Wastewater-based epidemiology has emerged as a transformative surveillance tool for estimating substance consumption and monitoring disease prevalence, particularly during the COVID-19 pandemic. It enables the population-level monitoring of illicit drug use, pathogen prevalence, and environmental pollutant exposure. In this perspective, we summarize the key challenges specific to the Chinese context: (1) Sampling inconsistencies, necessitating standardized 24-hour composite protocols with high-frequency autosamplers (≤ 15 min/event) to improve the representativeness of samples; (2) Biomarker validation, requiring rigorous assessment of excretion profiles and in-sewer stability; (3) Analytical method disparities, demanding inter-laboratory proficiency testing and the development of automated pretreatment instruments; (4) Catchment population dynamics, reducing estimation uncertainties through mobile phone data, flow-based models, or hydrochemical parameters; and (5) Ethical and data management concerns, including privacy risks for small communities, mitigated through data de-identification and tiered reporting platforms. To address these challenges, we propose an integrated framework that features adaptive sampling networks, multi-scale wastewater sample banks, biomarker databases with multidimensional metadata, and intelligent data dashboards. In summary, wastewater-based epidemiology offers unparalleled scalability for equitable health surveillance and can improve the health of the entire population by providing timely and objective information to guide the development of targeted policies.
China/epidemiology* ; Humans ; Wastewater/analysis* ; COVID-19/epidemiology* ; Public Health ; Wastewater-Based Epidemiological Monitoring ; SARS-CoV-2

Background::Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods::Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed.Results::A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43–0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04–13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65–3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38–1.53; P <0.001). Conclusions::In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration::ClinicalTrials.gov, NCT02309398.

Objective:To explore the role of mechanical hemodynamic support (MHS) in mapping and catheter ablation of patients with hemodynamically unstable ventricular tachycardia (VT), report single-center experience in a cohort of consecutive patients receiving VT ablation during MHS therapy, and provide evidence-based medical evidence for clinical practice.Methods:This was a retrospective cohort study. Patients with hemodynamically unstable VT who underwent catheter ablation with MHS at Beijing Anzhen Hospital, Capital Medical University between August 2021 and December 2023 were included. Patients were divided into rescue group and preventive group according to the purpose of treatment. Their demographic data, periprocedural details, and clinical outcomes were collected and analyzed.Results:A total of 15 patients with hemodynamically unstable VT were included (8 patients in the rescue group and 7 patients in the preventive group). The acute procedure was successful in all patients. One patient in the rescue group had surgical left ventricular assist device (LVAD) implantation, remaining 14 patients received extracorporeal membrane oxygenation (ECMO) for circulation support. ECMO decannulation was performed in 12 patients due to clinical and hemodynamic stability, of which 6 patients were decannulation immediately after surgery and the remaining patients were decannulation at 2.0 (2.5) d after surgery. Two patients in the rescue group died during the index admission due to refractory heart failure and cerebral hemorrhage. During a median follow-up of 30 d (1 d to 12 months), one patient with LVAD had one episode of ventricular fibrillation at 6 months after discharge, and no further episodes of ventricular fibrillation and/or VT occurred after treatment with antiarrhythmic drugs. No malignant ventricular arrhythmia occurred in the remaining 12 patients who were followed up.Conclusions:MHS contributes to the successful completion of mapping and catheter ablation in patients with hemodynamically unstable VT, providing desirable hemodynamic status for emergency and elective conditions.

Objective To comprehensively understand the dynamic transcriptional landscape during infection through investigating the temporal molecular changes in macrophages RAW 264.7 upon infection with Salmonella typhimurium SL1344.Methods Macrophages RAW 264.7 were infected with Salmonella typhimurium SL1344,and cell samples were collected at 0 h,8 h,and 16 h for RNA-sequencing(RNA-seq).Upstream and downstream analyses of the transcriptome data including differential gene expression,clustering,functional annotation,and mo-lecular network studies were conducted to elucidate the signaling pathways changes in macrophages.Results Infec-ted macrophages exhibited significant morphological and transcriptional changes.Differential gene analysis identified significant upregulation and downregulation patterns.Clustering revealed six gene clusters involving various signaling pathways,such as immune response,membrane transport,and lipid catabolic process.Conclusions Macrophages dynamically respond to Salmonella typhimurium infection,displaying distinct temporal gene expression patterns.The coordinated activation of immune response,membrane transport,and lipid catabolic process pathways implies a multifaceted cellular adaptation to external infections,providing essential insights into the molecular mechanisms of macrophage response to Salmonella typhimurium infection.

