Objective To analyze the characteristics of viral hepatitis mortality and life loss among residents in Pudong New Area from 2003 to 2023, and to provide a basis for related prevention and control work. Methods Viral hepatitis mortality data were obtained from the Pudong New Area mortality monitoring system. The crude mortality rate (CMR), standardized mortality rate (SMR), potential years of life lost (PYLL), average years of life lost (AYLL), and standardized potential years of life lost (SPYLL) were calculated to analyze viral hepatitis deaths. The average annual change (AAPC) and annual percentage change (APC) of the mortality rate were calculated by Joinpoint regression analysis to analyze the trend of mortality. Results The CMR and SMR of viral hepatitis among residents in Pudong New Area from 2003 to 2023 were 3.89/100000 and 1.98/100000, respectively. Both CMR and SMR of viral hepatitis showed a decreasing trend over time (CMR:APC=-5.476, t=-13.581, P<0.001; SMR:APC=- 7.624, t= -21.253, P<0.001). The CMR for males was 4.75/100000 and the SMR for males was 2.65/100000; the CMR for females was 3.04/100000 and the SMR for females was 1.32/100000, with a higher mortality rate for males than for females（Z_CME=12.094，P<0.001; Z_SMR=-14.718，P<0.001). Deaths were concentrated in the age groups of 45-64 years old and 65 years old and above, accounting for 91.62% of the total deaths. The PYLL of deaths due to viral hepatitis among residents in Pudong New Area from 2003 to 2023 was 26912 person-years, with a PYLLR of 0.45% and an AYLL of 8.88 years per person. Conclusion The mortality rate of viral hepatitis among the residents of Pudong New Area in 2003-2023 shows a decreasing trend over time. The mortality rate of males is higher than that of females, and the deaths of middle-aged and elderly people account for a large proportion of the total deaths. Chronic hepatitis B is the main cause of death.

Objective To elucidate the application scope and delineate the criteria of dobutamine stress echocardiography (DSE) in assessing surgical risk associated with valvular heart diseases in patients presenting with reduced left ventricular ejection fraction (LVEF). Methods This retrospective analysis encompassed data from patients with reduced LVEF (LVEF<40%) who underwent DSE prior to valvular heart surgery at the Valvular Surgery Center of Beijing Anzhen Hospital between May 2016 and September 2024. Patients were stratified based on the terminal dose of dobutamine into two cohorts: a limited dose group [receiving a maximum dobutamine dose of <5 µg/(kg·min) due to concomitant conditions such as suspected atrial thrombus, aortic dilation, or previous myocardial infarction] and a non-limited dose group (where dosage was adjusted to either achieve the maximum positive standard or the maximal dose tolerable by the patient). Within the non-limited dose group, patients were further classified into positive and negative response groups. The positive response post DSE was defined based on the following criteria: LVEF≥55% (the maximum positive standard), LVEF<55% but with a 5% improvement (the minimum positive standard) from resting situation, aortic maximum velocity (AVmax)≥400 cm/s, or mean pressure gradient (meanPG)≥40 mm Hg, latter two applicable only to patients with aortic stenosis. Clinical indicators were compared in the three groups. Results A total of 99 patients were enrolled, aged 35 to 87 years, with an average age of (61.7±10.1) years. The number of males was significantly higher than that of females (3:1). There were 61 (61.6%) patients undergoing aortic valve surgery, 25 (25.3%) undergoing mitral valve surgery, and 13 (13.1%) undergoing combined aortic and mitral valve surgery. Nineteen (19.2%) patients experienced adverse symptoms such as palpitations, head and face numbness, dizziness, chest tightness post DSE. Additionally, new-onset or aggravated ventricular premature ventricular contractions were in 40 (40.4%) patients. All above symptoms and signs resolved minutes after cessation of the test. No severe adverse events necessitating oxygen therapy or emergency intervention occurred. Among the 93 patients in the non-limited dose group, 86 were classified in the positive response group and 7 in the negative response group. The left ventricular end diastolic diameter, left ventricular end systolic diameter, and LVEF in the positive group all showed significant improvement compared to preoperative values, and were also significantly better than those in the negative group (P<0.05). All 7 patients with negative DSE results underwent interventional surgery, which was significantly different from the positive group (36 patients, 41.9%). In the limited dose group (n=6), 4 patients with a positive result or a positive trend on DSE underwent median sternotomy, 2 received interventional treatment due to a negative response. No significant differences in mortality were observed among the groups (P>0.05). Conclusion Dobutamine stress echocardiography significantly contributes to risk stratification in surgical interventions for patients with valvular heart disease complicated by reduced LVEF. It aids in determining optimal timing and methods for surgery. With comprehensive patient evaluation and controlled dobutamine dosing, the application of DSE can be safely expanded.

