Lignans are a powerful weapon for plants to resist stresses and have diverse bioactive functions to protect human health. Elucidating the mechanisms of stereoselective biosynthesis and response to stresses of lignans is important for the guidance of plant improvement. Here, we identified the complete pathway to stereoselectively synthesize antiviral (-)-lariciresinol glucosides in Isatis indigotica roots, which consists of three-step sequential stereoselective enzymes DIR1/2, PLR, and UGT71B2. DIR1 was further identified as the key gene in respoJanuary 2024nse to stresses and was able to trigger stress defenses by mediating the elevation in lignan content. Mechanistically, the phytohormone-responsive ERF transcription factor LTF1 colocalized with DIR1 in the cell periphery of the vascular regions in mature roots and helped resist biotic and abiotic stresses by directly regulating the expression of DIR1. These systematic results suggest that DIR1 as the first common step of the lignan pathway cooperates with PLR and UGT71B2 to stereoselectively synthesize (-)-lariciresinol derived antiviral lignans in I. indigotica roots and is also a part of the LTF1-mediated regulatory network to resist stresses. In conclusion, the LTF1-DIR1 module is an ideal engineering target to improve plant Defenses while increasing the content of valuable lignans in plants.

Bacterial biofilms gave rise to persistent infections and multi-organ failure, thereby posing a serious threat to human health. Biofilms were formed by cross-linking of hydrophobic extracellular polymeric substances (EPS), such as proteins, polysaccharides, and eDNA, which were synthesized by bacteria themselves after adhesion and colonization on biological surfaces. They had the characteristics of dense structure, high adhesiveness and low drug permeability, and had been found in many human organs or tissues, such as the brain, heart, liver, spleen, lungs, kidneys, gastrointestinal tract, and skeleton. By releasing pro-inflammatory bacterial metabolites including endotoxins, exotoxins and interleukin, biofilms stimulated the body’s immune system to secrete inflammatory factors. These factors triggered local inflammation and chronic infections. Those were the key reason for the failure of traditional clinical drug therapy for infectious diseases.In order to cope with the increasingly severe drug-resistant infections, it was urgent to develop new therapeutic strategies for bacterial-biofilm eradication and anti-bacterial infections. Based on the nanoscale structure and biocompatible activity, nanobiomaterials had the advantages of specific targeting, intelligent delivery, high drug loading and low toxicity, which could realize efficient intervention and precise treatment of drug-resistant bacterial biofilms. This paper highlighted multiple strategies of biofilms eradication based on nanobiomaterials. For example, nanobiomaterials combined with EPS degrading enzymes could be used for targeted hydrolysis of bacterial biofilms, and effectively increased the drug enrichment within biofilms. By loading quorum sensing inhibitors, nanotechnology was also an effective strategy for eradicating bacterial biofilms and recovering the infectious symptoms. Nanobiomaterials could intervene the bacterial metabolism and break the bacterial survival homeostasis by blocking the uptake of nutrients. Moreover, energy-driven micro-nano robotics had shown excellent performance in active delivery and biofilm eradication. Micro-nano robots could penetrate physiological barriers by exogenous or endogenous driving modes such as by biological or chemical methods, ultrasound, and magnetic field, and deliver drugs to the infection sites accurately. Achieving this using conventional drugs was difficult. Overall, the paper described the biological properties and drug-resistant molecular mechanisms of bacterial biofilms, and highlighted therapeutic strategies from different perspectives by nanobiomaterials, such as dispersing bacterial mature biofilms, blocking quorum sensing, inhibiting bacterial metabolism, and energy driving penetration. In addition, we presented the key challenges still faced by nanobiomaterials in combating bacterial biofilm infections. Firstly, the dense structure of EPS caused biofilms spatial heterogeneity and metabolic heterogeneity, which created exacting requirements for the design, construction and preparation process of nanobiomaterials. Secondly, biofilm disruption carried the risk of spread and infection the pathogenic bacteria, which might lead to other infections. Finally, we emphasized the role of nanobiomaterials in the development trends and translational prospects in biofilm treatment.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective: To determine the nutritional status and associated factors of vitamin D in primary and middle school students in Shandong Province, so as to provide reference for developing targeted vitamin deficiency interventions. Methods: From January to September 2021, using multi stage stratified random sampling, physical examinations and laboratory tests were carried out among 3 539 primary and middle school students in Shandong Province. Associated factors of vitamin D were analyzed by Logsitc regression analysis. Results: The average vitamin D level among primary and middle school students was (17.56±6.65) ng/mL, while the deficiency and severe deficiency rate was 67.4%. Multivariate Logistic regression analysis showed that girls ( OR =1.95), students in junior high school ( OR =2.14) and senior high school ( OR =2.36) were at higher risk of vitamin D deficiency and severe deficiency ( P <0.05). Students from coastal areas ( OR =0.54), physical examination in summer and autumn ( OR = 0.74 ), and 35 g of egg intake per day ( OR =0.53), and with outdoor activity time greater than 60-120 min and >120 min ( OR =0.63, 0.48) had lower risk of vitamin D deficiency ( P <0.05). Conclusions The nutritional status of vitamin D among elementary and secondary school students in Shandong Province warrants further attention. Intervention measures such as nutritional education, healthy diet and prolonging outdoor activities should be promoted in primary and middle school students.

