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Existing research has investigated student problem-solving strategies across science, technology, engineering, and mathematics; however, there is limited work in undergraduate biology education on how various aspects that influence learning combine to generate holistic approaches to problem solving. Through the lens of situated cognition, we consider problem solving as a learning phenomenon that involves the interactions between internal cognition of the learner and the external learning environment. Using phenomenography as a methodology, we investigated undergraduate student approaches to problem solving in biology through interviews. We identified five aspects of problem solving (including knowledge, strategy, intention, metacognition, and mindset) that define three qualitatively different approaches to problem solving; each approach is distinguishable by variations across the aspects. Variations in the knowledge and strategy aspects largely aligned with previous work on how the use or avoidance of biological knowledge informed both concept-based and nonconcept-based strategies. Variations in the other aspects revealed intentions spanning complete disengagement to deep interest with the course material, different degrees of metacognitive reflections, and a continuum of fixed to growth mindsets. We discuss implications for how these characterizations can improve instruction and efforts to support development of problem-solving skills.

Liqun Luo,1 Xiulin Wen,1 Jingrong Wang,2 Qian Xiao,3 Liuju Su,3 Min Zhou3 1Department of Nursing, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Surgical, The Second Affiliated Hospital of the Air Force Military Medical University, Xi’an, People’s Republic of China; 3School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of ChinaCorrespondence: Xiulin Wen, Tel +86 13991893501, Email 332919997@qq.comBackground: Pressure injuries are present in all healthcare environments and not only pose a significant health risk to individuals but also impose a heavy economic burden on society and families. Nurses, as the primary caregivers responsible for the prevention and management of pressure injuries, have knowledge that directly determines the incidence of pressure injuries.Aim: To understand the current status of nurses’ knowledge of pressure injuries in Shaanxi Province and the factors influencing it.Design: A cross-sectional survey.Methods: In April - May 2022, 16,599 nurses from hospitals at all levels in Shaanxi Province were selected as survey subjects by convenience sampling method. They were surveyed using the general information questionnaire and the Pieper-Zulkowski pressure injury Knowledge Questionnaire through the Questionnaire Star platform.Results: 16,599 nurses had a pressure injury knowledge score of (44.32± 10.11). Wound description and pressure ulcer staging dimensions were less than 60% correct. Comparison of pressure injury knowledge scores of nursing staff with different genders, hospital levels, titles, education, whether they were specialized nurses in wound stoma when they last attended a lecture on pressure ulcers, when they last read literature or books on pressure ulcers, and whether they ever looked for information about pressure ulcers on the Internet showed that the differences were statistically significant (P < 0.05), which were the influencing factors of the knowledge scores of the nursing staff in Shaanxi Province.Conclusion: Clinical nurses’ awareness of stress-related injuries still needs to be improved, and nursing administrators can improve the quality of pressure-related injury care by increasing nursing staff’s awareness through continuing education, tiered training, and other measures.Keywords: pressure injury, knowledge, prevention, management, influencing factor

Hong Yang,1 Maogang Chen,2 Ying Hu,1 Mengjiao Xu,1 Yiping Li,1 Lunhao Liu,1 Dan Yuan,1 Fengshun Yuan,1 Ling Li,1 Li Ye,1 Chang Zhou,1 Yan Zhang,1 Shu Liang,1 Ling Su1 1Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China; 2Department of Microbiology, Liangshan Yi Autonomous Prefecture Center for Disease Control and Prevention, Xichang, People’s Republic of ChinaCorrespondence: Shu Liang; Ling Su, Email liangshu523@163.com; sl7512@163.comBackground: Men who have sex with men (MSM) is one main type of high-risk activities facilitating HIV-1 transmission in Sichuan province. Previous works on HIV-1 incidence and prevalence among MSM only concentrated before 2018, the situation after that is unknown. In addition, the distribution of hot-spots related to current HIV-1 epidemic is also rarely known among MSM in Sichuan.Objective: To update trends of HIV-1 prevalence and incidence and to visualize hot-spots of ongoing transmission in Sichuan province during surveillance period among MSM between 2018 and 2022.Methods: Limiting Antigen Avidity assay was performed to detect recent infection within new HIV-1 diagnoses founded during surveillance period among MSM. The HIV-1 prevalence and incidence were calculated according to an extrapolation method proposed by publications and guidelines. Trend tests were performed using χ2 tests with linear-by-linear association. The spatial analysis was conducted with ArcGIS 10.7 to figure hot-spots of HIV-1 recent infections among MSM.Results: Between 2018 and 2022, 16,697 individuals participated in HIV-1 MSM sentinel surveillance program, of which 449 samples (98.25%) were tested with LAg-Avidity EIA, and 230 samples were classified as recent infection. Respectively, the overall prevalence and incidence were 2.74% and 3.69% (95% CI: 3.21, 4.16) and both had significant declining trends (p < 0.001). Luzhou city had a highest HIV-1 incidence (10.74%, 95% CI: 8.39, 13.10) over the study period and was recognized as a hot-spot for recent HIV-1 infection among MSM.Conclusion: During the surveillance period, both HIV-1 prevalence and incidence were declining. However, Luzhou city had an unusually high HIV-1 incidence and became an emerging hot-spot of recent HIV-1 infection among MSM. This finding suggested focused attention, cross-regional intervention strategies, and prevention programs are urgently required to curb the spread of ongoing transmission.Keywords: human immunodeficiency virus type 1, HIV-1 recent infection, incidence, hot-spots, men who have sex with men

