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Min Gu,1,2,&ast; Xiaohui Zhang,1,2,&ast; Fang Ni,1,2 Jue Wang,1,2 Wenying Xia,1,2 Yanfei Lu1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanfei Lu; Wenying Xia, Department of Laboratory Medicine, Jiangsu Province Hospital, Street No. 300, Guangzhou, 210029, People’s Republic of China, Tel +8625-6830-6287, Email 549793546@qq.com; xiawenying21106891@163.comPurpose: To explore the characteristics of the pathogen distribution and drug resistance in bloodstream infections (BSIs) during the COVID-19 pandemic in a tertiary hospital in eastern China, and to compare them with those before the pandemic.Patients and Methods: Non-repetitive strain data of BSIs were retrospectively obtained before the COVID-19 pandemic (Pre-Pandemic, n=2698) and during the COVID-19 pandemic (Pandemic, n=2922), the distribution of pathogens and drug resistance were compared between the two groups.Results: The main pathogens of BSIs were Gram-negative bacteria (57.91%), followed by Gram-positive bacteria (32.58%), fungi and anaerobic bacteria accounting for 5.48% and 3.39%, respectively. Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus were the top 3 isolates. The proportion of Serratia marcescens, Enterobacter aerogenes, Enterococcus faecium, Enterococcus faecalis and Candida tropicalis were significantly increased, while those of Pseudomonas aeruginosa, Streptococcus sanguinis and Streptococcus pneumoniae were significantly decreased when compared to the Pre-Pandemic (P< 0.05). Carbapenem-resistant Enterobacterales (CRE) significantly elevated during the Pandemic (17.4% vs 14.4%, P=0.041); the detection of carbapenem-resistant Pseudomonas aeruginosa (CRPA) significantly ascended (39.0% vs 24.4%, P=0.016); and the proportion of carbapenem-resistant Acinetobacter baumannii (CRAB) maintained stable (78.8%). Gram-positive bacteria had the lowest resistance to linezolid, vancomycin and tigecycline, which remained a stable trend with the Pre-Pandemic (< 5.0%). The isolate rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) were 38.9% and 1.0%, respectively. Staphylococcus aureus showed a decrease in the isolation rate of vancomycin minimum inhibitory concentration (MIC) ≤ 0.5 μg/mL (χ 2=7.676, P=0.006) and an increase with vancomycin MIC=1 μg/mL (χ 2=9.008, P=0.003).Conclusion: The pathogen distribution and drug resistance of BSIs during the COVID-19 pandemic were transformed from Pre-Pandemic and accompanied by increasing bacterial resistance. Clinical management of antibiotic application and infection control should be strengthened.Keywords: COVID-19 pandemic, bloodstream infection, pathogen distribution, antibiotic resistance

Xujie Zhang, Xinrui Huang, Feilin Ni, Xiaopei Mao, Danhua Yang, Min Xu Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, 310003, People’s Republic of ChinaCorrespondence: Min Xu, Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), No. 54, Youdian Road, Hangzhou, Zhejiang, 310003, People’s Republic of China, Email yudi1212@163.comObjective: We aimed to understand the commonly used acupoints and the acupoint combination rules in Guasha therapy for primary headaches using data mining technology, providing a reference for the clinical application of Guasha therapy for primary headaches.Methods: Literature related to Guasha therapy for primary headaches in PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database were searched, up until May 12, 2023. A database of acupoints for Guasha therapy for primary headaches was established in Excel. The frequency of the acupoints used for Guasha in therapy of primary headaches were calculated by SPSS 25.0. The association rules between the acupoints were further described using SPSS Modeler 18.0.Results: A total of 67 papers were included, involving 51 acupoints for Guasha against primary headaches. The most commonly used acupoints were Fengchi, Baihui, Taiyang, Shuaigu, Tianzhu, and Hegu. The common acupoint combinations for Guasha therapy for primary headaches were Fengchi-Taiyang, Fengchi-Baihui, Fengchi-Taiyang-Baihui, Fengchi-Tianzhu-Baihui, and Fengchi-Shuaigu-Taiyang-Baihui.Conclusion: Data mining can effectively analyze the commonly used acupoints and the acupoint combination rules in Guasha therapy for primary headaches, providing a reliable basis for clinical acupoint selection.Keywords: primary headache, Guasha, data mining, acupoint selection rules, Chinese medicine nursing

