ObjectiveTo investigate the value of liver stiffness measurement （LSM） and spleen stiffness measurement （SSM） measured by two-dimensional shear wave elastography （2D-SWE） in the diagnosis of severe portal hypertension （SPH） and high-risk varices （HRV）， and to provide a basis for noninvasive assessment of portal hypertension. MethodsA prospective study was conducted among 78 patients with cirrhotic portal hypertension who were treated in Liver Research Center of Beijing Friendship Hospital， Capital Medical University， from December 2019 to April 2023. According to hepatic venous pressure gradient （HVPG）， the patients were divided into 6 mmHg≤HVPG<12 mmHg group， 12 mmHg≤HVPG<20 mmHg group， and HVPG ≥20 mmHg group. All patients underwent gastroscopy and 2D-SWE within 1 week after HVPG measurement， and SWE-LSM and SWE-SSM measured by 2D-SWE were recorded. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. With HVPG and gastroscopy findings as the gold standard， the receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to evaluate diagnostic performance， while the DeLong test was used for comparison of AUC. The Pearson or Spearman correlation analysis was used to investigate the correlation between variables， and the linear regression analysis and the Logistic regression analysis were used to investigate the influencing factors for HVPG and HRV. ResultsThe mean HVPG was 18.1±6.4 mmHg for the patients enrolled in this study， and HRV was observed in 62 patients （79.5%）. Both SWE-LSM and SWE-SSM were significantly positively correlated with HVPG （r=0.413 and 0.633， both P<0.001）， with an AUC of 0.812 and 0.902， respectively， in the diagnosis of HVPG≥12 mmHg and an AUC of 0.804 and 0.789， respectively， in the diagnosis of HVPG≥20 mmHg （all P>0.05）. The multivariate linear regression analysis showed that SWE-SSM was an independent influencing factor for HVPG （β=0.17， P<0.001）. In the diagnosis of HRV， only SWE-SSM showed a significant positive correlation with HRV （r=0.432， P<0.001）， with a better diagnostic performance than SWE-LSM in terms of AUC （0.808 vs 0.642， Z=2.775， P=0.006）. The multivariate Logistic regression analysis showed that platelet count was an independent influencing factor for HRV （odds ratio=0.97， P=0.014）. ConclusionSWE-SSM is closely correlated with both HVPG and HRV， showing a good performance in the diagnosis of SPH and HRV， and therefore， it is expected to become an effective noninvasive tool for assessing portal hypertension.

OBJECTIVE To investigate the effect and mechanism of Tangzhi formula（TZF） on improving glucose and lipid metabolism disorders in type 2 diabetes mellitus （T2DM） rats.METHODS Thirty SPF-grade SD rats were used to establish a T2DM rat model through high-fat diet feeding combined with intraperitoneal injection of streptozotocin. After successful modeling， the rats were divided into the model group， metformin group （positive control， 0.18 g/kg）， and TZF low-， medium-， and high-dose groups （5， 10， and 20 g/kg）， with 6 rats in each group. An additional 6 rats were selected as the blank group. The rats in each group were orally administered the corresponding volume of drug solution or saline， and continuous dosing was performed for 6 weeks， once daily. Fasting blood glucose （FBG）， area under the curve of oral glucose tolerance test （OGTT-AUC）， area under the curve of intraperitoneal insulin tolerance test （IPITT-AUC）， serum total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） levels were measured. Hematoxylin-eosin （HE） staining and oil red O staining were used to observe hepatic pathological morphology and lipid deposition. Differentially expressed proteins in liver tissues were screened by proteomics analysis， and key proteins in signaling pathways were verified by Western blot and immunofluorescence staining.RESULTS Compared with the blank group， the levels of FBG， OGTT-AUC， IPITT-AUC， LDL-C， TG， and TC in the model group were significantly increased （ P ＜0.05）， while HDL-C level was significantly decreased （ P ＜0.05）； the liver tissues showed disordered hepatic cords， punctate necrosis of hepatocytes， and significant lipid deposition， the NAFLD activity score and positive area of lipid droplets were significantly increased（ P ＜0.05）. Compared with the model group， the above indicators in TZF low-， medium-， and high-dose groups and metformin group were significantly reversed （ P ＜0.05）； hepatic pathological injury and lipid deposition were alleviated. Proteomics results showed that a total of 442 differentially expressed proteins were screened between the model group and the blank group， and 358 differentially expressed proteins were screened between the TZF high-dose group and the model group. Among these differentially expressed proteins， multiple proteins closely related to glucose and lipid metabolism showed a reversal trend after TZF intervention. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis showed that the peroxisome proliferator-activated receptor （PPAR） signaling pathway was significantly enriched. The validation experiment results showed that TZF could significantly up-regulate the expression of PPARα， PPARγ， and apolipoprotein A1 （ApoA1） in rat liver tissues （ P ＜0.05）， and down-regulate the expression of stearoyl-CoA desaturase 1 （SCD1） and perilipin 2 （PLIN2） （ P ＜0.05）.CONCLUSIONS TZF can improve glucose and lipid metabolism disorders in T2DM rats； its mechanism may be related to the activation of the PPAR signaling pathway and the regulation of downstream lipid metabolism-related proteins SCD1， PLIN2， and ApoA1.

