ObjectiveTo understand the seropositivity of neutralizing antibodies (NAb) and low-level NAb against SARS-CoV-2 infection in the community residents, and to explore the impact of COVID-19 vaccination and SARS-CoV-2 infection on the levels of NAb in human serum. MethodsOn the ground of surveillance cohort for acute infectious diseases in community populations in Shanghai, a proportional stratified sampling method was used to enroll the subjects at a 20% proportion for each age group (0‒14, 15‒24, 25‒59, and ≥60 years old). Blood samples collection and serum SARS-CoV-2 NAb concentration testing were conducted from March to April 2023. Low-level NAb were defined as below the 25^th percentile of NAb. ResultsA total of 2 230 participants were included, the positive rate of NAb was 97.58%, and the proportion of low-level NAb was 25.02% (558/2 230). Multivariate logistic regression analysis indicated that age, infection history and vaccination status were correlated with low-level NAb (all P<0.05). Individuals aged 60 years and above had the highest risk of low-level NAb. There was a statistically significant interaction between booster vaccination and one single infection (aOR=0.38, 95%CI: 0.19‒0.77). Compared to individuals without vaccination, among individuals infected with SARS-CoV-2 once, both primary immunization (aOR=0.23, 95%CI: 0.16‒0.35) and booster immunization (aOR=0.12, 95%CI: 0.08‒0.17) significantly reduced the risk of low-level NAb; among individuals without infections, only booster immunization (aOR=0.28, 95%CI: 0.14‒0.52) showed a negative correlation with the risk of low-level NAb. ConclusionsThe population aged 60 and above had the highest risk of low-level NAb. Regardless of infection history, a booster immunization could reduce the risk of low-level NAb. It is recommended that eligible individuals , especially the elderly, should get vaccinated in a timely manner to exert the protective role of NAb.

Objective:To investigate the effect of phosphorus-containing replacement solution for the prevention and treatment of hypophosphatemia during continuous renal replacement therapy (CRRT) in critically ill patients with blood phosphorus level ≤1.45 mmol/L, and to provide clinical reference.Methods:It was a historical prospective cohort study. The critically ill patients receiving CRRT with blood phosphorus ≤ 1.45 mmol/L in the intensive care unit of Henan Provincial People's Hospital from October 2021 to January 2023 and from April 2023 to January 2024 was selected as the study subjects. The patients were divided into test group (from April 2023 to January 2024) and control group (from October 2021 to January 2023) according to whether phosphate (1.0 mmol/L) was added to the replacement solution during CRRT, and the differences of clinical data before and after CRRT between the two groups were compared. The patients were divided into hypophosphatemia group and non-hypophosphatemia group according to whether blood phosphorus < 0.81 mmol/L within 24 h after the end of CRRT, and the differences of clinical data between the two groups were compared. Logistic regression analysis was used to analyze the related factors of hypophosphatemia.Results:A total of 149 critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT were enrolled in the study, with age of 64(47, 75) years and 87 males (58.4%). Among 149 patients, 84(56.4%) had hypophosphatemia after CRRT, and no hyperphosphatemia occurred. The incidence of hypophosphatemia in test group and control group was 40.0% (30/75) and 73.0% (54/74), respectively. There was no statistically significant difference in baseline clinical data before CRRT between test group and control group (all P>0.05). C-reactive protein ( Z=-3.356, P=0.001), blood calcium ( Z=-3.835, P<0.001) and proportion of hypophosphatemia ( χ2=16.467, P<0.001) in the test group were lower than those in the control group, and blood phosphorus ( Z=3.886, P<0.001) in the test group was higher than that in the control group within 24 h after CRRT. Compared with non-hypophosphatemia group, the proportion of parenteral nutrition ( χ2=6.802, P=0.009) and blood calcium within 24 h after CRRT ( Z=-2.515, P=0.012) in the hypophosphatemia group were higher, and blood phosphorus within 24 h after CRRT ( Z=-10.451, P<0.001), blood phosphorus after 24 h after CRRT treatment ( Z=-5.331, P<0.001) and the proportion of applied replacement solution containing phosphorus ( χ2=16.467, P<0.001) in the hypophosphatemia group were lower. The results of multivariate logistic regression analysis showed that parenteral nutrition ( OR=2.521, 95% CI 1.228-5.175, P=0.012) and application of phosphorus- containing replacement solution ( OR=0.241, 95% CI 0.119-0.491, P<0.001) were independent relevant factors of hypophosphatemia after CRRT in the whole cohort of patients. Conclusions:The application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT is safe and effective, and the incidence of hypophosphatemia is low. Application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT can reduce the incidence risk of hypophosphatemia after CRRT.

