OBJECTIVES: To analyze sex and age distribution of global disease burden of calcific aortic valve disease (CAVD) from 1990 to 2021. METHODS: CAVD data during 1990-2021 were obtained from the IHME website for Global Burden of Disease (GBD). The prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed by gender and age groups. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage change (AAPC). RESULTS: In 2021, there were 13.32 million CAVD patients and 142 000 deaths caused by CAVD globally. Age-standardized prevalence was higher in males (193.2/10⁵) than that in females (128.9/10⁵). Patients in 65-<85 age group accounted for 64.0% of total cases, while those ≥85 years old accounted for 16.1%. From 1990 to 2021, prevalence increased in both sexes with an AAPC of 0.72% for males and 0.57% for females, respectively. Prevalence grew fastest from 2000 to 2010, slowed thereafter, and declined from 2015 to 2021. In <65 years old, the mortality of males was 2.4 times higher than that of females, while in ≥85 years old, mortality of females (117.3/10⁵) exceeded that of males (99.1/10⁵). YLD rates increased with age, and were higher in males for all age groups. DALY rates decreased overall but increased in ≥85 years old, with a greater increase in females. CONCLUSIONS There are significant gender and age disparities in global disease burden of CAVD, with the elderly, especially super-elderly females deserving particular attention. It is recommended to develop personalized intervention strategies for these populations.
Humans ; Male ; Female ; Aged ; Calcinosis/mortality* ; Prevalence ; Global Burden of Disease ; Aged, 80 and over ; Middle Aged ; Aortic Valve/pathology* ; Aortic Valve Stenosis/epidemiology* ; Age Distribution ; Adult ; Disability-Adjusted Life Years ; Sex Distribution ; Global Health ; Aortic Valve Disease/epidemiology* ; Sex Factors

Objective To establish a reliable prediction model for radiation pneumonitis(RP)based on multi-regional radiomics analysis of localizable CT images.Methods A retrospective analysis was conducted on 185 patients who received radiotherapy from January 2021 to June 2023 in the Department of Radiotherapy,Xuzhou Cancer Hospital.Patients were classified as having RP or not based on imaging combined with clinical diagnosis.Three regions of interest(ROI)were defined in the localizable CT images:Lung,Lung-PTV and PTV,and their radiomics features were extracted.After feature screening using methods such as Mann-Whitney Utest,recursive feature elimination,and Lasso,a prediction model was established using support vector machine classification algorithm.The model performance was validated using 6 evaluation metrics:the area under the receiver operating characteristic curve(AUC),accuracy,specificity,sensitivity,positive predictive value,and negative predictive value.Results The prediction model consisted of 7 radiomics features.The clinical model of target-to-lung ratio,PTV model,Lung model,and Lung-PTV model achieved AUC values of 0.535,0.801,0.672,and 0.706 in the test set,respectively.The AUC value and accuracy of PTV model reached 0.843 and 0.775 in the training set,while 0.801 and 0.750 in the test set.PTV model was superior to Lung model,Lung-PTV model,and clinical model in predictive performance.The AUC values of the combined PTV+(Lung-PTV)model in the training and test sets were 0.867 and 0.806,respectively,higher than those of PTV model and Lung-PTV model.Conclusion The predictive ability of the prediction models constructed from radiomics features in different ROI for symptomatic RP varies.The radiomics prediction model using PTV as ROI exhibits superior predictive performance,and the combined multi-regional radiomics model can further improve the predictive ability for RP.

Amoenucles A-F (1-6), six previously undescribed nucleoside derivatives, and two known analogs (7 and 8) were isolated from the culture of Aspergillus amoenus TJ507. Their structures were elucidated through spectroscopic analysis, single-crystal X-ray crystallography, and chemical reactions. Notably, 3 and 4 represent the first reported instances of nucleosides with an attached pyrrole moiety. Of particular significance, the absolute configuration of the sugar moiety of 1-4 was determined using nuclear magnetic resonance (NMR), electric circular dichroism (ECD) calculations, and a hydrolysis reaction, presenting a potentially valuable method for confirming nucleoside structures. Furthermore, 1, 2, and 5-8 exhibited potential tumor necrosis factor α (TNF-α) inhibitory activities, which may provide a novel chemical template for the development of agents targeting autoimmune and inflammatory diseases.
Aspergillus/chemistry* ; Tumor Necrosis Factor-alpha/antagonists & inhibitors* ; Molecular Structure ; Nucleosides/isolation & purification* ; Crystallography, X-Ray ; Animals ; Humans ; Mice ; Magnetic Resonance Spectroscopy

