Objective To investigate the species of sandflies and the prevalence of Leishmania infections in sandflies from selected areas of northern and northwestern China, so as to provide insights into identification of leishmaniasis vectors and assessment of epidemiological trends of leishmaniasis in China. Methods Sandfly samples were collected from Mentougou District of Beijing Municipality, Xiangning County in Linfen City of Shanxi Province, Ejin Banner in Alxa League of Inner Mongolia Autonomous Region, and Payzawat County of Karamay District of Karamay City, Gaochang District of Turpan City in Xinjiang Uygur Autonomous Region from July 2023 to July 2024. Approximately 100 intact female sandfly samples were randomly selected from each site and the species of sandflies was identified according to morphological characteristics and molecular assays. Female sandflies originating from the same habitat were grouped into pools of 10 individuals. Leishmania infection was detected using polymerase chain reaction (PCR) assay targeting the internal transcribed spacer 1 (ITS-1) gene, and the prevalence of Leishmania infection was calculated in sandflies from different sampling sites using the minimum infection rate (MIR) method. In addition, positive amplicons were sequenced and subjected to phylogenetic analysis. Results A total of 6 155 sandflies were collected from different environments at sampling sites across the six aforementioned regions from July 2023 to July 2024. Phlebotomus chinensis (96.00%) was the dominant sandfly species in Mentougou District, Beijing Municipality, with a small proportion of Ph. sergenti (4.00%), and only Ph. chinensis was found in Xiangning County, Linfen City, Shanxi Province. Ph. wui was the only sandfly species detected in Ejin Banner, Alxa League, Inner Mongolia Autonomous Region, and Payzawat County, Kashgar City, Xinjiang Uygur Autonomous Region, and Ph. caucasicus (97.70%) was the dominant sandfly species in Karamay District, Karamay City, Xinjiang Uygur Autonomous Region, with a small proportion of Ph. wui (2.30%), while Ph. alexandri was the only species in Gaochang District, Turpan City, Xinjiang Uygur Autonomous Region. A total of 40, 60, 34, 18, 18, and 22 pools of sandfly samples were tested from Mentougou District in Beijing Municipality, Xiangning County in Linfen City of Shanxi Province, Ejin Banner in Alxa League of Inner Mongolia Autonomous Region, Payzawat County in Kashgar City, Karamay District in Karamay City, and Gaochang District in Turpan City of Xinjiang Uygur Autonomous Region, respectively. L. infantum was detected in Ph. chinensis samples from Mentougou District in Beijing Municipality, and Xiangning County of Linfen City in Shanxi Province, with MIR of 0.25% to 1.00%, and L. donovani was detected in Ph. wui from Ejin Banner in Alxa League of Inner Mongolia Autonomous Region, and Payzawat County in Kashgar City of Xinjiang Uygur Autonomous Region, with MIR of 0.56% to 0.88%; however, no Leishmania infection was detected in Ph. caucasicus from Karamay District in Karamay City or Ph. alexandri from Gaochang District in Turpan City of Xinjiang Uygur Autonomous Region. Phylogenetic analysis showed that the Leishmania ITS-1 gene sequences obtained from Mentougou District in Beijing Municipality and Xiangning County in Linfen City of Shanxi Province were clustered into the same clade with the reference sequences of L. infantum ITS-1 gene, while the Leishmania ITS-1 gene sequences obtained from Ejin Banner in Alxa League of Inner Mongolia Autonomous Region and Payzawat County in Kashgar City of Xinjiang Uygur Autonomous Region were clustered into the same clade with the reference sequences of L. donovani ITS-1 gene. Conclusions There are variations in sandfly species in selected areas of northern and northwestern China, and variations in the species of Leishmania infecting sandflies. Improved surveillance of sandfly vectors and targeted control strategies with adaptations to geographical features and leishmaniasis vectors are recommended.

