Objective:To investigate the completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients in the national multicenter real-world database.Methods:The prospective real-world study was conducted. The clinicopathological data of 1 074 patients who underwent surgical treatment for mid and low rectal cancer in 47 national medical institutions, including Peking Union Medical College Hospital et al, from May 12,2023 to May 11,2024 were collected. Observation indicators: (1) clinical characteristics of patients with mid and low rectal cancer; (2) initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer; (3) initial imaging evaluation of patients with mid and low rectal cancer; (4) imaging evaluation after neoadjuvant therapy for patients with mid and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absoluter numbers and/or percentages. Results:(1) Clinical characteristics of patients with mid and low rectal cancer. Of the 1 074 patients, there were 713 males and 361 females, aged 63(56,70)years. The body mass index of 1 074 patients was 24(21,26)kg/m 2.For American Society of Anesthesiologists classification, there were 147 cases of stage Ⅰ, 641 cases of stage Ⅱ, 157 cases of stage Ⅲ, 2 cases of stage Ⅳ, and there were 127 cases missing data. (2) Initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer. Of the 1 074 patients, there were 787 cases (73.28%) undergoing complete colonoscopy, and there were only 197 cases (18.34%) undergoing immunohistochemical evaluation of all four mismatch repair proteins. (3) Initial imaging evaluation of patients with mid and low rectal cancer. Of the 1 074 patients, there were 842(78.40%) patients completing magnetic resonance imaging (MRI) or ultrasound evaluation, and there were 914(85.10%) patients completing chest, abdomen, and pelvis enhanced computed tomography (CT) evaluation. In the 149 patients completing rectal ultrasound evaluation, there were 122 cases (81.88%) comple-ting T staging evaluation, and there were 81 cases (54.36%) completing N staging evaluation. In the 808 patients completing rectal MRI evaluation, there were 708 cases (87.62%) completing T staging evaluation, and there were 590 cases (73.02%) completing N staging evaluation. (4) Imaging evalua-tion after neoadjuvant therapy for patients with mid and low rectal cancer. Of the 388 patients with neoadjuvant therapy, there were 332 patients (85.57%) completing MRI or ultrasound evaluation, and there were 327 patients (84.28%) completing chest, abdomen, and pelvis enhanced CT evalua-tion. In the 70 patients completing rectal ultrasound evaluation, there were 65 cases (92.86%) com-pleting T staging evaluation, and there were 49 cases (70.00%) completing N staging evaluation. In the 327 patients completing rectal MRI evaluation, there were 246 cases (75.23%) completing T staging, and there were 228 cases (69.72%) completing N staging evaluation. Conclusion:The com-pletion rate of tumor imaging evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients on a national scale is relatively good.

Objective:To integrate and analyze the trend of the disease burden of tracheal,bronchus,and lung cancer(TBL)attributable to secondhand smoke in China from 1990 to 2021 and to analyze future projections,aiming to provide data support for the prevention and treatment of TBL in China.Methods:Based on the global burden of disease(GBD)2021 database,TBL with ICD-10 disease classification C33,C34-C34.92 was studied.Using secondhand smoke as a risk factor,the data on TBL mortality and disability-adjusted life year(DALY)due to secondhand smoke in China from 1990 to 2021 were further age-standardized.Using Joinpoint 4.7.1 regression analysis model to calculate annual percentage change(APC)and average annual percentage change(AAPC),Hiplot software was used to plot disease burden data for different ages and genders,and R 4.3.1 software was used to construct a grey model GM(1,1)to predict the predicted value and trend of TBL disease burden attributed to secondhand smoke in China from 2022 to 2031.Results:From 1990 to 2021,the TBL mortality rate,age-standardized mortality rate,and DALY rate attributed to secondhand smoke in China increased from 1.76/100 000,2.63/100 000,and 49.43/100 000 to 4.08/100 000,2.80/100 000,and 95.57/100 000,respectively;the growth was 131.18%,6.45%,and 93.34%;the age-standardized DALY rate decreased from 65.04/100 000 to 63.32/100 000 with the reduction of 2.65%.The results of the Joinpoint regres-sion showed that the AAPC(95%CI)of mortality,age-standardized mortality rate,and DALY rate for TBL were 2.75(2.58-2.93)%,0.16(0.11-0.21)%,and 2.15(2.11-2.18)%,respectively,with an overall increasing trend;the AAPC(95%CI)of age-standardized DALY rate was-0.14(-0.40-0.12)%,with an overall fluctuating and unchanged trend and it was higher in males than in females.In both 1990 and 2021,the TBL mortality rate attributable to secondhand smoke in China gradually increased with age,and the DALY rate first increased and then slowed down with age.The main groups of the burden of disease were the elderly and males.The grey prediction model GM(1,1)showed that the age-standardized mortality rate of TBL attributable to secondhand smoke from 2022 to 2031 showed a slow increasing trend,and the predicted value in 2031 would increase to 2.95/100 000.The age-standardized DALY showed a slow decreasing trend,and the predicted value in 2031 would decrease to 63.83/100 000.Conclusions:From 1990 to 2021,the TBL mortality,age-standardized mortality,and DALY rates attributable to secondhand smoke in China increased,and the age-standardized DALY rate decreased.Men and the elderly are the main groups affected by TBL.Appropriate measures should be formulated to reduce exposure to and contact with secondhand smoke,tak-ing into account gender and age differences.Additionally,efforts should be made to strengthen secondhand smoke prevention and public health education.

