BACKGROUND: Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021. METHODS: Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index. RESULTS: In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval [UI]: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates. CONCLUSIONS Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.
Humans ; Global Burden of Disease ; Male ; Female ; Middle Aged ; Adult ; Asia/epidemiology* ; Prevalence ; Aged ; Pulmonary Arterial Hypertension/mortality* ; Adolescent ; Young Adult ; Child ; Child, Preschool ; Infant ; Hypertension, Pulmonary/epidemiology*

BACKGROUND:The inferior pole of the patella is very important for the integrity and stability of the knee extensor mechanism and maintaining good knee joint function.Currently,there is no unified surgical method for the clinical treatment of inferior pole patella fractures,but effective internal fixation should have the ability to counteract the tensile stress of the quadriceps and patellar ligament,the flexion stress of the femoral condyle,and the separation and displacement of the fracture ends.OBJECTIVE:A three-dimensional model of patellar inferior pole fracture was established by finite element method to compare the fixation effect and biomechanical stability of Kirschner-tension band,Kirschner-tension band combined with encircling,Kirschner-tension band combined with longitudinal binding,so as to provide a reliable surgical choice for clinical treatment of patellar inferior pole fracture.METHODS:A healthy female volunteer was selected to undergo CT scan of the knee joint,and a model of the fracture of the inferior pole of the patella was constructed using finite element software.According to different internal fixation methods,they were divided into three groups:A,B and C.Group A received tension-band wiring;group B received tension-band wiring combined with cerclage wiring,and group C received tension-band wiring combined with separate vertical wiring.Under the same support and constraint conditions,the biomechanical properties of the three internal fixation models were evaluated by finite element analysis software.RESULTS AND CONCLUSION:The results of finite element analysis showed that group C had the smallest displacement of the whole model,the patella and the internal fixator,and the smallest stress of the model and the internal fixator compared with group A and group B when different loads were applied in the direction of 45°.It is indicated that compared with Kirschner-tension band wiring and Kirschner-tension band wiring combined with cerclage wiring,Kirschner-tension band wiring combined with separate vertical wiring exhibits smaller displacement and stress,with superior biomechanical strength,providing a more reliable internal fixation.Theoretically,it is sufficient to meet the needs of patients to perform functional exercises after surgery in the early postoperative period.

BACKGROUND:There is currently still no absolute standard for internal fixation of plates in the treatment of proximal humerus fractures in clinical practice,but reconstruction of the medial humeral distance and effective resistance to inversion displacement of the humeral head are the key points in achieving strong fixation of proximal humerus fractures.OBJECTIVE:Finite element analysis techniques were used to obtain the mechanical differences between these three internal fixation modalities acting on proximal humerus fractures and to compare which internal fixation method provides more stable fixation support.METHODS:A healthy female volunteer was selected to undergo CT scanning of the left shoulder joint,and finite element analysis software was used to construct a model of proximal humerus fracture with medial column support defect.The model was categorized into three groups based on different internal fixation methods.In group A,Philos plate fixation was applied only on the lateral side.In group B,Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the medial side.In group C,Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the anterior medial side.The biomechanical stability of these three groups of internal fixation models was evaluated using ANSYS analysis software under the same fixation support and constraint conditions.RESULTS AND CONCLUSION:(1)The stress of the internal fixation in the three groups of internal fixation models did not exceed 450 MPa.(2)The stress of the humerus and internal fixation in group A was higher than that in groups B and C under different loading conditions,whereas the stress of the humerus and internal fixation in group C was the minimum.(3)Under the flexion loading condition,the relative displacement in group C had a smaller value than that in groups A and B.(4)The relative displacement of the fracture end in group B was the smallest under all the loading conditions.The relative displacement of group B was about half of that of group A under the loading conditions of internal retraction,abduction,and axial compression.(5)The relative displacements between group C and group B were not significantly different,and all of the relative displacements in group C were smaller than those in group A as well.(6)It was found that the combination of the lateral Philos plate and the medial miniature in-line locking compression plate,as well as the combination of the lateral Philos plate and the anterior medial miniature in-line locking compression plate,demonstrated significant stability of the internal fixation system compared with the application of the lateral Philos plate alone.However,when comparing the combination of the lateral Philos plate with the medial miniature in-line locking compression plate and the combination of the lateral Philos plate with the anterior medial miniature in-line locking compression plate,no significant difference in internal fixation system stability was observed.Considering the difficulty of operation in clinical practice,the combination of lateral Philos plate and anterior medial miniature in-line locking compression plate may bring better treatment results in the treatment of proximal humerus fractures.

