Objective: To explore whether digital facial and tongue diagnostic technologies can support the assessment of coronary heart disease (CHD) patients for coronary artery stenosis severity, and examine potential associations between digital tongue diagnosis features and myocardial biomarkers. Methods: The TFDA-1 face and tongue diagnosis instrument and the TDAS analysis system were used to perform intelligent visual examination and analysis of the facial and tongue in CHD patients who attended the Department of Cardiology at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine between October 2, 2023 and July 31, 2024. Variables were screened using principal component analysis (PCA) and multicollinearity analysis to construct four machine learning models, including random forest, LightGBM, decision tree, and naive Bayes, for the early prediction of coronary artery stenosis severity. Model performance metrics, including sensitivity, specificity, precision, F1 score, accuracy, and the area under the receiver operating characteristic (ROC) curve (AUC), were evaluated. Visual analyses were performed using the SHapley Additive exPlanations (SHAP) interpreter and decision curve analysis. For patients after percutaneous coronary intervention (PCI), a conceptual model linking cardiac biomarkers and tongue diagnosis was constructed using the partial least squares structural equation modeling (PLS-SEM), and its validity was assessed. Results: A total of 459 CHD patients were enrolled and assigned to a PCI group and a non-PCI group (which comprised two subgroups: mild stenosis or less group, moderate stenosis or greater group). For sublingual vein (SV) features, the PCI group had lower SV-a and SV-b than the other groups (P < 0.01 and P < 0.05, respectively). For tongue surface features, the PCI group had significantly higher tongue body (TB)-L, TB-a, and TB-b (P < 0.05, P < 0.01, and P < 0.001, respectively), as well as higher tongue coating (TC)-a and TC-b (P < 0.01 and P < 0.001, respectively). Age, SV-a, SV-b, creatine kinase-myocardial band (CK-MB), CK, TC-a, lip-L, and lip-b were incorporated in the machine learning models. The random forest model performed best, with an AUC of 0.924, an F1 score of 0.839, precision of 0.807, accuracy of 0.864, sensitivity of 0.873, and specificity of 0.839. Decision curve analysis indicated that both LightGBM and random forest had clinical utility. PLS-SEM confirmed the pathway relationships: myocardial biomarkers → TB and myocardial biomarkers → TC (coefficient = – 0.238, t = 2.239, P = 0.025, and coefficient = – 0.270, t = 2.522, P = 0.012, respectively). Conclusion This study developed a noninvasive early warning model for coronary artery stenosis in patients with CHD. It applied PLS-SEM to investigate the association between post-PCI cardiac biomarkers and tongue diagnosis, and validated the proposed association chain. These findings suggest that intelligent traditional Chinese medicine (TCM) visual diagnosis integrated with modern digital technology may support CHD risk assessment and comprehensive health management.

ObjectiveTo investigate the mechanism by which Kangxian Yixin prescription regulates the circular RNA 0006719 （circ0006719）/microRNA 6852-5p （miR-6852-5p）/transforming growth factor-β₁ （TGF-β₁）/Smad axis to ameliorate myocardial fibrosis in rats with dilated cardiomyopathy （DCM） and angiotensin Ⅱ （Ang Ⅱ）-induced activation of cardiac fibroblasts （CFs）. MethodsA DCM rat model was established by administration of furazolidone. The rats were divided into normal group， model group， captopril （CAP， 10.1 mg·kg^-1·d^-1） group， and low-， medium-， and high-dose Kangxian Yixin prescription groups （0.9， 1.8， 3.6 g·kg^-1·d^-1）， with 15 rats in each group. After modeling， the treatment groups received corresponding drug solutions by gavage， whereas the normal and model groups received an equal volume of normal saline for 60 consecutive days. Echocardiography was used to measure left ventricular end-systolic diameter （LVESD）， left ventricular end-diastolic diameter （LVEDD）， left ventricular ejection fraction （LVEF）， and left ventricular fractional shortening （LVFS）. Transmission electron microscopy （TEM）， hematoxylin-eosin （HE） staining， and Masson staining were used to observe myocardial ultrastructure， pathological changes， and collagen deposition. Immunohistochemistry （IHC） was used to detect the protein expression of collagen type Ⅰ alpha 1 （Col1A1） and collagen type Ⅲ（Col Ⅲ） in myocardial tissue. Real-time quantitative polymerase chain reaction （Real-time PCR）， Western blot， and fluorescence in situ hybridization （FISH） were used to detect the expression and localization of circ0006719， miR-6852-5p， fibrosis-related molecules， and TGF-β₁/Smad pathway-related molecules in myocardial tissue and CFs. CFs from neonatal rats were isolated and cultured in vitro. Cell Counting Kit-8 （CCK-8） assay was used to determine the optimal concentration of Kangxian Yixin prescription for subsequent intervention. An Ang Ⅱ-induced CF activation model was established， and the cells were divided into normal group， Ang Ⅱ group， Ang Ⅱ+CAP group， Ang Ⅱ+Kangxian Yixin prescription group， and Ang Ⅱ+Kangxian Yixin prescription+miR-6852-5p inhibitor group. CF viability and fibrosis-related molecular expression were detected. RNA immunoprecipitation （RNA IP） and dual-luciferase reporter assays were used to verify the targeting relationship between circ0006719 and miR-6852-5p. ResultsCompared with the normal group， the model group showed significantly increased LVESD and LVEDD， significantly decreased LVEF and LVFS， aggravated myocardial ultrastructural and histopathological injury， and significantly increased collagen volume fraction （CVF） in myocardial tissue （P<0.01）. The expression of circ0006719， Col1A1 mRNA， Col ⅢmRNA， and Col1A1， Col Ⅲ， TGF-β₁， Smad3， and Smad4 proteins in myocardial tissue was significantly upregulated， whereas miR-6852-5p expression and Smad7 protein expression were significantly downregulated （P<0.01）. Compared with the model group， the CAP group and the high- and medium-dose Kangxian Yixin prescription groups showed varying degrees of improvement in cardiac function， myocardial fibrosis， circ0006719/miR-6852-5p expression， and TGF-β₁/Smad pathway-related indicators， with more pronounced improvements in the CAP group and the high-dose Kangxian Yixin prescription group （P<0.05， P<0.01）. In in vitro experiments， 2.0 g·L^-1 was determined as the optimal concentration of Kangxian Yixin prescription for subsequent intervention. Compared with the normal group， the Ang Ⅱ group showed significantly increased CF viability， significantly upregulated expression of circ0006719， Col1A1 mRNA， α-smooth muscle actin （α-SMA） mRNA， and Col1A1， α-SMA， TGF-β₁， Smad3， and Smad4 proteins in CFs， and significantly downregulated miR-6852-5p expression and Smad7 protein expression （P<0.01）. Compared with the Ang Ⅱ group， the Ang Ⅱ+CAP group and the Ang Ⅱ+Kangxian Yixin prescription group showed markedly decreased CF viability and fibrosis-related mRNA and protein expression， markedly increased miR-6852-5p expression， and markedly attenuated TGF-β₁/Smad pathway activation （P<0.05， P<0.01）. Compared with the Ang Ⅱ+Kangxian Yixin prescription group， the Ang Ⅱ+Kangxian Yixin prescription+miR-6852-5p inhibitor group showed significantly increased CF viability （P<0.01）， markedly increased expression of circ0006719， Col1A1 mRNA， and Col1A1， TGF-β₁， and Smad4 proteins in CFs， and markedly decreased miR-6852-5p expression （P<0.05， P<0.01）. RNA IP and dual-luciferase reporter assays showed a targeting binding relationship between circ0006719 and miR-6852-5p （P<0.01）. ConclusionKangxian Yixin prescription may alleviate myocardial collagen deposition and myocardial fibrosis， improve cardiac function in DCM rats， and inhibit Ang Ⅱ-induced abnormal activation of CFs. Its mechanism may be associated with downregulation of circ0006719， restoration of miR-6852-5p expression， and inhibition of the TGF-β₁/Smad pathway.

