Objective Objective To analyze the potential spatial factors affecting the genetic differentiation of Oncomelania hupensis robertsoni in Yunnan Province. Methods A total of 13 administrative villages were selected from schistosomiasis-endemic areas of Yunnan Province as O. hupensis snail sampling sites. At least 200 snails were collected in each site, and the spatial variable data of each site were recorded, including longitude, latitude and altitude. Thirty active and Schistosoma japonicum uninfected O. hupensis snails were selected from each sampling site by means of the crawling method and the cercarial shedding method. Genomic DNA was extracted from O. hupensis snails. Following PCR amplification, purification of PCR amplification products and sequencing, the gene sequences of O. hupensis snail samples were spliced and edited using the DNAstar software and the NCBI database to yield the complete mitochondrial sequences of O. hupensis snails at each sampling site, and the mitochondrial genetic distance matrix of O. hupensis robertsoni was calculated at each sampling site. The geographical coordinates of each sampling site were marked using the software ArcGIS 10.2, and the straight-line geographical distance between each sampling site was calculated. The altitude difference, longitude difference and latitude difference between each sampling site were calculated using the Excel software, and the correlation between the mitochondrial genetic distance matrix of O. hupensis robertsoni and each spatial variable matrix was examined by using the Mantel test at 13 sampling sites in Yunnan Province. Results Among the 13 O. hupensis snail sampling sites in Yunnan Province, the largest mitochondrial genetic distance of O. hupensis robertsoni snail populations was seen between Anding Village, Nanjian Yi Autonomous County and Caizhuang Village, Midu County (26.244 2), and the largest geographical distance was seen between Dongyuan Village, Gucheng District and Cangling Village, Chuxiong County (272.64 km). The highest altitude difference was seen between Anding Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1 086.10 m), and the largest longitude difference was found between Qiandian Village, Eryuan County and Cangling Village, Chuxiong County (1.86°), while the largest latitude difference was measured between Leqiu Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1.81°). In addition, the mitochondrial genetic distance of O. hupensis robertsoni snail populations was positively correlated with altitude at 13 snail sampling sites in Yunnan Province (r = 0.542 8, P < 0.001), and showed no significant correlations with geographical distance (r = 0.093 4, P > 0.05), longitude (r = −0.199 5, P > 0.05) or latitude (r = 0.205 7, P > 0.05). Conclusion Altitude may be a potential spatial factor affecting the genetic differentiation of O. hupensis robertsoni in Yunnan Province.

High-quality development of public hospitals requires cultural construction as an endogenous driving force,ai-ming to build a cultural system that integrates systematic,innovative,and humanistic characteristics.Leveraging its century-old historical legacy,Qilu Hospital of Shandong University has established a cultural construction pathway characterized by"strategic planning,heritage preservation,brand building,exemplary leadership,and communication innovation"through five major sys-tems:improving top-level design,inheriting historical heritage,building distinctive brands,cultivating exemplary models,and expanding communication channels.This approach provides cultural and spiritual impetus for the hospital's high-quality develop-ment.Empirical evidence demonstrates that cultural construction in public hospitals must emphasize systematic top-level design,distinctive cultural identity,synergy between tradition and innovation,and long-term sustainability,ultimately transforming cul-tural"soft power"into"hard support"for development.This practice offers a replicable"Qilu Model"for nationwide public hos-pital cultural development,while injecting new connotations into the implementation of the Healthy China strategy.

