OBJECTIVE To observe the epidemiological characteristics,virulence and drug resistance genes in Kleb-siella oxytoca complex(KOX)strains isolated from the children in Suzhou so as to provide theoretical bases for clinical prevention and control.METHODS The clinical distribution and drug resistance of 101 strains of KOX that were isolated from Children's Hospital of Soochow University from Jan.2021 to Mar.2024 were retrospectively analyzed.Fifty strains were randomly selected to detect the expressions of 18 types of virulence genes and 12 types of drug resistance genes.RESULTS Of the 97 strains of KOX isolated from hospitalized children,32.67％from i-solated from sputum,27.72％from stools and 24.74％from urine;45.54％were isolated from hematology de-partment,18.81％from neonatology department and 10.89％from ICU.The strains expressed a variety of viru-lence genes,among which the ironophore-related genes entB(82.00％),irp-1(64.00％),irp-2(64.00％),ybtS(64.00％)and fyuA(64.00％)were dominant.Carbapenem-sensitive KOX(CS-KOX)strains were susceptible to most of the antibiotics,while the drug resistance rates of the CR-KOX strains to most of the antibiotics were relatively high.The detection rates of extended-spectrum β-lactamase gene CTX(56.52％)and carbapenemase gene NDM(78.26％)were relatively high among the CR-KOX strains;38.89％(7/18)of the strains expressed NDM gene and meanwhile expressed other carbapenemase genes.CONCLUSIONS The KOX strains isolated from the hospitalized children in Suzhou carry a variety of virulence and drug resistance genes,and there is risk of trans-mission of CR-KOX in the hospital.Therefore,it is necessary to attach great importance to the surveillance of drug-resistant strains for the long-term hospitalized children and raise the awareness of infection control so as to prevent the transmission of such bacteria.

OBJECTIVE To observe the epidemiological characteristics,virulence and drug resistance genes in Kleb-siella oxytoca complex(KOX)strains isolated from the children in Suzhou so as to provide theoretical bases for clinical prevention and control.METHODS The clinical distribution and drug resistance of 101 strains of KOX that were isolated from Children's Hospital of Soochow University from Jan.2021 to Mar.2024 were retrospectively analyzed.Fifty strains were randomly selected to detect the expressions of 18 types of virulence genes and 12 types of drug resistance genes.RESULTS Of the 97 strains of KOX isolated from hospitalized children,32.67％from i-solated from sputum,27.72％from stools and 24.74％from urine;45.54％were isolated from hematology de-partment,18.81％from neonatology department and 10.89％from ICU.The strains expressed a variety of viru-lence genes,among which the ironophore-related genes entB(82.00％),irp-1(64.00％),irp-2(64.00％),ybtS(64.00％)and fyuA(64.00％)were dominant.Carbapenem-sensitive KOX(CS-KOX)strains were susceptible to most of the antibiotics,while the drug resistance rates of the CR-KOX strains to most of the antibiotics were relatively high.The detection rates of extended-spectrum β-lactamase gene CTX(56.52％)and carbapenemase gene NDM(78.26％)were relatively high among the CR-KOX strains;38.89％(7/18)of the strains expressed NDM gene and meanwhile expressed other carbapenemase genes.CONCLUSIONS The KOX strains isolated from the hospitalized children in Suzhou carry a variety of virulence and drug resistance genes,and there is risk of trans-mission of CR-KOX in the hospital.Therefore,it is necessary to attach great importance to the surveillance of drug-resistant strains for the long-term hospitalized children and raise the awareness of infection control so as to prevent the transmission of such bacteria.

