Objective To study the spatial distribution of the incidence of pulmonary tuberculosis in Hubei Province and its influencing factors, so as to improve the theoretical basis for scientific development of tuberculosis prevention and control measures in the future. Methods The data of reported incidence of tuberculosis and related influencing factors in various counties and districts of Hubei Province in 2020 were collected. Global Moran's I index, hotspot analysis and geographically weighted regression (GWR) model analysis were used to calculate the spatial autocorrelation of the incidence of tuberculosis, and to analyze the influencing factors affecting the incidence rate of tuberculosis. Results There were obvious regional differences in the space distribution of the incidence rate of tuberculosis. Hot spot analysis showed positive spatial correlation and obvious clustering. The GWR model (AICc=784.251) in this study had higher AICc value compared to the ordinary least squares regression (OLS) model (AICc=804.2585). The GWR model showed that the increase in the proportion of the population aged 65 and above and the proportion of the ethnic minority population had a significant promoting effect on the increase of the incidence rate of tuberculosis, and there was significant spatial heterogeneity. The effect of PM_2.5 concentration on the incidence rate of pulmonary tuberculosis varied in different regions, and the degree of effect was also different. Conclusion The proportion of people aged 65 and above and the proportion of ethnic minorities may significantly influence the incidence of pulmonary tuberculosis. The effect of PM_2.5 concentration varies in different regions, so targeted measures should be formulated according to the situation in different regions.

Objective To study the population genetic structure and phylogenetic relationships by combining Y-STR haplotype genetic information from the Han population in Dalian with 32 domestic and foreign groups.Methods Blood samples of 958 Han male volunteers from Dalian were collected.Genetic typing of 42 genetic loci was completed using Y-STR fluorescent reagent kits and capillary electrophoresis.Related forensic parameters were calculated.Nei's standard genetic distances among 33 populations based on 17 Y-STR loci were computed,in order to create a principal coordinate analysis as well as construct a phylogenetic tree.Results The analysis of genetic polymorphisms at 42 Y-STR loci revealed 30 unconventional alleles at 10 loci.Genetic analysis of the population based on 17 Y-STR loci confirmed that Dalian's Han population had the closest genetic distance to the Anshan's Han population,followed by populations from Henan,Heilongjiang,Jilin,Shandong,and Chongqing.Furthermore,the genetic distances between the Han population in Dalian and the Qiang population in Beichuan or the Miao population in Guizhou were relatively closer than that to the Manchu population living in Liaoning.Conclusion The genetic distance between the Han population in Dalian and other groups is not entirely proportional to ethnicities and geographical proximity.Both population migration and ethnic assimilation or isolation may have influence on it.

Objective To evaluate 99mTc-HYNIC-TOC somatostatin receptor and 131 I-MIBG imaging in clinical diag-nostic of pheochromocytoma and paraganglioma(PPGL).Methods This was a retrospective study.359 PPGL pa-tients diagnosed by pathology microscopy were included.The diagnostic sensitivity and influencing factors on 99mTc-HYNIC-TOC somatostatin receptor and 131 I-MIBG imaging were analyzed.Results The positive rate of 99mTc-HYN-IC-TOC somatostatin receptor scintigraphy was 57.7%(184/319)and 131I-MIBG imaging was 83.2%(232/279).The positive rates of 99m Tc-HYNIC-TOC somatostatin receptor imaging in the adrenal glands,retroperitoneum,head and neck,heart and mediastinum,pelvis and bladder were 53.3%,62.5%,95.0%,66.7%,50.0%and 11.0%respec-tively and the positive rates of 131I-MIBG imaging were 86.7%,88.5%,45.4%,50.0%,75.0%and 33.3%respec-tively.The positive rate of the two imaging did not showed difference among patients with different genetic back-grounds(SDH,VHL,RET mutations).The median maximum diameter of tumors was 4.4(3.0,6.1)cm.and the diag-nostic sensitivity of somatostatin receptor imaging and 131 I-MIBG imaging for larger tumors(≥4.4 cm)was signifi-cantly higher than those for the smaller tumor group(＜4.4 cm)(64.0%vs.51.3%;92.3%vs.74.1%)(P＜0.01).Tumors in 19 patients(5.3%)failed to uptake neither imaging method.Conclusions This is the largest PPGL cohort in China concerning 99m Tc-HYNIC-TOC somatostatin receptor imaging and 131 I-MIBG imaging.The sensitivity of 131 I-MIBG imaging is higher than that of 99m Tc-HYNIC-TOC somatostatin receptor imaging,but for some tumors,such as head and neck paraganglioma,the latter has obvious advantages.These two imagings technol-ogies are complementary and the choice of them should depend the individual situation of patients.