Objective To investigate the effect of precision nutrition management on the weight gain and pregnancy outcome in the patients with rapid gestational weight gain (GWG).Methods A total of 121 pregnant women with regular antenatal check-up and rapid GWG in this hospital from July 2022 to May 2023 were selected as the study subjects and divided into the observation group (n=58) and control group (n=63) by the random number table method.The two groups all received the conventional antenatal check-up,health-care and health education.The observation group simultaneously received the precision nutrition intervention for 4 weeks,in which one extra meal was replaced with 30 g of low glycaemic index nutritional formula pow-der.The diet situation and physical activity levels in the observation group were investigated before interven-tion and during the intervention period.The baseline information,post-intervention body weight,delivery body weight and pregnant maternal and neonate outcomes were collected in the two groups.Results Compared with before intervention,whole grains and miscellaneous beans[0(0,30.0)g/d vs.0(0,2.5)g/d],fish and shrimp[65.0(0,130.0)g/d vs.0(0,100.0)g/d],vegetables[(310.5±98.9)g/d vs.(248.2±117.9)g/d],iron[20.30(18.70,23.90)mg/d vs.18.75(14.80,22.80)mg/d]intake and weekly activity time[350(280,420) min vs.210(150,280)min]during the intervention period in the observation group were increased,fruits[179.0(145.0,238.0)g/d vs.200.0(179.0,366.0)g/d],total energy[1702(1608,1837)kcal/d vs.2055 (1848,2327)kcal/d],saturated fatty acids[11.50(8.20,15.80)g/d vs.15.75(12.30,19.00)g/d]intake and proportion of fat calories[(31.71±5.22)％ vs.(35.12±6.17)％]were decreased,the differences were statis-tically significant (P<0.05).Compared with the control group,the intervention period[0.45(0.29,0.63)kg/week vs.0.63(0.50,0.88)kg/week]and the weekly weight gain in 4 weeks after the intervention[0.50 (0.34,0.64)kg/week vs.0.70(0.50,0.93)kg/week],GWG excess ratio (60.3％ vs.77.8％) in the observa-tion group were lower,and the differences were statistically significant (P<0.05).Compared with the control group,complicating anemia during pregnancy (15.5％ vs.31.7％),macrosomia (5.2％ vs.17.2％),incidence rate of adverse delivery outcomes (1.7％ vs.12.7％) and neonatal birth weight[(3292.2±420.9)g vs. (3497.6±454.7)g]in the observation group were lower,and the natural labor process was shorter[5.17 (3.33,9.15)h vs.10.00(6.37,18.00)h],the differences were statistically significant (P<0.05).Conclusion Preci-sion nutrition management could effectively control rapid GWG and the increasing velocity of gestational weight.

