Objective:To investigate the clinical characteristics, prevalent serum groups, and drug sensitivity test results of epidemic cerebrospinal meningitis in children in Shanghai area.Methods:The study was a retrospective case-control study. The children hospitalized for epidemic cerebrospinal meningitis in Children′s Hospital of Fudan University from January 2003 to December 2023 were enrolled. Clinical data were collected, including demographic characteristics, clinical manifestations, pathogen detection results, strain typing, and drug sensitivity test results.Results:A total of 77 children with confirmed epidemic cerebrospinal meningitis were hospitalized, including 50 males (64.94%) and 27 females (35.06%). The age was 24(8, 60) months, with 16 cases (20.78%) aged 0 to five months, nine cases (11.69%) aged six to 11 months, 21 cases (27.27%) aged 12 to 35 months, 16 cases (20.78%) aged three to five years, 13 cases (16.89%) aged six to 11 years, and two cases (2.60%) aged 12 years. The highest number of cases was in spring, with 36 cases (46.75%), followed by winter with 25 cases (32.47%). Thirty-three cases (42.86%) had vaccinated with meningococcal vaccine. The clinical symptoms included fever in all 77 cases (100.00%), skin petechiae and ecchymosis in 58 cases (75.32%), vomiting in 56 cases (72.73%), respiratory symptoms in 12 cases (15.58%), convulsions in 17 cases (22.08%), conscious disturbance in 24 cases (31.17%), shock in 38 cases (49.35%), circulatory failure in 13 cases (16.88%), and respiratory failure in seven cases (9.09%). Among the 77 children, fifty-seven cases (74.03%) were common type and 20 cases (25.97%) were fulminant type, with seven deaths (9.09%). Neisseria meningitidis (Nm) was detected in 55 cases (71.43%), with the positive rates of skin petechiae smear and cerebrospinal fluid smear of 23.26%(10/43) and 19.44%(14/72), respectively. The positive rates of cerebrospinal fluid culture and blood culture were 36.51%(23/63) and 31.51% (23/73), respectively. The positive rate of polymerase chain reaction detection was 79.17%(38/48). The serogroups were determined in the 38 Nm strains, including 18 cases (47.37%) of group B, 14 cases (36.84%) of group C, five cases (13.16%) of group A, and one case (2.63%) of group Y. Among the 29 Nm strains tested for antimicrobial susceptibility, one strain (3.45%) was resistant to penicillin, two strains (6.90%) were resistant to cefotaxime, 21 strains (72.41%) were resistant to ciprofloxacin, and 25 strains (86.21%) were resistant to sulfamethoxazole/trimethoprim. All strains were sensitive to ceftriaxone, azithromycin, meropenem, rifampicin, chloramphenicol, and minocycline. Conclusions:Epidemic cerebrospinal meningitis presents a low prevalence trend in children in Shanghai area. Infants and toddlers remain the major susceptible individuals. Nm has reduced sensitivity to penicillin, but remains sensitive to ceftriaxone. Ceftriaxone is recommended as the first-line choice for antibiotic therapy. The prevalent serogroups are Group B, Group C, Group A and Group Y in sequence. Immunization plan adjustment should be suggested. Vaccination covering the current epidemic serum population as early as possible should be recommended.

Objective:To establish a stable rat model of sequelae of pelvic inflammatory disease(SPID)with clinical characteristics,and to provide a reliable experimental model for the study of the pharmcological effect and mechanism of SPID.Methods:Twenty-four 7-week-old SD rats were divided into sham operation group,model-A(108 cfu/mL mixed bacterial solution,0.2 mL),model-B(109 cfu/mL mixed bacterial solution 0.2 mL),and model-C(108 cfu/mL E.coli 0.2 mL).The weight of the rat's uterine was weighed and the uterine index was calculated.The automatic hematology analyzer was used to detect the blood routine;hematoxylin-eosin staining(HE)and masson staining were used to detect uterine pathlogical changes in rats.Enzyme-linked immunosorbent assay(ELISA)was used to detect interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in rat uterine tissue homogenates.Western blot was used to detect the expression of proteins related to NF-κB signaling pathway.Results:Compared with the sham operation group,the uterine index of model-A,model-B,and model-C were significantly increased(P＜0.05,P＜0.01).The levels of WBC and NE in the model-A increased significantly(P＜0.01).The level of LY in model-B decreased significantly(P＜0.01).The levels of IL-1β,TNF-α in model-A,model-B,and model-C were significantly increased(P＜0.01).The levels of IL-6 in model-A and model-B were significantly increased(P＜0.05,P＜0.01).The collagen volume fraction of model-A and model-B were significantly increased(P＜0.01).Mechanism study indicates that the expression levels of p-IKKβ/IKKβ,p-IκBα/IκBα and p-p65/p65 in model-A were significantly increased(P＜0.01),and the expression levels of IκBα/β-actin were significantly decreased(P＜0.01).The expression level of p-IKKβ/IKKβ in model-B was significantly increased(P＜0.01).Conclusions:A stable rat model of SPID that conforms to clinical characteristics can be successfully constructed by combining 0.2 mL of mixed bacterial solution with a concentration of 108 cfu/mL and mechanical injury.This modeling method intervened in the expression of the NF-κB inflammatory signaling pathway.