Objective:To evaluate the efficacy of early bronchoalveolar lavage using electronic bronchoscopy in pediatric drowning cases.Methods:A retrospective analysis of clinical data from 81 pediatric drowning cases treated in the intensive care unit of Hunan Children's Hospital from January 2017 to September 2023 was conducted.Among these,43 cases underwent bronchoalveolar lavage with electronic bronchoscopy within 24 hours of drowning,constituting the treatment group,while 38 cases either did not receive treatment within 24 hours or underwent the procedure after 24 hours,forming the control group.We compared the two groups regarding pre-admission observations,admission observations,and disease progression or prognosis indicators to assess the clinical efficacy of early bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases.Results:Compared to the control group,children in the treatment group exhibited a significant reduction in invasive ventilation time [(73.33±13.33) h vs.(94.82±15.77) h] and a significant decrease in pediatric intensive care unit stay [105.00 (94.00,121.00) h vs.123.5 (109.75,149.00) h],with both differences being statistically significant( P<0.05).No significant differences in white blood cell count and neutrophil percentage were observed between the treatment group and control group at admission and on the first day( P>0.05).However,by the third day,there was a significant improvement in white blood cell count in both groups,with statistical significance( P<0.05).There was a significant decrease in C-reactive protein and procalcitonin levels between the treatment group and control group on the 1st and 3rd days,with the differences being significant( P<0.05).Six hours after electronic bronchoalveolar lavage,the P/F ratio in the treatment group was lower than that in the control group (177.09±41.27 vs. 233.50±48.23),but it increased more significantly at 24 hours (286.00±34.32 vs.256.34±44.22),with a significant difference between two groups.The positive rate of lavage fluid culture in the treatment group was significantly higher than that in the control group,and the difference was statistically significant( P<0.05).There was no significant difference in the number of organ function damage between two groups( P>0.05).However,regarding prognosis,the treatment group showed significantly better outcomes than the control group( P<0.05). Conclusion:For pediatric patients with wilderness drowning,early electronic bronchoscopy with alveolar lavage may shorten the duration of invasive mechanical ventilation and pediatric intensive care unit stay,improving prognosis,and is worth promoting.

Objective:To compare the clinical effects of plasma exchange（PE）combined with continuous veno-venous hemodiafiltration（CVVHDF）at different time points in children with Kawasaki disease shock syndrome（KDSS）.Methods:Thirty-five children with KDSS admitted to the intensive care unit of Hunan Children's Hospital from January 2018 to December 2022 were enrolled.According to whether PE combined with CVVHDF was performed within 24 hours after reaching the blood purification criteria for KDSS，the patients were divided into the early treatment group(8 cases) and the control group (27 cases).The clinical and laboratory indicators and prognosis were compared between the two groups.Results:There were no statistically significant differences in age，gender，mean arterial pressure，and pediatric critical illness score between the two groups before treatment（ P>0.05）.In the early treatment group,the vasoactive inotropic score (VIS) gradually decreased,and was significantly lower than that in the control group after 24 hours of treatment.The duration of vasopressor use，pediatric logistic organ dysfunction score（PELOD），inflammatory markers，total hospitalization time，and PICU stay were all lower in the early treatment group than in the control group（ P<0.05）.The incidence of coronary artery involvement within 6 months post-discharge was lower in the early treatment group than in the control group（ P<0.05）.Among the 12 children who underwent PE combined with CVVHDF，four cases were in the late treatment group.The duration of CVVHDF，PICU stay，and PELOD scores were lower in the early treatment group than in the late treatment group（ P<0.05）.Additionally，the concentrations of interleukin-6，tumor necrosis factor-α，heparin-binding protein，and N-terminal pro-brain natriuretic peptide before PE were lower in the early treatment group than in the late treatment group（ P<0.05）. Conclusion:Early PE combined with CVVHDF treatment for KDSS patients can reduce inflammatory response，shorten the course of the disease，and reduce the duration of vasopressor use.However，most patients' conditions can be controlled with active conventional treatment.

