Objective: To analyze changes in tuberculosis infection among junior high school students before and after tuberculosis exposure, so as to provide a reference for improving school tuberculosis prevention and control measures and policy formulation. Methods: Retrospectively collect data on a tuberculosis outbreak that occurred in a grade of a junior high school in Chongqing in 2025, including tuberculosis screening records of students in this grade upon their enrollment in 2022 (1 156 students) and after two tuberculosis outbreaks in 2023 (206 students) and 2025 (171 students). The Wilcoxon signed rank test for paired design was used to compare the induration diameters of the subjects, and the Chi square test was adopted to analyze the rate of tuberculosis infection among students. Results: In the tuberculosis outbreak in 2023, the rate of tuberculosis infection among close contacts ( 11.84 %) and the rate of tuberculosis infection among freshrman at school enrollment (12.89%) showed no statistically significant difference ( χ 2=0.25, P >0.05). The rate of tuberculosis infection of close contacts in the 2025 tuberculosis outbreak (55.56%) was higher than that in the 2023 outbreak (11.84%) ( χ 2=30.42, P <0.01). Among the 106 students included in the cohort analysis, the median induration diameter was 3.50 (1.50, 7.50) mm in 2023 and 8.75 (4.25, 11.50) mm in 2025, with a statistically significant difference ( Z=-5.76, P <0.01). There was no statistically significant difference between the infection rate in 2022 (16.98%) and that in 2023 (10.38%) ( χ 2=1.96, P =0.16). The infection rate in 2025 (43.40%) was higher than those in 2022 and 2023 ( χ 2=17.55, 29.39, both P <0.017). The seroconversion rate of students in the same class in 2025 ( 58.00 %) was higher than that of students in different classes (16.07%), with a statistically significant difference ( χ 2=20.19, P <0.01). All 72 individuals with latent tuberculosis infections identified during the pandemic in 2023 and 2025 refused to undergo prophylactic treatment. Conclusions The lack of preventive treatment may be the underlying cause of the successive outbreaks during the epidemic. Early detection of infection sources and standardized outbreak management are crucial to controlling the spread of the epidemic.

Objective: To develop and validate a clinically actionable prediction model for postoperative pulmonary complications (PPCs) in cardiac surgery patients, focusing on modifiable preoperative risk factors amenable to targeted optimization. Methods: In this prospective observational cohort study, 492 adults undergoing open-chest cardiac surgery between August 15, 2023 and December 31, 2023 were analyzed. Prespecified predictors included gas exchange variables, pulmonary function, inspiratory muscle strength, and physical performance. Univariable and multivariable logistic regression analyses were used to develop the prediction model. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC). Results: A total of 90 patients (14.1%) developed PPCs after surgery. Five independent predictors were identified: elevated arterial PaCO2 (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.00–1.26), oxygen desaturation (SpO2<93%) (OR 12.47, 95% CI 3.51–48.13), reduced gait speed (OR 0.17, 95% CI 0.04–0.71), lower FEV1/FVC ratio (OR 0.96, 95% CI 0.92–1.00), and diminished inspiratory muscle strength (MIP % predicted) (OR 0.96, 95% CI 0.92–0.99). The model demonstrated good discriminative ability with an AUC of 0.86 (95% CI 0.80–0.93) in the training cohort and 0.87 (95% CI 0.74–0.93) in the validation cohort. Conclusion This parsimonious model achieved high predictive accuracy using five modifiable physiological variables. By targeting abnormalities in gas exchange, pulmonary mechanics, muscle strength, and functional reserve, the model offers a practical tool to guide individualized prehabilitation strategies for reducing PPC risk in cardiac surgery patients.

This study reports a new species of Culicoides(Avaritia)isolated from Xunke County, Heilongjiang Province, China. The new species, Culicoides(Avaritia)dongshanensis Liu et Wang, sp. nov., was identified and illustrated based on female adults. Its diagnostic characteristics are as follows: eyes contiguous over a short distance, with short interfacetal hair, antennal ratio(AR)of 1.20, palpal ratio(PR)of 2.16, wing length of 0.83 mm, mandible with 15 teeth, one pale spot in base cell M1, one pale spot in cell M4, two pale spots in cell A, and two unequal spermathecae. Type specimens were deposited at the Center for Disease Control and Prevention of the Northern Theater Command.

