Objective To establish a fluorescent recombinase-aided amplification (RAA) assay for detection of Strongyloides stercoralis nucleic acid and to preliminarily evaluate its performance. Methods Six sets of specific primers targeting S. stercoralis 18S ribosomal RNA (18S rRNA) gene and one fluorescent probe were designed and synthesized. The optimal primer-probe set was determined through systematic screening and optimization to establish the fluorescent RAA assay. The assay was evaluated using S. stercoralis genomic DNA at concentrations of 100, 10, and 1 pg/μL, and 100, 10, and 1 fg/μL, as well as recombinant pUC57 plasmids containing the target gene fragments at 1 × 10⁵, 1 × 10⁴, 1 × 10³, 1 × 10², 1 × 10¹, 1 × 10⁰ copies/reaction, to determine the analytical sensitivity. Genomic DNA from Ascaris lumbricoides, Ancylostoma duodenale, Enterobius vermicularis, Angiostrongylus cantonensis, Trichinella spiralis, Clonorchis sinensis, Schistosoma japonicum, and Taenia saginata was used to assess assay specificity. A total of 25 stool samples from patients suspected of S. stercoralis infection were tested by the modified Baermann funnel technique, PCR, and the established fluorescent RAA assay. The sensitivity, specificity, concordance rate and their 95% confidence intervals (CI) of these three techniques were estimated, and agreement between methods was evaluated using the Kappa coefficient. Results Exo-4 was identified as the optimal primer set screened from the six primer sets, and the best amplification performance was achieved when the final concentrations of the forward and reverse primers were 0.44 μmol/L and a probe concentration was 0.20 μmol/L. The limit of detection of the fluorescent RAA assay was 100 fg/μL for genomic DNA of S. stercoralis and 1 × 10⁰ copies/reaction for recombinant plasmids. Specific fluorescence signals were detected within 5 min, with no cross-reactivity observed with A. lumbricoides, A. duodenale, E. vermicularis, A. cantonensis, T. spiralis, C. sinensis, S. japonicum, or T. saginata. Among the 25 clinical stool samples from patients suspected of S. stercoralis infections, the modified Baermann funnel technique and fluorescent RAA assay detected 19 positives and 6 negatives, whereas PCR detected 18 positives and 7 negatives. The fluorescent RAA assay showed a sensitivity of 100.00% [95% CI: (82.35%, 100.00%)], specificity of 100.00% [95% CI: (54.07%, 100.00%)], concordance rate of 100.00% [95% CI: (86.28%, 100.00%)], and a Kappa coefficient of 1.00 [95% CI: (1.00, 1.00)] (P < 0.001) relative to the modified Baermann funnel technique, and a sensitivity of 100.00% [95% CI: (81.47%, 100.00%)], specificity of 85.71% [95% CI: (42.13%, 99.64%)], concordance rate of 96.00% [95% CI: (79.65%, 99.90%)], and a Kappa coefficient of 0.90 [95% CI: (0.70, 1.00)] (P < 0.001). Positive amplification products emitted green fluorescence under a portable blue-light device, enabling visual interpretation of results. Conclusions The fluorescent RAA assay established in this study is rapid, highly sensitive, and highly specific. It enables detection of S. stercoralis nucleic acid under isothermal conditions and allows visual interpretation of results, providing a novel tool for rapid clinical diagnosis and field screening of S. stercoralis infections.

Obesity, as a chronic recurrent disease, has become a major public health challenge in China. To implement the requirements of the Healthy China Initiative (2019—2030), under domestic guidelines or consensus statements on overweight and obesity, and in alignment with the latest scientific advances globally, the Quality control protocol for adult overweight and obesity screening in health management (examination) institutions (2025 edition) was developed. This protocol was drafted by the Health Management Center of Shanghai Changzheng Hospital and formulated through multiple rounds of deliberation by experts in China’s health examination quality control field. The protocol establishes unified standards for screening facilities, personnel qualifications, and measurement or testing procedures. It defines specific screening items, outlines a standardized screening pathway, and sets requirements for the final medical review, ensuring the scientific validity, effectiveness, and safety of the screening process. The implementation of this protocol will enhance the consistency of weight management practices for adults across health examination institutions and strengthen the quality control of overweight and obesity screening programs.

