OBJECTIVE To investigate a suspected hospital-acquired infection cluster of Enterococcus faecium(Efm)in a neonatal intensive care unit(NICU)of the First Medical Center of Chinese PLA General Hospital,identify the source of infection and transmission routes,and provide a reference for precise prevention and control of hospital-acquired infections.METHODS Epidemiological investigations and environmental microbiological sam-pling were conducted for two neonates with Efm bloodstream infections in the NICU in Jul.2024 to detect Efm in the ward environment.Whole-genome average nucleotide identity(ANI)and multilocus sequence typing(MLST)were used to analyze the homology,drug resistance,and virulence factors of Efm isolates from patients and envi-ronments.Targeted intervention measures were proposed.RESULTS Two cases of Efm bloodstream infection were detected.A total of 37 environmental specimens were collected,and 2 were cultured Efm(the wipe dispenser o-pening and incubator handle of the patients).The drug susceptibility testing results of 2 environmental specimens were consistent with those of the two patient specimens.Genomic analysis confirmed high homology(ANI＞99.99％)among the four Efm isolates.After implementing a series of measures including centralized isolation,strict hand hygiene,thorough environmental cleaning and disinfection,strict disinfection and management of inva-sive devices,enhanced grouping of medical staff for diagnosis and treatment,the incident was effectively con-trolled.CONCLUSIONS This incident can be determined as cluster of hospital-acquired infection with Enterococcus faecium in the neonatal intensive care unit.The wet wipes are the source or transmission medium of contamina-tion.Inadequate disinfection of items and the environment,and insufficient hand hygiene of medical staff are the main reasons for this infection outbreak.Early identification of abnormal cluster of infection,investigation of the source of infection and transmission routes and timely implementation of targeted measures are the keys for preventing infection outbreaks.

Objective To construct a prediction model of epidermal growth factor receptor(EGFR)gene mutation in patients with non-small cell lung cancer(NSCLC)based on spectral CT parameters,lymphocyte to monocyte ratio(LMR)and systemic inflam-mation response index(SIRI).Methods The spectral CT parameters,LMR and SIRI of EGFR mutant and wild types NSCLC patients were compared,respectively.The influencing factors of EGFR gene mutation were analyzed and a risk prediction model was estab-lished.Results The LMR,70 keV CT value in arterial phase and venous phase,normalized iodine concentration(NIC),slope of spectral curve(λHU)and venous phase ΔCT value in EGFR mutant type patients were significantly higher than those in EGFR wild type patients,while SIRI,arterial phase and venous phase normalized water concentration(NWC)were significantly lower than those in EGFR wild type patients(P<0.05).Female,adenocarcinoma,no smoking history,LMR,increased NIC,λHU,and ΔCT value in venous phase were the risk factors for EGFR gene mutation,and increased SIRI was a protective factor(P<0.05).The decision curve showed that when the risk threshold was 0.2-0.6,the prediction model had a good risk-benefit ratio.The P value of Hosmer-Lemeshow goodness of fit test was 0.519,and the area under the curve for predicting EGFR gene mutation in NSCLC patients was 0.911.Conclusion Spectral CT parameters,LMR and SIRI may be associated with EGFR gene mutation in NSCLC patients,the model constructed based on the above indicators has a high predictive efficacy for EGFR gene mutation.

