Objective To analyze the incidence of congenital syphilis in four regions of China from 2005 to 2020 and predict its change trend, and to provide a scientific basis for the prevention and control of congenital syphilis. Methods The incidence data of congenital syphilis in eastern, western, central and northeastern China from 2005 to 2020 were collected. The annual change percentage (APC) and average annual change percentage (AAPC) were calculated by Joinpoint software, and the change trend was analyzed. The ARIMA model was established by SPSS26.0 software to predict the incidence from 2021 to 2025. Results From 2005 to 2020, there were 107 504 cases of congenital syphilis, and the incidence reached the peak in 2011, which was 0.90/100 000, and decreased to 0.09/100 000 in 2020. The incidence of congenital syphilis in the eastern, central, western, and northeastern regions of China decreased to 0.07/100 000, 0.06/100 000, 0.12/100 000, and 0.15/100 000 in 2020, respectively. Joinpoint regression analysis found that from 2005 to 2020, the incidence of congenital syphilis showed a downward trend in the whole country (AAPC=-8.68%, t=-5.18, P＜0.05), the eastern region (AAPC=-12.01%, t=-6.81, P＜0.05), the central region (AAPC=-5.45%, t=-2.09, P＜0.05), and the western region (AAPC=-6.05%, t=-3.00, P＜0.05), while the incidence in the northeast region was relatively stable (AAPC=-1.66%, t=-1.18，P＞0.05). The ARIMA (2,2,0) model was constructed to predict that the annual incidence of congenital syphilis from 2021 to 2025 would be 0.06/100,000, 0.03/100,000, 0.02/100,000, 0.01/100,000, and 0.01/100,000, respectively. Conclusion From 2005 to 2020, the incidence of congenital syphilis in China shows an overall downward trend. The western and northeastern regions are the key prevention and control areas, and the work of ^"eliminating mother to child transmission of syphilis^" needs to be continuously promoted.

Objective: To analyze the impact of premature death due to four major chronic diseases on life expectancy in Yangpu District, Shanghai Municipality from 2010 to 2021, so as to provide the evidence for formulating chronic disease prevention and control strategies. Methods : Mortality data of registered residents in Yangpu District from 2010 to 2021 were collected through the Death Information Registration and Management System of the Shanghai Municipal Disease Control and Prevention Information Management Platform. The premature death probability of malignant tumors, diabetes, cardiovascular and cerebrovascular diseases, and chronic respiratory diseases, and life expectancy of residents were calculated using the abridged life table method. Trends in premature death probability for four types of chronic diseases were analyzed using the average annual percent change (AAPC). The impact of premature death probability due to four chronic diseases on life expectancy was assessed by Arriaga's decomposition method. Results : The premature death probability due to four major chronic diseases in Yangpu District decreased from 9.88% in 2010 to 9.22% in 2021, showing an overall declining trend (AAPC=-0.540%, P<0.05). Among females, the premature death probability declined from 6.71% to 4.90% (AAPC=-2.715%, P<0.05), whereas no statistically significant trend was observed in males (P>0.05). Life expectancy increased from 82.52 years in 2010 to 84.50 years in 2021, with an overall upward trend (AAPC=0.244%, P<0.05). Life expectancy rose by 1.71 years for males and 2.34 years for females (AAPC=0.197% and 0.303%,both P<0.05). Declines in premature death probability from malignant tumors (AAPC=-0.967%, P< 0.05) and chronic respiratory diseases (AAPC=-3.071%, P<0.05) contributed to gains in life expectancy of 0.30 years and 0.03 years, with contribution rates of 12.18% and 1.29%, respectively. Changes in premature death probability due to diabetes as well as cardiovascular and cerebrovascular diseases were not statistically significant (both P>0.05), resulting in reductions in life expectancy of 0.05 years and 0.10 years, with contribution rates of -2.40% and -5.05%, respectively. Notably, an increase in premature death probability due to cardiovascular and cerebrovascular diseases among males (AAPC=1.673%) contributed to a decrease of 0.22 years in male life expectancy, whereas a decrease among females (AAPC=-3.824%) contributed to an increase of 0.03 years in female life expectancy, with contribution rates of -13.03% and 1.14%, respectively. Conclusions From 2010 to 2021, Yangpu District experienced an overall decline in premature death probability due to four major chronic diseases and an increase in life expectancy. Greater attention should be paid to the negative impacts of premature death probability from diabetes as well as cardiovascular and cerebrovascular diseases among males on life expectancy.

ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

Background: High-mobility group box protein 1 (HMGB1) is a chromatin-binding protein involved in arthritis, ischemia, sepsis, atherosclerosis, neurodegenerative disorders, meningitis, and cancer. HMGB1 exhibits dual roles in cancer, acting as either a tumor suppressor or oncoprotein depending on context. Objective: This research aimed to elucidate HMGB1’s functional significance in cutaneous squamous cell carcinoma (cSCC). Methods: We overexpressed HMGB1 in cSCC cell lines using recombinant adenovirus and examined its effects on cell proliferation, colony formation, and cell migration. Results: Immunohistochemical analysis revealed elevated HMGB1 expression levels in cSCC tissue relative to normal epidermis. To assess the influence of HMGB1, we employed recombinant adenoviruses expressing HMGB1 to transduce SCC cell lines (SCC12 and SCC13). Enhanced HMGB1 expression significantly promoted cellular proliferation and colony formation capacity.Notably, HMGB1 overexpression elevated the levels of proliferation regulators, including P63, SOX2, CDK4 and CDK6. Furthermore, HMGB1 overexpression substantially enhanced tumor invasiveness, accompanied by upregulation of epithelial-mesenchymal transition (EMT) biomarkers. Mechanistically, overexpression of HMGB1 enhanced transforming growth factor-β signaling by increasing phosphorylation of SMAD2/3, the key mediators of EMT. Conclusion These data imply that HMGB1 acts as a tumor-promoting factor in cSCC.

Low anterior resection syndrome （LARS） is a common complication of sphincter-preserving rectal cancer surgery， and its manifestations change dynamically at different stages. By analyzing and summarizing the clinical symptoms and pathomechanism evolution of LARS across different stages， this paper proposes a staged prevention and treatment strategy using acupuncture. During perioperative stage， the main principle is activating the transport function of the body， supplemented by regulating the mind， with the use of dredging the bowels as needed. During the stoma reversal stage， treatment focuses primarily on fortifying the spleen， with draining dampness as a supplementary method， to help consolidate the intestines. During the radiotherapy or chemotherapy stage， the main focus is reinfor-cing healthy qi， with reducing toxin as an adjunct， to achieve the effect of activating the transport of the pivot. During the survival management stage， treatment primarily focuses on tonifying the kidneys and secondarily on fortifying the spleen， with regulating the corporeal soul as the therapeutic emphasis. Acupoints are selected and combined in accordance with the treatment principles at each stage， and different stimulation methods such as electroacupuncture and moxibustion are applied. An analysis of the mechanisms underlying acupuncture for LARS is also provided， offering a theoretical basis and practical approach for the prevention and treatment of LARS with acupuncture.

