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Objective: This case report aims to present a rare occurrence of fallopian tube prolapse into the vaginal vault following hysterectomy, underscoring the importance of recognizing this uncommon complication. Case Report: A 45-year-old woman, with a history of hysterectomy for adenomyosis, presented with symptoms mimicking a vaginal tumor, including persistent discharge, abdominal pain, postcoital bleeding, and weight loss. Imaging raised concerns of malignancy, but surgery revealed a prolapsed fallopian tube with chronic inflammation. This case highlights the diagnostic challenges, with less than 100 reported instances. Differential diagnoses encompassed diverse pelvic pathologies, necessitating histological confirmation. Factors contributing to prolapse include poor vault closure and early sexual activity. Awareness of this complication is pivotal when evaluating post-hysterectomy symptoms, ensuring precise diagnosis and appropriate management. Conclusion: Fallopian tube prolapse into the vaginal vault is a rare post-hysterectomy complication. Early recognition and accurate diagnosis are essential for effective management of patients presenting with post-hysterectomy symptoms, such as vaginal bleeding and discharge.

The emergence of hypervirulence (hv) and carbapenem resistance (CR) as distinct evolutionary directions for Klebsiella pneumoniae presents a significant threat in clinical settings. However, in recent years, there has been a growing identification of K. pneumoniae strains that integrate both phenotypes, resulting in severe clinical outcomes. Carbapenem-resistant hypervirulent K. pneumoniae (CRhvKP) typically emerges through the acquisition of plasmids carrying either virulence or CR-encoded genes by carbapenem-resistant K. pneumoniae or hypervirulent K. pneumoniae. Furthermore, the acquisition of a hybrid plasmid can confer a combination of CR and hv. CRhvKP can cause a variety of infections, including pneumonia, urinary tract infections, bloodstream infections, liver abscesses, and other related conditions. While the sequence type 11 (ST11) dominates the majority of CRhvKP strains in China, the molecular factors responsible for the success of ST11 CRhvKP largely remain unknown. Here, we provide an overview of the current understanding of the variation and distribution of crucial virulence determinants, the mechanisms driving the merging of hv and CR, and the potential molecular factors influencing the epidemiological success of ST11 CRhvKP. This research aims to contribute to a comprehensive understanding of the complexities surrounding CRhvKP. It is imperative to underscore the development of combination therapies, precision medicine, and vaccine strategies as pivotal approaches in effectively combating CRhvKP. Considering the widespread prevalence of CRhvKP, a prioritized, multifaceted approach encompassing infection control, active surveillance, and the development of innovative therapeutics is essential.

Abstract Open class is a public-oriented pedagogical practice aimed at enhancing teachers’ professional learning in China. This study examines how teachers conduct the open class and explores how open class facilitates the professional development of teachers. Through fieldwork at Sailing School and semi-structured interviews with nineteen teachers, four distinct phases of participation were identified: beginning (preparation for a show), presentation (using performance strategies), ending (evaluating teachers’ performance), and teamwork (cooperating with peers and students). Open class fosters four key forms of professional learning: enhancing the ability of instructional design, developing PCK in practice, fostering a pedagogical tact, and improving theoretical skills. The findings underscore open class as a platform to bridge the gap between practice and theory, while also highlighting a shift in teacher values from individualism to collectivism in open classes.

Abstract Background Intravenous fluid administration and prophylactic vasopressor infusion are the primary methods for preventing spinal anesthesia-induced hypotension during cesarean delivery. However, evidence regarding the impact of different volumes of crystalloid solution on the phenylephrine infusion dosage for preventing this hypotension remains inconclusive. This study aimed to determine the effect of two IV fluid infusion rates (10 or 20 mL/kg/h) on phenylephrine requirement for preventing spinal anesthesia-induced hypotension. Methods Eighty healthy parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. Participants were randomly assigned to receive either 10 mL/kg/h (group 10) or 20 mL/kg/h (group 20) of lactated Ringer’s solution. The first patient in each group received 0.5 µg/kg/min of phenylephrine infusion immediately after intrathecal injection. The phenylephrine dose in subsequent patients was adjusted by increments or decrements of 0.05 µg/kg/min based on the previous patient’s response. The ED50 of phenylephrine infusion for preventing spinal-induced hypotension for cesarean delivery was estimated using a modified up-down sequential analysis, with probit analysis applied as a backup sensitivity analysis. Results The ED50 values for preventing spinal anesthesia-induced hypotension were 0.30 µg/kg/min (95% CI, 0.29–0.32 µg/kg/min) for group 10, and 0.19 µg/kg/min (95% CI, 0.16–0.22 µg/kg/min) for group 20, respectively. The estimated relative potency for phenylephrine in group 10 compared to group 20 was 1.52 (95%CI, 1.24–1.97), showing a significant difference in the ED50 values between the two groups. Conclusion This study found that a higher crystalloid co-loading rate significantly reduces prophylactic phenylephrine requirement for preventing spinal anesthesia induced hypotension. Trials registration https://www.chictr.org.cn/showproj.html?proj=125918 (Trial number: ChiCTR2100048002).

Abstract This study aimed to construct a high-performance prediction and diagnosis model for type 2 diabetic retinopathy (DR) and identify key correlates of DR. This study utilized a cross-sectional dataset of 3,000 patients from the People’s Liberation Army General Hospital in 2021. Logistic regression was used as the baseline model to compare the prediction performance of the machine learning model and the related factors. The recursive feature elimination cross-validation (RFECV) algorithm was used to select features. Four machine learning models, support vector machine (SVM), decision tree (DT), random forest (RF), and gradient boost decision tree (GBDT), were developed to predict DR. The models were optimized using grid search to determine hyperparameters, and the model with superior performance was selected. Shapley-additive explanations (SHAP) were used to analyze the important correlation factors of DR. Among the four machine learning models, the optimal model was GBDT, with predicted accuracy, precision, recall, F1-measure, and AUC values of 0.7883, 0.8299, 0.7539, 0.7901, and 0.8672, respectively. Six key correlates of DR were identified, including rapid micronutrient protein/creatinine measurement, 24-h micronutrient protein, fasting C-peptide, glycosylated hemoglobin, blood urea, and creatinine. The logistic model had 27 risk factors, with an AUC value of 0.8341. A superior prediction model was constructed that identified easily explainable key factors. The number of correlation factors was significantly lower compared to traditional statistical methods, leading to a more accurate prediction performance than the latter.

