Objective: To optimize the Shenzhen universal infant hepatitis B immunization method. Methods: To analyze the long effectiveness of different immunization strategies and disease transition after hepatitis B virus infection by using cost-effectiveness method through decision-tree and Markov models among the Shenzhen newborns cohort in 2010 based on the local parameters. Results:Through the current strategies, the program of screening all pregnant women for HBsAg and vaccinating newborns of single-positive mothers combing with HBIG and vaccine would not only prevent more new cases, hepatic carcinoma and related deaths; but also gain more living years and QALYs. From the social prospect, it will save about RMB 40 million compared with the current program. Conclusion: It is suggested that Shenzhen Government should amend the current universal infant hepatitis B immunization program to gain more economic and social benefits.

ObjectiveThis study was to explore the feasibility of using the orthogonal plane dose formed by the coronal and sagittal plane to verify the volumetric modulated arc therapy (VMAT) plan.MethodsThe VMAT plans of 12 patients were included in this study.The orthogonal plane dose formed by the coronal and sagittal plane were measured based on the combination of 2D ionization chamber array and multicube phantom,and the point dose were measured based on a multiple hole cylindrical phantom attached with two 0.125 cm3 ionization chamber probes.ResultsIn the measurement of the point dose,the average error was 1.5％ in high dose area ( more than 80％ of maximum),and 1.7％ in low dose area ( less than 80％ of maximum),respectively.The discrepancy of point dose measurement was 1.3％ between the 2D ionization chamber array and the VMAT planning system.In the measurement of the orthogonal plane dose,the pass rate of γ were 93.7％ for 2％/2 mm and 97.2％ for 3％/3 mm.ConclusionIt is reliable for using the orthogonal plane dose formed by the coronal and sagittal plane to verify the VMAT plan.

Adolescent ; Adult ; Endoscopy ; Ethmoid Sinus ; surgery ; Eyelids ; surgery ; Female ; Humans ; Male ; Middle Aged ; Orbital Fractures ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Young Adult

Objective　To understand the impact of early and timely treatment and initial antiviral treatment regimen on mortality and attrition of antiretroviral therapy. Methods A retrospective cohort study was conducted using download data on antiretroviral therapy for HIV-infected patients in Liuzhou City, Guangxi Province, from the database of the Basic Information System for AIDS Control and Prevention (BISAC) from 2010 to 2020. The Cox proportional risk regression model was used to analyze the influencing factors of mortality and attrition. Results A total of 15 713 infected patients were included, including 53.4% aged 18-<50 years, 69.4% male, 61.0% farmer, 75.1% CD4 count <350 cells /μL before initial antiviral treatment, the overall mortality rate was 4.30/100 person-years, and the overall attrition was 2.42/100 person-years. The results of Cox regression analysis showed that the influencing factors of mortality were pretreatment CD4 counts of 350-<500 cells/μL(AHR=0.72, 95%CI: 0.63-0.81) and ≥500 cells/μL (AHR= 0.64, 95%CI: 0.55-0.76); duration from diagnosis to initial antiviral treatment 91-180 days (AHR=1.25, 95%CI: 1.08-1.45), 181-365 days (AHR=1.26, 95%CI: 1.08-1.47), and ≥365 days (AHR=1.26, 95%CI: 1.11-1.44); initial antiviral treatment regimens of D4T+3TC+EFV/NVP (AHR=1.47, 95%CI: 1.32-1.63) and AZT/D4T/TDF+3TC+LPV/r (AHR=1.73, 95%CI: 1.50-1.99). Factors affecting attrition were pretreatment CD4 counts of 350-499 cells/μL (AHR=1.32, 95%CI: 1.16-1.50) and ≥500 cells/μL (AHR=1.28, 95%CI: 1.10-1.50); interval from HIV positivity confirmation to initial dosing ≥365 days (AHR=1.21, 95%CI: 1.04-1.40), initial antiviral treatment regimens of TDF+3TC+NVP (AHR=1.32, 95%CI: 1.13-1.55), AZT+3TC+EFV/NVP (AHR=1.43, 95%CI: 1.26-1.62) and AZT/D4T/TDF+3TC+LPV/r (AHR=1.33, 95CI%: 1.06-1.67). Conclusions　Early and timely treatment and the initial antiviral treatment regimen of TDF+3TC+EFV have good efficacy, but attention should be paid to the high risk of attrition of HIV-infected people with high CD4 count before treatment.

