The aim of this study was to prepare a self-assembled nanoparticle monkeypox vaccine candidate and study its immune response characteristics,so as to provide reference test data for its vaccine design.The antigen protein A29L-SpyTag and the backbone protein Mi3-SpyCatcher were expressed and purified by prokaryotic system,and nanoparticles A29L-Mi3 were prepared by chemical assembly,then the antibody titers were determined by ELISA,the antibody neutralization was determined by plaque test,and the cytokine secretion of lymphocytes was determined by flow cytometry to describe the immune response characteristics.Data showed that A29L-Mi3 nanoparticles were successfully prepared,and the particles were uniformly distributed in hollow cages,with an average particle size of(29±0.19)nm.After the A29L-Mi3 nanoparticle vaccine candidate was combined with SP01 adjuvant,the neutralizing antibody titer was stronger than that of the A29L protein candidate,and the A29L-Mi3 nanoparticle vaccine candidate could obtain neutralizing antibodies with similar titers after two immunizations.The level of mouse T lymphocyte immune response activated by the A29L-Mi3 nanoparticle vaccine candidate was higher than that of the A29L protein vaccine candidate.In conclusion,A29L-Mi3 protein nanoparticles with uniform structure have successfully assembled in vitro,which has strong immunogenicity and improved neutralization ability after combination with SP01 adjuvant,thus provided reference data for the optimization of immune programs.In addition,the level of cellular immune response is higher than that of A29L protein alone,which provides a reference for the design and development of monkeypox vaccine.

Objective To analyze the impact of feedforward control nursing intervention on emergence agitation and recovery quality in general anesthesia surgery patients. Methods A total of 118 patients undergoing general anesthesia surgery were selected by convenient sampling, and randomly divided into control group and observation group, with 59 patients in each group. The control group received routine nursing intervention during emergence anesthesia, while the observation group received feedforward control nursing intervention. The incidence of emergence agitation, recovery quality, pain condition, and nursing quality were compared between the two groups. Results The incidence of emergence agitation during emergence in the observation group was significantly lower than that in the control group (42.37% versus 69.49%, P < 0.05). The Richmond Agitation-Sedation Scale (RASS) scores, duration and frequency of agitation were lower or shorter in the observation group than those in the control group (P < 0.05). The observation group exhibited shorter time for spontaneous respiration recovery, eye opening, extubation, full consciousness, and stay in the postanesthesia care unit compared to the control group(P < 0.05). The Steward emergence score was higher in the observation group (P < 0.05). The postoperative pain score was lower, while nursing quality score was higher in the observation group than those in the control group(P < 0.05). Conclusion Feedforward control nursing intervention can reduce the incidence of emergence agitation in general anesthesia surgery patients, improve recovery quality, alleviate postoperative pain, and enhance nursing quality.

Objective:To summarize the best evidence of intracranial hypertension nursing for adult patients with severe brain injury, and to provide reference for clinical nursing practice.Methods:According to the evidence-based methodology, a systematic search of Chinese and English literature on intracranial hypertension nursing of adult patients with severe brain injury was conducted in domestic and foreign databases such as CNKI, Wanfang, PubMed, Cochrane Library and Cinahl Plus and so on, as well as related guide websites and professional association websites from the establishment of database to August 2022. Two researchers independently evaluated literature quality and screened evidence, and then the project team summarized and concluded the evidence.Results:A total of 6 009 articles were obtained through preliminary search, and 33 articles were included after screening, including 13 guidelines, 1 systematic review, 17 expert consensus, 1 evidence summary, and 1 meta-analysis. In total, 33 pieces of best evidence were obtained from 8 dimensions, including intracranial pressure related threshold, assessment and monitoring, respiratory care, circulation care, analgesic and sedative care, temperature care, nutrition care and cerebrospinal fluid care.Conclusions:This study summarizes the evidence-based basis of intracranial hypertension nursing in adult patients with severe brain injury, which provides a basis for the standardized construction of clinical nursing strategies and empirical research.

