ObjectiveTo compare the clinical outcomes and prognosis of regional citrate anticoagulation and systemic heparin anticoagulation in patients with sepsis-associated acute kidney injury undergoing continuous renal replacement therapy.MethodsThis retrospective cohort study (2020-2024) included 168 adults with sepsis-associated acute kidney injury who received continuous renal replacement therapy at the intensive care unit of Taizhou Municipal Hospital. Kaplan-Meier curves and multivariable Cox regression were used to evaluate 14- and 28-day mortality, with subgroup analyses performed to assess effect modification.ResultsAmong 168 eligible patients, 1:1 propensity score matching yielded 42 well-balanced pairs (regional citrate anticoagulation, n = 42; systemic heparin anticoagulation, n = 42) with comparable baseline characteristics. Hospital mortality was lower with regional citrate anticoagulation (59.5%) than with systemic heparin anticoagulation (71.4%); however, the difference did not reach statistical significance (P = 0.251). The 14-day comparison demonstrated a higher survival probability with regional citrate anticoagulation (log-rank P = 0.043; hazard ratio, 2.10; 95% confidence interval: 1.01-4.39), and a similar benefit persisted at 28 days (log-rank P = 0.042; hazard ratio, 1.76; 95% confidence interval: 1.01-3.05). Subgroup analysis further indicated that the survival benefit of regional citrate anticoagulation on 28-day mortality was most pronounced among patients with pre-existing hypertension (hazard ratio, 2.75; 95% confidence interval: 1.32-5.71; P = 0.007; interaction P = 0.028).ConclusionsIn patients with sepsis-associated acute kidney injury requiring continuous renal replacement therapy, regional citrate anticoagulation may confer better short-term (14- and 28-day) survival than systemic heparin anticoagulation; however, no clear difference in overall hospital mortality was observed. This potential benefit may be more pronounced among patients with hypertension, meriting further evaluation of tailored anticoagulation approaches.

Sepsis is a life-threatening syndrome characterized by excessive oxidative stress and uncontrolled inflammation, ultimately leading to multiple organ dysfunction. Curcumin has shown considerable potential for the treatment of sepsis due to its antioxidant and anti-inflammatory properties; however, its clinical application is limited by poor water solubility, low bioavailability, and instability. Herein, a reactive oxygen species (ROS)-responsive nanoplatform (Cur@NPs) was developed for curcumin delivery by encapsulating curcumin into self-assembled mPEG-b-PPS nanoparticles. The resulting Cur@NPs exhibited an appropriate particle size, high encapsulation efficiency, and good colloidal stability. In addition, Cur@NPs showed oxidation-triggered drug release and effectively scavenged multiple ROS species under oxidative conditions. In vitro studies demonstrated that Cur@NPs markedly reduced intracellular ROS levels and suppressed the production of pro-inflammatory mediators, including TNF-α, IL-6, and NO, in LPS-stimulated macrophages. In an LPS-induced murine sepsis model established via intraperitoneal injection, Cur@NPs significantly attenuated systemic inflammation and alleviated multiple organ injury. Collectively, these findings suggest that Cur@NPs provide an effective ROS-responsive curcumin delivery strategy and may serve as a candidate nanoplatform for further sepsis studies.

INTRODUCTION:The aim of this study was to analyze the clinical characteristics and risk factors of bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (KP). METHODOLOGY:A retrospective study was conducted by enrolling clinically confirmed KP-BSI cases (2019-2023). Clinical data were collected and analyzed through review of the electronic medical records. Patients with ESBL-positive KP-BSI were compared to those with ESBL-negative KP-BSI. Multivariate logistic regression analysis was used to identify risk factors associated with ESBL-producing KP-BSI. RESULTS:A total of 199 patients were included, among whom 47 (23.6%) had ESBL-producing KP-BSI. Univariate analysis revealed that the proportion of patients undergoing surgery within 48 hours before blood sampling was higher in the ESBL-positive group than in the ESBL-negative group (40.4% vs. 23.0%, p < 0.05). Regarding infection source, liver-origin infections were less frequent in the ESBL-positive group compared to the ESBL-negative group (6.4% vs. 24.3%, p < 0.05), while urinary tract-origin infections were significantly more frequent in the ESBL-positive group (38.3% vs. 18.4%, p < 0.05). Hospital-acquired infection was more common in the ESBL-positive group than in the ESBL-negative group (40.4% vs. 23.7%, p < 0.05). Multivariate analysis identified urinary tract origin (adjusted odds ratio [aOR], 2.162; 95% confidence interval [CI], 1.003-4.661) as an independent risk factor for ESBL-producing KP-BSI. CONCLUSIONS:Primary urinary tract infections constitute an independent risk factor for ESBL-producing KP-BSI. Given the therapeutic complexity of ESBL-producing strains, KP-BSI of urinary tract origin warrant heightened clinical vigilance among clinicians.

