Objective To investigate the global burden of visceral leishmaniasis (VL) from 1990 to 2021 and predict the trends in the burden of VL from 2022 to 2035, so as to provide insights into global VL prevention and control. Methods The global age-standardized incidence, prevalence, mortality and disability-adjusted life years (DALYs) rates of VL and their 95% uncertainty intervals (UI) were captured from the Global Burden of Disease Study 2021 (GBD 2021) data resources. The trends in the global burden of VL were evaluated with average annual percent change (AAPC) and 95% confidence interval (CI) from 1990 to 2021, and gender-, age-, country-, geographical area- and socio-demographic index (SDI)-stratified burdens of VL were analyzed. The trends in the global burden of VL were projected with a Bayesian age-period-cohort (BAPC) model from 2022 to 2035, and the associations of age-standardized incidence, prevalence, mortality, and DALYs rates of VL with SDI levels were examined with a smoothing spline model. Results The global age-standardized incidence [AAPC = -0.25%, 95% CI: (-0.25%, -0.24%)], prevalence [AAPC = -0.06%, 95% CI: (-0.06%, -0.06%)], mortality [AAPC = -0.25%, 95% CI: (-0.25%, -0.24%)] and DALYs rates of VL [AAPC = -2.38%, 95% CI: (-2.44%, -2.33%)] all appeared a tendency towards a decline from 1990 to 2021, and the highest age-standardized incidence [2.55/10⁵, 95% UI: (1.49/10⁵, 4.07/10⁵)], prevalence [0.64/10⁵, 95% UI: (0.37/10⁵, 1.02/10⁵)], mortality [0.51/10⁵, 95% UI: (0, 1.80/10⁵)] and DALYs rates of VL [33.81/10⁵, 95% UI: (0.06/10⁵, 124.09/10⁵)] were seen in tropical Latin America in 2021. The global age-standardized incidence and prevalence of VL were both higher among men [0.57/10⁵, 95% UI: (0.45/10⁵, 0.72/10⁵); 0.14/10⁵, 95% UI: (0.11/10⁵, 0.18/10⁵)] than among women [0.27/10⁵, 95% UI: (0.21/10⁵, 0.33/10⁵); 0.06/10⁵, 95% UI: (0.05/10⁵, 0.08/10⁵)], and the highest mortality of VL was found among children under 5 years of age [0.24/10⁵, 95% UI: (0.08/10⁵, 0.66/10⁵)]. The age-standardized incidence (r = -0.483, P < 0.001), prevalence (r = -0.483, P < 0.001), mortality (r = -0.511, P < 0.001) and DALYs rates of VL (r = -0.514, P < 0.001) correlated negatively with SDI levels from 1990 to 2021. In addition, the global burden of VL was projected with the BAPC model to appear a tendency towards a decline from 2022 to 2035, and the age-standardized incidence, prevalence, mortality and DALYs rates were projected to be reduced to 0.11/10⁵, 0.03/10⁵, 0.02/10⁵ and 1.44/10⁵ in 2035, respectively. Conclusions Although the global burden of VL appeared an overall tendency towards a decline from 1990 to 2021, the burden of VL showed a tendency towards a rise in Central Asia and western sub-Saharan African areas. The age-standardized incidence and prevalence rates of VL were relatively higher among men, and the age-standardized mortality of VL was relatively higher among children under 5 years of age. The global burden of VL was projected to continue to decline from 2022 to 2035.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective To investigate the expression level and clinical application value of G-protein coupled receptor 15 ligand (GPR15L) in patients with systemic lupus erythematosus (SLE). Methods In a retrospective cohort, real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression levels of G-protein coupled receptor 15 (GPR15) mRNA and GPR15L mRNA in peripheral blood from 63 SLE patients (SLE group) and 57 healthy controls (control group). Enzyme-linked immunosorbent assay was employed to measure the serum GPR15L protein expression levels in the SLE group, control group, and 50 rheumatoid arthritis (RA) patients (disease control group). The relationship between serum GPR15L and laboratory indicators as well as therapeutic efficacy in SLE patients was analyzed. Receiver operating characteristic (ROC) curves were used to assess the diagnostic efficacy of serum GPR15 alone and combination with common autoantibody indicators for SLE. Multivariate Logistic regression analysis was conducted to explore the independent risk factors for SLE onset. Results Compared with the control group, the SLE group exhibited increased levels of GPR15 mRNA and GPR15L mRNA in peripheral blood (P=0.016 4, P < 0.000 1, respectively). The serum GPR15L expression in the SLE group was higher than that in the disease control group (P < 0.000 1). The serum GPR15L protein expression level in SLE patients was positively correlated with GPR15L mRNA and disease activity (r=0.301 3, P=0.016 4; r=0.361 7, P=0.003 6) and negatively correlated with complement C3 and C4 levels (r=-0.341 2, P=0.006 2; r=-0.338 4, P=0.006 7). The ROC curves showed that the area under the curve (AUC) for serum GPR15L in distinguishing the SLE group from the control group was 0.870 8, and the AUC for distinguishing the SLE group from the control group was 0.765 5. The diagnostic efficacy of serum GPR15L combined with anti-SSA for SLE was significantly improved, with an AUC of 0.895 2. Multivariate Logistic regression analysis revealed that elevated GPR15L protein and GPR15L mRNA were independent risk factors for SLE onset (P < 0.05). Conclusion The significant increase in serum GPR15L protein levels in SLE patients is closely related to SLE disease activity, and abnormal expression of GPR15L may play an important role in the pathogenesis of SLE.

