ObjectiveTo analyze the genomic characteristics of Streptococcus pyogenes (GAS) isolated from children with respiratory tract infections in a tertiary hospital in Jinshan District of Shanghai during 2013‒2024, to compare the changes in trend for genomic characteristics before and after 2000, and to provide scientific data for the prevention and control of GAS infections. MethodsGAS strains isolated from children with respiratory tract infections in this hospital were collected from 2013 to 2024. Antimicrobial susceptibility of the isolated strains to 12 antibiotics, including penicillin, cefotaxime, cefepime, linezolid, vancomycin, meropenem, chloramphenicol, ofloxacin, levofloxacin, erythromycin, clindamycin, and tetracycline, was determined using broth microdilution plate method. Besides, whole genome sequencing (WGS) was used to analyze multilocus sequence type (MLST), emm typing, carriage of superantigen genes, mobile genetic element (MGE), carriage of virulence gene, and genomic phylogenetic tree of the isolated strains. ResultsA total of 50 GAS strains were collected and identified from children with respiratory tract infections aged 4‒14 years old, and the resistance rates of those isolates to erythromycin, clindamycin, and tetracycline were 100.00%, 100.00%, and 86.00%, respectively. There were two emm types in the GAS isolates; the emm12 type accounted for 76.00% (38/50), corresponding to ST36 type, and the emm1 type accounted for 24.00% (12/50), corresponding to ST28, ST1274, and new-1 types. There was a statistically significant difference in the constitution of the MLST before and after 2020 (P=0.015). All the isolates carried the superantigen genes speC, speG, ssa, and smeZ. The predominant emm12 isolates belonged to the Clade Ⅱ, carrying the mobile elements ICE-emm12 (harboring erythromycin-resistance gene ermB and tetracycline-resistance gene tetM) and ΦHKU.vir (carrying virulence genes speC and ssa). The emm1 isolates carried the mobile elements ICE-HKU488 (harboring erythromycin-resistance gene ermB and tetracycline-resistance gene tetM) and ΦHKU488.vir (carrying virulence genes speC and ssa), and had close phylogenetical relationships with isolates from Hong Kong, China. No M1_UK new clone strains were found. The ST1274 isolates of emm1 were newly discovered in 2020‒2024, and belonged to a separate phylogenetic clade. ConclusionGAS strains isolated from children with respiratory tract infections in a tertiary hospital in Jinshan District of Shanghai exhibit a high resistance to erythromycin, clindamycin, and tetracycline. It is recommended that the clinical treatments change to use other antimicrobial drugs, such as penicillin, third-generation cephalosporins, and fluoroquinolones. During 2020‒2024, a new ST1274 clone strain is discovered in emm1 GAS isolates, without M1_UK new clone strains being found. It is essential to continuously concern locally prevalent GAS strains and perform early identification of MLST types to promptly monitor the internal changes of the bacterial population and potential prevalence of new clones.

Objective To explore the diagnostic value of endoscopic grading of gastric intestinal metaplasia (EGGIM) score under acetic acid-enhanced narrow band imaging (AA-NBI) observation mode for gastric intestinal metaplasia (GIM). Methods A total of 120 patients who underwent gastroscopy at Jinshan Hospital of Fudan University from February 2022 to February 2023 were selected. All patients underwent both white light and AA-NBI endoscopy, with photographic records of intestinal metaplasia in five areas: greater curvature of antrum, lesser curvature of antrum, greater curvature of corpus, lesser curvature of corpus and incisura. EGGIM score was performed: 0 for no intestinal metaplasia, 1 point for focal intestinal metaplasia (GIM area ratio≤30%), 2 points for extensive intestinal metaplasia (GIM area ratio＞30%), with a total score of 10 points. Targeted biopsies were performed on suspicious GIM lesions found during endoscopy. If no suspicious GIM lesions were observed, random biopsies were performed according to the updated Sydney system. The pathological histological examination results were staged based on the operative link on gastric intestinal metaplasia assessment (OLGIM) system. The diagnostic value of EGGIM score for OLGIM stage Ⅲ-Ⅳ patients was evaluated using receiver operating characteristic (ROC) curves. Results The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of AA-NBI in detecting GIM were 96.3%, 91.6%, 94.5%, 95.0%, and 93.6%, respectively. The area under the ROC curve for EGGIM diagnosing OLGIM stage Ⅲ-Ⅳ was 0.952 (95%CI 0.914-0.990). The optimal cut-off value for EGGIM was 5 points, with a sensitivity of 96.7% (95%CI 87.6%-99.4%) and specificity of 88.1% (95%CI 76.5%-94.7%). Conclusions EGGIM score (≥5 points) under AA-NBI mode has good diagnostic capability for patients with OLGIM stage Ⅲ-Ⅳ.

Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.

