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.

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 investigate the effects of Icariin(ICA)on the proliferation,angiogenesis,and migration of human retinal pigment epithelial(RPE)cells in a high-glucose environment and its mechanism.Methods ARPE-19 cells in good growth state were selected and divided into five groups:control group(Control group),high glucose group(HG group),high glucose+low-dose Icariin group(HG+ICA-L group),high glucose+medium-dose Icariin group(HG+ICA-M group),and high glucose+high-dose Icariin group(HG+ICA-H group).The cells in the control group were cul-tured in a medium containing 5.5 mmol·L-1 glucose.Cells in the HG group were cultured in a medium containing 30.0 mmol·L-1 glucose.The cells in each ICA intervention group were first cultured in a medium containing 30.0 mmol·L-1 glucose,and then 10.0 μmol·L-1,20.0 μmol·L-1 and 40.0 μmol·L-1 ICA were added for culture,respectively.The CCK-8 assay was used to detect cell proliferation activity,the EdU assay was used to detect cell proliferation,the Transwell assay was used to detect cell migration ability,and the Matrigel assay was used to detect in vitro tube formation ability.The expression levels of α-smooth muscle actin(α-SMA),matrix metalloproteinase-2(MMP-2),vascular endothelial growth factor A(VEGFA),epidermal growth factor receptor(EGFR),and proteins related to the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)pathway were detected by Western blot.Results The cell viability and EdU-positive rate of ARPE-19 cells in the HG group were higher than those in the Control group(all P＜0.05).The cell viability and EdU-positive rate in the HG+ICA-L,HG+ICA-M,and HG+ICA-H groups were lower than those in the HG group(all P＜0.05).The number of migrated cells and tubes formed in the HG+ICA-L,HG+ICA-M,and HG+ICA-H groups were less than those in the HG group,and the expression levels of α-SMA,MMP-2,VEGFA,and EGFR proteins were lower than those in the HG group(all P＜0.05).The levels of p-PI3K and p-Akt in the HG+ICA-L,HG+ICA-M,and HG+ICA-H groups were lower than those in the HG group(all P＜0.05).Conclusion ICA inhibits the proliferation,migration,and angiogenesis of ARPE-19 cells stimulated by high glucose by suppressing the activation of the PI3K/Akt pathway.

Objective:To investigate the diagnostic value of preoperative fine-needle aspiration (FNA) of lymph nodes combined with washout thyroglobulin testing (FNA-Tg) for detecting lymph node metastasis in papillary thyroid carcinoma (PTC).Methods:A prospective study was conducted on 112 patients diagnosed with PTC at Wenzhou Central Hospital from December 2021 to December 2023, all of whom had suspicious lateral cervical lymph node metastasis identified through preoperative ultrasound. All patients underwent lymph node FNA and FNA-Tg. The suspicious lymph nodes were surgically excised. The diagnostic efficacy of FNA, FNA-Tg, and the combination of FNA and FNA-Tg for PTC with lymph node metastasis was compared.Results:A total of 112 patients were identified with 120 lymph nodes, among which 98 lymph nodes were confirmed to have metastasis by pathology. The results of the FNA cytology examination revealed 83 positive cases and 37 negative cases. The accuracy, sensitivity, and specificity for diagnosing lateral cervical lymph node metastasis were 80.83%, 80.61%, and 81.82%, respectively. In the FNA-Tg, there were 89 positive cases and 31 negative cases, with accuracy, sensitivity, and specificity for diagnosing lateral cervical lymph node metastasis at 89.17%, 88.78%, and 90.91%, respectively. When FNA and FNA-Tg were used in combination, there were 101 positive cases and 19 negative cases; the accuracy, sensitivity, and specificity for diagnosing lateral cervical lymph node metastasis were 94.17%, 97.96%, and 77.27%, respectively. The combined use of FNA and FNA-Tg demonstrated significantly higher accuracy in diagnosing metastatic lateral cervical lymph nodes in PTC compared to FNA and FNA-Tg alone ( χ2 = 50.64, P < 0.001; χ2 = 64.81, P < 0.001). Conclusions:The combined use of FNA and FNA-Tg demonstrates high accuracy in diagnosing lateral cervical lymph node metastasis in PTC.

