Objective To investigate the suitable habitats of Phlebotomus chinensis in Gansu Province, so as provide insights into effective management of mountain-type zoonotic visceral leishmaniasis (MT-ZVL). Methods The geographical coordinates of locations where MT-ZVL cases were reported were retrieved in Gansu Province from 2015 to 2023, and data pertaining to 26 environmental variables were captured, including 19 climatic variables (annual mean temperature, mean diurnal range, isothermality, temperature seasonality, maximum temperature of the warmest month, minimum temperature of the coldest month, temperature annual range, mean temperature of the wettest quarter, mean temperature of the driest quarter, mean temperature of the warmest quarter, mean temperature of the coldest quarter, annual precipitation, precipitation of the wettest month, precipitation of the driest month, precipitation seasonality, precipitation of the wettest quarter, precipitation of the driest quarter, precipitation of the warmest quarter, and precipitation of the coldest quarter), five geographical variables (elevation, annual normalized difference vegetation index, vegetation type, landform type and land use type), and two population and economic variables (population distribution and gross domestic product). Twelve species distribution models were built using the biomod2 package in R project, including surface range envelope (SRE) model, generalized linear model (GLM), generalized additive model (GAM), multivariate adaptive regression splines (MARS) model, generalized boosted model (GBM), classification tree analysis (CTA) model, flexible discriminant analysis (FDA) model, maximum entropy (MaxEnt) model, optimized maximum entropy (MAXNET) model, artificial neural network (ANN) model, random forest (RF) model, and extreme gradient boosting (XGBOOST) model. The performance of 12 models was evaluated using the area under the receiver operating characteristic curve (AUC), true skill statistics (TSS), and Kappa coefficient, and single models with high performance was selected to build the optimal ensemble models. Factors affecting the survival of Ph. chinensis were identified based on climatic, geographical, population and economic variables. In addition, the suitable distribution areas of Ph. chinensis were predicted in Gansu Province under shared socioeconomic pathway 126 (SSP126), SSP370 and SSP585 scenarios based on climatic data during the period from 1991 to 2020, from 2041 to 2060 (2050s), and from 2081 to 2100 (2090s) . Results A total of 11 species distribution models were successfully built for prediction of potential distribution areas of Ph. chinensis in Gansu Province, and the RF model had the highest predictive accuracy (AUC = 0.998). The ensemble model built based on the RF model, XGBOOST model, GLM, and MARS model had an increased predictive accuracy (AUC = 0.999) relative to single models. Among the 26 environmental factors, precipitation of the wettest quarter (12.00%), maximum temperature of the warmest month (11.58%), and annual normalized difference vegetation index (11.29%) had the greatest contributions to suitable habitats distribution of Ph. sinensis. Under the climatic conditions from 1991 to 2020, the potential suitable habitat area for Ph. chinensis in Gansu Province was approximately 5.80 × 10⁴ km², of which the highly suitable area was 1.42 × 10⁴ km², and primarily concentrated in the southernmost region of Gansu Province. By the 2050s, the unsuitable and lowly suitable areas for Ph. chinensis in Gansu Province had decreased by varying degrees compared to that of 1991 to 2020 period, while the moderately and highly suitable areas exhibited expansion and migration. By the 2090s, under the SSP126 scenario, the suitable habitat area for Ph. chinensis increased significantly, and under the SSP585 scenario, the highly suitable areas transformed into extremely suitable areas, also showing substantial growth. Future global warming is conducive to the survival and reproduction of Ph. chinensis. From the 2050s to the 2090s, the highly suitable areas for Ph. chinensis in Gansu Province will be projected to expand northward. Under the SSP126 scenario, the suitable habitat area for Ph. chinensis in Gansu Province is expected to increase by 194.75% and 204.79% in the 2050s and 2090s, respectively, compared to that of the 1991 to 2020 period. Under the SSP370 scenario, the moderately and highly suitable areas will be projected to increase by 164.40% and 209.03% in the 2050s and 2090s, respectively, while under the SSP585 scenario, they are expected to increase by 195.98% and 211.66%, respectively. Conclusions The distribution of potential suitable habitats of Ph. sinensis gradually shifts with climatic changes. Intensified surveillance and management of Ph. sinensis is recommended in central and eastern parts of Gansu Province to support early warning of MT-ZVL.