Abstract Background NUP98 rearrangements (NUP98-r) are rare but overrepresented mutations in pediatric acute myeloid leukemia (AML) patients. NUP98-r is often associated with chemotherapy resistance and a particularly poor prognosis. Therefore, characterizing pediatric AML with NUP98-r to identify aberrations is critically important. Methods Here, we retrospectively analyzed the clinicopathological features, genomic and transcriptomic landscapes, treatments, and outcomes of pediatric patients with AML. Results Nine patients with NUP98-r mutations were identified in our cohort of 142 patients. Ten mutated genes were detected in patients with NUP98-r. The frequency of FLT3-ITD mutations differed significantly between the groups harboring NUP98-r and those without NUP98-r (P = 0.035). Unsupervised hierarchical clustering via RNA sequencing data from 21 AML patients revealed that NUP98-r samples clustered together, strongly suggesting a distinct subtype. Compared with that in the non-NUP98-r fusion and no fusion groups, CMAHP expression was significantly upregulated in the NUP98-r samples (P

Abstract Objective To compare therapeutic outcomes of predicted proliferative and nonproliferative hepatocellular carcinoma (HCC) after microwave ablation (MWA) using a previously developed imaging-based predictive model, the SMARS score. Methods This multicenter retrospective study included consecutive 635 patients with unresectable HCC who underwent MWA between August 2013 and September 2020. Patients were stratified into predicted proliferative and nonproliferative phenotypes according to the SMARS score. Overall survival (OS) and recurrence-free survival (RFS) were compared between the predicted proliferative and nonproliferative HCCs before and after propensity score matching (PSM). OS and RFS were also compared between the two groups in subgroups of tumor size smaller than 30 mm and tumor size 30–50 mm. Results The SMARS score classified 127 and 508 patients into predicted proliferative and nonproliferative HCCs, respectively. The predicted proliferative HCCs exhibited worse RFS but equivalent OS when compared with nonproliferative HCCs before (p < 0.001 for RFS; p = 0.166 for OS) and after (p < 0.001 for RFS; p = 0.456 for OS) matching. Regarding subgroups of tumor size smaller than 30 mm (p = 0.098) and tumor size 30–50 mm (p = 0.680), the OSs were similar between the two groups. However, predicted proliferative HCCs had worse RFS compared to nonproliferative HCCs in the subgroup of tumor size 30–50 mm (p < 0.001), while the RFS did not differ in the subgroup of tumor size smaller than 30 mm (p = 0.141). Conclusion Predicted proliferative HCCs have worse RFS than nonproliferative ones after MWA, especially in tumor size larger than 30 mm. However, the phenotype of the tumor may not affect the OS. Critical relevance statement Before performing microwave ablation for hepatocellular carcinoma, the tumor phenotype should be considered because it may affect the therapeutic outcome. Key Points Proliferative hepatocellular carcinoma (HCC) may be identified using the SMARS score, an imaging-based predictive model. SMARS predicted proliferative HCCs have worse recurrence-free and equivalent overall survival compared to nonproliferative HCC after microwave ablation. Tumor phenotype should be considered before performing microwave ablation. Graphical Abstract

Based on 778 earthquakes (2009—2022) and their observation reports recorded by the Hunan Seismic Network, through the analysis of the cross-correlation of the waveforms, 149 repeated earthquake pairs were identified which were recorded at least 3 stations with cross-correlation coefficients no less than 0.8. After obtaining these data, the location errors and phase picking errors of the Hunan Seismic Network were statistically analyzed. The results show that the horizontal location error is around 3.5 km, and the vertical location error is around 3 km. The Pg and Sg phase picking errors are about 0.4 s and 0.7 s, respectively. There is no significant difference in location error in Hunan region, except for the Changde area, where the error is basically within 4 km.

Abstract Bacteria often evolve antibiotic resistance through mutagenesis. However, the processes causing the mutagenesis have not been fully resolved. Here, we find that a broad range of ribosome-targeting antibiotics cause mutations through an underexplored pathway. Focusing on the clinically important aminoglycoside gentamicin, we find that the translation inhibitor causes genome-wide premature stalling of RNA polymerase (RNAP) in a loci-dependent manner. Further analysis shows that the stalling is caused by the disruption of transcription-translation coupling. Anti-intuitively, the stalled RNAPs subsequently induce lesions to the DNA via transcription-coupled repair. While most of the bacteria are killed by genotoxicity, a small subpopulation acquires mutations via SOS-induced mutagenesis. Given that these processes are triggered shortly after antibiotic addition, resistance rapidly emerges in the population. Our work reveals a mechanism of action of ribosomal antibiotics, illustrates the importance of dissecting the complex interplay between multiple molecular processes in understanding antibiotic efficacy, and suggests new strategies for countering the development of resistance.

Abstract Small nucleolar RNAs (snoRNAs) were previously regarded as a class of functionally conserved housekeeping genes, primarily involved in the regulation of ribosome biogenesis by ribosomal RNA (rRNA) modification. However, some of them are involved in several biological processes via complex molecular mechanisms. DNA damage response (DDR) is a conserved mechanism for maintaining genomic stability to prevent the occurrence of various human diseases. It has recently been revealed that snoRNAs are involved in DDR at multiple levels, indicating their relevant theoretical and clinical significance in this field. The present review systematically addresses four main points, including the biosynthesis and classification of snoRNAs, the mechanisms through which snoRNAs regulate target molecules, snoRNAs in the process of DDR, and the significance of snoRNA in disease diagnosis and treatment. It focuses on the potential functions of snoRNAs in DDR to help in the discovery of the roles of snoRNAs in maintaining genome stability and pathological processes.