Objective:To investigate the association between serum klotho level and risk of all-cause mortality in the population with diabetic kidney disease (DKD).Methods:It was a retrospective cohort study. DKD patients from the National Health and Nutrition Examination Survey (NHANES) database in the United States, which covered five survey cycles from 2007 to 2016 were selected. Relevant demographic and laboratory examination data were collected, and all-cause mortality was regarded as the endpoint event. Patients were divided into high serum klotho group and low serum klotho group according to the optimal klotho threshold of predicting survival outcomes, and the differences of baseline characteristics between the two groups were compared. The weighted Kaplan-Meier method was used to draw the survival curves of the high and low serum klotho groups during the follow-up period. Log-rank test was used to compare the survival rates between the two groups. Weighted Cox proportional hazards regression analysis and further stratified analysis were used to estimate the correlation between serum klotho level and the risk of all-cause mortality.Results:A total of 633 DKD patients were included in this study, with age of 65 (56, 72) years, and 323 (51.03%) males. Among them, there were 510 patients in the high klotho level (>556.6 ng/L) group, and 123 patients in the low klotho level (≤556.6 ng/L) group. The serum creatinine level in the high klotho level group was significantly lower than that in the low klotho level group ( Z=-2.650, P=0.010), while the estimated glomerular filtration rate (eGFR, Z=2.489, P=0.015) and fasting blood glucose ( Z=2.275, P=0.026) were significantly higher than those in the low klotho level group. There was no statistically significant difference between the two groups in terms of age, gender distribution, racial distribution, proportion of smoking, body mass index, proportion of hypertension, total cholesterol, triglyceride, and urine albumin/creatinine ratio (all P>0.05). The follow-up time was 81 (49, 116) months, and a total of 204 (32.23%) all-cause death events occurred. Kaplan-Meier survival analysis showed that the survival rate of the high klotho level group was significantly higher than that of the low klotho level group (Log-rank test, χ2=4.21, P=0.040). Cox proportional hazards regression analysis showed that, after adjusting for gender, age, race, smoking, body mass index, hypertension, blood glucose, triglyceride, total cholesterol and eGFR, the risk of all-cause death in the low klotho level group was 1.63 times than that in the high klotho level group ( HR=1.63, 95% CI 1.03-2.63). Further stratified analysis showed that there was no interaction effect of age, gender, race and eGFR on the impact between low serum klotho level and the risk of all-cause death (all P>0.05), indicating that the correlation between low serum klotho level and the risk of all-cause death was consistent when DKD individuals were divided into different subgroups. Conclusions:Low serum klotho level are significantly associated with increased risk of all-cause mortality in the DKD population. Maintaining an adequate serum klotho level may reduce the risk of death in DKD patients.

Objective:To evaluate the effectiveness and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with stage 4/M neuroblastoma (NB).Methods:This study was a prospective, single-arm, multicenter clinical trial conducted by Sun Yat-sen Memorial Hospital, Children′s Hospital of Nanjing Medical University, Children′s Hospital, Zhejiang University School of Medicine, the First Affiliated Hospital of Guangxi Medical University, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. From March, 2019 to August, 2023, 25 children with confirmed with stage 4/M NB and received allo-HSCT were enrolled. The patients received either unrelated cord blood transplantation (UCBT) or peripheral blood stem cell transplantation (PBSCT). Conditioning regimens for UCBT was fludarabine+busulfan+cyclophosphamide+topotecan, and for PBSCT was fludarabine+busulfan+melphalan+thiotepa+antithymocyte globulin, respectively. Until the last follow-up date of September, 2023, the overall survival (OS) rate and event free survival (EFS) rate were analyzed to evaluate efficacy. The engraftment rate and transplant-related complications were statistically assessed to evaluate safety. Survival analysis was performed using the Kaplan-Meier method.Results:Of the 25 patients, there were 15 males and 10 females. The age at transplantation was 5.7 (3.8, 7.3) years. The engraft rate was 100%, with recovery time of neutrophil as 15.7 (12.5, 17.0) d, and the recovery time of platelets as 33.5 (18.0, 48.0) d. Seventeen of the 25 children (68%) developed acute graft versus host disease (aGVHD), occurred at 18.0 (13.0, 22.5) d after transplantation, including 13 of grade Ⅲ-Ⅳ cases. The main sites of aGVHD were skin and intestinal tract. After treatment, 13 cases improved, 4 patients developed chronic graft-versus-host disease (cGVHD). After allo-HSCT, 14 children received maintenance therapy. Twenty of the 25 patients survived, the 2-year cumulative OS rate was (80±9)%, and 2-year EFS rate was (56±11)%. Nine cases (36%) relapsed, the time from allo-HSCT to disease relapse was 10.9 (5.5, 16.0) months. Five cases (20%) died. The hematopoietic stem cell transplantation associated mortality rate was 4% (1/25).The 2-year OS rate of patients who had partial remission prior to allo-HSCT was significant lower than those who had complete remission prior to allo-HSCT ((33±25)% vs. 100%, P=0.037). Conclusion:allo-HSCT is an effective treatment for patients with stage 4/M NB.