Kaixiong Liu,1– 3,&ast; Luling Wu,4,5,&ast; Gongping Chen,1– 3,&ast; Dunhuan Zeng,1– 3 Qiwei Zhong,6 Li Luo,1,2 Bin Song,7 Xiuhong Ying,1,2 Fayu Ni,8 Lifang Yu,8 Liyu Xu,9 Xin Lin,9 Xiaoyan Chen,10 Xin Zou,11 Jianhong Xiao,7 Yuekai Hu5,12,13 1Department of Respiratory and Critical Care medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 3Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People’s Republic of China; 4Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 5Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 6Department of Respiratory and Critical Care Medicine, Minnan Hospital, the First Affiliated Hospital of Fujian Medical University, Quau zhou, People’s Republic of China; 7Department of Respiratory and Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Ningde, People’s Republic of China; 8Department of Respiratory, Fuqing General Hospital Affiliated to Fujian Medical University, Fuzhou, People’s Republic of China; 9Department of Respiratory and Critical Care Medicine, Fuzhou First Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 10Department of Emergency Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, People’s Republic of China; 11Department of Respiratory and Critical Care Medicine, LongYan First Hospital Affiliated to Fujian Medical University, Longyan, People’s Republic of China; 12Department of Infectious Diseases, First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 13Department of Infectious Diseases, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuekai Hu; Jianhong Xiao, Email huyuekai@fudan.edu.cn; xjh1030@sina.comObjective: This study aimed to describe and compare the epidemiological, demographic, clinical, laboratory and radiological characteristics as well as the complications, treatments, and outcomes of these patients.Methods: We retrospectively investigated clinical data of patients with C. psittaci infection (psittacosis) in eight Grade IIIA hospitals of Fujian. Metagenomic next-generation sequencing (mNGS) was used identify C. psittaci in clinical samples of all included patients.Results: A total of 74 patients (39 severe/35 non-severe) was diagnosed with psittacosis, 25 (33.8%) of whom had history of poultry exposure. Common symptoms included high fever (98% [37/74]), fatigue (52.7% [39/74]), and dyspnea (51.4% [38/74]). Common manifestations in imaging included consolidation (89.2%), pleural effusion (77.0%), and air bronchogram (66.2%). Common complications included acute respiratory distress syndrome (55.4% [41/74]), type I respiratory failure (52.7% [39/74]), acute liver injury (41.9% [31/74]), and secondary infection (27.0% [20/74]). The in-hospital mortality rate was 8.11% (6/74).Conclusion: C. psittaci infection is represents an underestimated cause of CAP. For SCAP patients with poultry and bird contact history, specimens were encouraged to be sended for mNGS test in time. C. psittaci infection can lead to severe, multiple system involvement, and several complications. mNGS facilitate timely diagnosis of C. psittaci infection.Keywords: Chlamydia psittaci, metagenomic next-generation sequencing, community-acquired pneumonia, bronchoalveolar lavage fluid

Yaling Li,1,&ast; Kaiyang Shao,1,&ast; Ruyi Cai,1 Yi Liu,2 Xiaojing Liu,2,3 Feihua Ni,1 Huiyan Zheng,1 Ruying Hu,1 Ting Sun1 1Department of Health Management Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ting Sun, Department of Health Management Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, People’s Republic of China, Email 1195037@zju.edu.cnBackground: The coexistence of blaNDM-1 with other resistance determinants is rarely reported for Providencia rettgeri. Therefore, this study investigates the phenotypic and genetic characteristics of a multidrug-resistant P. rettgeri strain YQ150713.Methods: P. rettgeri YQ150713 was identified as carrying blaNDM-1. S1-pulsed-field gel electrophoresis (S1-PFGE), Southern blotting, and conjugation experiments were used to determine plasmid characteristics. An antimicrobial susceptibility test was conducted. The complete genomic sequence of YQ150713 was obtained using Illumina NovaSeq 6000 and Oxford nanopore platforms. To further characterize the phylogenetic structure of P. rettgeri YQ150713, average nucleotide identity (ANI) and phylogenetic analyses were conducted.Results: The S1-PFGE, Southern blot, and conjugation assays have confirmed that the isolate P. rettgeri YQ150713 contains the blaNDM-1 gene on a conjugative plasmid pYQ150713-NDM-1. Antimicrobial susceptibility testing has indicated that strain YQ150713 was resistant to various common antibiotics, except aztreonam and fosfomycin. Bioinformatics analysis has further shown that pYQ150713-NDM-1 was a novel plasmid with a size of 265,883 bp, and blaNDM-1 and blaOXA-10 were co-located on it. Phylogenetic analysis suggesting P. rettgeri has spread widely throughout the world.Conclusion: In this study, blaNDM-1 and blaOXA-10 were co-localized on a novel plasmid pYQ150713-NDM-1 with a horizontal transfer function. To reduce the risk of the dissemination of such P. rettgeri isolates in clinical settings, more surveillance will be required in the future.Keywords: antimicrobial resistance, blaNDM-1, blaOXA-10, Providencia rettgeri, carbapenemase-producing, average nucleotide identity, phylogenetic

