[Objective] To analyze the influencing factors of repeat blood donor lapsing using a zero-inflated poisson regression model (ZIP). [Methods] The blood donation behavior of 12 498 whole blood donors from 2020 was tracked until December 31, 2023. The factors influencing the frequency of blood donations in a given year was analyzed using ZIP, and donors with 0 blood donation in that year were considered to have lapsed. The changes in relevant influencing factors associated with each blood donation were measured and modeled for analysis. [Results] The zero-inflated part of ZIP showed that the risk of lapsing of male blood donors was 2.24 times that of female blood donors (OR 95% CI:1.864-2.696, P<0.001); the risk of lapsing of the 35-44 age group and over 45 age group was respectively 40% (OR 95% CI:0.455-0.790, P<0.001) and 61%(OR 95% CI:0.268-0.578, P<0.001) lower than that of the under 25 age group; the risk of lapsing for those who have donated blood twice and ≥3 times was respectively 50% (OR 95% CI:0.405-0.609, P<0.001) and 81% (OR 95% CI:0.154-0.225, P<0.001) lower than that of first-time donors; the risk of lapsing of those with junior high or high school education was 1.2 times that of those with a college degree or higher (OR 95% CI:1.033-1.384, P<0.05); the risk of lapsing for the divorced group was 2.02 times that of the married group (OR 95% CI:1.445-2.820, P<0.001); the risk of lapsing for those with an income (Yuan) of 10 000 to 50 000, 50 000 to 100 000 and more than 100 000 was respectively 0.67 (OR 95% CI:0.552-0.818, P<0.001), 0.72 (OR 95% CI:0.591-0.884, P=0.002) and 0.67 (OR 95% CI:0.535-0.834, P<0.001) times that of those with an income (Yuan) of less than 10 000. The results of the Poisson part are consistent with the results of the zero-inflated part in terms of age and education level. [Conclusion] Blood donor lapsing is overall related to factors such as gender, age, donation frequency, education, marital status and family income. It's essential to care for those blood donors prone to lapse to retain more regular blood donors.

OBJECTIVE To provide empirical basis for promoting the dynamic adjustment of the pharmaceutical care catalogue and the formulation of policies such as hierarchical payment of medical insurance. METHODS A multicenter cross- sectional survey method was adopted to conduct a questionnaire survey among 424 inpatients in 22 tertiary medical institutions in 12 prefecture-level cities of Hubei Province to evaluate their demand for pharmaceutical care， willingness to pay and preference for service forms. Combined with univariate and multivariate Logistic regression analysis， the influencing factors and key factors that affect patients’ willingness to pay for pharmaceutical care were identified. RESULTS Only 39.86% of the patients were aware of pharmaceutical care or pharmacists， and 89.62% of the patients hope to receive pharmaceutical care. Among the 16 types of pharmaceutical care， the patients surveyed had a relatively high recognition rate for guidance on drug usage and dosage， notification of medication precautions， and the identification， prevention and handling of adverse drug reactions. 96.70%， 95.30%， and 94.12% respectively expressed strong approval and approval. The demand for services such as insurance-related policy consultation， popular science on the mechanism of drug action， and assessment of the combined use of traditional Chinese and Western medicines was relatively low， with 61.65%， 68.47%， and 68.47% expressing strong approval and approval respectively. The positive influencing factors of willingness to pay were household monthly income ＞ 5 000 yuan （OR＝1.742）， awareness of pharmaceutical care or pharmacists （OR＝3.620）， and the desire to receive pharmaceutical care （OR＝4.686） （P＜0.05）， while self-rating health as “good” （OR＝0.390） was a negative influencing factor （P＜0.05）. Cardiovascular and cerebrovascular diseases （54.48%） and antihypertensive drugs （45.05%） were the service scenarios that the surveyed patients most hope to be covered. 85.14% of the patients preferred “service when xiaochnye@126.com needed”， with a single service duration of less than 10 minutes being appropriate （84.43%）， and the willingness to pay within 20 yuan being the main type （85.38%）. CONCLUSIONS Based on the characteristics of patients’ needs and payment behaviors， it is suggested that our country could consider establishing a hierarchical payment mechanism for pharmaceutical care， and focus on differentiated design in combination with diseases and medication situations. At the same time， the rights， responsibilities and service standards of resident pharmacists in the links such as medication reorganization and medical order review should be further clarified to comprehensively enhance the clinical value and policy operability of pharmaceutical care.