Based on the sampling survey data of 11 164 medical researchers in China, this paper analyzed the understanding, attitude and compliance of medical researchers on scientific research ethics in China. The survey found that although most medical researchers claim to have more understanding of scientific research ethics, the level of understanding of scientific research ethics is not optimistic; the channels to scientific research ethics knowledge are diversified, but the standardized training channels are insufficient; most researchers held the positive attitude toward following the ethical norms, but those male, youth under 35, with senior professional titles, or from northeast China held negative attitude relatively; more than half of the researchers claimed that the supervision of research ethics in China was basically in place, but some people said that the violation of scientific research ethics was common, and some researchers reported that there was a phenomenon of "direct seal consent and reply" in ethical review. Compared with medical institutions, enterprises and universities are the weak links of scientific research ethics training, education and review. Based on the above actuality, it puts forward policy suggestions to strengthen the scientific research ethics training and ethics review requirements.

The cognition and attitude of scientific research ethics consciousness affect the willingness and degree of individual researchers to follow research ethics norms. This study investigated the awareness, access and training needs of Chinese medical researchers (n=11 164) on the knowledge of scientific research ethics. The survey found that more than 50.0% of people were aware of the "golden rice incident" and "skull transplantation"; 80.0% of people were knew of Operational Quideline for the Ethic Review of Biomedical Research Involving Human Subject; 90.0% said that "respecting people" and "not harming" were the basic ethical principles, but 42.8% and 75.1% chose "beneficial" and "fair" respectively; more than 60.0% of people have acquired scientific research ethics knowledge through "self-study", "special training organized by units" or "words and deeds taught by mentors or colleagues", but still 30.0% have not participated in scientific research ethics lectures in recent three years; In terms of training needs, more than 50.0% chose "ethical norms for research and application", followed by "frontier ethical issues" (41.0%) and "ethical review" (36.7%). Based on this, this paper puts forward some suggestions to improve the content and form of scientific research ethics education and training in China.

Objective:To summarize the clinical features of primary segmental volvulus (PSV) in neonates.Methods:A retrospective analysis was conducted on the clinical data of neonates with PSV who were admitted to the Department of Neonatal Surgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2014 to May 2023. The clinical manifestations, auxiliary examinations, treatment and prognosis of the neonates were summarized, and descriptive statistical analysis was performed on the collected data.Results:A total of 10 neonates with PSV were included, with a mean gestational age of (34.1±3.0) weeks and birth weight of (2 291±646) g. Eight cases had an onset age of 3 d or less, and 2 cases had an onset age of more than 3 d. Abdominal distension was observed as the main manifestation in all cases, while bilious vomiting occurred in seven cases and hematochezia in five cases. Imaging examinations mainly revealed low intestinal obstruction without specific manifestations. Laboratory tests showed metabolic acidosis and varing degrees of anaemia. Nine cases underwent diagnostic abdominal puncture, of which five had bloody ascites, two had clear ascites, one had bloody mixed with fecal-like ascites, and one had chylous ascites. All the cases underwent emergency exploratory laparotomy and segmental small bowel resections with either primary intestinal anastomosis or enterostomy. All cases were successfully cured and had been followed up to the age of 4 months to 9 years with good growth and development as normal children of the same age.Conclusions:Neonatal PSV is an independent abdominal emergency characterized by non-specific clinical manifestations and difficult preoperative diagnosis, but the overall prognosis is favorable after active surgical treatment.

Osteoporosis is a systemic metabolic bone disease characterized by decreased bone mass, damage to bone tissue microstructure, increased bone fragility, and susceptibility to fractures, while sarcopenia is a syndrome characterized by progressive reduction in overall muscle mass and functional decline. Based on the common pathophysiological mechanism and close correlation between the two, the concept of "osteosarcopenia" has gradually emerged to describe the simultaneous attenuation of muscles and bones. Signaling pathways serve as important signal transmission channels between muscles and bones, and if abnormal, they can lead to osteosarcopenia. The aim of this article, therefore, is to review the signaling pathways related to osteogenesis and myogenesis, such as Hedgehog, Hippo, mTOR, MAPK, in order to provide new ideas for targeted treatment of osteosarcopenia.

