Objective To evaluate the efficacy of the venous thromboembolism(VTE)digital risk prevention and control platform based on whole-process closed-loop management for the quality management of VTE in Peking University Shenzhen Hospital.Methods The data of 360 718 hospitalized patients from 2021 to 2024 were collected to analyze the rate of VTE risk assessment,the proportion of VTE intermediate and high-risk patients,the rate of VTE prophylaxis implementation(physical/pharmacological),and the VTE outcome indexes,and the differences between groups were verified using the Cochran-Armitage χ2 trend test.Results The VTE initial risk assessment rate,the implementation rate of VTE physical prophylaxis,and the rate of VTE pharmacological prophylaxis all showed an upward trend;the incidence rate of hospital correlated VTE,and the incidence rate of VTE in hospitalized surgical patients all showed a downward trend.Conclusion The establishment of the VTE digital risk prevention and control intelligent platform can effectively improve the level of standardized prevention and treatment of in-hospital VTE and the efficacy of quality management,and provide a digital management paradigm for the implementation of the national healthcare quality and safety improvement goals and the monitoring indicators of surgical quality and safety improvement actions.

Objective To assess the global and Chinese disease burden of early-onset lung cancer(di-agnosed in patients aged 15-49 years)and its major risk factors.Methods Based on the GLOBOCAN 2022 and Global Burden of Disease(GBD)2021 datasets,we evaluated the disease burden and associated risk fac-tors of early-onset lung cancer globally and in China,stratified by age,sex,geographic location,and human development index(HDI).Key indicators included age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and disability adjusted life years(DALYs)attributable to risk factors.Results In 2022,there were 137 705 new cases and 72 646 deaths from early-onset lung cancer globally,with ASIR and ASMR of 3.43 per 100 000 and 1.82 per 100 000 population,respectively.The disease burden was higher in males than in females(ASIR:3.72 per 100 000 vs.3.14 per 100 000;ASMR:2.31 per 100 000 vs.1.33 per 100 000).High-HDI regions exhibited the highest ASIR(5.51 per 100 000)and ASMR(2.57 per 100 000),with health inequality analysis revealing a concentration of disease burden in higher-HDI areas.China bore the heaviest burden,accounting for 48.69%of global new cases and 35.77%of deaths.China's ASIR(8.21 per 100 000)and ASMR(3.17 per 100 000)exceeded global averages,with incidence higher in fe-males(8.78 per 100 000 vs.7.67 per 100 000)but mortality higher in males(4.01 per 100 000 vs.2.29 per 100 000).Smoking and ambient particulate matter pollution were the leading risk factors globally(DALYs contribution:42.01%and15.62%)and in China(DALYs contribution:46.78%and 20.84%).Globally,household air pollution ranked third,whereas in China,secondhand smoke replaced it as the third leading risk factor,with household air pollution dropping to fifth.Risk factor profiles varied significantly across age groups,with modifiable risks contributing less to disease burden in the 15-24 age group.Conclusions The burden of early-onset lung cancer varies markedly by sex,region,and HDI,with China facing a disproportionately high burden.Policymakers should prioritize equitable resource allocation and targeted interventions,particularly in tobacco control and air pollution mitigation,to enhance cancer prevention and control efforts.

