Objective: To understand the epidemiological characteristics and disease burden of influenza like illness (ILI) among student populations, so as to provide data support for policy formulation and optimal allocation of health resources. Methods: From January 2024 to February 2025, a questionnaire survey was conducted among parents of kindergarten, primary school, junior and senior high school students in 9 districts of Shenzhen, including Longhua, Futian, Bao an, Longgang, Luohu, Nanshan, Guangming, Pingshan and Yantian. Parents were asked to complete the questionnaire based on whether their children had fever, cough, vomiting, diarrhea, rash and other common symptoms in 2024. A total of 3 537 parents were investigated, and 444 ILI cases were included as study subjects. The epidemiological burden, including incidence rate of influenza, visitation rate, years lived with disability (YLDs) and economic burden (including direct economic burden, indirect economic burden and intangible burden) were analyzed. Results: The incidence rate of influenza among students in Shenzhen in 2024 was 12.55%. The ILI incidence rates in kindergarten, primary school, junior and senior high school were 14.01%, 11.69% and 5.23%, respectively, with a statistically significant difference ( χ 2= 45.20, P <0.01). The ILI consultation rate among students was 85.36%, and the consultation rates in kindergarten (87.36%) and primary school students (84.62%) were higher than those in junior and senior high school students ( 56.52 %) ( χ 2=16.47, P <0.01). A total of 78.88% of cases did not receive etiological detection.The median total economic burden per ILI case was 2 354.62 yuan, including direct medical costs of 300.00 yuan, direct non medical costs of 212.50 yuan, indirect costs of 1 000.00 yuan, and intangible burden of 500.00 yuan. Conclusions Schools are high risk environment for influenza, and younger students are a high risk group for ILI. The disease burden caused by student ILI remains substantial.

The bioactivity-guided isolation of potentially active natural products has been widely utilized in pharmaceutical discovery. In this study, by screening fungal extracts against coxsackievirus B3 (CVB3), three new aspochalasins, templichalasins A‒C (1‒3), along with six known aspochalasins (4‒9) were isolated from an active extract derived from the endophytic fungus Aspergillus templicola LHWf045. Compound 1 features a unique 5/6/5/7/5 pentacyclic ring system, while compounds 2 and 3 possess unusual 5/6/6/7 tetracyclic skeletons. Their structures were characterized through extensive spectroscopic analyses, electronic circular dichroism (ECD) calculations, and single-crystal X-ray diffraction analysis. Additionally, we demonstrated that compound 4 can be readily converted into compounds 1‒3 under mild acidic conditions and proposed a plausible mechanism for this conversion. Bioactivity evaluation of compounds 1‒9 against CVB3 revealed the inhibitory effects of all compounds against the virus. Notably, compound 9 exhibited superior antiviral activity, surpassing the commercial drug ribavirin in selectivity index (SI) value.
Antiviral Agents/isolation & purification* ; Aspergillus/chemistry* ; Molecular Structure ; Enterovirus B, Human/drug effects* ; Endophytes/chemistry* ; Cytochalasins/isolation & purification* ; Drug Discovery ; Humans