Objective To develop a deep learning model based on fundus retinal images to improve the detection rate of mild cognitive impairment(MCI)in patients with coronary heart disease,achieve early intervention and improve prognosis.Methods The study was a single-center cross-sectional study that retrospectively included patients diagnosed with coronary heart disease(CHD)by coronary angiography(≥50％ stenosis of at least one coronary vessel)from Beijing Anzhen Hospital between November 2021 and December 2022.The whole data set was randomly divided into the training set and the testing set according to the ratio of 8∶2 for model development.After that,the patient data of the same center from January 2023 to April 2023 were included in the time verification method to verify the model.The diagnostic criteria for MCI were MMSE＜27 or MoCA＜26.Four kinds of convolutional neural network(CNN)architectures were used to train fundus images,and a comprehensive vision model of MCI detection was established through model integration.The area under the curve(AUC),sensitivity and specificity of the receiver operating curve(ROC)were used to evaluate the performance of the AI model.Results We collected 5 880 eligible fundus images from 3 368 CHD patients.Based on the results of the MMSE scale,the algorithm was labeled,including 2 898 males and 527 MCI patients.The AUC of the deep learning model in the test group is 0.733(95％CI 0.688-0.778),and the sensitivity of the algorithm in the test group is 0.577(95％CI 0.528-0.625)by using the operating point with the maximum sum of sensitivity and specificity.With a specificity of 0.758(95％CI 0.714-0.802),corresponding to a validated AUC of 0.710(95％CI 0.601-0.818).Based on the results of the MoCA scale,the algorithm labels 2 437 males and 1 626 MCI patients.The AUC of the deep learning model in the test group was 0.702(95％CI 0.671-0.733).The operating point with the maximum sum of sensitivity and specificity was selected,and the sensitivity of the algorithm was 0.749(95％CI 0.719-0.778)and the specificity was 0.561(95％CI 0.527-0.595),corresponding to the AUC value of the verification group was 0.674(95％CI 0.622-0.726).Conclusions The deep learning algorithm model based on fundus images has good diagnostic performance,and may be used as a new non-invasive,convenient and rapid screening method for MCI in CHD population.

