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 investigate the mid- to long-term follow-up results of ascending aorta (AAO)-descending thoracic aorta (DTA) bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation. Methods A retrospective analysis was conducted on the clinical data of patients with complex aortic arch coarctation who underwent AAO-DTA bypass grafting via median sternotomy incision at the First Hospital of Tsinghua University from August 2004 to May 2017. Results A total of 7 patients were enrolled, including 4 males and 3 females, aged (13.3±4.6) years, and weighted (40.2±12.2) kg. Six (85.7%) patients had concomitant upper limb hypertension. Four patients were aortic arch coarctation combined with intracardiac malformations, two were post-operative restenosis, and 1 was post-operative restenosis combined with intracardiac malformation. All patients underwent surgery under cardiopulmonary bypass. There were no perioperative deaths or major complications. The pre-operative upper-lower limb pressure difference was (39.3±19.2) mm Hg, which decreased to (2.9±2.7) mm Hg post-operatively (P<0.01). The follow-up period was (14.9±5.9) years. There were no long-term deaths or artificial graft-related complications. Except for one patient who still had mild hypertension, the blood pressure of the remaining patients returned to normal. Conclusion AAO-DTA bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation can effectively reduce upper limb blood pressure and the upper-lower limb arterial pressure difference, has fewer complications, and demonstrates satisfactory mid- to long-term efficacy.

This comprehensive review synthesizes the latest advancements in understanding inflammatory disorders affecting cerebral small vessels, a distinct yet understudied category within cerebral small vessel diseases (SVD). Unlike classical SVD, these inflammatory conditions exhibit unique clinical presentations, imaging patterns, and pathophysiological mechanisms, posing significant diagnostic and therapeutic challenges. Highlighting their heterogeneity, this review spans primary angiitis of the central nervous system, cerebral amyloid angiopathy-related inflammation, systemic vasculitis, secondary vasculitis, and vasculitis in autoinflammatory diseases. Key discussions focus on emerging insights into immune-mediated processes, neuroimaging characteristics, and histopathological distinctions. Furthermore, this review underscores the importance of standardized diagnostic frameworks, individualized immunomodulation approaches, and novel targeted therapies to address unmet clinical demands.
Humans ; Cerebral Small Vessel Diseases/pathology* ; Inflammation/pathology* ; Cerebral Amyloid Angiopathy/pathology* ; Vasculitis, Central Nervous System/pathology* ; Vasculitis/pathology*

Objective To analyze the levels of serum CTCs and ctDNA in NSCLC patients receiving first-line EGFR-TKI treatment, and to explore the clinical value of CTCs and ctDNA detection in assessing the efficacy of treatment for advanced lung cancer. Methods A total of 109 NSCLC patients receiving first-line EGFR-TKI treatment were enrolled. Serum tumor markers CEA, CTCs, and ctDNA were detected at baseline and after one month of treatment. Chest CT scans were performed, and treatment efficacy was evaluated based on RECIST1.1 criteria. CTCs were counted by enrichment-staining-computational algorithm to analyze malignant features, while ctDNA was assessed using digital PCR. Results Survival rate was low in patients with abnormal CEA and ctDNA tests at baseline and in patients with reduced serum CTCs after treatment. In the SD subgroup of patients with brain metastases and advanced stage, the PFS benefit was low. Conclusion Patients in the SD subgroup have significantly higher recurrence risks than those in the PR or CR subgroups. Therefore, CTC and ctDNA testing should be applied to patients in the SD subgroup to identify high-risk patients with poor response to EGFR-TKI treatment, intervene with additional treatment promptly, and obtain long progression-free survival.

To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

Objective:To explore the feasibility and clinical effect of surgical treatment for patients with malignant tumor complicated with coronary heart disease.Methods:The medical records of 12 patients with malignant solid tumor complicated with coronary heart disease who were treated by the same surgical team in the Department of Cardiac Surgery, the First Hospital of Tsinghua University from January 2018 to May 2025 were collected retrospectively, including 8 cases of digestive system tumors, 3 cases of lung tumors and 1 case of urinary system tumor. All patients underwent simultaneous (4 cases) or staged (8 cases) coronary artery bypass grafting and tumor resection. Coronary artery bypass grafting under cardiopulmonary bypass was performed in 2 cases, and off-pump coronary artery bypass grafting was performed in the remaining 10 cases. Postoperative follow-up was conducted.Results:None of the 12 patients died during hospitalization, and all were cured and discharged. No perioperative myocardial ischemia or infarction occurred during hospitalization, and no postoperative surgical bleeding occurred. The 12 patients were followed up for 1 month to 7 years and 5 months. One patient with rectal cancer complicated with coronary heart disease had liver and lung metastases 13 months after surgery and died suddenly during the second cycle of chemotherapy 16 months after surgery. The remaining 11 patients survived.Conclusions:It is feasible to perform coronary artery bypass grafting and tumor resection in patients with coronary heart disease complicated with malignant tumor, and the short-term and medium-term effects are satisfactory.