Objective:To analyze the characteristics of anonymous online dating and related factors of not being tested for HIV among men who have sex with men and to provide the basis for developing targeted HIV prevention strategies and intervention measures.Methods:Using a cross-sectional study design, respondents were recruited with the assistance of MSM social organizations from April to July 2023 in eight cities in Shandong Province. Snowball sampling, activity venues, and networks were employed, targeting a sample size of 400 people per city. A face-to-face questionnaire survey collected data on sociodemographic characteristics, drug use, sexual intercourse, and online informed dating. Blood samples were also collected for HIV and syphilis antibody testing.Results:In the past six months, 2 787 MSM sought homosexual partners through the Internet, and 78.26% (2 181/2 787) chose to make anonymous online dating. Before having homosexual sex with online sexual partners, 10.41% (290/2 787) of them did not ask each other about HIV infection status and 33.37% (930/2 787) of them not being tested for HIV. There were statistically significant differences in the distribution of age, marital status, household registration, education level, sexual orientation, ways to find male sexual partners, not asking online sexual partners about their HIV status before sexual intercourse, no mutual HIV testing with online sexual partners before sexual intercourse, and syphilis antibody between anonymous and non-anonymous online dating persons (all P<0.05). The results of multivariate logistic regression analysis showed that <25 years old (a OR=1.43, 95% CI: 1.15-1.77) and ≥35 years old age group (a OR=1.61, 95% CI: 1.29-2.01), people with no AIDS knowledge (a OR=2.37, 95% CI: 1.25-4.49), drug users (a OR=1.38, 95% CI: 1.17-1.63), online dating anonymous (a OR=2.19, 95% CI: 1.76-2.73), HIV antibody positive (a OR=3.61, 95% CI: 2.22-5.88) and no intervention services in the last 1 year (a OR=1.58, 95% CI: 1.05-2.38) were the related factors of MSM not being tested for HIV before having sexual intercourse through online dating. Conclusions:The phenomenon of anonymous online dating was common among MSM in Shandong Province, and the proportion of MSM not being tested for HIV before having sexual intercourse through anonymous online dating was relatively high. It is necessary to strengthen health publicity and promote informed dating in MSM.

Objective:To identify the serotype and genotype characteristics of the first cluster infection of Brucella in Nujiang Lisu Autonomous Prefecture of Yunnan Province. Methods:The information of seven suspected cluster brucellosis cases reported in Lanping County, Nujiang Lisu Autonomous Prefecture in April 2023 were collected, blood samples were collected, and the strains were isolated and cultured. Serological methods were employed for brucellosis diagnosis, bacterial species identification was performed using BCSP31-PCR and AMOS-PCR. Multilocus locus variable-number tandem repeat analysis (MLVA) was conducted for strain genotyping, followed by phylogenetic analysis comparing the strains with those from other regions of China.Results:All seven cases were diagnosed with brucellosis, they were all villagers from the same village and had daily contact with sheeps. Four suspected Brucella strains were isolated, identified as Brucella melitensis biotype by BCSP31-PCR and AMOS-PCR. The four isolated strains exhibited identical MLVA-16 genotype, with MLVA-8 genotype 42 and MLVA-11 genotype 180, belonging to the Eastern Mediterranean lineage. Compared with the MLVA-16 of the isolated strains from other regions of China, the four isolated strains formed an independent cluster. Conclusion:The first cluster infection of Brucella in Nujiang Lisu Autonomous Prefecture of Yunnan Province is caused by Brucella melitensis biotype, and the four isolated strains have showed unique MLVA genotype.

