[Objective]To explore the epidemiology and clinical characteristics of kala-azar patients in Kashgar region,so as to improve the diagnosis and treatment.[Methods]A retrospective analysis was conducted on the clinical data of 71 kala-azar patients admitted to the First People's Hospital of Kashgar Region between January 2013 and December 2023.[Results]Among the 71 patients,the majority were aged 0-5 years(52.11%,37/71),with a male-to-female ratio of 0.92:1.Most cases occurred in winter and spring.Common clinical manifestations included fever,fatigue,decreased appetite,splenomegaly and hepatomegaly.Laboratory investigations mainly found pancytopenia,reversed albumin-to-globulin ratio,elevated transaminases,and increased C-reactive protein and procalcitonin.The positive rates of anti-rK39 antibody detection and bone marrow microscopy were 100%(23/23)and 91.38%(53/58),respectively.Metagenomics next-generation sequencing(mNGS)of liver tissue identified Leishmania donovani in one case.The common complications were infectious toxic hepatitis 49.30%(35/71),myocarditis 29.56%(21/71),and bronchopneumonia 23.94%(17/71).[Conclusions]Potential kala-azar should be taken into consideration for patients from the endemic areas with long-term irregular fever accompanied by splenomegaly,hemocytopenia,and reversed albumin-to-globulin ratio.Bone marrow smear microscopy and anti-rK39 antibody detection are recommended for the diagnosis,and mNGS provides a novel diagnostic solution.

Objective To analyze the effectiveness of the digital medicine boosting county-town-village linkage diabetes mellitus(DM)management model.Methods A total of 135 patients with T2DM from 9 villages in 3 towns of Longyou County from June to September 2021 were selected and randomly grouped into a control(Con,n=45)group and an intervention(Exp,n=90)group at a ratio of 1∶2 by village.The Con group implements routine management.The Exp group implemented the internet+boosting county-town-village linkage DM management model.Both groups were followed up for one year.The body mass index(BMI),waist circumference(WC),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),urine albumin/creatinine ratio(UACR),management compliance,and the proportion of new DM complications were compared between the two groups.Results All patients in the Con group completed follow-up,8 patients in the Exp group were lost to follow-up,and 82 patients were finally included.After the intervention,BMI,WC,SBP,DBP,FPG,HbA1c,TC,TG,LDL-C and UACR were significantly decreased in both groups(P<0.05),while HDL-C and DM self-management scale(SDSCA)scores increased(P<0.05).In Exp group,SBP,DBP,FPG,HbA1c,TC,TG,LDL-C and UACR were lower than those in Con group(P<0.05),while HDL-C and SDSCA scores and the compliance rates of FPG,HbA1c,TC,TG were higher than those in Con group(P<0.05).There was no statistically significant difference in the changes of medication methods,the incidence of diabetic kidney disease and diabetic peripheral neuropathy between the two groups(P>0.05).Conclusions The digital medicine boosting county-town-village linkage DM management model,which helps achieve glycolipid standards and opens up new ideas for the management of diabetes in rural areas.

Colorectal cancer is a malignant tumor that originates from the epithelial cells of the colon and rectum. It has the third highest incidence and the second highest mortality rate among malignant tumors worldwide. With the rapid development of the economy and the increasing Westernization of dietary habits in China， its incidence in China has been rising year by year. Over the past decade， despite the introduction of numerous treatment methods for colorectal cancer， the efficacy of existing therapies remains unsatisfactory. In recent years， traditional Chinese medicine （TCM） has become a major focus in the treatment of colorectal cancer due to its advantages of multi-target， multi-pathway mechanisms and low toxicity and side effects. Vascular endothelial growth factor （VEGF） is an important angiogenic factor that promotes blood vessel formation， providing nutrients and oxygen for tumor growth. It also increases vascular permeability， allowing tumor cells to easily pass through the blood vessel wall into other tissues， thereby facilitating metastasis. Several studies have shown that TCM can inhibit tumor angiogenesis and lymphangiogenesis， promote tumor cell apoptosis， and inhibit the proliferation of colorectal cancer cells by acting on the VEGF signaling pathway， thereby delaying tumor growth. In recent years， research in this field has been rapidly updated， but there is a lack of relevant summaries， making subsequent literature searches inconvenient. Therefore， this article focuses on the physiological functions of the VEGF signaling pathway， its role in the occurrence of colorectal cancer， and the intervention of TCM on VEGF， providing a supplement and summary of relevant information to offer a reference for future research in this area.