Objective To explore the influencing factors of readmission within 90 days in frail patients with chronic obstructive pulmonary disease(COPD),construct an early warning model and evaluate its discrimination and effectiveness.Methods A total of 831 COPD patients with frailty were included and divided into the readmission group(290 cases)and the control group(541 cases)based on whether they were readmitted within 90 days after discharge.The electronic medical record data were collected and compared between the two groups of patients.Multivariate Logistic regression analysis was used to screen independent influencing factors for readmission within 90 days in COPD weak patients.A predictive model was established.The column chart was drawn.The discriminability of the predictive model was evaluated through receiver operating characteristic(ROC)curves.The clinical practicality and the predictive model calibration were evaluated through decision curves and calibration curves.Results The body mass index(BMI)of the readmission group was lower than that of the non readmission group,and the proportion of acute exacerbation of COPD hospitalizations≥2 times in the past year,the Edmonton frailty scale(REFS)score and the Chalson comorbidity index(CCI)were higher in the readmission group than those of the non readmission group(P＜0.05).Multivariate Logistic regression analysis showed that BMI(OR=0.721,95%CI:0.636-0.818),the number of acute exacerbations of COPD hospitalizations in the past year(OR=3.040,95%CI:1.944-4.753),REFS score(OR=1.726,95%CI:1.486-2.005)and CCI score(OR=3.917,95%CI:3.079-4.983)were all independent influencing factors for readmission within 90 days in COPD frail patients(P＜0.05).Based on the results of multiple factor Logistic regression analysis,the column chart warning model was constructed.The AUC value of the ROC curve was 0.847(95%CI:0.820-0.874),the specificity was 87.20%and the sensitivity was 64.50%.The calibration curve of the predictive model was close to the diagonal,and the calibrationa degree was good.The decision curve suggested that the prediction model had clinical practicality.Conclusion The early warning model constructed based on the influencing factors of readmission hospitalization within 90 days in weak patients with COPD has good predictive effect and clinical practicability.

Objective:To deeply understand newly employed nurses' cognition and experience of reflective practice (RP) and explore its application in clinical settings, providing a scientific basis for constructing an RP training system.Methods:A descriptive phenomenological research method was used, with purposive sampling to select newly employed nurses from the Affiliated Hospital of Yangzhou University between October and December 2023. Semi-structured interviews were conducted, and traditional content analysis was used to analyze the data.Results:Fourteen newly employed nurses were interviewed, including 3 males and 11 females, aged 22-25 (22.92 ± 0.92) years old. A total of 190 000 words of interview data were transcribed. Four themes and eight sub-themes were extracted: understanding of RP, attitudes toward RP, differences in RP abilities, and challenges in the clinical application of RP.Conclusions:Newly employed nurses have some understanding of RP, but there are issues such as insufficient learning pathways, negative attitudes toward RP, differences in RP abilities, and challenges in clinical application. RP learning should be incorporated into the training of newly employed nurses to promote the improvement of their RP abilities.

OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapen-em-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43％)were iso-lated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-re-sistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P＜0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P＜0.05).The carrying rates of blaKPC,blaNDM,blaSHV-1,blaTEM-1,blaCTX-M,blaqnrS,blaacc(6')-Ib and blarmtB genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57％)was dominant.ST11(n=25,39.68％)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

Objective This study aimed to evaluate the interaction between antiretroviral drug efavirenz and anti-tuberculosis 1H3P3(isoniazid plus rifapentine)in people living with HIV.Methods HIV-positive individuals on efavirenz-containing(600 mg)antiretroviral therapy(ART)received 1H3P3 regimen containing rifapentine(450 mg)plus isoniazid(400 mg)3 times a week for 1 month.Efavirenz concentrations were measured at weeks 0,2,4,8.Rifapentine concentration was determined at weeks 2 and 4.HIV RNA load was determined at weeks 0 and 8.Treatment target was efavirenz concentration＞1 mg/L.The anti-TB prevention was considered acceptable if the target of efavirenz concentration was achieved in more than 80％of participants.The participants were followed up for 18 months to evaluate the efficacy of treatment.Results Thirty-one participants living with HIV were enrolled in the study.Two participants were excluded from PK analysis because his/her baseline efavirenz concentration＜1 mg/L,suggesting poor treatment adherence.Evaluable PK data were available for 29 participants,including 23(79.3％)males.The median[interquartile range(IQR)]age of the participants was 43.0(32.5,53.5)years.The median(IQR)efavirenz plasma concentration was 2.33(1.96,2.34)mg/L at week 0,2.32(1.90,3.28)mg/L at week 2,2.07(1.83,3.09)mg/L at week 4,and 2.71(2.14,3.33)mg/L at week 8.Efavirenz concentration did not show significant difference between the 4 time points(P＞0.05).Median(IQR)rifapentine concentration was 9.36(6.23,16.47)mg/L at week 2,and 9.36(6.41,15.56)mg/L at week 4.Rifapentine concentration did not show significant difference between week 2 and week 4(P＞0.05).Efavirenz concentrations was＞1 mg/L in all participants at weeks 2,4,and 8.Furthermore,efavirenz concentration was significantly higher in females and patients with body weight＜60 kg compared with males and those with body weight ≥60 kg(P＜0.05).None of the participants had symptoms or signs of active tuberculosis during 18-month follow-up.Conclusions Isoniazid plus rifapentine(1H3P3 regimen)did not have significant effect on the plasma concentrations of efavirenz.

