ObjectiveTo investigate a suspected outbreak of healthcare-associated infection with carbapenem-resistant Klebsiella pneumoniae (CRKP) in a geriatric emergency ward, and to provide references for the prevention and control of multidrug-resistant bacteria in a hospital in Shanghai. MethodsOn-site epidemiological investigation, combined with environmental hygiene monitoring and pulsed field gel electrophoresis (PFGE) molecular typing method, were adopted to investigate a suspected outbreak of CRKP infection in the geriatric emergency ward of a hospital from October to November 2022, aiming at finding out factors caused the outbreak before taking corresponding control measures. ResultsA total of 3 cases of healthcare-associated CRKP infection were identified, of which 2 cases were homologous to a previous case of community-associated CRKP infection. What’s more, the 2 cases lived in the same ward with the latter and with adjacent beds, but the third case was non-homologous to the community-associated infection case. A total of 46 samples were collected from the environmental surfaces and the hands of healthcare workers, of which 7 samples tested positive for CRKP and were identical to the strains from the 2 healthcare-associated infection cases and the 1 community-associated infection case, originating from the bedrails, bedside tables, surface of non-invasive ventilator, bed curtains and panels of monitoring equipment, with a detection rate of 15.22%. But none of the 11 samples from the hands of healthcare workers tested positive for CRKP. The outbreak was effectively controlled after taking specific prevention and control measures such as strengthening personnel management, intensifying environmental cleaning and disinfection and strictly enforcing hand hygiene among healthcare workers. Subsequently, no similar new cases were reported during the 14-day follow-up period. ConclusionIncomplete environmental cleaning and disinfection, as well as inadequate enforcement of hand hygiene among heatheare workers may have contributed to the suspected outbreak of CRKP in the geriatric emergency ward. Early warning and timely investigation of suspected outbreaks of multidrug-resistant bacteria are crucial for preventing and controlling such outbreaks in hospitals.

Objective:To understand the trends of the disease burden of Alzheimer's disease(AD)attributable to high body mass index(BMI)and high fasting plasma glucose(FPG)in the past 30 years and future trends in China, and to provide suggestions for the prevention and treatment of AD.Methods:Based on the Global Burden of Disease Research Database(GBD), data on AD deaths and disability adjusted life years(DALYs)attributable to high BMI and high FPG were collected from 1990 to 2021 in Chinese and global populations.The Joinpoint log-linear regression model was used to explore and compare the changing trends of AD burden in China and globally from 1990 to 2021, and a Bayesian age-period-cohort model was constructed for predictive analysis.Results:In 2021, the age-standardized mortality and DALYs rates of AD attributed to high BMI in the Chinese population were 1.256/100, 000 and 24.751/100, 000, respectively, and those attributed to high FPG were 3.636/100, 000 and 66.721/100, 000, respectively.The age-standardized rates of mortality and DALYs of females were both higher than those of males.From 1990 to 2021, the age-standardized rates of mortality and DALYs of AD attributed to high BMI increased slowly at first and then rapidly in China, the corresponding average annual percent change(AAPC)and 95% confidence interval(95% CI)were 9.87%(9.63%-10.12%), and 9.81%(9.54%-10.09%), respectively( P<0.001). The age-standardized rates of mortality and DALYs of AD caused by high FPG showed a fluctuating upward trend, with AAPC of 0.29%(95% CI: 0.17%-0.41%)and 0.53%(95% CI: 0.45%-0.61%), respectively( P<0.001). It is predicted that by 2030, the age-standardized rates of mortality and DALYs of AD attributed to high BMI and high FPG in the whole population of China will increase to 4.87/100 000 and 97.20/100 000, both lower than the global level(5.45/100 000 and 100.24/100 000). In addition to a slight decline in the age-standardized mortality rate in Chinese men, the age-standardized rates of mortality and DALYs attributed to high BMI and high FPG in Chinese women and the global population will both show an upward trend. Conclusions:The burden of AD attributed to high BMI and high FPG is relatively severe, with gender differences, and is expected to increase slightly by 2030.It is recommended that early identification of key high-risk populations of AD should be strengthened, especially for the elderly and female groups.Interventions targeting modifiable risk factors should be carried out, and effective measures should be adopted to reduce the burden of AD.

