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 propose a deep learning（DL）-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus（BP），and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses，the Third Medical Center of the Chinese PLA General Hospital，and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus（BP）images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers，a dataset comprising 1 289 standardized images were constructed and the improved model（CHA-TransUNet）was trained. The test set was input into 6 different models（CHA-TransUNet，R50-Unet，TransUnet，SegFormer，SwinUnet，MISSFormer）for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient（DSC），95% Hausdorff distance（HD95）and mean intersection over union（mIoU），and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels（junior physicians and senior physicians）to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%，mIoU of 91.02%，and HD95 of 8.08. Its accuracy was higher than other mainstream models（DSC：90.15% vs. 87.60%，87.77%，81.35%，84.78%，84.55%），significantly better than junior physicians（DSC：90.15% vs. 68.73%， Z=-127.76， P<0.001），and approached the level of senior physician（DSC：90.15% vs. 86.15%， Z=-31.33， P=0.549）. The model demonstrated superior boundary recognition in complex anatomical structures（e.g.，C6/C7 nerve roots）compared to ultrasound physicians（junior and senior）（HD95：8.08 vs. 26.34，17.44，56.80）. Conclusions:This study proposes an analysis model for BP ultrasound images，CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability，outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.

Objective:To investigate and analyze the relationship between genotype and phenotype in patients with early-onset high myopia (eoHM) associated with hereditary eye diseases.Methods:A family-based study was conducted among 30 families diagnosed with eoHM at Department of Ophthalmology of People's Hospital of Ningxia Hui Autonomous Region from January 2022 to June 2023. Seven families (23.3%, 7/30), all probands, and their 14 parents were included. These seven families were unrelated. Detailed patient and family histories were collected. All participants underwent comprehensive ophthalmic examinations, including best-corrected visual acuity, color vision testing, fundus color photography, optical coherence tomography, fluorescein fundus angiography, and fundus autofluorescence imaging. Full-field electroretinography was performed in four cases. Peripheral venous blood samples were collected from patients and their parents for whole-genome DNA extraction and whole-exome sequencing. Potential pathogenic variants were identified, and their pathogenicity was analyzed and confirmed by Sanger sequencing. The pathogenicity of newly discovered gene variants was evaluated according to the guidelines of the American College of Medical Genetics and Genomics (ACMG). Literature on previously reported eoHM associated with hereditary eye diseases was reviewed to analyze the relationship between variant genes and clinical phenotypes.Results:Among the seven families, three exhibited X-linked inheritance, two showed autosomal recessive inheritance, and two demonstrated autosomal dominant inheritance. All the patients were male. Among the seven patients, one case each was identified with congenital stationary night blindness (CSNB), Bornholm eye disease, X-linked retinitis pigmentosa (XL-RP), cone-rod dystrophy, Knobloch syndrome, familial exudative vitreoretinopathy (FEVR), and Stickler syndrome. Genetic testing revealed nine gene variants highly correlated with the observed phenotypes. The genetic testing results revealed that all patients were found to carry nine gene variants highly associated with the phenotype, including: a hemizygous missense variant NYX c.647A>T (p.N216I) (M1), an OPN1LW LIAVA haplotype variant (M2), a hemizygous frameshift variant RPGR c.3096_3097del (p.E1033RfsTer45) (M3), compound heterozygous variants TTLL5 c.1588_1589del (p.L531EfsTer24) and c.850G>C (p.D284H) (M4, M5), compound heterozygous variants COL18A1 c.2118dup (p.G707RfsTer23) and c.3523_3524del (p.L1175VfsTer72) (M6, M7), a heterozygous missense mutation FZD4 c.1499C>T (p.T500I) (M8), and a heterozygous frameshift variant COL11A2 c.966dup (p.T323HfsTer19) (M9). Among them, M2, M4, M5, M8 and M9 were newly discovered mutation sites, and M1, M3, M6 and M7 were known mutation sites. According to the classification standards and guidelines of genetic variation issued by ACMG, M2, M3, M4, M6, M7, and M9 were judged to be pathogenic variants, while M1, M5, and M8 were of unknown clinical significance. Through literature review, it was found that eoHM was more common among the clinical phenotypes of 4 types of hereditary retinal diseases, including CSNB, Stickler syndrome, FEVR and XL-RP. Conclusion:eoHM is intricately associated with inherited eye diseases and may serve as the earliest indicator of such conditions.