Objective:To quantitatively detect plasma ceramide (Cer) levels using high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS) and analyze plasma ceramide levels in homozygous familial hypercholesterolemia (HoFH) patients.Methods:A case-control study was conducted. Plasma samples were collected from 70 healthy individuals who underwent physical examinations at the Health Check-Up Center of Suzhou Municipal Hospital between October 2023 and December 2023, as well as from 34 HoFH patients (including 11 patients with concomitant coronary artery disease) who were treated in the Cardiology Department of the same hospital during the same period. Deuterated isotopes were used as internal standards, and a Phenomenex Kinetex C18 column (2.1×100 mm, 2.6 μm) was employed for separation. An LC-MS/MS method was developed using an AB Sciex 6500+triple quadrupole mass spectrometer for the detection of ceramides, followed by method validation. Additionally, the differences in ceramide levels among healthy individuals, HoFH patients, and HoFH patients with concomitant coronary artery disease were compared. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value of various ceramides for HoFH.Results:A method for the quantification of 9 plasma ceramides was established, showing excellent linearity ( r>0.99), precision (1.8%-11.0%), and recovery rates (89.9%-114.7%), meeting the requirements for detection. Compared to the control group, the HoFH group exhibited significantly higher levels of Cer(d18∶1/14∶0), Cer(d18∶1/16∶0), Cer (d18∶1/18∶0), Cer (d18∶1/18∶1), Cer (d18∶1/20∶0), Cer(d18∶1/22∶0), Cer(d18∶1/24∶0), and Cer(d18∶1/24∶1) ( P<0.05). ROC curve analysis revealed that Cer(d18∶1/18∶0) had the highest diagnostic value for HoFH, with an area under the curve (AUC) of 0.83, a cutoff value of 64.6 ng/ml, and sensitivity and specificity of 82.4% and 87.1%, respectively. In HoFH patients complicated with coronary artery disease, the plasma ceramide levels of Cer(d18∶1/18∶0) [(155.7±25.1) ng/ml vs (103.0±11.1) ng/ml, P=0.03] and the ratio of Cer (d18∶1/18∶0) to Cer(d18∶1/24∶0) (0.077±0.012 vs 0.048±0.006, P=0.03) were significantly higher than in HoFH patients without coronary artery disease. Conclusion:A quantitative LC-MS/MS method was developed for detecting ceramides in human plasma, which shows potential diagnostic value for patients with HoFH.

Objective:To analyze the grassroots diseases category policy of DIP,explore the influencing mechanism on patient flow,and provide references for other DIP reform pilot regions.Methods:It conducts game theory analysis on the service supply behaviors of different medical institutions under the grassroots diseases category policy,and reveals the reasons affecting the role of grassroots diseases category.Results:Research has found that grassroots diseases can weaken the siphonage of tertiary institutions,but the prerequisite is to establish reasonable disease payment standards;there is a competitive relationship among secondary medical institutions,and secondary medical institutions will still exacerbate grassroots siphonage;the supervision and assessment mechanism for grassroots diseases is not sound,making it difficult to avoid the unreasonable medical service behavior of medical institutions under grassroots diseases.Conclusion:It is needed to further optimize the formulation of payment standards for grassroots diseases in medical insurance departments,consider adding grassroots diseases to primary medical institutions and resolving competitive conflicts between primary and secondary medical institutions,improve the supervision and assessment mechanism for grassroots diseases to prevent unreasonable medical service behavior.

Objective To establish a reliable prediction model for radiation pneumonitis(RP)based on multi-regional radiomics analysis of localizable CT images.Methods A retrospective analysis was conducted on 185 patients who received radiotherapy from January 2021 to June 2023 in the Department of Radiotherapy,Xuzhou Cancer Hospital.Patients were classified as having RP or not based on imaging combined with clinical diagnosis.Three regions of interest(ROI)were defined in the localizable CT images:Lung,Lung-PTV and PTV,and their radiomics features were extracted.After feature screening using methods such as Mann-Whitney Utest,recursive feature elimination,and Lasso,a prediction model was established using support vector machine classification algorithm.The model performance was validated using 6 evaluation metrics:the area under the receiver operating characteristic curve(AUC),accuracy,specificity,sensitivity,positive predictive value,and negative predictive value.Results The prediction model consisted of 7 radiomics features.The clinical model of target-to-lung ratio,PTV model,Lung model,and Lung-PTV model achieved AUC values of 0.535,0.801,0.672,and 0.706 in the test set,respectively.The AUC value and accuracy of PTV model reached 0.843 and 0.775 in the training set,while 0.801 and 0.750 in the test set.PTV model was superior to Lung model,Lung-PTV model,and clinical model in predictive performance.The AUC values of the combined PTV+(Lung-PTV)model in the training and test sets were 0.867 and 0.806,respectively,higher than those of PTV model and Lung-PTV model.Conclusion The predictive ability of the prediction models constructed from radiomics features in different ROI for symptomatic RP varies.The radiomics prediction model using PTV as ROI exhibits superior predictive performance,and the combined multi-regional radiomics model can further improve the predictive ability for RP.