Objective To study the relationship between serum neuron-specific enolase(NSE)and clinical features of pheochromocytoma/paraganglioma(PPGL).Methods Totally 501 PPGL patients diagnosed from January 2019 to December 2022 were divided into normal NSE group(NSE≤16.3 ng/mL)and elevated NSE group(NSE＞16.3 ng/mL).The clinical characteristics were compared between the two groups.Results Compared with normal NSE group,patients in the elevated NSE group had larger diameter in primary tumor(5.00 cm vs.4.60 cm),higher 24-hour urinary norepinephrine(NE)and 24-hour urinary dopamine(DA)levels,and a higher rate of metasta-sis(31.6%vs.13.7%)(P＜0.05).NSE level was positively correlated with the primary tumor size(r=0.131,P＜0.05),24-hour urinary NE level(r=0.195,P＜0.05)and 24-hour urinary DA level(r=0.119,P＜0.05).Conclusions The level of NSE is related to tumor size,secretion function and metastasis in PPGL patients.

Objective:To retrospectively summarize the clinical characteristics and treatment of 49 patients with hyperthyroid cardiopath and to explore the diagnosis and treatment methods of hyperthyroid cardiopathy.Methods:A total of 49 patients with hyperthyroid cardiopath(HC group) who were successfully treated and followed up in the Department of Endocrinology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, from January 2016 to December 2021 were collected, and 85 cases of Graves′ disease without heart disease were collected as the control group(GD group). The medical history, laboratory tests, and echocardiographic parameters of the two groups were compared. Differences in thyroid and cardiac indicators before and after treatment in the HC group were summarized, along with the dosage of β-receptor blockers used in treating different types of conditions(atrial fibrillation and heart failure.Results:Patients in the HC group were older and had a longer duration of hyperthyroidism than those in the GD group( P<0.001, P=0.002). There were no significant differences in thyroid hormone levels between the two groups except for reverse triiodothyronine(rT 3). Age and rT 3 were independent risk factors of hyperthyroid cardiopathy. rT 3 level was linearly positively correlated with brain natriuretic peptide, systolic pulmonary artery pressure, left artrium diamete (LAD) and left ventricular end-systolic diameter(LVDs; r=0.352, P<0.001; r=0.392, P=0.019; r=0.202, P=0.029; r=0.242, P=0.028). In patients of HC group, free triiodothyronine(FT 3) level returned to normal range after 2.87(1.63, 5.53) months of treatment with radioiodine(41/49) or antithyroid drugs(8/49), while brain natriuretic peptide, LAD, LVDs, and systolic pulmonary artery pressure declined after 5.00(1.25, 8.00) months of treatment. Non-selective β-receptor blockers were used for both hyperthyroid heart failure and atrial fibrillation, and there was no statistically significant difference in dosage[(86.52±47.83)mg vs(88.67±47.19)mg, P>0.05]. Conclusions:rT 3 may be a biomarker of hyperthyroid cardiopath and indicate the severity of hyperthyroidism. β-receptor blockers are crucial in treating patients with hyperthyroidism who develop atrial fibrillation and heart failure.