Objective To study the distribution and trend of HIV-1 drug resistance mutation in Dalian blood donors be-tween 2011 and 2020.Methods The protease-reverse transcriptase(PR-RT)region was sequenced in Dalian blood donors tested HIV-1 positive between 2011 and 2020.Drug resistance mutation(DRM)rate and level of resistance to selected drugs were analyzed by the Stanford HIV Drug Resistance Database.Results DRM were detected in 17.2%(30/174)of samples,while transmitted drug resistance(TDR)was5.7%(10/174).Between2011 and2020,DRM and TDR rates in-creased significantly in 2019 and reached their highest levels in 2020(44.4%and 22.2%,respectively).DRM carriage was associated with people with college degree or above and with local residents(P<0.05).NNRTI DRMs were the most fre-quently detected(12.6%,22/174),followed by PIs(5.7%,10/174),with V179D/E/T and M46I being the main DRMs detected.Only one HIV-1strain(0.57%,1/174)carried a NRTI DRM(L74I).The overall rate of predicted high level re-sistance to antiretroviral drugs was 6.9%(12/174),with the highest proportion of NNRTI resistance(83.3%,10/12).Two samples were classified as highly resistant to EFV and NVP,accounting for 1.1%(2/174).CRF55_01B strains showed a significantly higher DRM rate than strains of other HIV-1 genotypes(P<0.05).Conclusion Between 2011 and 2020,the rate of HIV-1 DRMs in blood donors in Dalian showed a significant upward trend,particularly in 2019-2020,with NNRTI resistance being the most common.The combination of DRMs detection before and after implementation of ART un-der the latest national ART treatment plan would improve the effectiveness of HIV-1 prevention and control locally.

[Objective] To explore the characteristics of lifestyle behaviors and mental health status among blood donors in Guangzhou, and to investigate the correlation between donation frequency and these factors. [Methods] A cross-sectional study was conducted among 13 042 whole blood donors from 17 street blood donation sites of Guangzhou Blood Center from May to August 2020. Descriptive analysis was used to describe the characteristics of lifestyle behaviors and mental health status among blood donors in Guangzhou. Ordinal multinomial logistic regression model was used to analyze the correlation between donation frequency and these factors. [Results] It was found that some of 13 042 blood donors had unhealthy habits, such as 6.8% (698/10 214，2 828 missing values) had severe tobacco dependence, 30.6% (3 997/13 042) had low exercise levels, 38.8%（5 056/13 042）had poor sleep quality, and 2.2% (271/12 159，883 missing values) had alcohol dependence. In addition, 2.8% (364/13 042) and 1.3% (172/13 042) of the donors may have moderate to severe depression and anxiety symptoms, respectively. The results of the ordinal multinomial logistic regression model showed that exercise level was significantly negatively correlated with the degree of depression and anxiety among blood donors. With the decrease in exercise level, the possibility of depression and anxiety among donors increased significantly. BMI, household income, education level, marital status, donation frequency, alcohol consumption and smoking had no significant correlation with the mental health status of donors. [Conclusion] Improving the exercise habits of blood donors may help enhance their mental health level. It is recommended that blood station staff strengthen the content of exercise when providing health education to blood donors to maintain a healthy lifestyle. It also suggests that there may be a certain degree of under-diagnosis of mental health problems in the process of health consultation before blood donation, and conducting more comprehensive and effective mental health assessments for blood donors is recommended.

