OBJECTIVE To analyze occupational exposure to sharps injuries among medical staff in different posi-tions in a three-A hospital.METHODS A retrospective collection of all sharps injury cases reported from 2018 to 2023 in a general hospital was conducted.The basic characteristics,high-risk links,involved instruments,post-exposure emergency treatment and follow-up situations were analyzed,while sharps injury characteristics of medi-cal staff in different positions were classified and discussed.RESULTS Over six years,340 sharps injuries occurred with the highest incidence among interns(2.70 cases/100 FTE·year)and the lowest among logistics staff(1.05 cases/100 FTE·year).Jun.was the month with the highest incidence,averaging 7.33 cases.High-risk links in-cluded instruments handling,placing instruments into sharp containers and removing needles from rubber or other barriers,accounting for 76.47%.Nurses experienced injuries mostly occurred in general wards and were related to scalp needles;doctors mostly occurred in operating rooms and were due to surgical instruments;interns were pri-marily injured by blood collection needles;pharmacists and medical technicians were related to ampoule handling;while logistical staff were mostly injured by hollow needles and glass fragments from waste disposal.Nurses and doctors were the main injured groups,with a higher incidence among females(25-<35 years)and males(less than five years of work experience).The exposure source was mainly hepatitis B virus(HBV)infection.Post-ex-posure treatment was primarily standardized emergency treatment,but a higher proportion of non-standardized treatment was observed among logistics staff.Follow-up reports showed that interns and logistical staff had lower submission rates and lower training coverage.CONCLUSIONS Significant differences exist in sharps injury charac-teristics among medical staff in different positions.Attention should be paid to position-specific high-risk links and instruments.Targeted training and occupational health management should be strengthened to effectively prevent occupational exposure.

Objective:To investigate the clinical characteristics of left-sided infective endocarditis (IE) without underlying valvular heart diseases (VHD).Methods:This was a retrospective study. Clinical data of 206 patients with left-sided IE (age: (50.4±16.1) years; 144 males (69.9%)) discharged from Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2011 to May 2021 were retrospectively analyzed, including 129 cases with underlying VHD (IE+VHD group) and 77 cases without underlying VHD (IE group). The 6-month survival rate of patients after discharge was analyzed with Kaplan-Meier survival curve; and the 6-month survival rates of the patients with different sizes of endocardial vegetation and different treatment modalities in the IE group were further analyzed with log-rank method.Results:The proportions of patients with age ≥65 years old, arrhythmia and aortic valve involvement, and the in-hospital mortality in the IE group were significantly lower than those in the IE+VHD group ( P<0.05). However, the proportion of patients with fever and speech vague/limb movement disorder/headache, those with mitral valve involvement in the IE group were significantly higher than those in the IE+VHD group ( P<0.05). The median value of C-reactive protein (CRP) in the IE group was significantly higher than that in the IE+VHD group ( P<0.05). Nevertheless, the median value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the IE group was significantly lower than that in the IE+VHD group ( P<0.05). There were as no significant differences in the positive rates of bacterial/fungal blood cultures and the proportion of patients with mitral and aortic valve involvement of endocardial vegetation between the two groups (all P>0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference in 6-month survival rate of patients between the IE group and IE+VHD group (88.7% vs. 93.6%, log-rank χ2=0.887, P=0.346). In the IE group, the 6-month survival rate after discharge in patients with maximum diameter of vegetation ≤10 mm was higher than that in patients with maximum diameter of vegetation >10 mm (96.3% vs. 80.7%, log-rank χ2=4.111, P=0.043). There was no significant difference in 6-month survival rate between patients treated with antibiotics combined with surgery and those treated with antibiotics alone (96.2% vs. 78.6%, log -rank χ 2=2.976, P=0.084). Conclusion:Compared to left-sided IE patients with underlying VHD, patients without underlying VHD are likely to have a younger age, more mitral valve involvement and lower in-hospital mortality; for those patients with maximum diameter of vegetation ≤10 mm there is a higher survival rate, and antibiotics combined with surgery may help to improve the survival rate.

