This study aims at examining the application and development of digital teaching materials in the field of epidemiology, encompassing both China and international contexts. The research involved conducting search on websites and literature databases to assess the status of digital teaching materials in epidemiology, nationally and internationally. At present, in China, digital teaching materials used in epidemiology are primarily presented in the form of printed books with added QR codes, providing teaching resources such as videos and exercises. However, issues with the level of interactivity have been identified. In foreign countries, with stronger emphasis placed on personalization, interactivity, and the use of rich media technologies in the digital teaching materials, epidemiologically. Enhanced digitization regarding materials and learning outcomes is achieved through features such as real-time notes, interactive animations, and quizzes. These approaches are considered worth considering for adoption. This study provides valuable insights for the digital transformation of epidemiology education.

Purpose To investigate whether ketogenic diet(KD)can promote cognition by regulating brain metabolism and neuroinflammation in Alzheimer's disease model mice.Materials and Methods Twenty male APP/PS1 mice were randomly assigned to either a KD group(APP/PS1+KD)or a regular diet group(APP/PS1),with 10 mice in each group.Additionally,10 wild-type C57BL/6 male mice served as the control group.The APP/PS1+KD group was fed with a ketogenic feed,the APP/PS1 group received a regular diet,and the control group was maintained on standard chow for a duration of 4 months.Blood ketone levels of mice were monitored after 4 weeks and 4 months of continuous feeding.Cognitive function was assessed via the morris water maze.18F-FDG and 18F-DPA-714 micro PET/CT were performed to evaluate the effects of KD on glucose metabolism and neuroinflammation across various brain regions in the Alzheimer's disease mice.Following PET/CT imaging,brain tissue samples were collected,and the hippocampal Cal region was selected for paraffin sectioning to detect the expression of glial fibrillary acidic protein and ionized calcium-binding adapter molecule 1 through immunofluorescence analysis.Results In the Morris water maze in the fourth month,compared with the control group,the APP/PS1 group had a significantly longer escape latency on days 3-4(P＜0.05 or P＜0.01).Compared with the control group,the APP/PS1 group showed a significant decrease in relative 18F-FDG uptake in brain regions such as the striatum,hippocampus,dorsal thalamus,central gray matter,superior colliculus,olfactory bulb,and midbrain(P＜0.01,P＜0.05).Compared with the APP/PS1 group,the APP/PS1+KD group showed a significant increase in relative 18F-FDG uptake in the hippocampus and dorsal thalamus(P＜0.01).Compared with the control group,the APP/PS1 group showed a significant increase in relative uptake of 18F-DPA-714 in brain regions such as the striatum,hippocampus and hypothalamus(P＜0.05 or P＜0.001).Compared with the APP/PS1 group,the APP/PS1+KD group decreased the relative uptake of 18F-DPA-714 in the hippocampus(P＜0.01).Compared with the control group and APP/PS1+KD group,the fluorescence intensity of glial fibrillary acidic protein and ionized calcium-binding adapter molecule 1 protein in the brain(hippocampus)of APP/PS1 group mice was significantly increased(both P＜0.01).Conclusion KD has the potential to ameliorate cognitive and behavioral deficits in APP/PS1 mice by enhancing brain metabolism and attenuating neuroinflammation.

