[Current status and prospects of genetic research on membranous nephropathy]

Primary membranous nephropathy (PMN) is one of the most frequent pathological subtypes of nephrotic syndrome in adults. The use of genome-wide association study (GWAS) technology has propelled the transition from conventional medicine to precision medicine, offering a fresh perspective for comprehending the pathogenesis of PMN and individual variations in greater detail. Furthermore, GWAS will aid in clinical translation, laying a firm foundation for the precise diagnosis and treatment of PMN.

A study of the pesticide residues in rapeseeds in China: Levels, distribution and health risk assessment

The aim of this survey was to evaluate the residue levels, distribution and exposure risk of the 38 most commonly used pesticides in rapeseed samples collected from the main production areas in China over a two-year period. The sampling area covered 12 provinces, including Guizhou, Shaanxi, Yunnan, Hunan, Jiangxi, Sichuan, Chongqing, Anhui, Henan, Hubei, Zhejiang, and Jiangsu provinces. The pesticide residues were determined using a QuEChERS (Quick Easy Cheap Effective Rugged and Safe) method coupled with gas chromatography-tandem mass spectrometry and liquid chromatography-tandem mass spectrometry. 8.4% of the rapeseed samples contained pesticides with a residue level ranging from 0.001 to 0.634 mg/kg. The detected analytes were imidacloprid, quizalofop-P-ethyl, thiamethoxam, paclobutrazol, prochloraz, tebuconazole, difenoconazole, s-metolachlor, carbofuran, and carbendazim. The concentrations of four analytes, including thiamethoxam, difenoconazole, carbendazim and prochloraz, exceeded the maximum residue level set by the Chinese government for rapeseed, with exceedance rates of 0.1%, 0.1%, 0.1%, and 1.1%, respectively. Based on the index of quality for residues (IqR) values, 91.6% of the total rapeseed samples had an IqR category of Excellent (IqR = 0). Only 1.5% of the tested samples were of inadequate quality. Furthermore, the assessment of chronic and acute exposure, as well as health risks associated with pesticide residues in rapeseed, was conducted for different age groups within the Chinese population, including adults (6-14 years), children (15-49 years), and the elderly (50-74 years). The results of this assessment indicated that pesticide residues in rapeseed cultivated in China are not expected to be of short- or long-term risks to the Chinese customers.

Lignin bioconversion based on genome mining for ligninolytic genes in Erwinia billingiae QL-Z3

BACKGROUND

Bioconversion of plant biomass into biofuels and bio-products produces large amounts of lignin. The aromatic biopolymers need to be degraded before being converted into value-added bio-products. Microbes can be environment-friendly and efficiently degrade lignin. Compared to fungi, bacteria have some advantages in lignin degradation, including broad tolerance to pH, temperature, and oxygen and the toolkit for genetic manipulation.

RESULTS

Our previous study isolated a novel ligninolytic bacterial strain Erwinia billingiae QL-Z3. Under optimized conditions, its rate of lignin degradation was 25.24% at 1.5 g/L lignin as the sole carbon source. Whole genome sequencing revealed 4556 genes in the genome of QL-Z3. Among 4428 protein-coding genes are 139 CAZyme genes, including 54 glycoside hydrolase (GH) and 16 auxiliary activity (AA) genes. In addition, 74 genes encoding extracellular enzymes are potentially involved in lignin degradation. Real-time PCR quantification demonstrated that the expression of potential ligninolytic genes were significantly induced by lignin. 8 knock-out mutants and complementary strains were constructed. Disruption of the gene for ELAC_205 (laccase) as well as EDYP_48 (Dyp-type peroxidase), ESOD_1236 (superoxide dismutase), EDIO_858 (dioxygenase), EMON_3330 (monooxygenase), or EMCAT_3587 (manganese catalase) significantly reduced the lignin-degrading activity of QL-Z3 by 47-69%. Heterologously expressed and purified enzymes further confirmed their role in lignin degradation. Fourier transform infrared spectroscopy (FTIR) results indicated that the lignin structure was damaged, the benzene ring structure and groups of macromolecules were opened, and the chemical bond was broken under the action of six enzymes encoded by genes. The abundant enzymatic metabolic products by EDYP_48, ELAC_205 and ESOD_1236 were systematically analyzed via liquid chromatography-mass spectrometry (LC-MS) analysis, and then provide a speculative pathway for lignin biodegradation. Finally, The activities of ligninolytic enzymes from fermentation supernatant, namely, LiP, MnP and Lac were 367.50 U/L, 839.50 U/L, and 219.00 U/L by orthogonal optimization.

CONCLUSIONS

Our findings provide that QL-Z3 and its enzymes have the potential for industrial application and hold great promise for the bioconversion of lignin into bioproducts in lignin valorization.

Performance of Metagenomic Next-Generation Sequencing of Cell-Free DNA From Vitreous and Aqueous Humor for Diagnoses of Intraocular Infections

BACKGROUND

Delayed diagnosis and improper therapy for intraocular infections usually result in poor prognosis. Due to limitations of conventional culture and polymerase chain reaction methods, most causative pathogens cannot be identified from vitreous humor (VH) or aqueous humor (AH) samples with limited volume.

METHODS

Patients with suspected intraocular infections were enrolled from January 2019 to August 2021. Metagenomic next-generation sequencing (mNGS) was used to detected causative pathogens.

RESULTS

This multicenter prospective study enrolled 488 patients, from whom VH (152) and AH (336) samples were respectively collected and analyzed using mNGS of cell-free DNA (cfDNA). Taking final comprehensive clinical diagnosis as the gold standard, there were 39 patients with indefinite final diagnoses, whereas 288 and 161 patients were diagnosed as definite infectious and noninfectious diseases, respectively. Based on clinical adjudication, the sensitivity (92.2%) and total coincidence rate (81.3%) of mNGS using VH samples were slightly higher than those of mNGS using AH samples (85.4% and 75.4%, respectively).

CONCLUSIONS

Using mNGS of cfDNA, an era with clinical experience for more rapid, independent, and impartial diagnosis of bacterial and other intraocular infections can be expected.

Intelligent Electrochemical Point-of-Care Test Method with Interface Control Based on DNA Pyramids: Aflatoxin B1 Detection in Food and the Environment

Sensitive, intelligent point-of-care test (iPOCT) methods for small molecules like aflatoxin B1 (AFB1) are urgently needed for food and the environment. The challenge remains of surface control in iPOCT. Herein, we developed an electrochemical sensor based on the DNA pyramid (DNP), combining a smartphone, app, and mobile electrochemical workstations to detect AFB1. The DNP's structure can reduce local overcrowding and entanglement between neighboring probes, control the density and orientation of recognition probes (antibodies), produce uniform and orientational surface assemblies, and improve antigen-antibody-specific recognition and binding efficiency. Simultaneously, the hollow structure of the DNP enhances the electron transfer capacity and increases the sensitivity of electrochemical detection. In this work, the biosensor based on DNP was first combined with electrochemical (Ec) iPOCT to simultaneously achieve ordered interface modulation of recognition probes and intelligent detection of AFB1. Under optimal conditions, we found a detection limit of 3 pg/mL and a linear range of 0.006-30 ng/mL (R2 = 0.995). Further, using peanut, soybean, corn, and lake water as complex matrices, it recorded recoveries of 82.15-100.53%, excellent selectivity, acceptable stability, and good reproducibility. Finally, this Ec iPOCT provides consistent results compared to the high-performance liquid chromatography-tandem mass spectrometry method.