Objective To compare the long-term prognosis differences between surgical radical resection and endoscopic resection for early gastric cancer patients based on the SEER database. Methods A total of 1 437 patients with stage Tis to T_1b gastric adenocarcinoma were selected from the SEER database from January 1, 2004 to December 31, 2013. They were divided into a surgery group (n=1 257) and an endoscope group (n=180) according to the treatment method. Kaplan-Meier survival curve and Cox regression model were used to analyze survival outcomes. Results The patients in the surgery group were younger than those in the endoscope group ([67.63±12.97] years old vs [71.29±10.82] years old), with higher rates of T₁ stage (97.45% vs 87.78%) and lymph node metastasis (19.73% vs 5.00%, all P＜0.001). The median follow-up time for all patients was 37 (15, 66) months, and the mortality rate of gastric cancer in the endoscope group was lower than that in the surgery group (23.33% vs 27.13%, P＜0.001). Univariate Cox analysis showed that treatment modality, age, sex, T stage, lymph node metastasis were all associated with early gastric cancer mortality (all P＜0.05), and the risk of death in the endoscope group was 43% of that in the surgery group (HR=0.43, P=0.015). After adjusting for multiple factors, there was no statistically significant difference in mortality risk between the two groups (P=0.067), but after excluding lymph node positive patients, the mortality risk in the endoscope group was 46% of that in the surgery group (HR=0.46, P=0.048). Conclusions For early gastric cancer patients with negative lymph nodes, endoscopic resection may provide better survival benefits than surgical procedures, suggesting that it can be the preferred treatment strategy for patients with low risk of lymph node metastasis.

Objective:To examine the distribution of pathogens that cause postoperative nosocomial infections in patients with rectal cancer(RC)and to construct a predictive nomogram for nosocomial infection.Methods:The clinical data of 1537 RC patients admitted to Sir Run Run Shaw Hospital between January 2021 and December 2022 were collected.Patients were assigned 1∶1 by propensity score matching(PSM)to the infection group(n=83)and control group(n=83)based on the occurrence of nosocomial infection.The dis-tribution and drug resistance of bacteria in patients with nosocomial infection were analyzed.Risk factors for postoperative nosocomial infection were identified by least absolute shrinkage and selection operator(LASSO)regression,and a predictive nomogram was con-structed using multivariate logistics regression.The predictive performance of the model was evaluated by receiver operating character-istic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results:A total of 93 strains of pathogens were isolated from the 83 infected patients,including 62 strains of Gram-negative bacteria(66.67%;predominantly Escherichia coli and Pseudomonas ae-ruginosa),25 strains of Gram-positive bacteria(26.88%;mainly Enterococcus faecalis),and 6 strains of fungi(6.45%;all Candida albicans).LASSO and multivariate logistics regression showed that smoking(odds ratio[OR]=3.97,95%CI=1.27-12.43),the dwelling time of drainage tube(OR=1.19,95%CI=1.08-1.30),difference in preoperative and postoperative neutrophil counts(OR=1.23,95%CI=1.01-1.49),and difference between preoperative and postoperative C-reactive protein levels(OR=1.05,95%CI=1.03-1.07)were inde-pendent risk factors for postoperative nosocomial infection in RC patients.The area under the ROC curve of the nomogram constructed based on the above factors was 0.933(95%CI=0.896-0.969).The calibration curve showed that the predicted risk was in good agree-ment with the actual observed risk of infection.In addition,DCA demonstrated that the nomogram has good clinical utility and high net clinical benefits in predicting nosocomial infection.Conclusion:The nomogram constructed in this study has a good predictive perfor-mance in postoperative nosocomial infection in RC patients.

Objective:To investigate the value of voice recognition function in the early screening of dementia.Methods:A total of 55 elderly individuals with cognitive function impairment were enrolled as group A,and 115 normal elderly individuals were enrolled as group B.Mini-mental state examination(MMSE)was used to determine the presence or absence of cognitive function impairment,and then the two questions of basic voice discrimination and celebrity voice recognition were designed to determine whether there was a decline in voice recognition function and analyze the association between voice recognition function and cognitive function.Results:The correct number of basic sound discrimination questions:Group A was lower than group B(P<0.001),and the difference was statis-tically significant.The correct number of celebrity voice recognition questions:Group A was lower than group B(P<0.001),and the difference was statistically significant.The AUROC analysis showed that the correlation between cognitive function and basic voice discrimination test was 0.180(95%CI=0.108-0.253),and the correlation between cognitive function and celebrity voice recognition test was AUROC=0.139(95%CI=0.079-0.199),both of which showed statistical significance.The voice recognition function test was used for preliminary screening,and under the premise of ensuring a negative predictive value of about 90%,the basic voice discrimina-tion test had a cut-off value of 10 questions(12 questions in total),and the celebrity voice recognition test had a cut-off value of 7 questions(12 questions in total).Conclusion:There are significant differences in the performance for basic voice discrimination test and celebrity voice recognition test between the elderly patients with cognitive function impairment and the normal elderly individuals,suggesting that voice recognition function test can be used for the screening for patients with early dementia,thereby delaying disease progression and reducing medical burden.