Objective:To document any effect of repeated high-frequency repetitive transcranial magnetic stimulation (rTMS) using double-cone coils on the lower limb motor function of stroke survivors.Methods:A total of 40 stroke survivors were randomly divided into an rTMS group and a sham stimulation group, each of 20. The rTMS group received rTMS at 10Hz with a double-cone coil, while a coil that produced sound but no magnetic stimulation was used with the sham group. The treatments were administered daily, five times a week, for three weeks. Before as well as after 1, 2 and 3 weeks of treatment, lower limb motor function, balance, and the root mean square (RMS) and median frequency (MF) of the rectus femoris and tibialis anterior muscles were evaluated using the Fugl-Meyer lower extremity assessment (FMA-LE), the Berg Balance Scale (BBS), the Modified Barthel Index (MBI), Brunnstrom staging, the TecnoBody balance assessment system, and surface electromyography.Results:Compared with the sham stimulation group, the BBS score of the rTMS group was significantly higher after 2 weeks of treatment, and both the FMA-LE and BBS scores were significantly higher after 3 weeks. The average Brunnstrom stage in the sham group had increased significantly after 3 weeks, but in the rTMS group it had increased after 2 weeks. By 3 weeks there were no significant differences between the two groups. In terms of movement control, the average motion ellipse area in the rTMS group was significantly smaller than among the sham group after 2 weeks, and after 3 weeks the average motion trajectory length was significantly shorter than in the sham group. The average RMS of the rectus femoris in the rTMS group was significantly higher than the sham group′s average after 3 weeks of treatment, indicating improved muscle activation.Conclusions:High-frequency rTMS using a conical coil can effectively improve the lower limb motor function and balance ability of stroke survivors, demonstrating promising clinical application potential.

Objective:To document any effect of repeated high-frequency repetitive transcranial magnetic stimulation (rTMS) using double-cone coils on the lower limb motor function of stroke survivors.Methods:A total of 40 stroke survivors were randomly divided into an rTMS group and a sham stimulation group, each of 20. The rTMS group received rTMS at 10Hz with a double-cone coil, while a coil that produced sound but no magnetic stimulation was used with the sham group. The treatments were administered daily, five times a week, for three weeks. Before as well as after 1, 2 and 3 weeks of treatment, lower limb motor function, balance, and the root mean square (RMS) and median frequency (MF) of the rectus femoris and tibialis anterior muscles were evaluated using the Fugl-Meyer lower extremity assessment (FMA-LE), the Berg Balance Scale (BBS), the Modified Barthel Index (MBI), Brunnstrom staging, the TecnoBody balance assessment system, and surface electromyography.Results:Compared with the sham stimulation group, the BBS score of the rTMS group was significantly higher after 2 weeks of treatment, and both the FMA-LE and BBS scores were significantly higher after 3 weeks. The average Brunnstrom stage in the sham group had increased significantly after 3 weeks, but in the rTMS group it had increased after 2 weeks. By 3 weeks there were no significant differences between the two groups. In terms of movement control, the average motion ellipse area in the rTMS group was significantly smaller than among the sham group after 2 weeks, and after 3 weeks the average motion trajectory length was significantly shorter than in the sham group. The average RMS of the rectus femoris in the rTMS group was significantly higher than the sham group′s average after 3 weeks of treatment, indicating improved muscle activation.Conclusions:High-frequency rTMS using a conical coil can effectively improve the lower limb motor function and balance ability of stroke survivors, demonstrating promising clinical application potential.

To investigate the effects of zearalenone(ZEA)on the proliferation and apoptosis of sika deer antler chondrocytes,the chondrocytes were isolated and cultured in vitro and treated with 50μmol/L ZEA for 24 h.Flow cytometry was used to assess cell proliferation,cell cycle,apoptosis,mitochondrial membrane potential,and intracellular levels of reactive oxygen species(ROS).The expression changes of hypertrophic cartilage cell marker genes Col X,Runx2,Alpl,and apoptosis-related genes Casp-3,Bax,Bcl-2 were measured using quantitative PCR.Additionally,glutathione reductase(GR)activity and the levels of the oxidative stress marker malondialdehyde(MDA)were determined.The results showed that after 24 h of ZEA treatment,cell proliferation was sig-nificantly inhibited,with an increase in the number of cells in the G0/G1 phase and a decrease in the S phase.The expression levels of hypertrophic chondrocyte marker genes Col X,Runx2 and Al-pl were significantly increased.Apoptosis rate was significantly increased,with elevated expression of pro-apoptotic genes Casp-3,Bax and reduced expression of the anti-apoptotic gene Bcl-2.The content of MDA in the antler chondrocytes increased,ROS levels rose,and GR activity decreased.The mitochondrial membrane potential reduced.The results suggested that ZEA could inhibit the proliferation of antler chondrocytes and promote the apoptosis by regulating cellular oxidative stress responses and the expression of apoptosis-related genes.