Objective:To analyze the distribution characteristics of traditional Chinese medicine (TCM) syndromes in patients with coronavirus disease 2019 (COVID-19) in plateau areas, and to provide theoretical basis for further clinical treatment of patients with COVID-19.Methods:From August 9 to August 24, 2022, patients with COVID-19 admitted to the Third People's Hospital of Tibet Autonomous Region (designated hospital for COVID-19) were included, and their baseline characteristics (age, gender, source), clinical classification and distribution of TCM syndrome types were collected and analyzed. Data analysis was performed using SPSS 26.0 statistical software.Results:A total of 161 COVID-19 patients were enrolled with ethnic distribution: 124 (77.02%) Tibetans, 35 (21.74%) Han, and 2 (1.24%) Hui, 68 males and 93 females. The male-to-female ratio was 0.73∶1. Aged 1 to 94 years, the average age was (39.06±23.64) years old, of which 4 patients were under 1 year old (excluded because the information was missing). A total of 157 patients were enrolled, and 124 patients (78.9%) were under 60 years old, including 120 cases of common type, 4 cases of severe type, 0 cases of critical type, 7 cases over 80 years old, 1 case over 90 years old, and 32 cases under 18 years old. The clinical manifestations of the patient are mainly cough, expectoration, fever, aversion to cold, dry throat, headache, fatigue, running nose, dry mouth, bitter mouth, etc. Most of the tongue is pale, red, and white greasy moss or thin white coating. In TCM, the most common syndrome was cold-dampness blocking lung syndrome (99 cases, 63.06%), followed by cold-dampness stagnant lung syndrome (22 cases, 14.01%), damp-heat accumulating lung syndrome (22 cases, 14.01%), and humidity stagnant lung syndrome (11 cases, 7.01%). Syndromes of epidemic (2 cases, 1.27%), epidemic toxins blocking the lung pattern (1 cases, 0.64%), toxins with dryness intense heat in both qi and ying phases pattern (0 cases) accounted for less than 2%, and the distribution of various syndrome types in COVID-19 patients was uneven ( χ2 = 0.48, P < 0.05). Conclusion:The most common TCM syndromes of COVID-19 patients in Lhasa are cold-dampness blocking lung syndrome, followed by cold-dampness stagnant lung syndrome, damp-heat accumulating lung syndrome, and humidity stagnant lung syndrome.

Objective:To investigate the epidemiological characteristics of influenza-like illnesses (ILI) and the etiological characteristics of influenza viruses in Minhang District of Shanghai from 2010 to 2021.Methods:The surveillance data collected by influenza surveillance sentinel hospitals and the influenza laboratory network from the first week of 2010 to the 52 nd week of 2021 were used for a statistical analysis. Results:A total of 122 903 cases with ILI were reported by the national influenza surveillance sentinel hospitals in Minhang during 2010 to 2021, and the average percentage of ILI cases was 0.94%, showing an increasing trend ( P<0.001). Among them, those aged 0-4, 5-14, 15-24, 25-59 and ≥60 years accounted for 4.35%, 13.30%, 14.30%, 54.32% and 13.73%, respectively. The percentage of ILI showed obvious periodicity. The seasonal incidence of ILI peaked from December to February and from July to September. But the winter peak at the beginning of 2013 was postponed. There was no significant peak in 2021. A total of 11 625 samples were tested from 2010 to 2021, in which the detection rate of influenza viruses was 20.92% (2 432/11 625). The positive rate was 12.83% (1 492/11 625) for influenza A viruses and 8.09% (940/11 625) for influenza B viruses, indicating that the epidemic intensity caused by influenza A viruses was greater than that caused by influenza B viruses. The overall positive rates for influenza A/H3N2 virus, influenza A/H1N1 virus, influenza B/Victoria lineage and influenza B/Yamagata lineage were 9.04% (1 051/11 625), 3.79% (441/11 625), 2.69% (313/11 625) and 2.19% (255/11 625) during 2010 to 2021. The predominant circulating strains altered between influenza A and influenza B viruses in Minhang District of Shanghai during 2010 to 2019. It generally took six months for an epidemic strain to be replaced by a new one. No obvious regularity was observed in 2020 or 2021. The tendency of the incidence of ILI reported from 2010 to 2019 was basically the same as that of the positive rate of influenza viruses, while there were significant differences in 2020 and 2021. Conclusions:Influenza viruses circulated seasonally in Minhang District of Shanghai with alternating prevalent viral subtypes and the infections mostly occurred in the winter and summer seasons. During the epidemic of COVID-19, the intensity of influenza was decreased, but with the normalization of prevention and control measures, the influenza epidemic showed an obvious upward trend. Therefore, it was important to strengthen the prevention and monitoring of influenza and analyze the virus variations in time.