Establishment and application of TSDPSO-SVM model combined with multi-dimensional feature fusion method in the identification of fracture-related infection

Fracture-related infection (FRI) is one of the most common and intractable complications in orthopedic trauma surgery. This complication can impose severe psychological burdens and socio-economic impacts on patients. Although the definition of FRI has been proposed recently by an expert group, the diagnostic criteria for FRI are not yet standardized. A total of 4761 FRI patients and 4761 fracture patients (Non-FRI) were included in the study. The feature set of patients included imaging characteristics, demographic information, clinical symptoms, microbiological findings, and serum inflammatory markers, which were reduced by the Principal Component Analysis. To optimize the Support Vector Machine (SVM) model, the Traction Switching Delay Particle Swarm Optimization (TSDPSO) algorithm, a recognition method was proposed. Moreover, five machine learning models, including TSDPSO-SVM, were employed to distinguish FRI from Non-FRI. The Area under the Curve of TSDPSO-SVM was 0.91, at least 5% higher than that of other models. Compared with the Random Forest, Backpropagation Neural Network (BP), SVM and eXtreme Gradient Boosting (XGBoost), TSDPSO-SVM demonstrated remarkable accuracy in the test set ([Formula: see text]). The recall of TSDPSO-SVM was 98.32%, indicating a significant improvement ([Formula: see text]). Compared with BP and SVM, TSDPSO-SVM exhibited significantly superior specificity, false positive rate and precision ([Formula: see text]. The five models yielded consistent results in the training and testing of FRI patients across different age groups. TSDPSO-SVM is validated to have the maximum overall prediction ability and can effectively distinguish between FRI and Non-FRI. For the early diagnosis of FRI, TSDPSO-SVM may provide a reference basis for clinicians, especially those with insufficient experience. These results also lay a foundation for the intelligent diagnosis of FRI. Furthermore, these findings exhibit the application potential of this model in the diagnosis and classification of other diseases.

NIR-II fluorescent Ag2Se polystyrene beads in a lateral flow immunoassay to detect biomarkers for breast cancer

Fluorescent lateral flow immunoassay (LFA), one tool in point of care testing (POCT) systems for breast cancer, has attracted attention because it is quick, simple, and convenient. However, samples and the constituent material exhibit autofluorescence in the visible region, which is a very large obstacle in the development of fluorescent LFAs. The autofluorescence of biological samples is scarcely found in the second near-infrared (NIR-II) range and samples scatter and absorb less NIR-II light than visible light. Here, we report an NIR-II QD-LFA platform using the NIR-II fluorescent Ag2Se quantum dots (QDs) with 1020 nm emission encapsulated into polystyrene beads as fluorescent probes. The NIR-II LFA platform was established to detect breast cancer tumour markers (CEA and CA153) within 15 min with a low limit of detection (CEA: 0.768 ng mL-1, CA153: 1.192 U mL-1), high recoveries (93.7% ~ 108.8%), and relative standard deviations (RSDs) of less than 10%. This study demonstrated the potential of NIR-II Ag2Se polystyrene beads as a fluorescent probe in LFA for rapid and accurate identification of biomarkers. They are suited for use in professional situations.

A case report of rib osteosarcoma and literature review

About half of osteosarcomas occur near the knee joint, but other sites such as the humerus, upper femur, fibula, spine, and ilium can also occur. However, rib osteosarcoma is rarely reported. Here, we report the case of a 17-year-old female who was found to have a left dorsal mass on physical examination. Computed tomography (CT) revealed bone destruction in the seventh rib, leading to surgery for mass excision. Pathological results suggested chondroblastic osteosarcoma. After surgery, the patient was treated with chemotherapy and is doing well.

Healthy aging, early screening, and interventions for frailty in the elderly

With the intensification of population aging worldwide, the health problems of the elderly have become a particular concern. Functional disability is a prominent problem in the aging of this population, resulting in the decreased quality of life of senile people. Risk factors for functional disability in the elderly include geriatric syndromes and the associated diseases such as frailty. The influence of frailty on the health of the elderly has been a hot topic in recent years. As a dynamic and reversible geriatric syndrome, it has become one of the important public health problems emerging around the world. Frailty lies between self-reliance and the need for care and is reversible. Reasonable preventive interventions can restore the elderly to an independent life. If no interventions are implemented, the elderly will face a dilemma. There is no gold standard for frailty screening around the world. In order to alleviate frailty in the elderly, many countries have conducted early screening for frailty, mainly focusing on nutrition, physical activity, and social participation, in order to detect and prevent frailty earlier and to reduce the incidence of frailty. This topic provides an overview of the current status of frailty, early screening for frailty, and the interventions for frailty in most countries of the world.

Vitamin D3 attenuates SARS-CoV-2 nucleocapsid protein-caused hyperinflammation by inactivating the NLRP3 inflammasome through the VDR-BRCC3 signaling pathway in vitro and in vivo

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-caused coronavirus disease 2019 (COVID-19) is a global crisis with no satisfactory therapies. Vitamin D3 (VD3) is considered a potential candidate for COVID-19 treatment; however, little information is available regarding the exact effects of VD3 on SARS-CoV-2 infection and the underlying mechanism. Herein, we confirmed that VD3 reduced SARS-CoV-2 nucleocapsid (N) protein-caused hyperinflammation in human bronchial epithelial (HBE) cells. Meanwhile, VD3 inhibited the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation in N protein-overexpressed HBE (HBE-N) cells. Notably, the inhibitors of caspase-1, NLRP3, and NLRP3 or caspase-1 small interference RNA (siRNA) enhanced VD3-induced NLRP3 inflammasome inactivation, with subsequent suppression of interleukin-6 (IL6) and IL1β release in HBE-N cells, which were abolished by the NLRP3 agonist. Moreover, VD3 increased NLRP3 ubiquitination (Ub-NLRP3) expression and the binding of the VDR with NLRP3, with decreased BRCA1/BRCA2-containing complex subunit 3 (BRCC3) expression and NLRP3-BRCC3 association. VD3-induced Ub-NLRP3 expression, NLRP3 inflammasome inactivation, and hyperinflammation inhibition were improved by the BRCC3 inhibitor or BRCC3 siRNA, which were attenuated by the vitamin D receptor (VDR) antagonist or VDR siRNA in HBE-N cells. Finally, the results of the in vivo study in AAV-Lung-enhanced green fluorescent protein-N-infected lungs were consistent with the findings of the in vitro experiment. In conclusion, VD3 attenuated N protein-caused hyperinflammation by inactivating the NLRP3 inflammasome partially through the VDR-BRCC3 signaling pathway.

Retinal and choroidal microvascular characterization and density changes in different stages of diabetic retinopathy eyes

Background

The purpose of this study was to evaluate the changes in fundus vascular density and micromorphological structure of all vascular plexuses during the different stages of diabetic retinopathy (DR), and the correlation between fundus blood flow and the DR severity.

Methods

This observational cross-sectional study was conducted of 50 eyes with different stages of DR, 25 diabetes mellitus (DM) patients without clinical signs of DR and 41 healthy eyes. The foveal avascular zone (FAZ), vessel density of superficial capillary plexus (SCP), and deep retinal capillary plexus (DCP) were acquired by RTVue XR Avanti OCTA device. The perfusion density (PD), skeleton vessel density (SVD) was manually calculated using ImageJ. The area under receiver operating characteristic (ROC) curve was used to determine the diagnostic value of OCTA parameters in distinguishing DR and healthy eyes.

Results

The choroidal VD were significantly higher in the healthy group than in the DM without DR, NPDR, and PDR groups (p < 0.001). The mean retinal parafovea VD, PD, and retinal SVD were higher in healthy and DM without DR eyes compared with NPDR and DR eyes in all vascular layers (p < 0.001). The parafoveal VD of SCP, and DCP decreased, and FAZ area increased with the exacerbation of DR. The OCTA parameters, including FAZ area, parafovea VD, PD, and SVD in all vascular layers showed significant correlation with DR severity (all p < 0.001). ROC curves of OCTA parameters (FAZ area, retinal parafovea VD, retinal PD, and SVD in all vascular layers) for had high sensitivity and specificity in distinguishing DR versus healthy eyes.

Conclusion

The choroidal parafovea VD, retinal parafovea VD, retinal PD, and SVD in the two plexuses decreased, and retinal FAZ area increased significantly with worsening DR. VD, PD, and SVD might be potential early biomarkers indicating the progression of DR before appearance of clinically PDR in patients with DM. In this study, OCTA parameters had high sensitivity and specificity in distinguishing DR and healthy eyes.