Objective To explore the expression and clinical value of serum calprotectin and toll like receptor 2(TLR2)with type 2 diabetic kidney disease(DKD).Method According to the levels of UACR,90 T2DM patients treated in our hospital from January 2019 to January 2022 were divided into normal albuminuria group(Con,UACR<30 mg/g),microalbuminuria group(Micro,UACR 30～300 mg/g),and macroalbuminuria group(Macro,UACR>300 mg/g),30 cases per group.Result The levels of BMI,HbAlc,calprotectin,TLR2,and NLRP3 increased sequentially from Con,Micro to Macro groups(P<0.05),while eGFR in the Macro group was lower than that in the Con or Micro groups(P<0.05).Pearson correlation analysis showed that serum calprotectin was positively correlated with BMI,WC,SBP,FPG,HbAlc,TC,TG,Scr,UACR(P<0.05 or P<0.01),and negatively correlated with eGFR(P<0.01);NLRP3 is positively correlated with BMI,WC,SBP,FPG,HbAlc,TC,TG,Scr,SUA,and UACR(P<0.01),and negatively correlated with eGFR(P<0.01);TLR2 was positively correlated with BMI,WC,SBP,FPG,HbAlc,TC,TG,Scr and UACR(P<0.05 or P<0.01),and negatively correlated with eGFR(P<0.01).Multiple linear regression analysis showed that FPG,HbAlc,TC,Scr,calprotectin,and TLR2 were the influencing factors of UACR.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve for diagnosing DKD with serum calprotectin and TLR2 was 0.883 and 0.961,with sensitivities of 73.33%and 96.67%,and specificity of 100.00%and 83.33%.Conclusion Serum calprotectin and TLR2 are closely related to the occurrence and development of DKD.The diagnostic value of TLR2 for DKD is superior to serum calprotectin.

Objective To investigate the significance of auditory brainstem response(ABR)combined with auditory steady-state response(ASSR)for the assessment of mild sensorineural hearing loss in infants.Methods Data from 114 infants with mild sensorineural hearing loss were retrospectively analyzed,and their ABR and ASSR results were collected for rank sum test and correlation analysis.Results In the rank sum test,the difference in thresholds between tone-burst ABR(Tb-ABR)and ASSR at 0.5,1,2,4 kHz was statistically significant(P＜0.05),and they were also correlated at 0.5,1,2,4 kHz(P＜0.05),r=0.613,0.569,0.616,0.71.After grouping by gender and ear,there was a correlation between ABR and ASSR at 0.5,1,2,and 4 kHz,male:r=0.61,0.56,0.671,0.774;female:r=0.581,0.558,0.546,0.608;left ear:r=0.61,0.558,0.576,0.715;right ear:r=0.631,0.581,0.662,0.71.And after grouping by age at diagnosis,only infants diagnosed from 7～12 months of age did not correlate at 0.5 kHz and 1 kHz(P＞0.05),while the rest of the groups had a good correlation(P＜0.05),0～3 months:r=0.686,0.643,0.671,0.742;4～6 months:r=0.671,0.626,0.616,0.693;7～12 months at 2 kHz and 4 kHz:r=0.571,0.706.Conclusion In infants with mild sensorineural hearing loss,ABR and ASSR correlate in assessing hearing thresholds at all frequencies,and the combination of the two tests could provide a more accurate assessment of the subject's true hearing.

