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 analyze the characteristics and changes in incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents from 2015 to 2019.Methods:The incidence and mortality data of ischemic and hemorrhagic stroke from 2015 to 2019 were collected from the China Registry of Cardiovascular Events (China RACE), which was established in 2014 and covered 100 counties (cities and districts) in 31 provinces in China. The age-standardized incidence rate (ASIR) was calculated using the Seventh National Census data as the standard population. The ratio of the incidence rate of ischemic stroke to hemorrhagic stroke was calculated. The subtype-specific mortality-to-incidence ratio (M/I) was calculated by the ratio of the number of deaths to the reported incidence cases. The relative ratio (RR) of M/I for ischemic to hemorrhagic stroke was calculated. The Joinpoint model was used to analyze the annual percentage change (APC) and trend of the incidence rate of stroke.Results:From 2015 to 2019, a total of 1 354 614 new stroke cases were reported, including 1 077 244 (79.52%) ischemic stroke and 277 370 (20.48%) hemorrhagic stroke cases, respectively. A total of 248 620 stroke deaths were reported, including 119 819 (48.19%) ischemic stroke deaths and 128 801 (51.81%) hemorrhagic stroke deaths. The incidence ratio of ischemic/hemorrhagic stroke from 2015 to 2019 was 3.50∶1, 3.76∶1, 3.63∶1, 4.23∶1, and 4.35∶1, respectively. From 2015 to 2019, there was no statistically significant annual trend of ASIR of ischemic stroke in overall, urban and rural areas and males ( Ptrend>0.05), while there was a downward trend in females (APC=-1.02%, Ptrend=0.042). The incidence of hemorrhagic stroke in the whole population, rural areas, males and females showed a downward trend ( Ptrend<0.05). Patients aged 45-49 years had an upward trend in the incidence rate of ischemic stroke (APC=3.82%, Ptrend=0.011), while those aged 70-74 years (APC=-7.37%, Ptrend=0.034), 80-84 years (APC=-9.75%, Ptrend=0.001) and 85 years and over (APC=-11.22%, Ptrend=0.017) presented a downward trend in the incidence of hemorrhagic stroke. During the period, the overall relative ratio of M/I (RR) for ischemic to hemorrhagic stroke was 4.2∶1, which was lower in urban than in rural areas (3.8 vs. 4.3). The largest gap between urban and rural areas was in the 55-59 age group (6.8 vs. 9.3). Conclusion:The incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents are severe from 2015 to 2019, and there are regional and population differences.

Objective:To present the epidemiological characteristics of ≤28 days case fatality in both hemorrhagic stroke (HS) and ischemic stroke (IS) patients in national cardiovascular disease surveillance areas from 2015 to 2019.Methods:Data on all new patients with stroke and ≤28 days outcomes from 2015 to 2019 were from the China Registry of Cardiovascular Events, which was established in 2014, covering 100 counties (cities, districts) in 31 provinces in China. Poisson regression was used to analyze the annual trend of ≤28 days case fatality. The age-standardized case fatality was directly calculated based on all new stroke onset.Results:In total, 112 069 deaths in HS patients ≤28 days after the onset, as well as 94 373 in IS patients, were identified during the study period. In 2019, the ≤28 days case fatality rate in HS patients was 4.75 times that of IS patients (37.08% vs. 7.80%), as well as that 4.06 times in urban areas (30.13% vs. 7.43%) and 5.30 times in rural areas (42.63% vs. 8.05%), respectively. Thus, in rural areas, HS patients showed 41.49% higher ≤28 days case fatality rate than that in urban areas, as well as 8.34% higher in IS patients. Those ≤28 days case fatality in both stroke subtypes onset increased with age and reached the highest level in those aged 85 years and over. During the study period, HS and IS patients in each age group displayed significant decrease trend in ≤28 days case fatality rate (trend P<0.001). Compared with that in 2015, the age-standardized ≤28 days case-fatality in HS patients in 2019 decreased by 28.52%, which was more in urban areas (-34.27%) than that in rural areas (-23.19%). Meanwhile, IS patients experienced a 39.90% reduction in ≤28 days case fatality, which was much lower in urban areas (-31.62%) than in rural areas (-45.10%, all trend P<0.001). Conclusions:From 2015 to 2019, ≤28 days case fatality in both HS and IS patients decreased in China. Wide variations of ≤28 days case-fatality were evident in the level and trend in stroke subtype, age of patients, as well as urban and rural areas. More precise and comprehensive strategies for stroke prevention, treatment, and post-stroke management are urgently required in China.

