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This study was carried to reveal the genetic mechanisms of trimethoprim/sulfamethoxazole (SXT) resistance. Among 300 clinical Stenotrophomonas maltophilia isolates from China, resistance determinants such as sul and dfrA genes, integrons and transposase were examined using PCR, DNA sequencing and thermal asymmetric interlaced PCR (TAIL-PCR). Data were analyzed using SPSS 20.0. Of the 300 isolates, 116 (38.7%) were resistant to SXT. An alarming trend of increased resistance to SXT were found over the 10-year period. The positive rates of sul and class 1 integrase (intI1) increased gradually with the development of SXT resistance over the 10-year period. Multiple logistic regression analyses indicated that the genes of qacEΔ1-sul1 (81% vs 46.2%, p = 0.000), sul2 (50.9% vs 9.8%, p = 0.000), intI1 (83.6% vs 65.8%, p = 0.000), dfrA12 (25% vs 3.3%, p = 0.000), dfrA17 (15.5% vs 3.8%, p = 0.000) and dfrA27 (4.3% vs 1.6%, p = 0.01) were more prevalent in SXT-resistant isolates than SXT-susceptible isolates except dfrA1(p = 0.83) and dfrA5(p = 0.18). Sequencing data revealed 12 types of resistance gene cassettes (aar-3-dfrA27, dfrA12-aadA2, dfrA17-aadA5, cmlA1, aacA4, aadA5, arr-3-aacA4, aadA1, aadB-aadA4, aacA4-catB8-aadA1, aadB-aac(6')-II-blaCARB-8 and aac(6')-II-blaCARB-8) located in the class 1 integron in 163 isolates (87% SXT-resistant vs 33.7% SXT-susceptible isolates, p = 0.000). A novel finding was the aar-3-dfrA27 (KC748137) gene cassette. The gene of sul2 linked to transposase in 50 SXT- resistant and 7 SXT- susceptible isolates was detected by TAIL-PCR. The findings demonstrated a higher prevalence of sul, dfrA, intI1 and resistance gene cassettes in class 1 integron in SXT-resistant clinical S. maltophilia isolates in China. The sul1 and dfrA genes located in integrons and the sul2 linked to transposase may imply wide and rapid dissemination of resistance gene in bacteria.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease characterized by a high case fatality rate. Despite extensive research on acute-phase manifestations, the long-term clinical sequelae in survivors remain poorly characterized. In this prospective cohort study from 2010 to 2024, 1,197 SFTS survivors and 188 age/sex-matched febrile controls without SFTS were enrolled from the highest endemic region in China. Participants underwent face-to-face interview, serial clinical evaluations and laboratory testing at 6, 12, 18 and 24 months post-discharge, with extended follow-up for a subset (n = 294) over 11 years. Propensity score matching and multivariate logistic regression were used to determine the factors associated with long-term sequelae risk. A total of 62.57% (749/1,197) of survivors developed persistent sequelae, significantly higher than controls (51.60%, 97/188; P < 0.05). Key manifestations included memory impairment (33.50%, 401/1,197), arthralgia (33.08%, 396/1,197), alopecia (32.25%, 386/1,197) and visual decline (31.08%, 372/1,197). Laboratory abnormalities persisted for ≥10 years in 0.33% of survivors, notably thrombocytopenia, elevated lactate dehydrogenase, and cystatin C. Compared to non-SFTS group, a significantly higher proportion of SFTS survivors had decreased white blood cell count, eosinophil percentage and mean corpuscular hemoglobin. The long-term sequelae risk exhibited distinct patterns across factors: encephalitis development was associated with significantly higher risks of memory impairment (adjusted OR = 2.39) and thrombocytopenia (adjusted OR = 3.36); corticosteroid usage during hospitalization showed increased risks of arthralgia (adjusted OR=2.17) and elevated BUN (adjusted OR=3.87); while high viral load (≥1 × 106 copies/mL) exhibited significantly higher incidences of most prevalent clinical manifestations and multiple laboratory abnormalities (all P < 0.05). SFTS survivors exhibit multisystemic sequelae, with high viral load and acute-phase neurological involvement serving as critical prognostic indicators. These findings underscore the need for long-term monitoring and targeted therapeutic strategies for SFTS.