Objective To investigate the clinical efficacy of minimally invasive mitral valvuloplasty (MVP) in the treatment of infective endocarditis (IE) with mitral regurgitation (MR). Methods A retrospective analysis was conducted on the clinical data of patients who underwent MVP for IE with MR at the Department of Cardiovascular Surgery in Zhongshan Hospital, Fudan University from 2016 to 2020. Patients were divided into two groups based on the surgical incision: those with a right mini-thoracotomy were classified as a minimally invasive surgery (MIS) group, and those with a median sternotomy (MS) were classified as an MS group. All patients had isolated mitral valve involvement. Perioperative data were analyzed, and mid- to long-term outcomes were compared between the two groups. Results A total of 86 patients were included, with 40 in the MIS group [22 males and 18 females, with a mean age of (39.78±15.36) years ranging from 14 to 75 years] and 46 in the MS group [27 males and 19 females, with a mean age of (49.94±16.13) years ranging from 14 to 71 years]. The patients in the MIS group were relatively younger (P=0.004) with better preoperative cardiac function (P=0.004). There was no statistical difference in preoperative fever, gender, or comorbidities between the two groups (P>0.05). The MIS group had shorter postoperative ventilation times, less postoperative 24-hour drainage, less blood transfusion, and shorter total hospital stays compared to the MS group (P＜0.05). There was no statistical difference in cardiopulmonary bypass times or ICU stays between the two groups (P>0.05). The perioperative complication rates and mortality rates were not significantly different between the two groups (P>0.05). Follow-up was conducted for 11-92 months, with a mean duration of (49±19) months and an overall follow-up rate of 91.9%. During the follow-up, 3 patients in each group required reoperation for mitral valve issues, with no statistical difference in incidence (7.5% vs. 6.5%, P=0.691). There were no warfarin-related complications, recurrences, or deaths in either group during follow-up. Multivariate regression analysis identified age, preoperative cardiac function, and surgeon experience as influencing factors for the choice of surgical approach. Conclusion Minimally invasive MVP for IE with MR is relatively safe in the perioperative period and shows significant efficacy, with clear mid- to long-term outcomes. It is recommended for younger patients with better preoperative cardiac function and when performed by surgeons with extensive experience in mitral valvuloplasty.

Background Work-related musculoskeletal disorders (WMSDs) are common across industries. Workers in the hairdressing industry are frequently exposed to repetitive upper-limb movements and awkward working postures, which may increase their susceptibility to WMSDs. However, evidence on WMSDs among workers in this industry remains limited. Objective This study aimed to investigate the prevalence of self-reported WMSDs symptoms and associated factors among workers in the hairdressing industry in Hongkou District, Shanghai. Methods A cross-sectional survey was conducted using quota sampling in all eight subdistricts of Hongkou District, Shanghai. Hair salons in each subdistrict were ranked by the number of hairdressers and shampoo workers, and the 6 salons with the largest staff size in each subdistrict were selected, resulting in 48 survey sites. Hairdressers and shampoo workers who met the inclusion and exclusion criteria were surveyed using the Chinese version of the Musculoskeletal Disorders Questionnaire. Information on their individual characteristics, musculoskeletal symptoms, and work-related factors was collected. Chi-square tests and Firth logistic regression were used to estimate the prevalence of self-reported WMSDs symptoms and identify associated factors. Results The overall prevalence of self-reported WMSDs symptoms among workers in the hairdressing industry was 45.72%. Among hairdressers, the most commonly affected body regions were the neck (31.51%), shoulders (25.57%), lower back (15.98%), and feet (14.61%). Among shampoo workers, the most commonly affected regions were the neck (24.17%), lower back (24.17%), shoulders (20.83%), and upper back (10.83%). Firth logistic regression showed that fatigue in the corresponding body region after several hours of continuous work was positively associated with self-reported WMSDs symptoms in both types of workers (OR=6.544-52.838). Regarding individual characteristics, shorter height (female≤160 cm, male≤165 cm) was positively associated with self-reported neck and foot symptoms among hairdressers, and self-reported shoulder symptoms among shampoo workers (OR=16.324, 15.084, 9.680). Female shampoo workers had higher odds of self-reported neck symptoms than male shampoo workers (OR=4.924). Smoking was positively associated with self-reported upper-back and lower-back symptoms among shampoo workers (OR=10.544, 4.381). Among work-related factors, maintaining a fixed neck posture for long periods among hairdressers and prolonged standing among shampoo workers were positively associated with self-reported neck symptoms (OR=6.123, 3.080). Among shampoo workers, frequent overtime and maintaining a twisted posture were positively associated with self-reported upper-back symptoms (OR=11.710, 35.306). Sufficient rest time was negatively associated with self-reported foot symptoms among hairdressers (OR=0.238). Conclusion The prevalence of self-reported WMSDs symptoms was relatively high among workers in the hairdressing industry. Work-related fatigue and awkward working postures were strongly associated with WMSDs symptoms. Measures such as optimizing work-rest schedule, improving ergonomic workplace design, implementing fatigue monitoring and management, promoting work-break exercises, and providing training on appropriate working posture may help reduce the burden of WMSDs symptoms in this occupational group.