Mengqi Wang,1,&ast; Shuting Lan,1,&ast; Wenqi Zhang,1,&ast; Qin Jin,2 Hua Du,3 Xiaomei Sun,1 Lijun He,1 Xiangyun Meng,1 Liya Su,1 Gang Liu1 1Key Laboratory of Medical Cell Biology, Department of Achievement Transformation, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of China; 2Department of Pathology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 3Department of Pathology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Gang Liu, Email 20190043@immu.edu.cnIntroduction: The anti-cancer potency of copper-doped carbon quantum dots (Cu-CDs) against breast cancer progression needs more detailed investigations.Methods: With urea and ethylene glycol applied as carbon sources and copper sulfate used as a reactive dopant, Cu-CDs were synthesized in the current study by a one-step hydrothermal synthesis method, followed by the characterization and biocompatibility evaluations of Cu-CDs. Subsequently, the anti-cancer potency of Cu-CDs against breast cancer progression was confirmed by these biochemical, molecular, and transcriptomic assessments, including viability, proliferation, migration, invasion, adhesion, clonogenicity, cell cycle distribution, apoptosis, redox homeostasis, and transcriptomic assays of MDA-MB-231 cells.Results: The biocompatibility of Cu-CDs was confirmed based on the non-significant changes in the pathological and physiological parameters in the Cu-CDs treated mice, as well as the noncytotoxic effect of Cu-CDs on normal cells. Moreover, the Cu-CDs treatments not only decreased the viability, proliferation, migration, invasion, adhesion, and clonogenicity of MDA-MB-231 cells but also induced the redox imbalance, cell cycle arrest, and apoptosis of MDA-MB-231 cells via ameliorating the mitochondrial dysfunctions and regulating the MAPK signaling pathway.Conclusion: Our findings confirmed the biosafety and excellent anti-cancer potency of Cu-CDs against breast cancer progression by tapping into mechanisms that disrupt malignant behaviors and oxidative homeostasis of breast cancer cells.Keywords: copper, carbon quantum dots, breast cancer, oxidative stress, MAPK signaling pathway

Yan Zhang,1 Haolin Jiang,2 Wenkai Xiang,3 Jun Zhu,3 Xueqin Hou,3 Shu Liang,1 Dan Yuan,1 Chang Zhou,1 Ling Su1 1Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China; 2Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, People’s Republic of China; 3Center for AIDS/STD Control and Prevention, Guangyuan Center for Disease Control and Prevention, Guangyuan, People’s Republic of ChinaCorrespondence: Ling Su, Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, No. 6, Middle School Road, Wuhou District, Chengdu, Sichuan Province, 610000, People’s Republic of China, Tel +8618982092195, Email sl7512@163.comPurpose: Guangyuan was selected as the first pilot city of molecular transmission network in Sichuan Province to implement dynamic monitoring. This study aim to insight the characteristics of HIV-1 molecular epidemiology and explore the influencing factors of transmission dynamics. Furthermore, it predict the driving factors of network expansion by established a transmission risk prediction model.Patients and Methods: A longitudinal cohort study was conducted to obtain a total of 1434 plasma samples from newly diagnosed HIV-infected patients from 2010 to June 2022. Phylogenetic relationship and cluster analysis were performed using HIV-1 polymerase (pol) gene sequences to study the risk factors of clustering. We applied Logistic ML algorithms to establish a transmission risk prediction model, and model performance was checked using 10-fold cross-validation in the training set and receiver operating characteristic (ROC) curve analysis.Results: A total of 1360 pol sequences linked demographics obtained in this study cover approximately 94.8% of newly notified infections from 2010 to June 2022. The major epidemic genotypes were CRF07_BC, CRF01_AE, CRF08_BC and B subtypes, accounting for 93.82% of all. The differences of some clinical and demographic factors (eg, age, marital status) were statistically significant (P< 0.05). We identified 136 clusters containing 654 HIV-1 pol sequences and observed that some characteristics (eg, over 50 years, married) were more likely to associated to the clusters (P< 0.05). The predictive model showed excellent predictive ability to forecast cluster growth.Conclusion: The epidemic genotypes were relatively complex and diverse in Guangyuan. There was a potential transmission association caused widely spread in local area after the new strains entering. The transmission risk prediction model showed excellent predictive ability to forecast cluster growth which can predict the risk factors causing clusters expansion and provide a guidance for precise intervention strategies.Keywords: HIV-1, genotype, cluster analysis, transmission risk prediction model

