Objective: To develop a comprehensive health economics evaluation model for HIV blood screening using Markov modeling, so as to evaluate the quality-of-life adjustment years (QALYs) gained by transfusion recipients after implementation of blood HIV screening. Methods: Shenzhen Blood Center was selected as the validation case for model development. Based on historical HIV screening data of Shenzhen Blood Center and published literature, the health economics evaluation of donor HIV screening was performed using cost-utility analysis. The single factor sensitivity analysis was performed on parameters in the model. Results: 3.09 QALYs were gained for each transfusion recipient prevented from HIV infection. During 2020-2023, donor HIV screening at Shenzhen Blood Center saved 506.76 QALYs, and each QALY saved 182 900 yuan. Conclusion: From the perspective of long-term benefit of transfusion recipients, HIV screening of blood donors demonstrates high health and economic value.

Objective: To develop a comprehensive health economics evaluation model for HIV blood screening using Markov modeling, so as to evaluate the quality-of-life adjustment years (QALYs) gained by transfusion recipients after implementation of blood HIV screening. Methods: Shenzhen Blood Center was selected as the validation case for model development. Based on historical HIV screening data of Shenzhen Blood Center and published literature, the health economics evaluation of donor HIV screening was performed using cost-utility analysis. The single factor sensitivity analysis was performed on parameters in the model. Results: 3.09 QALYs were gained for each transfusion recipient prevented from HIV infection. During 2020-2023, donor HIV screening at Shenzhen Blood Center saved 506.76 QALYs, and each QALY saved 182 900 yuan. Conclusion: From the perspective of long-term benefit of transfusion recipients, HIV screening of blood donors demonstrates high health and economic value.

Extensive epigenetic reprogramming involves in memory CD8+ T-cell differentiation. The elaborate epigenetic rewiring underlying the heterogeneous functional states of CD8+ T cells remains hidden. Here, we profile single-cell chromatin accessibility and map enhancer-promoter interactomes to characterize the differentiation trajectory of memory CD8+ T cells. We reveal that under distinct epigenetic regulations, the early activated CD8+ T cells divergently originated for short-lived effector and memory precursor effector cells. We also uncover a defined epigenetic rewiring leading to the conversion from effector memory to central memory cells during memory formation. Additionally, we illustrate chromatin regulatory mechanisms underlying long-lasting versus transient transcription regulation during memory differentiation. Finally, we confirm the essential roles of Sox4 and Nrf2 in developing memory precursor effector and effector memory cells, respectively, and validate cell state-specific enhancers in regulating Il7r using CRISPR-Cas9. Our data pave the way for understanding the mechanism underlying epigenetic memory formation in CD8+ T-cell differentiation.
CD8-Positive T-Lymphocytes/metabolism* ; Cell Differentiation ; Chromatin/immunology* ; Animals ; Mice ; Immunologic Memory ; Epigenesis, Genetic ; SOXC Transcription Factors/immunology* ; NF-E2-Related Factor 2/immunology* ; Mice, Inbred C57BL ; Gene Regulatory Networks ; Enhancer Elements, Genetic