This study investigates the molecular complexities of non-alcoholic fatty liver disease(NAFLD)-induced brain dysfunction,with a focus on the liver-intestine-brain axis and potential therapeutic interventions.The main objectives include understanding critical microbiota shifts in NAFLD,exploring altered me-tabolites,and identifying key regulatory molecules influencing brain function.The methods employed encompassed 16S ribosomal RNA(rRNA)sequencing to scrutinize stool microbiota in NAFLD patients and healthy individuals,non-targeted metabolomics using LC-MS to uncover elevated levels of deoxycholic acid(DCA)in NAFLD mice,and single-cell RNA sequencing(scRNA-seq)to pinpoint the pivotal gene Hpgd in microglial cells and its downstream Janus kinase 2/signal transducer and activator of transcription 3(JAK2/STAT3)signaling pathway.Behavioral changes and brain function were assessed in NAFLD mice with and without fecal microbiota transplantation(FMT)treatment,utilizing various assays and analyses.The results revealed significant differences in microbiota composition,with increased levels of Bacter-oides in NAFLD patients.Additionally,elevated DCA levels were observed in NAFLD mice,and FMT treatment demonstrated efficacy in ameliorating liver function and brain dysfunction.Hpgd inhibition by DCA activated the JAK2/STAT3 pathway in microglial cells,leading to inflammatory activation,inhibition of mitochondrial autophagy,induction of neuronal apoptosis,and reduction in neuronal action poten-tials.This study elucidates the intricate molecular mechanisms underlying the liver-gut-brain axis in NAFLD,and the identification of increased DCA and the impact of JAK2/STAT3 signaling on microglial cells highlight potential therapeutic targets for addressing NAFLD-induced brain dysfunction.

This study investigates the molecular complexities of non-alcoholic fatty liver disease (NAFLD)-induced brain dysfunction, with a focus on the liver-intestine-brain axis and potential therapeutic interventions. The main objectives include understanding critical microbiota shifts in NAFLD, exploring altered metabolites, and identifying key regulatory molecules influencing brain function. The methods employed encompassed 16S ribosomal RNA (rRNA) sequencing to scrutinize stool microbiota in NAFLD patients and healthy individuals, non-targeted metabolomics using LC-MS to uncover elevated levels of deoxycholic acid (DCA) in NAFLD mice, and single-cell RNA sequencing (scRNA-seq) to pinpoint the pivotal gene Hpgd in microglial cells and its downstream Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway. Behavioral changes and brain function were assessed in NAFLD mice with and without Fecal microbiota transplantation (FMT) treatment, utilizing various assays and analyses. The results revealed significant differences in microbiota composition, with increased levels of Bacteroides in NAFLD patients. Additionally, elevated DCA levels were observed in NAFLD mice, and FMT treatment demonstrated efficacy in ameliorating liver function and brain dysfunction. Hpgd inhibition by DCA activated the JAK2/STAT3 pathway in microglial cells, leading to inflammatory activation, inhibition of mitochondrial autophagy, induction of neuronal apoptosis, and reduction in neuronal action potentials. This study elucidates the intricate molecular mechanisms underlying the liver-gut-brain axis in NAFLD, and the identification of increased DCA and the impact of JAK2/STAT3 signaling on microglial cells highlight potential therapeutic targets for addressing NAFLD-induced brain dysfunction.

