ObjectiveTo analyze the evolutionary characteristics and genetic variations of the HA (hemagglutinin) and NA (neuraminidase) genes of influenza A(H1N1) viruses in Shanghai during 2024, to investigate their transmission patterns, and to evaluate their potential impact on vaccine effectiveness. MethodsFrom January to October 2024, throat swab specimens were collected from influenza like illness (ILI) patients at 4 hospitals in Shanghai. Real-time fluorescence ploymerase chain reaction (RT-PCR) was used for virus detection and isolation of H1N1 influenza viruses. Forty influenza A(H1N1) virus strains were sequenced using Illumina NovaSeq 6000 platform, followed by phylogenetic analyses, genetic distance analysis, and amino acid variation analyses of HA and NA genes. ResultsPhylogenetic tree of the HA and NA genes revealed that the 40 influenza A(H1N1) virus strains circulating in Shanghai in 2024 exhibited no significant geographic clustering, with a broad origin of strains and complex transmission chains. Genetic distance analyses demonstrated that the average intra-group genetic distances of HA and NA genes among the Shanghai strains were 0.005 1±0.000 6 and 0.004 6±0.000 6, respectively, which were comparable to or higher than those observed in global surveillance strains. Both HA and NA genes displayed frequent mutations. Compared to the 2023‒2024 and 2024‒2025 Northern Hemisphere A(H1N1) vaccine strains (WHO-recommended), the HA proteins of 40 Shanghai strains exhibited amino acid substitutions at positions 120, 137, 142, 169, 216, 223, 260, 277, 356 and 451, with critical mutations at positions 137 and 142 located within the Ca2 antigenic determinant. Furthermore, mutations in the NA protein were observed at positions 13, 50, 200, 257, 264, 339 and 382. ConclusionThe genetic background of the 2024 Shanghai influenza A(H1N1) virus strains is complex and diverse, and antigenic variation may affect vaccine effectiveness. Therefore, it is recommended to enhance genomic surveillance of influenza viruses, evaluate vaccine suitability, and implement more targeted prevention and control strategies against imported influenza viruses.

Objective To evaluate the current radiation doses in pediatric non-cardiac interventional procedures, and analyze the associated clinical factors, and to provide data references for reducing pediatric radiation exposure. Methods We conducted a retrospective analysis of the radiation doses of children who had undergone non-cardiac interventional procedures at the interventional department of a tertiary pediatric hospital in Jinan from January 2022 to October 2024. The collected data included basic demographic information, surgical date, anatomical site, disease type, and radiation dose parameters (cumulative fluoroscopy time, cumulative dose area product in cine mode, cumulative air kerma, and the number of images acquired). The Kruskal-Wallis H test was used for comparative analysis between groups (P < 0.05 was considered statistically significant). Results Among the 475 included children, 99 cases (20.8%) had infantile hemangioma (median P_ka, 0.136 Gy·cm²; median K_a,r, 0.38 mGy), 235 cases (49.5%) had venous malformation (median P_ka, 9.82 Gy·cm²; median K_a,r, 40.99 mGy), 75 cases (15.8%) had lymphatic malformation (median P_ka, 0.06 Gy·cm²; median K_a,r, 0.18 mGy), 32 cases (6.7%) had retinoblastoma (median P_ka, 6.58 Gy·cm²; median K_a,r, 52.34 mGy), 12 cases (2.5%) had arteriovenous malformation (median P_ka, 42.3 Gy·cm²; median K_a,r, 162.87 mGy), and 22 cases (4.6%) had other vascular malformations (median P_ka, 21.7 Gy·cm²; median K_a,r, 89.1 mGy). There were significant differences between children with different disease types in the cumulative fluoroscopy time, cumulative dose area product in cine mode, cumulative air kerma at the patient entrance reference point, and the number of images acquired during non-cardiac interventional procedures (all P < 0.01). Conclusion This study presented the types and proportions of pediatric non-cardiac interventional procedures, evaluated the radiation dose levels of different surgical types, and analyzed the effects of weight and anatomical site on radiation exposure, which can be useful for preliminary assessment of radiation doses in pediatric non-cardiac interventional procedures.