Objective To isolate pathogenic bacteria from the skin of a nude mouse exhibiting squamous skin scurfs, and perform bacterial identification, traceability analysis, and pathogenicity studies to provide a new approach for the diagnosis of pathogens in nude mice with squamous skin scurfs. MethodsSkin swab samples were collected from a nude mouse exhibiting squamous skin scurfs for nucleic acid testing, bacterial isolation and culture, biochemical identification, 16S rDNA gene amplification and sequencing, and whole genome sequencing to construct a phylogenetic tree. Fifteen BALB/c nude mice were randomized into a saline-treated control group, a high-concentration group treated with 1.8×10⁸ CFU/mL of the isolated bacterial suspension, and a low-concentration group treated with 1.8×10⁷ CFU/mL of the isolated bacterial suspension. Pathogenicity was assessed by animal infection experiments and observation of histopathological changes in skin tissue using HE staining. Results The nucleic acid test for Corynebacterium bovis was negative, excluding infection by this organism. The pathogen isolated on mannitol salt agar and blood agar, combined with Gram staining, suggested a Gram-positive Staphylococcus species. The isolated strain was identified by 16S rDNA sequencing and a fully automated microbial identification system as Staphylococcus xylosus. Phylogenetic tree analysis based on whole genome sequencing showed that the strain was most closely related to an isolate from leafy vegetables in South Korea (GenBank GCA_00207825.1). In the high-concentration group, squamous skin scurfs appeared on the head, neck, and back of nude mice on the 17th day post-infection, while in the low concentration group, similar symptoms appeared on the 20th day post-infection and gradually spread to other areas. The scaling symptoms were transient, lasting for 7 days in the high-concentration group and 3 days in the low-concentration group, after which the skin returned to normal. The infection rate was 33.33% in both the high- and low-concentration groups. No significant pathological changes were observed in the skin tissues of infected mice compared to the control group, indicating marked individual differences in the pathogenicity of the strain in nude mice. Conclusion A strain of Staphylococcus xylosus was isolated from the skin of a nude mouse exhibiting squamous skin scurfs. The strain is an opportunistic pathogen that causes transient squamous skin scurfs without significant histopathological changes, and there are individual differences in the sensitivity of nude mice to this strain. These findings can provide valuable data for pathogen identification in immunodeficient or gene knockout mice.

Objective To isolate pathogenic bacteria from the skin of a nude mouse exhibiting squamous skin scurfs, and perform bacterial identification, traceability analysis, and pathogenicity studies to provide a new approach for the diagnosis of pathogens in nude mice with squamous skin scurfs. MethodsSkin swab samples were collected from a nude mouse exhibiting squamous skin scurfs for nucleic acid testing, bacterial isolation and culture, biochemical identification, 16S rDNA gene amplification and sequencing, and whole genome sequencing to construct a phylogenetic tree. Fifteen BALB/c nude mice were randomized into a saline-treated control group, a high-concentration group treated with 1.8×10⁸ CFU/mL of the isolated bacterial suspension, and a low-concentration group treated with 1.8×10⁷ CFU/mL of the isolated bacterial suspension. Pathogenicity was assessed by animal infection experiments and observation of histopathological changes in skin tissue using HE staining. Results The nucleic acid test for Corynebacterium bovis was negative, excluding infection by this organism. The pathogen isolated on mannitol salt agar and blood agar, combined with Gram staining, suggested a Gram-positive Staphylococcus species. The isolated strain was identified by 16S rDNA sequencing and a fully automated microbial identification system as Staphylococcus xylosus. Phylogenetic tree analysis based on whole genome sequencing showed that the strain was most closely related to an isolate from leafy vegetables in South Korea (GenBank GCA_00207825.1). In the high-concentration group, squamous skin scurfs appeared on the head, neck, and back of nude mice on the 17th day post-infection, while in the low concentration group, similar symptoms appeared on the 20th day post-infection and gradually spread to other areas. The scaling symptoms were transient, lasting for 7 days in the high-concentration group and 3 days in the low-concentration group, after which the skin returned to normal. The infection rate was 33.33% in both the high- and low-concentration groups. No significant pathological changes were observed in the skin tissues of infected mice compared to the control group, indicating marked individual differences in the pathogenicity of the strain in nude mice. Conclusion A strain of Staphylococcus xylosus was isolated from the skin of a nude mouse exhibiting squamous skin scurfs. The strain is an opportunistic pathogen that causes transient squamous skin scurfs without significant histopathological changes, and there are individual differences in the sensitivity of nude mice to this strain. These findings can provide valuable data for pathogen identification in immunodeficient or gene knockout mice.

