Objective To investigate the virulence and drug resistance characteristics of diarrheagenic Escherichia coli isolated from patients with infectious diarrhea in our hospital.Methods The preliminary identification of microbes was carried out by the VITEK-MS microbial mass spectrometry detection system and virulence genes were detected by the multiplex real-time PCR.Five types of diarrhea-genic Escherichia coli(DEC)clinically isolated from patients with infectious diarrhea in our hospital were identified.The drug resist-ance characteristics of DEC strains were detected by the microbroth dilution and E-test.The drug-resistant molecular characteristics were analyzed by the next-generation sequencing and bioinformatics.The Fisher exact probability method was used for statistical analy-sis.Results The detection rate of DEC in our hospital was 11.9%,with enteroaggregative E.coli(EAEC)accounting for 37.5%,a-typical enteropathogenic Escherichia coli(EPEC)accounting for 34.38%,enterotoxigenic E.coli(ETEC)accounting for 25.0%,and enteroinvasive E.coli(EIEC)accounting for 3.12%.None of enterohemorrhagic E.coli(EHEC)strain was detected.The resistance rates of 32 DEC strains to ampicillin,tetracycline,and trimethoprim/sulfamethoxazole were 53.12%,43.75%,and 37.5%,respec-tively.ESBLs(+)strains accounted for 18.75%,and the detection rate of multidrug-resistant strains was 83.83%,significantly higher than that of ESBLs(-)strains(P=0.042).A total of 25 ST genotypes were obtained from 32 DEC strains.The dominant genotypes were ST10(4 strains,12.5%),followed by ST28(2 strains,6.25%),ST31(2 strains,6.25%),ST3153(2 strains,6.25%),and the other 21 genotypes(1 strain,3.13%).One carbapenem resistant strain carrying the blaNDM-1 gene was detected in EAEC.Conclu-sion Four virulence genes such as aggR,pic,astA,and eae,are more common in the DEC of patients with infectious diarrhea in our hospital,with EAEC and EPEC as the main subtypes.The genotypes are highly polymorphic,and multidrug-resistant strains have been detected.

Objective: To investigate the epidemiological characteristics of overseas imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021, so as to provide insights into the prevention and control of overseas imported arthropod-borne infectious diseases. Methods: The data pertaining to imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021 were collected from the Chinese Disease Prevention and Control Information System, and the temporal distribution, regional distribution, population distribution, sources, diagnosis and treatment of imported dengue fever and malaria cases were descriptively analyzed. Results: Totally 4 332 overseas imported dengue fever cases and 2 011 overseas imported malaria cases were reported in Yunnan Province form 2015 to 2021, which accounted for 30.09% of all reported dengue fever cases and 98.53% of all reported malaria cases. The number of overseas imported dengue fever and malaria cases peaked from August to November (83.13% of all imported dengue fever cases) and from April to July (59.08% of all imported malaria cases), and the cases were predominantly reported in Dehong Prefecture (50.99% and 58.88%), with farmers as the predominant occupation (40.21% and 67.93%). The dengue fever and malaria cases were mainly imported from Southeast Asia (99.04% and 88.21%), and the proportions of definitive diagnosis of dengue fever and malaria were 88.33% and 97.80% at township hospitals, respectively. Conclusions The number of overseas imported dengue fever and malaria cases peaked from August to November and from April to July in Yunnan Province from 2015 to 2021, and the cases were predominantly reported in Dehong Prefecture and imported from Southeast Asia, with farmers as the predominant occupation.

Microglial surveillance plays an essential role in clearing misfolded proteins such as amyloid-beta, tau, and α-synuclein aggregates in neurodegenerative diseases. However, due to the complex structure and ambiguous pathogenic species of the misfolded proteins, a universal approach to remove the misfolded proteins remains unavailable. Here, we found that a polyphenol, α-mangostin, reprogrammed metabolism in the disease-associated microglia through shifting glycolysis to oxidative phosphorylation, which holistically rejuvenated microglial surveillance capacity to enhance microglial phagocytosis and autophagy-mediated degradation of multiple misfolded proteins. Nanoformulation of α-mangostin efficiently delivered α-mangostin to microglia, relieved the reactive status and rejuvenated the misfolded-proteins clearance capacity of microglia, which thus impressively relieved the neuropathological changes in both Alzheimer's disease and Parkinson's disease model mice. These findings provide direct evidences for the concept of rejuvenating microglial surveillance of multiple misfolded proteins through metabolic reprogramming, and demonstrate nanoformulated α-mangostin as a potential and universal therapy against neurodegenerative diseases.