Objective: To assess the impact of long-term antiretroviral therapy (ART) on human immunodeficiency virus (HIV) blood screening outcomes in post-exposure prophylaxis (PEP) failure cases through a longitudinal analysis of blood screening results over a 7-year period in a patient with HIV PEP failure. Methods: This study conducted 13 follow-up assessments for a high-risk individual who initiated ART shortly after exposure. The effectiveness of various blood screening methods, including immunological assays and nucleic acid testing (NAT), was analyzed. Blood samples were also tested with HIV RNA quantification testing, Western blot (WB) confirmation testing, chemiluminescence immunoassay (CLIA), and HIV rapid tests utilizing gold and selenium labels. A comprehensive analysis was performed to evaluate the changes in diagnostic capabilities of different testing methods for HIV biomarkers over an extended period following PEP failure. Results: The patient had two high-risk exposures: one day before ART initiation (BA1) and seven days preceding treatment (BA7). On the first day after the ART treatment (AA1), the HIV RNA concentration (viral load) was 9.07×10 copies/mL; by day five (AA5), the viral load decreased to 1.04×10 copies/mL. At day eleven (AA11), NAT and ELISA tests were both positive, with the WB result remaining indeterminate (gp160+). At day 48 (AA48), the S/CO value of the fourth generation ELISA reagent was 1.07, while results from a 6-sample pool and quantitative NAT were negative. However, a single sample NAT returned a positive result and WB tests indicated positivity for p17, p24, and gp160. At AA74, the quantitative NAT rebounded to 2.83×10 copies/mL, with positive NAT results for single and 6-sample pool NAT tests. The S/CO values of the imported and domestic ELISA reagents were 3.39 and 23.44, respectively. At AA201, 6-sample pool and quantitative NAT were negative again, while single sample NAT remained positive. From AA319 to AA2221, all NAT results have remained consistently below the minimum detection limit. At AA2221, S/CO values of the imported and domestic ELISA reagents were 3.47 and 23.44, respectively. Conclusion: The findings indicate that patients experiencing PEP failure after high-risk HIV exposure are at a higher risk of being missed by mixed-sample NAT pools and individual serological tests. Nonetheless, anti-HIV antibody levels are sustained at elevated values for an extended duration, underscoring antibody testing as an effective measure for blood screening.

Objective:To investigate the clinicopathological characteristics of oxyntic gland adenoma(OGA)and gastric adenocarcinoma of the fundic gland type(GA-FG).Methods:Six cases of fundic gland-type tumors(three OGA and three GA-FG)diagnosed at the Fujian Cancer Hospital between August 2020 and February 2023 were retrospectively analyzed.The clinical data,endoscopic features,pathological charac-teristics,immunohistochemical results,treatment,and prognosis were analyzed.Results:Six patients with an average age of 57 years,in-cluding one male and five females,were mainly affected in the gastric fundus and body,with the superficial elevated type being the most common.The pathological features of gastric gland-type tumors are mostly located in the deep layer of the gastric mucosa,showing a dis-ordered glandular structure mainly composed of chief cell-type cells.There were three cases of OGA and three cases of GA-FG.Immunohis-tochemical results showed that pepsinogen 1 was positive in five cases,mucin 6(MUC6)in five cases,synaptophysin(Syn)in six cases,chro-mogranin(CgA)was negative in all cases,and Ki-67 was less than 10%.Conclusions:The incidences of OGA and GA-FG are low,and there is no obvious endoscopic specificity.Endoscopy physicians have an insufficient understanding,which can easily lead to misdiagnoses and missed diagnoses.Immunohistochemistry is helpful for the differential diagnosis,and endoscopic mucosal resection or stripping is the pre-ferred treatment option.

Objective To summarize the electrophysiological indexes and scales used for evaluation of post-stroke spasticity, for integration of clinical management of spasms. Methods Literatures on identification and evaluation of post-stroke spasticity from databases of Web of Science, PubMed, CNKI, and Wanfang Data up to May 15, 2021 were retrieved and the indicators related to post-stroke spasticity were extracted for a scoping review. Results The scales of modified Asworth Scale, Comprehensive Spasticity Scale and modified Tardieu Scale; the electrophysiological indexes of F wave, H reflex, motor evoked potentials, visual-startle reaction time and vestibular evoked myogenic potentials were used to identify and evaluate post-stroke spasticity. Conclusion More clinical researches are needed to explore earlier identification and evaluation of post-stroke spasticity more objectively and accurately.