Objective To investigate the effect of cisplatin treatment on the transcriptional level of human liver cancer cells by conducting transcriptome sequencing analysis after treating human liver cancer cell lines with differ-ent concentrations of cisplatin(CDDP).Methods Liver cancer cell lines HepG2 and Huh7 were incubated with cisplatin at different final concentrations of 0,20,50,100 and 200 μmol/L.After 12 hours,cell viability,immuno-fluorescence and RNA-sequencing(RNA-seq)were performed.Differential gene expression analysis(DEG),KEGG pathway analysis,and protein-protein interaction network analysis were conducted.Results Cisplatin de-creased cell viability and increased DNA damage in HepG2,Huh7 cells.Among the genes regulated after cisplatin treatment at different concentrations,59 genes were commonly up-regulated in both HepG2 and Huh7 cells,while 81 genes were commonly down-regulated.The commonly upregulated genes were mainly enriched in cancer initiation and progression pathways.The 81 commonly down-regulated genes were mainly enriched in Rap1 signaling pathway,Ras signaling pathway,signaling pathways regulating pluripotency of stem cells,axon guidance,and cell adhesion-related pathways.Survival analysis of key nodes in the protein-protein interaction network of commonly up-regulated and downregulated genes revealed a significant correlation between high expression of Jun proto-oncogene,AP-1 transcription factor subunit(JUN)and prolonged patient survival and a significant correlation between low ex-pression of growth arrest and DNA damage inducible alpha(GADD45A)and prolonged patient survival.Conclu-sions The study revealed common transcriptional changes in liver cancer cells under cisplatin treatment.Differential expression of JUN and GADD45A is a potential core mechanism to explain drug resistance.This conclusion provides some important prognostic indicators for clinical treatment.

Objective To analyze the relationship of lipoprotein(a)[Lp(a)]with poor prognosis in chronic heart failure(CHF)patients aged over 80 years,and explore the influencing factors for poor prognosis in these patients.Methods A total of 135 over-80-year-old patients with acute de-compensated CHF admitted in Tianjin University Chest Hospital from June 2018 to August 2021 were enrolled in this study.With Lp(a)300 mg/L as the cut-off value,they were divided into higher Lp(a)group(73 cases)and lower Lp(a)group(62 cases).Their baseline clinical data and outcomes after 12 months of follow-up were collected.The primary endpoint was composite end-point including re-hospitalization due to CHF and/or all-cause mortality.Kaplan-Meier survival curve were plotted to compare the survival rates between the two groups.Logistic regression anal-ysis was employed to analyze the risk factors of poor prognosis in these patients.Results The higher Lp(a)group had larger proportion of chronic kidney disease and higher levels of homocys-teine,total cholesterol and low-density lipoprotein-cholesterol than the lower Lp(a)group(P＜0.05).Kaplan-Meier survival analysis showed that the lower group obtained significantly longer 1-year survival time without primary endpoint events than the higher group[9.8 months(95％CI:8.884-10.665)vs 8.2 months(95％CI:7.057-9.272),P＜0.05].Multivariate logistic regression analysis revealed that Lp(a)≥300 mg/L(OR=2.841,95％CI:1.133-7.092,P=0.026),female(OR=2.809,95％CI:1.111-7.092,P=0.029)and use of diuretic(OR=4.631,95％CI:1.103-19.443,P=0.036)were independent risk factors for primary endpoint events within 1 year.Con-clusion Lp(a)≥300 mg/L is an independent risk factor for re-hospitalization due to CHF and/or all-cause mortality in elderly CHF patients within 1 year after discharge.

Objective:To compare the short-term efficacy of drug-coated balloon and common balloon in the treatment of with below-the-ankle arteriosclerosis obliterans (ASO).Methods:The clinical and follow-up data of 115 patients (118 limbs) with lower extremity ASO of Rutherford 4-6 admitted to the Department of Peripheral Vascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences from Jun 2021 to Jun 2023 were retrospectively analyzed.Results:Patients were divided into group of 52 limbs using paclitaxel-coated balloon and group of 66 limbs using common balloon. During the 6-month follow-up period, The total effective rate of wound surface was 98.1% in the drug-coated balloon group and 92.4% in the common balloon group. The difference was statistically significant ( P<0.05); the increase of ankle-brachial index (ABI) and toe-brachial index (TBI) in the drug-coated balloon group were significantly better than common balloon group, and the difference was statistically significant ( P<0.01). No major adverse events occurred in the two groups during the 6-month follow-up period. Compared with the common balloon group, the drug-coated balloon group had a higher limb salvage rate (100.0% vs. 98.5% ) and a lower target vessel reconstruction rate (7.7% vs.18.2%), though the difference was not statistically significant ( P>0.05). Conclusion:Compared with the common balloon, the drug-coated balloon is more effective in the treatment of patients with wound healing rate and vascular patency rate in Rutherford 4-6 grade below-the-ankle artery lesions.