ObjectiveTo investigate the mechanism by which Kangxian Yixin prescription regulates the circular RNA 0006719 （circ0006719）/microRNA 6852-5p （miR-6852-5p）/transforming growth factor-β₁ （TGF-β₁）/Smad axis to ameliorate myocardial fibrosis in rats with dilated cardiomyopathy （DCM） and angiotensin Ⅱ （Ang Ⅱ）-induced activation of cardiac fibroblasts （CFs）. MethodsA DCM rat model was established by administration of furazolidone. The rats were divided into normal group， model group， captopril （CAP， 10.1 mg·kg^-1·d^-1） group， and low-， medium-， and high-dose Kangxian Yixin prescription groups （0.9， 1.8， 3.6 g·kg^-1·d^-1）， with 15 rats in each group. After modeling， the treatment groups received corresponding drug solutions by gavage， whereas the normal and model groups received an equal volume of normal saline for 60 consecutive days. Echocardiography was used to measure left ventricular end-systolic diameter （LVESD）， left ventricular end-diastolic diameter （LVEDD）， left ventricular ejection fraction （LVEF）， and left ventricular fractional shortening （LVFS）. Transmission electron microscopy （TEM）， hematoxylin-eosin （HE） staining， and Masson staining were used to observe myocardial ultrastructure， pathological changes， and collagen deposition. Immunohistochemistry （IHC） was used to detect the protein expression of collagen type Ⅰ alpha 1 （Col1A1） and collagen type Ⅲ（Col Ⅲ） in myocardial tissue. Real-time quantitative polymerase chain reaction （Real-time PCR）， Western blot， and fluorescence in situ hybridization （FISH） were used to detect the expression and localization of circ0006719， miR-6852-5p， fibrosis-related molecules， and TGF-β₁/Smad pathway-related molecules in myocardial tissue and CFs. CFs from neonatal rats were isolated and cultured in vitro. Cell Counting Kit-8 （CCK-8） assay was used to determine the optimal concentration of Kangxian Yixin prescription for subsequent intervention. An Ang Ⅱ-induced CF activation model was established， and the cells were divided into normal group， Ang Ⅱ group， Ang Ⅱ+CAP group， Ang Ⅱ+Kangxian Yixin prescription group， and Ang Ⅱ+Kangxian Yixin prescription+miR-6852-5p inhibitor group. CF viability and fibrosis-related molecular expression were detected. RNA immunoprecipitation （RNA IP） and dual-luciferase reporter assays were used to verify the targeting relationship between circ0006719 and miR-6852-5p. ResultsCompared with the normal group， the model group showed significantly increased LVESD and LVEDD， significantly decreased LVEF and LVFS， aggravated myocardial ultrastructural and histopathological injury， and significantly increased collagen volume fraction （CVF） in myocardial tissue （P<0.01）. The expression of circ0006719， Col1A1 mRNA， Col ⅢmRNA， and Col1A1， Col Ⅲ， TGF-β₁， Smad3， and Smad4 proteins in myocardial tissue was significantly upregulated， whereas miR-6852-5p expression and Smad7 protein expression were significantly downregulated （P<0.01）. Compared with the model group， the CAP group and the high- and medium-dose Kangxian Yixin prescription groups showed varying degrees of improvement in cardiac function， myocardial fibrosis， circ0006719/miR-6852-5p expression， and TGF-β₁/Smad pathway-related indicators， with more pronounced improvements in the CAP group and the high-dose Kangxian Yixin prescription group （P<0.05， P<0.01）. In in vitro experiments， 2.0 g·L^-1 was determined as the optimal concentration of Kangxian Yixin prescription for subsequent intervention. Compared with the normal group， the Ang Ⅱ group showed significantly increased CF viability， significantly upregulated expression of circ0006719， Col1A1 mRNA， α-smooth muscle actin （α-SMA） mRNA， and Col1A1， α-SMA， TGF-β₁， Smad3， and Smad4 proteins in CFs， and significantly downregulated miR-6852-5p expression and Smad7 protein expression （P<0.01）. Compared with the Ang Ⅱ group， the Ang Ⅱ+CAP group and the Ang Ⅱ+Kangxian Yixin prescription group showed markedly decreased CF viability and fibrosis-related mRNA and protein expression， markedly increased miR-6852-5p expression， and markedly attenuated TGF-β₁/Smad pathway activation （P<0.05， P<0.01）. Compared with the Ang Ⅱ+Kangxian Yixin prescription group， the Ang Ⅱ+Kangxian Yixin prescription+miR-6852-5p inhibitor group showed significantly increased CF viability （P<0.01）， markedly increased expression of circ0006719， Col1A1 mRNA， and Col1A1， TGF-β₁， and Smad4 proteins in CFs， and markedly decreased miR-6852-5p expression （P<0.05， P<0.01）. RNA IP and dual-luciferase reporter assays showed a targeting binding relationship between circ0006719 and miR-6852-5p （P<0.01）. ConclusionKangxian Yixin prescription may alleviate myocardial collagen deposition and myocardial fibrosis， improve cardiac function in DCM rats， and inhibit Ang Ⅱ-induced abnormal activation of CFs. Its mechanism may be associated with downregulation of circ0006719， restoration of miR-6852-5p expression， and inhibition of the TGF-β₁/Smad pathway.