Objective:To analyze the carriage status, subtype distribution and flanking gene sequence characteristics of oxacillinases (OXA enzyme) in 241 clinical strains of Pseudomonas aeruginosa, and assess their roles in the drug resistance of Pseudomonas aeruginosa and ability to horizontally transfer across species. Methods:Clinical P. aeruginosa isolates were collected from four hospitals in Sanya, Tangshan, Zhangjiakou, and Beijing. The prevalence of oxacillinases and their flanking gene sequences was analyzed by whole-genome sequencing (NGS) and bioinformatic approaches. Results:A total of 241 isolates of P. aeruginosa were gathered, and 35 blaOXA subtypes were identified through screening of 252 blaOXA genes. These genes were classified into three subfamilies: blaOXA-50-like (241, 95.6%), blaOXA-1-like (9, 3.6%) and blaOXA-10-like (2, 0.8%). Among these, 11 subtypes (11, 31.4%) were novel blaOXA subtypes. Nine of these belonged to the blaOXA-50-like subfamily and were designated as blaOXA-1244, blaOXA-1245, blaOXA-1246, blaOXA-1250, blaOXA-1252, blaOXA-1253, blaOXA-1254, blaOXA-1255, and blaOXA-1256. The remaining two belonged to the blaOXA-10-like subfamily and were named blaOXA-1247 and blaOXA-1248. Compared to the amino acid sequence of OXA-10, the newly identified subtype OXA-1247 exhibited a mutation at position 117, where a valine was replaced by a leucine. This change was thought to improve the enzyme′s ability to hydrolyze carbapenems. In the analysis of the flanking sequences of the blaOXA genes, Class I integrons were identified in four bacterial strains. The variable regions of these integrons carried three distinct patterns of resistance gene cassettes: aac( 6′) -Ib-blaOXA-1247-ant( 3′′) -Ia, aac( 6′) -Ib-blaOXA-1248 and aac( 6′) -Ib- blaIMP-45-blaOXA-1-catB3. Among these, the strain BJ2326 carried a class I integron that was connected to the downstream IS CR1 element to form a composite class I integron structure, additionally carrying the resistance gene blaPER-1. Out of the 223 non-wild-type P. aeruginosa strains, 127 strains exhibited non-wild-type profiles to the four beta-lactam antibiotics MEM, CAZ, FEP, and TZP, with the combination of MEM+CAZ+FEP being the most prevalent, representing 57.0% of the total. Conclusions:The blaOXA genes in 241 clinical P. aeruginosa strains showed diversity. Some blaOXA genes had a co-transfer risk with the metallo-β-lactamase resistance gene blaIMP-45. Among the 11 newly discovered blaOXA subtypes, the new subtype OXA-1247 may have carbapenemase activity and potential for horizontal transfer.

Objective To explore the predictive value of the atherogenic index of plasma(AIP),triglyceride-glucose(TyG)index,and cerebral small vascular disease(CSVD)imaging load score regarding the early prognosis of patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods A total of 379 inpatients diagnosed with AIS at the Shengli Oilfield Central Hospital and treated with intravenous thrombolysis from January 2022 to December 2023 were retrospectively analyzed.Relevant data were collected,and the CSVD imaging load score was evaluated.The patients were classified into the good prognosis group(≥18％)and the poor prognosis group(＜18％)based on the early neurological improvement rate 14 d after thrombolysis.An investigation into the independent risk factors influencing the early prognostic outcomes in patients suffering from AIS was conducted utilizing binary Logistic regression analysis.The efficacy of early prognosis prediction in patients undergoing intravenous thrombolysis was assessed through receiver operating characteristic(ROC)curve analysis.Results Systolic blood pressure,AIP,TyG index,neutrophil to lymphocyte ratio(NLR),cerebral microbleeds(CMB),enlarged perivascular spaces(EPVS)and a CSVD imaging load score of 2 points or higher served as independent risk factors influencing the early prognosis in AIS patients undergoing thrombolysis.The ROC curve analysis revealed that the area under the curve(AUC)for the CSVD imaging load score was 0.821,with a sensitivity of 80.4％and a specificity of 74％.The AUC of the AIP was 0.951,with a sensitivity of 89.2％and a specificity of 91.7％.The AUC of the TyG index was 0.918,with a sensitivity of 93.1％and a specificity of 82.7％.Conclusions The AIP,TyG index,and CSVD imaging load score serve as efficacious indicators in assessing the premature prognostication of AIS patients who underwent subsequently to intravenous thrombolytic therapy.