Objective To investigate the epidemiological and pathogenic characteristics of viral diarrhea in Minhang District, Shanghai. Methods Random sampling on diarrhea was conducted in intestinal outpatient departments of 2 sentinel hospitals according to a certain sampling interval in Minhang District，Shanghai from 2014 to 2020. Real time PCR technology was used to detect Rotavirus, Norovirus, adenovirus, Astrovirus and Sapovirus in fecal samples. Results A total of 646 out of 1 839 stool specimenswere tested positive, and the positive rate was 35.13%.Five pathogenic viruses were detected , mostly norovirus (421 cases, 65.17%) followed by rotavirus (151 cases, 23.37%).The positive rate of norovirus was higher in the age group of 20- 69 years, and the positive rate of Rotavirus was higher in the age group of 0- 9 years. Conclusions Norovirus and rotavirus accounted for the majority of reported infection diarrhea cases in MinhangDistrict of Shanghai from 2014 to 2020, with significant seasonal peaks. Tailored prevention and control measures should be carried out, particularly in risk seasons.

Objective: To understand physical activity status of children and adolescents in Tujia inhabited areas, and to provide reference for the intervention model of physical activity of children and adolescents in minority areas. Methods: A cluster sample of 2 466 Tujia pupils from two primary schools in Lichuan City, Enshi Tujia and Miao Autonomous Prefecture of Hubei Province was selected to investigate physical activity status of Tujia pupils. The univariate χ 2 test was used to analyze the physical activity status of Tujia children and adolescents and its influencing factors. Results: The median duration of high intensity activity was 49.9 minutes/day in the last week, and 47.93% of participants met the physical activity standard( χ 2=80.47, P <0.01), the median duration of sitting was 396.1 minutes/day in the last week, and the qualified rate of screen time was 78.99%, and the differences of qualified rate between daystudents and residential students were of statistical differences( χ 2=35.12, P <0.01)). Conclusion The children and adolescents in the Tujia community are lack of physical activity. Therefore, it is necessary to take effective intervention measures to pay attention to the children and adolescents physical activity.

Objective:To observe the application effect of formative evaluation of embedded standard patient (SP) on internal medicine practice teaching.Methods:In this study, 110 students from our school in Batch 2014 who were interned in the internal medicine of the same affiliated hospital were selected as the research objects, and they were randomized into the experimental group and the control group, with 55 students in each group. The control group was trained with traditional clinical practice teaching methods. The experimental group used SP combined mini-clinical evaluation exercise (Mini-CEX) to participate in the evaluation during the clinical practice teaching of internal medicine. After the internal medical practice, the two groups of students were evaluated by Mini-CEX, and the teaching effect of both groups was evaluated through questionnaires.Results:There was no significant difference in the degree of difficulty in the examinations ( P>0.05), but the test scores of the experimental group were significantly higher than those of the control group. The results of Mini-CEX used in inquiry skills, physical examination, humanistic care, and organizational effectiveness were significantly higher in the experimental group than in the control group. The experimental group was highly satisfied with the formative evaluation of SP participation in improving the effect of internal medicine practice, with statistical significance ( P<0.05). Conclusion:The formative evaluation with SP participation in this study can improve the clinical practice teaching effect of medical students to a certain extent.