Objective To analyze the effectiveness of the digital medicine boosting county-town-village linkage diabetes mellitus(DM)management model.Methods A total of 135 patients with T2DM from 9 villages in 3 towns of Longyou County from June to September 2021 were selected and randomly grouped into a control(Con,n=45)group and an intervention(Exp,n=90)group at a ratio of 1∶2 by village.The Con group implements routine management.The Exp group implemented the internet+boosting county-town-village linkage DM management model.Both groups were followed up for one year.The body mass index(BMI),waist circumference(WC),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),urine albumin/creatinine ratio(UACR),management compliance,and the proportion of new DM complications were compared between the two groups.Results All patients in the Con group completed follow-up,8 patients in the Exp group were lost to follow-up,and 82 patients were finally included.After the intervention,BMI,WC,SBP,DBP,FPG,HbA1c,TC,TG,LDL-C and UACR were significantly decreased in both groups(P<0.05),while HDL-C and DM self-management scale(SDSCA)scores increased(P<0.05).In Exp group,SBP,DBP,FPG,HbA1c,TC,TG,LDL-C and UACR were lower than those in Con group(P<0.05),while HDL-C and SDSCA scores and the compliance rates of FPG,HbA1c,TC,TG were higher than those in Con group(P<0.05).There was no statistically significant difference in the changes of medication methods,the incidence of diabetic kidney disease and diabetic peripheral neuropathy between the two groups(P>0.05).Conclusions The digital medicine boosting county-town-village linkage DM management model,which helps achieve glycolipid standards and opens up new ideas for the management of diabetes in rural areas.

[Objective]To explore the epidemiology and clinical characteristics of kala-azar patients in Kashgar region,so as to improve the diagnosis and treatment.[Methods]A retrospective analysis was conducted on the clinical data of 71 kala-azar patients admitted to the First People's Hospital of Kashgar Region between January 2013 and December 2023.[Results]Among the 71 patients,the majority were aged 0-5 years(52.11%,37/71),with a male-to-female ratio of 0.92:1.Most cases occurred in winter and spring.Common clinical manifestations included fever,fatigue,decreased appetite,splenomegaly and hepatomegaly.Laboratory investigations mainly found pancytopenia,reversed albumin-to-globulin ratio,elevated transaminases,and increased C-reactive protein and procalcitonin.The positive rates of anti-rK39 antibody detection and bone marrow microscopy were 100%(23/23)and 91.38%(53/58),respectively.Metagenomics next-generation sequencing(mNGS)of liver tissue identified Leishmania donovani in one case.The common complications were infectious toxic hepatitis 49.30%(35/71),myocarditis 29.56%(21/71),and bronchopneumonia 23.94%(17/71).[Conclusions]Potential kala-azar should be taken into consideration for patients from the endemic areas with long-term irregular fever accompanied by splenomegaly,hemocytopenia,and reversed albumin-to-globulin ratio.Bone marrow smear microscopy and anti-rK39 antibody detection are recommended for the diagnosis,and mNGS provides a novel diagnostic solution.

Idiopathic oligoasthenospermia （IO） has been increasingly emphasized in the diagnosis and treatment of male infertility. Oxidative stress damage directly affects sperm quality and spermatogenesis， constituting a major causative factor of IO. Firstly， due to its high content of polyunsaturated fatty acids， the sperm plasma membrane is highly sensitive to reactive oxygen species （ROS）， leading to lipid peroxidation accumulation and even inducing ferroptosis. Secondly， deficient downstream key proteins in the base excision repair pathway render sperm unable to repair extensive DNA oxidative damage under oxidative stress. Simultaneously， under oxidative stress， the apoptotic pathway of sperm is cascade-activated， causing rapid loss of motility. ROS further disrupts the hypothalamic-pituitary-gonadal axis， inhibiting testosterone production and ultimately affecting spermatogenesis. Wuzi Yanzongwan，in line with traditional Chinese medicine theory of treating IO through "nourishing kidney essence and harmonizing Yin and Yang"， clinically demonstrates its ability to improve sperm morphology， count， and motility， thereby enhancing male fertility. The research on the pharmacological constituents of Wuzi Yanzongwan primarily involves establishing a characteristic spectrum of Chinese medicine to achieve quality control and exploring the pharmacology of effective components. Studies have found that its main active ingredients consist of flavonoids and phenylpropanoids. Specifically， compounds such as hyperin， acteoside， kaempferol， and schisandrin A are identified as the primary active substances and quality control components. These compounds exhibit strong antioxidant activity and have been partly applied in research related to reproductive endocrine disorders. Tripterygium glycoside is primarily used for modeling of oxidative stress-induced IO. It leads to the accumulation of various lipid peroxides in testicular tissues and concurrently compromises the body's antioxidant capacity. Mechanistic studies have found that Wuzi Yanzongwan can inhibit elevated ROS levels in IO models and enhance the body's antioxidant capacity， thereby ameliorating inflammation， suppressing cell apoptosis， promoting testosterone production， and ultimately alleviating the decline in sperm quality and spermatogenesis caused by oxidative stress.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

