Objective To analyze and compare the disease burden of high BMI in Kunshan City in different periods, and to provide a scientific basis for the prevention and control of overweight and obesity in Kunshan City. Methods Using the global burden of disease research method, the number of deaths attributable to high BMI and attributable YLL in Kunshan City were calculated using the survey data of chronic diseases and their risk factors and the data of the death registration system in Kunshan City. Results In 2023, R5.46% of deaths in Kunshan City were attributed to high BMI, with 345 attributable deaths, and attributable mortality rate and standardized attributable mortality rate were 39.16/100 000 and 33.82/100 000, Rrespectively. Attributable YLL rate and standardized attributable YLL rate were 692.35/100 000 and 604.46/100 000, respectively. High BMI caused a loss of 0.52 years of life expectancy per capita. Compared with 2012, PAF, standardized attributable mortality rate, standardized attributable YLL rate and life expectancy loss per capita of high BMI in 2023 increased by 121.95%, 100.71%, 57.05%, and 100%, respectively. Among different genders, PAF increased by 91.05% for males and 161.97% for females from 2012 to 2023. Among different diseases, cardiovascular and cerebrovascular diseases and cancers had the highest attributable disease burden, while diabetes, chronic kidney disease and Alzheimer's disease all had a significant increase. Conclusion The burden of disease attributable to high BMI has risen dramatically in Kunshan City, and the adverse health effects of overweight and obesity need to be reduced through scientific weight loss and comprehensive practical measures.

Objective To analyze and compare the disease burden of high BMI in Kunshan City in different periods, and to provide a scientific basis for the prevention and control of overweight and obesity in Kunshan City. Methods Using the global burden of disease research method, the number of deaths attributable to high BMI and attributable YLL in Kunshan City were calculated using the survey data of chronic diseases and their risk factors and the data of the death registration system in Kunshan City. Results In 2023, R5.46% of deaths in Kunshan City were attributed to high BMI, with 345 attributable deaths, and attributable mortality rate and standardized attributable mortality rate were 39.16/100 000 and 33.82/100 000, Rrespectively. Attributable YLL rate and standardized attributable YLL rate were 692.35/100 000 and 604.46/100 000, respectively. High BMI caused a loss of 0.52 years of life expectancy per capita. Compared with 2012, PAF, standardized attributable mortality rate, standardized attributable YLL rate and life expectancy loss per capita of high BMI in 2023 increased by 121.95%, 100.71%, 57.05%, and 100%, respectively. Among different genders, PAF increased by 91.05% for males and 161.97% for females from 2012 to 2023. Among different diseases, cardiovascular and cerebrovascular diseases and cancers had the highest attributable disease burden, while diabetes, chronic kidney disease and Alzheimer's disease all had a significant increase. Conclusion The burden of disease attributable to high BMI has risen dramatically in Kunshan City, and the adverse health effects of overweight and obesity need to be reduced through scientific weight loss and comprehensive practical measures.

Objective To analyze the burden of disease of malignant tumors in Kunshan City from 2006 to 2021. Methods The global burden of disease research methodology was applied. The indicators of cancer incidence, mortality, and disability-adjusted life years (DALYs) in Kunshan were calculated using the data from the Tumor Registry System and Death Registry System in Kunshan. The changes in cancer were compared. Results In 2021, the number of incidences and deaths and the DALYs of cancer were 4724 cases, 1618 cases, and 20887.90 person-years, respectively. The incidence, mortality, and DALYs rates were 427.42/100000, 146.39/100000, and 18.90‰. Compared with those in 2006, the incidence rate increased by 53.40%, and the mortality and DALYs rates decreased by 24.23% and 25.73%, respectively. The DALYs rate of cancer was higher for males than for females at 22.12‰ and 15.91‰ in 2021, respectively. The DALYs rate increased with age, and it started to increase sharply after 45 years of age. The top 10 cancers in 2021 in terms of DALYs were lung cancer, stomach cancer, colorectal cancer, liver cancer, pancreatic cancer, breast cancer, leukemia, esophageal cancer, brain and nervous system cancer, and gallbladder and biliary tract cancer, accounting for 83.83% of all cancers. The proportion of years lived with disability (YLD) in DALYs increased continuously (27% in 2021), with females increasing faster than males. Conclusion The disease burden of cancer in Kunshan City remains high, and the incidence of cancer must be reduced by developing comprehensive measures and continuously strengthening the capacity of early screening and treatment of cancer.

