Objective To systematically analyze the characteristics of the disease burden of hypertensive heart disease (HHD) in the elderly (≥60 years) globally and in China from 1990 to 2021, and to predict its future trends from 2022 to 2040, with the aim of providing data support for optimizing comprehensive prevention and control strategies for HHD. Methods Based on the Global Burden of Disease (GBD) 2021 database, the number of prevalent cases and disability-adjusted life years (DALYs) of HHD in the elderly were extracted for the world, China, and five regions categorized by sociodemographic index (SDI). Joinpoint regression was used to analyze the temporal trends of age-standardized prevalence rate and age-standardized DALYs rate of HHD in the elderly. A three-factor decomposition method was applied to evaluate the relative contributions of aging, population growth, and epidemiological changes to the variations in the elderly HHD burden. Additionally, a Bayesian age-period-cohort model was used to predict the elderly HHD burden from 2022 to 2040. Results In 2021, the number of prevalent elderly HHD cases reached 10 283 000 globally and 3 412 400 in China, representing increases of 179.20% and 159.20% respectively, compared with 1990. The DALYs of elderly HHD were 18 812 700 person-years globally and 4 731 400 person-years in China, rising by 76.08% and 29.45% respectively from 1990. Meanwhile, the growth rates of the number of prevalent cases and DALYs of elderly HHD varied across different SDI regions. From 1990 to 2021, the age-standardized prevalence rate of elderly HHD in China, as well as the age-standardized DALYs rate of elderly HHD both globally and in China, showed significant downward trends (all average annual percentage changes<0, all P<0.001). In 2021, the 70-74 years age group accounted for the highest proportion of prevalent cases and DALYs of elderly HHD, both globally and in China. Decomposition analysis revealed that population growth was the dominant factor driving the increase in the elderly HHD burden across all regions. The prediction model results indicated that the number of prevalent cases and DALYs of elderly HHD would continue to rise globally and in China from 2022 to 2040, with the growth rate of the elderly HHD burden in China between 2021 and 2040 expected to exceed the global average. Conclusion Over the past 32 years, although the age-standardized disease rates of elderly HHD have mainly shown a downward trend globally and in China, the absolute number of the disease burden has increased substantially. The projection model indicates a continued upward trajectory, with the growth rate in China higher than the global average. Therefore, there is an urgent need to implement precise prevention and control strategies to effectively mitigate the disease burden of elderly HHD.

Objective To analyze the disease burden trend of non-rheumatic degenerative mitral valve disease (NR-DMVD) in China from 1990 to 2023 and compare it with global levels and those in the United States and India. Methods Based on the Global Burden of Disease (GBD) 2023 database, data on incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for NR-DMVD were extracted. Joinpoint regression, decomposition analysis, and autoregressive integrated moving average model (ARIMA) were used to analyze trends, drivers, and project burden to 2040. Results In 2023, China's age-standardized DALY rate (2.56/100 000) and mortality rate (0.037/100 000) for NR-DMVD were significantly lower than those in the United States, India, and globally, while its age-standardized incidence rate (10.39/100 000) and prevalence rate (126.03/100 000) showed slow increases. From 1990 to 2023, the estimated annual percentage changes (EAPC) for China's age-standardized DALY rate and mortality rate were –2.11% [95%CI (–2.25%, –1.98%)] and –4.54% [95%CI (–4.92%, –4.16%)], respectively, while the incidence rate and prevalence rate continued to rise; India showed increasing trends in all burden indicators. Decomposition analysis indicated that population aging was the primary driver of the increase in DALYs and prevalence cases, while epidemiological improvement was the key factor that led to the reduction in the number of deaths. Joinpoint analysis showed that China's age-standardized DALY rate declined most rapidly between 2000 and 2013, while the age-standardized mortality rate decreased fastest between 2007 and 2013. ARIMA models projected that China's prevalence rate would continue to rise and mortality rate would continue to decline through 2040. Conclusion NR-DMVD in China exhibits a dual-track pattern of "declining mortality but rising prevalence", driven by population aging. A tiered prevention and control system focusing on the elderly and high-risk male groups is needed.