Xiaohui Zhang,1,2,&ast; Fei Jin,1,2,&ast; Yanfei Lu,1,2 Fang Ni,1,2 Yuqiao Xu,1,2 Wenying Xia1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuqiao Xu; Wenying Xia, Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Street No. 300, Guangzhou, 210029, People’s Republic of China, Tel +8625-6830-6146 ; +8625-6830-6287, Fax +8625-8372-4440, Email joe8165@163.com; xiawenying21106891@163.comPurpose: This study aimed (i) to investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with infective endocarditis (IE) and (ii) to compare the differences in three age groups.Methods: A total of 240 IE cases diagnosed using the modified Duke criteria between January 2016 and December 2019 were included and retrospectively studied. Patients were stratified into three age groups: < 50 y, 50– 65 y, and > 65 y.Results: The mean age of the patients was 51 ± 14 y, and 154 patients (64.2%) were male. In addition, 136 (56.7%) patients with IE had no previous cardiac disease. Congenital heart disease (CHD, 21.3%) was the most common underlying heart disease, followed by rheumatic heart disease (RHD, 8.8%). Streptococcus was found in 55 (22.9%) patients and was the most common causative pathogen, comprising 52.9% of all positive blood cultures. Echocardiography showed the presence of vegetations in 88.3% of cases and the predominant involvement of the left heart valves. Fever and cardiac murmur were the most frequent presentations, with no significant differences among age groups. Compared with younger patients, elderly patients had a lower operation rate and higher in-hospital mortality. The independent risk factors of in-hospital mortality were age > 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection.Conclusion: CHD replaces RHD as the most common underlying heart disease in IE patients. Patients without previous cardiac disease are at increased risk of IE. Streptococcus is still the primary causative pathogen of IE. Elderly patients present with more comorbidities and complications, in addition to a more severe prognosis than younger patients. Age older than 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection showed poorer in-hospital outcomes.Keywords: infective endocarditis, clinical characteristics, risk factors, elderly patients

Yanfei Lu,1,2,&ast; Wenying Xia,1,2,&ast; Fang Ni,1,2 Yuqiao Xu1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuqiao Xu, Department of Laboratory Medicine, Jiangsu Province Hospital, Guangzhou Street No. 300, Nanjing, 210029, People’s Republic of China, Tel + 8625-6830-6287, Fax + 8625-8372-4440, Email joe8165@163.comAbstract: Peptoniphilus asaccharolyticus is a Gram-positive anaerobic coccus, which forms part of the normal flora and the human commensals of the skin, genitourinary system, and gut. It can cause opportunistic infections in immunocompromised patients and is frequently isolated as part of polymicrobial spectra. Severe monomicrobial infections caused by the genus rarely occur. In this study, we report on septic shock, renal abscess, and bacteremia due to P. asaccharolyticus in a woman with nephrosis and diabetes mellitus. To the best of our knowledge, this report is the first to describe P. asaccharolyticus isolated from both renal abscess and blood cultures purely. The underlying diseases of the host and the removal of the double J tube were significant predisposing factors in this infection.Keywords: Peptoniphilus asaccharolyticus, septic shock, renal abscess, bacteremia, immunocompromised

Yanfei Lu,1,2,&ast; Xiaohui Zhang,1,2,&ast; Fang Ni,1,2 Wenying Xia1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wenying XiaDepartment of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Street No. 300, Guangzhou, 210029, People’s Republic of ChinaTel +8625-6830-6287Fax +8625- 8372-4440Email xiawenying21106891@163.comAbstract: Human protothecosis is a rare infection caused by Prototheca spp., which are environmental achloric algae ubiquitously existing in nature. Members of the genus of Prototheca usually cause localized infection that affects the skin or wounds. Systemic infection is extremely rare and tends to occur in immunocompromised patients. Here, we report a case of cutaneous protothecosis and meningitis due to Prototheca wickerhamii in an immunocompetent teenager who obtained full-body tattoos at the time of infection. To the best of our knowledge, this is the first description of P. wickerhamii isolated from both skin tissue and cerebrospinal fluid. The data contained in this report will increase our understanding of this pathogen and elucidate the most optimal treatment.Keywords: Prototheca wickerhamii, cutaneous protothecosis, meningitis, immunocompetent

Yaping Han,1,2 Lei Huang,1,2 Chengcheng Liu,1,2 Xu Huang,3 Ruiying Zheng,1,2 Yanfei Lu,1,2 Wenying Xia,1,2 Fang Ni,1,2 Yaning Mei,1,2 Genyan Liu1,2 1Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, People’s Republic of China; 3Department of Laboratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, People’s Republic of ChinaCorrespondence: Genyan LiuDepartment of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, People’s Republic of ChinaTel +86 25-6830-3453Fax +86 25- 8372-4440Email liugenyan@njmu.edu.cnObjective: Nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great threat to severely ill patients. Here we report an outbreak of K. pneumoniae ST15 isolates co-producing KPC-2, CTX-M-15, and SHV-28 in the cardiac surgery intensive care unit (CSICU) of a tertiary hospital.Materials and Methods: From November 2019 to August 2020, all non-duplicated CRKP isolates were collected from the CSICU. The VITEK-2 compact system was used for bacterial identification and antimicrobial susceptibility testing. Clinical data were retrieved from electronic case records. All strains were also subjected to antibiotic resistance genes detection. Clonal relationships were analyzed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE).Results: A total of 28 non-duplicated CRKP isolates were collected, including 23 strains belonging to ST15 and 5 strains belonging to ST11. All ST15 isolates were susceptible to amikacin, tigecycline, polymyxin B and ceftazidime/avibactam, but resistant to carbapenems, cephalosporins, quinolones, tobramycin and gentamicin. The detection of resistant determinants showed that 21 strains of ST15 CRKP co-harboured blaKPC-2, blaCTX-M-15, blaSHV-28, blaTEM-1, blaOXA-1 and aac(6ʹ)-Ib-cr. All the 28 CRKP isolates were classified into five PFGE patterns (A, B, C, D and E), of which type A and B belonged to ST15 and type C, D and E belonged to ST11. PFGE type A was the predominant clonotype of this nosocomial infection and belonged to ST15.Conclusion: K. pneumoniae ST15 co-producing KPC-2, CTX-M-15, SHV-28, TEM-1, OXA-1 and aac(6ʹ)-Ib-cr is the predominant clone spread in the CSICU. Surveillance and comprehensive infection control measures should be strengthened in clinical practice.Keywords: Klebsiella pneumoniae ST15, carbapenem-resistant, KPC-2, multidrug resistance, resistance gene

