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 potential impact of pre-existing coronary artery stenosis (CAS) on right ventricular (RV) function during acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and RV dysfunction in patients with acute PE. METHODS: In this multicenter, case-control study, 89 cases and 176 controls matched for age were enrolled at three study centers (Peking Union Medical College Hospital, Fuwai Hospital, and the Second Affiliated Hospital of Harbin Medical University) from January 2016 to December 2020. The cases were patients with acute PE with CAS, and the controls were patients with acute PE without CAS. Coronary artery assessment was performed using coronary computed tomographic angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression analysis was used to evaluate the association between CAS and RV dysfunction. RESULTS: The percentages of RV dysfunction (19.1% [17/89] vs. 44.6% [78/176], P <0.001) and elevated systolic pulmonary artery pressure (sPAP) (19.3% [17/89] vs. 39.5% [68/176], P = 0.001) were significantly lower in the case group than those in the control group. In the multivariable logistic regression model, CAS was independently and negatively associated with RV dysfunction (adjusted odds ratio [OR]: 0.367; 95% confidence interval [CI]: 0.185-0.728; P = 0.004), and elevated sPAP (OR: 0.490; 95% CI: 0.252-0.980; P = 0.035), respectively. CONCLUSIONS Pre-existing CAS was significantly and negatively associated with RV dysfunction and elevated sPAP in patients with acute PE. This finding provides new insights into RV dysfunction in patients with acute PE with pre-existing CAS.
Humans ; Pulmonary Embolism/complications* ; Case-Control Studies ; Male ; Ventricular Dysfunction, Right/physiopathology* ; Female ; Middle Aged ; Aged ; Coronary Stenosis/complications* ; Logistic Models ; Adult

To explore the impact of an airway stepwise management strategy in the treatment of hospital acquired pneumonia (HAP) in the ultra elderly critically ill patients.

Objective:To analyze the genus, drug resistance/virulence and phylogenetic characteristics of Brucella strains isolated from brucellosis surveillance sentinels in Henan Province from 2013 to 2022, and provide baseline data for the surveillance, early warning and outbreak tracing of brucellosis. Methods:Blood samples were collected from patients with Brucella infection for strain isolation, culture and species identification, drug susceptibility test, whole genome sequencing, splicing and assembly, functional/virulence/resistance gene prediction analysis and phylogenetic tree drawing based on single nucleotide polymorphism (SNP). Results:In 36 brucellosis patients, the majority were men (86.11%, 31/36), young adults aged 18-50 (88.89%, 32/36) and farmers/herdsmen (72.22%, 26/36). A total of 36 strains of Brucella melitensis were isolated, and average 1 305 functional proteins of 21 categories were predicted by strain genome; all the strains carried four main virulence factors (pmm, VirB group, BtpA/BtpB, BvrS/BvrR). The drug sensitivity rate was 100.00% to six types of antibiotics including levofloxacin, rifampicin, doxycycline, streptomycin, tetracycline and gentamicin, they showed different resistances to three antibiotics including compound trimethoprim-sulfamethoxazole, ciprofloxacin and ampicillin. The strains carried four types of resistance genes and two clusters of resistance genes, with four combinations of genotypes, the resistance mechanisms included antibiotic degradation/modification enzymes, resistant nodular cell differentiation (RND) efflux pumps, 16S/23S ribosomal rRNA binding site mutations, etc. The number of SNP differed in the genomes of 36 Brucellamelitensis strains ranged from 0 to 454 and phylogenetic tree was divided into three major branches, with relative branch distances between 0.000 0 and 0.498 6 for each strain. Conclusions:Human Brucellamelitensis strains isolated from surveillance sentinels in Henan from 2013 to 2022 carried multiple virulence and antibiotic resistance genes and had different drug resistance phenotypes. Single nucleotide polymorphism analysis and phylogenetic tree analysis showed significant differences in phylogenetic relationships among different strains.

