Hypervirulent Klebsiella pneumoniae(hvKP)is a highly pathogenic pathogen that is more virulent than classic Klebsiella pneumoniae(cKP)and often leads to severe disseminated infections.The horizontal transfer of virulence plasmids and carbapenem-resistant genes in hvKP through plasmids and mobile genetic elements(MG-Es)has led to the emergence of carbapenem-resistant(CR)-hvKP,posing a serious threat to public health.A deep understanding of the epidemiological characteristics,pathogenic mechanisms and convergence of virulence and drug resistance in hvKP is crucial for preventing and monitoring infections caused by this bacterium.

Objective:To explore the construction of a core competency evaluation indicator system for pediatric surgery operating room specialist nurses.Methods:The evaluation indicator system was constructed by reviewing literature, analyzing semi-structured interview results, and examining the characteristics of training specialized nurses in pediatric surgery operating rooms, as well as combining the characteristics of pediatric surgery and multi-source data. The research group discussed and proposed a preliminary core competency evaluation indicator system for specialized nurses in pediatric surgery operating rooms. This study used the Delphi expert inquiry method to conduct two rounds of expert consultation and ultimately established the core competency evaluation indicator system for pediatric surgery operating room specialist nurses. The expert positivity coefficient was represented by the questionnaire response rate, and the expert authority coefficient was calculated using the judgment coefficient and familiarity degree. The coefficient of variation and Kendall's W coefficient were used to measure the degree of coordination of expert opinions. Results:The effective response rates for the two rounds of expert consultation were 100.00% and 95.24%, respectively. The authority coefficients of the two rounds of expert consultation were 0.92 and 0.90, respectively. The coefficients of variation of indicators at various levels were less than 0.25. The Kendall's W coefficients for the first-, second-, and third-level indicators in the first and second rounds of expert consultation were 0.516-0.664 and 0.652-0.711, respectively ( P<0.001). The final core competency evaluation indicator system for pediatric surgery operating room specialist nurses included 3 first-level indicators, 15 second-level indicators, and 52 third-level indicators. Conclusions:The core competency evaluation indicator system for pediatric surgery operating room specialist nurses constructed in this study provides a scientific and practical guidance for training pediatric surgery operating room specialist nurses in China.

Objective:To evaluate the efficacy of role-playing games with parental involvement and immediate therapist feedback for children with autism spectrum disorder(ASD)and to explore their impact on parental compe-tence,thereby providing new insights for ASD rehabilitation.Method:Seventy children with ASD were randomly assigned to either a control or an intervention group.The control group received traditional one-on-one role-playing therapy with parents as observers.In addition to this therapy,the intervention group participated in a 60-minute parent-inclusive role-playing session with real-time therapist feedback.Assessments of children's social perspective-taking abilities and parental competence were conducted at pre-and post-intervention and at follow-up.Children's developmental outcomes were further evalu-ated using the Griffiths Scales at the same timepoints.Result:Sixty-four participants provided valid data.The intervention group showed significant improvements in social perspective-taking post-intervention and at follow-up compared to baseline(P<0.05).At follow-up,chil-dren in the intervention group also scored higher on personal and social,hearing,and language development domains of the Griffiths Scale than the control group(P<0.05).Parental competence in the intervention group significantly increased(P<0.05).Conclusion:The integrated intervention of role-playing games with immediate feedback effectively enhances so-cial perspective-taking in children with ASD,promotes developmental levels,and strengthens parental competence.