The current transformation of the tripartite linkage of medical treatment has gradually shifted towards collaborative development and governance among medical care,medical insurance,and medicine,necessitating a clear understanding of the internal mechanisms underpinning this collaboration and governance to lay a theoretical foundation for practical exploration.Drawing on synergetics theory,it delves into the self-organizing characteristics of the collaborative development and governance among the tripartite system,grasping its fundamental operational laws.Through a questionnaire survey of the main functional departments in each field of the tripartite system to verify the rationality of the sequence parameters selected for the study.It ultimately identifies the order parameters as the value standard centered on health,the interest contract focused on public interest,new system for mobilizing resources nationwide,the innovative capacity of the pharmaceutical industry,and the rigorous accountability system.Furthermore,it systematically expounds on the self-organizing evolution process of the collaborative development and governance among the tripartite system,thereby revealing the inherent mechanisms of its collaborative development and governance.It proposes countermeasures and suggestions for establishing and improving diversified collaboration mechanisms,innovating monitoring and early warning mechanisms,and fostering positive feedback mechanisms,aiming to facilitate more scientific and efficient collaborative development and governance among the tripartite system.

Objective:To investigate devices for radiodiagnosis used in medical institutions in Beijing, China, as well as radiation workers and the devices′ application frequencies, in order to provide data support for determining radiation protection measures and allocating resources for clinical radiodiagnosis.Methods:In October 2023, questionnaires were distributed to the members of the Radiation Technology Branch of the Beijing Medical Association who work in medical institutions at different levels across varying districts of Beijing. The collected data included information about devices for radiodiagnosis and radiation workers, as well as the application frequencies of various medical X-ray imaging devices during 2018-2022, in 38 medical institutions of Level 3 Grade A, Level 3, and Level 2 in 14 municipal districts of Beijing. Then, the collected data were organized using the Microsoft Power BI software to form report models, followed by the statistical analysis of data on the devices, radiation workers, and application frequencies were using the RStudio software.Results:The 38 medical institutions in Beijing possess 591 devices for radiodiagnosis and 2 018 staff in the departments of radiology, including 1 037 radiologic technologists and 738 physicians, with 1.77 technologists and 1.26 physicians arranged for a single device on average. From 2018 to 2022, among all examinations of radiodiagnosis, computed tomography (CT) scans showed the highest frequencies, with total and average annual growth rates of 138.06% and 108.40%, respectively. Specifically, chest CT scans exhibited total and average annual growth rates of 225.20% and 122.50%, respectively. X-ray imaging ranked second in application frequency, with total average annual growth rates of 70.20% and 91.53%, respectively. Notably, chest X-ray imaging showed total and average annual growth rates of 63.89% and 89.41%, respectively.Conclusions:From 2018 to 2022, X-ray imaging examinations displayed significantly fluctuating frequencies with an overall decline trend in the 38 medical institutions. In contrast, the CT scans showed increased frequencies, with chest CT scans displaying an increased frequency and proportion. This necessitates ensuring the justification of CT scans.

Objective:To understand spatial aggregation of lung cancer mortality and its changing trends over the past fifty years in different counties and districts of Shandong Province from 1970 to 2021.Methods:The mortality data of lung cancer were obtained from the death registration system of Shandong province and three retrospective surveys of death cause. The mortality rate and age-standardized mortality rate were used to describe the changing trend of lung cancer in different years, and the contribution value of population factors and non-population factors in lung cancer mortality change was calculated by the mortality differential decomposition method. GeoDa 1.20 and ArcGIS 10.8 software were used for spatial autocorrelation analysis and visualization map display.Results:The crude mortality rate of lung cancer in Shandong Province showed a significant upward trend from 1970 to 2021, rising from 7.22 per 100 000 in 1970-1974 to 62.73 per 100 000 in 2020-2021, with an increase of 7.69 times. Meanwhile, the standardized mortality rate of lung cancer exhibited a trend of increasing first and then decreasing. The differential analysis of lung cancer mortality in different years revealed that changes in crude mortality rates were the result of the combined effects of demographic and non-demographic factors. The proportion of population factors (aging population) leading to an increase in lung cancer mortality rate rose from 2.12% in 1990-1992 to 40.20% in 2020-2021. From a spatial distribution perspective, there were significant regional differences in lung cancer mortality rates among counties (cities, districts) in Shandong Province across different eras. Compared to the period of 1970-1974, the lung cancer mortality rates in all counties and districts in 2020-2021 showed a considerable increase, and there were noticeable changes in the areas of high-high and low-low clustering of lung cancer mortality rates across different eras.Conclusion:There have been significant temporal and spatial changes in the mortality rate of lung cancer in Shandong Province from 1970 to 2021. The crude mortality rate has shown an upward trend, while the standardized mortality rate increases first and then decreases. The concentration of lung cancer mortality rates in counties and districts has also undergone significant changes.