Objective:Exploring the clinical characteristics and treatment outcomes of tailgut cysts, and improving the understanding of this disease.Methods:A retrospective analysis of 42 patients with tailgut cyst surgically treated from Jan 2012 to Mar 2024 was conducted.Results:This study included 42 patients (28 females,14 males) with a median age of 51 (23-76)years old. Nineteen cases of perineal/abdominal pain, 13 cases of perianal swelling, 10 cases of perianal abscess, 7 cases of sacrococcygeal sinus, and 4 cases of anal mass were observed. These symptoms often occurred simultaneously. All 42 patients had lesions located behind the rectum, with a relative position to the coccyx (7 above the coccyx, 17 below the coccyx, 11 above and between the coccyx levels, and 7 horizontally).Tailgut cysts were located in the pelvic floor, with 3 cases above the levator ani muscle, 17 cases below the levator ani muscle, and 22 cases between the levator ani muscle levels. Forty-one cases were treated with posterior approach, and 1 case was treated with combined approach. Thirty-two were unilocular and 10 multilocular. Female patients with multiple compartments were significantly more common than males ( P<0.05), while tumor location, tumor size, recurrence, and malignancy were all independent of gender. After surgery, 8 cases (19％) experienced recurrences and 5 cases of malignant transformation patients had a long term multiple relapses. Conclusions:Tailgut cysts are rare,while women were common seen.Non-specific symptoms of pain in the perineum or abdomen, perianal swelling or abscess, are usually observed. In addition, multiple relapses could have malignant transformation. Surgical complete resection is the most reasonable treatment method and the appropriate surgical path should be selected based on the size, location, and relationship with adjacent tissues of the tumor.

The pachychoroid spectrum disorders (PSD) refers to a group of clinical disorders characterized by common features of pathological choroidal thickening and potential pathogenic mechanisms. The pathological mechanism of PSD is very complex, and the theory of venous overload provides valuable research directions. The multimodal imaging technology represented by optical coherence tomography angiography has continuously evolved to provide clear and three-dimensional images of the fundus, making it easier to diagnose and monitor PSD at an early stage. There is no unified consensus on how to develop a treatment plan for PSD, and current research has shown that feasible treatments include drug therapy, laser photocoagulation therapy, and photodynamic therapy. However, the evidence of effectiveness and safety provided by these studies is still not sufficient. Surgery and integrative Chinese and Western medicine may provide new prospects for the treatment of PSD. In the future, it is necessary to further develop reasonable research programs, expand the sample size, strengthen follow-up observation, and provide more safe and effective treatment programs for patients.

Objective To explore the clinical characteristics of renal paraganglioma(PGL).Methods The clinical data of a rare case of renal paraganglioma in a pediatric patient were reported and published cases of renal paragan-gliomas both domestically and internationally were reviewed.Results A 12-year-old male patient underwent surgery for a right renal mass,with histopathological confirmation revealing a renal paraganglioma.Immunohistochemical staining results were positive for CgA and S-100,while Ki-67 index showed positivity in hot spots at 20%.The SDHB stain was negative.Germline genetic testing detected a heterozygous mutation in exon 6 of the SDHB gene,c.641A＞C(p.Gln214Pro).Following surgery,local radiotherapy was administered to the operative area.A posto-perative 18 F-FDG-PET/CT scan did not reveal any metastatic lesions.A total of 15 cases of renal paraganglioma have been reported at home and abroad since 2001,of which 8 were male and 7 were female,with an average age at diagnosis being(42±17)years old.Only 5 patients had hypertension preoperatively,and only 2 pres-ented with typical clinical symptoms.Out of 8 patients who underwent catecholamine testing before surgery,only 4 demonstrated elevated levels.The maximum tumor diameter was(9.9±7.3)cm,with 67%(10 out of 15 cases)having tumors larger than or equal to 5 cm in diameter.In this group,30%(3 out of 10 cases)had tumors that were S-100 negative,and 50%(2 out of 4 cases)had tumors with a Ki-67 index of≥3%.Conclusions Renal paraganglioma is extremely rare,and some patients present without clinical symptoms and with normal catecholamine,making misdiagnosis more likely.Due to the frequent occurrence of large tumors and high Ki-67 indexes,such tumors carry a relatively higher risk of recurrence and metastasis.Therefore,close follow-up is essential after the operation.