Objective To explore the influence of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with brain-computer interface rehabilitation robot in patients with upper limb motor dysfunction after stroke.Methods A total of 126 patients with upper limb motor dysfunction after stroke were divided into the combined group(61 cases,low-frequency rTMS combined with brain-computer interface rehabilitation robot on the basis of routine rehabilitation treatment)and the magnetic stimulation group(65 cases,low-frequency rTMS on the basis of routine rehabilitation treatment)according to different treatment methods,and both groups were continuously treated for 3 weeks.The upper limb motor function[upper-extremity Fugl-Meyer scale(UFMA),action research arm test(ARAT)],hand Brunnstrom staging,upper limb surface electromyography indicators[root mean square(RMS)and integrated electromyography(iEMG)of biceps brachii,triceps brachii,deltoid anterior bundle and deltoid middle bundle],cerebral artery hemodynamics[systolic blood flow velocity(Vs),resistance index(RI),mean blood flow velocity(Vm)]and ratio of fractional anisotropy(FA)of central region of brain lesion and FA of mirror-image region of healthy cerebral hemisphere(rFA)were observed before and after treatment in the two groups.Results Compared with the magnetic stimulation group,the UFMA score,ARAT score,hand Brunnstrom staging,Vs,Vm and rFA were higher after treatment in the combined group(P＜0.05).The RMS and iEMG of biceps brachii,triceps brachii,deltoid anterior bundle and deltoid middle bundle were higher in the combined group compared with those of the magnetic stimulation group(P＜0.05),while the RI was lower(P＜0.05).Conclusion Combined treatment can more effectively improve the upper limb motor function of patients,enhance hand activity ability,promote the recovery of upper limb muscle and nerve function,and regulate the hemodynamics of cerebral arteries.

Objective To evaluate the effects of low-dose intrathecal morphine(ITM)combined with liposomal bupivacaine adductor canal block(LB-ACB)on postoperative analgesia and opioid-sparing efficacy in patients undergoing total knee arthroplasty(TKA).Methods In this randomized,double-blind,controlled trial,80 TKA patients were allocated to either an intervention group(ITM 0.1 mg+LB-ACB,n=40)or a control group(intrathecal saline+LB-ACB,n=40).Primary outcomes included resting/movement visual analog scale(VAS)scores at 6,12,24,48,and 72 hours postoperatively,48-hour morphine consumption,time to first rescue analgesia,and incidence of complications.Results(1)The intervention group showed significantly lower resting and movement VAS scores at 6,12,24,and 48 hours postoperatively compared with controls(all P<0.05),except at 72 hours(P>0.05).(2)The intervention group had a significant reduction in 48-hour morphine consumption(4.58±1.0 mg vs.9.34±4.8 mg,P=0.027),a significantly lower rescue analgesia rate(15.0%vs.47.5%,P=0.002),and a significantly prolonged time to first rescue analgesia(48.8±7.5 h vs.14.5±5.5 h,P<0.001).(3)The intervention group demonstrated a significant decrease in the incidence of nausea(from 15.0%to 35.0%,P=0.039)and vomiting(from 10.0%to 27.5%,P=0.045),but no significant differences were observed in the incidences of pruritus,urinary retention,or motor block(all P>0.05).Conclusion Low-dose ITM(0.1 mg)combined with LB-ACB significantly enhances early postoperative analgesia,reduces opioid consumption,and decreases nausea/vomiting risk,without increasing the risks of other complications.This regimen aligns with enhanced recovery after surgery(ERAS)principles.

Objective To explore the identification method,pathogenesis,clinical characteristics and individualized pharmacotherapy of asymptomatic hyperuricemia after renal transplantation.Methods The pharmacist was on duty at the organ transplant outpatient clinic.During this time,they analyzed and sorted out the medications,identified and differentiated a case of asymptomatic hyperuricemia related to spironolactone in a patient who had undergone a renal transplant,and provided comprehensive care throughout the entire process.Results The asymptomatic hyperuricemia in this patient might be associated with spironolactone,and the adverse reactions of the patient were alleviated by pharmacists through optimizing clinical treatment.Up to now,no hyperuricemia occurred.Conclusions Pharmacists are required to collaborate closely with clinicians to establish medication profiles for patients under long-term follow-up and to closely monitor and evaluate drug-related adverse reactions.Additionally,they should assess the renal function and immune status of transplant recipients promptly and formulate individualized treatment plans in order to enhance the long-term survival of both the transplanted kidneys and the recipients.