Objective This study was performed to establish and compare guinea pig models of tuberculosis using intranasal and aerosol infection routes at different doses.The overall goal was to provide a foundation for establishing a standardized guinea pig model of tuberculosis for the study of respiratory tract infection.Methods Twenty-four female guinea pigs were randomly divided into six groups of four guinea pigs each.They were then infected with two doses of Mycobacterium tuberculosis through either the aerosol route(groups A,B,and C)or intranasal route(groups D,E,and F).Aerosol infection groups consist of 3 groups:group A(Aerosol control group,uninfected control group),group B(Aerosol low-dose group,5×102 CFU),and group C(Aerosol high-dose group,5×103 CFU)Intranasal infection groups also consist of 3 groups:group D(Intranasal control group,uninfected control group),group E(Intranasal low-dose group,1×104 CFU),and group F(Intranasal high-dose group,5×104 CFU).The clinical manifestations of the guinea pigs were observed after infection.All guinea pigs were euthanized on day 14.Lung,spleen,and liver tissues were obtained for gross examination and histopathological analysis using hematoxylin-eosin staining to identify characteristic lesions associated with tuberculosis.Acid-fast staining was performed on in situ tissues and organs followed by bacterial culture to analyze the bacterial load.Results The guinea pigs in four infection groups(B,C,E,and F)exhibited macroscopic tuberculosis lesions in the lung,spleen,and liver.Histopathological examination revealed the presence of tuberculous granuloma lesions.Acid-fast staining and bacterial load analysis demonstrated that the bacteria were primarily localized in the lung tissue of aerosol-infected groups B and C,with a few also present in the spleen and liver,and the bacterial load was 104～105 CFU/mL.In intranasal infection groups E and F,bacteria were found in the lung,spleen,and liver with a similar bacterial load of 104～105 CFU/mL.There was no significant difference in lesion severity or bacterial load among groups B,C,E,and F;however,groups B,C,and F showed low standard deviations for both pathology and etiology.Conclusions A guinea pig model of acute tuberculosis was successfully established using two doses administered through distinct routes of infection.Pathological examination and pathogenic analysis demonstrated that an aerosol dose of 5×102 CFU of Mtb effectively established a homogeneous model of acute tuberculosis with good consistency among the animals.Additionally,intranasal infection with 5×104 CFU of Mtb produced a relatively uniform model of tuberculosis.Notably,however,aerosol infection at 5×102 CFU progressed to an acute tuberculosis model more rapidly than intranasal infection at 5×104 CFU.

Endoplasmic reticulum stress refers to a cellular stress response triggered when cells are stimulated,which is manifested as the disruption of endoplasmic reticulum homeostasis and dysfunction in various pathological conditions,resulting in the accumulation of a large number of misfolded and unfolded proteins within the endoplasmic reticulum and an imbalance of calcium ions.Macrophages are the most abundant immune cells in the liver and play an important role in maintaining liver homeostasis and various liver diseases.Recent studies have confirmed that the unfolded protein response caused by endoplasmic reticulum stress plays an important role in regulating macrophage immune response.This article reviews the mechanisms of endoplasmic reticulum stress regulating macrophage immune response and its role in liver diseases such as ischemia-reperfusion injury during organ transplantation,liver fibrosis,and hepatocellular carcinoma,in order to deepen the understanding of the mechanism of macrophage immune regulation and provide new ideas for research and interventional treatment related to liver diseases.

Extranodal natural killer/T-cell lymphoma (ENKTCL) is the subtype of non-Hodgkin lymphoma with high heterogeneity and invasiveness. Though most ENKTCL patients are present as early-stage at diagnosis, clinical prognosis significantly differs due to the limitations of clinical staging. Radiotherapy (RT) and chemotherapy (CT) are the first-line treatments for early ENKTCL patients. However, there is no consensus on the combined modalities of RT and CT, and their optimal strategy. With the continuous renewal of clinical staging and prognostic models, early-stage ENKTCL patients tend to accept risk-adapted treatment with proper stratification. In this review, the latest research progresses on clinical staging, prognostic models and treatment were retrospectively analyzed, aiming to provide references for clinical decision-making.

Objective:To construct of a terahertz metamaterial sensing method for detection of microRNA-21 (miRNA-21) based on duplex-specific nuclease triggered rolling circle amplification.Methods:First, a THz metamaterial sensing method was constructed, and verified by polyacrylamide gel electrophoresis and zeta potential; after optimizing the detection conditions of the sensor, different concentrations of miRNA-21 and other different miRNAs were detected. And this biosensor was compared with other miRNA detection methods; finally, the recovery rate of the biosensor was evaluated.Results:Under the optimal experimental conditions, through the dual signal amplification strategy of duplex-specific nuclease (DSN) cycle recognition and rolling circle amplification (RCA), the THz metamaterial sensor has a response range of 10 fmol/L to 10 nmol/L to the target miRNA-21, with a detection limit of 8.49 fmol/L. And the biosensor has good specificity with the ability to recognize the target miRNA-21 from a variety of microRNAs. And the experiment with recovery rate from 94.33% to 115.33% has been further verified in commercial human serum samples.Conclusion:The terahertz biosensor can achieve highly sensitive and specific detection of the target miRNA-21, which proves the potential for label-free diagnosis and early warning of miRNA-related diseases.

