Objective To analyze the genetic characteristics and variations of influenza A (H3N2) viruses in Ma'anshan from 2022 to 2024, and to provide a scientific basis for local influenza prevention and control. Methods From April 2022 to March 2024, influenza-like illness (ILI) specimens were collected from three national influenza surveillance sentinel hospitals in Ma’anshan. Samples positive for influenza by real-time PCR were subjected to virus culture and identification. A total of 40 representative A/H3N2 strains with hemagglutination titers ≥8 were selected for whole-genome sequencing. Genetic evolution, homology, amino acid variations, and glycosylation sites were analyzed. Results All H3N2 representative strains from the 2022–2023 influenza season belonged to clade 3C.2a1b.2a.1a.1, while those from the 2023–2024 season fell into clade 3C.2a1b.2a.2a.3a.1. The nucleotide and amino acid sequence similarities of HA and NA between the 40 representative strains and the vaccine strain A/Darwin/6/2021 were all above 97.35%. Compared with the vaccine strain, amino acid mutations were identified in antigenic sites A, B, C, and E, as well as in receptor-binding sites of the HA protein. An I222V substitution was detected in the NA protein. The HA protein contained four additional glycosylation sites compared to the vaccine strain, while the glycosylation pattern of the NA protein remained consistent. Conclusion No antigenic drift was observed in the influenza A/H3N2 viruses in Ma'anshan City from 2022 to 2024, but genetic changes such as branching variations, key amino acid substitutions, and an increase in HA glycosylation sites were observed. These findings underscore the importance of sustained molecular surveillance of local influenza viruses.

Objective To translate the nursing time management scale(NTMS)into Chinese and test its reliability and validity,hence to provide a tool for evaluating the time management among nurses in China.Methods Authorised by the author on June 30th,2023,the English version of NTMS was translated into a Chinese version through forward translation,reverse translation,cross-cultural debugging and pre-test by using Brislin translation model.Between September 2023 and January 2024,a convenience sampling method was employed to select a total of 409 nurses as the test subjects from five hospitals of Grade IIA and above in Dongguan.Then the reliability and validity of the translated version of NTMS were tested.Results All 409 nurses completed the tests.The Chinese version of NTMS included three dimensions comprising 15 items:6 in nursing work planning and goal setting,3 in organisation of nursing work and 6 in coordination of nursing work.It was found that the mean scale content validity index(S-CVI/Ave)was 0.920,and the item-level CVI(I-CVI)ranged from 0.840 to 1.000.The overall Cronbach's α coefficient of the scale was 0.894,with 0.700 for the split-half reliability coefficient of and 0.942 for the retest reliability.The Cronbach's α coefficient of each of the 3 dimensions ranged from 0.781 to 0.901,with the split-half reliability coefficient from 0.823 to 0.870 and the retest reliability from 0.692 to 0.965.In the exploratory factor analysis,the KMO value was 0.904.The statistic test of Bartlett's sphericity was 3941.503(P<0.05),with the factor load range of each entry from 0.629 to 0.838.The cumulative variance contribution rate was 67.672%.Conclusion The translated Chinese version of the nursing time management scale demonstrates good reliability and validity.It can be applied as an effective evaluation tool in the nursing time management.

Objective To report the diagnosis and treatment processes of a fungal keratitis case caused by Lasio-diplodia theobromae(L.theobromae),and enhance the diagnosis and treatment experience on fungal keratitis caused by this rare pathogen.Methods Corneal scraping specimen from a patient with fungal keratitis was collec-ted.Gram-staining and fluorescence staining were conducted on specimen,followed with direct microscopic observa-tion and isolation culture.The strain was identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS)technology and targeted DNA sequencing.Antimicrobial susceptibility testing was conducted.Literatures were summarized and clinical data on fungal keratitis caused by this pathogen were sorted out.Results Septal fungal hyphae could be seen on the corneal scraping specimen microscopically.The strain was identified as L.theobromae by both MALDI-TOF MS and targeted DNA sequencing after culture.Antimicrobial susceptibility testing(microdilution method)showed that the minimal inhibitory concentrations(MICs)of ampho-tericin B,vorionazole,itraconazole,posaconazole,fluconazole,5-fluorocytosine,micafungin,caspofungin,and anidulafungin against this strain were 1,0.25,＞8,0.25,＞256,8,16,2,and 0.25 μg/mL,respectively.Pa-tient recovered well after antifungal treatment plan was adjusted according to antimicrobial susceptibility testing re-sults.Conclusion L.theobromae is a rare pathogen that causes fungal keratitis.Laboratory tests provide rapid mi-croscopic examination results,and take MALDI-TOF MS and targeted DNA sequencing identification techniques as effective means to detect rare pathogen.In vitro antimicrobial susceptibility testing result can provide reference for clinicians to correctly use antifungal agents for treatment of infection due to this pathogen.

