Objective: To establish evidence-based, safe and efficient management of HIV-reactive blood donors by investigating safe and feasible assessment strategies for HIV-reactive blood donors based on routine blood screening data. Methods: The data of blood screening, supplementary testing, follow-up and CDC confirmation for HIV-reactive blood donors in our center from 2014 to 2024 were analyzed systematically to confirm HIV infection and identify infection status. Results: There were 1 235 samples (0.13%, 1 235/928 000) reactive in HIV blood screening over the 11-year period. A-mong them, 199 donors (16.11%) in asymptomatic HIV infection (HIV Ag/Ab++&HIV RNA+), 2(0.16%) as acute early HIV infection (HIV Ag/Ab+-&HIV RNA+) and 7(0.57%) as window-period infection (HIV RNA positive only) were confirmed. Donors with the result of HIV Ag/Ab+-&HIV RNA-(single-positive) were all excluded for HIV infection, while 1 in 6 HIV Ag/Ab++&HIV RNA-donors (double-positive) was confirmed to have HIV infection. When HIV Ag/Ab reagents were used continuously before and after the follow-up, it's observed in one reagent that the proportion of negative results in subsequent follow-up in single-positive donors who had negative results in the first sampling was significantly higher than the proportion of negative results in subsequent follow-up in those initially single-positive (P<0.05). But no significant difference was observed in another reagent (P>0.05). When reagents were changed in follow-up, the rate of singlepositive donors with negative results in the first sampling reached 96.7%, which was significantly higher than the negative rate of those without reagent changing in follow-up (P<0.05). Conclusion: Based on the serological and nucleic acid testing results of HIV blood screening, the confirmation of HIV infection and identification of infection status can be achieved accurately and efficiently. All HIV Ag/Ab+-&HIV RNA-donors were confirmed as false positive, and should be maintained their eligibilities for blood donation, but recommended to pass the retest before next donation. Using a different reagent for retesting helps improve the eligible rate. HIV Ag/Ab++&HIV RNA-donors should be deferred permanently due to the risk of true positivity.

Objective: To explore the management of blood donors tested reactive to HCV in blood screening based on confirmation of HCV infection. Methods: Multiple HCV antibody assays, repeating HCV RNA testing, follow-up of blood donors and retesting of archive samples were performed to confirm HCV infection, identify infection status, and exclude false positives in blood donors reactive to HCV in blood screening. Results: From 2011 to 2024, the unqualified rate of HCV detection in blood screening was 2.45‰(2 751/1 122 026). Among these, anti-HCV+-&NAT-accounted for 1.85‰, followed by anti-HCV++ at 0.60‰. The proportion of anti-HCV+-&NAT-and HCV RNA yields was extremely low (0.007‰). The positive rate of anti-HCV+-&NAT-samples tested by electrochemiluminescence method (ELCIA) was approximately 7.5%, differing among reagents (P<0.05). The follow-up of anti-HCV+-&NAT-donors showed that 96.2% (202/210) were false positives, but 51.4% of donors remained anti-HCV+-&NAT-during follow-up. Among them, 8 donors (3.8%) could not be ruled out from HCV infection due to positive retesting by ELCIA. Of the anti-HCV+-&NAT-donors who were reactive at the first follow-up, 86.8% remained anti-HCV+-&NAT-at the second follow-up. The sampling confirmation data showed that all of 260 anti-HCV++ donors were confirmed as anti-HCV positive, and the proportion of false positives or missed detections by NAT was very low. Two occult HBV infections (OBIs) and one HBsAg carrier were identified among the 3 anti-HCV +-&NAT+ donors, and no HCV infection was confirmed in 5 anti-HCV--&HCV RNA + donors. Conclusion: The prevalence of HCV among blood donors in Dalian was about 0.06%, with extremely low proportion of window-period infection and slightly higher proportion of resolved infections than that of current infections. The majority of anti-HCV+-&NAT-were false positive. Blood donors confirmed as false positive should be qualified in blood screening 3 months later before next donation. In order to reduce the false positive results, it was advisable to avoid the same type of supplementary reagents as the initial reagents when performing confirmation.