Purpose To study the expression of of mono-clonal and polyclonal TRPS1 antibodies in synovial sarcoma,and to explore the value of TRPS1 in the diagnosis and differen-tial diagnosis of synovial sarcoma and the sensitivity and speci-ficity of polyclonal TRPS1 for the diagnosis of synovial sarcoma.Methods Immunohistochemical EnVision method was used to detect the expression of monoclonal and polyclonal TRPS1 anti-bodies in the synovial sarcomas and its mimickers.Results A-mong 31 cases of synovial sarcoma,the positive rates of poly-clonal and monoclonal TRPS1 antibodies were 54.8％and 93.5％,respectively.Of 30 synovial sarcoma mimicking le-sions,2 were positive for TRPS1(polyclonal antibody),which was 6.67％,and TRPS1 was more frequently expressed in syno-vial sarcoma than in non-synovial sarcoma(P＜0.05).The sensitivity of polyclonal TRPS1 antibody for the diagnosis of syn-ovial sarcoma was 93.5％,and the specificity was 93.3％.Conclusion Polyclonal TRPS1 antibody has a higher sensitivity and specificity for the diagnosis of synovial sarcoma and it there-fore is recommended in routine pathologic diagnosis.

Objective:To investigate the clinical characteristics and treatment strategies of patients with connective tissue disease (CTD) related lymphatic duct obstruction.Methods:The clinical data, laboratory tests results, imaging data, and treatment of CTD patients associated with lymphatic vessel obstruction were retrospectively collected from January 2008 to December 2020 at Beijing Shijitan Hospital. Lymphatic duct obstruction was confirmed by thoracic duct ultrasound or thoracic duct MRI or lymphoscintigraphy or direct lymphangiography. SLE and RA patients were matched with gender and age in a 1∶2 ratio, and SLE and RA patients without lymphatic reflux disorder admitted at the same time were randomly selected as the control group. When comparing the data between the two groups, t-test or rank sum test was used to test continuous variables, and chi-square test or Fisher′s exact probability method was used to test categorical variables. Results:Forty-four patients with CTD complicated with thoracic duct obstruction were included, with a male-to-female ratio of 7∶37, including 14 cases of rheumatoid arthritis (RA), 21 cases of systemic lupus erythematosus (SLE), 8 cases of primary Sjogren's syndrome (pSS), and 1 case of systemic sclerosis (SSc). The onset age of CTD ranged from 14 to 68 years, the mean age was (37±15) years and the median duration of CTD was 66 (range 1~480) months. The median age at the onset of lymphatic duct obstruction such as limb edema or thoracoabdominal effusion was (42±17) years, and the median duration of lymphatic duct obstruction symptoms was 12 (range 3~480) months. 59%(26/44) of patients were diagnosed with CTD followed by the diagnosis of thoracic duct obstruction, and 41%(18/44) of patients had lymphatic duct obstruction symptoms as the initial presentation of CTD. Thoracic duct-related imaging was performed in 44 patients and showed thoracic duct obstruction (64%, 28/44), thoracic duct malformation or variation (36%, 16/44), limb lymphatic reflux disorder (34%, 15/44), and small bowel lymphatic duct dilatation or intestinal protein loss (18%, 8/44), respectively. Compared with the control group, among these patients, patients with RA complicated with lymphatic involvement had a younger onset age [(34±14)years old vs. (44±13)years old, t=-2.15, P=0.037)] and longer RA course [(17±11)months vs. (7±7)months, t=3.38, P=0.002] and presented with limb swelling (12/14). While compared with the control group, SLE patients complicated with lymphatic duct obstruction presented with celiac multi-plasmatic effusion (20/21), more patients presented with multiple serous cavity effusion [95%(20/21) vs. 62%(25/42), χ2=7.63, P=0.006], but the prevalence of lupus nephritis [(60%(12/21) vs. 86%(36/42), χ2=4.87, P=0.027] and lupus encephalopathy [0%(0/21) vs. 16.7%(17/42), χ2=6.11, P=0.013] was lower. 27% (12/44) of patients improved with aggressive glucocorticoids combined with immunosuppressive therapy, 54%(24/44) of patients were performed with lymphatic duct reconstruction surgery on top of medical treatment, 5 patients were lost of follow-up, and 2 patients deceased. Conclusion:CTD patients may develop lymphatic duct obstruction during the disease course, while lymphatic duct obstruction can also be the initial presentation of CTD. Rheumatologists and surgeons should be alert to this rare situation. Young women with refractory polyserositis or lymphedema should be examined for the possibility of combined CTD. Lymphatic duct obstruction may be associated with long-term chronic inflammation in CTD. Glucocorticoids combined with immunosuppressive agents and surgery can be used to treat lymphatic duct obstruction in patients with CTD.

