates. CONCLUSIONS Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.
Humans ; Global Burden of Disease ; Male ; Female ; Middle Aged ; Adult ; Asia/epidemiology* ; Prevalence ; Aged ; Pulmonary Arterial Hypertension/mortality* ; Adolescent ; Young Adult ; Child ; Child, Preschool ; Infant ; Hypertension, Pulmonary/epidemiology*

With the increasingly wide application of herbal medicines and dietary supplements worldwide,herb-induced liver injury(HILI)has become an important etiology of drug-induced liver injury.Due to the diverse manifestations of HILI,the difficulty in medical history collection,and the lack of specific biomarkers,how to identify suspected patients and make a correct diagnosis has become a major challenge in practice.Causality assessment is commonly used in the diagnosis of HILI,but there is still a lack of prospective cohort studies with a large sample size.In addition,further studies are needed to search for the specific biomarkers for the diagnosis of HILI.The diagnosis and differential diagnosis of HILI are challenging,and currently there is still no universally accepted uniform and standard method for the diagnosis of all-cause HILI.

OBJECTIVE To compare the cost-utility of eight programmed death 1(PD-1)/programmed cell death-ligand 1(PD-L1) inhibitor combination regimens for first-line treatment of advanced non-small cell lung cancer(NSCLC) from the perspective of Chinese healthcare system. METHODS Relevant data were derived from a published network meta-analysis and randomized controlled trails, a three-state Markov model was established to analyze the cost-utility of eight immunotherapy combinations. The robustness of results were validated through sensitivity analyses and a series of scenario analyses was also conducted. RESULTS The incremental cost-utility ratio(ICUR) of the sintilizumab plus chemotherapy group and the tislelizumab plus chemotherapy group were ￥125143.88/quality adjusted life year(QALY) and ￥189609.64/QALY, respectively, which were less than the willingness-to-pay(WTP) threshold of ￥257094/QALY, and all the ICURs of other PD-1/PD-L1 inhibitor combination regimens exceeded the WTP threshold and were not economical. Scenario analyses found that even if the medical insurance reimbursement ratio reached 80%, the different combinations of pembrolizumab, nivolumab and atezolizumab were not economical. CONCLUSION Compared with other PD-1/PD-L1 inhibitor combination regimens, sintilizumab plus chemotherapy and tislelizumab plus chemotherapy have cost-utility advantages in the first-line treatment of advanced NSCLC, which can provide a certain reference for selecting a reasonable treatment plan for NSCLC patients.

Objective:To report the sampling study design and radiography protocol of a large-sample investigation on skeletal maturation of 3 to 18-year-old children in China.Methods:Multi-stage stratified random sampling was employed in this study. Two provinces, municipalities, or autonomous regions were randomly selected from each of the seven regions of China, including Northeast China, Northwest China, North China, Central China, East China, Southwest China, and South China. Then one rural and one urban investigation site were randomly selected from each province, municipality, or autonomous region. In total 28 sites were included. Among those sites, four residential districts were randomly selected from each urban site, and four townships from each rural site. For each residential district or township, 1-4 kindergartens, primary schools, and middle schools were chosen. Random cluster sampling was used to extract 3-<6-year-old children in kindergartens, and 6-18-year-old children in primary schools and middle schools. The investigation on skeletal maturation was sampled proportionate to the sampling of the whole study. The estimated simple size was 780 for each site, and 21 840 for all 28 sites in total. There were six groups of 3-<6-year-old children classified at 0.5-year intervals, and 12 groups of 6-18-year-old children classified at 1-year intervals. Posteroanterior position radiography of the left hand and wrist was achieved for all subjects.Results:The study was performed from August 26, 2019 to October 16, 2021. In total, 20 444 children received posteroanterior position radiography of the left hand and wrist, including 10 196 males and 10 248 females, 9 711 urban and 10 733 rural, respectively. The 3-<6-year-old group included 1 611 (male 819, female 792) subjects, and the 6 to 18-year-old group included 18 833 (male 9 377, female 9 456) subjects.Conclusion:This nationwide investigation on skeletal maturation of 3 to 18-year-old children in seven regions of China was successfully preformed. The results of this study can provide an important reference for establishing the current evaluation criteria of bone age in Chinese children and adolescents.

Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.

Objective:To explore the application effect of flipped classroom model based on Simodont dental training system in the standardized training teaching of prosthodontics.Methods:The control experiment was used in this study. Seventy two students from Batch 2018 and Batch 2019 of Stomatology Hospital of Air Force Medical University were selected and randomly divided into experimental group (flipped classroom model based on Simodont dental training system) and control group (Simodont dental training system training mode after traditional teaching), with 18 students every academic year in each group. Questionnaire survey was conducted to evaluate the teaching effect, and the results of after-class theory test and practical computer test were compared between the two groups. SPSS 20.0 was used for chi-square test and t test. Results:The experimental group was better than the control group in enhancing classroom interest, improving the ability of independent analysis and problem-solving, and cultivating the ability of cooperation and expression ( P<0.05). The scores of after-class theory test and practical computer test in the experimental group [(23.36±0.21) points and (90.56±0.52) points] were significantly better than those in the control group[(21.81±0.25) points and (88.31±0.48) points] ( P<0.01). Conclusion:The flipped classroom model based on Simodont dental training system can effectively improve the effect of standardized training and teaching of professional skills in prosthodontics. At the same time, the students' ability of independent analysis and problem solving, cooperation and communication and expression are effectively improved.

Objective:To investigate the potential factors influencing the extent of coronary artery lesion in acute coronary syndrome (ACS) patients with an emphasis on the role of serum SIRT1.Methods:We assessed the clinical data from 81 ACS patients admitted to China-Japan Friendship Hospital. Serum SIRT1 was detected by enzyme linked immunosorbent assay (ELISA), and the extent of coronary artery lesion was evaluated by SYNTAX score before revascularization. All the patients were divided into two groups: high SYNTAX score (severe coronary artery lesion, n=38) and low SYNTAX score (moderate coronary artery lesion, n=43), by means of the median of SYNTAX score. Potential factors influencing SYNTAX score were analyzed through multiple linear regression analysis. Results:Compared with the low SYNTAX score group, patients in the high SYNTAX score group had higher serum SIRT1 level [379.38 (490.14) ng/L vs. 242.95 (173.85) ng/L, P<0.001] and frequency of coronary artery disease family history (42.11% vs. 20.93%, P=0.039). There was no statistical difference among other factors between the two groups. Serum SIRT1 was positively correlated with SYNTAX score in ACS patients ( R=0.452, P<0.010). Serum SIRT1 (ln adjusted), age and estimated glomerular filtration rate were independently correlated with SYNTAX score (ln adjusted) in multiple linear regression analysis (Adjusted R2=0.330, P<0.001). Conclusions:For the first time, we discussed the correlation of serum SIRT1 with extent of coronary artery lesion in ACS patients. Cardiologists should pay more attention to high-risk patients in order to improve the prognosis of ACS patients through timely revascularization strategies.