Objective:The aim of this study was to explore the risk factors that affect implementation of the innovative technique of single-incision laparoscopic appendectomy (solo-SLA) without assistance in patients with complicated appendicitis, the goal being improving surgical success rates and reducing the incidence of complications.Methods:This was an observational study. Indications for solo-SLA surgery were as follows: (1) computed tomography or ultrasound findings suggestive of acute appendicitis, accompanied by a high white blood cell count and C-reactive protein concentration; (2) disease course exceeding 72 hours, standard anti-infection treatment ineffective, inflammatory reaction not localized, surgery mainly aimed at abscess drainage, and the appendix removed if indicated intraoperatively; (3) acute onset stabilized for more than 3 months after conservative treatment; and (4) recurrent chronic appendicitis. Relative contraindications comprised: (1) cardiopulmonary insufficiency, extremely high risk for general anesthesia for laparoscopic surgery; (2) severe coagulation dysfunction; and (3) imaging findings suggestive of formation of a peri-appendiceal abscess, stable after anti-infection treatment, and a tendency for the inflammatory reaction to localize. We retrospectively collected clinical data of 106 patients with complicated appendicitis who had undergone solo-SLA in the Department of Emergency Surgery, Peking University People's Hospital from February to October 2023. Preoperative computed tomography showed appendiceal fecaliths, blurring of the tissue surrounding fat, intra- and extra-luminal gas and exudate, peri-appendiceal abscess, ascites, and intestinal obstruction by appendicitis. The study cohort comprised 53 male and 53 female patients aged (41.4±17.4) years. The median body mass index was (24.2±3.6) kg/m 2 and median preoperative body temperature (37.3±0.9)℃ Appendicitis had been present for >3 days in 21 of the patients (19.8%) and the maximum diameter of the appendix was (12.4±3.8) mm. The efficacy of the surgery was assessed and logistic regression analysis used to explore the factors affecting the duration of the procedure. The relationship between the maximum diameter of the appendix and duration of surgery was non-linear and was explored using a logistic regression model with restricted cubic spline (RCS). Results:Only one patient required conversion to open surgery; all the other patients successfully completed solo-SLA with a median intraoperative blood loss of 10 (1-100) ml and a surgical time of (65.4±31.7) minutes. Pain scores on postoperative Day 1 and 7 were (3.4±3.2) points and (1.5±1.7) points, respectively. There were no significant postoperative complications .The postoperative hospital stay was (3.5±1.5) days and the interval to resuming normal activities 14 (2-40) days. According to univariate and multivariate analyses, disease course >3 days (OR=5.19, 95%CI: 1.59-16.98, P=0.006) and C-reactive protein >10 mg/L (OR=1.01,95%CI: 1.00-1.02, P=0.003) were independent risk factors for surgical duration >60 minutes, whereas the maximum diameter of the appendix was not independently associated with duration of surgery (OR=1.10, 95%CI: 0.97-1.25, P=0.119). RCS analysis results showed a "U-shaped" association between the maximum diameter of the appendix and duration of surgery, the inflection point of the RCS curve being at a diameter of 10 mm. When the maximum diameter of the appendix was <10 mm, increases in diameter were not associated with longer duration of surgery (OR=1.15,95%CI: 0.55-2.58, P=0.710); whereas when the diameter was ≥10 mm, the maximum diameter of the appendix was associated with increased duration of surgery (OR=1.20, 95% CI: 1.04-1.42, P=0.022). Conclusion:The solo-SLA procedure can be performed to treat complicated appendicitis. A disease course >3 days, C-reactive protein concentration >10 mg/L, and maximum diameter of the appendix ≥10 mm are all associated with greater difficulty of solo-SLA surgery.