ObjectiveTo construct a risk prediction model for carotid artery plaques in high-risk populations of stroke based on five machine learning methods. MethodsThe clinical information of the high-risk population of stroke was collected. Factor analysis and statistical analysis of syndrome elements were conducted on their traditional Chinese medicine （TCM） symptoms and tongue and pulse manifestations. On the basis of the results of factor analysis and variable screening， five machine learning methods-classification and regression tree （CART） decision tree， support vector machine （SVM）， back propagation（BP） neural network， logistic regression， and random forest-were used to construct the risk prediction model for carotid artery plaques. ResultsThe most common TCM syndrome elements in the high-risk population of stroke was Qi deficiency. The scores of Qi deficiency， Yin deficiency， and Yang deficiency in the population with carotid artery plaques were higher than those without carotid artery plaques （P<0.05）. The CART decision tree， SVM， logistic regression， BP neural network， and random forest models showed the areas under the receiver operating characteristic （ROC） curves of 0.71， 0.75， 0.76， 0.76， and 0.75， the accuracy rates of 68.94%， 69.27%， 69.44%， 70.10%， and 69.60%， the precision rates of 68.56%， 68.53%， 68.75%， 69.74%， and 69.42%， the recall rates of 68.91%， 67.93%， 67.92%， 68.10%， and 67.31%， and the F₁ values of 0.69， 0.68， 0.68， 0.68， and 0.68， respectively. ConclusionAmong the high-risk population of stroke， the most frequently distributed TCM syndrome element is Qi deficiency， with the rest mainly being fire heat， Yin deficiency， Yang deficiency， phlegm dampness， blood stasis， and Qi stagnation. Deficiency syndrome may be a major factor leading to carotid artery plaques in the high-risk population of stroke. The BP neural network model demonstrates better performance in predicting the risk of carotid artery plaques in the high-risk population of stroke. People with carotid artery plaques are more likely to present with symptoms such as a heavy head， dizziness， headache， and thready pulse. The primary community benefits more widely when the BP neural network model is adopted to predict the risk of carotid artery plaques in the high-risk population of stroke over 40 years old.