Abstract Functionalized mesoporous materials have become a promising carrier for enzyme immobilization. In this study, Santa Barbara Amorphous 15 (SBA-15) was modified by N-aminoethyl-γ-aminopropyl trimethoxy (R). R-SBA-15 was employed to purify and immobilize recombinant β-glucosidase from Terrabacter ginsenosidimutans (BgpA) in one step for the first time. Optimum pH of the constructed R-SBA-15@BgpA were 7.0, and it has 20 ℃ higher optimal temperature than free enzyme. Relative activity of R-SBA-15@BgpA still retained > 70% at 42 ℃ after 8-h incubation. The investigation on organic reagent resistance revealed that the immobilized enzyme can maintain strong stability in 15% DMSO. In leaching test and evaluation of storage stability, only trace amount of protein was detected in buffer of the immobilized enzyme after storage at 4 ℃ for 33 days, and the immobilized BgpA still maintained > 50% relative activity. It also demonstrated good reusability, with 76.1% relative activity remaining after fourteen successive enzymatic hydrolyses of epimedin A to sagittatoside A. The newly proposed strategy is an effective approach for the purification and immobilization of BgpA concurrently. In addition, R-SBA-15@BgpA was demonstrated to have high efficiency and stability in this application, suggesting its great feasibility and potential to produce bioactive compounds such as secondary glycosides or aglycones from natural products. Graphical Abstract

Background & Aims: Hepatocellular carcinoma (HCC) is characterized by a high mortality rate. The Liver Imaging Reporting and Data System (LI-RADS) results in a considerable number of indeterminate observations, rendering an accurate diagnosis difficult. Methods: We developed four deep learning models for diagnosing HCC on computed tomography (CT) via a training–validation–testing approach. Thin-slice triphasic CT liver images and relevant clinical information were collected and processed for deep learning. HCC was diagnosed and verified via a 12-month clinical composite reference standard. CT observations among at-risk patients were annotated using LI-RADS. Diagnostic performance was assessed by internal validation and independent external testing. We conducted sensitivity analyses of different subgroups, deep learning explainability evaluation, and misclassification analysis. Results: From 2,832 patients and 4,305 CT observations, the best-performing model was Spatio-Temporal 3D Convolution Network (ST3DCN), achieving area under receiver-operating-characteristic curves (AUCs) of 0.919 (95% CI, 0.903–0.935) and 0.901 (95% CI, 0.879–0.924) at the observation (n = 1,077) and patient (n = 685) levels, respectively during internal validation, compared with 0.839 (95% CI, 0.814–0.864) and 0.822 (95% CI, 0.790–0.853), respectively for standard of care radiological interpretation. The negative predictive values of ST3DCN were 0.966 (95% CI, 0.954–0.979) and 0.951 (95% CI, 0.931–0.971), respectively. The observation-level AUCs among at-risk patients, 2–5-cm observations, and singular portovenous phase analysis of ST3DCN were 0.899 (95% CI, 0.874–0.924), 0.872 (95% CI, 0.838–0.909) and 0.912 (95% CI, 0.895–0.929), respectively. In external testing (551/717 patients/observations), the AUC of ST3DCN was 0.901 (95% CI, 0.877–0.924), which was non-inferior to radiological interpretation (AUC 0.900; 95% CI, 0.877–-923). Conclusions: ST3DCN achieved strong, robust performance for accurate HCC diagnosis on CT. Thus, deep learning can expedite and improve the process of diagnosing HCC. Impact and implications:: The clinical applicability of deep learning in HCC diagnosis is potentially huge, especially considering the expected increase in the incidence and mortality of HCC worldwide. Early diagnosis through deep learning can lead to earlier definitive management, particularly for at-risk patients. The model can be broadly deployed for patients undergoing a triphasic contrast CT scan of the liver to reduce the currently high mortality rate of HCC.

Previous studies have mainly focused on outpatient cases of skin and soft tissue infections (SSTIs), with limited attention to inpatient occurrences. Thus, we aimed to compare the clinical parameters of inpatients with SSTIs, performed genomic characterization, and determined the subtypes of Panton-Valentine leucocidin (PVL) bacteriophages of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from these patients. We found that PVL-positive patients had shorter hospital stays (mean, 9 vs. 24 days; p

The escalation of antibiotic resistance and the diminishing antimicrobial pipeline have emerged as significant threats to public health. The ESKAPE pathogens – Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. – were initially identified as critical multidrug-resistant bacteria, demanding urgently effective therapies. Despite the introduction of various new antibiotics and antibiotic adjuvants, such as innovative β-lactamase inhibitors, these organisms continue to pose substantial therapeutic challenges. People’s Republic of China, as a country facing a severe bacterial resistance situation, has undergone a series of changes and findings in recent years in terms of the prevalence, transmission characteristics and resistance mechanisms of antibiotic resistant bacteria. The increasing levels of population mobility have not only shaped the unique characteristics of antibiotic resistance prevalence and transmission within People’s Republic of China but have also indirectly reflected global patterns of antibiotic-resistant dissemination. What’s more, as a vast nation, People’s Republic of China exhibits significant variations in the levels of antibiotic resistance and the prevalence characteristics of antibiotic resistant bacteria across different provinces and regions. In this review, we examine the current epidemiology and characteristics of this important group of bacterial pathogens, delving into relevant mechanisms of resistance to recently introduced antibiotics that impact their clinical utility in China.

ABSTRACTST11 is the most common lineage among carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in Asia. Diverse morphotypes resulting from genetic mutations are associated with significant differences in microbial characteristics among K. pneumoniae isolates. Here, we investigated the genetic determinants and critical characteristics associated with distinct morphotypes of ST11 CRKP. An ST11-KL47 CRKP isolate carrying a pLVPK-like virulence plasmid was isolated from a patient with a bloodstream infection; the isolate had the “mcsw” morphotype. Two distinct morphotypes (“ntrd” and “msdw”) were derived from this strain during in vitro passage. Whole genome sequencing was used to identify mutations that cause the distinct morphotypes of ST11 CRKP. Transmission electron microscopy, antimicrobial susceptibility tests, growth assays, biofilm formation, virulence assays, membrane permeability assays, and RNA-seq analysis were used to investigate the specific characteristics associated with different morphotypes of ST11 CRKP. Compared with the parental mcsw morphotype, the ntrd morphotype resulted from mutation of genes involved in capsular polysaccharide biosynthesis (wza, wzc, and wbaP), a result validated by gene knockout experiments. This morphotype showed capsule deficiency and lower virulence potential, but higher biofilm production. By contrast, the msdw morphotype displayed competition deficiency and increased susceptibility to chlorhexidine and polymyxin B. Further analyses indicated that these characteristics were caused by interruption of the sigma factor gene rpoN by insertion mutations and deletion of the rpoN gene, which attenuated membrane integrity presumably by downregulating the phage shock protein operon. These data expand current understanding of genetic, virulence, and antimicrobial resistance characteristics associated with distinct morphotypes in ST11 CRKP.