Objective To understand the changing composition and antibiotic resistance of bacterial species in the clinical isolates from outpatient and emergency department(hereinafter referred to as outpatients)and inpatient children over time in various hospitals,and to provide laboratory evidence for rational antibiotic use.Methods The data on clinically isolated pathogenic bacteria and antimicrobial susceptibility of isolates from outpatients and inpatient children in the CHINET program from 2015 to 2021 were collected and analyzed.Results A total of 278 471 isolates were isolated from pediatric patients in the CHINET program from 2015 to 2021.About 17.1％of the strains were isolated from outpatients,primarily group A β-hemolytic Streptococcus,Escherichia coli,and Staphylococcus aureus.Most of the strains(82.9％)were isolated from inpatients,mainly SS.aureus,E.coli,and H.influenzae.The prevalence of methicillin-resistant S.aureus(MRSA)in outpatients(24.5％)was lower than that in inpatient children(31.5％).The MRSA isolates from outpatients showed lower resistance rates to the antibiotics tested than the strains isolated from inpatient children.The prevalence of vancomycin-resistant Enterococcus faecalis or E.faecium and penicillin-resistant S.pneumoniae was low in either outpatients or inpatient children.S.pneumoniae,β-hemolytic Streptococcus and S.viridans showed high resistance rates to erythromycin.The prevalence of erythromycin-resistant group A β-hemolytic Streptococcus was higher in outpatients than that in inpatient children.The prevalence of β-lactamase-producing H.influenzae showed an overall upward trend in children,but lower in outpatients(45.1％)than in inpatient children(59.4％).The prevalence of carbapenem-resistant Klebsiella pneumoniae(CRKpn),carbapenem-resistant Pseudomonas aeruginosa(CRPae)and carbapenem-resistant Acinetobacter baumannii(CRAba)was 14％,11.7％,47.8％in outpatients,but 24.2％,20.6％,and 52.8％in inpatient children,respectively.The prevalence of multidrug-resistant E.coli,K.pneumoniae,Proteus mirabilis,P.aeruginosa and A.baumannii strains was lower in outpatients than in inpatient children.The prevalence of fluoroquinolone-resistant E.coli,ESBLs-producing K.pneumoniae,ESBLs-producing P.mirabilis,carbapenem-resistant E.coli(CREco),CRKpn,and CRPae was lower in children in outpatients than in inpatient children,but the prevalence of CRAba in 2021 was higher than in inpatient children.Conclusions The distribution of clinical isolates from children is different between outpatients and inpatients.The prevalence of MRSA,ESBL,and CRO was higher in inpatient children than in outpatients.Antibiotics should be used rationally in clinical practice based on etiological diagnosis and antimicrobial susceptibility test results.Ongoing antimicrobial resistance surveillance and prevention and control of hospital infections are crucial to curbing bacterial resistance.

Objective To investigate the changing antibiotic resistance profiles of E.coli isolated from patients in the 52 hospitals participating in the CHINET program from 2015 to 2021.Methods Antimicrobial susceptibility was tested for clinical isolates of E.coli according to the unified protocol of CHINET program.WHONET 5.6 and SPSS 20.0 software were used for data analysis.Results Atotal of 289 760 nonduplicate clinical strains ofE.coli were isolated from 2015 to 2021,mainly from urine samples(44.7±3.2)％.The proportion of E.coli strains isolated from urine samples was higher in females than in males(59.0％vs 29.5％).The proportion of E.coli strains isolated from respiratory tract and cerebrospinal fluid samples was significantly higher in children than in adults(16.7％vs 7.8％,0.8％vs 0.1％,both P＜0.05).The isolates from internal medicine department accounted for the largest proportion(28.9±2.8)％with an increasing trend over years.Overall,the prevalence of ESBLs-producing E.coli and carbapenem resistant E.coli(CREco)was 55.9％and 1.8％,respectively during the 7-year period.The prevalence of ESBLs-producing E.coli was the highest in tertiary hospitals each year from 2015 to 2021 compared to secondary hospitals.The prevalence of CREco was higher in children's hospitals compared to secondary and tertiary hospitals each year from 2015 to 2021.The prevalence of ESBLs-producing E.coli in tertiary hospitals and children's hospitals and the prevalence of CREco in children's hospitals showed a decreasing trend over the 7-year period.The prevalence of CREco in secondary and tertiary hospitals increased slowly.Antibiotic resistance rates changed slowly from 2015 to 2021.Carbapenem drugs(imipenem,meropenem)were the most active drugs amongβ-lactams against E.coli(resistance rate≤2.1％).The resistance rates of E.coli to β-lactam/β-lactam inhibitor combinations(piperacillin-tazobactam,cefoperazone-sulbactam),aminoglycosides(amikacin),nitrofurantoin and fosfomycin(for urinary isolates only)were all less than 10％.The resistance rate of E.coli strains to antibiotics varied with the level of hospitals and the departments where the strains were isolated,especially for cefazolin and ciprofloxacin,to which the resistance rate of E.coli strains from children in non-ICU departments was significantly lower than that of the strains isolated from other departments(P＜0.05).The E.coli isolates from ICU showed higher resistance rate to most antimicrobial agents tested(excluding tigecycline)than the strains isolated from other departments.The E.coli strains isolated from tertiary hospitals showed higher resistance rates to the antimicrobial agents tested(excluding tigecycline,polymyxin B,cefepime and carbapenems)than the strains from secondary hospitals and children's hospitals.Conclusions E.coli is an important pathogen causing clinical infection.More than half of the clinical isolates produced ESBL.The prevalence of CREco is increasing in secondary and tertiary hospitals over the 7-year period even though the overall prevalence is still low.This is an issue of concern.