Background: Stroke is a leading cause of death and disability worldwide, with poststroke complications such as pneumonia significantly increasing mortality and healthcare burden. Existing models for predicting pneumonia risk in stroke patients have limitations, particularly in ICU settings. Methods: This retrospective study utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to construct a nomogram predicting pneumonia risk in stroke patients within the ICU. The nomogram integrated multiple risk factors identified through univariate and multivariate logistic regression analyses. Results: The study included 6542 stroke patients, with 11.5% developing pneumonia. Key predictive weight loss. The nomogram demonstrated good discrimination ability and calibration, with an AUC of 0.821 in the training set and 0.809 in the test set. Conclusions: The nomogram provides a valuable tool for clinicians to assess pneumonia risk in stroke patients in the ICU, potentially improving patient outcomes and reducing the burden of pneumonia. Further research is needed for external validation and to incorporate additional variables.

Acute pancreatitis (AP) is a common gastrointestinal inflammatory disease that requires hospitalization, with 40-70% of patients in moderate to severe stages potentially developing sepsis, which is closely related to high mortality rates and poor prognosis. Therefore, early identification of AP patients at risk of developing sepsis is crucial for reducing mortality. This study aims to identify core genes associated with sepsis to provide new core genes for early warning and management of patients with acute pancreatitis. The study utilized the GSE54514, GSE57065, GSE95233, and GSE194331 datasets for analysis, employing weighted gene co-expression network analysis (WGCNA) and protein-protein interaction (PPI) network construction. Six core genes were identified using two machine learning methods and validated with the GSE3644 and GSE28750 datasets. The analysis revealed that the identified core genes (NDUFA1, COX7A2, COX7B, UQCRQ, SNRPG, and NDUFA4) are related to the oxidative phosphorylation (OxPhos) pathway, and significant differences were observed in the immune cell composition between AP and sepsis patients. SNRPG may play a role in the progression from AP to sepsis by regulating NDUFA4, linking it to cellular metabolism and redox balance. The newly identified core genes and their associated molecular mechanisms provide important clinical insights into the progression of acute pancreatitis to sepsis, potentially offering new research directions for future therapeutic strategies. Clinical trial number: This study was approved by the Ethics Committee of (Municipal Hospital affiliated to Taizhou University), in accordance with the Declaration of Helsinki. Approval number: LWSL202400220.

Purpose:This study aimed to analyze the clinical characteristics and risk factors of multidrug-resistant Klebsiella pneumoniae bloodstream infections (MDR KP-BSI) compared to non-MDR KP-BSI among adult patients in China, providing guidance for clinicians to prevent MDR KP-BSI. Patients and Methods:A retrospective analysis of 240 adult patients with KP-BSI (2019-2023) was conducted. Clinical data were analyzed using multivariable logistic regression to identify risk factors. Results:MDR KP-BSI prevalence was 22.5% (54/240). The MDR KP-BSI group had higher rates of comorbidities (hemiplegia, COPD/severe asthma, chronic cardiac insufficiency, cerebrovascular accident) and higher disease severity scores (APACHE II, SOFA, Pitt bacteremia, Charlson index, all P<0.05). Treatment-related factors (antibiotic exposure, ICU admission, nutrition support, invasive procedures) were more frequent in the MDR KP-BSI group (P<0.05). Pulmonary origin was significantly more common (42.6% vs 12.4%, P<0.05), while liver origin was less common (1.9% vs 24.2%, P<0.05) in MDR versus non-MDR KP-BSI. MDR KP-BSI patients had significantly worse outcomes: higher 7-day (40.7% vs 11.8%, P<0.001), 14-day (35.2% vs 10.8%, P<0.001), and 28-day mortality (27.8% vs 8.6%, P<0.001), and prolonged hospitalization [26.5 days (14.0, 64.5) vs 13.0 days (8.0, 23.0), P<0.001]. Multivariable analysis identified independent risk factors: recent antibiotic exposure (adjusted OR [aOR] 7.025; 95% CI 2.695-18.313), cerebrovascular accident history (aOR 3.095; 95% CI 1.054-9.903), and pulmonary infection source (aOR 2.941; 95% CI 1.101-7.895). Conclusion:These predictors emphasize the need for antibiotic stewardship, infection control, and early interventions in high-risk patients to reduce MDR KP-BSI incidence.