Objective:To explore the effect of secreted frizzled-related protein 3 (sFRP3) on tau aggregation.Methods:(1) Twelve wild-type C57BL/6J mice and 12 P301S mutant tau transgenic (tau P301S) mice were selected; Western blotting was used to detect the sFRP3 protein expression in the brain tissues; co-immunoprecipitation experiment was conducted to verify endogenous sFRP3 binding to tau; and double immunofluorescent staining was performed to observe whether sFRP3 co-localized with phosphorylated tau. (2) Recombinant human tau (K18) and sFRP3 protein were purified, and pre-formed fibrils (PFFs) containing only K18 or mixed PFFs (containing both sFRP3 and K18) were prepared; His pull-down assay was adopted to verify exogenous purified sFRP3 binding to tau. Aggregation of these two types of PFFs was observed by thioflavin T (ThT) fluorescence,and anti-digestibility of these two types of PFFs was detected by proteinase K (PK) assay. Ultrastructure of two types of PFFs was observed under transmission electron microscope. (3) HEK293 cells stably expressing green fluorescent protein (GFP) and tau repeat domain (GFP-tau RD HEK293) were treated with the two tpyes of PFFs; intracellular tau aggregation was observed by immunofluorescence; intracellular soluble or insoluble component was evaluated by density gradient lysis. SH-SY5Y cells were treated with the two types of PFFs; cell counting kit-8 (CCK-8) assay was used to detect cell viability; Western blotting was used to detect the expressions of apoptosis-related proteins (Bcl-2-associated X protein [Bax] and cleaved caspase-3); double staining with propidium iodide (PI) and Hoechst 33342, and TUNEL were used to detect cell apoptosis. Primary neurons were treated with the two types of PFFs; density of dendritic spines was measured by 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) staining; expressions of synaptic proteins, such as synapsin I and vesicle-associated membrane protein 2 (VAMP2), were detected by Western blotting and double immunofluorescent staining. Results:(1) sFRP3 expression in the brain tissues of tau P301S mice was significantly higher than that in wild-type mice (1.10±0.05 vs. 0.79±0.06, P<0.05). In the brain tissues of wild-type mice, endogenous sFRP3 could bind to tau, and in the brain tissues of tau P301S mice, sFRP3 and phosphorylated tau were co-localized. (2) Exogenous tau and sFRP3 could interact with each other. After constant temperature oscillation for approximately 180 minutes, the ThT fluorescent intensity in mixed PFFs was significantly higher than that in K18 PFFs. Remaining proteins of mixed PFFs were significantly increased compared with those of K18 PFFs after the same digestion time of 1 and 2 μg/mL PK (0.77±0.02 vs. 0.67±0.03; 0.52±0.04 vs. 0.33±0.02, P<0.05). The ultrastructure of mixed PFFs was longer and more compact than K18 PFFs. (3) Compared with K18 PFFs, mixed PFFs formed more intracellular tau aggregation points and had more insoluble components (insoluble protein and soluble protein ratio: 0.43±0.04 and 0.92±0.08), with significant differences ( P<0.05). Compared with K18 PFFs, mixed PFFs had significantly decreased SH-SY5Y cell viability (0.44±0.01 vs. 0.24±0.02), significantly up-regulated Bax and cleaved caspase-3 protein expressions (0.71±0.04 vs. 0.87±0.04; 0.60±0.06 vs. 0.88±0.03), significantly increased percentage of apoptotic cells (PI/Hoechst staining: 8.00%±0.49% vs. 18.11%±1.13%; TUNEL staining: 6.62%±0.91% vs. 14.94%±1.32%, P<0.05). Compared with the K18 PFFs group, the mixed PFFs group had significantly decreased density of dendritic spines ([5.7±0.28]/10 μm vs. [2.7±0.29]/10 μm), synapsin I and VAMP2 expressions (0.95±0.02 vs. 0.48±0.04; 0.88±0.03 vs. 0.52±0.06), and average fluorescent intensity of synapsin I and VAMP2 in the primary neurons (7.73±0.70 vs. 2.74±0.34; 6.14±0.60 vs. 2.96±0.54, P<0.05). Conclusion:sFRP3 interacts with tau to promote tau aggregation, and enhance the cytotoxic effect of tau aggregation.

