ObjectiveTo develop and validate a diagnostic prediction model for differentiating pulmonary tuberculosis from community-acquired pneumonia based on routine blood parameters. MethodsA total of 642 patients with pulmonary tuberculosis and 503 patients with community-acquired pneumonia were retrospectively enrolled from the Seventh Hospital of Tangshan. They were randomly divided into a training set and an internal validation set at a 7∶3 ratio. Additionally， 218 patients from the 981st Hospital were independently included as an external validation set. The Boruta algorithm and recursive feature elimination were employed to select predictors from 82 blood parameters， sex， and age. A multivariate Logistic regression model was established and evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis. ResultsThe final model incorporated eight predictors， namely uric acid， urea nitrogen， alkaline phosphatase， monoamine oxidase， alanine aminotransferase， glutathione， neutrophil percentage， and age. The model achieved areas under the curve （AUCs） of 0.800 （95%CI： 0.769-0.830）， 0.787 （95%CI： 0.738-0.836）， and 0.736 （95%CI： 0.667-0.835） in the training， internal validation， and external validation sets， respectively. The model demonstrated good calibration， and decision curve analysis showed clinical net benefit within the threshold probability range of 10%-80%. ConclusionThe developed model exhibits good discriminative ability and clinical utility， serving as an effective early screening tool for primary healthcare institutions.

Objective To investigate the impact of body mass index(BMI)on the perioperative outcomes and prognosis in patients with clear cell renal cell carcinoma(ccRCC)undergoing robot-assisted partial nephrectomy(RAPN),so as to provide reference for optimizing clinical management strategies.Methods The clinical data of 745 ccRCC patients undergoing RAPN at our hospital during 2014 and 2023 were retrospectively analyzed.Patients were categorized into three groups according to preoperative BMI:normal weight(18＜BMI＜24,n=202),overweight(24＜BMI＜28,n=428),and obese(BMI≥28,n=115).Baseline characteristics,surgical parameters,postoperative complications,pre-and post-operative estimated glomerular filtration rate(eGFR),and overall survival(OS)were compared among the groups.Multivariate regression analyses were performed to adjust potential confounders.Results Among baseline characteristics,only the gender distribution differed significantly among the three groups(P=0.009).Multivariate analysis showed that gender had no significant effects on reoperation,transfusion,operation time,intraoperative blood loss,or postoperative renal function.The median follow-up was 32(12,55)months.Compared with the normal-weight group,the obese group had longer operation time[140.0(115.0,170.0)min vs.160.0(125.0,190.0)min,P=0.009]and greater intraoperative blood loss[50.0(50.0,100.0)mL vs.100.0(50.0,150.0)mL,P=0.003].No statistically significant differences were observed among the three groups in pre-and post-operative eGFR,overall complication rate,long-term follow-up eGFR,or OS(P＞0.05).Conclusion RAPN provides comparable surgical benefits across BMI categories in patients with ccRCC;however,obese patients may experience increased operation time and blood loss.

Objective To investigate the impact of body mass index(BMI)on the perioperative outcomes and prognosis in patients with clear cell renal cell carcinoma(ccRCC)undergoing robot-assisted partial nephrectomy(RAPN),so as to provide reference for optimizing clinical management strategies.Methods The clinical data of 745 ccRCC patients undergoing RAPN at our hospital during 2014 and 2023 were retrospectively analyzed.Patients were categorized into three groups according to preoperative BMI:normal weight(18＜BMI＜24,n=202),overweight(24＜BMI＜28,n=428),and obese(BMI≥28,n=115).Baseline characteristics,surgical parameters,postoperative complications,pre-and post-operative estimated glomerular filtration rate(eGFR),and overall survival(OS)were compared among the groups.Multivariate regression analyses were performed to adjust potential confounders.Results Among baseline characteristics,only the gender distribution differed significantly among the three groups(P=0.009).Multivariate analysis showed that gender had no significant effects on reoperation,transfusion,operation time,intraoperative blood loss,or postoperative renal function.The median follow-up was 32(12,55)months.Compared with the normal-weight group,the obese group had longer operation time[140.0(115.0,170.0)min vs.160.0(125.0,190.0)min,P=0.009]and greater intraoperative blood loss[50.0(50.0,100.0)mL vs.100.0(50.0,150.0)mL,P=0.003].No statistically significant differences were observed among the three groups in pre-and post-operative eGFR,overall complication rate,long-term follow-up eGFR,or OS(P＞0.05).Conclusion RAPN provides comparable surgical benefits across BMI categories in patients with ccRCC;however,obese patients may experience increased operation time and blood loss.