Objective To analyze the death rate and life loss of injuries in Jinshan District of Shanghai from 1990 to 2023, and to provide a scientific basis for the formulation of injury prevention and control measures. Methods Excel 2010 was used to establish a database for injury death reports in Jinshan District from 1990 to 2023, and the crude mortality rate, standardized mortality rate, age-specific mortality rate, potential years of life lost (PYLL), rate of potential years of life lost (PYLLR) and standardized rate of potential years of life lost (SPYLLR) were calculated. Results From 1990 to 2023, the crude mortality rate due to injuries in Jinshan District was 52.25/100 000, while the standardized mortality rate was 36.95/100 000. Based on the standardized mortality rate, the top four causes of injury-related deaths were traffic accidents, falls, drowning, and suicide. Traffic accidents ranked first as the leading cause of death for both males (19.30/100 000) and females (8.41/100 000). The top cause of death for the 0-14 years old group was drowning, the 15-64 years old group was traffic accidents, and the 65 years old and above was falls. Over the 34-year period, according to SPYLLR, the top four causes of death for both genders were consistently traffic accidents, drowning, suicide, and falls. Conclusion From 1990 to 2023, traffic accidents, falls, drowning, and suicide have been the primary causes of injury-related deaths in Jinshan District, Shanghai. It is essential to develop targeted prevention and control strategies based on the specific characteristics of these injury-related fatalities.

Objective To analyze the death rate and life loss of injuries in Jinshan District of Shanghai from 1990 to 2023, and to provide a scientific basis for the formulation of injury prevention and control measures. Methods Excel 2010 was used to establish a database for injury death reports in Jinshan District from 1990 to 2023, and the crude mortality rate, standardized mortality rate, age-specific mortality rate, potential years of life lost (PYLL), rate of potential years of life lost (PYLLR) and standardized rate of potential years of life lost (SPYLLR) were calculated. Results From 1990 to 2023, the crude mortality rate due to injuries in Jinshan District was 52.25/100 000, while the standardized mortality rate was 36.95/100 000. Based on the standardized mortality rate, the top four causes of injury-related deaths were traffic accidents, falls, drowning, and suicide. Traffic accidents ranked first as the leading cause of death for both males (19.30/100 000) and females (8.41/100 000). The top cause of death for the 0-14 years old group was drowning, the 15-64 years old group was traffic accidents, and the 65 years old and above was falls. Over the 34-year period, according to SPYLLR, the top four causes of death for both genders were consistently traffic accidents, drowning, suicide, and falls. Conclusion From 1990 to 2023, traffic accidents, falls, drowning, and suicide have been the primary causes of injury-related deaths in Jinshan District, Shanghai. It is essential to develop targeted prevention and control strategies based on the specific characteristics of these injury-related fatalities.

OBJECTIVE To investigate the effect of pharyngeal cavity and genoglossus muscle exercises in patients with mild obstructive sleep apnea syndrome(OSAHS)left over after palatopharyngoplasty with diastolic cardiac dysfunction.METHODS A total of 75 patients with mild OSAHS left after palatopharyngoplasty with diastolic cardiac dysfunction from January 2021 to August 2023 were selected for retrospective study.Among them,37 patients underwent pharyngeal cavity and mentoglossum muscle exercise(observation group),while 38 patients did not(control group).Using postoperative data as baseline value.mean blood oxygen saturation(MSpO2),lowest oxygen saturation(LSpO2),sleep efficiency,apnea index(AI),sleep latency,apnea hypopnea index(AHI),hypopnea index(HI),microarousal index(MAI),rapid eye movement latency,arterial blood pressure of carbon dioxide(PaCO2),pH,arterial partial oxygen pressure(PaO2),left ventricular end-systolic diameter(LVDs),blood lactic acid,left ventricular ejection fraction(LVEF),Tei index,left ventricular end-diastolic diameter(LVDd),daytime Epworth sleepiness scale(ESS)score,Pittsburgh sleep quality index(PSQI)score and incidence of adverse cardiovascular events(MACE)were compared at baseline and 3 months later.RESULTS After 3 months,AHI,HI and AI in observation group were lower than those in control group,and MSpO2 and LSpO2 were higher than those in control group(P<0.05);Sleep efficiency of observation group was higher than control group,daytime ESS score,PSQI score and MAI were lower than control group(P<0.05).There were no significant differences in PaCO2,LVDd,PaO2,blood lactic acid,sleep latency,pH,LVEF,rapid eye movement latency,LVDd,Tei index between the observation group and the control group(P>0.05).The incidence of MACE in the observation group was 5.41%(2/37),compared with 13.16%(5/38)in the control group,there was no significant difference(P>0.05).CONCLUSION In patients with mild OSAHS left after palatopharyngoplasty with diastolic cardiac dysfunction,the exercise of pharyngeal cavity and genoglossus can improve hypopnea,alleviate clinical symptoms and improve sleep quality,but it has limited effect on the improvement of cardiac function.