Objective To explore the value of diffusion-weighted imaging(DWI)and apparent diffusion coefficient(ADC)in magnetic resonance imaging(MRI)in differential diagnosis of benign and malignant cervical lymph nodes in patients with nasopharyngeal carcinoma.Methods Clinical data of 98 patients diagnosed with nasopharyngeal carcinoma were retrospectively analyzed.This cohort included 65 patients with pathologically confirmed malignant lymph nodes and 33 patients with benign lymph nodes.Prior to pathological diagnosis,all patients underwent routine MRI scans and DWI.ADC values of both benign and malignant lymph nodes were recorded.The diagnostic performance was evaluated using receiver operating characteristic(ROC)curve analysis.Additionally,the diagnostic efficacy of MRI and ADC values in distinguishing benign and malignant lymph nodes of nasopharyngeal carcinoma was compared.Results Of the 65 patients with malignant lymph nodes,42 cases were accompanied by liquefactive necrosis,and 13 cases were accompanied by extracapsular invasion.Most benign lymph nodes showed no signal on DWI sequence,while malignant lymph nodes showed obvious high signal or mixed signals.The ADC value of benign lymph nodes was(1.724±0.365)×10-3 mm2/s,which was higher than that of malignant nodes(1.022±0.210)×10-3 mm2/s(P＜0.01).The ROC curve analysis results showed that the area under the curve of ADC value for diagnosing benign and malignant lymph nodes was 0.843(95%CI:0.782-0.904),with a cutoff value of 1.363×10-3 mm2/s.At this point,the sensitivity and specificity for differentiating benign and malignant lymph nodes were 0.856 and 0.849,respectively,and Youden index was 0.705.When the ADC value was lower than the cutoff value,the accuracy,sensitivity and specificity for differentiating cervical lymph nodes in nasopharyngeal carcinoma patients were 0.878,0.892 and 0.848,respectively,which were superior to MRI(P＜0.05).Conclusion The DWI images of malignant lymph nodes in patients with nasopharyngeal carcinoma show high signal and low ADC,and ADC has high efficiency in the differential diagnosis of benign and malignant cervical lymph nodes.

Objective:To explore the relationships between physical activity and cognitive impairment in older adults aged ≥65 years in longevity areas in China.Methods:A total of 6 081 older adults aged ≥65 years from the Healthy Ageing and Biomarkers Cohort Study in China in 2021 were included in this study. Information about their demographic characteristics, lifestyles, and chronic disease histories were collected, the intensity of physical activity was evaluated by using Physical Activity Scale for the Elderly, and the cognitive function was evaluated by using Mini-Mental State Examination Scale (Chinese version). Multifactorial logistic regression model was used to analyze the associations between different levels and types of physical activity and cognitive impairment in older adults.Results:In the 6 081 older adults, 1 829 (30.1%) had cognitive impairment. After adjusting for confounders, older adults with T2 and T3 levels of physical activity had lower risks for cognitive impairment compared with those with T1 levels of physical activity, with ORs of 0.47 (95% CI: 0.40-0.55) and 0.22 (95% CI: 0.18-0.28). The results of different types of physical activities showed that the ORs in leisure activity T2 and T3 groups were 0.52 (95% CI: 0.44-0.63) and 0.49 (95% CI: 0.41-0.58), and the ORs in housework activity T2 and T3 groups were 0.36 (95% CI: 0.30-0.42) and 0.19 (95% CI: 0.16-0.24). There was no significant association between work-related activity and cognitive impairment. Conclusion:There is a negative association between the intensity level of physical activity and cognitive impairment, and active leisure and household activities might reduce the risk for cognitive impairment.

Objective:To explore the relationship between urinary cadmium levels and thyroid hormone levels in people aged 40-89 years old in selected areas of China.Methods:Based on the "Investigation of the Impact of Soil Quality of Agricultural Land on Human Health in Typical Areas" project from October 2019 to August 2020, a multi-stage stratified random sampling method was used to include 6 588 middle-aged and older adults aged 40-89. Demographic characteristics, dietary frequency and disease status were collected through the questionnaire and physical examination. Urinary cadmium and urinary creatinine were detected by random midstream urine. Fasting venous blood was collected for the detection of Triiodothyronine (T3) and Thyroxine (T4). The linear mixed effects model was used to explore the association of urine cadmium levels with thyroid hormone levels. Its dose-response relationship was explored by using the restricted cubic spline.Results:The age of the subjects was (63.48±12.18) years, with males accounting for 51.28%. The M ( Q 1,Q 3) of urinary cadmium level, T3 and T4 was 2.48 (1.36, 4.42) μg/g·creatinine, (1.96±0.51) nmol/L and (113.75±29.11) nmol/L, respectively. The linear mixed effects model showed that the changes of T3 and T4 were 0.027 (0.009, 0.044) nmol/L and 2.019 (1.084, 2.953) nmol/L for each one-unit increase (natural logarithm transformed) of urinary cadmium. The restricted cubic spline showed that there was a positive nonlinear association between urinary cadmium and T3 as well as T4 (all Pnonlinear<0.05). Conclusion:In selected areas of China, the urinary cadmium level of middle-aged and older adults aged 40-89 years is positively associated with T3 and T4.