Background The crude mortality rate of sudden death has shown a steady upward trend. Pudong New Area, Shanghai, is a highly urbanized and densely populated district that is substantially affected by the urban heat island effect and has experienced frequent extreme temperature events in recent years. However, evidence on the association between ambient temperatures and sudden death among local residents remains limited. Objective To examine the association between daily mean temperature and sudden death in Pudong New Area, and to provide evidence for reducing temperature-related risks of sudden death. Methods Data on sudden death, meteorological factors (daily average temperature, daily average relative humidity, and daily average air pressure), and air pollutants [inhalable particulate matter (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂)] in Pudong New Area from 2016 to 2021 were collected. A distributed lag non-linear model was used to examine the associations of daily mean temperature with total sudden death and sudden death due to cardiovascular and cerebrovascular diseases, including lagged and cumulative effects (lag0, 0-3, 0-7, 0-14, and 0-21 d). Stratified analyses were performed by sex, age, and education level to identify vulnerable populations. The temperature attributable burden of sudden death was assessed by calculating attributable number (AN) and attribute fraction (AF). Results A total of 19458 sudden deaths were reported in Pudong New Area from 2016 to 2021, of which 11082 (56.95%) were due to cardiovascular and cerebrovascular diseases. Both low (P₅, 4.6 ℃) and high (P₉₅, 30.2 ℃) temperatures were associated with increased risks of sudden death. The cumulative risks associated with low temperature peaked at lag 0-21 d for both total sudden death and sudden death due to cardiovascular and cerebrovascular diseases. In contrast, the cumulative risks associated with high temperature peaked at lag 0-7 d for total sudden death and at lag 0-3 d for sudden death due to cardiovascular and cerebrovascular diseases. Stratified analyses showed that females, individuals aged ≥65 years, and those with primary school education or below were more sensitive to low temperature; whereas females, individuals aged <65 years, and those with secondary school education or above were more sensitive to high temperature. Using 21.5 ℃ as the minimum mortality temperature, the AN of total sudden deaths attributable to non-optimal temperature was 3791 (95%CI: 1853, 5587), with an AF of 20.41% (95%CI: 9.47%, 28.94%); the AN attributable to low temperature was 3358 (95%CI: 1087, 5062), with an AF of 17.26% (95%CI: 5.89%, 26.01%), whereas the AN attributable to high temperature was 225 (95%CI: −274, 655), with an AF of 2.03% (95%CI: −2.53%, 5.78%). For sudden deaths due to cardiovascular and cerebrovascular diseases, the AN attributable to non-optimal temperature was 2721 (95%CI: 1747, 5575), with an AF of 24.55% (95%CI: 9.59%, 28.65%); the AN attributable to low temperature was 2496 (95%CI: 988, 3562), with an AF of 22.53% (95%CI: 8.97%, 32.41%), whereas the AN attributable to high temperature was 614 (95%CI: −15, 1176), with an AF of 3.15% (95%CI: −0.08%, 6.02%). Conclusions Both low (P₅, 4.6 ℃) and high (P₉₅, 30.2 ℃) temperatures are associated with increased risks of sudden death in Pudong New Area, Shanghai. High temperature shows a relative short-term effect, whereas low temperature shows a stronger cumulative effect. Females, people ≥65 years, and individuals with primary school educational attainment or below are more vulnerable to low temperature, while females, people <65 years, and those with secondary school educational attainment or above are more vulnerable to high temperature. The attributable burden of low temperature is greater than that of high temperature. Targeted health protection measures should be strengthened for vulnerable populations during extreme temperature events.