Objective This study aims to assess the impact of four-dimensional cone-beam computed tomography (4D-CBCT) image guidance on setup error correction and target dose distribution optimization in patients receiving stereotactic body radiotherapy for lung cancer. Methods A total of 82 lung cancer patients treated with SBRT in our hospital between February 2023 and February 2025 were randomly selected as study subjects. Using a random number table, they were divided into two groups. The conventional group underwent positioning verification using traditional three-dimensional cone-beam CT, while the study group underwent verification using 4D-CBCT. Setup errors, target dose-volume parameters, organ at risk dose-volume parameters, and adverse reactions were compared between the two groups. Results The setup errors in the X, Y, and Z axes in the study group were 0.21, 0.19, and 0.23 mm, respectively, which were significantly lower than 0.58, 0.62, and 0.59 mm in the conventional group (P<0.05). The three-dimensional vector error was 0.34 (0.21, 0.48) mm in the study group, which was significantly lower than 0.98 (0.65, 1.32) mm in the conventional group (P<0.05). The rotational errors in left-right, anteroposterior, and superior-inferior directions in the study group were (0.25±0.12)°, (0.21±0.10)°, and (0.23±0.11)°, respectively; these values were significantly lower than (0.48±0.18)°, (0.42±0.15)°, and (0.45±0.16)° in the conventional group (P<0.05). The minimum dose received by 95% of the target volume [(59.45±0.85) Gy] and the percentage of the target volume receiving at least 100% of the prescription dose [(95.82±2.65)%] in the study group were higher than those in the conventional group [(58.90±1.20) Gy and (93.65±3.85)%]. The homogeneity index and conformity index in the study group were 1.07±0.03 and 1.15±0.05, respectively, which were lower than 1.12±0.05 and 1.23±0.08 in the conventional group (P<0.05). No significant differences were observed between the two groups in the volume of the lung receiving 5 Gy [(28.11±5.52)% vs. (28.85±6.24)%], the volume of the lung receiving 20 Gy [(12.84±3.56)% vs. (13.45±3.90)%], mean lung dose [(8.65±2.11) Gy vs. (8.95±2.34) Gy], maximum spinal cord dose [(18.54±3.62) Gy vs. (19.13±4.25) Gy], or mean heart dose[(14.85±4.22) Gy vs. (16.27±4.83) Gy](P>0.05). The incidence rates of radiation pneumonitis, radiation esophagitis, and skin reactions in the study group were 12.20%, 7.32%, and 4.88%, respectively, which were not significantly different from 17.07%, 9.76%, and 7.32% in the conventional group (P>0.05). Conclusion The 4D-CBCT can reduce setup errors, improve target dose accuracy and conformity in lung cancer patients undergoing SBRT, and minimize radiation exposure to normal tissues, making it worthy of clinical promotion.

Objective This study aims to assess the impact of four-dimensional cone-beam computed tomography (4D-CBCT) image guidance on setup error correction and target dose distribution optimization in patients receiving stereotactic body radiotherapy for lung cancer. Methods A total of 82 lung cancer patients treated with SBRT in our hospital between February 2023 and February 2025 were randomly selected as study subjects. Using a random number table, they were divided into two groups. The conventional group underwent positioning verification using traditional three-dimensional cone-beam CT, while the study group underwent verification using 4D-CBCT. Setup errors, target dose-volume parameters, organ at risk dose-volume parameters, and adverse reactions were compared between the two groups. Results The setup errors in the X, Y, and Z axes in the study group were 0.21, 0.19, and 0.23 mm, respectively, which were significantly lower than 0.58, 0.62, and 0.59 mm in the conventional group (P<0.05). The three-dimensional vector error was 0.34 (0.21, 0.48) mm in the study group, which was significantly lower than 0.98 (0.65, 1.32) mm in the conventional group (P<0.05). The rotational errors in left-right, anteroposterior, and superior-inferior directions in the study group were (0.25±0.12)°, (0.21±0.10)°, and (0.23±0.11)°, respectively; these values were significantly lower than (0.48±0.18)°, (0.42±0.15)°, and (0.45±0.16)° in the conventional group (P<0.05). The minimum dose received by 95% of the target volume [(59.45±0.85) Gy] and the percentage of the target volume receiving at least 100% of the prescription dose [(95.82±2.65)%] in the study group were higher than those in the conventional group [(58.90±1.20) Gy and (93.65±3.85)%]. The homogeneity index and conformity index in the study group were 1.07±0.03 and 1.15±0.05, respectively, which were lower than 1.12±0.05 and 1.23±0.08 in the conventional group (P<0.05). No significant differences were observed between the two groups in the volume of the lung receiving 5 Gy [(28.11±5.52)% vs. (28.85±6.24)%], the volume of the lung receiving 20 Gy [(12.84±3.56)% vs. (13.45±3.90)%], mean lung dose [(8.65±2.11) Gy vs. (8.95±2.34) Gy], maximum spinal cord dose [(18.54±3.62) Gy vs. (19.13±4.25) Gy], or mean heart dose[(14.85±4.22) Gy vs. (16.27±4.83) Gy](P>0.05). The incidence rates of radiation pneumonitis, radiation esophagitis, and skin reactions in the study group were 12.20%, 7.32%, and 4.88%, respectively, which were not significantly different from 17.07%, 9.76%, and 7.32% in the conventional group (P>0.05). Conclusion The 4D-CBCT can reduce setup errors, improve target dose accuracy and conformity in lung cancer patients undergoing SBRT, and minimize radiation exposure to normal tissues, making it worthy of clinical promotion.