Objective:To compare the clinical manifestations,laboratory results,and imaging features between pyogenic spondylitis(PS) and tuberculous spondylitis(TS).Methods:This was a cross-sectional study. A total of 88 patients with infectious diseases of spine(IDS) admitted to Shanghai Sixth People′s Hospital from January 2021 to December 2023 were analyzed,including 61 PS cases(PS group) and 27 TS cases(TS group). The clinical manifestations,laboratory results,and imaging features were compared between two groups. The factors associated with PS were analyzed by multivariate logistic regression. The diagnostic efficacy for pathogen identification was compared between metagenomics next-generation sequencing(mNGS) and bacterial culture methods in PS and TS patients.Results:Compared with the TS group,the PS group had a higher age-adjusted Charlson comorbidity index(aCCI)[3.0(1.5,4.0) points vs. 2.0(1.0,3.0) points, Z=-2.189, P=0.029],shorter onset time of disease[1.0(0.8,3.0) months vs. 6.0(2.0,12.0) months,Z=-4.353, P<0.001],and higher median blood leukocyte counts and serum ferritin(SF) level(7.2×10 9/L vs. 6.3×10 9/L, Z=-2.652, P=0.008; 571.3 ng/ml vs. 266.0 ng/ml, Z=-4.773, P<0.001). The proportions of lumbar spine involvement,non-collapsed involved vertebrae,and bone bridges formed were all higher in the PS group compared to the TS group[68.8%(99/144) vs. 41.4%(29/70), χ2=14.628, P<0.001; 68.9%(42/61) vs. 18.5%(5/27), χ2=19.055, P<0.001; 41.0%(25/61) vs. 7.4%(2/27), χ2=9.921, P=0.002]. The proportions of thoracic spine involvement,severe vertebral collapse,severe narrowing of the involved intervertebral space,sequestrum,and paravertebral soft tissue calcification were all higher in the TS group compared to the PS group[52.9%(37/70) vs. 18.1%(26/144), χ2=27.463, P<0.001; 55.6%(15/27) vs. 13.1%(8/61), χ2=17.462, P<0.001; 74.1%(20/27) vs. 37.7%(23/61), χ2=9.907, P=0.002; 74.1%(20/27) vs. 18.0%(11/61), χ2=25.761, P<0.001; 51.9%(14/27) vs. 6.6%(4/61), χ2=23.599, P<0.001]. Multivariate logistic regression analysis indicated that a symptom duration<5.5 months( OR=30.644,95% CI: 2.022-464.529, P<0.05) and a leukocyte count>7.35×10 9/L( OR=48.653,95% CI: 2.045-1 157.721, P<0.05) indicated a higher likelihood of PS; while the vertebral collapse indicated a higher likelihood of TS( OR=0.025,95% CI: 0.001-0.638, P<0.05). The most common pathogen in the PS group was Staphylococcus aureus(31 cases,50.8%),followed by Streptococcus species(10 cases,16.4%). The positive rates of mNGS testing in the PS and TS groups were 84.1%(37/44) and 12/13,respectively,which were higher than those of conventional bacterial culture[77.8%(42/54)] and Mycobacteriumtuberculosis culture(2/11). Conclusions:Compared with the TS patients,the PS patients have shorter onset time,higher aCCI scores,higher blood leukocyte counts and SF levels,less vertebral collapse and intervertebral space narrowing,and more bone bridge formation. The TS patients have more dead bones and calcifications. The mNGS has a higher diagnostic efficacy than bacterial cultures for PS and TS.

Kirsten rat sarcoma viral oncogene homolog(KRAS)protein inhibitors are a promising class of thera-peutics,but research on molecules that effectively penetrate the blood-brain barrier(BBB)remains limited,which is crucial for treating central nervous system(CNS)malignancies.Although molecular generation models have recently advanced drug discovery,they often overlook the complexity of bio-logical and chemical factors,leaving room for improvement.In this study,we present a structure-constrained molecular generation workflow designed to optimize lead compounds for both drug effi-cacy and drug absorption properties.Our approach utilizes a variational autoencoder(VAE)generative model integrated with reinforcement learning for multi-objective optimization.This method specifically aims to enhance BBB permeability(BBBp)while maintaining high-affinity substructures of KRAS in-hibitors.To support this,we incorporate a specialized KRAS BBB predictor based on active learning and an affinity predictor employing comparative learning models.Additionally,we introduce two novel metrics,the knowledge-integrated reproduction score(KIRS)and the composite diversity score(CDS),to assess structural performance and biological relevance.Retrospective validation with KRAS inhibitors,AMG510 and MRTX849,demonstrates the framework's effectiveness in optimizing BBBp and highlights its potential for real-world drug development applications.This study provides a robust framework for accelerating the structural enhancement of lead compounds,advancing the drug development process across diverse targets.