【Objective】 To evaluate the performance and clinical application of a high-throughput nucleic acid blood screening detection system for SARS-CoV-2, so as to provide basis and technical means for its application in detection of plasma from recovered COVID-19 patients. 【Methods】 The SARS-CoV-2 nucleic acid was detected by real-time fluorescence quantitative PCR, and the sensitivity, precision, anti-interference and other parameters were evaluated. Blood donor samples collected during COVID-19 epidemic period were screened using the detection system to evaluate its applicability. 【Results】 The detection limits of gene N and ORF 1ab were 3.98 copies/mL and 9.38 copies/mL, respectively. The CV of high and low concentration samples were both less than 5%. Hemoglobin at 500 mg/dL and triglyceride at 3g/dL had little effect on the results. The detection system can effectively prevent carryover, thus avoiding false positive results. The SARS-CoV-2 nucleic acid blood screening was carried out in a total of 39 306 blood samples, and all samples were negative. 【Conclusion】 The established method can meet the needs of SARS-CoV-2 nucleic acid screening therefore ensure the safe application of plasma from recovered COVID-19 patients.

Objective: To investigate the clinical features and prognosis factors of acquired immunodeficiency syndrome (AIDS) patients complicated with cryptococcal meningitis (CM). Methods: Retrospective analyses were performed on clinical features, laboratory data, treatment status and related prognosis factors in 81 AIDS patients with CM admitted to the Department of Infectious Diseases, Beijing You′an Hospital, Capital Medical University from January 2010 to December 2017. The t test, rank sum test and χ² test were employed to analyze the data. Results: Of the 81 AIDS patients with CM, 71 cases were infected with human immunodeficiency virus (HIV) by sexual transmission (87.7%). The most common clinical symptoms were fever in 60 (74.1%), headache in 72 (88.9%), and nausea and vomiting in 56 (69.1%). Cerebrospinal fluid (CSF) examination results show that 60 cases (74.1%) had elevated opening pressure, the white blood cell count was 17.0 (6.0, 44.5)×10⁶/L, monocyte count was 9.0 (3.0, 29.5)×10⁶/L, the level of chloride was (117.26±5.61) mmol/L, of glucose was 2.89 (2.05, 3.41) mmol/L, of protein was 0.32 (0.21, 0.65) g/L, ink staining positive rate was 84.0% (68/81), fungal culture positive rate was 59.3% (48/81). The positive rate of serum cryptococcal antigen was 96.3% (78/81), and CSF cryptococcal antigen positive rate was 93.8% (76/81). The clinical efficacies were not significant different among different treatment regimens (χ²=1.479, P=0.533). After treatment, 60 patients survived and 21 died, with an overall mortality rate of 25.9%. Univariate analysis showed that consciousness disorder and CSF opening pressure were significantly higher in the death group than those in the survival group (χ²=22.365, t=0.317, respectively, both P<0.05), while serum albumin (Alb) and CD4⁺ T lymphocyte counts were significantly lower in the death group than those in the survival group (t=7.975, Z=-3.073, respectively, both P<0.05). Multivariate logistic regression analysis showed that consciousness disorder and Alb were independent factors influencing the clinical outcome of AIDS patients with CM. Consciousness disorder was related with poor outcome (odd ratio (OR)=26.704, P=0.011, 95% confidence interval (CI) 2.115-337.247), and higher Alb was related with good outcome (OR=0.671, P=0.005, 95%CI 0.507-0.888). The area under the receiver operating characteristic curve of serum Alb for predicting poor outcomes of AIDS patients with CM was 0.932 (95% CI 0.859-0.998, P<0.01). By using 31.7 g/L as cut-off value, the sensitivity was 95% and the specificity was 81% for predicting poor outcome. Conclusions AIDS complicated with CM has a high mortality rate, and its clinical features are lack of specificity. Consciousness disorder and Alb are independent prognosis factors.