Umbrella-frame silicon nanorod arrays decorated with Au nanoparticles as recyclable SERS substrates

Surface-enhanced Raman scattering (SERS) is a powerful technique for detection and identification of trace amounts of molecules with high specificity. A variety of two- and three-dimensional (3D) SERS substrates have been developed. Among these SERS substrates, to further develop new morphology of 3D SERS-active substrate with robust SERS functionality is still desired and necessary. In this paper, what we believe to be a novel and effective SERS-active substrate based on large-scale 3D Si hierarchical nanoarrays in conjunction with homogeneous Au nanoparticles (AuNPs) was proposed. Its building block shaped like the umbrella-frame structure was fabricated by a simple and cost-effective top-down nanofabrication method. Such umbrella-frame structure achieved excellent SERS performance with high sensitivity and spatial uniformity. For R6G molecules, the detection limit can be as low as 10^-14 M, with an enhancement factor of up to 10⁷. The relative standard deviation can reach about 11% above 30 positions across an area of 100×100 μm². This is mainly attributed to much more active-sites provided by the umbrella-frame structure for adsorption of target molecules and AuNPs, and sufficient 3D hotspots generated by the coupling between the SiNRs guided mode and AuNPs localized surface plasmon resonance (LSPR), as well as that between AuNPs LSPR. Especially by introducing the umbrella-ribs SiNRs and AuNPs, the light field can be greatly confined to the structure surface, creating strongly enhanced and even zero-gap fields in 3D space. Moreover, the proposed SERS-active substrate can be erased and reused multiple times by plasma cleaning and exhibits typically excellent recyclability and stability for robust SERS activity. The experimental results demonstrate the proposed substrate may serve as a promising SERS platform for trace detection of chemical and biological molecules.

Novel gene signature for predicting biochemical recurrence-free survival of prostate cancer and PRAME modulates prostate cancer progression

Biochemical recurrence (BCR) is considered as an early sign of prostate cancer (PCa) progression after initial treatment, such as radical prostatectomy and radiotherapy; hence, it is important to stratify patients at risk of BCR. In this study, we established a robust 8-gene signature (APOF, Clorf64, RPE65, SEMG1, ARHGDIG, COMP, MKI67 and PRAME) based on the PCa transcriptome profiles in the Cancer Genome Atlas (TCGA) for predicting BCR-free survival of PCa, which was further validated in the MSK-IMPACT Clinical Sequencing Cohort (MSKCC) PCa cohort. Moreover, we found that one risk-related gene (PRAME) was upregulated in tumor samples, particularly in high-risk group was well as in patients metastatic tumor and was correlated with chemotherapeutic drug response. In vitro experiments showed that knocking down PRAME reduced the proliferation, migration, and invasion of PCa cells. Therefore, our study established a new 8-gene signature that could accurately predict the BCR risk of PCa. Inhibition of PRAME attenuated the proliferation, invasion, and migration of PCa cells. These findings provide a novel tool for stratifying high-risk PCa patient and shed light on the mechanism of PCa progression.

Brine available two-dimensional nano-architectonics of fluorescent probe based on phosphate doped ZIF-L for detection of Fe3

Herein, we propose a simple and effective strategy for designing a zeolitic imidazolate frameworks (ZIFs) fluorescent probe with a two-dimensional leaf-like structure. By doping ZIF-L with phosphate, we developed a fluorescent probe for iron (Fe3+) in systems with high salinity. The fluorescence of P-ZIF-L was quenched effectively with the presence of Fe3+. The physicochemical structure, surface morphology, selectivity, stability and composition of the probe were investigated. Under optimized conditions, the fluorescent probe had a detection limit of 0.5 μM. Furthermore, the results that the probe exhibited desirable salt-tolerance and was suitable for determination of Fe3+ in brine water samples with satisfactory results.

Genetic characteristics of classical astroviruses in Shenzhen, China, 2016-2019

Human astrovirus (HAstV) is a single-stranded, positive-sense RNA virus and is the leading cause of viral gastroenteritis. However, despite its prevalence, astroviruses still remain one of the least studied enteroviruses. In this study, we sequenced 11 classical astrovirus strains from clinical samples collected in Shenzhen, China from 2016 to 2019, analyzed their genetic characteristics, and deposited them into GenBank. We conducted phylogenetic analysis using IQ-TREE software, with references to astrovirus sequences worldwide. The phylogeographic analysis was performed using the Bayesian Evolutionary Analysis Sampling Trees program, through Bayesian Markov Chain Monte Carlo sampling. We also conducted recombination analysis with the Recombination Detection Program. The newly sequenced strains were categorized as HAstV genotype 1, which is the predominant genotype in Shenzhen. Phylogeographic reconstruction indicated that HAstV-1 may have migrated from the United States to China, followed by frequent transmission between China and Japan. The recombination analysis revealed recombination events within and across genotypes, and identified a recombination-prone region that produced relatively uniform recombination breakpoints and fragment lengths. The genetic analysis of HAstV strains in Shenzhen addresses the current lack of astrovirus data in the region of Shenzhen and provides key insights to the evolution and transmission of astroviruses worldwide. These findings highlight the importance of improving surveillance of astroviruses.

[Population structure of food-borne Staphylococcus aureus in China]

Objective: To understand the population structure of food-borne Staphylococcus (S.) aureus in China. Methods: Whole genome sequencing was used to analyze 763 food-borne S. aureus strains from 16 provinces in China from 2006 to 2020. Multilocus sequence typing (MLST), staphylococcal protein A gene (spa) typing, and staphylococcal chromosome cassettemec (SCCmec) typing were conducted, and minimum spanning tree based on ST types (STs) was constructed by BioNumerics 7.5 software. Thirty-one S. aureus strains isolated from imported food products were also included in constructing the genome phylogenetic tree. Results: A total of 90 STs (20 novel types) and 160 spa types were detected in the 763 S. aureus isolates. The 72 STs (72/90, 80.0%) were related to 22 clone complexes. The predominant clone complexes were CC7, CC1, CC5, CC398, CC188, CC59, CC6, CC88, CC15, and CC25, accounting for 82.44% (629/763) of the total. The STs and spa types in the predominant clone complexes changed over the years. The methicillin-resistant S. aureus (MRSA) detection rate was 7.60%, and 7 SCCmec types were identified. The ST59-t437-Ⅳa (17.24%, 10/58), ST239-t030-Ⅲ (12.07%, 7/58), ST59-t437-Ⅴb (8.62%, 5/58), ST338-t437-Ⅴb (6.90%, 4/58) and ST338-t441-Ⅴb (6.90%, 4/58) were the main types in MRSA strains. The genome phylogenetic tree had two clades, and the strains with the same CC, ST, and spa types clustered together. All CC7 methicillin sensitive S. aureus strains were included in Clade1, while 21 clone complexes and all MRSA strains were in Clade2. The MRSA strains clustered according to the SCCmec and STs. The strains from imported food products in CC398, CC7, CC30, CC12, and CC188 had far distances from Chinese strains in the tree. Conclusions: In this study, the predominant clone complexes of food-borne strains were CC7, CC1, CC5, CC398, CC188, CC59, CC6, CC88, CC15, and CC25, which overlapped with the previously reported clone complexes of hospital and community-associated strains in China, suggesting that close attention needs to be paid to food, a vehicle of pathogen transmission in community and food poisoning.

Facile and High-Efficiency Chemical Presodiation Strategy on the SnS2/rGO Composite Anode for Stable Sodium-Ion Batteries

SnS₂/reduced graphite oxide (rGO) composite materials show great potential as high-performance anode candidates in sodium-ion batteries (SIBs) owing to their high specific capacities and power densities. However, the repeated formation/decomposition of the solid electrolyte interface (SEI) layer around composite anodes usually consumes additional sodium cations, resulting in poor Coulombic efficiency and decreasing specific capacity upon cycling. Therefore, in order to compensate for the large irreversible sodium loss of the SnS₂/rGO anode, this study has proposed a facile strategy by implementing organic solutions of sodium-biphenyl/tetrahydrofuran (Na-Bp/THF) and sodium-naphthylamine/dimethoxyethane (Na-Naph/DME) as chemical presodiation reagents. Particularly, the storage stability of Na-Bp/THF and Na-Naph/DME in ambient air accompanied by their presodiation behavior on the SnS₂/rGO anode has been investigated, and both reagents exhibited desirable ambient air-tolerant storage stability with favorable sodium supplement effects even after 20 days of storage. More importantly, the initial Coulombic efficiency (ICE) of SnS₂/rGO electrodes could be controllably increased by immersing in a presodiation reagent for different durations. Consequently, with a facile chemical presodiation strategy of immersion in Na-Bp/THF solution for only 3 min in ambient air, the presodiated SnS₂/rGO anode has exhibited an outstanding electrochemical performance with a high ICE of 95.6% as well as an ultrahigh specific capacity of 879.2 mAh g^-1 after 300 cycles (83.5% of its initial capacity), highly superior to the pristine SnS₂/rGO anode. This efficient and scalable presodiation strategy provides a new avenue for the prevailing application of other anode candidates in high-energy SIBs.

