[Objective] To conduct a retrospective statistical comparison of alanine aminotransferase (ALT) test values in blood donors prior to blood collection, aiming to analyze the objective characteristics of the population with elevated ALT levels (ALT>50 U/L) and provide reference data for adjusting the screening eligibility threshold for ALT. [Methods] The preliminary ALT screening data of 30 341 blood donor samples collected prior to blood donation from three smart blood donation sites at the Shenzhen Blood Center between 2022 and 2023 were extracted and compared with data from a health examination department of a tertiary hospital in Shenzhen (representing the general population, n=24 906). Both datasets were categorized and statistically described. A retrospective analysis was conducted to examine the associations between ALT test results and factors such as donors' gender, age, ethnicity, donation site, donation season, and frequency of blood donation. [Results] The ALT levels in both blood donors and the general population were non-normally distributed. The 95th percentile of ALT values was calculated as 61.4 U/L (male: 67.8 U/L, female: 39.3 U/L) for blood donors and 58.1 U/L (male: 63.7 U/L, female: 51.2 U/L) for the general population. The non-compliance rates (ALT>50 U/L) were 7.65% (2 321/30 341) in blood donors and 7.08% (1 763/24 906) in the general population. There were significant differences (P<0.05) in the ALT failure rate among blood donors based on gender, age, and donation site, but no significant differences (P>0.05) during the blood donation season. There was no statistically significant difference (P>0.05) in the positive rates of four serological markers (HBsAg, anti HCV, HIV Ag/Ab, anti TP) for blood screening pathogens between ALT unqualified and qualified individuals (2.05% vs 1.5%). If the ALT qualification threshold was raised from 50 U/L to 90 U/L, the non qualification rates of male and female blood donors would decrease from 9.82% (2 074/21 125) to 2.23% (471/21 125) and from 2.70% (249/9 216) to 0.75% (69/9 216), respectively. Among the 154 blood donors who donated blood more than 3 times, 88.31% of the 248 ALT test results were in the range of 50-90 U/L. Among them, 9 cases had ALT>130 U/L, and ALT was converted to qualified in subsequent blood donations. [Conclusion] There are differences in the ALT failure rate among blood donors of different genders and ages, and different blood donation sites and operators can also affect the ALT detection values of blood donors. The vast majority of blood donors with ALT failure are caused by transient and non pathological factors. With the widespread use of blood virus nucleic acid testing, appropriately increasing the ALT qualification threshold for blood donors can expand the qualified population and alleviate the shortage of blood sources, and the risk of blood safety will not increase.

Objective: To comprehensively evaluate the current alanine aminotransferase (ALT) screening strategies and provide a basis for their optimization. Methods: ALT test results of 21 345 blood samples were collected from 33 blood collection institutions. Multiple probability distribution functions were employed to fit the data, and the akaike information criterion (AIC) was used to determine the optimal fitting model. Based on this model, 1 million random samplings were conducted to simulate the final ALT test results of blood donors under different ALT screening strategies, eligibility criteria, and pre-donation ALT detection deviations. A decision tree was subsequently constructed for health economic analysis. Results: The log-normal distribution with a mean of 2.96 and a variance of 0.65 provided the best fit for the data. When the eligibility criteria was 50 U/L and the pre-donation detection deviation was ±20%, not conducting pre-donation testing increased blood donation by 1.14%. When the pre-donation detection deviation was ±20% and the eligibility criteria was raised from 50 U/L to 100 U/L, conducting and not conducting pre-donation testing increased blood donation by 7.59% and 6.60%, respectively. With a eligibility criteria of 50 U/L and a pre-donation detection deviation of ±20%, 1.14% of eligible blood donors would be disqualified from donating blood. Health economic analysis showed that when the eligibility criteria was adjusted to 56 U/L or higher, not conducting pre-donation ALT testing was the dominant strategy; under other conditions, conducting pre-donation testing was the dominant strategy. Conclusion: The selection of ALT testing strategies is a complex process influenced by multiple factors, and it is necessary to adopt an appropriate ALT screening strategy based on specific testing circumstances.

