ObjectiveTo construct an automatic measurement model for palmar tilt and radial inclination suitable for traditional Chinese medicine （TCM） clinical scenarios， and to validate its accuracy and efficiency in TCM manipulative reduction settings. MethodsData on anteroposterior （AP） and lateral X-rays of distal radius fractures were collected from patients admitted to 18 TCM/ integrated TCM and western medicine hospitals in Jiangsu province between September 1st， 2023， and September 1st， 2024， via the Jiangsu Diagnosis and Treatment Big Data Platform for TCM Dominant Diseases. A medical image segmentation framework based on multi-scale feature fusion and edge-awareness was employed， combined with anatomical knowledge specific to TCM orthopedics， to optimize the feature extraction strategy of an artificial intelligence （AI） model. This framework enabled automatic segmentation of fracture regions and measurement of distal radius palmar tilt and radial inclination. The accuracy of the AI model in measuring radial inclination and volar tilt was validated， and the measurement time and average time gain rate of the AI model were compared to those of manual measurement. ResultsA total of 15,444 AP and lateral X-ray images of distal radius fractures were collected， and were divided into a training set （11,144 images， 5066 AP and 6078 lateral）， a validation set （3700 images， 1840 AP and 1860 lateral）， and an independent test set （600 images， 300 AP and 300 lateral） after preprocessing. In the measurement of 300 AP X-rays in the independent test set for radial inclination， when the degree error between AI measurement and manual measurement was ＜3° and ＜5°， AI measurement accuracy was 83% and 93%， respectively. In 300 lateral X-rays in the test set for palmar tilt， when AI measurements had an error of ＜3° and ＜5° compared to manual measurements， corresponding accuracy rate was 78% and 90%， respectively. For 50 X-ray images， AI measurement time was （1.37±0.05） min for radial inclination while manual measurement time was （22.57±2.52） min （P＜0.001）； in terms of palmar tilt， the AI measurement time was （1.33±0.14） min， shorter than （23.70±2.80） min for manual measurement time （P＜0.001）. Average time gain rates for manual and AI measurements were 93.93% and 94.39% respectively. ConclusionAn automatic measurement model for palmar tilt and radial inclination in distal radius fractures has been established， enabling more accurate and efficient assessment as well as providing a tool to support the quantitative evaluation of the efficacy of TCM manipulative reduction and large-sample clinical research.

Objective To explore the correlation between a body shape index(ABSI)and osteoporosis in postmenopausal women and evaluate its screening value.Methods The clinical data of 285 postmenopausal women were retrospectively collected.The patients were divided into the normal(n=100),osteopenia(n=102),and osteoporosis(n=85)groups based on the dual-energy X-ray absorptiometry(DXA)results,and their clinical characteristics were compared.Pearson's correlation and logistic regression analyses were performed to assess the correlation between ABSI and osteoporosis.The ABSI value for osteoporosis screening was evaluated using a receiver operating characteristic(ROC)curve.Results The ABSI value was significantly higher in the osteoporosis group than in the normal and osteopenia groups(P＜0.05),consistent with the results of the modified a body shape index for Chinese adults(CABSI)based on the body shape cha-racteristics of the Chinese population.Lumbar spine and bilateral hip bone mineral density were positively correlated with diastolic blood pressure(DBP),fasting blood glucose(FBG),triglyceride(TG),uric acid(UA),height,weight,waist circumference,and body mass index(BMI)(P＜0.05)and negatively correlated with age,high-density lipoprotein cholesterol(HDL-C),ABSI,and CABSI(P＜0.05).Logistic regression analysis revealed that the osteoporosis risk in the highest quartile groups of ABSI and CABSI was 3.084-and 3.541-fold that of the lowest quartile groups,respectively.The CABSI showed the highest sensitivity(77.1％),whereas weight exhibited the best diagnostic accuracy(area under the curve=0.691)and highest specificity(80.7％).Conclusion Elevated ABSI and CABSI scores are significantly associated with osteoporosis risk in postmenopausal women.Overall,CABSI shows a relatively high screening sensitivity and is therefore a potential indicator for early osteoporosis identification.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective:To explore the influence of oligospermia(OS)on the detection of sperm DNA fragmentation index(DFI)by fluorescence method based on artificial intelligence(AI)recognition and flow cytometry-based sperm chromatin structure as-say(SCSA).Methods:We collected semen samples from 201 males,including 50 azoospermia(AS)patients as negative controls,90 OS patients(sperm concentration＞0 × 106/ml and＜15 × 106/ml),and 61 normal men(sperm concentration ≥15 ×106/ml).Then we subdivided the OS patients into a mild OS(sperm concentration ≥10 × 106/ml and＜15 × 106/ml),a moderate OS(sperm concentration ≥5 × 106/ml and＜10 × 106/ml)and a severe/extremely severe OS group(sperm concentration＞0 × 106/ml and＜5 × 106/ml),with 30 cases in each group,and compared the results of DFI detection between the AI fluorescence method and tradi-tional flow cytometry.Results:The DFI value detected by AI fluorescence method showed statistically significant difference from that detected by flow cytometry in the AS,moderate OS and severe/extremely severe OS groups(P＜0.01),the former even lower than the latter,but not in the normal control and the mild OS groups(P＞0.05).In the AS group,a dramatically lower rate of non-0 results was achieved by AI fluorescence method than by flow cytometry(8％vs 100％,P＜0.01).The DFI values detected by AI fluores-cence method exhibited a good linear correlation to those obtained by flow cytometry in the normal control and mild OS groups(β2=0.7470;R2=0.7180),but a poor linear correlation in the OS full-sample,moderate OS and severe/extremely severe OS groups(R2=0.3092;R2=0.3558;R2=0.2147).Conclusion:The AI fluorescence method has a higher specificity and is more suitable than flow cytometry for detection of sperm DFI in OS patients.The DFI values obtained by the two methods are consistent with sperm concen-tration ≥10 × 106/ml,but the accuracy of the results of detection may be affected with sperm concentration＞0 × 106/ml and＜10 × 106/ml.

