Objective To investigate the species of ticks in Suizhou City, Hubei Province, so as to provide insights into management of ticks and tick-borne diseases. Methods During the period between May 2023 and June 2024, livestock breeding farms and vegetation neighboring the place of residence of confirmed and suspected patients with tick-borne disease were selected as sampling points in rural areas from Yindian Township, Gaocheng Township, Wanhe Township, Wushan Township, Xiaolin Township, Xihe Township, Hedian Township and Beijiao Street in Suizhou City, Hubei Province, where confirmed and suspected cases with tick-borne diseases had been reported. The parasitic ticks on the body surface of free-range livestock were captured with tweezers in livestock breeding farms, and free ticks on the vegetation surface were captured with the flagging method. Morphological identification of tick samples was performed under a microscope, and the gender and developmental stage of ticks were determined. One engorged adult tick, 2 to 3 blood-feeding but non-engorged adult ticks, 10 to 15 unfed female ticks, 15 to 20 unfed male ticks, and 30 to 40 tick nymphs or larvae were assigned into a group, respectively. Genomic DNA was extracted from tick samples in each group, and mitochondrial 16S rRNA gene was amplified. Sequence analysis was performed with the DNASTAR software, and phylogenetic analysis was performed using the software MEGA 7.0. In addition, the phylogenetic tree was generated using the maximum likelihood method based on the Kimura 2 parameter model. Results A total of 2 438 ticks were captured from Suizhou City, Hubei Province during the period between May 2023 and June 2024, including 595 free ticks and 1 483 parasitic ticks. Three developmental stages of ticks were captured, including larvae, nymphs, and adults, and 75.18% (1 899/2 438) of captured ticks were adult, in which 79.04% (1 501/1 899) were female. Morphological and molecular biological assays identified one family, three genera and four species of captured ticks, including 2 425 Haemaphysalis longicornis ticks (99.47%) and one H. flava tick (0.04%) of the genus Haemaphysalis, 11 Rhipicephalus microplus ticks (0.45%) of the genus Rhipicephalus, and one Ixodes sinensis tick (0.04%) of the genus Ixodes in the family Ixodidae. Phylogenetic analysis revealed that the H. longicornis sequence (SZ49) in this study was clustered with sequences from Yunnan Province (GenBank accession number: MH024510.1), Hebei Province (GenBank accession number: MK450606.1) and Henan Province (GenBank accession number: MZ230645.1) into a clade, and the H. flava sequence (SZ19) in this study was clustered with sequences from Japan (GenBank accession number: MW064044.1), South Korea (GenBank accession number: ON629585.1), and Jiangsu Province (GenBank accession number: PP494741.1) and Hebei Province of China (GenBank accession number: MH520685.1) into a clade, while the R. microplus sequence (SZ8) in this study was clustered with the sequences from India (GenBank accession number: MK621328.1), and Henan Province (GenBank accession number: MT555307.1) and Guizhou Province of China (GenBank accession number: PP446801.1) into a clade. The sequence of I. sinensis (SZ23) in this study had 99.51% homology with that (GenBank accession number: OM368265.1) of ticks sampled from Wuhan City, Hubei Province. Conclusion There are four tick species of H. longicornis, H. flava, R. microplus and I. sinensis in Suizhou City, Hubei Province, and H. longicornis is the dominant species. H. flava is firstly recorded in Suizhou City.