Yuqiao Xu,1,2 Wenying Xia,1,2 Fang Ni1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Nanjing, People’s Republic of ChinaCorrespondence: Wenying Xia; Fang NiDepartment of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Guangzhou Street No. 300, 210029, People’s Republic of ChinaTel + 86 25-6830-6287Fax + 86 25- 8372-4440Email xiawenying21106891@163.com; 13813972378@163.comAbstract: Cryptococcus neoformans (C. neoformans) is an opportunistic fungal pathogen to humans, which can be acquired from environmental sources. Its most important virulence factor is its polysaccharide capsule, which can be used for diagnostic tests that identify the cryptococcal antigen (CrAg). The CrAg lateral flow assay (LFA) is a dipstick immunochromatographic assay with high sensitivity and specificity; however, several false-negative cases have been reported. Here, we present a case of a false-negative serum CrAg LFA, in which the blood culture from a matched sample was positive for C. neoformans, thus demonstrating the postzone phenomenon.Keywords: Cryptococcus neoformans, lateral flow immunoassay, postzone phenomenon

Xiaohui Zhang,1,2,* Yanfei Lu,1,2,* Huimin Qian,3 Genyan Liu,1,2 Yaning Mei,1,2 Fei Jin,1,2 Wenying Xia,1,2 Fang Ni1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Nanjing, People’s Republic of China; 3Key Laboratory of Enteric Pathogenic Microbiology of Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenying Xia; Fang NiDepartment of Laboratory Medicine, Jiangsu Province Hospital, Guangzhou Street No. 300, 210029, People’s Republic of ChinaTel +8625-6830-6287Fax +8625-8372-4440Email xiawenying21106891@163.com; 13813972378@163.comAbstract: Non-O1, non-O139 Vibrio cholerae (NOVC) does not agglutinate with O1 and O139 antisera and can cause intestinal and extraintestinal infections in immunocompromised individuals. NOVC bacteremia has the highest mortality among NOVC infections, and the number of reports has increased in recent years. Nevertheless, some clinicians are poorly informed about this disease. Herein, we describe a documented case of NOVC bacteremia in a male patient with impaired liver function. Blood cultures revealed the presence of V. cholerae, but this strain showed self-coagulation on the serum agglutination test. To our knowledge, this phenomenon is unreported among cases of NOVC infections. This pathogen was finally confirmed as NOVC via PCR. Because the patient worked as a garbage transporter, he was likely infected after contact with contaminated water through a foot wound. The patient developed septic shock shortly after admission and ultimately died from the illness. This paper reviews 23 cases of NOVC bacteremia from 2015 to 2019. To improve the accuracy of identifying NOVC and analyze its virulence factors, relevant detection methods were reviewed and analyzed.Keywords: bacteremia, non-O1/non-O139 Vibrio cholerae, V. cholerae, virulence factors

Yanfei Lu, 1, 2,* Wenying Xia, 1, 2,* Xiaohui Zhang, 1, 2,* Fang Ni, 1, 2 Yaning Mei 1, 2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fang Ni; Yaning MeiDepartment of Laboratory Medicine, Jiangsu Province Hospital, Guangzhou Street No. 300, Nanjing 210029, People’s Republic of ChinaTel +86 25-6830-6287Fax +86 25- 8372-4440Email 13813972378@163.com; myn303@163.comAbstract: The genus Myroides are gram-negative bacilli which are completely aerobic, non-motile, non-fermenting and yellow-pigmented with a characteristic fruity odor. Myroides species are widely found in the environment, especially in water and soil, and are considered as low-grade opportunistic pathogens for humans. Myroides infections are most commonly seen in immunocompromised patients and only rarely occur in immunocompetent patients. We here report the first confirmed catheter-related bloodstream infection (CRBSI) due to Myroides odoratimimus in an immunocompetent patient. We also review the literature related to Myroides infections.Keywords: Myroides odoratimimus, CRBSI, immunocompetent patient