The increasing demand for lightweight, damage-resistant, wear-resistant, and corrosion-resistant materials in implant applications has driven the development of novel bone-inspired composites. This study introduces AZ31 (Mg–3Al–1Zn)/hydroxyapatite (HA) composites fabricated using centrifugal freeze casting and pressureless infiltration. The unique formation mechanism and structure-property relationship of these composites were investigated. The gradient distribution of HA particles and the nucleation and growth behavior of ice crystals, influenced by varying solid content in the centrifugal field, resulted in a radially increasing ceramic-layer-to-metal-layer thickness ratio. Consequently, the composites exhibited a gradient distribution of compression strength, hardness, wear resistance, and corrosion resistance. Moreover, the composites showed no cytotoxicity and promoted osteoblast proliferation, making them suitable for bone tissue engineering applications. These findings provide valuable insights for developing new materials in bone tissue engineering and pave the way for future research in this field.

Abstract Objectives The aim of this study was to evaluate the characteristics of immunocyte associated with bloodstream infection (BSI) caused by Klebsiella pneumoniae (Kpn). Methods Patients with BSI-Kpn were included from 2015 to 2022 in our hospital. Immunocyte subpopulations of enrolled BSI-Kpn patients were tested on the same day of blood culture using multicolor flow cytometry analysis. Antibiotic susceptibility test was determined by agar dilution or broth dilution method. All included isolates were subjected to whole genome sequencing and comparative genomics analysis. Clinical and genetic data were integrated to investigate the risk factors associated with clinical outcome. Results There were 173 patients with non-duplicate BSI-Kpn, including 81 carbapenem-resistant Kpn (CRKP), 30 extended-spectrum β-lactamases producing Kpn (ESBL-Kpn), 62 none CRKP or ESBL-Kpn (S-Kpn). Among 68 ST11-CRKP isolates, ST11-O2v1:KL64 was the most common serotypes cluster (77.9%, 53/68), followed by ST11-OL101: KL47 (13.2%, 9/68). Compared with CSKP group, subpopulations of immunocyte in patients with CRKP were significantly lower (P

We employed a novel technique combining wire and powder co-delivery to fabricate a functionally gradient material (FGM) structure consisting of Al-based composites reinforced with alternating TiC and B4C particles. The TiC content increases from the bottom up and then decreases, while the B4C content gradually increases, resulting in a continuous gradient structure. Correspondingly, the grain size of the Al matrix also changes with the variation of ceramic particles, forming a dual-gradient change trend. This FGM structure exhibits a multi-performance balance of strength, ductility, anti-wear and damping properties, making it a promising candidate for the cost-effective application in multi-performance heterostructured components.

Correct and timely identification of an invasive species during quarantine or at an early stage of invasion before establishment or spread is critical for preventing biological invasions. However, taxonomic confusion of potential invasive earthworm species caused by incorrect taxonomic treatment or reckless taxonomic work has made it difficult to properly recognize potential invasion threats. Through analyzing publicly available DNA sequences of the mitochondrial cytochrome c oxidase subunit I (COI) gene, we confirmed the validity of the specific status of Amynthas masatakae (Beddard, 1892), a peregrine earthworm species in East Asia with the potential to spread to other regions of the world, and designated two new synonyms of A. masatakae: Amynthas tralfamadore Blakemore, 2012 syn. nov. and Amynthas scaberulus Sun and Jiang, 2021 syn. nov. Additionally, the name A. triastriatus usualis Dong, Jiang, Yuan, Zhao and Qiu, 2020 is nomenclaturally unavailable since it was published in an electronic journal without ZooBank registration and an explicit statement establishing a new nominal taxon. Specimens described under this unavailable name actually belong to A. masatakae. Inadequate literature review and erroneous species identities associated with sequences in GenBank have caused even more problems in the already confusing earthworm taxonomy.

Abstract The inspiral of compact stellar objects into massive black holes are one of the main astrophysical sources for the Laser Interferometer Space Antenna (LISA) and Taiji. These extreme-mass-ratio inspirals (EMRIs) have great potential for cosmology and fundamental physics. A binary extreme-mass-ratio inspiral (b-EMRI) describes the case where binary black holes (BBHs) are captured by a supermassive black hole. The b-EMRIs serve as multi-band gravitational wave sources and provide insights into the dynamics of nuclei and tests of general relativity. However, if the b-EMRIs can be distinguished from the normal EMRIs or not is still not clear. In this work, with a few of assumptions, and using the Teukolsky equation, we calculate the approximate gravitational waves of b-EMRIs and assess their detectability by space-based detectors. We also decouple the secondary object information from the Teukolsky equation, enabling us to calculate the energy fluxes and generate the waveforms more conveniently. Variations in the quadrupole of the binary result in small but non-negligible changes in energy fluxes and waveforms, making it possible to distinguish b-EMRI signals with data analysis. This opens up the potential of using b-EMRIs to test gravity theories and for further astrophysical studies.

This work investigated the functional changes in whey proteins obtained from goat milk subject to various temperature treatments. Ultra-high temperature instantaneous sterilization (UHTIS) caused less damage than the common low-temperature, whereas spray-drying treatment had the opposite effect. A total of 426 proteins were identified in UHTIS and control treatment groups, including 386 common proteins and 16 and 14 unique proteins. The UHTIS treatment upregulated 55 whey proteins while down-regulated 98. The UHTIS-treated whey proteins may upregulate three metabolic pathways but downregulate one. Overall, UHTIS only slightly impacted the composition and functions of whey proteins from goat milk compared to the common low-temperature treatments.

