OBJECTIVE To investigate the current status of prevalence of hand eczema(HE)among the health care workers,explore the influencing factors and analyze the association with hand hygiene.METHODS A questionnaire survey was conducted for the health care workers.The health care workers who had HE were followed up by the dermatology department and were completed the assessment of severity.Logistic regression analysis was per-formed for the influencing factors.RESULTS The questionnaires were distributed to the health care workers of Shanghai First Peoples Hospital in Jul.2024,and 659 valid questionnaires were recycled.The prevalence rate of HE by self-report was 37.03％in recent almost one year.The finger and dorsal hand were the predilection sites of skin damage,with the symptom dominated by itching;dryness,desquamation and vesicles were the primary man-ifestations of skin damage,most of which(64.81％)were moderate.Wearing gloves in work environment and contact with hand sanitizer and disinfectants could make the HE symptoms ever more severe.The use of hand san-itizer/frequent hand washing with soap lye and prolonged glove-wearing were the leading causes of HE.The nurses were dominant among the health care workers with HE(P=0.003),and the proportion of those with allergic his-tory was even higher(P＜0.001).As for the health care workers who washed hands for surgeries,high volume of daily surgical procedures(OR=1.325,95％CI:1.121 to 1.567)and glove-wearing duration more than 120 min(OR=3.177,95％CI:1.087 to 9.281)were the risk factors for HE.As for the common hand-washing health care workers,daily hand washing more than 15 times(OR=3.199,95％CI:1.014 to 10.137),glove-wearing dura-tion more than 120 min(OR=2.216,95％CI:1.117 to 4.391)and use of powdered latex glove(OR=1.591,95％CI:1.058 to 2.390)were the risk factors for HE.CONCLUSION The prevalence rate of HE is high among the health care workers.It is necessary to attach great importance to the hand skin health of the health care work-ers and take comprehensive intervention measures for prevention of HE such as optimization of hand hygiene pro-cedure,enhancement of barrier protection and stress on occupational health education so as to achieve the dual goals of infection control and skin health.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective To analyze the active screening results on bacteria from neonates from different sources in the neonatal ward of a tertiary general hospital in Shanghai,provide a basis for the prevention and control of neo-natal infections.Methods The monitoring results of active screening on all neonates admitted to the neonatal ward of the hospital from 2017 to 2023 were collected retrospectively.Changes in bacterial detection among neonates ad-mitted from the obstetrics department and the community were compared and analyzed.Results From 2017 to 2023,a total of 4 265 neonates were admitted to the hospital,including 3 339 from department of obstetrics(obste-trics source group)and 926 from community(community source group).Active screening showed that 490 and 572 neonates were detected with bacteria,respectively.Bacterial detection rate of neonates in obstetrics source group was lower than community source group(14.68％vs 61.77％,P＜0.001);detection rates of bacteria from pha-rynx and umbilical site of neonates in community source group were both higher than obstetrics source group(both P＜0.001);detection rate of bacteria from neonates'umbilical site was higher than that from pharynx of both ob-stetrics source group and community source group(both P＜0.001).A total of 1 348 bacterial strains were detec-ted,detection rates of Escherichia coli,Staphylococcus epidermidis,Enterococcus faecalis,Streptococcus agalac-tiae,and Acinetobacter baumannii in the obstetrics source group were all higher than community source group(all P＜0.05),detection rates of Staphylococcus aureus and Enterobacter cloacae in the obstetrics source group were both lower than community source group(both P＜0.05).66 neonates were detected multidrug-resistant organism(MDRO),14 were from obstetrics source group and 52 from community source group,63 neonates were detected methicillin-resistant Staphylococcus aureus(MRSA).The detection rates of MDRO and MRSA from community source group were both higher than obstetrics source group(both P＜0.001);detection rate of MDRO from neo-nates'umbilical site was higher than that from the pharynx of the community source group(P＜0.001).Conclusion Bacteria detected in the obstetrics source group is mainly Escherichia coli,while that detected from community source group is mainly Staphylococcus aureus.MRSA is the main MDRO from neonates,and bacterial screening of neonates admitted from the community should be strengthened to prevent and control the spread of MDRO,espe-cially community-acquired MRSA in neonatal wards.

