Objective:To investigate the role of TcpC, a virulence factor of uropathogenic Escherichia coli (UPEC), in immune evasion, and analyze its related pathogenic mechanism. Methods:C57BL/6 mice were injected with 10 9 colony-forming unit of wild-type (CFT073 wt) or tcpc gene-knockout (CFT073 Δ tcpc) UPEC CFT073 strains from urethra into bladder to construct a mouse model of pyelonephritis. These mice were sacrificed 5 d after infection and their kidneys were taken to observe the gross pathological changes. Hematoxylin-eosin staining was used to observe histopathological changes in kidney tissues and immunohistochemistry was performed to locate TcpC in kidney tissues. The bacterial loads in urine samples of UPEC infected-mice were counted by ten-fold dilution method, and the presence of tcpc gene in the genomic DNA of bacteria from CFT073-infected mouse kidney or urine samples was measured by PCR. The expression of TcpC at mRNA level was detected by qRT-PCR after infecting dendritic cells with CFT073 wt strains. The influences of UPEC infection on the activation of NF-κB signaling pathway and the secretion of proinflammatory factors by dendritic cells were analyzed by Western blot and ELISA, respectively. The viability of UPEC strains in dendritic cells were observed by laser confocal microscope. Results:Compared with the CFT073 Δ tcpc group, the mice in the CFT073 wt group had obvious abscess in the kidneys as well as massive neutrophil infiltration and abundant TcpC in kidney tissues. The bacterial loads in the urine of CFT073 wt-infected mice were significantly higher than those in the urine of CFT073 Δ tcpc mice. PCR results showed that tcpc gene was successfully amplified from mouse kidney and urine samples. Increased expression of TcpC at both mRNA and protein levels was detected in CFT073 wt-infected dendritic cells. CFT073 wt infection inhibited the phosphorylation of NF-κB p50 and the production of proinflammatory factors in dendritic cells. TcpC promoted the survival of CFT073 wt in dendritic cells. Conclusions:TcpC expression increases significantly during CFT073 wt infection or in mice with CFT073 wt-induced pyelonephritis. It promotes the survival of CFT073 wt in dendritic cells by inhibiting the activation of NF-κB signaling pathway and reducing the secretion of pro-inflammatory cytokines. TcpC is involved in the pathogenesis of UPEC and immune evasion.

Background::Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.Methods::This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demographics, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram.Results::Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations. Conclusion::A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.Registration::Chictr.org.cn, ChiCTR2100049131.

Background: In the Chinese coal industry, widespread blame avoidance behavior (BAB) greatly impacts coal mine accidents. Therefore, it is necessary to stop the BAB of coal mine managers and raise the management level of coal mine enterprises for the safe development of Chinese coal industry. Methods: Based on the semi-structured interviews and questionnaire surveys (20 middle-level managers in coal mines), this paper used the Grounded Theory and Nvivo Software qualitative research methodology to open, spindle, and selectively encode the interview data. Then, an index system of factors influencing BAB of coal mine managers was constructed. The influence degree, affected degree, centrality degree, cause degree of each influencing factor were calculated and the hierarchical model of influencing factors of BAB of coal mine managers was established by the DEMATEL-ISM method which is a decision support tool used to evaluate and analyze the interdependencies between influencing factors. Results: Index system of factors influencing BAB of coal mine managers included four levels and 12 influencing factors: individual, organizational, institutional environmental, and situational factors. The hierarchical model identified eight causal factors and four consequential factors, of which safety management (15.355), work attitude (14.380), and work group performance (14.281) in the top three of the centrality rankings are the key factors affecting the avoidance behavior of coal mine managers; A 3-level multilevel structure was constructed to reflect the interactions among the factors influencing the BAB of coal mine managers in terms of direct, indirect, and root causes, and corresponding improvement measures were proposed. Conclusion This study offers a theoretical complement and practical guidance for stopping BAB of coal mine managers.

Background: In the Chinese coal industry, widespread blame avoidance behavior (BAB) greatly impacts coal mine accidents. Therefore, it is necessary to stop the BAB of coal mine managers and raise the management level of coal mine enterprises for the safe development of Chinese coal industry. Methods: Based on the semi-structured interviews and questionnaire surveys (20 middle-level managers in coal mines), this paper used the Grounded Theory and Nvivo Software qualitative research methodology to open, spindle, and selectively encode the interview data. Then, an index system of factors influencing BAB of coal mine managers was constructed. The influence degree, affected degree, centrality degree, cause degree of each influencing factor were calculated and the hierarchical model of influencing factors of BAB of coal mine managers was established by the DEMATEL-ISM method which is a decision support tool used to evaluate and analyze the interdependencies between influencing factors. Results: Index system of factors influencing BAB of coal mine managers included four levels and 12 influencing factors: individual, organizational, institutional environmental, and situational factors. The hierarchical model identified eight causal factors and four consequential factors, of which safety management (15.355), work attitude (14.380), and work group performance (14.281) in the top three of the centrality rankings are the key factors affecting the avoidance behavior of coal mine managers; A 3-level multilevel structure was constructed to reflect the interactions among the factors influencing the BAB of coal mine managers in terms of direct, indirect, and root causes, and corresponding improvement measures were proposed. Conclusion This study offers a theoretical complement and practical guidance for stopping BAB of coal mine managers.