Objective:To learn about the geographical distribution and bio-tying diversity characteristics of Brucella strains isolated in Yunnan Province. Methods:From March 2017 to December 2023, 516 suspected Brucella strains were collected from brucellosis surveillance sites and hospitals in Yunnan Province, and Yunnan Institute of Endemic Disease Control and Prevention. The Brucella isolates were confirmed to genus level by BCSP31-PCR, and subsequently identified to species and biovar level using conventional biotyping methods and AMOS-PCR. The geographical distribution of the strains was visualized using ArcGIS 10.8 software, simultaneously analyze the general characteristics of brucellosis patients. Results:Among the 516 suspected Brucella strains, 514 strains were isolated from patient blood samples and 2 strains were isolated from sheep blood samples. BCSP31-PCR identification showed that all strains were Brucella spp. The results of conventional biotyping and AMOS-PCR identification revealed that the isolates comprised 514 Brucella melitensis strains (16 strains of Brucella melitensis biovar 1 and 498 strains of Brucella melitensis biovar 3), one Brucella abortus (biovar 1) strain, and one Brucella canis strain. The strain was distributed in 69 counties/cities of 13 prefectures/cities in Yunnan Province, involving 390 administrative villages in 186 townships. Brucella melitensis was the dominant epidemic strain, and the largest number of Brucella melitensis was distributed in Kunming City( n = 205), followed by Honghe Hani and Yi Autonomous Prefecture ( n = 98) and Qujing City ( n = 72). Brucella abortus was only distributed in Lincang City ( n = 1), and Brucella canis was distributed Wenshan Zhuang and Miao Autonomous Prefecture ( n = 1). The age range of 514 brucellosis patients ranged from 10 months to 88 years, with the majority being between 40 and 60 years old (52.72%, 271/514). The predominant occupational group was farmers (89.11%, 458/514), followed by students (5.06%, 26/514). Conclusion:Brucella exhibits a wide distribution and species/biovar diversity in Yunnan Province, with infection among the farming population emerging as a serious public health problem in the area.

Recent years have witnessed significant advancements in the perioperative trea-tment of locally advanced gastric cancer (LAGC), yet numerous challenges persist. Current research focuses primarily on the precise application of immunotherapy, breakthroughs in targeted therapy, optimization of multidisciplinary comprehensive treatment models, and the selection of postopera-tive adjuvant therapy regimens. Although immunotherapy has achieved remarkable progress in the treatment of advanced gastric cancer, its application in the perioperative setting remains controver-sial, particularly regarding its long-term survival benefits. In terms of targeted therapy, the applica-tion of drugs targeting human epidermal growth factor receptor-2 and Claudin 18.2 in the periopera-tive setting for LAGC still requires further validation. Additionally, the optimization of multidisci-plinary comprehensive treatment models, such as the long-term survival benefits of neoadjuvant chemoradiotherapy combined with perioperative chemotherapy, remains unclear. There are also many disputes surrounding the selection of postoperative adjuvant therapy regimens and surgical strategies following neoadjuvant treatment, including the extent of lymph node dissection. Addres-sing these issues will help further optimize the perioperative treatment strategies for LAGC, thereby improving patient survival rates and quality of life. Therefore, the authors explore in depth the key issues and relevant strategies for perioperative treatment of LAGC.