Poly(lactic-co-glycolide)(PLGA)is a key excipient in long-acting sustained-release preparations,and its degradation properties directly affect the drug release behavior.In this study,PLGA microspheres were prepared by microfluidic techniques,and the morphology changes of the microspheres were observed by scanning electron microscopy(SEM).In alkaline environment,due to the accelerated hydrolysis of ester bonds,the surface of the microspheres was rapidly dissolved and eroded,and the degradation rate was significantly higher than that in acidic environment.High temperature accelerated the degradation of PLGA microspheres.Under neutral and alkaline conditions,the microspheres showed aggregation and adhesion.Under acidic conditions,the microspheres gradually decomposed into irregular fragments.The high ionic strength further promoted the surface corrosion of the microspheres,especially under extreme pH conditions.Simultaneously,PLGA microspheres encapsulating coumarin were prepared to simulate the microsphere formulation.The release rate of coumarin after degradation of the microspheres under different conditions was observed by measuring the absorbance with ultraviolet-visible spectrophotometry.The results were consistent with those of the blank microspheres.This study revealed that the degradation of PLGA microspheres was significantly pH-dependent,temperature sensitive and ion strength responsive.These findings not only helped to understand and optimize the long-term stability and controlled release performance of drug-carrying microspheres,but also provided a theoretical basis for further improvement of PLGA-based drug carrier design.

Objective To investigate the relationship between traditional Chinese medicine(TCM)constitution and body composition such as visceral fat in overweight and obese individuals.Methods A total of 320 overweight/obese patients who visited the Preventive Treatment Center of Foshan Hospital of Traditional Chinese Medicine between September 15,2023,and September 14,2024,were selected as study subjects.Among them,135 were classified into the overweight group and 185 into the obese group.Data were collected using the TCM Constitution Questionnaire and a body composition analyzer(InBody570).The differences in TCM constitution distribution between the overweight and obese groups,as well as between genders,were compared.The correlation between TCM constitution types and body composition parameters was analyzed.Logistic regression analysis was employed to identify risk factors for biased constitutions in the overweight/obese population.Results Among the 320 overweight/obese patients,phlegm-damp constitution(56.25％)and damp-heat constitution(40.31％)were the most predominant biased constitutions.The proportions of blood stasis constitution,qi depression constitution,and inherited special constitution in females were significantly higher than those in males(P＜0.05 or P＜0.01),with the risk of qi depression constitution in females being 6.028 times higher than that in males(P＜0.01).Yang deficiency constitution was positively correlated with protein content but negatively correlated with skeletal muscle mass and body fat mass(P＜0.05).The proportion of blood stasis constitution in the overweight group was higher than that in the obese group(P＜0.01).In overweight/obese individuals with blood stasis constitution,the risk of excessive visceral fat was 2.658 times as high as those without excessive visceral fat.Blood stasis constitution was positively correlated with body fat mass,bone mineral content,intracellular water,and skeletal muscle mass index(SMI),but was negatively correlated with body mass index(BMI)and body cell mass(P＜0.05 or P＜0.01).Coclusion For overweight and obese populations,special attention should be paid to the management of visceral fat in individuals with blood stasis constitution and to emotional intervention in females.A staged and precise prevention and treatment strategy should be developed by integrating TCM constitution and body composition indicators.