Objective: To evaluate repeated testing on blood screening platforms in confirmation of non-discriminatory reactive (NDR) samples in nucleic acid testing (NAT). Methods: A total of 102 HBsAg-negative/NAT NDR samples were collected from voluntary blood donors at Dalian Blood Center between January 2021 and December 2023. Repeated testing was performed using two NAT platforms (Cobas s201 and Panther). For the first round of repeated testing, all samples were tested 12 times on each system; for the second round, the samples which were non-reactive or only reactive once in the first round were tested an additional 8 times. Anti-HBc and anti-HBs was detected using electrochemiluminescence assay (ECA). Meanwhile, blood donors were followed up. Results: The proportion of anti-HBc+ in 102 NDR samples was 88.2%. Forty-one samples (40.2%, 41/102) and 7 samples were confirmed HBV DNA+ in first-round and second-round repeated testing, respectively. The cumulative confirmation rate of HBV DNA+ was 47.1% (48/102) after repeated testing. Extra five blood donors detected HBV DNA+ in follow-up were identified as anti-HBc+ occult hepatitis B virus infection (OBI), while no window period infection was observed. Ultimately, there were 53 HBV infected donors confirmed, 46 HBV infection-unconfirmed, and 3 HBV uninfected. No significant difference was observed between the confirmation rate of the first-round testing and the cumulative confirmation rate after the second-round testing (P>0.05). The proportion of anti-HBc+ donors was quite high in both HBV infection-confirmed (98.1%) and unconfirmed group (82.6%), and donors with seronegative and anti-HBs-only occupied a high proportion in the latter (P<0.05). Conclusion: Numerous repeated testing of NDR samples using NAT platforms cannot achieve complete confirmation of HBV infection. Supplementary anti-HBc testing can minimize potential OBI risk among NDR donors, and is low-cost and efficient.

Objective: To investigate the impact of current laboratory testing models and screening strategies on blood safety by analyzing repeat nucleic acid testing (NAT) results obtained from blood donors who had dual-reactive enzyme-linked immunosorbent assay (ELISA) results but were initially nonreactive by NAT. Methods: Samples from blood donors with dual-reactive ELISA results and initially nonreactive NAT results collected at Dalian Blood Center from 2017 to 2025 were included. Repeated testing was performed using two NAT systems: transcription-mediated amplification (TMA) and polymerase chain reaction (PCR). The results were analyzed in terms of the frequency of reactive NAT results and the testing strategies, including minipool and individual donation testing. Results: A total of 199 samples with dual-reactive ELISA results and initially nonreactive NAT results were included，comprising 66 HBsAg-reactive samples，130 anti-HCV-reactive samples，and 3 HIV Ag/Ab-reactive samples. Among the HBsAg-reactive samples，57（57/66，86.4%）showed at least one reactive NAT result upon repeated testing，and 49 showed two or more repeat reactive results. Anti-HBc was reactive in 64 samples（64/66，97.0%）and nonreactive in 2 samples（2/66，3.0%）；both anti-HBc-nonreactive samples remained nonreactive in repeated NAT. No stable repeat nucleic acid reactivity was observed in anti-HCV- or HIV Ag/Abreactive samples. The TMA system detected 50 reactive samples（50/66，75.8%）through three combined assays plus one discriminatory assay, whereas the PCR system detected 51 reactive samples (51/66, 77.3%) through four rounds of individual-donation testing. Fortyfour samples were reactive on both systems, 6 were reactive only on the TMA system, and 7 were reactive only on the PCR system. Conclusion: Among blood donors with dual-reactive ELISA results and initially non-reactive NAT results, HBsAg-reactive samples contain a high proportion of low viral load HBV-related cases, with intermittent and probabilistic nucleic acid detectability. Both testing frequency and detection strategy significantly affect the detection of low viral load samples. These findings highlight the importance of recognizing the detection characteristics of low viral load HBV-related samples in order to optimize blood screening strategies and improve blood safety.

