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Objective To compare the impact of different primary tumor sites on the survival of patients with metastatic urothelial carcinoma(mUC)before and after the approval of immune checkpoints inhibitors(ICIs)based on data from Surveillance,Epidemiology,and End Results(SEER).Methods The mUC cases during 2013 and 2017 in the SEER database were enrolled.Cohorts were defined by primary tumor sites(renal pelvis,ureter,bladder)and then stratified by ICIs availability into non-ICIs era(2013)and ICIs era(2017).The survival differences in each cohort between the two eras were compared,and stratified analysis was performed.The 2-year overall survival(OS)was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards analysis.Results A total of 1750 mUC cases were enrolled,with 785 cases in the non-ICIs era and 965 in the ICIs era.No significant differences existed across different anatomical sites in the non-ICIs era,whether in the whole urinary system or inside bladder.The 2-year survival rates were 23.5％for ureteral cancer,18.0％for renal pelvic cancer,and 15.9％for bladder cancer.Significant prognostic disparities emerged among patients based on primary tumor sites in ICIs era(P＜0.05).The 2-year survival rates were 37.7％for ureteral cancer,25.5％for renal pelvic cancer,and 25.7％for bladder cancer.Further analysis revealed that the OS of the lesions originating from the bladder dome was significantly longer than that of the other bladder subgroups(P＜0.05),while the OS of the lesions in bladder bottom was the shortest.The 2-year survival rates were 52.0％for the bladder dome,13.0％for the bladder body,and 10.7％for the bladder bottom.Conclusion Our study indicates that in the non-ICIs era,there was no significant difference in the prognosis among mUC patients with lesions from different primary sites.In the ICIs era,the OS of ureteral cancer was significantly longer than that of bladder cancer and renal pelvis cancer.As for patients with metastatic bladder cancer,those with tumor located at the top of the bladder had a significantly better prognosis than those with tumors at other sites.

Objective To explore the disinfection effect of periodic hypochlorous acid infusion on water supply pipelines.Methods Water specimens from 6 water outlets of central sterile supply department were collected at baseline for microbial culture.After introducing a slightly acidic hypochlorous acid water generator,water speci-mens were collected every 10 days.Continuous disinfection with hypochlorous acid was carried out on the 1st-3rd day,and discontinued on the 4th-10th day.Water specimens of 6 water outlets were collected on the 1st,4th,7th,and 10th day of each cycle,in total 3 cycles.Microbial culture and metagenomic next-generation sequencing(mNGS)analysis were conducted simultaneously on all water specimens from the outlets of the endoscope cleaning tank.Results Before disinfection of the pipeline,a total of 18 bottles of water specimens were collected.Bacterial count of water specimens from 10 bottles(55.56％)was between 102 and 104 CFU/mL,mainly Sphingomonas ad-hesins and Bacillus cereus.After disinfection,only 2 out of 72 water specimens(2.78％)exceeded the bacterial lim-it.The mNGS results showed that three most dominant bacterial genera in the pre-disinfection water specimens were Sphingomonas,Methylobacterium,and Ralstonia,with stringent mapped reads number(SMRN)ranging from 10 000 to 100 000;while the most dominant bacterial genera in post-disinfection water specimens were Lacto-baci-llus,Ralstonia,Acinetobacter,and Bradyrhizobium.PCoA analysis showed that there was a statistically sig-nificant difference in β-diversity of water specimens before and after disinfection(P＜0.05).Conclusion Periodic hypochlorous acid infusion disinfection can effectively remove bacterial biofilms in water pipelines,but there is a risk of bacterial biofilm recovery during disinfection suspension.In the future,monitoring and management of medical water should be strengthened.

Objective:To explore the enhancement factors for the China-PAR assessment model based on a university employee cohort and validate its predictive efficacy.Methods:In this retrospective cohort study, 423 employees from a university in Beijing who underwent health checks at Peking University Third Hospital from 2019 to 2022 were enrolled. General demographics, physical examination data, biochemical indicators, and carotid artery ultrasound results were collected. The China-PAR model was used to predict initial atherosclerosis risk in those subjects. Univariate and multivariate analyses of carotid atherosclerosis progression were used to identify enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint, the ROC curve was employed to compare the predictive efficacy of the China-PAR model for the risk of atherosclerosis before and after the incorporation of the enhancement factors.Results:Among the 423 employees included in the analysis, there were 224 males and 199 females, with a baseline age of (56.2±11.8) years. The proportions of carotid atherosclerosis progression were significantly higher in populations with hyperuricemia, hyperhomocysteinemia, body mass index≥28 kg/m2, waist-to-height ratio>0.5, and low-density lipoprotein cholesterol (LDL-C)≥3.4 mmol/L than those in patients without these health issues (66.0% vs 55.3%, 68.0% vs 56.2%, 72.1% vs 56.6%, 64.5% vs 54.2%, 80.5% vs 56.8%, respectively) (all P<0.05). Hyperhomocysteinemia ( OR=1.833, 95% CI: 1.076-3.123) and LDL-C≥3.4 mmol/L ( OR=3.891, 95% CI: 1.600-9.116) were positively correlated with carotid atherosclerosis progression (all P<0.05) and could be considered as enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint event, the AUC of the China-PAR model after the incorporation of the enhancement factors was higher than that before incorporation (0.743 vs 0.684) ( P<0.05). The C-statistics of the China-PAR model before and after the incorporation of the enhancement factors was 0.702 and 0.757, respectively, with a net reclassification index of 0.090. Conclusion:Using carotid atherosclerosis progression as the follow-up endpoint, the China-PAR model incorporating hyperhomocysteinemia and LDL-C≥3.4 mmol/L as enhancement factors can better predict the risk of atherosclerosis among university employees.