Objective To analysis the effectiveness and cost of Internet-based anticoagulation clinic versus traditional anticoagulation clinic treatment at Nanjing Drum Tower Hospital during the COVID-19 pandemic.Methods We reviewed and analyzed the clinical data of patients receiving anticoagulation management through Internet-based outpatient care and traditional outpatient care in Nanjing Drum Tower Hospital,from June 1,2020 to June 30,2021.Variability in time in therapeutic range(TTR)and international normalized ratio(INR)were calculated for enrolled patients.Patients meeting TTR≥60%and INR variability<0.65 were considered optimal anticoagulation quality.Cost-effectiveness analysis was conducted from the patients'perspective,with results expressed using the incremental cost-effectiveness ratio(ICER).Results In the"Internet-based anticoagulation outpatient care"and"traditional face-to-face anticoagulation outpatient care"groups,19 individuals(67.86%)and 67 individuals(76.14%)met the criteria for optimal anticoagulation quality,respectively.The mean TTR was(71.83±19.17)%in the Internet-based group and(71.74±23.41)%in the traditional face-to-face group,indicating similar levels of warfarin anticoagulation quality between the two groups.The ICER was calculated as 327.17 yuan,less than the per capita gross domestic product(GDP)of 2021.Conclusion During the COVID-19 pandemic,Nanjing Drum Tower Hospital's Internet-based anticoagulation outpatient care effectively complemented the government's epidemic control policies.It ensured equivalent anticoagulation outcomes and significantly reduced patients'financial burdens.This approach offers new insights and guidance for optimizing healthcare services in the post-pandemic era.

Objective:To investigate the relationship between advanced glycation end products (AGEs) in the lens and type 2 diabetes mellitus.Methods:226 subjects were recruited between August 14 to September 14, 2018 from the Endocrinology Department of Central South University Xiangya Hospital, the Third Hospital of Changsha City, and the Fourth Hospital of Changsha City. The OGTT test, combined with clinical indicators, were used as the gold standard. Subjects were screened for type 2 diabetes using both the lens AGE fluorescence assay and the gold standard. Drawing the receiver operating characteristic (ROC) curve, we calculated the area under the curve (AUC) and its 95% CI and calculated the AGE for the diagnosis of type 2 diabetes. Sensitivity, specificity, Youden index, Kappa value, and its 95% CI, and the optimal cut-off value were determined according to the Youden index. Taking diabetes as the outcome indicator and AGE as the binary indicator, three logistic regression models were constructed. Stratified by age and sub-center, the differences between fasting blood glucose and 2 h postprandial blood glucose were compared between the AGE-negative and AGE-positive groups to determine the relationship between AGE and diabetes. Results:The area under the ROC curve was 0.86(95% CI: 0.81-0.91). According to the Youden index, the optimal cut-off point for AGE was 0.24. At this time, the sensitivity was 82.86(95% CI: 77.81-87.91), the specificity was 77.06(95% CI: 71.43-82.7), the Youden index was 59.92(95% CI: 53.36-66.49), the Kappa value was 79.62(95% CI: 74.22-85.02). Except for the 20-39-year-old group, the fasting blood glucose and 2 h postprandial blood glucose of the AGE-positive group in different age groups, different sub-centers, and the general population were higher than those of the AGE-negative group (all P<0.05). After adjusting for the confounding effects of age, gender, and sub-center (model 3), the relative risk of diabetes in the AGE-positive group was 11.75 times higher than the AGE-negative group (95% CI: 5.61-24.60), all with P<0.001. Conclusion:There was a high correlation between AGE in the lens and the risk of type 2 diabetes. When the cut-off point of AGE is 0.24, it had high sensitivity and specificity and could be used as a practical tool for early screening of type 2 diabetes.