Objective:To study the epidemiological characteristics and clinical diagnosis of human brucellosis in Qujing City, Yunnan Province.Methods:Through the Infectious Disease Reporting Information Management System of the China Disease Prevention and Control Information System, the basic information and clinical diagnostic data of brucellosis cases reported in Qujing City from January 2008 to December 2023 were retrospectively collected. Descriptive epidemiological methods were used to analyze the epidemic profile, three distribution characteristics (time, population, region), and diagnosis of brucellosis.Results:A total of 1 417 brucellosis cases were reported in Qujing City from 2008 to 2023, with no death. The annual average incidence of brucellosis was 1.49/100 000, with no cases reported in 2009 and 2010, and the highest incidence in 2023 (7.82/100 000). The incidence of brucellosis showed an increasing trend year by year (χ 2trend = 1 874.58, P < 0.001). The number of cases from June to November accounted for 61.54% (872/1 417). The majority of brucellosis cases were in the age group of 36 - 65 years old, accounting for 67.82% (961/1 417). Among them, there were 954 males and 463 females, with a gender ratio of 2.06 ∶ 1.00. Farmers were the main occupation, accounting for 84.33% (1 195/1 417). The cases were mainly distributed in Luliang County (621 cases), Xuanwei City (282 cases) and Shizong County (137 cases), accounting for 73.39% (1 040/1 417). The median interval between onset and diagnosis was 13 days, and the cases with intervals ≤7 d, 8 - 30 d, and ≥31 d accounted for 32.11% (455/1 417), 40.16% (569/1 417), and 27.73% (393/1 417), respectively. Totally 63.94% (906/1 417) of the cases were confirmed in medical institutions in Qujing City. Conclusions:The incidence of brucellosis in Qujing City is increasing year by year, with men, middle-aged and elderly people and farmers as the main population, summer and autumn as the peak period, and Luliang County, Xuanwei City and Shizong County as the high incidence areas. Most cases have an interval of less than 30 days between onset and diagnosis, and can be diagnosed within the jurisdiction.

Objective:To establish the model of acute kidney injury (AKI), search for more sensitive and reliable biomarkers.Methods:In April 2018, 100 male Wister rats aged 6 to 8 weeks were selected and randomly divided into experimental group (n=90) and control group (n=10). The experimental group was given Diachalefin (140 mg/kg body weight) by intragastric administration, while the control group was given saline intragastric administration. Ten rats in the experimental group were killed 0.5 h, 2 h, 6 h, 24 h, 3 d, 7 d, 14 d, 21 d and 28 d after intragastric administration, respectively. Serum creatinine (Cr), urea nitrogen (BUN) and uric acid (UA) were detected by automatic biochemical analyzer with 5 ml of blood from inferior vena cava puncture. Serum neutrophil gelatinase-associated lipid carrier protein (NGAL), kidney damage molecule-1 (KIM-1) and transforming growth factor-β1 (TGF-β1) levels were determined by enzyme-linked immunosorbent assay (ELISA). The data between groups were compared using two independent sample t tests.Results:The renal tissue structure of rats in the control group was not significantly abnormal, while the renal tissue cell damage of rats in the experimental group was obvious, which gradually increased with the extension of time in the early stage, and gradually recovered in the later stage. UA in experimental group reached its peak at 24 h after exposure and was still higher than that in control group at 14 d ( P<0.05), Cr reached its peak at 7 d, and then gradually decreased, and there was no statistical significance between experimental group and control group at 28 d ( P>0.05). BUN increased at 6 h after exposure and reached the highest value at 7~14 d ( P<0.05). Blood NGAL increased at 0.5 h after exposure, reached its peak at 24 h, continued to increase at 3, 7 and 14 days ( P<0.05), and began to decrease at 21 days. KIM-1 began to increase at 0.5 h, continued to peak at 24 h, 3 and 7 d after exposure, and began to decrease at 14 d, but it was still higher than that in control group ( P<0.05). There was no significant difference in TGF-β1 at each time point ( P>0.05). Western blot assay results: Compared with control group, there was no significant difference in the expression level of TGF-β1 in kidney tissue of experimental group ( P>0.05). NGAL increased gradually from 2 h and was higher at 7 and 14 d, with statistical significance ( P<0.05). KIM-1 increased at 2 h, decreased at 6 and 24 h, and increased again at 3 and 7 d. Conclusion:NGAL and KIM-1 can be used as early diagnostic biomarkers for diquat-induced acute kidney injury.