This article reviewed the progress in military operational medicine in the U.S.Armed Forces in 2024 in terms of improved capabilities of health care in extreme natural environments,protection from noise damage,sleep interventions,intelligence monitoring of operational efficiency and more academic exchanges in this field.These measures are intended to improve the operational performance of soldiers in every possible way.This article is expected to provide useful references for related research.

Silver nanoparticles(AgNPs)are employed as disinfectants due to their extensive antimi-crobial properties,but their biosafety in the livestock industry has not been comprehensively as-sessed.In this study,16 Black-skin Red-crowned chickens aged 32 weeks were randomly divided in-to four groups and sprayed with AgNP solution at the concentration of 0,0.064,0.128 or 0.256 g/L,respectively,every 72 h in their coops for 30 d.The effects of AgNPs as the disinfectant on lung tissue in chicken were investigated through calculation of organ coefficients,observation of lung tissue sections,analysis of bronchoalveolar lavage fluid,measurement of inflammatory factors,de-tection of silver residue in lung tissue,and exploration of signaling pathways in pulmonary fibrosis.The results indicated that chickens in the 0.128 and 0.256 g/L AgNPs treatment groups showed the blurred pulmonary lobule boundaries,the destroyed alveolar structure,and the significant in-crease in pulmonary fibrosis.These pathological changes were accompanied by the decrease in lung organ coefficient,the reduced SP-C content,the increased total protein concentration in lavage flu-id,and the elevated LDH and silver content in lung tissue.The levels of IL-6 and TNF-α in the 0.128 and 0.256 g/L AgNPs treatment groups were significantly higher than the control group,which suggested that AgNPs exposure could induce the pulmonary inflammatory responses.High concentrations of AgNPs can trigger pulmonary tissue fibrosis,damaging the structure and func-tions of lungs.The relative mRNA expression levels of NF-κB in all AgNPs treatment groups,TGF-β in the 0.128 g/L AgNPs treatment group,and Smad3 in the 0.128 and 0.256 g/L AgNPs treatment groups were significantly higher than these in the control group,respectively.Spraying chickens with 0.128 or 0.256 g/L AgNPs for disinfection led to pulmonary deposition of AgNPs,causing direct structural and functional damages to the lungs.It could also induce the chronic pul-monary inflammation through the NF-κB pathway and promote the TGF-β/Smad3 pathway to in-crease collagen synthesis,leading to pulmonary fibrosis.Therefore,the application of high concen-trations of AgNPs in livestock farming requires careful consideration of their potential biological safety issues.

Silver nanoparticles(AgNPs)are employed as disinfectants due to their extensive antimi-crobial properties,but their biosafety in the livestock industry has not been comprehensively as-sessed.In this study,16 Black-skin Red-crowned chickens aged 32 weeks were randomly divided in-to four groups and sprayed with AgNP solution at the concentration of 0,0.064,0.128 or 0.256 g/L,respectively,every 72 h in their coops for 30 d.The effects of AgNPs as the disinfectant on lung tissue in chicken were investigated through calculation of organ coefficients,observation of lung tissue sections,analysis of bronchoalveolar lavage fluid,measurement of inflammatory factors,de-tection of silver residue in lung tissue,and exploration of signaling pathways in pulmonary fibrosis.The results indicated that chickens in the 0.128 and 0.256 g/L AgNPs treatment groups showed the blurred pulmonary lobule boundaries,the destroyed alveolar structure,and the significant in-crease in pulmonary fibrosis.These pathological changes were accompanied by the decrease in lung organ coefficient,the reduced SP-C content,the increased total protein concentration in lavage flu-id,and the elevated LDH and silver content in lung tissue.The levels of IL-6 and TNF-α in the 0.128 and 0.256 g/L AgNPs treatment groups were significantly higher than the control group,which suggested that AgNPs exposure could induce the pulmonary inflammatory responses.High concentrations of AgNPs can trigger pulmonary tissue fibrosis,damaging the structure and func-tions of lungs.The relative mRNA expression levels of NF-κB in all AgNPs treatment groups,TGF-β in the 0.128 g/L AgNPs treatment group,and Smad3 in the 0.128 and 0.256 g/L AgNPs treatment groups were significantly higher than these in the control group,respectively.Spraying chickens with 0.128 or 0.256 g/L AgNPs for disinfection led to pulmonary deposition of AgNPs,causing direct structural and functional damages to the lungs.It could also induce the chronic pul-monary inflammation through the NF-κB pathway and promote the TGF-β/Smad3 pathway to in-crease collagen synthesis,leading to pulmonary fibrosis.Therefore,the application of high concen-trations of AgNPs in livestock farming requires careful consideration of their potential biological safety issues.

