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]Our study seeks to investigate the connection between systemic immune inflammatory index and renal function,as well as to assess its predictive capacity for the deterioration of renal function in chronic kidney disease patients with non-dialysis.[Methods]Adult non-dialyzing patients diagnosed with CKD were included.The computation of SII was calculated as the product of the peripheral blood neutrophil count(×10?/L)and platelet count(×10?/L),divided by the lymphocyte count(×10?/L).The logistic and Cox regression models were employed to scrutinize the linkage between SII levels and CKD.[Results]Out of the cohort,a significant portion of patients,numbering 244,which constitutes 17.2％,experienced progression of CKD.A notable upsurge in SII corresponded with an increased prevalence of advanced CKD and its progression,with significant difference.This trend was mirrored by a decline in the estimated glomerular filtration rate and hemoglobin levels,while serum creatinine,C-reactive protein,and lipoprotein(a)levels were on the rise.After adjusting for multiple variables,the natural logarithm of SII exhibited an independent association with advanced CKD[OR=1.85 95％CI(1.46,2.35),P<0.01].Furthermore,Cox proportional hazards model analysis revealed that SII acted as an independent predictor for CKD progression[adjusted HR=1.35,95％CI(1.09,1.67),P<0.01].Subgroup analysis indicated a significant interaction among SII,gender,and hypertension concerning CKD progression.[Conclusion]Our findings underscore the robust relationship between SII and renal function,positioning SII as a potential forecaster for the progression of CKD.

Objective To evaluate the quality of treatment planning(TP)and re-optimization planning(RP)of radiotherapy for rectal cancer using PlanIQ software,thereby providing methods and tools for the screening and optimization of radiotherapy plans.Methods Twenty patients with rectal cancer who received radiotherapy were selected retrospectively,with 10 cases of intensity-modulated radiotherapy(IMRT)and 10 of volumetric modulated arc therapy(VMAT).(1)TP:IMRT plan involved 5-field irradiation,and VMAT plan involved two 360°arcs.The prescription doses were 50 Gy/25 f for PTV1 and 45 Gy/25 f for PTV2.All plans underwent direct machine parameter optimization and required 95%isodose lines to cover 100%of the target volume.Organs-at-risk(OAR)were limited by reference to tolerated dose standards.After the planning was completed,the plans were reviewed and confirmed by a physician,and the treatment was implemented after dose verification.(2)RP:a physicist with 10 years of experience re-optimized the 20 TP plans,with the irradiation technique and field setting unchanged.The re-optimization involved adjusting planning conditions and parameters based on individual experience until the dose to OAR was minimized while without affecting PTV coverage.The quality of TP plans and RP plans were quantitatively evaluated using PlanIQ software.Non-parametric Wilcoxon signed rank test was performed for dose-volume histogram parameters and plan quality index between two groups.Results The dose-volume histogram parameters in RP plans were superior to those in TP plans,and the differences in the Dmax of PTV1,the V45 Gy and Dmax of small intestine,and the V45 Gy of colon were statistically significant(P<0.05).The quality scores of RP plans for IMRT group,VMAT group and all patients were significantly higher than those of TP plans(P<0.05),with plan quality index of 88.55±3.35 vs 86.61±4.63(P=0.005),89.72±3.15 vs 87.21±3.04(P=0.028),and 89.14±3.22 vs 86.91±3.22(P=0.001),respectively.Conclusion RP can further improve the quality of radiotherapy plan for rectal cancer.PlanIQ software serves as an effective tool for quality control and screening of radiotherapy planning.

Purpose: This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients. Materials and Methods: Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010. Results: With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group. Conclusion Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