Objective:To construct of a terahertz metamaterial sensing method for detection of microRNA-21 (miRNA-21) based on duplex-specific nuclease triggered rolling circle amplification.Methods:First, a THz metamaterial sensing method was constructed, and verified by polyacrylamide gel electrophoresis and zeta potential; after optimizing the detection conditions of the sensor, different concentrations of miRNA-21 and other different miRNAs were detected. And this biosensor was compared with other miRNA detection methods; finally, the recovery rate of the biosensor was evaluated.Results:Under the optimal experimental conditions, through the dual signal amplification strategy of duplex-specific nuclease (DSN) cycle recognition and rolling circle amplification (RCA), the THz metamaterial sensor has a response range of 10 fmol/L to 10 nmol/L to the target miRNA-21, with a detection limit of 8.49 fmol/L. And the biosensor has good specificity with the ability to recognize the target miRNA-21 from a variety of microRNAs. And the experiment with recovery rate from 94.33% to 115.33% has been further verified in commercial human serum samples.Conclusion:The terahertz biosensor can achieve highly sensitive and specific detection of the target miRNA-21, which proves the potential for label-free diagnosis and early warning of miRNA-related diseases.

Objective:To investigate the risk factors of turning temporary stoma into permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma.Methods:A case-control study was carried out. Data of rectal cancer patients who underwent transabdominal anterior resection with temporary stoma and completed follow-up in Department of General Surgery of Xiangya Hospital of Central South University from June 2008 to June 2018 were collected and analyzed. In this study, temporary stoma included defunctioning stoma (ostomy was made during operation) and salvage stoma (ostomy was made within one month after operation due to anastomotic leakage or severe complications). Cases of multiple intestinal tumors were excluded. A total of 308 rectal cancer patients were enrolled in the study, including 198 males and 110 females with a median age of 56 (48-65) years. Ninety-four patients received intraperitoneal chemotherapy during operation. Among 308 patients, upper rectal cancer was observed in 64 cases, middle rectal cancer in 89 cases and low rectal cancer in 155 cases. Twenty patients underwent transverse colostomy and 288 underwent ileostomy. Phone call following-up was conducted from August to September 2019 to investigate whether stoma was reversed, causes of reversal failure, and tumor relapsed or not in detail. Permanent stoma was defined as that the stoma was still not reversed by the latest follow-up. The univariate analysis was performed with chi-square test or Fisher's exact test, and variables with P value < 0.10 were included in the non-conditional logistic regression model for multivariate analysis. Results:The median follow-up time was 54.3 (32.4-73.8) months. During follow-up, 8 cases had local recurrence and 37 cases had distant metastasis. Among the 308 patients with temporary ostomy, 247 (80.2%) patients had stomas reversed and the median interval time was 4.5 (3.5-6.1) months. The median interval time in 65 patients with salvage stoma was significantly longer that in 182 patients with defunctioning stoma [5.5 (4.3-7.5) vs. 4.2 (3.4-5.5) months; Z=-4.387, P<0.001]. The temporary ostomy was confirmed to become permanent stoma in 61 patients (19.8%), including 45 cases of defunctioning stoma and 16 cases of salvage stoma. Univariate analysis showed that preoperative anemia, intraperitoneal chemotherapy during operation, middle rectal cancer, transverse colostomy, pathological stage, postoperative local recurrence and distant metastasis were associated with permanent stoma (all P<0.10). Multivariate analysis revealed that the intraperitoneal chemotherapy during operation (OR=1.961, 95% CI: 1.029-3.738, P=0.041), middle rectal cancer (OR=2.401, 95% CI: 1.195-4.826, P=0.014), transverse colostomy (OR=3.433, 95% CI: 1.234-9.553, P=0.018), and distant metastasis (OR=8.282, 95% CI:3.820-17.954, P<0.001) were independent risk factors of permanent stoma. Conclusions:There is high risk of turning temporary stoma into permanent stoma among rectal cancer patients undergoing transabdominal anterior resection who receive intraperitoneal chemotherapy during operation, present as the middle rectal cancer, undergo transverse colostomy or develop distant metastasis. Surgeons need to evaluate and balance the risks and benefits thoroughly, and then inform the patients in order to avoid potential conflicts.

