The modern Silk Road spirit advocating for win-win cooperative partnerships, aligns with the target of the “Belt and Road” Initiative, which provides new opportunities for collaboration on tropical disease control among countries along the “Belt and Road”. The modern Silk Road spirit may effectively facilitate tropical disease control programmes and improve disease control concepts and approaches through collaborative research, information sharing, infrastructure development, and joint efforts in pharmaceuticals and vaccine development; however, there are still multiple challenges that require to be overcome, including political and cultural differences, and data sharing. Therefore, countries participating in the “Belt and Road” Initiative need to work together with mutual respects, build effective collaborative mechanisms and improve communications to jointly facilitate the sustainable development of global tropical disease control programmes and cultural exchange, so as to contribute to global health and prosperities. This article discusses the contribution of the modern Silk Road spirit to facilitating global tropical disease control programmes in the context of the “Belt and Road” Initiative.

Objective To analyze the epidemiological characteristics and disease burden of drug-resistant tuberculosis cases among elderly patients in Wuhan.Methods Clinical data of elderly pa-tients with pulmonary tuberculosis in Wuhan from January 2019 to December 2022 were retrospectively analyzed.Sputum samples were collected for Mycobacterium tuberculosis isolation,and drug suscepti-bility testing was performed using the proportion method.The epidemiological characteristics of drug-resistant tuberculosis and the direct economic burden of the patients were analyzed.Results A total of 972 elderly patients with positive Mycobacterium tuberculosis tests were included.The overall tuberculosis drug resistance rate was 21.19％(206/972).Male,rural residence,lower education level(primary school or below)and retreatment history significantly increased the risk of developing drug-resistant tu-berculosis(P＜0.05).The direct economic burden for elderly patients with drug-resistant tuberculosis was 24,101.52(8,283.98,39,598.89)RMB,and the indirect economic burden was 1,858.64(528.66,3,085.26)RMB.Conclusion The incidence of drug resistance in elderly tuberculosis is high,and male,rural residence,low education level and tuberculosis retreatment are the risk factors for drug resistance in elderly tuberculosis,and their economic burden is heavy after drug resistance.

Objective　: To verify the feasibility of using a homemade lung phantom for quality control of Cyberknife by comparing the measurement results of the homemade lung phantom and CIRS dynamic phantom in E2E testing of Cyberknife lung tracking.  Methods　 : The patient treatment process was simulated, including CT positioning, plan design, irra- diation implementation, film scanning, and analysis using the homemade phantom and CIRS phantom. The two phantoms were measured five times using MLC under the S7 generation Cyberknife and five times using Iris under the M6 generation Cyberknife. The differences in measurement results between the two phantoms were analyzed using independent sample t-test. Results　: For the S7 generation Cyberknife, the statistical analysis of differences between the two phantoms in the detection values on the X-axis, Y-axis, Z-axis, and total deviation showed P values of 0.236, 0.175, 0.289, and 0.668, respect- ively. For the M6 generation Cyberknife, the statistical analysis showed P values of 0.880, 0.891, 0.573, and 0.433, respect- ively. The P values were all > 0.05. Therefore, there were no statistically significant differences in the detection results between the homemade lung phantom and the CIRS phantom under the S7 and M6 generation Cyberknife. The total deviation values were <1.5 mm. Conclusion　 The homemade lung phantom and CIRS phantom have consistent measurement results in the E2E testing of Cyberknife lung tracking and meet the requirements of Report of AAPM TG-135 and WS 667- 2019 standard. Therefore, the homemade lung phantom is feasible for clinical quality control of Cyberknife.

