Objective To construct the K64 capsule depolymerase recombinant protein,Dep44,and investigate its potential application against carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Methods The de-polymerase-encoding phage vB_Kpn_HF1013(GenBank:PP803128)was isolated and genomically analyzed to screen for candidate depolymerases.The recombinant protein Dep44 was constructed and functionally verified for depolymerase activity.Dep44 sensitive range was validated and Dep44 antimicrobial activity was assessed by bio-film disruption and serum sterilization assays.Results The tail spike protein of phage vB_Kpn_HF1013 exhibited depolymerase activity and recombinant protein Dep44 specifically degraded K64 CRKP capsule.Biofilm eradication assays demonstrated that recombinant Dep44 at both 2 μg/mL and 10 μg/mL significantly disrupted bacterial bio-films relative to the control.Serum bactericidal assays showed that Dep44 exhibited synergistic activity with serum,dependent on the complement system,as Dep44 alone lacked bactericidal properties.Conclusion Dep44 effec-tively targets and degrades K64 CRKP capsule,disrupts biofilms,and enhances serum bactericidal activity,high-lighting its potential for managing K64 CRKP infections and clearing biofilms from medical devices.

Objective:To explore the application effectiveness of the treatment interference protocol (TIP) in managing physical restraints for patients in the Emergency Intensive Care Unit (EICU) .Methods:Using a convenience sampling method, 98 patients admitted to the EICU of Lihuili Hospital, Ningbo Medical Center, from April 2020 to April 2022 were selected as the study subjects. They were randomly divided into two groups using a random number table, with 49 patients in each group. The control group received physical restraint management based on the experience of medical staff, while the observation group received management based on the TIP. The levels of knowledge, attitude, and practice regarding physical restraints among nurses before and after the intervention were compared. Additionally, the physical restraint conditions (total restraint time and proportion of patients subjected to physical restraints), incidence of unplanned extubation, and occurrence of restraint-related complications were compared between the two groups.Results:After the intervention, nurses demonstrated statistically significant improvements in knowledge, attitude, practice, and overall scores related to physical restraints ( P<0.05). The physical restraint rate in the observation group was 26.53% (13/49), significantly lower than the control group at 46.94% (23/49) ( P<0.05). The total duration of physical restraints in the observation group was also shorter than that in the control group ( P<0.05). There was no significant difference in the incidence of unplanned extubation between the two groups ( P>0.05). However, the incidence of restraint-related complications in the observation group was lower than that in the control group ( P<0.05) . Conclusions:TIP effectively improves nurses' knowledge, attitude, practice levels regarding physical restraints, reduces the proportion of patients subjected to physical restraints, decreases the occurrence of restraint-related complications, and shortens the duration of physical restraints without increasing the risk of unplanned extubation.

Objective:To analyze the evolution of ceftazidime/avibactam (CZA) resistance phenotyes and clinical features of 11 ST11-KL64 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates carrying bla KPC. Methods:Eleven CRKP isolates, designated K01 to K11, obtained from infected liver transplant patients from June to September 2024 were retrospectively studied. Broth microdilution method, whole genome sequencing (WGS) and plasmid conjugation assays were employed to investigate the antimicrobial susceptibility, resistance mechanisms, and genetic structural characteristics of these CRKP isolates. Clinical data were simultaneously collected and organized to analyze the correlation between bla KPC gene mutations and the clinical efficacy of antimicrobial therapy. Results:All eleven isolates of CRKP exhibited multidrug resistance phenotypes. Among them, K01-K09 and K11 were sensitive to CZA and resistant to carbapenems, while K10 was resistant to CZA and displayed sensitivity or intermediate resistance to carbapenems. WGS analysis showed that all 11 CRKP isolates belonged to the ST11-KL64 clonal type. Among these isolates, the K01-K09 and K11 isolates carry the bla KPC-2 gene, whereas the K10 isolate carries the bla KPC-33 gene. A single nucleotide mutation in bla KPC-2 (G532T) resulted in a substitution of tyrosine (Y) for aspartic acid (D) at Ambler position 179 (D179Y), causing resistance of CRKP to CZA and reduced sensitivity to Imipenem and Meropenem. The conjugative plasmid was successfully constructed, and compared to the parental strain, its minimum inhibitory concentration (MIC) to CZA increased 32 folds. Clinical data revealed that the patient developed the bla KPC-33 mutation after 51 days of CZA treatment. Conclusions:The bla KPC-33 mutation following CZA treatment for CRKP infection exhibits a considerable delay. It is essential to dynamically monitor the evolution of CRKP resistance to ensure timely adjustment of therapeutic strategies in case of the occurrence of mutations such as bla KPC-33.

