BACKGROUND:Socket-shield technique can effectively maintain labial soft and hard tissues,but the incidence of postoperative complications such as exposure and displacement of root shield is relatively high.It is speculated that the root shield may be exposed and displaced due to excessive load after long-term function of dental implants. OBJECTIVE:Through three-dimensional finite element analysis,we aim to study the influence of varying root shield thicknesses on the stress distribution,equivalent stress peaks,and displacement in the root shield,periodontal ligaments,implant,and surrounding alveolar bone under normal occlusal loading.We also attempt to analyze the correlation between the thickness of the root shield and occurrence of mechanical events such as root shield exposure,displacement,and fracture. METHODS:Cone-beam CT data of a patient who met the indication standard of socket-shield technique for maxillary central incisor were retrieved from database.Reverse engineering techniques were used to build models of the maxillary bone and root shield,while forward engineering was used to create models for the implant components based on their parameters.Models depicting various root shield thicknesses(0.5,1.0,1.5,and 2.0 mm)were created using Solidworks 2022 software.ANSYS Workbench 2021 software was then used to simulate and analyze the effects of varying root shield thicknesses on stress distribution,equivalent stress peaks,and displacement of the root shields,periodontal ligaments,implants,and surrounding alveolar bone under normal occlusion. RESULTS AND CONCLUSION:(1)In all root shield models,the stress was concentrated on the palatal cervical side,both sides of the edges and the lower edge of the labial side.As the thickness of the root shield increased,the equivalent stress peak and displacement showed a decreasing trend.The 0.5 mm thickness model produced a stress concentration of 176.20 MPa,which exceeded the yield strength(150 MPa)of tooth tissue.(2)The periodontal ligament stress in each group was concentrated in the neck margin and upper region.With the increase of root shield thickness,the equivalent stress peak and displacement of periodontal ligament showed a decreasing trend.(3)Implant stress in all models was concentrated in the neck of the implant and the joint of the implant-repair abutment,and the labial side was more concentrated than the palatal side.With the increase of root shield thickness,the equivalent stress peak of the implant in the model showed an increasing trend.(4)In each group of models,stress of cortical bone concentrated around the neck of the implant and the periphery of the root shield,and the labial side was more concentrated than the palatal side.With the increase of the thickness of the root shield,the equivalent stress peak around the root shield decreased;the peak value of the equivalent stress of the bone around the neck of the implant showed an increasing trend.In the model,the stress of cancellous bone was mainly concentrated around the neck of the lip of the implant,the top of the thread,the root tip and the lower margin of the root shield,and the labial side was more concentrated than the palatal side.With the increase of the thickness of the root shield,the peak value of the equivalent stress of the bone around the root shield in the model showed a decreasing trend.The minimum principal stress of cortical bone in each group of models was concentrated around the neck of the implant,exhibiting a fan-shaped distribution.As the thickness of the root shield increased,the minimum principal stress of cortical bone showed an increasing trend.(5)These results indicate that different thicknesses of the root shield have different biomechanical effects.The root shield with a thickness of 0.5 mm is easy to fracture.For patients with sufficient bone width,the root shield with a thickness of 2.0 mm is an option to reduce the risk of complications such as root shield exposure,fracture,and displacement.Meanwhile,it should be taken into account to protect the periodontal ligament in the preparation process,and rounding treatments ought to be carried out on both sides and the lower edge of the root shield.

Nuclear emergency medical rescue is one of the important courses of military medical professional education, and improving the training level of nuclear emergency medical rescue plays a very important role in improving post competency of trainees. Based on the problem of disconnection between "teaching" and "need" in the occupational education of nuclear emergency medical rescue in the past, this study proposes the curriculum goal of "the combination of three abilities" and performs the optimization and practice of the occupational education curriculum system of nuclear emergency medical rescue from the aspects of curriculum setting, curriculum content, teaching methods, and assessment and evaluation. The results show that the new curriculum system can significantly improve the comprehensive ability of nuclear emergency medical rescue among trainees and better meet the requirements for their posts, thereby playing an important role in cultivating high-quality military medical talents in nuclear emergency medical rescue.