Objective:To evaluate the levels and source of cadmium exposure by dietary pathway among middle-aged and elderly people ≥40 in cadmium-contaminated areas of China.Methods:A total of 7 193 people aged 40-89 years from four typical cadmium-contaminated areas in China were selected as the study subjects. Food Frequency Questionnaire (FFQ), Total Diet Study (TDS) and a 3-day-24-hour dietary recall survey were conducted. Dietary cadmium intake and food sources through dietary pathways were assessed based on cadmium content in foods, consumption amounts and intake frequencies.Results:The mean age of the participants was 63.39±12.21 years, with 50.05% being males. The average monthly dietary cadmium intake was 7.39 μg/(kg·BW). Staple foods and vegetables were the primary sources of dietary cadmium intake, accounting for 57.51% and 32.48%, respectively. The monthly dietary cadmium intake in all surveyed regions did not exceed the Provisional Tolerable Monthly Intake (PTMI) recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA).Conclusion:The monthly dietary cadmium intake among middle-aged and elderly people in cadmium-contaminated areas of China is relatively low, with the risk remaining at an acceptable level. Staple foods and vegetables are the most significant contributors to dietary cadmium intake.

Objective To analyze the results of human-machine coupling quality control(QC)for inpatient medical re-cords,compare them with manual QC results,and evaluate the value of the human-machine coupling approach.Methods Dis-charge medical records from a tertiary hospital between January 1,2024,and November 30,2024,underwent QC via two meth-ods:human-machine coupling QC and manual QC.Manual QC was performed based on medical record documentation standards and medical record management quality control indicators.The differences in the results obtained by human-machine coupling QC and manual QC were statistically analyzed.Results The human-machine coupling method reviewed 76 204 medical records,i-dentifying 204 544 issues.Manual QC reviewed 521 records,identifying 2 032 issues.The identified problems were categorized into five types:documentation,diagnosis and treatment,front page(administrative data),communication documents,and ap-proval documents.Conclusion Rule-based human-machine coupling QC achieves comprehensive and full-process coverage of inpatient medical records.The generated QC reports can display the distribution and correction status of detected issues,provi-ding a basis and direction for hospital management.

Objective:To explore the relationships between physical activity and cognitive impairment in older adults aged ≥65 years in longevity areas in China.Methods:A total of 6 081 older adults aged ≥65 years from the Healthy Ageing and Biomarkers Cohort Study in China in 2021 were included in this study. Information about their demographic characteristics, lifestyles, and chronic disease histories were collected, the intensity of physical activity was evaluated by using Physical Activity Scale for the Elderly, and the cognitive function was evaluated by using Mini-Mental State Examination Scale (Chinese version). Multifactorial logistic regression model was used to analyze the associations between different levels and types of physical activity and cognitive impairment in older adults.Results:In the 6 081 older adults, 1 829 (30.1%) had cognitive impairment. After adjusting for confounders, older adults with T2 and T3 levels of physical activity had lower risks for cognitive impairment compared with those with T1 levels of physical activity, with ORs of 0.47 (95% CI: 0.40-0.55) and 0.22 (95% CI: 0.18-0.28). The results of different types of physical activities showed that the ORs in leisure activity T2 and T3 groups were 0.52 (95% CI: 0.44-0.63) and 0.49 (95% CI: 0.41-0.58), and the ORs in housework activity T2 and T3 groups were 0.36 (95% CI: 0.30-0.42) and 0.19 (95% CI: 0.16-0.24). There was no significant association between work-related activity and cognitive impairment. Conclusion:There is a negative association between the intensity level of physical activity and cognitive impairment, and active leisure and household activities might reduce the risk for cognitive impairment.