Abstract Background Human adipose stromal cells-derived extracellular vesicles (haMSC-EVs) have been shown to alleviate inflammation in acute lung injury (ALI) animal models. However, there are few systemic studies on clinical-grade haMSC-EVs. Our study aimed to investigate the manufacturing, quality control (QC) and preclinical safety of clinical-grade haMSC-EVs. Methods haMSC-EVs were isolated from the conditioned medium of human adipose MSCs incubated in 2D containers. Purification was performed by PEG precipitation and differential centrifugation. Characterizations were conducted by nanoparticle tracking analysis, transmission electron microscopy (TEM), Western blotting, nanoflow cytometry analysis, and the TNF-α inhibition ratio of macrophage [after stimulated by lipopolysaccharide (LPS)]. RNA-seq and proteomic analysis with liquid chromatography tandem mass spectrometry (LC–MS/MS) were used to inspect the lot-to-lot consistency of the EV products. Repeated toxicity was evaluated in rats after administration using trace liquid endotracheal nebulizers for 28 days, and respiratory toxicity was evaluated 24 h after the first administration. In vivo therapeutic effects were assessed in an LPS-induced ALI/ acute respiratory distress syndrome (ARDS) rat model. Results The quality criteria have been standardized. In a stability study, haMSC-EVs were found to remain stable after 6 months of storage at − 80°C, 3 months at − 20 °C, and 6 h at room temperature. The microRNA profile and proteome of haMSC-EVs demonstrated suitable lot-to-lot consistency, further suggesting the stability of the production processes. Intratracheally administered 1.5 × 108 particles/rat/day for four weeks elicited no significant toxicity in rats. In LPS-induced ALI/ARDS model rats, intratracheally administered haMSC-EVs alleviated lung injury, possibly by reducing the serum level of inflammatory factors. Conclusion haMSC-EVs, as an off-shelf drug, have suitable stability and lot-to-lot consistency. Intratracheally administered haMSC-EVs demonstrated excellent safety at the tested dosages in systematic preclinical toxicity studies. Intratracheally administered haMSC-EVs improved the lung function and exerted anti-inflammatory effects on LPS-induced ALI/ARDS model rats.

Abstract Background Long non-coding RNAs (LncRNAs) regulating the immune microenvironment of cancer is a hot spot. But little is known about the influence of the immune-related lncRNA (IRlncRs) on the chemotherapeutic responses and prognosis of cervical cancer (CC) patients. The purpose of the study was to identify an immune-related lncRNAs (IRlncRs)-based model for the prospective prediction of clinical outcomes in CC patients. Methods CC patients’ relevant data was acquired from The Cancer Genome Atlas (TCGA). Correlation analysis and Cox regression analyses were applied. A risk score formula was formulated. Prognostic factors were combined into a nomogram, while sensitivity for chemotherapy drugs was analyzed using the OncoPredict algorithm. Results Eight optimal IRlncRs(ATP2A1-AS1, LINC01943, AL158166.1, LINC00963, AC009065.8, LIPE-AS1, AC105277.1, AC098613.1.) were incorporated in the IRlncRs model. The overall survival (OS) of the high-risk group of the model was inferior to those in the low-risk group. Further analysis demonstrated this eight-IRlncRs model as a useful prognostic marker. The Nomogram had a concordance index of survival prediction of 0.763(95% CI 0.746–0.780) and more robust predictive accuracy. Furthermore, patients in the low-risk group were found to be more sensitive to chemotherapy, including Paclitaxel, Rapamycin, Epirubicin, Vincristine, Docetaxel and Vinorelbine. Conclusions An eight-IRlncRs-based prediction model was identified that has the potential to be an important tool to predict chemotherapeutic responses and prognosis for CC patients.

Objective: Powerful adjuvant strategies are required to improve the survival of patients with completely resected stage ΙΙΙA non-small cell lung cancer (NSCLC). We aimed to compare the efficacy of traditional Chinese medicine (TCM) treatment versus observation after adjuvant chemotherapy in these patients. Methods: Eligible patients were randomized 1:1 to receive either oral decoctions based on Qi-Yin syndrome differentiation (TCM group) or observation (observation group). The intervention lasted for 12 months. The primary endpoint was 1-year disease-free survival (DFS). Secondary endpoints were DFS, quality of life, regulatory T cells (Tregs), and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) on the surface of Tregs in peripheral blood. We used EORTC QLQ-LC43 to evaluate quality of life. Results: Between Apr 29, 2019, and Nov 11, 2021, 75 patients were randomly assigned to oral decoctions based on Qi-Yin syndrome differentiation (n = 38) or observation (n = 37). The full analysis set included 35 patients in the TCM group and 35 in the observation group. After a median follow-up of 24.2 months, oral decoctions based on Qi-Yin syndrome differentiation improved DFS compared with observation (HR 0.378, 95% CI: 0.157-0.912; P = .03). One-year DFS was 82.1% in the TCM group and 61.9% in the observation group ( P = .06). Three months after randomization, scores of total health, role function, emotional function, and social function in the TCM group were higher than those in the observation group ( P

Objective To compare the ability of gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA) and gadobenate dimeglumine (Gd-BOPTA) to display the 3 major features recommended by the Liver Imaging Reporting and Data System (LI-RADS 2018v) for diagnosing hepatocellular carcinoma (HCC). Materials and Methods In this retrospective study, we included 98 HCC lesions that were scanned with either Gd-EOB-DTPA-MR or Gd-BOPTA-M.For each lesion, we collected multiple variables, including size and enhancement pattern in the arterial phase (AP), portal venous phase (PVP), transitional phase (TP), delayed phase (DP), and hepatobiliary phase (HBP). The lesion-to-liver contrast (LLC) was measured and calculated for each phase and then compared between the 2 contrast agents. A P value 0.750). When conducting a total evaluation of the combined data across the 5 phases, the display efficiency was excellent (AUC > 0.950). Conclusion Gd-BOPTA and Gd-EOB-DTPA are liver-specific contrast agents widely used in clinical practice. They have their own characteristics in displaying the 3 main signs of HCC. For accurate noninvasive diagnosis, the choice of agent should be made according to the specific situation.

ObjectiveTo develop a robust machine learning prediction model for the automatic screening and diagnosis of obstructive sleep apnea (OSA) using five advanced algorithms, namely Extreme Gradient Boosting (XGBoost), Logistic Regression (LR), Support Vector Machine (SVM), Light Gradient Boosting Machine (LightGBM), and Random Forest (RF) to provide substantial support for early clinical diagnosis and intervention.MethodsWe conducted a retrospective analysis of clinical data from 439 patients who underwent polysomnography at the Affiliated Hospital of Xuzhou Medical University between October 2019 and October 2022. Predictor variables such as demographic information [age, sex, height, weight, body mass index (BMI)], medical history, and Epworth Sleepiness Scale (ESS) were used. Univariate analysis was used to identify variables with significant differences, and the dataset was then divided into training and validation sets in a 4:1 ratio. The training set was established to predict OSA severity grading. The validation set was used to assess model performance using the area under the curve (AUC). Additionally, a separate analysis was conducted, categorizing the normal population as one group and patients with moderate-to-severe OSA as another. The same univariate analysis was applied, and the dataset was divided into training and validation sets in a 4:1 ratio. The training set was used to build a prediction model for screening moderate-to-severe OSA, while the validation set was used to verify the model's performance.ResultsAmong the four groups, the LightGBM model outperformed others, with the top five feature importance rankings of ESS total score, BMI, sex, hypertension, and gastroesophageal reflux (GERD), where Age, ESS total score and BMI played the most significant roles. In the dichotomous model, RF is the best performer of the five models respectively. The top five ranked feature importance of the best-performing RF models were ESS total score, BMI, GERD, age and Dry mouth, with ESS total score and BMI being particularly pivotal.ConclusionMachine learning-based prediction models for OSA disease grading and screening prove instrumental in the early identification of patients with moderate-to-severe OSA, revealing pertinent risk factors and facilitating timely interventions to counter pathological changes induced by OSA. Notably, ESS total score and BMI emerge as the most critical features for predicting OSA, emphasizing their significance in clinical assessments. The dataset will be publicly available on my Github.