Objective:To analyze the characteristics of drug resistance genes in a Klebsiella pneumoniae strain coproducing carbapenemases KPC-2 and NDM-5. Methods:Klebsiella pneumoniae KPN-hnqyy was separated from the stool specimen of a patient in the Hematology Department of Affiliated Cancer Hospital of Zhengzhou University. The strain was identified with a BD Phenix-M50 automated microbiology system and the minimum inhibitory concentration against the strain was measured as well. The genotypes of the carbapenemases were tested by enzyme immunochromatographic assay and PCR method. The transferability of related plasmids was analyzed by conjugation test. Whole-genome sequencing of the strain was conducted using PacBio and Illumina platforms. The MLST type, resistance gene and plasmid type of the strain were retrieved in BacWGSTdb. The genome and open reading frame sequence of the strain were compared using Easyfig_2.2.3. Visual cycle graphs were generated using BRIG v0.95. Results:Klebsiella pneumoniae KPN-hnqyy was resistant to carbapenem antibiotics. It belonged to ST11 and carried two carbapenemase genes of blaKPC-2 and blaNDM-5. The conjugant only harbored the blaKPC-2 gene. Whole-genome sequencing revealed that the strain contained one chromosome and three plasmids. Its chromosome genome shared more than 99.9% similarity with that of Klebsiella pneumonia KP69 and KP19-2029. Moreover, a similar IncR and IncFⅠ resistance gene fusion region was contained in different types of plasmids carried by them: the blaKPC-2 gene was located in a structure—which evolved from the Tn3-△Tn4401-Tn1721/Tn1722 sequence—inside this fusion region with its ends inserted into the transposase IS26 gene; the blaNDM-5 gene was located on a transposon containing the special plasmids of the insertion fragment in phages, with its ends inserted into the transposase IS26 gene too. Conclusions:The IncR and IncFⅡ resistance gene fusion region of blaKPC-2 carried by Klebsiella pneumoniae ST11 might be widely coexistent with the chromosomal genome. The blaNDM-5 gene carried by special plasmids might be accidentally obtained through gene recombination mediated by transposable element IS26. The wide transmission of Klebsiella pneumoniae ST11 carrying the blaKPC-2 gene in China and its ability to obtain other carbapenemase genes through transposable element IS26 were well worth attention.

Objective To collect the serum samples of patients with nonalcoholic fatty liver disease (NAFLD), and to investigate the changes in serum metabolic biomarkers before and after lifestyle intervention. Methods A total of 23 patients who were diagnosed with NAFLD in Department of Gastroenterology and Inpatient Department, Putuo District Central Hospital of Shanghai, from January 2019 to January 2020 were enrolled, and all patients received the intervention with aerobic exercise and equicaloric low-carbohydrate high-protein diet. A total of 13 healthy volunteers who underwent physical examination in Physical Examination Center were enrolled as control group. For the patients with NAFLD, basic information was collected before and after intervention, blood samples were collected twice to measure liver function, blood glucose, and blood lipids, and part of serum was used for serum metabolomics analysis. The serum samples were analyzed by ultra-performance liquid chromatography/tandem high-resolution mass spectrometry. The data collected were processed in Compound Discover, and then principal component analysis (PCA) and orthogonal partial least squares discriminant analysis were used to establish the profile of differentially expressed blood metabolites between patients and healthy people and perform the enrichment analysis of differentially expressed metabolic pathways. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon non-parametric test was used for comparison of non-normally distributed continuous data between two groups. Results After lifestyle intervention, the patients had significant reductions in body mass index ( P < 0.01), body weight ( P < 0.01), and serum biochemical parameters alkaline phosphatase, albumin, gamma-glutamyl transpeptidase, and alanine aminotransferase (all P < 0.05), as well as a significant reduction in total protein ( P < 0.01), while there were no significant improvements in cholinesterase, aspartate aminotransferase, and glucose. As for the four items for blood lipids, there was a significant reduction in triglyceride ( P < 0.01), while there were no significant improvements in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol. The metabolomics analysis showed that 33 serum metabolites changed significantly after lifestyle intervention. In addition, PCA results showed that after intervention, the level of metabolites in patients tended to be normal. The signaling pathway analysis showed that exercise and diet mainly affected the pathways of bile acid, unsaturated fatty acid synthesis, and phenylalanine metabolism. Conclusion Lifestyle intervention can achieve varying degrees of reduction in the body weight of patients with NAFLD, improve serum biochemical parameters, and regulate the abnormal metabolic pathway in patients with NAFLD, which has important clinical value and significance for guiding clinicians to formulate reasonable diet and exercise strategies for patients with NAFLD and prevent the progression of NAFLD.