Objective:To investigate the efficacy and toxicity of blinatumomab in the first-line and second-line treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL).Methods:A multi-center retrospective cohort study was conducted to analyze clinical data from 323 pediatric B-ALL patients treated with blinatumomab across 14 hospitals in China from May 2021 to July 2023. Patients were divided into four groups based on the treatment phase and disease status when blinatumomab was used: relapsed/refractory group, post-consolidation minimal residual disease (MRD)-positive group, early MRD-positive group, and MRD-negative group. Blinatumomab for the relapsed/refractory group was considered as second-line treatment, while the other 3 groups as first-line treatment. The MRD negativity rate after treatment, the survival rates and the incidence of severe adverse events were compared across these groups. Patients who received blinatumomab for more than 7 days were included in the efficacy analysis. Survival analysis was performed using the Kaplan-Meier method, and Log-Rank test was used to compare the survival rates among groups.Results:Among the 323 patients, 191 (59.1%) were male, with the age of 6.2 (3.9, 10.5) years. There were 117 patients in the relapsed/refractory group, 62 cases in the post-consolidation MRD-positive group, 43 cases in the early MRD-positive group, and 101 cases in the MRD negative group. In the relapsed/refractory group, the complete remission rate and MRD negativity rate after one course of blinatumomab were 71.4% (35/49) and 81.5% (75/92) for the 49 children without complete remission and the 92 children with flow cytometry-positive MRD, respectively. In the post-consolidation MRD-positive group, the MRD negativity rates after one course of blinatumomab were 100.0% (27/27), 12/16 and 9/19 for patients with MRD positivity detected by flow cytometry, polymerase chain reaction and next-generation sequencing, respectively. In the early MRD-positive group, the MRD negativity rates were 96.7% (29/30) and 9/9 for flow cytometry and next-generation sequencing, respectively. The 2-year overall survival rate and event-free survival rate for the 319 children evaluable for efficacy were (90.6±1.7)% and (87.6±1.9)%, respectively, with the relapsed/refractory group showing significantly lower overall survival rates and event-free survival rate compared to the other groups ( χ2=21.40, 26.21,both P<0.001). Grade 3 or higher adverse events occurred in 128 cases (39.6%), with hematological toxicity observed in 101 cases, while cytokine release syndrome (CRS), infection, and neurotoxicity occurred in 11, 26 and 8 cases, respectively. In addition, there were statistically significant differences in the grade 3 or higher CRS among the four groups ( χ2=8.03, P<0.05). Conclusion:Blinatumomab can clear MRD more effectively and achieve superior survival outcomes when used as first-line treatment for pediatric B-ALL, with less CRS.

Objective:To explore the diagnostic value of gradient characteristics of quantitative parameters of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinoma.Methods:A retrospective case series study was conducted. The clinical data of 120 patients with thyroid diseases who underwent pathological examination for samples collected through fine needle aspiration or surgical resection and underwent CEUS examination before surgery at Shanxi Province Cancer Hospital from January 2018 to May 2023 were collected. A total of 120 thyroid nodules were selected and divided into the benign group (37 nodules) and the malignant group (83 nodules) according to pathological results. The VueBox software was used to depict the four regions of interest in nodules of the two groups, which were the overall, central and marginal areas and surrounding normal thyroid tissues. The time-intensity curve (TIC) was drawn and the relevant parameters including peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in rate (WiR), wash-out rate (WoR), and time to increase (TI) were analyzed, and the gradient values (ΔPE within the nodules, ΔWiAUC within the nodules, ΔWiR within the nodules, ΔWoR within the nodules, ΔTI within the nodules) between two groups of nodules and surrounding normal tissues, as well as between the central and marginal areas of the nodules were calculated.Results:The conventional ultrasound characteristics of benign and malignant nodules showed only a statistically significant difference in aspect ratio ( χ2 = 14.76, P < 0.001). There were statistically significant differences in PE, WiAUC, WiR, and WoR between the overall malignant nodules and the surrounding normal tissues, as well as between the central and marginal areas within the nodules (all P < 0.05); there was a statistically significant difference in WiAUC between the overall benign nodules and the surrounding normal tissues (7 362.06 vs. 7 281.16, Z = -2.07, P = 0.038); there was no statistically significant difference in TI between the two groups of overall nodules and the surrounding normal tissues, as well as the central and marginal areas within the nodules (both P > 0.05); there were statistically significant differences in ΔPE, ΔWiAUC, ΔWiR, and ΔWoR in different regions of the nodules between the two groups (all P < 0.05); binary logistic analysis showed that overall ΔPE and intra nodule ΔWoR were independent predictive factors for the malignancy of thyroid nodules (both P < 0.05); receiver operating characteristic (ROC) curve analysis showed that the overall ΔPE had better diagnostic efficacy for benign and malignant thyroid nodules than the intra nodule ΔWoR, with a cut-off value of -536.23 a.u. Its combination with CEUS had the highest diagnostic efficacy for malignant thyroid nodules, with sensitivity, specificity, positive predictive value, and negative predictive value of 86.7%, 81.1%, 91.1%, and 73.2%, respectively. Conclusions:The peak intensity gradient value (overall ΔPE) between thyroid nodules and surrounding normal tissues can serve as an effective indicator for distinguishing between benign and malignant thyroid nodules. The combination of overall ΔPE and CEUS has good diagnostic efficacy.