Objective:To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia（MRMPP）.Methods:A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae，patients were divided into three groups：Doxycycline group（those treated with doxycycline，12 cases）；Azithromycin group（those treated with azithromycin，53 cases）；and Switch group（those switched from azithromycin to doxycycline，27 cases）.Clinical outcomes and adverse reactions were compared among the three groups.Results:Significant statistical differences were found among the three groups in terms of age（ F=49.365， P<0.001）and weight（ H=40.595， P<0.001），with the Doxycycline group presenting the highest average age and median weight，followed by the Switch group，and then the Azithromycin group.After antibiotic treatment，children in the Doxycycline group，when compared to the Switch group and the Azithromycin group，showed a shorter fever resolution time[3.0（2.0，3.8）days vs.5.0（4.0，5.0）days vs.6.0（5.0，7.0）days， H=25.243， P<0.001]，a higher defervescence rate at 48 hours and 72 hours (41.7% vs.0 vs.0 at 48 hours，and 75.0% vs.0% vs.5.7% at 72 hours，both P<0.001]，a shorter mechanical ventilation duration[83.0（70.0，93.0）hours vs.135.0（129.0，172.0）hours vs.152.0（139.0，164.5）hours， H=9.980， P=0.007]，a shorter ICU stay[7.0（6.0，8.0）days vs.10.0（8.0，13.0）days vs.11.0（9.0，13.0）days， H=21.887， P<0.001]，and a lower proportion of Methylprednisolone usage [8.3% vs.57.1% vs.54.7%， P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens（both P>0.05）.Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin，with rates of 10.3%（4/39）and 13.8%（11/80）,respectively，showing no statistical significance（ P=0.771）.Among the 67（72.8%）cases with available follow-up data，the incidence of bronchiolitis obliterans was 8.3%（1/12）in the Doxycycline group，13.6%（3/22）in the Switch group，and 15.2%（5/33）in the Azithromycin group，with no statistical significance（ P>0.05）.Among the 34 cases using doxycycline with follow-up data available，none had tooth discoloration or enamel hypoplasia related to the medication. Conclusion:Doxycycline in the treatment of severe MRMPP in children could rapidly improve clinical symptoms，shorten the course of the disease，reduce the likelihood of methylprednisolone use，and is relatively safe for short-term use.

Objective:To comprehensively assess the nutritional literacy among family caregivers of elderly patients with chronic heart failure (CHF), so as to provide reference for developing clinical nutrition management strategies for elderly CHF patients.Methods:This study was a descriptive qualitative research. From February to March 2025, purposive sampling was used to select 17 family caregivers of elderly CHF patients at Affiliated Hospital of Yangzhou University as research subjects for semi-structured interviews. The data was analysed using a directed content analysis approach.Results:Three themes and nine subthemes were identified, including functional nutrition literacy (lack of disease-related nutrition knowledge, difficulty in knowledge transformation and utilization, and barriers to voluntary nutritional adherence), interactive functional literacy (limited channels for accessing nutrition information, broken healthcare services, insufficient motivation for proactive communication, and demand for professional dietary guidance), and critical nutrition literacy (challenges in distinguishing information authenticity, reliance on inherent cognition for evaluation) .Conclusions:Family caregivers of elderly patients with CHF commonly lack relevant nutritional knowledge. Healthcare providers should attach importance to the education of nutrition knowledge and skills for family caregivers, establish a multidimensional nutrition education system, develop personalized nutrition guidance plans, and integrate the family-community-medical collaborative support network to systematically strengthen caregivers' understanding of disease nutrition management for elderly CHF patients and enhance their compliance with nutrition care practices.