Objective To compare six existing Chinese standards related to visual disability,including Disability Assessment and Code for Life Insurance(Insurance Standard),Specification for Ability Assessment of Older Adults(Elderly Stan-dard),Grading of Disability due to Human Body Injury(Judicial Standard),Standard for Identify Work Ability—Gradation of Disability Caused by Work-related Injuries and Occupational Diseases(Work Injury Standard),Standard for Assessment of Disability Grades of Military Personnel(Military Standard),and Classification and Grading Criteria of Disability(Disability Classification Standard).Methods Based on the theoretical framework of International Classification of Functioning,Disability and Health(ICF)and International Classification of Diseases,the 11th Revision(ICD-11),and with reference to World Report on Vision(WRV),this study analyzed and compared five key dimensions of visual disability across the six stan-dards:definition,classification,grading,assessment methods and coding systems.Results In terms of definition,the insurance,work injury,military,and disability classification standards emphasized vi-sual structure and function,focusing on visual acuity and visual field;the insurance and elderly standards incor-porated activities and participation,reflecting the concept of functional vision;the judicial standard lacked a dedi-cated definition of visual disability.In terms of grading,each standard graded visual disability into different lev-els acoording to different functional indicators.In terms of coding,only the insurance standard adopted the ICF framework,while others used non-ICF numeric codes or lacked standardized coding.In terms of assessment tools,the elderly standard employed a customized perceptual and participation scoring system,while others re-lied primarily on vision charts.Conclusion Most current Chinese standards focus on impairments in visual function,with limited attention to activity limitations and participation restrictions.It is needed for incorporating the concept of functional vision,aligned with ICF and WRV,to establish a unified conceptual framework,terminology,coding system for visual disability,and comprehensive assessments that reflect not only impairments but also the impact on daily functioning and en-vironmental interaction.

Objective The finite element pelvis model with detailed anatomical structures which meets the Chinese human 95th percentile characteristics is developed,and the influence of cortical bone modeling method on the biomechanical response of the real pelvis is explored.Methods Based on the pelvic medical images of a 95th percentile male volunteer,two finite element pelvis models with real hip bone cortical bone thickness(REA-M)and 2 mm uniform cortical bone thickness(CON-M)dominated by hexahedral elements were constructed.Using the simulation method to reconstruct the loading conditions of cadaver experiments,the validation of models was verified by comparing the cadaver experimental results and simulation results,and biomechanical response differences of two models under different working conditions were discussed.Results The simulation data showed that there was a strong correlation between the overall biomechanical responses of two pelvic models and the cadaver experiment,and the mechanical response difference between two models was mostly within 8％,and the correlation score difference between two models was smaller than 2％.Conclusions The validation of two pelvic models established in this study is verified by rebuilding multiple simulation experiments.Although the biomechanical responses of CON-M and REA-M models were different,the difference was small.From the perspective of model simplification,the CON-M model can be used to study the biomechanical response of the pelvis.

Objective To develop a data-driven model for estimating tangential ground reaction force(GRFt)from lower limb kinematic data and select the most suitable input based on a balance between input quantity and estimation accuracy,with the aim of measuring GRFt in outdoor gait experiments.Methods Gait data from ten subjects walking at five different inclines(-10°,-5°,0°,5°,10°)were used to train two data-driven models,namely a backpropagation neural network(BPNN)-based model and a polynomial sparse identification(PSI)-based model.The performance of these models was evaluated using eight kinematic data combinations and the normal ground reaction force(GRFn)as inputs to determine the optimal model and input combination.Results Under the same input dimensionality,the combination of hip-knee joint angles proved more accurate in estimating GRF,than the knee-ankle joint angle combination.Specifically,the BPNN and PSI models based on the former combination predicted GRF,with errors of 1.61％BW(body weight)and 1.84％BW,respectively,while the latter combination resulted in errors of 2.82％BW and 3.15％BW.When GRFn and all joint angles were used as inputs,the model's prediction error was only 1.46％BW.Conclusions The combination of GRFn and hip-knee joint angles achieves an optimal balance between computational complexity and estimation accuracy.This study supports the accurate estimation of GRF,in outdoor gait testing.