Objective This study aimed to understand the epidemic status and phylogenetic relationships of rotavirus group A(RVA)in the Pearl River Delta region of Guangdong Province,China. Methods This study included individuals aged 28 days-85 years.A total of 706 stool samples from patients with acute gastroenteritis collected between January 2019 and January 2020 were analyzed for 17 causative pathogens,including RVA,using a Gastrointestinal Pathogen Panel,followed by genotyping,virus isolation,and complete sequencing to assess the genetic diversity of RVA. Results The overall RVA infection rate was 14.59%(103/706),with an irregular epidemiological pattern.The proportion of co-infection with RVA and other pathogens was 39.81%(41/103).Acute gastroenteritis is highly prevalent in young children aged 0-1 year,and RVA is the key pathogen circulating in patients 6-10 months of age with diarrhea.G9P[8](58.25%,60/103)was found to be the predominant genotype in the RVA strains,and the 41 RVA-positive strains that were successfully sequenced belonged to three different RVA genotypes in the phylogenetic analysis.Recombination analysis showed that gene reassortment events,selection pressure,codon usage bias,gene polymorphism,and post-translational modifications(PTMs)occurred in the G9P[8]and G3P[8]strains. Conclusion This study provides molecular evidence of RVA prevalence in the Pearl River Delta region of China,further enriching the existing information on its genetics and evolutionary characteristics and suggesting the emergence of genetic diversity.Strengthening the surveillance of genotypic changes and gene reassortment in RVA strains is essential for further research and a better understanding of strain variations for further vaccine development.

Objective To measure the distance between the lateral compression Ⅱ(LC-Ⅱ)screw guide needle and the surrounding important structures around the anterior inferior iliac spine in pelvic fractures and to locate the needle point,so as to provide anatomical reference for clinical nail placement.Methods Totally 40 adult gross specimens of embalming were implanted with LC-Ⅱ screw guide needle under the surveillance of C-arm machine,and the specimens were dissected.The shortest distance between the insertion point and the lateral femoral cutaneous nerve,femoral nerve,femoral artery,femoral vein,anterior superior iliac spine and inguinal ligament was measured.The triangle was constructed between the insertion point,anterior superior iliac spine and inguinal ligament,and the exact location of the entry point was calculated.Results The average distance between the insertion point of the male needle and the femoral vein was(50.67±7.29)mm＞the anterior superior iliac spine(43.83±7.58)mm＞the femoral artery(38.35±6.63)mm＞the femoral nerve(31.17±1.67)mm=the inguinal ligament(28.69±6.59)mm＞the lateral femoral cutaneous nerve(7.98±3.81)mm.The mean distance between the insertion point of the female needle and the anterior superior iliac spine was(45.28±7.07)mm=femoral vein(43.72±6.89)mm＞femoral artery(33.76±6.33)mm＞femoral nerve(25.66±6.46)mm=inguinal ligament(23.22±5.00)mm＞lateral femoral cutaneous nerve(8.97±4.76)mm.The projection distance of the entry point was 31.77 mm for men and 38.41 mm for women.The Angle b was 42.81°for men and 31.71° for women.Conclusion The lateral femoral cutaneous nerve is most vulnerable to injury when LC-Ⅱ screw is inserted,and the risk of injury has nothing to do with sex.The insertion point positioning method a and b made LC-Ⅱ screw placement quickly,safely and accurately,and reduced fluoroscopy time and frequency.

Objective To evaluate the clinical effect of ultra-early endovascular treatment of ruptured tiny intracranial aneurysms(RTIAs).Methods A total of 35 patients with RTIAs who were treated with endovascular embolization within 24 hours after subarachnoid hemorrhage in our department from May 2017 to November 2022 were retrospectively analyzed.The basic clinical information,endovascular treatment results,clinical and imaging follow-up results were analyzed.Results The mean aneurysms maximum diameter is was(2.5±0.4)mm.Of these 35 patients with RTIAs,23 patients(65.7％)were treated with simple coil embolization,12 patients(34.3％)with stent assisted coiling.Immediate angiographic results showed that Raymond grade Ⅰ in 20 patients(57.1％),Ⅱ in 13(37.2％),Ⅲ in 2(5.7％).Perioperative complications occurred in 4 patients(11.4％),including Intraoperative aneurysm rupture in 2(5.7％),intra-stent thrombosis in 2(5.7％),massive cerebral infarction followed by decompressive craniectomy in 1,postoperative death in 1.Angiographic follow-up was performed in 24 patients(68.6％),recurrence in 1 patient receiving retreatment.Clinical follow-up were performed in 33 patients,The mRS of 0-2 were in 31 patients(93.9％).Conclusion Ultra-early endovascular treatment of RTIAs is effective and relatively safe,with favorable angiographic results and clinical outcomes at follow up.Intraoperative aneurysm rupture and thrombosis are the major perioperative complications.