Objective:To analyze the clinical features of adult deficiency of adenosine deaminase 2 (DADA2) with neurological impairment.Methods:The clinical data of an adult DADA2 patient with concurrent neurological damage who visited the Department of Neurology, Mindong Hospital Affiliated to Fujian Medical University on September 18, 2023 were retrospectively analyzed. The clinical studies or case reports related to adult DADA2 with nervous system involvement from Pubmed, CNKI, and Wanfang databases were retrieved, and the clinical characteristics of adult DADA2 with neurological damage were summarized. The clinical data of children with nervous system involvement in the same study cohorts were also collected, and the clinical features of DADA2 between adults and children were compared.Results:The patient was a 30-year-old male, mainly presenting with manifestations of livedo reticularis, stroke and spastic paraplegia. Genetic testing showed a compound heterozygous mutation in the adenosine deaminase 2 ( ADA2) gene, and brain MRI showed lacunar infarcts in the right basal ganglia and thalamus, hypertrophic inferior olivary degeneration. The literature review found that a total of 22 adult DADA2 patients with neurological damage have been reported, with a onset age of 25 (19, 29) years. Stroke was the most common feature of neurological involvement in patients with this disease (17/22, 77.3%), followed by cranial nerve damage (7/22, 31.8%) and limb nerve damage (8/22, 36.4%). After the treatment with tumor necrosis factor (TNF) inhibitors, the condition of 17/20 patients remained stable or improved. Compared with pediatric DADA2 patients with concurrent neurological damage, the incidence of fever [12/22(54.5%) vs 48/59(81.4%)], arthritis [6/22(27.3%) vs 34/59(57.6%)], and hematological abnormalities [4/22(18.2%) vs 28/60(46.7%)] in adult DADA2 patients was significantly reduced, and the difference was statistically significant (χ 2=5.998, 5.907, 5.489, respectively, all P<0.05). Conclusions:Adult DADA2 with concurrent neurological damage generally onset in early adulthood, mainly manifested as stroke, and may also be accompanied by peripheral nerve damage. Adult patients have fewer systemic symptoms than children, and timely treatment with TNF inhibitors can lead to better outcomes.

Objective:To analyze the real clinical effects and prognosis of neoadjuvant therapy for locally advanced resectable esophageal cancer.Methods:Two hundred and one patients with locally advanced resectable esophageal cancer who underwent different neoadjuvant treatments at Nanchong Central Hospital of Sichuan Province from January 2019 to December 2021 were retrospective analyzed. Patients were divided into neoadjuvant chemoradiotherapy group ( n=87), neoadjuvant immunochemotherapy group ( n=69), and neoadjuvant chemotherapy group ( n=45) according to the different methods of neoadjuvant therapy. Patients underwent surgical treatment 4-6 weeks after completing neoadjuvant therapy. The postoperative pathological response of three groups of patients were compared. Kaplan-Meier method was used to draw survival curves. Log-rank tests were performed to analyze overall survival (OS) rate, local recurrence-free survival (LRFS) rate, and distant metastasis-free survival (DMFS) rate in three groups of patients. Results:The pathological complete response rates of the neoadjuvant chemoradiotherapy group, neoadjuvant immunochemotherapy group and neoadjuvant chemotherapy group were 33.3% (29/87), 40.6% (28/69) and 13.3% (6/45), respectively, with a statistically significant difference ( χ2=9.68, P=0.008). The pathological complete response rates in the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were higher than that in the neoadjuvant chemotherapy group, with statistically significant differences ( χ2=6.09, P=0.014; χ2=9.66, P=0.002) ; there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group ( χ2=0.87, P=0.351). The major pathologic response rates of the three groups were 58.6% (51/87), 59.4% (41/69) and 31.1% (14/45), respectively, with a statistically significant difference ( χ2=10.89, P=0.004). The major pathologic response rates of the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were significantly higher than that of the neoadjuvant chemotherapy group, with statistically significant differences ( χ2=8.98, P=0.003; χ2=8.74, P=0.003) ; there was no statistically significant difference between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group ( χ2=0.10, P=0.920). The 3-year OS rates of the three groups were 43.7%, 42.0% and 33.3%, respectively, with no statistically significant difference ( χ2=0.79, P=0.347). The 3-year LRFS rates of the three groups were 67.8%, 66.7% and 46.7%, respectively, with a statistically significant difference ( χ2=7.58, P=0.023), the LRFS rates in the neoadjuvant chemoradiotherapy group and neoadjuvant immunochemotherapy group were significantly higher than that in the neoadjuvant chemotherapy group, with statistically significant differences ( χ2=4.17, P=0.041; χ2=4.15, P=0.042) ; there was no statistically significant difference in LRFS rates between the neoadjuvant chemoradiotherapy group and the neoadjuvant immunochemotherapy group ( χ2=0.01, P=0.923). The 3-year DMFS rates of the three groups were 37.9%, 37.7% and 28.9%, respectively, with no statistically significant difference ( χ2=0.14, P=0.707) . Conclusion:Different neoadjuvant therapies have different therapeutic effects in the treatment of locally advanced resectable esophageal cancer, neoadjuvant chemoradiotherapy and neoadjuvant immunochemotherapy can achieve a better pathological response rates and LRFS rates.