The prevalence rate of nonalcoholic fatty liver disease (NAFLD) is increasing year by year and it has become one of the most common chronic liver diseases in the world. Studies have shown that circular RNA (circRNA) is closely associated with NAFLD and is considered a potential diagnostic biomarker and therapeutic target for NAFLD. This article summarizes the regulatory role of circRNA in the pathogenesis of NAFLD and its value in diagnosis and treatment and points out that circRNA plays an important role in the development and progression of NAFLD and may have important clinical significance in the diagnosis and treatment of NAFLD.

ObjectiveTo observe the efficacy and safety of sertraline combined with low-dose olanzapine in the treatment of depression and anxiety comorbidity and its effect on sleep quality， so as to provide references for the related clinical treatment. MethodsA total of 121 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode and generalized anxiety disorder in The Third People's Hospital of Tianshui and the Sanatorium for Mental Illness of Veterans in Tianshui from October 2019 to August 2020 were enrolled， and they were divided into two groups according to the random number table method. Study group （n=61） received sertraline combined with low-dose olanzapine， while control group （n=60） received sertraline only. Then the disease severity degree， sleep quality and adverse reactions were assessed using Hamilton Depression Scale - 17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pittsburgh Sleep Quality Index （PSQI） and Treatment Emergent Symptom Scale （TESS） at the baseline， 1^st， 2^nd， 4^th， 6^th and 8^th weekend， respectively. ResultsPost-treatment HAMD-17， HAMA and PSQI scores in both groups were lower than those before treatment （P<0.05）. At each time point after treatment， HAMD-17， HAMA and PSQI scores of study group were lower than those of control group， with statistical significance （P<0.05）. ConclusionSertraline alone and its combination with low-dose olanzapine are both effective in the treatment of depression and anxiety comorbidity， while the combination therapy achieves better efficacy and higher safety in alleviating anxiety and insomnia symptoms.

The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing year by year and NAFLD has become one of the most common liver diseases in the world. Metabolomics follows the research thoughts of genomics and proteomics and conducts a quantitative analysis of all metabolites in organisms to explore the association between metabolites and physiological and pathological changes, which provides a new way for studying the traditional Chinese medicine diagnosis and treatment of NAFLD. This article summarizes the research advances in metabolomics and traditional Chinese medicine syndromes in NAFLD, so as to provide new thoughts and methods for further exploration of NAFLD.