Objective:To explore the relationship between the binaural high-frequency mean hearing threshold and the hypertension of female workers exposed to noise, and to understand the application significance of the binaural high-frequency mean hearing threshold as an internal effect indicator of the risk of hypertension in female workers exposed to noise.Methods:From January to December 2018, a total of 20882 female workers exposed to noise in Guangzhou were selected by cluster sampling. Pure tone audiometry, blood pressure, age and length of service were collected. Trend test was used to evaluate the effects of exposure to noise and binaural high-frequency mean hearing threshold on blood pressure. Binary logistic regression model was used to evaluate the risk of hypertension associated with exposure to noise and binaural high-frequency mean hearing threshold.Results:The detection rate of normal hearing threshold, mild hearing loss and severe hearing loss was 80.73% (16858/20882) , 16.21% (3384/20882) and 3.06% (640/20882) respectively. The prevalence of hypertension was 6.04% (1018/16858) in normal hearing group, 10.28% (348/3384) in patients with high frequency mild hearing loss, and 11.25% (72/640) in patients with high frequency severe hearing loss. There was a linear relationship between the increase of working age and high-frequency mean hearing threshold and the increase of systolic and diastolic blood pressure ( P< 0.05) . Compared with those exposed to noise for less than 1 year, the risk of hypertension in female workers with 7-9 years and more than 9 years was decreased ( OR= 0.79, 0.75, P<0.05) . Compared with normal hearing group, the risk of hypertension in high frequency mild hearing loss group was increased ( OR=1.31, P<0.05) . Conclusion:The increase in the binaural high-frequency mean hearing threshold of female workers exposed to noise can increase the blood pressure level and the risk of hypertension, and attention should be paid to female workers with high-frequency mild hearing loss.

Objective:To evaluate the accuracy of the Autonomous Dental Implant Robotic System (ADIR) in vivo through animal experiments. Methods:Nine canine models with bilateral mandibular premolars loss were prepared. Two implants were placed in each side of canine′s mandibular edentulous area. On each side, the two implants were completed by ADIR (robot group) and one experienced doctor using digital full-guided plate (guide template group) respectively. After the operation, the deviation between the actual implant position and the planned position was evaluated. The primary stability of the implant was measured, and the results of the robot group and the guide template group were statistically analyzed.Results:ADIR could successfully place implant for missing teeth in animals, and the coronal deviation, apical deviation and angular deviation [ M( Q)] were 0.269 (0.152) mm, 0.254 (0.218) mm and 0.989° (0.517°) respectively, which were significantly lower than those of guide template group [the coronal deviation, apical deviation and angular deviation were 0.910 (0.872) mm, 1.179 (1.176) mm and 4.209°(5.208°) respectively] ( P<0.05). Besides, there was no significant difference in the primary stability of the implant between the two groups ( P>0.05). Conclusions:This study confirmed the accuracy of the ADIR in vivo, and laid a foundation for further clinical trials.

Objective:To explore the relationship between the binaural high-frequency mean hearing threshold and the hypertension of female workers exposed to noise, and to understand the application significance of the binaural high-frequency mean hearing threshold as an internal effect indicator of the risk of hypertension in female workers exposed to noise.Methods:From January to December 2018, a total of 20882 female workers exposed to noise in Guangzhou were selected by cluster sampling. Pure tone audiometry, blood pressure, age and length of service were collected. Trend test was used to evaluate the effects of exposure to noise and binaural high-frequency mean hearing threshold on blood pressure. Binary logistic regression model was used to evaluate the risk of hypertension associated with exposure to noise and binaural high-frequency mean hearing threshold.Results:The detection rate of normal hearing threshold, mild hearing loss and severe hearing loss was 80.73% (16858/20882) , 16.21% (3384/20882) and 3.06% (640/20882) respectively. The prevalence of hypertension was 6.04% (1018/16858) in normal hearing group, 10.28% (348/3384) in patients with high frequency mild hearing loss, and 11.25% (72/640) in patients with high frequency severe hearing loss. There was a linear relationship between the increase of working age and high-frequency mean hearing threshold and the increase of systolic and diastolic blood pressure ( P< 0.05) . Compared with those exposed to noise for less than 1 year, the risk of hypertension in female workers with 7-9 years and more than 9 years was decreased ( OR= 0.79, 0.75, P<0.05) . Compared with normal hearing group, the risk of hypertension in high frequency mild hearing loss group was increased ( OR=1.31, P<0.05) . Conclusion:The increase in the binaural high-frequency mean hearing threshold of female workers exposed to noise can increase the blood pressure level and the risk of hypertension, and attention should be paid to female workers with high-frequency mild hearing loss.