Purpose To investigate the changes of free water(FW)values in the key basal ganglia of dopamine system in the brain of early Parkinson's disease(PD)by free water imaging,and to reveal the potential relationship between the changes and early PD.Materials and Methods From February to December 2023,62 patients with early PD and 27 healthy controls were enrolled in the Parkinson's Disease Progression Markers Project database,and 25 age-and sex-matched healthy controls were self-recruited from Henan Provincial People's Hospital.All subjects underwent clinical scale assessment and MRI data collection.Free water imaging was used to calculate the FW values of key nuclei in dopamine system,and the difference of FW values between PD group and healthy controls group,the correlation between FW values of PD group and clinical scale scores were analyzed.Results The FW values of compact part of substantia nigra(SNc)and ventral tegmental area(VTA)in PD group were significantly higher than those in healthy controls group(Z=2.458-3.914,all P<0.05).Regression analysis showed that FW values of SNc were correlated with the movement disorder society-sponsored revision unified Parkinson′s disease rating scale(MDS-UPDRS)Ⅲ scores and state-trait anxiety inventory(STAI)scores on both sides(r2=0.223,P<0.001;r2=0.125,P=0.018;r2=0.151,P=0.003;r2=0.128,P=0.017),the FW value of VTA on the left was significantly correlated with MDSUPDRS Ⅲ score(r2=0.143,P=0.004)and the FW value of the right VTA was significantly correlated with the STAI score(r2=0.125,P=0.019).Conclusion The FW values of SNc and VTA in PD patients are significantly increased in the early stage,and are correlated with motor and non-motor symptoms in PD patients.FW values may reflect brain degeneration,and this change may be related to the decline of motor and non-motor function in patients.

Objective:To investigate the value of coronary CTA (CCTA)-based traditional features and radiomics of plaque in the identification of culprit lesions that caused acute myocardial infarction (AMI).Methods:This was a retrospective multicenter study. From July 2016 to November 2023, a total of 344 patients from the Affiliated Hospital of Qingdao University (training cohort, n=184), Shandong Provincial Hospital Affiliated to Shandong First Medical University (validation cohort, n=88) and Qilu Hospital of Shandong University (test cohort, n=72) who received percutaneous coronary intervention (PCI) due to AMI and underwent CCTA within 48 hours of AMI were enrolled. The culprit plaques and non-culprit plaques were identified using a combination of electrocardiogram, CCTA, and angiographic findings. The vessel, plaque location, plaque type, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score, high-risk plaque characteristics, plaque length, plaque volume, and burden were analyzed, and 1 904 radiomics features were extracted for each plaque. The traditional imaging model, the radiomics model, and the combined model were established by using multivariate Logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each model in identifying culprit lesions. The DeLong test was used for the comparison of AUC between every two models. The net reclassification index (NRI) was used to evaluate the incremental value of the combined model to the traditional imaging model and the radiomics model. The decision curve analysis (DCA) was used to assess the clinical net benefit of these models. A correlation heatmap was used to evaluate the correlation between the radiomics score and traditional CCTA factors. The interpretable analysis of the decision process of the combined model was performed by the Shapley Additive exPlanations (SHAP). Results:In the validation cohort and the test cohort, the AUC of the traditional imaging model developed by the vessel, plaque type, positive remodeling and CAD-RADS score was 0.898 (95% CI 0.869-0.922) and 0.881 (95% CI 0.848-0.910), respectively. The radiomics model developed by six radiomics features was 0.863 (95% CI 0.831-0.891) and 0.863 (95% CI 0.827-0.864), respectively. The AUC of the combined model was 0.930 (95% CI 0.905-0.950)and 0.919 (95% CI 0.889-0.942), respectively. In the validation cohort and the test cohort, the AUC of the combined model was higher than that of the traditional imaging model ( Z=4.013, 4.272, P<0.001) and that of the radiomics model ( Z=4.819, 3.784, P<0.001), respectively. In the validation cohort, the combined model yielded an NRI of 20.43% (95% CI 10.43%-30.44%, P<0.001) and 20.21% (95% CI 9.62%-30.80%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. In the test cohort, the combined model yielded an NRI of 28.05% (95% CI 16.72%-39.38%, P<0.001) and 23.57% (95% CI 13.58%-33.56%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. DCA showed the combined model had the highest clinical net benefit. The correlation heatmap showed the radiomics score was not correlated or only weakly correlated with traditional CCTA factors. SHAP indicated the radiomics and CAD-RADS score contributed significantly to the model. Conclusion:The CCTA-based traditional features and radiomics of plaque have favorable performance for the identification of culprit plaques in patients with AMI.

