Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

It is considered that the fundamental pathogenesis of pediatric pertussis lies in the dysfunction of lung qi， and it is advocated to treat the disease with the method of regulating qi and relieving cough. Clinically， the disease is divided into three stages for syndrome differentiation and treatment， initial coughing stage， spasmodic coughing stage， and prolonged coughing stage. In the initial coughing stage， the pathogenesis involves invasion by external pathogens and failure of lung qi to disperse； the treatment principle is to release the exterior， expel pathogens， ventilate the lungs， and relieve cough. For cold patterns， modified San'ao Decoction （三拗汤） is prescribed； for heat type， a self-formulated Qingqi Xuanfei Decoction （清气宣肺汤） is used. In the spasmodic coughing stage， the pathogenesis is the congealing of phlegm and fire with impaired lung purification； the treatment focuses on eliminating phlegm， dredging the meridians， purging the lungs， and relieving cough. Mild cases are treated with a self-formulated Tongluo Xiefei Decoction （通络泻肺汤）， while severe cases are treated with a modified combination of Maxing Shigan Decoction （麻杏石甘汤） and Qianjin Weijing Decoction （千金苇茎汤）. In the prolonged coughing stage， the pathogenesis involves the depletion of qi and yin and latent pathogens in a weakened lung； the treatment aims to tonify qi， nourish yin， moisten the lungs， and eliminate residual pathogens. For lung yin deficiency， modified Shashen Maidong Decoction （沙参麦冬汤） is used； for lung-spleen qi deficiency， a self-formulated Jianpi Gufei Decoction （健脾固肺汤） is prescribed.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Myocardial fibrosis is a serious cause of heart failure and even sudden cardiac death. However, the mechanisms underlying myocardial ischemia-induced cardiac fibrosis remain unclear. Here, we identified that the expression of sterile alpha and TIR motif containing 1 (SARM1), was increased significantly in the ischemic cardiomyopathy patients, dilated cardiomyopathy patients (GSE116250) and fibrotic heart tissues of mice. Additionally, inhibition or knockdown of SARM1 can improve myocardial fibrosis and cardiac function of myocardial infarction (MI) mice. Moreover, SARM1 fibroblasts-specific knock-in mice had increased deposition of extracellular matrix and impaired cardiac function. Mechanically, elevated expression of SARM1 promotes the deposition of extracellular matrix by directly modulating P4HA1. Notably, by using the Click-iT reaction, we identified that the increased expression of ZDHHC17 promotes the palmitoylation levels of SARM1, thereby accelerating the fibrosis process. Based on the fibrosis-promoting effect of SARM1, we screened several drugs with anti-myocardial fibrosis activity. In conclusion, we have unveiled that palmitoylated SARM1 targeting P4HA1 promotes collagen deposition and myocardial fibrosis. Inhibition of SARM1 is a potential strategy for the treatment of myocardial fibrosis. The sites where SARM1 interacts with P4HA1 and the palmitoylation modification sites of SARM1 may be the active targets for anti-fibrosis drugs.

Perimenopause raises the risk and incidence of depression, whereas the underlying molecular mechanism remains unclear. Disturbed glucose regulation has been widely documented in depressive disorders, which renders the brain susceptible to various stresses such as estrogen depletion. However, whether and how glucose dysfunction regulates depression-like behaviors and neuronal damage in perimenopausal transition remains unexplored. Here, a prominent depressive phenotype was found in perimenopausal mice induced by the ovarian toxin 4-vinylcyclohexene diepoxide (VCD). The VCD depression susceptible group (VCD^SS) and the VCD depression resilient group (VCD^RES) were determined using a ROC-based behavioral screening approach. We found that the hippocampus, a crucial region linked to depression, had hyperglycemia and mitochondrial abnormalities. Interestingly, oral administration of the SGLT2 inhibitor empagliflozin (EMPA) and intrahippocampal glucose infusion suggest a close relationship between hyperglycemia in the hippocampus and the susceptibility to depression. We verified that cytochrome c oxidase 7c (COX7C) downregulation is a potential cause of the high glucose-induced neuronal injury using proteomic screening and biochemical validations. High glucose causes COX7C to be ubiquitinated in a S-phase kinase associated protein 1 (SKP1)-dependent manner. According to these results, SKP1/COX7C represents a unique therapeutic target and a novel molecular route for treating perimenopausal depression.