Objective To explore the influence of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with brain-computer interface rehabilitation robot in patients with upper limb motor dysfunction after stroke.Methods A total of 126 patients with upper limb motor dysfunction after stroke were divided into the combined group(61 cases,low-frequency rTMS combined with brain-computer interface rehabilitation robot on the basis of routine rehabilitation treatment)and the magnetic stimulation group(65 cases,low-frequency rTMS on the basis of routine rehabilitation treatment)according to different treatment methods,and both groups were continuously treated for 3 weeks.The upper limb motor function[upper-extremity Fugl-Meyer scale(UFMA),action research arm test(ARAT)],hand Brunnstrom staging,upper limb surface electromyography indicators[root mean square(RMS)and integrated electromyography(iEMG)of biceps brachii,triceps brachii,deltoid anterior bundle and deltoid middle bundle],cerebral artery hemodynamics[systolic blood flow velocity(Vs),resistance index(RI),mean blood flow velocity(Vm)]and ratio of fractional anisotropy(FA)of central region of brain lesion and FA of mirror-image region of healthy cerebral hemisphere(rFA)were observed before and after treatment in the two groups.Results Compared with the magnetic stimulation group,the UFMA score,ARAT score,hand Brunnstrom staging,Vs,Vm and rFA were higher after treatment in the combined group(P＜0.05).The RMS and iEMG of biceps brachii,triceps brachii,deltoid anterior bundle and deltoid middle bundle were higher in the combined group compared with those of the magnetic stimulation group(P＜0.05),while the RI was lower(P＜0.05).Conclusion Combined treatment can more effectively improve the upper limb motor function of patients,enhance hand activity ability,promote the recovery of upper limb muscle and nerve function,and regulate the hemodynamics of cerebral arteries.

Objective To evaluate the effects of low-dose intrathecal morphine(ITM)combined with liposomal bupivacaine adductor canal block(LB-ACB)on postoperative analgesia and opioid-sparing efficacy in patients undergoing total knee arthroplasty(TKA).Methods In this randomized,double-blind,controlled trial,80 TKA patients were allocated to either an intervention group(ITM 0.1 mg+LB-ACB,n=40)or a control group(intrathecal saline+LB-ACB,n=40).Primary outcomes included resting/movement visual analog scale(VAS)scores at 6,12,24,48,and 72 hours postoperatively,48-hour morphine consumption,time to first rescue analgesia,and incidence of complications.Results(1)The intervention group showed significantly lower resting and movement VAS scores at 6,12,24,and 48 hours postoperatively compared with controls(all P<0.05),except at 72 hours(P>0.05).(2)The intervention group had a significant reduction in 48-hour morphine consumption(4.58±1.0 mg vs.9.34±4.8 mg,P=0.027),a significantly lower rescue analgesia rate(15.0%vs.47.5%,P=0.002),and a significantly prolonged time to first rescue analgesia(48.8±7.5 h vs.14.5±5.5 h,P<0.001).(3)The intervention group demonstrated a significant decrease in the incidence of nausea(from 15.0%to 35.0%,P=0.039)and vomiting(from 10.0%to 27.5%,P=0.045),but no significant differences were observed in the incidences of pruritus,urinary retention,or motor block(all P>0.05).Conclusion Low-dose ITM(0.1 mg)combined with LB-ACB significantly enhances early postoperative analgesia,reduces opioid consumption,and decreases nausea/vomiting risk,without increasing the risks of other complications.This regimen aligns with enhanced recovery after surgery(ERAS)principles.