Objective This study aims to assess the impact of four-dimensional cone-beam computed tomography (4D-CBCT) image guidance on setup error correction and target dose distribution optimization in patients receiving stereotactic body radiotherapy for lung cancer. Methods A total of 82 lung cancer patients treated with SBRT in our hospital between February 2023 and February 2025 were randomly selected as study subjects. Using a random number table, they were divided into two groups. The conventional group underwent positioning verification using traditional three-dimensional cone-beam CT, while the study group underwent verification using 4D-CBCT. Setup errors, target dose-volume parameters, organ at risk dose-volume parameters, and adverse reactions were compared between the two groups. Results The setup errors in the X, Y, and Z axes in the study group were 0.21, 0.19, and 0.23 mm, respectively, which were significantly lower than 0.58, 0.62, and 0.59 mm in the conventional group (P<0.05). The three-dimensional vector error was 0.34 (0.21, 0.48) mm in the study group, which was significantly lower than 0.98 (0.65, 1.32) mm in the conventional group (P<0.05). The rotational errors in left-right, anteroposterior, and superior-inferior directions in the study group were (0.25±0.12)°, (0.21±0.10)°, and (0.23±0.11)°, respectively; these values were significantly lower than (0.48±0.18)°, (0.42±0.15)°, and (0.45±0.16)° in the conventional group (P<0.05). The minimum dose received by 95% of the target volume [(59.45±0.85) Gy] and the percentage of the target volume receiving at least 100% of the prescription dose [(95.82±2.65)%] in the study group were higher than those in the conventional group [(58.90±1.20) Gy and (93.65±3.85)%]. The homogeneity index and conformity index in the study group were 1.07±0.03 and 1.15±0.05, respectively, which were lower than 1.12±0.05 and 1.23±0.08 in the conventional group (P<0.05). No significant differences were observed between the two groups in the volume of the lung receiving 5 Gy [(28.11±5.52)% vs. (28.85±6.24)%], the volume of the lung receiving 20 Gy [(12.84±3.56)% vs. (13.45±3.90)%], mean lung dose [(8.65±2.11) Gy vs. (8.95±2.34) Gy], maximum spinal cord dose [(18.54±3.62) Gy vs. (19.13±4.25) Gy], or mean heart dose[(14.85±4.22) Gy vs. (16.27±4.83) Gy](P>0.05). The incidence rates of radiation pneumonitis, radiation esophagitis, and skin reactions in the study group were 12.20%, 7.32%, and 4.88%, respectively, which were not significantly different from 17.07%, 9.76%, and 7.32% in the conventional group (P>0.05). Conclusion The 4D-CBCT can reduce setup errors, improve target dose accuracy and conformity in lung cancer patients undergoing SBRT, and minimize radiation exposure to normal tissues, making it worthy of clinical promotion.