Fubiao Ni,1,* Hengjie Tang,1,* Cheng Wang,1,* Hewei Zhang,1 Chenlei Zheng,1 Ning Zhang,2 Bicheng Chen,1 Linxiao Sun1 1Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Zhejiang Provincial Top Key Discipline in Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People’s Republic of China; 2First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Linxiao Sun; Bicheng Chen Email sunlinxiao@wmu.edu.cn; bichengchen@hotmail.comBackground: Although the incidence of pancreatic cancer has increased markedly, the 5-year survival rate for this disease is considerably low compared with other types of cancer. Moreover, the mortality rate of pancreatic cancer is similar to its incidence rate. Current therapeutic agents exhibit a lack of specificity for pancreatic cancer. Baohuoside I is traditionally used to treat orgasmic disorder and inflammation. However, its role in pancreatic cancer is unknown.Objective: To explore the effects of Baohuoside I on pancreatic cancer and to study the potential-related molecular mechanism.Materials and methods: In the present study, the antineoplastic effect of Baohuoside I was investigated with regard to pancreatic cancer via colony formation, transwell and migration assay. The energy metabolism changes of pancreatic cancer were tested by flow cytometry analysis and oxidative phosphorylation and glycolysis assay. The target signaling members were analyzed by Western blot.Results: Baohuoside I inhibited the cell growth of pancreatic cancer cells. In addition, it affected intracellular energy metabolism to induce cancer cell apoptosis via the mTOR/S6K1 and the caspase/Bcl2/Bax signaling pathways.Conclusion: The present data provide further insight into the development of novel drugs against pancreatic cancer.Keywords: Baohuoside I, pancreatic cancer, apoptosis

Fubiao Ni,1,* Hengjie Tang,1,* Cheng Wang,1,* Zixiang Wang,2 Fangyi Yu,2 Bicheng Chen,1 Linxiao Sun1 1Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Zhejiang Provincial Top Key Discipline in Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2First College of Clinical Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Linxiao SunKey Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Zhejiang Provincial Top Key Discipline in Surgery, First Affiliated Hospital of Wenzhou Medical University, Fanhai West Road, Nanbaixiang Street, Wenzhou 325006, Zhejiang, People’s Republic of ChinaEmail sunlinxiao@wmu.edu.cnnBackground: Current investigations suggest that the Base Excision Repair (BER) system may change DNA repair capacity and affect clinical gastric cancer progression such as overall survival. However, the prognostic value of BER system members in gastric cancer remains unclear.Methods: We explored the prognostic correlation between 7 individual BER genes, including uracil-DNA glycosylase (UNG), Single-strand-selective monofunctional uracil-DNA glycosylase 1 (SMUG1), Methyl-CpG binding domain 4 (MBD4), thymine DNA glycosylase (TDG), 8-oxoguanine DNA glycosylase (OGG1), MutY DNA glycosylase (MUTYH) and Nei like DNA glycosylase 1 (NEIL1), expression and overall survival (OS) in different clinical data, such as Lauren classification, pathological stages, human epidermal growth factor receptor-2 (HER2) expression status, treatment strategy, gender and differentiation degree in gastric cancer patients, using Kaplan-Meier plotter (KM plotter) online database. Based on the bioinformatics analysis, we utilized Berzosertib (VE-822) to inhibit DNA damage repair in cancer cells compared to solvent control group via real-time cellular analysis (RTCA), flow cytometry, colony formation and migration assay. Finally, we utilized reverse transcription-polymerase chain reaction (RT-PCR) to confirm the expression of BER members between normal and two gastric cancer cells or solvent and VE-822 treated groups.Results: Our work revealed that high UNG mRNA expression was correlated with high overall survival probability; however, high SMUG1, MBD4, TDG, OGG1, MUTYH and NEIL1 mRNA expression showed relatively low overall survival probability in all GC patients. Additionally, UNG was associated with high overall survival probability in intestinal and diffuse types, but SMUG1 and NEIL1 showed opposite results. Further, VE-822 pharmacological experiment suggested that inhibition of DNA damage repair suppressed gastric cancer cells’ proliferation and migration ability via inducing apoptosis. Further, real-time polymerase chain reaction results proposed the inhibition of gastric cancer cells by VE-822 may be through UNG, MUTYH and OGG-1 of BER system.Conclusion: We comprehensively analyze the prognostic value of the BER system (UNG, SMUG1, MBD4, TDG, OGG1, MUTYH and NEIL1) based on bioinformatics analysis and experimental confirmation. BER members are associated with distinctive prognostic significance and maybe new valuable prognostic indicators in gastric cancer.Keywords: base excision repair, gastric cancer, Kaplan-Meier plotter