Linfei Su,1,2 Zehui Lin,1 Youyuan Li,1 Xiaoyan Wang,3 Zengping Lin,3 Lanjuan Dong,3 Ling Wei1 1Department of Psychology, School of Health, Fujian Medical University, Fuzhou, People’s Republic of China; 2Institute of Psychology, School of Education Science, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 3Fuzhou Xingyu School, Fuzhou, People’s Republic of ChinaCorrespondence: Ling Wei, Tel +86-15960096260, Email ysyang-78@163.comBackground: The own-age effect is the phenomenon in which individuals perceive and recognize faces of their own age better than others in terms of cognitive processing. Previous eye movement studies on children with autism spectrum disorders (ASD) have reported that children with ASD have an attentional bias toward own-age faces and own-age scenes.Methods: The present study used own-age faces as the intervention material and examined the application of the own-age effect in the emotional recognition of faces in ASD. The length of the intervention was 12 weeks, and 2 sessions were conducted each week.Results: The results revealed that the own-age face intervention group gazed at children’s faces significantly more often than before the intervention, gazed at children’s angry faces significantly longer than before the intervention, and gazed at adults’ happy faces significantly longer and more often than before the intervention; the other-age faces intervention group did not differ significantly from the preintervention in gazing at children’s and adults’ faces after the intervention.Conclusion: The results suggest that own-age faces as teaching materials can better promote the emotion recognition ability of children with ASD than other-age faces.Plain language summary: ASD have difficulties with facial emotion recognition and previous study found that children with ASD correctly identified emotions in own-age faces more often than in other-age faces. Therefore, using pictures of children’s faces to intervene in children with ASD is beneficial to improve their facial emotion recognition ability. Previous studies have mostly used questionnaires to assess the effects of peer-matched interventions, and few have used an eye-movement technique that can effectively monitor changes in eye gaze patterns across different emotions.We found that the own-age face intervention group gazed at children’s faces significantly more often than before the intervention, gazed at children’s angry faces significantly longer than before the intervention, and gazed at adults’ happy faces significantly longer and more often than before the intervention. It indicates that own-age faces as teaching materials can better promote the emotion recognition ability of children with ASD than other-age faces.The own-age effect can be applied to experimental materials, the attribute settings of intervention materials, and the selection of accompanying objects to further expand the own-age effect in the educational intervention and training of social and cognitive abilities in ASD. It is expected to help autism improve its social skills and better integrate into the society.Keywords: children with autism spectrum disorders, own-age faces, intervention, eye tracking

Hong Yang, Yiping Li, Mengjiao Xu, Ying Hu, Fengshun Yuan, Lunhao Liu, Ling Li, Dan Yuan, Li Ye, Chang Zhou, Yan Zhang, Ling Su, Shu Liang Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of ChinaCorrespondence: Shu Liang; Ling Su, Email liangshu523@163.com; sl7512@163.comBackground: Sichuan Province has gradually become a hot-spot for HIV/AIDS. Little is known about the HIV-1 incidence and prevalence among four sub-groups since 2015. Meanwhile, the distributions of hot-spot areas related to recent infection cases that indicate current transmission among the four subgroups are also rare.Objective: The main purpose of this study was to assess the HIV-1 prevalence and incidence and to visualize the distributions of hot-spot areas of current transmission among four subgroups (people who inject drugs, male STD clinic attendees, female sex workers and men who had sex with men) during the surveillance period in Sichuan province between 2016 and 2022.Results: Of the 267,617 individuals, 2158 HIV-positive samples were tested with Lag-Avidity EIA, among which 493 samples were identified as recent infections. Among people who inject drugs (PWID), both HIV-1 prevalence (from 1.41% to 0.34%) and incidence (from 0.03% to 0.140%) showed a significant decreasing trend. Among men who had sex with men (MSM), female sex workers (FSWs), and male STD clinic attendees, HIV-1 prevalence indicated significant decreasing trends, whereas HIV-1 incidence showed no significant changes. Spatial analysis demonstrated the formation of hot-spots and clusters of current transmissions sharing regional differences, mainly concentrated in the southeast, and most of these were consecutive hot-spots.Conclusion: The prevention and control were efficacious and persistent. However, among the other three subgroups, there is a need for a regional cooperative in prevention and control approaches and collaborative research in many aspects.Keywords: human immunodeficiency virus, recent infection, hot spots, people who inject drugs, PWID, male STD clinic attendees, mSTD, female sex workers, FSWs