Objective: To explore the diagnosis, treatment and prognosis of primary prostatic signet ring cell carcinoma (SRCC), so as to provide reference for the clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on the clinical data of 6 patients with primary prostatic SRCC treated in Nanjing Drum Tower Hospital during Nov.2020 and Sep.2024.The clinical manifestations, imaging features, treatment methods, histological characteristics and prognosis were summarized. Results: The average age of the patients was (72.00±4.28) years.Varying degrees of dysuria occurred in 4 patients. All patients underwent multi-parametric magnetic resonance imaging (mpMRI) examination before surgery, and the results indicated typical prostate cancer.Preoperative biopsies showed high-grade (Gleason 8-10) prostate acinar adenocarcinoma.Postoperative pathological diagnoses were mixed types of prostate acinar adenocarcinoma and SRCC, and no metastasis was found in the pelvic lymph nodes.All patients were followed up for 1 to 46 months after surgery and are currently alive.Robot-assisted laparoscopic radical prostatectomy only was performed in 3 cases; apalutamide and leuprolide/triptorelin was administered after surgery in 2 cases; bicalutamide + goserelin was administered after surgery in 1 case, who developed bladder metastasis of prostate cancer 24 months later, and the serum prostate-specific antigen (PSA) concentration decreased to a safe level (<0.2 ng/mL) after the use of darolutamide with radiotherapy.No recurrence or metastasis was found in the remaining patients. Conclusion: Primary prostatic SRCC is a rare and highly aggressive malignant tumor of the prostate.The diagnosis depends on pathological examinations due to lack of specific imaging features and clinical manifestations.The prognosis is poor, and there is currently no standardized treatment.The combined use of surgery, hormonotherapy and radiotherapy can help improve the survival rate of patients.

ObjectiveTo explore the possible mechanism of Qishao Tongbi Capsule （芪芍通痹胶囊， QTC） in the treatment of intervertebral disc degeneration （IDD）. MethodsSeventy-five rats were randomly divided into control group， model group， low-dose QTC group， high-dose QTC group， high-dose QTC +agonist group， with 15 rats in each group. Except for the control group， all other groups were subjected to a fibrous ring puncture to prepare an IDD model. After modeling， rats in low-dose QTC group and high-dose QTC group were given QTC at doses of 0.2 and 0.8 g/（kg·d） by gavage， respectively. Rats in high-dose QTC+ agonist group was given QTC at 0.8 g/（kg·d） and SKL2001 solution at 10 mg/（kg·d） by gavage. The control group and model group were given 10 ml/（kg·d） distilled water by gavage. All treatments were given once a day for 4 consecutive weeks. After treatment， X-ray and magnetic resonance imaging （MRI） were used to detect IDD degree. Hematoxylin-eosin （HE） staining and Safranin O-Fast Green staining were used to observe the morphological changes of the intervertebral disc tissue. Immunohistochemical staining was performed to examine the levels of proteoglycan， type Ⅱ collagen （COL Ⅱ）， and matrix metalloproteinase-3 （MMP-3） in the intervertebral disc tissue. Western blotting was used to detect the extracellular matrix （ECM）-related proteins （proteoglycan， COL Ⅱ， MMP-3， MMP-9， MMP-13）， aging-related proteins （P53， P21， P16）， apoptosis related proteins， including B-cell lymphoma/leukemia 2 （BCL-2）， BCL-2 related X protein （BAX）， Cleaved Caspase-3， and Wnt/β-catenin pathway related proteins such as Wnt3a， glycogen synthase kinase-3β （GSK-3β） and β-catenin in the intervertebral disc nucleus pulposus （NP） tissue. Reverse Transcription Quantitative Polymerase Chain Reaction （RT-qPCR） was used to assess the mRNA expression of Wnt3a， GSK-3β， and β-catenin in intervertebral disc tissue. ResultsCompared with the model group， rats in the low-dose QTC group and high-dose QTC group exhibited improved DHI， decreased Pfirmann grading， and alleviated IDD. The structural integrity of the NP and annulus fibrosus increased， and the number of the NP increased. The levels of proteoglycan， COL Ⅱ， BCL-2 and GSK-3β increased， while the levels of MMP-3， MMP-9， MMP-13， P53， P21， P16， BAX， Cleaved Caspase-3， Wnt3a and β-catenin protein decreased. The mRNA expression of Wnt3a and β-catenin mRNA decreased， while GSK-3β mRNA expression increased （P＜0.05）. Compared with the low-dose QTC group， the high-dose QTC group showed further improvements in DHI， decrease in Pfirrmann grading （P＜0.05）， and greater alleviation of IDD. The structural integrity of NP and annulus fibrosus was further enhanced， and the number of NP cells further increased. The levels of proteoglycan， COL Ⅱ， BCL-2 and GSK-3β were higher， while the levels of MMP-3， MMP-9， MMP-13， P53， P21， P16， BAX， Cleaved Caspase-3， Wnt3a and β-catenin were lower. The mRNA expression of Wnt3a and β-catenin decreased， while GSK-3β mRNA expression increased （P＜0.05）. Compared with the high-dose QTC group， the high-dose QTC +agonist group showed a decrease of DHI， an increase of Pfirmann grading （P＜0.05）， significant aggravation of IDD， reduction in structural integrity of the NP and annulus fibrosus， a decrease of NP cell count， lower levels of proteoglycan， COL Ⅱ， BCL-2 and GSK-3β， and higher levels of MMP-3， MMP-9， MMP-13， P53， P21， P16， BAX and Cleaved Caspase-3. Additionally， GSK-3β mRNA expression decreased （P＜0.05）. ConclusionQTC can inhibit NP cell aging， apoptosis， and ECM degradation in IDD rats， and its therapeutic effect may be mediated through the inhibition of the Wnt/β-catenin pathway.