Objective To describe the diagnosis,treatment,and clinical course of a patient with severe acute organophosphorus pesticide poisoning(AOPP)complicated by recurrent respiratory failure,intermediate syndrome(IMS),multiple organ dysfunction syndrome(MODS)and sepsis.Methods On May 8,2021,a patient who self-administered the pesticide Dimethoate AOPP was admitted to the department of internal medicine intensive care unit(MICU)of the First People's Hospital of Yunnan Province.After 29 days of treatment,the patient was successfully cured and discharged.The clinical diagnosis and treatment process was introduced.Results The 78-year-old male patient suffered from severe AOPP due to self-ingestion of the pesticide leptophos.Upon admission,he rapidly developed respiratory failure requiring urgent endotracheal intubation and mechanical ventilation support.A series of targeted treatments were administered,including the use of reactivators such as pralidoxime iodide,anticholinergic agents like atropine and scopolamine,as well as antibiotic therapy and management of water-electrolyte balance and acid-base equilibrium.Throughout his treatment,the patient experienced multiple complications,including episodes of sepsis,fluctuating cholinesterase levels,infections from multidrug-resistant bacteria,and recurrent respiratory failures.After 29 days of meticulous care,the patient was successfully weaned off the ventilator,regained normal organ function,and was discharged.Conclusion The analysis of this case highlights the importance of closely monitoring and managing drug dosage adjustments,preventing and treating infections,addressing septic shock,paying attention to the prevention and control of ventilator-associated pneumonia(VAP),conducting timely psychological evaluations,and providing interventions during the treatment process for AOPP.

Hepatocellular carcinoma is one of the common causes of tumor-related death, and it has high morbidity and mortality rates in China. Recent studies have shown that platelets are closely associated with the development of hepatocellular carcinoma. Literature review shows that platelets not only participate in hemostasis, but also act on liver cells and tumor microenvironment, promote the formation of new blood vessels, and participate in the development and progression of hepatocellular carcinoma as a cell mediator through immune response and other pathways. In addition, platelets and their derivatives can be used as potential therapeutic targets for hepatocellular carcinoma. Therefore, antiplatelet therapy is expected to become a new adjuvant strategy for the treatment of hepatocellular carcinoma, which has important clinical significance.

Sepsis is a common cause of acute kidney injury (AKI), and the pathogenesis of sepsis-related AKI is very complicated. Recent studies have shown that oxidative stress in septic patients damages mitochondria in renal tubular epithelial cells, and causes cell death. Meanwhile, mitochondrial quality control is inhibited, including imbalance of division and fusion, excessive autophagy, and synthesis disorders, which aggravates kidney injury. Therefore, mitochondria play an important role in the pathogenesis of sepsis-related AKI, and can serve as a potential therapeutic target for sepsis-related AKI. This article reviews the mechanism of mitochondria in the pathogenesis of sepsis-related AKI and explores the treatment strategy by targeting mitochondria.

Objective:To explore the feasibility and safety of long-term home mechanical ventilation(HMV) in children with chronic respiratory failure.Methods:Clinical data of 11 children with chronic respiratory failure, who underwent HMV with the care of the First Affiliated Hospital of Xiamen University from January 2013 to December 2019, were retrospectively reviewed. The clinical manifestation, growth and development, quality of life, adverse events and prognosis of HMV children were analyzed.Results:There were 8 boys and 3 girls with the onset age of 26 days to 13 years old; and the age at starting HMV was 3 months to 13 years old. Eight children were diagnosed as neuromuscular diseases, and 3 children were diagnosed as respiratory diseases. The duration of institutional mechanical ventilation was 2 weeks to 8 months. Six patients underwent invasive HMV via a tracheostomy, and 5 received non-invasive ventilation via nasal and face masks. Bi-level positive airway pressure ventilation mode was applied in all the patients. The duration of HMV was 3 months to 27 months. During follow-up, no HMV related adverse events were observed. Both the quality of life and nutritional status were improved in all cases. One patient lost follow-up 9 months later and 1 patient died of severe adenovirus pneumonia during hospitalization for examination, the remaining 9 cases survived. Liberation from HMV was obtained in 4 patients. The frequency of readmission was 1 to 2 times.Conclusion:It is suggested that long-term HMV is safe and feasible for children with chronic respiratory failure.