Jiying Xiao,1 Lin Su,2,3 Shumin Huang,2,3 Lingyue Liu,1 Kamran Ali,4 Zhimin Chen2,3 1Department of Pulmonology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310015, People’s Republic of China; 2Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310052, People’s Republic of China; 3National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China; 4Department of Oncology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, 322000, People’s Republic of ChinaCorrespondence: Zhimin Chen, Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, Zhejiang, 310052, People’s Republic of China, Email zmchen@zju.edu.cnAbstract: Haemophilus influenzae (H. influenzae) is a significant pathogen responsible for causing respiratory tract infections and invasive diseases, leading to a considerable disease burden. The Haemophilus influenzae type b (Hib) conjugate vaccine has notably decreased the incidence of severe infections caused by Hib strains, and other non-typable H. influenzae (NTHi) serotypes have emerged as epidemic strains worldwide. As a result, the global epidemic trends and antibiotic resistance characteristics of H. influenzae have been altered. Researches on the virulence factors of H. influenzae, particularly the mechanisms underlying biofilm formation, and the development of anti-biofilm strategies hold significant clinical value. This article provides a summary of the epidemic trends, typing methods, virulence factors, biofilm formation mechanisms, and prevention strategies of H. influenzae. The increasing prevalence of NTHi strains and antibiotic resistance among H. influenzae, especially the high β-lactamase positivity and the emergence of BLNAR strains have increased clinical difficulties. Understanding its virulence factors, especially the formation mechanism of biofilm, and formulating effective anti-biofilm strategies may help to reduce the clinical impact. Therefore, future research efforts should focus on developing new approaches to prevent and control H. influenzae infections.Keywords: Haemophilus influenzae, epidemiology, virulence factors, biofilms, prevention strategies

Min Gao,1,2,&ast; Yongwen Li,3,&ast; Hua Huang,4,&ast; Yaguang Fan,3 Ruifeng Shi,4 Lianchun Su,5 Chen Chen,3 Xuanguang Li,4 Guangsheng Zhu,4 Di Wu,4 Peijun Cao,4 Hongyu Liu,3 Jun Chen,3– 5 Shirong Kang1 1Department of Thoracic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010010, People’s Republic of China; 2Inner Mongolia Medical University, Hohhot, 010010, People’s Republic of China; 3Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 4Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 5Department of Thoracic Surgery, First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Chen; Shirong Kang, Email huntercj2004@qq.com; bssbzzk2013@163.comBackground: Genetic susceptibilities play a large role in the pathogenesis of lung cancer (LC). The polycomb repressive complex 2 (PRC2) is a conserved chromatin-associated complex that represses gene expression and is crucial for proper organismal development and gene expression patterns. Despite PRC2 dysregulation has been observed in various human cancers, the relationship between PRC2 genes variants and lung cancer risk remains largely unexplored.Methods: To investigate the association between single nucleotide polymorphisms (SNPs) in PRC2 genes and the risk of developing LC, we genotyped blood genomic DNA from 270 LC patients and 452 healthy individuals of Chinese Han ethnicity using the TaqMan™ genotyping technique.Results: We found that rs17171119T>G(adjusted odds ratio (OR) = 0.662, 95% CI: 0.467– 0.938, P < 0.05), rs10898459 T>C(adjusted OR = 0.615, 95% CI: 0.4– 0.947, P < 0.05), and rs1136258 C>T(adjusted OR = 0.273, 95% CI: 0.186– 0.401, P < 0.001) were significantly associated with a reduced risk of LC. Stratified analysis revealed a protective effect of rs17171119 in both male and female patients, specifically those with lung adenocarcinoma (LUAD). Additionally, rs1391221 showed a protective effect in both the LUAD and lung squamous cell carcinoma (LUSC) groups, while rs1136258 exhibited a protective effect in both females and males, as well as in both LUAD and LUSC groups. Furthermore, analysis of The Cancer Genome Atlas (TCGA) dataset revealed expression levels of EED and RBBP4 in both LUAD and LUSC.Conclusion: This study provides evidence that allelic variants in EZH2, EED, and RBBP4 may act as protective factors against LC development and could serve as genetic markers associated with susceptibility to LC.Keywords: the polycomb repressive complex 2, single nucleotide polymorphism, lung cancer