Objective:To analyze the drug resistance status and related risk factors in elderly patients with pulmonary tuberculosis,and to construct and validate a drug resistance risk prediction model for elderly pulmonary tuberculosis patients,providing evidence for early clinical identification of high-risk populations.Methods:A retrospective study was conducted,consecutively enrolling 315 pulmonary tuberculosis patients aged ≥60 years from January 2019 to December 2021.Based on drug susceptibility test results,patients were divided into drug-resistant group(85 cases)and drug-sensitive group(230 cases).Data on demographic characteristics,clinical manifestations,comorbidities,imaging features,and previous treatment history were collected.Univariate and multivariate logistic regression analyses were performed to identify drug resistance-related factors,and a prediction model was constructed accordingly.The model was internally validated using the concordance index(C-index)and Bootstrap method.Results:Among 315 elderly pulmonary tuberculosis patients,the drug resistance rate was 26.98％,predominantly mono-resistance(48.24％)and multidrug-resistance(28.24％).Multivariate logistic regression analysis showed that previous anti-tuberculosis treatment history[OR=4.537,95％CI(1.962-10.498),P=0.005],diabetes mellitus[OR=3.286,95％CI(1.547-6.979),P=0.002],pulmonary cavitation[OR=4.158,95％CI(1.926-8.973),P＜0.001],pleural effusion[OR=2.563,95％CI(1.218-5.390),P=0.013],and tracheobronchial tuberculosis[OR=2.819,95％CI(1.352-5.876),P=0.006]were independent risk factors for drug resistance in elderly pulmonary tuberculosis.The prediction model constructed based on these factors had a C-index of 0.815(95％CI:0.762-0.868).Conclusion:The drug resistance rate is high among elderly pulmonary tuberculosis patients.Previous anti-tuberculosis treatment history,diabetes mellitus,pulmonary cavitation,pleural effusion,and tracheobronchial tuberculosis are independent risk factors for drug resistance in elderly pulmonary tuberculosis.The prediction model constructed based on these factors has good predictive value for identifying high-risk populations,which is helpful for early clinical intervention and individualized treatment strategy formulation.

This study was aimed at establishing a sensitive and specific sandwich ELISA detection method for Brucella.We screened monoclonal capture antibodies and detection antibodies for Brucella detection,and optimized and determined the opti-mal antibody coating time and concentration,as well as the optimal blocking solution,blocking time,and yin-yang critical val-ue.The specificity of this method was verified by examination of other bacteria prone to cross-reacting with Brucella.The sen-sitivity of the method was verified by detection of a gradient dilution of inactivated Brucella.Moreover,the sandwich ELISA detection results were compared with test tube agglutination and qPCR results.The selected capture antibody was 4A12,and the selected detection antibody was 6C12.Experimental analysis indicated that the optimal coating concentration for the 4A12 capture antibody was 5 μg/mL,and the optimal dilution ratio for the 6C12 detection antibody was 1∶2000.The optimal coating conditions were overnight at 4℃,and blocking with 5％skim milk powder for 2 hours.The established double antibody sand-wich ELISA method reacted with only Brucella but not other bacteria,thus demonstrating the method's good specificity.Inac-tivated Brucella solution was still detectable after dilution to 1 × 105 CFU/mL,thus demonstrating the method's good sensitiv-ity.The intra-and inter batch coefficients of variation were both below 10％,thus indicating the method's good repeatability.Thus,this study successfully established a dual antibody sandwich ELISA method for Brucella detection,which has good spe-cificity and sensitivity,and might provide an effective approach for the precise diagnosis and effective prevention and control of brucellosis.