Objective:To explore the morphology of coronoid process fracture in terrible triad injury based on Adams classification.Methods:A retrospective cross-sectional study was used to analyze the three-dimensional CT data of 51 patients with terrible trind injury treated at First Affiliated Hospital of Fujian Medical University from January 2013 to August 2021, including 33 males and 18 females, aged 18-88 years [(44.7±12.0)years]. The model of ulna coronoid process fracture was established by three-dimensional CT reconstruction technology and was classified according to Adams coronoid process fracture classification. Type I was the coronoid process tip fracture, type II the coronoid process transverse fracture, type III the base fracture of the coronoid process, type IV anterior internal fracture the anteromedial oblique fracture of the coronoid process, and type IV anterior external fracture the anterolateral oblique fracture of the coronoid process. According to the characteristics of the coronoid fracture fragment, type IV anterior external fracture was divided into two subtypes: α subtype involving the coronoid tip and β subtype without involving the coronoid tip. Then, the proportion, height, surface area and volume of different types of coronoid fractures were measured. The proportion, height, surface area and volume of fracture fragments of two subtypes of type IV anterior external fracture were measured, as well as the area of ulnar trochlear joint, area of trochlear joint of ulnar fracture fragment, proportion of the area of trochlear joint affected by the ulnar fragment, area of proximal radioulnar joint, area of proximal radioulnar joint of ulnar fracture fragment and proportion of the area of proximal radioulnar joint affected by the ulnar fragment.Results:Among the patients with terrible triad injury, the ulnar coronoid process fracture was Adams type I in 17 patients (33%), type II in 4 (8%), type III in 4 (8%), type IV anterior internal fracture in 4 (8%) and type IV anterior external fracture in 22 (43%). The height of fracture fragment of type I, type II, type III, type IV anterior internal fracture and type IV anterior external fracture was (3.7±1.9)mm, (10.8±1.1)mm, (14.4±1.2)mm, (5.2±2.4)mm and (6.7±2.6)mm, respectively; the surface area was 63.7(21.4, 221.0)mm 2, 1 086.8(606.8, 1 434.2)mm 2, 1 658.8(1 335.6, 1 695.4)mm 2, 437.3(185.6, 437.3)mm 2 and 511.8(198.8, 646.5)mm 2, respectively; the volume was 46.3(21.4, 180.5)mm 3, 938.7(629.8, 1 011.3)mm 3, 1 797.4(1 520.2, 1 903.7)mm 3, 429.3(138.1, 992.4)mm 3 and 461.9(144.9, 707.1)mm 3, respectively. There were significant differences in the height, surface area and volume of coronoid process fracture with different Adams classification (all P<0.01). Among 22 patients with type IV anterior external fracture, 12 patients were with α subtype and 10 with β subtype. The fracture height of α and β subtypes was (8.6±2.6)mm and (5.0±2.4)mm, respectively; the surface area was 633.2 (530.3, 727.4)mm 2 and 181.4 (136.7, 450.3)mm 2, respectively; the volume was 692.8 (477.6, 778.0)mm 3 and 128.0 (74.2, 405.1)mm 3, respectively. The height, surface area and volume of fracture fragment were significantly different between the two subtypes (all P<0.01). The area of ulnar trochlear joint of α and β subtypes were 901.4(755.1, 1 060.6)mm 2 and 835.2(767.7,909.3)mm 2, respectively; the area of trochlear joint of α and β subtype fragment was 104.1(79.4, 139.9)mm 2 and 38.8(21.3, 58.1)mm 2, respectively; the proportion of the area of trochlear joint affected by α and β subtype fragment was 0.12(0.09, 0.15) and 0.05(0.03, 0.07), respectively. There was no significant difference between α and β subtypes in the area of trochlear joint of ulna ( P>0.05), but the area of trochlear joint of α subtype fragment and proportion of the area of trochlear joint affected by α subtype fragment were higher than those of β subtype fragment (all P<0.01). The area of proxima radioulnar joint of α and β subtypes was 147.9(111.7,164.2)mm 2 and 137.0(118.7,166.7)mm 2, respectively; the area of proximal radioulnar joint of α and β subtypes fragment was 17.7(13.4, 52.2)mm 2 and 6.1(2.6, 20.0)mm 2, respectively; the proportion of the area of proximal radioulnar joint affected by α and β subtypes fragment was 0.12(0.10, 0.35) and 0.05(0.03, 0.15), respectively. There were no significant differences between the two subtypes in proximal radioulnar joint damage (all P>0.05). Conclusions:Adams type IV fracture of the coronoid process of the ulna occupies a large proportion in terrible triad injury, and the type IV anterior external fracture is the main type containing two subtypes with differences in fragment size and shape. However, the injuries to the proximal radioulnar joint surface are similar for the two subtypes, so the injuries of type IV anterior external fracture with different sizes to the proximal radioulnar joint surface should not be neglected in clinical treatment.