Objective To establish an allogeneic rat model of endometriosis and to evaluate the effects of gonadotropin-releasing hormone (GnRH) agonist GenSci006 on experimental rat endometriosis. Methods Endometrium from SPF grade donor female SD rats were transplanted onto the abdominal wall of recipient female rats to construct an allogeneic endometriosis model. The rats undergoing sham surgery were divided into the sham group. Three weeks later, the length, width and height of the ectopic endometrium were measured, and the volume of the endometrium (V₁) was calculated before drug administration. The modeling rats were randomly divided into four groups: model group, triptorelin group (0.25 mg/kg), GenSci006-1 group (0.125 mg/kg) and GenSci006-2 group (0.25 mg/kg). Each group had 16 rats and received a single dose of the corresponding drug. The sham group and model group were administered an equal volume of solvent. Three weeks after administration, ectopic endometrium was measured to calculate the volume V₂ and inhibition rate. The effect of GenSci006 on rat uterus and ovarian tissues was assessed by comparing organ coefficients and changes in pathological sections. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of serum estradiol (E₂), progesterone (P₄), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Real-time fluorescent quantitative PCR was used to detect the expression of GnRH receptor (GnRHR) mRNA in the hypothalamus and pituitary. Western blot was used to detect the expression of estradiol receptor alpha (ERα), beta (ERβ) and progesterone receptor (PR) in ectopic endometrium. Results Three weeks after administration, compared with the model group, the body weight of rats in the triptorelin and GenSci006-2 groups significantly increased (P < 0.05), while the volume of ectopic endometrium significantly decreased (P < 0.05). Compared with the sham group, the model group showed no significant changes in uterine and ovarian organ coefficients or endometrial thickness (P > 0.05). Compared with the model group, the uterine organ coefficients and endometrial thickness were significantly reduced in the triptorelin and GenSci006-2 groups (P < 0.05). Compared with the sham group, the serum levels of E₂, P₄, FSH and LH in the model group showed no significant changes (P > 0.05). Compared with the model group, the ovarian organ coefficient and serum P₄ levels of rats in the Triptorelin, GenSci006-1, and GenSci006-2 groups were significantly reduced (P < 0.05), while the serum LH levels of rats in the GenSci006-1 group were significantly increased (P < 0.05). However, there were no significant changes in serum E₂ and FSH levels in each group (P > 0.05). Compared with the model group, the expression levels of GnRHR mRNA in the pituitary tissue of rats in the triptorelin and GenSci006-2 groups were significantly downregulated (P < 0.05), with no significantly changes in the hypothalamus (P > 0.05). There were no significant changes in the expression level of GnRHR mRNA in the hypothalamus or the protein levels of ERα, ERβ and PR in the ectopic endometrial tissue in any group (P > 0.05). Conclusion The allogeneic endometriosis rat model is a suitable animal model for screening and evaluating drugs for treating endometriosis. The volume of ectopic endometrium, inhibition rate, uterine and ovarian organ coefficients, and serum E₂ levels may serve as indicators for detecting drug efficacy.

Objective To investigate the role of the renin-angiotensin system(RAS)in the pathogenesis of acute kidney injury(AKI)after laparoscopic radical nephrectomy(LRN)and the predictive value of RAS activation status for AKI.Methods Eighty-two patients undergoing LRN at the Third Medical Center of General Hospital of PLA from December,2023 to March,2024 were enrolled,including 57 with postoperative AKI and 25 without AKI according to KDIGO criteria.Blood and urine samples were collected from the patients before and at 24 h after the operation for analyzing the correlation of urinary aldosterone,plasma ACE2,Ang1-7,Nrf-2,and IL-10 levels with postoperative AKI.Univariate and multivariate logistic regression analyses and ROC curve were employed to identify the risk factors for postoperative AKI and their predictive value for AKI.Results Compared with those without postoperative AKI,the patients with AKI had significantly higher postoperative urinary aldosterone levels and lower plasma ACE 2,Ang 1-7,Nrf-2,and IL-10 levels(P<0.05).Postoperative urinary aldosterone level was positively correlated with AKI and negatively with estimated glomerular filtration rate(eGFR)(P<0.05);plasma levels of ACE 2,Nrf-2,and IL-10 were all negatively correlated with AKI and positively with eGFR.Urinary aldosterone was a risk factor and plasma ACE 2,Ang 1-7,Nrf-2 and IL-10 were protective factors for AKI,and among them urinary aldosterone was an independent risk factor(AUC=0.651)and plasma Nrf-2 was an independent protective factor(AUC=0.679).The unconventional RAS pathway indices had an AUC of 0.758,and aldosterone combined with the unconventional pathway indices had an AUC of 0.788 for predicting postoperative AKI.Conclusion Activation of the conventional RAS pathway and suppression of the unconventional pathway contribute to AKI following LRA possibly by affecting eGFR.Aldosterone combined with the unconventional pathway indicators can predict the occurrence of AKI after LRN.