Objective:To analyze the grassroots diseases category policy of DIP,explore the influencing mechanism on patient flow,and provide references for other DIP reform pilot regions.Methods:It conducts game theory analysis on the service supply behaviors of different medical institutions under the grassroots diseases category policy,and reveals the reasons affecting the role of grassroots diseases category.Results:Research has found that grassroots diseases can weaken the siphonage of tertiary institutions,but the prerequisite is to establish reasonable disease payment standards;there is a competitive relationship among secondary medical institutions,and secondary medical institutions will still exacerbate grassroots siphonage;the supervision and assessment mechanism for grassroots diseases is not sound,making it difficult to avoid the unreasonable medical service behavior of medical institutions under grassroots diseases.Conclusion:It is needed to further optimize the formulation of payment standards for grassroots diseases in medical insurance departments,consider adding grassroots diseases to primary medical institutions and resolving competitive conflicts between primary and secondary medical institutions,improve the supervision and assessment mechanism for grassroots diseases to prevent unreasonable medical service behavior.

Objective:To quantitatively detect plasma ceramide (Cer) levels using high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS) and analyze plasma ceramide levels in homozygous familial hypercholesterolemia (HoFH) patients.Methods:A case-control study was conducted. Plasma samples were collected from 70 healthy individuals who underwent physical examinations at the Health Check-Up Center of Suzhou Municipal Hospital between October 2023 and December 2023, as well as from 34 HoFH patients (including 11 patients with concomitant coronary artery disease) who were treated in the Cardiology Department of the same hospital during the same period. Deuterated isotopes were used as internal standards, and a Phenomenex Kinetex C18 column (2.1×100 mm, 2.6 μm) was employed for separation. An LC-MS/MS method was developed using an AB Sciex 6500+triple quadrupole mass spectrometer for the detection of ceramides, followed by method validation. Additionally, the differences in ceramide levels among healthy individuals, HoFH patients, and HoFH patients with concomitant coronary artery disease were compared. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value of various ceramides for HoFH.Results:A method for the quantification of 9 plasma ceramides was established, showing excellent linearity ( r>0.99), precision (1.8%-11.0%), and recovery rates (89.9%-114.7%), meeting the requirements for detection. Compared to the control group, the HoFH group exhibited significantly higher levels of Cer(d18∶1/14∶0), Cer(d18∶1/16∶0), Cer (d18∶1/18∶0), Cer (d18∶1/18∶1), Cer (d18∶1/20∶0), Cer(d18∶1/22∶0), Cer(d18∶1/24∶0), and Cer(d18∶1/24∶1) ( P<0.05). ROC curve analysis revealed that Cer(d18∶1/18∶0) had the highest diagnostic value for HoFH, with an area under the curve (AUC) of 0.83, a cutoff value of 64.6 ng/ml, and sensitivity and specificity of 82.4% and 87.1%, respectively. In HoFH patients complicated with coronary artery disease, the plasma ceramide levels of Cer(d18∶1/18∶0) [(155.7±25.1) ng/ml vs (103.0±11.1) ng/ml, P=0.03] and the ratio of Cer (d18∶1/18∶0) to Cer(d18∶1/24∶0) (0.077±0.012 vs 0.048±0.006, P=0.03) were significantly higher than in HoFH patients without coronary artery disease. Conclusion:A quantitative LC-MS/MS method was developed for detecting ceramides in human plasma, which shows potential diagnostic value for patients with HoFH.

In the current clinical diagnosis, medical images have become an important basis for diagnosis, and different modes of medical images provide different tissue information and functional information. Single-mode images can only provide single diagnostic information, by which difficult and complicated diseases cannot be diagnosed, and comprehensive and accurate diagnostic results can be obtained only with the help of multiple diagnostic information. The multimodal fusion technology fuses multiple modes of medical images into single-mode images, and thus the single-mode images contain complementary information between multiple modes of images, so that sufficient information for clinical diagnosis can be obtained in a single image. In this paper, the multimodal medical image fusion methods are sorted into two types, namely the traditional fusion method and the fusion method based on deep learning.

Objective To investigate whether brachial-ankle pulse wave velocity(baPWV),independently and jointly with the level of body mass index(BMI),affect the risk of incident diabetes with hypertension. Methods The effects of baPWV and BMI level on incident diabetes with hypertension were evaluated using Kaplan-Meier curves (log-rank test) and multi logistical regression models after adjustment for various confounding factors. Results A total of 2 222 participants were recruited in this study. Higher baPWV (Q4) was associated with a greater risk of incident diabetes with hypertension simultaneously compared with baPWV in the lower quartiles(Q1-Q3),with HR 4.16(95% CI 2.14,8.09)in the crude model,2.52(95% CI 1.10,5.78) in modelI,and 2.45(95% CI 1.05, 5.70)in modelⅡ.The highest risk of diabetes with hypertension simultaneously was in the group with high baPWV and BMI≥25 kg/m2,with HR 11.50(95% CI 4.5,29.9)in the crude model,4.20(95% CI 1.4,13.1)in modelI,and 4.30(95% CI 1.4,13.3) in modelⅡ. Conclusions The joint effect of baPWV and BMI level on incident diabetes with hypertension simultaneously is a better predictor than their independent effect. The risk of incident diabetes with hypertension markedly increases in the subjects with BMI≥25 kg/m2and higher baPWV.