ObjectiveTo construct a risk prediction model for carotid artery plaques in high-risk populations of stroke based on five machine learning methods. MethodsThe clinical information of the high-risk population of stroke was collected. Factor analysis and statistical analysis of syndrome elements were conducted on their traditional Chinese medicine （TCM） symptoms and tongue and pulse manifestations. On the basis of the results of factor analysis and variable screening， five machine learning methods-classification and regression tree （CART） decision tree， support vector machine （SVM）， back propagation（BP） neural network， logistic regression， and random forest-were used to construct the risk prediction model for carotid artery plaques. ResultsThe most common TCM syndrome elements in the high-risk population of stroke was Qi deficiency. The scores of Qi deficiency， Yin deficiency， and Yang deficiency in the population with carotid artery plaques were higher than those without carotid artery plaques （P<0.05）. The CART decision tree， SVM， logistic regression， BP neural network， and random forest models showed the areas under the receiver operating characteristic （ROC） curves of 0.71， 0.75， 0.76， 0.76， and 0.75， the accuracy rates of 68.94%， 69.27%， 69.44%， 70.10%， and 69.60%， the precision rates of 68.56%， 68.53%， 68.75%， 69.74%， and 69.42%， the recall rates of 68.91%， 67.93%， 67.92%， 68.10%， and 67.31%， and the F₁ values of 0.69， 0.68， 0.68， 0.68， and 0.68， respectively. ConclusionAmong the high-risk population of stroke， the most frequently distributed TCM syndrome element is Qi deficiency， with the rest mainly being fire heat， Yin deficiency， Yang deficiency， phlegm dampness， blood stasis， and Qi stagnation. Deficiency syndrome may be a major factor leading to carotid artery plaques in the high-risk population of stroke. The BP neural network model demonstrates better performance in predicting the risk of carotid artery plaques in the high-risk population of stroke. People with carotid artery plaques are more likely to present with symptoms such as a heavy head， dizziness， headache， and thready pulse. The primary community benefits more widely when the BP neural network model is adopted to predict the risk of carotid artery plaques in the high-risk population of stroke over 40 years old.

Objective To explore the temporal characteristics and correlation between active exercise rehabilitation behaviour and related symptoms in middle-aged chronic obstructive pulmonary disease(COPD)patients,and to provide a basis for constructing a full cycle precision rehabilitation management system.Methods The ecological momentary assessment method was used to select 63 middle-aged COPD patients from the respiratory and critical care medicine department of a tertiary comprehensive hospital in Wuhan from October 15 to December 1,2024,using convenience sampling.Their active exercise rehabilitation behaviour(number of exercise projects,duration)and related symptoms(dyspnea,fatigue,anxiety)were continuously monitored for a week by using baseline survey,daily active exercise rehabilitation behavior assessment questionnaire,daily symptom assessment questionnaire.A multi-layer linear model was used to analyze the dynamic correlation between active exercise rehabilitation behaviour and symptoms.Results 58 patients were included.During the 1-week ecological momentary assessment,the system triggered a total of 1,218 momentary assessments and obtained 1,120 valid responses(with the valid response rate of 91.95％),with patients completing an average of(2.76±0.39)assessments per day.Multilevel linear models showed that momentary dyspnoea,fatigue,anxiety symptoms and baseline kinesiophobia all significantly negatively influenced active exercise rehabilitation behaviour(P＜0.05).Conclusion There are dynamic changes in the active exercise rehabilitation behaviour and related symptoms of middle-aged COPD patients.Nursing staff should establish a precise rehabilitation intervention system based on symptom fluctuations,strengthen patient self-management efficiency through dynamic monitoring and hierarchical management,and achieve long-term optimization of lung rehabilitation effects.