Objective:To explore the possible mechanism of cognitive impairment in aged mice induced by sevoflurane and the role of the AMPK/GSK-3β/Nrf2 signaling pathway.Methods:Eighteen 16-month-old SPF male C57BL/6J mice were randomly assigned to either a control group or a sevoflurane group according to the random number table method( n=9 per group). Mice in the sevoflurane group were exposed to 3% sevoflurane for 2 h every day for three consecutive days.Cognitive function of mice was assessed by novel object recognition test and Morris water maze test.Golgi staining was used to analyze dendritic spine morphology and density in the hippocampus. Mitochondrial ultrastructure was examined by transmission electron microscopy. Oxidative stress in hippocampal tissue was evaluated by reactive oxygen species(ROS) and glutathione(GSH) assay kits. Western blot was performed to measure synaptic plasticity-related proteins and proteins involved in the AMPK/GSK-3β/Nrf2 signaling pathway, while Nrf2 expression was assessed by immunofluorescence. Statistical analysis was performed using GraphPad Prism 7 software with independent-samples t-test or Mann-Whitney U test for between-group comparisons. Results:(1) The novel object recognition test showed that the recognition index in the sevoflurane group was significantly lower than that in the control group ( Z=-3.256, P=0.001).The escape latency in the Morris water maze test was longer ((49.50±10.14) s, (18.62±6.59) s; t=-7.221, P<0.001) and the number of platform crossings was lower ( Z=-2.673, P=0.008) in the sevoflurane group compared with those of the control group. (2) Results from Western blot and Golgi staining showed that the expression levels of hippocampal synapse-related proteins in the sevoflurane group, including PSD95 ((0.38±0.07), (1.00±0.21); t=4.885) and SYN1 ((0.30±0.10), (1.00±0.10); t=8.575), were lower than those in the control group, as well as the number of dendritic spines ((10.3±2.5), (20.0±1.0); t=6.183)(all P<0.05). (3) Transmission electron microscopy showed mitochondrial damage in the hippocampus of the sevoflurane group, and the expression level of ROS ((3.05±0.90), (0.97±0.16); t=-4.555, P=0.004) was significantly higher than that of the control group, while the expression level of GSH ((0.71±0.07), (1.00±0.09); t=5.396, P=0.002) was significantly lower than that of the control group.(4) Western blot and immunofluorescence demonstrated that hippocampal p-AMPK, p-GSK-3β (Ser9), and HO-1 expression levels in the sevoflurane group were significantly lower than those in the control group ( t=2.845, 7.087, 4.551, all P<0.05), and Nrf2 fluorescence intensity was also markedly reduced ( P<0.05). Conclusion:The cognitive impairment induced by sevoflurane in aged mice may be caused by mitochondrial damage, oxidative stress response and synaptic damage, which maybe associated with the inhibition of the AMPK/GSK-3β/Nrf2 signaling pathway.

Objective:To explore the possible mechanism of cognitive impairment in aged mice induced by sevoflurane and the role of the AMPK/GSK-3β/Nrf2 signaling pathway.Methods:Eighteen 16-month-old SPF male C57BL/6J mice were randomly assigned to either a control group or a sevoflurane group according to the random number table method( n=9 per group). Mice in the sevoflurane group were exposed to 3% sevoflurane for 2 h every day for three consecutive days.Cognitive function of mice was assessed by novel object recognition test and Morris water maze test.Golgi staining was used to analyze dendritic spine morphology and density in the hippocampus. Mitochondrial ultrastructure was examined by transmission electron microscopy. Oxidative stress in hippocampal tissue was evaluated by reactive oxygen species(ROS) and glutathione(GSH) assay kits. Western blot was performed to measure synaptic plasticity-related proteins and proteins involved in the AMPK/GSK-3β/Nrf2 signaling pathway, while Nrf2 expression was assessed by immunofluorescence. Statistical analysis was performed using GraphPad Prism 7 software with independent-samples t-test or Mann-Whitney U test for between-group comparisons. Results:(1) The novel object recognition test showed that the recognition index in the sevoflurane group was significantly lower than that in the control group ( Z=-3.256, P=0.001).The escape latency in the Morris water maze test was longer ((49.50±10.14) s, (18.62±6.59) s; t=-7.221, P<0.001) and the number of platform crossings was lower ( Z=-2.673, P=0.008) in the sevoflurane group compared with those of the control group. (2) Results from Western blot and Golgi staining showed that the expression levels of hippocampal synapse-related proteins in the sevoflurane group, including PSD95 ((0.38±0.07), (1.00±0.21); t=4.885) and SYN1 ((0.30±0.10), (1.00±0.10); t=8.575), were lower than those in the control group, as well as the number of dendritic spines ((10.3±2.5), (20.0±1.0); t=6.183)(all P<0.05). (3) Transmission electron microscopy showed mitochondrial damage in the hippocampus of the sevoflurane group, and the expression level of ROS ((3.05±0.90), (0.97±0.16); t=-4.555, P=0.004) was significantly higher than that of the control group, while the expression level of GSH ((0.71±0.07), (1.00±0.09); t=5.396, P=0.002) was significantly lower than that of the control group.(4) Western blot and immunofluorescence demonstrated that hippocampal p-AMPK, p-GSK-3β (Ser9), and HO-1 expression levels in the sevoflurane group were significantly lower than those in the control group ( t=2.845, 7.087, 4.551, all P<0.05), and Nrf2 fluorescence intensity was also markedly reduced ( P<0.05). Conclusion:The cognitive impairment induced by sevoflurane in aged mice may be caused by mitochondrial damage, oxidative stress response and synaptic damage, which maybe associated with the inhibition of the AMPK/GSK-3β/Nrf2 signaling pathway.