With the rapid development of digital technology, digital twin technology shows great potential for application in the medical and nursing fields. This paper reviews the main elements and key aspects of digital twins, their application scenarios and effects in medicine and nursing, and application challenges faced, with a view to providing innovative solution ideas for healthcare professionals and promoting the application and development of digital twins in medicine and nursing.

With the rapid development of digital technology, digital twin technology shows great potential for application in the medical and nursing fields. This paper reviews the main elements and key aspects of digital twins, their application scenarios and effects in medicine and nursing, and application challenges faced, with a view to providing innovative solution ideas for healthcare professionals and promoting the application and development of digital twins in medicine and nursing.

Objective:To investigate the effect of phosphorus-containing replacement solution for the prevention and treatment of hypophosphatemia during continuous renal replacement therapy (CRRT) in critically ill patients with blood phosphorus level ≤1.45 mmol/L, and to provide clinical reference.Methods:It was a historical prospective cohort study. The critically ill patients receiving CRRT with blood phosphorus ≤ 1.45 mmol/L in the intensive care unit of Henan Provincial People's Hospital from October 2021 to January 2023 and from April 2023 to January 2024 was selected as the study subjects. The patients were divided into test group (from April 2023 to January 2024) and control group (from October 2021 to January 2023) according to whether phosphate (1.0 mmol/L) was added to the replacement solution during CRRT, and the differences of clinical data before and after CRRT between the two groups were compared. The patients were divided into hypophosphatemia group and non-hypophosphatemia group according to whether blood phosphorus < 0.81 mmol/L within 24 h after the end of CRRT, and the differences of clinical data between the two groups were compared. Logistic regression analysis was used to analyze the related factors of hypophosphatemia.Results:A total of 149 critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT were enrolled in the study, with age of 64(47, 75) years and 87 males (58.4%). Among 149 patients, 84(56.4%) had hypophosphatemia after CRRT, and no hyperphosphatemia occurred. The incidence of hypophosphatemia in test group and control group was 40.0% (30/75) and 73.0% (54/74), respectively. There was no statistically significant difference in baseline clinical data before CRRT between test group and control group (all P>0.05). C-reactive protein ( Z=-3.356, P=0.001), blood calcium ( Z=-3.835, P<0.001) and proportion of hypophosphatemia ( χ2=16.467, P<0.001) in the test group were lower than those in the control group, and blood phosphorus ( Z=3.886, P<0.001) in the test group was higher than that in the control group within 24 h after CRRT. Compared with non-hypophosphatemia group, the proportion of parenteral nutrition ( χ2=6.802, P=0.009) and blood calcium within 24 h after CRRT ( Z=-2.515, P=0.012) in the hypophosphatemia group were higher, and blood phosphorus within 24 h after CRRT ( Z=-10.451, P<0.001), blood phosphorus after 24 h after CRRT treatment ( Z=-5.331, P<0.001) and the proportion of applied replacement solution containing phosphorus ( χ2=16.467, P<0.001) in the hypophosphatemia group were lower. The results of multivariate logistic regression analysis showed that parenteral nutrition ( OR=2.521, 95% CI 1.228-5.175, P=0.012) and application of phosphorus- containing replacement solution ( OR=0.241, 95% CI 0.119-0.491, P<0.001) were independent relevant factors of hypophosphatemia after CRRT in the whole cohort of patients. Conclusions:The application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT is safe and effective, and the incidence of hypophosphatemia is low. Application of phosphorus-containing replacement solution in critically ill patients with blood phosphorus level ≤1.45 mmol/L undergoing CRRT can reduce the incidence risk of hypophosphatemia after CRRT.