Objective To investigate the current status of infection management quality control centers in county-level hospitals in Guangdong Province,providing reference for the development of quality control management programs for county-level infection control centers by provincial infection control centers,and exploring corresponding management strategies.Methods A survey was conducted using the QuestionStar questionnaire platform to investigate county-level quality control centers established in Guangdong Province before December 31,2023.The survey covered the establishment time,personnel structure,level of in-formatization,management,quality control,and training of hospital infection management professional quality control centers.Results There are 68 county-level infection control centers in Guangdong Province,with a coverage rate of 50.37%,and 95.59%of them have been established within the past five years.Experts mainly come from clinical and nursing backgrounds(accounting for23.75%and62.97%respectively),and the majority have a bachelor's degree(71.06%).Only 13%have operational funding.Among them,39 have established hospital infection informatization monitoring,23 have not been equipped,and 6 are under construction.Twenty centers have conducted quality control supervision and issued quality control reports,ac-counting for 29.41%,while 41 have organized training,accounting for 60.29%.Conclusion The coverage rate of county-level infection management quality control centers in Guangdong Province is steadily increasing,but not all counties and districts are covered.There is a lack of policy and funding support,insufficient personnel allocation,and inadequate professional coverage.The health administrative departments and county-level infection control centers need to unify monitoring standards,quality con-trol specifications,and evaluation programs,improve infection control capabilities,and enhance the"four-level"management and training system to effectively promote the quality and safety management level of primary healthcare institutions.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To analyze the genetic sequences of two patients with a rare Ael blood subgroup.Methods:Two female patients undergoing treatment respectively for adenomyoma of the uterus and gastritis at the Second Affiliated Hospital, Yuying Children′s Hospital of Wenzhou Medical University in June 2019 and September 2020 were selected as the study subjects. Their Ael subtypes were identified with a saline tube agglutination assay and absorption-emission assay. Sequence of the ABO gene Ael subtypes was determined by the Sanger method. The impact of genetic variants on the structural stability of N-acetylgalactosaminyl transferase (GTA) was analyzed with PyMOL software by constructing a structure predicted model. Results:Both patients were determined as Ael blood subgroup. Sequencing result of patient 1 was ABO* O.01.02/ ABO* O.01.02, which has resulted in a p. Thr88Profs*31 amino acid substitution. The sequencing result of patient 2 was ABO* Ael.06/ ABO* O.01.02, in which c. 425C>T and c. 467C>T variants in exon 7 have led to p. Met142Thr and p. Pro156Leu substitutions. Prediction of the protein model speculated that the p. Met142Thr not only can change the binding of GTA protein with water molecules, but also the local hydrogen bond network of GTA, which may lead to decreased enzymatic activity. By contrast, the p. Pro156Leu variant has trivial effect on the structural stability of GTA. Conclusion:The molecular structure of Ael subtypes can be diverse. The genotypes of the two patients have been respectively determined as ABO* O.01.02/ ABO* O.01.02 with a G261 deletion and ABO* Ael.06/ ABO* O.01.02.

Abstract: Objective　To confirm three severe scrub typhus patients in Mianyang of Sichuan Province using laboratory diagnosis and analyze their clinical characteristics to provide theoretical evidence for the prevention and treatment of scrub typhus in this area. Methods　From June 2021 to August 2022, blood specimens and clinical data were collected from three severe scrub typhus patients in Mianyang of Sichuan Province. The epidemiological history was surveyed and the collected clinical data were analyzed. Acute-phase whole blood, serum samples at admission, and convalescent-phase serum samples two weeks later were collected, and the IgG titers of anti-Orientia tsutsugamushi were detected by indirect immunofluorescence assay (IFA) assays. Total DNA was extracted from anticoagulation whole blood using DNA extraction kit, and semi-nested polymerase chain reaction (PCR) was used to amplify the special gene of O. tsutsugamushi. Phylogenetic trees were constructed using the maximum likelihood (ML) method to determine the genotype of the strains. Results　The clinical symptoms of these three patients were extremely similar to other infectious febrile diseases, with two cases showing obvious eschars on physical examination and all three cases causing pneumonia. Epidemiological investigation revealed that all had a history of wild animal exposure or fieldwork. Specific IgG antibodies to O. tsutsugamushi tests showed that convalescent serum antibodies increased by four times or more compared to the acute-phase serum. The TSA56 gene sequence fragment was obtained by PCR amplification, and BLASTn comparison on the NCBI website showed a close phylogenetic relationship with the TA763 genotype and Karp genotype of Orientia tsutsugamushi. The results indicated that these three cases were indeed infections of O. tsutsugamushi. Conclusions　Laboratory diagnosis confirmed the clinical diagnosis of severe scrub typhus in three patients, providing specific evidence of etiology. This is the first report of etiology-confirmed cases of scrub typhus in Mianyang City, Sichuan Province. Analyzing their clinical features as well as the genotypes is of guiding significance for early diagnosis, differential diagnosis, and adjuvant therapy of scrub typhus in this region.