During sudden outbreaks of major infectious diseases,traditional vaccine clinical trials often fail to deliver timely and meaningful outcomes.To address this,innovative trial designs are essential to accelerate or restructure the traditional three-phase clinical trial process while maintaining adherence to scientific principles of drug candidate safety and efficacy.This paper presents various innovative vaccine clinical trial designs and concepts,along with critical considerations for their application,to serve as a methodological reference for related research.Adaptive designs provide flexibility by dynamically adjusting trial parameters—such as dose selection,population stratification,and sample size reestimation—based on interim analysis results.Bayesian designs incorporate historical data and prior information,reducing sample size requirements.Master protocol designs enable the evaluation of multiple treatments or target populations within a unified framework,significantly improving efficiency.Additionally,real-world data(RWD),including electronic health records vaccination records and insurance claims,supports the creation of virtual control groups,addressing ethical concerns while enhancing trial feasibility.A hybrid design combining randomized controlled trials(RCTs)with RWD is also proposed to leverage the strengths of both methodologies.These innovative designs optimize the research process,accelerating vaccine development and regulatory approval.By integrating these approaches,robust evidence-based insights can be generated,advancing precision medicine goals and strengthening public health responses to emerging infectious diseases.

Objective To investigate and compare the epidemiological characteristics of common respiratory viruses among influenza-like illness(ILI)and severe acute respiratory infection(SARI)cases in Huzhou,Zhejiang Province before and after the COVID-19 pandemic,so as to provide a basis for formulating and adjusting the prevention and control strategies for viral respiratory infectious diseases.Methods ILI and SARI cases at two influenza surveillance sentinel hospitals in Huzhou and had throat swab samples collected during Nov 2017 to Feb 2020(pre-COVID-19 pandemic period)and Dec 2022 to Apr 2024(post-COVID-19 mitigation phase)were selected as the participants.Seven common viral respiratory pathogens were tested,including influenza A virus(H1N1 and H3N2 subtypes),influenza B virus(Victoria lineage,FluB),respiratory syncytial virus(RSV),rhinovirus(HRV),adenovirus(ADV),and severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).The positive rates of respiratory pathogens before and after the COVID-19 pandemic were compared across different age groups and different time.Results A total of 7 948 ILI samples and 2 294 SARI samples were included.The overall positive rate of ILI samples increased from 33.6%to 47.1%,primarily due to the increase in influenza and COVID-19 infections;the overall positive rate of SARI samples decreased from 31.4%to 24.8%,mainly due to the reduction in HRV and ADV infections.During the post-COVID-19 mitigation phase,SARS-CoV-2(22.1%),H3N2(12.7%),and FluB(6.0%)were the primary pathogens in ILI samples,while RSV(7.1%),H3N2(5.3%),and HRV(4.5%)dominated in SARI samples.During the post-COVID-19 mitigation phase,the influenza virus circulation period was shortened.Before the COVID-19 pandemic,RSV was mainly detected in autumn and winter,while during the post-COVID-19 mitigation phase,out-of-season RSV epidemics were observed in spring and summer.Co-infection rate in ILI cases increased significantly in the post-COVID-19 mitigation phase,predominantly consisting of co-infections of COVID-19 and influenza A virus,while co-infection rate in SARI cases showed a decline.Conclusion We found important epidemiological changes in respiratory viruses in Huzhou during the post-COVID-19 mitigation phase compared to pre-COVID-19 period,including increased positive rates of influenza and COVID-19,and disruptions to the seasonal patterns of influenza and RSV.The prevention and control strategies should be adjusted in a timely manner based on the monitoring data.