A food poisoning caused by ST7 Staphylococcal aureus harboring sea gene in Hainan province, China

ST7 Staphylococcus aureus is highly prevalent in humans, pigs, as well as food in China; however, staphylococcal food poisoning (SFP) caused by this ST type has rarely been reported. On May 13, 2017, an SFP outbreak caused by ST7 S. aureus strains occurred in two campuses of a kindergarten in Hainan Province, China. We investigated the genomic characteristics and phylogenetic analysis of ST7 SFP strains combined with the 91 ST7 food-borne strains from 12 provinces in China by performing whole-genome sequencing (WGS). There was clear phylogenetic clustering of seven SFP isolates. Six antibiotic genes including blaZ, ANT (4′)-Ib, tetK, lnuA, norA, and lmrS were present in all SFP strains and also showed a higher prevalence rate in 91 food-borne strains. A multiple resistance plasmid pDC53285 was present in SFP strain DC53285. Among 27 enterotoxin genes, only sea and selx were found in all SFP strains. A ФSa3int prophage containing type A immune evasion cluster (sea, scn, sak, and chp) was identified in SFP strain. In conclusion, we concluded that this SFP event was caused by the contamination of cakes with ST7 S. aureus. This study indicated the potential risk of new emergencing ST7 clone for SFP.

Quantitative risk assessment of college campus considering risk interactions

Because of the more emerging risks and stronger risk interactions, the risk of college campuses as well as students and staff received more and more attention. Current works on campus risk mostly focus on single-category factors, and few of them considered risk interactions. Therefore, an integrated model for assessing comprehensive risks on the campus is proposed to put forward risk reduction strategies. First, a comprehensive risk identification of the college campus is conducted by integrating the modified egg model and the fault tree. Then, DEMATEL (Decision-Making Trial and Evaluation Laboratory) is applied to quantify the complex risk interactions and determine the influential causes for further modelling. Finally, the Bayesian network is established for cause diagnosis, consequence prediction, and risk reduction. The identified most sensitive cause is alcohol use. In the case of the four sensitive causes simultaneously occurring, the probability of high campus risk will increase from 21.9% of the original to 39.4%. Moreover, an efficiency analysis of different risk reduction strategies is performed to determine the most efficient risk reduction strategy. The results indicate that the proposed methodology may of great significance for the risk reduction of the college campus in the changing age.

UNC45A-related osteo-oto-hepato-enteric syndrome in a Chinese neonate

Unexplained diarrhea and cholestasis are common clinical phenotypes in newborns, indicating there is only a little common genetic basis for these conditions. However, it has been reported that defects in the UNC45A gene can lead to osteo-oto-hepato-enteric syndrome. However, to date, only 10 patients with this syndrome have been reported in 2 studies; therefore, there is still a lack of analysis regarding the correlation between disease phenotype and genotype. Trio-whole exome sequencing was conducted using DNA samples from a newborn with congenital diarrhea and cholestasis from a Chinese Han family. The UNC45A variants were verified using Sanger sequencing. In addition, we applied a crystal structure model to analyze the potential hazards associated with the variants. The plasmids were constructed in vitro and transfected into human 293T cells for Western blot (WB) analysis. After the mutant protein was fused with the Green Fluorescent Protein label, intracellular localization was observed using laser confocal microscopy. The gene detection results showed that the UNC45A gene of the newborn examined in the present study harbored the compound heterozygous variants p.Arg819Ter, and p.Leu237Pro; this was confirmed via Sanger sequencing. Analysis of the Leu237Pro crystal structure model suggested that this variant may decrease local structural stability and affect protein function. The Western blot and laser confocal microscopy observation results suggested that the Leu237Pro mutation leads to reduced protein expression, while the Arg819Ter mutation completely inhibits the expression of the protein. The compound heterozygous variants of UNC45A (p.Arg819Ter and p.Leu237Pro) may be pathogenic factors of congenital diarrhea and cholestasis in this neonatal patient. Therefore, UNC45A deficiency should be considered when intractable diarrhea and cholestasis occur in newborns.

[Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China]

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Application of metagenomic next-generation sequencing in suspected intraocular infections

PURPOSE

To evaluate the efficacy of metagenomic next-generation sequencing (mNGS) and to explore its value in the diagnosis of intraocular infection.

METHODS

A retrospective case-series study of patients with suspected intraocular infection was performed. Intraocular fluid samples were collected from all the patients and sent for mNGS. Detailed clinical data, the results of mNGS and other laboratory examinations, the sequencing data of mNGS, and the final diagnosis were recorded.

RESULTS

Fifteen eyes of 15 patients were included in the study. Eight samples were identified as positive for different kinds of pathogens by mNGS, which were all confirmed by other laboratory examinations or effective diagnostic treatment. The mNGS results were negative in seven samples. The final diagnosis was still intraocular infection in four of the seven negative results. Of these, one patient was diagnosed with fungal endophthalmitis according to the clinical characteristics and good treatment response to the anti-fungal therapy, one patient underwent vitrectomy and the bacterial culture of the vitreous sample was positive for Brucella melitensis, and two patients were diagnosed with ocular tuberculosis according to the positive T-SPOT test and effective anti-tuberculous treatments.

CONCLUSIONS

mNGS could be helpful in determining pathogens in cases of suspected intraocular infection. The mNGS protocols should be optimized for the detection of intracellular bacterial and fungal pathogens.

A study on the assessment and scoring standard of badminton course in colleges and universities: A review

With the continuous promotion of quality education, the importance of physical education in college teaching is increasingly prominent. In order to meet the sports needs of different students, badminton courses are introduced in colleges and universities. Badminton not only has a strong entertainment, but also a good physical exercise, loved by students. However, due to the existing badminton class evaluation standard is not scientific and reasonable, which is not conducive to the smooth implementation of physical education, this paper studies the current situation of badminton assessment and scoring standards, points out the existing problems in the teaching process, and gives a new way to improve the assessment and scoring standards of badminton in colleges and universities, in order to provide reference for the assessment system of badminton in colleges and universities, and then improve the teaching effect of badminton.

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

The COVID-19 pandemic has severely impacted healthcare systems worldwide. This study investigated cardiologists’ opinions on how the COVID-19 pandemic impacted clinical practice patterns in atrial fibrillation (AF). A multicenter clinician survey, including demographic and clinical questions, was administered to 300 cardiologists from 22 provinces in China, in April 2022. The survey solicited information about their treatment recommendations for AF and their perceptions of how the COVID-19 pandemic has impacted their clinical practice patterns for AF. The survey was completed by 213 cardiologists (71.0%) and included employees in tertiary hospitals (82.6%) and specialists with over 10 years of clinical cardiology practice (53.5%). Most respondents stated that there were reductions in the number of inpatients and outpatients with AF in their hospital during the pandemic. A majority of participants stated that the pandemic had impacted the treatment strategies for all types of AF, although to different extents. Compared with that during the assumed non-pandemic period in the hypothetical clinical questions, the selection of invasive interventional therapies (catheter ablation, percutaneous left atrial appendage occlusion) was significantly decreased (all p < 0.05) during the pandemic. There was no significant difference in the selection of non-invasive therapeutic strategies (the management of cardiovascular risk factors and concomitant diseases, pharmacotherapy for stroke prevention, heart rate control, and rhythm control) between the pandemic and non-pandemic periods (all p > 0.05). The COVID-19 pandemic has had a profound impact on the clinical practice patterns of AF. The selection of catheter ablation and percutaneous left atrial appendage occlusion was significantly reduced, whereas pharmacotherapy was often stated as the preferred option by participating cardiologists.