Kirsten rat sarcoma viral oncogene homolog (KRAS) protein inhibitors are a promising class of therapeutics, but research on molecules that effectively penetrate the blood-brain barrier (BBB) remains limited, which is crucial for treating central nervous system (CNS) malignancies. Although molecular generation models have recently advanced drug discovery, they often overlook the complexity of biological and chemical factors, leaving room for improvement. In this study, we present a structure-constrained molecular generation workflow designed to optimize lead compounds for both drug efficacy and drug absorption properties. Our approach utilizes a variational autoencoder (VAE) generative model integrated with reinforcement learning for multi-objective optimization. This method specifically aims to enhance BBB permeability (BBBp) while maintaining high-affinity substructures of KRAS inhibitors. To support this, we incorporate a specialized KRAS BBB predictor based on active learning and an affinity predictor employing comparative learning models. Additionally, we introduce two novel metrics, the knowledge-integrated reproduction score (KIRS) and the composite diversity score (CDS), to assess structural performance and biological relevance. Retrospective validation with KRAS inhibitors, AMG510 and MRTX849, demonstrates the framework's effectiveness in optimizing BBBp and highlights its potential for real-world drug development applications. This study provides a robust framework for accelerating the structural enhancement of lead compounds, advancing the drug development process across diverse targets.

OBJECTIVE To systematically analyze the functional system and construction requirements for infection prevention and control('infection control system'in short)in medical institutions so as to facilitate the effective,standardized and practical construction of the infection control system.METHODS The questionnaires were de-signed based on the relevant criteria and literatures that were released in China with the combination of expect con-sultant and were distributed to experts or professionals involving multiple fields such as hospital infection manage-ment,clinical medical treatment and information technology.The questionnaires were recycled,summarized and analyzed.RESULTS The list of functions of the infection control system(consultative draft)was formulated after review of literatures and expert consultation,including fundamental functions such as data management,case sur-veillance and intervention feedback as well as the advanced functions like target surveillance,occupational protec-tion and interconnection.The surveyed subjects agreed unanimously after the questionnaire survey that all of the function modules and elements enlisted were important,the average score of importance was more than 4 points,the score of coefficient of variable(CV)for importance of the function modules was less than 0.25,indicating that there was high consistency in the opinions among the surveyed subjects.The element of tracing and epidemiologi-cal survey function was adopted and added according to the feedback suggestions from some of the subjects;two function elements including data query and clinical interaction were revised,and the list of function requirements for the infection control systems was finally defined.CONCLUSION The requirements for functions of the infection control system that are determined in the study can provide important bases and data support for the research and standardized development of future infection control system.

OBJECTIVE To systematically analyze the functional system and construction requirements for infection prevention and control('infection control system'in short)in medical institutions so as to facilitate the effective,standardized and practical construction of the infection control system.METHODS The questionnaires were de-signed based on the relevant criteria and literatures that were released in China with the combination of expect con-sultant and were distributed to experts or professionals involving multiple fields such as hospital infection manage-ment,clinical medical treatment and information technology.The questionnaires were recycled,summarized and analyzed.RESULTS The list of functions of the infection control system(consultative draft)was formulated after review of literatures and expert consultation,including fundamental functions such as data management,case sur-veillance and intervention feedback as well as the advanced functions like target surveillance,occupational protec-tion and interconnection.The surveyed subjects agreed unanimously after the questionnaire survey that all of the function modules and elements enlisted were important,the average score of importance was more than 4 points,the score of coefficient of variable(CV)for importance of the function modules was less than 0.25,indicating that there was high consistency in the opinions among the surveyed subjects.The element of tracing and epidemiologi-cal survey function was adopted and added according to the feedback suggestions from some of the subjects;two function elements including data query and clinical interaction were revised,and the list of function requirements for the infection control systems was finally defined.CONCLUSION The requirements for functions of the infection control system that are determined in the study can provide important bases and data support for the research and standardized development of future infection control system.