Objective:To investigate the differences of comprehensively curative effect of neuro navigation system(NNS)-guided minimally invasive puncture(MIP)and conventional craniotomy hematoma evacuation(CHE)in treatment for traumatic intracerebral hemorrhage,and analyze the mechanisms of affecting the differences of the trajectories postoperative neurologically functional recovery between two kinds of surgical methods.Methods:Based on the design of multicenter prospective cohort study,a total of 240 patients with traumatic intracerebral parenchymal hemorrhage,who admitted to the Neurosurgery Center of Rugao Hospital of Traditional Chinese Medicine between June 2021 and May 2024,were selected.They were randomized into the NNS group(n=120)and the CHE group(n=120)by using a stratified block randomization method.The NNS group underwent NNS-guided surgical intervention,while the CHE group received conventional craniotomy.The primary endpoint was hematoma evacuation rate at the postoperative 7th day.The secondary endpoints encompassed surgical parameters,complications,and the prognostic indicators of function.Microstructural assessment was performed by using three-dimensional image fusion technique[three-dimensional-T1weighted imaging magnetic resonance imaging(3D-T1WI MRI)combined with thin-slice computed tomography(CT)]and tract-based spatial statistics(TBSS).Results:At the dimension of hematoma evacuation,the average hematoma evacuation rate of NNS group was(88.37±6.52)%at the postoperative 7th day,which was significantly higher than(76.15±10.32)%of CHE group,and the residual hematoma volume of NNS group was(5.23±2.15)mL at the postoperative 7th day,which was less than(11.49±4.78)ml,and the differences of them between two groups were significant(t=9.843,7.015,P<0.05),respectively.The surgical trauma parameters appeared polarization:the mean incision length in the NNS group was(3.15±0.73)cm,which reduced 76.3%of(13.24±2.15)cm of the CHE group,with statistically significant difference(Z=15.327,P<0.05).The operative duration of NNS group was(68.34±15.32)min,which was shorter than(142.56±23.48)min,and the difference was significant(t=29.846,P<0.05).The radiation dose of NNS group was(312.45±85.32)cGy·cm2,which was significantly higher than(45.23±12.15)cGy·cm2 of CHE group,and the difference was significant(Z=24.156,P<0.05).The volume of intraoperative blood transfusion of NNS group was(50.34±25.36)ml,which was significantly less than(325.67±158.32)ml,and the difference was significant(Z=18.943,P<0.05),The result of complication genealogy analysis indicated that the re-bleeding incidence of the NNS group was 6.67%,which decreased by 9.16%than 15.83%of the CHE group,and the difference of that between two groups was statistical significance(x2=5.627,P<0.05).However,there was not significant difference in infection rates and incidences of deep vein thrombosis between the two groups(P>0.05).For functional recovery,the proportion of patients whose modified Rankin Scale(mRS)scores was≤2 at the postoperative 90th day was 52.50%in the NNS group,which increased 13.33%than 39.17%in the CHE group,and the difference of that between two groups was statistical significance(x2=4.302,P<0.05).Additionally,the improvement value of National Institutes of Health Stroke Scale(NIHSS)was(9.34±4.156)in the NNS group,which existed marginal advantage of 2.19 points than(7.15±5.327)of the CHE group,and the difference was significant between two groups(Z=3.842,P<0.05).Conclusion:NNS-guided MIP appears notable advantages in enhancing hematoma evacuation efficiency and improving prognosis of neurological function.However,its increased amount of radiation exposure,and risks of specific complication should be considered.The craniotomy approach remains indispensable for complex hematoma morphologies.