ObjectiveTo investigate the association between serum interleukin (IL) and liver pathological changes in patients with chronic hepatitis B (CHB). MethodsA total of 59 patients with CHB who were treated in Putuo District Central Hospital of Shanghai from February 2018 to February 2019 were enrolled as subjects, and liver biopsy was performed for all patients. According to the degree of liver inflammation, the patients were divided into mild inflammation (G1-G2) group and severe inflammation (G3-G4) group, and according to the degree of liver fibrosis, the patients were divided into mild fibrosis (S0-S2) group and severe fibrosis (S3-S4) group. Serum liver function parameters, blood lipids, interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) were measured for all patients. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon non-parametric test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was also performed. ResultsThe degree of liver fibrosis increased with the increase in liver inflammation (rs=0.538, P＜0.001). Compared with the mild inflammation group, the severe inflammation group had significantly higher serum levels of alanine aminotransferase ［95.00 (45.00-16925) U/L vs 51.00 (29.00-88.00) U/L, Z=-2.625, P=0.009］, aspartate aminotransferase ［54.50 (34.75-84.50) U/L vs 38.00 (30.00-49.00) U/L, Z=-2.014, P=0.044］, and gamma-glutamyl transpeptidase ［91.00 (56.72-192.25) U/L vs 44.00 (24.00-100.00) U/L, Z=-2.400, P=0.016］. The severe fibrosis group had a significantly higher serum level of high-density lipoprotein than the mild fibrosis group ［0.97 (0.32-1.08) mmol/L vs 1.23 (0.36-1.38) mmol/L, Z=-1.300, P=0.008］. The severe inflammation group had a significantly higher serum level of IL-2 receptor than the mild inflammation group ［704.00(418.00-103800) U/ml vs 436.00(335.00-555.00) U/ml, Z=-3.405, P=0.001］, and the severe fibrosis group had a significantly higher serum level of IL-2 receptor than the mild fibrosis group ［735.00(523.00-890.50) U/ml vs 447.00 (351.50-624.50) U/ml, Z=-5.358, P=0.001］. ConclusionThe degree of liver inflammation is positively correlated with that of liver fibrosis, while the serum level of IL-2 receptor increases with the increase in the degrees of liver inflammation and fibrosis, indicating that IL-2 receptor can reflect the degrees of liver inflammation and fibrosis to some extent.

The incidence rate of nonalcoholic fatty liver disease (NAFLD) keeps increasing year by year, making NAFLD one of the most common liver diseases in the world. Reasonable diet and exercise are currently recognized as the most crucial step in the treatment of NAFLD and are the cornerstone of the management of NAFLD patients. However, diet and exercise regimens vary across countries, regions, and societies due to various objective reasons. This article reviews the diet and exercise regimens for NAFLD patients reported in different countries, regions, and literatures in recent years, in order to provide a basis for clinicians to guide NAFLD patients to develop reasonable diet and exercise strategies.

Objective:To analyze the characteristics of plasmids in KPC-2-producing Serratia marcescens ( S. marcescens) isolates. Methods:Four carbapenem-resistant S. marcescens strains were isolated from four patients admitted to the hepatobiliary ward of Affiliated Cancer Hospital of Zhengzhou University in 2016. BD Phenix-100 was used to identify the strains and detect the minimum inhibitory concentrations (MICs). Homology analysis was performed using pulsed-field gel electrophoresis (PFGE). The modified Hodge test was used to detect the phenotypes of carbapenemase. PCR and gene sequencing were used to detect the types of carbapenem resistance genes. The transferability of plasmids was detected by conjugation test. The characteristics of plasmids were analyzed by genomic alignment method after whole genome sequencing. DNAMAN V9 software was used to compare the amino acid sequences of the replication initiation proteins. A phylogenetic tree was constructed with neighbor-joining method using MEGA7.0. Results:All of the four S. marcescens strains were resistant to carbapenem antibiotics. They were highly homologous according to PFGE. Hodge test results were all positive and the carbapenemase genotype was blaKPC-2. Conjugation test results were positive. The plasmid was a circular DNA of 42 742 bp in length. It had the similar skeleton of incX6 plasmid and the similar amino acid sequence of replication initiation protein. Moreover, it and incX6 plasmid were at the same node in the phylogenetic tree. The blaKPC-2 was located in the core of drug resistance, which was composed of insertion elements including Tn3 family transposons, recombinant enzyme genes, △ISKpn6 and ISKpn27. Conclusions:The plasmid was incX6-like. The blaKPC-2 gene was located in the transposon of △Tn6296. More attention should be paid to the bacteria carrying KPC-2 in incX plasmids.