Objectives:To evaluate the safety and efficacy of implantation of subcutaneous implantable cardioverter defibrillator(S-ICD)after transvenous lead extraction(TLE)in ICD patients without pacing indications. Methods:All patients who underwent TLE at Peking University People's Hospital from June 2018 to October 2023 were consecutively included.TLE indication,S-ICD implantation indication,defibrillation threshold(DFT)test,complications and postoperative follow-up were collected and analyzed. Results:A total of 11 patients with TV-ICD underwent S-ICD implantation after TLE,eight patients were males and median age were 56(44,65)years.The indications for TLE were infection and lead dysfunction.Nine patients were implanted with S-ICD for secondary prevention,and the most common cause of implantation was ion channelopathies(5 cases).The operative time for S-ICD was 51(48,58)minutes and no perioperative complications were noted.Eight patients underwent DFT testing,and 100%were successful.During a median follow up of 30(9,39)months,a total of six appropriate treatments occurred in two patients,and no complications occurred,including inappropriate treatment,ineffective treatment,infection,lead malfunction and death. Conclusions:Our study provides evidence for S-ICD implantation as a replacement after TV-ICD removal.The S-ICD implantation after TLE is safe and effective.

ObjectiveTo analyze the effect of O₃ pollution on outpatient visits for respiratory diseases in a district of Shanghai. MethodsWe collected the respiratory disease outpatient data， and atmospheric and meteorological data of from a suburban general hospital in Shanghai from 2015 to 2017. A time-series analysis by generalized additive model was conducted to examine the relationship between O₃ pollution and daily outpatient visits. ResultsThe daily outpatient volume for respiratory diseases was 831. The daily 8 h median concentration of O₃ was 101.04 μg·m^-3. The excess relative risk was 0.461% （95%CI： 0.240%‒0.682%） at lag3. Stratified by gender and age， females， child and the aged had higher risk of respiratory diseases. In the double-pollutant model， PM_2.5 and PM₁₀ increased health effects， while CO reduced health effects. ConclusionThe increase of O₃ concentration can increase the daily outpatient volume of respiratory diseases.

【Objective】 To investigate the recurrence of patients with renal cell carcinoma (RCC) after robot-assisted partial nephrectomy (RAPN), and to explore the related factors of recurrence. 【Methods】 Clinical data of 367 RCC patients who underwent RAPN during 2015 and 2020 in our hospital were retrospectively collected. Patients were divided into recurrence group and non-recurrence group. The related factors of recurrence and 5-year cumulative recurrence rate of RCC and clear cell renal cell carcinoma (ccRCC) in the recurrence group were analyzed. 【Results】 The median follow-up was 48 (IQR:38-60) months. Recurrence occurred in 9 patients, with a 5-year cumulative recurrence rate of 97.5%. For RCC patients, univariate analysis showed that tumor size, T-stage, R. E. N. A. L. score, R value, N value, and operation time were significantly associated with postoperative recurrence (P<0.05), while multivariate analysis showed that N value (HR=15.75, 95%CI:2.00-124.17, P=0.009) was an independent related factor. For ccRCC patients, univariate analysis showed that hypertension, tumor size, T-stage, R. E. N. A. L. score, N value, operation time and WHO/ISUP grade were significantly associated with postoperative recurrence (P<0.05), while multivariate analysis showed that WHO/ISUP grade (HR=4.99, 95%CI:1.04-24.01, P=0.045) was an independent related factor. 【Conclusion】 The 5-year cumulative recurrence rate of RCC patients after RAPN is 2.5%. N value and WHO/ISUP grade are the independent related factor of recurrence of RCC and ccRCC, respectively.

【Objective】 To explore the influencing factors of planned robot-assisted partial nephrectomy (RAPN) converted to radical nephrectomy (RN). 【Methods】 Clinical data and operation records of 488 patients planned for RAPN in our hospital during 2015 and 2020 were retrospectively collected. The patients were divided into converted and unconverted groups, and relevant clinical data of the two groups were compared. The causes and influencing factors for conversion were analyzed. 【Results】 Among the 488 patients, 14 (2.9%) converted to RN. The causes included: ①complicated tumor anatomy and surgical difficulties; ②local advanced renal tumor suspected during operation; ③severe intraoperative hemorrhage. Univariate analysis showed that R. E. N. A. L score (P<0.001), E value (P<0.001), N value (P<0.001), L value (P<0.001), renal hilum position (P<0.001) and T stage (P=0.002) were influencing factors of conversion. 【Conclusion】 Causes for the conversion of RAPN to RN include complicated tumor anatomy, suspected local advanced renal tumor and severe intraoperative hemorrhage. The R. E. N. A. L score, E value, N value, L value, renal hilum position and T stage are influencing factors.