Objective:To investigate the effects of cardiomyocyte-specific TSHR knockout on myocardial insulin resistance in a mouse model of heart failure.Methods:A cardiomyocyte-specific TSHR knockout(TSHR CKO) mouse model was generated by crossing TSHR flox/flox mice with α-MHC-Cre transgenic mice. F1 offspring(TSHR flox+ /-α-MHC-Cre+ mice) were interbred to obtain TSHR CKO mice, and littermate TSHR flox/flox mice served as controls. Fasting blood glucose levels were measured using a Roche glucometer, and fasting insulin levels were determined using a mouse insulin ELISA kit. Cardiac function and the expression of ANP, BNP, β-MHC, IRS-1, IRβ, GLUT-4, phosphorylated IRS-1, phosphorylated IRβ, and TSHR in myocardial tissues were assessed by echocardiography, RT-qPCR, Western blot, and immunohistochemistry(IHC). IHC was also used to evaluate the myocardial expression of IRS-1 and GLUT-4, while Masson′s trichrome staining was performed to assess the degree of myocardial fibrosis. Comparisons between groups were made using ANOVA. Results:The insulin resistance index indicated no systemic insulin resistance in all groups. Echocardiography revealed that compared with the FLOX group, the FLOX-ISO group exhibited significant reductions in left ventricular ejection fraction(LVEF), left ventricular fractional shortening(LVFS), left ventricular end-systolic volume(LVESV), and left ventricular end-diastolic volume(LVEDV), along with increases in heart weight-to-body weight(HW/BW), left ventricular end-systolic diameter(LVESD), and left ventricular end-diastolic diameter(LVEDD). Compared with the FLOX-ISO group, the CKO-ISO group showed significantly increased LVEF and decreased LVESV, LVEDV, LVESD, and LVEDD. Immunohistochemistry results demonstrated that myocardial TSHR knockout increased the expression of IRS-1 and GLUT-4. Additionally, RT-qPCR and Western blotting showed that ANP, BNP, and β-MHC expression levels were reduced, while IRS-1, IRβ, and GLUT-4 expression levels were elevated in TSHR CKO mice. Conclusion:Cardiomyocyte-specific TSHR knockout improves myocardial insulin resistance in mice with heart failure.

OBJECTIVE To summarize the procedural management practice of hospital infection review for new medical technologies and projects so as to provide references for other medical institutions.METHODS The data with the respect to review of new technologies and projects were collected from Zhejiang Provincial Hospital of Chinese Medicine between 2018 and 2023,and the process of review and management practice were summarized.The potential risk for infection was evaluated by establishing the evaluation indexes for nosocomial infection man-agement of new technologies and projects and conducting procedural management of the review so as to make clear of the corresponding prevention and control measures.The tracking closed-loop management was carried out for the new technologies and projects that have been already implemented.RESULTS Totally 629 items of new medical technologies and projects were involved in the review and tracking closed-loop management,including 499(79.33％)medical technologies and pharmacy-related projects and 130(20.67％)nursing.The result of review showed that there were 606(96.34％)items with'approval',14(2.23％)items with'approval after revision',3(0.48％)items with'approval after reexamination,and 6(0.95％)items with'disapproval'.The result of risk as-sessment indicated that there were 5(0.79％)items of high-risk projects and 624(99.21％)items of low-risk pro-jects.There was no severe nosocomial infection or infection cluster incident during the tracking of clinical applica-tion of the approved items.CONCLUSION The risk of nosocomial infection has been controlled from the origin through the practice,which further standardizes the clinical application of the new technologies and projects and provides evidence for normalized application of the new technologies and projects in the medical institutions.

Objective To explore the development trajectory and root cause of kinesiophobia in patients with diabetic peripheral neuropathy.Methods By the convenience sampling method,240 diabetic peripheral neuropathy patients who were hospitalized in the Department of Endocrinology of a tertiary A hospital in Jiangsu Province from May 2022 to November 2022 were selected.The baseline data of the patients are collected using a general questionnaire,the Tampa Scale for Kinesiophobia,the Chinese version of the Multidimensional Fatigue Inventory-20,the Pittsburgh Sleep Quality Index,the Social Support Rate Scale,and the Numerical Rating Scale for Pain.At the time of discharge,and at 3,6,and 12 months post-discharge,the level of kinesiophobia in the patients is assessed.The growth mixture model was used to classify the trajectory of kinesiophobia and analyze its root causes.Results Ultimately,227 patients in this study completed the survey.The trajectories of kinesiophobia in patients with diabetic peripheral neuropathy were divided into 3 latent classes:persistent high kinesiophobia group(22.5％),moderate kinesiophobia decline group(44.9％)and persistent low kinesiophobia group(32.6％).The results of multivariate Logistic regression analysis showed that age,frequency of hypoglycemia,complications,sleep quality,fall history within a year,pain and fatigue score were influencing factors of the latent classes of kinesiophobia trajectories in patients with DPN(P＜0.05).Conclusion Within 12 months after discharge,the kinesiophobia of patients with diabetic peripheral neuropathy shows population heterogeneity.Medical staff should give targeted interventions according to the developmental trajectories of kinesiophobia and root cause analysis.