Objective To explore the effect of multiparameter electroencephalogram(EEG)-guided anesthesia management on EEG burst suppression(BS)and postoperative delirium(POD)in elderly patients undergoing lower abdominal laparoscopic surgery.Methods A total of 100 elderly patients,48 males and 52 females,aged 65-85 years,BMI 18.5-28.0 kg/m2,and ASA physical status Ⅱ or Ⅲ,were enrolled for lower abdominal surgery under general anesthesia.Patients were randomly divided into two groups:multiparameter group and single parameter group,50 patients in each group.In multiparameter group,multiparameter EEG monitoring with patient statu index(PSI),spectral edge frequency(SEF),burst suppression ratio(BSR)and density spectral array(DSA)were used to guide the depth management of anesthesia.In single parameter group,single parameter PSI was used to guide the depth management of anesthesia.The total area under the hypotensive threshold of MAP(AUTMAP)was calculated,and the amount of anesthetic used during the operation and the use of vasoactive drugs,duration of anesthesia,extu-bation time,duration of PACU stay,and postoperative hospitalisation days were recorded.HR,MAP,PSI,and SEF were recorded before the induction of anesthesia,5 minutes after induction of anesthesia,5,30,and 60 minutes after incision,and at the end of surgery.The incidence,duration,and maximum BSR of in-traoperative BS,as well as the incidence of POD 1,2,and 3 days after surgery were recorded.Results There was no significant difference in AUTMAP values between the two groups.Compared with single parame-ter group,intraoperative propofol and remifentanil dosage were significantly decreased(P＜0.05),awak-ening time,PACU stay,and postoperative hospitalization time were significantly shorter in multiparameter group(P＜0.05),the PSI was significantly increased 5,30,and 60 minutes after incision and at the end of surgery,and the SEF was significantly increased 5 minutes after induction of anesthesia,5,30,and 60 minutes after induction and the end of surgery(P＜0.05).Compared with single parameter group,inci-dence of intraoperative BS was significantly decreased,duration of BS was significantly shorter,smaller maximum BSR was significantly decreased,and incidence of POD on 1 day after surgery in multiparameter group(P＜0.05).Conclusion Anesthesia management guided by multiparameter EEG can inhibit the oc-currence of BS,mitigate the degree of BS,and reduce the incidence of POD in elderly patients undergoing abdominal surgery.

Objective:To investigate the efficacy and the safety of intravascular therapy for cerebrovascular ischemic tandem stenosis.Methods:Clinical data of 35 patients with symptomatic anterior circulation and posterior circulation tandem stenosis who received intravascular therapy for two sites of stenosis at the same time at Department of Neurosurgery of Peking University First Hospital from January 2013 to December 2018 were analyzed retrospectively. There were 27 males and 8 females,aged (65.6±9.4)years (range:47 to 81 years).There were 14 cases of anterior circulation tandem stenosis and 21 of posterior circulation tandem stenosis.The medical records were collected with emphasis on postoperative symptoms,imaging manifestations and modified Rankin scale(mRS) scores.Results:Sixty-eight stents were implants in to 35 patients,including 49 extracranial implants and 19 intracranial implants.The surgical success rate was 100%.The perioperative death rate was 0,and 1 patient(1/35,2.9%) had cerebral hemorrhage.All patients were followed up for 18 months.During 3 to 12 months after the intervention,1 case(1/35,2.9%) had stent restenosis,and 4 cases(4/35,11.4%) had persisted symptoms such as dizziness and weakness in limbs.All patients′mRS scores were ≤2. No new stroke occurred. During 12 to 18 months after the intervention,3 cases had in-stent restenosis,increasing the rate to 11.4% (4/35). The mRS scores of 32 patients(32/35,91.4%) were ≤2.Conclusion:Intravascular therapy for patients with symptomatic tandem stenosis is a feasible and safe procedure with good short-term outcomes.