BACKGROUND: Endoscopic sphincterotomy (EST) is widely used to treat common bile duct stones (CBDS); however, long-term studies have revealed the increasing incidence of recurrent CBDS after EST. Loss of sphincter of Oddi function after EST was the main cause of recurrent CBDS. Reparation of the sphincter of Oddi is therefore crucial. This study aims to investigate the effectiveness and safety of endoclip papilloplasty (ECPP) for repairing the sphincter of Oddi and elucidate its mechanism. METHODS: Eight healthy Bama minipigs were randomly divided into the EST group and the ECPP group at a 1:1 ratio, and bile samples were collected before endoscopy and 6 months later. All minipigs underwent transabdominal biliary ultrasonography for the diagnosis of cholelithiasis 6 months after endoscopy. The biliary microbiota composition and alpha and beta diversity were analyzed by 16S ribosomal RNA gene sequencing. Differential metabolites were analyzed by bile acid metabolomics to explore the predictive indicators of cholelithiasis. RESULTS: Three minipigs were diagnosed with cholelithiasis in the EST group, while none in the ECPP group showed cholelithiasis. The biliary Firmicutes/Bacteroidota (F/B) ratio was increased after EST and decreased after ECPP. The Chao1 and observed species index significantly decreased 6 months after EST ( P  = 0.017 and 0.018, respectively); however, the biliary α-diversity was similar before and 6 months after ECPP. The β-diversity significantly differed in the EST group before and 6 months after EST, as well as in the ECPP group before and 6 months after ECPP (analysis of similarities [ANOSIM]: R  = 0.917, P  = 0.040; R  = 0.740, P  = 0.035; respectively). Glycolithocholic acid (GLCA) and taurolithocholic acid (TLCA) accumulated in bile 6 months after EST. CONCLUSIONS ECPP has less impact on the biliary microenvironment than EST and prevents duodenobiliary reflux by repairing the sphincter of Oddi. The bile levels of GLCA and TLCA may be used to predict the risk of cholelithiasis.
Animals ; Swine, Miniature ; Swine ; Cholelithiasis/prevention & control* ; Sphincterotomy, Endoscopic/methods* ; Sphincter of Oddi/surgery* ; Female ; Male

Objective To report a case of fungal keratitis caused by plant pathogens,evidenced by laboratory testing.Methods Specimens were collected by corneal scraping from a 52-year-old male patient for pathogen culture.The patient was treated at Qionghai People's Hospital for fungal keratitis.The isolates were identified and tested for antimicrobial susceptibility.PubMed,CNKI,Wanfang,and VIP database were searched using keywords Diaporthe or Diaporthe phaseolorum in English and Chinese from the establishment of the database to December 10,2024.A retrospective literature review was conducted on the cases of human infection caused by Diaporthe.Results The specimens from corneal scraping were directly examined under a microscope.Septate fungal hyphae were observed.The isolate was identified as Diaporthe phaseolorum by targeted DNA sequencing.Antimicrobial susceptibility testing by microdilution method showed that the minimum inhibitory concentrations(MIC)of fluorocytosine,fluconazole,amphotericin B,voriconazole,itraconazole,posaconazole,micafungin,caspofungin,and anidulafungin against this strain were＞64,64,0.5,0.12,2,0.06,0.03,＜0.03,and 0.12 mg/L,respectively.Clinicians adjusted the antifungal treatment plan timely based on the antimicrobial susceptibility testing results.The patient's vision was restored.Literature review found that of the 12 reported cases of infection worldwide,6 were localized skin or soft tissue infections,3 were peritonitis,and the remaining 3 cases were keratitis.Overall,9 patients were immunocompromised and 3 had normal immune function.Human infections caused by Diaporthe often occur in immunocompromised individuals.Invasive infections often lead to patient mortality.There are no established breakpoints for common antifungal agents against Diaporthe.The MICs against the strain were higher for flucytosine and fluconazole,but lower for azoles,echinocandins,and polyenes.Conclusions Fungal keratitis caused by D.phaseolorum is an emerging infection.The information in this case,including clinical symptoms,the morphology of D.phaseolorum under microscope after corneal scraping,the growth characteristics and antifungal susceptibility testing,targeted DNA sequencing,can inform the microbiology laboratory staff and clinicians of D.phaseolorum infections in the future.