Objective:This study aims to study the mental health status of people with different identities during the fight against COVID-19. Further, we propose psychological intervention strategies for people with different identities.Methods:857 participants from Guangdong province (215 identified as first-level population referring to the impact severity of the outbreak, 91 as second-level population, 120 as third-level population, and 431 as fourth level population) were cross-sectionally surveyed online from January 30 to February 28, 2020. The Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Perceived Stress Scale (PSS-10) were used to evaluate the mental health status of different populations. The Kruskal-Wallis H test was used to test the differences of the total scores of these three scales across populations at different levels, and the groups were compared pairwise with the Bonferroni method. Finally, the Wilcoxon rank sum test was used to further analyze the dimensions between the scales. Results:In all 857 subjects, the total scores of GAD-7, PHQ-9, and PSS-10 were 4(1,8), 4(1,9), and 16(11,19), respectively. There were statistically significant differences in the scores of GAD-7 ( H=15.235, P<0.01), PHQ-9 ( H=9.265, P=0.026), and PSS-10 ( H=8.435, P=0.049) among different levels of the population. For the score of GAD-7, the anxiety severity of the first-level crowd was higher than that of the second-level crowd and the fourth-level crowd. The pairwise comparisons were statistically significant ( Z=-2.932, -4.012, -2.949, P<0.005); there were significant between-group differences in domains of "becoming easily annoyed or irritable" and "seemingly terrible things will happen". For the score of PHQ-9, the depression severity of the first-level crowd and the second-level crowd was higher than that of the fourth-level crowd, and the pairwise comparisons were statistically significant ( Z=-3.387, -2.682, P<0.005). There were significant between-group differences in domains of "difficult to fall asleep or not awake", "feeling depressed" and other related domains. For the score of PSS-10, the stress severity of the third-level crowd was higher than that of the first-level crowd and the fourth-level crowd ( Z=-2.702, -3.693, -2.735, P<0.005). There were significant between-group differences in domains of "feel confident", "life is as expected", "the ability to control anger", "the things are all under control", and other related domains. Conclusion:The impact of the COVID-19 on mental health in people with different identities is different, and appropriate psychological interventions should be provided for different populations according to their mental health status.

Objective:This study aims to study the mental health status of people with different identities during the fight against COVID-19. Further, we propose psychological intervention strategies for people with different identities.Methods:857 participants from Guangdong province (215 identified as first-level population referring to the impact severity of the outbreak, 91 as second-level population, 120 as third-level population, and 431 as fourth level population) were cross-sectionally surveyed online from January 30 to February 28, 2020. The Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Perceived Stress Scale (PSS-10) were used to evaluate the mental health status of different populations. The Kruskal-Wallis H test was used to test the differences of the total scores of these three scales across populations at different levels, and the groups were compared pairwise with the Bonferroni method. Finally, the Wilcoxon rank sum test was used to further analyze the dimensions between the scales. Results:In all 857 subjects, the total scores of GAD-7, PHQ-9, and PSS-10 were 4(1,8), 4(1,9), and 16(11,19), respectively. There were statistically significant differences in the scores of GAD-7 ( H=15.235, P<0.01), PHQ-9 ( H=9.265, P=0.026), and PSS-10 ( H=8.435, P=0.049) among different levels of the population. For the score of GAD-7, the anxiety severity of the first-level crowd was higher than that of the second-level crowd and the fourth-level crowd. The pairwise comparisons were statistically significant ( Z=-2.932, -4.012, -2.949, P<0.005); there were significant between-group differences in domains of "becoming easily annoyed or irritable" and "seemingly terrible things will happen". For the score of PHQ-9, the depression severity of the first-level crowd and the second-level crowd was higher than that of the fourth-level crowd, and the pairwise comparisons were statistically significant ( Z=-3.387, -2.682, P<0.005). There were significant between-group differences in domains of "difficult to fall asleep or not awake", "feeling depressed" and other related domains. For the score of PSS-10, the stress severity of the third-level crowd was higher than that of the first-level crowd and the fourth-level crowd ( Z=-2.702, -3.693, -2.735, P<0.005). There were significant between-group differences in domains of "feel confident", "life is as expected", "the ability to control anger", "the things are all under control", and other related domains. Conclusion:The impact of the COVID-19 on mental health in people with different identities is different, and appropriate psychological interventions should be provided for different populations according to their mental health status.