Objective To summarize the operation experience of 1 case of ultra-long-distance single-port robotic-assisted laparoscopic renal cyst decortication using a domestic robotic system,and provide references for the development of long-distance telesurgery.Methods The procedure was performed using a domestically produced single-port robotic system.The distance between the main control end and the patient end was 2 400 km.The operation was conducted remotely via a 5G network and a 100 Mbps dedicated line provided by China Telecom.The surgeon controlled the robotic arm remotely.Results The surgery was completed smoothly within a duration of 32 min.The real-time latency was(90±20)ms.Blood loss during the operation was 10 mL,and no drainage tube was placed.The patient recovered smoothly and returned to the ward without any complications.Conclusion It is safe and feasible for the domestically produced single-port robotic system to implement ultra-long-distance telesurgery.This approach facilitates the decentralization of advanced medical resources and helps mitigate disparities in healthcare access.

Objective:To analyze the clinicopathological features, PET/CT parameters and efficacy of neoadjuvant therapy (NAT) in breast cancer patients with different human epidermal growth factor receptor 2 (HER2) expression levels.Methods:Data of 400 patients with breast cancer (all females, age 50.0(43.0, 58.0) years) who underwent PET/CT examination from May 2014 to June 2023 in Tianjin Medical University Cancer Institute and Hospital were collected retrospectively. All patients were divided into hormone receptor (HR) positive group and HR negative group, and then divided into 3 subgroups defined as HER2-zero expression, HER2-low expression and HER2-over expression. Clinicopathological features, PET/CT parameters and NAT efficacy of patients in different groups were compared. Kruskal-Wallis rank sum test, Bonferroni method, and χ2 test were performed to analyze the data. Results:Among 400 patients, there were 279 patients in HR positive group (69.75%) and 121 in HR negative group (30.25%). In HR positive group, there were 36, 171 and 72 patients in HER2-zero expression, HER2-low expression and HER2-over expression subgroups respectively, which were 27, 39 and 55 in HR negative group, respectively. In HR positive group, Ki-67, pathological complete response (pCR) rate, SUV max, SUV mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of patients in 3 subgroups were statistically different ( H values: 4.99-13.27, χ2=21.98, all P<0.05). Among them, Ki-67, pCR rate, MTV, SUV max, SUV mean and TLG of patients in HER2-low expression subgroup were lower than those in HER2-over expression subgroup (all P<0.017 (Bonferroni method corrected)). In the HR negative group, Ki-67, pCR rate, SUV max, SUV mean, MTV and TLG of patients in 3 subgroups were also statistically different ( H values: 6.29-26.95, χ2=17.23, all P<0.05). Among them, compared to patients in HER2-over expression subgroup, higher Ki-67 and lower pCR rate of patients in HER2-zero subgroup and HER2-low expression subgroup were found (all P<0.017 (Bonferroni method corrected)). MTV of patients in HER2-low expression subgroup was lower than that in other subgroups, and TLG was also lower than that in HER2-zero expression subgroup (all P<0.017 (Bonferroni method corrected)). Conclusion:Clinicopathological features, PET/CT parameters and NAT efficacy of breast cancer patients with HER2-low expression are different from those with HER2-zero expression and HER2-over expression.

