ObjectiveTo describe the epidemiological characteristics and trend of pulmonary tuberculosis among the elderly in Shanghai from 2014 to 2023, to estimate the incidence between 2024‒2025, so as to provide references for optimizing the prevention and control strategies of pulmonary tuberculosis for elderly in Shanghai. MethodsData of pulmonary tuberculosis patients aged ≥60 years in Shanghai registered in the Tuberculosis Registration and Management System of Chinese Center for Disease Control and Prevention from 2014 to 2023 was derived to describe the demographic characteristics of the elderly patients with pulmonary tuberculosis, and to calculate the reported incidence rate and annual percentage change (APC) of pulmonary tuberculosis. The autoregressive integrated moving average (ARIMA) model was constructed using monthly reported incidence data from January 2014 to June 2023, and data from July to December in 2023 were used to validate the model and predict the reported incidence rate of pulmonary tuberculosis among elderly in 2024 and 2025. ResultsA total of 19 208 elderly pulmonary tuberculosis patients were registered and reported in Shanghai from 2014 to 2023, with an average annual reported incidence rate of 35.04/100 000. The reported incidence rate of pulmonary tuberculosis in elderly showed an overall decreasing trend, APC=-3.34% (t=-3.360,P=0.010). While, the proportion of elderly pulmonary tuberculosis patients showed a yearly increasing trend among the total registered and reported cases, APC=5.65% (t=10.820, P<0.001). The difference in the average annual reported incidence rate of pulmonary tuberculosis in elderly was statistically significant in different regions (χ²=31.762, P=0.007), with the central urban areas(33.23/100 000) being lower than that in suburban areas (36.46/100 000), and the annual decreasing rate was faster in central urban area, APC=-4.88% (t=-4.838, P<0.001) and -2.76% (t=-2.811, P=0.023), respectively. The incidence rate was significantly higher in males than that in females (χ²=514.395, P<0.001). Additionally, the difference in reported incidence rate was statistically significant among different age groups(χ²=119.751,P<0.001), among which patients aged ≥80 years had the highest average annual incidence rate (59.69/100 000), and those aged ≤60 years had the lowest average annual incidence rate (28.57/100 000). Compared with the non-residential permanent elderly population (47.68/100 000), the average annual incidence rate of pulmonary tuberculosis among the elderly with household registration in Shanghai was lower (33.82/100 000) (χ²=24.295, P<0.001). The ARIMA (0,0,1) (0,1,1) 12 model was used to predict the incidence rate of pulmonary tuberculosis among the elderly in Shanghai in 2024 and 2025, and which was predicted to be 37.41/100 000 and 35.92/100 000, respectively. ConclusionThe reported incidence rate of pulmonary tuberculosis among the elderly in Shanghai showed an overall yearly downward trend from 2014 to 2023, but its proportion in the total number of reported pulmonary tuberculosis cases increased year by year. Prevention and control efforts should still not be slackened and emphasis should be placed on male, suburban and non-residential permanent elderly populations.

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.

ObjectiveWe conducted a drug resistance and homology analysis of diarrheagenic Escherichia coli （DEC） in Fengxian District of Shanghai in order to provide a basis for clinical rational drug use， risk monitoring and early warning. MethodsDEC were isolated from diarrheal patients in Fengxian District， Shanghai from 2019 to 2022. The minimum inhibitory concentrations （MIC） of 21 drugs to the DEC were determined. Genotyping and homology analysis were conducted with pulsed-field gel electrophoresis （PFGE）. ResultsThe DEC detection rate of diarrhea cases was 18.99% （131/690）， including enteroaggregative E.coli （EAEC） 64.89% （85/131）， enterotoxigenic E.coli （ETEC） 22.14% （29/131）， enteropathogenic E.coli （EPEC） 12.21% （16/131）， and enterohemorrhagic E.coli （EHEC） 0.76%（1/131）. The DEC detection showed obvious seasonal characteristics with a high incidence in summer. The DEC multidrug resistance rate was 66.41% with a total of 65 drug resistance profiles. The five antimicrobial drugs with the highest resistance rate were ampicillin （60.31%）， nalidixic acid （51.91%）， cefazolin （50.38%）， tetracycline （44.27%）， and cotrimoxazole （35.11%）. The rate of DEC resistance to levofloxacin was significantly increased from 2019 to 2022. Cluster analysis showed that the similarity of 85 EAEC cluster was 58.4%‒100.0%， and 69 band patterns were obtained. The similarity of 29 ETEC cluster was 58.5%‒100.0%， and 13 band patterns were obtained， including 2 dominant band types. The similarity of 16 EAEC clusters was 53.9%‒100.0%， and 15 band patterns were obtained. Five groups of homologous strains were found， consistent with the resistance phenotypes. ConclusionAmong the diarrhea cases， the DEC epidemic intensity is high， the drug resistance situation is severe， and the risk of outbreak infection is high in Fengxian District， Shanghai. Therefore， health monitoring and prevention need to be strengthened.