BackgroundRumination can play a certain degree role of psychological adjustment in cancer patients. Previous studies have focused on studying the level of rumination in a single type of cancer patient， but there is a lack of comprehensive investigation and influencing factor research on rumination levels in different types of cancer patients. ObjectiveTo explore the level of rumination and its influencing factors among middle-advanced cancer inpatients， so as to provide certain guidance for targeted psychological care in clinical practice. MethodsFrom January 2021 to December 2022， a systematic sampling technique was used to recruit 346 patients with TNM stage III or above tumors hospitalized in Nuclear Industry 416 Hospital， Chengdu Sixth People's Hospital and the First People's Hospital of Yibin. All individuals were assessed using Perceived Social Support Scale （PSSS） and the Chinese version of Event-Related Ruminant Inventory （C-ERRI）， and Logistic regression analysis was utilized to identify the influencing factors of rumination. ResultsIn terms of C-ERRI， patients scored （15.59±5.61） on intrusive rumination and （14.59±5.43） on deliberate rumination. Education levels of junior high school/high school/vocational training school （OR=0.817， P<0.01） and junior college and above （OR=0.579， P<0.05） were the protective factors of intrusive rumination， whereas annual personal incomes of <10 000 yuan （OR=4.918， P<0.01） or 10 000~50 000 yuan （OR=2.076， P<0.01） and low （OR=6.882， P<0.01） or middle （OR=3.114， P<0.01） level of social support were the risk factors of intrusive rumination. For deliberate rumination， education levels of junior high school/high school/vocational training school （OR=0.574， P<0.01） and junior college and above （OR=0.449， P<0.05） were the protective factors， and low （OR=1.391， P<0.01） or middle （OR=1.161， P<0.05） levels of social support were the risk factors. ConclusionThe level of intrusive rumination of inpatients with middle-advanced cancer is related to education level， economic status and social support， furthermore， the level of deliberate rumination is related to the educational level and social support. ［Funded by Medical Research Project of Chengdu Health Commission （ number， 2020119）］

ObjectiveTo investigate the contamination status, transmission risk and drug resistance of Klebsiella pneumoniae (KP) on the object surfaces in the surrounding environment of hospitalized patients infected with carbapenem-resistant Klebsiella pneumoniae (CRKP) , so as to provide a scientific guidance for the prevention and control of healthcare-associated infection. MethodsSamples from the surfaces of objects in the surrounding environment of CRKP infected patients living in the intensive care unit (ICU) and hand specimens from healthcare workers were collected for KP isolation and identification, as well as drug susceptible test in a medical institution located in Minhang District, Shanghai from 2021 to 2023. Additionally, both univariate and multivariate logistic regression analyses were used to identify the influencing factors associated with KP contamination in the hospital environment. ResultsA total of 546 surface samples were collected from the surrounding environment objects of 15 patients infected with CRKP, with a KP detection rate of 6.59% (36/546).The KP detection rate in the ICU of general ward (10.22%) was higher than that in the ICU of emergency department (2.94%) (χ²=12.142, P<0.001). Moreover, the KP detection rate on the surfaces of patient-contacted items (15.66%) was higher than that on shared-use items (6.25%), cleaning items (10.00%), and medical supplies (3.30%) (χ²=17.943, P<0.001). Besides, the detection rate of KP in items sent out of hospital for disinfection (15.38%) was higher than that in those self-disinfected (4.20%) (χ²=19.996, P<0.001).The highest detection rate of KP was observed in high-temperature washing (15.13%, 18/119) (χ²=21.219, P<0.001), while the lowest detection rate was observed in antibacterial hand sanitizer with trichlorohydroxydiphenyl ether sanitizing factor (0, 0/60) ( χ²=21.219, P<0.001).The detection rate of KP in samples taken more than 24 hours after the last disinfection (23.08%) was higher than that in those taken at 4 to24 hours (12.90%) and less than 4 hours (4.22%) (χ²=23.398,P<0.001).ICU of general ward (OR=4.045, 95%CI: 2.206‒7.416), patient-contacted items (OR=3.113, 95%CI: 1.191‒8.141), and self-disinfection ( OR=0.241, 95%CI:0.144‒0.402) were influencing factors for KP contamination in environmental surface. From 2021 to 2023, the drug resistance rates of hospital environmental KP isolates showed an upward trend (P<0.001) to antibiotics such as ceftazidime and gentamicin. Furthermore, high drug resistance rates of KP (>90%) were observed to ciprofloxacin, levofloxacin, cefotaxime, ceftriaxone, and cefepime. ConclusionCRKP can be transmitted outward through the surfaces of objects in the patients’ surroundings, and the drug resistance situation is severe. In clinical settings, it is necessary to implement isolation measures for CRKP infection patients, to increase the frequency of disinfection for objects in their surroundings, to strengthen hand hygiene practices, and to use antibiotics appropriately.