Purpose To explore the influence of thrombolysis therapy before percutaneous coronary intervention(PCI)on long-term left ventricular global and regional function in ST segment elevation myocardial infarction(STEMI)patients by cardiac magnetic resonance(CMR).Materials and Methods A retrospective analysis was conducted on 67 STEMI patients who were enrolled in a prospective study from November 2021 to August 2022 in the First Affiliated Hospital with Nanjing Medical University,the First People's Hospital of Lianyungang,the Affiliated Hospital of Jiangnan University,Changzhou No.2 People's Hospital and Huai'an Second People's Hospital and underwent CMR examination one year later.STEMI patients were divided into thrombolysis group and non-thrombolysis group according to whether a single half-dose of 5 mg recombinant staphylokinase(r-SAK)was given within two hours before the first medical contact and PCI.Based on CMR cine images,the traditional left ventricular function,global and segmental functional parameters were measured,and the differences between the two groups were compared.According to the degree of late gadolinium enhancement involvement,myocardial segments were divided into the following four types:transmural infarcted segments,non-transmural infarcted segments,locally infarcted segments,and non-infarcted segments.The parameters of the two groups were compared across these different segments.Results At the patient level,the cardiac index,left ventricular wall thickening and left ventricular wall motion in r-SAK thrombolysis group were higher than those in non-thrombolysis group(t/Z=-2.426,-4.307,-2.735,all P<0.05).At the segment level,compared with non-thrombolysis group,patients received r-SAK before primary PCI showed greater segmental radial strain in non-transmural infarcted segments(Z=-2.117,P=0.034);larger segmental wall motion in locally infarcted segments(Z=-2.235,P=0.025),and better segmental circumference strain in the non-infarcted segments(Z=-3.869,P<0.001).Conclusion The thrombolytic therapy before PCI in STEMI patients retain better long-term left ventricular global and regional function evaluating by CMR.

Objective To assess the global and Chinese disease burden of early-onset lung cancer(di-agnosed in patients aged 15-49 years)and its major risk factors.Methods Based on the GLOBOCAN 2022 and Global Burden of Disease(GBD)2021 datasets,we evaluated the disease burden and associated risk fac-tors of early-onset lung cancer globally and in China,stratified by age,sex,geographic location,and human development index(HDI).Key indicators included age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and disability adjusted life years(DALYs)attributable to risk factors.Results In 2022,there were 137 705 new cases and 72 646 deaths from early-onset lung cancer globally,with ASIR and ASMR of 3.43 per 100 000 and 1.82 per 100 000 population,respectively.The disease burden was higher in males than in females(ASIR:3.72 per 100 000 vs.3.14 per 100 000;ASMR:2.31 per 100 000 vs.1.33 per 100 000).High-HDI regions exhibited the highest ASIR(5.51 per 100 000)and ASMR(2.57 per 100 000),with health inequality analysis revealing a concentration of disease burden in higher-HDI areas.China bore the heaviest burden,accounting for 48.69%of global new cases and 35.77%of deaths.China's ASIR(8.21 per 100 000)and ASMR(3.17 per 100 000)exceeded global averages,with incidence higher in fe-males(8.78 per 100 000 vs.7.67 per 100 000)but mortality higher in males(4.01 per 100 000 vs.2.29 per 100 000).Smoking and ambient particulate matter pollution were the leading risk factors globally(DALYs contribution:42.01%and15.62%)and in China(DALYs contribution:46.78%and 20.84%).Globally,household air pollution ranked third,whereas in China,secondhand smoke replaced it as the third leading risk factor,with household air pollution dropping to fifth.Risk factor profiles varied significantly across age groups,with modifiable risks contributing less to disease burden in the 15-24 age group.Conclusions The burden of early-onset lung cancer varies markedly by sex,region,and HDI,with China facing a disproportionately high burden.Policymakers should prioritize equitable resource allocation and targeted interventions,particularly in tobacco control and air pollution mitigation,to enhance cancer prevention and control efforts.