ObjectiveTo investigate the risk factors for rebleeding after endoscopic therapy for esophageal and gastric varices in liver cirrhosis patients， to construct a clinical predictive model， and to provide a reference for predicting rebleeding in the early stage， reducing the incidence rate of rebleeding， and improving the clinical outcome of patients. MethodsA retrospective analysis was performed for the clinical data of 194 liver cirrhosis patients with gastroesophageal variceal bleeding who received initial endoscopic therapy at Department of Gastroenterology， The Second People’s Hospital of Lanzhou， from January 1， 2021 to May 31， 2025. According to whether rebleeding occurred within 1 year after endoscopic therapy， the patients were divided into rebleeding group and non-rebleeding group. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The patients enrolled were randomly divided into a training set and a validation set at a ratio of 7∶3. In the training set， the Lasso regression analysis was used to obtain optimal predictive variables， and the factors that might affect prognosis were included in the univariate and multivariate Logistic regression analyses to identify independent predictive factors for rebleeding after endoscopic therapy for esophageal and gastric varices in liver cirrhosis patients， which were used to construct a nomogram model. In both the training set and the validation set， the receiver operating characteristic （ROC） curve and the calibration curve were used to assess the discriminatory ability and calibration of the model， and decision curve analysis and the clinical impact curve were used to assess the clinical practicability of the model. ResultsAmong the 194 liver cirrhosis patients with esophageal and gastric varices， 116 （59.79%） experienced rebleeding within 1 year after endoscopic therapy， with 76 patients in the training set and 40 patients in the validation set. In the training set， the Lasso regression analysis and the univariate and multivariate Logistic regression analyses showed that etiology of liver cirrhosis （odds ratio ［OR］=3.540， 95% confidence interval ［CI］： 1.520 — 7.150， P<0.001）， Child-Pugh class （OR=3.560， 95%CI： 1.380 — 9.500， P=0.019）， severity of esophageal and gastric varices （OR=8.190， 95%CI： 3.568 — 17.850， P=0.026）， and main portal vein diameter （OR=2.954， 95%CI： 1.349 — 15.030， P=0.044） were independent predictive factors for rebleeding of esophageal and gastric varices in liver cirrhosis patients. A nomogram model was constructed based on the above independent predictive factors. The ROC curve analysis showed that this model had an area under the ROC curve of 0.845 （95%CI： 0.778 — 0.912） in the training set and 0.801 （95%CI： 0.798 — 0.868） in the validation set. The model had an index of concordance of 0.832 in the training set and 0.820 in the validation set， suggesting that the model had a good discriminatory ability. The Hosmer-Lemeshow test showed P values of 0.320 and 0.550 in the training set and validation set， respectively， the calibration curve indicated that the predicted probabilities of the nomogram model were in good concordance with the actual observed probabilities， suggesting that the model had good calibration. The decision curve analysis and the clinical impact curve showed that the model had good clinical utility. ConclusionThe nomogram model based on etiology of liver cirrhosis， Child-Pugh class， severity of esophageal and gastric varices， and main portal vein diameter has a certain clinical value in predicting the risk of rebleeding from esophageal and gastric varices in liver cirrhosis.

Metabolic dysfunction-associated fatty liver disease （MAFLD） has become the most common chronic liver disease worldwide. Its pathological process is centered on the “two-hit” theory， with gut-liver axis dysregulation running through the entire disease course from steatosis to liver cirrhosis and even hepatocellular carcinoma， and it forms an extensive cross-system regulatory mechanism with the metabolic， cardiovascular， renal， and psychological and nervous systems through multi-dimensional pathways such as the “gut-liver-brain axis”， the “liver-kidney axis”， and the “liver-heart axis”. Disease progression is not limited to the liver itself， and it also involves functional imbalance of multiple organ systems throughout the body. This article systematically elaborates on the association mechanism of “liver pathological progression-multi-axis regulation-comorbidity occurrence” in MAFLD， proposes synergistic management strategies integrating early screening based on risk stratification， targeted intervention， and multidisciplinary diagnosis and treatment， and analyzes the limitations of current research and future development directions， in order to provide a theoretical basis and practical guidance for precise diagnosis and treatment and individualized management of MAFLD.

AIM:To investigate alterations in the expression levels of inflammatory cytokines and subsets of CD8+ T cells in the peripheral blood of patients with diabetic retinopathy(DR).METHODS:Retrospective study. A total of 40 patients with type 2 diabetes admitted to Xi'an People's Hospital(Xi'an Fourth Hospital)from April to July 2022 were recruited for this study and categorized into two groups: 20 cases in the simple type 2 diabetes mellitus(DM)group, and 20 cases in the DR group. Additionally, 20 healthy individuals undergoing routine physical examinations served as the control group. The expression levels of cytokines, including interleukin(IL)-6, IL-8, and IL-10 in peripheral blood were quantified using ELISA. Flow cytometry was employed to analyze the expression of programmed cell death-1(PD-1), T cell immunoglobulin domain and mucin domain protein-3(TIM-3), CD28, and CD57 on CD8+ T cells.RESULTS:The peripheral blood expression of IL-6, IL-8, and IL-10 inflammatory cytokines were significantly elevated in DR patients as detected by ELISA(all P<0.001); flow cytometry analysis showed that the expression of PD-1, TIM-3, and CD57 were elevated in peripheral blood CD8+ T cells of DR patients(all P<0.001), and the expression of CD28 was decreased(all P<0.001).CONCLUSION:In DR patients, CD8+ T cells may undergo depletion and senescence as a result of elevated pro-inflammatory cytokines, including IL-6, IL-8, and IL-10.

Isosteviol is a tetracyclic diterpenoid compound obtained by hydrolysis of natural stevia glycoside under acidic conditions. It has many pharmacological activities, such as anti-tumor, hypoglycemic, anti-inflammatory and antibacterial. Due to its low water solubility, low activity and low bioavailability, isosteviol has poor performance. In order to overcome these shortcomings, scholars have obtained a large number of isosteviol derivatives with novel structures and excellent activity. In this paper, we review the recent progress in the research on the structure modification, biological activity, structure-activity relationship and microbial transformation of isosteviol, in order to provide a reference for the development of new drugs of isosteviol and its derivatives.