Objective To analyze the 10-year survival outcome and failure patterns for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT),aiming to provide reference for optimized treatment for NPC.Methods Clinical data of 866 patients with NPC receiving IMRT from January 2001 to December 2008 were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier estimator.Univariate analysis was carried out by log-rank test and multivariate analysis was performed using Cox proportional hazards model.Results The median follow-up time was 132 months.The 10-year local recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),progression-free survival (PFS) and disease specific survival (DSS) were 92.0％,83.4％,75.7％ and 78.6％,respectively.A total of 210 patients died including 124 patients (59.0％) from distant metastasis,which was the primary cause of death,and 47 (22.3％) from local regional recurrence.Independent negative factors of DSS included age＞50 years (P=0.00),LDH ≥ 245 IU/L (P=0.00),Hb＜ 120 g/L (P=0.01),T2-T4 staging (P=0.00),N1-N3 staging (P=0.00) and GTV-nx＞20 cm3(P=0.00).The 10-year LRFS,DMFS and DSS of stage Ⅱ NPC patients did not significantly differ after IMRT alone and chemoradiotherapy (P=0.83,0.22,0.23).For patients with stage Ⅲ NPC,the 10-year LRFS and DSS in the chemoradiotherapy arm were significantly higher than those in the IMRT alone (P=0.01,0.01),whereas no statistical significance was observed in the DMFS between two groups (P=0.14).The overall survival of stage Ⅳa+Ⅳb NPC patients is relatively poor.Conclusions IMRT can improve the long-term survival of NPC patients.Distant metastasis is the primary failure pattern.Patients with stage Ⅰ-Ⅱ NPC can obtain satisfactory survival outcomes after IMRT alone.The addition of chemotherapy can further enhance the LRFS and DSS of stage Ⅲ NPC patients.However,the optimal therapeutic strategy remains to be urgently investigated for stage a+ Ⅳb NPC patients.

Themedical's () infantgenre in western Hunan Province is one of the most famous infantgenres in China. Based on physiological and pathological characteristics of infants, generation-inhibition theory of five-elements andmedical's promotion-inhibition theory of five-meridians, theprotocol of "" was flexibly adjusted; according to different constitution types, including lung-deficiency type, spleen-deficiency type, kidney-deficiency type,-deficiency type,-deficiency type,-deficiency type, phlegm-wet type, phlegm-heat type, different protocols were adopted to prevent or reduce the asthma recurrence and reach the aim of regulating constitution and disease prevention.

Objective To explore the effect of continuous aspiration of subglottic secretion at different negative pressure levels on mechanical ventilation. Methods Toally 142 patients were randomized by way of lottery into the control group (n=70) and the experiment group ( n = 72 ): the control group received continuous negative pressure aspiration of subglottic secretion at a negative pressure of 60 mmHg while the experiment group did 30~40 mmHg for grade I of the sticky secretion , 40~60 mmHg for gradeⅡ~Ⅲof the sticky secretion, respectively. The two groups were compared in terms of the rate of ventilator associated pneumonia (VAP), airway mucosal injury and cough. Result There was no significant difference in the rate of ventilator associated pneumonia (P>0.05), but the rates of airway mucosal injury and cough were lower in the experiment group than those of the control group (P < 0.05). Conclusion It is reasonable to choose different negative pressure levels based on stickiness of the secretions for mechanical ventilation, for it can prevent the ventilator associated pneumonia and airway mucosal injury.

Objective To develop a network management system for tumor radiotherapy information that integrates process management and quality assurance functions, and to investigate its clinical value. Methods Based on the requirements of radiotherapy process quality assurance and control, the client-server ( C-S) pattern, along with SQL SERVER 2008 database structure, international standard DICOM 3.0, DICOM RT, and HL7 protocols, and system hardware and self-developed software in local area network, was adopted to establish the network management system for radiotherapy information, and clinical tests were performed to evaluate the operation performance of this platform.Results ( 1 ) The interactive integrated management platform and client-side functional modules with a uniform interface were developed.( 2) The safe and reliable standardized data interface was developed, which could be connected to accelerators, treatment planning systems, and hospital information systems developed by mainstream manufacturers.( 3) The modules for radiotherapy process management and quality assurance and management were designed and developed.( 4) The platform passed all the tests before operation and had been used in clinical departments for almost 3 years, which confirmed that the system was safe and stable during operation and that all functions designed were realized.Conclusions The integrated management platform meets the requirements for application and management of radiotherapy information and data, improves the overall work efficiency in radiotherapy department and the level of quality assurance and control, and holds promise for clinical application as a good tool for tumor radiotherapy departments.