Objective:To investigate the value of coronary CTA (CCTA)-based traditional features and radiomics of plaque in the identification of culprit lesions that caused acute myocardial infarction (AMI).Methods:This was a retrospective multicenter study. From July 2016 to November 2023, a total of 344 patients from the Affiliated Hospital of Qingdao University (training cohort, n=184), Shandong Provincial Hospital Affiliated to Shandong First Medical University (validation cohort, n=88) and Qilu Hospital of Shandong University (test cohort, n=72) who received percutaneous coronary intervention (PCI) due to AMI and underwent CCTA within 48 hours of AMI were enrolled. The culprit plaques and non-culprit plaques were identified using a combination of electrocardiogram, CCTA, and angiographic findings. The vessel, plaque location, plaque type, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score, high-risk plaque characteristics, plaque length, plaque volume, and burden were analyzed, and 1 904 radiomics features were extracted for each plaque. The traditional imaging model, the radiomics model, and the combined model were established by using multivariate Logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each model in identifying culprit lesions. The DeLong test was used for the comparison of AUC between every two models. The net reclassification index (NRI) was used to evaluate the incremental value of the combined model to the traditional imaging model and the radiomics model. The decision curve analysis (DCA) was used to assess the clinical net benefit of these models. A correlation heatmap was used to evaluate the correlation between the radiomics score and traditional CCTA factors. The interpretable analysis of the decision process of the combined model was performed by the Shapley Additive exPlanations (SHAP). Results:In the validation cohort and the test cohort, the AUC of the traditional imaging model developed by the vessel, plaque type, positive remodeling and CAD-RADS score was 0.898 (95% CI 0.869-0.922) and 0.881 (95% CI 0.848-0.910), respectively. The radiomics model developed by six radiomics features was 0.863 (95% CI 0.831-0.891) and 0.863 (95% CI 0.827-0.864), respectively. The AUC of the combined model was 0.930 (95% CI 0.905-0.950)and 0.919 (95% CI 0.889-0.942), respectively. In the validation cohort and the test cohort, the AUC of the combined model was higher than that of the traditional imaging model ( Z=4.013, 4.272, P<0.001) and that of the radiomics model ( Z=4.819, 3.784, P<0.001), respectively. In the validation cohort, the combined model yielded an NRI of 20.43% (95% CI 10.43%-30.44%, P<0.001) and 20.21% (95% CI 9.62%-30.80%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. In the test cohort, the combined model yielded an NRI of 28.05% (95% CI 16.72%-39.38%, P<0.001) and 23.57% (95% CI 13.58%-33.56%, P<0.001) for identifying culprit lesions compared with the traditional imaging model and the radiomics model, respectively. DCA showed the combined model had the highest clinical net benefit. The correlation heatmap showed the radiomics score was not correlated or only weakly correlated with traditional CCTA factors. SHAP indicated the radiomics and CAD-RADS score contributed significantly to the model. Conclusion:The CCTA-based traditional features and radiomics of plaque have favorable performance for the identification of culprit plaques in patients with AMI.

Purpose To investigate the changes of free water(FW)values in the key basal ganglia of dopamine system in the brain of early Parkinson's disease(PD)by free water imaging,and to reveal the potential relationship between the changes and early PD.Materials and Methods From February to December 2023,62 patients with early PD and 27 healthy controls were enrolled in the Parkinson's Disease Progression Markers Project database,and 25 age-and sex-matched healthy controls were self-recruited from Henan Provincial People's Hospital.All subjects underwent clinical scale assessment and MRI data collection.Free water imaging was used to calculate the FW values of key nuclei in dopamine system,and the difference of FW values between PD group and healthy controls group,the correlation between FW values of PD group and clinical scale scores were analyzed.Results The FW values of compact part of substantia nigra(SNc)and ventral tegmental area(VTA)in PD group were significantly higher than those in healthy controls group(Z=2.458-3.914,all P<0.05).Regression analysis showed that FW values of SNc were correlated with the movement disorder society-sponsored revision unified Parkinson′s disease rating scale(MDS-UPDRS)Ⅲ scores and state-trait anxiety inventory(STAI)scores on both sides(r2=0.223,P<0.001;r2=0.125,P=0.018;r2=0.151,P=0.003;r2=0.128,P=0.017),the FW value of VTA on the left was significantly correlated with MDSUPDRS Ⅲ score(r2=0.143,P=0.004)and the FW value of the right VTA was significantly correlated with the STAI score(r2=0.125,P=0.019).Conclusion The FW values of SNc and VTA in PD patients are significantly increased in the early stage,and are correlated with motor and non-motor symptoms in PD patients.FW values may reflect brain degeneration,and this change may be related to the decline of motor and non-motor function in patients.

