OBJECTIVE To explore the risk factors for postoperative surgical site infection(SSI)in the neurosur-gery department patients undergoing craniocerebral surgeries and establish Nomogram prediction model and verify it.METHODS A total of 1 265 patients who underwent craniocerebral surgeries in neurosurgery department of the First Hospital of Quanzhou City from Jan.2021 to Dec.2022 were recruited as the research subjects.The risk factors for the postoperative SSI were explored by logistic regression model.The Nomogram prediction model was established based on the independent risk factors that were screened by logistic regression analysis,and the model was verified.RESULTS Among 1 265 patients who underwent the craniocerebral surgeries,68 had SSI,with the infection rate of 5.38％.Diabetes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days were the independent risk factors for the postoperative SSI in the patients undergoing craniocerebral surgeries(P＜0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of the established Nomogram pre-diction model was 0.842 in the training group,0.863 in the verification group.the calibration curves were drawn,the goodness of fit of the established Nomogram risk prediction model was assessed by means of Hosmer-Leme-show test;the predicted probability of SSI was highly consistent with the actual probability of infection,with the modeling group(P=0.851),the validation group(P=0.893).CONCLUSIONS The postoperative SSI in the neurosurgery department patients undergoing craniocerebral surgeries is closely associated with the diabe-tes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days.The established Nomogram prediction model has high prediction capability and can accurately assess the risk of SSI in the patients.

Objective To analyze the drug resistance and genomic characteristics of clinically isolated hypermuco-viscous Klebsiella pneumoniae(hmKp).Methods Klebsiella pneumoniae isolated from clinical specimens from the sentinel hospitals of National Pathogen Identification Network in Huai'an City from 2019 to 2023 were collected,strains were identified by VITEK 2 Compact,mucus phenotype was determined by string test,resistance of hmKp was determined by microbroth dilution method.Molecular typing was conducted by whole-genome sequencing tech-nology,annotation of virulence and resistance genes carried by strains was performed.Results A total of 60 strains of hmKp were collected,mainly isolated from sputum specimens(33.33％)and blood specimens(28.33％).The average genome size of 60 strains was 5.6 Mb,with an average GC content of 57.09％.Multilocus sequence typing(MLST)showed that there were 28 ST types,with the dominant ST types being ST1 1(11.67％),ST15(11.67％),and ST412(10.00％).Core genome MLST(cgMLST)analysis revealed that some strains were highly homologous,and no outbreak strains were found.Multidrug-resistant strains accounted for 60.00％,while imipe-nem-resistant strains accounted for 28.33％.64 types of resistance genes were carried,84.38％of which were loca-ted on mobile element.The carriage rates of fosfomycin-related resistance genes and extended-spectrum β-lactam an-tibiotic-related resistance genes were relatively high in the strains,at 100％and 98.33％,respectively.Among car-bapenem-resistance gene blaKPC-2,21.67％was carried by ST11,ST1,and ST15 strains,among bla NDM-5 gene,3.33％was carried by ST76 strain.A total of 101 virulence genes were carried,most were Colibactin and type Ⅵsecretion system-related virulence genes.All strains carried capsule synthesis regulation-related genes(rcsA,rcsB),efflux pump-related genes(acrA,acrB),and enterobacterin-related genes(entABCEF,fepABCDFG,fes).Conclusion Clinically isolated hmKp in Huai'an exhibits multidrug resistance,with dominant ST types ST11,ST15,and ST412,carrying multiple horizontally transferable resistance and virulence genes,prevention and control measures should be strengthened.