Objective:Given the high incidence and mortality rate of sepsis,early identification of high-risk patients and timely intervention are crucial.However,existing mortality risk prediction models still have shortcomings in terms of operation,applicability,and evaluation on long-term prognosis.This study aims to investigate the risk factors for death in patients with sepsis,and to construct the prediction model of short-term and long-term mortality risk. Methods:Patients meeting sepsis 3.0 diagnostic criteria were selected from the Medical Information Mart for Intensive Care-IV(MIMIC-IV)database and randomly divided into a modeling group and a validation group at a ratio of 7?3.Baseline data of patients were analyzed.Univariate Cox regression analysis and full subset regression were used to determine the risk factors of death in patients with sepsis and to screen out the variables to construct the prediction model.The time-dependent area under the curve(AUC),calibration curve,and decision curve were used to evaluate the differentiation,calibration,and clinical practicability of the model. Results:A total of 14 240 patients with sepsis were included in our study.The 28-day and 1-year mortality were 21.45%(3 054 cases)and 36.50%(5 198 cases),respectively.Advanced age,female,high sepsis-related organ failure assessment(SOFA)score,high simplified acute physiology score II(SAPS II),rapid heart rate,rapid respiratory rate,septic shock,congestive heart failure,chronic obstructive pulmonary disease,liver disease,kidney disease,diabetes,malignant tumor,high white blood cell count(WBC),long prothrombin time(PT),and high serum creatinine(SCr)levels were all risk factors for sepsis death(all P<0.05).Eight variables,including PT,respiratory rate,body temperature,malignant tumor,liver disease,septic shock,SAPS II,and age were used to construct the model.The AUCs for 28-day and 1-year survival were 0.717(95%CI 0.710 to 0.724)and 0.716(95%CI 0.707 to 0.725),respectively.The calibration curve and decision curve showed that the model had good calibration degree and clinical application value. Conclusion:The short-term and long-term mortality risk prediction models of patients with sepsis based on the MIMIC-IV database have good recognition ability and certain clinical reference significance for prognostic risk assessment and intervention treatment of patients.

Objective To investigate the role of the renin-angiotensin system(RAS)in the pathogenesis of acute kidney injury(AKI)after laparoscopic radical nephrectomy(LRN)and the predictive value of RAS activation status for AKI.Methods Eighty-two patients undergoing LRN at the Third Medical Center of General Hospital of PLA from December,2023 to March,2024 were enrolled,including 57 with postoperative AKI and 25 without AKI according to KDIGO criteria.Blood and urine samples were collected from the patients before and at 24 h after the operation for analyzing the correlation of urinary aldosterone,plasma ACE2,Ang1-7,Nrf-2,and IL-10 levels with postoperative AKI.Univariate and multivariate logistic regression analyses and ROC curve were employed to identify the risk factors for postoperative AKI and their predictive value for AKI.Results Compared with those without postoperative AKI,the patients with AKI had significantly higher postoperative urinary aldosterone levels and lower plasma ACE 2,Ang 1-7,Nrf-2,and IL-10 levels(P<0.05).Postoperative urinary aldosterone level was positively correlated with AKI and negatively with estimated glomerular filtration rate(eGFR)(P<0.05);plasma levels of ACE 2,Nrf-2,and IL-10 were all negatively correlated with AKI and positively with eGFR.Urinary aldosterone was a risk factor and plasma ACE 2,Ang 1-7,Nrf-2 and IL-10 were protective factors for AKI,and among them urinary aldosterone was an independent risk factor(AUC=0.651)and plasma Nrf-2 was an independent protective factor(AUC=0.679).The unconventional RAS pathway indices had an AUC of 0.758,and aldosterone combined with the unconventional pathway indices had an AUC of 0.788 for predicting postoperative AKI.Conclusion Activation of the conventional RAS pathway and suppression of the unconventional pathway contribute to AKI following LRA possibly by affecting eGFR.Aldosterone combined with the unconventional pathway indicators can predict the occurrence of AKI after LRN.