Objective To compare the efficacy of recombinant human interleukin-11(rhIL-11)and herombopag olamine tablets on chemotherapy-induced thrombocytopenia(CIT)in breast cancer.Methods Eighty-six prospectively selected breast cancer patients with CIT were randomly divided into the control group(administered rhIL-11)and the study group(administered herombopag olamine tablets),with 43 cases in each group.Before treatment and 14 days after treatment,platelet parameters[platelet count(PLT),plateletcrit(PCT),platelet distribution width(PDW)and mean platelet volume(MPV)]and flow cytometry were measured by automated hematology analyzer.Cellular immune indicators(CD3+,CD4+,CD8+and CD4+/CD8+)were detected by flow cytometer.Enzyme-linked immunosorbent assay was used to determine the levels of thrombopoietin(TPO)and interleukin-11(IL-11).The above parameters were compared between the two groups,and the incidence of adverse reactions in the two groups was recorded.Results After treatment,PLT,PCT,CD3+,CD4+,CD4+/CD8+,TPO and IL-11 in both groups were higher than before treatment,and which was higher in the study group than the control group(P＜0.05).After treatment,PDW,MPV and CD8+of both groups were lower than before treatment,and the study group was lower than the control group(P＜0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P＞0.05).Conclusion Both rhIL-11 and herombopag olamine tablets are effective in treating breast cancer with CIT.Compared with rhIL-11,herombopag olamine tablets have more advantages in improving platelet parameters,cellular immune indicators,TPO and IL-11,and do not increase the adverse reactions.

Objective:To construct an evidence-based practice program for dietary management of patients with non-dialysis chronic kidney disease (CKD) based on best evidence and to evaluate the effectiveness of its application.Methods:The best evidence for dietary management of non-dialysis CKD patients was summarized. From September to October 2022, following the evidence clinical transformation model of the Fudan University Centre for Evidence-based Nursing, the best evidence was screened and evidence-based practice program were developed, taking into account patients' wishes, expert opinions, and clinical contexts. From November 2022 through March 2023, baseline reviews, analysis of barriers and facilitators were implemented. Between April 2023 and April 2024, evidence-based practice was carried out in the Department of Nephrology of the Second Affiliated Hospital of Guangzhou Medical University to compare the implementation rate of review indicators at the system, practitioner, and patient levels, and practitioners' knowledge before and after the application of evidence.Results:A total of 14 review indicators were developed. The implementation rate of the 12 review indicators and the practitioners' knowledge of the CKD diet were elevated after the evidence-based practice ( P<0.05) . Conclusions:Evidence-based practice program for dietary management of patients with non-dialysis CKD has a positive effect on improving practitioners' knowledge of non-dialysis CKD diets, implementation rate of dietary management behaviors, and patients' dietary behaviors.