Objective To investigate the role of reactive oxygen species(ROS)and the extracellular signal-regulated kinase(ERK)/cAMP response element binding protein(CREB)signaling pathway in arsenic-induced apoptosis in HT-22 cells.Methods HT-22 cells were cultured in vitro and exposed to NaAsO2.The cells were divided into the following groups:control group,4,6,8,and 10 μmol/L NaAsO2 groups,NAC(5 mmol/L)group,and NAC(5 mmol/L)+NaAsO2(10 μmol/L)group.ROS levels were measured using a DCFH-DA assay.The expression of ERK/CREB signaling pathway-related and apoptosis-related proteins were analyzed by Western blotting.Apop-tosis rates were evaluated using flow cytometry.Results Compared with the control group,ROS levels in HT-22 cells significantly increased,while p-ERK protein level in the nucleus and p-CREB and Bcl-2 protein levels in the cells significantly decreased in the NaAsO2 only exposed groups(P＜0.05).Additionally,the apoptosis rate significantly increased in the 8 and 10 μmol/L NaAsO2 groups compared with the control group(P＜0.05).In the NAC+NaAsO2 group,ROS levels and the apoptosis rate significantly decreased while p-ERK protein level in the nucleus and p-CREB and Bcl-2 protein levels in the cells significantly increased compared with the 10 μmol/L NaAsO2 group(P＜0.05).Conclusion Arsenic exposure induces oxidative stress,inhibits the nuclear translocation of p-ERK,and dis-rupts the CREB signaling pathway,leading to apoptosis.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To analyze the drug resistance status and related risk factors in elderly patients with pulmonary tuberculosis,and to construct and validate a drug resistance risk prediction model for elderly pulmonary tuberculosis patients,providing evidence for early clinical identification of high-risk populations.Methods:A retrospective study was conducted,consecutively enrolling 315 pulmonary tuberculosis patients aged ≥60 years from January 2019 to December 2021.Based on drug susceptibility test results,patients were divided into drug-resistant group(85 cases)and drug-sensitive group(230 cases).Data on demographic characteristics,clinical manifestations,comorbidities,imaging features,and previous treatment history were collected.Univariate and multivariate logistic regression analyses were performed to identify drug resistance-related factors,and a prediction model was constructed accordingly.The model was internally validated using the concordance index(C-index)and Bootstrap method.Results:Among 315 elderly pulmonary tuberculosis patients,the drug resistance rate was 26.98％,predominantly mono-resistance(48.24％)and multidrug-resistance(28.24％).Multivariate logistic regression analysis showed that previous anti-tuberculosis treatment history[OR=4.537,95％CI(1.962-10.498),P=0.005],diabetes mellitus[OR=3.286,95％CI(1.547-6.979),P=0.002],pulmonary cavitation[OR=4.158,95％CI(1.926-8.973),P＜0.001],pleural effusion[OR=2.563,95％CI(1.218-5.390),P=0.013],and tracheobronchial tuberculosis[OR=2.819,95％CI(1.352-5.876),P=0.006]were independent risk factors for drug resistance in elderly pulmonary tuberculosis.The prediction model constructed based on these factors had a C-index of 0.815(95％CI:0.762-0.868).Conclusion:The drug resistance rate is high among elderly pulmonary tuberculosis patients.Previous anti-tuberculosis treatment history,diabetes mellitus,pulmonary cavitation,pleural effusion,and tracheobronchial tuberculosis are independent risk factors for drug resistance in elderly pulmonary tuberculosis.The prediction model constructed based on these factors has good predictive value for identifying high-risk populations,which is helpful for early clinical intervention and individualized treatment strategy formulation.