Based on the theory of cancer-toxin pathogenesis， this article proposes that cancer toxin persists throughout the entire course of colorectal cancer （CRC）， with spleen qi depletion as the root of disease and damp-heat and stasis toxin as key factors in the evolution of pathogenesis. It further explores the intrinsic relationship between these pathogenetic features and the modern pathological process of "inflammasome pre-activation/repeated activation/gasdermin D-mediated pyroptotic microenvironmental imbalance". Spleen qi depletion is regarded as an upstream pathological basis for inflammasome pre-activation， while damp-heat and stasis toxin are considered key drivers of repeated inflammasome activation， the gasdermin D-mediated amplification of pyroptotic inflammation， and persistent microenvironmental imbalance. These two pathogenetic aspects interact sequentially and concurrently， jointly contributing to the early development and progression of CRC. Guided by the principle of anti-cancer and detoxification， and based on the traditional Chinese medicine （TCM） treatment strategy of simultaneously fortifying the spleen and replenishing qi， clearing and resolving damp-heat， and resolving stasis and toxins， this study further elucidates the modern mechanistic connotations of how these relevant therapies intervene in the gasdermin D-mediated pyroptotic microenvironment imbalance in CRC. The ultimate aim is to provide a theoretical basis for the modern scientific interpretation of cancer-toxin pathogenesis and the clinical syndrome differentiation and treatment of CRC.

Based on the theory of cancer-toxin pathogenesis， this article proposes that cancer toxin persists throughout the entire course of colorectal cancer （CRC）， with spleen qi depletion as the root of disease and damp-heat and stasis toxin as key factors in the evolution of pathogenesis. It further explores the intrinsic relationship between these pathogenetic features and the modern pathological process of "inflammasome pre-activation/repeated activation/gasdermin D-mediated pyroptotic microenvironmental imbalance". Spleen qi depletion is regarded as an upstream pathological basis for inflammasome pre-activation， while damp-heat and stasis toxin are considered key drivers of repeated inflammasome activation， the gasdermin D-mediated amplification of pyroptotic inflammation， and persistent microenvironmental imbalance. These two pathogenetic aspects interact sequentially and concurrently， jointly contributing to the early development and progression of CRC. Guided by the principle of anti-cancer and detoxification， and based on the traditional Chinese medicine （TCM） treatment strategy of simultaneously fortifying the spleen and replenishing qi， clearing and resolving damp-heat， and resolving stasis and toxins， this study further elucidates the modern mechanistic connotations of how these relevant therapies intervene in the gasdermin D-mediated pyroptotic microenvironment imbalance in CRC. The ultimate aim is to provide a theoretical basis for the modern scientific interpretation of cancer-toxin pathogenesis and the clinical syndrome differentiation and treatment of CRC.

Objective:To investigate the clinical characteristics, bleeding site distribution, and factors associated with hospitalization for surgical management in patients with refractory posterior epistaxis.Methods:This cross-sectional study retrospectively analyzed data from 3 473 patients with refractory posterior epistaxis treated at ENT department or Emergency Department of Affiliated Zhangzhou Hospital of Fujian Medical University, between January 2018 and December 2024. The demographic and clinical data of patients were collected. Univariate analyses and multivariable logistic regression were applied to identify factors associated with hospitalization for surgical intervention.Results:Among 3 473 patients (65.94%(2 290 cases) male; mean age (54±21) years), 46.96% (1 631 cases)were aged 41-69 years. Bleeding predominantly occurred at night (89.66%, 3 114 cases) and in winter (29.92%, 1 039 cases). The most frequent bleeding sites were the olfactory cleft (25.22%,876 cases) and inferior meatus vault (25.63%,890 cases), followed by the posterior regions of middle meatus (11.26%,391 cases), the foremost regions of nasal cavity (11.20%,389 cases), the nasal septum surface (11.23%,390 cases), the bottom of nasal cavity (9.42%,327 cases), and the others or uncertain sites (6.05%,210 cases). Endoscopic electrocautery was performed in 75.01% of cases. Overall, 2 715 patients required hospitalization for surgery. Univariate analysis identified older age (≥70 years), male sex, alcohol use, nighttime onset, winter season, hypertension, diabetes, and anticoagulant use as significantly associated with hospitalization ( χ2=6.51, 8.03, 5.11, -0.17, 7.53, 12.52, 6.83, 5.18, all P<0.05). Multivariable logistic regression confirmed older age ( OR=2.45, 95% CI: 1.81-7.50), winter season ( OR=9.55, 95% CI: 2.26-9.38), nighttime onset ( OR=6.78, 95% CI: 1.84-6.96), alcohol use ( OR=27.71, 95% CI: 11.97-64.14), hypertension ( OR=7.93, 95% CI: 1.64-11.84), and anticoagulant use ( OR=6.39, 95% CI: 1.06-9.47) as independent positive factors associated with hospitalization for surgical management (all P<0.05). Conclusions:Refractory posterior epistaxis most commonly affects individuals aged 41-69 years, with bleeding frequently originating from the olfactory cleft or inferior meatus vault, and exhibits seasonal (winter) and diurnal (nighttime) patterns. Independent factors significantly associated with the need for hospitalization and surgical intervention include older age, winter onset, nighttime onset, alcohol use, hypertension, and anticoagulant use. Identifying these factors may aid in risk stratification and clinical decision-making.