Hong Yang, Yiping Li, Fang He, Fengshun Yuan, Lunhao Liu, Ling Li, Dan Yuan, Li Ye, Chang Zhou, Yan Zhang, Ling Su, Shu Liang Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of ChinaCorrespondence: Shu Liang; Ling Su, Email liangshu523@163.com; sl7512@163.comBackground: Sichuan Province is severely affected by the HIV epidemic in China. Little is known about the characteristics of recent infections among new HIV diagnoses, which is critical to prevention strategies, evaluation of the HIV epidemic and health resource allocation. Meanwhile, individuals at primary stages of infection are related to the hot-spot areas of ongoing transmission in new HIV diagnoses, which is also rarely known.Objective: This article aimed to report the proportion of recent infections among new HIV diagnoses, and to reveal demographic characteristics associated with HIV recent infections, and finally, to indicate the hot-spot areas of ongoing transmission in Sichuan province between 2018 and 2020.Methods: Limiting Antigen (LAg)-Avidity assay was performed to detect recent infection within new HIV diagnoses reported in odd months between 2018 and 2020. Results were reclassified according to the data on CD4 cell count, antiretroviral treatment and the existence of an AIDS-defining illness. Logistic regression was used to determine characteristics associated with HIV recent infections. The spatial analysis was conducted with ArcGIS 10.7 to figure hot-spot areas of HIV recent infections.Results: 42,089 newly diagnosed HIV-1 cases were tested using the LAg-Avidity EIA. In total, 5848 (13.89%) of those were classified as HIV recent infections. Female, age between 18– 25 years and men who had sex with men were related to higher proportion of HIV recent infections. Logistic regression revealed that MSM aged between 18– 25 years were more likely to be classified as recent infection. Spatial analysis demonstrated significant clustering in Chengdu, Yibin, Luzhou city between 2018 and 2020. Hot spots were mainly clustered in the center of Sichuan in 2018, but gradually spread to southwest and northwest between 2019 and 2020.Conclusion: Enhanced preventive measures among relevant risk groups and areas where the potential HIV-1 transmission is ongoing is urgently needed to curb further spread.Keywords: human immunodeficiency virus, HIV, HIV recent infection, Sichuan, hot spots

Exams constitute the predominant form of summative assessment in undergraduate biology education, with the assumption that exam performance should reflect student conceptual understanding. Previous work highlights multiple examples in which students can answer exam problems correctly without the corresponding conceptual understanding. This disconnect can significantly undermine instructors' ability to interpret exam performance in relation to student learning. Here, we investigate problem-solving strategies used by undergraduate students in biological sciences. Participants were interviewed using a semi-structured protocol: They were asked to solve genetics problems, in multiple-choice and short-answer formats, and were prompted to explain their strategies. Data analysis took a grounded-theory approach and involved iterative close reading of the interview transcripts to examine students problem-solving strategies. Three case studies of participants with similar overall exam performance are presented to explore the variety of strategies. We identified two non-conceptual strategies based on algorithms or patterns within the exam problems. In contrast, the third case-study participant used mostly conceptual strategies grounded in an understanding of biology. We also observed participants switching between conceptual and non-conceptual strategies. These results identify different strategies that undergraduate students use to solve problems in biological sciences, and potential implications on the design of exams and assessments are discussed.

Wenjuan Chen,1,2 Chen Peng,1,2 Jianfeng Zheng,1,2 Xiya Lu,1,2 Yangfeng Ding,1,2 Lina Su1,2 1Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Institute of Psoriasis, Tongji University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Lina Su; Yangfeng Ding, Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jing’an District, Shanghai, 200443, People’s Republic of China, Email sulina11@hotmail.com; vygd112@163.comAbstract: Psoriasis is an immune-mediated systemic disease with multiple organs involvement, such as cardiovascular, live, gut, endocrine, and so on. Bullous pemphigoid (BP) is a rare comorbidity associated with psoriasis, while BP occurring in erythrodermic psoriasis (EP) is very rare. In this case, we reported a woman with severe EP who developed BP, in whom beta hemolytic streptococcus infection was a possible triggering factor. The complicated condition of such patients needs to draw attention of the physician and study further for better treatment.Keywords: bullous pemphigoid, erythrodermic psoriasis, comorbidity