Objective To systematically evaluate robot-assisted gait training(RAGT)on motor function,ambulation and activities of daily living of patients after stroke and spinal cord injury(SCI),and to investigate the clinical value of differ-ent robotic technologies and control strategies.Methods In accordance with PRISMA guidelines,relevant randomized controlled trials(RCTs)published between 2020 and 2024 were identified from databases including Scopus,Web of Science,PubMed,Cochrane Library and CNKI.The PEDro scale was used to assess methodological quality,and a comprehensive analysis was performed on the therapeutic effects of RAGT on walking ability,balance,lower limb muscle strength and functional inde-pendence.Results Eight RCTs involving 702 participants were included,originating from countries such as China,Italy,India,Tur-key and Poland.The population consisted of adult patients with various subtypes of stroke or SCI.These studies were published in journals across geriatric neuroscience,biosciences,medicine and sports science.Interventions involved three categories of lower limb exoskeleton including treadmill-based systems(end-effector and exoskel-eton models),overground exoskeletons and specialized joint/platform-based robots.The training frequency was 20 to 45 minutes a time,once to twice a day,one to seven days a week,for a total of two to ten weeks.RAGT might significant improve gait parameters and lower limb muscle strength,though its impact on functional inde-pendence was heterogeneous.Adaptive control strategies(e.g.,assist-as-needed)proved superior to fixed-parame-ter modes.Treadmill-based systems(e.g.,Lokomat)were well-suited for early-stage rehabilitation,while over-ground exoskeletons(e.g.,EKSO-GT)better facilitated adaptation to real-world environments.Conclusion RAGT is an effective modality for improving gait and lower limb function of patients with stroke and SCI.The therapeutic outcome is contingent upon personalized setup of the exoskeleton and the implementation of adaptive control strategies.Different adaptive control modes have been developed for the three main types of lower limb exoskeleton.Rehabilitation training should consider the specific lower limb tasks with the robot's cor-responding adaptive movement and control modes.

Objective:To explore the application effects of a method combining progressive case study and fishbone diagram in clinical teaching of interns in general surgery, and evaluate its impact on medical students' theoretical knowledge mastery, clinical practice ability development, and systematic thinking cultivation.Methods:Sixty undergraduate clinical medicine students who interned in the Department of General Surgery from July 2022 to December 2023 were selected as the research subjects and randomly divided into a control group ( n=30) and an observation group ( n=30). The control group received traditional case-based teaching through centralized lectures, group discussions, and review/Q&A sessions. The observation group received an integrated teaching approach combining progressive case study and fishbone diagram through the design of progressive cases and fishbone diagrams. Teaching effectiveness was evaluated through theoretical assessment, practical assessment, and teaching satisfaction survey. SPSS 22.0 was used for t-test and χ2 test. Results:The total score of theoretical assessments for the observation group interns was higher than that of the control group [(86.97±4.60) vs. (66.06±5.96), t=-17.79, P<0.001]. The differences in scores of diagnosis and treatment standards [(17.03±1.82) vs. (14.07±2.35)] and differential diagnosis [(12.85±1.42) vs. (8.92±2.37)] were particularly significant. In the practical assessments, the total score of the observation group interns [(90.19±5.04) vs. (68.63±4.30), t=-17.82, P<0.001] and their scores in individual assessments were higher than those of the control group, especially in acute abdomen evaluation [(18.23±1.72) vs. (14.37±2.05)], laparoscopic spatial positioning [(8.83±0.95) vs. (5.92±1.38)], and intraoperative emergency management [(8.95±0.97) vs. (6.05±1.23)]. The satisfaction scores of the observation group interns were higher than those of the control group ( P<0.001), with the greatest improvement in clinical thinking [(4.65±0.61) vs. (3.10±0.71)] and teacher-student interaction quality [(4.72±0.53) vs. (3.11±0.63)]. Conclusions:The teaching method combining progressive case study and fishbone diagram significantly improved interns' theoretical assessment scores, practical operation ability, and clinical decision-making level through the dynamic presentation of case evolution processes and the application of structured analysis tools, and also enhanced the teaching satisfaction.