Pengfei Sun,1,2,* Wenying Xia,1,2,* Genyan Liu,1,2 Xu Huang,1,2 Chenjie Tang,1,2 Chengcheng Liu,1,2 Yuqiao Xu,1,2 Fang Ni,1,2 Yaning Mei,1,2 Shiyang Pan1,2 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China; 2National Key Clinical Department of Laboratory Medicine, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Genyan LiuDepartment of Laboratory Medicine, Jiangsu Province Hospital, Guangzhou Street No. 300, Nanjing 210029, People’s Republic of ChinaTel +8625 6830 7332Fax +8625 8372 4440Email liugenyan@njmu.edu.cnPurpose: The emergence and spread of carbapenem-resistant Enterobacteriaceae deserves special concern worldwide. Unlike the epidemiological characteristics reported in other studies, we found that the production of New Delhi metallo-β-lactamase 5 was the main mechanism for the resistance of Escherichia coli to carbapenems.Methods: All carbapenem-resistant strains were collected from July 2017 to July 2018 of the First Affiliated Hospital of Nanjing Medical University. The presence of carbapenemase-encoding genes was detected using PCR and gene sequencing. Genetic relatedness of the blaNDM-5-positive E. coli strains was determined with PFGE and MLST. Susceptibility profiles were measured with broth microdilution method and E-test strips. Transferability features of blaNDM-5 gene were assessed by conjugation experiments, S1-PFGE, southern blotting and PCR-based replicon typing methods. The genetic structures surrounding blaNDM-5 were acquired by whole genome sequencing and PCR mapping.Results: Among the 28 carbapenem-resistant E. coli strains, 18 (64%) were verified as NDM-5 producers. The 18 blaNDM-5-positive E. coli strains showed high resistance to most antibiotics, but 100% were sensitive to colistin and tigecycline. In addition, the 18 blaNDM-5-positive E. coli strains belonged to eight STs, among which ST167, ST410 and ST101 were found to cause clonal spread in the hospital. Further studies found that the blaNDM-5 gene was located on an IncX3-type plasmid, and all plasmids harbored an IS3000-ΔISAba125-IS5-blaNDM-5-bleMBL-trpF-dsbC-IS26 structure.Conclusion: The clonal spread of blaNDM-5-positive E. coli strains and horizontal dissemination via the pNDM-MGR 194-like plasmids should draw more attention. Appropriate infection control operations should be performed to prevent the further spread of blaNDM-5.Keywords: Escherichia coli, carbapenem-resistant Enterobacteriaceae, New Delhi metallo-β-lactamase, blaNDM-5, IncX3 type plasmid

Ji-guo Yu,1,* Fang Ni,1,* Yi Xiang,1 Yi-fan Feng,2 Jue Wang,1 Xun-an Fu11Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, 2Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workPurpose: To evaluate postoperative pain and other irritation symptoms after 20-gauge (20G) pars plana vitrectomy.Materials and methods: A total of 110 consecutive patients were enrolled in our studies, and 87 patients who underwent the conventional 20G pars plana vitrectomy were included in the final analysis. All vitrectomies were performed using the same surgical technique by the same surgeon. Patients were examined before surgery and 1 day, 3 days, 7 days, 1 month, and 2 months postoperatively. The main outcome measures include patient age and sex, intraocular pressure (IOP), ocular pain, pain score, pain medication use, and other irritation symptoms comprising itching, foreign body sensation, burning, photophobia, and dryness. The pain was evaluated using the Numerical Rating Scale scored from 0 to 10.Results: Postoperative pain was relatively common during the first day after surgery, as it was reported by 43 (49.4%) patients. Then, the prevalence gradually decreased to eleven (12.6%) patients at 2 months. Most patients reported mild or moderate pain, with a pain score of 1–5, but only four patients were given analgesics for ocular pain. A postoperative rise of IOP was noted in 25 patients at day 1. Most of these patients with high IOP reported moderate pain. Other ocular irritation symptoms were varied after surgery. There was still one-quarter of patients that had foreign body sensation and dryness symptoms at month 2 after surgery.Conclusion: Mild and moderate ocular pain were relatively common after 20G vitrectomy, which is more often associated with elevated IOP. Other irritation symptoms were also presented after surgery and could affect the life quality of patients. Therefore, the discomforts after 20G pars plana vitrectomy should be of concern, and timely management should be provided as part of routine postoperative care.Keywords: eye, pain, irritation symptom, 20G vitrectomy

Pavement segments are functionally interdependent under traffic equilibrium, leading to interdependent maintenance and rehabilitation (M&R) decisions for different segments, but it has not received significant attention in the pavement management community yet. This study developed a maintenance optimization model for interdependent pavement networks based on the simultaneous network optimization (SNO) framework and a multi‐agent reinforcement learning algorithm. The established model was demonstrated on a highway pavement network in the real‐world, compared to a previously built two‐stage bottom‐up (TSBU) model. The results showed that, compared to TSBU, SNO produced a 3.0% reduction in total costs and an average pavement performance improvement of up to 17.5%. It prefers concentrated M&R schedules and tends to take more frequent preventive maintenance to reduce costly rehabilitation. The results of this research are anticipated to provide practitioners with quantitative estimates of the possible impact of ignoring segment interdependencies in M&R planning. [ABSTRACT FROM AUTHOR]

Sintering temperature is the key factor affecting the structure and performance of tungsten carbide (WC) ceramics. Thus, the effect of sintering temperature on the microstructure and mechanical properties of WC-Ni-Co coarse grain ceramics, obtained from the mixture containing: 60wt.% of ultra-coarse WC, 30 wt.% of fine WC, 7 wt.% of Co and 3wt.% of Ni powders, was analysed. The mechanical properties of WC ceramics did not change much when the sintering temperature was varied between 1410 and 1430 °C and the comprehensive performances of the ceramics were the best in this temperature range. In order to confirm that the coarse grain WC-Ni-Co ceramics can be applicable for harsh environments, it was compared with the standard WC-Co ceramics of the same grain size, and the reasons and mechanisms for the differences in microstructure and properties between the two ceramics were tested and analysed. The study shows that the average grain size of two ceramics does not differ much, and there are no decarburisation, graphite-phase and other impurity phases inside the ceramics. In addition, the difference in the mechanical properties is also small. However, the addition of Ni effectively improves the corrosion resistance of the WC-Co ceramics. Therefore, WC-Ni-Co can replace WC-Co ceramics as shield cutting tool material with the same grain size.