Objective:The effect of three-dimensional(3D)printed bone-attached guide plate assisted cannulated screw fixation of pelvic fracture is reliable,but extensive soft tissue dissection is still required when installing the guide plate.This study aims to compare the efficacy of posterior pelvic ring fracture fixation with iliosacral screw insertion between the assistance of modified percutaneous patient specific 3D printed guide template and conventional fluoroscopy. Methods:From May,2019 and September 2021,28 patients sustained posterior pelvic ring fractures were randomized into 2 groups:A guide template group,in which the iliosacral screw was inserted for fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template,and a fluoroscopy group,in which the iliosacral screw was inserted under the guidance of conventional fluoroscopy.The operation time,fluoroscopic frequency,intraoperative blood loss,and incision length were recorded for each screw insertion.Fracture reduction was evaluated according to the Matta criteria.The screw position was evaluated according to the modified Gras classification,and the functional outcome was evaluated according to Majeed score.The parameters of both groups were compared,and statistical analysis was performed. Results:All the 28 patients were followed up for 12-24 months.Of them,15 iliosacral screws were inserted in 14 patients in the guide template group,and 14 iliosacral screws were inserted in 14 patients in the fluoroscopy group.The operation time,fluoroscopic frequency,screw deviation,incision length,and blood loss in the guide template group were 20-30(25.8±2.8)min,9-15(12.2±1.9),2-4(2.6±0.7)mm,4-5(4.6±0.5)cm,and 5-10(7.8±1.7)mL,respectively,whereas those in the fluoroscopy group were 30-60(48.1±7.5)min,40-96(64.7±16.3),3-6(4.2±0.9)mm,0.8-1.2(1.0±0.1)cm,and 2-5(3.1±1.3)mL,respectively,and there were statistical significance(all P<0.001).Fracture reduction was evaluated according to the Matta criteria,and all the patients reached excellence and good(P=0.584)in the 2 groups.According to modified Gras classification,there were 12 Grade Ⅰ screws,3 Grade Ⅱ screws,and 0 Grade Ⅲ screws in the guide template group,and 10 Grade Ⅰ screws,3 Grade Ⅱ screws,and 1 Grade Ⅲ screw in the fluoroscopy group,with no statistical significance(P=0.334).The functional outcome was evaluated according to Majeed score at the last follow-up,without significant difference between the guide template group and the fluoroscopy group(P=0.908). Conclusion:Compared with the conventional fluoroscopy,it would cost less operation time,less fluoroscopic frequency and increase more accurate screw insertion to fixate the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template.

Objective:To investigate short-term safety, efficacy and the learning curve of this self-developed novel transcatheter valve repair system (Neonova?) in patients with mitral regurgitation, and explore the role of perioperative echocardiography.Methods:Ten patients who visited the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2021 to March 2022 and met the inclusive criteria were prospectively enrolled. All the patients were at high risk of surgery with moderate to severe or severe mitral regurgitation (MR). Clamps of Neonova? were implanted under guidance of transesophageal echocardiography and digital subtraction angiography. Clinical outcomes, echocardiography indexes and learning curves of this technique were evaluated immediately after intervention, 7 d, 1 month and 3 months post-intervention.Results:The technical success rate was 100% with MR relieved in all patients immediately after intervention. The device and procedural success rates were both 90.0% with 1 patient received surgical replacement at 37 days post-intervention while the others′ reduced to mild (8/9) and moderate (1/9) MR. New York Heart Association class and the Kansas City Cardiomyopathy Questionnaire improved significantly (all P<0.001). Mean mitral valve pressure gradient didn′t increase significantly after intervention when compared with that before intervention( P=0.324), and no mitral stenosis was observed. Left ventricular end-diastolic diameter decreased significantly ( P=0.008) during follow up.Procedure duration ranged from 60 to 300 (175.8±75.2)minutes. The simple linear regression model between procedure volume and duration showed that procedure duration decreased significantly with the increase of procedure volume ( F=15.857, P=0.004). Conclusions:Neonova? implantation can improve MR severity and clinical symptoms safely and effectively. Transthoracic echocardiography and transesophageal echocardiography are essential for perioperative management of transcatheter mitral valve repair.