There was an increasing incidence of spinal infections. This study aimed to compare and contrast the clinical characteristics and treatment regimens for diverse types of spondylitis and to provide guidance for clinicians to make timely diagnosis and treatment. One hundred and twenty-five patients with spinal infections admitted to the First Affiliated Hospital of Anhui Medical University from October 2019 to December 2024 were recruited. The patients were classified as having tuberculous spondylitis (TBS), brucellosis spondylitis (BS), or pyogenic spondylitis (PS). The patient's treatment regimen and course were dynamically followed up during hospitalization and after discharge. Comparisons of clinical characteristics and treatment among the three groups were performed by SPSS 26.0 and GraphPad Prism 10 statistical software. The proportion of male patients was greater than female patients (65.00% vs 35.00%). Fever accompanied by pain was more prevalent in the BS and PS groups than in the TBS group (P=0.003). Compared with the TBS and BS groups, the PS group had the shortest duration from symptom onset to hospitalization (P<0.001). Sepsis, invasive manipulation, elevated inflammatory markers, psoas abscesses, and the involvement of three or more vertebrae were significantly associated with the PS. In this study, the median duration of treatment was 77 weeks for TBS, 19 weeks for BS, and 13 weeks for PS. Adverse drug reactions (ADRs) should be monitored during treatment. Our results indicated that omadacycline and contezolid exhibited remarkable efficacy in the treatment of spinal infections. Patients of spinal infections with diverse etiologies presented varied clinical features and risk factors, the treatment should be individualized. Due to the long course of treatment, ADRs need to be monitored during treatment, and newer drugs such as omadacycline and contezolid are efficacious and have favorable safety profiles.

In order to improve the efficiency of ship hydrodynamic optimization and reduce resistance, this study employed machine learning methods to predict resistance. In response to the limitations of machine learning's generalization ability on high-dimensional sparse data, an IXGB-MAML hybrid model based on improved eXtreme Gradient Boosting (XGBoost) and model-agnostic meta-learning strategy methods was proposed. The predictive ability of the hybrid model in regression tasks was tested based on standard functions. Subsequently, the proposed hybrid method was used to train a resistance prediction model based on computational fluid dynamics (CFD) simulation data, and its prediction accuracy was verified through error analysis and performance evaluation. Therefore, a ship form optimization design framework is constructed by integrating the prediction, optimization, and deformation modules. The prediction results of machine learning were used to guide the optimization search to achieve a nonlinear optimization of ship form. The results indicate that the hybrid method performs excellently in resistance prediction, and the resistance of the optimized ship form in both calm water and waves is reduced, thereby demonstrating good hydrodynamic potential. The IXGB-MAML method can effectively reduce the computational cost, and is helpful in promoting the application of intelligent optimization methods in ship design.

Bacterial cystitis, a commonly occurring urinary tract infection (UTI), is renowned for its extensive prevalence and tendency to recur. Despite the extensive utilization of levofloxacin as a conventional therapeutic approach for bacterial cystitis, its effectiveness is impeded by adverse toxic effects, drug resistance concerns, and its influence on the gut microbiota. This study introduces Lev@PADM, a hydrogel with antibacterial properties that demonstrates efficacy in the treatment of bacterial cystitis. Lev@PADM is produced by combining levofloxacin with decellularized porcine acellular dermal matrix hydrogel and exhibits remarkable biocompatibility. Lev@PADM demonstrates excellent stability as a hydrogel at body temperature, enabling direct administration to the site of infection through intravesical injection. This localized delivery route circumvents the systemic circulation of levofloxacin, resulting in a swift and substantial elevation of the antimicrobial agent’s concentration specifically at the site of infection. The in vivo experimental findings provide evidence that Lev@PADM effectively prolongs the duration of levofloxacin’s action, impedes the retention and invasion of E.coli in the urinary tract, diminishes the infiltration of innate immune cells into infected tissues, and simultaneously preserves the composition of the intestinal microbiota. These results indicate that, in comparison to the exclusive administration of levofloxacin, Lev@PADM offers notable benefits in terms of preserving the integrity of the bladder epithelial barrier and suppressing the recurrence of urinary tract infections. Graphical Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) has become an increasing public health threat in China, with Yantai City representing a major endemic focus. A fine-scale, long-term epidemiological analysis integrating human case data with vector surveillance is essential for understanding local transmission dynamics. Methods: We conducted a retrospective analysis using 12-year (2013–2024) county-level SFTS surveillance data from Yantai City. Temporal trends were analyzed by Joinpoint regression. Concurrent field surveillance of Haemaphysalis longicornis (2019–2024) was used to quantify local SFTSV infection rates in ticks. Associations between SFTS incidence and environmental/livestock factors were evaluated using Spearman’s correlation and multivariable negative binomial regression. Results: A total of 1964 SFTS cases were reported. The annual incidence rate increased from 0.65 to 5.12 per 100,000 population, with an average annual percentage change (AAPC) of 13.56% 2013–2024, showing the most substantial rise among the elderly. Marked spatial heterogeneity was observed, with county-level mean incidence ranging from 0.30 to 5.23 per 100,000. The SFTSV infection rate in ticks surged from 0.54% in 2019 to 3.24% in 2024, and showed a strong positive correlation with human incidence both seasonally (ρ = 0.998) and across counties (ρ = 0.79), a pattern likely driven by shared environmental factors. Multivariable analysis identified grassland coverage (adjusted IRR [aIRR] = 1.21), woodland coverage (aIRR = 2.31), goat density (aIRR = 1.49), and tick infection rate (aIRR = 1.65) as independent risk factors, while urban land was protective (aIRR = 0.83). The overall case fatality rate was 8.86%, showing a declining trend, but was significantly higher in males (10.90%) than in females (7.04%), particularly among the elderly. Conclusions: SFTS incidence in Yantai increased significantly over the past decade, characterized by a heightened burden on the elderly and strong spatiotemporal clustering. Risk is independently mediated by ecological interfaces, notably woodland/grassland habitats and goat rearing. These findings delineate high-risk areas and populations, offering crucial insights for developing targeted public health strategies.