Background:Klebsiella pneumoniae (KP), a prominent member of the Enterobacteriaceae family, is recognized as an opportunistic pathogen responsible for a variety of diseases. Despite its significant threat to public health, there is a lack of epidemiological information concerning the burden of KP infection in the lower respiratory tract. Methods:Age-standardized rates (ASR) of disability-adjusted life-years (DALYs) and deaths rates (ASDRs) attributed to KP infection were obtained from Global Burden of Disease (GBD) 2021, stratified by sex, age, socio-demographic Index (SDI) quintiles and seven super regions. We also calculated the average annual percentage changes (AAPCs) of ASR-DALYs and ASDRs for KP infection using the Joinpoint regression analysis to evaluate the trend of disease burden. Results:In 2021, the global ASR-DALYs and ASDRs attributable to KP infection were 124.4 and 2.68 per 100,000, with AAPCs of -3.23% and -2.42%, respectively. The highest burden of ASR-DALYs was observed in children under 5 years of age, with a rate of 775.75 per 100,000 (95% uncertainty interval [UI]: 601.07 to 973.76), while the highest ASDRs were found in individuals over 70 years of age, with a rate of 18.05 per 100,000 (95% UI: 15.84-19.70). Notably, there were significant increasing trends in DALYs and death rates due to KP infection in Central Europe, Eastern Europe, and Central Asia across all age groups above 15 years, with the most pronounced increase observed in individuals over 70 years of age, characterized by AAPCs of 0.85% (95% confidence interval [CI]: 0.64 to 1.05) and 1.00% (95% CI: 0.85-1.17), respectively. Conclusion:Over the past 32 years, the global burden of KP infection in the lower respiratory tract has generally declined, but it has increased among the older population in Central/Eastern Europe and Central Asia. This rise is likely due to inappropriate antibiotic use, widespread antimicrobial resistance, emerging virulent and multidrug-resistant strains, and an aging population, highlighting the need for vigilant monitoring and intervention measures.