(±)-Talapyrones A-F (1-6), six pairs of dimeric polyketide enantiomers featuring unusual 6/6/6 and 6/6/6/5 ring systems, were isolated from the fungus Talaromyces adpressus. Their structures were determined by spectroscopic analysis and HR-ESI-MS data, and their absolute configurations were elucidated using a modified Mosher's method and electronic circular dichroism (ECD) calculations. (±)-Talapyrones A-F (1-6) possess a 6/6/6 tricyclic skeleton, presumably formed through a Michael addition reaction between one molecule of α-pyrone derivative and one molecule of C₈ poly-β-keto chain. In addition, compounds 2/3 and 4/5 are two pairs of C-18 epimers, respectively. Putative biosynthetic pathways of 1-6 were discussed.
Polyketides/isolation & purification* ; Talaromyces/chemistry* ; Stereoisomerism ; Molecular Structure ; Circular Dichroism ; Pyrones/chemistry*

OBJECTIVE To explore the risk factors for postoperative surgical site infection(SSI)in the neurosur-gery department patients undergoing craniocerebral surgeries and establish Nomogram prediction model and verify it.METHODS A total of 1 265 patients who underwent craniocerebral surgeries in neurosurgery department of the First Hospital of Quanzhou City from Jan.2021 to Dec.2022 were recruited as the research subjects.The risk factors for the postoperative SSI were explored by logistic regression model.The Nomogram prediction model was established based on the independent risk factors that were screened by logistic regression analysis,and the model was verified.RESULTS Among 1 265 patients who underwent the craniocerebral surgeries,68 had SSI,with the infection rate of 5.38％.Diabetes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days were the independent risk factors for the postoperative SSI in the patients undergoing craniocerebral surgeries(P＜0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of the established Nomogram pre-diction model was 0.842 in the training group,0.863 in the verification group.the calibration curves were drawn,the goodness of fit of the established Nomogram risk prediction model was assessed by means of Hosmer-Leme-show test;the predicted probability of SSI was highly consistent with the actual probability of infection,with the modeling group(P=0.851),the validation group(P=0.893).CONCLUSIONS The postoperative SSI in the neurosurgery department patients undergoing craniocerebral surgeries is closely associated with the diabe-tes mellitus,NNIS score no less than 2 points,NRS2002 score no less than 3 points,operation duration no less than 4.33 hours and drainage tube indwelling time more than 3 days.The established Nomogram prediction model has high prediction capability and can accurately assess the risk of SSI in the patients.

Objective To analyze the drug resistance and genomic characteristics of clinically isolated hypermuco-viscous Klebsiella pneumoniae(hmKp).Methods Klebsiella pneumoniae isolated from clinical specimens from the sentinel hospitals of National Pathogen Identification Network in Huai'an City from 2019 to 2023 were collected,strains were identified by VITEK 2 Compact,mucus phenotype was determined by string test,resistance of hmKp was determined by microbroth dilution method.Molecular typing was conducted by whole-genome sequencing tech-nology,annotation of virulence and resistance genes carried by strains was performed.Results A total of 60 strains of hmKp were collected,mainly isolated from sputum specimens(33.33％)and blood specimens(28.33％).The average genome size of 60 strains was 5.6 Mb,with an average GC content of 57.09％.Multilocus sequence typing(MLST)showed that there were 28 ST types,with the dominant ST types being ST1 1(11.67％),ST15(11.67％),and ST412(10.00％).Core genome MLST(cgMLST)analysis revealed that some strains were highly homologous,and no outbreak strains were found.Multidrug-resistant strains accounted for 60.00％,while imipe-nem-resistant strains accounted for 28.33％.64 types of resistance genes were carried,84.38％of which were loca-ted on mobile element.The carriage rates of fosfomycin-related resistance genes and extended-spectrum β-lactam an-tibiotic-related resistance genes were relatively high in the strains,at 100％and 98.33％,respectively.Among car-bapenem-resistance gene blaKPC-2,21.67％was carried by ST11,ST1,and ST15 strains,among bla NDM-5 gene,3.33％was carried by ST76 strain.A total of 101 virulence genes were carried,most were Colibactin and type Ⅵsecretion system-related virulence genes.All strains carried capsule synthesis regulation-related genes(rcsA,rcsB),efflux pump-related genes(acrA,acrB),and enterobacterin-related genes(entABCEF,fepABCDFG,fes).Conclusion Clinically isolated hmKp in Huai'an exhibits multidrug resistance,with dominant ST types ST11,ST15,and ST412,carrying multiple horizontally transferable resistance and virulence genes,prevention and control measures should be strengthened.