This study aims to compare the vaccination rates and incidence of adverse reaction rates following administration of two domestically produced human papillomavirus (HPV) vaccines in individuals aged 9-30 years,investigate the impact of distinct manufacturing processes and vaccination schedules on adverse reaction rates. From November 2023 to June 2024, the Immunization Planning Department of Liuzhou Center for Disease Control and Prevention conducted a single-center, randomized, open-label, parallel-group trial using community-based recruitment of eligible participants aged 9 to 30 years. Participants were randomly assigned to receive either of two domestically produced HPV vaccines (Walrinvax or Cecolin). As specified in the vaccine package inserts, subjects were stratified into a two-dose regimen group (aged 9-14 years) and a three-dose regimen group (aged 15-30 years). Vaccination rates were recorded, and adverse reactions within 0-30 days post-vaccination were monitored. The results showed that a total of 400 participants were enrolled. Both the full vaccination rate and the timely completion rate were significantly higher in the two-dose regimen group compared to the three-dose regimen group (Fisher′s exact test, P<0.01; χ2=7.06, P<0.01). A total of 985 doses were administered. The overall adverse reaction rate was 18.78% (185/985), with local and systemic reactions occurring at 8.02% (79/985) and 10.76% (106/985), respectively. The most frequent adverse reactions were injection site pain (4.97%, 49/985) and fever (4.47%, 44/985). No grade 4 or special-interest adverse events were reported.The incidence of adverse reactions for the two domestic HPV vaccines with different production processes (at 0/6 months) was 13.96% (55/394) and 17.46% (69/395) respectively, with no statistically significant difference (χ2=1.83, P>0.05).The adverse reaction rate was significantly lower in the 9-14 years group (9.77%) compared the 15-30 years group (24.91%)(χ 2=35.67, P<0.01). In conclusion, both domestic HPV vaccines demonstrated a favorable safety profile in the 9-30 years age group, with mostly mild adverse reactions. Compared to the three-dose schedule (15-30 years group), the two-dose HPV vaccination schedule (9-14 years group) significantly reduced the incidence of adverse reactions and improved vaccination compliance.

Rapid and ultrasensitive detection of pathogen-associated biomarkers is vital for the early diagnosis and therapy of bacterial infections.Herein,we developed a close-packed and ordered Au@AgPt array coupled with a cascade triggering strategy for surface-enhanced Raman scattering(SERS)and colorimetric identification of the Staphylococcus aureus biomarker micrococcal nuclease(MNase)in serum samples.The trimetallic Au@AgPt nanozymes can catalyze the oxidation of 3,3',5,5'-tetramethylbenzidine(TMB)molecules to SERS-enhanced oxidized TMB(oxTMB),accompanied by the color change from colorless to blue.In the presence of S.aureus,the secreted MNase preferentially cut the nucleobase AT-rich regions of DNA sequences on magnetic beads(MBs)to release alkaline phosphatase(ALP),which subsequently mediated the oxTMB reduction for inducing the colorimetric/SERS signal fade away.Using this"on-to-off"triggering strategy,the target S.aureus can be recorded in a wide linear range with a limit of detection of 38 CFU/mL in the colorimetric mode and 6 CFU/mL in the SERS mode.Meanwhile,the MNase-mediated strategy characterized by high specificity and sensitivity successfully discriminated between patients with sepsis(n=7)and healthy participants(n=3),as well as monitored the prog-nostic progression of the disease(n=2).Overall,benefiting from highly active and dense"hot spot"substrate,MNase-mediated cascade response strategy,and colorimetric/SERS dual-signal output,this methodology will offer a promising avenue for the early diagnosis of S.aureus infection.

Objective:To explore the construction of an evaluation model for aortic root anatomy and calcium burden in patients with bicuspid aortic valve (BAV) stenosis before transcatheter aortic valve replacement (TAVR) based on deep learning (DL) algorithms.Methods:A retrospective collection of 362 BAV stenosis patients who underwent TAVR from September 2023 to May 2024 was performed. All patients underwent cardiac CT angiography. The patients were divided into training group ( n=104), internal validation group ( n=206), and external validation group ( n=52). A DL model was trained on the training dataset to assess aortic root anatomy and calcification burden. The evaluation included the segmentation accuracy of the algorithm, the measurement performance of key anatomical structures (i.e., valve leaflets and type-1 and type-2 fusion raphe), and calcification burden, as well as the measurement efficiency. Overall segmentation performance was assessed using the average Dice coefficient (ADC). The fine-scale segmentation quality was validated by the 95th-percentile Hausdorff distance (HD-95) and the average symmetric surface distance (ASSD). The consistency of the measurement results was assessed using the Pearson correlation coefficient and the intraclass correlation coefficient ( ICC) with a two-way mixed model for absolute agreement. In addition, the total time and total mouse movement distance required for manual assessment versus the DL model on the validation datasets were recorded and compared. Results:The algorithm demonstrated excellent segmentation performance on aortic root anatomical targets, achieving outstanding consistency within both internal and external validation datasets (0.955