Objective To analyze the correlation between inflammation indicators(systemic inflammatory response syndrome and systemic immune-inflammation index)and adverse outcomes in patients with symptomatic stroke during hospitalization.Methods This study was a prospective cohort study including consecutive patients with symptomatic stroke who were hospitalized in Fuwai Hospital from January to September 2023.The past medical history,clinical symptoms and signs of the patients were collected.The neurological damage was evaluated with National Institute of Health Stroke Scale(NIHSS).Laboratory test results were recorded and the SIRI and SII in-dex were calculated.Patients were followed up for 90 days after the stroke,and their neurological outcomes were evaluated using the modified Rankin Scale.A score of 0-1 was classified as good outcome,and a score ≥2 was classified as poor outcome.The correlation between inflammatory response indicators and poor outcomes was as-sessed using multiple Logistic regression.Results A total of 97 patients with in-hospital symptomatic stroke were included with an average age of 61.8±12.7 years.Among them,there were 28 females(28.9％,28/97),9 with a history of prior stroke(9.3％,9/97),15 with atrial fibrillation(15.5％,15/97),16 with heart failure(16.5％,16/97),and 7 with myocardial infarction(7.2％,7/97).Correlation analysis showed that the NIHSS score at the time of stroke onset was significantly correlated with the patient's post-stroke SIRI(r=0.237,P＜0.05)and SII(r=0.234,P＜0.05).After 90 days of follow-up,41 cases(42.3％,41/97)had a poor outcome.Multiple Logistic regression analysis showed that post-stroke SIRI(Or=4.71,95％CI:1.24-17.90)and SII(Or=3.13,95％CI:0.88-11.06)were correlated with poor outcomes within 90 days after the stroke.Analysis using restricted cubic splines showed that as the levels of SIRI and SII increased,the risk of poor out-comes in patients with in-hospital symptomatic stroke increased.Conclusions SIRI is an independent risk factor for poor outcomes in patients with in-hospital symptomatic stroke,and the risk of poor neurological outcomes in-creases with high level of SIRI.

Objective:To integrate and analyze the trend of the disease burden of tracheal,bronchus,and lung cancer(TBL)attributable to secondhand smoke in China from 1990 to 2021 and to analyze future projections,aiming to provide data support for the prevention and treatment of TBL in China.Methods:Based on the global burden of disease(GBD)2021 database,TBL with ICD-10 disease classification C33,C34-C34.92 was studied.Using secondhand smoke as a risk factor,the data on TBL mortality and disability-adjusted life year(DALY)due to secondhand smoke in China from 1990 to 2021 were further age-standardized.Using Joinpoint 4.7.1 regression analysis model to calculate annual percentage change(APC)and average annual percentage change(AAPC),Hiplot software was used to plot disease burden data for different ages and genders,and R 4.3.1 software was used to construct a grey model GM(1,1)to predict the predicted value and trend of TBL disease burden attributed to secondhand smoke in China from 2022 to 2031.Results:From 1990 to 2021,the TBL mortality rate,age-standardized mortality rate,and DALY rate attributed to secondhand smoke in China increased from 1.76/100 000,2.63/100 000,and 49.43/100 000 to 4.08/100 000,2.80/100 000,and 95.57/100 000,respectively;the growth was 131.18%,6.45%,and 93.34%;the age-standardized DALY rate decreased from 65.04/100 000 to 63.32/100 000 with the reduction of 2.65%.The results of the Joinpoint regres-sion showed that the AAPC(95%CI)of mortality,age-standardized mortality rate,and DALY rate for TBL were 2.75(2.58-2.93)%,0.16(0.11-0.21)%,and 2.15(2.11-2.18)%,respectively,with an overall increasing trend;the AAPC(95%CI)of age-standardized DALY rate was-0.14(-0.40-0.12)%,with an overall fluctuating and unchanged trend and it was higher in males than in females.In both 1990 and 2021,the TBL mortality rate attributable to secondhand smoke in China gradually increased with age,and the DALY rate first increased and then slowed down with age.The main groups of the burden of disease were the elderly and males.The grey prediction model GM(1,1)showed that the age-standardized mortality rate of TBL attributable to secondhand smoke from 2022 to 2031 showed a slow increasing trend,and the predicted value in 2031 would increase to 2.95/100 000.The age-standardized DALY showed a slow decreasing trend,and the predicted value in 2031 would decrease to 63.83/100 000.Conclusions:From 1990 to 2021,the TBL mortality,age-standardized mortality,and DALY rates attributable to secondhand smoke in China increased,and the age-standardized DALY rate decreased.Men and the elderly are the main groups affected by TBL.Appropriate measures should be formulated to reduce exposure to and contact with secondhand smoke,tak-ing into account gender and age differences.Additionally,efforts should be made to strengthen secondhand smoke prevention and public health education.