Objective:To explore the applicability and effectiveness of the "Hand as Foot" visual teaching method in bedside teaching of spinal surgical diseases, investigate its impact on enhancing student learning outcomes and clinical application abilities, and provide new directions and guidance for teaching methods.Methods:A total of 60 students from the five-year clinical medicine program enrolled in 2019 at Inner Mongolia Medical University were selected and randomly assigned to either an experimental group or a control group (30 students each) using a random number table. The teaching content covered bedside knowledge related to spinal surgery. The control group received traditional oral bedside teaching method, while the experimental group received the "Hand as Foot" visual teaching method. Both groups of students received eight 45-min bedside teaching sessions. After class, teaching effectiveness was evaluated through a theoretical knowledge examination and student classroom satisfaction was evaluated, including interest in learning, enthusiasm and participation, classroom activity, teacher-student interaction, and mastery of theoretical knowledge. SPSS 27.0 software was used for statistical analysis. Continuous variables were expressed as mean ± standard deviation and compared using the t-test; categorical variables were presented as numbers or percentages and compared using the chi-square test. Results:The experimental group scored (78.80±3.19) on the theoretical knowledge examination, while the control group scored (73.20±4.89), with a significant difference between the two groups ( t=3.72, P=0.001). In the classroom satisfaction survey, the experimental group also outperformed the control group in learning interest [(9.60±0.51) vs. (8.40±0.74)], enthusiasm and participation [(9.40±0.63) vs. (8.07±0.70)], classroom activity [(9.53±0.64) vs. (8.67±0.81)], teacher-student interaction [(9.53±0.52) vs. (8.33±0.72)], and mastery of theoretical knowledge [(8.60±0.91) vs. (7.20±0.77)], with all differences being statistically significant ( P<0.05). Conclusions:The "Hand as Foot" visual teaching method is suitable for bedside teaching of spinal diseases, allowing students to understand diseases more vividly. This method not only facilitates effective communication between teachers and students, enhances student understanding of relevant knowledge, and improves their confidence in learning, but also inspires a more proactive learning attitude.

Objective To explore the risk factors for clinical severity in patients with hypertriglyceridemic acute pancreatitis(HTG-AP).Methods A retrospective cohort study was conducted to collect the clinical data of HTG-AP patients admitted to the First Hospital of Putian City from June 2022 to December 2023.Patients were divided into a non-severe group(132 cases)and a severe group(22 cases)according whether they developed complications such as organ dysfunction and pancreatitcs necrosis.The differences in baseline characteristics between the two groups were compared,such as general data[including gender,age,body mass index(BMI),history of hypertension and diabetes],laboratory examination indicators[including glycated hemoglobin(HbA1c),white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),systemic immune-inflammation index(SII),serum albumin(Alb),serum mylase to serum calcium ration(ACR),D-dimer,platelet count(PLT),total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL),and low-density lipoprotein(LDL)].Univariate and multivariate Logistic regression analyses were used to screen for independent risk factors for clinical severity in HTG-AP patients,and the predictive efficacy of various risk factors for clinical severe progression of HTG-AP was evaluated using the receiver operator characteristic curve(ROC curve).Results A total of 154 patients were included,including 131 males and 23 females;the age range was 18-67 years,average was(39.00±8.74)years.A total of 22 patients developed clinical severity,with an incidence rate of 14.3%.There were no statistically significant differences between the two groups in terms of gender,age,BMI,hypertension,diabetes,HbA1c,WBC,CRP,Alb,PLT,TC,TG,HDL,and LDL.Compared with the non-severe group,the levels of PCT,D-dimer,ACR,and SII were significantly higher in the severe group[PCT(μg/L):0.34(0.12,0.49)vs.0.09(0.05,0.35),D-dimer(μg/L):1 010(340,1 790)vs.310(200,700),ACR:201.10(121.71,568.53)vs.61.79(27.99,153.77),SII:2 076.57(1 187.06,3 665.47)vs.1 033.95(717.95,1 466.76),all P<0.05].Multivariate Logistic regression analysis showed that ACR at admission was an independent risk factors for the development of clinical severity in HTG-AP patients(P<0.05).ROC curve analysis indicated that ACR has certain value in predicting clinical severity in HTG-AP area under the curve(AUC)=0.787[95%confidence interval(95%CI)was 0.685-0.890],P<0.001,and when the optimal cut-off value was set at 79.663,its sensitivity was 90.9%and specificity was 58.3%.Conclusion An abnormally elevated ACR at admission in HTG-AP patients is significantly associated with the risk of clinical severity and can be used as potential predictive indicator for early identification of high-risk patients.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.