Abstract KIF18B is a key member of the kinesin-8 family, involved in regulating various physiological processes such as microtubule length, spindle assembly, and chromosome alignment. This article briefly introduces the structure and physiological functions of KIF18B, examines its role in malignant tumors, and the associated carcinogenic signaling pathways such as PI3K/AKT, Wnt/β-catenin, and mTOR pathways. Research indicates that the upregulation of KIF18B enhances tumor malignancy and resistance to radiotherapy and chemotherapy. KIF18B could become a new target for anticancer drugs, offering significant potential for the treatment of malignant tumors and reducing chemotherapy resistance.

The cGAS-STING signaling pathway is a critical component of the innate immune response, playing a significant role in various diseases. As a central element of this pathway, STING responds to both endogenous and exogenous DNA stimuli, triggering the production of interferons and pro-inflammatory cytokines to enhance immune defenses against tumors and pathogens. However, dysregulated activation of the STING pathway is implicated in the pathogenesis of multiple diseases, including autoinflammation, viral infections, and cancer. Traditional Chinese Medicines (TCMs), which have a long history of use, have been associated with positive effects in disease prevention and treatment. TCM formulations (e.g., Lingguizhugan Decoction, Yi-Shen-Xie-Zhuo formula) and active compounds (e.g., Glabridin, Ginsenoside Rd) can modulate the cGAS-STING signaling pathway, thereby influencing the progression of inflammatory, infectious, or oncological diseases. This review explores the mechanisms by which TCMs interact with the cGAS-STING pathway to regulate immunity, focusing on their roles in infectious diseases, malignancies, and autoimmune disorders.

Purposes Rebar plays an indispensable role in construction engineering; however, challenges such as densely packed end faces, non-uniform diameter scales, adhesive boundaries, background fusion, and occlusions between end faces have made precise counting a significant challenge. In recent years, deep learning has made remarkable strides in the field of dense object counting. Nonetheless, deep leaming faces limitations because of the need for large-scale data and computational resources, hindering its practical application. Methods In response to these challenges, an enhanced YOLOv8 model framework is introduced for rebar end detection. The framework incorporates Spatial and Channel reconstruction Convolutional (SCConv) modules and the Normalized Wasserstein Distance (NWD) loss function tailored for small object detection. Findings Experimental results from ablation tests demonstrate that the SCConv module significantly reduces network parameters while maintains network performance. Furthermore, the NWD loss function notably enhances the accuracy of rebar end detection in large models. This re search provides an effective solution for achieving high-precision and lightweight rebar counting.

Background: Buyang Huanwu Decoction (BHD) is widely used in Chinese clinical practice for the treatment and prevention of ischemic cerebral vascular diseases. This study was designed to investigate the effects of BHD on ischemic stroke (IS) and its underlying mechanism. Methods: The middle cerebral artery occlusion (MCAO) rat model and oxygen-glucose deprivation and reoxygenation (OGD/R) rat brain microvascular endothelial cell (RBMVEC) models were established. Brain infarction size and neurological score were calculated following MCAO surgery. Evans blue was used to measure blood brain barrier (BBB) permeability. Cell counting kit-8 (CCK-8) and TUNEL assays were performed to evaluate the cell viability and apoptosis of RBMVECs. Dual-luciferase reporter assay was used to analyze the transcriptional activities of apoptosis-related genes. Results: Results showed that higher infarction volume, neurological scores, and BBB permeability in the MCAO group rats were reduced after BHD treatment. Drug serum (DS) treatment had no impact on the normal RBMVECs’ cell viability and cell apoptosis. Besides, DS treatment decreased the lactate production, glucose uptake, and extracellular acidification rate in normal and OGD/R-induced RBMVECs. DS treatment downregulated the protein levels of pan-lysine lactylation (kla), histone H3 lysine 18 lactylation (H3K18la), and the transcriptional of apoptotic protease activating factor-1 (Apaf-1) in OGD/R-treated RBMVECs. In addition, Apaf-1 overexpression decreased cell viability and increased apoptosis and glycolysis activity of OGD/R-treated RBMVECs. Conclusion: In summary, BHD inhibited glycolysis and apoptosis via suppressing the pan-kla and H3K18la protein levels and the Apaf-1 transcriptional activity, thus restraining the progression of IS.