Background: Very few studies have characterized patients with myocardial injury due to Klebsiella pneumoniae bloodstream infections (KP-BSI). Our study aimed to investigate the clinical characteristics, risk factors and outcomes of patients with myocardial injury due to KP-BSI. Methods: A double-center retrospective cohort study of patients with KP-BSI was conducted from January 1, 2013 to December 31, 2022. The clinical data was collected by reviewing electronic medical records. Classification of patients with KP-BSI into myocardial injury and nonmyocardial injury groups based on the levels of high-sensitivity cardiac troponin I (hs-cTnI) after 48 h onset of KP-BSI. Results: Patients with myocardial injury due to KP-BSI were generally younger than those without such injuries, with the former presenting a median age of 60 versus 67 in the latter (p < 0.001). Conditions like chronic cardiac insufficiency and chronic pulmonary disease were more prevalent in the myocardial injury cohort (10.0% and 7.1%, respectively) compared to those without myocardial injury (4.7% and 2.6%, respectively; p values 0.002 and 0.001). However, the nonmyocardial injury group had a higher incidence of solid tumors (15.3% vs. 10.4%, p=0.038). Severity assessments like the acute physiology and chronic health evaluation (APACHE) II, the sequential organ failure assessment (SOFA), and the Charlson Comorbidity Index (CCI) all registered higher for the myocardial injury group (all p < 0.001). Similarly, intensive care unit (ICU) admissions, use of mechanical ventilation, and central venous catheter (CVC) placement were notably more common in this group (all p < 0.001). Regarding infection sources, the myocardial injury group had a higher incidence of pneumonia as the cause for KP-BSI (29.8% vs. 15.9%, p < 0.001), whereas liver and biliary tract infections were less frequent compared to their counterparts. Mortality rates at 7, 14, and 28 days, along with in-hospital mortality, were significantly higher for those with myocardial injury (all p < 0.001). Multivariate analysis identified age > 67 [adjusted odds ratio (aOR), 2.32; 95% confidence interval (CI), 1.59-3.38], SOFA score > 6 (aOR, 3.04; 95% CI, 2.10-4.39), mechanical ventilation (aOR, 1.67; 95% CI, 1.15-2.39), and CVC in place (aOR, 1.50; 95% CI, 0.96-2.02) as independent prognostic factors for myocardial injury in KP-BSI. Conclusions: Older age (> 67 years), higher SOFA score (> 6), mechanical ventilation, and CVC in place were found to be significantly associated with an increased risk of myocardial injury. Clinical physicians should be alert to the potential for myocardial injury in elderly critically ill patients, especially those who are on mechanical ventilation and have indwelling CVC, in the event of KP-BSI.

Traditional antimicrobial-susceptibility testing methodologies, including the isolation and culture of bacteria from urine samples and antibiotic-susceptibility test (AST), are expensive and time-consuming. Therefore, a rapid, user-friendly phenotypic AST is urgently needed to guide treatment strategies. Several novel phenotypic AST platforms based on the physiological characteristics of bacteria obtained directly from clinical urine samples have been proposed as promising methods as rapid AST and appropriate antibiotic treatments. However, inaccurate bacterial quantification can lead to false results when high-accuracy quantitative assays are required using these procedures. Coupling the expression of catalase by pathogens with a chemiluminescence-based analytical method enables a convenient and low-cost operation. Herein, we demonstrate a rapid self-calibrating chemiluminescence sensor that can measure bacterial viability through the variation in catalase activity and its response to hydrogen peroxide after treatment with antibiotics. This rapid nanosensor platform can be utilized to determine the antibiotic susceptibility of uropathogenic Escherichia coli and Klebsiella pneumoniae, which account for 80% of all urinary tract infections, directly from clinical urine samples within 40 min without bacterial quantification. The proposed ultrafast and highly accurate AST can enable the precise guidance of antibiotic prescriptions and shorten the time required for clinical decision-making.

BackgroundSepsis-associated acute lung injury (SA-ALI) is a severe complication of sepsis with high mortality. This study aimed to identify key diagnostic genes and potential therapeutic drugs for SA-ALI.MethodsTranscriptomic data from GSE10474 and GSE32707 were integrated for differential expression and WGCNA analysis. Hub genes were screened using PPI network construction and three machine learning algorithms, and validated by Western blot. Functional enrichment, immune infiltration, and drug prediction (DSigDB) were performed, followed by molecular docking.ResultsSix hub genes (PGM3, GDF15, GART, GFOD2, E2F2, ATP1B2) were identified and validated with elevated expression in SA-ALI. These genes were enriched in inflammation, immune regulation, oxidative stress, and tissue remodeling pathways, and showed significant correlations with specific immune cell subsets. Five candidate small molecules were predicted; molecular docking revealed Celastrol had the strongest binding to all six proteins, particularly GDF15 (-9.988 kcal/mol), while Thiostrepton showed strong binding to PGM3, GFOD2, and GDF15.ConclusionSix diagnostic hub genes and two priority candidate drugs, Celastrol and Thiostrepton, were identified for SA-ALI, providing potential biomarkers and therapeutic targets.