OBJECTIVES: To analyze bone mass distribution and the factors affecting bone mass in a general Chinese Han cohort undergoing physical examinations at our center. METHODS: We retrospectively collected the data of bone mineral density (BMD) measurements from 30 599 healthy Han Chinese adults (age≥20 years) who underwent dual-energy X-ray absorptiometry scans at our hospital from July, 2013 to July, 2023. Basic parameters including height, body weight, and gender were recorded, and descriptive statistics and correlation analyses were performed using R software. RESULTS: In this cohort, the male individuals had a mean peak BMD of 1.00±0.12 g/cm² in the lumbar vertebrae, 0.94±0.14 g/cm² in the femoral neck, and 0.99±0.13 g/cm² in the total hip, significantly higher than the values in the female individuals [0.99±0.12 g/cm² in the lumbar vertebrae (P=0.022), 0.79±0.11 g/cm² in the femoral neck (P<0.001), and 0.88±0.11 g/cm² in the total hip (P<0.001)]. In the overall cohort, the BMD values of the lumbar spine and femur decreased with age after reaching their peak levels. There was a positive correlation between BMD value and body mass index (BMI) in both male and female individuals. The 2013-2014 period recorded the lowest BMD values in the lumbar, hip, and femoral neck, which tended to increase steadily in the following years (2015-2023). CONCLUSIONS Our data suggest that the BMD values vary among different populations, and future multi-center studies using more accurate BMD detection technology are warranted to capture the variation patterns of BMD with demographic characteristics of specific populations.
Humans ; Bone Density ; Absorptiometry, Photon ; Male ; Female ; Retrospective Studies ; Osteoporosis/diagnostic imaging* ; Adult ; Middle Aged ; Lumbar Vertebrae/diagnostic imaging* ; China/epidemiology* ; Femur Neck/diagnostic imaging* ; Aged ; Beijing/epidemiology* ; Young Adult

Objective:To explore the value of difference value and relative value of pulmonary vascular quantitative parameters of biphasic CT in diagnosis of chronic obstructive pulmonary disease (COPD) and high-risk groups.Methods:The study was a cross-sectional study. A retrospective study of 624 patients who underwent biphasic chest CT scanning in the Second Affiliated Hospital of PLA Naval Medical University from August 2018 to December 2020. Subjects were divided into three groups according to pulmonary function test: normal group ( n=321), preserved ratio impaired spirometry (PRISm) ( n=204) and COPD group ( n=99). The pulmonary vascular quantitative parameters were obtained by the workstation, including the number of pulmonary vessels (N total), cross-sectional area less than that of 5 mm 2 (N CSA5), vessel area (VA total) of 9, 12, 15, 18, 21 mm from the pleura, total blood vessels volume (TBV) and total blood vessels volume under 5 mm 2 (BV5) at expiratory and inspiratory phase. The difference value, relative value of biphasic CT were calculated. ANOVA test or Kruskal-Wallis H test was used to compare the differences of pulmonary vascular quantitative parameters among the three groups, and LSD or Bonferroni tests were used for multiple comparisons. Results:The N total, N CSA5, VA total of the whole lung in the inspiratory phase at the level of 9, 12, 15, 18 and 21 mm from the pleura and TBV, BV5 in the normal group, PRISm group and COPD group, showed an overall trend of decreasing and then increasing, and the PRISm group was lower than those of the normal group ( P<0.05). The differences in N total, N CSA5, VA total between the COPD group and the normal group at the level of 9 and 21 mm from the pleura were not statistically significant ( P>0.05), while the N total, N CSA5, V Atotal of biphasic difference value and relative value in COPD group demonstrated a significant difference from those in normal group ( P<0.05). Conclusion:The difference value and relative value of pulmonary vascular quantitative parameters in biphasic CT are more useful than single inspiratory-phase vascular parameters to differentiate the changes in pulmonary vascular remodeling between COPD patients and the normal population, and also to complement the pulmonary vascular characteristics of the PRISm population, which can provide a basis for early warning of COPD and high-risk populations.