Shumin Huang,1,2 Jing He,1,2 Yiting Zhang,1,2 Lin Su,1,2 Lin Tong,1,2 Ying Sun,1,2 Mingming Zhou,2,3 Zhimin Chen1,2 1Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China; 2National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China; 3Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of ChinaCorrespondence: Zhimin Chen, Email zmchen@zju.edu.cnObjective: This study aimed to investigate the biofilm-forming ability, molecular typing, and antimicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains isolated from the respiratory tract of children and their correlation with clinical characteristics.Methods: All CA-MRSA strains were isolated from hospitalized children, and their presentation, molecular typing, antimicrobial susceptibility, and biofilm formation were investigated. The clinical characteristics were compared between the strong and weak biofilm producer groups.Results: Fifty-three CA-MRSA strains were isolated from the respiratory samples of 53 children, with nearly half of them being young infants (0– 12 months). Approximately, 88.7% (47/53) of the isolates were resistant to four or more antibiotics, mainly β-lactam antibiotics, lincosamides, and macrolides. Twelve sequence types (STs) and 20 subtypes of staphylococcal protein A (spa) typing were identified, with ST59-t437 (39.6%, 21/53) as the predominant subtype. All strains showed the ability to form biofilms. When compared to children with weak biofilm-forming CA-MRSA strains, those with strong biofilm-forming strains had higher proportions of lower respiratory tract infections (LRTI) (88.5% vs 59.3%), obvious cough symptoms (84.6% vs 51.9%), and severe chest imaging manifestations (76.9% vs 37.0%). Furthermore, a strong biofilm-forming ability significantly increased the risk of prolonged cough in children with LRTI (44.4% vs 14.3%), and a positive correlation between the duration of cough and the extent of biofilm formation was observed. Medical history investigation revealed that the strong biofilm-forming group had a much higher percentage of macrolides intake than the weak biofilm-forming group in the last month before admission (61.5% vs 14.8%).Conclusion: ST59-t437 was the most prevalent clone in CA-MRSA respiratory isolates among the hospitalized children. All CA-MRSA strains formed biofilms. The stronger the biofilm-forming ability, the more serious and prolonged were the respiratory symptoms.Keywords: CA-MRSA, biofilm, respiratory infection, child, genotype

Minhua Lin,1 Tianxiang Huang,2 Xuan Wang,1 Xuenan Li,3 Jingjiao Ma,3 Lan Su,3 Jun Wu2 1Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 2Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 3Beijing Genetron Health, Co. Ltd, Beijing, 102206, People’s Republic of ChinaCorrespondence: Jun Wu, Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China, Tel +86 13508480515, Fax +86 731-89753039, Email junwucs@csu.edu.cnIntroduction: NF-κB signaling is involved in a wide range of biological processes including cell proliferation, cell survival and immunity. Meanwhile, as one of the major oncogenic pathways, its upregulation has been observed in many cancer types. Compared with canonical NF-κB signaling, its non-canonical branch was much less studied in cancerous context.Methods: In this study, we leveraged multi-omics data across multiple platforms to investigate the activity of non-canonical NF-κB signaling in low-grade glioma (LGG) and explore its connection with molecular characteristics of LGG.Results: We found that non-canonical NF-κB signaling could classify LGG patients into subgroups with significant survival difference. Non-canonical NF-κB-low group enriched with oligodendroglioma featured by CIC mutations and 1p19q co-deletion. On the another hand, LGG in non-canonical NF-κB-high group showed high frequency of EGFR mutations but relatively low frequency of IDH mutations. In addition, LGG in this group reflected immunosuppressive environment characterized by high level of cytotoxic T cell exhaustion and macrophage M2 infiltration. More comprehensive evaluation implied that LGG in non-canonical NF-κB-high group reflected significantly higher immunogenicity. Through a series of feature selection technique, we developed a model that can predict the prognosis of LGG patients in a cost-effective way.Conclusion: Our analysis demonstrated the prognostic value of non-canonical NF-κB signaling in LGG. The survival difference between non-canonical NF-κB stratified groups may be explained by their distinct molecular characteristics as well as cellular context. Our prognostic model may help in offering better therapeutic strategy and clinical management.Keywords: lower grade glioma, non-canonical NF-κB signaling, immune microenvironment, T cell exhaustion, M2 macrophages, prognosis