OBJECTIVE To investigate the current status of contamination with carbapenem-resistant gram-negative bacteria in environment of intensive care units(ICU)of tertiary hospitals in Shanghai and find out the potential contamination sources so as to provide bases for prevention and control of multidrug-resistant organisms infec-tions in the ICUs.METHODS The surroundings of the ICU patients detected with CRGNB and environmental ob-jects surfaces in public area were sampled by mSuperCARBA chromogenic media from Dec.2024 to Jan.2025,the strains were isolated,and the targeted strains were identified by matrix-assisted laser desorption/ionization time-of-flight(MALDI-TOF)mass spectrometer.RESULTS A total of 653 samples were collected in the survey,76 of which were positive for bacterial culture,60 were detected with CRGNB,and the isolation rate of CRGNB was 9.19％.The isolation rate of CRGNB was 53.40％in the water-source group,0.91％in the non-water-source group,and there was significant difference(x2=286.450,P＜0.001).The result of whole genome sequencing for 17 strains of CRKP showed that ST11 and ST15 were the two major types of multilocus typing(MT),respective-ly carrying 2-12 types of drug resistance genes.CONCLUSIONS The CRGNB strains are detected in some environ-mental sites of the ICUs of 15 tertiary hospitals in Shanghai,and the isolation rate of CRKP is highest among them.The colonization rate of CRGNB is relatively low on the highly frequent-contact object surfaces of the ICUs,however,sink drain holes poses a risk of hospital-acquired CRGNB infections transmissions.Additionally,the ba-sins and towels of the CRGNB patients are hard to be thoroughly cleaned,disinfected and dried,resulting in a high contamination rate.

Objective:To observe the adaptive changes in the cardiovascular system after travelling to high altitude in healthy people using supine bicycle exercise stress echocardiography（SE），and to reveal the changes in right heart function，pulmonary vascular reserve and right ventricular systolic reserve in healthy people after acute high altitude exposure.Methods:Thirty-six healthy adults were prospectively collected to undergo SE at low altitude（500 m）and high altitude（3 600 m）. Offline analysis was conducted to acquire resting and peak exercise ultrasound parameters at high and low altitudes：tricuspid regurgitant velocity（TRV），tricuspid annular peak systolic velocity（TV-s′），right ventricular end-diastolic area（RVEDA），right ventricular end-systolic area（RVESA），right ventricular fractional area change（RVFAC），right ventricular basal transverse dimension（RVD1），right ventricular mid-ventricular transverse dimension（RVD2），right ventricular longitudinal dimension（RVD3），right ventricular free wall longitudinal strain（RVFWS），right ventricular global longitudinal strain（RVGLS），left ventricular cardiac output（CO），pulmonary artery systolic pressure（PASP），mean pulmonary artery pressure（mPAP），pulmonary resistance（PVR）and the ratio of tricuspid annular systolic displacement（TAPSE）to PASP（TAPSE/PASP）. The pulmonary vascular reserve and right ventricular systolic reserve indices including pulmonary vascular reserve and right ventricular systolic reserve indices（mPAP/CO slope，change in tricuspid annular systolic displacement（ΔTAPSE），change in fractional area change（ΔRVFAC），change in overall long-axis strain of the right ventricle（ΔRVGLS），and change in peak velocity of the lateral wall of the tricuspid annulus（ΔTV-s′）were calculated. The differences of these parameters betweet high and low altitudes were compared.Results:During the resting period，the values of TRV，PASP，mPAP，PVR，RVD2，and RVD3 were higher at high altitude than at low altitude（all P<0.05）. TAPSE/PASP，RVFAC，RVGLS，and RVFWS were lower at high altitude than at low altitude（all P<0.05）. During the peak exercise period，TRV，PASP，mPAP，PVR，RVAD，RVAS，RVD2，and RVD3 were all higher at high altitude than at low altitude（all P<0.05），and RVFAC at high altitude was lower than at low altitude（ P<0.05）. Right ventricular systolic reserve and pulmonary vascular reserve：mPAP/CO slope at high altitude was higher than at low altitude，ΔTV-s′ and RVFAC were lower than at low altitude（all P<0.05），there were no significant differences in ΔTAPSE and ΔRVGLS between the two altitudes（all P>0.05）. Conclusions:Acute high altitude exposure causes adaptive dilatation of the right ventricle accompanied by a reduction in pulmonary vascular reserve and right ventricular contractile reserve function.