Objective:To investigate the clinical outcomes and prognosis of patients with HBV associated hepatocellular carcinoma (HCC) combined with non-alcoholic fatty liver disease (NAFLD) after liver lobectomy.Methods:113 HBV infected HCC patients (HBV HCC group), 113 HCC patients with concomitant NAFLD (NAFLD-HCC group) and 113 HCC patients with concomitant HBV infection and NAFLD (HBV/NAFLD-HCC group) who underwent liver lobectomy at Heji Hospital Affiliated to Changzhi Medical College from Jan. 2018 to Jan. 2021 were selected. All patients underwent radical liver lobectomy and were followed up every 3 months from the date of discharge. The clinical pathological parameters, surgical related indicators, postoperative complications, short-term and long-term prognosis of three groups of patients were compared. Logistic regression analysis was used to identify risk factors related to overall survival of HBV/NAFLD-HCC patients.Results:①Compared with patients in HBV-HCC group and NAFLD-HCC group, body mass index, ratio of combined basic diseases (hyperlipidemia, hypertension, diabetes), and maximum tumor diameter of patients in HBV/NAFLD-HCC group were significantly higher ( P<0.05). While the proportion of patients with liver cirrhosis in HBV HCC group was significantly higher than that in NAFLD-HCC group and HBV/NAFLD-HCC group ( P<0.05). ②There was no significant statistical difference ( P>0.05) among three groups of patients in terms of intraoperative vascular occlusion time, surgical time, intraoperative bleeding volume, blood transfusion volume, or postoperative hospitalization time. ③Compared with HBV-HCC and NAFLD-HCC groups, the incidence of postoperative complications (including postoperative bleeding, liver failure after hepatectomy, biliary fistula, subphrenic effusion, and pleural effusion) and the number of perioperative deaths in HBV/NAFLD-HCC group were significantly higher ( P<0.05). ④Compared with HBV-HCC group and NAFLD-HCC group, the postoperative recurrence rate of HBV/NAFLD-HCC group was significantly higher ( P<0.05), and the overall survival and relapse-free survival of HBV/NAFLD-HCC group were significantly shortened ( P<0.05). ⑤Multivariate Cox regression analysis showed that hyperlipidemia, hypertension, diabetes, cirrhosis, and the largest tumor diameter were risk factors affecting the overall survival of HBV/NAFLD-HCC patients ( P<0.05) . Conclusions:Compared with patients in HBV-HCC and NAFLD-HCC group, HBV/NAFLD-HCC patients have poorer postoperative complications and prognosis. Hyperlipidemia, hypertension, diabetes, cirrhosis, and tumor maximum diameter are risk factors affecting the overall survival of HBV/NAFLD-HCC patients.

Objective:To construct an evidence-based practice program for dietary management of patients with non-dialysis chronic kidney disease (CKD) based on best evidence and to evaluate the effectiveness of its application.Methods:The best evidence for dietary management of non-dialysis CKD patients was summarized. From September to October 2022, following the evidence clinical transformation model of the Fudan University Centre for Evidence-based Nursing, the best evidence was screened and evidence-based practice program were developed, taking into account patients' wishes, expert opinions, and clinical contexts. From November 2022 through March 2023, baseline reviews, analysis of barriers and facilitators were implemented. Between April 2023 and April 2024, evidence-based practice was carried out in the Department of Nephrology of the Second Affiliated Hospital of Guangzhou Medical University to compare the implementation rate of review indicators at the system, practitioner, and patient levels, and practitioners' knowledge before and after the application of evidence.Results:A total of 14 review indicators were developed. The implementation rate of the 12 review indicators and the practitioners' knowledge of the CKD diet were elevated after the evidence-based practice ( P<0.05) . Conclusions:Evidence-based practice program for dietary management of patients with non-dialysis CKD has a positive effect on improving practitioners' knowledge of non-dialysis CKD diets, implementation rate of dietary management behaviors, and patients' dietary behaviors.

Objective:To investigate the clinical outcomes and prognosis of patients with HBV associated hepatocellular carcinoma (HCC) combined with non-alcoholic fatty liver disease (NAFLD) after liver lobectomy.Methods:113 HBV infected HCC patients (HBV HCC group), 113 HCC patients with concomitant NAFLD (NAFLD-HCC group) and 113 HCC patients with concomitant HBV infection and NAFLD (HBV/NAFLD-HCC group) who underwent liver lobectomy at Heji Hospital Affiliated to Changzhi Medical College from Jan. 2018 to Jan. 2021 were selected. All patients underwent radical liver lobectomy and were followed up every 3 months from the date of discharge. The clinical pathological parameters, surgical related indicators, postoperative complications, short-term and long-term prognosis of three groups of patients were compared. Logistic regression analysis was used to identify risk factors related to overall survival of HBV/NAFLD-HCC patients.Results:①Compared with patients in HBV-HCC group and NAFLD-HCC group, body mass index, ratio of combined basic diseases (hyperlipidemia, hypertension, diabetes), and maximum tumor diameter of patients in HBV/NAFLD-HCC group were significantly higher ( P<0.05). While the proportion of patients with liver cirrhosis in HBV HCC group was significantly higher than that in NAFLD-HCC group and HBV/NAFLD-HCC group ( P<0.05). ②There was no significant statistical difference ( P>0.05) among three groups of patients in terms of intraoperative vascular occlusion time, surgical time, intraoperative bleeding volume, blood transfusion volume, or postoperative hospitalization time. ③Compared with HBV-HCC and NAFLD-HCC groups, the incidence of postoperative complications (including postoperative bleeding, liver failure after hepatectomy, biliary fistula, subphrenic effusion, and pleural effusion) and the number of perioperative deaths in HBV/NAFLD-HCC group were significantly higher ( P<0.05). ④Compared with HBV-HCC group and NAFLD-HCC group, the postoperative recurrence rate of HBV/NAFLD-HCC group was significantly higher ( P<0.05), and the overall survival and relapse-free survival of HBV/NAFLD-HCC group were significantly shortened ( P<0.05). ⑤Multivariate Cox regression analysis showed that hyperlipidemia, hypertension, diabetes, cirrhosis, and the largest tumor diameter were risk factors affecting the overall survival of HBV/NAFLD-HCC patients ( P<0.05) . Conclusions:Compared with patients in HBV-HCC and NAFLD-HCC group, HBV/NAFLD-HCC patients have poorer postoperative complications and prognosis. Hyperlipidemia, hypertension, diabetes, cirrhosis, and tumor maximum diameter are risk factors affecting the overall survival of HBV/NAFLD-HCC patients.