Objective:To investigate the effects of repetitive transcranial magnetic stimulation(rTMS) on learning memory and abnormal Aβ deposition in cerebral amyloid angiopathy(CAA) model mice, and further to investigate whether the mechanism involves the transport function of glymphatic system.Methods:Eight-month-old SPF grade Tg-SWDI mice were randomly divided into the CAA group and the rTMS group according to the random number table method with 7 in each group.Seven wild-type mice of the same genetic background and age served as the control group. The mice in rTMS group received two weeks of high-frequency rTMS intervention, and the mice in CAA group and control group were only restrained without rTMS intervention.Learning and memory functions were evaluated using the Morris water maze test.Amyloid-beta deposition, glymphatic system clearance, and aquaporin-4(AQP4) polarization were assessed using immunofluorescence, and AQP4 expression levels were measured by Western blot.Statistical analysis of the data was conducted using SPSS 25.0 and GraphPad Prism 9.5 softwares.Repeated-measures ANOVA was used for data on escape latency, and one-way ANOVA was used for comparisons between multiple groups for other data.Results:(1)In the novel object recognition test, there were statistically significant differences in recognition indices among the three groups of mice ( F=22.59, P<0.05). Compared with the control group, the mice in the CAA group showed a significant decrease in the new object recognition index ( P<0.05).Compared with the CAA group, the mice in the rTMS group showed a significant increase in the new object recognition index ( P<0.05).(2)In the Y-maze, there were statistical differences in the spontaneous alternation rates among the three groups ( F=5.00, P<0.05). Compared with the control group, the spontaneous alternation rate in the CAA group was significantly lower ( P<0.05).And compared with the CAA group, the spontaneous alternation rate in the rTMS group was significantly higher ( P<0.05).(3)In the Morris water maze test, there were significant interactions in escape latency among the three groups ( F=4.05, P=0.02), significant main effects of time ( F=713.22, P<0.01), and significant main effects of group ( F=421.55, P<0.01). There was no significant statistical difference in swimming speed among the three groups ( F=0.19, P>0.05), while the difference of the number of entries into the inner zone and the proportion of time spent were statistically significant( F=71.67, 294.14, both P<0.05).Compared with the control group, the CAA group mice significantly decreased in the number of entries into the inner zone and the proportion of time spent in the middle zone (both P<0.01).(4)Compared with the CAA group, the rTMS group significantly increased in the number of entries into the inner zone and the proportion of time spent in the middle zone (both P<0.01).The result of immunofluorescence test showed that there was a statistically significant difference in the levels of Aβ in the cerebral vessels among the three groups( F=385.76, P<0.01).The levels of Aβ in the cerebral vessels of the CAA group (62.00±2.65) were significantly higher than those in the control group (9.00±1.00, P<0.01).The levels in the rTMS group (51.33±3.21) were significantly lower than those in the CAA group (62.00±2.65, P<0.01). Using the residual fluorescence tracer levels of the control group as a baseline, there were statistically significant differences in the tracer intensities in the corpus callosum and cerebral cortex( F=258.97, 46.44, both P<0.05), the tracer intensities in the corpus callosum (3.57±0.21) and cerebral cortex (4.96±0.79) of the CAA group mice were significantly higher than those in the rTMS group (1.45±0.14, 1.78±0.47, P<0.01). The polarization of AQP4 in the cerebral cortex of rTMS group (0.51±0.07) was significantly higher than that in the CAA group (0.30±0.02, P<0.01). Conclusion:rTMS can alleviate learning memory and abnormal Aβ deposition in CAA model mice by modulating AQP4 polarisation and promoting transport function of glymphatic system.