Objective:To investigate the protocol and clinical efficacy of hair follicle-bearing microskin (HF-MS) transplantation in the treatment of hypertrophic scars.Methods:Prospective randomized controlled trial. From January to November 2024, patients with hypertrophic scars were recruited from the Medical Cosmetic Center of Affiliated Hangzhou First People’s Hospital with Westlake University School of Medicine and the Department of Plastic and Reconstructive Surgery of Ningbo Sixth Hospital. Patients were randomly divided into the observation group and the control group using a random number table. In the observation group, 1.0 mm punch decompression was performed on the hypertrophic scar area, followed by implantation of HF-MS extracted from the scalp donor site using follicular unit excision (FUE) into the decompression pores. The control group underwent only 1.0 mm punch decompression. Vancouver scar scale (VSS) scores (total score 0-15, higher scores indicating more severe scarring) were assessed preoperatively and at 1, 3, and 6 months postoperatively. Efficacy at 6 months, improvement in hypertrophic scar area, hair survival rate (observation group), adverse reactions, and patients’ satisfaction rates were evaluated. Categorical data were expressed as frequency (%) and analyzed using chi-square tests; normally distributed measurement data were expressed as Mean ± SD and analyzed using independent samples t-tests. Results:A total of 50 patients were included (25 per group), with 22 males and 28 females, aged 18-60 years (mean age: 33 years). The effective rate was 92% (23/25) in the observation group and 68% (17/25) in the control group, showing a statistically significant difference ( P<0.05). Preoperative VSS scores did not differ significantly between the observation and control groups [(6.67±3.19) vs. (7.12±2.89), P>0.05]. At 1, 3, and 6 months postoperatively, the observation group had VSS scores of (5.48±2.60), (4.64±2.39), and (3.80±2.10), respectively, compared to (6.36±2.53), (5.84±2.28), and (5.32±2.09) in the control group. The 6-month postoperative VSS scores differed significantly between groups ( P<0.05). Preoperative hypertrophic scar areas showed no significant difference [(5.75±2.83) cm 2 vs. (6.91±3.31) cm 2,P>0.05]. At 6 months postoperatively, the observation group had significantly smaller scar areas than the control group [(3.15±1.55) cm 2 vs. (5.37±2.93) cm 2,P<0.01]. The average hair survival rate in the observation group was 41% at 6 months. Adverse reactions occurred in 3 cases in the observation group (2 skin indurations, 1 hyperpigmentation) and 7 cases in the control group (4 hyperpigmentation, 2 skin atrophy, 1 skin induration). The observation group had a significantly lower adverse reaction rate [12% (3/25) vs. 28% (7/25), P<0.05]. Patient satisfaction rates were 88% (22/25) in the observation group and 64% (16/25) in the control group ( P<0.05). Conclusion:HF-MS transplantation demonstrates definitive clinical efficacy in treating hypertrophic scars, effectively improving scar morphology, clinical symptoms, and patient quality of life.