Objective To explore the identification method,pathogenesis,clinical characteristics and individualized pharmacotherapy of asymptomatic hyperuricemia after renal transplantation.Methods The pharmacist was on duty at the organ transplant outpatient clinic.During this time,they analyzed and sorted out the medications,identified and differentiated a case of asymptomatic hyperuricemia related to spironolactone in a patient who had undergone a renal transplant,and provided comprehensive care throughout the entire process.Results The asymptomatic hyperuricemia in this patient might be associated with spironolactone,and the adverse reactions of the patient were alleviated by pharmacists through optimizing clinical treatment.Up to now,no hyperuricemia occurred.Conclusions Pharmacists are required to collaborate closely with clinicians to establish medication profiles for patients under long-term follow-up and to closely monitor and evaluate drug-related adverse reactions.Additionally,they should assess the renal function and immune status of transplant recipients promptly and formulate individualized treatment plans in order to enhance the long-term survival of both the transplanted kidneys and the recipients.

A 11-year old female patient with severe thalassemia, receipt a lentivirus-based cell and gene therapy (CGT) therapy in Shenzhen Children′s Hosptial on July 27th, 2021. At the two follow-up visits after discharge, patient were continuously tested positive for HIV screening through HIV Ag/Ab Combo assay (chemiluminescence Immunoassay), and the viral load results of HIV-1 nucleic acid testing (NAT) were both>5 000 copies/ml. The patient can be diagnosed with HIV infection according to the National Guideline for Detection of HIV/AIDS(2020 Revised Edition). The thorough investigation findings and supplementary experiment results indicated that the false-positive HIV-1 NAT results was caused by cross-reactivity between the target sites detected by conventional HIV-1 NAT reagents and the lentiviral vectors fragments integrated into the genome of patient′s hematopoietic stem/progenitor cells. In conclusion, it is important for laboratories to select appropriate HIV-1 NAT testing platforms which won′t cause cross-reactivity for the testing of samples from patients who have been treated with HIV-derived vectors. It is also recommended to design and develop NAT testing platforms with multiple target regions labeled by different fluorescents for HIV NAT supplementation experiment to reduce the risk of false-positive diagnoses of HIV infection.

Objective:To construct a prognostic nomogram based on epithelial-stromal interaction protein 1(EPSTI1)and predict the pro-gnosis of clear cell renal cell carcinoma(ccRCC).Methods:A retrospective analysis was performed from January 2012 to December 2015 at The First Affiliated Hospital of Fujian Medical University,on 221 patients with ccRCC who underwent surgical treatment in our center and 533 patients with ccRCC in The Cancer Genome Atlas(TCGA)database.Immunohistochemical(IHC)staining was performed on adjacent nor-mal and cancerous tissues to analyze the expression level of EPSTI1 and its correlation with clinicopathological characteristics.Kaplan-Meier survival analysis was performed for the overall survival(OS)and disease-free survival(DFS)of patients with high and low EPSTI1 expression levels.Univariate and multivariate Cox proportional hazards models were used to analyze the prognostic factors for OS,and a nomogram model was constructed and verified.Results:The IHC scores and mRNA expression levels of EPSTI1 were significantly higher in ccRCC tissues than in normal tissues(all P<0.001).EPSTI1 was expressed at higher levels in cancer tissues at higher T stages(P=0.036,P=0.006).The EPSTI1 protein expression level was related to the maximum tumor diameter and TNM stage(P=0.002,P=0.032,respectively).The OS and DFS were higher in the low-EPSTI1-expression group than the high-EPSTI1-expression group(P=0.046,P=0.003,P=0.001).Univariate and multivariate Cox regression analyses showed that a high EPSTI1 protein expression level,WHO/ISUP grade,and AJCC/TNM stage were independent risk factors for poor prognosis(P=0.009,P=0.039,P<0.001).The prognostic nomogram model constructed based on the above variables was su-perior to the AJCC/TNM stage in predicting the 5-year OS,and the calibration curve showed that the predicted value of the model was con-sistent with the actual value.Conclusions:The nomographic model based on EPSTI1,AJCC/TNM staging and WHO/ISUP staging has a strong predictive ability for the prognosis of renal clear cell carcinoma.