Objective To construct the K64 capsule depolymerase recombinant protein,Dep44,and investigate its potential application against carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Methods The de-polymerase-encoding phage vB_Kpn_HF1013(GenBank:PP803128)was isolated and genomically analyzed to screen for candidate depolymerases.The recombinant protein Dep44 was constructed and functionally verified for depolymerase activity.Dep44 sensitive range was validated and Dep44 antimicrobial activity was assessed by bio-film disruption and serum sterilization assays.Results The tail spike protein of phage vB_Kpn_HF1013 exhibited depolymerase activity and recombinant protein Dep44 specifically degraded K64 CRKP capsule.Biofilm eradication assays demonstrated that recombinant Dep44 at both 2 μg/mL and 10 μg/mL significantly disrupted bacterial bio-films relative to the control.Serum bactericidal assays showed that Dep44 exhibited synergistic activity with serum,dependent on the complement system,as Dep44 alone lacked bactericidal properties.Conclusion Dep44 effec-tively targets and degrades K64 CRKP capsule,disrupts biofilms,and enhances serum bactericidal activity,high-lighting its potential for managing K64 CRKP infections and clearing biofilms from medical devices.

Objective:To explore the application effectiveness of the treatment interference protocol (TIP) in managing physical restraints for patients in the Emergency Intensive Care Unit (EICU) .Methods:Using a convenience sampling method, 98 patients admitted to the EICU of Lihuili Hospital, Ningbo Medical Center, from April 2020 to April 2022 were selected as the study subjects. They were randomly divided into two groups using a random number table, with 49 patients in each group. The control group received physical restraint management based on the experience of medical staff, while the observation group received management based on the TIP. The levels of knowledge, attitude, and practice regarding physical restraints among nurses before and after the intervention were compared. Additionally, the physical restraint conditions (total restraint time and proportion of patients subjected to physical restraints), incidence of unplanned extubation, and occurrence of restraint-related complications were compared between the two groups.Results:After the intervention, nurses demonstrated statistically significant improvements in knowledge, attitude, practice, and overall scores related to physical restraints ( P<0.05). The physical restraint rate in the observation group was 26.53% (13/49), significantly lower than the control group at 46.94% (23/49) ( P<0.05). The total duration of physical restraints in the observation group was also shorter than that in the control group ( P<0.05). There was no significant difference in the incidence of unplanned extubation between the two groups ( P>0.05). However, the incidence of restraint-related complications in the observation group was lower than that in the control group ( P<0.05) . Conclusions:TIP effectively improves nurses' knowledge, attitude, practice levels regarding physical restraints, reduces the proportion of patients subjected to physical restraints, decreases the occurrence of restraint-related complications, and shortens the duration of physical restraints without increasing the risk of unplanned extubation.

Objective:To analyze the evolution of ceftazidime/avibactam (CZA) resistance phenotyes and clinical features of 11 ST11-KL64 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates carrying bla KPC. Methods:Eleven CRKP isolates, designated K01 to K11, obtained from infected liver transplant patients from June to September 2024 were retrospectively studied. Broth microdilution method, whole genome sequencing (WGS) and plasmid conjugation assays were employed to investigate the antimicrobial susceptibility, resistance mechanisms, and genetic structural characteristics of these CRKP isolates. Clinical data were simultaneously collected and organized to analyze the correlation between bla KPC gene mutations and the clinical efficacy of antimicrobial therapy. Results:All eleven isolates of CRKP exhibited multidrug resistance phenotypes. Among them, K01-K09 and K11 were sensitive to CZA and resistant to carbapenems, while K10 was resistant to CZA and displayed sensitivity or intermediate resistance to carbapenems. WGS analysis showed that all 11 CRKP isolates belonged to the ST11-KL64 clonal type. Among these isolates, the K01-K09 and K11 isolates carry the bla KPC-2 gene, whereas the K10 isolate carries the bla KPC-33 gene. A single nucleotide mutation in bla KPC-2 (G532T) resulted in a substitution of tyrosine (Y) for aspartic acid (D) at Ambler position 179 (D179Y), causing resistance of CRKP to CZA and reduced sensitivity to Imipenem and Meropenem. The conjugative plasmid was successfully constructed, and compared to the parental strain, its minimum inhibitory concentration (MIC) to CZA increased 32 folds. Clinical data revealed that the patient developed the bla KPC-33 mutation after 51 days of CZA treatment. Conclusions:The bla KPC-33 mutation following CZA treatment for CRKP infection exhibits a considerable delay. It is essential to dynamically monitor the evolution of CRKP resistance to ensure timely adjustment of therapeutic strategies in case of the occurrence of mutations such as bla KPC-33.