Objective:To analyze the prevalence, trends in disease burden, and risk factors of esophageal cancer in various provinces of China from 1990 to 2019.Methods:Utilizing data from the 2019 global burden of disease study, the disease burden of esophageal cancer of 31 provinces, municipalities, and autonomous regions, as well as Hong Kong Special Administrative Region and Macao Special Administrative Region of China from 1990 to 2019 were analyzed. The disease burden of esophageal cancer in China was described with the number (and incidence) of cases, the number (and mortality) of death, and disability-adjusted life year (DALY) and their age-standardized rates. Joinpoint regression analysis and t-test were used to evaluate the annual percent change and the average annual percent change (AAPC). Scatter plots and Spearman correlation coefficients were performed to analyze the correlation between the disease burden of esophageal cancer and the socio-demographic index (SDI), as well as DALY in each province. Results:In 2019, there were 278 121 new cases of esophageal cancer and 257 316 deaths in China, increased by 60.13% and 45.70% respectively compared with 1990. The top 3 provinces with the highest age-standardized incidence of esophageal cancer were Sichuan Province (25.96/100 000), Jiangsu Province (23.80/100 000), and Fujian Province (21.98/100 000). From 1990 to 2019, except for Jiangsu Province and Sichuan Province, the age-standardized incidence in other provinces showed a declining trend. The age-standardized mortality and DALYs of esophageal cancer decreased in all provinces as well as in Hong Kong and Macao Special Administrative Regions of China. The attributable risk factors of esophageal cancer caused deaths in China mainly included smoking, alcohol consumption, high body mass index, and low fruit intake, accounting for 91.38% of all the cases. With the increase of the SDI, the age-standardized rates of DALY in high incidence areas of esophageal cancer (Sichuan Province, Jiangsu Province, Fujian Province, Henan Province, Chongqing City, Xinjiang Uygur Autonomous Region, Shanxi Province, and Anhui Province) demonstrated a trend of initially decline and then an upward. In contrast, the age-standardized rates of DALY of esophageal cancer in other provinces, as well as in Hong Kong and Macao Special Administrative Regions of China, showed a trend of initially upward and then decline. The age-standardized rate of DALY of esophageal cancer showed a negative correlation with SDI ( r=-0.315, P<0.001). From 1990 to 2019, the age-standardized incidence and mortality of esophageal cancer generally demonstrated a downward trend. The AAPC was -1.43% ( t=-19.16, P<0.001) for incidence and -1.83% ( t=-29.63, P<0.001) for mortality, respectively. It is projected that by 2044, the actual number of new esophageal cancer cases in China will increase from 278 121 in 2019 to 291 206 in 2044, and the actual number of deaths will increase from 257 316 to 275 856. Conclusions:In recent years, the disease burden of esophageal cancer in China remains a serious status, with significant differences in geography and gender. It is projected that by 2044, the number of new esophageal cancer cases and deaths in China will continue to increase. Effective strategies and policies are urgently needed to reduce the disease burden.

Objective:To investigate the clinical efficacy of a self-detachable single-J internal stent drainage tube in the laparoscopic primary suture of the common bile duct for hepatolithiasis.Methods:Clinical data of 36 patients with hepatobiliary duct stones who underwent laparoscopic common bile duct primary suture combined with self-detached single J-type internal stent drainage at the First Affiliated Hospital of Xiamen University from April 2022 to April 2025 were retrospectively analyzed, including 17 males and 19 females, aged (54.3±8.7) years. All 36 patients underwent choledochoscopic stone extraction, primary common bile duct suture, and drainage with the self-expelling single-J internal stent. Total bilirubin, aspartate transaminase, and alanine transaminase before and 3 days after operation, as well as operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications (bile leakage, cholangitis, intestinal obstruction, and stent retention), and stent expulsion time were collected.Results:All 36 patients successfully underwent the operation. Total bilirubin, aspartate transaminase, and alanine transaminase 3 days after operation showed significant improvement compared to preoperative levels (all P<0.05). The operation time was (86.5±22.6) min, intraoperative blood loss was 34.2 (13.7, 56.8) ml, and the postoperative hospital stay was (6.6±1.8) days. All single-J internal stents were spontaneously expelled via the anus between 6 and 21 days postoperatively, with the expulsion time of (10.7±2.1) days. No single J-type internal stent drainage tube was displaced into the bile duct in all cases, and there were no complications such as intestinal obstruction, bile leakage, cholangitis, or residual internal stent drainage tube. Conclusion:The self-detachable single-J internal stent drainage tube has been applied in the laparoscopic primary suture of the common bile duct for patients with hepatolithiasis, which demonstrated a good safety and effectiveness.

In the context of further promoting the construction of an integrated healthcare service system,traditional quantitative indicators for measuring continuity of care may have limitations.The analysis of domestic and foreign studies on the mortality rate associated with service continuity measured by quantitative indicators shows that a lack of correlation or even an inverse correlation between continuity of care and mortality.This phenomenon may be attributed to the fact that the indicators have only single dimension and unable to capture the multidimensional nature of continuity of care.Based on these findings,some ideas are proposed for the improvement of the indicators,which contribute to thoughts and suggestions on the quantitative measurement of continuity of care.