Objective To investigate the correlation between thyroid hormone levels and cognitive function in schizophrenia(SCZ)patients with metabolic syndrome(MetS),as well as the mediating role of thyroid hormones in the relationship between MetS-related indicators and cognitive function.Methods A cross-sectional trial was conducted on 120 SCZ inpatients and outpatients(40 cases of MetS and 80 cases of non-MetS)and 80 healthy controls admitted in the Chongqing Mental Health Center from August 2023 to December 2024.Thyroid function indicators[Thyroid-stimulating hormone(TSH),triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),and free thyroxine(FT4)],MetS-related parameters[blood glucose,triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and waist circumference],Positive and Negative Syndrome Scale(PANSS)score,and Montreal Cognitive Assessment(MoCA)scores were collected.One-way ANOVA or Kruskal-Wallis rank sum test was applied to analyze the differences among the 3 groups,and LSD test or Bonferroni correction was performed for post hoc analysis.Pearson correlation analysis was conducted to assess the relationship between thyroid hormone levels and metabolic parameters as well as cognitive/clinical scale scores(MoCA,PANSS)in the MetS group.Results The MetS group exhibited significantly lower FT4 level(P<0.05)and MoCA score(P=0.001),but higher TSH level(P<0.05)and PANSS negative symptom score(P<0.001)when compared to the non-MetS group.Correlation analysis indicated that in the MetS group,TSH level was positively correlated with TG(r=0.672,P<0.001)and PANSS negative symptom score(r=0.458,P<0.05),and negatively with HDL-C(r=-0.377,P=0.017)and MoCA score(r=-0.667,P<0.001);FT4 level was positively correlated with MoCA score(r=0.534,P<0.001).In the non-MetS group,TSH level was positively correlated with PANSS negative symptom score(r=0.267,P=0.017)and negatively with HDL-C(r=-0.236,P=0.036),T3 was positively with waist circumference(r=0.268,P=0.017).No correlation was observed in FT4 level with HDL-C(r=-0.207,P=0.067)or MoCA score(r=0.216,P=0.055).Mediation analysis revealed that TSH partially mediated the association between TG and MoCA score,with a mediation effect accounting for 29.91%of the total effect.The mediating effect was not significant in the non-MetS group.Conclusion Abnormal elevation of TSH may serve as a critical link between MetS and cognitive impairment in SCZ patients,which providing novel insights into the mechanisms underlying cognitive dysfunction in the patients.

Allergic rhinitis （AR） is one of the most common chronic non-infectious inflammatory diseases in children. Traditional Chinese medicine （TCM） employs a comprehensive therapeutic system integrating treatment by stages and syndrome differentiation and treatment， demonstrating significant advantages in the management of pediatric AR. This article systematically reviews the clinical treatment methods and underlying mechanisms of TCM for pediatric AR in recent years. It is found that internal therapies （such as herbal formulas or Chinese patent medicines like Xiaoqinglong decoction， Yiqi tuomin decoction）， external therapies （including intradermal needles， acupoint application， tuina， and herbal nasal therapy）， as well as combined internal and external approaches （oral herbs combined with acupoint application）， have demonstrated significant effects in alleviating clinical symptoms， improving immune indicators， and reducing recurrence rates in children with AR. The underlying mechanisms are primarily associated with the regulation of signaling pathways such as Toll-like receptor/nuclear factor-kappa B and mitogen-activated protein kinase， thereby modulating immune balance， suppressing inflammatory responses， inhibiting pyroptosis， reducing mucus secretion， and promoting nasal mucosal repair.

Objective:To propose a deep learning（DL）-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus（BP），and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses，the Third Medical Center of the Chinese PLA General Hospital，and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus（BP）images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers，a dataset comprising 1 289 standardized images were constructed and the improved model（CHA-TransUNet）was trained. The test set was input into 6 different models（CHA-TransUNet，R50-Unet，TransUnet，SegFormer，SwinUnet，MISSFormer）for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient（DSC），95% Hausdorff distance（HD95）and mean intersection over union（mIoU），and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels（junior physicians and senior physicians）to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%，mIoU of 91.02%，and HD95 of 8.08. Its accuracy was higher than other mainstream models（DSC：90.15% vs. 87.60%，87.77%，81.35%，84.78%，84.55%），significantly better than junior physicians（DSC：90.15% vs. 68.73%， Z=-127.76， P<0.001），and approached the level of senior physician（DSC：90.15% vs. 86.15%， Z=-31.33， P=0.549）. The model demonstrated superior boundary recognition in complex anatomical structures（e.g.，C6/C7 nerve roots）compared to ultrasound physicians（junior and senior）（HD95：8.08 vs. 26.34，17.44，56.80）. Conclusions:This study proposes an analysis model for BP ultrasound images，CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability，outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.