BACKGROUND:The inferior pole of the patella is very important for the integrity and stability of the knee extensor mechanism and maintaining good knee joint function.Currently,there is no unified surgical method for the clinical treatment of inferior pole patella fractures,but effective internal fixation should have the ability to counteract the tensile stress of the quadriceps and patellar ligament,the flexion stress of the femoral condyle,and the separation and displacement of the fracture ends.OBJECTIVE:A three-dimensional model of patellar inferior pole fracture was established by finite element method to compare the fixation effect and biomechanical stability of Kirschner-tension band,Kirschner-tension band combined with encircling,Kirschner-tension band combined with longitudinal binding,so as to provide a reliable surgical choice for clinical treatment of patellar inferior pole fracture.METHODS:A healthy female volunteer was selected to undergo CT scan of the knee joint,and a model of the fracture of the inferior pole of the patella was constructed using finite element software.According to different internal fixation methods,they were divided into three groups:A,B and C.Group A received tension-band wiring;group B received tension-band wiring combined with cerclage wiring,and group C received tension-band wiring combined with separate vertical wiring.Under the same support and constraint conditions,the biomechanical properties of the three internal fixation models were evaluated by finite element analysis software.RESULTS AND CONCLUSION:The results of finite element analysis showed that group C had the smallest displacement of the whole model,the patella and the internal fixator,and the smallest stress of the model and the internal fixator compared with group A and group B when different loads were applied in the direction of 45°.It is indicated that compared with Kirschner-tension band wiring and Kirschner-tension band wiring combined with cerclage wiring,Kirschner-tension band wiring combined with separate vertical wiring exhibits smaller displacement and stress,with superior biomechanical strength,providing a more reliable internal fixation.Theoretically,it is sufficient to meet the needs of patients to perform functional exercises after surgery in the early postoperative period.

BACKGROUND:There is currently still no absolute standard for internal fixation of plates in the treatment of proximal humerus fractures in clinical practice,but reconstruction of the medial humeral distance and effective resistance to inversion displacement of the humeral head are the key points in achieving strong fixation of proximal humerus fractures.OBJECTIVE:Finite element analysis techniques were used to obtain the mechanical differences between these three internal fixation modalities acting on proximal humerus fractures and to compare which internal fixation method provides more stable fixation support.METHODS:A healthy female volunteer was selected to undergo CT scanning of the left shoulder joint,and finite element analysis software was used to construct a model of proximal humerus fracture with medial column support defect.The model was categorized into three groups based on different internal fixation methods.In group A,Philos plate fixation was applied only on the lateral side.In group B,Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the medial side.In group C,Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the anterior medial side.The biomechanical stability of these three groups of internal fixation models was evaluated using ANSYS analysis software under the same fixation support and constraint conditions.RESULTS AND CONCLUSION:(1)The stress of the internal fixation in the three groups of internal fixation models did not exceed 450 MPa.(2)The stress of the humerus and internal fixation in group A was higher than that in groups B and C under different loading conditions,whereas the stress of the humerus and internal fixation in group C was the minimum.(3)Under the flexion loading condition,the relative displacement in group C had a smaller value than that in groups A and B.(4)The relative displacement of the fracture end in group B was the smallest under all the loading conditions.The relative displacement of group B was about half of that of group A under the loading conditions of internal retraction,abduction,and axial compression.(5)The relative displacements between group C and group B were not significantly different,and all of the relative displacements in group C were smaller than those in group A as well.(6)It was found that the combination of the lateral Philos plate and the medial miniature in-line locking compression plate,as well as the combination of the lateral Philos plate and the anterior medial miniature in-line locking compression plate,demonstrated significant stability of the internal fixation system compared with the application of the lateral Philos plate alone.However,when comparing the combination of the lateral Philos plate with the medial miniature in-line locking compression plate and the combination of the lateral Philos plate with the anterior medial miniature in-line locking compression plate,no significant difference in internal fixation system stability was observed.Considering the difficulty of operation in clinical practice,the combination of lateral Philos plate and anterior medial miniature in-line locking compression plate may bring better treatment results in the treatment of proximal humerus fractures.