Objective:To evaluate the application value of extended latissimusdorsi musculocutaneous flap combined with breast precision hand in stage Ⅰ breast reconstruction.Methods:Twelve cases of extended latissimusdorsi musculocutaneous flap combined with stage Ⅰ breast reconstruction for breast cancer precision surgery were collected from January 2022 to February 2023 in our department, the postoperative complications of surgical techniques were analyzed, and the cosmetic effects of breast reconstruction were evaluated according to Harris standards.Results:All 12 cases underwent breast reconstruction with extended latissimusdorsi musculocutaneous flap, and the survival rate of the flap was 100%. There was local cutaneous margin necrosis in 1 case of back incision, partial ischemic necrosis of the nipple in 1 case, and effusion in the donor area of the back in 5 cases. Harris evaluation of cosmetic effect of breast reconstruction was excellent in 3 cases, good in 6 cases, and fair in 3 cases. Follow-up time was 4-16 months (median was 12 months), and no local recurrence or distant metastasis was observed during follow-up.Conclusions:The extended latissimusdorsi musculocutaneous flap combined with precision mastectomy stage Ⅰ reconstruction is a safe and feasible treatment method for breast cancer.

【Objective】 To investigate the prevalence of depression in blood donors and analyze the related factors, so as to develop a rapid depression screening model for blood donors. 【Methods】 A total of 13 015 street whole blood donors in Guangzhou Blood Center during May to August, 2020 filled in an anonymous e-questionnaire, including social demography information and the Patient Health Questionnaire-9 before donation. The cut-off value for detecting depression was 10. Logistic regression by SPSS 26.0 was used to analyze depression related factors. 2-level decision tree with 30/10 as the minimum number of cases in parent/child node, 10-fold cross validation was used to cut items of PHQ-9 to form the depression screening model. 【Results】 364 out of 13 015 (2.80%) street whole blood donors reported a score ≥ 10. Donors with 18-29 years old (P <0.05), unmarried (P<0.05), less than 50 000 RMB household income per year (P< 0.05) were more prone to depression. 81.96% donors in "<10 scores" group, while 3.85%donors in "≥ 10 scores" group were in two terminal nodes formed by Item-6, 2 and 4 of PHQ-9. After verification by the 10 fold crossover method, the estimated misclassification risk of the model was 1.7%. 【Conclusion】 The screening prevalence of depression based on PHQ-9 in Guangzhou blood donors was 2.8%(95% CI: 2.52%-3.09%) . Donation frequency was not related to depression. A rapid and efficient depression screening model for blood donors based on item-6, 2 and 4 of PHQ-9 was developed.

【Objective】 To investigate the prevalence of hepatitis D virus in Dalian blood donors. 【Methods】 The samples reactive to HBV in blood screening were selected with the following confirmed results: 1)HBsAg+ &HBV DNA+ ; 2)HBsAg+ & HBV DNA-; 3)HBsAg-&HBV DNA+ ; 4)NAT-yield uncertain. Qualified samples in routine blood screening were additionally tested with anti-HBc+ and anti-HBs+. All samples selected were tested HDV IgG further. Initial reactive samples would be tested by another HDV IgG assay and HDV IgM assay. HDV IgG positive was confirmed when samples were reactive to two HDV IgG assays. 【Results】 None HDV antibodies were detected among 1 344 unqualified samples (507 HBsAg+ &HBV DNA+, 33 HBsAg+ &HBV DNA-, 477 HBsAg-&HBV DNA+ and 327 NAT-yield uncertain samples) or 766 qualified samples (397 anti-HBc+ and 369 anti-HBs samples) in blood screening. 【Conclusion】 The prevalence of HDV infections among Dalian blood donors eligible in pre-donation screening seemed extremely low. However, for areas with high HBV prevalence, the risk of blood safety caused by OBI co-infection with HDV should not be ignored.