Objective:To analyze the characteristics of anonymous online dating and related factors of not being tested for HIV among men who have sex with men and to provide the basis for developing targeted HIV prevention strategies and intervention measures.Methods:Using a cross-sectional study design, respondents were recruited with the assistance of MSM social organizations from April to July 2023 in eight cities in Shandong Province. Snowball sampling, activity venues, and networks were employed, targeting a sample size of 400 people per city. A face-to-face questionnaire survey collected data on sociodemographic characteristics, drug use, sexual intercourse, and online informed dating. Blood samples were also collected for HIV and syphilis antibody testing.Results:In the past six months, 2 787 MSM sought homosexual partners through the Internet, and 78.26% (2 181/2 787) chose to make anonymous online dating. Before having homosexual sex with online sexual partners, 10.41% (290/2 787) of them did not ask each other about HIV infection status and 33.37% (930/2 787) of them not being tested for HIV. There were statistically significant differences in the distribution of age, marital status, household registration, education level, sexual orientation, ways to find male sexual partners, not asking online sexual partners about their HIV status before sexual intercourse, no mutual HIV testing with online sexual partners before sexual intercourse, and syphilis antibody between anonymous and non-anonymous online dating persons (all P<0.05). The results of multivariate logistic regression analysis showed that <25 years old (a OR=1.43, 95% CI: 1.15-1.77) and ≥35 years old age group (a OR=1.61, 95% CI: 1.29-2.01), people with no AIDS knowledge (a OR=2.37, 95% CI: 1.25-4.49), drug users (a OR=1.38, 95% CI: 1.17-1.63), online dating anonymous (a OR=2.19, 95% CI: 1.76-2.73), HIV antibody positive (a OR=3.61, 95% CI: 2.22-5.88) and no intervention services in the last 1 year (a OR=1.58, 95% CI: 1.05-2.38) were the related factors of MSM not being tested for HIV before having sexual intercourse through online dating. Conclusions:The phenomenon of anonymous online dating was common among MSM in Shandong Province, and the proportion of MSM not being tested for HIV before having sexual intercourse through anonymous online dating was relatively high. It is necessary to strengthen health publicity and promote informed dating in MSM.

Objective To explore the objective characteristics of tongue in primary immune thrombocytopenia(ITP);To provide references for accurate syndrome differentiation.Methods Totally 112 patients with ITP were divided into groups according to their platelet count,TCM symptoms and drug treatment lines.Infrared thermal imager,hygrometer,colorimetry and image analysis software were used to detect the temperature,humidity,colorimetry and morphology of tongue body(TB),tongue coating(TC)and sublingual vessel(SV),and analyze their characteristics.The tongue was divided into five areas:tip of tongue(T),middle of tongue(M),behind of tongue(B),middle left of tongue(ML)and middle right of tongue(MR),and its temperature was measured.Humility(H)of tongue and tongue coating were measured by hygrometer.The images of tongue body,tongue coating and sublingual collaterals were taken,and the chromaticity indexes of R,G,B,L,a,b were analyzed by Adobe Photoshop 2023.The width,length and tortuosity of sublingual collaterals were under morphological analysis.Results ① Comparison of platelet count groups:compared with 30-50 platelet count group and more than 100 platelet count group,the TB-R of 51-100 platelet count group decreased(P<0.05,P<0.01),and compared with 30-50 platelet count group,the TB-a of 51-100 platelet count group decreased(P<0.01);compared with platelet<30 group and platelet 30-50 group,the TC-H of platelet>100 group increased(P<0.05,P<0.01);compared with platelet>100 group,the length of sublingual collaterals in platelet<30 group was longer(P<0.05).② Comparison of different TCM symptom groups:compared with the bleeding group and asymptomatic group,the M and SV-B in the fatigue group decreased(P<0.05,P<0.01);compared with the asymptomatic group,the TC-b in the anxious group was significantly higher(P<0.05).③ Comparison of administration groups:compared with the Danazol group and Chinese materia medica group,the TC-H in the glucocorticoid group was significantly higher(P<0.05,P<0.01).Conclusion There are differences in tongue characteristic indexes among ITP patients with different platelet counts,TCM symptoms and drug treatment lines,which can measure of tongue indexes to provide references for accurate syndrome differentiation of ITP.