With the rapid development of artificial intelligence technology, its applications in medical imaging have become increasingly extensive. This review aimed to analyze the current development status and future direction of intelligent imaging technology by investigating its application in various medical departments. To achieve this, we conducted a comprehensive search of various data sources up to 2024, including PubMed, Web of Science, and Google Scholar, based on the principle of comprehensive search. A total of 332 articles were screened, and after applying the inclusion and exclusion criteria, 56 articles were selected for this study. According to the findings, intelligent imaging technology exhibits robust image recognition capabilities, making it applicable across diverse medical imaging modalities within hospital departments. This technology offers an efficient solution for the analysis of various medical images by extracting and accurately identifying complex features. Consequently, it significantly aids in the detection and diagnosis of clinical diseases. Its high accuracy, sensitivity, and specificity render it an indispensable tool in clinical diagnostics and related tasks, thereby enhancing the overall quality of healthcare services. The application of intelligent imaging technology in healthcare significantly enhances the efficiency of clinical diagnostics, resulting in more accurate and timely patient assessments. This advanced technology offers a faster and more precise diagnostic approach, ultimately improving patient care and outcomes. This review analyzed the socioeconomic changes brought about by intelligent imaging technology to provide a more comprehensive evaluation. Also, we systematically analyzed the current shortcomings of intelligent imaging technology and its future development directions, to enable future research.
Humans ; Artificial Intelligence ; Diagnostic Imaging/methods* ; Hospitals

Chemoresistance to 5-fluorouracil (5-FU) is a significant challenge in treating colorectal cancer (CRC). Novel combined regimens to thwart chemoresistance are therefore urgently needed. Herein, we demonstrated that the combination of Avenanthramide A (AVN A) and 5-FU has significant therapeutic advantages against CRC. Mechanistically, AVN A directly binds to the S198 site of the histone lysine demethylase KDM4C to promote its degradation, which subsequently fosters H3K9me3 occupancy on the MIR17HG promoter to block its transcription and derepress Bim expression. AVN A enhanced the therapeutic efficacy of 5-FU via impairing the KDM4C/MIR17HG/GSK-3β negative feedback loop. Importantly, the clinical correlation of the KDM4C/MIR17HG/Bim signaling axis with 5-FU response was validated in the refractory CRC patients. We provide evidence for the enhanced effectiveness of 5-FU when combined with AVN A in chemoresistant xenografts, CRC organoids, and Apc ^Min/+ mouse model. Additionally, AVN A mitigated the systemic adverse effects of 5-FU. Overall, our findings demonstrate that combinatorial therapy with AVN A and 5-FU represents an appealing opportunity and highlights KDM4C/MIR17HG/GSK-3β negative feedback loop which confers therapeutically exploitable vulnerability to chemo-refractory CRC patients.

Objective To investigate the epidemiological characteristics of Salmonella infection in foodborne diseases in Shanxi Province, and to provide a scientific basis for the prevention and control of Salmonella infection. Methods Automatic microbial biochemical identification system was used to identify Salmonella , and descriptive epidemiological methods were used to analyze the characteristics of Salmonella infections in foodborne diseases in Shanxi Province from 2016 to 2021. Results The basic information of 10 037 cases of foodborne diseases and their Salmonella detection results were analyzed. The detection rate of Salmonella was 5.25%, and the main serotype was Salmonella enteritidis (209/522). The positive detection rate of Salmonella in the 0-10 years old age group was the highest (6.04%), and the difference was statistically significant (χ²= 19.23, P = 0.01). The positive detection rate of Salmonella in kindergarteners was the highest at 10.71%, and there was a significant difference in the positive detection rate among different occupations (χ²= 43.31, P < 0.05). The detection rate of bulk foods (5.16%) was higher than that of pre-packaged foods (3.70%), and the difference was statistically significant (χ²= 4.43, P = 0.04). Cases involving food stores had a higher Salmonella detection rate (9.54%), and the peak period of Salmonella infection was from May 24 to August 23. Conclusion The incidence of Salmonella infection in foodborne diseases is high in summer and autumn. Foods in food stores and bulk foods are more likely to cause Salmonella infection. Supervision and management of food stores should be strengthened, and special attention should be paid to children in kindergartens during the epidemic peak.