Sepsis and septic shock have high morbidity and mortality. The key point is that huge amount of nitric oxide (NO) is releasing into circulation, inducing marked dilation of blood vessels, and continuously decreased of blood pressure. The central link is inflammation and oxidative stress. Methylene blue can effectively inhibit NO, remove excessive NO and block the signal transduction pathway named inducible nitric oxide synthase-NO-soluble guanylate cyclase-cyclic guanosine monophosphate (iNOS-NO-sGC-cGMP). Meanwhile, it also play a role in inhibiting oxidative stress and inflammation. This paper reviews the mechanism of methylene blue in the treatment of sepsis and septic shock, as well as its treatment time window, optimal dose, administration mode and potential adverse reactions, to provide new ideas for clinical treatment.

Objective:To prevent the occurrence of children′s unintentional injuries, clinical characteristics were analyzed for 1 379 children hospitalized for unintentional injuries over a 5-year period at the First Affiliated Hospital of Xiamen University.Methods:We searched the First Affiliated Hospital of Xiamen University Pediatric Refined Management Database for all cases of children aged 0-14 years who were hospitalized for unintentional injuries from January 1, 2015 to December 31, 2019.Descriptive statistics were calculated for age, gender, season of injury, location of residence, education level of the child′s parents/guardians, injury etiology and outcome, and cost of treatment.Results:Of 1 379 cases, 894 children(64.8%) were boys and 485(35.2%) were girls.The majority of cases were 1-5 years old(61.6%, n=849). The top three causes of unintentional injuries were foreign bodies(38.1%, n=526), falls(27.0%, n=372), and burns(17.1%, n=236). Children′s unintentional injuries occurred most frequently during the summer(29.0%). More children came from rural locations(56.3%, n=777). Approximately half of the parents/guardians had attained an education level of junior high school or below(50.5%, n=696). There were 47 cases(3.4%) resulting in death or permanent injury and 292 cases(21.2%) resulting in disability.Children injured in traffic accidents had the longest average length of hospital stay [11(7, 18)d] and incurred the highest healthcare costs per case[11 130.32(5 389.69, 24 216.90)RMB]. Conclusion:Children′s unintentional injuries are concentrated among rural boys aged 1-5 years, foreign bodies are the most common cause of unintentional injuries.Children from families with low parental/guardian education levels may be at heightened risk of unintentional injuries.

Objective:To investigate the expression and significance of the angiotensin Ⅱ and its receptors in lipopolysaccharide (LPS)-induced acute lung injury and acute kidney injury in rats.Methods:Forty eight Wistar rats were randomly divided into two groups: control group and endotoxin group (LPS group). LPS was injected through tail vein in LPS group, and the same amount of saline was injected through tail vein in control group.Samples were collected at 2 h, 6 h, 12 h and 24 h, respectively.The histopathology of lung and kidney was observed by HE staining.We detected lung wet/dry weight ratio, serum creatinine, urea nitrogen and Ang Ⅱ concentration in plasma, lung and kidney tissues by radioimmunoassay.Western blot and immunohistochemistry were used to detect the expression changes of AT1R and AT2R in lung and kidney tissue.Results:Compared with the control group, the pathology of lung and kidney tissue in LPS group showed different degrees of damage.The lung wet/dry weight ratio, serum creatinine and urea level in LPS group were significantly increased than that in control group( P<0.05). The Ang Ⅱ content in plasma increased significantly at 2 h and 6 h ( P<0.05), and the expression level of Ang Ⅱ in lung and kidney increased significantly at all time points ( P<0.05). The expression of AT1R in lung and kidney decreased significantly ( P<0.05), while the AT2R protein expression increased significantly ( P<0.05). Additionally the correlation analysis showed that the expression level of Ang Ⅱ and AT2R were positively correlated with lung and renal function, while the expression of AT1R was negatively correlated with lung and renal function. Conclusion:LPS results in the damage of lung and kidney function and the change of renin-angiotensin system.The changes of Ang Ⅱ and angiotension receptors were correlated with lung and kidney injury.Ang Ⅱ and angiotension receptors may be involved in LPS induced lung and kidney injury.