The Department of Plastic and Reconstructive Surgery of the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medical, has witnessed and propelled the remarkable evolution of China’s plastic and reconstructive surgery over the past sixty years. Established in 1961 under the leadership of its founding father, Professor Ti-sheng Chang, the department was built on the mission of "Preventing the injured from disabled, the disabled from incapable". It pioneered groundbreaking advancements in flap microsurgery, craniofacial surgery, and lymphatic medicine. Entering the 21st century, guided by its motto of "Openness, Innovation, Excellence, and Dedication", the department has developed a comprehensive, full-cycle diagnostic and treatment system covering all disease spectrums. With seven major specialties and 24 subspecialty divisions, it has achieved continuous breakthroughs in surface organ reconstruction, hemangioma and neurofibroma treatment, fat transplantation, and craniomaxillofacial surgery. These innovations have yielded landmark achievements, with multiple technologies receiving National Science and Technology Progress Awards, significantly advancing the field of reconstructive surgery in China. Committed to talent development, the department, as one of China’s first doctoral training centers and a national standardized training base for resident and specialist physicians, has trained over 750 postgraduate students, more than 240 resident and specialist trainees, and over 2 000 clinic fellow. It has also led the compilation of multiple national standardized textbooks in plastic surgery, making substantial contributions to professional education and training standardization. Through administration innovation, the department has established a "bed-bench-bed" closed-loop model, driving technological advancements and facilitating major translational achievements, including Class 1.1 new drugs and stem cell therapies. It pioneered a structured multi-site practice platform for surgeons, optimizing the allocation of medical resources. Now, the department is focusing on high-quality patient cohort and biobank development while exploring cutting-edge fields such as AI-assisted diagnostics, gene therapy, and brain-computer interfaces, striving to build a world-class discipline at the forefront of global reconstructive surgery.

Objective:To learn about the clinical characteristics of patients with neurobrucellosis (NB) and provide references for clinical diagnosis and treatment of NB.Methods:The clinical data of 22 NB patients diagnosed and treated at Beidahuang Industry Group General Hospital from January 2018 to November 2024 and 178 healthy individuals undergoing physical examinations during the same period were retrospectively collected. The epidemiological characteristics, clinical manifestations, laboratory tests, treatment and prognosis of NB patients were analyzed.Results:Among the 22 NB patients, 12 were males (54.55%) and 10 were females (45.45%). The age was (51.77 ± 12.75) years old, ranging from 27 to 80 years old. Most of the patients were farmers (95.45%, 21/22), and 16 cases (72.73%) had contacted with cattle/sheep. The onset seasons were mainly in summer (40.91%, 9/22) and spring (31.82%, 7/22). Among all NB patients, there were 10 cases of encephalitis/meningoencephalitis, 9 cases of myelitis, and 3 cases of meningitis. The general symptoms were mainly fever (68.18%, 15/22), the neurological symptoms were mainly nausea and vomiting (36.36%, 8/22), and the physical signs were mainly muscle weakness (50.00%, 11/22) and pathological signs (45.45%, 10/22). The laboratory test results showed that the levels of hemoglobin, hematocrit, C-reactive protein, total protein, albumin, γ-glutamyl transpeptidase, α-hydroxybutyric acid dehydrogenase, lactate dehydrogenase, and glutathione reductase in NB patients were significantly different from those in healthy individuals ( P < 0.001). Brain magnetic resonance imaging revealed ischemic changes in 5 cases (22.73%), abnormal brain signals in 2 cases (9.09%), and demyelinating lesions in white matter in 1 case (4.55%). After treatment, 18 NB patients were followed up and showed good prognosis, with only 2 cases exhibiting varying degrees of sequelae (walking disorders or memory impairment). Conclusions:The clinical manifestations of NB patients are diverse. A comprehensive judgment should be made by combining epidemiological characteristics, clinical manifestations, laboratory tests and imaging examinations.