Minxi Lao,1,* Kaicong Zhang,1,* Meng Zhang,2,* Qian Wang,1 Jin Li,1 Lei Su,1 Meilin Ding,1 Wen He,1 Yingying Gong1 1Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Pathology, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yingying Gong Email gongyy5@mail.sysu.edu.cnIntroduction: Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection. Old age is one of the important risk factors of IPA. However, data regarding the clinical characteristics and prognostic factors of elderly patients with IPA are limited, with data regarding co-infection of other bacteria or fungi even scarcer.Methods: We performed a retrospective study of elderly patients (aged≥ 60) with IPA diagnosed in the First Affiliated Hospital of Sun Yat-sen University from January 2000 to December 2019. Data collection included demographic characteristics, premorbid conditions, underlying diseases, clinical manifestations, therapeutic procedures, and pathogenic detection. Associated factors were analyzed by logistic regression analysis.Results: A total of 97 elderly patients (75 males, 22 females) with IPA were included. The all-cause mortality rate was 36.1% (35/97). Body mass index (BMI) (adjusted odds ratio (OR) 1.27, 95% confidence interval (CI) 1.08– 1.50, P=0.01), solid organ malignancy (adjusted OR 5.37, 95% CI 1.35– 21.33, P=0.02), and co-infections (adjusted OR 5.73, 95% CI 1.40– 23.51, P=0.02) were associated with mortality in the elderly patients with IPA. Nearly, 76.3% (74/97) of the patients developed co-infections. Most of the infections (55/74, 74.3%) involved the lung. A total of 77 strains of bacteria were isolated, and Gram-negative bacteria (63/77, 81.3%) were predominant. Patients with co-infections are older (72.3± 7.6 vs 67.4± 7.4, P=0.04), prone to admit to the intensive care unit (ICU) (59.5% vs 26.1%, P=0.01), and present lymphopenia (60.8% vs 26.1%, P=0.004). In multivariate analysis, ICU admission (adjusted OR 4.57, 95% CI 1.53– 13.67, P=0.01), and lymphopenia (adjusted OR 4.82, 95% CI 1.62– 14.38, P=0.01) were significantly associated with co-infection in the elderly patients with IPA.Conclusion: IPA is a fatal disease in the elderly population. Co-infection is closely associated with mortality. Lymphopenia could be an indicator for co-infection in the elderly patients with IPA.Keywords: pulmonary aspergillosis, elderly, co-infection, mortality

Xiaoxian Pan,1,* Caihong Wang,1,* Rong Li,2 Li Su,1,3,4 Mingwei Zhang,1,3,4 Chuanshu Cai,1,3,4 Shiping Liu,1 Weijian Zhang,1,3,4 Jihong Song,2 Jinsheng Hong1,3,4 1Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 2The School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 3Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People’s Republic of China; 4Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinsheng Hong Email 13799375732@163.comPurpose: This study aims to explore the applicability of the Nutrition Risk Screening 2002 (NRS2002) tool in screening nutritional risk and the Patient-Generated Subjective Global Assessment (PG-SGA) in determining nutrition status in nasopharyngeal carcinoma (NPC) patients.Materials and Methods: NRS2002 and PG-SGA were simultaneously applied to evaluate the nutritional status of NPC patients before induction chemotherapy, as well as before and after radiotherapy. The PG-SGA results were considered golden standard in evaluating nutrition status, and the ROC curve value and Youden index were applied to analyze NRS2002 effectiveness in screening nutritional risk.Results: A total of 102 NPC patients were included in this study. Patients with an NRS2002 score < 3 and PG-SGA score ≥ 4 accounted for 5.3% (5/95), 19.6% (18/92) and 94.8% (36/38) at the time before induction chemotherapy, before radiotherapy and at the end of radiotherapy, respectively. The cut-off values of NRS2002 scores all < 2 corresponded to the maximum Youden index at the three procedural times. And the area under curve (AUC) were 0.598 (P = 0.390), 0.665 (P = 0.015) and 0.940 (P = 0.034), respectively. At the end of radiotherapy, NRS2002 scores of < 3 and < 2 were used as cut-off values for nutritional risk screening, respectively. Additionally, the malnutrition-missed detection rates were 36.0% and 12.0% (χ2 = 15.789; P < 0.001).Discussion: NRS2002 nutritional risk screening combined with the PG-SGA nutritional assessment has certain applicability in NPC. NRS2002 score ≥ 2 can be considered as a new cut-off point for nutritional assessment.Keywords: nasopharyngeal carcinoma, nutritional risk screening, nutrition assessment, NRS2002, PG-SGA

Interactive response systems "clickers" can provide multiple benefits to the students and faculty who use them, including immediate performance feedback and greater student engagement in learning. My own exploration of this technology has yielded five pedagogically different types of polling questions, specifically measurement of student confidence levels, their comfort levels with various topics, assessment of attitude change due to class discussions, retention of course information, and basic mastery of course content. The present investigation revealed that students acknowledge the possible benefits to the instructor of using these polling questions, yet they were most appreciative of the opportunity to see sample quiz questions. More surprising, these students were unaware of the price of "clickers," despite having purchased them at the start of the semester, suggesting that use of this technology does not constitute a financial hardship for many students. (Contains 1 table.)