ABSTRACT Background Septic cardiomyopathy (SCM) is a potentially fatal complication of sepsis. In this study, transcriptomic and proteomic analyzes of serum samples from sepsis patients were conducted to uncover the underlying pathological mechanisms and identify potential therapeutic targets for SCM. Methods This retrospective, dual‐center study investigated the progression of sepsis to SCM in patients admitted to intensive care units. A total of 50 patients were enrolled and divided into two groups: sepsis with cardiomyopathy (25 cases) and sepsis without cardiomyopathy (25 cases). Co‐expression network analysis was employed to elucidate the biological significance of differentially expressed proteins. By integrating proteomic and transcriptomic data, molecular networks were constructed to visualize interactions among key molecules, aiming to enhance data interpretation and support the study's findings. Results Proteomic analysis identified 216 differentially expressed proteins (Fold change > 1.5, p‐value < 0.05) between the two groups. Transcriptomic analysis revealed two proteins, including Interleukin‐27 subunit beta (IL‐27B) and carbonic anhydrase, co‐downregulated in patients with septic cardiomyopathy. IL‐27B was associated with the immune response, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis indicated its involvement in the cytokine‐cytokine receptor interaction signaling pathway. Conclusion Comprehensive integrated transcriptomic and proteomic analyzes identified significant changes in protein expression associated with SCM, primarily associated with inflammation‐related pathways and amino acid metabolism. These findings provide new insights into the pathological mechanisms of SCM and highlight potential therapeutic targets for its treatment. Trial Registration The Clinical Research Ethics Committee of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University approved this study, and written informed consent was given by all patients or their legal representatives. (NO.K20201110).

BACKGROUND:Chronic heart failure (CHF) has always posed a significant threat to human survival and health. The efficacy of thiamine supplementation in CHF patients remains uncertain. HYPOTHESIS:Receiving supplementary thiamine may not confer benefits to patients with CHF. METHODS:A comprehensive search was conducted across the Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, and Web of Science databases up until May 2023 to identify articles investigating the effects of thiamine supplementation in CHF patients. Predefined criteria were utilized for selecting data on study characteristics and results. RESULTS:Seven randomized, double-blind, controlled trials (five parallel trials and two crossover trials) involving a total of 274 patients were enrolled. The results of the meta-analysis pooling these studies did not reveal any significant effect of thiamine treatment compared with placebo on left ventricular ejection fraction (WMD = 1.653%, 95% CI:  -1.098 to 4.405, p = 0.239, I2 = 61.8%), left ventricular end-diastolic volume (WMD = -6.831 mL, 95% CI:  -26.367 to 12.704, p = 0.493, I2 = 0.0%), 6-min walking test (WMD = 16.526 m, 95% CI:  -36.582 to 69.634, p = 0.542, I2 = 66.3%), N-terminal pro-B type natriuretic peptide (WMD = 258.150 pg/mL, 95% CI:  -236.406 to 752.707, p = 0.306, I2 = 21.6%), or New York Heart Association class (WMD = -0.223, 95% CI:  -0.781 to 0.335, p = 0.434, I2 = 87.1%). However, it effectively improved the status of thiamine deficiency (TD). CONCLUSIONS:Our meta-analysis indicates that thiamine supplementation does not have a direct therapeutic effect on CHF, except for correcting TD.

Abstract Objective To analyze the spatial autocorrelation and spatiotemporal clustering characteristics of severe fever with thrombocytopenia syndrome(SFTS) in Anhui Province from 2011 to 2023. Methods Data of SFTS in Anhui Province from 2011 to 2023 were collected. Spatial autocorrelation analysis was conducted using GeoDa software, while spatiotemporal scanning was performed using SaTScan 10.0.1 software to identify significant spatiotemporal clusters of SFTS. Results From 2011 to 2023, 5720 SFTS cases were reported in Anhui Province, with an average annual incidence rate of 0.7131/100,000. The incidence of SFTS in Anhui Province reached its peak mainly from April to May, with a small peak in October. The spatial autocorrelation results showed that from 2011 to 2023, there was a spatial positive correlation(P < 0.05) in the incidence of SFTS in all counties and districts of Anhui Province. Local autocorrelation high-high clustering areas are mainly located in the south of the Huaihe River. The spatiotemporal scanning results show three main clusters of SFTS in recent years: the first cluster located in the lower reaches of the Yangtze River, the eastern region of Anhui Province; the second cluster primarily focused on the region of the Dabie Mountain range, while the third cluster primarily focused on the region of the Huang Mountain range. Conclusions The incidence of SFTS in Anhui Province in 2011–2023 was spatially clustered.