Bone age, the most commonly used and effective indicator for understanding children's growth and development, plays an important role in the diagnosis and efficacy evaluation of various growth and development disorders. Clinically, X-rays of the left hand and wrist are mostly taken for bone age assessment, but there is a certain radiation risk. Ultrasound can clearly display the epiphysis and secondary ossification center, and conveniently perform multi-site scanning and dynamic measurement without radiation. In recent years, great progress has been made in the research and clinical application of ultrasound in bone age assessment. This article, by reviewing the latest literature, discusses the value of musculoskeletal ultrasound and quantitative ultrasound in bone age assessment, raises the problems in the study of ultrasound assessment of bone age, and suggests direction for improvement.

Preliminary exploration of using ultrasound to quantitatively evaluate the development of epiphyseal cartilage and analyze its correlation with bone age, based on the ultrasound findings of the long bone joint end.

A study was conducted on adolescents studying at a sports school in Jining from March to June 2023. Age, height and other information were recorded. Bone age assessment by X ray were performed within 1 week with an endocrinologist interpreted the bone age using the Greulich-Pyle atlas. Two sonographers scanned a total of 7 sites in the hand, wrist and knee joint of the non-dominant side (including the dorsal side of the third metacarpal head, the ulnar styloid process, the radial styloid process, the medial and the lateral femoral epicondyle, dorsal tibia, and medial tibial condyle). The ultrasonic epiphyseal cartilage thickness (UECT) was measured and its correlation with bone age was analyzed. Intraclass correlation coefficient (ICC) was used to evaluate the reliability and repeatability of UECT measurement.

A total of 141 adolescents were included, with 80 males and 61 females. The average age was 13 (12-14) years old. The average bone age was 15(13-17) years in males and 16 (14-17) years in females. The proportion of the males and females whose bone age was 1 year older than chronological age was 60% and 67%, respectively, and the height of the males was significantly higher than that of the females(P < 0.001). The UECT of 7 sites in the males and females decreased with the increase of bone age, and there was a significant negative correlation between UECT and bone age. In males, UECT was highly and negatively correlated with bone age (|r|≥0.80), while in females, it was moderately and negatively correlated (0.65≤|r|≤0.75). The correlation between the sum of UECT at seven sites and bone age reached high levels in both sexes(|r|=0.93, |r|=0.80).When 3 sites of hand and wrist or 4 sites of knee joint were selected separately, the UECT of the females was highly negatively correlated with bone age (|r| ≥0.76), while that of the males showed a very high correlation (|r| ≥0.90). The measurement consistency of UECT in all seven sites was good (ICC≥0.75).

Ultrasound can observe and describe the developmental change of long bone, and UECT has potential value in quantitative evaluation of bone maturity.

To research on area ossification ratio (AOR), a novel parameter for quantitatively assessing adolescent bone age by conventional ultrasonography, and evaluate the correlation between AOR and radiographic bone age.

The study selected healthy adolescents from a middle school in Shandong Province in June 2023. Ultrasonic images were collected from five anatomical sites (the styloid process of the ulna, the styloid process of the radius, the lateral epicondyle of the femur, the medial condyle of the tibia, and the posterior median sagittal plane of the tibia). The second ossification center and epiphyseal area on these 2D ultrasound images were delineated to calculate AOR. This ratio was then compared with radiographic bone age measured by Greulich-Pyle (GP) atlas. Inter- and intra-observer consistency was evaluated using intraclass correlation coefficient (ICC) and the Bland-Altman method.

A total of 179 healthy adolescents (109 males and 70 females) were included. For both genders, AOR of each site exhibited a significant to high correlation with radiological bone age (r=0.60~0.91). The sum of the AORs of the five sites showed a high correlation with radiological bone age (males: r=0.95, females: r=0.87). Measurements of AOR by different doctors and the same doctor at different times demonstrated high repeatability (inter-observer: ICC=0.926, P < 0.001, intra-observer: ICC=0.954, P < 0.001).