Objective To report the diagnosis and treatment processes of a fungal keratitis case caused by Lasio-diplodia theobromae(L.theobromae),and enhance the diagnosis and treatment experience on fungal keratitis caused by this rare pathogen.Methods Corneal scraping specimen from a patient with fungal keratitis was collec-ted.Gram-staining and fluorescence staining were conducted on specimen,followed with direct microscopic observa-tion and isolation culture.The strain was identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS)technology and targeted DNA sequencing.Antimicrobial susceptibility testing was conducted.Literatures were summarized and clinical data on fungal keratitis caused by this pathogen were sorted out.Results Septal fungal hyphae could be seen on the corneal scraping specimen microscopically.The strain was identified as L.theobromae by both MALDI-TOF MS and targeted DNA sequencing after culture.Antimicrobial susceptibility testing(microdilution method)showed that the minimal inhibitory concentrations(MICs)of ampho-tericin B,vorionazole,itraconazole,posaconazole,fluconazole,5-fluorocytosine,micafungin,caspofungin,and anidulafungin against this strain were 1,0.25,＞8,0.25,＞256,8,16,2,and 0.25 μg/mL,respectively.Pa-tient recovered well after antifungal treatment plan was adjusted according to antimicrobial susceptibility testing re-sults.Conclusion L.theobromae is a rare pathogen that causes fungal keratitis.Laboratory tests provide rapid mi-croscopic examination results,and take MALDI-TOF MS and targeted DNA sequencing identification techniques as effective means to detect rare pathogen.In vitro antimicrobial susceptibility testing result can provide reference for clinicians to correctly use antifungal agents for treatment of infection due to this pathogen.

Objective To report a case of fungal keratitis caused by plant pathogens,evidenced by laboratory testing.Methods Specimens were collected by corneal scraping from a 52-year-old male patient for pathogen culture.The patient was treated at Qionghai People's Hospital for fungal keratitis.The isolates were identified and tested for antimicrobial susceptibility.PubMed,CNKI,Wanfang,and VIP database were searched using keywords Diaporthe or Diaporthe phaseolorum in English and Chinese from the establishment of the database to December 10,2024.A retrospective literature review was conducted on the cases of human infection caused by Diaporthe.Results The specimens from corneal scraping were directly examined under a microscope.Septate fungal hyphae were observed.The isolate was identified as Diaporthe phaseolorum by targeted DNA sequencing.Antimicrobial susceptibility testing by microdilution method showed that the minimum inhibitory concentrations(MIC)of fluorocytosine,fluconazole,amphotericin B,voriconazole,itraconazole,posaconazole,micafungin,caspofungin,and anidulafungin against this strain were＞64,64,0.5,0.12,2,0.06,0.03,＜0.03,and 0.12 mg/L,respectively.Clinicians adjusted the antifungal treatment plan timely based on the antimicrobial susceptibility testing results.The patient's vision was restored.Literature review found that of the 12 reported cases of infection worldwide,6 were localized skin or soft tissue infections,3 were peritonitis,and the remaining 3 cases were keratitis.Overall,9 patients were immunocompromised and 3 had normal immune function.Human infections caused by Diaporthe often occur in immunocompromised individuals.Invasive infections often lead to patient mortality.There are no established breakpoints for common antifungal agents against Diaporthe.The MICs against the strain were higher for flucytosine and fluconazole,but lower for azoles,echinocandins,and polyenes.Conclusions Fungal keratitis caused by D.phaseolorum is an emerging infection.The information in this case,including clinical symptoms,the morphology of D.phaseolorum under microscope after corneal scraping,the growth characteristics and antifungal susceptibility testing,targeted DNA sequencing,can inform the microbiology laboratory staff and clinicians of D.phaseolorum infections in the future.