Objective:To explore the dynamic change trajectory and influencing factors of postoperative fatigue (POF) in patients with early digestive tract cancer undergoing endoscopic submucosal dissection (ESD), so as to provide theoretical basis for individualized management of such patients.Methods:Using cross-sectional survey and convenient sampling method, the patients who underwent ESD for early cancer of digestive tract in the endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June 2024 were selected as the research objects. The questionnaires were conducted at 30 min, 24 h, 3 days, 5 days, 7 days after ESD with Christensen's postoperative fatigue score. Spearman test was used to analyze the correlation between pain, insomnia and POF. The latent variable growth model was used to identify the potential categories of POF trajectory, and the influencing factors were analyzed by Logistic regression.Results:A total of 232 patients were finally induded, with ages of 19-94(59.53 ± 13.29) years, including 120 males and 112 femalss. The POF level of patients with early cancer of digestive tract showed a downward trend one week after operation. Three postoperative fatigue trajectories were fitted, 9.05% in moderate or severe fatigue low-speed smooth descent group (C1 group); 32.76% in moderate fatigue first decreased quickly and then slowly group (C2 group) and 58.19% in mild fatigue continuous decline group (C3 group). The result of Logistic regression analysis showed that, compared with C1 group, people without religious beliefs were morelikely to enter C2 group [ β = 1.572, OR = 4.818(1.033 - 22.465), P<0.05]; compared with C3 group, patients with high pain level and severe insomnia degree were likely to enter C1 [ β = 2.621, 0.663, OR were 13.754(2.692 - 70.283) and 1.942(1.429 - 2.638), both P<0.05] and C2 [ β = 2.010, 0.491, OR were 7.464(1.890 - 29.482) and 1.634(1.348 - 1.982), both P<0.05] group. Conclusions:There were three potential types of POF in patients with early digestive tract cancer ESD. Medical staff should pay attention to patients with severe insomnia, intense pain and religious beliefs, and give staged fatigue assessment and individualized intervention, so as to reduce the level of POF and promote rapid recovery.

Objective To investigate the drivers,stakeholders,core tasks,and differentiated development models of digital transformation in Chinese hospitals,develop a hospital digital transformation model,and propose advancement pathways.Methods Leveraging ROCCIPI theory,socio-technical systems theory,and social network theory,a multiple case study approach was employed to analyze four representative Chinese hospitals,examining the driving factors,social network relationship,and core tasks of digital transformation.Results Hospital digital transformation is a complex process driven by regulations,opportunities,and capabilities,requiring efficient collaboration among stakeholders focused on patient services,clinical operations,hospital management,and security.It identified three development models-ecology-oriented,regional integration,and grassroots enhancement—based on the distinct characteristics of the hospitals.A theoretical model for digital transformation in four Chinese hospitals was developed,along with proposed pathways and strategies.Conclusion It presents a digital transformation model and advancement pathways for hospitals through multiple case analyses,addressing the limited perspectives of existing research and providing a reference for practice.

Objective:To evaluate the efficacy and safety of Rituximab (RTX) combined with short-term use of glucocorticoids in the treatment of the initial episode of steroid-sensitive nephrotic syndrome (SSNS).Methods:A retrospective case summary.A total of 30 children with SSNS treated in the Department of Intrarenal Rheumatism and Immunology, Xuzhou Children′s Hospital from December 2021 to March 2023, were enrolled in this study.They were given a standard dose of RTX (375 mg/m 2) and glucocorticoids for a short term.The patients were followed up for 1 year, and the general condition, changes in CD19 + B lymphocytes expression after RTX treatment, the relapse rate, the median relapse-free survival and adverse reactions of RTX were recorded.Kaplan-Meier method was used to analyze the relapse-free survival time. Results:CD19 + B lymphocytes were depleted 2 weeks after RTX treatment, and the median time required for CD19 + B lymphocytes reconstitution was 5 months after RTX treatment.The 1-year relapse-free rate was 90.00%, and the median relapse-free survival was 11 months.The glucocorticoid discontinuation rate was 93.33% in 3 months after RTX treatment, and 100% in 6 and 12 months after RTX treatment.Adverse reactions included infusion reactions in 7 cases (23.33%), neutropenia/leukopenia in 5 cases (16.67%), hypoimmunoglobulinemia in 10 cases (33.33%), infections in 4 cases.One case was complicated with severe influenza A virus infection after CD19 + B lymphocytes reconstruction. Conclusions:A standard dose of RTX can significantly reduce the relapse frequency, maintain long-term remission of proteinuria, and reduce the dose of glucocorticoids in patients at the initial episode of SSNS.Thus, it is worthy of clinical promotion.