The sum of AORs in adolescents is highly correlated with radiographic bone age, and the measurement method shows high repeatability. The AOR is a reliable parameter for the ultrasonic quantitative assessment of bone age in adolescents.

To evaluate the correlation between ultrasound ossification ratio(OR) and exercise intensity among adolescents.

This cross-sectional study used stratified sampling to select adolescents aged 11-15 years from a sports school and some ordinary middle schools in Shandong Province in June 2023. The participants were divided into two groups: competitive sports group (high exercise intensity), and general sports group (moderate exercise intensity), based on their exercise intensity. Ultrasound images of long bones from nine body regions (including 3 upper limb bones and 6 lower limb bones) were collected for both groups. Two sonographers interpreted the images and calculated the ultrasound OR values (the ratio of ossification center length to epiphyseal length on the standard ultrasound section). The intraclass correlation coefficient (ICC) was used to assess the consistency of image interpretation between the observers. Differences in ultrasound OR values between the two groups were compared, and multivariate Logistic regression analysis was performed to assess the correlation between ultrasound OR values and exercise intensity.

A total of 252 adolescents who met the inclusion and exclusion criteria were included, with 154 in the competitive sports group (97 males and 57 females) and 98 in the general sports group (52 males and 46 females). The median height and average daily exercise duration were significantly higher in the competitive sports group than in the general sports group (all P < 0.001). The overall ICC for the interpretation of ultrasound OR values of long bones at 9 sites in 50 adolescents by the two sonographers was 0.930 (range: 0.853-0.964), indicating excellent inter-observer consistency. The medial femoral ultrasound OR values were higher in the competitive sports group than in the general sports group for both males and females (males: 0.87±0.07 vs. 0.84±0.04, P=0.025; females: 0.90±0.06 vs.0.85±0.14, P=0.027). Additionally, the differences in ultrasound OR values between the groups were observed in the lateral femoral and fibular bones in males and the radial bone in females (all P < 0.05). Multivariate Logistic regression analysis showed that the reciprocal of the medial femoral ultrasound OR value was correlated with exercise intensity (OR=0.046, 95% CI: 0.012-0.145, P=0.043), indicating that a decrease of 0.1 in the reciprocal of the medial femoral ultrasound OR value (equivalent to an increase of approximately 0.05-0.10 in the ultrasound OR value) was associated with a 2.17-fold increase in the likelihood of high-intensity exercise.

The medial femoral ultrasound OR value was correlated with exercise intensity among adolescents. This indicator may serve as an objective imaging parameter for assessing whether adolescent exercise meets recommended standards.

Objective: To propose the concept of a novel regional control and prevention (RCP) system for the outbreak of COVID-19 infectious disease, design an emergency epidemic prevention information system based on the existing network architecture and information system in the region, and a remote intelligent medical consultation and remote office platform, research and develop the technology of risk assessment and early warning for people in the region, and improve the regions’prevention and control ability facing emergency of major infectious diseases. Methods: Taking colleges, affiliated (teaching) hospitals, and cloud applications as typical RCP regional units, the existing local area network interaction methods between the cloud and universities and affiliated (teaching) hospitals are established to realize remote work in the network environment, remote medical imaging, psychological and ethical consultation and interaction; applying multi-agent propagation model based on complex network, combining Global Positioning System (GPS), Radio Frequency Identification (RFID), and electronic fence technology, to realize the risk classification and early warning of units and personnel in the area. Results: In the RCP, a system architecture combining campus network, affiliated (teaching) hospital intranet, and the Internet is used. Dynamic connection is made using distributed technology and cloud storage. The data buffer mechanism of the intermediary database in the network realized telemedicine consultation and telecommuting. Relying on the platform, multi-agent propagation model based on complex network and cellular automaton model are used to realize the score and early warning of population exposure risk in the region by using GPS, RFID and electronic fence technology. Conclusions In the epidemic phase of major infectious diseases, the construction of RCP can improve the response speed of wartime epidemic prevention, provide reasonable data-based warnings and risk ratings, and reduce the exposure risk of susceptible people. The design and development of RCP is a systematic project that needs to combine regional structural and functional characteristics, and the foundation of the early informatization work in the region and the level of the emergency development team determine the development progress, maintenance, and actual application effects. It is recommended to establish a peacetime and wartime combined RCP mode and incorporate it into the government's disease control system to improve the national and regional level of prevention and control of major infectious diseases.