Objective:To construct and evaluate a radiomics model for predicting perineural invasion in patients with intrahepatic cholangiocarcinoma (ICC).Methods:Clinical data of 144 patients with ICC undergoing surgery in the People’s Hospital of Zhengzhou University ( n=113) and the Affiliated Cancer Hospital of Zhengzhou University ( n=31) from January 2018 to June 2023 were retrospectively analyzed, including 80 males and 64 females, aged (58.8±10.1) years. The patients were randomly divided into a training set ( n=100) and a test set ( n=44) at a ratio of 7: 3. The former set was used to build the model for predicting perineural invasion, and the latter was used to evaluate the model. Enhanced CT images and clinical data of the patients were collected, and features related to perineural invasion were screened. A light gradient boosting machine was used to construct an imaging genomics model. The model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results:Univariate and multivariate logistic regression analysis showed that none of the clinical features were associated with neural invasion in ICC patients (all P>0.05). Six, 25, 32, and 37 radiomics features were obtained by screening the intratumoral, 2 mm peritumoral, 5 mm peritumoral, and 8 mm peritumoral regions, respectively. The area under the ROC curve for predicting perineural invasion in ICC patients was 0.849 (95% CI: 0.774-0.923) in the training set and 0.745 (95% CI: 0.597-0.894) in the test set for the intratumoral model, 0.966 (95% CI: 0.938-0.995) and 0.750 (95% CI: 0.604-0.896) for the 5mm peritumoral model, 0.936 (95% CI: 0.892-0.980) and 0.792 (95% CI: 0.644-0.939) for the 2mm peritumoral model, and 0.961 (95% CI: 0.929-0.992) and 0.689 (95% CI: 0.526-0.853) for the 8mm peritumoral model. The area under the ROC curve, accuracy, sensitivity, and specificity of the combined intratumoral and 5mm peritumoral model for predicting perineural invasion were 0.927 (95% CI: 0.878-0.976), 88.0%, 84.5%, and 89.8% in the training set, and 0.849 (95% CI: 0.737-0.960), 77.3%, 85.2%, and 72.0% in the test set, respectively. The calibration curve showed a deviation between the calibration curve of the combined intratumoral and 5mm peritumoral model and the ideal line, but it could achieve basic consistency. DCA showed that when the threshold was between 0.18 and 0.70, the combined intratumoral and 5mm peritumoral model could bring clinical net benefit to patients when predicting neural invasion. Conclusion:The intratumoral and 5mm peritumoral imaging genomics model based on enhanced CT features can effectively predict neural invasion and offer clinical benefits in patients with ICC.

Objective To compare the efficacy and safety of gemcitabine combined with conventional-dose cisplatin(70 mg/m2,day 2)versus split-dose cisplatin(35 mg/m2,days 1 and 8)in neo-adjuvant therapy for muscle-invasive bladder cancer(MIBC).Methods The clinical data of 33 MIBC patients receiving(gemcitabine+cisplatin,GC)-based neoadjuvant chemotherapy in the Department of Urology of Xinhua Hospital,during Jan.2021 and Aug.2024 were retrospectively analyzed,including 18(54.5％)patients treated with a conventional-dose regimen(GC group),and 15(45.5％)patients treated with a split-dose regimen(GCs group).The efficacy endpoints and incidence/severity of adverse reactions were compared between the two groups.Results Baseline characteristics were well-balanced between the two groups(P＞0.05).No significant differences were observed in the complete response rate(CR:33.3％vs.22.2％),objective response rate(ORR:66.7％vs.61.1％),or disease control rate(DCR:80.0％vs.88.9％)between the GCs and GC groups(P＞0.05).The GCs group exhibited a significantly lower incidence of chemotherapy-related renal injury(6.7％vs.38.9％,P＜0.05),while the occurrence of other adverse events was comparable between the two groups.Notably,the GCs group demonstrated significantly attenuated nephrotoxicity,as evidenced by markedly smaller changes in estimated glomerular filtration rate[eGFR:(4.5±4.7)％vs.(18.0±11.8)％]and serum creatinine[SCr:(5.7±5.6)％vs.(20.2±19.5)％]compared to the GC group(P＜0.05).Conclusion Compared with the conventional-dose regimen,the split-dose regimen maintains equivalent clinical efficacy of GC-based neoadjuvant chemotherapy while significantly reducing chemotherapy-related nephrotoxicity,thereby providing MIBC patients with a safer therapeutic option.