Objective:To investigate the correlation between the Type D personality and the severity of white matter hyperintensities (WMHs) in patients with cerebral small vessel disease (CSVD).Methods:Consecutive patients with CSVD admitted to the Changzhou First People's Hospital between November 2020 and June 2021 were enrolled prospectively. The patients were scored on the Type D Personality Scale at admission; the scores of negative affectivity (NA) and social inhibition (SI) dimension were calculated respectively. The general data, laboratory examination data and imaging data of the patients were collected. Periventricular and deep WMHs were scored using the Fazekas visual scoring method. The total score 0-2 was defined as low-WMHs (L-WMHs), and 3-6 was defined as high-WMHs (H-WMHs). Multivariate logistic regression analysis was used to determine the independent influencing factor of WMHs. Results:A total of 100 patients with CSVD were enrolled, including 51 males (51%), aged 67.21±9.38 years, 29 (29%) had Type D personality; 56 (56%) were in the L-WMHs group and 44 (44%) were in the H-WMHs group. Univariate analysis showed that the proportion of Type D personality, NA dimension score, the proportion of hypertension, diastolic blood pressure, triglyceride and homocysteine in the H-WMHs group were significantly higher than those in the L-WMHs group (all P<0.05). Multivariate logistic regression analysis showed that NA dimension score (odds ratio [ OR] 18.351, 95% confidence interval [ CI] 2.780-121.135; P=0.003), age ( OR 1.134, 95% CI 1.039-1.238; P=0.005) and hypertension ( OR 7.771, 95% CI 1.525-39.607; P=0.014) were significantly positively correlated with the severity of WMHs, while triglycerides were significantly negatively correlated with the severity of WMHs ( OR 0.306, 95% CI 0.130-0.722; P=0.007). Conclusion:Type D personality is closely associated with the severity of WMHs in patients with CSVD.

Objective:To establish the norm of clinical nursing teachers' competency in tertiary first-class hospitals in northwest China.Methods:From August 2019 to February 2020, 1 077 clinical nursing teachers were selected from 12 tertiary first-class hospitals in northwest China by stratified, random and proportional sampling, and were investigated with the Clinical Nursing Teacher Competency Evaluation Scale. Descriptive statistics were carried out on the sample data, and univariate variance analysis and pairwise comparison were carried out on the multi-classification variables of age, nursing age, professional title, teaching years and the number of teachers per year. The verified data were exported to SPSS 26.0 for statistical analysis, variance analysis was used for multi-group comparison, and LSD test was used for pairwise comparison between groups.Results:①The corresponding mean norm was established by grouping the total score and the first-class index; the percentile norm was made with 5% spacing; P10, P30, P70 and P90 were selected as the grading demarcation points, and the demarcation norm was constructed. ②Factor analysis showed that there were statistical differences in personality characteristics among different ages, nursing ages and professional titles ( P<0.05), and also in professional attitudes among different nursing ages and professional titles ( P<0.05). Conclusion:The establishment of norm provides references for individuals or units to evaluate teachers' competence.

Non-coplanar radiotherapy is a kind of radiotherapy technology which employs multiple non-coplanar fixed fields or non-coplanar arcs. The non-coplanar field can be defined that the central axis of each field is not on the same plane, while the non-coplanar arc can be described that the trajectory formed by each arc is not on the same plane. Compared with coplanar radiotherapy, non-coplanar radiotherapy can achieve multi-angle or multi-radian irradiation, which effectively improves the focusing level of ray and is beneficial to enlarge the radiation dose of the target area between the surrounding normal tissues. Its dosimetric advantages have been proven in multiple types of tumors, such as intracranial tumors, liver cancer and lung cancer, etc. Multiple approaches can be employed to realize non-coplanar radiotherapy, which can be divided into the non-coplanar conic radiotherapy, non-coplanar conformal radiotherapy, non-coplanar intensity-modulated radiotherapy and non-coplanar volumetric modulated arc therapy according to the established sequence. In this review, the development process and principal characteristics of these implementations were summarized.

Objective:To observe the effect of project-based learning (PBL) in the clinical teaching of radiation physics.Methods:Thirty-two residents specializing in radiotherapy were included in the study. In the experimental group ( n=16), PBL was adopted, while traditional clinical teaching method was employed in the control group ( n=16). After the rotation, the assessment was conducted, as well as a questionnaire survey was performed, including five aspects: overall satisfaction, understanding of radiation physics knowledge, learning motivation, learning burden, and learning efficiency. Results:The assessment score in the experimental group was 86.31±5.41, which was higher than 75.28±5.91 in the control group, and the difference was statistically significant. Residents in the experimental group were satisfied with the effect of PBL.Conclusion:Compared with the traditional teaching method, PBL can improve the learning motivation, efficiency, and performance of radiotherapy residents, which is highly recognized by the residents.