This study was aimed at establishing a sensitive and specific sandwich ELISA detection method for Brucella.We screened monoclonal capture antibodies and detection antibodies for Brucella detection,and optimized and determined the opti-mal antibody coating time and concentration,as well as the optimal blocking solution,blocking time,and yin-yang critical val-ue.The specificity of this method was verified by examination of other bacteria prone to cross-reacting with Brucella.The sen-sitivity of the method was verified by detection of a gradient dilution of inactivated Brucella.Moreover,the sandwich ELISA detection results were compared with test tube agglutination and qPCR results.The selected capture antibody was 4A12,and the selected detection antibody was 6C12.Experimental analysis indicated that the optimal coating concentration for the 4A12 capture antibody was 5 μg/mL,and the optimal dilution ratio for the 6C12 detection antibody was 1∶2000.The optimal coating conditions were overnight at 4℃,and blocking with 5％skim milk powder for 2 hours.The established double antibody sand-wich ELISA method reacted with only Brucella but not other bacteria,thus demonstrating the method's good specificity.Inac-tivated Brucella solution was still detectable after dilution to 1 × 105 CFU/mL,thus demonstrating the method's good sensitiv-ity.The intra-and inter batch coefficients of variation were both below 10％,thus indicating the method's good repeatability.Thus,this study successfully established a dual antibody sandwich ELISA method for Brucella detection,which has good spe-cificity and sensitivity,and might provide an effective approach for the precise diagnosis and effective prevention and control of brucellosis.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To investigate the clinical characteristics, prevalent serum groups, and drug sensitivity test results of epidemic cerebrospinal meningitis in children in Shanghai area.Methods:The study was a retrospective case-control study. The children hospitalized for epidemic cerebrospinal meningitis in Children′s Hospital of Fudan University from January 2003 to December 2023 were enrolled. Clinical data were collected, including demographic characteristics, clinical manifestations, pathogen detection results, strain typing, and drug sensitivity test results.Results:A total of 77 children with confirmed epidemic cerebrospinal meningitis were hospitalized, including 50 males (64.94%) and 27 females (35.06%). The age was 24(8, 60) months, with 16 cases (20.78%) aged 0 to five months, nine cases (11.69%) aged six to 11 months, 21 cases (27.27%) aged 12 to 35 months, 16 cases (20.78%) aged three to five years, 13 cases (16.89%) aged six to 11 years, and two cases (2.60%) aged 12 years. The highest number of cases was in spring, with 36 cases (46.75%), followed by winter with 25 cases (32.47%). Thirty-three cases (42.86%) had vaccinated with meningococcal vaccine. The clinical symptoms included fever in all 77 cases (100.00%), skin petechiae and ecchymosis in 58 cases (75.32%), vomiting in 56 cases (72.73%), respiratory symptoms in 12 cases (15.58%), convulsions in 17 cases (22.08%), conscious disturbance in 24 cases (31.17%), shock in 38 cases (49.35%), circulatory failure in 13 cases (16.88%), and respiratory failure in seven cases (9.09%). Among the 77 children, fifty-seven cases (74.03%) were common type and 20 cases (25.97%) were fulminant type, with seven deaths (9.09%). Neisseria meningitidis (Nm) was detected in 55 cases (71.43%), with the positive rates of skin petechiae smear and cerebrospinal fluid smear of 23.26%(10/43) and 19.44%(14/72), respectively. The positive rates of cerebrospinal fluid culture and blood culture were 36.51%(23/63) and 31.51% (23/73), respectively. The positive rate of polymerase chain reaction detection was 79.17%(38/48). The serogroups were determined in the 38 Nm strains, including 18 cases (47.37%) of group B, 14 cases (36.84%) of group C, five cases (13.16%) of group A, and one case (2.63%) of group Y. Among the 29 Nm strains tested for antimicrobial susceptibility, one strain (3.45%) was resistant to penicillin, two strains (6.90%) were resistant to cefotaxime, 21 strains (72.41%) were resistant to ciprofloxacin, and 25 strains (86.21%) were resistant to sulfamethoxazole/trimethoprim. All strains were sensitive to ceftriaxone, azithromycin, meropenem, rifampicin, chloramphenicol, and minocycline. Conclusions:Epidemic cerebrospinal meningitis presents a low prevalence trend in children in Shanghai area. Infants and toddlers remain the major susceptible individuals. Nm has reduced sensitivity to penicillin, but remains sensitive to ceftriaxone. Ceftriaxone is recommended as the first-line choice for antibiotic therapy. The prevalent serogroups are Group B, Group C, Group A and Group Y in sequence. Immunization plan adjustment should be suggested. Vaccination covering the current epidemic serum population as early as possible should be recommended.