Purpose To explore factors influencing vaginal delivery during the first stage of labor using intrapartum ultrasound and to construct predictive models for delivery decision-making.Materials and Methods A total of 473 nulliparous women admitted to Heping Hospital,Northern Theater General Hospital from July to December 2021 were prospectively enrolled as the training set.Clinical data on admission and fetal biometric parameters(biparietal diameter,femur length,head circumference and abdominal circumference)measured within one week before delivery were collected.Ultrasound assessments of fetal position,angle of progression(AOP)and head-perineum distance(HPD)were performed during the first stage of labor.The latent phase group(n=255)was subdivided into vaginal delivery group(n=186)and cesarean section group(n=69);the active phase group(n=218)was divided into vaginal delivery group(n=168)and cesarean section group(n=50).The associations between fetal position,AOP,HPD and vaginal delivery were analyzed,and predictive models were constructed for the latent phase(model 1)and active phase(model 2).A validation set of 547 women from January to September 2022 was used to evaluate model performance via area under the curve(AUC),calibration curves and decision curve analysis.Results In the latent phase,multivariate regression identified maternal height(OR=3.970,P=0.002),pre-pregnancy body mass index(OR=0.893,P=0.036),labor onset type(OR=2.415,P=0.045),neonatal birth weight(OR=3.728,P=0.002),AOP(OR=11.649,P<0.001)and HPD(OR=4.240,P=0.004)as significant predictors.The training and validation sets showed AUCs of 0.917 and 0.869,respectively.Goodness-of-fit tests indicated excellent model calibration(χ2=3.437,P=0.904;χ2=10.877,P=0.209).Decision curve analysis demonstrated strong clinical utility.For the active phase,significant predictors included maternal height(OR=6.532,P<0.001),neonatal birth weight(OR=11.890,P<0.001),fetal position(OR=4.600,P=0.003),AOP(OR=7.229,P<0.001)and HPD(OR=4.722,P=0.005).AUCs were 0.943(training)and 0.906(validation),with good calibration(χ2=4.340,P=0.740;χ2=9.836,P=0.277)and clinical applicability.Conclusion First stage ultrasound assessment of fetal position,AOP and HPD correlates with delivery outcomes.The developed nomogram models combining these parameters with clinical factors provide valuable guidance for delivery decision-making.

Objective To investigate the drivers,stakeholders,core tasks,and differentiated development models of digital transformation in Chinese hospitals,develop a hospital digital transformation model,and propose advancement pathways.Methods Leveraging ROCCIPI theory,socio-technical systems theory,and social network theory,a multiple case study approach was employed to analyze four representative Chinese hospitals,examining the driving factors,social network relationship,and core tasks of digital transformation.Results Hospital digital transformation is a complex process driven by regulations,opportunities,and capabilities,requiring efficient collaboration among stakeholders focused on patient services,clinical operations,hospital management,and security.It identified three development models-ecology-oriented,regional integration,and grassroots enhancement—based on the distinct characteristics of the hospitals.A theoretical model for digital transformation in four Chinese hospitals was developed,along with proposed pathways and strategies.Conclusion It presents a digital transformation model and advancement pathways for hospitals through multiple case analyses,addressing the limited perspectives of existing research and providing a reference for practice.