Objective To translate the nursing time management scale(NTMS)into Chinese and test its reliability and validity,hence to provide a tool for evaluating the time management among nurses in China.Methods Authorised by the author on June 30th,2023,the English version of NTMS was translated into a Chinese version through forward translation,reverse translation,cross-cultural debugging and pre-test by using Brislin translation model.Between September 2023 and January 2024,a convenience sampling method was employed to select a total of 409 nurses as the test subjects from five hospitals of Grade IIA and above in Dongguan.Then the reliability and validity of the translated version of NTMS were tested.Results All 409 nurses completed the tests.The Chinese version of NTMS included three dimensions comprising 15 items:6 in nursing work planning and goal setting,3 in organisation of nursing work and 6 in coordination of nursing work.It was found that the mean scale content validity index(S-CVI/Ave)was 0.920,and the item-level CVI(I-CVI)ranged from 0.840 to 1.000.The overall Cronbach's α coefficient of the scale was 0.894,with 0.700 for the split-half reliability coefficient of and 0.942 for the retest reliability.The Cronbach's α coefficient of each of the 3 dimensions ranged from 0.781 to 0.901,with the split-half reliability coefficient from 0.823 to 0.870 and the retest reliability from 0.692 to 0.965.In the exploratory factor analysis,the KMO value was 0.904.The statistic test of Bartlett's sphericity was 3941.503(P<0.05),with the factor load range of each entry from 0.629 to 0.838.The cumulative variance contribution rate was 67.672%.Conclusion The translated Chinese version of the nursing time management scale demonstrates good reliability and validity.It can be applied as an effective evaluation tool in the nursing time management.

Objective By analyzing the anti-tumor innovative drug policies text in China,this study aimed to explore the focus and shortcomings of policies related to anti-tumor innovative drugs,and provide the reference for future policy formula-tion and optimization in the field of anti-tumor innovative drug.Methods By accessing the official websites of relevant minis-tries and subordinate institutions such as the Central Committee of the Communist Party of China,the State Council of the People's Republic of China,the National Health Commission of the People's Republic of China,and National Medical Products Administra-tion,and using the keywords"cancer","tumor","anti-tumor drug",and"innovative drug",etc,the national level policies related to the anti-tumor innovative drugs from January 1,2005,to December 31,2022,were collected.Based on a two-dimensional analy-sis framework of policy tools and stakeholders,the collected policy texts were classified,encoded,and statistically analyzed.Results A total of 30 policy texts were involved,and a total of 90 policy codes were generated.There were 24,43,and 23 codes for demand-based policy tools,environmental policy tools,and supply-based policy tools,accounting for 26.67%,47.78%,and 25.56%,respectively.Based on policy tools and stakeholders,a total of 183 codes were generated,with government departments,pharmaceutical enterprises,medical institutions,and patients having 70,36,54,and 23 codes respectively,accounting for 38.25%,19.67%,29.51%,and 12.57%.Conclusions China had the highest proportion of environmental policy tools in the application of innovative anti-tumor drug policies,while supply-oriented and demand-oriented policy tools were underutilized,resulting in an overall imbalance in application;The distribution pattern of stakeholders was not coordinated,with government departments and medical institutions having higher attention than pharmaceutical enterprises and patients..It was necessary to reasonably promote the collaborative application of anti-tumor innovative drug policy tools,scientifically plan the layout of anti-tumor innovative drug policy sub-tools,and balance the interests of all stakeholders to ensure the efficient implementation of the policies.

Background/Aims: Gastric intestinal metaplasia (GIM), a common precancerous lesion of gastric cancer, can be caused by bile acid reflux. GATA binding protein 4 (GATA4) is an intestinal transcription factor involved in the progression of gastric cancer. However, the expression and regulation of GATA4 in GIM has not been clarified. Methods: The expression of GATA4 in bile acid-induced cell models and human specimens was examined. The transcriptional regulation of GATA4 was investigated by chromatin immunoprecipitation and luciferase reporter gene analysis. An animal model of duodenogastric reflux was used to confirm the regulation of GATA4 and its target genes by bile acids. Results: GATA4 expression was elevated in bile acid-induced GIM and human specimens.GATA4 bound to the promoter of mucin 2 (MUC2) and stimulate its transcription. GATA4 and MUC2 expression was positively correlated in GIM tissues. Nuclear transcription factor-κB activation was required for the upregulation of GATA4 and MUC2 in bile acid-induced GIM cell models. GATA4 and caudal-related homeobox 2 (CDX2) reciprocally transactivated each other to drive the transcription of MUC2. In chenodeoxycholic acid-treated mice, MUC2, CDX2, GATA4, p50, and p65 expression levels were increased in the gastric mucosa. Conclusions GATA4 is upregulated and can form a positive feedback loop with CDX2 to transactivate MUC2 in GIM. NF-κB signaling is involved in the upregulation of GATA4 by chenodeoxycholic acid.