Objective:To investigate the risk factors of turning temporary stoma into permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma.Methods:A case-control study was carried out. Data of rectal cancer patients who underwent transabdominal anterior resection with temporary stoma and completed follow-up in Department of General Surgery of Xiangya Hospital of Central South University from June 2008 to June 2018 were collected and analyzed. In this study, temporary stoma included defunctioning stoma (ostomy was made during operation) and salvage stoma (ostomy was made within one month after operation due to anastomotic leakage or severe complications). Cases of multiple intestinal tumors were excluded. A total of 308 rectal cancer patients were enrolled in the study, including 198 males and 110 females with a median age of 56 (48-65) years. Ninety-four patients received intraperitoneal chemotherapy during operation. Among 308 patients, upper rectal cancer was observed in 64 cases, middle rectal cancer in 89 cases and low rectal cancer in 155 cases. Twenty patients underwent transverse colostomy and 288 underwent ileostomy. Phone call following-up was conducted from August to September 2019 to investigate whether stoma was reversed, causes of reversal failure, and tumor relapsed or not in detail. Permanent stoma was defined as that the stoma was still not reversed by the latest follow-up. The univariate analysis was performed with chi-square test or Fisher's exact test, and variables with P value < 0.10 were included in the non-conditional logistic regression model for multivariate analysis. Results:The median follow-up time was 54.3 (32.4-73.8) months. During follow-up, 8 cases had local recurrence and 37 cases had distant metastasis. Among the 308 patients with temporary ostomy, 247 (80.2%) patients had stomas reversed and the median interval time was 4.5 (3.5-6.1) months. The median interval time in 65 patients with salvage stoma was significantly longer that in 182 patients with defunctioning stoma [5.5 (4.3-7.5) vs. 4.2 (3.4-5.5) months; Z=-4.387, P<0.001]. The temporary ostomy was confirmed to become permanent stoma in 61 patients (19.8%), including 45 cases of defunctioning stoma and 16 cases of salvage stoma. Univariate analysis showed that preoperative anemia, intraperitoneal chemotherapy during operation, middle rectal cancer, transverse colostomy, pathological stage, postoperative local recurrence and distant metastasis were associated with permanent stoma (all P<0.10). Multivariate analysis revealed that the intraperitoneal chemotherapy during operation (OR=1.961, 95% CI: 1.029-3.738, P=0.041), middle rectal cancer (OR=2.401, 95% CI: 1.195-4.826, P=0.014), transverse colostomy (OR=3.433, 95% CI: 1.234-9.553, P=0.018), and distant metastasis (OR=8.282, 95% CI:3.820-17.954, P<0.001) were independent risk factors of permanent stoma. Conclusions:There is high risk of turning temporary stoma into permanent stoma among rectal cancer patients undergoing transabdominal anterior resection who receive intraperitoneal chemotherapy during operation, present as the middle rectal cancer, undergo transverse colostomy or develop distant metastasis. Surgeons need to evaluate and balance the risks and benefits thoroughly, and then inform the patients in order to avoid potential conflicts.

Objective: To investigate the vascular anatomy of the stomach, especially the right gastroepiploic artery for the reconstruc-tion of a gastric tube during esophagectomy. Methods: The vascular anatomy of the stomach was studiing in 28 embalmed human specimens provided by the Department of Anatomy, Shanghai Medical College, Fudan University, included 10 female and 18 male spec-imens. The length and diameter of gastric vessels were measured. The ratio of the length of the right gastroepiploic artery to the length of the greater curvature was calculated. Anastomosis between the left and right gastroepiploic arteries was also assessed. Re-sults: Twenty-five left gastric arteries were observed in the autopsies, with the mean diameter of 3.40 (2.10-6.40) mm. Twenty-one right gastric arteries were measured, with the mean diameter of 1.97 (0.68-3.56) mm. Twenty-six left gastroepiploic arteries were ob-served, with the mean diameter of 1.87 (0.80-2.96) mm. Twenty-eight right gastroepiploic arteries were measured, with the mean di-ameter of 2.82 (1.58-4.80) mm. The mean lengths of the 28 right gastroepiploic arteries and their greater curvatures were 216.71 (120-318) mm and 356.39 (248-487) mm, respectively. The ratio of the length of right gastroepiploic arteries and greater curvatures was 0.61 (0.45-0.82). The anastomosis between the left and right gastroepiploic arteries was observed in 60.7% (17/28) of the specimens. Conclusions: The length and diameter of gastric vessels were calculated. It was assumed that the right gastroepiploic artery provides an average of 61% of the blood supply for the great curvature. In addition, the anastomotic branch of the right and left gastroepiploic arteries was observed in 60.7% specimens. These anatomical data allow surgeons to estimate the blood supply and to choose an opti-mal method of gastric tube reconstruction during esophagectomy.