Objective To establish testing and evaluation methods for radiation shielding performance of a self-shielded radiotherapy system by measuring the radiation levels around the self-shielded head and neck radiotherapy system. Methods A total of 14 monitoring points were selected outside the restricted zone of the system. Under radiation conditions from five different fixed directions, an ion chamber survey meter was used to measure and identify the maximum ambient dose equivalent rate at the 14 points. The time-averaged dose rate was then calculated based on the workload. In accordance with relevant radiation protection standards, an instantaneous dose rate of 10 μSv/h and a time-averaged dose rate of 2.0 μSv/h were proposed as the criteria for shielding protection evaluation. Results Based on the ambient dose equivalent rates at the 14 monitoring points outside the restricted zone, the maximum instantaneous dose rate outside the restricted zone was 7.4 μSv/h. With a workload of 15 patients per day, the maximum time-averaged dose rate was 1.0 μSv/h, which can be used as the criteria for shielding protection evaluation. Conclusion By considering both instantaneous dose rate and time-averaged dose rate, a comprehensive safety assessment of the radiation shielding performance of a self-shielded radiotherapy system can be conducted.

Personalized medicine emphasizes individualized and dynamic treatment decisions. There is an urgent need for a new efficacy evaluation system that can adapt to this approach. By reviewing past clinical research practices， this article pointed out the innovative needs of traditional Chinese medicine （TCM） efficacy evaluation from the perspective of personalized medicine in terms of ethical review， trial design， data management， and statistical analysis. Focusing on these needs， the article has proposed a strategic framework using syndrome differentiation and treatment in TCM as an example. The framework includes a method based on subgroup dynamic-static parallel group design and analysis， a safeguard mechanism of continuous review， dynamic informed consent， and multicenter ethical review， a technological support platform for personalized clinical efficacy evaluation and evidence support， and a statistical strategy integrating Bayesian and traditional analysis methods， aiming to promote the development of personalized TCM diagnosis and treatment.

Objective To explore the correlation between serum fibroblast growth factor-23 (FGF23) concentration and heart failure and all-cause death in patients with end-stage renal disease (ESRD).Methods The prospective cohort study design was used in the present study.The ESRD patients who were admitted to the department of ne-phropathy in the Hospital and without heart failure symptoms were recruited in this study.The data of patients was collected through baseline questionnaires, physical examinations, echocardiography, and laboratory examinations.The serum FGF23 levels were measured by enzyme-linked immunosorbent assay (ELISA) .The follow-up time was 2 years.The onset of heart failure (ACC/AHA stage C-D) and all-cause death were composite endpoint events.The Cox proportional risk model was used to explore the risk factors of outcome events.Through subgroup analyses and interaction analyses, further exploration was conducted to determine whether there was heterogeneity in the as-sociation between FGF23 and outcome events in different subgroups.Results Ultimately,107 ESRD patients were included in this study, with an average age of (52.00 ± 12.51) years.There were 39 males (36.45％), and the median follow-up time was 23 months (21, 25 months).There were 32 (29.9％) outcome events, of which 22 (20.6％) onset of heart failure and 10 (9.3％) all-cause of deaths.The results of this study showed that the con-centration of FGF23 in the outcome event group was significantly higher than that in the non-event group [ (4.40 ± 1.16) pmol/ml vs (3.85 ± 0.82) pmol/ml,P<0.05].The Cox proportional risk model showed that the elevated FGF23 was associated with increased risk of the composite endpoint events in ESRD patients (HR=1.730 , 95％CI:1.164-2.570 , P=0.007) .Subgroup analyses showed that there was an interactive effect between FGF23 levels and gender on the risk of cardiovascular outcome events.Especially in male ESRD patients, the increased FGF23 level was correlated with a higher risk of cardiovascular events (P-interaction <0.05).Conclusion Elevated serum FGF23 is an independent risk factor for the onset of heart failure and all-cause of mortality in ESRD patients, especially in male patients.