Abstract Background The infection of carbapenem-resistant organisms was a huge threat to human health due to their global spread. Dealing with a carbapenem-resistant Serratia marcescens (CRSM) infection poses a significant challenge in clinical settings. This study aims to provide insights into strategies for controlling CRSM infection by exploring the transformation mechanism of carbapenem-resistance. Methods We used whole genome sequencing (WGS) to investigate the mechanism of carbapenem resistance in 14 S. marcescens isolates in vivo. The expression level of related genes and the minimum inhibitory concentration of meropenem (MICMEM) were also evaluated to confirm the mechanism of carbapenem resistance. Results Seven groups of S. marcescens, each consisting of two strains, were collected from a hospital and displayed a shift in MICMEM from low to high levels. Homology analysis revealed that the isolates in five groups were significantly different from the remaining two. WGS and experimental evidence indicated that four groups of strains developed carbapenem resistance by acquiring the bla KPC (obtaining group), while two groups (persisting group) increased the expression level of the bla KPC. In contrast, isolates in the last group (missing group) did not carry the bla KPC. All strains possessed multiple β-lactamase genes, including bla CTX−M−14, bla SRT−1, and bla SRT−2. However, only in the missing group, the carbapenem-resistant strain lost an outer membrane protein-encoding gene, leading to increased bla CTX−M−14 expression compared to the carbapenem-susceptible strain. Conclusion The study findings suggest that S. marcescens strains developed diverse carbapenem resistance in vivo through the evolution of drug resistance, rather than through clone replacement. We hypothesize that carbapenem resistance in S. marcescens was due to certain clonal types with a distinct mechanism.

Baphicacanthus cusia (Nees) Bremek has a rich historical significance in China. Its stems and leaves have been used for traditional Chinese medicine or a dye called Qing-Dai in Chinese, while its roots are referred to as Nan-Ban-Lan-Gen in Chinese after processing. Both have been recognized and documented in the Chinese Pharmacopoeia. Modern pharmacological studies have revealed that B. cusia has numerous bioactive properties, such as antitumor, antiviral, anti-inflammatory, antioxidant, hepatoprotective, and neuroprotective properties. Moreover, B. cusia has been employed in clinical settings for its antitumor activity. The pivotal bioactive compounds in B. cusia are indirubin, indigo, and tryptanthrin. These potent substances and their derivatives demonstrate antitumor effects through inducing cell cycle arrest, triggering programmed cell death, inhibiting metastasis, and overcoming multidrug resistance. Nonetheless, the metabolic pathway of these compounds, particularly indole alkaloids, in B. cusia remains inadequately investigated. To increase the production of indole alkaloids such as indirubin and indigo, various biosynthetic approaches are employed. Consequently, this review discusses the bioactive compounds present in B. cusia, and elucidates their antitumor mechanisms, metabolism, and biosynthesis pathway. Existing studies indicate that B. cusia is a crucial medicinal plant harboring numerous biologically active substances, and its exploitation and application hold significant potential for substantial economic gains.

Objectives: Postoperative central nervous system infections (PCNSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) frequently result in unfavourable outcomes. However, CRE PCNSIs have not been well described from a clinical and microbiological perspective. Methods: A total of 254 PCNSIs cases were included (January 2017 through June 2020), and clinical features were compared based on pathogenic classification. Cox regression analysis was performed to assess risk factors for mortality. Antibiotic susceptibility testing and whole genome sequencing were conducted on CRE isolates preserved. MLST, cgMLST, resistance genes and virulence genes were further analysed. Results: Among 254 PCNSI cases, 15.4% were caused by Enterobacteriaceae including 28 cases by CRE. The 28-day mortality rates for CRE, CSE and non-Enterobacteriaceae PCNSIs were 50.0%, 27.3%, and 7.4%, respectively. 42.9% (12/28) of the CRE PCNSIs patients achieved clinical cure, with 25.0% achieved microbiological clearance. ST11-KL64 carrying blaKPC-2 was dominant in CRE (17/23, 73.9%), and the 28-day mortality rate of its infection was 58.5%. Most CRKP carried rampA/rampA2 genes (17/23, 73.9%). Conclusion: ST11-KL64 CRKP carrying blaKPC-2 dominated among CRE PCNSIs. Targeted anti-infective combination therapy based on ceftazidime/avibactam or amikacin, combined with intrathecal administration of amikacin, was found to be effective. These findings render a new insight into the clinical and microbiological landscape of CRE PCNSIs.

The wettability and reactivity of Al alloys and B4C are of vital importance in the production of B4C-reinforced Al-matrix composites. However, previous research has primarily focused on pure Al/B4C systems, with little focus on alloying elements. In this paper, we investigated the influence of Si, Ti and Cu as alloying elements on the wettability and interfacial reactivity of an Al/B4C system using improved sessile drop methods. The B4C substrate was not wetted by molten Al at 700−1000 °C, with initial contact angles higher than 100°. However, rapid spreading was observed in the initial stages due to the formation of Al3BC and Al4C3. Si had a noticeable effect on the interfacial wettability only at levels of 15 wt% or above, with the interfacial products changing from Al3BC and AlB2 to SiC-dominated phases. The addition of Ti to Al led to the formation of TiB2-dominated interfacial products, which replaced the Al3BC and AlB2 phases, with the spreading kinetics mainly controlled by interfacial reactions in the early stages and the diffusion of Ti from the bulk of the drop to the triple line in the later stages. The addition of Cu had a negligible effect on the wettability but slightly weakened the formation of AlB2 by promoting substrate dissolution.