Objective:To explore the genetic background for a patient with refractory myelodysplastic/myeloproliferative neoplasm (MDS/MPN) with co-morbid neutrophilia patient.Methods:A MDS/MPN patient who was admitted to the First Affiliated Hospital of Nanjing Medical University in May 2021 was selected as the study subject. RNA sequencing was carried out to identify fusion genes in his peripheral blood mononuclear cells. Fusion gene sequence was searched through transcriptome-wide analysis with a STAR-fusion procedure. The novel fusion genes were verified by quantitative real-time PCR and Sanger sequencing.Results:The patient, a 67-year-old male, had progressive thrombocytopenia. Based on the morphological and molecular examinations, he was diagnosed as MDS/MPN with co-morbid neutropenia, and was treated with demethylating agents and Bcl-2 inhibitors. Seventeen months after the diagnosis, he had progressed to AML. A novel fusion gene NCOR1: : GLYR1 was identified by RNA-sequencing in his peripheral blood sample, which was verified by quantitative real-time PCR and Sanger sequencing. The patient had attained morphological remission after a DCAG regimen (a combinatory chemotherapy of decitabine, cytarabine, aclarubicin and granulocyte colony-stimulating factors) plus Chidamide treatment. A significant decrease in the NCOR1: : GLYR1 expression was revealed by quantitative real-time PCR at post-chemotherapy evaluation. Conclusion:NCOR1: : GLYR1 gene is considered as the pathogenic factor for the MDS/MPN patient with neutropenia.

Patients with low-prognosis undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment are mainly manifested as poor ovarian response to exogenous gonadotropin stimulation and a lower clinical pregnancy rate than normal responders of the same age. In the past, Bologna criteria was used to define and diagnose those patients. In 2016, the Patient Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) group proposed a new subdivision standard for low prognosis population in order to improve the homogeneity of them, which conceptually moved from poor response to poor prognosis and provided a classification basis for clinical treatment guidance and clinical counselling for POSEIDON patients. There are various controlled ovarian hyperstimulation protocols applied to POSEIDON groups, which have different effects on clinical application among different subgroups. This article will describe and summarize the progress of different ovulation induction regimens and adjuvant treatment strategies for patients with low-prognoses based on the POSEIDON criteria.

[Objective]To explore the clinical characteristics of neurobrucellosis in Kashi,Xinjiang Uygur Autono-mous Region,thus improve the diagnosis and treatment.[Methods]A retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between Decem-ber 2019 and January 2024.[Results]The study included 9 males and 9 females,with a median age of 36 years(range:17-54.5).A clear epidemiological history was found in all the 18 brucllosis patients,12 of whom presented with meningo-encephalitis,5 meningitis,and 1 encephalitis.Two comorbided with spinal meningitis,2 osteoarthritis and 1 epididymitis.Most frequently reported clinical symptoms were headache,fever and fatigue.The prevalence rates of brucellosis by rose bengal plate agglutination test(RBPT)and serum agglutination test(SAT)were 11/12 and 8/9,respectively.Two of 10 patients had positive blood cultures,four of 16 had positive cerebrospinal fluid(CSF)cultures and five of five were detect-ed to be positive by next-generation sequencing(NGS)for pathogens in CSF.CSF showed exudative changes and elevated number of leukocytes,with predominance of single nucleated cells.All patients were treated with the combined use of two to four from the drugs like doxycycline,rifampicin,ceftriaxone,cefixime,minocycline,levofloxacin and sulfanilamide.Most patients had a favorable prognosis.[Conclusions]Neurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas.If there are exudative changes in CSF,differential diagnoses can be made by serological testing,blood culture,CSF culture and NGS.NGS could significantly increase the accuracy for neuro-brucellosis diagnosis.