OBJECTIVE: To identify and analysis three ABO variant Bw subtypes. METHODS: Serological assays were carried out to identify the ABO blood group of the proband. ABO gene was identified by Sanger sequencing. RESULTS: The genotype of three individuals are ABO*Bw.11/0.01.02, ABO*Bw.12/0.01.01, ABO*Bw.34/A1.02, receptively. Sequencing results showed that there were c.695T>C, c.278C>T, c.889G>A, resulting in variants in Leu232Pro, Pro93Leu and Glu297Lys, receptively. CONCLUSION Bw11, Bw12 and Bw34 subgroups were identified, and gene testing can be used as a supplement to determine the ABO blood group subtypes.
ABO Blood-Group System/genetics* ; Alleles ; Blood Grouping and Crossmatching ; Exons ; Genotype ; Humans ; Phenotype ; Sequence Analysis

Objective : To investigate the incidence of new HIV infection and its influencing factors among men who have sex with men ( MSM ) in China, so as to provide the evidence for formulating the AIDS control strategy. Methods : Cohort studies pertaining to new HIV infections among Chinese MSM populations were retrieved in Chinese and English electronic databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase and Cochrane Library, and the retrieval time was set to build the database until May 2021. A meta-analysis was performed to investigate the incidence of new HIV infection and its influencing factors among Chinese MSM populations. The publication bias was assessed using funnel plot and Egger's test, and the stability of outcome parameters was evaluated using sensitivity analysis. Results : A total of 850 publications were retrieved, and 43 eligible literatures ( 44 studies ) were included in the final analysis. The pooled incidence of new HIV infection was 4.93 ( 95%CI: 4.15 to 5.72) per 100 person-years among Chinese MSM populations. Egger's test showed a publication bias ( t=2.411, P=0.021). Subgroup analysis revealed high incidence of new HIV infection in east ( 5.21 per 100 person-years ), north ( 5.30 per 100 person-years ) and southwest (4.84 per 100 person-years) China, and the lowest incidence in northwest China ( 2.87 per 100 person-years ), and showed higher incidence in first-tier cities ( 5.12 per 100 person-years ) than in nonfirst-tier cities ( 3.89 per 100 person-years ). Syphilis infection ( HR=3.41 ), unprotected anal sex ( HR=2.52 ), multiple sexual partners ( HR=3.51 ), seeking sex partners in bars, public baths and parks ( HR=3.44 ), age of > 25 years ( HR=0.44 ), Han Ethnicity ( HR=0.35 ), awareness of AIDS-related knowledge ( HR=0.20 ) and provision of HIV preventive services ( HR=0.18 ) were associated with new HIV infection in Chinese MSM populations. In addition, publication bias was found in studies reporting syphilis infection ( t=4.841, P<0.001 ), unprotected anal sex ( t=4.114, P=0.006 ) and ethnicity ( t=-5.018, P=0.038 ). Conclusions The incidence of new HIV infection is high among Chinese MSM populations. Interventions targeting the factors affecting new HIV infections are required to reduce in the incidence of new HIV infections among Chinese MSM populations.

Objective:To explore the correlation between post-transplant non-HLA antibodies and humoral rejection(HR)after kidney transplantation(KT).Methods:A retrospective study was conducted for KT recipients with non-HLA antibody level detected from September 2019 to January 2021.The recipients with biopsy confirmed HR and donor-specific HLA antibodies negative or feeble positive at the time of HR were designated as HR group while recipients with stable renal allograft function from 2 weeks post-KT to the time of detecting non-HLA antibody as stable group.The levels of HLA antibody, MHC classⅠchain-related gene A(MICA)antibody and 32 non-HLA antibodies were tested by Luminex single antigen bead and the levels of angiotensin Ⅱ type 1 receptor(AT1R)antibody quantified by enzyme-linked immunosorbent assay (ELISA). Inter-group differences in positive rate of non-HLA antibodies and number of positive non-HLA antibodies were analyzed.Results:Twenty-four recipients had positive non-HLA antibodies while the remainders had no positive non-HLA antibodies.Three HR recipients were positive for actin antibody, collagen Ⅲ antibody, glutathione S-transferase theta-1 antibody or IFN-γ antibody respectively.However, all four non-HLA antibodies of stable recipients were negative.There was significant inter-group difference( P=0.017). Four HR recipients were positive for collagenⅡantibody while only 1 stable recipient was positive for collagenⅡantibody.The positive rate of collagenⅡ antibody was significantly higher in HR recipients than that in stable recipients( P=0.023). HR recipients had an average of 2.36 positive non-HLA antibodies while stable recipients had an average of 0.90.There was significant inter-group difference ( P=0.008). Conclusions:A high level of non-HLA antibodies may elevate the risk of HR after KT.

Objective To explore the infection situation of fungi and trichomonas and the changes of pus cell and epithelial cell counts in patients with non-bacterial vaginosis in Lanzhou .Methods The pus and epithelial cell counts of vaginal secretion samples from patients with vaginitis were detected .Fungi and trichomoniasis were checked under high power microscope ,and the samples were defined positive if fungal spores or pseudohyphae were found .Results In the 4 404 cases of patients with vaginitis ,the total rate of fungi and trichomoniasis infection was 28 .63% (1 261/4 404) .The infection rate for fungi was 25 .39% ,and for trichomonad was 3 .25% ,respectively .The dual infection rate of fungi and trichomonad was 0 .54% .Compared with ≤20 age group ,the counts of pus cells and epithelial cells in other age groups were significantly different(P<0 .05) .Conclusion Fungi were the primary in-fection etiology of non-bacterial vaginosis in Lanzhou .