Huifang Zhou,1,2 Libo Su,3 Chao Liu,3 Baosheng Li,2 Hui Li,4 Ying Xie,3 Dianxing Sun1,2 1Graduate School of Hebei Medical University, Hebei Medical University, Shijiazhuang, People’s Republic of China; 2The Liver Disease Center of PLA, The 980th Hospital of PLA Joint Logistics Support Force, Shijiazhuang, People’s Republic of China; 3Hebei Key Laboratory of Laboratory Animal Science, Hebei Medical University, Shijiazhuang, People’s Republic of China; 4Department of Pathology, The 980th Hospital of PLA Joint Logistics Support Force, Shijiazhuang, People’s Republic of ChinaCorrespondence: Dianxing SunThe Liver Disease Center of PLA, The 980th Hospital of PLA Joint Logistics Support Force, 398 West Zhongshan Road, Shijiazhuang 050082, People’s Republic of ChinaTel +86 311 8797 8434Fax +86 311 8797 8434Email sundianxing@hotmail.comYing XieHebei Key Lab of Laboratory Animal Science, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, People’s Republic of ChinaTel +86 311 8626 6844Fax +86 311 8626 6844Email 15930141651@163.comBackground: Hepatocellular carcinoma is a common malignant cancer and the second most common cause of cancer-related deaths worldwide. Collagen triple helix repeat containing 1 (CTHRC1) has been increasingly reported to be involved in tumorigenesis and/or tumor progression. However, limited data are available regarding the role of CTHRC1 in hepatocellular carcinoma.Methods: Paraffin-embedded specimens from a total of 29 patients with HCC were collected in our study. The expression of CTHRC1 in hepatocellular carcinoma was evaluated using immunohistochemistry and bioinformatics analysis. Furthermore, Spearman analysis was performed to identify factors of correlation between CTHRC1 and clinicopathological features. Survival curves for hepatocellular carcinoma were produced using the Kaplan-Meier method and the log rank test.Results: In this study, we confirmed that CTHRC1 is highly expressed in tissues and hepatoma cell lines. The statistical analysis revealed that the levels of CTHRC1 were significantly correlated with cirrhosis (P=0.024), tumor size (P=0.006), vascular invasion (P

Lianyuan Tao,1,2 Li Su,3 Chunhui Yuan,1 Zhaolai Ma,1 Lingfu Zhang,1 Shiping Bo,4 Yunyun Niu,4 Sijia Lu,4 Dianrong Xiu11Department of General Surgery, Peking University Third Hospital, Beijing 100191, People’s Republic of China; 2Department of Hepatobiliary Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, Henan 450003, People’s Republic of China; 3Medical and Health Analytical Center, Peking University Health Science Center, Beijing 100191, People’s Republic of China; 4Department of Clinical Research, Yikon Genomics Co. Ltd., Shanghai, People’s Republic of ChinaPurpose: The aim of this study was to evaluate the value of flow cytometry (FCM) detection of portal vein circulating tumor cells (CTCs) in predicting postoperative metastasis.Methods: Samples of portal venous blood and peripheral blood were collected from 39 patients during surgery, and CTCs were detected by FCM, with confirmation by laser confocal microscopy and single-cell sequencing.Results: Among all patients, a portal EpCAM+CD45- percentage ≥24.5×10−4 (P=0.06), peripheral EpCAM+CD45- count ≥97/5 mL (P=0.034), peripheral EpCAM+CD45- percentage ≥4.4×10−4 (P=0.042), and CA242≥3.5 U/mL (P=0.027) were significant predictors of metastasis. Further analysis showed that the portal EpCAM+CD45- ratio ≥24.5×10−4 is a predictor of metastasis (P=0.025) in pancreatic cancer after curative resection.Conclusion: CTCs detected by FCM in portal venous blood are of significant value for the prediction of postoperative metastasis in pancreatic or periampullary tumors.Keywords: circulating tumor cells, flow cytometry, portal vein, pancreatic cancer, metastases

In recent years, commissions and reports have called for laboratory courses that engage undergraduates in authentic research experiences. We present an iterative approach for developing course-based undergraduate research experiences (CUREs) that help students learn scientific inquiry skills and foster expert-like perceptions about biology. This study involves the design, implementation, evaluation, and revision of two large introductory biology laboratory courses, where students work collaboratively on research projects developed from faculty laboratories on campus. Quantitative surveys, qualitative focus groups, and student course evaluations are used to evaluate these courses and to provide continuing feedback for improvement over two implementation cycles. Pre- versus postsurvey data indicate that students gain self-efficacy in scientific inquiry skills and develop more expert-like perceptions of biology. These gains are more significant and have larger effect sizes in the second implementation year, a trend also supported by qualitative data. Together, these data indicate a progression of improvement of efficacies of these CUREs.