Objective To analyze the occurrence of postoperative pneumonia(POP)in a tertiary general first-class hospital in Shanghai,and provide basis for strengthening the implementation of POP prevention and control meas-ures for the target population.Methods The real-time monitoring data of healthcare-associated infection(HAI)from 2017 to 2023 were retrospectively surveyed.The occurrence of POP in all surgical patients(including minimal-ly invasive interventional surgery)were analyzed.Results A total of 701 postoperative patients had POP.The inci-dence of POP was 0.30％.Incidence of POP was higher in male patients than in female patients(0.48％vs 0.15％),in 65-year-old-population than in＜65-year-old-population(0.58％vs 0.17％),and in elective surgery than in emergency surgery(0.35％vs 0.27％),differences were statistically significant(all P＜0.05).The inter-val from postoperative time to POP occurrence in 701 POP patients was 6(4,10)days,with emergency surgery pa-tients developing POP later than elective surgery(7[4,11]days vs 6[3,10]days),and difference was statistically significant(P＜0.05).The top five departments with higher incidences of POP were neurosurgery(5.84％),cardi-ac surgery(4.01％),thoracic surgery(1.92％),abdominal surgery(0.74％),and minimally invasive intervention(0.17％).Incidence of POP in emergency neurosurgery was higher than that in elective neurosurgery(9.71％vs 2.14％),while incidences of POP in elective cardiac surgery and thoracic surgery were both higher than emergency surgery(5.09％vs 2.93％,2.46％vs 0.58％,respectively),differences were all statistically significant(all P＜0.05).A total of 675 strains of pathogens were detected from 701 POP patients,with Gram-negative bacteria being the major pathogens(n=520,77.04％).The predominant detected pathogens were Acinetobacter baumannii(n=119),Pseudomonas aeruginosa(n=116),Staphylococcus aureus(n=108),Klebsiella pneumoniae(n=104),and Stenotrophomonas maltophilia(n=47).Conclusion In the prevention and control of perioperative infection,the key populations for POP prevention and control should be males and those aged ≥65 years old,and the key depart-ments should be neurosurgery,cardiac/thoracic surgery,and abdominal surgery.Minimal invasive surgery also has the risk of POP,which should be paid more attention.

OBJECTIVE To investigate the current status of prevalence of hand eczema(HE)among the health care workers,explore the influencing factors and analyze the association with hand hygiene.METHODS A questionnaire survey was conducted for the health care workers.The health care workers who had HE were followed up by the dermatology department and were completed the assessment of severity.Logistic regression analysis was per-formed for the influencing factors.RESULTS The questionnaires were distributed to the health care workers of Shanghai First Peoples Hospital in Jul.2024,and 659 valid questionnaires were recycled.The prevalence rate of HE by self-report was 37.03％in recent almost one year.The finger and dorsal hand were the predilection sites of skin damage,with the symptom dominated by itching;dryness,desquamation and vesicles were the primary man-ifestations of skin damage,most of which(64.81％)were moderate.Wearing gloves in work environment and contact with hand sanitizer and disinfectants could make the HE symptoms ever more severe.The use of hand san-itizer/frequent hand washing with soap lye and prolonged glove-wearing were the leading causes of HE.The nurses were dominant among the health care workers with HE(P=0.003),and the proportion of those with allergic his-tory was even higher(P＜0.001).As for the health care workers who washed hands for surgeries,high volume of daily surgical procedures(OR=1.325,95％CI:1.121 to 1.567)and glove-wearing duration more than 120 min(OR=3.177,95％CI:1.087 to 9.281)were the risk factors for HE.As for the common hand-washing health care workers,daily hand washing more than 15 times(OR=3.199,95％CI:1.014 to 10.137),glove-wearing dura-tion more than 120 min(OR=2.216,95％CI:1.117 to 4.391)and use of powdered latex glove(OR=1.591,95％CI:1.058 to 2.390)were the risk factors for HE.CONCLUSION The prevalence rate of HE is high among the health care workers.It is necessary to attach great importance to the hand skin health of the health care work-ers and take comprehensive intervention measures for prevention of HE such as optimization of hand hygiene pro-cedure,enhancement of barrier protection and stress on occupational health education so as to achieve the dual goals of infection control and skin health.