There has been a growing interest in the use of hemp as an animal feed ingredient considering its economic value and nutritional properties. However, there is a paucity of research regarding the safety of hemp-based animal feed currently. Thus, this raises safety concerns on the potential transfer of cannabinoids from hemp-based animal feed to animal products intended for human consumption and its health effects. As such, the detection and quantification of cannabinoids in meat and animal feeds would be desirable for monitoring purposes. In this study, a simple, rapid and sensitive method for the simultaneous quantification of four major cannabinoids (delta-9-tetrahydrocannabinol, cannabidiol, cannabinol and tetrahydrocannabinolic acid) in meat and animal feeds by liquid chromatography–tandem mass spectrometry (LC-MS/MS) was successfully developed and validated. The method was selective and sensitive, achieving limits of detection and quantification for the four cannabinoids from 5 to 7 µg/kg and 15 to 21 µg/kg, respectively. The overall recovery with matrix-matched calibration curves for the cannabinoids ranged from 87–115%. The coefficients of variation were between 2.17–13.38% for intraday precision and 3.67–12.14% for inter-day precision. The method was subsequently applied to monitor cannabinoids in 120 meat and 24 animal feed samples. No cannabinoid was detected, suggesting no imminent food safety concerns arising from the potential incorporation of hemp and by-products in animal feed and nutrition under the promotion of sustainable agricultural practices.

Abstract Objectives The aim of this study was to compare the metastatic patterns of synchronous bone metastasis (SBM) and metachronous bone metastasis (MBM) in nasopharyngeal carcinoma (NPC). Methods This study included bone metastases in NPC patients from 2005 to 2016 in a Chinese hospital. Cohort 1 was collected from 2005 to 2010 for discovery, and Cohort 2 from 2011 to 2016 for validation. The chi‐squared test, Wilcoxon rank sum test, and Kaplan–Meier technique were used to compare site, time, and survival between cohorts 1 and 2. Prognostic factors were analyzed using univariate or multivariate Cox regression. Results Cohort 1 had 112 individuals with SBM and 394 with MBM, and cohort 2 had 328 with SBM and 307 with MBM. The thoracic vertebra was the most frequently affected site of metastasis. Patients with SBM more often had metastasis to the cervical vertebrae compared with patients with MBM (34.5% vs. 22.3%, p

Abstract Background Patients with triple-negative breast cancer (TNBC) tend to develop visceral metastasis within five years, making them the most challenging BC patients to treat. The MAP7 protein family is a group of microtubule-binding proteins with a well-known role in microtubule-related cell migration, but its role in metastasis-related properties of TNBC remains unclear. Methods qRT-PCR and western blot were used to validate mRNA and protein expression of the MAP7 family in the isogenic pairs of TNBC cell lines with low and high metastasis potential. Functional characterization of MAP7D3 was carried out using cell-based and mouse models. The clinical association between MAP7D3 and TNBC was established using datasets in the public domain. Results MAP7D3 expression was consistently upregulated in the metastatic subline IV2 and 468-LN at both mRNA and protein levels. Knockdown of MAP7D3 inhibited the 3D colony-forming ability, cell migration, and invasion ability of IV2 and 468-LN, indicating its significant contribution to the metastasis phenotypes. Mechanistically, inhibition of MAP7D3 could significantly increase the sensitivity of metastatic TNBC cells to docetaxel and gemcitabine treatment by reducing the expression of proteins related to breast cancer-initiating cells (BCICs) and drug resistance, as well as suppressing the activity of Rac1. The animal study showed that the depletion of MAP7D3 drastically reduced TNBC tumor growth and impaired the metastatic capability of TNBC cells. Elevated expression of MAP7D3 was found in the metastatic lymph nodes and was significantly associated with advanced stage and higher grade TNBC. Moreover, MAP7D3 expression was significantly correlated with the TNBC population, and its high expression was significantly associated with lymph node metastasis and poor survival outcomes of patients with TNBC. Conclusion Our study indicates that targeting MAP7D3 could be a promising therapeutic strategy for addressing the progression of TNBC, and MAP7D3 may serve as a novel predictive biomarker for the survival outcomes of triple-negative breast cancer.

PurposeSphingosine-1-phosphate (S1P) is a signaling lipid involved in many biological processes, including inflammatory and immune regulatory responses. The study aimed to determine whether admission S1P levels are associated with disease severity and prognosis after spontaneous intracerebral hemorrhage (ICH).MethodsData of 134 patients with spontaneous ICH and 120 healthy controls were obtained from Biological Resource Sample Database of Intracerebral Hemorrhage at the First Affiliated Hospital of Zhengzhou University. Plasma S1P levels were measured. Regression analyses were used to analyze the association between S1P levels and admission and 90-day modified Rankin scale (mRS) scores. Receiver operating characteristic (ROC) curves assessed the predictive value of S1P levels for ICH severity and prognosis.ResultsPatients with ICH exhibited elevated plasma S1P levels compared to the control group (median 286.95 vs. 239.80 ng/mL, p

Key Clinical Message An encephalocele is a congenital malformation characterized by protrusion of the intracranial contents through a cranial defect. We report that a fetus of a pregnant mother who had two consecutive pregnancies with ultrasound‐detected encephalocele carried compound heterozygous variants in B3GALNT2 NM_152490.5:c.[1423C > T (p.Gln475Ter)]; [261‐2A > G] of maternal and paternal origins, respectively, as confirmed by exome sequencing followed by Sanger sequencing validation. The present case implies that mutations in B3GALNT2, a well‐known dystroglycanopathy causative gene, may result in a phenotype of neural tube defect, providing new insights into the clinical spectrum of B3GALNT2‐related disorders. Our study may contribute to prenatal screening/diagnosis and genetic counseling of congenital brain malformations.

Long-term exposure to sunlight, especially ultraviolet (UV), induces eye injury in people. We investigated the protective potential of Polyphenolic extract from Ascophyllum nodosum (PEAn) against UV-B-induced oxidative damage in retinal Müller cells (RMCs). In the UV-B-induced damage model of RMCs, PEAn demonstrated a potent photoprotective effect that reduced oxidative damage and apoptosis. PEAn significantly regulated the concentrations of ROS, Caspase-3, and Calcium ions (Ca2+) in RMCs generated by UV-B. The mitochondrial membrane potential (ΔΨm) and activities of various antioxidant enzymes (SOD, CAT, and GSH-Px) were significantly increased, whereas the MDA was reduced. Lipidomic research in RMCs also revealed that UV-B irradiation significantly altered the lipid compounds in the cells, while PEAn therapy gradually restored normal cells. Both the accumulation of triacylglycerides and the toxicity of the lipids in RMCs were simultaneously reduced by PEAn. The findings indicated that PEAn could be a potential natural photochemical protectant against UV-B-induced oxidative damage.