Water-in-Oil Pickering Emulsions Stabilized by Hydrophobized Protein Microspheres

Water-in-oil (w/o) Pickering emulsions have gained considerable attention in colloid science and daily applications. However, for the formation of w/o emulsions, especially those with high internal water content, the particulate stabilizers are required to be sufficiently hydrophobic, and synthetic or chemically modified particles have been mostly reported until now, which are not biocompatible and sustainable. We present a zein protein-based microsphere derived from the Pickering emulsion template, in which protein microspheres are feasibly in situ hydrophobized by silica nanoparticles, enabling the stabilization of w/o Pickering emulsions. The effects of microsphere concentration, water/oil volume ratio, oil types, and pH on the stabilization of prepared w/o emulsions are systematically studied, revealing prominent characteristics of the controllable size, high water fraction, universal adaptation of oils, as well as broad pH stability. As a demonstration, the Pickering emulsion effectively encapsulates vitamin C and shows high stability for long storage duration against ultraviolet radiation/heat. Therefore, this novel proteinaceous particle-stabilized w/o Pickering emulsion has great potential in the delivery and protection of water-soluble bioactive substrates.

Nipple adenoma with ipsilateral Spitz nevus in a 26-year-old female: a case report

A 26-year-old female with a palpable mass and progressively darker itchy area in her left nipple was admitted to hospital. The left nipple surface showed furfuraceous desquamation and bloody discharge, with a 1.0×0.7×0.4 cm area of grayish-brown pigmentation in the ipsilateral nipple and areola. Surgical resection of the primary skin tumor and biopsy of the partial mass in the middle of the nipple were undertaken since color Doppler ultrasonography and dermoscopy were unable to make a differential diagnosis. We thus report the first case of a nipple adenoma with concomitant ipsilateral nipple areola Spitz nevus.

Differences in Neuropathic Pain and Radiological Features Between AQP4-ON, MOG-ON, and IDON

Purpose

The purpose of this study was to investigate pain and radiological features of different types of first-episode demyelinating optic neuritis (ON).

Methods

Eighty-three patients presenting with first-episode aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n = 28), myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n = 26) and idiopathic demyelinating optic neuritis (IDON, n = 29) were included in this retrospective case-control study. We assessed optic nerve lesions on magnetic resonance imaging (MRI), acute pain associated with onset of optic neuritis and clinical characteristics of those ON patients with different serum autoantibody status.

Results

24 AQP4-ON patients (85.75%), 23 MOG-ON patients (88.5%) and 24 IDON patients (82.8%) suffered from ON-associated pain. MOG-ON had mostly retro-orbital pain; AQP4-ON and IDON had mostly neuropathic pain. In addition, pain was more severe in AQP4ON patients than in other ON patients. In MRI, bilateral involvement was more common in AQP4-ON than IDON (26.9 and 3.7%); radiological optic nerve head swelling was more common in MOG-ON than in AQP4-ON and IDON (68.0 vs. 23.1 vs. 25.9%). MRI lesion in peri-optic nerve sheath was more common in AQP4-ON (53.8 vs. 16.0 vs. 3.7%). In 70 patients with ON-associated pain, gadolinium enhancement of orbital optic nerve was most common in MOG-ON patients (82.4 vs. 55.0 vs. 33.3%, P = 0.018), and enhancement of optic chiasma was most common in AQP4-ON patients (40.0 vs. 5.9 vs. 6.7%, P = 0.015). Perineural and orbital enhancement was observed only in patients with MOG-ON (P < 0.001). The length of enhancement was longer in AQP4-ON patients than in MOG-ON and IDON patients.

Conclusion

Pain is a common symptom in patients with all types of demyelinating ON. AQP4-ON is frequently associated with severe ON-associated pain and longitudinally extensive optic nerve inflammatory lesions. Intra-orbital and peri-optic inflammation were more frequently observed in patients with MOG-ON, which was closely related to optic disc swelling and retro-orbital pain provoked by eye movements.

Dissemination of blaNDM-5 in Escherichia coli through the IncX3 Plasmid from Different Regions in China

The spread of NDM-5-producing Escherichia coli has become a severe challenge in clinical therapy, which necessitates reliable detection and surveillance methods. However, limited information is available regarding the prevalence and dissemination of the bla_NDM-5 gene in E. coli in China. Therefore, we investigated the dissemination of the bla_NDM-5 gene in carbapenem-resistant E. coli isolates from different regions. A total of 1,180 carbapenem-resistant enterobacteriaceae strains were obtained from patients admitted to the 20 sentinel hospitals in 8 cities. Strains positive for bla_NDM-5 were detected using the Vitek 2 compact system, 16S ribosomal RNA (rRNA) gene sequencing, polymerase chain reaction, the S1 pulsed-field gel electrophoresis assay, and Southern blot hybridization. The horizontal-transfer capability of the bla_NDM gene was assessed by filter mating with a standard E. coli J53 azide-resistant strain as the recipient. Genotyping, susceptibility testing, and whole genome sequencing were performed. Seven strains of bla_NDM-5-positive E. coli were detected in 1,180 clinical strains from different regions in China. The bla_NDM-5-carrying strains showed resistance to multiple tested antibiotics and belonged to two widespread sequence types, sequence type (ST)167 and ST405. Antimicrobial resistance genes, including bla_CTX-M, bla_OXA, bla_CMY, and two novel bla_TEM variants (bla_TEM-230 and bla_TEM-231) were also identified. Southern blotting located the bla_NDM-5 gene on 46 kb IncX3 plasmids in all isolates, which showed only two single nucleotide differences between EJN003 and the other strains. This study further confirms the increasing occurrence of bla_NDM-5-carrying IncX3 plasmids and the dissemination of carbapenem resistance in E. coli isolates using the plasmid from different parts in China, which warrants stringent surveillance and control measures.

Efficient Antimicrobial Effect of Alginate-Catechol/Fe2+ Coating on Hydroxyapatite toward Oral Care Application

Reducing the formation of oral bacterial biofilms is critical to prevent common dental diseases. Though many strategies for restricting bacterial adhesion on tooth surfaces have been reported, a simple method for efficient oral bacteriostasis is still highly expected. Herein, we have proved a soft gel made of an alginate-catechol conjugate (SA-DA) and the ferrous cation (Fe²⁺) as an effective antibacterial coating on hydroxyapatite (HAP, a tooth model). As suggested by quartz crystal microbalance (QCM) measurements, SA-DA/Fe²⁺ coating possessed a high binding affinity to HAP without destruction by either immersion in artificial saliva or simulated tooth brushing. Significantly less protein (bovine serum albumin) and Streptococcus mutans (S. mutans, an oral bacterial model) could be found on HAP after coating with SA-DA/Fe²⁺, indicating that the prepared gel could resist well the adhesion of biofouling and microbes due to its hydrophilicity. Notably, such an antibacterial effect (around 70% S. mutans was inhibited) could be maintained for 3 d, which resulted from the extremely good stability of SA-DA/Fe²⁺ coating, as confirmed by QCM analysis. Our results may offer possibilities for developing applications in order to further improve oral hygiene.

Individual cells generate their own self-reinforcing contact guidance cues through local matrix fiber remodeling

Directed cell migration arises from cells following a microenvironmental gradient (e.g. of a chemokine) or polarizing feature (e.g. a linear structure). However cells not only follow, but in many cases, also generate directionality cues by modifying their microenvironment. This bi-directional relationship is seen in the alignment of extracellular matrix (ECM) fibers ahead of invading cell masses. The forces generated by many migrating cells cause fiber alignment, which in turn promotes further migration in the direction of fiber alignment via contact guidance and durotaxis. While this positive-feedback relationship has been widely described for cells invading en masse, single cells are also able to align ECM fibers, as well as respond to contact guidance and durotaxis cues, and should therefore exhibit the same relationship. In this study, we directly tested this hypothesis by studying the migration persistence of individual HT-1080 fibrosarcoma cells migrating in photocrosslinked collagen matrices with limited remodeling potential. Our results demonstrate that this positive-feedback relationship is indeed a fundamental aspect of cell migration in fibrillar environments. We observed that the cells’ inability to align and condense fibers resulted in a decrease in persistence relative to cells in native collagen matrices and even relative to isotropic (glass) substrates. Further experiments involving 2D collagen and electrospun polymer scaffolds suggest that substrates composed of rigid, randomly oriented fibers reduce cells’ ability to follow another directionality cue by forcing them to meander to follow the available adhesive area (i.e. fibers). Finally, our results demonstrate that the bi-directional relationship between cell remodeling and migration is not a “dimensionality” effect, but a fundamental effect of fibrous substrate structure.