Objective To analyze the occurrence of postoperative pneumonia(POP)in a tertiary general first-class hospital in Shanghai,and provide basis for strengthening the implementation of POP prevention and control meas-ures for the target population.Methods The real-time monitoring data of healthcare-associated infection(HAI)from 2017 to 2023 were retrospectively surveyed.The occurrence of POP in all surgical patients(including minimal-ly invasive interventional surgery)were analyzed.Results A total of 701 postoperative patients had POP.The inci-dence of POP was 0.30％.Incidence of POP was higher in male patients than in female patients(0.48％vs 0.15％),in 65-year-old-population than in＜65-year-old-population(0.58％vs 0.17％),and in elective surgery than in emergency surgery(0.35％vs 0.27％),differences were statistically significant(all P＜0.05).The inter-val from postoperative time to POP occurrence in 701 POP patients was 6(4,10)days,with emergency surgery pa-tients developing POP later than elective surgery(7[4,11]days vs 6[3,10]days),and difference was statistically significant(P＜0.05).The top five departments with higher incidences of POP were neurosurgery(5.84％),cardi-ac surgery(4.01％),thoracic surgery(1.92％),abdominal surgery(0.74％),and minimally invasive intervention(0.17％).Incidence of POP in emergency neurosurgery was higher than that in elective neurosurgery(9.71％vs 2.14％),while incidences of POP in elective cardiac surgery and thoracic surgery were both higher than emergency surgery(5.09％vs 2.93％,2.46％vs 0.58％,respectively),differences were all statistically significant(all P＜0.05).A total of 675 strains of pathogens were detected from 701 POP patients,with Gram-negative bacteria being the major pathogens(n=520,77.04％).The predominant detected pathogens were Acinetobacter baumannii(n=119),Pseudomonas aeruginosa(n=116),Staphylococcus aureus(n=108),Klebsiella pneumoniae(n=104),and Stenotrophomonas maltophilia(n=47).Conclusion In the prevention and control of perioperative infection,the key populations for POP prevention and control should be males and those aged ≥65 years old,and the key depart-ments should be neurosurgery,cardiac/thoracic surgery,and abdominal surgery.Minimal invasive surgery also has the risk of POP,which should be paid more attention.

During sudden outbreaks of major infectious diseases,traditional vaccine clinical trials often fail to deliver timely and meaningful outcomes.To address this,innovative trial designs are essential to accelerate or restructure the traditional three-phase clinical trial process while maintaining adherence to scientific principles of drug candidate safety and efficacy.This paper presents various innovative vaccine clinical trial designs and concepts,along with critical considerations for their application,to serve as a methodological reference for related research.Adaptive designs provide flexibility by dynamically adjusting trial parameters—such as dose selection,population stratification,and sample size reestimation—based on interim analysis results.Bayesian designs incorporate historical data and prior information,reducing sample size requirements.Master protocol designs enable the evaluation of multiple treatments or target populations within a unified framework,significantly improving efficiency.Additionally,real-world data(RWD),including electronic health records vaccination records and insurance claims,supports the creation of virtual control groups,addressing ethical concerns while enhancing trial feasibility.A hybrid design combining randomized controlled trials(RCTs)with RWD is also proposed to leverage the strengths of both methodologies.These innovative designs optimize the research process,accelerating vaccine development and regulatory approval.By integrating these approaches,robust evidence-based insights can be generated,advancing precision medicine goals and strengthening public health responses to emerging infectious diseases.