Purpose To explore the influence of thrombolysis therapy before percutaneous coronary intervention(PCI)on long-term left ventricular global and regional function in ST segment elevation myocardial infarction(STEMI)patients by cardiac magnetic resonance(CMR).Materials and Methods A retrospective analysis was conducted on 67 STEMI patients who were enrolled in a prospective study from November 2021 to August 2022 in the First Affiliated Hospital with Nanjing Medical University,the First People's Hospital of Lianyungang,the Affiliated Hospital of Jiangnan University,Changzhou No.2 People's Hospital and Huai'an Second People's Hospital and underwent CMR examination one year later.STEMI patients were divided into thrombolysis group and non-thrombolysis group according to whether a single half-dose of 5 mg recombinant staphylokinase(r-SAK)was given within two hours before the first medical contact and PCI.Based on CMR cine images,the traditional left ventricular function,global and segmental functional parameters were measured,and the differences between the two groups were compared.According to the degree of late gadolinium enhancement involvement,myocardial segments were divided into the following four types:transmural infarcted segments,non-transmural infarcted segments,locally infarcted segments,and non-infarcted segments.The parameters of the two groups were compared across these different segments.Results At the patient level,the cardiac index,left ventricular wall thickening and left ventricular wall motion in r-SAK thrombolysis group were higher than those in non-thrombolysis group(t/Z=-2.426,-4.307,-2.735,all P<0.05).At the segment level,compared with non-thrombolysis group,patients received r-SAK before primary PCI showed greater segmental radial strain in non-transmural infarcted segments(Z=-2.117,P=0.034);larger segmental wall motion in locally infarcted segments(Z=-2.235,P=0.025),and better segmental circumference strain in the non-infarcted segments(Z=-3.869,P<0.001).Conclusion The thrombolytic therapy before PCI in STEMI patients retain better long-term left ventricular global and regional function evaluating by CMR.

Objective To evaluate the efficacy of the venous thromboembolism(VTE)digital risk prevention and control platform based on whole-process closed-loop management for the quality management of VTE in Peking University Shenzhen Hospital.Methods The data of 360 718 hospitalized patients from 2021 to 2024 were collected to analyze the rate of VTE risk assessment,the proportion of VTE intermediate and high-risk patients,the rate of VTE prophylaxis implementation(physical/pharmacological),and the VTE outcome indexes,and the differences between groups were verified using the Cochran-Armitage χ2 trend test.Results The VTE initial risk assessment rate,the implementation rate of VTE physical prophylaxis,and the rate of VTE pharmacological prophylaxis all showed an upward trend;the incidence rate of hospital correlated VTE,and the incidence rate of VTE in hospitalized surgical patients all showed a downward trend.Conclusion The establishment of the VTE digital risk prevention and control intelligent platform can effectively improve the level of standardized prevention and treatment of in-hospital VTE and the efficacy of quality management,and provide a digital management paradigm for the implementation of the national healthcare quality and safety improvement goals and the monitoring indicators of surgical quality and safety improvement actions.

Humans ; Female ; Breast Neoplasms/pathology* ; Multiomics ; Trastuzumab ; Receptor, ErbB-2/genetics* ; Machine Learning

Objective: More than 75% of ovarian cancer patients are diagnosed at advanced stages and die of tumor cell metastasis. This study aimed to identify new epigenetic and transcriptomic alterations associated with ovarian cancer metastasis. Methods: Two cell sublines with low- and high-metastasis potentials were derived from the ovarian cancer cell line A2780. Genome-wide DNA methylome and transcriptome profiling were carried out in these two sublines by Reduced Representation Bisulfite Sequencing and RNA-seq technologies. Cell-based assays were conducted to support the clinical findings. Results: There are distinct DNA methylation and gene expression patterns between the two cell sublines with low- and high-metastasis potentials. Integrated analysis identified 33 methylation-induced genes potentially involved in ovarian cancer metastasis. The DNA methylation patterns of two of them (i.e., SFRP1 and LIPG) were further validated in human specimens, indicating that they were hypermethylated and downregulated in peritoneal metastatic ovarian carcinoma compared to primary ovarian carcinoma. Patients with lower SFRP1 and LIPG expression tend to have a worse prognosis. Functionally, knockdown of SFRP1 and LIPG promoted cell growth and migration, whereas their overexpression resulted in the opposite effects. In particular, knockdown of SFRP1 could phosphorylate GSK3β and increase β-catenin expression, leading to deregulated activation of the Wnt/β-catenin signaling. Conclusion Many systemic and important epigenetic and transcriptomic alterations occur in the progression of ovarian cancer. In particular, epigenetic silencing of SFRP1 and LIPG is a potential driver event in ovarian cancer metastasis. They can be used as prognostic biomarkers and therapeutic targets for ovarian cancer patients.