Objective To construct a prediction model of epidermal growth factor receptor(EGFR)gene mutation in patients with non-small cell lung cancer(NSCLC)based on spectral CT parameters,lymphocyte to monocyte ratio(LMR)and systemic inflam-mation response index(SIRI).Methods The spectral CT parameters,LMR and SIRI of EGFR mutant and wild types NSCLC patients were compared,respectively.The influencing factors of EGFR gene mutation were analyzed and a risk prediction model was estab-lished.Results The LMR,70 keV CT value in arterial phase and venous phase,normalized iodine concentration(NIC),slope of spectral curve(λHU)and venous phase ΔCT value in EGFR mutant type patients were significantly higher than those in EGFR wild type patients,while SIRI,arterial phase and venous phase normalized water concentration(NWC)were significantly lower than those in EGFR wild type patients(P<0.05).Female,adenocarcinoma,no smoking history,LMR,increased NIC,λHU,and ΔCT value in venous phase were the risk factors for EGFR gene mutation,and increased SIRI was a protective factor(P<0.05).The decision curve showed that when the risk threshold was 0.2-0.6,the prediction model had a good risk-benefit ratio.The P value of Hosmer-Lemeshow goodness of fit test was 0.519,and the area under the curve for predicting EGFR gene mutation in NSCLC patients was 0.911.Conclusion Spectral CT parameters,LMR and SIRI may be associated with EGFR gene mutation in NSCLC patients,the model constructed based on the above indicators has a high predictive efficacy for EGFR gene mutation.

Objective To explore the value of diffusion-weighted imaging(DWI)and apparent diffusion coefficient(ADC)in magnetic resonance imaging(MRI)in differential diagnosis of benign and malignant cervical lymph nodes in patients with nasopharyngeal carcinoma.Methods Clinical data of 98 patients diagnosed with nasopharyngeal carcinoma were retrospectively analyzed.This cohort included 65 patients with pathologically confirmed malignant lymph nodes and 33 patients with benign lymph nodes.Prior to pathological diagnosis,all patients underwent routine MRI scans and DWI.ADC values of both benign and malignant lymph nodes were recorded.The diagnostic performance was evaluated using receiver operating characteristic(ROC)curve analysis.Additionally,the diagnostic efficacy of MRI and ADC values in distinguishing benign and malignant lymph nodes of nasopharyngeal carcinoma was compared.Results Of the 65 patients with malignant lymph nodes,42 cases were accompanied by liquefactive necrosis,and 13 cases were accompanied by extracapsular invasion.Most benign lymph nodes showed no signal on DWI sequence,while malignant lymph nodes showed obvious high signal or mixed signals.The ADC value of benign lymph nodes was(1.724±0.365)×10-3 mm2/s,which was higher than that of malignant nodes(1.022±0.210)×10-3 mm2/s(P＜0.01).The ROC curve analysis results showed that the area under the curve of ADC value for diagnosing benign and malignant lymph nodes was 0.843(95%CI:0.782-0.904),with a cutoff value of 1.363×10-3 mm2/s.At this point,the sensitivity and specificity for differentiating benign and malignant lymph nodes were 0.856 and 0.849,respectively,and Youden index was 0.705.When the ADC value was lower than the cutoff value,the accuracy,sensitivity and specificity for differentiating cervical lymph nodes in nasopharyngeal carcinoma patients were 0.878,0.892 and 0.848,respectively,which were superior to MRI(P＜0.05).Conclusion The DWI images of malignant lymph nodes in patients with nasopharyngeal carcinoma show high signal and low ADC,and ADC has high efficiency in the differential diagnosis of benign and malignant cervical lymph nodes.