Background: Despite strengthened efforts on human immunodeficiency virus (HIV) prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV-prevention tool, has recently been included in China's Action Plan of HIV Prevention and Control. To promote future PrEP implementation, this study aims to identify the barriers and facilitators in PrEP use intention among MSM in China.Methods: In 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a seven-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a seven-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP use intention. Results: Overall, 44.67％ of the participants had more than two male sexual partners and 5.56％ had HIV-positive sexual partners. Only 57.00％ had heard of PrEP and only four (1.33％) participants had used PrEP. However, 75.34％ expressed the willingness to use oral PrEP if its efficacy was assured. The beliefs that "PrEP can prevent HIV if taken as prescribed" (adjusted odds ratio (AOR) = 4.84, P < 0.001) and "PrEP can be scaled up in the community" (AOR = 3.24, P < 0.001) were positively associated with oral PrEP use intention. Concerns of side effects were negatively associated with oral PrEP use intention (AOR = 0.32, P = 0.006). Further, 77.00％ of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, "Not certain if doctors can prescribe PrEP if I go to the clinic" was positively associated with the intention to use injectable or implanted PrEP (AOR = 3.03). The items "Heard of PrEP" (AOR = 2.74) and "PrEP can prevent HIV if taken as prescribed" (AOR = 2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67％) and side effects (38.67％). The most common reasons for using injectable and implanted PrEP were adherence (81.94％ and 77.86％, respectively) and privacy concerns (56.48％ and 55.00％, respectively). Affordable price and coverage by health insurance were the driving factors for PrEP use. Conclusion: Given the low level of awareness of PrEP-related information in China, it's necessary to provide interventions for high-risk individuals and communities, in order to increase their awareness and knowledge of PrEP. Furthermore, additional alternatives to HIV prevention, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Even if this programme could be approved by the National Medical Products Administration of China and implemented, a supportive social environment for MSM is essential during its implementing.

Objective: To investigate the antimicrobial resistance, macrolide-resistance genes, virulence genes and emm types in Streptococcus pyogenes isolates. Methods: A total of 247 oropharyngeal swab specimens were collected from pediatric outpatients (aged 2-11 years) who were clinically diagnosed as scarlet fever in Children′s Hospital of Fudan University from January to December, 2018. These specimens were timely sent to the Microbiology Laboratory for isolation and identification of Streptococcus pyogenes strains were isolate after culturing and identified with bacitracin susceptibility test. Moreover, the diameter of bacitracin inhibition zone was measured by vernier caliper. Their susceptibility to seven antibiotics, including erythromycin, clarithromycin, clindamycin, ampicillin, ceftriaxone, norfloxacin and chloramphenicol, were measured using KB method. Macrolide-resistance genes (mefA, ermA, ermB and Tn916 transposon) and virulence genes (speA, speB, speC, speG, speH, speI, speJ and speK) were detected by PCR. Amplification and sequencing of emm gene were conducted according to the protocol in the website of Centre for Disease Control and Prevention (CDC). Results: A total of 86 strains of Streptococcus pyogenes were isolated from the 247 specimens. Their resistance rates to erythromycin, clarithromycin and clindamycin were 89.5%, 95.3% and 96.5%, respectively. However, these isolates showed high susceptibility to ampicillin (100.0%), ceftriaxone (100.0%), norfloxacin (90.7%) and chloramphenicol (95.3%). The positive rates of mefA, ermA, ermB and Tn916 genes were 20.9%, 24.4%, 98.8% and 97.7%. There was significant difference in the mefA-carrying rates between patients with scarlet fever and angina. The positive rates of virulence genes of speA, speB, speC, speG, speH, speI, speJ, speK, speL and speM were 8.1%, 100.0%, 95.3%, 100.0%, 80.2%, 90.7%, 10.5%, 100.0%, 5.8% and 5.8%. Seven emm types were identified and the predominant types were emm12.0 (75.6%), emm12.19 (9.3%) and emm1.0 (8.1%). The diameter of bacitracin inhibition zone was smaller in isolates of emm1.0 type than in emm12.0 type strains. The profile of virulence genes varied in the strains of different emm types. All types of strains carried speB, speG and speK genes. The isolates of emm1.0 type carried speA virulence gene, while speB, speC, speG, speH, speI and speK genes were more often identified in emm12.0 type isolates. Conclusions This study showed that emm types were associated with the profile of virulence genes and the diameter of bacitracin inhibition zone. It was recommended that the diameter of bacitracin inhibition zone should be measured in bacitracin inhibition susceptibility test apart from only observing the formation of inhibition zone.