Objective::To analyze the temporal trends of maternal mortality ratio (MMR) due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019, to identify whether the rate of change has accelerated or slowed down during this period, and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods::Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019. Maternal death was defined according to the World Health Organization’s criterion. The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases -10. Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable. The MMR and 95% confidence intervals ( CI) for regions or causes were estimated by Poisson’s distribution. Joinpoint regression was used to assess the accurate temporal patterns. Results::The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births (95% CI: 15.0-22.2) in 2000. It peaked in 2001 (22.1 per 100,000 live births, 95% CI: 18.3-26.4) and was lowest in 2019 (1.6 per 100,000 live births, 95% CI: 1.0-2.3). For specific regions, the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise, followed by a rapid decline, and then a slow decline. For specific causes, no change point was found in joinpoint analysis of the national MMR caused by placenta previa, postpartum uterine atony, and retained placenta (the annual percent change was -12.0%, -10.5%, and -21.0%, respectively). The MMR caused by postpartum hemorrhages (PPH) significantly declined by 8.0% (95% CI: 1.9-13.6) per year from 2000 to 2007. The annual percent change of MMR caused by PPH accelerated further to -25.0% between 2007 and 2011, and then decreased to -7.8% between 2011 and 2019. The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6% (8/105) in 2000 to 14.3% (4/28) in 2019. The changes in the proportion of causes were different for maternal deaths due to PPH. The proportion of postpartum uterine atony increased from 39.0% (41/105) in 2000 to 60.7% (17/28) in 2019, and the proportion of uterine rupture also increased from 12.3% (13/105) in 2000 to 14.3% (4/28) in 2019. However, the proportion of retained placenta decreased from 37.1% (39/105) in 2000 to 7.1% (2/28) in 2019. Conclusion::Over the last 20 years, the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage. However, the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture. China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage, especially for postpartum uterine atony and uterine rupture.

Objective::To analyze the temporal trends of maternal mortality ratio (MMR) due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019, to identify whether the rate of change has accelerated or slowed down during this period, and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods::Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019. Maternal death was defined according to the World Health Organization’s criterion. The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases -10. Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable. The MMR and 95% confidence intervals ( CI) for regions or causes were estimated by Poisson’s distribution. Joinpoint regression was used to assess the accurate temporal patterns. Results::The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births (95% CI: 15.0-22.2) in 2000. It peaked in 2001 (22.1 per 100,000 live births, 95% CI: 18.3-26.4) and was lowest in 2019 (1.6 per 100,000 live births, 95% CI: 1.0-2.3). For specific regions, the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise, followed by a rapid decline, and then a slow decline. For specific causes, no change point was found in joinpoint analysis of the national MMR caused by placenta previa, postpartum uterine atony, and retained placenta (the annual percent change was -12.0%, -10.5%, and -21.0%, respectively). The MMR caused by postpartum hemorrhages (PPH) significantly declined by 8.0% (95% CI: 1.9-13.6) per year from 2000 to 2007. The annual percent change of MMR caused by PPH accelerated further to -25.0% between 2007 and 2011, and then decreased to -7.8% between 2011 and 2019. The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6% (8/105) in 2000 to 14.3% (4/28) in 2019. The changes in the proportion of causes were different for maternal deaths due to PPH. The proportion of postpartum uterine atony increased from 39.0% (41/105) in 2000 to 60.7% (17/28) in 2019, and the proportion of uterine rupture also increased from 12.3% (13/105) in 2000 to 14.3% (4/28) in 2019. However, the proportion of retained placenta decreased from 37.1% (39/105) in 2000 to 7.1% (2/28) in 2019. Conclusion::Over the last 20 years, the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage. However, the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture. China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage, especially for postpartum uterine atony and uterine rupture.