[Magnetic resonance imaging quantitative analysis of knee joint injury and cartilage before and after long-distance march and training for college students]

Objective: To assess the effects of long-distance march and training on acute knee injury and knee cartilage sub-regions of college students using quantitatively magnetic resonance imaging analysis. Methods: Twenty-seven young male students from freshman classes in the Army Military Medical University were enrolled in September 2019, aged from 17 to 20 (19.48±0.14) years, participated in the whole 8-day, 240 km long-distance march and training. Three-dimensional quantitative MRI was performed on the right knee using high-field MRI before (baseline) and 1 day after (follow-up) march. The assessment indexes included: meniscus and cartilage injury(5-point scale), bone marrow and ligament injury, and joint effusion(3-point scale). Using semi-automatic cartilage segmentation and 3D data post-processing techniques, a total of 21 sub-regions of cartilage volume and thickness were measured in the medial and lateral femur, medial and lateral tibia. Paired-samples t-test was used to compare the changes in quantitative cartilage indices of the knee joint before and after march. Results: In terms of acute knee injuries, medial and lateral meniscus injuries (grade 1-3) occurred in 8 and 9 college students, respectively compared with those before march. Anterior cruciate ligaments injury occurred in 4 college students and developed from grade 0 to grade 1. Bone marrow edema occurred in 10 students and developed from grade 0 to grade 2, and in 5 students from grade 0 to grade 1. Joint effusion occurred in 5 college students and developed from grade 1 to grade 2 (all P<0.05). In terms of quantitative analysis of cartilage subregion of knee joint, the volume of central region of femoral pulley increased [(1.84±0.32) mm³ vs (1.67±0.29) mm³] and the volume of central region of medial femoral condyle decreased [(1.18±0.21) mm³ vs (1.26±0.17) mm³] compared with that before march (all P<0.05); The cartilage thickness of 11 cartilage subregion [(1.37±0.27) mm vs (1.53±0.18) mm], [(1.42±0.25) mm vs (1.54±0.17) mm], [(1.53±0.20) mm vs (1.62±0.20) mm], [(1.72±0.28) mm vs (1.83±0.28) mm], [(1.84±0.45) mm vs (2.04±0.42) mm], [(2.20±0.58) mm vs (2.46±0.50) mm], [(1.74±0.19) mm vs (1.85±0.21) mm] [(1.45±0.21) mm vs (1.58±0.16) mm], [(1.81±0.22) mm vs (1.91±0.15) mm], [(1.44±0.13) mm vs (1.53±0.15) mm] was thinner than that before march (all P<0.05). The T₂ values of 7 cartilage subregion [(40.57±26.23) ms vs (67.10±47.46) ms], [(80.10±20.56) ms vs (98.42±23.58) ms], [(87.92±24.95) ms vs (108.84±29.24) ms], [(50.49±19.18) ms vs (76.97±37.16) ms], [(38.89±15.82) ms vs (69.70±40.16) ms] [(55.84±24.53) ms vs (106.35±50.01) ms] and [(72.38±36.64) ms vs (105.31±39.34) ms] were lower than those before march, while the T₂ values of the two subregions of patellar cartilage [(102.13±44.47) ms vs (72.20±28.37) ms], [(97.42±44.86) ms vs (76.67±51.64) ms] were higher than those before march (P<0.05). There was no significant difference in other cartilage subareas (P>0.05). Conclusions: Long distance hiking will lead to acute injury of knee joint of young college students. The thickness of cartilage subregion of knee joint showed a thinning trend as a whole, while the volume and T₂ values showed different trends.

New cerebral microbleeds in AF patients on non-vitamin K oral anticoagulants or warfarin: One-year follow-up

Anticoagulant treatment increases the risk of intracerebral hemorrhage (ICH), but whether the treatment, more specifically non-vitamin K oral anticoagulants (NOACs), increases the risk of cerebral microbleeds (CMBs) remains uncertain. We performed this study to investigate the development of new CMBs due to NOACs or warfarin treatment in patients with atrial fibrillation (AF).We prospectively recruited AF patients before anticoagulation from June 2016 to June 2018. We performed susceptibility-weighted imaging (SWI) examinations on all enrolled AF patients and re-examined SWI 1 year later. We compared demographic features and new CMBs between the NOACs group and the warfarin group. Univariate analysis of clinical factors was performed according to the development of new CMBs; and age, a HAS-B(L)ED score, warfarin use, and the presence of baseline CMBs were then selected for inclusion in the multivariate logistic regression model.A total of 72 AF patients were recruited, 29 of whom were assigned to the NOACs group and 43 to the warfarin group. Finally, 1 patient in the NOACs group (3.4%) and 9 patients (20.9%) in the warfarin group developed new CMBs after 1 year follow-up (P = .08). Univariate analysis showed that age, a HAS-B(L)ED score ≥4, the presence of baseline CMBs were associated with the development of new CMBs (P < .05). And multivariate regression analysis showed baseline CMBs (P = .03, odds ratio = 6.37, 95% confidence interval 1.15-35.36) was independently related to the increase in new CMBs.AF patients treated with NOACs may have a decreased trend in the development of new CMBs compared with those treated with warfarin. Baseline CMBs increased the frequency of new CMBs during anticoagulant treatment. The development of new CMBs in AF patients with anticoagulation requires further longitudinal studies with longer follow-up in larger samples.

Genetic Characterization of mcr-1-Positive Multidrug-Resistant Salmonella enterica Serotype Typhimurium Isolated From Intestinal Infection in Children and Pork Offal in China

With the rapid emergence of plasmid-mediated colistin resistance gene mcr-1, the increased resistance of Salmonella has attracted extensive attention. This study reports on 11 multidrug-resistant Salmonella enterica serovar Typhimurium strains harboring mcr-1 in China. They all presented resistance to colistin, and additionally, one that was isolated from a child’s stool sample was also resistant to ceftriaxone and azithromycin. We screened 1454 strains of Salmonella for mcr-1 gene through PCR, and these strains are all preserved in our laboratory. Antimicrobial sensitivity analysis was carried out for the screened mcr-1 positive strains. Genetic polymorphism analysis of S. Typhimurium was performed by using the Pulsed-Field Gel Electrophoresis (PFGE). The plasmids harboring mcr-1 were identified by S1-PFGE and southern blotting. Plasmid conjugation assays were used to analyze the transferability of colistin resistance. The plasmids harboring mcr-1 were characterized by sequencing and bioinformatic analysis. Eleven S. Typhimurium strains harboring mcr-1 with colistin resistance (MICs 4μg/ml) were detected, which were isolated from children and pig offal in China. All of them were multidrug-resistant strains. PFGE results revealed that the strains isolated from different samples or locations have identical genotypes. S1-PFGE and southern blotting experiments showed that three plasmids of different sizes (33, 60, and 250 kb) all carried the mcr-1 gene. The plasmid conjugation assays revealed that Salmonella acquired mcr-1 harboring plasmids by horizontal transfer. Sequencing and plasmid type analysis revealed that these plasmids were types IncX4, IncI2, and IncHI2. Among them, IncX4 and IncI2 plasmids had extremely similar backbones and contained one resistant gene mcr-1. IncHI2 plasmid contained multiple resistant genes including bla_CTX–M, oqxB, sul, aph, aadA, and bla_TEM. We identified 11 mcr-1 harboring S. Typhimurium strains in China and described their characteristics. Our findings indicate that the mcr-1 gene can effectively spread among intestinal bacteria by horizontal transfer of three types of plasmids. Moreover, the IncHI2 plasmid can also mediate the transfer of other drug resistance genes. These results reveal that constant surveillance of mcr-1 harboring S Typhimurium is imperative to prevent the spread of colistin resistance.