Objective To investigate the application effect of cold snare endoscopic mucosal resection(CS-EMR)in the treatment of 6 to 9 mm colorectal small polyps.Methods A total of 82 patients with small colonic polyps in our hospital from March 2022 to August 2023 were collected and divided into the observation group(45 cases received CS-EMR)and the control group[37 cases received hot snare endoscopic mucosal resection(HS-EMR)]according to different surgical methods.The clinical efficacy,polyp resection status,complete polyp resection rate,perioperative indicators and occurrence of complications were compared between the two groups.Results Follow-up for 1 month after operation,the effective rate of treatment in the observation group was higher than that in the control group(P<0.05).There was no statistically significant difference in the polyp resection status or perioperative indicators between the two groups(P>0.05).There was no statistically significant difference in the complete polyp resection rates of patients with different pathological types or total complete resection rate between the two groups(P>0.05).The incidence of delayed bleeding and endoscopic hemostasis rate in the observation group were lower than those in the control group(P<0.05).Conclusion The complete resection rate of 6～9 mm colorectal polyps through CS-EMR was comparable to that of HS-EMR,and CS-EMR has a better efficacy and lower risk of perioperative bleeding,along with higher safety.

The aim of this study is to establish an gene editing method of Mesomycoplasma hyo-pneumoniae(Mhp)based on the homologous recombination principle.The restriction enzyme di-gestion and ligation method combined with gene synthesis were used to construct a shuttle plasmid to achieve replication in both Mhp and Escherichia coli(E.coli).The pGEM?-T vector was used as the skeleton.The oriC sequence of Mhp which can achieve the replication of the plasmid in Mhp was inserted into the vector.Sequences of the Spiroplasma promoter and puromycin resistance gene were then inserted into the above constructed plasmid to screen recombinant clones.The up-stream and downstream homologous arms of p97 were constructed to initiate homologous recombination.The recA gene of E.coli is inserted to improve the efficiency of homologous recom-bination.The obtained shuttle plasmid was then delivered into Mhp by electro-transformation or chemical transformation.A shuttle plasmid,pGEM?-Mhp-oriC-p 97,which can replicate in both Mhp and E.coli was constructed.With the transformation of this plasmid,the carried puromycin gene and recA gene can be expressed,the p97 gene can be edited.Finally,the genetically unstable p97 gene mutant was initially obtained.In this study,a tool for Mhp gene editing based on the principle of homologous recombination was established,which laid a foundation for the develop-ment of tools for studying the pathogenesis of Mhp.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To establish a liver disease refined management platform encompassing hepatocellular carcinoma(HCC)screening for high-risk populations,longitudinal patient follow-up management,multidisciplinary team(MDT)consulta-tions for complex cases,and intelligent data analysis.This platform aims to achieve early detection and standardized management of individuals at risk of HCC,thereby improving the rates of curative treatment and patient survival.Methods Standardized data interfaces were utilized to integrate diverse medical data,including electronic health records,laboratory test results,and imaging reports.Multiple HCC risk assessment models were applied to assist clinicians in patient risk stratification and diagnosis.For un-diagnosed patients,personalized follow-up programs were implemented according to their risk categories.Clinical information of patients requiring MDT discussions was systematically collated to support comprehensive case evaluations.Results After the platform's introduction,a total of 6 187 patients were enrolled,accounting for 23.2％of outpatient attendees.The number of MDT discussions reached 351,representing a 46.3％year-on-year increase.The outcomes demonstrated significant improvements in the quality of liver disease management and diagnostic processes.Conclusion The platform can effectively achieve precise stratification of HCC risk groups,providing significant support for the early detection,diagnosis,and treatment of high-risk indi-viduals.Additionally,it offers a digital solution for facilitating the full-cycle precision management of liver disease patients,from screening to diagnosis treatment and follow-up.

Objective To explore the impact of admission modes on the reperfusion time and short-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods 497 patients who visited the Chest Pain Center of Xiamen Cardiovascular Hospital of Xiamen University from January 2023 to November 2024 and were diagnosed with STEMI were included.All patients received direct percutaneous coronary intervention.According to admission modes,the patients were divided into the self-referral group(122 cases),emergency medical service group(EMS)(51 cases)and transfer PCI group(324 cases).The basic characteristics,reperfusion time,complications between group were compared.Results The age of the patients in this study was(58.64±13.62)years old,and there were 423 male cases(85.11%).Compared with the self-referral group and the EMS group,the time of door-wire in transfer PCI group was shorter[35(29,45)min vs.43(35,53)min vs.43(33,48)min,P＜0.001],but the time of first medical contact-wire was longer[123(80,192)min vs.43(35,52)min vs.57(51,76)min,P＜0.001].Compared with the self-referral group and the transfer PCI group,the time of symptom-to-first medical contact and the time of symptom-to-wire in EMS group were both shorter,which were[55(32,136)min vs.185(116,360)min vs.120(60,236)min,P＜0.001]and[136(101,188)min vs.228(169,413)min vs.282(190,400)min,P＜0.001].The incidence of infections in the transfer PCI group was lower than that in the self-referral group(12.65%vs.22.95%,P＜0.05).Conclusions To comprehensively enhance the treatment effect,it is necessary to prioritize the promotion and continuous optimization of the response process of EMS,simultaneously strengthen the standardized collaboration of referral,and enhance the identification ability of STEMI through public education to reduce the delay of self-referral patients..