Objective:To investigate the strategy and the clinical effect of single stage treatment for intracranial or extracranial artery stenosis with intracranial aneurysm.Methods:The clinical data of 15 patients with intracranial aneurysms and extracranial or intracranial artery stenosis treated by one-stage endovascular therapy at Department of Neurosurgery of Peking University First Hospital from April 2013 to September 2018 were analyzed,respectively.There were 6 males and 9 females,aged (63.9±9.1)years (range:43 to 79 years).Fifteen arterial stenosis were found, including 8 in anterior circulatiion and 7 in posterior circulation, and the stenosis rates ranged from 75% to 95%. There were 17 aneurysms, among which 11 in the anterior circulation and 6 in the posterior.The maximal diameter was (5.3±1.2)mm (range:3 to 7 mm).All patients were treated with stenting and embolization at one stage. The operation choices, perioperative and postoperative symptoms,imaging data and complications were recorded.Results:Stents were successfully implanted into arterial stenosis of 15 cases, reducing the stenosis rates to less than 30%.Among the 17 aneurysms,10 cases were treated by coil embolization alone,7 cases by stenting and coil embolization. Eventually all the 17 aneurysms reached complete embolization.One patient had mild symptoms of the cerebral infarction during the perioperative period,and the rest had not shown surgical complications.The follow-up time was (43.8±8.2)months (range:24 to 85 months). All the patients underwent digital subtraction angiography 6 to 12 months after operation.Among them,2 cases had asymptomatic in-stent restenosis,and no recurrence was found in aneurysms.Up to the last follow-up,no patients had showed new symptoms or signs of intracranial hemorrhage or ischemic stroke.Conclusions:For patients suffered from both stenosis and aneurysms,individualized treatment should be made based on the location and severity of the vascular stenosis and aneurysms.With careful preoperative evaluation and surgical planning,the single stage endovascular treatment for intracranial or extracranial artery stenosis combined with intracranial aneurysm is safe,feasible and effective for selected patients.

Objective:To investigate the efficacy and the safety of intravascular therapy for cerebrovascular ischemic tandem stenosis.Methods:Clinical data of 35 patients with symptomatic anterior circulation and posterior circulation tandem stenosis who received intravascular therapy for two sites of stenosis at the same time at Department of Neurosurgery of Peking University First Hospital from January 2013 to December 2018 were analyzed retrospectively. There were 27 males and 8 females,aged (65.6±9.4)years (range:47 to 81 years).There were 14 cases of anterior circulation tandem stenosis and 21 of posterior circulation tandem stenosis.The medical records were collected with emphasis on postoperative symptoms,imaging manifestations and modified Rankin scale(mRS) scores.Results:Sixty-eight stents were implants in to 35 patients,including 49 extracranial implants and 19 intracranial implants.The surgical success rate was 100%.The perioperative death rate was 0,and 1 patient(1/35,2.9%) had cerebral hemorrhage.All patients were followed up for 18 months.During 3 to 12 months after the intervention,1 case(1/35,2.9%) had stent restenosis,and 4 cases(4/35,11.4%) had persisted symptoms such as dizziness and weakness in limbs.All patients′mRS scores were ≤2. No new stroke occurred. During 12 to 18 months after the intervention,3 cases had in-stent restenosis,increasing the rate to 11.4% (4/35). The mRS scores of 32 patients(32/35,91.4%) were ≤2.Conclusion:Intravascular therapy for patients with symptomatic tandem stenosis is a feasible and safe procedure with good short-term outcomes.