Abstract Background Urinary pan-cancer system is a general term for tumors of the urinary system including renal cell carcinoma (RCC), prostate cancer (PRAD), and bladder cancer (BLCA). Their location, physiological functions, and metabolism are closely related, making the occurrence and outcome of these tumors highly similar. Cuproptosis is a new type of cell death that is different from apoptosis and plays an essential role in tumors. Therefore, it is necessary to study the molecular mechanism of cuproptosis-related lncRNAs to urinary system pan-cancer for the prognosis, clinical diagnosis, and treatment of urinary tumors. Method In our study, we identified 35 co-expression cuproptosis-related lncRNAs (CRLs) from the urinary pan-cancer system. 28 CRLs were identified as prognostic-related CRLs by univariate Cox regression analysis. Then 12 CRLs were obtained using lasso regression and multivariate cox analysis to construct a prognostic model. We divided patients into high- and low-risk groups based on the median risk scores. Next, Kaplan–Meier analysis, principal component analysis (PCA), functional rich annotations, and nomogram were used to compare the differences between the high- and low-risk groups. Finally, the prediction of tumor immune dysfunction and rejection, gene mutation, and drug sensitivity were discussed. Conclusion Finally, the candidate molecules of the urinary system pan-cancer were identified. This CRLs risk model may be promising for clinical prediction of prognosis and immunotherapy response in urinary system pan-cancer patients.

Tellurium is used for optimizing sulfide inclusion morphology in the iron and steel industry. In this study, the effects of tellurium on sulfide inclusion, microstructure, mechanical properties, fatigue performance, machinability, and corrosion resistance of industrial 38MnVS bars were investigated. The results show that the weight ratio of Te/S of the tellurium-treated steel was 0.043. Further, tellurium was mainly in the form of an MnS substitutional atom. The MnS inclusions were refined and strengthened via tellurium modification, promoting ferrite transformation and refinement. Additionally, the yield strength increased, and the elongation anisotropy decreased slightly after tellurium modification. However, the tellurium modification had an insignificant effect on the ultimate tensile strength. The ferrite refinement also promoted fatigue performance. Moreover, tellurium modification is beneficial for machinability. The cutting force was reduced, and the surface quality was improved after tellurium modification. Under the tellurium content conditions described herein, tellurium modification has an insignificant effect on corrosion resistance. The suggested tellurium content is below 0.075 times sulfur content for medium carbon microalloyed steels.

Achieving lightweight, robust, and resilient materials is a sought-after goal, yet concurrently achieving these attributes presents a substantial challenge. A biomimetic design approach opens doors to innovative possibilities in this domain. In this paper, we use the ice-shaping properties of zirconium acetate (ZRA) to obtain Al/Al2O3 composites with tunable architectures through freeze casting and pressure infiltration. The concentration of ZRA in the initial slurry is critical in controlling the final structure of the composites. The composites’ bending strength, compressive strength, and crack-initiation fracture toughness KIc improve with increasing ZRA concentration in the initial slurry. Interestingly, the crack-extension fracture toughness KJc demonstrates an initial decrease followed by subsequent improvement. In addition, the relationship between cracking mode and structural features in the composites is elucidated to explain the underlying strengthening and toughening mechanisms. This tunable and scale-able ice-templating and manufacturing approach opens new doors for developing high-performance metal-ceramic composites.

Non-judicious and indiscriminate use of veterinary drugs in animal husbandry may result in accumulation of residues in animal tissues, and consequently in food for human consumption. The abuse of veterinary drugs presents a potential risk to consumer health, especially if the residue level is higher than the health-based guidance value (HBGV) such as the acceptable daily intake (ADI). Contamination of drug residues in food also promotes the emergence of antimicrobial resistance (AMR) which poses a serious threat to public health globally. There has been limited information on the occurrence and dietary exposure to veterinary drug residues in Singapore to date. In this study, the occurrence of four classes of veterinary drugs, namely beta-agonists, coccidiostats, fluoroquinolones and macrolides, were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in food widely consumed by Singapore residents. The magnitude of dietary exposure was assessed based on the consumption profile of Singapore population. Out of 216 food samples, 9.72 % were detected positive with veterinary drug residues, where majority of the positive samples were poultry and its derived products, followed by eggs and egg products. 7 veterinary drugs, specifically ciprofloxacin, enrofloxacin, clopidol, diclazuril, lasalocid, nicarbazin and tilmicosin, were detected in the samples, with clopidol and enrofloxacin being the most frequently detected drugs. Dietary exposure was evaluated using the estimated daily intake (EDI) of the detected drugs and benchmarked against the corresponding acceptable daily intake (ADI). All the %ADI values were far less than 100 in both the average and high consumer scenarios, indicating that the health risk associated with dietary exposure to these drugs in Singapore is low.

Abstract Adaptation to selective pressures is crucial for clinically important pathogens to establish epidemics, but the underlying evolutionary drivers remain poorly understood. The current epidemic of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a significant threat to public health. In this study we analyzed the genome sequences of 794 CRKP bloodstream isolates collected in 40 hospitals in China between 2014 and 2019. We uncovered a subclonal replacement in the predominant clone ST11, where the previously prevalent subclone OL101:KL47 was replaced by O2v1:KL64 over time in a stepwise manner. O2v1:KL64 carried a higher load of mobile genetic elements, and a point mutation exclusively detected in the recC of O2v1:KL64 significantly promotes recombination proficiency. The epidemic success of O2v1:KL64 was further associated with a hypervirulent sublineage with enhanced resistance to phagocytosis, sulfamethoxazole-trimethoprim, and tetracycline. The phenotypic alterations were linked to the overrepresentation of hypervirulence determinants and antibiotic genes conferred by the acquisition of an rmpA-positive pLVPK-like virulence plasmid and an IncFII-type multidrug-resistant plasmid, respectively. The dissemination of the sublineage was further promoted by more frequent inter-hospital transmission. The results collectively demonstrate that the expansion of O2v1:KL64 is correlated to a repertoire of genomic alterations convergent in a subpopulation with evolutionary advantages.