Objective:To improve the understanding of the relationship between lymphedema and retroperitoneal fibrosis (RPF).Methods:Four cases with lymphedema and RPF in Beijing Shijitan Hospital Capital Medical University were reported. The diagnosis and treatment were analyzed and discussed.Results:All four patients had lymphedema onset and imaging showed suspicious RPF. One case of non-Hodgkin's lymphoma was confirmed by lymph node biopsy. The malignant lesions were excluded in the other two cases by pathology or positron emission tomography (PET)/computerized tomography (CT). They were proved to be idiopathic retroperitoneal fibrosis after treatment with glucocorticoid combined immunosuppressive agents. Another case was systemic amyloidosis mimicking retroperitoneal fibrosis.Conclusion:Lymphatic involvement in RPF is relatively rare, and the possibility of RPF should be considered when patients develop lymphedema. Even if the initial diagnosis is RPF, we should be wary of tumors or other diseases. Imaging examination should be performed, and tissue biopsy should be used if necessary, so as to facilitate early diagnosis and treatment and improve the prognosis of patients.

【Objective】 To investigate the effect of Qingkailing injection on platelet function preserved in vitro. 【Methods】 A total of 15 bags of plateletpheresis (≥250 mL/bag), adding Qingkailing injection(1.25 mL/bag) at the final concentration of 1%, were stored at 22 ℃ with gentle agitation as the experimental group, and samples were collected on day 1, 3, 5, 8, 10 and 14 to detect the thromboelastogram (TEG), CD62p expression rate and mitochondrial membrane potential (JC-1). The control group was set up synchronously, with the same volume and storage conditions as the experimental groups, and samples were taken on day 1, 3 and 5 after preservation to undertake the same test items as the experimental groups. The differences of detection indexes between the two groups were compared. 【Results】 1) In the experimental group, there was no significant change in K and α during day 1 to 14(P>0.05). The R value (min) increased from 6.12±1.58 to 11.02±2.26, and the CI value changed from 0.27±1.24 to -10.47±3.51 (P<0.05). The MA value (mm) had no significant change within 5 days (P>0.05), but decreased to 53.18±2.71 on day 8 and 22.88±3.45 on day 14 (P<0.05). In the control group during day 1 to 5, K(min) and α showed no significant change, while R(min) was significantly prolonged, MA (mm) decreased and CI increased significantly (P<0.05). 2) The expression rate of CD62p (%) was 70.50±9.12 in the experimental group on day 5 (vs 83.16±5.33 in the control groups, P<0.05) and 82.77±7.17 on day 14 (P<0.05). 3) There was no significant change in JC-1 (%) during regular preservation period between the experimental group and control group (P>0.05), but JC-1 (%) was 86.75±3.88 vs 70.36±19.8 on day 5 (P<0.05). In the experimental group, JC-1(%) was 81.04±9.50 vs 71.38±8.77 vs 82.77±7.17 on day 8, 10 and 14, respectively. 【Conclusion】 The activation and aggregation as well as anti-apoptosis function of plateletpheresis, adding Qingkailing injection at the final concentration of 1%, are similar to those of routine preservation.