Objective To explore the effect of intelligent rehabilitation exercise device on improving postoperative self-efficacy of breast cancer patients,promoting postoperative functional recovery of affected limbs and improving postoperative upper limb edema.Methods A total of 60 postoperative breast cancer patients in Jiaxing Hospital of Traditional Chinese Medicine were selected from January 2022 to Apil 2023,all of them underwent axillary dissection.The patients were randomly divided into control group(30 cases)and experimental group(30 cases)according to random number method.The patients in control group were treated with postoperative upper limb functional exercise,and the patients in experimental group were treated with intelligent rehabilitation exercise device after breast cancer surgery.Self-efficacy and functional exercise compliance at 3 months after operation,shoulder range of motion and incidence of upper limb edema 1 month and 3 months after operation were compared between two groups.Results After 3 months of surgery,the self-efficacy and functional exercise compliance of patients in experimental group were higher than those in control group(P＜0.05);After surgery 1 month and 3 months,the shoulder joint range of motion of patients in experimental group was better than that in control group(P＜0.05);The incidence of postoperative upper limb edema in experimental group was lower than that in control group 1 month after surgery,and the difference was not statistically significant(P＞0.05).The experimental group was lower than control group 3 months after surgery,and the difference was statistically significant(P＜0.05).Conclusion Intelligent rehabilitation exercise device after breast cancer operation can improve patients'self-efficacy,improve patients'compliance with functional exercise,promote functional recovery of affected limbs,prevent and treat postoperative upper limb edema,which is worthy of clinical promotion.

Objective: To monitor and analyze the epidemiological characteristics of influenza in schools and understand the disease burden of students, and to provide a scientific reference for instructing the prevention of influenza in schools. Methods: A school influenza surveillance sentinel to conduct influenza like case (ILI) surveillance and outbreak surveillance. Through network, we understood the burden of flu disease among students. Descriptive epidemiology was used to analyze influenza like case surveillance and questionnaire survey data. Results: Surveillance confirmed that from the 42th week of 2019 to the 1st week of 2020, the cumulative reported ILI of 3 school influenza surveillance sites in Jinan accounted for 7.91% (ILI%) of the total number of surveillance personnel during the same period, with the highest ILI% (24.19%) of kindergarten children, ILI% gradually decreased with the increase of grade, and teachers were the lowest. The reporting of ILI was concentrated in the 49th to 52nd week of 2019, during which the reported influenza like cases accounted for 84.81% of the total number of ILI reported during the surveillance period. Two influenza outbreaks were monitored. The pathogens were H3N2 and B (Victoria). The epidemics mainly occurred in the lower grades of elementary school. A survey of 2 297 students found that 577 people had fever and respiratory symptoms since October 2019. Among them, 85.26% of them went to the hospital, 32.75% of those who used anti influenza drugs such as oseltamivir, and 64.81% of those who used antibiotics. 42.63% received infusion therapy, 3.99% were hospitalized, and the average cost of inpatients was 6 686 yuan. The sick students were absent from school for an average of 3.77 days, and the parents of the sick children missed work for an average of 4.26 days. Conclusion Surveillance of influenza like cases in schools is an important way to proactively discover influenza epidemic trends and outbreaks, and to accurately grasp the characteristics of influenza epidemics in schools. The key populations affected by influenza are kindergarten children and lower grades of primary school students. Suffering from influenza has caused a heavy disease burden on students and children in kindergartens, and is also an important factor that causes student absenteeism and parents to miss work.

Objective To analyze the epidemiological characteristics and spatiotemporal clustering of scarlet fever in Jinan, from 2014-2019, and to provide a basis for scarlet fever prevention and control. Methods The case data of scarlet fever in Jinan during 2013-2019 were extracted from the Chinese National Notifiable Infectious Disease Reporting System. Descriptive epidemiology and spatiotemporal rearrangement scanning methods were used to analyze the epidemiological characteristics and spatiotemporal distribution of scarlet fever. The RR values of scarlet fever in different towns (streets) were calculated, and the contour map of RR value was drawn. Results A total of 9 715 cases of scarlet fever were reported in Jinan from 2014 to 2019. During this period, the number of cases and the incidence rate showed a gradual increase, with two seasonal peaks in the winter and spring each year. Spatiotemporal clustering analysis detected a total of eight spatiotemporal aggregation areas, and the strongest one was in Licheng and Lixia Districts, from March 2017 to December 2019 (RR=3.45, LLR=577.88, P<0.001). The relative risk maps in each year from 2014 to 2019 were similar, and the areas with the highest risk were located in the central area of Jinan. Conclusion From 2014 to 2019, scarlet fever is highly prevalent in the central area of Jinan, with obvious spatial and temporal clustering. There are clustering areas in the central, southwest and eastern areas of Jinan, and there was a tendency for the disease to spread to Zhangqiu in the east and Pingyin in the southwest.

Diabetic gastroparesis (DGP) is characterized by delayed gastric emptying caused by reduction of gastrointestinal motility. Its clinical manifestations include vomiting, nausea, belching, early satiety, postprandial fullness, and abdominal distention, etc. The mechanism of DGP is still not clear. Depletion of interstitial cells of Cajal, myopathy and neuropathy are considered to be the main pathogenic factors. Gastric prokinetics, gastric electric stimulation and endoscopic therapy are the main treatment options, but the long-term efficacy of these symptomatic treatment is not very satisfactory, which seriously affects patients' quality of life. This article reviewed the advances in study on pathogenesis and treatment of DGP.