Objective:To investigate the effect of "four-staff co-management" follow-up mode on risk factor control and medium-term prognosis improvement in patients with coronary heart disease after percutaneous coronary intervention (PCI).Methods:This was a intervention study. Patients with coronary heart disease who were admitted to the Xiamen Cardiovascular Hospital of Xiamen University from June 2021 to January 2022 and successfully discharged after PCI were included. According to the different types of follow-up after discharge, patients were divided into the traditional follow-up group and the "four-staff co-management" follow-up group. The "four-staff co-management" follow-up mode means that specialists, specialist managers in third-level A hospitals and general practitioners and health managers in basic hospitals were jointly responsible for post-discharge follow-up of PCI patients. Baseline clinical data were collected. The primary endpoints were the rate of compliance of coronary heart disease risk factor control at 12 months after surgery, the rate of secondary surgery, and the incidence of mid-term major adverse cardiovascular and cerebrovascular events (MACCE). Unplanned secondary PCI included symptom-driven secondary PCI and asymptomatic secondary PCI. MACCE includes myocardial infarction, hospitalization for heart failure, stroke, major bleeding, all-cause death, and composite endpoints including these events.Results:A total of 2 181 patients were enrolled, including 1 097 patients in the traditional follow-up group and 1 084 patients in the "four-staff co-management" follow-up group. At baseline, there were no statistically significant differences in gender, age, discharge diagnosis, co-existing diseases, echocardiographic indexes, and coronary artery lesions between the two groups (all P>0.05). There were no significant differences between the two groups in total PCI stent length, maximum internal diameter of stent, proportion of patients using drug balloon, proportion of patients with a planned second surgery during hospitalization, and discharge with drugs (all P>0.05). Twelve months after PCI, the reduction in HbA1c and low-density lipoprotein cholesterol was greater in the "four-staff co-management " follow-up group than that in the traditional follow-up group (all P<0.05), and the rate of reaching the standard for low-density lipoprotein cholesterol was higher than that in the traditional follow-up group ( P=0.001), but there was no statistical significance between the two groups for blood pressure and blood glucose (all P>0.05). During the follow-up period, the proportion of symptom-driven second operation patients was lower in the "four-staff co-management" follow-up group than that in the traditional follow-up group ( P<0.001), and there was no significant difference in the proportion of asymptomatic second operation patients between the two groups ( P=0.191). The proportion of hospitalized patients with heart failure in the "four-staff co-management" follow-up group was lower than that in the traditional follow-up group ( P=0.029), and there was no significant difference in the proportion of myocardial infarction, cerebral infarction, cerebral hemorrhage, massive hemorrhage, death and complex endpoint events between the two groups (all P>0.05). Conclusion:The "four-staff co-management" follow-up mode can effectively improve the control of risk factors and medium-term prognosis in patients with coronary heart disease after PCI.

Objectives:To summarize the characteristics of Fabry′s disease with cardiac involvement.Methods:This was a single-center, cross-sectional, retrospective study. Patients with Fabry disease who were admitted to Zhongda Hospital Affiliated to Southeast University from January 2022 to March 2023 were included. Clinical data, laboratory results, electrocardiogram, echocardiography and cardiac magnetic resonance findings of enrolled patients were collected. Clinical presentations and imaging features of patients with Fabry′s disease with cardiac involvement were summarized and analyzed.Results:A total of 17 patients from 8 families were included, with 9 males and diagnosis age of (44.35±13.72) years. Cardiac involvement and other organ involvement were presented in all patients and the heart was the most vulnerable organ (17/17). 24 h electrocardiogram showed frequent sinus arrhythmia in 3 patients. Echocardiography showed reduced left ventricular ejection fraction in 1 patient, myocardial hypertrophy in 13 patients, and left ventricular wall thickness ≥13 mm in 10 patients. Mitral regurgitation was observed in 11 patients and tricuspid regurgitation in 12 patients. Two patients underwent two-dimensional speckle tracking echocardiography, both revealing reduced regional longitudinal strain of the left ventricle, primarily in the basal segments. Cardiac magnetic resonance showed reduced left ventricular ejection fraction in 2 patients, myocardial hypertrophy in 16 patients, and left ventricular wall thickness≥13 mm in 14 patients. T1 value was reduced in 16 patients, with late gadolinium enhancement observed in 9 patients and “pseudo-normalization” of T1 values in 1 patient. The most susceptible target organ besides the heart was the kidneys (14/17), followed by the central nervous system (9/17). Additional findings inclucling cutaneous angiokeratoma in 4 patients, peripheral neuropathy with burning pain and hypohidrosis or hyperhidrosis in 6 patients, and corneal vortex opacities in 2 patients.Conclusion:The main manifestations of cardiac involvement in Fabry′s disease are decreased cardiac function, left ventricular hypertrophy and myocardial fibrosis. Advanced imaging techniques such as two-dimensional speckle tracking, T1 Mapping, and late gadolinium enhancement are useful in detecting myocardial pathological changes of Fabry′s disease.