Objective To develop a new cardiac rehabilitation exercise program based on the LEARNS health education model for patients undergoing percutaneous coronary intervention(PCI),and to evaluate its effectiveness.Methods A total of 78 inpatients with acute coronary syndrome(ACS)who received PCI between February and May 2024 in a tertiary hospital were enrolled.Using a random number table,participants were assigned to either an intervention group or a control group(n=39 each).The control group received routine health education,while the intervention group received a cardiac rehabilitation exercise program developed based on the LEARNS model.The intervention started during hospitalization and lasted for two weeks.After the intervention,patients'willingness to participate in Phase II cardiac rehabilitation,exercise self-efficacy and exercise behavior,were evaluated.Results All 76 patients completed the study.After the intervention,the intervention group showed significantly higher scores in willingness to participate in rehabilitation(P<0.001)and exercise self-efficacy(P<0.001)compared with the control group.In terms of exercise behaviors,the intervention group also performed better than the control group,with statistically significant differences across related indicators(P<0.05).Conclusion The application of a new PCI postoperative rehabilitation program based on the LEARNS health education model can significantly enhance patients'willingness to participate in Phase II cardiac rehabilitation,improve their exercise self-efficacy and behavior,and effectively promote the implementation and sustainability of cardiac rehabilitation.

Objective To develop a new cardiac rehabilitation exercise program based on the LEARNS health education model for patients undergoing percutaneous coronary intervention(PCI),and to evaluate its effectiveness.Methods A total of 78 inpatients with acute coronary syndrome(ACS)who received PCI between February and May 2024 in a tertiary hospital were enrolled.Using a random number table,participants were assigned to either an intervention group or a control group(n=39 each).The control group received routine health education,while the intervention group received a cardiac rehabilitation exercise program developed based on the LEARNS model.The intervention started during hospitalization and lasted for two weeks.After the intervention,patients'willingness to participate in Phase II cardiac rehabilitation,exercise self-efficacy and exercise behavior,were evaluated.Results All 76 patients completed the study.After the intervention,the intervention group showed significantly higher scores in willingness to participate in rehabilitation(P<0.001)and exercise self-efficacy(P<0.001)compared with the control group.In terms of exercise behaviors,the intervention group also performed better than the control group,with statistically significant differences across related indicators(P<0.05).Conclusion The application of a new PCI postoperative rehabilitation program based on the LEARNS health education model can significantly enhance patients'willingness to participate in Phase II cardiac rehabilitation,improve their exercise self-efficacy and behavior,and effectively promote the implementation and sustainability of cardiac rehabilitation.

Objective:To explore the feasibility and clinical effect of surgical treatment for patients with malignant tumor complicated with coronary heart disease.Methods:The medical records of 12 patients with malignant solid tumor complicated with coronary heart disease who were treated by the same surgical team in the Department of Cardiac Surgery, the First Hospital of Tsinghua University from January 2018 to May 2025 were collected retrospectively, including 8 cases of digestive system tumors, 3 cases of lung tumors and 1 case of urinary system tumor. All patients underwent simultaneous (4 cases) or staged (8 cases) coronary artery bypass grafting and tumor resection. Coronary artery bypass grafting under cardiopulmonary bypass was performed in 2 cases, and off-pump coronary artery bypass grafting was performed in the remaining 10 cases. Postoperative follow-up was conducted.Results:None of the 12 patients died during hospitalization, and all were cured and discharged. No perioperative myocardial ischemia or infarction occurred during hospitalization, and no postoperative surgical bleeding occurred. The 12 patients were followed up for 1 month to 7 years and 5 months. One patient with rectal cancer complicated with coronary heart disease had liver and lung metastases 13 months after surgery and died suddenly during the second cycle of chemotherapy 16 months after surgery. The remaining 11 patients survived.Conclusions:It is feasible to perform coronary artery bypass grafting and tumor resection in patients with coronary heart disease complicated with malignant tumor, and the short-term and medium-term effects are satisfactory.

Objective:To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods:This was a prospective study. Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 65-83 yr, weighing 50-80 kg, scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital, were divided into 2 groups ( n=30 each) using a random number table method: bupivacaine liposome group (LB group) and ropivacaine group (R group). Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia, bupivacaine liposome diluent 20 ml (133 mg) was injected in LB group, and 0.5% ropivacaine 20 ml was injected in R group. Patient-controlled intravenous analgesia was performed after operation, and tramadol was used for rescue analgesia when the visual analogue scale (VAS) score ≥3. VAS scores at rest and during activity were recorded at 8, 12, 24, 48 and 72 h after surgery. The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery. The quadriceps muscle strength was measured at 1 day before surgery and 12, 24, 48 and 72 h after surgery. The knee joint range of motion was assessed at 1 day before surgery and 24, 48 and 72 h after surgery. Patient′s satisfaction with analgesia was recorded at 72 h after surgery. The adverse reactions within 72 h after surgery were also recorded. Results:Compared with R group, VAS scores at rest and during activity were significantly decreased at 12, 24, 48 and 72 h after surgery, the time to the first pressing analgesia pump was prolonged, the rate of rescue analgesia after surgery was decreased, the score for the patient′s satisfaction with analgesia was increased, the knee joint range of motion was increased ( P<0.05), and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group ( P>0.05). Conclusions:Ultrasound-guided adductor canal block with bupivacaine liposome provides better analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.