Objective:To explore the spatial clustering of the mortality rate of cervical cancer in different counties (cities, districts) in Shandong Province from 1970 to 2021 and its 50-year changing trend, so as to provide basis for the implementation and evaluation of prevention and control strategies and programs such as cervical cancer screening, early diagnosis and treatment, human papilloma virus (HPV) vaccination, etc.Methods:The mortality data of cervical cancer were obtained from the death registration system of Shandong Province and the data of three retrospective surveys of death causes. The mortality rate and age-standardized mortality rate (using the population composition of China in 1964) are used to describe the changing trend of cervical cancer in different years. The contribution values of population factors and non-population factors in cervical cancer mortality change are calculated by mortality differential decomposition method. ArcGIS 10.8 software is used for spatial distribution and spatial autocorrelation analysis.Results:From 1970 to 2021, the crude mortality rate and age standardized mortality rate of cervical cancer in Shandong Province showed a trend of first rapid decline and then slow increase. The crude mortality rate and standardized mortality rate of female cervical cancer in Shandong Province in 1970-1974 were the highest, reaching 17.22/10 5 and 13.17/10 5, respectively. In 2004-2005, it dropped to the lowest levels of 1.50/10 5 and 0.83/10 5. Subsequently, it slowly rose to 4.12/10 5 and 1.56/10 5 in 2020-2021. The differential analysis of cervical cancer mortality in different years found that the change of cervical cancer mortality was caused by the combined action of population factors and non-population factors. Among them, demographic factors (aging population) led to the increase of cervical cancer mortality, but non-demographic factors (early diagnosis and treatment, HPV infection level, medical technology level, etc) lead to the decrease of cervical cancer mortality. Compared with 1970-1974, with the passage of time, the absolute values of the contribution values of population factors and non-population factors showed an increasing trend, while the contribution of non-population factors was greater than that of population factors, which led to the decline of cervical cancer mortality. From the perspective of spatial distribution, there were great regional differences in the mortality rate of cervical cancer in different counties of Shandong Province. In 2020-2021, the mortality rate of cervical cancer in all counties decreased to a great extent compared with that in 1970-1974, and the high-high and low-low concentration areas of cervical cancer mortality in different years changed obviously. The high-aggregation areas of the cervical cancer mortality rate in Shandong Province from 2020 to 2021 were mainly distributed in some counties and districts of Linyi City, Zaozhuang City, and Heze City in the southwest. Conclusions:There are significant temporal and spatial changes in the mortality rate of cervical cancer in Shandong Province from 1970 to 2021. According to these trends and their geographical and spatial clustering, prevention and control strategies of cervical cancer in different regions should be further formulated and evaluated.

Objective:To investigate the efficacy and safety of transurethral incision for the treatment of ureterocele in infants.Methods:A retrospective analysis of 28 cases of ureterocele admitted from March 2012 to May 2023 were reviewed, all of which were less than 1 year old, 16 male and 12 female, with an average age of(5.7±3.5)months. The ureterocele was located on the left side in 8 cases, on the right side in 15 cases, and bilaterally in 5 cases. There were 12 cases of single system ureterocele, of which 7 cases were unilateral and 5 cases were bilateral. Duplex system ureterocele was observed in 16 cases, all of which were unilateral. Clinical manifestations: urinary tract infection in 13 cases, 11 cases of ureterocele or hydronephrosis and ureteral dilation were found during antenatal examination, and 4 cases of ureterocele were found after birth. Urological ultrasound, intravenous pyelography(IVP) and voiding cystourethrography(VCUG) were performed in all children, and 17 cases underwent magnetic resonance urolography (MRU), and confirm the diagnosis of ureterocele preoperatively. All of the cases were performed the transurethral incision.The ureterocele was punctured and incised 1-2 mm at the base of the bulge, and 2-4 points were punctured according to the bulge atrophy. Bilateral ureteroceles were punctured and incised simultaneously. Postoperative urine routine test, urinary tract color ultrasound and VCUG were performed to determine if there is urinary tract infection, hydronephrosis, ureteral dilation and bulging, and whether a second surgery is needed.Results:All operations were conducted successfully. The intraoperative bleeding was less than 3 ml and no intraoperative complications. The operative time was (28.4±10.3) min. The median postoperative follow-up was 34 (32, 36) months. Six cases underwent postoperative VCUG examination. Eleven children were recovered well with single systemic ureterocele. One child developed grade Ⅳ vesicoureteral reflux(VUR)and combined with bladder diverticulum, and ureterocele underwent open diverticulotomy and ureteral reimplantation six months after surgery. Nine children were recovered well with duplex systemic ureterocele. Six cases of children developed infection, of which 2 cases had an infection once within one month after TUI, and the other four cases still had intermittent infections after six months and VCUG was performed, and one case showed grade Ⅲ VUR of the lower ureter, which was observed conservatively, while the other three cases had enlarged cysts but no VUR, and upper heminephrectomy was performed, and the patients recovered well after surgery. Except for these 6 exceptions, in another case, after ten years of follow-up, the ureterocele became larger but no VUR, and the results were good after a second transurethral incision. There was no significant difference in the postoperative infections, new VUR cases, and secondary surgeries between the two groups.Conclusions:Transurethral incision has good surgical effect on children with single system ureterocele and duplex system ureterocele, and has advantages of easy operation, less trauma, safety and effectiveness, and few complications. It deserves to be recommended as the treatment of choice, especially for infants and young children.