Objective To explore the expression of serum growth differentiation factor-8(GDF-8)and silent information regulator 4(Sir4)in elderly patients with chronic heart failure(CHF)and their relationship with left ventricular remodeling and cardiac function.Methods A total of 300 CHF patients admitted in our hospital from Jan 2021 to Dec 2023 were recruited and assigned into an observation group,and 100 healthy individuals who took physical examination during the same period served as control group.Based on New York Heart Association(NYHA)heart function classification,the patients in the observation group were divided into Grade Ⅰ(60 cases),Ⅱ(72 cases),Ⅲ(102 cases),and Ⅳ(66 cases)subgroups.Their clinical data were collected,serum GDF-8 and Sir4 levels were detected,left ventricular remodeling was evaluated with echocardiography,and cardiac dysfunction was assessed with NYHA cardiac function grading.Pearson and Spearman correlation analyses were used to analyze the correlation of GDF-8 and Sir4 levels with left ven-tricular remodeling and myocardial injury.Results The observation group had significantly larger left atrial diameter(LAD)and left ventricular end diastolic diameter(LVEDD),thicker left ven-tricular posterior wall thickness(LVPWT)and interventricular septum thickness(IVST),and higher left ventricular mass index(LVMI)and serum Sir4 and GDF-8 levels(42.46±4.75 mm vs 36.39±5.33 mm,54.63±7.96 mm vs 47.42±8.08 mm,9.44±1.21 mm vs 8.49±0.88 mm,9.27±1.58 mm vs 8.66±1.71 mm,141.49±5.32 g/m2 vs 106.52±7.33 g/m2,3.69±1.06 g/L vs 1.48±0.42 g/L,33.75±10.64 g/L vs 19.08±5.13 g/L,P＜0.01),but lower LVEF[(40.02±10.14)％vs(63.64±6.13)％,P＜0.01]and left ventricular remodeling index(LVRI,1.05±0.24 g/ml vs 1.32±0.33 g/ml,P＜0.01)when compared with the control group.The levels of Sir4 and GDF-8,as well as LVMI,were gradually increased,while the LVRI was decreased in Grades Ⅰ,Ⅱ,Ⅲ,and Ⅳ subgroups in turn,with statistical differences in the subgroups(P＜0.01).Pearson and Spearman correlation analyses showed that Sir4 and GDF-8 levels were positively correlated with LAD,LVEDD,LVPWT,IVST,LVMI,and NHYA cardiac function grade(P＜0.01),and nega-tively with LVEF and LVRI(P＜0.01).Conclusion Serum Sir4 and GDF-8 levels are abnormally elevated in elderly CHF patients,and their levels are positively correlated with the severity of left ventricular remodeling and the severity of cardiac dysfunction.