Objective:To observe the value of superb microvascular imaging(SMI)combined with contrast-enhanced ultrasound(CEUS)in the differential diagnosis of benign and malignant superficial enlarged lymph nodes.Methods:A total of 82 patients with superficial enlarged lymph nodes who admitted to the Fourth Hospital of Qinhuangdao City from March 2020 to June 2022 were selected.All patients underwent SMI and CEUS examinations,and the ultrasound-guided needle biopsy was used as the"gold standard",and Kappa values was used to analyze the consistencies of single SMI and CEUS,and the combination of them with the"gold standard"in diagnosing benign and malignant superficial enlarged lymph nodes.Results:The results of ultrasound-guided needle biopsy showed that 34 superficial enlarged lymph nodes were benign lymph nodes and 63 superficial enlarged lymph nodes were malignant lymph nodes in 97 superficial enlarged lymph nodes of 82 patients.The results of SMI examination showed that 37 superficial enlarged lymph nodes were benign lymph nodes and 60 superficial enlarged lymph nodes were malignant lymph nodes in 97 superficial enlarged lymph nodes.The results of consistency analysis indicated that SMI has favorable value in differential diagnosis of benign and malignant superficial enlarged lymph nodes,which has better consistency with needle biopsy(Kappa=0.712).The results of CEUS examination showed that 36 cases of the 97 superficially enlarged lymph nodes were benign lymph nodes and 61 cases were malignant lymph nodes.The results of consistency analysis indicated that CEUS has better value in differential diagnosis of benign and malignant superficial enlarged lymph nodes,which has higher consistency with needle biopsy(Kappa=0.821).The results of SMI combined with CEUS examination showed that 35 cases of 97 superficial enlarged lymph nodes were benign lymph nodes and 62 cases were malignant lymph nodes.The result of consistency analysis indicated that SMI combined with CEUS has better value in differential diagnosis of benign and malignant superficial enlarged lymph nodes,and has higher consistency with needle biopsy(Kappa=0.886).Conclusion:Both SMI and CEUS examinations have better value in differential diagnosis of benign and malignant superficial enlarged lymph nodes,and the combination of them can further improve the consistency with result of pathological examination,and enhance the diagnostic value,which has a certain guidance significance in clinical screening malignant lymph nodes.

Objective:To analyze the prognostic outcomes of 1 147 patients who underwent liver transplantation at Qingdao University Affiliated Hospital and to summarize measures to enhance the efficacy of liver transplantation.Methods:A retrospective analysis was conducted on the clinical and follow-up data of 1 147 liver transplant patients at Qingdao University Affiliated Hospital.Results:The overall postoperative 1-, 3-, and 5-year survival rates for the 1 147 liver transplant patients were 87.20%, 73.40%, and 65.60%, respectively. The survival rates for benign disease liver transplant recipients were 88.01%, 84.98%, and 81.39% at 1, 3, and 5 years post-transplant, respectively, compared to recipients transplanted for malignancies of 78.11%, 64.41%, and 60.06% (all P<0.001). Among the mid vs more recent period, patients' 1-year and 3-year postoperative survival rates were 84.20%, 70.80% vs 90.50%, 71.70%, respectively,significantly in favor of recently enrolled patients ( P=0.022). In the complex surgery group, patients' 1-, 3-, and 5-year survival rates were 82.70%, 65.50%, 56.70%, while in less complicated group, it was 89.00%, 76.50%, 69.20% ( P<0.001). The primary causes of death for benign disease recipients were multi-organ failure (4.1%), while in recipients with malignant disease primary cause of death was tumor recurrence (23.7%). Postoperative complications included primary graft dysfunction, delayed graft function recovery, portal vein thrombosis, hepatic artery thrombosis, biliary stricture, post-transplant lymphoproliferative disorder, and graft-versus-host disease, with occurrence rates of 1.05%, 6.89%, 1.92%, 0.44%, 2.00%, 0.61%, and 0.44%, respectively. Conclusions:With the continuous improvement in surgical techniques and perioperative care levels, the 3-year survival rate of recipients at our center has increased. Malignant diseases and complex liver transplantation remain crucial factors affecting recipient prognosis, highlighting the need to further enhance comprehensive treatment capabilities for patients with malignant diseases and complex surgeries.

Objective To explore the protective effect of Lycium barbanun glycopeptide(LbGP)against osteogenic inhibition induced by exosomes derived from human gingival fibroblasts(HGFs)exposed to radiation.Methods Cultured HGFs with or without LbGP pretreatment were exposed to 8 Gy X-ray radiation,and the changes in cell apoptosis,senescence and α-SMA level were detected using RT-qPCR,Western blotting and β-galactosidase staining.The exosomes secreted by the treated cells were extracted,and after identification by electron microscopy,particle size analysis and Western blotting,the exosomes were added into primary cultured bone mesenchymal stem cells(BMSCs),and osteoclast activity and osteogenesis in the cell cultures were detected by Trap staining,Alizarin red staining,ALP staining,RT-qPCR and Western blotting.Results In cultured HGFs,X-ray radiation significantly increased the percentage of senescent cells,which was obviously lowered by LbGP treatment.X-ray radiation significantly reduced Bcl-2/Bax ratio and increased α-SMA expression in HGFs,and these changes were significantly suppressed by LbGP pretreatment.In rat BMSCs,incubation with the exosomes derived from HGFs with radiation exposure caused a significant increase of osteoclasts,reduced calcium nodules and lowered alkaline phosphatase expression in the cells;The opposite changes were observed in the cells treated with exosomes from LbGP-pretreated HGFs,which also significantly increased the cellular expressions of the osteogenic genes(BMP2,ALP,and RUNX2)and proteins(ALP and RUNX2)as compared with the exosomes from irradiated HGFs.Conclusion LbGP can effectively inhibit osteoclast activity and promote osteogenesis by acting on exosomes secreted by irradiated HGFs,suggesting its potential value for treatment of osteoradionecrosis of the jaw.