Introduction: Concern about Klebsiella pneumoniae ( K. pneumoniae ) bloodstream infections (KP-BSIs) is widespread because of their high incidence and lethality. The aim of this study was to investigate the clinical features of, and risk factors for mortality caused by KP-BSIs. Methodology: This was a single-center retrospective observational study performed between 1 January 2019 and 31 December 2021, at a tertiary hospital. All patients with KP-BSIs were enrolled and their clinical data were retrieved from electronic medical records. Results: A total of 145 patients were included (121 in the survival group and 24 in the non-survival group). There was a higher proportion of lower respiratory tract infections in the non-survival group than in the survival group (33.3% vs. 12.4%) ( p < 0.05). There was a higher proportion of multi drug resistant (MDR) strains of K. pneumoniae in the non-survival group than in the survival group (41.7% vs. 16.5%) ( p < 0.05). Multivariate analysis revealed that sequential organ failure assessment (SOFA) score > 6.5 (OR, 13.71; 95% CI, 1.05-179.84), admission to the intensive care unit (ICU) (OR, 2.27; 95% CI, 0.26-19.61) and gastrointestinal bleeding (OR, 19.97; 95% CI, 1.11-361.02) were independent risk factors for death in patients with KP-BSIs. Conclusions: Among all KP-BSIs, a high proportion of K. pneumoniae originated from lower respiratory tract infections, and a high proportion of K. pneumoniae were MDR; however, mortality was not influenced. SOFA score > 6.5, admission to the ICU, and gastrointestinal bleeding were independent risk factors for death in patients with KP-BSI.

Rapid and safe hemostasis is crucial for the survival of bleeding patients in prehospital care. It is urgent to develop high performance hemostatic material to control the massive hemorrhage in the military field and accidental trauma. In this work, an efficient protein hemostat of thrombin was immobilized onto commercial gauze, which was mediated by self-polymerization and anchoring of tannic acid (TA). Through TA treatment, the efficient immobilization of thrombin was achieved, preserving both the biological activity of thrombin and the physical properties of the dressing, including absorbency, breathability, and mechanical performance. Moreover, in the presence of TA coating and thrombin, Gau@TA/Thr could obviously shortened clotting time and enriched blood components such as plasma proteins, platelets, and red blood cells, thereby exhibiting an enhanced in vitro coagulation effect. In SD rat liver volume defect and artery transection hemorrhage models, Gau@TA/Thr still had outstanding hemostatic performance. Besides, the Gau@TA/Thr gauze had inherent antibacterial property and demonstrated excellent biocompatibility. All results suggested that Gau@TA/Thr would be a potential candidate for treating uncontrollable hemorrhage in prehospital care.

Since the outbreak of coronavirus disease 2019 (COVID-19), it has caused serious casualties worldwide. In recent months, the virus has mutated into an increasingly infectious form (Delta variant) and spread rapidly. In the current study, we analyzed the clinical, epidemiological and viral genetic characteristics of the first four imported Delta cases in Anhui Province, China. These four patients developed lung inflammation, tissue damage and recovered after admission, and the serum high-sensitivity C-reactive protein (hs-CRP) and CRP levels showed a first increasing and then decreasing trend. The results showed that hs-CRP/CRP level showed the same trend as the degree of chest lesions in these patients, and serum neutralizing antibodies (Nab) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) level was also associated with the regression of chest lesions. The combination of genetic sequencing and epidemiological analysis suggested that the SARS-CoV-2 delta variant infection of these four patients may originate from Russia. Although the relatively smaller sample size of this study limited the extrapolation of the results, our study found a certain correlation between hs-CRP/CRP and Nab levels and the occurrence, development and outcome of COVID-19 delta variant, suggesting that monitoring hs-CRP/CRP and Nab levels of COVID-19 delta variant patients at hospital admission may be useful for understanding the severity of patients’ current conditions.