Objective: To investigate the efficacy of posterior decompression pedicle screw fixation and single pedicle screw fixation for thoracolumbar fracture with greenstick lamina fracture. Methods: A retrospective case series study was conducted to analyze the clinical data of 106 patients with thoracolumbar fractures combined with greenstick lamina fractures admitted to the 909th hospital from January 2011 to May 2016. There were 68 males and 38 females, aged 21-58 years [(39.5±7.1)years]. The fracture was located at T₁₁ in 9 patients, at T₁₂ in 6, at L₁ in 28, at L₃ in 11. A total of 58 patients underwent posterior decompression pedicle screw fixation including 37 males and 21 females, aged 23-58 years [(38.7±6.6)years]. The preoperative neurological function was evaluated according to ASIA grade: grade A for three patients, grade B for nine, grade C for 14, grade D for 27, and grade E for 53 patients. A total of 48 patients were treated with single posterior pedicle screws fixation including 31 males and 17 females, aged 21-57 years [(41.4±5.8)years]. Statistical indicators included operation time, intraoperative blood loss, anterior height ratio of injured vertebrae, sagittal Cobb angle, visual analogue scale (VAS), ASIA grading, dural tears and/or cauda equina entrapment, and complications. Results: All patients were followed up for 24-72 months [(30.2±4.7)months]. The operation time ranged from 105 to 137 minutes [(113.5±21.3)minutes], and the intraoperative blood loss was 235-310 ml [(252.2±28.6)ml] in the posterior decompression and pedicle screws fixation group. In the posterior pedicle screw fixation group, the operation time ranged from 52 to 85 minutes [(65.3±9.6)minutes], and the intraoperative blood loss was 72-125 ml [(90.2±23.6)ml]. The anterior height ratio of injured vertebrae, sagittal Cobb angle and VAS score of the two groups were significantly improved immediately after operation and at the last follow-up (all P<0.01). At one year follow up, the ASIA grading in patients treated with single posterior pedicle screw fixation remained the same while the ASIA grading of patients treated with posterior decompression pedicle screw fixation was significantly improved compared with before operation. Dural tears were found in 12 patients and cauda equina entrapment were found in five patients during decompression. Three patients had neurological function injury after posterior pedicle screw internal fixation surgery, and they received a second decompression operation. Dural tears and/or cauda equina entrapment were subsequently found in all of the three patients. No complications related to internal fixation occurred during follow-up. Conclusions Both posterior decompression pedicle screw fixation and single pedicle screw fixation can effectively correct the kyphosis deformity, restore vertebral body height, and relieve pain in the treatment of thoracolumbar fracture with greenstick lamina fracture. Dural tears and/or cauda equina entrapment might be subsequently found in greenstick lamina fracture. Posterior pedicle screw fixation can not release the entrapped cauda nerve, so attention should be paid to the risk of secondary surgery.

OBJECTIVE: To study the combined effect of noise and hydrogen cyanide on noise-induced hearing loss( NIHL)in a metal electroplating enterprise. METHODS: The judgment sampling method was used to select 663 workers in a largescale metal electroplating enterprise as the study subjects. Among them,186 workers exposed to noise alone were designated as noise group; 138 workers exposed to hydrogen cyanide alone were designated as hydrogen cyanide group; and161 workers exposed to noise and hydrogen cyanide were designated as combined effect group,and 178 workers without exposure from occupational disease risk factors were designated as control group. Questionnaires survey and pure tone audiometry were used for analyzing the effects of combined noise and hydrogen cyanide exposure on NIHL. RESULTS: The hearing loss detection rate of the study subjects was 40. 4%. The hearing loss detection rates in the control group,noise group,hydrogen cyanide group,and combined effect group were 17. 4%,47. 8%,32. 6% and 64. 0%,respectively. The detection rate of hearing loss in the control group was lower than that in the other three groups( P < 0. 008). The NIHL detection rates in the combined effect group and the noise group were higher than that in the hydrogen cyanide group( P <0. 008). The hearing loss detection rate of the combined effect group was higher than that of the noise group and the hydrogen cyanide group( P < 0. 008). Ordinal multi-categorical logistic regression model results showed that after adjusting confounding factors such as age,length of service,gender,marital status,smoking,alcohol drinking,we found hydrogen cyanide exposure,noise exposure,and combined exposure to hydrogen cyanide and noise had effects on workers' hearing(P < 0. 05). The risk of hearing loss in workers exposed to noise and hydrogen cyanide was higher than that of workers exposed to noise alone or hydrogen cyanide alone. CONCLUSION: There is a combined effect of noise and hydrogen cyanide in this metal electroplating enterprise,which can increase the risk of NIHL in workers.