Objective:To investigate and analyze the relationship between genotype and phenotype in patients with early-onset high myopia (eoHM) associated with hereditary eye diseases.Methods:A family-based study was conducted among 30 families diagnosed with eoHM at Department of Ophthalmology of People's Hospital of Ningxia Hui Autonomous Region from January 2022 to June 2023. Seven families (23.3%, 7/30), all probands, and their 14 parents were included. These seven families were unrelated. Detailed patient and family histories were collected. All participants underwent comprehensive ophthalmic examinations, including best-corrected visual acuity, color vision testing, fundus color photography, optical coherence tomography, fluorescein fundus angiography, and fundus autofluorescence imaging. Full-field electroretinography was performed in four cases. Peripheral venous blood samples were collected from patients and their parents for whole-genome DNA extraction and whole-exome sequencing. Potential pathogenic variants were identified, and their pathogenicity was analyzed and confirmed by Sanger sequencing. The pathogenicity of newly discovered gene variants was evaluated according to the guidelines of the American College of Medical Genetics and Genomics (ACMG). Literature on previously reported eoHM associated with hereditary eye diseases was reviewed to analyze the relationship between variant genes and clinical phenotypes.Results:Among the seven families, three exhibited X-linked inheritance, two showed autosomal recessive inheritance, and two demonstrated autosomal dominant inheritance. All the patients were male. Among the seven patients, one case each was identified with congenital stationary night blindness (CSNB), Bornholm eye disease, X-linked retinitis pigmentosa (XL-RP), cone-rod dystrophy, Knobloch syndrome, familial exudative vitreoretinopathy (FEVR), and Stickler syndrome. Genetic testing revealed nine gene variants highly correlated with the observed phenotypes. The genetic testing results revealed that all patients were found to carry nine gene variants highly associated with the phenotype, including: a hemizygous missense variant NYX c.647A>T (p.N216I) (M1), an OPN1LW LIAVA haplotype variant (M2), a hemizygous frameshift variant RPGR c.3096_3097del (p.E1033RfsTer45) (M3), compound heterozygous variants TTLL5 c.1588_1589del (p.L531EfsTer24) and c.850G>C (p.D284H) (M4, M5), compound heterozygous variants COL18A1 c.2118dup (p.G707RfsTer23) and c.3523_3524del (p.L1175VfsTer72) (M6, M7), a heterozygous missense mutation FZD4 c.1499C>T (p.T500I) (M8), and a heterozygous frameshift variant COL11A2 c.966dup (p.T323HfsTer19) (M9). Among them, M2, M4, M5, M8 and M9 were newly discovered mutation sites, and M1, M3, M6 and M7 were known mutation sites. According to the classification standards and guidelines of genetic variation issued by ACMG, M2, M3, M4, M6, M7, and M9 were judged to be pathogenic variants, while M1, M5, and M8 were of unknown clinical significance. Through literature review, it was found that eoHM was more common among the clinical phenotypes of 4 types of hereditary retinal diseases, including CSNB, Stickler syndrome, FEVR and XL-RP. Conclusion:eoHM is intricately associated with inherited eye diseases and may serve as the earliest indicator of such conditions.

Umbilical cord inflammatory myofibroblastic tumor is rare. This article reports a case of a male patient admitted to the hospital due to “difficulty in urination for 1 month”. Physical examination revealed a soft abdomen without tenderness or rebound tenderness in the bladder area，and no abnormal masses were palpated. CT imaging showed a cord-like structure connecting to the mass and extending towards the umbilicus，leading to the anatomical localization diagnosis of an umbilical cord origin. The ring-like enhancement of the tumor capsule was its radiological feature. After completing preoperative preparations，the patient underwent laparoscopic umbilical cord tumor resection and transurethral bladder lesion resection under general anesthesia. During the operation，the bladder was filled with fluid，and a localized mucosal protrusion measuring 3.0 cm × 3.0 cm was observed at the bladder dome. The tumor margin was identified with the guidance of the cystoscope light beam. The bladder tissue was incised layer by layer from the outside to the inside under laparoscopy，and the bladder wall was incised 2 cm away from the tumor margin. After the bladder mucosa was exposed，the bladder was emptied，and the tumor was completely resected. This surgical approach ensured negative surgical margins while maximizing the preservation of bladder tissue. The postoperative pathology indicated inflammatory myofibroblastic tumor of the urachus，with no recurrence observed during a 4-month follow-up.