What is already known about this topic?:Monkeypox, first identified in Africa in 1958, is a zoonotic disease caused by monkeypox virus (MPXV). Since January 2022, a global outbreak of mpox has spread to over 100 non-endemic countries. As of June 30, 2024, there have been 99,176 confirmed cases and 535 probable cases across 116 countries, resulting in 208 deaths. What is added by this report?:This report presents an analysis of the whole genome sequences of seven MPXVs from Anhui Province. We discovered that, compared to the reference sequence (NC_063383.1), these genomes exhibit 91 nucleotide substitutions and 42 amino acid mutations. They are highly similar to genomes of MPXVs that emerged simultaneously in China, Japan, the Republic of Korea, and Portugal, and are classified within the IIb C.1.1 lineage, with multiple transmission chains and no new branch. What are the implications for public health practice?:The MPXV in Anhui Province has undergone mutations in areas critical for viral replication, transcription, and immune escape, posing a risk of recurrent outbreaks. Therefore, vigilant mutation monitoring of MPXV is imperative.

The order Rickettsiales in the class Alphaproteobacteria comprises vector-borne pathogens of both medical and veterinary importance. Ticks, as a group, are second only to mosquitoes as vectors of pathogens to humans, playing a critical role in the transmission of rickettsiosis. In the present study, 880 ticks collected from Jinzhai County, Lu'an City, Anhui Province, China in 2021-2022 were identified as belonging to five species from three genera. DNA extracted from individual ticks was examined using nested polymerase chain reaction targeting the 16S rRNA gene (rrs), and the gene fragments amplified were sequenced to detect and identify Rickettsiales bacteria in the ticks. For further identification, the rrs-positive tick samples were further amplified by PCR targeting the gltA and groEL gene and sequenced. As a result, 13 Rickettsiales species belonging to the genera Rickettsia, Anaplasma, and Ehrlichia were detected, including three tentative species of Ehrlichia. Our results reveal the extensive diversity of Rickettsiales bacteria in ticks from Jinzhai County, Anhui Province. There, emerging rickettsial species may be pathogenic and cause under-recognized diseases. Detection of several pathogens in ticks that are closely related to human diseases may indicate a potential risk of infection in humans. Therefore, additional studies to assess the potential public health risks of the Rickettsiales pathogens identified in the present study are warranted.

Background To systematically assess the safety and effectiveness of titanium mesh grafting compared with bone grafting in the treatment of spinal tuberculosis. Methods Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were searched from their inception until April 2023. The outcome indicators for patients treated with titanium mesh grafting or bone grafting for spinal tuberculosis include surgical duration, intraoperative blood loss, graft fusion time, American Spinal Injury Association (ASIA) Spinal Cord Injury Grade E assessment, VAS score, lumbar pain score, post-graft kyphotic angle, and postoperative complications. The Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used for quality assessment and evidence grading of clinical studies. Funnel plots and Begg’s test were employed for bias assessment. Results A total of 8 studies were finally included, comprising 523 patients, with 267 cases of titanium mesh fixation and 256 cases of bone grafting. The meta-analysis showed no significant statistical differences in surgical duration (Weighted Mean Difference (WMD) = -7.20, 95% Confidence Interval (CI): -28.06 to 13.67, P = 0.499), intraoperative blood loss (WMD = 16.22, 95% CI: -40.62 to 73.06, P = 0.576), graft fusion time (WMD = 0.97, 95% CI: -0.88 to 2.81, P = 0.304), ASIA Spinal Cord Injury Grade E assessment (Relative Risk (RR) = 1.03, 95% CI: 0.97 to 1.09, P = 0.346), and overall complications (RR = 0.87, 95% CI: 0.49 to 1.55, P = 0.643). Differences in VAS score, ODI lumbar pain score, and post-graft kyphotic angle between the titanium mesh grafting group and the bone grafting group were not significant within the 95% CI range. The rate of postoperative implant subsidence was slightly lower in bone grafting than in titanium mesh grafting (RR = 9.30, 95% CI: 1.05 to 82.22, P = 0.045). Conclusions Both bone grafting and titanium mesh grafting are effective and safe for the surgery, with no significant statistical differences in the results. Considering the limitations of the present study, large-scale randomized controlled trials are warranted to further verify the reliability of this finding.