【Objective】 To investigate the serological and molecular characteristics of HBsAg+ /HBV DNA non-reactive (NR) infections. 【Methods】 Samples tested as HBsAg+ and HBV DNA NR were confirmed by individual NAT repeat testing, viral particle concentration by PEG precipitation combined with in-house nested PCR and real-time quantitative PCR, anti-HBc testing, and HBsAg quantification. HBV sequences were compared with those from donors with chronic and occult infection as controls. 【Results】 A total of 792 195 samples were screened between January 2011 and December 2020, of which 53 (1: 14 947) were confirmed HBsAg+ /HBV DNA NR. HBV DNA was detected further in five (9.4%) samples; three S sequences and four Pre Core/Core sequences were obtained. Unique amino acid substitutions (P130T, P135Q/S, R151Q, G153S and S155F) were found in the Core protein that may affect virus packaging and replication. 【Conclusion】 Extremely low HBV DNA level was detected in plasmas of HBsAg+ /HBV DNA NR donors. Barely detectable HBV DNA might be associated with unusual mutations in the Pre Core/Core protein affecting viral replication. More sensitive HBV DNA and/or HBsAg assays may be considered to further reduce the potential HBV transfusion-transmission residual risk.

【Objective】 To investigate HIV-1 subtype distribution and trend among Dalian blood donors between 2011 and 2020, in order to provide information to improve blood safety and HIV prevention. 【Methods】 HIV RNA was purified from plasma samples of Dalian blood donors with confirmed HIV infection, which were collected between 2011 and 2020. The HIV pol gene was amplified and sequenced. HIV-1 subtypes were determined by phylogenetic analysis. 【Results】 HIV RNA was successfully genotyped in 174 samples from HIV-infected donors. The main subtypes among Dalian blood donors were CRF01_AE(69.5%), CRF07_BC(17.2%), B(5.2%), CRF02_AG(2.9%), C(1.1%), CRF55_01B(1.1%), CRF08_BC(0.6%), CRF59_01B(0.6%) and CRF79_0107(0.6%). There were still 2 cases (1.1%) unclassified. Significant difference was observed when comparing with the published national data. The prevalence of CRF01_AE strains decreased over the years, while CRF07_BC increased significantly. CRF02_AG carriers differed from donors infected with other HIV subtypes by being mostly females (40.0% vs. 2.4%), aged (median: 35y vs. 26y) and lower educational background(junior school degree or below). And 96.7% of local CRF01_AE cases were related to HIV strains, which were reported to circulate in Northeast China and in the MSM population. 【Conclusion】 HIV-1 among Dalian blood donors had unique molecular epidemiology and the trends of 07_BC increasing and 01_AE decreasing lagged behind the overall national data. Donor education on blood safety and consultation services to high risk group before donation still need improvement.

【Objective】 To improve the efficiency and screening strategy by evaluating the performance of HBsAg screening before blood donation in Dalian. 【Methods】 The confirmed HBsAg positive samples were detected qualitatively and quantitatively, and retested with HBsAg rapid testing kit pre-donational used parallelly. Efficiency of HBsAg screening before donation was calculated, and compared between first-time and repeated donors. 【Results】 The pre-donation HBsAg screening was conducted for 199 553 cases, including 95 321 first-time donors (63.2%) and 55 396 repeated donors(36.8%).1 015 donors (first-time/repeated: 999/16) were reactive in HBsAg rapid testing. 113 samples (first-time/repeated: 108/5), initially negative in HBsAg rapid testing, were confirmed HBsAg positive by laboratory testing. The efficiency of pre-donation HBsAg screening for first-time donors(10.9‰) was significantly higher than that of repeated donors(0.3‰)(P<0.05). The positive rate of retesting was 41.1% (39/95), among which 70% were classified as median or strong positive.Significant difference was observed among HBsAg values(IU/mL) [median(range)] of negative, weak positive, median positive and strong positive samples (P<0.05) which were 0.41 (<0.05-11.35), 6.71 (2.49-23.15), 36.48 (7.01->130) and 92.44 (18.7->130), respectively. 【Conclusion】 The HBsAg rapid testing kit used in Dalian Blood Center could meet requirements for blood donor screening before donation, while good efficiency of HBsAg pre-donation screening could be achieved only in first-time blood donors.