Radiation therapy is an essential component of comprehensive treatment for breast cancer. In comparison to photons, proton beam, with its unique Bragg peak, limits the dose distribution to normal tissues around the tumor while improving dose coverage within the target area. Therefore, it could be an appealing therapeutic option for breast cancer treatment. Current researches indicate that proton therapy for breast cancer treatment has a distinct dosimetric advantage in protecting the heart and lungs. However, there are potentially increased risks of side-effects such as skin reactions and rib fractures, etc. Future Subsequent studies should seek a better understanding of the relative biological effectiveness changes along the proton beam range to improve the proton plan evaluation. Additionally, efforts should be directed towards identifying patients who would derive maximum benefit from proton therapy, addressing concerns related to its limited accessibility and high cost. This review provides an overview of the current clinical experiences, research progress and controversies in proton therapy for breast cancer.

Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

Objective To evaluate the quality of ultrafine powder of Spatholobus suberectus from different sources by combined HPLC fingerprint and chemical pattern recognition.Methods Separation was performed on a Amethyst C18-H column(4.6 mmx250 mm,5 pm)and the mobile phase was 0.1％phosphoric acid-acetonitrile with gradient elution.The flow rate was 1.0 mL/min and the wavelength was 260 nm.The column temperature was 30 ℃.The cluster analysis(CA),least partial squares-discriminant analysis(PLS-DA)and principal component analysis(PCA)were applied to studying the HPLC fingerprint and chemical pattern recognition.Results Thirteen common peaks were identified in ultrafine powder samples of 10 batches of Spatholobus suberectus and 3 components were identified by reference substances.The similarity of fingerprint was 0.921-0.989,indicating good similarity.The samples were divided into 3 groups by cluster analysis;principal component analysis results extracted 4 principal components.According to the composite score,the quality of ultrafine powder samples of Spatholobus suberectus from S6,S1,S2,S3 were better than others.And 4 kinds of marker compounds that caused the quality difference of ultrafine powder samples of Spatholobus suberectu were screened out through the least partial squares-discriminant analysis,which were epicatechin and peaks 1,6 and 4 respectively.Conclusion The fingerprint method is simple and reproducible,and can be used to evaluate the quality of ultrafine powder samples of Spatholobus suberectus in combination with multi-mode stoichiometric analysis.

ObjectiveTo explore the understanding degree of medical students, researchers, and medical statistics teachers on P value in statistics and its related factors, so as to provide references for the improvement of medical statistics teaching. MethodsConvenience sampling method was used to distribute 175 questionnaires through the online platform questionnaire star (Wenjuanxing). Based on case study, the questionnaire was designed with 6 true-or-false questions about P values. Accuracy rate of understanding on P value by medical students, researchers and professional teachers was evaluated through questionnaire survey. Descriptive analysis and multivariate logistic regression analysis were used to explore the related factors affecting the understanding of P value. ResultsA total of 170 questionnaires were collected, with 50 from the medical students, 98 from the researchers, and 22 from the professional teachers, respectively. The results indicated that the professional teachers had the highest accuracy rate (89.5%), whereas the medical students had a relatively low accuracy rate (31.6%). Multivariate logistic regression analysis revealed that individuals with a doctoral degree, compared to those with a bachelor’s degree or below, had a higher accuracy rate (OR=2.10, 95%CI: 1.18‒3.76, P=0.012). Additionally, researchers who had received training in medical statistics (OR=4.20, 95%CI: 2.23‒7.93, P<0.001) or medical research design courses (OR=2.40, 95%CI:1.33‒4.33, P=0.004) exhibited higher accuracy rates. ConclusionMedical students and researchers generally have misunderstandings about P values. It is recommended to improve the understanding about P values, such as strengthening medical statistics teaching at the academic education levels, setting up medical research design courses, increasing student-led discussions, and intensifying continuing education and science popularization activities.