Background: In the Chinese coal industry, widespread blame avoidance behavior (BAB) greatly impacts coal mine accidents. Therefore, it is necessary to stop the BAB of coal mine managers and raise the management level of coal mine enterprises for the safe development of Chinese coal industry. Methods: Based on the semi-structured interviews and questionnaire surveys (20 middle-level managers in coal mines), this paper used the Grounded Theory and Nvivo Software qualitative research methodology to open, spindle, and selectively encode the interview data. Then, an index system of factors influencing BAB of coal mine managers was constructed. The influence degree, affected degree, centrality degree, cause degree of each influencing factor were calculated and the hierarchical model of influencing factors of BAB of coal mine managers was established by the DEMATEL-ISM method which is a decision support tool used to evaluate and analyze the interdependencies between influencing factors. Results: Index system of factors influencing BAB of coal mine managers included four levels and 12 influencing factors: individual, organizational, institutional environmental, and situational factors. The hierarchical model identified eight causal factors and four consequential factors, of which safety management (15.355), work attitude (14.380), and work group performance (14.281) in the top three of the centrality rankings are the key factors affecting the avoidance behavior of coal mine managers; A 3-level multilevel structure was constructed to reflect the interactions among the factors influencing the BAB of coal mine managers in terms of direct, indirect, and root causes, and corresponding improvement measures were proposed. Conclusion This study offers a theoretical complement and practical guidance for stopping BAB of coal mine managers.

Background: In the Chinese coal industry, widespread blame avoidance behavior (BAB) greatly impacts coal mine accidents. Therefore, it is necessary to stop the BAB of coal mine managers and raise the management level of coal mine enterprises for the safe development of Chinese coal industry. Methods: Based on the semi-structured interviews and questionnaire surveys (20 middle-level managers in coal mines), this paper used the Grounded Theory and Nvivo Software qualitative research methodology to open, spindle, and selectively encode the interview data. Then, an index system of factors influencing BAB of coal mine managers was constructed. The influence degree, affected degree, centrality degree, cause degree of each influencing factor were calculated and the hierarchical model of influencing factors of BAB of coal mine managers was established by the DEMATEL-ISM method which is a decision support tool used to evaluate and analyze the interdependencies between influencing factors. Results: Index system of factors influencing BAB of coal mine managers included four levels and 12 influencing factors: individual, organizational, institutional environmental, and situational factors. The hierarchical model identified eight causal factors and four consequential factors, of which safety management (15.355), work attitude (14.380), and work group performance (14.281) in the top three of the centrality rankings are the key factors affecting the avoidance behavior of coal mine managers; A 3-level multilevel structure was constructed to reflect the interactions among the factors influencing the BAB of coal mine managers in terms of direct, indirect, and root causes, and corresponding improvement measures were proposed. Conclusion This study offers a theoretical complement and practical guidance for stopping BAB of coal mine managers.

Background: In the Chinese coal industry, widespread blame avoidance behavior (BAB) greatly impacts coal mine accidents. Therefore, it is necessary to stop the BAB of coal mine managers and raise the management level of coal mine enterprises for the safe development of Chinese coal industry. Methods: Based on the semi-structured interviews and questionnaire surveys (20 middle-level managers in coal mines), this paper used the Grounded Theory and Nvivo Software qualitative research methodology to open, spindle, and selectively encode the interview data. Then, an index system of factors influencing BAB of coal mine managers was constructed. The influence degree, affected degree, centrality degree, cause degree of each influencing factor were calculated and the hierarchical model of influencing factors of BAB of coal mine managers was established by the DEMATEL-ISM method which is a decision support tool used to evaluate and analyze the interdependencies between influencing factors. Results: Index system of factors influencing BAB of coal mine managers included four levels and 12 influencing factors: individual, organizational, institutional environmental, and situational factors. The hierarchical model identified eight causal factors and four consequential factors, of which safety management (15.355), work attitude (14.380), and work group performance (14.281) in the top three of the centrality rankings are the key factors affecting the avoidance behavior of coal mine managers; A 3-level multilevel structure was constructed to reflect the interactions among the factors influencing the BAB of coal mine managers in terms of direct, indirect, and root causes, and corresponding improvement measures were proposed. Conclusion This study offers a theoretical complement and practical guidance for stopping BAB of coal mine managers.