To explore the effectiveness of "near peer learning" (NPL) in the electromyography(EMG)teaching module for neurology residents.

Objective To develop and validate a fatigue risk nomogram model in Chronic Obstructive Pulmonary Disease(COPD)patients.Methods A prospective study design was adopted,and 430 COPD patients recruited from a tertiary A hospital in Huzhou City from January to December 2022 were conveniently selected for model construction,and 129 patients were recruited from the same hospital from January to June 2023 for external validation of the model.The general information questionnaire,Pittsburgh Sleep Quality Index,2-item Generalized Anxiety Disorder Scale,2-item Patient Health Questionnaire,modified British Medical Research Council Dyspnea Index,International Physical Activity Questionnaire,and Fatigue Severity Scale were used for questionnaire survey.The risk prediction model and nomograms model were constructed using Logistic regression analysis and R 4.3.2 software,and the area under the receiver operating characteristic(ROC)curve was used to test the prediction effect of the model.Results Univariate and binary logistic regression analysis results showed that age(OR=1.095),gender(OR=2.077),dyspnea(OR=3.309),sleep quality(OR=1.979),anemia(OR=3.289),the number of acute exacerbation(OR=2.991)were independent influencing factors for fatigue in COPD patients.The internal evaluation and external validation results of the model showed that the areas under the curve are 0.912 and 0.844 respectively,and the Hosmer-Lemeshow goodness of fit test P values were 0.806 and 0.526 respectively.The average absolute errors were 0.013 and 0.019 respectively.Conclusion The COPD fatigue risk prediction model constructed in this study has good prediction effect.The visual nomogram is intuitive,convenient and easy to operate.It can provide a tool for early screening of fatigue in COPD patients.

Arteriovenous malformations(AVMs)are a kind of high-flow vascular malformation.AVMs can be classified in many ways,including histo-embryological classification,hemodynamic classification,etc.At present,the two mainstream classification systems used to guide the embolization treatment of peripheral AVMs are proposed by Cho and Yakes respectively based on the angiographic morphology of the lesions.Interventional embolization is the first-line treatment for AVMs.Among the many embolization agents,absolute ethanol is a permanent liquid embolization agent.Absolute ethanol can directly destroy the vascular endothelial cells to achieve a good curative efficacy,therefore,it has been wildly used in the treatment of peripheral AVMs.Yakes classification combines the angiographic classification with absolute ethanol embolization therapy.During absolute ethanol treatment,close attention should be paid to the occurrence of complications such as elevated pulmonary artery pressure.Although there are challenges remaining in the treatment of AVMs,the rapid development of molecular genetics has made targeted drug adjunctive treatment for AVMs possible.Perhaps,the novel therapeutic mode of combination use of traditional therapy targeted drug may be able to make a breakthrough in the treatment of AVMs.

Objective Virtual reality(VR)technology is closely related to eye vision.With the development and progress of hardware and software equipment,VR has been applied widely in the field of ophthalmology.This article describes the application of VR technology in the clinical research and ophthalmology education,reviews the current research results and advantages of this new technology,including the new curative effect in amblyopia/strabismus,myopia and glaucoma,as well as research on the technology's application in cataract surgery training and ophthalmology education.The article also discusses the dangers and difficulties of VR application and predicts its future application trend.In view of the shortcomings of VR in current research applications,the paper discusses and looks forward to provide powerful strategies for amblyopia,myopia and other ophthalmic diseases and clinical research.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

The global COVID-19 coronavirus pandemic has infected over 109 million people, leading to over 2 million deaths up to date and still lacking of effective drugs for patient treatment. Here, we screened about 1.8 million small molecules against the main protease (M^pro) and papain like protease (PL^pro), two major proteases in severe acute respiratory syndrome-coronavirus 2 genome, and identified 1851M^pro inhibitors and 205 PL^pro inhibitors with low nmol/l activity of the best hits. Among these inhibitors, eight small molecules showed dual inhibition effects on both M^pro and PL^pro, exhibiting potential as better candidates for COVID-19 treatment. The best inhibitors of each protease were tested in antiviral assay, with over 40% of M^pro inhibitors and over 20% of PL^pro inhibitors showing high potency in viral inhibition with low cytotoxicity. The X-ray crystal structure of SARS-CoV-2 M^pro in complex with its potent inhibitor 4a was determined at 1.8 Å resolution. Together with docking assays, our results provide a comprehensive resource for future research on anti-SARS-CoV-2 drug development.
Humans ; Antiviral Agents/chemistry* ; COVID-19 ; COVID-19 Drug Treatment ; High-Throughput Screening Assays ; Molecular Docking Simulation ; Protease Inhibitors/chemistry* ; SARS-CoV-2/enzymology* ; Viral Nonstructural Proteins