To address the challenges of detecting small nodules in lung CT images and achieving a balance between lightweight and high-precision with the existing lung nodule detection algorithms,a high-precision and lightweight lung nodule detection algorithm based on improved YOLOv5 is proposed. The main improvements are focused on 4 aspects. (1) Replacing the stride-2 downsampling operation in the YOLOv5 backbone with space-to-depth downsampling operations to enhance fine feature extraction for detecting small nodules more comprehensively. (2) Employing an asymptotic feature pyramid network in the YOLOv5 neck to establish connections among feature maps from different paths,thereby enhancing interaction among different hierarchical levels. (3) Introducing global context-aware attention to the end of YOLOv5 neck network for improving the model's ability to understand key features and semantic information of lung nodules from a global perspective. (4) Utilizing the loss rank mining approach to strategically train on hard samples,thereby strengthening the model's discrimination ability. The improved algorithm achieves 96.0％ precision,95.0％ recall rate and 97.3％ average precision on the LUNA16 dataset,which are 14.0％,10.2％ and 12.1％ higher than the original YOLOv5 model,demonstrating its effectiveness for lung nodule detection.

Objective:To investigate the psychological characteristics of self-injurious behavior (SIB) among Chinese adolescents with depression and the chain mediation mechanism of emotional-behavioral difficulties.Methods:A total of 214 hospitalized adolescents with depression (158 SIB, 56 non-SIB) were assessed using the Rosenberg self-esteem scale (SES), Barratt impulsiveness scale-11 (BIS-11), self-rating depression scale (SDS), and strength and difficulty questionnaire (SDQ) from March 2022 to January 2024. Permutation test, ridge regression, and Bootstrap chain mediation models were applied to identify predictors and pathways by R 4.4.1 software.Results:The SIB group exhibited significantly lower self-esteem (21.6±4.9 vs 24.8±6.4, F=14.9, P<0.01) compared with the non-SIB group.The scores of impulsivity (68.1±8.9 vs 63.2±10.6), depression (33.0±6.2 vs 27.5±7.6), and emotional-behavioral difficulties (21.5±5.8 vs 17.4±7.5) in the SIB group were significantly higher than those in the non-SIB group( F=11.5, 29.0, 17.9, all P<0.01). Ridge regression identified depression ( β=0.137, P<0.001) as the core predictor. Chain mediation analysis revealed that the direct effect of emotional-behavioral difficulties on SIB was not significant ( β=0.004, 95% CI=-0.011-0.018).Emotional-behavioral difficulties affected self-injurions behavior indirectly through the mediating effects of functional impairment and depression, as well as their chain mediating effect, with a total indirect effect of 0.015 (95% CI=0.006-0.026). Conclusion:SIB is driven by the chain mechanism linking emotional-behavioral difficulties, functional impairment, and depression, necessitating integrated interventions targeting emotional regulation and functional recovery.

Traditional urostomy management methods primarily rely on clinical experience, lacking precise prediction and personalized intervention approaches. In recent years, the rapid advancement of artificial intelligence technology in the medical field has provided new solutions for intelligent monitoring, risk assessment, and nursing optimization of urostomy leakage. This paper reviews the research on the application of artificial intelligence in urostomy leakage, introduces the overview of artificial intelligence, the application and effectiveness of artificial intelligence in urostomy leakage, analyzes the shortcomings of this research field, and explores future development trend, in order to provide a reference for formulating clinical nursing programs and prognosis rehabilitation suitable for the leakage of bladder cancer patients with urostomy, and reduce the incidence of leakage and maintain the health of peristomal skin.