Objective:To explore the factors on malnutrition or risk of malnutrition in patients with Alzheimer′s disease (AD)-related cognitive impairment,and to further analyze the association between the severity of behavioral and psychological symptoms in dementia (BPSD) and nutritional status.Methods:The clinical data of 247 patients with AD-related cognitive impairment were collected continuously from the Chinese Imaging, Biomarkers and Lifestyle Study of Alzheimer′s Disease (CIBL) cohort between June 1, 2021 and August 31, 2022. The patients were divided into well-nourished group ( n=128) and malnourished group ( n=119) according to the scores of Mini-Nutritional Assessment scale (MNA). The sociodemographic data (sex, age, body mass index, waist-to-hip ratio, education level), the medical history of olfactory dysfunction, combination with more than two chronic diseases, and gastrointestinal diseases, presenting BPSD, and the scores of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Activity of Daily Living (ADL), Caregiver Burden Inventory (CBI) and Dietary Diversity Score (DDS) were compared between the two groups. The factors with statistically significant differences in hypothesis test and univariate Logistic regression analysis were enrolled in multivariate Logistic regression analysis to further identify independent factors associated with malnutrition in patients with AD-related cognitive impairment. Furthermore, the association between NPI scores and MNA scores was analyzed by Spearman′s rank correlation test. Results:Compared with those in the well-nourished group, patients in the malnourished group had higher age [(66.70±7.01) years vs (69.14±8.87) years, t=-2.39, P=0.018], lower body mass index [(24.68±2.84) kg/m 2vs (22.69±3.63) kg/m 2, t=4.78, P<0.001], and higher proportion of presenting BPSD [22.66% (29/128) vs 76.47% (91/119), χ 2=71.49, P<0.001]; lower scores of MMSE, MoCA, and DDS [24.27±4.69 vs 18.95±8.40, t=6.09; 20.29±5.18 vs 14.55±8.12, t=6.56; 8.00 (8.00, 9.00) vs 8.00 (7.00, 8.00), Z=-4.66; all P<0.001], and higher scores of NPI, ADL and CBI [1.00 (0, 6.00) vs 10.00 (2.00, 25.00), Z=-6.50; 20.00 (20.00, 22.00) vs 27.00 (20.00, 40.00), Z=-7.08; 1.00 (0, 14.75) vs 12.00 (2.00, 35.00), Z=-5.13; all P<0.001]. There were no statistically significant differences in the sex, waist-to-hip ratio, education level, and the medical history of olfactory dysfunction, combination with more than two chronic diseases, and gastrointestinal diseases between the two groups. The multiple Logistic regression analysis demonstrated that the decreased body mass index ( OR=0.79, 95% CI 0.70-0.89, P<0.001), presenting BPSD ( OR=7.84, 95% CI 3.67-16.73, P<0.001), elevated ADL scores ( OR=1.15, 95% CI 1.06-1.24, P<0.001) and CBI scores ( OR=0.98, 95% CI 0.97-1.00, P=0.026), and decreased scores of DDS ( OR=0.66, 95% CI 0.51-0.84, P=0.001) were independently associated with malnutrition in patients with AD-related cognitive impairment. The MNA scores were significantly negatively associated with NPI scores ( r=-0.483,95% CI -0.58--0.38, P<0.001). Conclusions:The decreased body mass index, dietary diversity, and ability of daily living, and presenting BPSD and heavy burden of caregivers can independently contribute to the malnutrition in patients with AD-related cognitive impairment. The more serious the BPSD, the worse the nutritional status.