Objective:To assess the effectiveness of a model created using clinical features and preoperative chest CT imaging features in predicting the chronic obstructive pulmonary disease (COPD) among patients diagnosed with lung cancer.Methods:A retrospective analysis was conducted on clinical (age, gender, smoking history, smoking index, etc.) and imaging (lesion size, location, density, lobulation sign, etc.) data from 444 lung cancer patients confirmed by pathology at the Second Affiliated Hospital of Naval Medical University between June 2014 and March 2021. These patients were randomly divided into a training set (310 patients) and an internal test set (134 patients) using a 7∶3 ratio through the random function in Python. Based on the results of pulmonary function tests, the patients were further categorized into two groups: lung cancer combined with COPD and lung cancer non-COPD. Initially, univariate analysis was performed to identify statistically significant differences in clinical characteristics between the two groups. The variables showing significance were then included in the logistic regression analysis to determine the independent factors predicting lung cancer combined with COPD, thereby constructing the clinical model. The image features underwent a filtering process using the minimum absolute value convergence and selection operator. The reliability of these features was assessed through leave-P groups-out cross-validation repeated five times. Subsequently, a radiological model was developed. Finally, a combined model was established by combining the radiological signature with the clinical features. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) curves were plotted to evaluate the predictive capability and clinical applicability of the model. The area under the curve (AUC) for each model in predicting lung cancer combined with COPD was compared using the DeLong test.Results:In the training set, there were 182 cases in the lung cancer combined with COPD group and 128 cases in the lung cancer non-COPD group. The combined model demonstrated an AUC of 0.89 for predicting lung cancer combined with COPD, while the clinical model achieved an AUC of 0.82 and the radiological model had an AUC of 0.85. In the test set, there were 78 cases in the lung cancer combined with COPD group and 56 cases in the lung cancer non-COPD group. The combined model yielded an AUC of 0.85 for predicting lung cancer combined with COPD, compared to 0.77 for the clinical model and 0.83 for the radiological model. The difference in AUC between the radiological model and the clinical model was not statistically significant ( Z=1.40, P=0.163). However, there were statistically significant differences in the AUC values between the combined model and the clinical model ( Z=-4.01, P=0.010), as well as between the combined model and the radiological model ( Z=-2.57, P<0.001). DCA showed the maximum net benifit of the combined model. Conclusion:The developed synthetic diagnostic combined model, incorporating both radiological signature and clinical features, demonstrates the ability to predict COPD in patients with lung cancer.

Abstract: Objective To investigate the clinical distribution characteristics, drug resistance trends and the carrying of antiseptic resistance gene of Pseudomonas aeruginosa infection in children in Suzhou, in order to provide theoretical basis for the prevention and treatment of Pseudomonas aeruginosa infection in children. Methods The clinical distribution characteristics and drug resistance trends of Pseudomonas aeruginosa isolated from Children's Hospital of Soochow University from 2016 to 2021 were retrospectively analyzed. Forthermore, 101 strains of Pseudomonas aeruginosa were randomly selected to detect the expression of 9 antiseptic resistance genes (qacEΔ1-sul1, qacE, qacEΔ1, qacG, sugE(p), sugE©, emrE, ydgE, ydgF) by polymerase chain reaction. Results Pseudomonas aeruginosa in Soochow University Children's Hospital was mainly isolated from respiratory specimen (47.83%), pus (28.60%) and urine (11.72%); the main departments were intensive care unit(21.45%), general surgery department (15.71%) and respiratory department (12.31%). Patients were mainly aged from 1 month to 1 year old and older than 6 years old (34.31% and 25.38%). The top three drug resistance rates of Pseudomonas aeruginosa were imipenem (11.25%), aztreonam (9.26%) and meropenem (8.02%). Among the 853 strains of Pseudomonas aeruginosa, the drug-resistant strains were mainly from the intensive care unit (58/183), hematology department (33/91), neonatology department (31/96), and there were 57 strains of multi-drug-resistant strains with the detection rate of 6.68%. There were 98 strains (11.49%) of Carbapenem resistant Pseudomonas aeruginosa, and the annual detection rates were 22.06%, 8.40%, 3.60%, 5.67%, 9.85% and 17.20%, respectively. Among the 9 antiseptic resistance genes, the carrying rate of ydgF, sugE© and qacE was 98.02%, 94.06% and 0 respectively. Conclusion Pseudomonas aeruginosa has high resistance to some drugs, so attention should be paid to rational drug use. The carriage rates of of two antiseptic resistance genes exceeded 90%, indicating the need to strengthen research on the mechanism of antiseptic resistance research and rational use of disinfectants