Quality appraisal of clinical practice guidelines on physical restraints in ICU: a systematic review

BACKGROUND

Physical restraint has been regarded as a protective measure in the intensive care unit (ICU) in order to avoid unexpected events. But a great number of researches have proven that physical restraints can cause bad influences on patients' mental health, such as language delays of children, sense of uncertainty, loss of trust, etc. However, it is unclear whether there are currently high-quality clinical practice guidelines (CPGs) to guide clinical practice in physical restraints. So we aim to analyze available CPGs on physical restraints in ICU with Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluating methodological quality and Reporting Items for Practice Guidelines in Healthcare (RIGHT) evaluating reporting quality.

METHODS

We systematically searched PubMed, Embase, Web of Science, CINAHL, CNKI (Chinese database), Wanfang data (Chinese database), relevant websites (GIN, NICE, SIGN, RNAO, AHRQ, AACN), and Google from their inception to Nov 21, 2021. Two reviewers independently use the AGREE II tool and RIGHT checklist to evaluate methodological and reporting quality of included guidelines on physical restraints in ICU. The number and proportion of reported items of RIGHT checklist and the scores of each domain of AGREE II were calculated. We also evaluated the consistency among the reviewers via use of the intragroup correlation coefficient.

RESULTS

A total of six guidelines were included. The mean AGREE II score for the included guidelines was 39.56% with a range of 30.27-69.85%. No guideline was "high quality", and only one guideline was "moderate quality" with 69.85% mean AGREE II score. The mean RIGHT reporting score for guidelines was 41.0% with a range of 24.7-77.7%. Only one guideline was "moderate-reported" with a mean reporting score of 77.7%.

DISCUSSION

In general, the methodological and reporting quality of physical restraints guidelines is low, and future development or updating of high-quality guidelines to guide clinical practice is needed.

Artificial intelligence promotes the diagnosis and screening of diabetic retinopathy

Deep learning evolves into a new form of machine learning technology that is classified under artificial intelligence (AI), which has substantial potential for large-scale healthcare screening and may allow the determination of the most appropriate specific treatment for individual patients. Recent developments in diagnostic technologies facilitated studies on retinal conditions and ocular disease in metabolism and endocrinology. Globally, diabetic retinopathy (DR) is regarded as a major cause of vision loss. Deep learning systems are effective and accurate in the detection of DR from digital fundus photographs or optical coherence tomography. Thus, using AI techniques, systems with high accuracy and efficiency can be developed for diagnosing and screening DR at an early stage and without the resources that are only accessible in special clinics. Deep learning enables early diagnosis with high specificity and sensitivity, which makes decisions based on minimally handcrafted features paving the way for personalized DR progression real-time monitoring and in-time ophthalmic or endocrine therapies. This review will discuss cutting-edge AI algorithms, the automated detecting systems of DR stage grading and feature segmentation, the prediction of DR outcomes and therapeutics, and the ophthalmic indications of other systemic diseases revealed by AI.

Coupled modeling of in- and below-cloud wet deposition for atmospheric 137Cs transport following the Fukushima Daiichi accident using WRF-Chem: A self-consistent evaluation of 25 scheme combinations

Wet deposition, including both in- and below-cloud scavenging, is critical for the atmospheric transport modeling of ¹³⁷Cs following the Fukushima Daiichi Nuclear power plant (FDNPP) accident. Although intensively investigated, wet deposition simulation is still subject to uncertainties of meteorological inputs and wet scavenging modeling, leading to biased ¹³⁷Cs transport prediction. To reduce the dual uncertainties, in- and below-cloud wet scavenging schemes of ¹³⁷Cs were simultaneously integrated into Weather Research and Forecasting-Chemistry (WRF-Chem), yielding online coupled modeling of meteorology and the two wet scavenging processes. The integration was performed using 25 combinations of different in- and below-cloud schemes, covering most schemes in the literature. Two microphysics schemes were also tested to better reproduce the precipitation. The 25 models and the ensemble mean of 9 representative models were systematically compared with the below-cloud-only WRF-Chem model, using the cumulative deposition and atmospheric concentrations of ¹³⁷Cs measurements. The results reveal that, with the Morrison's double moment cloud microphysics scheme, the developed models could better reproduce the rainfall and substantially improve the cumulative deposition simulation. The in-cloud scheme is influential to the model behaviors and those schemes considering cloud parameters also improve the atmospheric concentration simulations, whereas the others solely dependent on the rain intensity are sensitive to meteorology. The ensemble mean achieves satisfactory performance except one plume event, but still outperforms most models.

Engineering proteinaceous colloidosomes as enzyme carriers for efficient and recyclable Pickering interfacial biocatalysis

Despite Pickering interfacial biocatalysis being a popular topic in biphasic biocatalysis, the development of water-in-oil (w/o) emulsion systems stabilized by single particles remains a challenge. For the first time, hydrophobized proteinaceous colloidosomes with magnetic-responsiveness are developed to function as both an enzyme carrier and emulsifier, achieving a breakthrough in protein-based w/o Pickering bioconversion. Enzyme-loaded protein colloidosomes are synthesized by a facile and mild method via emulsion templating. This system exhibits superior catalytic activity to other systems at the oil–water interface. Besides, feasible enzyme recovery and reusability ensure that this novel system can be employed as an efficient and eco-friendly recyclable platform.

Engineering proteinaceous colloidosomes with magnetic-responsiveness are designed as both enzyme carrier and emulsifier, achieving a breakthrough in protein-based w/o Pickering interfacial biocatalysis.

A Surface-Confined Gradient Conductive Network Strategy for Transparent Strain Sensors toward Full-Range Monitoring

The development of transparent and flexible sensors suitable for the full-range monitoring of human activities is highly desirable, yet presents a daunting challenge due to the need for a combination of properties such as high stretchability, high sensitivity, and good linearity. Gradient structures are commonly found in many biological systems and exhibit excellent mechanical properties. Here, we report a novel surface-confined gradient conductive network (SGN) strategy to construct conductive polymer hydrogel-based stain sensors (CHSS). This CHSS showed an ultrahigh stretchability of 4000% strain, transparency above 90% at a wavelength of 600 nm, as well as skin-like Young's modulus of 40 kPa. Impressively, the sensitivity was improved to 3.0 and outstanding linear sensing performance was achieved simultaneously in the ultrawide range of 0% to 4000% strain with a high R-square value of 0.994. With the help of SGN strategy, this CHSS was able to monitor both large-scale and small-scale human motions and activities. This SGN strategy can open a new avenue for the development of novel flexible strain sensors with excellent mechanical, transparent, and sensing performance for full-range monitoring of human activities.

Extra-pulmonary vein driver mapping and ablation for persistent atrial fibrillation in obese patients

AIMS

The aim of this study was to determine whether driver ablation effectively treats persistent atrial fibrillation (AF) in obese patients.

METHODS AND RESULTS

We randomly assigned 124 persistent AF obese patients to two groups, one undergoing conventional ablation (n = 62) and the other undergoing driver ablation (n = 62). Sixty-two non-obese patients with persistent AF undergoing driver ablation served as matched controls. Bipolar electrogram dispersion was analysed for driver mapping. Epicardial adipose tissue (EAT) volume was measured using cardiac computed tomography. Obese patients had a higher proportion of driver regions in the posterior wall (56.5% vs. 32.3%, P = 0.007). Driver complexity, measured as the average number and area of driver regions, was higher in the obese group than in the non-obese group (3.5 ± 1.0 vs. 2.9 ± 0.9, P < 0.001; 15.5% ± 4.2% vs. 9.8 ± 2.6%, P < 0.001, respectively). Left atrial EAT volume correlated better with the proportion of area of driver regions than did body mass index (BMI) and total EAT (BMI: r2 = 0.250, P < 0.001; total EAT: r2 = 0.379, P < 0.001; and left atrial EAT: r2 = 0.439, P < 0.001). The rate of AF termination was significantly higher in the driver ablation group than in the conventional ablation group (82.9% vs. 22.8%, P < 0.001). During the follow-up period of 16.9 ± 6.5 months, patients in the driver ablation group had significantly better AF-free survival (91.91% vs. 79.0%, log rank test, P = 0.026) and AF/atrial tachycardia-free survival (83.9% vs. 64.5%, log rank test, P = 0.011) than did patients in the conventional ablation group.