OBJECTIVE To analyze the current research status and development trends in the field of biosecurity both domestically and internationally,and to provide references for biosecurity-related research and evaluation.METHODS Using CiteSpace software,bibliometrics was employed to collect thematic research on bios-ecurity published in the Science Citation Index database from 2004 to 2024.Research trends,keyword clustering and emergence research were investigated,with visual analysis conducted on the number of publications,contribu-ting countries and keywords.RESULTS A total of 13 108 articles were included in this study.Research on biosecu-rity both domestically and internationally was in a phase of rapid growth,with related fields exhibiting an"expo-nential"growth trend.China ranked first in terms of the number of publications(35.62％),followed by the Unit-ed States(19.33％)and Australia(10.38％).Analysis of keyword clustering revealed 20 clusters,including risk assessment,antibacterial drug resistance,green synthesis,gene therapy,one health,drug delivery,invasive spe-cies,bovines,emergency animal diseases and highly pathogenic avian influenza.Regarding antibacterial drug re-sistance,the focus was primarily on the transmission mechanisms of drug-resistant pathogens in poultry farming,while exploring novel antibacterial technologies such as biomaterials and probiotic alternatives to address the chal-lenge of drug-resistant bacteria.In terms of strategies,research was primarily conducted on the development,ap-plication and safety of agricultural biotechnology and genetically modified crops.Keywords burst analysis indicated that different research topics had certain temporal research popularity,with carbon nanotubes,Anopheles ste-phensi,coronaviruses and one health being recent emerging themes.CONCLUSION China achieves certain pro-gress in the field of biosecurity research,and conducts certain exploratory research on prevention,diagnosis,treatment and intervention of biosecurity.Biosecurity risk assessment,as a research hotspot,deserves close attention.

OBJECTIVE To analyze the current research status and development trends in the field of biosecurity both domestically and internationally,and to provide references for biosecurity-related research and evaluation.METHODS Using CiteSpace software,bibliometrics was employed to collect thematic research on bios-ecurity published in the Science Citation Index database from 2004 to 2024.Research trends,keyword clustering and emergence research were investigated,with visual analysis conducted on the number of publications,contribu-ting countries and keywords.RESULTS A total of 13 108 articles were included in this study.Research on biosecu-rity both domestically and internationally was in a phase of rapid growth,with related fields exhibiting an"expo-nential"growth trend.China ranked first in terms of the number of publications(35.62％),followed by the Unit-ed States(19.33％)and Australia(10.38％).Analysis of keyword clustering revealed 20 clusters,including risk assessment,antibacterial drug resistance,green synthesis,gene therapy,one health,drug delivery,invasive spe-cies,bovines,emergency animal diseases and highly pathogenic avian influenza.Regarding antibacterial drug re-sistance,the focus was primarily on the transmission mechanisms of drug-resistant pathogens in poultry farming,while exploring novel antibacterial technologies such as biomaterials and probiotic alternatives to address the chal-lenge of drug-resistant bacteria.In terms of strategies,research was primarily conducted on the development,ap-plication and safety of agricultural biotechnology and genetically modified crops.Keywords burst analysis indicated that different research topics had certain temporal research popularity,with carbon nanotubes,Anopheles ste-phensi,coronaviruses and one health being recent emerging themes.CONCLUSION China achieves certain pro-gress in the field of biosecurity research,and conducts certain exploratory research on prevention,diagnosis,treatment and intervention of biosecurity.Biosecurity risk assessment,as a research hotspot,deserves close attention.

OBJECTIVE To analyze occupational exposure to sharps injuries among medical staff in different posi-tions in a three-A hospital.METHODS A retrospective collection of all sharps injury cases reported from 2018 to 2023 in a general hospital was conducted.The basic characteristics,high-risk links,involved instruments,post-exposure emergency treatment and follow-up situations were analyzed,while sharps injury characteristics of medi-cal staff in different positions were classified and discussed.RESULTS Over six years,340 sharps injuries occurred with the highest incidence among interns(2.70 cases/100 FTE·year)and the lowest among logistics staff(1.05 cases/100 FTE·year).Jun.was the month with the highest incidence,averaging 7.33 cases.High-risk links in-cluded instruments handling,placing instruments into sharp containers and removing needles from rubber or other barriers,accounting for 76.47%.Nurses experienced injuries mostly occurred in general wards and were related to scalp needles;doctors mostly occurred in operating rooms and were due to surgical instruments;interns were pri-marily injured by blood collection needles;pharmacists and medical technicians were related to ampoule handling;while logistical staff were mostly injured by hollow needles and glass fragments from waste disposal.Nurses and doctors were the main injured groups,with a higher incidence among females(25-<35 years)and males(less than five years of work experience).The exposure source was mainly hepatitis B virus(HBV)infection.Post-ex-posure treatment was primarily standardized emergency treatment,but a higher proportion of non-standardized treatment was observed among logistics staff.Follow-up reports showed that interns and logistical staff had lower submission rates and lower training coverage.CONCLUSIONS Significant differences exist in sharps injury charac-teristics among medical staff in different positions.Attention should be paid to position-specific high-risk links and instruments.Targeted training and occupational health management should be strengthened to effectively prevent occupational exposure.