Objective:To investigate the psychological characteristics of self-injurious behavior (SIB) among Chinese adolescents with depression and the chain mediation mechanism of emotional-behavioral difficulties.Methods:A total of 214 hospitalized adolescents with depression (158 SIB, 56 non-SIB) were assessed using the Rosenberg self-esteem scale (SES), Barratt impulsiveness scale-11 (BIS-11), self-rating depression scale (SDS), and strength and difficulty questionnaire (SDQ) from March 2022 to January 2024. Permutation test, ridge regression, and Bootstrap chain mediation models were applied to identify predictors and pathways by R 4.4.1 software.Results:The SIB group exhibited significantly lower self-esteem (21.6±4.9 vs 24.8±6.4, F=14.9, P<0.01) compared with the non-SIB group.The scores of impulsivity (68.1±8.9 vs 63.2±10.6), depression (33.0±6.2 vs 27.5±7.6), and emotional-behavioral difficulties (21.5±5.8 vs 17.4±7.5) in the SIB group were significantly higher than those in the non-SIB group( F=11.5, 29.0, 17.9, all P<0.01). Ridge regression identified depression ( β=0.137, P<0.001) as the core predictor. Chain mediation analysis revealed that the direct effect of emotional-behavioral difficulties on SIB was not significant ( β=0.004, 95% CI=-0.011-0.018).Emotional-behavioral difficulties affected self-injurions behavior indirectly through the mediating effects of functional impairment and depression, as well as their chain mediating effect, with a total indirect effect of 0.015 (95% CI=0.006-0.026). Conclusion:SIB is driven by the chain mechanism linking emotional-behavioral difficulties, functional impairment, and depression, necessitating integrated interventions targeting emotional regulation and functional recovery.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective Tetanus is a serious infectious diseases with high mortality,which is an important global public health issue.This study aims to analyze the epidemiological burden and changing trends of tetanus in China from 1990 to 2021,providing a basis for disease prevention and control.Methods Epidemiological indicators and global socio-demographic index(SDI)related to tetanus in China were retrieved and collected from the 2021 Global Burden of Disease database(GBD 2021).The trend analysis of the incidence rate,mortality rate and disability-ad-justed life years(DALYs)rate of tetanus in China from 1990 to 2021 was conducted by Joinpoint 5.3 software.Results From 1990 to 2021,the age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and age-standardized disability-adjusted life years(DALYs)rate of tetanus in China decreased significantly(average annual percent change[AAPC]＜0,P＜0.001),with males being significantly higher than females.The crude incidence rate,crude mortality rate,and crude DALYs rate for all age groups showed overall declining trends,with the lar-gest decline in the 0-14 years age group.In 2021,the crude incidence rate,crude mortality rate,and crude DALYs rate of tetanus in the population aged 70-years were higher than those in the population aged 0-14,15-49,and 50-69 years groups.The ASIR,ASMR,and age-standardized DALYs rate of tetanus in China in 2021 were lower than the global level,only higher than those in the high SDI regions.Conclusion From 1990 to 2021,the disease burden of tetanus in China varied with gender and age,with an overall declining trend over time.It is necessary to strengthen tetanus health education for males and the ≥70 years population,and to improve the overall level of pri-mary prevention measures for tetanus.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program.Results A total of 589 746 respiratory isolates were collected from 2015 to 2021.Overall,82.6％of the isolates were Gram-negative bacteria and 17.4％were Gram-positive bacteria.The bacterial isolates from outpatients and inpatients accounted for(6.0±0.9)％and(94.0±0.1)％,respectively.The top microorganisms were Klebsiella spp.,Acinetobacter spp.,Pseudomonas aeruginosa,Staphylococcus aureus,Haemophilus spp.,Stenotrophomonas maltophilia,Escherichia coli,and Streptococcus pneumoniae.Each microorganism was isolated from significantly more males than from females(P＜0.05).The overall prevalence of methicillin-resistant S.aureus(MRSA)was 39.9％.The prevalence of penicillin-resistant S.pneumoniae was 1.4％.The prevalence of extended-spectrum β-lactamase(ESBL)-producing E.coli and K.pneumoniae was 67.8％and 41.3％,respectively.The overall prevalence of carbapenem-resistant E.coli,K.pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa,and Acinetobacter baumannii was 3.7％,20.8％,9.4％,29.8％,and 73.3％,respectively.The prevalence of β-lactamase was 96.1％in Moraxella catarrhalis and 60.0％in Haemophilus influenzae.The H.influenzae isolates from children(＜18 years)showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults(P＜0.05).Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance.Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.