Objective:To explore the differences of functional small airway and pulmonary vascular parameters in chronic obstructive pulmonary disease (COPD) of different imaging phenotypes.Methods:One hundred and thirty COPD patients underwent biphasic CT scanning in Shanghai Changzheng Hospital from August 2018 to August 2020 were analyzed retrospectively. The patients were classified into three phenotypes based on the presence of emphysema and bronchial wall thickening on CT images. Phenotype A: no emphysema or mild emphysema, with or without bronchial wall thickening; Phenotype E: obvious emphysema without bronchial wall thickening; phenotype M: significant emphysema and bronchial wall thickening were present. Parametric response map (PRM) and pulmonary vascular parameters were quantitatively measured at the whole lung level. PRM parameters included the volume of emphysema (PRMV Emphysema), the volume of functional small airway (PRMV fSAD), the volume of normal pulmonary parenchyma (PRMV Normal) and its volume percentage (%). Pulmonary vascular parameters included the number of vessels (N) and cross-sectional area vessels<5 mm 2 (N -CSA<5) at 6, 9, 12, 15, 18 21, 24 mm distance from the pleura. ANOVA or Kruskal-Wallis H tests were used to compare the differences for PRM and pulmonary vascular parameters among the three phenotypes, and LSD or Bonferroni tests were used for multiple comparisons. Results:There were significant differences among the three phenotypes for PRMV fSAD, PRMV Emphysema, PRMV fSAD%, PRMV Emphysema%, and PRMV Normal% at the whole lung level ( P<0.05). PRMV Emphysema, PRMV Emphysema%, PRMV Fsad, PRMV fSAD% of phenotype A were lower than those of phenotype E and M ( P<0.001), while there was no significant difference for PRMV Emphysema, PRMV Emphysema%, PRMV fSAD, PRMV fSAD% between phenotype E and phenotype M ( P>0.05). There were significant differences in N and N -CSA<5 that 6 mm distance from the pleura among the three groups( P<0.05). Among them, N and N -CSA<5 that 6 mm distance from pleura in phenotype M were significantly lower than those in phenotype A( P<0.001,0.002); No significant differences was found in N between phenotype M and phenotype E( P>0.05), while there was significant differences in N -CSA<5 between phenotype M and phenotype E( P=0.034). Conclusion:Biphasic quantitative CT analysis can reflect the heterogeneity of the functional small airways and pulmonary vascular abnormality in COPD with different phenotypes, and provide objective evidence for individualized diagnosis and treatment.

Objective:To explore the predictive value of random forest regression model for pulmonary function test.Methods:From August 2018 to December 2019, 615 subjects who underwent screening for three major chest diseases in Shanghai Changzheng Hospital were analyzed retrospectively. According to the ratio of forced expiratory volume in the first second to forced vital capacity (FEV 1/FVC) and the percentage of forced expiratory volume in the first second to the predicted value (FEV 1%), the subjects were divided into normal group, high risk group and chronic obstructive pulmonary disease (COPD) group. The CT quantitative parameter of small airway was parameter response mapping (PRM) parameters, including lung volume, the volume of functional small airways disease (PRMV fSAD), the volume of emphysema (PRMV Emph), the volume of normal lung tissue (PRMV Normal), the volume of uncategorized lung tissue (PRMV Uncategorized) and the percentage of the latter four volumes to the whole lung (%). ANOVA or Kruskal Wallis H was used to test the differences of basic clinical characteristics (age, sex, height, body mass), pulmonary function parameters and small airway CT quantitative parameters among the three groups; Spearman test was used to evaluate the correlation between PRM parameters and pulmonary function parameters. Finally, a random forest regression model based on PRM combined with four basic clinical characteristics was constructed to predict lung function. Results:There were significant differences in the parameters of whole lung PRM among the three groups ( P<0.001). Quantitative CT parameters PRMV Emph, PRMV Emph%, and PRMV Normal% showed a moderate correlation with FEV 1/FVC ( P<0.001). Whole lung volume, PRMV Normal,PRMV Uncategorized and PRMV Uncategorized% were strongly or moderately positively correlated with FVC ( P<0.001), other PRM parameters were weakly or very weakly correlated with pulmonary function parameters. Based on the above parameters, a random forest model for predicting FEV 1/FVC and a random forest model for predicting FEV 1% were established. The random forest model for predicting FEV 1/FVC predicted FEV 1/FVC and actual value was R 2=0.864 in the training set and R 2=0.749 in the validation set. The random forest model for predicting FEV 1% predicted FEV 1% and the actual value in the training set was R 2=0.888, and the validation set was R 2=0.792. The sensitivity, specificity and accuracy of predicting FEV 1% random forest model for the classification of normal group from high-risk group were 0.85(34/40), 0.90(65/72) and 0.88(99/112), respectively; and the sensitivity, specificity and accuracy of predicting FEV 1/FVC random forest model for differentiating non COPD group from COPD group were 0.89(8/9), 1.00 (112/112) and 0.99(120/121), respectively. While the accuracy of two models combination for subclassification of COPD [global initiative for chronic obstructive lung disease (GOLD) Ⅰ, GOLDⅡ and GOLD Ⅲ+Ⅳ] was only 0.44. Conclusions:Small airway CT quantitative parameter PRM can distinguish the normal population, high-risk and COPD population. The comprehensive regression prediction model combined with clinical characteristics based on PRM parameter show good performance differentiating normal group from high risk group, and differentiating non-COPD group from COPD group. Therefore, one-stop CT scan can evaluate the functional small airway and PFT simultaneously.