Purpose To investigate the clinicopathological features,differential diagnosis,and prognosis of breast carcinoma within fibroadenoma(FA).Methods A retrospective analysis was performed on the clinical and imaging data of 21 cases of FA-associated carcinoma.HE staining,immunohistochemistry using the EnVision method,and next-generation sequencing were employed to assess the clinicopathological characteristics and genetic alterations,with a review of the relevant literature.Results All patients were female,aged 21-67 years,with a median age of 48 years.Clinically,all lesions presented with well-circumscribed mass lesions.On imaging,12 cases demonstrated punctate or coarse calcifications,while 3 cases exhibited locally indistinct margins.Pathological examination revealed that the tumors had an average maximum diameter of 2.25 cm,with a gray-white nodular cut surface resembling FA.Microscopically,there was proliferation of either epithelial or spindle cells.The pathological diagnosis was FA-associat-ed in situ carcinoma in 16 cases(15 cases of low-grade ductal carcinoma in situ and 1 case of lobular carcinoma in si-tu),and invasive carcinoma in 5 cases(comprising 2 cases of invasive carcinoma-no special type,1 case of invasive lobular carcinoma,1 case of low-grade adenosquamous carcinoma and 1 case of fibromatosis-like metaplastic carcino-ma).In 18 cases,the carcinoma was confined within the FA,whereas in 3 cases the tumor locally extended beyond the FA,and 1 case exhibited ipsilateral axillary lymph node metastasis.Immunophenotypically,tumor cells in in situ carcinomas were negative for CK5/6,while the myoepithelial cells were p63-positive,and both estrogen receptor(ER)and progesterone receptor(PR)were diffusely and consistently positive.In invasive carcinoma,both ductal and lobular subtypes were ER and PR positive and HER2 negative.Conversely,in the low-grade adenosquamous carcinoma and fi-bromatosis-like metaplastic carcinoma,ER,PR,and HER2 were all negative,with p63 and CK5/6 positivity.Two ca-ses were negative for mismatch repair protein PMS2.Six cases had a family or personal history of malignant tumors;a-mong the 5 cases that underwent next-generation sequencing,2 cases harbored germline BRCA2 mutations,2 cases had germline PMS2 mutations,and 1 case exhibited no definitive genetic alteration.Conclusion Carcinoma arising within FA exhibits atypical clinical and imaging features.In patients with high-risk factors for breast cancer or family history of malignancy,or when calcifications are observed on imaging,prompt excision and biopsy are recommended.Recogniz-ing the abnormal morphology within FA and the use of immunohistochemistry are essential for accurate diagnosis,with careful differentiation from spindle cell metaplastic carcinoma and low-grade adenosquamous carcinoma.Overall,the prognosis is relatively favorable,and treatment should be tailored according to tumor type,molecular subtype,and stage.