Severe fever with thrombocytopenia syndrome (SFTS) as an emerging infection disease results in high morbidity and mortality in China. In this study, the circulating levels of 36 inflammatory mediators in 33 SFTS patients on days 3–7, 8–12 and 13–20 post-illness were measured by a multiplex Luminex® system dynamically. Among the patients, 15 severe patients recovered, 11 severe patients died within three weeks. We found IL-1RA, IL-6, IL-15, IL-10, TNF-α, IFN-γ, G-CSF, eotaxin, IL-8, IP-10, MCP-1, MIP-1α, MIP-1β and fractalkine were significantly upregulated in SFTS patients. Elevated IL-15 and eotaxin in SFTS patients were reported firstly. The highest levels of pro-inflammatory and anti-inflammatory cytokines coexisted in fatal patients during the first week. Inflammatory mediators remained high levels when death occurred in fatal patients, they were recovered within three weeks in nonfatal patients. Our results showed the occurrence of inflammatory storm in SFTS patients were associated with the severity of SFTS. RANTES and PDGF were down regulated and remained significantly lower levels in fatal patients throughout the course of disease, the concentrations of RANTES and PDGF were remarkably positively correlated with the platelet count. Our results demonstrated that dysregulated inflammatory response was associated with disease pathogenesis and mortality in SFTS patients.

Background Neisseria meningitidis serogroup C has emerged as a cause of epidemic disease in Hefei. The establishment of serogroup C as the predominant cause of endemic disease has not been described. Methods We conducted national laboratory-based surveillance for invasive meningococcal disease during 2000–2010. Isolates were characterized by pulsed-field gel electrophoresis and multilocus sequence typing. Results A total of 845 cases of invasive meningococcal disease were reported. The incidence increased from 1.25 cases per 100,000 population in 2000 to 3.14 cases per 100,000 in 2003 (p < 0.001), and peaked at 8.43 cases per 100,000 in 2005. The increase was mainly the result of an increase in the incidence of serogroup C disease. Serogroup C disease increased from 2/23 (9%) meningococcal cases and 0.11 cases per 100,000 in 2000 to 33/58 (57%) cases and 1.76 cases per 100,000 in 2003 (p < 0.01). Patients infected with serogroup C had serious complications more frequently than those infected with other serogroups. Specifically, 161/493 (32.7%) cases infected with serogroup C had at least one complication. The case-fatality rate of serogroup C meningitis was 11.4%, significantly higher than for serogroup A meningitis (5.3%, p = 0.021). Among patients with meningococcal disease, factors associated with death in univariate analysis were age of 15–24 years, infection with serogroup C, and meningococcemia. Conclusions The incidence of meningococcal disease has substantially increased and serogroup C has become endemic in Hefei. The serogroup C strain has caused more severe disease than the previously predominant serogroup A strain.

Accurate and efficient determination of neutralizing antibody (nAb) is critical for assessing individual immune status of severe fever with thrombocytopenia syndrome (SFTS) and identifying key ecological reservoirs of the SFTS virus (SFTSV). However, conventional virus neutralization tests (cVNT) require live virus and are limited by their inability to support rapid, high-throughput screening. Here, we report a novel SFTSV virus neutralization test targeting the interaction between the SFTSV Gn protein and its receptor (LRP1). The test, which has been validated with SFTS patient plasma, achieves a sensitivity of 96.79% and a specificity of 100%. It also shows good correlation with cVNT, with an value of 0.8902 in head-to-head comparison. This platform offers a safe, rapid, and high-throughput alternative for large-scale population screening and the real-time monitoring of immune responses in SFTS patients.