Objective:To investigate the frequency and severity of systemic adverse reactions in children with allergic rhinitis (AR) undergoing subcutaneous immunotherapy (SCIT).Methods:The clinical data of 321 children with allergic rhinitis receiving SCIT at Department of Otorhinolaryngology, Changzhou Third People′s Hospital from January 2016 to January 2020 were retrospectively analyzed. There were 180 boys and 141 girls aged 5 to 14 years. Patients were injected subcutaneously with standardized dust mites allergen extract. The onset time, symptoms and signs and treatment of adverse reactions were documented. The relationship of adverse reactions with gender, age, treatment course and dosage of allergen injection were analyzed.Results:Patients received total 13 053 injections, and 115 adverse reactions (0.88%) occurred in 56 cases (17.45%). The incidence of adverse reactions in children aged 5-9 years was higher than in those aged 10-14 years, for both the number of cases and injections (χ2=4.41, P=0.04; χ2=9.13, P<0.01), but no significant differences were observed in gender of patients. The incidence of adverse reactions in the age group 2-3 years was lower than that in age groups<1 year and 1-<2 years in both of cases and injections (χ2=22.86, P<0.01; χ2=6.43, P=0.01; χ2=12.14, P<0.01; χ2=13.74, P<0.01). The incidence of adverse reactions in the high-dosage phase (100 000 SQ-U) was higher than that in the low-dosage phase (<100 000 SQ-U) (χ2=4.35, P=0.04). Conclusions:The study shows that the incidence of adverse reactions in children with allergic rhinitis receiving subcutaneous immunotherapy is less than 1% in the number of injections and most of them are grade Ⅰ adverse reactions. The study also shows that younger age, the early course of treatment and the high dosage of allergens are risk factors for adverse reactions.

Objective:To design a drum-shaped applicator through Monte Carlo simulation for breast intraoperative radiotherapy.Methods:Applicator designing process is as follows: first, determined the shape of the applicator based on the geometric characteristics of the breast tumor bed closed to the chest wall; second, calculated the scattering angle and dose rate of the electron beam after passing through a series of scattering foils of different thicknesses to determine the thickness of the scattering foil; thrid, modeled the layer according to the applicator′s geometric characteristics where modulator located, and designed the modulator through the relationship between the geometric characteristics of the layer and the surface dose of the applicator. EGSnrc/BEAMnrc and EGS4/DOSXYZ were employed to model the head of the Mobetron, the layer, the applicator, and to calculate the dose distributions.Results:The applicator has two components. The upper component is a 3cm-diametre cylindrical collimator with 0.5cm wall made of 0.3cm steel and 0.2cm water equivalent material (WEM), a 0.13cm-foil made of tansgen. The lower component is a 4cm-diametre drum made of 0.2cm WEM and a 0.14cm maximum thickness hill-shaped modulator made of steel. When the energy of electron beam was 12MeV, the dose rate was about 90.44 cGy/min, and the depth of the 50% isodose curve was 1cm.Conclusion:The applicator is successfully designed, and can obtain a drum-shaped dose distribution.

Objective:To establish an automatic planning method using volumetric-modulated arc therapy (VMAT) for primary liver cancer (PLC) radiotherapy based on predicting the feasibility dose-volume histogram (DVH) and evaluate its performance.Methods:Ten patients with PLC were randomly chosen in this retrospective study. Pinnacle Auto-Planning was used to design the VMAT automatic plan, and the feasibility DVH curve was obtained through the PlanIQ dose prediction, and the initial optimization objectives of the automatic plan were set according to the displayed feasible objectives interval. The plans were accessed according to dosimetric parameters of the planning target volume and organs at risk as well as the monitor units. All patients′ automatic plans were compared with clinically accepted manual plans by using the paired t-test. Results:There was no significant difference of the planning target volume D 2%, D 98%, D mean or homogeneity index between the automatic and manual plans ((58.55±2.81) Gy vs.(57.98±4.17) Gy, (47.15±1.58) Gy vs.(47.82±1.38) Gy, (53.14±0.95) Gy vs.(53.44±1.67) Gy and 1.15±0.05 vs. 1.14±0.07, all P>0.05). The planning target volume conformity index of the manual plan was slightly higher than that of the automatic plan (0.77±0.08 vs. 0.69±0.06, P<0.05). The mean doses of normal liver, V 30Gy, V 20Gy, V 10Gy, V 5Gy and V< 5Gy of the automatic plan were significantly better than those of the manual plan ((26.68±11.13)% vs.(28.00±10.95)%, (29.96±11.50)% vs.(31.89±11.51)%, (34.88±11.51)% vs.(38.66±11.67)%, (45.38±12.40)% vs.(50.74±13.56)%, and (628.52±191.80) cm 3vs.(563.15±188.39) cm 3, all P<0.05). The mean doses of the small intestine, the duodenum, and the heart, as well as lung V 10 of the automatic plan were significantly less than those of the manual plan ((1.83±2.17) Gy vs.(2.37±2.81) Gy, (9.15±9.36) Gy vs.(11.18±10.49) Gy, and (5.44±3.10) Gy vs.(6.25±3.26) Gy, as well as (12.70±7.08)% vs.(14.47±8.11)%, all P<0.05). Monitor units did not significantly differ between two plans ((710.67±163.72) MU vs.(707.53±155.89) MU, P>0.05). Conclusions:The automatic planning method using VMAT for PLC radiotherapy based on predicting the feasibility DVH enhances the quality for PLC plans, especially in terms of normal liver sparing. Besides, it also has advantages for the protection of the intestine, whole lung and heart.