Objective To study the splenic injuries caused by high-altitude falling and underwater explosion and the 2-dimensional ultrasound and contrast-enhanced ultrasound(CEUS)characteristics.Methods Twenty-three healthy Beagle dogs were divided into high-altitude falling group(n=13)and underwater explosion group(n=10).Free-fall high-platform device and gram-grade trinitrotoluene were used to simulate high-altitude falling injury and underwater explosion injury in Beagle dogs,respectively.Ultrasound examination of the spleen was performed immediately after injury,with follow-up examinations every hour.CEUS examination was performed in surviving dogs.Spleen specimens were taken from deceased dogs after injury to observe gross injuries.Pathological changes in tissue morphology and cell apoptosis were observed by hematoxylin-eosin(H-E)staining.Results In the high-altitude falling model,6,2,1,and 1 dogs died in the 6 m,7 m,8 m,and 9 m groups,respectively;in the underwater explosion model,1 and 4 dogs died in the buoyancy and frogman groups,respectively.Two-dimensional ultrasound examination of the high-altitude falling model showed spleen rupture(disruption of splenic parenchymal structure),perisplenic fluid accumulation,subcapsular hematoma,intrasplenic hematoma,increased splenic vein echo,and uneven splenic parenchymal echo.Two-dimensional ultrasound examination of the underwater explosion model showed increased splenic vein echo and uneven splenic parenchymal echo,which were less serious compared with the high-altitude falling model.CEUS results indicated 4 major contrast patterns in both models.The Beagle dogs with type Ⅰ(large focal contrast defect),type Ⅱ(diffuse contrast defect),or type Ⅲ(no contrast agent entry into the splenic vein)contrast patterns all had splenic rupture after injury.H-E staining results showed true splenic rupture,diffuse intrasplenic hemorrhage,splenic hematoma/ecchymosis,subcapsular hematoma/ecchymosis,and venous congestion after spleen injury,which were consistent with the 2-dimensional ultrasound findings.Conclusion High-altitude falling causes more serious spleen injuries in Beagle dogs compared with underwater explosions.Routine ultrasound performs well in diagnosing typical splenic injuries,while CEUS has advantages in evaluating atypical splenic injuries and has good predictive ability for delayed splenic rupture.

Objective To explore the protective effect of Lycium barbanun glycopeptide(LbGP)against osteogenic inhibition induced by exosomes derived from human gingival fibroblasts(HGFs)exposed to radiation.Methods Cultured HGFs with or without LbGP pretreatment were exposed to 8 Gy X-ray radiation,and the changes in cell apoptosis,senescence and α-SMA level were detected using RT-qPCR,Western blotting and β-galactosidase staining.The exosomes secreted by the treated cells were extracted,and after identification by electron microscopy,particle size analysis and Western blotting,the exosomes were added into primary cultured bone mesenchymal stem cells(BMSCs),and osteoclast activity and osteogenesis in the cell cultures were detected by Trap staining,Alizarin red staining,ALP staining,RT-qPCR and Western blotting.Results In cultured HGFs,X-ray radiation significantly increased the percentage of senescent cells,which was obviously lowered by LbGP treatment.X-ray radiation significantly reduced Bcl-2/Bax ratio and increased α-SMA expression in HGFs,and these changes were significantly suppressed by LbGP pretreatment.In rat BMSCs,incubation with the exosomes derived from HGFs with radiation exposure caused a significant increase of osteoclasts,reduced calcium nodules and lowered alkaline phosphatase expression in the cells;The opposite changes were observed in the cells treated with exosomes from LbGP-pretreated HGFs,which also significantly increased the cellular expressions of the osteogenic genes(BMP2,ALP,and RUNX2)and proteins(ALP and RUNX2)as compared with the exosomes from irradiated HGFs.Conclusion LbGP can effectively inhibit osteoclast activity and promote osteogenesis by acting on exosomes secreted by irradiated HGFs,suggesting its potential value for treatment of osteoradionecrosis of the jaw.