Objective:To explore the enhancement factors for the China-PAR assessment model based on a university employee cohort and validate its predictive efficacy.Methods:In this retrospective cohort study, 423 employees from a university in Beijing who underwent health checks at Peking University Third Hospital from 2019 to 2022 were enrolled. General demographics, physical examination data, biochemical indicators, and carotid artery ultrasound results were collected. The China-PAR model was used to predict initial atherosclerosis risk in those subjects. Univariate and multivariate analyses of carotid atherosclerosis progression were used to identify enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint, the ROC curve was employed to compare the predictive efficacy of the China-PAR model for the risk of atherosclerosis before and after the incorporation of the enhancement factors.Results:Among the 423 employees included in the analysis, there were 224 males and 199 females, with a baseline age of (56.2±11.8) years. The proportions of carotid atherosclerosis progression were significantly higher in populations with hyperuricemia, hyperhomocysteinemia, body mass index≥28 kg/m2, waist-to-height ratio>0.5, and low-density lipoprotein cholesterol (LDL-C)≥3.4 mmol/L than those in patients without these health issues (66.0% vs 55.3%, 68.0% vs 56.2%, 72.1% vs 56.6%, 64.5% vs 54.2%, 80.5% vs 56.8%, respectively) (all P<0.05). Hyperhomocysteinemia ( OR=1.833, 95% CI: 1.076-3.123) and LDL-C≥3.4 mmol/L ( OR=3.891, 95% CI: 1.600-9.116) were positively correlated with carotid atherosclerosis progression (all P<0.05) and could be considered as enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint event, the AUC of the China-PAR model after the incorporation of the enhancement factors was higher than that before incorporation (0.743 vs 0.684) ( P<0.05). The C-statistics of the China-PAR model before and after the incorporation of the enhancement factors was 0.702 and 0.757, respectively, with a net reclassification index of 0.090. Conclusion:Using carotid atherosclerosis progression as the follow-up endpoint, the China-PAR model incorporating hyperhomocysteinemia and LDL-C≥3.4 mmol/L as enhancement factors can better predict the risk of atherosclerosis among university employees.

Objective:To observe the adaptive changes in the cardiovascular system after travelling to high altitude in healthy people using supine bicycle exercise stress echocardiography（SE），and to reveal the changes in right heart function，pulmonary vascular reserve and right ventricular systolic reserve in healthy people after acute high altitude exposure.Methods:Thirty-six healthy adults were prospectively collected to undergo SE at low altitude（500 m）and high altitude（3 600 m）. Offline analysis was conducted to acquire resting and peak exercise ultrasound parameters at high and low altitudes：tricuspid regurgitant velocity（TRV），tricuspid annular peak systolic velocity（TV-s′），right ventricular end-diastolic area（RVEDA），right ventricular end-systolic area（RVESA），right ventricular fractional area change（RVFAC），right ventricular basal transverse dimension（RVD1），right ventricular mid-ventricular transverse dimension（RVD2），right ventricular longitudinal dimension（RVD3），right ventricular free wall longitudinal strain（RVFWS），right ventricular global longitudinal strain（RVGLS），left ventricular cardiac output（CO），pulmonary artery systolic pressure（PASP），mean pulmonary artery pressure（mPAP），pulmonary resistance（PVR）and the ratio of tricuspid annular systolic displacement（TAPSE）to PASP（TAPSE/PASP）. The pulmonary vascular reserve and right ventricular systolic reserve indices including pulmonary vascular reserve and right ventricular systolic reserve indices（mPAP/CO slope，change in tricuspid annular systolic displacement（ΔTAPSE），change in fractional area change（ΔRVFAC），change in overall long-axis strain of the right ventricle（ΔRVGLS），and change in peak velocity of the lateral wall of the tricuspid annulus（ΔTV-s′）were calculated. The differences of these parameters betweet high and low altitudes were compared.Results:During the resting period，the values of TRV，PASP，mPAP，PVR，RVD2，and RVD3 were higher at high altitude than at low altitude（all P<0.05）. TAPSE/PASP，RVFAC，RVGLS，and RVFWS were lower at high altitude than at low altitude（all P<0.05）. During the peak exercise period，TRV，PASP，mPAP，PVR，RVAD，RVAS，RVD2，and RVD3 were all higher at high altitude than at low altitude（all P<0.05），and RVFAC at high altitude was lower than at low altitude（ P<0.05）. Right ventricular systolic reserve and pulmonary vascular reserve：mPAP/CO slope at high altitude was higher than at low altitude，ΔTV-s′ and RVFAC were lower than at low altitude（all P<0.05），there were no significant differences in ΔTAPSE and ΔRVGLS between the two altitudes（all P>0.05）. Conclusions:Acute high altitude exposure causes adaptive dilatation of the right ventricle accompanied by a reduction in pulmonary vascular reserve and right ventricular contractile reserve function.