Background The population with diabetes in China is increasing year by year. Current research has found that either air pollution or temperature has an impact on the occurrence and development of diabetes, but the interaction between the two is unclear yet. Objective To investigate the effects and the lag effects of air pollutants and temperature on the risk of hospital admission for type 2 diabetes in Hefei, Anhui Province from 2016 to 2019, as well as to verify potential interaction between air pollutants and temperature. Methods This study collected hospital admission data for patients with type 2 diabetes from a tertiary hospital in Hefei, Anhui Province, and the corresponding monitoring data on air pollutants and meteorological factors from 2016 to 2019. Firstly, a distributed lag non-linear model (DLNM) was used to explore the effects of air pollutants and temperature on the risk of hospital admission for type 2 diabetes. Subsequently, a bivariate response surface model was used to explore potential interaction between temperature and various pollutants on frequency of hospital admission due to diabetes. Temperature was further divided into lower, medium, and higher levels by percentiles during the study period, and the potential interaction between air pollutants and temperature strata were verified . Results After controlling long-term trend, seasonal trend, holiday effect, and day of the week effect, the results of single pollutant models showed that for every 10 μg·m⁻³ increase in fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), and nitrogen dioxide (NO₂), the relative risk (RR) values for hospital admission due to type 2 diabetes were 1.032 (95%CI: 1.021, 1.043), 1.018 (95%CI: 1.008, 1.026), and 1.037 (95%CI: 1.016, 1.058), respectively; for every 1 mg·m⁻³ increase in carbon monoxide (CO), the RR value for hospital admission due to type 2 diabetes was 1.319 (95%CI: 1.163, 1.495); the increases in sulfur dioxide (SO₂), ozone (O₃), and daily average temperature showed no statistically significant impact on hospital admission due to type 2 diabetes. The results of bivariate response surface models suggested that daily average temperature and various pollutant levels spontaneously affected the risk of hospital admission for type 2 diabetes, but the stratified analysis did not find significant differences in the effect of PM_2.5 on the risk of hospital admission due to type 2 diabetes across different temperature strata. Conclusion Increases in the concentrations of PM_2.5, PM₁₀, NO₂, and CO elevate the risk of hospital admission for type 2 diabetes. This study could not confirm the interactions between daily average temperature and various pollutants.

A 98-year-old male patient received cefoperazone sodium and sulbactam sodium and ambroxol etc. due to pulmonary infection. Before treatments, the patient′s coagulation function was basically normal, and the platelet count was within the reference range. Due to poor anti-infection effect, cefoperazone sodium and sulbactam sodium was changed to voriconazole combined with piperacillin sodium and tazobactam sodium 13 days later, which was adjusted to voriconazole, meropenem and linezolid glucose injection 7 days later. Three days after linezolid administration, the patient′s temperature was 39.3 ℃, and scattered dark red petechiae appeared on his both hands, upper limbs, shoulders and back, with some appearing as patchy ecchymosis, without tenderness pain and fading when pressing. Laboratory tests showed that prothrombin time was 18.4 s, international normalized ratio was 1.50, activated partial thromboplastin time was 53.6 s, fibrinogen was 5.11 g/L, and plasma D-dimer was 4.27 mg/L. It was considered to be allergic purpura, which might be related to linezolid glucose injection. The drug was stopped and replaced by tigecycline, and the treatment such as anti-allergy, fluid replacement, and plasma infusion were given. Eleven days later, the patient′s skin petechiae and ecchymosis disappeared. Laboratory tests showed prothrombin time 16.2 s, international normalized ratio 1.28, activated partial thromboplastin time 35.6 s, fibrinogen 2.62 g/L, and plasma D-dimer 2.48 mg/L.

A 98-year-old male patient received cefoperazone sodium and sulbactam sodium and ambroxol etc. due to pulmonary infection. Before treatments, the patient′s coagulation function was basically normal, and the platelet count was within the reference range. Due to poor anti-infection effect, cefoperazone sodium and sulbactam sodium was changed to voriconazole combined with piperacillin sodium and tazobactam sodium 13 days later, which was adjusted to voriconazole, meropenem and linezolid glucose injection 7 days later. Three days after linezolid administration, the patient′s temperature was 39.3 ℃, and scattered dark red petechiae appeared on his both hands, upper limbs, shoulders and back, with some appearing as patchy ecchymosis, without tenderness pain and fading when pressing. Laboratory tests showed that prothrombin time was 18.4 s, international normalized ratio was 1.50, activated partial thromboplastin time was 53.6 s, fibrinogen was 5.11 g/L, and plasma D-dimer was 4.27 mg/L. It was considered to be allergic purpura, which might be related to linezolid glucose injection. The drug was stopped and replaced by tigecycline, and the treatment such as anti-allergy, fluid replacement, and plasma infusion were given. Eleven days later, the patient′s skin petechiae and ecchymosis disappeared. Laboratory tests showed prothrombin time 16.2 s, international normalized ratio 1.28, activated partial thromboplastin time 35.6 s, fibrinogen 2.62 g/L, and plasma D-dimer 2.48 mg/L.

In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.