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 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 explore the effects of home-based exercise rehabilitation on cardiac structure, valvular function, and exercise capacity in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). Methods 49 patients with severe AS who underwent TAVR at Zhongshan Hospital, Fudan University, from January 2024 to February 2025 were enrolled. They were divided into an exercise group (n＝25) or a non-exercise group (n＝24) based on participating or not in home-based rehabilitation after TAVR. The exercise group received 12 weeks of home-based exercise training (aerobic exercise plus resistance training every week); the non-exercise group received routine care. Transthoracic echocardiography (TTE) was used to assess cardiac structural parameters before discharge (T0) and after 12 weeks of exercise (T1). Functional outcomes including the 6-minute walk test (6MWT), Duke Activity Status Index (DASI), and Short Physical Performance Battery (SPPB) were compared between the two groups. A linear mixed-effects model was used to analyze the effect of home-based rehabilitation on echocardiographic parameters. Patients were stratified by baseline 6MWT (＜240 m as low-function subgroup, ≥240 m as high-function subgroup) to compare exercise-related outcomes between subgroups. Results At T1, the exercise group had a longer 6MWT distance than the non-exercise group (P＝0.012). The linear mixed-effects model showed that after 12 weeks of exercise, the left ventricular end-diastolic diameter (LVEDD) decreased in the exercise group but slightly increased in the non-exercise group, with a significant difference in changes over time between the two groups (P_interaction＝0.030). The exercise group also showed greater improvement in effective orifice area index (P_interaction＝0.028) and effective orifice area (P_interaction＝0.042) than the non-exercise group. Subgroup analysis revealed that in the low-function subgroup, the exercise group showed greater improvement in the 6MWT (P_interaction＝0.035) and the effective orifice area index (P_interaction＝0.046) compared to the non-exercise group; in the high-function subgroup, the exercise group showed greater improvement only in LVEDD compared to the non-exercise group (P_interaction＝0.046). Conclusions Home-based exercise rehabilitation improves exercise capacity, optimizes left ventricular remodeling, and enhances valvular function in patients with severe AS after TAVR, with greater benefits observed in patients with lower baseline 6MWT.

Objective To explore the predictive value of quantitative parameters of dual-layer detector spectral CT(DLCT)for Ki-67 expression in solid lung adenocarcinoma.Methods The data of 103 patients were retrospectively collected,and the patients were divided into Ki-67 high expression and Ki-67 low expression groups according to Ki-67 proliferation index.The quantitative parame-ters of DLCT were measured and calculated,and the differences in these parameters between the two groups were compared.The parameters with statistically significant differences were assessed for correlation with Ki-67 expression.The efficacy of DLCT param-eters and combined parameters in predicting Ki-67 expression in solid lung adenocarcinoma were evaluated by receiver operating character-istic(ROC)curve and compared by DeLong test.Results Long diameter,short diameter and smoking history were positively corre-lated with the Ki-67 expression in solid lung adenocarcinoma(r>0,P<0.05).Gender and quantitative parameters of DLCT were nega-tively correlated with the Ki-67 expression in solid lung adenocarcinoma(r<0,P<0.05).The combined parameters of convention and spectral CT had the highest prediction efficiency.Conclusion The quantitative parameters of DLCT can be used to evaluate the Ki-67 expres-sion in solid lung adenocarcinoma.

Objective:To present the epidemiological characteristics of ≤28 days case fatality in both hemorrhagic stroke (HS) and ischemic stroke (IS) patients in national cardiovascular disease surveillance areas from 2015 to 2019.Methods:Data on all new patients with stroke and ≤28 days outcomes from 2015 to 2019 were from the China Registry of Cardiovascular Events, which was established in 2014, covering 100 counties (cities, districts) in 31 provinces in China. Poisson regression was used to analyze the annual trend of ≤28 days case fatality. The age-standardized case fatality was directly calculated based on all new stroke onset.Results:In total, 112 069 deaths in HS patients ≤28 days after the onset, as well as 94 373 in IS patients, were identified during the study period. In 2019, the ≤28 days case fatality rate in HS patients was 4.75 times that of IS patients (37.08% vs. 7.80%), as well as that 4.06 times in urban areas (30.13% vs. 7.43%) and 5.30 times in rural areas (42.63% vs. 8.05%), respectively. Thus, in rural areas, HS patients showed 41.49% higher ≤28 days case fatality rate than that in urban areas, as well as 8.34% higher in IS patients. Those ≤28 days case fatality in both stroke subtypes onset increased with age and reached the highest level in those aged 85 years and over. During the study period, HS and IS patients in each age group displayed significant decrease trend in ≤28 days case fatality rate (trend P<0.001). Compared with that in 2015, the age-standardized ≤28 days case-fatality in HS patients in 2019 decreased by 28.52%, which was more in urban areas (-34.27%) than that in rural areas (-23.19%). Meanwhile, IS patients experienced a 39.90% reduction in ≤28 days case fatality, which was much lower in urban areas (-31.62%) than in rural areas (-45.10%, all trend P<0.001). Conclusions:From 2015 to 2019, ≤28 days case fatality in both HS and IS patients decreased in China. Wide variations of ≤28 days case-fatality were evident in the level and trend in stroke subtype, age of patients, as well as urban and rural areas. More precise and comprehensive strategies for stroke prevention, treatment, and post-stroke management are urgently required in China.