AIM:Clopidogrel and aspirin are com-monly used drugs for the secondary prevention of cerebrovascular disease.Due to drug resistance,their preventive effect is often affected.This article explores the clinical value of clopidogrel and aspirin pharmacogenetic genetic testing in the secondary prevention of ischemic stroke.METHODS:220 pa-tients with mild ischemic stroke or TIA admitted to our hospital from 2021.7 to 2022.9 were included and randomly divided into individualized treatment group and clopidogrel conventional treatment group(control group).The patients were followed up for one year to observe stroke recurrence and hemorrhagic events.RESULTS:(1)Compared with the control group,the recurrence rate of ischemic stroke in the individualized treatment group after 1-year follow-up was slightly lower(5.82％vs.7.92％,P＞0.05),the risk of cerebral hemorrhage was simi-lar,but the risk of other occurrences was increased(6.79％vs.0.99％,P＜0.05).(2)COX regression analy-sis showed that ESRS(HR 2.576,95％CI 1.226-5.413,P=0.013)and history of hypertension(HR 5.517,95％CI 1.624-18.737,P=0.006)were associated with recurrence of ischemic stroke,independent of anti-thrombotic regimen(HR 0.918,95％CI 0.291-2.894,P=0.883).CONCLUSION:Aspirin GPIBA,PTGS1,and ITGB3 gene polymorphisms have limited signifi-cance in guiding antiplatelet medication.Selecting aspirin maintenance therapy for clopidogrel CYP2C19*2*3 allele carriers cannot significantly re-duce the risk of recurrence of minor ischemic stroke and may increase other bleeding risks.COX regression analysis shows that ESRS and history of hypertension are independent risk factors for stroke recurrence.

Objective To assess inter-observer variations(IOV)in the delineation of target volumes and organs-at-risk(OAR)for intensity-modulated radiotherapy(IMRT)of nasopharyngeal carcinoma(NPC)among physicians from different levels of cancer centers,thereby providing a reference for quality control in multi-center clinical trials.Methods Twelve patients with NPC of different TMN stages were randomly selected.Three physicians from the same municipal cancer center manually delineated the target volume(GTVnx)and OAR for each patient.The manually modified and confirmed target volume(GTVnx)and OAR delineation structures by radiotherapy experts from the regional cancer center were used as the standard delineation.The absolute volume difference ratio(△V_diff),maximum/minimum volume ratio(MMR),coefficient of variation(CV),and Dice similarity coefficient(DSC)were used to compare the differences in organ delineation among physicians from different levels of cancer centers and among the 3 physicians from the same municipal cancer center.Furthermore,the IOV of GTVnx and OAR among physicians from different levels cancer centers were compared across different TMN stages.Results Significant differences in the delineation of GTVnx were observed among physicians from different levels of cancer centers.Among the 3 physicians,the maximum values of △V_diff,MMR,and CV were 97.23%±83.45%,2.19±0.75,and 0.31±0.14,respectively,with an average DSC of less than 0.7.Additionally,there were considerable differences in the delineation of small-volume OAR such as the left and right optic nerves,chiasm,and pituitary,with average MMR>2.8,CV>0.37,and DSC<0.51.However,relatively smaller differences were observed in the delineation of large-volume OAR such as the brainstem,spinal cord,left and right eyeballs,and left and right mandible,with average△V_diff<42%,MMR<1.55,and DSC>0.7.Compared with the differences among physicians from different levels cancer centers,the differences among the 3 physicians from the municipal cancer center were slightly reduced.Furthermore,there were also differences in the delineation of target volumes for NPC among physicians from different levels cancer centers,depending on the staging of the disease.Compared with the delineation of target volumes for earlier stage patients(stages I or II),the differences among physicians in the delineation of target volumes for advanced stage patients(stages III or IV)were smaller,with average △V_diff and DSC of 98.31%±67.36%vs 69.38%±72.61%(P<0.05)and 0.55±0.08 vs 0.72±0.12(P<0.05),respectively.Conclusion There are differences in the delineation of GTVnx and OAR in radiation therapy for NPC among physicians from different levels of cancer centers,especially in the delineation of target volume(GTVnx)and small-volume OAR for early-stage patients.To ensure the accuracy of multicenter clinical trials,it is recommended to provide unified training to physicians from different levels of cancer centers and review their delineation results to reduce the effect of differences on treatment outcomes.