Objective:To understand the trends of the disease burden of Alzheimer's disease(AD)attributable to high body mass index(BMI)and high fasting plasma glucose(FPG)in the past 30 years and future trends in China, and to provide suggestions for the prevention and treatment of AD.Methods:Based on the Global Burden of Disease Research Database(GBD), data on AD deaths and disability adjusted life years(DALYs)attributable to high BMI and high FPG were collected from 1990 to 2021 in Chinese and global populations.The Joinpoint log-linear regression model was used to explore and compare the changing trends of AD burden in China and globally from 1990 to 2021, and a Bayesian age-period-cohort model was constructed for predictive analysis.Results:In 2021, the age-standardized mortality and DALYs rates of AD attributed to high BMI in the Chinese population were 1.256/100, 000 and 24.751/100, 000, respectively, and those attributed to high FPG were 3.636/100, 000 and 66.721/100, 000, respectively.The age-standardized rates of mortality and DALYs of females were both higher than those of males.From 1990 to 2021, the age-standardized rates of mortality and DALYs of AD attributed to high BMI increased slowly at first and then rapidly in China, the corresponding average annual percent change(AAPC)and 95% confidence interval(95% CI)were 9.87%(9.63%-10.12%), and 9.81%(9.54%-10.09%), respectively( P<0.001). The age-standardized rates of mortality and DALYs of AD caused by high FPG showed a fluctuating upward trend, with AAPC of 0.29%(95% CI: 0.17%-0.41%)and 0.53%(95% CI: 0.45%-0.61%), respectively( P<0.001). It is predicted that by 2030, the age-standardized rates of mortality and DALYs of AD attributed to high BMI and high FPG in the whole population of China will increase to 4.87/100 000 and 97.20/100 000, both lower than the global level(5.45/100 000 and 100.24/100 000). In addition to a slight decline in the age-standardized mortality rate in Chinese men, the age-standardized rates of mortality and DALYs attributed to high BMI and high FPG in Chinese women and the global population will both show an upward trend. Conclusions:The burden of AD attributed to high BMI and high FPG is relatively severe, with gender differences, and is expected to increase slightly by 2030.It is recommended that early identification of key high-risk populations of AD should be strengthened, especially for the elderly and female groups.Interventions targeting modifiable risk factors should be carried out, and effective measures should be adopted to reduce the burden of AD.

Objective To analyze and compare the change of disease burden attributed to high temperature in the Chinese population in 2019 compared with 1990. Methods Based on the global burden of disease study data in 2019, the number of deaths, mortality, disability-adjusted life years (DALY) and DALY rate attributable to high temperature in Chinese population of different ages and genders in 1990 and 2019 were extracted to analyze the changing trend of disease burden attributable to high temperature exposure in Chinese population and its main causes. The Joinpoint regression model was used to analyze the trend of changes in standardized attributable DALY rates. Results Compared with 1990, the number of disease deaths attributable to high temperature in China in 2019 increased from 10 700 to 13 900, and the attributable DALY decreased from 532,200 to 276 100 person-years. The standardized mortality and DALY rates decreased by 35.25% and 65.20%, respectively. The burden attributable to high temperature was higher in males than in females, and the burden was relatively heavier in the population aged 70 and above. In 2019, chronic non-communicable diseases were the main cause of the attributable burden of high temperature exposure, and ischemic heart disease had the highest DALY burden, with an age-standardized DALY rate of 4.64/100 000. Conclusion The absolute death burden attributable to high temperature exposure in Chinese population is still increasing. It is necessary to pay more attention to high-risk groups such as men and the elderly, continue to strengthen environmental protection, and formulate relevant interventions in a targeted way to further reduce the disease burden caused by high temperature exposure.

The abuse of antibiotics and other antimicrobial drugs has led to a significant increase in the prevalence of bacterial drug resistance. The advent of nanotechnology offers a promising way to address this challenge. Metal nanomaterials have emerged as a prominent class of antimicrobial agents, offering a number of advantages, including ease of preparation, high stability, potent efficacy against drug-resistant bacteria, and low toxicity. In this review, the antibacterial mechanisms of metal nanomaterials and the current research progress of gold, silver, copper, iron, platinum, palladium, and gallium nanomaterials and their application in the field of antibacterial were summarized with the aim of providing reference for the antibacterial use of metal nanomaterials.

ObjectiveTo analyze the effect of physical activity on executive function of children and adolescents, and sort out the related factors. MethodsArticles about physical activity intervention for children and adolescents on executive function were retrieved from CNKI, Wanfang Data, Google Scholar, Wiley Online Library and PubMed, from January 1st, 2010 to June 30th, 2021. The articles were screened, evaluated and systematically reviewed. ResultsA total of 21 articles were included, from eleven countries, including 13 randomized controlled trials, involving 2 496 subjects, aged five to 18 years. The articles were published from 2010 to 2019, with mean score of Physiotherapy Evidence Database scale as 5.57. The physical activity intervention mainly involved physical fitness, skills and sport games, with low to high intensity, eight to 120 minutes a time, one to five times a week, no more than ten months. Physical activity was indicated to improve the executive function, specifically inhibition control, working memory and cognitive flexibility, such as the improvement of the accuracy and reaction time of cognitive tasks, and activation of bilateral prefrontal cortex activity. Types, intensity, duration, frequency and cycle of physical activity, participant selection, and assessment tools were related to the effect of intervention. ConclusionPhysical activity can improve the inhibition control, working memory and cognitive flexibility of children and adolescents. The main factors related to the intervention effect are the physical activity elements, the participant's factors and the experimental design factors.