Attention-deficit/hyperactivity disorder(ADHD)is a common behavioral disorder in children and has significant non-specific symptoms.The specific pathogenesis of ADHD remains unclear.Chinese medicine has a unique advantage in treating this disease.The"qi cycle in round"theory is a unique diagnosis and treatment system constructed by Huang Yuanyu,a Qing Dynasty physician,through systematic integration and innovative development of the theoretical framework of traditional Chinese medicine,which is widely used in clinical practice.Based on the"qi cycle in round"theory,the pathogenesis of ADHD in children was discussed,and the abnormal middle qi was proposed as the root cause of the disease,with hyperactivity of the liver,lung depletion,and fire as the key contributing factors.Guided by the"qi cycle in round"theory in the treatment of ADHD in children,the approach focuses on restoring and balancing central qi.It emphasized the understanding of the overall changes in the spleen,stomach,lungs,liver,heart,kidney,and other viscera,along with the movement of qi.Treatment focuses on methods such as lifting clear yang,reducing stomach turbidity,softening the liver and quenching the wind,suppressing the lungs and reducing the inversion,and reducing the fire and returning to the yuan.These interventions aim to promote the smooth circulation of the qi circulation from multiple perspectives,thereby facilitating recovery.

[Purpose]To analyze the trends in pancreatic cancer mortality and disease burden among residents in Shanghai Pudong New Area from 2002 to 2022,and to investigate the effects of age,period,and birth cohort on mortality risk.[Methods]Data on pancreatic cancer deaths among residents of Pudong New Area from 2002 to 2022 were collected through the Shanghai Population Cause of Death Registration System.The crude mortality rate,age-standardized mortality rate by Chinese standard population(ASMRC),potential years of life lost(PYLL),potential years of life lost rate(PYLLR),and average years of life lost(AYLL)were calculated.Joinpoint regression was applied to calculate the average annual percentage change(AAPC)for analyzing the changing trend of the mortality rate of pancreatic cancer.The age-period-cohort model was applied with R 4.4.1 to analyze the age,period,and cohort effects on the mortality risk of pancreatic cancer.[Results]The crude mortality rate of pancreatic cancer among residents in Pudong New Area increased from 10.42/105 in 2002 to 18.73/105 in 2022,showing a significant upward trend(AAPC=2.90％,P＜0.001);the ASMRC was generally stable(AAPC=-0.05％,P=0.775).The crude mortality rate of males(17.09/105)was higher than that of females(13.75/105),and both showed an upward trend(AAPC=3.05％and 2.75％respectively,both P＜0.001).After the age of 40,the mortality rate of pancreatic cancer increased significantly with the growth of age in both sexes.The PYLL was 31 347 person-years,showing an upward trend(AAPC=1.83％,P＜0.001),and the AYLL was 3.59 years,showing a downward trend(AAPC=-2.45％,P＜0.001).The age effect showed that the mortality risk of pan-creatic cancer was increased with age;the period effect showed that the mortality risk decreased from 2002 to 2016 and then increased;the cohort effect showed that the mortality risk increased with the advancement of the birth cohort.[Conclusion]From 2002 to 2022,the crude mortality rate of pancreatic cancer in Pudong New Area showed an upward trend,and the mortality rate of males was higher than that of females.The mortality risk of pancreatic cancer increases with age,and the later the birth year of the residents,the higher the mortality risk.Early screening should be strengthened for men and the elderly,environmental and lifestyle risk factors should be paid attention to in combination with the characteristics of cohort effect,and the prevention and control strategy for the whole population should be optimized.