Objective To explore the potential influencing factors of post-operative healthcare-associated infection(HAI)in colorectal cancer patients,as well as the mediating effect relationship between the influencing factors and the diagnosis-intervention packet(DIP)payment differentials.Methods Medical data of patients who underwent colorectal cancer surgery in a tertiary first-class cancer hospital in Guangzhou were retrospectively analyzed.According to HAI status,patients were divided into infection group and non-infection group.Baseline demographic information and differences in DIP payment differentials between two groups of patients were compared by rank sum test or chi-square test.The influence of each potential factor on the occurrence of HAI was analyzed by logistic re-gression.Mediating analysis was preformed by bootstrap method,and mediating effect of HAI and total hospitaliza-tion days on DIP payment differentials was evaluated.Results A total of 350 patients were included in analysis,50 were in the infection group and 300 in the non-infection group.The incidence of HAI was 14.29％.Logistic regres-sion analysis result showed that risk of HAI in patients with central venous catheterization ≥10.00 days was 13.558 times higher than that＜10.00 days(P＜0.001);risk of HAI in patients with urinary catheterization ≥3.00 days was 2.388 times higher than that＜3.00 days(P=0.022).There were all statistically significant differences in DIP payment differentials among patients with different ages,prognostic nutritional index(PNI),HAI status,total length of hospitalization stay,duration of surgery,central venous catheterization days,and catheterization days(all P＜0.05).The mediating analysis results showed that the occurrence of HAI resulted a change in DIP payment di-fferentials by affecting the total number of hospitalization days.The mediating effect value of total hospitalization days was 0.038,accounting for 35.68％of the total effect.Conclusion Medical institutions should pay attention to HAI resulting from prolonged central venous and urinary catheterization in patients underwent surgery for colorectal cancer,reducing the total length of hospital stay,thus reducing the overruns associated with the increased DIP pay-ment differentials.

Objective:To analyze thalassemia genotypes and distribution of children in Wuzhou Guangxi,and evaluate the diagnostic value of HbA2 in children's thalassemia screening,so as to provide scientific evidence for the prevention and control strategies of thalassemia.Methods:Four hundred and fifty-eight children suspected with thalassemia in Wuzhou were enrolled from March 2017 to June 2022.The level of HbA2 was detected using Bio-Rad VARIANT Ⅱ Hb analysis system.The deletion of α-thalassemia was measured with gap-PCR assay,and the point mutation of α-and β-thalassemia was tested with DNA reverse dot blot hybridization assay.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of HbA2 for children's thalassemia.Results:A total of 304 thalassemia carriers were detected in 458 children,accounting for 66.38％.One hundred and seventy-five cases were defined to be α-thalassemia,with the main type of--SEA/αα(54.86％).Thirty-six cases were defined to be intermediate α-thalassemia,with the main type of-α3.7/--SEA(9.72％).In 108 cases with β-thalassemia,βCD41-42/βN was the main type,accounting for 49.07％,followed by βIVS-Ⅱ-654/βN(14.81％).Seven cases were moderate/severe β-thalassemia(predominantly β-28/β-28 and βCD41-42/βCD17)Twenty-one genotypes of α-and β-thalassemia were found in the children.There was significant difference of HbA2 level between the children with different types of thalassemia and healthy controls(all P＜0.001).ROC curve analysis showed that the sensitivities of HbA2 for α-thalassemia,β-thalassemia and αβ-thalassemia were 74.3％,82.4％and 85.7％,with the optimal cut-off values of 2.60％,3.60％and 3.70％,respectively,the specificities were 64.3％,96.1％and 96.8％,and the area under the curve were 0.690,0.887 and 0.916,respectively.Conclusion:The thalassemia genotypes of children in Wuzhou are diverse.It is necessary to further strengthen the prevention and control measure of thalassemia to reduce birth defects and improve birth quality.