BACKGROUNDKlebsiella pneumoniae carbapenemase (KPC)-producing Escherichia (E.) coli has been reported in China since 2008. However, there is no information about the molecular epidemiology of KPC-producing E. coli in China. In this study, we aimed to investigate the sequence type (ST) and characteristics of KPC-producing E. coli isolates in China.

METHODSThree carbapenem-resistant isolates of E. coli (E1, E2, and E3) from one teaching hospital in Hangzhou covering a one year period were analyzed. Antibiotic susceptibility was determined by Etest. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used for epidemiological analysis. The genetic structure around blaKPC, the major plasmid incompatibility typing, and the identification of β-lactamase gene types were performed by PCR and the positive products were subsequently sequenced. Plasmids were analyzed by transformation, restriction, and Southern blotting.

RESULTSPFGE demonstrated that patterns of isolates E1 and E2 were clonally-related and designated as patterns A1 and A2; pattern of isolate E3 was different and designated as pattern B. MLST analysis showed that the three isolates displayed one common sequence type ST131. The identification of bla gene types by PCR and sequencing showed that blaKPC-2, blaCTX-M-14, and blaTEM-1 were detected in all three isolates. All three isolates carried a KPC-2-encoding plasmid of the IncN replicon. Plasmid analysis and hybridization experiments showed that the isolates were found simultaneously to carry two or four plasmids. The blaKPC-2 gene in E1 and E2 was located in a plasmid with size of ca. 50 kb. However, the blaKPC-2 gene in E3 was located in a plasmid with size of ca. 130 kb.

CONCLUSIONSE. coli ST131 with KPC-2 β-lactamase has emerged in China, which enlarges the geographical area where the ST131 KPC-producing E. coli strains have diffused.

Bacterial Proteins ; genetics ; China ; Electrophoresis, Gel, Pulsed-Field ; Escherichia coli ; enzymology ; genetics ; Klebsiella pneumoniae ; enzymology ; Multilocus Sequence Typing ; beta-Lactamases ; genetics

Objective To investigate the synergistic efficacy of different antibiotic combinations against KPC-2 carbapenemase producing Klebsiella pneumoniae strains in vitro and search for effective antibiotic combination.Methods During 2008 - 2009,a total of 24 strains of K.pneumoniae producing KPC-2 carbapenemase were collected from 8 hospitals in the First Affiliated Hospital of Medical School of Zhejiang University,Ningbo LiHuiLi Hospital,Zhejiang People's Hospital,Hangzhou Third Hospital,the Second Hospital of Shaoxing,Hangzhou First Hospital,Fudan University Huashan Hospital,General Hospital of Nanjing Military Region.MLST technique was used for epidemiological analysis.The MIC of antibiotics,such as amikacin,minocycline,imipenem,amoxicillin/clavulanic-acid,ceftazidime,meropenem,gentamicin,cefoxitin,cefepime,rifampicin,polymyxinB,ciprofloxacin were determined by an agar dilution method,the MIC of tigecycline and piperacillin/tazobactain were determined by Etest.The antibacterial activities of cefepime in combination with amoxicillin/clavulanic-acid,amikacin,or ciprofloxacin,amikacin with ciprofloxacin,imipenem with amikacin,ciprofloxacin,polymyxinB,or minocycline,polymyxin B with rifampicin,ceftazidime with amoxicillin/clavulanic-acid were assessed by chequerboard synergy agar dilution tests against all the isolates.Results MLST showed 5 STs among 24 strains of KPC-2 carbapenemase producing K.pneumoniae,and the most prevalent clone was ST11 (15 strains).All isolates were susceptible to polymyxin B and tigecycline,and the resistance rate of minocycline was 4.2％.The synergetic effects were observed in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin,ceftazidime-amoxicillin/clavulanic acid combinations as 19 isolates,13 isolates,and 13 isolates,respectively.Conclusions KPC-2 carbapenemase producing K.pneumoniae is sensitive to polymyxin B,tigecycline and minocycline.The synergetic effect is predominant in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin ceftazidime-amoxicillin/clavulanic acid combinations in vitro,their clinical efficacy are worthy of further observation.