Since the identification of the poliovirus in 1908, over a hundred serotypes of enteroviruses have been discovered, capable of causing a range of diseases including hand, foot, and mouth disease, newborn sepsislike syndrome, aseptic meningitis, acute flaccid paralysis, respiratory disorders, and acute hemorrhagic conjunctivitis. In recent years, enteroviruses such as EV-A71 and EV-D68 have exhibited globalized periodic outbreaks, emerging as a significant and indisputable challenge in the field of public health. However, the current preventive and control measures for enteroviruses remain notably limited, necessitating a pressing need to delve deeper into the molecular mechanisms responsible for enteroviral pathogenesis. This will facilitate the development of novel targets and methodologies for the creation of effective, safe, and broad-spectrum antiviral drugs. This comprehensive review focuses on the classification, epidemiology, structure, life cycle, interplay between viral proteins and host factors, pathogenic mechanisms, clinical treatments, and the establishment and application of animal infection models relevant to enteric viruses. The aim is to serve as a theoretical referential basis for the prevention and control of enteroviruses, offering novel perspectives for the development of drugs and the establishment of a vaccine repository dedicated to combating enteroviruses.

Abstract Background Ovarian cancer (OC) is a severe gynecological malignancy with significant diagnostic and therapeutic challenges. The discovery of reliable cancer biomarkers can be used to adjust diagnosis and improve patient care. However, serous OC lacks effective biomarkers. We aimed to identify novel biomarkers for OC and their pathogenic causes. Methods The present study used the differentially expressed genes (DEGs) obtained from the “Limma” package and WGCNA modules for intersection analysis to obtain DEGs in OC. Three hub genes were identified—claudin 3 (CLDN3), interferon regulatory factor 6 (IRF6), and prostasin (PRSS8)—by searching for hub genes through the PPI network and verifying them in GSE14407, GSE18520, GSE66957, and TCGA + GTEx databases. The correlation between IRF6 and the prognosis of OC patients was further confirmed in Kaplan-Miller Plotter. RT-qPCR and IHC confirmed the RNA and protein levels of IRF6 in the OC samples. The effect of IRF6 on OC was explored using transwell invasion and scratch wound assays. Finally, we constructed a ceRNA network of hub genes and used bioinformatics tools to predict drug sensitivity. Results The joint analysis results of TCGA, GTEx, and GEO databases indicated that IRF6 RNA and protein levels were significantly upregulated in serous OC and were associated with OS and PFS. Cell function experiments revealed that IRF6 knockdown inhibited SKOV3 cell proliferation, migration and invasion. Conclusion IRF6 is closely correlated with OC development and progression and could be considered a novel biomarker and therapeutic target for OC patients.

The two patients included in the study had mixed and refractory post-tuberculosis tracheobronchial stenosis (PTTS), having experienced unsuccessful interventional therapies such as balloon dilation and V-shaped stent placement before the operation. Following the secure placement of L-shaped silicone stents, examinations with a fiberbronchoscope during the first and third months post-operation revealed a significant reduction in bronchial mucosa inflammation for both patients. Additionally, the opening diameter of the upper and lower branch segments increased, and chest CT scans indicated a noticeable absorption of left pulmonary lesions. Three months post-operation, fiberbronchoscopy confirmed the stable fixation of the stent without any movement. The patients exhibited substantial improvements in pulmonary function, dyspnea index, and blood gas analysis, with no reported adverse complications. After 7 months, a follow-up fiberbronchoscope for one case revealed excellent stent fixation. Simultaneously, the chest CT scan indicated favorable re-expansion. The placement of L-shaped silicone stents proves effective in preventing displacement, alleviating airway stenosis or obstruction, and ensuring the safety and efficacy of PTTS treatment – particularly in cases where V-shaped silicone stent placement has failed. To our knowledge, this is the first study describing the L-shaped silicone stent in two patients with PTTS.

Sarcomatoid renal cell carcinoma (SRCC), a manifestation of sarcomatoid dedifferentiation in renal cell carcinoma, is characterized by elevated invasiveness and a grim prognosis. Typically, SRCC patients present with advanced or metastatic conditions and survival rates rarely extend beyond one year. In this study, we describe a case of SRCC characterized by the patient exhibiting right flank pain without hematuria. Initially, imaging interpretations led to a diagnosis of severe hydronephrosis. Subsequently, an open right nephrectomy post-surgery confirmed the pathology of sarcomatoid renal cell carcinoma.

Abstract Prodrug photolysis enables spatiotemporal control of drug release at the desired lesions. For photoactivated therapy, near-infrared (NIR) light is preferable due to its deep tissue penetration and low phototoxicity. However, most of the photocleavable groups cannot be directly activated by NIR light. Here, we report a upconversion-like process via only one step of energy transfer for NIR light-triggered prodrug photolysis. We utilize a photosensitizer (PS) that can be activated via singlet-triplet (S-T) absorption and achieve photolysis of boron-dipyrromethene (BODIPY)-based prodrugs via triplet-triplet energy transfer. Using the strategy, NIR light can achieve green light-responsive photolysis with a single-photon process. A wide range of drugs and bioactive molecules are designed and demonstrated to be released under low-irradiance NIR light (100 mW/cm2, 5 min) with high yields (up to 87%). Moreover, a micellar nanosystem encapsulating both PS and prodrug is developed to demonstrate the practicality of our strategy in normoxia aqueous environment for cancer therapy. This study may advance the development of photocleavable prodrugs and photoresponsive drug delivery systems for photo-activated therapy.