CONCLUSION

Obesity is associated with increased driver complexity. Driver ablation improves long-term outcomes in obese patients with persistent AF.

Environmental risk assessment and comprehensive index model of disaster loss for COVID-19 transmission

This paper focuses on the study of environmental risk assessment and comprehensive index model of disaster loss for COVID-19 transmission. Considering the five environmental vectors of carrier vulnerability, environmental instability of pregnancy and disaster, intensity of disaster-causing factors, disaster prevention and mitigation capacity and emergency prevention and control capacity and its 38 indicators, the correlation coefficient matrix and principal component expressions of each vector are established by principal component analysis, respectively, and the index model of each vector is established on the basis. Then, considering the index models of these five vectors, we established the disaster loss composite index model, which was used to conduct environmental risk assessment and disaster loss composite index analysis of the transmission of COVID-19 in Hubei Province during the period of January 21, 2020 to March 18, 2020. The empirical study showed that: (1) the risk index peaked from January 21 to January 23; (2) the risk index was at a low but volatile level from January 24 to March 14; (3) the risk index rose again slightly from March 15 and rose to another peak on March 16. These fluctuating, smooth and fluctuating processes of the comprehensive index of disaster losses of COVID-19 in Hubei Province are basically stable and consistent with the actual situation of the virus outbreak in the early stage, isolation and prevention and control in the middle stage, and resumption of work and production in the late stage. The study in this paper provides a scientific decision-making reference for the prevention and control of COVID-19 as well as emergency prevention and control measures.

Radiofrequency ablation for paroxysmal atrial fibrillation in a patient with dextrocardia and interruption of the inferior vena cava: a case report

Background

Dextrocardia with interruption of the inferior vena cava (I-IVC) is a very rare anatomical variant. Catheter ablation of atrial fibrillation (AF) in patients with this anatomical variant is challenging for electrophysiologists. This case report presents a safe, effective, and radiation-free approach for high-power ablation of AF via a superior transseptal approach in patients with dextrocardia and I-IVC.

Case summary

A 57-year-old man with paroxysmal AF with dextrocardia and I-IVC with azygos continuation was referred to our hospital for radiofrequency (RF) ablation. It was evident that transseptal puncture and pulmonary vein isolation (PVI) would be impossible using an IVC approach via the femoral vein. Therefore, we decided to perform left atrium (LA) ablation via the superior vena cava approach. A phased array intracardiac echocardiography (ICE) catheter was inserted in the right femoral vein. Three-dimensional (3D) anatomical reconstruction of LA, right atrium (RA), and coronary sinus (CS) ostium were performed using ICE with azygos vein and RA imaging. Navigation-enabled electrodes were inserted into annotated CS on cardiac 3D ICE image. The left internal jugular vein was accessed using an SL1 transseptal sheath and Brockenbrough needle. Transseptal puncture was performed under ICE with an RF-assisted approach. We accomplished ablation index guided high-power pulmonary vein isolation using a bi-directional guiding sheath with visualization capabilities and a surround flow contact force-sensing catheter. No complications occurred during or after the procedure.

Discussion

With the application of multitude of newer technologies, we can accomplish safe, effective, and fluoroscopy-free RF ablation of AF using the superior approach in patients with complex anomaly.

AIEgens enabled ultrasensitive point-of-care test for multiple targets of food safety: Aflatoxin B1 and cyclopiazonic acid as an example

Food safety is currently a significant issue for human life and health. Various fluorescent nanomaterials have been applied in the point-of-care test (POCT) for food safety as labeling materials. However, previous fluorescent nanomaterials can cause aggregation-caused quenching (ACQ), thus reducing the detection sensitivity. Conversely, aggregation-induced emission luminogens (AIEgens) are promising candidates for POCT in the food safety field because they can enhance detection sensitivity and throughput. Mycotoxins, such as aflatoxin B₁ (AFB₁) and cyclopiazonic acid (CPA), are a primary threat to human life and health and a significant food safety issue, and their on-site detection from farm to table is needed. Herein, an ultrasensitive point-of-care test was developed based on TPE-Br, a blue-emissive tetraphenylethylene derivative AIEgen. Under optimal conditions, this AIEgen-based lateral-flow biosensor (ALFB) allowed for a rapid response of 8 min toward AFB₁ and CPA detection, with considerable sensitivities of 0.003 and 0.01 ng/mL in peanut matrices, respectively. In peanut matrices, the recoveries were 90.3%-110.0% for both mycotoxins, with relative standard deviations (RSDs) below 6%. The ALFB was further validated via UPLC-MS/MS using spiked peanut samples. AIEgens open an avenue for on-site, ultrasensitive, high-throughput detection methods and can be extensively used in point-of-care tests in food safety.

Photoelectrical Properties Investigated on Individual Si Nanowires and Their Size Dependence

Periodically ordered arrays of vertically aligned Si nanowires (Si NWs) are successfully fabricated with controllable diameters and lengths. Their photoconductive properties are investigated by photoconductive atomic force microscopy (PCAFM) on individual nanowires. The results show that the photocurrent of Si NWs increases significantly with the laser intensity, indicating that Si NWs have good photoconductance and photoresponse capability. This photoenhanced conductance can be attributed to the photoinduced Schottky barrier change, confirmed by I-V curve analyses. On the other hand, electrostatic force microscopy (EFM) results indicate that a large number of photogenerated charges are trapped in Si NWs under laser irradiation, leading to the lowering of barrier height. Moreover, the size dependence of photoconductive properties is studied on Si NWs with different diameters and lengths. It is found that the increasing magnitude of photocurrent with laser intensity is greatly relevant to the nanowires' diameter and length. Si NWs with smaller diameters and shorter lengths display better photoconductive properties, which agrees well with the size-dependent barrier height variation induced by photogenerated charges. With optimized diameter and length, great photoelectrical properties are achieved on Si NWs. Overall, in this study the photoelectrical properties of individual Si NWs are systematically investigated by PCAFM and EFM, providing important information for the optimization of nanostructures for practical applications.

Clinical Characteristics and Aqueous Humor Laboratory Analysis of Chinese Patients With Rubella Virus-Associated and Cytomegalovirus-Associated Fuchs Uveitis Syndrome

Purpose: To describe and compare the clinical characteristics and laboratory analysis results of aqueous humor (AH) in fuchs uveitis syndrome (FUS) patients caused by rubella virus (RV) and cytomegalovirus (CMV).

Methods: A retrospective and observation-based study was performed on 32 patients with FUS. Etiologies, clinical characteristics, ocular complications, visual prognoses, inflammatory cytokines, and virus-specific antibodies in AH were compared.

Results: Among all the cases involved, 24 had RV FUS and 8 had CMV FUS. The mean age at diagnosis of FUS in the CMV group was older than that of the RV group (P = 0.031). The mean LogMAR best corrected visual acuity (BCVA) at initial presentation and at the final visit were both significantly higher in the CMV FUS group than those in the RV FUS group (P = 0.004, 0.047). The highest intraocular pressure (IOP) was significantly higher in the CMV group (P = 0.040). Consistent with elevated IOP, the CMV FUS patients were significantly more prone to developing glaucoma eventually than the RV FUS patients (P = 0.039). Vitreous opacity was found in 66.7% of the RV patients and 25.0% of the CMV patients (P = 0.038). The gender ratio, initial symptoms, presence and types of keratic precipitates, severity of anterior segment inflammation, iris lesions, and incidence of complicated cataract were similar between the two groups. There was no detectable difference of inflammatory cytokines in AH between RV FUS and CMV FUS.

Conclusion: The clinical manifestations and disease prognosis vary between CMV FUS and RV FUS. However, clinical differences are always not obvious enough for differential diagnosis. The laboratory AH analysis is necessary to identify the etiology, determine the therapeutic strategies, and assess the disease prognosis.