Attention-deficit/hyperactivity disorder(ADHD)is a common behavioral disorder in children and has significant non-specific symptoms.The specific pathogenesis of ADHD remains unclear.Chinese medicine has a unique advantage in treating this disease.The"qi cycle in round"theory is a unique diagnosis and treatment system constructed by Huang Yuanyu,a Qing Dynasty physician,through systematic integration and innovative development of the theoretical framework of traditional Chinese medicine,which is widely used in clinical practice.Based on the"qi cycle in round"theory,the pathogenesis of ADHD in children was discussed,and the abnormal middle qi was proposed as the root cause of the disease,with hyperactivity of the liver,lung depletion,and fire as the key contributing factors.Guided by the"qi cycle in round"theory in the treatment of ADHD in children,the approach focuses on restoring and balancing central qi.It emphasized the understanding of the overall changes in the spleen,stomach,lungs,liver,heart,kidney,and other viscera,along with the movement of qi.Treatment focuses on methods such as lifting clear yang,reducing stomach turbidity,softening the liver and quenching the wind,suppressing the lungs and reducing the inversion,and reducing the fire and returning to the yuan.These interventions aim to promote the smooth circulation of the qi circulation from multiple perspectives,thereby facilitating recovery.

[Purpose]To analyze the trends in pancreatic cancer mortality and disease burden among residents in Shanghai Pudong New Area from 2002 to 2022,and to investigate the effects of age,period,and birth cohort on mortality risk.[Methods]Data on pancreatic cancer deaths among residents of Pudong New Area from 2002 to 2022 were collected through the Shanghai Population Cause of Death Registration System.The crude mortality rate,age-standardized mortality rate by Chinese standard population(ASMRC),potential years of life lost(PYLL),potential years of life lost rate(PYLLR),and average years of life lost(AYLL)were calculated.Joinpoint regression was applied to calculate the average annual percentage change(AAPC)for analyzing the changing trend of the mortality rate of pancreatic cancer.The age-period-cohort model was applied with R 4.4.1 to analyze the age,period,and cohort effects on the mortality risk of pancreatic cancer.[Results]The crude mortality rate of pancreatic cancer among residents in Pudong New Area increased from 10.42/105 in 2002 to 18.73/105 in 2022,showing a significant upward trend(AAPC=2.90％,P＜0.001);the ASMRC was generally stable(AAPC=-0.05％,P=0.775).The crude mortality rate of males(17.09/105)was higher than that of females(13.75/105),and both showed an upward trend(AAPC=3.05％and 2.75％respectively,both P＜0.001).After the age of 40,the mortality rate of pancreatic cancer increased significantly with the growth of age in both sexes.The PYLL was 31 347 person-years,showing an upward trend(AAPC=1.83％,P＜0.001),and the AYLL was 3.59 years,showing a downward trend(AAPC=-2.45％,P＜0.001).The age effect showed that the mortality risk of pan-creatic cancer was increased with age;the period effect showed that the mortality risk decreased from 2002 to 2016 and then increased;the cohort effect showed that the mortality risk increased with the advancement of the birth cohort.[Conclusion]From 2002 to 2022,the crude mortality rate of pancreatic cancer in Pudong New Area showed an upward trend,and the mortality rate of males was higher than that of females.The mortality risk of pancreatic cancer increases with age,and the later the birth year of the residents,the higher the mortality risk.Early screening should be strengthened for men and the elderly,environmental and lifestyle risk factors should be paid attention to in combination with the characteristics of cohort effect,and the prevention and control strategy for the whole population should be optimized.

Precancerous lesion of gastric carcinoma(PLGC)is a critical component of the occurrence,development,and metastasis of the"inflammation-cancer transformation".Traditional Chinese medicine(TCM)is characterized by a unique mode of diagnosis and treatment which adopts a holistic concept to differentiate and treat syndromes.With this mode,it can improve symptoms in patients,enhance the quality of their lives and elevate the histopathological performance.The pathogenic factors of PLGC are mostly related to spleen,among which the weakness of spleen and stomach is the pathogenetic basis of it.Over time,dampness,phlegm and blood stasis will accumulate in the body,causing local lesions.Spleen deficiency is associated with various development mechanisms of PLGC,including the gastric mucosal inflammation,intragastric flora,gastric mucosal barrier,immune function,energy metabolism,and gastric mucosal secretion.To treat PLGC from the perspective of the spleen theory,physicians should take steps to reinforce healthy Qi to eliminate pathogenic factors,give equal consideration to deficiency and excess,and harmonize the center to restore the balance in the viscera,which will invigorate the spleen and stomach,resolve dampness,clear heat and regulate qi and blood at the same time.The differentiation of the holistic and local syndromes should be combined and the treatment with drugs should take both diseases and syndromes into consideration.