Objective To investigate the causes and factors affecting unplanned reoperation,and to provide a reference basis for reducing the incidence of unplanned return of the patient to the operating room for reoperation.Methods Surgical data from the hospital was extracted spanning from January to December 2022,and subjected to a descriptive analysis of the overall situation,departmental distribution,primary reasons,and patient referrals related to unplanned reoperations in the hospital,and analyzed factors contributing to unplanned reoperations in the hospital using binary logistic regression.Results In 2022,130 unplanned reoperations were reported in this hospital,corresponding to an incidence of 0.35％.Patients who required unplanned reoperation were predominantly male(63.08％).The majority had surgical incision grade of category 0(46.92％),and surgeries were classified as levels 3 and 4(80.77％).Furthermore,88.46％of the surgeries were performed by surgeons with advanced degrees or higher.The common causes were postoperative bleeding,failure to achieve the desired result,need for the condition,probing for the cause,and occurrence of leakage or fistula,collectively accounting for 50.00％of the cases.Key factors contributing to unplanned reoperations were sex,type of surgical incision,and incision healing grade;among which male patients(OR=1.733,P=0.006),patients with class Ⅰ surgical incision(OR=2.909,P=0.004),and patients with incision grade B healing(OR=6.565,P＜0.001)showed a higher propensity for unplanned reoperations.Conclusion Hos-pitals should emphasize monitoring and managing unplanned reoperations by improving perioperative supervision,conducting thorough root cause analyses,and focusing on continuous quality improvement to enhance surgical outcomes and patient safety.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective:To investigate the role of adenosine triphosphatase phospholipid transporter 10a(ATP10a)methylation assay in the triage of atypical squamous cell of undetermined significance(ASC-US)and low-grade squamous intraepithelial lesions(LSIL)in cervical cytology.Methods:188 patients with cervical exfolia-ted cells of ASC-US and LSIL were selected,and High-risk human papilloma virus(HR-HPV)typing and cervical biopsy results of the patients were collected at the same time.The cervical biopsy pathology results were used as the gold standard,and they were divided into inflammation,LSIL,high grade squamous intraepithelial lesions(HSIL)and cervical squamous cell carcinoma(SCC).Classify inflammation and LSIL as LSIL-group,HSIL and SCC as HSIL+group to compare the efficacy of ATP10a methylation and HR-HPV testing for diagnosis of HSIL+in this population(including HSIL and SCC).Results:The methylation detection value of ATP10a in the inflam-mation,LSIL,HSIL,and SCC patients were 19.035(16.478,20.823),13.446(5.890,20.674),10.336(4.733,17.336),4.223(1.713,7.754),respectively.The methylation detection value of ATP10a in the LSIL-group was 17.812(10.787,20.686),while that in the HSIL+group was 7.251(3.170,14.194).There was a statistically sig-nificant difference between the groups(Z=-5.824,P＜0.001).The proportion of HR-HPV positivity in the LSIL-group was 70.9％,which was lower than that of the HSIL+group(88.2％),and the difference was statistically significant(Z=-2.887,P=0.004).The specificity,negative predictive value(NPV),and area under the receiver operating characteristic(ROC)curve(AUC)of ATP10A methylation diagnosis of HSIL+(66.0％,79.1％,and 0.747)were higher than those of HR-HPV detection(29.1％,50.7％,0.587).Sensitivity and positive predictive value(PPV)(78.8％and 65.7％)were lower than those of HR-HPV testing(88.2％and 75.0％).when using ATP10a methylation instead of HR-HPV detection for triage of cytological abnormalities(ASC-US,LSIL),the col-poscopy referral rate could be reduced to 54.3％.In the ASC-US population,the AUC(0.683)for the diagnosis of HSIL+by ATP10a methylation test was higher than that of HR-HPV test(0.599),and the difference was statisti-cally significant(P=0.028).In the LSIL population,the AUC(0.828)for the diagnosis of HSIL+by ATP10a methylation test was still higher than that of HR-HPV test(0.563),and the difference was statistically significant(P=0.005).Conclusions:ATP10a methylation levels increased with the severity of cervical lesions,and the di-agnostic efficacy of ATP10a methylation detection for the severity of cervical lesions may not be lower than HR-HPV typing.