Lymphocyte-activation gene 3 (LAG-3), also known as CD223, is a 498-amino-acid type I transmembrane protein encoded by LAG-3 gene, which consists of extracellular, transmembrane and intracellular regions.LAG-3 negatively regulates T lymphocyte by binding extracellular domain to ligand, thus avoiding autoimmunitycaused by T cell over-activation. Like programmed cell death 1 (PD-1) and cytotoxic T lymphocyte antigen 4 (CTLA-4), LAG-3 is an important immune checkpoint in vivo and plays a balanced regulatory role in human immune system.Tumor cells escape the surveillance of the immune system by over-expressing LAG-3 ligand. With the development in research of immune checkpoints, LAG-3 has become a new generation of immunotherapy targets after PD-1 and CTLA-4. This article reviews the structure and function of LAG-3 and the application of its inhibitors in tumor immunotherapy, in order to provide reference for the further study of LAG-3.

Objective To explore the relationship between microelement intake and metabolic syndrome (MS) in elderly males and females in Zhejiang province. Methods Non-parametric Kruskal-Wallis tests were used to compare the intake of microelements by sex among different groups according to the diagnostic criteria of MS in 780 people(404 male,376 female).Logistic regression was used to explore the association between microelements and MS and its components.Results The percentages of inadequate intake of Mn,Zn and Se were relatively high among elderly people of Zhejiang province(males:30.45%,72.52%,75.74%;females:47.34%,33.78%,80.59%,respectively).Microelement intake in males were higher than females(P<0.05).The intake of Fe and Se were higher in the abdominal obesity group than the non-abdominal obesity group among elderly males,the intakes of Fe,Zn,Se in hypertension group were lower, and Se intake was higher in hyperglycemia and hypertriglyceridemia groups. Furthermore, enough intake of Fe(odds ratio OR,0.41;95% confidence interval CI:0.19,0.87)and Se(OR,0.30;95% CI:0.14, 0.63)decreased the risk of hypertension,and high Cu(OR,2.35;95% CI:1.18,4.71)intake increased the risk of hyperglycemia.Among females,Zn intake in the MS group was lower than in the non-MS group;the intakes of Cu, Zn and Se in the hypertension group were lower; the intakes of Fe, Mn and Zn in the hyperglycemia group were lower as well;and Se intake was lower in the low HDL-C group.Again,the high intake of Zn (OR, 3.21; 95% CI: 1.36, 7.59) and Se (OR, 2.79; 95% CI: 1.24, 6.27) increased the risk of abdominal obesity, but moderate intake of Cu (OR, 0.37; 95% CI: 0.19, 0.72) had a protective effect on hypertension. Conclusions The percentages of inadequate microelement intake were relatively high in elderly people of Zhejiang province. There is a relationship between dietary microelements and MS or its components. It is necessary to guide elderly people to adopt reasonable diet by referring to the Chinese dietary reference intake and Dietay Guidelines in order to improve the situation of microelements intake and promote health.