Objective:To systematically evaluate the efficacy and safety of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) versus laparoscopic common bile duct exploration (LCBDE) for the treatment of choledocholithiasis.Methods:PubMed, Library, Embase, Cochrane, CNKI, VIP, CBMdisc, Wanfang and other databases were searched to collect relevant literature about LTM-CBDE treatment of choledocholithiasis from December 2013 to December 2023. The main observational indexes were operation time, intraoperative bleeding, drainage tube banding time, postoperative gastrointestinal function recovery time, hospitalization time and postoperative complication rate. Meta-analysis was performed using Review Manager 5.4 software.Results:A total of 15 studies were collected, including one in English and 14 in Chinese. Five were randomized controlled clinical trials and 10 were case-control studies. A total of 1 493 patients, including 690 males and 803 females, aged (53.7±9.2) years old. Among them, 732 patients underwent LTM-CBDE as the microdissection group and 761 patients underwent LCBDE as the control group. Compared with the control group, the meta-analysis showed that patients in the microdissection group had a shorter drain banding time ( MD=-3.34, 95% CI: -4.69--1.99, P<0.001), a faster recovery time of postoperative gastrointestinal function ( MD=-0.63, 95% CI: -1.00--0.25, P=0.001), a shorter hospital stay ( MD=-2.18, and 95% CI: -2.79--1.57, P<0.001), and a lower incidence of bile leak ( OR=0.36, 95% CI: 0.22-0.59, P<0.001) and overall complications ( OR=0.28, 95% CI: 0.18-0.42, P<0.001). Conclusion:LTM-CBDE is safer and more effective than LCBDE in the treatment of choledocholithiasis and deserves clinical promotion.

Tumor microenvironment contributes to poor prognosis of pancreatic adenocarcinoma (PAAD) patients. Proper regulation could improve survival. Melatonin is an endogenous hormone that delivers multiple bioactivities. Here we showed that pancreatic melatonin level is associated with patients' survival. In PAAD mice models, melatonin supplementation suppressed tumor growth, while blockade of melatonin pathway exacerbated tumor progression. This anti-tumor effect was independent of cytotoxicity but associated with tumor-associated neutrophils (TANs), and TANs depletion reversed effects of melatonin. Melatonin induced TANs infiltration and activation, therefore induced cell apoptosis of PAAD cells. Cytokine arrays revealed that melatonin had minimal impact on neutrophils but induced secretion of Cxcl2 from tumor cells. Knockdown of Cxcl2 in tumor cells abolished neutrophil migration and activation. Melatonin-induced neutrophils presented an N1-like anti-tumor phenotype, with increased neutrophil extracellular traps (NETs) causing tumor cell apoptosis through cell-to-cell contact. Proteomics analysis revealed that this reactive oxygen species (ROS)-mediated inhibition was fueled by fatty acid oxidation (FAO) in neutrophils, while FAO inhibitor abolished the anti-tumor effect. Analysis of PAAD patient specimens revealed that CXCL2 expression was associated with neutrophil infiltration. CXCL2, or TANs, combined with NET marker, can better predict patients' prognosis. Collectively, we discovered an anti-tumor mechanism of melatonin through recruiting N1-neutrophils and beneficial NET formation.

Estimation of postmortem interval (PMI) is one of the important research contents in forensic pathology, and it has always been the focus and hot spot of research work. In recent years, scholars at home and abroad have made some research progress in estimating PMI by using ocular tissue. After death, the changes of cornea, aqueous humor, iris, lens, vitreous humor and retina all show time sequence change rule highly related to PMI. This paper reviews the research progress of PMI estimation based on the morphological, biochemical, molecular and genetic material changes of different ocular tissue structures after death, and discusses the existing problems and development trends.
Humans ; Postmortem Changes ; Time Factors ; Autopsy ; Vitreous Body ; Forensic Pathology