Objective:To explore the mediating effect of frailty between stress perception and kinesiophobia in elderly patients after temporary cardiac pacemaker implantation.Methods:A total of 129 elderly patients who underwent temporary cardiac pacemaker implantation surgery in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Zhengzhou University from February 2023 to April 2024 were selected by convenience sampling method, and were surveyed by the general information questionnaire, the exercise fear scale, the perceived stress scale and the Chinese Tilburg frailty scale.The t test, one-way ANOVA and non parametric test were used to analyze the data by SPSS 29.0 software.The macro program PROCESS was used to construct and test the mediation model. Results:The total score of kinesiophobia was (41.08±2.77), the total score of stress perception was (36.22±3.07), and the total score of frailty was (11.19±1.53) in elderly patients after temporary cardiac pacemaker implantation. The total score of kinesiophobia was positively correlated with the total score of stress perception ( r=0.383, P<0.01), the total score of kinesiophobia was positively correlated with the total score of frailty ( r=0.451, P<0.01), and the total score of stress perception was positively correlated with the total score of frailty ( r=0.289, P<0.01).The total effect of stress perception on motor fear was 0.359 ( P<0.01) and the direct effect was 0.226 ( P<0.01).Frailty played a partial mediating role between stress perception and kinesiophbia in elderly patients after temporary pacemaker implantation, with an indirect effect of 0.133 (95% CI=0.062-0.243), accounting for 37.05% of the total effect. Conclusion:Stress perception not only directly affects kinesiophobia in elderly patients with temporary cardiac pacemaker implantation, but also indirectly affects kinesiophobia through frailty.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective:To compare and analyze the similarities and differences in clinical manifestations, laboratory findings, pathological characteristics, and prognosis between urticarial vasculitis (UV) and chronic spontaneous urticaria with pigmentation (CSUwp) .Methods:A retrospective analysis was conducted on the clinical data and follow-up results from 35 UV patients and 54 CSUwp patients who attended the Department of Dermatology, Southwest Hospital, Army Medical University from 2014 to 2024. The clinical characteristics (duration of rash, pigmentation, petechiae and ecchymosis, itching, burning sensation, fever, fatigue, skin lesion characteristics, etc.) , laboratory test results, pathological features, and prognosis were compared between the two groups. Statistical analysis was carried out by t test, chi-square test, Mann-Whitney U test, and Kaplan-Meier survival analysis. Results:There were no significant differences in gender, age, or age of onset between the UV group and CSUwp group (all P < 0.05) . The proportions of patients with petechiae/purpura (68.57% [24/35] vs. 11.11% [6/54]) , and those with burning sensation (22.86% [8/35] vs. 3.70% [2/54]) were significantly higher in the UV group than in the CSUwp group (both P < 0.05) . Compared with the CSUwp patients, the UV patients presented with a greater number of lesions, larger lesion areas, and more frequent involvement of the lower limbs (all P < 0.05) , also showed significantly higher incidence rates of peripheral blood complement reduction, perivascular neutrophil infiltration, nuclear dust, fibrinoid necrosis of the vessel wall, and erythrocyte extravasation (all P < 0.05) , as well as more extensive dermal perivascular inflammation ( Z = -4.506, P < 0.001) . Among patients who achieved remission, the natural disease course was significantly longer in the CSUwp patients than in the UV patients (6.00 [2.5, 24] months vs. 2.00 [0.5, 24] months; Z = -2.618, P = 0.009]. However, the survival analysis showed no significant difference in the natural disease course or clinical outcomes between the two groups ( χ2 = 2.771, P = 0.096) . There were also no significant differences in rash duration or in the incidence rates of itching, angioedema, or joint pain between the two groups (all P > 0.05) . Conclusions:UV patients exhibited certain differences from CSUwp patients in clinical characteristics, laboratory test results, histopathological features, and prognosis. However, whether their natural disease courses differ requires further follow-up studies to confirm.

Objective:To evaluate the efficacy of role-playing games with parental involvement and immediate therapist feedback for children with autism spectrum disorder(ASD)and to explore their impact on parental compe-tence,thereby providing new insights for ASD rehabilitation.Method:Seventy children with ASD were randomly assigned to either a control or an intervention group.The control group received traditional one-on-one role-playing therapy with parents as observers.In addition to this therapy,the intervention group participated in a 60-minute parent-inclusive role-playing session with real-time therapist feedback.Assessments of children's social perspective-taking abilities and parental competence were conducted at pre-and post-intervention and at follow-up.Children's developmental outcomes were further evalu-ated using the Griffiths Scales at the same timepoints.Result:Sixty-four participants provided valid data.The intervention group showed significant improvements in social perspective-taking post-intervention and at follow-up compared to baseline(P<0.05).At follow-up,chil-dren in the intervention group also scored higher on personal and social,hearing,and language development domains of the Griffiths Scale than the control group(P<0.05).Parental competence in the intervention group significantly increased(P<0.05).Conclusion:The integrated intervention of role-playing games with immediate feedback effectively enhances so-cial perspective-taking in children with ASD,promotes developmental levels,and strengthens parental competence.