Objective:To explore the value of jellyfish sign, an abnormal ultrasonographic sign, in predicting adverse perinatal outcomes of women with complete placenta previa combined with placenta accreta spectrum disorders (PAS).Methods:This retrospective study analyzed the ultrasound images of 72 singleton gravidas, diagnosed with complete placenta previa combined with PAS, who underwent cesarean section at the First Affiliated Hospital of Nanjing Medical University between January 2020 and February 2023. Based on the presence and absence of the jellyfish sign in ultrasound images, these gravidas were divided into the jellyfish-sign group (15 cases, 20.8%) and the non-jellyfish-sign group (57 cases, 79.2%). The clinical data and perinatal outcomes of the two groups were analyzed. The adverse perinatal outcomes encompassed conditions such as abdominal aorta balloon block, uterine artery embolism, hysterectomy, postpartum hemorrhage, and neonatal intensive care unit (NICU) admission of their neonates. Statistical analysis was performed using two independent samples t-test, the Mann-Whitney U test and the Chi-square (or Fisher's exact) test. Results:(1) The jellyfish-sign group exhibited a higher parity [(1.6±0.7) times vs (1.2±0.6) times, t=2.01] and higher prenatal scores of placenta accreta [(12.3±1.5) scores vs (8.6±2.9) scores, t=6.59] than those in the non-jellyfish-sign group (both P<0.05). Among the 57 cases in the non-jellyfish-sign group, there were 14 cases of placenta creta (24.6%), 40 cases of placenta increta (70.2%), and three cases of placenta percreta (5.3%). Among the 15 cases in the jellyfish-sign group, nine cases were diagnosed with placenta increta, six with placenta percreta, and none with placenta creta. The difference in distribution between the two groups was statistically significant (Fisher's exact test, P<0.001). (2) Intraoperative blood loss [(for those who accepted abdominal aorta balloon block, 1 973±1 057) ml vs (1 211±576) ml, t=2.55], red blood cells transfused [4.0 U (2.0-23.0 U) vs 2.5 U (0.0-11.0 U), Z=－2.53], postoperative hospitalization time [(9.7±2.4) vs (7.5±2.2) d, t=3.36], the incidence of abdominal aorta balloon block [15/15 vs 38.6% (22/57), χ2=17.92], uterine artery embolism [for those who accepted abdominal aorta balloon block, 3/15 vs 1.8% (1/57), Fisher's exact test], and requiring blood transfusion [15/15 vs 63.2% (36/57), Fisher's exact test] were higher in the jellyfish-sign group than those in the non-jellyfish-sign group. However, the non-jellyfish-sign group had lower gestational age at delivery [(33.6±1.5) weeks vs (35.2±1.8) weeks, t=－3.24], and lower neonatal Apgar score at 1 min and 5 min [1 min: 8 scores (3-10 scores) vs 9 scores (4-10 scores), Z=－2.46; 5 min: 9 scores (7-10 scores) vs 10 scores (6-10 scores), Z=－2.02] (all P<0.05). There were no significant differences in emergency surgery rate, 24 h postoperative blood loss, neonatal birth weight, and proportion of NICU admission between the two groups. Additionally, no cases of hysterectomy or death were observed in the two groups. Conclusions:Ultrasound examination revealing jellyfish signs in patients with complete placenta previa and PAS is associated with an increased likelihood of adverse perinatal outcomes. Consequently, the management of these patients should be given greater attention.

Objective:To analyze the influencing factors of post stroke cognitive impairment (PSCI) and their correlation with cognitive scores in patients with acute ischemic stroke.Methods:In this cross-section study, 36 patients diagnosed with acute ischemic stroke and post stroke cognitive impairment (PSCI) admitted to the Department of Vascular Neurology of Beijing Tiantian Hospital Affiliated to Capital Medical University from June 1, 2022 to September 30, 2022 were selected as the PSCI group. And one to one matching was performed for patients without PSCI (PSNCI group) with an age±1 year and same gender admitted to the hospital during the same period (as control, 36 cases). Basic clinical data of the two groups were collected, the laboratory and imaging examinations were completed. Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used for cognitive evaluation by neuropsychologists. Hypothesis testing was used to compare the differences in basic data, laboratory tests and lesion sites between the two groups. Multi-factor conditional logistic regression was performed to analyze the influencing factors of PSCI, and Spearman correlation analysis was carried out to analyze the correlation between influencing factors of PSCI and the cognitive scores.Results:Compared with those in PSNCI group, the proportion of patients with stroke/transient ischemic attack history, hyperhomocysteinemia (HHcy), apolipoprotein E(ApoE) ε4 carriers and the ratio of temporal lobe and thalamus infarction were higher in PSCI group (41.7% vs 13.9%, 36.1% vs 2.8%, 30.6% vs 5.6%, 22.3% vs 2.8%, 25.0% vs 5.6%), the MMSE and MoCA scores were lower in PSCI group [16.50 (8.25, 19.00) vs 28.00 (27.00, 30.00), 10.00 (4.25, 14.50) vs 27.00 (25.00, 28.00)] (all P<0.05). Logistic regression analysis showed that HHcy was a positive correlation factor for PSCI ( OR=2.342, 95% CI=1.186-4.622, P=0.014). Spearman correlation analysis showed that MMSE ( r=-0.415) and MoCA ( r=-0.417) scores were negatively correlated with homocysteine (Hcy) (both P<0.05). Conclusion:HHcy is an important factor affecting the occurrence and development of PSCI in patients with acute ischemic stroke, and Hcy level is negatively correlated with cognitive scores in those patients.